颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

药物联合蓝光治疗新生儿黄疸临床分析

目的探讨药物联合蓝光治疗新生儿黄疸的疗效。方法收集新生儿黄疸住院病例204例,随机分成治疗组和对照组,治疗组采用常规药物联合蓝光治疗;对照组采用常规药物治疗。比较两组患儿总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）水平的变化。结果治疗组治疗后血清TBIL、IBIL下降幅度大于对照组（P〈0．01）。但DBIL下降幅度差异无统计学意义（P〉0．05）。治疗组患儿不同浓度血清胆红素水平下降幅度不同,水平越高下降幅度越大。结论常规药物加蓝光治疗降低新生儿血清胆红素水平效果优于单纯蓝光治疗法,具有安全、经济、方便的优点,是降低血清未结合胆红素简单而有效的方法。     

颅咽管瘤手术中垂体柄的辨认与保护

目的 探讨颅咽管瘤手术中垂体柄的辨认与保护方法及其对预后的影响。方法 对63例颅咽管瘤病人垂体柄的影像学和术中表现进行分析。结果 术中明确发现垂体柄33例,位于肿瘤瘤体后方23例、上方5例、侧方3例、前方2例。23例可在影像学上初步判断垂体柄与肿瘤的位置关系,均得到术中证实。垂体柄得到辨认与保护者术后尿崩的恢复好于术中未见垂体柄者。结论 垂体柄的辨认与保护对提高肿瘤全切除率、改善预后至关重要,MRI扫描可以为术中主动寻找及保护垂体柄提供帮助。     

北京21家市属医院科技成果转化调查

目的 探讨北京21家市属医院科技成果转化的现状和存在的问题,探索医院科技成果转化和产业化创新举措。方法 通过问卷形式对北京市医院管理局所属21家市属医院的科研工作者进行调查．了解科技成果转化情况。结果 2000年1月1日至2013年12月31日21家市属医院共有科技成果587项．已转化进入市场57项,转化率9．7％;外科、内科等为北京市属医院的成果高产学科;产业转化类成果估计市值大部分集中在100万～500万元;近5年市属医院科研投入人民币5亿元．其中政府投入占76．6％,医院自有经费占20．8％。结论 市属医院科技成果转化主要存在转化资金不足、转化比例小、价值不高,成果产出依赖优势专业等特点,可从增加投入、加强院企合作、培训宣讲、人才培养等方面探索解决问题的措施。     

炎症相关因子IFN-α及TGF-β1在颅咽管瘤的表达及意义

目的探讨炎症相关因子IFN-α、TGF-β1与颅咽管瘤炎症反应的关系。方法采用免疫组化GTVisionTM法检测α-干扰素(interferon-α,IFN-α)、转化生长因子-β1(transforming growth factorβ1,TGF-β1)在58例颅咽管瘤组织中的表达情况,比较不同病理类型颅咽管瘤、复发组及初发组颅咽管瘤组织中IFN-α、TGF-β1的表达水平。结果造釉细胞型及复发颅咽管瘤IFN-α表达广泛。44例造釉细胞型颅咽管瘤有40例IFN-α表达阳性(90.91%),鳞状乳头型14例中有12例表达阳性,造釉细胞型IFN-α阳性表达率明显高于鳞状乳头型(Z=-2.003,P<0.05)。16例复发颅咽管瘤均有IFN-α阳性表达,阳性表达率高于初发组(Z=-2.085,P<0.05)。TGF-β1在鳞状乳头型颅咽管瘤明显表达,14例中有10例阳性表达,而造釉细胞型44例仅有14例表达阳性(Z=-2.129,P<0.05)。经Spearman相关分析,在全部颅咽管瘤中,IFN-α与TGF-β1表达程度呈负相关(rs=-0.273,P<0.05)。结论颅咽管瘤存在复杂的炎症反应,炎症相关因子IFN-α、TGF-β1可能参与颅咽管瘤细胞的生长调控,两者之间可能存在拮抗作用。     

核转录因子κB在颅咽管瘤炎症中的表达

目的探讨NF-κB与颅咽管瘤炎症反应的关系。方法免疫组化SP法检测核转录因子(nuclear factor-κB,NF-κB)的P65亚基、骨桥蛋白(osteopontin,OPN)在54例颅咽管瘤组织中的表达情况,以及炎症标志物C反应蛋白在成釉细胞型颅咽管瘤患者血清、脑脊液及肿瘤囊液中的检测结果,结合临床资料分析颅咽管瘤与炎症的关系。结果NF-κB(P65亚基)在成釉细胞型中过度表达,经Mann-Whitney U检验分析,成釉细胞型颅咽管瘤的表达显著高于鳞状细胞型颅咽管瘤(Z=-4.532,P0.001)。经Spearman相关分析,在成釉细胞型中NF-κB(P65亚基)与OPN表达程度呈正相关。C反应蛋白在成釉细胞型颅咽管瘤患者肿瘤囊液、脑脊液及血清中明显升高,分别为(4.28±0.90)mg/mL、(0.035±0.006)mg/mL、(1.72±0.54)mg/mL。结论炎症是颅咽管瘤与周围重要结构紧密粘连主要的影响因素,NF-κB与颅咽管瘤炎症的发生密切相关。     

视交叉后颅咽管瘤的手术治疗

目的探讨视交叉后部颅咽管瘤的显微手术经验。方法根据影像学所示肿瘤生长部位及扩展方向选择适当手术入路,对84例视交叉后部颅咽管瘤病人进行手术切除,并对术中技术要点及术后反应进行分析。结果本组全切除63例(75.0%),近全切除20例(23.8%),大部切除1例(1.2%)。术后最常见的肿瘤残留部位是肿瘤与第三脑室底部前端连续处。术后最常见的下丘脑反应为尿崩症(72例,85.7%)及低钠、高钠血症(63例,75.0%)。围手术期死亡2例(2.4%)。对64例随访5年,复发9例。结论根据肿瘤生长方向及大小选择合适的手术入路,多数颅咽管瘤可以得到良好的长期控制。     

2009年杭州市市售虾中创伤弧菌的定量检测及其基因分型

近年来,浙江省因弧菌引发的食源性疾病问题日益突出,每年因进食海水产品引起的病例占了较大比例.创伤弧菌是一种带荚膜的革兰阴性嗜盐弧菌,存在于虾、牡蛎、鱼等海产品中,进食被创伤弧菌污染海产品而引起的食物中毒是最为严重的食源性疾病之一,其致死率可高达50%～60%[1],近年来我省也报道了由创伤弧菌导致的散发致死病例[2-3].在日本和我国上海、广州等地的市场上,虾中创伤弧菌存在较高的阳性检出率[4],因此创伤弧菌被认为是虾食用者的一种健康威胁,为了解杭州市虾中创伤弧菌的污染情况及其致病基因型别,笔者于2009年7-8月对杭州市市售虾中的创伤弧菌进行调查监测.