输尿管上段结石的微创手术治疗

目的：探讨输尿管上段结石的治疗方法。方法：回顾性分析输尿管镜下气压弹道碎石(URSL），后腹腔镜输尿管切开取石(RLU)、经皮肾穿刺取石(PCNL)治疗输尿管上段结石患者的临床资料。其中URSL组25例，RLU组20例。PCNL组9例。结果：URSL组碎石成功18例；7例不成功，其中3例改为开放手术，1例改为后腹腔镜取石。2例行ESWL术，1例仅留置双J管。术后1个月拔管后自行排出。2例并发输尿管穿孔。RLU组取石成功18例，2例滑入肾内，经配合输尿管镜和腹腔镜直视下经皮肾穿刺取石成功，术后15例有伤口漏尿。PCNL组成功9例，无并发症。结论：USRL创伤小。术后恢复快。是治疗输尿管上段结石的较为满意的治疗方法。PCNL创伤小，取石成功率高，在结石靠近肾盂、儿童输尿管上段结石并同侧肾结石和结石以下输尿管狭窄时应优先考虑。但技术难度较大。RLU可作为URSL不成功后的辅助治疗方法。     

脂蛋白残粒RLP-c检测的临床意义

目的 探讨脂蛋白残粒RLP-c作为新的脂质指标的临床意义。方法 采用免疫分离法测定正常对照组(NC)、冠心病组(CHD)和2型糖尿病组(T2DM)的RLP-c水平,并比较RLP-c与其他脂质指标的相关性。结果 CHD组和T2DM组RLP-c水平明显高于NC组(P<0.01),其水平与甘油三脂(TG)和极低密度脂蛋白胆固醇(VLDL-c)高度相关(P<0.01)。结论 RLP-c可用于对动脉粥样硬化的危险性评估。     

胰岛素抑制突变亨廷顿蛋白的聚积和毒性

目的:探讨胰岛素对细胞内突变亨廷顿蛋白(Huntingtin,htt)聚集物形成及其细胞毒性的影响.方法:利用脂质体转染法在培养的Hela细胞和HEK293细胞瞬时或稳定转染编码正常或突变htt的氨基末端片段的cDNA,检测不同浓度胰岛素刺激对细胞内突变htt聚集物形成以及细胞活力的影响.结果:在瞬时转染的Hela细胞和稳定转染的HEK293细胞中,含20个谷氨酰胺重复序列(20Q)的正常htt氨基末端片段弥散分布在胞浆内,而含150个谷氨酰胺重复序列(150Q)的突变htt氨基末端片段在多数细胞胞浆或核内形成聚集物.150Q的Hela和HEK293细胞经一定浓度的胰岛素刺激后聚集物的形成显著减少,细胞活力也明显提高.而胰岛素的刺激对20Q的细胞内正常htt的表达以及细胞活力无明显影响.结论:胰岛素能有效抑制细胞内突变htt聚集物的形成及其细胞毒性.     

17β-雌二醇对子宫内膜异位症患者在位子宫内膜间质细胞β-catenin mRNA和蛋白表达的影响

目的研究17β-雌二醇(17β-E2)对子宫内膜异位症(内异症)患者在位子宫内膜间质细胞β-catenin mRNA和蛋白表达的影响,探讨Wnt/β-catenin信号通路在介导雌激素促进内异症发生发展的作用。方法体外分离培养内异症患者在位子宫内膜间质细胞。用不同浓度17β-E2处理子宫内膜间质细胞48 h;此后选用10-10mol/L 17β-E2处理子宫内膜间质细胞12、24和48 h,逆转录聚合酶链反应(RT-PCR)和免疫印迹法(Western blotting)检测17β-E2处理前后子宫内膜间质细胞β-catenin mRNA和蛋白的表达水平。同法分析雌激素受体拮抗剂ICI182,780(10-6mol/L)对17β-E2促进β-catenin mRNA和蛋白表达的影响。免疫组织化学染色观察17β-E2作用后β-catenin在子宫内膜间质细胞中的定位。结果17β-E2能明显促进内异症患者在位子宫内膜间质细胞β-catenin mRNA和蛋白的表达,并呈剂量和时间依赖性,于10-10mol/L作用48 h最明显。雌激素受体拮抗剂ICI182,780能明显抑制17β-E2对子宫内膜间质细胞β-catenin mRNA和蛋白的表达。免疫组织化学染色发现17β-E2能促进β-catenin在子宫内膜间质细胞核内的表达。结论雌激素可能通过激活Wnt/β-catenin信号通路促进内异症在位子宫内膜的异位种植。     

纸夹板内收位固定与石膏外展位固定治疗Bennett骨折的随机对照试验

目的：研究比较纸夹板内收位固定与石膏外展位固定治疗Bennett骨折的疗效差异。方法：选择2005年10月至2007年4月门诊就诊的70例Bennett骨折患者，按区组随机的方法分为试验组35例（纸夹板内收位固定）和对照组35例（石膏外展位固定）进行治疗。骨折达到临床愈合拆除固定后，对患者进行为期6个月的随访观察。分别于骨折后6、8、12、16、20及24周按改良的Gabriele评分系统对其患手功能进行量化评分比较。结果：两组的优良率在8、12、16及20周时比较试验组优于对照组，差异有统计学意义（P〈0．05）；6周和24周时比较差异无统计学意义（P〉0．05）。两组在功能评分方面，8、12、16、20及24周时比较试验组高于对照组，差异有统计学意义（P〈0．05）；6周时积分差异无统计学意义（P〉0．05）。结论：在Bennett骨折的治疗中，纸夹板内收位固定与石膏外展位固定相比能明显加快患手功能的恢复，而且固定轻便、舒适，患者易于接受，可以作为一种有效的固定方法在临床推广。     

In vitro reversal MDR of human carcinoma cell line by an antisense oligodeoxynucleotide-doxorubicin conjugate.

A conjugate of antisense oligodeoxynucleotide (AS ODN) covalently linked with deoxorubicin (DOX) was synthesized. Its properties and antitumour activity in human carcinoma DOX resistant cells (KB-A-1) were investigated in vitro. The results showed that the conjugate was strongly stable both in Dulbecco's Phosphate-Buffered Saline (PBS) and in culture medium. The intracellular concentration of the conjugate was higher than that of the AS DON by HPLC analysis. The conjugate showed potent dose-dependent inhibition to the growth of KB-A-1 cells. Chemosensitivity of KB-A-1 cells to DOX was also investigated in vitro. When the cells were first exposed to the conjugate (0.5 microM) and then exposed to DOX for 24 h, the IC50 value of DOX decreased from 21.5 to 2.2 microM. In contrast, when treated with the mixture of the same concentration of the AS ODN with equivalent DOX, the IC50 value of DOX was 16.8 microM. Intracellular DOX concentration was detected in KB-A-1 treatment with the conjugate in vitro by HPLC. The results showed that the intracellular DOX concentration was 6.4-fold increased in KB-A-1 cells treated with the conjugate compared to treatment with DOX alone. In contrast, 1.8-fold increasing was observed when treated with the AS ODN. Western blot analysis showed a significantly decrease in the amount of P-glycoprotein in KB-A-1 cells. These results suggest that the conjugate is effective in reversing multidrug resistance. Certainly, further studies are conducting to explore the antitumour effect of the conjugate in vivo.     

大龄腭裂患者的手术治疗方法与语音治疗效果的对比研究

目的 对单纯行裂隙关闭术和同期行咽后壁咽成形术的大龄腭裂患者,术前、术后发音效果进行检测分析和对比研究,评定手术的治疗效果.方法 对24例同期行腭裂关闭术及咽后壁组织瓣咽成形术治疗和12例单纯行裂隙关闭术的大龄腭裂患者,术前、术后用鼻咽纤维镜检测其腭咽闭合情况,应用通用音频谱分析系统,对本组术后患者腭裂语音进行声学分析.结果 所有腭裂修复术后,创口均达到临床Ⅰ期愈合,语音也有不同程度改善.大龄腭裂患者采用腭裂关闭及同期咽成形术的修复组,术后发音明显优于单纯行裂隙关闭组.结论 大龄腭裂患者,采用腭裂关闭及同期咽成形术,是提高腭咽闭合和改善发音较好的手术方法.     

改良开放性手术治疗巨大良性前列腺增生症

目的探讨巨大良性前列腺增生症的开放性手术治疗方法及效果。方法回顾分析16例巨大良性前列腺增生症,年龄61~88岁,平均74岁。作耻骨上经膀胱前列腺切除术。结果手术均成功;手术时间35~65min,出血量100~200mL,术后前列腺重量为200~520g,平均215g;膀胱冲洗2~3d,拔导尿管5~7d;术后3d再出血1例,经DSA同侧髂内血管栓塞止血成功,排尿困难1例,短期尿失禁1例,其余患者术后均排尿通畅,控尿良好。结论开放性手术治疗巨大良性前列腺增生症,其梗阻解除彻底,是一种合理的治疗方法。恰当的手术方法是提高疗效及降低并发症的关键。     

Cardiac imaging in the evaluation of patients presenting to the emergency department with chest pain

Conclusions  Despite the utility and benefits that each imaging modality has to offer, it is easy to see why there is still no perfect choice for a noninvasive cardiac imaging modality to assist in the management of chest pain patients. All of the current imaging techniques have their own significant strengths and weaknesses when compared with other modalities. SPECT and echocardiography are wellestablished technologies that can directly assess the presence of myocardial ischemia and its functional consequence on RF; newer and more expensive techniques such as MDCT and CMR can directly assess coronary anatomy and have just started to be evaluated in the acute chest pain setting. There are no studies that directly compare these technologies, and more data are clearly needed before the question of whether anatomic imaging versus perfusion/function imaging is the better approach can be answered. Other comparisons such as relative safety, availability, logistics, and cost-effectiveness between the various technologies are also lacking. Of all of the imaging modalities discussed, MCE is the only portable technology. The images do not require expensive software or other technology for offline processing before interpretation, and any trained cardiologist can read the study at the bedside or, potentially, over the Internet, providing near-instantaneous results in the acute cardiac setting, where time is of the essence. MCE is also relatively cheap compared with other technologies, a potential advantage for payors but not necessarily for payees. How reimbursement rates and fee structures eventually affect clinical practice is also unknown. Despite these and other questions that need to be answered before any one technique will be used exclusively, the future of noninvasive cardiac imaging remains an exciting and ever-changing field. The adaptation of any one of these techniques into its proper role in the ED Journal of Nuclear Cardiology Wyrick and Wei 753 Volume 13, Number 6;749-55 Cardiac imaging in patients with chest pain will take considerably more time and effort in terms of research, money, and time-tested clinical experience.     

泰素蒂加顺铂治疗进展期NSCLC的临床研究

目的观察泰素蒂加顺铂方案治疗进展期非小细胞肺癌的临床疗效、毒副作用。方法收集可评价疗效的进展期非小细胞肺癌50例,以泰素蒂加顺铂方案进行化疗,泰素蒂75 mg/m2静脉滴注,第1天;顺铂25 mg/m2～30 mg/m2静脉滴注,第2天～第5天,每3周为一个周期,2～3周期后评价疗效和毒副反应并随访。结果50例患者中,总有效率为50.0 %,其中初治病例为53.1 %,复治病例为44.4 %,初复治病例间差异无显著性(P >0.05)。中位缓解期为5个月。中位生存期为9.5个月,1年生存率为61.0 %。毒副反应主要为骨髓抑制,白细胞下降达Ⅲ度、Ⅳ度者52.0 %,血小板下降达Ⅲ度、Ⅳ度者为14.0 %。血红蛋白下降不严重。其他毒副反应还有脱发、过敏反应、水钠潴留、静脉炎、末梢神经炎、口腔炎、腹泻等,但发生率均较低。结论泰素蒂加顺铂方案治疗进展期非小细胞肺癌,特别是复发病例,临床疗效比较满意,毒副反应能够耐受。辅以G蛳CSF可防治重度的骨髓抑制,有较好的临床应用价值。