人胚胎成纤维细胞的培养及饲养层的制备

目的 从人胚胎躯干中分离、培养人胚胎成纤维细胞,建立人胚胎成纤维细胞饲养层用于人精原干细胞的培养.方法 利用酶消化法从孕5～9周龄人胚胎躯干中分离培养人胚胎成纤维细胞,制作饲养层,使用不同浓度丝裂霉素C处理,以细胞形态、生长曲线作为胚胎成纤维细胞和饲养层的评价指标.结果 从人胚胎中成功分离培养出人胚胎成纤维细胞,该细胞可传代15代以上,且经过传代及冷冻复苏后生物学特性无改变.12.5mg/L丝裂霉素C作用2h可达到较好处理效果.结论 成功分离和培养人胚胎来源的成纤维细胞,用于人精原干细胞饲养层的制作.     

慢性前列腺炎患者的心理社会因素调查

目的探讨慢性前列腺炎忠者的心理社会因素。方法采用症状自评量表和社会支持评定量表对156例慢性前列腺炎患者进行测试，并与156例健康人作对照。结果慢性前列腺炎患者躯体化、抑郁、焦虑、恐怖等因子分明显高于对照组，差异有显著性（P〈0．05）。慢性前列腺炎患者的客观、主观支持及支持总分均低于健康对照组，差异有显著性（P〈0．05）。结论慢性前列腺炎患者心理健康状况较差、社会支持低，在进行躯体治疗时应实施心理干预。     

5.12汶川8.0级地震伤员的四肢放射学表现分析

目的分析5．12汶川8．0级地震中伤员四肢损伤类型和影像表现。方法回顾分析自2008年5月13日-5月27日在绵阳市中心医院放射科就诊的1121例地震伤员中四肢检查的671伤员的放射学资料，其中平片检查668人，约1200处投照部位，CT检查19人23个部位。结果446例伤员放射学检查为阳性，总阳性率约为66．47％，其中四肢单部位损伤为355例（52．91％），多个四肢损伤为91例（13．56％）。共有558个部位损伤，按发生率高低排列，依次为胫腓骨142例（25．45％），足踝113例（20．25％）、髋关节及股骨112例（20．07％），肘关节及尺桡骨54例（9．68％）、肱骨47例（8．42％），手腕38例（6．81％），肩关节36例（6．45％），锁骨16例（2．87％）；按照骨折类型，粉碎性骨折317例（56．81％），横行骨折102例（18．28％），关节脱位37例（6．63％），斜行骨折37例（6．63％），螺旋形骨折31例（5．56％），线形骨折17例（3．05％），嵌插骨折13例（2．33％），骺分离4例（0．72％）。结论地震造成四肢损害以下肢为主，骨折类型以粉碎性骨折及横行骨折为主。     

INCIDENCE,DISTRIBUTION AND MECHANISMS OF MICROSATELLITE INSTABILITY IN DIFFERENT COLORECTAL CANCER AGE GROUPS

The increase in the incidence of colorectal cancer (CRC) is higher for proximal than for distal tumors. As microsatellite instability (MSI) is a feature of proximal tumors, we hypothesize that an increase in MSI tumors may account for the age‐related proximal shift in CRC. Methods: A representative sample of 230 CRCs from 3 age groups was selected from a CRC database. MSI was determined by PCR. MLH1 and MSH2 expression was determined by immunohistochemistry, and the methylation of the MLH1 gene promotor (PM) by methylation‐specific PCR. Results: MSI tumors became more frequent (p < 0.01 chi square) and more proximal in distribution (p = 0.01 loglinear) in the oldest age group. MSI was associated with loss of expression of MSH2 in the young age group. PM and inactivation of MLH1 increased with age. Conclusion: MSI tumors became more frequent and proximal in older patients. This trend was associated with differences in the underlying mechanisms responsible for the MSI phenotype.     

Noninvasive Pancreatic Cystic Neoplasms can be Safely and Effectively Treated by Limited Pancreatectomy

Background Appropriate management of cystic lesions of the pancreas is controversial. Major pancreatectomies (pancreaticoduodenectomy or distal pancreatectomy with splenectomy) are the commonly used procedures, even though most cystic lesions are noninvasive neoplasms. We tested the adequacy of limited pancreatectomies in the treatment of pancreatic cystic lesions. Methods Data from 109 patients who underwent surgical resection of a pancreatic cystic lesion at National Taiwan University Hospital from 2001 to 2007 were retrospectively reviewed. Major pancreatomies (n = 79) constituted pancreaticoduodenectomy and total/distal pancreatectomies, while other resection procedures (n = 30) represented limited pancreatectomies. Clinicopathologic features were compared between the major and limited groups. Results There were no statistically significant differences in sex, age, presence of symptoms, cyst diameter, minor or major treatment complications, or pancreatic leakage between the two groups. Cystic lesions located in the neck/body/tail rather than in the head/uncinate process were significantly more often treated with limited pancreatectomy (P = .02). Both groups had similar pathologic distribution of cystic lesions, with the exception of nine invasive neoplasms. The latter were treated with major pancreatectomy. No recurrence was noted in 100 patients with noninvasive cystic neoplasms after major or limited pancreatectomy. Conclusions Noninvasive pancreatic cystic neoplasms can be safely and effectively treated by limited pancreatectomy.     

Clinical Application of Layered Anastomosis During Esophagogastrostomy

The aim of this study was to compare the operative results in regard to reducing anastomotic leakage and stricture formation using a newly designed layered manual esophagogastric anastomosis versus a stapler esophagogastrostomy versus the conventional hand-sewn whole-layer anastomosis after resection for esophageal or gastric cardiac carcinoma. From January 2004 to September 2006, a total of 1024 patients with esophageal or gastric cardia carcinoma underwent a layered esophagogastric anastomosis with the assistance of a three-leaf clipper in a single university medical center. The mucosal layers of the esophagus and stomach were sutured continuously with 4/0 Vicryl plus antibacterial suture (polyglyconate). From May 2002 to December 2003, there were also 170 patients and 69 patients who underwent stapler and conventional whole-layer anastomosis, respectively; they served as control groups. The results were analyzed retrospectively. The operative mortality rate was 0.7% in the layered group compared to 5.9% and 7.2% for the stapler group and the whole-layer group (p < 0.01), The anastomotic leakage rates were 0%, 3.5%, and 5.8% for the layered group, stapler group, and whole-layer group, respectively (p < 0.01). All patients were followed postoperatively. Six patients in the layered group (0.6%) developed mild stricture formation compared to 16 patients in stapled group (9.9%) and 5 patients in the conventional whole-layer group (7.8%) (p < 0.01). The application of layered esophagogastric anastomosis could reduce the incidence of anastomotic leakage and stricture after esophagectomy compared with the stapler and whole-layer manual anastomoses. It is easy to apply and could be used as an alternative for esophagogastric anastomosis after resection for esophageal or cardiac carcinoma. This abstract was accepted as a free paper and oral presentation at International Surgical Week 2007, Abstract 320, Montreal, Canada, August 2007     

Treatment Guidelines for Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: When Can We Operate or Observe?

Background The objectives of this study were to investigate the clinicopathological features of branch intraductal papillary mucinous neoplasm (IPMN) and to determine safe criteria for its observation. Most clinicians agree that surgical resection is required to treat main duct-type IPMN because of its high malignancy rate. However, no definite treatment guideline (with respect to surgery or observation) has been issued on the management of branch duct type IPMN. Methods We retrospectively reviewed the clinicopathological data of 138 patients who underwent operations for IPMN between 1993 and 2006 at five institutes in Korea. Results Of 138 patients (mean age, 60.6 years; 87 men, 51 women), 76 underwent pancreatoduodenectomy, 39 distal pancreatectomy, 4 total pancreatectomy, and 20 limited pancreatic resection. There were 112 benign cases: 47 adenoma, 63 borderline cases, and 26 malignant cases, with 9 of these being noninvasive and 17 invasive. By univariate analysis, tumor size and the presence of a mural nodule were identified as meaningful predictors of malignancy. By receiver operating characteristic curve analysis, a tumor size of >2 cm was found to be the most valuable predictor of malignancy. When cases were classified according to tumor size and the presence of a mural nodule, the malignancy rate for a tumor ≤2 cm without a mural nodule was 9.2%, for a tumor of ≤2 cm plus a mural nodule was 25%, and for other conditions such as tumor >2 cm, >25%. Conclusions Many branch duct IPMNs are malignant. Surgical treatment is recommended, except in cases that are strongly suspected to be benign or cases that present a high operative risk. Observation is only recommended in patients with a tumor size of ≤2 cm without a mural nodule.     

AAV-TGFβ1的构建及其与AV-TGFβ1对髓核细胞蛋白多糖合成影响的比较

目的探讨转化生长因子β1腺相关病毒表达系统(AAV-TGFβ1)的构建及其与转化生长因子β1腺病毒表达系统(AV-TGFβ1)对髓核细胞蛋白多糖合成影响的比较。方法采用PCR技术扩增转化生长因子β1(TGFβ1)基因,并于其两端分别连接EcoRI和SalI酶切位点。将TGFβ1基因亚克隆于腺相关病毒(AAV)载体中,并经酶切和测序分析进行鉴定。AAV-TGFβ1病毒被包装并转染H293细胞,通过免疫荧光检测AAV介导的目的基因表达。利用AAV-EGFP病毒检测AAV对髓核细胞的转染效率。AAV-TGFβ1和AV-TGFβ1分别转染髓核细胞后,通过Antonopulos法检测蛋白多糖的合成。结果测序分析证明TGFβ1序列与NCBI Gene Bank所报道的一致。经酶切鉴定证实AAV-TGFβ1重组质粒被成功构建。AAV可介导TGFβ1高效表达并高效转染髓核细胞。AV-TGFβ1可快速一过性地促进髓核细胞蛋白多糖合成,而AAV-TGFβ1可稳定促进蛋白多糖合成。结论AAV-TGFβ1病毒被成功构建并可稳定地促进髓核细胞蛋白多糖的合成。     

Tumor Necrosis Rate Adjusted by Tumor Volume Change Is a Better Predictor of Survival of Localized Osteosarcoma Patients

Background We assessed whether new parameter that considers both tumor volume change and necrosis rate predicts metastasis-free survival of localized osteosarcoma patients. We also evaluated relationship between tumor volume change and necrosis rate or metastasis-free survival. Methods We retrospectively reviewed 151 patients with stage II osteosarcoma who were treated with surgery and neoadjuvant chemotherapy. The tumor volume change was measured and calculated based on pre- and postchemotherapy magnetic resonance images. The mean metastasis-free interval was 83.1 months. We calculated adjusted tumor necrosis rate as following formula: 100–(100–necrosis rate) × postchemotherapy/prechemotherapy tumor volume. Survival and logistic regression analyses were used to evaluate the correlation among size parameters, tumor necrosis rate and survival. Results The 5-year metastasis-free survival rate of 151 patients was 71.4% (95% CI, 67.7–75.1%). American Joint Committee on Cancer (AJCC) stage IIB (RR 2.27; 95% CI, 1.11–4.62; P = 0.025) and poor adjusted tumor necrosis rate (RR 2.02; 95% CI, 1.05–3.89; P = 0.035) independently correlated with metastasis-free survival period. Further, tumor volume change independently correlated with necrosis rate. Decreased tumor volume could predict good response, with sensitivity of 80.2%, specificity of 68.6%, and positive predictive value (PPV) of 74.7%. Increased or stable tumor volume could predict poor response, with sensitivity of 68.6%, specificity of 80.2%, and PPV of 75.0 %. Conclusion The necrosis rate adjusted by the tumor volume change is an independent prognostic factor in osteosarcoma. This adjusted tumor necrosis rate may serve as a basis for risk-adapted therapy in combination with other prognostic factors.     

经直肠超声引导下重复穿刺活检在前列腺癌高危人群中的诊断价值(附45例分析)

目的探讨经直肠超声（TRUS）引导下重复穿刺活检在前列腺特异性抗原（PSA）升高或直肠指检阳性的前列腺癌（PCa）可疑人群中的诊断价值。方法在首次穿刺活检诊断为前列腺良性病变的45例Pca高危人群中开展TRUS引导下10点重复穿刺活检。平均年龄78（58-92）岁；45例患者PSA均大于2．6ng／ml，其中12例直肠指检异常。结果在45例前列腺重复穿刺的患者中，34例穿刺2次，8例穿刺3次，3例穿刺4次；确诊Pca 10例（22．2％），良性前列腺增生32例，慢性前列腺炎3例。结论在Pca高危人群中开展TRUS引导下重复穿刺可以提高Pca的诊断率。