肝内胆管囊腺肿瘤的诊断和手术治疗

目的 探讨肝内胆管囊腺肿瘤的临床特点及手术治疗。方法 回顾性分析2004年1月至2013年12月收治的14例肝内胆管囊腺肿瘤病例的临床资料及随访结果。结果 14例肝内胆管囊腺肿瘤经病理检查,诊断为肝内胆管囊腺瘤（intrahepatic biliary cystadenoma,IBC）8例,肝内胆管囊腺癌（intrahepatic biliary cystadenocarcinoma,IBCa）6例。临床均表现为右上腹肿物、上腹部胀满不适、上腹痛、黄疸、发热等,B超、CT和MRI表现为肝内囊性或囊实性占位。肿瘤均全部手术切除,术后随访至2014年6月,其中诊断为IBC8例患者7例存活至今,1例死于脑血管意外;诊断为IBCa6例患者,3例至今未见复发,3例因病情恶化死亡。结论 肝内胆管囊腺肿瘤包括囊腺瘤和囊腺癌,患者无特异性临床表现,临床确诊主要根据病理学检查结果。对于肝脏囊性病变提高警惕,应通过CT和MRI排除IBC,如有怀疑IBC,积极手术探查并完整切除是治疗肝内胆管囊腺肿瘤并改善预后的有效方法。n,TIAN Yifeng,Provincial Clinical Abstract】Objectiv.Methods The cli y 2004to December,of them eight pati cystadenocarcinoma inal distention,abd T/MR scan.The tu ients survived,one three patients of d patients.The diagn rasound and CT/MR Key words】liver neo肝内胆管囊腺肿patic biliary cyst癌（intrahepatic）,是非常罕见的学技术的普及,但由于本病无特异本文回顾性分析床影像、病理特点下。     

多排螺旋CT及重组技术对肝胆管囊腺瘤的特征分析

目的探讨多排螺旋CT及重组技术对肝胆管囊腺瘤的诊断价值,分析其影像特征,以提高肝胆管囊腺瘤的诊断准确率。方法回顾性分析5例经病理证实为肝胆管囊腺瘤的多排螺旋CT平扫及增强影像,并行多平面重组(MPR)、冠状面和矢状面最大密度投影(MIP)及容积再现(VR)图像重组。结果 5例肝胆管囊腺瘤的多排螺旋CT影像均表现为多房囊性病变,囊内有分隔,囊壁光滑,部分囊壁均匀增厚,部分较薄、不规则、呈结节状。增强后囊壁及分隔不同程度强化,延迟期大部呈等密度,其中1例延迟强化。MPR及MIP图像上清晰显示不同角度多房分隔的形态及壁结节形状,VR图像清晰显示门脉血管受压及移位程度。结论肝胆管囊腺瘤的多排螺旋CT影像具有一定的特征性表现,结合动态增强扫描及三维重组图像对诊断有重要价值,提高了和其他肝脏肿瘤的鉴别诊断能力。     

肝胆管囊腺癌的诊治分析

目的探讨肝胆管囊腺癌的临床特征及诊治方法。方法对肝胆管囊腺癌的病理组织来源、临床表现、诊断、治疗和预后进行分析。结果对肝胆管囊腺癌的病理组织来源、临床表现进行分析有助于提高肝胆管囊腺癌的诊断和治疗。结论肝脏胆管囊腺癌临床表现缺乏特异性,亦没有显著的实验室检查指标,影像学检查在诊断及治疗上的作用非常重要。     

Fascin在卵巢浆液性肿瘤中的表达及其临床意义

目的检测fascin蛋白在卵巢浆液性肿瘤中的表达及意义。方法选取卵巢浆液性囊腺瘤17例,卵巢交界性浆液性囊腺瘤22例,卵巢浆液性囊腺癌43例,以18例正常卵巢组织做为对照。制成组织芯片,用免疫组织化学EnVision二步法检测Fascin和Ki-67蛋白的表达,并与临床病理参数进行统计学分析。结果 Fascin表达在浆液性囊腺癌(81.4%)和交界性浆液性囊腺瘤(40.9%)中明显高于正常卵巢组织(0/18)和卵巢浆液性囊腺瘤(11.8%)(P<0.01),浆液性囊腺癌组高于交界性浆液性囊腺瘤组(P<0.01);卵巢浆液性囊腺癌中Fascin表达与病理分级、淋巴结转移情况相关(P<0.01)。Fascin低表达组的中位5年生存时间明显长于高表达组(36个月vs.23个月)(P<0.05)。卵巢浆液性囊腺癌中fascin与Ki-67的表达正相关(P<0.01)。结论 Fascin在卵巢浆液性囊腺癌的早期诊断、分级及预后判断中可能具有重要参考价值,也有望成为一个卵巢浆液性囊腺癌的治疗靶点。Fascin在卵巢浆液性囊腺癌中的表达与Ki-67具有相关性。     

肝胆管囊腺瘤与囊腺癌的临床病理观察

目的 探讨肝内胆管囊腺瘤及囊腺癌的临床病理特点. 方法 复习2005年1月至2009年12月我院收治的3例患者的病理切片,采用相应抗体进行免疫组织化学SP法染色观察,并结合文献资料加以讨论. 结果 3例患者均表现腹部包块和腹痛,病理检查1例为胆管囊腺瘤;2例为囊腺癌,分别为浸润型和非浸润型.免疫组织化学CK（AE1/AE3）、CK7、CK20、CA19-9及CEA均不同程度表达.术后平均随访12个月,患者一般情况良好. 结论 正确诊断胆管囊腺瘤和囊腺癌对临床治疗和预后的判断有重要指导意义.     

卵巢囊性肿瘤的多层螺旋CT诊断

目的探讨多层螺旋CT在卵巢囊腺瘤和囊腺癌中的诊断价值。方法回顾分析我院2005年3月～2008年8月经手术和病理证实使用多层螺旋CT诊断的16例卵巢囊腺瘤的CT影像资料。结果浆液性卵巢囊腺瘤8例（其中单房性浆液性囊腺瘤5例、浆液性乳头性囊腺瘤3例）,且见浆液性乳头状囊腺瘤内钙化1例。黏液性卵巢囊腺瘤6例．交界性黏液性卵巢囊腺瘤1例,浆液性卵巢囊腺癌1例（双侧卵巢发病）。术前诊断14例（87．5％）,误诊2例（12．5％）。结论多层螺旋CT能很好显示卵巢囊腺瘤、囊腺癌的特征．在鉴别诊断良恶性卵巢囊腺肿瘤上有价值。     

CT与MRCP对肝胆管结石并发肝胆管癌的诊断效果比较

目的 比较CT、磁共振胰胆管造影(MRCP)对肝胆管结石并发肝胆管癌的诊断效果。方法 选取该院2012年12月至2014年12月收治的62例肝胆管结石并发肝胆管癌患者分别行CT、MRCP、B超联合CT、B超联合MRCP检查,记录并比较各种方法对肝胆管结石并发不同类型肝胆管癌的诊断率。结果 CT总诊断阳性率[69.4%(43/62)]低于MRCP[85.5%(53/62)],差异有统计学意义(χ2=4.613,P<0.05)。MRCP对肝胆管结石并发结节型、团块型和胆管乳头型肝胆管癌的诊断率略高于CT,但差异无统计学意义(P>0.05);MRCP对肝胆管结石并发胆管增厚型肝胆管癌的诊断率明显高于CT,差异有统计学意义(P<0.05);B超联合MRCP检测的诊断率明显高于B超联合CT,但差异无统计学意义(P>0.05)。结论 CT和MRCP对肝胆管结石并发肝胆管癌均具有较高诊断准确率,并且B超分别与CT、MRCP联合使用可明显提高对肝胆管结石并发肝胆管癌的准确率。     

胰腺肿瘤的CT诊断

目的总结胰腺肿瘤螺旋CT表现,探讨CT对胰腺肿瘤的诊断价值。方法对经手术及病理证实确诊的60例胰腺肿瘤的CT征象进行回顾性分析。结果胰腺癌49例,胰腺黏液性囊腺瘤及囊腺癌3例,胰岛细胞瘤7例,胰腺导管内乳头状黏液性肿瘤1例。①胰腺癌49例(100%),胰腺囊腺瘤及胰腺囊腺癌3例(100%),胰岛细胞瘤5例(70%)出现胰腺增大。③胰腺癌25例(51%),胰腺导管内乳头状黏液性肿瘤(100%)出现胰管扩张。④胰腺癌35例(71%)出现肝内外胆管扩张⑤胰腺癌20例(40%)侵犯周围血管、器官及转移。结论全面分析CT表现,结合临床表现及实验室检查结果,提高螺旋CT在胰腺肿瘤的定性诊断的准确率。     

CT在卵巢囊腺瘤及囊腺癌诊断中的应用

目的探讨CT诊断卵巢囊腺瘤及囊腺癌的价值。方法回顾分析35例经临床手术及病理证实的卵巢囊腺瘤与囊腺癌的CT表现。结果35例中浆液性囊腺瘤17例,粘液性囊腺瘤10例;浆液性囊腺癌6例,粘液性囊腺癌2例;囊腺瘤表现为壁薄、光滑的单房或多房囊性肿块,无壁结节;囊腺癌表现为囊壁及间隔不规则增厚,多有壁结节或肿块实性部分。结论卵巢囊腺瘤及囊腺癌有特征性的CT表现,CT在其诊断和鉴别上有价值。     

原发性肝脏腺鳞癌一例

原发性肝脏腺鳞癌(adenosquamous carcinoma ASC)是一种非常罕见的肝脏恶性肿瘤[1-2],其组织学特点是同时具有腺癌和鳞癌两种细胞成分,其最先被描述为肝脏黏液上皮癌,1975年由Barr等[3]首先以肝脏腺鳞癌进行报道之后,目前全世界仅有70余例报道,国内有关的报道则更少[4-5].我院收治ASC 1例,现报告如下.     

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.

     

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.     

2-(Acetoxyphenyl)-(Z)-styryl sulfides as cyclooxygenase inhibitors

2-(Acetoxyphenyl)-(Z)-styryl sulfides are described as selective cyclooxygenase-2 (COX-2) inhibitors, useful for treating inflammation and COX-2-mediated disorders including neoplasia. 2-(Acetoxyphenyl)-(Z)-styryl sulfide is claimed to be the most potent COX inhibitor in the series with a COX-2 selectivity ratio of 33. This compound is also claimed to be superior to celecoxib (Celebrex^®, Pfizer) in inhibiting cell growth of colorectal carcinoma cells. In this evaluation, the COX inhibitory activity of this compound is compared to that previously disclosed for diarylheterocycles and 2-(acetoxyphenyl)alkyl sulfides. The validity of the DLD-1 cell line in the growth inhibition studies is questioned based on recent literature reports indicating the lack of COX-2 expression in this cell line.     

Sleep-disordered breathing with chronic opioid use

Chronic opioid use for pain relief or as substitution therapy for illicit drug abuse is prevalent in our societies. In the US, retail distribution of methadone and oxycodone has increased by 824 and 660%, respectively, between 1997 and 2003. μ-Opioids depress respiration and deaths related to illicit and non illicit chronic opioid use are not uncommon. Since 2001 there has been an emerging literature that suggests that chronic opioid use is related to central sleep apnoea of both periodic and non-periodic breathing types, and occurs in ～ 30% of these subjects. The clinical significance of these sleep-related abnormalities are unknown. This review addresses the present knowledge of control of ventilation mechanisms during wakefulness and sleep, the effects of opioids on ventilatory control mechanisms, the sleep-disordered breathing found with chronic opioid use and a discussion regarding the future research directions in this area.     

Drug targets for cognitive enhancement in neuropsychiatric disorders

The investigation of novel drug targets for treating cognitive impairments associated with neurological and psychiatric disorders remains a primary focus of study in central nervous system (CNS) research. Many promising new therapies are progressing through preclinical and clinical development, and offer the potential of improved treatment options for neurodegenerative diseases such as Alzheimer's disease (AD) as well as other disorders that have not been particularly well treated to date like the cognitive impairments associated with schizophrenia (CIAS). Among targets under investigation, cholinergic receptors have received much attention with several nicotinic agonists (α7 and α4β2) actively in clinical trials for the treatment of AD, CIAS and attention deficit hyperactivity disorder (ADHD). Both glutamatergic and serotonergic (5-HT) agonists and antagonists have profound effects on neurotransmission and improve cognitive function in preclinical experiments with animals; some of these compounds are now in proof-of-concept studies in humans. Several histamine H3 receptor antagonists are in clinical development not only for cognitive enhancement, but also for the treatment of narcolepsy and cognitive deficits due to sleep deprivation because of their expression in brain sleep centers. Compounds that dampen inhibitory tone (e.g., GABA_A α5 inverse agonists) or elevate excitatory tone (e.g., glycine transporter inhibitors) offer novel approaches for treating diseases such as schizophrenia, AD and Down syndrome. In addition to cell surface receptors, intracellular drug targets such as the phosphodiesterases (PDEs) are known to impact signaling pathways that affect long-term memory formation and working memory. Overall, there is a genuine need to treat cognitive deficits associated with many neuropsychiatric conditions as well as an increasingly aging population.