hMLH1及hMSH2蛋白免疫组化结合微卫星不稳定性检测在遗传性非息肉病性结直肠癌家系筛选中的作用

目的 探讨hMLH1及hMSH2蛋白免疫组化结合微卫星不稳定性检测在遗传性非息肉病性结直肠癌家系筛选中的敏感性、特异性及临床应用价值。方法 对12例符合Amsterdam标准的HNPCC患者和16例散发性结直肠癌患者的肿瘤标本进行hMLH1及hMSH2蛋白免疫组化检查和微卫星不稳定性检测。结果 hMLH1及hMSH2蛋白免疫组化筛选HNPCC家系的敏感性为91．7％,特异性为87．5％;微卫星不稳定性检测的敏感性为100％,特异性为75．0％;两者结合敏感性为91．7％,特异性为93．8％。结论 hMLH1及hMSH2蛋白免疫组化结合微卫星不稳定性检测筛选HNPCC家系敏感性和特异性明显提高,而且方法简单、经济,适合在临床广泛应用。     

A new approach to CNS repair using chimeric peripheral nerve grafts

We have examined whether transplanted freeze-thawed peripheral nerve (PN) sheaths repopulated ex vivo with purified adult Schwann cells (SCs) support the regeneration of adult rat retinal ganglion cell (RGC) axons. Cultured adult SCs were derived from donor rats or from the host animals themselves. We also transplanted PN sheaths filled with neonatal SCs or donor adult olfactory ensheathing glia (OEG). 100,000 cells were injected into 1.5-cm lengths of freeze-thawed PN. After 2 days in culture, repopulated PN segments were grafted onto the transected optic nerve of adult Fischer rats. Three weeks later, 6% fluorogold (FG) was applied to distal PN. Retrogradely labeled RGCs were counted in retinal wholemounts and PN grafts were processed for immunohistochemistry. As expected, there was no RGC axon regeneration in cell-free grafts. Regrowth was also absent in neonatal SC- and adult OEG-filled grafts, which contained only small numbers of surviving donor cells. Many cells were, however, seen in adult SC repopulated PN grafts, intermingled with pan-neurofilament(+) and GAP-43(+) fibers. SCs were aligned along the grafts and were S-100(+), p75(+). Ultrastructurally, SCs were associated with myelinated and unmyelinated axons. Hundreds of FG-labeled RGCs were seen in retinas of rats with congeneic or allogeneic PN sheaths repopulated with either donor or autologous (host-derived) adult SCs. Intraocular CNTF injections significantly increased the number of regenerating RGCs in donor and autologous adult SC groups. The use of chimeric grafts to bridge CNS tissue defects could provide a clinical alternative to using multiple PN autografts, the harvesting of which would exacerbate peripheral dysfunction in already injured patients.     

新生儿感染性疾病127例临床研究

目的探讨新生儿感染性疾病实验室非特异性指标相关因素的诊断价值。 方法选取2016年7月至2017年7月承德市中心医院NICU收治的127例出生0~3 d的感染性疾病患儿为感染组,103例0~3 d非感染性疾病新生儿为对照组,比较两组新生儿的临床症状、围产期因素以及实验室指标等。 结果与对照组新生儿相比,感染组患儿喂养困难（15.7%）、呼吸困难（30.7%）、呻吟（31.5%）、皮肤黄染（18.1%）和窒息（5%）等初始症状差异均有统计学意义（χ² = 4.136、24.574、33.282、38.039,P均< 0.001）。围产期因素中两组新生儿母亲孕晚期有感染病史和胎膜早破> 18 h两个因素差异有统计学意义（χ² = 10.536、10.717,P均= 0.001）。实验室指标结果显示,两组新生儿C-反应蛋白（CRP）、白细胞计数以及中性粒细胞百分比差异均有统计学意义（t = 2.740、P = 0.008,t = 6.378、P < 0.001,t = 4.860、P < 0.001）。感染组患儿ROC曲线分析显示：CRP、白细胞计数、中性粒细胞百分比最佳截断点分别为8.0 mg/dl、12.65 × 10⁹/L和63.15%,敏感性分别为24.3%、62.2%和68.9%,特异性分别为99.0%、81.2%和84.4%,曲线下面积（AUC）分别为0.544、0.707和0.769;CRP、白细胞计数和中性粒细胞百分比三者联合敏感性为83.8%,特异性为75.0%,曲线下面积（AUC）为0.860,显著高于单项指标。 结论新生儿感染性疾病的发生与多种围产期因素密切相关,以呼吸系统症状为始发临床表现多见。CRP、白细胞计数和中性粒细胞百分比联合诊断可以提高诊断价值。围产期因素、临床表现和实验室指标相结合,有利于早期识别新生儿感染性疾病。     

Targeting formyl peptide receptor 1 of activated macrophages to monitor inflammation of experimental osteoarthritis in rat

Macrophages play a crucial role in the pathogenesis of osteoarthritis (OA). In this study, the feasibility of a formyl peptide receptor 1 (Fpr1)‐targeting peptide probe cFLFLF‐PEG‐⁶⁴Cu via positron emission tomography (PET) imaging was investigated for detection of macrophage activity during development of OA. Monoiodoacetate (MIA) was intraarticularly injected into the knee joint of Sprague–Dawley rats to induce OA. Five days later, cFLFLF‐PEG‐⁶⁴Cu (～7,400 kBq/rat) was injected into the tail vein and microPET/CT imaging was performed to assess the OA inflammation by detecting infiltration of macrophages by Fpr1 expression. In addition, a murine macrophage cell line RAW264.7 and two fluorescent probes cFLFLF‐PEG‐cyanine 7 (cFLFLF‐PEG‐Cy7) and cFLFLF‐PEG‐cyanine 5 (cFLFLF‐PEG‐Cy5) were used to define the binding specificity of the peptide to macrophages. It was found with the MIA model that the maximal standard uptake values (SUV_max) for right (MIA treated) and left (control) knees were 17.96 ± 5.45 and 3.00 ± 1.40, respectively. Histological evaluation of cryomicrotome sections showed that Fpr1 expression, cFLFLF‐PEG‐Cy5 binding, and tartrate‐resistant acid phosphatase activity were elevated in the injured synovial membranes. The in vitro experiments demonstrated that both fluorescent peptide probes could bind specifically to RAW264.7 cells, which was blocked by cFLFLF but not by the scramble peptide. The findings highlighted the use of cFLFLF‐PEG‐⁶⁴Cu/PET as an effective method potentially applied for detection and treatment evaluation of OA. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1529–1538, 2016.     

Novel mutations of CYP27B1 gene lead to reduced activity of 1α-hydroxylase in Chinese patients

Pseudovitamin D-deficiency rickets (PDDR) is an autosomal recessive disorder resulting from a defect in renal 25-hydroxyvitamin D 1α-hydroxylase, the key enzyme in the pathway of vitamin D metabolism. We identified ten different mutations in the 1α-hydroxylase gene (CYP27B1) in eight Chinese families with PDDR by DNA-sequence analysis. Six of them are novel missense mutations: G57V, G73W, L333F, R432C, R459C, and R492W; three are novel deletion mutations: c48-60del, c1310delG, and c1446delA; and an insertion mutation c1325-1332insCCCACCC reported previously. Functional assay revealed that the missense mutants identified in this study retain 5.5-12.1% 1α-hydroxylase activity of the wild type. The study describes nine novel mutations in addition to 37 known mutations of CYP27B1 gene and shows the correlation between these mutations and the clinical findings of 1α-hydroxylase deficiency.     

肾癌多层螺旋CT表现与手术病理结果的对照研究

目的 评价螺旋CT在肾癌检查中的应用价值和肾癌CT征象与组织病理学的关系.方法 279例做了CT平扫及增强扫描,所有病例均经病理证实为肾癌.对肾癌的临床特征及CT表现与手术病理结果进行对照.结果 肾癌在CT增强扫描早期呈中度和显著强化者占90.32%,除颗粒细胞都为均匀强化外,其余细胞类型呈不均匀强化,32.26%肿瘤边缘有或多或少的短毛刺(χ~2=38.2,P<0.01),短毛刺征象与病理检查肾包膜侵犯有显著关系.CT定性诊断准确率为91.40%;CT分期与手术病理分期的相关系数为0.84;肾癌的CT分型与癌肿细胞类型没有明显相关性(P>0.05).结论 多层螺旋CT能更好地显示出肿瘤的影像学特征,提高对肾癌的诊断准确性和分期能力.     

卫生系统首次X、γ辐射防护仪器的测量比对

卫生部工卫所次级标准剂量学实验室于1988年6月21日至29日组织了第一次卫生系统的x、γ辐射防护仪器的测量比对实验, 其目的在于检验现场使用的防护仪器的测量误差。全国有26个省、直辖市和自治区的61个放射卫生防护单位派代表并携带83台仪器参加了这次比对活动。比对酒量中使用的辐射源为两个不同活度的^6OCoγ射线源和深部治疗x线机产生的中等过滤x射线束。比对测试点剂量率的约定真值是根据本实验室的次级标准剂量仪的测量结果确定的。比对测量结果表明, 仪器对γ辐射源响应的基本误差不大于±10%的仪器数占总仪器数的52.8%,不大于±20%的占83.4%,不大于±30%的占94.5%,仪器对X线响应的相对偏差不大于士10%的仪器数占总仪器数的49.3%,不大于±20%的占75.0%,不大于±30%的占91.2%.     

果糖二磷酸钠对室间隔缺损修补术后心肌保护作用的研究

目的观察果糖二磷酸钠(FDP)对室间隔缺损修补术的心肌保护作用。方法 20例室间隔缺损患儿随机分为两组,FDP治疗组在主动脉开放后1h静脉泵入,对照组用等量葡萄糖泵入,分别于麻醉诱导前、诱导后、主动脉阻断开放后1h、术后第5天,采集患儿中心静脉血,检测患儿磷酸肌酸激酶同工酶(CK-MB)、肌钙蛋白-I(cTn-I),并观察患儿术后拔管时间、术后第7天观察患儿左室射血分数(EF)。结果 FDP治疗组术后CK-MB、cTn-l、EF较对照组相比均有明显改善,拔管时间较对照组也明显缩短。结论 FDP在体外循环手术后能起到显著的心肌保护作用。     

双源CT冠状动脉成像对冠状动脉狭窄病变的诊断价值

目的：探讨双源CT（dual-source CT,DSCT）冠状动脉检查对冠状动脉狭窄病变的诊断价值.材料和方法：收集2009-05～2009-12 47例1周内同时做DSCT和冠状动脉造影（coronary angiography,CAG）检查的患者的影像学资料.以冠状动脉病变诊断的＂金标准＂CAG检查结果做对比,分析DSCT对冠状动脉病变诊断的准确性.结果：47例中,DSCT显示的冠状动脉节段共有631个,其中595个冠状动脉节段图像显示良好可以进行评估.DSCT诊断冠状动脉狭窄的灵敏度为79.7%（126/158）,特异度为96.3%（421/437）,阳性预测值为88.7%（126/142）,阴性预测值为92.9%（421/453）,正确率为91.9%（547/595）,DSCT与CAG检查具有中度一致性（Kappa=0.668）.DSCT对冠状动脉钙化、小分支病变诊断准确性欠佳.结论：DSCT冠状动脉成像能准确诊断有意义的冠状动脉狭窄病变,可作为临床上怀疑冠心病患者的CAG术前筛查及支架术后随访的首选方法.