超声引导下经直肠“6+X”点法前列腺穿刺活检术的临床应用

目的探讨在超声引导下经直肠"6+X"前列腺穿刺活检术对诊断前列腺癌的临床应用价值。方法对2011年1月至2013年6月的126例直肠指检阳性,血清PSA 4~100 ng/ml合并f/t PSA异常及经直肠超声前列腺声像图可见结节样改变的患者经直肠彩超引导下行Hodge氏6点前列腺传统穿刺术及"6+X"(对可疑X点进行目标穿刺)穿刺活检两种方法,并对上述资料进行回顾性统计分析。结果126例患者病理证实前列腺癌81例,前列腺良性增生32例,前列腺不典型增生6例,慢性前列腺炎症6例,前列腺结核1例。采用"6+X"点法前列腺癌穿刺阳性率为73%,传统Hodge氏6点法前列腺癌穿刺阳性率为51%。结论经直肠超声引导下"6+X"点法前列腺穿刺活检术安全有效,可以提高前列腺癌的检出率,对前列腺癌及前列腺其他疾病的诊断和鉴别诊断有较高的临床应用价值。     

超微血流成像技术在前列腺癌穿刺中的应用价值

目的 研究超微血流成像技术（SMI）在前列腺癌穿刺中的应用价值。方法 选取2017年11月至2018年12月安徽医科大学第二附属医院拟诊断为前列腺癌患者65例，术前分别对同一患者行经直肠超声的SMI技术和彩色多普勒血流显像技术（CDFI）检测。每位患者均通过经直肠超声引导下前列腺底部、中部、尖部三切面的12点穿刺活检术后的病理组织学验证，统计比较在良恶性病变中，前列腺体积的差异；比较SMI技术和CDFI技术对前列腺癌微血流信号检出的差异。结果 65例患者中，43例恶性、22例良性，其中穿刺230针为恶性。SMI技术筛检出活检前恶性病灶异常微血流的真阳性率、阴性预测值大于CDFI，差异有统计学意义（P < 0.05）。2种技术对前列腺癌检出的真阴性率、准确率、阳性预测值比较，差异无统计学意义（P > 0.05）。在前列腺恶性与良性病变中，前列腺体积差异无统计学意义（P > 0.05）。结论 与CDFI技术对比，SMI技术对前列腺癌微血流检出率高，为前列腺癌血流诊断提供了有效依据，具有临床应用价值。     

经直肠超声引导12＋1点前列腺穿刺活检的临床应用

目的评价经直肠超声引导下前列腺12＋1点穿刺活检术诊断前列腺癌的临床应用价值。方法选择我院103例临床疑诊前列腺癌的患者,首先用直肠超声探头常规扫查前列腺,观察声像图特征,确定结节和可疑病灶区域,选择穿刺角度,进行经直肠超声引导下前列腺12＋1点穿刺活检术。结果病理证实前列腺癌（prostatecancer,PCA）48例。前列腺增生（benignprostatehyperplasia,BPH）42例,前列腺慢性炎症8例,鳞状上皮化生5例。12＋1点穿刺活检PCA阳性检出率为46．6％,传统的6点法活检PCA阳性检出率为30％,两者比较有统计学差异,P=0．035。结论经直肠超声引导下前列腺12＋1点穿刺活检术明显高于传统的6点法。     

超声引导下经直肠前列腺穿刺活检术10点法与6点法在前列腺癌诊断中的临床价值比较

目的:探讨和分析超声引导下经直肠前列腺穿刺活检术10点法与6点法在前列腺癌诊断中的临床价值差异。方法:回顾性分析某院在2009年1月~2017年3月期间收治的80例疑似前列腺癌患者作为研究主体,按穿刺方法不同分为甲组和乙组,两组患者术前有前列腺特异性抗原(PSA)升高和(或)直肠指诊(DRE)阳性或经直肠超声(TRUS)发现前列腺可疑结节,每组各40例患者,均在超声引导下进行经直肠前列腺穿刺活检术,甲组10点法穿刺,乙组6点法穿刺,对比甲乙两组患者前列腺癌的阳性率、穿刺并发症发生情况。结果:甲组患者前列腺癌的阳性率高于乙组患者,差异对比存在统计学意义(P0.05),而并发症发生率同乙组患者相比,差异不存在统计学意义(P0.05)。结论:在前列腺癌诊断中,超声引导下经直肠前列腺穿刺活检术10点法比6点法获得更多的外周带病灶组织,提高了穿刺的阳性率,但没有增加病人的并发症,值得推广。     

徒手和超声引导经直肠前列腺穿刺活检术两种方法讨论

目的：讨论徒手和超声引导经直肠前列腺穿刺活检术两种方法的意义。方法：一种为对可疑前列腺癌（PCA）39例患者行徒手经直肠穿刺前列腺左右两侧叶共6点送病理检查,另一种对可疑前列腺癌63例患者依据TRUS选择穿刺点（均为左右两侧叶共6点）行经直肠前列腺穿刺活检（声像图检查有可疑PCA结节,则在该处穿刺1～2针（常规底部＋中部＋尖部＋超声可疑点）。如果声像图无明确病灶,则分别在前列腺的双侧底、中、尖部穿刺6针,穿刺标本完全满足组织学检查的要求。结果：A组39例,平均年龄71.4岁;B组63例,平均年龄72.3岁。直肠指检发现前列腺结节数A组4例,B组2例;两组穿刺取材良好,均获得病理结果。共检出前列腺癌20例,A组6例,B组14例,检出率分别为15.38%和22.22%。A组中有2例漏诊,B组中无1例漏诊,B本组有2例仅1个穿刺点有癌组织,为直径仅5mm的前列腺单发微小癌瘤。A组中39例均未能检查出前列腺上皮内瘤（PIN）,B组中有PINⅠ3例,PINⅡ2例。A组中6例均为中晚期患者,B组8例为早期患者,6例为中晚期患者。结论：依据TRUS定位行前列腺穿刺活检较徒手行前列腺穿刺活检,能提高PCA检出率,减少并发症,达到早期诊断、早期治疗的目的。     

3D-CTBA联合液体回退法在老年肺结节行同轴定位经皮肺穿刺活检中的应用效果

目的 探讨三维CT支气管血管成像（3D-CTBA）联合液体回退法在老年肺结节行同轴定位经皮肺穿刺活检中的效果。方法 回顾性分析2017年1月至2019年10月溧阳市人民医院收治的100例老年肺结节患者，按肺穿刺过程中是否使用3D-CTBA联合液体回退法分为观察组50例、对照组50例。观察组在3D-CTBA辅助下确定穿刺角度和深度，联合液体回退法使用同轴定位经皮肺穿刺；对照组直接CT平扫后使用同轴定位常规方法穿刺。比较两组穿刺时间、定位套管针首穿未达预定位数、穿刺成功率的差异，以及两组肺穿刺并发症发生率的差异。结果 两组穿刺时间、定位套管针首穿未达预定位数、穿刺成功率比较，差异均无统计学意义（P>0.05）；观察组气胸发生率（10%）、出血发生率（8%）均低于对照组，差异有统计学意义（P<0.05）；两组咯血、痰血、疼痛发生率差异无统计学意义（P均>0.05）。结论 3D-CTBA联合液体回退法应用在同轴定位经皮肺穿刺活检中，可有效降低气胸及出血并发症的发生率，值得临床推广。     

CT引导下经皮肺肿块穿刺组织病理学假阴性的影响因素分析

目的 探讨CT引导下经皮肺肿块穿刺活检组织病理学假阴性的影响因素。方法 回顾性分析2013年1月至2017年6月安徽医科大学第一附属医院收治的237例行CT引导下经皮肺肿块穿刺活检患者的肿块特征、穿刺组织病理学及细胞学结果等临床资料,对组织病理学诊断为假阴性患者肿块的部位、大小、是否合并炎症坏死、与体表的距离及细胞学假阴性等因素与组织病理学非假阴性的发生进行单因素相关性分析,对有统计学意义的因素进一步行logistic回归分析。结果 237例资料中,33例组织病理学诊断为假阴性,假阴性发生率13.9%（33/237）,穿刺活检组织病理学假阴性与肿块的部位、大小及与胸壁的距离无显著相关性（P>0.05）,logistic分析显示,肿块内合并炎症坏死（OR=3.615,P<0.05）及细胞学假阴性（OR=85.909,P<0.05）是组织病理学假阴性独立的危险因素。结论 CT引导下经皮肺肿块穿刺活检组织病理假阴性与肿块内伴有炎症坏死及穿刺活检细胞学假阴性密切相关。     

经直肠超声引导自动活检枪穿刺前列腺诊断前列腺癌

目的讨论经直肠超声引导自动活检枪穿刺前列腺诊断前列腺癌。方法①直肠指诊阳性;②4ng／ml〈PSA〈10ng／ml,前列腺超声显示低回声结节;③PSA〉10ng／ml共102例。在超声引导下,经直肠前列腺6点穿刺活检。结果本组39例确诊为前列腺癌。结论经直肠超声引导自动活检枪多点穿刺前列腺可为临床提供明确的前列腺癌组织学诊断,穿刺操作简便安全,取材成功率高。     

经直肠超声引导在前列腺13点法穿刺活检中的临床应用价值

目的探讨直肠超声引导在前列腺13点法穿刺活检术中的临床应用价值,提高诊断阳性率。方法对108例具有前列腺穿刺指征患者行超声引导下前列腺穿刺术,并分析临床资料。结果 108例患者均取材成功,成功率为100%。病理结果显示前列腺癌60例(55.56%)和良性前列腺增生48例(44.44%)。术后肛门滴血6例、尿道出血2例,无严重并发症发生。65例经直肠超声检查发现前列腺结节者,诊断与病理符合率为83.08%;43例未检出结节,符合率为51.16%,差异存在统计学意义(P<0.05)。穿刺前超声检查发现结节者,超声诊断灵敏度为89.36%,显著高于无结节者的30.77%,差异有统计学意义(P<0.05);但二者特异度相似,差异无统计学意义(P>0.05)。随着前列腺癌病理分级的升高,其血清中PSA浓度也相应升高,呈正相关(P<0.05)。结论经直肠超声引导下行前列腺13点穿刺活检术,穿刺成功率高、术后并发症少、有助于前列腺疾病的定性诊断,值得临床推广应用。     

基于NF-κB信号通路研究前列闭尔通栓对大鼠慢性非细菌性前列腺炎的影响

目的 探讨前列闭尔通栓对自身免疫性前列腺炎（EAP）大鼠的影响及作用机制。方法 50只SD大鼠采用前列腺蛋白提纯液联合完全弗氏佐剂制备EAP大鼠模型，另取10只作为对照组，造模成功大鼠随机分为模型组、前列通栓（0.42 g·只^-1）组和前列闭尔通栓低、中、高剂量（0.33、0.66、0.99 g·只^-1）组，直肠给药28 d。压力换能器测定膀胱内压变化速率，显微镜计数测定前列腺液中卵磷脂小体、白细胞数量，ELISA法检测前列腺组织炎症因子，HE染色观察前列腺组织病理变化，Westernblotting检测前列腺组织核因子κB（NF-κB）p65、磷酸化κB抑制因子激酶（p-IKK-α）/IKK-α、肿瘤坏死因子-α（TNF-α）、磷酸化IκB激酶-α（p-IκB-α）/IκB-α、环氧化酶-2（COX-2）蛋白表达；实时荧光定量PCR（qRT-PCR）法检测重组人趋化因子配体5（CXCL5）、白细胞介素-6（IL-6）、TNF-α、COX-2基因表达。结果 与对照组比较，模型组大鼠膀胱内压变化速率显著降低（P<0.01）；白细胞数量显著增加、卵磷脂小体数量显著减少（P<0.01）；前列腺组织TNF-α、IL-8水平显著升高（P<0.01），IL-10水平显著降低（P<0.01）；前列腺组织炎症反应明显，病理评分显著升高（P<0.01）；前列腺组织NF-κB p65、p-IKK-α、p-IκB-α、TNF-α、COX-2蛋白表达显著升高（P<0.05、0.01）；前列腺组织CXCL5、COX-2、TNF-α基因表达升高（P<0.05）。与模型组比较，前列闭尔通栓中剂量组膀胱内压变化速率显著升高（P<0.01）；各剂量组白细胞数量显著减少、卵磷脂小体数量显著增加（P<0.01）；中、高剂量组TNF-α、IL-8水平显著降低（P<0.05、0.01）；各剂量组前列腺组织炎症反应明显减轻，病理评分显著降低（P<0.01）；各剂量组前列腺组织p-IκBα/IκBα、COX-2蛋白表达显著降低（P<0.01）；低剂量组前列腺组织p-IKK-α/IKK-α蛋白表达显著降低（P<0.05）；低、高剂量组前列腺组织NF-κB p65蛋白表达显著降低（P<0.05）；中剂量组前列腺组织TNF-α蛋白表达显著降低（P<0.05） ；各剂量组前列腺组织CXCL5、IL-6、COX-2基因表达显著降低（P<0.05）。结论 前列闭尔通栓可有效改善EAP大鼠前列腺组织病理形态，减轻炎症反应，其作用机制可能与抑制NF-κB信号通路相关蛋白NF-κB p65、p-IKK-α、TNF-α、p-IκB-α表达相关。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.