冰冻切片诊断甲状腺滤泡性癌的探讨

冰冻切片诊断甲状腺滤泡性癌是病理诊断工作的难点之一。我们对３６例有包膜浸润的甲状腺滤泡性癌的术中冰冻切片标本和术后石蜡切片，与随机找５０例甲状腺腺瘤的术中冰冻切片标本和术后石蜡切片标本进行了观察比较，总结出３个方面滤泡性癌不同于甲状腺腺瘤的组织学表现，作为除浸润标准外冰冻切片诊断甲状腺滤泡性癌的综合考虑依据，供进一步探讨此问题参考。     

儿童下丘脑错构瘤导致癫痫的手术治疗

目的 探讨儿童下丘脑错构瘤导致癫痫的手术治疗。方法 报告儿童下丘脑错构瘤11例，男6例，女5例，年龄为2-15岁，发病年龄为2个月至14岁。首发症状为痴笑样癫痫者10例。为癫痫大发作者1例，伴发性早熟6例，伴发跌倒发作3例，伴发癫痫大发作6例。手术；翼点入路10例，终板入路1例，术中错构瘤深部电极检测4例。结果 全切错构瘤2例，大部切除8例，部分切除1例。术中错构瘤深部电极显示棘波1例。随诊19至90个月，痊愈2例，有效9例，术后一过性动眼神经麻痹3例。结论 手术切除错构瘤可有效治疗儿童下丘脑错构瘤导致的癫痫。     

The retinoic acid synthesis gene ALDH1a2 is a candidate tumor suppressor in prostate cancer

Prostate cancer is the most common cancer among men in the United States, and aberrant DNA methylation is known to be an early molecular event in its development. Here, we have used expression profiling to identify novel hypermethylated genes whose expression is induced by treatment of prostate cancer cell lines with the DNA methyltransferase inhibitor 5-Aza-2'-deoxycytidine (5-aza-dC). Of the 271 genes that were induced by 5-aza-dC treatment, 25 also displayed reduced expression in primary prostate tumors compared with normal prostate tissue, and the decreased expression of only one gene, aldehyde dehydrogenase 1 family, member A2 (ALDH1a2), was also associated with shorter recurrence-free survival. ALDH1a2 encodes an enzyme responsible for synthesis of retinoic acid (RA), a compound with prodifferentiation properties. By immunohistochemistry, we observed that ALDH1a2 was expressed in epithelia from normal prostate but not prostate cancer. Using bisulfite sequencing, we determined that the ALDH1a2 promoter region was significantly hypermethylated in primary prostate tumors compared with normal prostate specimens (P = 0.01). Finally, transfection-mediated reexpression of wild-type ALDH1a2 (but not a presumptive catalytically dead mutant) in the prostate cancer cell line DU145 resulted in decreased colony growth (P < 0.0001), comparable with treatment with either 5-aza-dC or RA. Taken together, our findings implicate ALDH1a2 as a candidate tumor suppressor gene in prostate cancer and further support a role of retinoids in the prevention or treatment of prostate cancer.     

血浆氨基末端B型利钠肽原检测在慢性心力衰竭患者住院期间主要心血管不良事件评估中的价值

目的 探讨血浆氨基末端B型利钠肽原（NT-proBNP）评估慢性心力衰竭患者住院期间心血管不良事件的临床价值.方法 选择120例符合诊断的单纯性慢性心力衰竭患者,入院时测定血浆NT-proBNP的水平,将患者分为≤中位数血浆NT-proBNP浓度组（A组）和＞中位数血浆NT-proBNP浓度组（B组）,观察两组住院期间发生室性心律失常及心脏性猝死情况.结果 B组患者左室舒张末内径明显大于A组患者[（58.80±6.90）mm比（54.32±8.00） mm,P=0.035],而B组患者的左室射血分数则明显低于A组患者[（29.16±8.31）％比（33.80±6.90）％,P=0.037];B组患者心血管不良事件发生率（11.63％）明显高于A组（1.67％）（P＜0.05）.经多变量（心脏左室舒张末内径、左室射血分数、血钾水平及血浆NT-proBNP水平）Logistic回归分析显示NT-proBNP水平与心力衰竭患者发生心血管不良事件的独立相关（OR=5.28,95％可信区间3.54～9.26,P＜0.05）.结论 慢性心力衰竭患者血浆NT-proBNP水平可预测其住院期间心血管不良事件发生率,对评估慢性心力衰竭患者临床预后及指导治疗具有重要临床价值.     

Role of GADD45 beta in the regulation of synovial fluid T cell apoptosis in rheumatoid arthritis

Rheumatoid arthritis (RA) is characterized by persistent Th1 cell infiltration and production of inflammatory cytokines in the location of joint lesion. It is known that infiltrated Th1 cells in the synovial fluid (SF) of RA patients are resistant to apoptosis. Here we demonstrate that Th1 cells accumulated in patient SF expressed a high level of GADD45β (Growth Arrest and DNA Damage-inducible 45β) which further inhibited Th1 cell apoptosis. Interestingly, in vitro culture of T cells with SF from RA patients increased GADD45β expression in Th1 cells and inhibited their apoptosis. Silencing of GADD45β by RNAi abolished the anti-apoptotic effect of RA SF, which was accompanied by down-regulation of Bcl-2 and up-regulation of Bax. Further analysis showed that TNF-α and IL-12 in RA SF could stimulate GADD45β expression in Th1 cells and inhibit their apoptosis. Taken together, our results suggest a novel mechanism by which specific cytokines in the RA SF elevate GADD45β expression in local Th1 cells and subsequently leading to the enhanced T cell survival.     

手术治疗腰椎退行性疾患所致足下垂的预后影响因素分析

目的 :分析腰椎退变性疾病致足下垂手术治疗结果 ,探讨手术治疗的预后影响因素。方法 :回顾分析2011年1月~2016年1月手术治疗的2341例腰椎退变性疾病患者,其中因腰椎间盘突出症或腰椎管狭窄症致足下垂者125例,108例完成完整随访并纳入研究。手术均采取腰椎后路、神经根减压、椎弓根螺钉内固定、椎间融合术治疗。术后随访1.4~5.2年,平均2.4±1.5年,以胫前肌肌力恢复至4或5级,患者可背伸足踝,步态基本正常,为治愈。收集患者年龄、性别、腰椎退变性质、足下垂病程、术前胫前肌肌力、受累肢体的数量、患肢感觉障碍、术前疼痛VAS评分、马尾综合征、外伤史、受累节段等指标,应用Log-rank检验进行单因素分析,并采用Cox回归分析患者手术治疗的预后影响因素。结果:108例患者,治愈59例,治愈率为54.6%。其中腰椎管狭窄症44例,治愈15例,治愈率为34.1%;腰椎间盘突出症64例,治愈44例,治愈率为68.7%。单因素分析结果示,年龄、腰椎退变性质、足下垂的病程、术前胫前肌肌力、受累肢体数量与足下垂的预后显著相关(P0.05)。Cox回归分析结果显示,年龄、腰椎退变性质、病程、术前胫前肌肌力是足下垂患者术后预后的独立影响因素(P0.05)。结论 :在腰椎退变性疾病致足下垂患者中,年龄、腰椎退变性质、病程、术前胫前肌肌力与足下垂患者的预后显著相关;年龄越小、病程越短、术前胫前肌肌力强者预后较好;腰椎间盘突出症较腰椎管狭窄症导致的足下垂者预后好。     

下颈段骨折脱位病人手术方法选择及其适应证

目的 探讨下颈段骨折脱位病人手术方法选择及其适应证。方法 对２３例下颈段骨折脱位病人根据其不同的损伤机制和术前Ｘ线,ＭＲ检查特点,分别采用前路ＡＯ钛板固定或后路张力钛缆固定或前路ＡＯ钛板＋后路张力钛缆固定方法手术治疗。结果 全组病人获短期随访,平均８．１个月,病人均能早期活动,进行康复锻炼,无任何早期并发症。     

成人髓母细胞瘤

目的　分析总结成人髓母细胞瘤的临床特点及治疗效果。方法　经手术及病理证实的成人髓母细胞瘤５３ 例, 其中男性３６ 例, 女性１７ 例, 平均年龄２５８ 岁。肿瘤均位于小脑, 蚓部２９ 例,小脑半球２４ 例, 伴鞍上转移１ 例。结果　全切２０ 例, 近全切除２０ 例, 大部切除１２ 例, 部分切除１例, 手术死亡率１９ ％ 。随访到４０ 例, 均已行放疗, 复发１７ 例, 中枢神经系统种植转移４ 例, ５ 年存活率４０ ％ 。结论　手术全切除肿瘤, 解除导水管梗阻, 术后予全脑加全脊髓放疗, 可延长生存期, 一旦出现种植转移, 则预后差。     

先天性巨结肠根治术后小肠结肠炎的防治

目的：探讨先天性巨结肠（ＨＤ）根治术后并发小肠结肠炎（ＨＥＣ）的防治经验。方法：总结报告１９８９～１９９９年２４例ＨＤ根治术后并发ＨＥＣ的临床资料并进行回顾性分析。结果：除１例放弃外,２１例行保守治疗,死亡２例,２例行造瘘术,死亡１例。随访１例,２例再次发生ＨＥＣ。结论：肠道免疫缺陷是本病的病理基础,若伴有远端梗阻则极易发生结肠炎。术前充分的肠道准备,彻底切除病变肠段,术后持续肛管减压可以有效地减少ＨＥＣ的发生,治疗应以快速补液、纠正水电解质紊乱等保守疗法为主,肠造瘘术不宜常规采用。     

来氟米特治疗类风湿关节炎双盲随机对照研究

Objective　To study efficacy and safety of leflunomide to rheumatiod arthritis (RA) compared with MTX.Methods　Sixty patients with active RA were randomly allocated to leflunomide treatment (20 mg/week) or MTX treatment (15 mg/week).Clinical and laboratory parameters were analyzed at start,weeks 12 and 24 of both treatments.Results　The response rate in the leflunomide was 80.0% and 83.3% respectively at weeks 12 and 24,compared to 70.0% in MTX (P＞0.05).Leflunomide and MTX significantly improved clinical and laboratory parameters which were indications of disease activity.Most common side effects with leflunomide were digestive tract reaction.Conclusion　Leflunomide is effective in treatment of rheumatoid arthritis and is well tolerated.