家兔颊黏膜上皮癌前病变模型制备及药物逆转超微结构观察

目的 建立鳞状上皮癌前病变动物模型,筛选癌前病变逆转药物,观察家兔颊黏膜上皮在此过程中超微结构变化.方法 12只家兔为空白对照组,48只家兔为实验组,将含有致癌剂二甲基苯并蒽(dimethyl-benzanthracene,DMBA)溶液及药膜涂抹或贴附于口腔颊黏膜;给药16周后做病理组织学检查及电镜扫描.再随机选取实验组中的32只进行药物逆转实验,12周后行病理组织学检查及电镜扫描.结果 涂抹二甲基苯并蒽16周后,家兔颊黏膜粗糙充血,局部可见增厚白斑,Ⅱ-Ⅲ 级不典型增生发生率为64.6％(31/48).不典型增生细胞排列紊乱,细胞核内异染色增多,线粒体水肿.药物逆转实验第12周,全反式维甲酸组病变进展率低,与对照组相比差异有统计学意义,康莱特组可见病变逆转,但与对照组相比差异无统计学意义.结论 应用DMBA可成功制备鳞状上皮癌前病变;全反式维甲酸(alltransretinoic acid,ATRA)可有效逆转癌前病变.     

A prospective analysis of staging laparoscopy in patients with primary and secondary hepatobiliary malignancies

Laparoscopy and laparoscopic ultrasound are used widely in cancer staging and are perceived to prevent unnecessary open exploration in many patients. The aim of this study was to analyze the impact of staging laparoscopy in improving resectability in patients with primary and secondary hepatobiliary malignancies. Over a 10-month period (November 1, 1997 to August 31, 1998), 186 patients with primary and secondary hepatobiliary cancers were submitted to operation for potentially curative resection. One hundred four patients staged laparoscopically (LAP) before laparotomy were compared prospectively to 82 patients undergoing exploration without laparoscopy (NO LAP). Assignment to each group was not random but was based on surgeon practice. Demographic data, diagnoses, the extent of preoperative evaluation, and the percentage of patients resected were similar in the two groups. Laparoscopy identified 26 (67%) of 39 patients with unresectable disease. In the NO LAP group, 28 patients (34%) had unresectable disease discovered at laparotomy. In patients with unresectable disease and submitted to biopsy only, the operating times were similar in the two groups (LAP 83 ±22 minutes vs. NO LAP 91 ±33 minutes; P = 0.4). However, laparoscopic staging significantly reduced the length of hospital stay (LAP 2.2 ±2 days vs. NO LAP 8.5 ±8.6 days; P = 0.006). Likewise, total hospital charges, normalized to 100 in the NO LAP patients, were significantly lower in the LAP group (LAP 54 ±42 vs. NO LAP 100 ±84; P = 0.02). Staging laparoscopy identified the majority of patients with unresectable hepatobiliary malignancies, significantly improved resectability, and reduced the number of days in the hospital and the total charges. The yield of laparoscopy was greatest for detecting peritoneal metastases (9 of 10), additional hepatic tumors (10 of 12), and unsuspected advanced cirrhosis (5 of 5) but often failed to identify nonresectability because of lymph node metastases, vascular involvement, or extensive biliary involvement. Eighty-three percent of patients subjected to laparotomy after laparoscopy underwent a potentially curative resection compared to 66% of those who were not staged laparoscopically. Supported in part by grants R01 CA76416 (Dr. Fong) and R01CA/DK80982 (Dr. Fong) from the National Institutes of Health. Presented at the Fortieth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Fla., May 16–19, 1999.     

Anaesthetic and Obstetric challenges of morbid obesity in caesarean deliveries-a study in South-eastern Nigeria

Background

Morbid obesity of parturient has become very important in perinatal medicine because of a worldwide obesity epidemic. Morbid obesity of parturient is reportedly associated with severely increased anaesthetic and obstetric risk.

Objective

To determine the prevalence rate, anaesthetic and obstetric complications in morbidly obese parturient that had caesarean delivery in a Nigerian tertiary care centre.

Methods

The obstetric theatre records and case files were reviewed for caesarean deliveries in the University of Nigeria Teaching Hospital, Enugu, Nigeria from May 2008 to December 2010. A sample size of 250 patients, calculated based on a prevalence rate of 19%, confidence interval of 95% , a power of 80% and a finite population of zero was used to determine the prevalence rate of morbid obesity (Body Mass Index of greater than or equal to 35kg/m²).

Results

There were thirty-one patients with morbid obesity (12.4%). The average Body Mass Index (BMI) was 38.3kg/m²(SD ± 2.99). Other findings included macrosomia (7 or 25.8%), gestational diabetes (13%) and pregnancy induced hypertension (7 or 22.5%).There were two neonatal deaths but no maternal deaths.

Conclusion

The prevalence rate of morbid obesity is about 10% in Nigerian women of child bearing age. This mirrors a World Health Organisation report published in the World Health Organisation Global Information Base.     

新疆和布克赛尔蒙古自治县囊型包虫病危险因素分析

目的 分析新疆和布克赛尔蒙古自治县囊型包虫病流行相关的危险因素及探讨预防措施.方法 在和布克赛尔蒙古自治县采用随机抽样方法 ,进行人群囊型包虫病的流行病学调查,调查内容包括民族、年龄、性别、职业及生活习惯等,并对囊型包虫病相关的危险因素进行多因素logistic回归分析.结果人群包虫病患病率为3.8%,血清阳性率为12.4%,其中囊型包虫病患病率为3.7%,泡型包虫病患病率为0.16%.通过多因素logistic回归分析,发现年龄和家庭屠宰牲畜与囊型包虫病患病有关,OR值分别是7.6(2.481～23.579)、3.2(1.297～7.809).50～60岁年龄组患病率最高,OR值是<20岁年龄组的7.6倍;牧民患病率最高.结论 和布克赛尔蒙古自治县囊型包虫病呈持续高流行势态;年龄和有家庭屠宰牲畜行为与患囊型包虫病相关.     

北京市549名中学生参与式急救知识技能培训效果评估

目的了解参与式中学生急救知识技能培训效果,探索适合中学生的急救培训模式。方法选取北京市14所完全中学的549名中学生,运用参与式培训方式进行急救知识技能培训,并对培训效果进行评价。结果急救培训后,培训对象的急救知识水平有所提高,合格率从培训前的40.4%提高到了96.1%(P0.05)。在24个知识点中,有20个知识点的正确率与培训前相比有不同程度的提高(P值均0.05)。72.6%的培训对象认为急救培训课程的效果很好。72.5%的学生喜欢"分小组实习"的培训方式。无论校医还是急救中心培训教师,均对参与式培训效果感到满意。结论参与式急救培训能有效提高中学生急救知识水平,方法有效。     

The impact of cross-border reproductive care or 'fertility tourism' on NHS maternity services

High order multiple pregnancies have substantial morbidity and mortality. Fertility treatment is commonly responsible for their conception and is available globally with variable regulation. We investigated cross-border fertility treatment in these pregnancies in a UK fetal medicine unit, recording mode of conception, country of fertility treatment, reason for non-UK treatment and fetal reduction. Over an 11-year period, 109 women had a high order multiple pregnancy. Ninety-four women (86%) conceived with fertility treatment of whom 24 (26%) had this performed overseas. Cross-border fertility treatment poses an increasing challenge to obstetricians. National data on its occurrence is urgently needed.     

绝经前后女性冠心病患者HDL及LDL颗粒与冠状动脉病变程度的相关性研究

目的探讨绝经前后女性冠心病患者高密度脂蛋白(HDL)颗粒及低密度脂蛋白(LDL)颗粒与冠状动脉病变程度的关系。方法收集经冠状动脉造影确诊的女性冠心病患者79例,根据是否绝经分为绝经前组(n=37)和绝经后组(n=42)。Lipoprint脂蛋白分析仪对HDL颗粒及LDL颗粒进行检测分析,探讨两种脂蛋白颗粒与冠状动脉病变程度的关系。结果与绝经前组比较,绝经后组大颗粒HDL浓度(102.6±45.2 mg/L比143.8±49.7 mg/L,P0.05)及所占比例(23.34%±8.26%比31.15%±7.98%,P0.05)、LDL颗粒平均直径(259.5±8.1比265.7±3.7,P0.05)均降低,小颗粒HDL浓度(124.0±76.8 mg/L比87.0±34.9 mg/L,P0.05)及所占比例(27.26%±12.34%比18.62%±6.53%,P0.05)、LDL B型比例(73.8%比48.6%,P0.05)、Gensini积分(50.88±26.46比30.43±18.54,P0.05)均增高。绝经前组及绝经后组多支病变患者大颗粒HDL浓度、LDL颗粒平均直径均低于单支病变患者,Gensini积分高于单支病变患者;绝经后组大颗粒HDL浓度、LDL颗粒平均直径均低于绝经前组,小颗粒HDL所占比例及Gensini积分高于绝经前组。绝经前组和绝经后组LDL颗粒大小及大颗粒HDL浓度均与Gensini积分呈负相关。结论与绝经前组相比,绝经后组大颗粒HDL浓度较低,小颗粒HDL浓度较高,LDL颗粒平均直径较小,冠状动脉病变程度较严重;大颗粒HDL浓度及LDL平均直径与冠状动脉病变严重程度明显相关。     

胰岛细胞及肾联合移植治疗胰岛素依赖型糖尿病合并尿毒症四例

目的　观察成人胰岛细胞及肾联合移植治疗胰岛素依赖型糖尿病合并尿毒症的临床效果。方法　对 4例胰岛素依赖型糖尿病合并尿毒症的患者施行成人胰岛细胞及肾联合移植。肾移植为常规术式 ,在移植肾开放血液循环后 ,将分离、纯化、培养好的胰岛细胞注入门静脉中。移植后监测患者的空腹血糖、基础C 酞、糖化血红蛋白及肾功能的变化 ,并与其术前各项指标比较。结果　 4例患者术后在观察期间内胰岛素的用量均较术前减少超过 2 5 % ,且持续 3个月以上 ;空腹血糖基本保持在正常水平 ,基础C 酞也基本维持在正常水平 ,糖化血红蛋白于术后降至正常水平 ;4例患者的移植肾功能良好 ,3例患者已恢复正常工作。结论　成人尸体胰岛细胞及肾联合移植治疗胰岛素依赖型糖尿病合并尿毒症的临床效果较好 ,具有操作简单、安全等优点     

血管内皮生长因子与大肠癌的研究进展

近年来随着分子生物学及免疫学的进展,使大肠癌的研究有了很大的进展。大量研究表明,血管内皮生长因子(VEGF)在大肠癌组织有高度表达,本文就VEGF在大肠癌的发生、发展及其对大肠癌诊断、治疗和预后中的作用进行综述。     

塞来昔布抑制人结肠癌细胞Caco-2细胞增生的分子机制

目的研究塞来昔布在体外对人结肠癌细胞Caco-2生长增生及其抗肿瘤的相关分子机制。方法体外培养人结肠癌细胞Caco-2,MTY法检测塞来昔布在相同浓度下,不同时间对于结肠癌细胞增生的影响,并计算Ic。值;RT—PCR法检验COX-2、Survivin的mRNA的表达影响。结果MTF结果显示：相同干预浓度塞来昔布抑制人结肠癌细胞增生,其24h,48h,72h的Ic。分别为：（99．519±10．355）μmol／L、（71．546±6．446）μmol／L、（59．622±15．999）μmol／L;RT-PCR结果显示：人结肠癌细胞Caco-2正常对照组及塞来昔布干预组COX-2mRNA灰度值分别为：0．808±0．021、0．101±0．002（t=19．037,P=0．000）;Survivin mRNA灰度值分别为：0．798±0．031、0．190±0．002（t=18．987,P=0．002）。结论塞来昔布抑制结肠癌细胞增生,塞来昔布抗肿瘤机制可能是通过抑制COX-2及Survivin的mRNA的表达来实现的。