干扰素γ抑制转化生长因子β1诱导的A549细胞上皮-间充质转化及对ERK1/2和STAT3的作用

目的 探讨干扰素γ(IFN-γ)对转化生长因子β1(TGF-β1)诱导的A549细胞上皮-间充质转化(EMT)过程的作用及对胞外调节激酶1/2(ERK1/2)和信号转导和转录激活因子3(STAT3)的作用.方法 ①体外培养A549细胞,分为TGF-β1处理组(5 μg/L)、IFN-γ处理组(200 μg/L)和TGF-β1(5 μg/L)+ IFN-γ(10、100、200 μg/L)联合处理组.处理时间48 h,免疫荧光及Western blot方法检测各组细胞E-钙黏素( E-cadherin)、α-平滑肌肌动蛋白(α-SMA)、波形蛋白(vimentin)和纤维连接蛋白(fibronectin)的蛋白表达.②处理不同时间(5、30和60 min),Western blot方法检测各组细胞STAT3、p-STAT3和ERK1/2、p-ERK1/2的蛋白表达.结果 ①与TGF-β1单独处理组相比,IFN-γ(200 μg/L)+TGF-β1联合处理组vimentin和fibronectin的蛋白表达减低(P＜0.05),而α-SMA和E-cadherin蛋白表达无显著变化.②作用后5、30和60 min,IFN-γ(200 μg/L)+ TGF-β1联合处理组STAT3磷酸化水平显著升高(P＜0.01).作用后5、60 min,IFN-γ(200 μg/L) +TGF-β1联合处理组ERK1/2磷酸化水平升高(P＜0.05).结论 IFN-γ可在体外抑制TGF-β1诱导的A549细胞发生EMT,其机制可能与上调ERK1/2和STAT3信号通路有关.     

小剂量咪达唑仑-芬太尼在支气管镜检查中的作用及其对心、肺功能的影响

目的 探讨在不需要麻醉科医师监护和特殊供氧条件下,小剂量咪达唑仑-芬太尼静脉复合麻醉在支气管镜检查中的作用及其对心、肺功能的影响.方法 选取在我院接受支气管镜检查的患者共47例,分为2组:A组为1％丁卡因喷喉及2％利多卡因环甲膜穿刺法局部黏膜表面麻醉,共20例;B组为上述局部麻醉方式加用小剂量咪达唑仑-芬太尼静脉注射镇静镇痛,共27例.记录对比患者术中镇静分级、不良反应发生情况、术后满意度、遗忘程度,观察其麻醉前、麻醉后术前、术中进声门时及术后生命体征(心率、呼吸频率、血氧饱和度、平均动脉压)和术前、术后10 min、术后4h肺功能指标[用力肺 活量(FVC)、第1秒用力呼气量(FEV1)、FEV1/FVC、最大呼气流量(PEF)]变化情况.结果 A、B两组在患者镇静分级、术中不良反应程度、术后遗忘程度及患者主观满意度四个方面差异具有统计学意义(P＜0.05),B组明显优于A组.两组肺功能指标FVC、FEV1及PEF在术后10 min均较术前下降,其中B组用力肺活量下降程度较A组更显著(P＜0.05);两组术后4h的肺功能可回到基线水平.两组生命体征指标:A组内心率、呼吸频率、平均动脉压在术中进声门时及术后较麻醉前升高,且术中进声门时血氧饱和度较麻醉前下降( P＜0.05);而B组仅心率较麻醉前差异具有统计学意义,且A组术中进声门时心率和平均动脉压的升高程度均大于B组(P＜0.05).结论 小剂量咪达唑仑-芬太尼复合麻醉在支气管镜麻醉效果方面明显优于传统局部麻醉方式,且对心血管系统及氧和方面的影响更小,对于术后4h肺功能各指标无附加影响;由于不需要专职麻醉医师监护管理以及其麻醉的有效性及安全性,更易于被医师及患者所接受,有利于其在临床推广.     

经皮射频导管消融肾脏去交感神经支配术治疗顽固性高血压

目的总结经皮射频导管消融肾脏去交感神经支配治疗顽固性高血压的效果和前景。方法通过文献检索,总结肾脏交感神经与高血压的关系,经皮射频导管消融肾脏去交感神经支配术在治疗顽固性高血压中的应用,以及此项技术的前景和不足。结果高血压作为一个严重的公共卫生问题,是目前临床治疗的重点。肾脏交感神经在血压调控的各方面都扮演着重要的角色,经皮射频导管消融肾脏去交感神经支配术在治疗顽固性高血压方面展示了极大的优越性。结论经皮射频导管消融肾脏去交感神经支配术在治疗顽固性高血压方面有着潜在的临床应用价值。     

小切口B-twin融合治疗腰椎间盘突出症并腰椎不稳

2006年3月~2010年12月,我科应用B-twin融合器治疗46例腰椎不稳症患者,疗效较满意,报道如下. 1 材料与方法 1.1 病例资料 本组46例,男28例,女18例,年龄26～71岁.患者均有腰骶部疼痛伴有下肢麻木及放散性疼痛,其中伴有间歇性跛行症状16例.突出部位:L3~45例,L4~5 21例,L5~S1 13例,L4~5、L5~S1双节段7例.     

KRAS Mutation in Patients with Lung Cancer: A Predictor for Poor Prognosis but Not for EGFR-TKIs or Chemotherapy

Background

The prognostic and predictive value of KRAS mutations in patients with lung cancer is controversial. Biases in disease stage, treatment regimen, small-scale patient studies, and biomarker status have led to inconsistent results in previous reports.

Methods

The KRAS and EGFR genes were examined in 1935 consecutive patients with non-small cell lung cancer. All patients were divided into KRAS mutation (KRAS group), EGFR mutation (EGFR group), and KRAS/EGFR wild type (WT group) groups. Randomly selected cases were paired with patients with the KRAS mutation, the EGFR mutation, and KRAS/EGFR wild type patients according to tumor, node, metastasis stage, time of first visit within 1 year, and pathology. Progression-free survival (PFS) and overall survival were evaluated by Kaplan–Meier and Cox models.

Results

The KRAS mutation rate for lung adenocarcinoma was 5.90 %. The overall survival was 14.47, 20.57, and 42.73 months for the KRAS group, WT group, and EGFR group, respectively (P < 0.001). Multivariate analysis indicated that KRAS mutation status was an independent prognostic factor (hazard ratio 2.69, 95 % confidence interval 1.91–3.80, P < 0.001). No difference was found in PFS and tumor responsiveness between patients with a KRAS mutation and those with wild type KRAS/EGFR for chemotherapy and EGFR tyrosine kinase inhibitors (TKI). PFS did not significantly differ for chemotherapy among the three groups (P = 0.270).

Conclusions

KRAS mutation is a poor prognosis factor, but it is not an independent predictor of response to EGFR-TKI or chemotherapy in patients with lung cancer.     

Femoral bone transport by a monolateral external fixator with or without the use of intramedullary nail: a single-department retrospective study

Backgrounds

Treatment for bone defect remains a challenge for orthopedists. Bone transport gives an effective alternative, which can be performed with an external fixator alone or combined with an intramedullary nail. Each has its advantages and disadvantages. We present a retrospective study to find out the optimal choice by evaluating the outcomes of treatment for femoral bone defect with two methods.

Methods

Two groups of patients, the monolateral external fixator alone (group A, n = 13) and the monolateral external fixator combined with intramedullary nail (group B, n = 15), were compared. Duration of the external fixator, external fixator index, radiographic consolidation index, complication, and total cost for treatment was also recorded. A modified classification of the Association for the Study and Application of the Method of Ilizarov (ASAMI) was used to assess results in two groups of patients; another SF-36 health survey questionnaire was used to assess the life qualities patients of two groups.

Results

Healing was achieved in 13/13 and 13/15 of the two groups, respectively. The rates of complications were significantly higher in the group A. Two patients performed amputations because of persistent deep infections in group B. Statistically significant difference was found when comparing ASAMI scores and categories of the SF-36 health survey.

Conclusions

Bone transport by monolateral external fixator with the use of intramedullary nail reduces the incidence of complication and the duration of external fixator time that give patients a better life quality in both physical and emotional. However, if chronic osteitis exists, bone transport should be treated with monolateral external fixator alone due to a lower rate of amputations.     

术前应力位摄片对于活动平台单髁膝关节置换病例选择的价值

目的探讨应力位摄片在膝关节前内侧骨关节炎（AMOA）的诊断和活动平台单髁置换（UKA）患者选择中的作用。方法从2009年8月到2013年3月,86例预手术患者的103膝接受应力位摄片检查,包括内外翻应力下的正位片和屈膝90。侧位片。摄片后诊断为AMOA者计划单髁治疗,如诊断有疑问,加做MRI检查。应力位摄片诊断的准确性由术中观察情况检验。UKA术后患者随访3至38月（平均16．8月）,通过HSS膝关节评分和患者自我满意度评分评估临床疗效。结果73例患者中85膝符合AMOA诊断,除2例有反复肿胀加做MRI诊断慢性滑膜炎患者外,其余均计划进行活动平台单髁置换,其中1膝在术中探查韧带情况后改为全膝关节置换。患者术后随访的功能评分和满意度评分都很高。应力位摄片诊断AMOA的准确率为98．8％（82／83）,如以最终接受UKA手术为标准,准确率为96．5％（82／85）。结论应力位摄片是一种可靠的评价膝关节内前交叉韧带（ACL）功能和软骨缺损的方法,对于选择适合活动平台单髁置换患者有非常高的临床应用价值。     

右肾上腺畸胎瘤1例并文献复习

目的探讨肾上腺畸胎瘤的诊断、治疗和预后。方法回顾我院近期诊治右肾上腺畸胎瘤1例,随访了解其复发和生存情况,检索中国期刊全文数据库和PubMed数据库,荟萃分析国内外研究现状。结果肾上腺畸胎瘤好发于右侧,中青年女性多见,一般因腰痛或查体发现,CT检查常有钙化,术后病理良性多见。结论肾上腺畸胎瘤较为罕见,外科手术是主要治疗方式,手术方式和预后有待进一步探讨。     

血管内治疗非Galen静脉脑动静脉瘘

目的探讨血管内栓塞治疗非Galen静脉脑动静脉瘘（NCAVF）的效果。方法2009年4月至2012年1月收治13例NCAVF,其中6例为单瘘口,7例为多瘘口;采用球囊辅助Glubran胶栓塞4例,弹簧圈辅助Glubran胶栓塞7例,单纯使用Glubran胶栓塞剂栓塞2例。结果术后即刻造影示,8例一次完全栓塞瘘口;3例分两次完全栓塞瘘口,1例分三次完全栓塞瘘口,1例三次栓塞后仍有部分瘘口残留。术后随访3个月~2年,12例复查DSA示11例瘘口完全栓塞,1例多瘘口大部分栓塞,但症状明显缓解;1例小儿患者,家属拒绝复查DSA,术后1年无明显临床症状。结论应用Glubran胶栓塞治疗NCAVF可以直接准确地堵塞瘘口,恢复正常的脑血液循环;在高流量瘘口栓塞中,使用球囊或弹簧圈辅助可以降低瘘口的血流速度,有利于栓塞瘘口。     

多学科协作模式在血流动力学不稳定闭合性骨盆骨折 早期救治的临床研究

目的探讨多学科协作(multidisciplinary team,MDT)模式在血流动力学不稳定闭合性骨盆骨折早期救治中的临床疗效。方法回顾性分析MDT模式实施后救治的23例血流动力学不稳定骨盆骨折患者临床资料(MDT组),以及MDT诊疗模式实施前传统分诊会诊制一体化模式救治的20例患者(一体化组),其中MDT组男性15例,女性8例;年龄19～70岁,平均38. 82岁;骨盆骨折侧方挤压型(LC型) 4例、前后挤压型(APC型) 11例、纵向剪切型(VS型) 5例、复合应力型(CM型) 3例。一体化组男性13例,女性7例;年龄18～62岁,平均41. 45岁; LC型3例、APC型9例、VS型4例、CM型4例。记录两组患者围手术期心率、收缩压、术后24h尿量、总输血量、ICU平均住院时间以及病死率。结果与一体化组相比,MDT组术后6h心率明显降低(P <0. 05),术后6h收缩压升高(P <0. 01),术后24h尿量明显增多(P <0. 01);一体化组总输血量高于MDT组(P <0. 05);一体化组ICU平均住院时间高于MDT组,但差异无明显统计学意义(P=0. 272);患者病死率一体化组为15. 0%,MDT组为8. 7%,差异无明显统计学意义(χ2=0. 551,P=0. 392)。结论 MDT模式在血流动力学不稳定骨盆骨折早期救治中能稳定血流动力学,有效提高患者救治成功率。