保留肾单位手术治疗早期小肾癌21例临床分析

OBJECTIVE: To evaluate the clinical effects of nephron-sparing surgery in patients with early-stage small renal cell carcinoma. METHODS: Nephron-sparing surgery was performed in 21 patients with renal cell carcinoma including 1 with solitary kidney, 3 with unilateral tumor and contralateral renal compromise, and 17 with unilateral tumor and normal contralateral kidney. The diameter of the tumors ranged from 1.5 to 6.0 cm, with a mean of 2.8 cm. The tumor diameter in 17 patients with normal contralateral kidney was less than 4 cm (mean 2.5 cm) and the average diameter in 4 patients with contralateral renal compromise was 4.2 cm. Sixteen cases were in stage T(1), 4 in stage T(2), and 1 in stage T(3). Of the 21 patients, 4 underwent tumor enucleation, 10 polar nephrectomy and 7 wedge resection. RESULTS: All patients were followed up for an average of 40.8 months (7 to 66 months). One patient suffered a right lung and mediastinum metastasis 3 years after the surgery later and 1 with chronic glomerulonephritis required dialysis 27 months after the operation. No surgical complication or local recurrence were found in other patients. CONCLUSION: As a safe and effective therapy for early-stage small renal cell carcinoma, nephron-sparing surgery can be considered as the gold-standard therapy for patients with lesions less than 4 cm in T(1) and T(2) stages of localized unilateral tumor with normal contralateral kidney.     

肝细胞癌的相关血清标志物

HCC的早期诊断是其治疗的关键，HCC血清标志物的检测又为其诊断提供了有利的途径，并且操作简单，敏感性高和特异性强。目前常用的血清标志物为AFP、AFP变异体、AFP mRNA、AFU、GGT、DCP、AIF、GPC3等。这些标志物的联合使用有助于HCC的诊断及预后。     

赤芍总苷对沙土鼠全脑缺血再灌注损伤的保护作用

OBJECTIVE: To study the protective effects of the total paeony glycoside (TPG) against global cerebral ischemia-reperfusion injury in gerbils. METHODS: Gerbils models of global cerebral ischemia-reperfusion injury were prepared by bilateral common carotid artery ligation for 12 min followed by 24-hour reperfusion. The effects of TGP on brain edema index, superoxide dismatase (SOD) activity and malonaldehyde (MDA) concentration of the cerebral tissue homogenate and pathology of the brain were examined 24 h after model establishment. RESULTS: Compared with the model group, TPG at the doses of 200 and 400 mg/kg could significantly relieve brain edema, enhance SOD activity and lower MDA concentration in the gerbils. Pathological examination showed that the gerbils with TPG treatment had milder injury of the cells in the hippocampal CA1 region. CONCLUSIONS: TPG has obvious protective effects against global cerebral ischemia-reperfusion injury.     

载瘤动脉闭塞术治疗颅内巨大动脉瘤的探讨

目的总结和探讨脑血管造影和载瘤动脉闭塞在治疗颅内巨大动脉瘤上的作用及特点。方法60例颅内巨大动脉瘤患者,根据其脑血管造影的特点采取血管内介入方法[可脱式球囊和(或)弹簧圈]闭塞载瘤动脉近端53例、闭塞载瘤动脉两端后孤立动脉瘤7例;其中23例闭塞前先行颅内-外血管搭桥术。结果出院时Rankin评分分级:单纯血管内介入治疗组37例中轻残3例,合并颅内-外血管搭桥术组23例中死亡1例、重残2例。1-6年的影像学随访动脉瘤无复发。结论血管内介入结合颅内-外血管搭桥术闭塞载瘤动脉是治疗颅内巨大动脉瘤的方法之一。     

手术治疗125例分化性甲状腺癌的5年随访结果分析

目的：探讨甲状腺全切除术在治疗分化性甲状腺癌中的临床应用价值。方法：采用我院1988年1月～2001年5月甲状腺全切除术或甲状腺侧叶切除加峡部切除术治疗分化性甲状腺癌125例,对其手术并发症发生、局部复发、转移情况及术后5年生存率进行回顾性对比分析。结果：甲状腺全切除术术后并发症发生率高于甲状腺侧叶切除加峡部切除术组;局部复发、转移率低于侧叶切除加峡部切除术组;5年生存率两组无显著性差异。结论：甲状腺全切除术是治疗甲状腺癌有效的手术方式,但应掌握手术指征,改进、提高手术技术,减少并发症。     

Wall-eyed bilateral internuclear ophthalmoplegia from lesions at different levels in the brainstem.

Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a rarely reported syndrome. There is dispute about whether WEBINO is caused by a pontine or a midbrain lesion and whether the medial rectus subnuclei are implicated. In a study of the clinical and imaging features of four patients with WEBINO, we found that that three of four lesions involved the midbrain but not necessarily the medial rectus subnuclei.     

糖尿病患者腹部手术后消化道功能的观察

目的了解糖尿病患者腹部手术后消化道功能恢复情况,为临床进行有针对性的护理提供依据.方法对72例糖尿病患者腹部手术后消化道功能恢复情况进行观察,并随机抽取70例非糖尿病腹部手术患者作对照.结果在肠鸣音恢复及肛门排气时间、进流质饮食后食欲状况、恶心呕吐、腹胀发生情况5个方面进行比较,两组消化道功能恢复差异明显(P均＜0.01).结论糖尿病患者腹部手术后消化道功能恢复延迟,临床护理中应予重视.     

协同学——中医药科学性的理论基础

通过深入分析我国中医药科学性研究中所存在的问题，依据协同学理论，提出了中医药科学性的理论基础是协同学的观点。基于此，阐释了中医药科学性的协同学解释，这在一定意义上为中医药科学性的研究提供了新的视角和有益的启示。     

Serine hydroxymethyltransferase isoforms are differentially inhibited by leucovorin: characterization and comparison of recombinant zebrafish serine hydroxymethyltransferases.

Serine hydroxymethyltransferase (SHMT) provides activated one-carbon units required for the biosynthesis of nucleotides, protein, and methyl group by converting serine and tetrahydrofolate to glycine and N(5),N(10)-methylenetetrahydrofolate. It is postulated that SHMT activity is associated with the development of methotrexate resistance and the in vivo activity of SHMT is regulated by the binding of N(5)-CHO-THF, the rescue agent in high-dose methotrexate chemotherapy. The aim of this study is to advance our understanding of the folate-mediated one-carbon metabolism in zebrafish by characterizing zebrafish mitochondrial SHMT. The cDNA encoding zebrafish mitochondrial SHMT was cloned, overexpressed in Escherichia coli, and purified with a three-step purification protocol. Similarities in structural, physical, and kinetic properties were revealed between the recombinant zebrafish mitochondrial SHMT and its mammalian orthologs. Surprisingly, leucovorin significantly inhibits the aldol cleavage of serine catalyzed by zebrafish cytosolic SHMT but inhibits to a lesser extent the reaction catalyzed by the mitochondrial isozyme. This is, to our knowledge, the first report on zebrafish mitochondrial folate enzyme as well as the differential inhibition of leucovorin on these two SHMT isoforms. Western blot analysis revealed tissue-specific distribution with the highest enrichment present in liver for both cytosolic and mitochondrial SHMTs. Intracellular localization was confirmed by confocal microscopy for both mitochondrial and cytosolic SHMTs. Unexpectedly, the cytosolic isoform was observed in both nucleus and cytosol. Together with the previous report on zebrafish cytosolic SHMT, we suggest that zSHMTs can be used in in vitro assays for folate-related investigation and antifolate drug discovery.     

氟尿嘧啶化放疗的现状与未来

20世纪60年代在肿瘤的根治和辅助治疗中就使用了氟尿嘧啶（Fluorouracil，FU）化放疗（外放疗同时进行化疗）。2002年．全世界约200万肿瘤患者接受了FU治疗．其中很大一部分是以FU为基础的化放疗。FU是许多肿瘤患者的基础治疗药物。总之，FU化放疗显著改善了肿瘤的局部控制．并提高了部分肿瘤患者的生存率：也提高了部分具有重要功能的器官的保留。