多聚酶链反应对病毒性前列腺炎的检测研究

为探讨病毒性前列腺炎的病原学，采用多聚酶链反应（ＰＣＲ）技术对７４例慢性非细菌性前列腺炎的前列腺液进行单纯疱疹病毒Ⅱ型（ＨＳＶⅡ）检测。结果：前列腺液中ＨＳＶⅡ阳性率为１６．２％，对照组均为阴性（Ｐ＜０．０１）。４例前列腺液ＨＳＶⅡ阳性者，前列腺按摩前初始尿和尿道粘膜脱落细胞ＰＣＲ检测均为阴性。结果进一步证实了病毒是非细菌性前列腺炎的重要病因之一，ＰＣＲ技术对病毒性前列腺炎的临床诊断、治疗及疗效判定有重要意义。     

单纯疱疹病毒感染与腰腿痛关系的探讨

单纯疱疹病毒（ＨＳＶ）感染后，该病毒能长期甚至终身以慢性低水平感染的方式潜伏于机体各种神经节，包括脊神经节、颅神经节以及自主神经节中。可引起腰腿痛、肩颈痛、偏头痛、眩晕、耳鸣、听力下降、视力减退、心悸、失眠、多梦、精神紧张、易于疲劳、烦燥或抑郁等一系列症状，我们暂称之为“感染性腰腿痛综合征”。这种疾病除有腰腿痛或肩颈痛外，常伴有反复发作的口周疱疹或口腔溃疡这一单纯疱疹感染特有的表现为特征。根据我们对１０００例腰腿痛患者的统计，本病约占腰腿痛患者总数的三分之一，这一新的诊断概念已得到国内外学者在病毒学，神经病理学，细胞生物学及分子生物学方面近二十年来的研究和成果的有力支持。它不仅使一些疑难腰腿痛的病因与发病机制方面得到一个合理的解释，也动摇了骨科现有的一些有关腰腿痛疾病的诊断名称。     

中药丹参、川芎联合强的松治疗特发性肺纤维化的临床疗效

目的：丹参、川芎嗪治疗大白鼠肺纤维化模型获良好疗效，应用于临床。方法：将确诊为特发性肺纤维化（IPF）者分为两组：联合组为丹参、川芎联合强的松治疗，对照组单用强的松治疗。结果：治疗后1个月、6个月随访，呼吸困难、咳嗽两组都有明显好转。胸部X线阴影、肺功能联合组20％有轻微吸收与改善，对照组为10％。呼吸道感染对照组较多。随访24个月联合组稳定73％，恶化27％，无死亡。对照组稳定60％，恶化30％，死亡10％。结论：丹参、川芎联合强的松治疗IPF，24个月后观察长期疗效，病情稳定，感染次数减少，免疫功能增加，病死率降低优于单纯强的松组。     

慢性前列腺炎与单纯疱疹病毒感染的关系

为了探讨慢性前列腺炎与单纯疱疹病毒（ＨＳＶ）感染的关系，对慢性前列炎患者的前列腺液进行了ＰＣＲ检测，发现８例ＨＳＶ阳性。经用无环鸟苷等抗病毒药物治疗后，临床症状减轻或消失，实验室检查ＨＳＶ转阴性。认为慢性前列腺炎与ＨＳＶ感染有关，ＨＳＶ很可能是某些慢性前列腺炎的病原体。     

用多聚酶链反应检测病毒DNA诊断肾移植受者术后人巨细胞病毒活性感染

应用多聚酶链反应（ＰＣＲ）技术，直接通过肾移植受者外周血白细胞检测病毒ＤＮＡ，诊断人类巨细胞病毒（ＨＣＭＶ）活性感染。结果术前所有受者及其供者ＤＮＡ检测均为阴性，术后共检出４例阳性受者。另有３例患者亦出现类似病毒感染的症状，ＤＮＡ检测为阴性，后经检查确诊为结核和霉菌感染。２例术后１年多出现发热的受者经ＤＮＡ检测，排除ＣＭＶ感染，确诊为慢性排斥反应和霉菌感染。以上结果表明，ＰＣＲ作为移植受者术后ＨＣＭＶ活性感染的诊断手段，简单快速，准确性高，成本低，并可用于鉴别其它细菌（如霉菌）感染或慢性排斥反应。     

西地那非增加特发性肺纤维化患者步行距离

肺动脉高压常见于特发性肺纤维变性的患者中，而且与发病率及死亡率的上升有关。西地那非可以减少肺纤维化患者的肺循环血管阻力并且可能会提高患者的功能状态。Collard HR等人进行了一项相关研究[Chest，2007，131（3）：897-899]。随访了一项开放性研究中接受西地那非治疗特发性肺纤维化合并肺内动脉高压患者，西地那非治疗前和治疗后3个月，分别测量患者的6min步行距离。14例患者入选，其中11例完成了2次测验。行走距离提高的平均值是49．0m（90％可信区间，17．5—84．0m），所有14例患者被分成2组：有效组（6min走路距离的改善情况〉20％的患者）和无效组（6min走路距离改善情况〈20％或者不能完成测试的患者），结果57％的患者属于有效组。研究结果提示，对于患有特发性肺纤维化合并肺动脉高压患者，口服西地那非是一种潜在的并且耐受良好的治疗手段，应该在大规模临床试验中进一步研究证实。     

膀胱移行细胞癌临床病理指标与外周血CK-20基因表达的相关研究

目的 探讨外周血角蛋白20（CK－20）基因表达在膀胱移行细胞癌微转移情况及其临床意义。方法 以逆转录多聚酶链反应（RT－PCR）检测91例膀胱癌不同临床分期及病理分级CK－20mRNA外周血表达情况。结果 91例膀胱癌外周血CK－20基因表达阳性47例(51.6%），外周血肿瘤细胞微转移与膀胱癌患者的临床分期密切相关（P＜0.05），而与病理分级无明显相关（P＞0.05），随访中未发现淋巴结转移的T1－2期患者，术后8个月2例复发且均为CK－20RNA表达阳性。结论 RT－PCR方法检测CK－20mRNA在外周血表达是判断膀胱癌微转移的重要标志，对准确分期及治疗有重要意义。     

定量检测大肠癌及大肠良性疾病癌胚抗原信使核糖核酸的研究

目的探讨利用定量巢式逆转录聚合酶链反应(NestedRTPCR)检测大肠良恶性疾病组织及其外周血CEAmRNA(癌胚抗原信使核糖核酸)方法的效果及其临床意义。方法用竞争性NestedRTPCR方法定量检测25例手术切除的大肠肿瘤、肠系膜淋巴结及22例大肠良性病变和6例健康人外周血中CEAmRNA的量。结果25例大肠癌均呈阳性,表达量亦大,拷贝数为105～109。25例淋巴结中病理报告肿瘤转移者11例(44%)中NestedRTPCR方法检测CEAmRNA均呈阳性且量多,拷贝数为106～108,而14例(56%)病理报告肿瘤阴性NestedRTPCR检测有5例(35.7%)CEAmRNA阳性,Copy数为102～103。随访发现CEAmRNA阳性的5例患者均在20个月内复发,而CEAmRNA阴性者均未复发。22例大肠良性病变中2例(均为息肉伴不典型增生改变者)CEAmRNA呈阳性,表达量101,阳性率9%。6例正常健康人外周血CEAmRNA均呈阴性。结论定量NestedRTPCR检测大肠癌CEAmRNA的方法优于常规病理检查并可进行量化。对大肠癌的诊断及判断淋巴结转移有重要意义。     

荧光定量聚合酶链反应检测大肠癌外周血角蛋白19、20的联合表达

目的研究大肠癌患者外周血CK19、CK20mRNA的表达,并探讨其临床意义。方法应用荧光定量聚合酶链反应(PCR)技术,检测大肠癌患者术前外周血CK19、CK20mRNA,并将其与临床、病理各项指标进行统计学分析。结果45例大肠癌患者外周血中CK19mRNA检测阳性率31.11%(14/45);CK20mRNA阳性率15.56%(7/45);联合检测CK19、CK20mRNA阳性率37.78%(17/45),较单项检测有明显提高。统计结果显示联合检测CK19、CK20mRNA与临床分期(χ2=4.54,P<0.05)、病理类型(χ2=5.66,P<0.05)、外周血CEA值(χ2=9.94,P<0.01)相关,差异有显著性。结论CK19、CK20mRNA是检测大肠癌微转移的标志物,对有外周血CK19、CK20RNA升高的患者应给予有效的免疫治疗、化疗和手术,并加以密切随访,以阻止微转移向转移灶的转变。     

青少年特发性脊柱侧弯与骨盆关系的研究进展

脊柱侧凸是一种三维脊柱畸形,青少年特发性脊柱侧凸(AIS)是最为常见的类型,由于脊柱侧凸的形态各异,脊柱外科医生一直致力于总结脊柱侧凸的规律,以指导手术方案的制定。骨盆作为脊柱的生物力学基础,对脊柱的平衡有重要的作用。本文强调了在以后的研究中要在三维层面上重视骨盆对脊柱侧凸的影响及两者之间的相互作用。     

Evolution and treatment of idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a chronic and devastating disease of unknown etiology, characterized by irreversible morphological changes, ultimately leading to lung fibrosis and death. In recent years, significant progress has been achieved in understanding the pathogenesis of IPF. Moreover, we assisted to the conceptual change of the pathogenic hypothesis that currently considers IPF as a primarily fibrotic driven disease. However, despite the undeniable progress, the diagnosis of IPF remains still very complex requiring the presence of a team of experts to achieve the highest level of diagnostic confidence. The advent of antifibrotics has radically changed the treatment landscape of IPF and new promising drugs are currently under evaluation. Furthermore, a more extensive use of non-pharmacological treatments has also to be encouraged in all patients both to reduce symptoms and improve quality of life.     

Chronic idiopathic pulmonary hilar fibrosis. A clinicopathological entity

Idiopathic pulmonary hilar fibrosis is a condition related to mediastinal fibrosis, characterized by localization of the fibrosing process to one or both pulmonary hila. This results in pulmonary hypertension and bronchial narrowing. Three patients suffering from this disease, in whom the diagnosis has been confirmed by thoracotomy, are reported. The clinical and pathological features are described and previously reported cases are reviewed. The syndrome is classified into two types, according to whether the obstruction affects mainly the pulmonary artery or veins. The disease is a self-limiting one but may lead to organic changes in the lungs causing severe disability.     

Lung transplantation for idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is characterized by relentlessly progressive lung function impairment that is consistently fatal in the absence of lung transplantation, as no curative pharmacological treatment exists. The pace of progression varies across patients, and acute life-threatening exacerbations occur unpredictably, causing further sharp drops in lung function. Recently introduced antifibrotic agents slow the pace of disease progression and may improve survival but fail to stop the fibrotic process. Moreover, the magnitude and kinetics of the response to these drugs cannot be predicted in the individual patient. These characteristics require that lung transplantation be considered early in the course of the disease. However, given the shortage of donor lungs, lung transplantation must be carefully targeted to those patients most likely to benefit. Current guidelines for lung transplantation listing may need reappraisal in the light of recent treatment advances. Patients with IPF often have multiple comorbidities such as coronary heart disease, frailty, and gastro-oesophageal reflux disease (GERD). Consequently, extensive screening for and effective treatment of concomitant conditions is crucial to appropriate candidate selection and outcome optimisation. A multidisciplinary approach is mandatory. Pulmonologists with expertise in IPF must work closely with lung transplant teams. Careful consideration must be given to preoperative optimisation, surgical technique, and pulmonary rehabilitation to produce the best post-transplantation outcomes.     

Short-term outcomes of lung transplant in idiopathic pulmonary fibrosis

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is currently the main indication for lung transplant (LTx) in the United States. Opinions differ regarding the outcomes in IPF compared to other conditions. This study compares the short-term outcomes of LTx in IPF versus non-IPF as well as single lung transplant (SLT) versus bilateral lung transplant (BLT) in IPF patients in a large nationally representative sample. METHODS: We performed a secondary analysis of the Nationwide Inpatient Sample (1988–2006). Patients aged 21 and above who underwent LTx during this period were included. The five post-operative outcomes evaluated were inpatient mortality (IM), transplant-related complications (TC), non-transplant related (NTC) complications during inpatient stay, length of stay (LOS) more than 14 days and any non-routine discharge (ND) destination. RESULTS: There were 1845 patients who underwent LTx during the analysis period. Controlling for confounders, and compared to non-IPF patients, IPF patients were more likely to be in hospital more than 14 days (OR = 1.75; 95% CI = 1.31, 2.36; p ≤ 0.001); as likely to have inpatient mortality (OR = 1.00; 95% CI = 0.58, 1.72) and non-routine discharge (OR = 0.95; 95% CI = 0.73, 1.50); and not significantly less likely to have transplant-related complications (OR = 0.82; 95% CI = 0.57, 1.17) and non-transplant related complications (OR = 0.89; 95% CI = 0.65, 1.22). IPF patients who underwent BLT were significantly more likely to develop transplant-related complications (OR = 2.52; 95% CI = 1.06, 5.97; p = 0.035) and non-transplant related complications (OR = 2.22; 95% CI = 1.17, 4.24; p = 0.015); and not significantly more likely to have inpatient mortality (OR = 2.24; 95% CI = 0.80, 6.27), length of stay longer than 14 days (OR = 1.84; 95% CI = 0.83, 4.11) and non-routine discharge (OR = 1.15; 95% CI = 0.44, 1.69). CONCLUSIONS: This paper demonstrated that in this population of patients in the United States, there was an increased risk of greater LOS for IPF patients. BLT in IPF patients had a significantly higher risk for inpatient complications.     

Results of lung transplantation in idiopathic pulmonary fibrosis patients

Lung transplantation (OLT) remains the only available therapy for patients with end-stage idiopathic pulmonary fibrosis (IPF). The objective of this study was to review our experience of OLT for end-stage IPF (IPFLT) patients, seeking to identify variables associated with survival for comparison with outcomes of other indications for LT (OILT). From October 1993 to December 2009, we performed 310 consecutive OLT in 301 patients for treatment of various end-stage pulmonary conditions. The indications for OLT were: IPF (n=89, 30.5%) chronic obstructive pulmonary disease (n=82), cystic fibrosis (n=80), bronchiectasis (n=12), alfa-1-antitrypsin deficit (n=6), primary pulmonary hypertension (n=4), bronchiolitis obliterans (n=4), other conditions (n=15). We observed significant differences in the actuarial survival between the IPFLT and the OILT groups particularly at the expense of worse perioperative 30-day and early 1-year mortality in the IPFLT group. Upon univariate and multivariate analyses, the need for cardiopulmonary bypass, previous recipient ventilator dependence, and donor age>50 years were all associated with poorer survival rates among IPF patients. In our experience, survival did not differ between patients who underwent a single versus a bilateral sequential lung transplant (BSLT); however, BSLT cases were associated with short-term damage but long-term survival. The functional results in the IPFLT group were excellent. We observed significant improvements in the values of arterial oxygen pressure (PaO2), arterial carbon dioxide pressure (PaCO2), forced vital capacity (FVC%) and forced expiratory volume in 1 second (FEV1%) at 6, 12, and 36 months compared to their pretransplant baseline results.