Evaluation of an anal sac adenocarcinoma tumor in a Spitz dog

A 9-year-old emasculated male Spitz with tenesmus and constipation had a subcutaneous mass at the left ventral aspect of the anus with history of polyuria and polydipsia. A complete blood cell count, serum biochemistry panel, and urinalysis (cystocentesis sample) were evaluated. Abnormalities in the serum biochemistry panel included a mildly elevated serum cholesterol concentration (7.28 mmol/L; reference interval, 2.70–5.94 mmol/L), increased serum alkaline phosphatase activity (184 U/L; reference interval, 9–90 U/L), alanine transaminase (122 U/L; reference interval, 5–60 U/L) activity and aspartate aminotransferase (80 U/L; reference interval, 5–55 U/L) activity, severe increased total calcium concentration (16.3 mg/dL; reference interval, 8.2–12.4 mg/dL or 9.3–11.4 mg/dL), and decreased total calcium concentration (3.4 mg/dL, reference interval, 2.5–5.6mg/dL). Furthermore, testing revealed an increased intact parathyroid hormone concentration (38.6 pmol/L; reference interval, 3–17 pmol/L). On cytologic and histopathologic examinations, various types of cells were observed. Most of the cells were oval to polygonal and had elliptical or elongate nuclei and a moderate amount of pale to basophilic cytoplasm. The remaining cells had round to oval nuclei and pale to basophilic cytoplasm. Cells of both types were loosely adhered to each other and were arranged in rosette-like structures. Both neoplastic cell types had fine homogenous chromatin and either a small indistinct nucleolus or no visible nucleolus. Mild anisokaryosis and anisocytosis were observed. Histologically, the mass consists of glandular structures formed by cuboidal cells admixed with bundles of spindle cells. Based on location and histologic features, the final diagnosis was adenocarcinoma of the apocrine gland of the anal sac, which should be included as a cytologic differential diagnosis when spindle cells and typical epithelial cells are observed in masses in the region of the anal sac of dogs.     

Primary epididymis malignant triton tumor: case report and review of the literature

Background

Malignant triton tumor (MTT) is a rare and histological complexity characterized by a mixture of peripheral nerve sheath tumors and with rhabdomyoblastic differentiation. It follows a particularly malignant course.

Case presentation

In the present study, we report the first MTT of epididymis. The patient is a 22-year-old male presented with swelling in the left scrotum over a 2-month period. He did not have the history or symptoms of neurofibromatosis type 1. A mass measured about 3 cm × 4 cm was found in the left epididymis by ultrasound and CT scan. It was diagnosed as epididymis tumor and underwent exploration; intraoperative frozen section was diagnosed malignant tumor and treated with radical orchidoepididymectomy. The pathological report was malignant triton tumor. Despite taken high-dose radiation therapy and followed by chemotherapy for four cycles, he was died of progressive disease with multiple metastases 26 months after surgery. The clinic pathologic characteristics and optimal treatment strategy are reviewed.     

腰椎持续引流对HIV阳性新型隐球菌性脑膜炎的疗效

目的 探讨不同引流方式对HIV阳性的新型隐球菌性脑膜炎（cryptococcal meningitis, CM）患者是否产生积极的影响。方法 收集2017年1月—2019年12月期间在广西医科大学第一附属医院感染性疾病科、广西医科大学附属南宁市传染病医院住院治疗的HIV阳性CM患者40例,其中20例腰椎持续引流为观察组,20例定期腰椎穿刺引流为对照组,记录患者治疗前后临床表现、CD4计数、脑脊液检查及隐球菌墨汁染色结果。结果 治疗前两组患者的一般资料差异无统计学意义（P>0.05）。治疗后观察组中脑脊液白细胞计数[（28.70±12.04）×10⁶/L]、蛋白含量[（477.25±198.61） mg/L]比治疗前[（68.80±34.71）×10⁶/L、（712.15±427.89） mg/L]明显下降（P<0.001）,对照组中也有相似的结果（P<0.05）,治疗后两组患者脑脊液的CD4计数[观察组（31.30±22.00）cells/µL、对照组（27.70±20.18）cells/µL]、糖含量[观察组（3.41±0.62）mmol/L、对照组（2.80±0.77） mmol/L]、氯化物[观察组（127.78±9.47）mmol/L、对照组（125.25±8.03） mmol/L]均较治疗前升高（P<0.05）。治疗后两组患者间CD4/CD8、白细胞计数、糖含量差异有统计学意义（P<0.05）。治疗后观察组头痛、恶心/呕吐症状较对照组改善更明显。最终,腰椎持续引流方式治疗有效15例,无效5例;定期腰椎穿刺引流治疗7例有效。结论 腰椎持续引流方式治疗隐球菌性脑膜炎,能较快缓解临床症状,加快脑脊液的更新,缩短病原菌清除时间,值得临床推广应用。     

Primary desmoplastic small round cell tumor of the duodenum

The desmoplastic small round cell tumor (DSRCT) is an extremely rare tumor that mainly affects adolescents and mostly involves the abdominal and pelvic peritoneum. A 14-year-old girl presented with intermittent epigastric pain; abdominal computed tomography and upper gastrointestinal barium X-ray revealed an 8 cm × 10 cm space-occupying mass in the duodenal region. The patient underwent pancreaticoduodenectomy and the final pathologic diagnosis was DSRCT. Although multi-agent systemic chemotherapy was given, the patient died of metastasis 8 months later. Early diagnosis and surgical treatment with adjuvant chemotherapy seems to be the best treatment choice for this disease.     

Effect of crystalloid cardioplegic solution at different calcium concentration on immature myocardium

OBJECTIVE To determine the myocardial protective effect of crystalloid cardioplegic solution at different calcium concentration on immature myocardium.

METHODS Isolated perfused neonatal rabbit hearts from three groups, arrested by intermittent infusion of St. Thomas II cardioplegic solution with different concentration of calcium (in each group, only calcium concentration of cardioplegic solution was modified, I. [Ca2+] 0.6 mmol/L; II. [Ca2+] 1.2 mmol/L; III. [Ca2+] 2.4 mmol/L), were kept ischemic globally at 20 degrees C for 90 minutes and then followed by 30 minutes of reperfusion in Langendorff mode.

RESULTS Although the recovery of LVDP, +dp/dtmax at calcium content of 2.4 mmol/L after 10 minutes of reperfusion was significantly higher than those at 0.6 and 1.2 mmol/L calcium (P < 0.05, P < 0.01, respectively). The declined tendency of left ventricular hemodynamics after 20 minutes of reperfusion in this group was detected. By the end of reperfusion, the left ventricular functional recovery at 2.4 mmol/L calcium did not differ from those at 1.2 and 0.6 mmol/L calcium. Conversely, postischemic left ventricular functions at 0.6 and 1.2 mmol/L calcium were gradually improved during 30 minutes of reperfusion. In 2.4 mmol/L calcium group, the Ca(2+)-ATPase activity significantly increased (P < 0.01, P < 0.001) whereas myocardial ATP content was lower when compared with 1.2 mmol/L (P < 0.001) and 0.6 mmol/L calcium groups.

CONCLUSIONS Our research demonstrated that there were no statistical differences with respect to hemodynamic recovery in three groups after 30 minutes of reperfusion although left ventricular functional recovery at 2.4 mmol/L calcium accelerated early after reperfusion. In addition, with 2.4 mmol/L calcium, myocardial ATP content was decreased significantly. We conclude that, from the point of view of myocardial energy metabolism, St. Thomas II cardioplegic solution at high concentration of calcium can not provide immature myocardium with optimal myocardial protection while with 1.2 mmol/L calcium, however, better high-energy store can be preserved.

     

Determination of inhibitory activity of Salvia miltiorrhiza extracts on xanthine oxidase with a paper-based analytical device

A novel paper-based analytical device (PAD) was prepared and applied to determine the xanthine oxidase (XOD) inhibitory activity of Salvia miltiorrhiza extracts (SME). First, polycaprolactone was 3D printed on filter paper and heated to form hydrophobic barriers. Then the modified paper was cut according to the specific design. Necessary reagents including XOD for the colorimetric assay were immobilized on two separate pieces of paper. By simply adding phosphate buffer, the reaction was performed on the double-layer PAD. Quantitative results were obtained by analyzing the color intensity with the specialized device system (consisting of a smartphone, a detection box and sandwich plates). The 3D-printed detection box was small, with a size of 9.0 cm × 7.0 cm × 11.5 cm. Color component G performed well in terms of linearity and detection limits and thus was identified as the index. The reaction conditions were optimized using a definitive screening design. Moreover, a 10% glycerol solution was found to be a suitable stabilizer. When the stabilizer was added, the activity of XOD could be maintained for at least 15 days under 4 °C or −20 °C storage conditions. The inhibitory activity of SME was investigated and compared to that of allopurinol. The results obtained with the PAD showed agreement with those obtained with the microplate method. In conclusion, the proposed PAD method is simple, accurate and has a potential for point-of-care testing. It also holds promise for use in rapid quality testing of medicinal herbs, intermediate products, and preparations of traditional Chinese medicines.     

Does Carica papaya leaf-extract increase the platelet count? An experimental study in a murine model

Objective

To investigate the potential role of fresh Carica papaya (C. papaya) leaf extract on haematological and biochemical parameters and toxicological changes in a murine model.

Methods

In total 36 mice were used for the trial. Fresh C. papaya leaf extract [0.2 mL (2 g)/mouse] was given only to the test group (18 mice). General behavior, clinical signs and feeding patterns were recorded. Blood and tissue samples were collected at intervals. Haematological parameters including platelet, red blood cell (RBC), white blood cell (WBC), packed cell volume (PCV), serum biochemistry including serum creatinine, serum glutamic-oxaloacetic transaminase (SGOT) and serum glutamic-pyruvic transaminase (SGPT) were determined. Organs for possible histopathological changes were examined.

Results

Neither group exhibited alteration of behavior or reduction in food and water intake. Similarly, no significant changes in SGOT, SGPT and serum creatinine levels were detected in the test group. Histopathological organ changes were not observed in either group of mice except in three liver samples of the test group which had a mild focal necrosis. The platelet count (11.33±0.35)×10⁵/µL (P=0.000 04) and the RBC count (7.97±0.61)×10⁶/µL (P=0.000 03) were significantly increased in the test group compared to that of the controls. However, WBC count and PCV (%) values were not changed significantly in the test group. The platelet count in the test group started to increase significantly from Day 3 (3.4±0.18×10⁵/µL), reaching almost a fourfold higher at Day 21 (11.3×10⁵/µL), while it was 3.8×10⁵/µL and 5.5×10⁵/µL at Day 3 and Day 21 respectively in the control. Likewise, the RBC count in the test group increased from 6×10⁶/µL to 9×10⁶/ µL at Day 21 while it remained near constant in the control group (6×10⁶/µL).

Conclusions

Fresh C. papaya leaf extract significantly increased the platelet and RBC counts in the test group as compared to controls. Therefore, it is very important to identify those chemicals of C. papaya leaves as it can be recommended to be used as a medication to boost thrombopoiesis and erythropoiesis in humans and in animals in which these cell lineages have been compromised.     

Dengue fever treatment with Carica papaya leaves extracts

The main objective of the current study is to investigate the potential of Carica papaya leaves extracts against Dengue fever in 45 year old patient bitten by carrier mosquitoes. For the treatment of Dengue fever the extract was prepared in water. 25 mL of aqueous extract of C. papaya leaves was administered to patient infected with Dengue fever twice daily i.e. morning and evening for five consecutive days. Before the extract administration the blood samples from patient were analyzed. Platelets count (PLT), White Blood Cells (WBC) and Neutrophils (NEUT) decreased from 176×10³/µL, 8.10×10³/µL, 84.0% to 55×10³/µL, 3.7×10³/µL and 46.0%. Subsequently, the blood samples were rechecked after the administration of leaves extract. It was observed that the PLT count increased from 55×10³/µL to 168×10³/µL, WBC from 3.7×10³/µL to 7.7×10³/µL and NEUT from 46.0% to 78.3%. From the patient feelings and blood reports it showed that Carica papaya leaves aqueous extract exhibited potential activity against Dengue fever. Furthermore, the different parts of this valuable specie can be further used as a strong natural candidate against viral diseases.     

胃肝样腺癌血清甲胎蛋白阳性的临床意义

目的探讨胃肝样腺癌（hepatoid adenocarcinoma of stomach,HAS）甲胎蛋白（α-fetoprotein,AFP）阳性的临床意义。方法分析经病理确诊为胃肝样腺癌患者15例的AFP水平,-包括术前测定其血清AFP浓度改变及术后免疫组化测定的肝样腺癌组织AFP的表达,评价AFP水平在诊断胃肝样腺癌时的价值。结果 15例患者术前血清AFP浓度范围为1.51~20 000μg/L;术后癌组织甲胎蛋白表达,AFP染色12例呈阳性,其中,3例呈强阳性（＋＋＋）,4例呈阳性（＋＋）,5例呈弱阳性（＋）。AFP表达3例呈阴性（-）。AFP阳性胃癌分为肝样化和肠化两种类型,前者血清AFP较高（即HAS）,后者AFP滴度较低。结论胃肝样腺癌AFP水平波动范围大,血清AFP升高是HAS重要的临床病理特点,AFP水平在HAS诊治中具有重要价值,可作为早期诊断的条件之一,胃癌患者术前应列为常规检查。     

晶体停搏液中钙离子浓度对幼兔未成熟心肌的保护作用

OBJECTIVE: To determine the myocardial protective effect of St. Thomas II cardioplegia at different calcium concentration on immature myocardium. METHODS: Isolated perfused neonatal rabbit hearts from three groups (the calcium concentration of St. Thomas II cardioplegia was modified: [Ca2+] 0.6 mmol/L; [Ca2+]1.2 mmol/L; [Ca2+]2.4 mmol/L) were subjected to 20 degrees C hypothermia, 90 minutes of global ischemia followed by 30 minutes reperfusion in Langendorff mode. RESULTS: Although the recovery of LVDP, +/- dp/dtmax at calcium content of 2.4 mmol/L after 10 minutes of reperfusion was significantly higher than that at 0.6 and 1.2 mmol/L calcium (P < 0.05, P < 0.01, respectively), the declined tendency of left ventricular hemodynamics in this group was detected after 20 minutes of reperfusion. By the end of 30-minute reperfusion, the left ventricular hemodynamic recovery at 2.4 mmol/L calcium did not differ from those at 0.6 mmol/L and 1.2 mmol/L calcium. Conversely, postischemic left ventricular functions at 0.6 and 1.2 mmol/L calcium were gradually improved during the 30 minutes reperfusion. Ca(2+)-ATPase activity at 2.4 mmol/L calcium showed significant increase (P < 0.01, P < 0.001), whereas ATP content was lower than that of other groups. CONCLUSION: Calcium accumulated in extracellular space during ischemia enters myocardial cell via Ca2+ channel and Ca2+/Na+ exchange after reperfusion, activates Ca(2+)-ATPase, and finally accelerates adenosinetriphosphate (ATP) consumption induced by calcium, which would be responsible for the results of our study. We conclude that, from the point of view of myocardial cell energy metabolism, St. Thomas II cardioplegia at high calcium concentration can not provide immature myocardium with optimal myocardial protection.     

连续应用重组人血小板生成素联合泼尼松治疗初治免疫性血小板减少症的临床研究

目的评价连续应用重组人血小板生成素(rh TPO)联合泼尼松治疗成人初治免疫性血小板减少症(ITP)的疗效及安全性。方法 119例初治ITP患者,男53例,女66例,随机分为试验组(59例)和对照组(60例)。对照组仅使用泼尼松治疗,泼尼松用法为起始剂量1 mg/kg/d。试验组在应用泼尼松基础上联合应用rhTPO 1.5万U/d×14 d;继之1.5万U,biw,用至90 d。比较两组患者的血小板水平、有效率及药物的不良反应。结果在第8、15,22、30、180 d,试验组血小板水平均高于对照组,检测结果分别为105±91×10~9/L对67±68×10~9/L(P=0.011);164±112×10~9/L对93±68×10~9/L(P=0.000);161±83×10~9/L对115±74×10~9/L(P=0.002);145±64×10~9/L对115±64×10~9/L(P=0.012)和124±54×10~9/L对101±66×10~9/L(P=0.040),差异有统计学意义。基线及第90 d,两组血小板水平的差异无统计学意义(P0.05)。试验组泼尼松使用剂量少于对照组且第15、22、30、90 d,试验组的空腹血糖水平低于对照组,两组的差异有统计学意义(P0.05)。结论连续应用rhTPO联合泼尼松治疗成人初治重症ITP患者,起效迅速,作用持久,不良反应少,可减少泼尼松的使用剂量。     

Uterine artery embolisation for uterine fibroids: Our experience at a tertiary care service hospital

Background

Uterine artery embolisation (UAE) has evolved as a minimally invasive and effective alternative, treatment modality for women with symptomatic fibroids. We discuss our initial experience of UAE in the management of symptomatic fibroids.

Methods

Twenty five symptomatic patients of uterine fibroids were treated with UAE by selectively cannulating and injecting poly vinyl alcohol particles into the uterine arteries. Post treatment follow up was done at 2 and 6 months respectively.

Results

Pre-treatment, the sizes of fibroids were between 3.9 and 10.9 cm (mean 7.4) on ultrasonography. Of the total 25 patients, 49 uterine arteries were embolised with a technical success rate of 98%. Menorrhagia persisted in 7 patients, dysmenorrhea in 4 patients and pressure symptoms in 2 patients respectively in follow up study of six months which corresponds to a reduction in symptoms by 68% for menorrhagia, 71% for dysmenorhoea and 75% for those with pressure symptoms respectively. At 2 months follow-up post embolisation, the mean diameter of the fibroid was 4.03 cm (range 2–5.2 cm) and at 6 months 3.2 cm (range 1.3–4.1 cm), corresponding to size reduction of 45.5% and 57%, respectively. Follow up with ultrasonography at 2 and 6 months period showed successful fibroid reduction in 24 patients with corresponding reduction in the symptomatology. One patient remained symptomatic with increase in fibroid size and had to undergo hysterectomy.

Conclusion

Uterine artery embolisation can be considered as an alternative to hysterectomy in appropriately selected symptomatic patients of uterine fibroids.     

Ovarian hemangioma occurring synchronously with contralateral mature cystic teratoma in an 81-year-old patient

Purpose

Ovarian hemangiomas are seen rarely. We present a case of an ovarian hemangioma occurring synchronously with contralateral mature cystic teratoma.

Case history

An 81-year-old woman presented with hypertension and hyponatremia. In ultrasonographic evaluation a pelvic mass was found located at the left ovary. Histologically, a mature cystic teratoma measuring 9.5 × 9 × 8 cm was seen in left ovary. In the right ovary an incidental vascular lesion measuring 3.5 × 1.5 × 1 cm was observed. Final histopathological examination of this lesion demonstrated a hemangioma of cavernous type.

Conclusion

To the best of our knowledge, this is the first ovarian hemangioma case occurring synchronously with contralateral mature cystic teratoma.     

肾上腺海绵状血管瘤1例及文献回顾

A 57-year-old male patient was referred to our department with complaints of his right adrenal gland occupancy and hypertension about 6 months. When admitted to the hospital, the blood pressure was about 160/100 mmHg, and the heart rate was 110 beats/min. He was no obvious obesity, acne, abnormal mood, without weakness of limbs, acral numbness, palpitation and headache. He presented with type 2 diabetes for more than 3 years, with oral administration of metformin enteric coated tablets and subcutaneous injection of insulin glargine to control blood glucose, and satisfied with blood glucose control. Enhanced CT showed that: the right adrenal gland showed a kind of oval isodense, slightly hypodense shadow, the edge was clear, lobular change, the size was about 5.8 cm×5.4 cm, uneven density, there were nodular and strip calcification, round lipid containing area and strip low density area, and the CT value of solid part was about 34 HU. Enhanced scan showed heterogeneous nodular enhancement in the solid part of the right adrenal gland, nodular enhancement could be seen inside. The CT values of solid part in arterial phase, venous phase and delayed phase were 45 HU, 50 HU and 81 HU, respectively. Considering from the right adrenal gland, cortical cancer was more likely. No obvious abnormality was found in his endocrine examination. After adequate preoperative preparation, retroperitoneal laparoscopic adrenalectomy was performed under general anesthesia. During the operation, the 6 cm adrenal tumor was closely related to the inferior vena cava and liver, and after careful separation, the tumor was completely removed and normal adrenal tissue was preserved. The operation lasted 180 min and the blood loss was 100 mL, and the blood pressure was stable during and after the operation. There was no obvious complication. The results of pathological examinations were as follows: the size of the tumor was 7.5 cm×6.0 cm×3.5 cm, soft, with intact capsule and grayish-red cystic in section. Pathological diagnosis: (right adrenal gland) cavernous hemangioma, secondary intravascular thrombosis, old hemorrhagic infarction with calcification and ossification. After 6 months of observation, no obvious complications and tumor recurrence were found. In summary, cavernous hemangioma of adrenal gland is a rare histopathological change. Its essence is a malformed vascular mass. Blood retention is the cause of thrombosis and calcification in malformed vessels. The imaging findings were inhomogeneous enhancement of soft tissue masses, and the adrenal function examination showed no obvious abnormalities. Retroperitoneal laparoscopic surgery is feasible after adequate preoperative preparation. It is difficult to diagnose the disease preoperatively and needs to be confirmed by postoperative pathology.     

Comparison of microalbuminuria among treatment na?ve HIV sero-positive and negative adult clients in Faith Alive Foundation Hospital,Jos

Background:

This study is to determine microalbuminuria in human immunodeficiency virus (HIV) infected patients before commencement of highly active anti-retroviral treatment (HAART).

Patients and Methods:

Consecutive patients with the HIV infection seen in the HIV counselling and testing (HCT) unit of the Faith Alive Foundation Hospital, Jos, and a similar group of healthy uninfected patients were evaluated for renal disease: Urinary albumin and urinary creatinine were analysed.

Results:

Of the 200 patients with HIV infection and 100 uninfected controls studied, increased urinary albumin excretion (UAE) was present in 39 (19.5%) of the subjects and 5.0 (5.0%) of controls. The difference between the mean values for the UAE for both subjects and controls [182.3 ± 54.3 and 163.9 ± 39.3 mg/l, respectively (P = 0.006)] was statistically significant. On the other hand the urinary creatinine for both the subjects and controls [11.7 ± 5.2 and 12.0 ± 4.8 mmol/L, respectively (P = 0.6)] was not statistically significant. The difference between the mean urinary albumin/creatinine ratio (UACR) for both subjects and controls [1.8 ± 1.2 mg/mmol and 1.4 ± 0.4 mg/mmol respectively (P = 0.001)] was statistically significant.

Conclusion/Recommendation:

Increase UAE is a common complication of HIV infection due to a number of factors other than HAART. Early screening for renal disease using microalbuminuria is very useful since the use of medications such as angiotensin converting enzyme inhibitors, which could help reverse progression to end-stage renal disease.     

Dengue related maculopathy and foveolitis

A 24 year-old Malay lady presented with high grade fever, myalgia, generalized rashes, severe headache and was positive for dengue serology test. Her lowest platelet count was 45 × 10⁹ cells/L. She complained of sudden onset of painlessness, profound loss of vision bilaterally 7 days after the onset of fever. On examination, her right eye best corrected vision was 6/30 and left eye was 6/120. Her anterior segment examination was unremarkable. Funduscopy revealed there were multiple retinal haemorrhages found at posterior pole of both fundi and elevation at fovea area with subretinal fluid. Systemic examination revealed normal findings except for residual petechial rashes. She was managed conservatively. Her vision improved tremendously after 2 months. The retinal hemorrhages and foveal elevation showed sign of resolving. Ocular manifestations following dengue fever is rare. However, bilateral visual loss can occur if both fovea are involved.     

皮肤基底鳞状细胞癌1例

患者女性,81岁,左鼻孔下方反复溃疡5 a,加重1 a。皮肤科情况:左鼻孔下方可见约3.0 cm×2.5 cm×0.6 cm的不规则溃疡,向周围呈浸润性生长。皮损组织病理诊断:真皮中上部可见基底样细胞组成的癌巢,基底样癌巢中央及周边可见鳞状细胞癌成分,癌巢中央可见角珠及鳞状涡。诊断:皮肤基底鳞状细胞癌。     

褪黑素联合顺铂、甲氨蝶呤对骨肉瘤SaOS-2细胞增殖的影响

目的探讨褪黑素(Mel)联合顺铂(DDP)、甲氨蝶呤(MTX)对骨肉瘤细胞系Sa OS-2增殖的影响,以及Mel与DDP、MTX是否具有协同抗肿瘤作用。方法 Mel、DDP、MTX、Mel+DDP、Mel+MTX作用于Sa OS-2细胞后,CCK-8法检测药物对细胞活性的影响,应用Compusyn软件分析药物的合并效应,流式细胞术分析细胞周期分布及细胞凋亡率。结果与对照组相比,Mel、DDP、MTX单独均能显著降低Sa OS-2细胞活性(P均<0.05),且呈剂量-效应关系。与单用DDP或MTX相比,Mel与DDP或MTX联合应用能显著降低Sa OS-2细胞的活性(P均<0.05)。1 mmol/L的Mel与6.67、16.67、33.33、66.66μmol/L的DDP合用时,联合用药指数(CI)分别为1.18、1.21、1.09、0.84,与0.1、0.5、1、2、4 mmol/L MTX合用后,CI分别为0.88、0.88、0.83、0.78、0.81。与对照组相比,Mel组与Mel+MTX组的G1期细胞比例显著增多(P均<0.05),S期细胞比例显著减少(P均<0.05);MTX组的S期细胞比例显著增多(P均<0.05)。药物作用组的细胞凋亡率均显著高于对照组(P均<0.05),联合用药组的细胞凋亡率显著高于单药组(P均<0.05)。结论 Mel在体外能抑制Sa OS-2细胞的活性,阻滞细胞周期于G1期,诱导凋亡,发挥抗肿瘤效应,与较低浓度DDP呈拮抗效应,而与MTX、较高浓度DDP联合应用时呈协同抗肿瘤效应。     

超声评估在支架植入治疗Meso-rex术后桥血管狭窄中的临床价值

目的 探究超声评估在支架植入治疗成人门静脉海绵样变Meso-rex术后桥血管狭窄中的可行性。方法 纳入因门静脉海绵样变行Meso-rex手术、且经术后超声诊断为桥血管狭窄、后行经皮肝穿门静脉造影并植入支架的患者,分析比较支架植入前后的超声测量指标和声像图表现、支架植入后门静脉高压症状的改善及相关临床指标。结果 最终入组8例患者,男∶女=5∶3,平均年龄(32.4±14.7)岁。支架植入后中位随访时间为26个月。超声测量Meso-rex术后桥血管狭窄处平均内径为(2.74±0.23)mm,支架植入后桥血管平均内径为(7.23±0.68)mm,支架植入后桥血管内径较前增宽(P=0.000);Meso-rex术后桥血管狭窄处平均最大流速为(195.88±30.83)cm/s,支架植入后桥血管平均最大流速为(72.75±29.94)cm/s,支架植入后桥血管流速较前减低(P=0.000);桥血管狭窄处彩色多普勒血流成像表现为花彩血流,支架植入后彩色多普勒血流成像表现为支架内较规则的接近层流及特征性门静脉左支内反向血流。患者介入治疗后未发生消化道出血、腹腔积液,且脾脏厚度中位数从支架植入前的6.0 cm降至5.4 cm(P=0.018)。支架植入前后血液学指标对比:血小板从(51.57±18.83)×10⁹/L升至(149.00±58.96)×10⁹/L(P=0.002);血氨水平从(66.25±21.78)μmol/L降至(44.88±10.60)μmol/L(P=0.012)。结论 超声能够准确评估Meso-rex术后桥血管狭窄患者支架植入前后桥血管的通畅性,并能有效监测门静脉血流动力学改变,介入治疗后临床症状可缓解。     

Dilution of the 75-g oral glucose tolerance test increases postprandial glycemia: implications for diagnostic criteria

BACKGROUND: Dilution has been noticed to increase the glycemic response to various sugars, including glucose. This effect may contribute to the poor reproducibility of the oral glucose tolerance test (OGTT). To test this hypothesis we assessed the effect of diluting a 75-g OGTT on 2-hour postprandial blood glucose based diagnostic outcomes, incremental glycemia and area under the glucose curve. METHODS: On 3 different occasions, 10 subjects (mean age 40 [and standard error of the mean (SEM) 3.2] years; mean body mass index 27.2 [and SEM 1.2] kg/m2) without previously diagnosed dysglycemia were given a 300-mL, 600-mL or 900-mL 75-g OGTT in random order. The protocol followed the American Diabetes Association's guidelines. Finger-prick capillary blood samples were obtained at fasting and then 15, 30, 45, 60, 90 and 120 minutes after the start of the test. RESULTS: At 30, 45 and 60 minutes, incremental glycemic concentrations were significantly higher with the 900-mL meal (means [and SEMs]: 4.9 [0.4] mmol/L, 5.1 [0.6] mmol/L and 4.6 [0.8] mmol/L, respectively) than with the 600-mL (means [and SEMs]: 4.0 [0.3] mmol/L, 4.2 [0.6] mmol/L and 3.6 [0.7] mmol/L, respectively) and the 300-mL meals (means and [SEMs]: 3.8 [0.5] mmol/L, 4.0 [0.5] mmol/L and 3.2 [0.6] mmol/L, respectively) (p < 0.05). The same was true for peak incremental blood glucose, regardless of time (p < 0.05). The area under the curve for the 900-mL meal (mean [and SEM] 404 [57] min.mmol/L) was significantly higher than for the 600-mL (mean [and SEM] 331 [51] min.mmol/L) and 300-mL meals (mean [and SEM] 280 [48] min.mmol/L) (p < 0.05). No other significant differences were observed. INTERPRETATION: Dilution of the 75-g OGTT will likely not affect current screening practices that use 2-h postprandial glucose levels as the basis for diagnosis. It may, however, bias the interpretation of older criteria that rely on intermediate time points because these midpoints appear to be sensitive to alterations in the total volume of the meal ingested.