慢性鼻窦炎鼻息肉合并支气管哮喘患者鼻窦内镜术后对支气管哮喘疗效的影响

目的观察鼻窦内镜术(endoscopic sinu ssurgery，ESS)对慢性鼻窦炎伴支气管哮喘患者哮喘发作的影响。方法对210例慢性鼻窦炎患者施行ESS术，其中伴有支气管哮喘病史者42例(20．0％)。210例患者均于术前、术后采用酶联免疫吸附测定法(ELISA)检测外周血单个核细胞(PBMC)培养上清液中的白细胞介素4(IL-4)，干扰素γ(IFN-γ)，可溶性白细胞介素2受体(sIL-2R)和可溶性IgE低亲和力受体(solube CD23，sCD23)的含量，并与20例正常对照组进行比较。通过主观和客观标准评定42例患者哮喘发作及对皮质类固醇的耐受状况，并对术后患者进行为期1年(10例)和3年(32例)的随访。结果鼻窦炎合并支气管哮喘患者术前PBMC培养上清液中IL-4，sIL-2R、sCD23含量较对照组显著升高，而IFN-γ含量较对照组显著减少。术后IL-4、sIL-2R、sCD23含量较对照组显著降低，而IFN-γ含量显著增高。术后哮喘改善水平由随访术后1年的45％提高到术后3年的70％。42例中32例(76％)哮喘发作次数明显减少，术前长期服用类固醇的2l例中，14例(67％)减少了对口服类固醇的使用。结论ESS对慢性鼻窦炎伴支气管哮喘患者的治疗有较满意的远期疗效。ESS能调节IL-4、IFN-γ sIL-2R、sCD23水平，降低哮喘的发作频率和对类固醇的依赖。     

多种血管新生指标在肝细胞肝癌中的表达及敏感性比较

目的　探讨血管新生指标CD34、CD31、vWF、Ⅳ型胶原纤维及层粘连蛋白在肝细胞肝癌(HCC)中的表达及意义 ,同时比较上述几种血管新生因子与增殖细胞核抗原 (PCNA)、病理指标及预后的相关性 ,以便筛选出有效的临床预后指标。方法　采用免疫组化方法 ,对 5 3例肝细胞肝癌的标本进行CD31、CD34、vWF、Ⅳ型胶原纤维及层粘连蛋白的染色、计数 ,并用检测数据与患者的临床资料进行统计分析。结果　统计染色的血管面积后发现 ,CD34与多种临床病理指标无相关性 ;CD31与肝内门静脉浸润相关 ;vWF与肿瘤的TNM分期及肝内门静脉浸润呈正相关 ;CollⅣ与肝内门静脉浸润呈正相关、与术后生存期呈负相关 ;Lam与肝硬化及术中出血量呈负相关、与术后生存期呈正相关。PCNA与肿瘤TNM分期有关。结论　在HCC中 ,CollⅣ、vWF、及CD31为肝细胞肝癌的有效血管新生及预后指标 ;Lam则与肝硬化及术中出血相关 ;PCNA指数肿瘤分期有关 ;CD34不能用作血管新生或预后指标     

Myasthenia Gravis Appearing After Thymectomy: a Case Report and Review of the Literature

A small proportion of thymoma patients without myasthenia gravis (MG) have been observed to develop MG after total removal of the thymoma. However, the underlying cause is not yet known due to the rarity of postoperative MG patients. We report a 39-year-old man in whom MG appeared after surgical removal of a thymoma. Computed tomography and magnetic resonance imaging showed no signs of recurrent or metastatic thymoma. Administration of pyridostigmine bromide resulted in the prompt improvement of myasthenic symptoms. Our observations indicate that postoperative follow-up care with monitoring of possible postoperative MG is necessary after resecting a thymoma.     

人工股骨头置换术治疗高龄非稳定性股骨转子间骨折

目的探讨高龄患者非稳定性股骨转子间骨折行人工股骨头置换术的临床疗效。方法本组74例，年龄75～89岁，平均80．3岁；骨折类型按Evans分类：ⅢA型31例，ⅢB型24例，Ⅳ型19例。其中3例为经内固定治疗失败病例，合并内科疾病者69例，在相关内科协同治疗后行双极骨水泥型人工股骨头置换术，术后早期进行康复锻炼。结果74例都顺利通过手术，住院期间无死亡病例；72例获得随访，随访时间3～16个月，平均9．2个月；无一例出现畸形，髋关节功能接近或恢复到受伤前水平，生活可自理；2例于出院后5个月、11个月死于其他疾病。结论人工股骨头置换术治疗高龄非稳定性股骨转子间骨折是一种效果确切的治疗方法，操作简单、创伤小、卧床时间短、并发症低、死亡率低，提高了高龄患者的生活质量。     

Comparison of the effects of three different combinations of general anesthetics on the electroretinogram of dogs

The objective of this study is to compare the effects of three different anesthetic combinations on the electroretinogram in the same animals under similar laboratory conditions. Thiopental–isoflurane (TI), medetomidine–ketamine (MK), and xylazine–ketamine (XK) were used on each of 12 healthy miniature schnauzer dogs (MS) with a period of at least 3 weeks in between subsequent anesthesia protocols, using the Dog Standard Protocol. The scotopic ERGs consisted of scotopic low stimulus strength (S) responses designated S1, S2, S3, S4, and S5, at 1, 5, 10, 15, and 20 min after dark adaptation, respectively, and scotopic standard stimulus strength (S-ST) responses. The photopic ERGs consisted of a photopic single flash (P) response and 31 Hz flicker (P-FL) responses. For S-ST (2.5 cd s/m²), the amplitude of the a-wave using TI was significantly lower than that using MK (adjusted P = 0.05) and XK (adjusted P = 0.03), and the implicit time of the a-wave was significantly shorter than that using MK (adjusted P = 0.04). For P (2.5 cd s/m²), the amplitude of the b-wave using XK was significantly higher than that using MK (adjusted P = 0.01). The implicit times of the b-wave using TI was significantly longer and shorter than that of MK for S1, S2 and P-FL and for S4 and S-ST, respectively, and than that of XK for S2 and P-FL and for S5 and S-ST, respectively. The results of the present study showed that TI affected both the amplitude and the implicit time of the a-wave for S-ST and the implicit time of the b-wave relatively more so than was the case when using XK or MK. Therefore, it appears that either XK or MK could be advantageous to use rather than TI for clinical studies.     

17 β雌二醇通过丝裂原活化蛋白激酶抑制前列腺癌细胞系PC3增殖

目的探讨丝裂原活化蛋白激酶在17β雌二醇(E2)抑制前列腺癌PC3细胞生长中的作用。方法检测不同浓度E2作用不同时间后PC3细胞生长抑制率。流式细胞仪分析细胞周期分布,TUNEL染色检测凋亡。Western blot检测ERK1/2,JNK和p38活性。RT-PCR法检测雌激素受体(ER)α、ERβ、P21WAF1和cyclinD1的表达。结果E2抑制PC3细胞增殖,并且可以激活ERK1/2、JNK和p38。处理因素作用48h后,对照组、E2、E2 PD98059、E2 SP600125、E2 SB203580组细胞的凋亡率分别为(0.9±0.1)%;(23.0±1.4)%;(30.0±1.2)%;(10.6±0.8)%和(14.6±0.7)%,(P<0.05)。E2使细胞阻滞在G1期,PD98059、SP600125、SB203580分别预处理1h后细胞分别进一步阻滞在G1期;轻度阻滞在G1期和进入S期。RT-PCR发现PC3细胞表达ERα和ERβ,E2、E2 PD98059、E2 SP600125、E2 SB203580组中cyclinD1、P21WAF1基因表达分别为对照组的(0.42±0.03)、(3.13±0.02)倍;(0.21±0.03)、(3.08±0.05)倍;(0.43±0.01)、(1.31±0.04)倍;(2.81±0.02)、(3.14±0.02)倍(P<0.05)。结论E2激活JNK增加P21WAF1基因表达,并激活p38抑制cyclinD1表达,使细胞阻滞在G1期,JNK和p38通路还介导E2引起PC3细胞凋亡。同时E2又可激活ERK1/2,轻度拮抗上述作用。     

血管介入仿真模拟器在心血管医生冠状动脉介入技术规范化培训中的作用

目的明确Angiomemor（美国Simbionix公司生产）血管介入仿真模拟器是否有助于冠状动脉造影技术的掌握和提高。方法选取16名无血管放射介入经验的心血管医生，接受相同课时的冠状动脉介入造影理论培训后，按随机表编码随机分为模拟器培训组与非培训组各8名，模拟器培训组8名医生接受Angiomemor血管介入仿真模拟器培训，模拟冠状动脉造影操作，非培训组8名心血管医生未接受仿真模拟器培训。在随后的真实临床环境中操作冠状动脉造影时，评价2组医生冠状动脉造影操作过程中错误的频数、平均造影时间、造影剂使用量及术中放射线剂量。结果相对于非培训组，模拟器培训组医生在冠状动脉造影操作中错误频数减少62．5％、平均造影时间减少44．0％、造影剂使用量减少44．0％，术中平均放射线曝光时间减少了57．7％，平均X线累计曝光剂量减少51．6％，单位面积X线累计曝光剂量减少了52．4％。结论Angiomemor血管介入仿真模拟器有助于医生较快地熟练掌握冠状动脉造影技术，是冠状动脉介入规范化培训的重要辅助手段之一。     

Intraoperative somatosensory evoked potential monitoring during anterior cervical discectomy and fusion in nonmyelopathic patients--a review of 1,039 cases.

BACKGROUND CONTEXT: Intraoperative somatosensory evoked potential (SSEP) monitoring has been shown to reduce the incidence of new postoperative neurological deficits in scoliosis surgery. However, its usefulness during cervical spine surgery remains a subject of debate. PURPOSE: To determine the utility of intraoperative SSEP monitoring in a specific patient population (those with cervical radiculopathy in the absence of myelopathy) who underwent anterior cervical discectomy and fusion (ACDF) surgery. STUDY DESIGN: Retrospective review. PATIENT SAMPLE: A total of 1,039 nonmyelopathic patients who underwent single or multilevel ACDF surgery. The control group (462 patients) did not have intraoperative SSEP monitoring, whereas the monitored group (577 patients) had continuous intraoperative SSEP monitoring performed. OUTCOME MEASURE: A new postoperative neurological deficit. METHODS: SSEP tracings were reviewed for all 577 patients in the monitored group and all significant signal changes were noted. Medical records were reviewed for all 1,039 patients to determine if any new neurological deficits developed in the immediate postoperative period. RESULTS: None of the patients in the control group had any new postoperative neurological deficits. In the monitored group there were six instances of transient SSEP changes (1 due to suspected carotid artery compression; 5 thought to be due to transient hypotension) which resolved with the appropriate intraoperative intervention (repositioning of retractors; raising the arterial blood pressure). Upon waking up from anesthesia, one patient in the monitored group had a new neurological deficit (partial central cord syndrome) despite normal intraoperative SSEP signals. CONCLUSIONS: ACDF appears to be a safe surgical procedure with a low incidence of iatrogenic neurological injury. Transient SSEP signal changes, which improved with intraoperative interventions, were not associated with new postoperative neurological deficits. An intraoperative neurological deficit is possible despite normal SSEP signals.     

305例尿石成份分析及预防对策

目的研究一种快速、简便的方法对泌尿系结石进行分析,并探讨其防治方法。方法用化学常量法对305例患者的尿石标本进行化学成份测定,并结合临床资料进行分析。结果发现结石发病男性多于女性(比例为3.2∶1),20~50岁多发,上尿路结石多于下尿路结石(5.4∶1)。结石中草酸钙检出率达82%,尿酸盐55.2%,磷酸钙48.6%,磷酸镁铵与碳酸磷灰石则多见于泌尿系感染病例,胱氨酸结石少见。结论化学常量法分析泌尿系结石简便、快捷、准确。结石成份分析对于了解结石成因、预防结石复发具有一定的意义。     

2种方法检测干细胞活率效果的比较

目的:比较碘化丙锭(PI)拒染试验和台盼蓝拒染试验对干细胞活率检测的效果.方法:选择18例干细胞动员后的采集物,在采集后的第1、3、5、7、9、11天,同时进行PI拒染试验和台盼蓝拒染试验.结果:PI拒染率与台盼蓝拒染率结果差异均无统计学意义,相关性检验显示2者呈显著正相关(r=0.996);精密度检验显示,PI拒染试验优于台盼蓝拒染试验(平均CV 1.46% vs 5.10%).结论:PI拒染试验在于细胞活率检测中优于台盼蓝拒染试验.