色素失禁症一家系NEMO基因突变检测

目的：检测中国汉族色素失禁症一家系NEMO基因突变。方法：收集该家系内2例患者及1名正常人外周静脉血和临床资料，提取家系及100名健康对照全基因组DNA，针对NEMO基因外显子区及其侧翼序列设计引物，PCR产物扩增后进行Sanger测序，同时MLPA检测该基因是否存在大片段缺失。结果：该家系2例患者均检测出NEMO基因第5号外显子存在一移码突变c.723_c.724insCAGG，但该家系正常人和100名健康对照个体均未检出此突变。家系内三位被检测者均不存在NEMO基因大片段缺失。结论：该色素失禁症家系内NEMO基因c.723_c.724insCAGG突变可能是其发病的原因。     

临床Ⅰa期非小细胞肺癌淋巴结清扫范围的探讨

背景与目的:肺癌手术中淋巴结的处理方式在学术界一直存在争论,尤其是早期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者.我们通过研究淋巴结转移规律来探讨Ⅰa期NSCLC手术中淋巴结清扫的合理范围.方法:41例临床Ⅰa期NSCL,C患者进行肺叶切除及纵隔淋巴结系统清扫,将淋巴结行病理切片,HE染色明确是否有癌转移.研究肺门、纵隔淋巴结转移规律.结果:共清扫淋巴结295组,转移42组(占14.2%),其中肺门淋巴结转移33组,纵隔淋巴结中转移9组.纵隔淋巴结转移中第7站淋巴结出现转移4例,第5、9站淋巴结出现转移各2例,第4站淋巴结出现转移1例.上叶肿瘤转移包括5、7站淋巴结,中下叶肿瘤转移包括4、7、9站淋巴结.结论:临床Ⅰa期非小细胞肺癌的肺门、纵隔淋巴结转移遵循区域性淋巴结引流规律,可行区域选择性淋巴结清扫,即上叶肿瘤在无肺门或隆突下淋巴结转移时可只清扫上纵隔淋巴结而无须清扫下纵隔淋巴结,中下叶肿瘤无论有无肺门或隆突下淋巴结转移都需要进行上下纵隔淋巴结清扫.     

Evaluation of Myocardial Viability after Myocardial Infarction with Intravenous Real-time Myocardial Contrast Echocardiography

The myocardial viability after myocardial infarction was evaluated by intravenous myocardial contrast echocardiography. Intravenous real-time myocardial contrast echocardiography was performed on 18 patients with myocardial infarction before coronary revascularization. Follow-up echocardiography was performed 3 months after coronary revascularization. Segmental wall motion was assessed using 18-segment LV model and classified as normal, hypokinesis, akinesis and dyskinesis. Viable myocardium was defined by evident improvement of segmental wall motion 3 months after coronary revascularization. Myocardial perfusion was assessed by visual interpretation and divided into 3 conditions： homogeneous opacification; partial or reduced opaciflcation or subendocardial contrast defect; contrast defect. The former two conditions were used as the standard to define the viable myocardium. The results showed that 109 abnormal wall motion segments were detected among 18 patients with myocardial infarction, including 47 segments of hypokinesis, 56 segments of akinesis and 6 segments of dyskinesis. The wall motion of 2 segments with hypokinesis before coronary revascularization which showed homogeneous opacification, 14 of 24 segments with hypokinese and 20 of 24 segments with akinese before coronary revascularization which showed partial or reduced opaciflcation or subendocardial contrast defect was improved 3 months after coronary revascularization. In our study, the sensitivity and specificity of evaluation of myocardial viability after myocardial infarction by intravenous real-time myocardial contrast echocardiography were 94.7% and 78.9%, respectively. It was concluded that intravenous real-time myocardial contrast echocardiography could accurately evaluate myocardial viability after myocardial infarction.     

医源性结肠损伤11例原因分析

医源性结肠损伤１１例原因分析魏翔，秦先慎，杨振德四川什邡县人民医院普外科我院近十年来共收治医源性结肠损伤１１例，手术操作不当是损伤的关键，疾病所致的解剖变化是潜在因素。教训颇多，兹报告如下。临床资料一、性别：男性６例，女性５例。二、年龄：１３～７１岁...     

罕见乏脂纵隔血管平滑肌脂肪瘤1例并文献复习

目的探讨乏脂纵隔血管平滑肌脂肪瘤的临床、病理特征和鉴别诊断。方法1例纵隔乏脂血管平滑肌脂肪瘤,同时结合国内外文献复习。结果1例46岁术前诊断为纵隔肿瘤,全麻下行纵隔肿瘤切除术。术后诊断为纵隔乏脂血管平滑肌脂肪瘤,组织学特征与其他部位血管平滑肌脂肪瘤相似,免疫组化表达HMB45、S-100、Des。结论本例罕见,诊断依靠临床、病理学特征及免疫组化三方面结合。乏脂纵隔血管平滑肌脂肪瘤必须经过全面思维和细致检查,以求正确诊断,为决策正确治疗提供科学依据。     

静脉移植血管的线粒体氧化损伤机制研究

目的 利用大鼠自体颈部静脉移植模型观察动脉化的静脉移植血管氧化应激对线粒体的损伤,探讨冠脉搭桥术后静脉桥再狭窄的发病机制.方法 将动物分成对照组和实验组,对照组将静脉血管桥吻合于颈静脉,实验组吻合于颈动脉,术后4周取材行病理检查,检测移植血管组织活性氧(ROS)、丙二醛(MDA)、超氧化物岐化酶(SOD)水平及线粒体膜电位,线粒体膜流动性.结果 对照组和实验组比较:血管内膜增厚[(1.92±0.87)μm比(32.66±5.32)μm],血管组织ROS升高(23.57±9.21比69.33±15.76),MDA水平升高[(5.32±0.49)nmol/mg pro比(16.83±3.53)nmol/mg pro],SOD活性下降[(14.74±3.58)U/mg pro比(4.77±2.07)U/mg pro],上述各组数据差异均有统计学意义(P＜0.01);对照组和实验组移植血管组织的线粒体膜电位降低[(162.74±10.66)mV比(97.53±12.82)mV],线粒体膜黏滞系数η升高(0.226±0.025比0.417±0.069),上述各组数据差异均有统计学意义(P＜0.01).结论 静脉移植物处于氧化应激状态,ROS通过损伤线粒体诱导内膜增生,其机制可能和静脉承受了高氧的动脉血流有关.     

微泡造影剂结合超声介导一氧化氮合成酶基因转染血管平滑肌细胞

目的 探讨微泡造影剂及超声辐照介导内皮型一氧化氮合成酶(eNOS)基因转染体外培养大鼠血管平滑肌细胞(VSMCs)的可行性.方法 实验分为A、B、C、D、E5组,分别为空白对照组、单纯质粒浸泡组、质粒+微泡造影剂组、质粒+超声辐照组、质粒+超声辐照+造影剂组.用重组真核表达载体pcDNA3.1- eNOS经微泡造影剂及超声辐照介导转染体外培养的大鼠VSMCs,辐照条件为超声探头频率为10 MHz,机械指数为1.9,辐照时间为10 min,重组真核细胞表达载体pcDNA3.1-eNOS 5μg/mL.辐照48 h后,采用RT-PCR、Western blot及免疫组化检测VSMCs内eNOSmRNA和蛋白的表达.结果 RT -PCR检测E组eNOS mRNA的表达最显著,积分吸光度(IA)比值为(91.11±3.41)％,B、C、D组也有少量表达,IA比值分别为(26.10±1.32)％、(31.42±2.43)％、(35.05±2.25)％,与E组相比均P＜0.05.蛋白印迹分析eNOS蛋白表达,A组有极少量表达,B、C、D组也有少量表达,IA比值分别为(22.12±1.33)％、(25.42±2.41)％、(33.11±3.11)％,而E组表达最明显,IA比值为(84.22±9.22)％,与各组相比均P＜0.05.结论 超声辐照结合微泡造影剂能显著提高eNOS基因在VSMCs的转染效率,提高细胞内一氧化氮合成酶的表达.     

原发性纵隔肉瘤2例报告并文献复习

原发性纵隔脂肪肉瘤(primary mediastium li-posarcoma,PML)是少见的纵隔恶性肿瘤,早期无特异性症状,缺乏可靠、特异的诊断方法,术前很难明确诊断,往往误诊为其他类型的纵隔肿瘤。武汉同济医院心胸外科自2009年1月至2010年1月共     

肺软骨瘤一例

患者 男，19岁。因体检发现左肺下叶肿块1周入院。查体：体温36.5℃，双肺呼吸音清晰，无干湿啰音，心率72次/分，律齐。血沉8mm/h。胸部CT示：左肺下叶占位性病变。肿块密度较均匀，边界较清晰，无卫星病灶及爆米花样钙化影，CT增强扫描病灶未见明显强化（图1，箭头所示）。