T1G3膀胱移行细胞癌的临床治疗

目的　探讨T1G3 膀胱移行细胞癌的治疗方法。　方法　T1G3 膀胱移行细胞癌患者6 7例 ,平均年龄 6 3岁。均行TURBt,术后BCG膀胱灌注 5 9例 ,丝裂霉素膀胱灌注 8例。　结果　6 7例患者经 1～ 5次治疗 ,随访 12～ 78个月 ,中位时间 4 7个月 ,有 2 8例出现 1次或 1次以上的复发。最终有 2 0例进展为T2 及以上分期肿瘤 ,16例施行膀胱全切 ,4例发生远处转移。 9例患者死于膀胱肿瘤。　结论　初发的T1G3 膀胱移行细胞癌患者可施行TURBt加术后膀胱内药物灌注治疗 ,术后严密随访 ;对肿瘤复发进展者应尽早施行根治性膀胱全切术。     

Experimental autoimmune anti-glomerular basement membrane glomerulonephritis: a protective role for IFN-gamma

IL-12 and IFN-gamma play key roles in murine lupus and planted antigen models of glomerulonephritis. However, their roles in renal organ-specific autoimmunity are unknown. To establish the roles of endogenous IFN-gamma and IL-12 in experimental autoimmune anti-glomerular basement membrane (GBM) glomerulonephritis (EAG), EAG was induced in normal C57BL/6 mice (WT), IL-12p40-deficient (IL-12p40-/-) mice, and IFN-gamma-deficient (IFN-gamma-/-) mice by immunization with alpha3-alpha5(IV)NC1 heterodimers. At 13 wk, WT mice developed EAG with linear mouse anti-GBM antibody deposition, histologic injury, proteinuria, and mild tubulointerstitial disease. Compared with WT mice, IL-12p40-/- mice had decreased histologic injury and trends to decreased leukocyte infiltrates. In contrast, 40% (4 of 10) of IFN-gamma-/- mice developed significant crescent formation and focal or diffuse interstitial infiltrates (WT, 0 of 8). Compared with WT and/or IL-12p40-/- mice, IFN-gamma-/- mice developed increased injury: histologic injury, total glomerular cell numbers, leukocytes in glomeruli, and renal expression of P-selectin and intercellular adhesion molecule 1. All groups developed similar serum anti-alpha3-alpha5(IV)NC1 antibodies and glomerular Ig deposition, but IFN-gamma-/- mice had decreased anti-alpha3-alpha5(IV)NC1 IgG2a. Therefore, IFN-gamma-/- mice developed increased cellular reactants despite a potentially less damaging antibody response. Dermal delayed-type hypersensitivity was increased in alpha3-alpha5(IV)NC1 immunized IFN-gamma-/- mice and was suppressed by recombinant murine IFN-gamma. CD4+ cells from draining nodes of immunized IFN-gamma-/- mice showed increased proportions of proliferating CD4+ cells but similar numbers of apoptotic cells. These studies demonstrate that in renal organ-specific autoimmunity, IL-12 is pathogenetic but IFN-gamma is protective. They lend weight to the hypothesis that depending on the context/severity of the nephritogenic immune response IFN-gamma has different effects.     

IL-4与IL-10联合诱导异种骨移植免疫耐受的体外研究

目的　探讨 IL - 4和 IL - 10在诱导异种骨移植免疫耐受中的作用。方法　反应细胞为 BAL B/c小鼠脾淋巴细胞 ,刺激细胞为新西兰白兔血淋巴细胞 ,刺激抗原为兔骨上清液。采用经典的混合淋巴细胞培养法及骨上清液与淋巴细胞混合培养法作为异种骨移植的体外实验模型。在各培养液中分别加入 IL - 4、IL - 10及两者联合应用 ,通过测定其 3H- Td R掺入率 ,观察不同细胞因子对刺激淋巴细胞增殖的影响。结果　无论在细胞刺激组还是骨上清液刺激组 ,IL- 4对淋巴细胞增殖均有显著抑制作用 (P<0 .0 0 1和 P<0 .0 5 ) ,IL- 10未表现出抑制作用 (P>0 .0 5 )。在两组 IL- 4和 IL - 10联合应用均产生比 IL - 4单独应用更为明显的细胞增殖抑制作用 (P<0 .0 0 1和 P<0 .0 5 )。结论　 IL - 4对由细胞或骨上清液刺激产生的淋巴细胞增殖均有很好的抑制作用 ,IL- 10没有表现出抑制作用 ;IL- 4与 IL- 10联合应用有协同抑制作用。     

Complementary alternative medicine practices and beliefs in spinal cord injury and non-spinal cord injured individuals

Context/Objective: To compare the beliefs and practices of individuals with spinal cord injury (SCI), their friends and family members (F&F SCI), and healthcare professionals (HCP) regarding complementary alternative medicine (CAM).

Design: A questionnaire regarding CAM practices and beliefs was administered to participants on paper or online.

Setting: An academic rehabilitation hospital.

Participants: Ninety-six individuals voluntarily participated in the study. Participants included 28 patients with SCI, 36 F&F SCI, and 32 HCP.

Interventions: Not applicable

Outcome Measures: The questionnaire assessed participants’ prior or current use of 14 CAM modalities, their willingness to use CAM in the future or recommend its use, and their beliefs and opinions of CAM.

Results: Participants with SCI and their family and friends, were more likely than HCP to have used CAM (P?≤?0.01 and P?≤?0.03, respectively) and recommend its use (P?≤?0.04 and P?≤?0.03, respectively). All three groups showed statistical significance in their willingness to ever use certain CAM modalities (P?≤?0.03 for SCI, P?≤?0.04 for F&F SCI, and P?≤?0.02 for HCP). SCI, F&F SCI, and HCP groups had similar beliefs and opinions regarding CAM.

Conclusion: Patients with SCI as well as their friends and family, have significantly more experience with CAM and are more likely to recommend its use than HCP, suggesting that they are interested and find benefit in alternative healthcare. This warrants further investigation of the integration of CAM into general health practices for those with SCI.     

MELANOMA OF THE FACE: THE SAFETY OF NARROW EXCISION MARGINS

Recent studies have shown that narrower excision margins may be safe, but the optimal or minimum margin for melanoma is unknown. Wide margins of excision are possible on the trunk and limbs, but functional and cosmetic constraints often limit the extent of excision on the face. A collaborative study from two continents (Cape Town, South Africa and Northwood, England) investigated the outcome of different excision margins of 106 patients with stage I melanoma of the face. The margin of excision was measured from the records of the pathological specimen. Thirty patients had margins of less than 1 cm, 64 had margins of between 1 and 2 cm, and 12 had margins greater than 2 cm. Primary apposition or flap closure was possible in 85 patients. Seven patients developed local recurrences and these were not influenced by the excision margin. This study supports the contention that the primary treatment of cutaneous melanoma on the face should be histologically confirmed complete excision, and that this can be achieved with margins of excision less than 1 cm. Local recurrence is not related to the margin of excision or to tumour thickness.     

Vagal Intramuscular Arrays: The Specialized Mechanoreceptor Arbors That Innervate the Smooth Muscle Layers of the Stomach Examined in the Rat

The fundamental roles that the stomach plays in ingestion and digestion notwithstanding, little morphological information is available on vagal intramuscular arrays (IMAs), the afferents that innervate gastric smooth muscle. To characterize IMAs better, rats were given injections of dextran biotin in the nodose ganglia, and, after tracer transport, stomach whole mounts were collected. Specimens were processed for avidin–biotin permanent labeling, and subsets of the whole mounts were immunohistochemically processed for c‐Kit or stained with cuprolinic blue. IMAs (n = 184) were digitized for morphometry and mapping. Throughout the gastric muscle wall, IMAs possessed common phenotypic features. Each IMA was generated by a parent neurite arborizing extensively, forming an array of multiple (mean = 212) branches averaging 193 µm in length. These branches paralleled, and coursed in apposition with, bundles of muscle fibers and interstitial cells of Cajal. Individual arrays averaged 4.3 mm in length and innervated volumes of muscle sheet, presumptive receptive fields, averaging 0.1 mm³. Evaluated by region and by muscle sheet, IMAs displayed architectural adaptations to the different loci. A subset (32%) of circular muscle IMAs issued specialized polymorphic collaterals to myenteric ganglia, and a subset (41%) of antral longitudinal muscle IMAs formed specialized net endings associated with the serosal boundary. IMAs were concentrated in regional patterns that correlated with the unique biomechanical adaptations of the stomach, specifically proximal stomach reservoir functions and antral emptying operations. Overall, the structural adaptations and distributions of the IMAs were consonant with the hypothesized stretch receptor roles of the afferents. J. Comp. Neurol. 524:713–737, 2016. © 2015 Wiley Periodicals, Inc.     

多房性囊性肾癌的诊治体会

目的:提高对多房性囊性肾癌(MCRCC)的诊治水平。方法:2006年1月～2011年3月我院共收治MCRCC患者12例,男8例,女4例,平均年龄50岁。该组患者均于体检时发现。术前均行B超、CT检查,其中有3例又行MRI检查,术前诊断囊实性占位10例,诊断肾囊肿2例,4例行根治性肾切除,6例行肾部分切除,1例术中病理为良性,行去顶减压术,术后病理为恶性而二次行肾切除术。1例患者术中取病理回报为恶性而行肾切除。结果:该组患者术后病理均证实为MCRCC,肿瘤最大直径为2.5～8.0cm,平均4.0cm。TNM分期均为T1N0M0期。病理分级G110例,G22例。随访3～62个月,平均36个月,均无瘤生存。结论:MCRCC恶性度低,预后好。术前诊断主要依赖于影像学检查,但影像学检查无特异性,不易与多房性肾囊肿鉴别,肾部分切除术是治疗的最佳选择。     

右美托咪定滴鼻对舒芬太尼引起咳嗽反射的影响

目的 观察右美托咪定滴鼻对舒芬太尼引起咳嗽反射的影响.方法 择期手术患者100例,随机均分为两组,分别在麻醉诱导前右美托咪定1 μg/kg滴鼻(D组)或等量生理盐水滴鼻(C组),15～30 min后两组均在3s内静脉推注舒芬太尼0.3μg/kg,观察1 min内咳嗽反射的发生情况.结果 D组咳嗽反射发生率明显低于C组(12％ vs.28％,P＜0.05).两组咳嗽程度和发生时间差异无统计学意义.结论 右美托咪定滴鼻可抑制舒芬太尼诱发的咳嗽反射.     

双叶瓣法修复鼻软组织缺损

目的 探讨利用双叶瓣法旋转修复局限性鼻部软组织缺损的美容效果,并总结手术操作的技巧和经验.方法 根据缺损的位置、形状和面积,设计邻近的双叶皮瓣,缺损纵轴和第二叶皮瓣纵轴呈90°～100°,皮瓣面积依次减小,通过递接式转移,最终完全覆盖创面及皮瓣供区.结果 16例患者获随访4～14个月,除鼻翼缘缺损的患者中有1例轻度鼻翼缘退缩,1例轻度鼻孔形状改变;所有缺损均得到很好的修复,鼻亚单位保存完好,无明显牵拉和扭曲,形态协调、自然.结论 对局限性鼻部软组织缺损,双叶瓣法是个很好的选择,可获得满意的手术效果,但是要选择好手术适应证,并严格遵循皮瓣的设计和操作原则.     

多种抗骨质疏松症药物对牙种植体的影响及研究

在种植体和骨组织之间建立和保持骨整合界面是确保种植义齿长期稳定地存留于颌骨中发挥支持固位功能的关键。骨质疏松症对牙种植体的骨整合有很大的影响。本文就骨质疏松症状态下的种植手术及药物干预等几个方面对种植牙骨结合的影响的研究进展进行探讨。