血管内皮生长因子受体启动子驱动双自杀基因联合survivin反义寡核苷酸对结直肠癌细胞及血管内皮细胞的特异性杀伤作用

目的探讨腺病毒介导血管内皮生长因子受体（KDR）启动子驱动的CDglyTK融合基因（AdKDR-CDsbrTK）体系联合survivin反义寡核苷酸（ASODN）对结直肠癌细胞（sw620）及血管内皮细胞（ECV304）的特异性杀伤作用。方法将质粒pAdEasy—KDR-CDglyTK在293细胞内包装、扩增产生重组腺病毒。体外感染表达KDR的SW620、ECV304细胞株,同时用survivin ASODN转染同一细胞株,观察腺病毒的感染效率和ASODN的转染情况。应用RT．PCR和Western印迹检测CDglyTK和survivin基因的表达．MTT法测定两者联合应用对细胞株的杀伤效应和旁观者效应。结果survivin ASODN可转染重组腺病毒感染的细胞,并且两者的转染及感染效率无明显变化。CDglyTK可在SW620、ECV304细胞株高效表达。survivin ASODN可明显降低survivin蛋白表达。各基因治疗组细胞存活率明显低于阴性对照组（P〈0．001）。survivinASODN与AdKDR—CDglyTK基因联用后。随着前药浓度的增加,细胞存活率迅速下降,两者联合作用与单一基因作用相比,差异具有统计学意义（P〈0．05）。但在GCV100μg／ml、5-FC 2000μg／ml时,联合基因治疗组细胞存活率略低于单用AdKDR-CDglyTK,两者间差异无统计学意义（P〉0．05）。Survivin ASODN和AdKDR—CDglyTK联合作用,在前药浓度较低时表现为协同效应,并具有更明显的旁观者效应。结论KDR启动子调控的AdKDR-cDglyTK体系和survivin ASODN基因联合,较单一基因具有更强的特异性杀伤结直肠癌细胞及血管内皮细胞的作用。     

Minimally invasive strategies and options for far-lateral lumbar disc herniation

Objective： To investigate the surgical procedures, options and surgical indications for far-lateral lumbar disc herniation between three different minimally invasive procedures.
Methods： From January 2000 to October 2006, 52 patients with far-lateral lumbar disc herniation （29 males and 23 females, with the average age of 41.5 years） were treated with minimally invasive procedures. All the patients were assessed by X-ray and CT. Some were given additional myeography, discography, Computerized tomography myelography （CTM） and MRI examination. Yeung Endoscopy Spine System （YESS）, METRx and X-tube procedures were performed in 25, 13 and 14 cases, respectively. All patients were followed up for a mean period of 13.5 months. Clinical outcomes were assessed by visual analog score （VAS） and Nakai criteria.
Results： The results indicated that the three procedures could significantly improve the radiating leg symptoms （P〈0.05）. The postoperative overall excellent and goodrates of YESS, METRx and X-tube procedures were 84.0%, 84.6% and 92.8% respectively, with no statistical difference among three groups （P〉0.05）. The YESS procedure had several advantages including shortest operation time, simplest anesthesia and least trauma as compared with the other two procedures, especially for simple type I far-lateral lum- bar disc herniation. METRx procedure was specially suitable for simple type II. And the procedure of posterior endoscopic facetectomy, posterior lumbar interbody fusion and unilateral pedicle screw instrumentation with X-tube was designed for far-lateral disc herniation combined with degenerative lumbar instability.
Conclusion： Minimally invasive strategies and options should be determined by different types of far-lateral lumbar disc herniation.     

腹膜后纤维化26例的诊治分析

目的 通过对本组患者临床资料的分析,提高对腹膜后纤维化的诊断和治疗水平.方法 总结分析我院1996年1月至2007年5月收治的26例腹膜后纤维化患者的外科诊治情况.术前行CT榆查、磁共振、B超、逆行尿路造影检查、肾动态显像等检查.14例急性发病和全身情况较差的患者首选输尿管双J管引流术或肾盂穿刺造瘘术.共进行开放手术治疗15例,其中9例行输尿管松解腹腔内置术.结果 26例均行B超检查,发现腹膜后肿块者3例.21例行CT检查,确诊18例,准确率86%.14例行磁共振检查,确诊8例,准确率57%.治疗后随访1～106个月,平均15个月.经输尿管双J管置人或肾盂穿刺造瘘术引流后平均血肌酐浓度由373.9μmol/L降至157.1μmol/L.输尿管松解腹腔内置术的疗效满意,平均血肌酐浓度由术前171.0 μmol/L降至139.6μmol/L.4例患者随访超过24个月,经B超和静脉肾盂造影检查未见肾积水征象.结论 CT枪查诊断准确率相对较高.及时合理的外科治疗可有效保护腹膜后纤维化患者的肾功能,而输尿管松解腹腔内置术是有效的手术治疗方法.     

The status quo of neurosurgery in China

With the application of great effort, much progress has been made to date in each specialty of neurosurgery in mainland China. In this article, we briefly review the present status of neurosurgery in China. The components and function of the Chinese Neurosurgical Society, the national organization for neurosurgery in China, are discussed. Neurosurgeons' acceptance of the concept of minimally invasive procedures has marked the start of an era of minimally invasive neurosurgery in China. Progress is evident in clinics, basic research, infrastructure, resident training, and multidisciplinary collaboration. Some weaknesses that need improvement are also mentioned. The current program offers a good basic foundation for development to meet future demands.     

Sirolimus-Based Immunosuppression Therapy in Liver Transplantation for Patients With Hepatocellular Carcinoma Exceeding the Milan Criteria

Aim

Sirolimus (SRL) acts as a primary immunosuppressant or antitumor agent. The aim of the present study was to evaluate the influence of SRL on the recurrence rate and survival of patients after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) exceeding the Milan criteria.

Materials and Methods

We retrospectively examined 73 consecutive patients who underwent OLT for HCC exceeding the Milan criteria from March 2004 through December 2005. Among them, 27 patients were treated with SRL-based immunosuppressive protocols after OLT, and 46 patients by an FK506-based protocol. Statistical analysis was based on the intent-to-treat method.

Results

The 2 groups were comparable in all clinicopathologic parameters. The mean overall survival was 594 ± 35 days in the SRL group and 480 ± 42 days in the FK506 group (P = .011); the mean disease-free survival period was 519 ± 43 days in the SRL group and 477 ± 48 days in the FK506 group (P = .234). Multivariate analysis revealed Child's status (P = .004) and immunosuppressive protocol (P = .015) were the significant factors affecting overall survival. Only microvascular invasion (P = .004) was significantly associated with disease-free survival. Among 24 surviving patient in the SRL group, 2 patients had SRL discontinued for toxicity; 10 had SRL monotherapy immunosuppression.

Conclusion

The SRL-based immunosuppressive protocol improved the overall survival of patients after OLT for HCC exceeding the Milan criteria, probably by postponing recurrence and with better tolerability.     

68Ga标记的SSR靶向多肽PET/CT显像的研究进展及其在神经内分泌肿瘤中的初步应用

近年来,68Ga标记的多肽PET/CT显像为神经内分泌肿瘤（NET）的诊断提供了新的方法和视角。68Ge/68Ga发生器已经商业化,容易获得,并且68Ga标记过程简单方便,显像剂稳定性好。在此基础上,越来越多的研究比较了68Ga标记的多肽PET/CT与传统的形态学显像方法（CT、MRI）及生长抑素受体扫描对NET病灶的诊断效能,发现68Ga标记的多肽PET/CT远远优于后者。此外,68Ga标记的多肽PET/CT显像还能为患者治疗方案的选择、辐射剂量的调整甚至预后效果的评估提供多种重要信息,其有望成为NET患者肿瘤显像的临床首选。笔者就近年来68Ga标记的多肽PET/CT显像在临床上的初步应用研究作一综述。     

持续床旁血液净化联合削痂治疗重度烧伤并发ARF

目的观察持续床旁血液净化联合早期削痂植皮对重度烧伤并发急性肾功能衰竭(ARF)的治疗疗效。方法以我院2011年1月~2013年12月收治的23例重度烧伤并发ARF患者为研究对象,入院后给予积极补液抗休克、纠正电解质紊乱、抗感染、早期削痂植皮及持续床旁静脉-静脉血液透析滤过等综合治疗。检测患者治疗前,治疗后1、3、7、14、21 d血生化指标、炎症因子的变化及治疗疗效。结果治疗后3 d开始,患者Hb、WBC、Scr、ALT、AST、血钾、TNF-α及IL-6与治疗前相比明显降低,尿量明显增多(P<0.05);治疗后7 d开始,BUN及m ALB与治疗前相比也明显降低(P<0.05),IL-10与治疗前相比明显增高(P<0.05)。所有患者经过积极综合治疗无死亡病例,早期削痂植皮存活率为(96.1±3.8)%,患者住院时间(31.5±8.2)d。治疗后5~20 d进入多尿期,平均(10.2±5.0)d,肾功能均恢复正常。结论持续床旁血液净化联合早期削痂植皮等综合治疗,可有效纠正重度烧伤并发ARF患者的内环境紊乱,恢复肾功能,临床疗效确切。     

CT技术诊断下肢动脉硬化闭塞症的应用进展

CT血管成像技术(CTA)在下肢动脉硬化闭塞症诊断中的应用日益广泛。该技术相对其他方法来说具有无创、简便等明显优势。数字减影血管造影以往被认为是诊断动脉硬化性疾病的唯一可靠方法, 而目前CTA技术对这个老的“金标准”提出了挑战。多源CT的应用使全动脉树形结构的无创成像成为可能, 该技术的优化令动脉硬化性疾病的诊断更加精准。对比剂的应用和仪器参数的优化, 使CTA检查的照射剂量明显降低。今后, 随着CT技术的快速发展, CTA技术必将成为诊断下肢动脉闭塞疾病的理想方法。     

3.0 T磁共振T2弛豫时间图技术在评估兔坐骨神经放射性损伤的价值

目的探讨使用磁共振T₂弛豫时间图（T₂ mapping）技术评估兔坐骨神经放射性损伤的可行性和准确性。方法选取21只新西兰大白兔,随机选取一侧后肢坐骨神经行单次立体定向照射,照射剂量35 Gy,照射中心位于神经层面距腓肠肌后缘3 cm,照射野直径1 cm,照射体积约0.79 cm³,对侧为对照侧。所有兔于照射前、照射后1 d、1个月、2个月、3个月、4个月评价肢体功能变化,并行T₂多回波及T₂WI/SPIR序列扫描。扫描完成后于上述各时间点随机处死2只兔,取照射段坐骨神经行电镜检查。结果照射后1 d,照射段神经T₂值明显升高,神经肿胀、T₂WI/SPIR信号稍增高;照射后1个月T₂值较1 d降低,接近正常水平,T₂WI/SPIR上信号未见升高;照射后2个月起T₂值进行性升高,并至4个月达高峰,T₂WI/SPIR上2个月起神经及周围肌间隙出现小片长T₂信号影,3、4个月异常信号逐渐加重并出现条索状短T₂信号影。结论 T₂值能较好地反映周围神经放射性损伤的急性改变,但它对于评价放射性损伤时神经的细微改变可能并不敏感。