经皮椎体后凸成形术后继发椎体压缩性骨折的危险因素分析及预测模型的建立与验证

目的 ：分析经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）后继发椎体压缩性骨折（subsequent vertebral compression fracture,SVCF）的危险因素,建立预测模型并进行验证。方法：回顾性分析在徐州医科大学附属医院骨科行PKP治疗的415例患者的临床资料,其中有24例（5.8%）患者在术后出现SVCF,所有患者术后随访时间16～30个月,根据术后是否出现SVCF,将患者分为SVCF组与非SVCF组。对两组患者的性别、年龄、体重指数（body mass index,BMI）、骨密度（bone mineral density,BMD）、临床合并症史（高血压病史、糖尿病史）、骨水泥注射量、骨水泥渗漏情况、初始手术节段数及手术前后的Cobb角和椎体前缘高度（anterior vertebral height,AVH）进行单因素分析。根据套索（LASSO）回归,选择与PKP术后SVCF显著相关的危险因素;随后将筛选出来的危险因素纳入多因素Logistic回归分析,最终依据多因素Logistic回归分析结果建立预测模型,并通过绘制列...     

腰椎管狭窄症的腰椎体感诱发电位评价

目的分析腰椎体感诱发电位（1umbar somatosensory evoked potentials,LP）在腰椎管狭窄症（lubar spihal stenosis,LSS）临床评价中的应用价值。方法2004年9月至2007年9月的40例患者,男16例,女24例;年龄52-83岁,平均67．3岁,23例单纯LSS患者,17例合并腰椎退变性滑脱;18例单侧肢体出现症状,22例双下肢均出现症状;37例合并间歇性跛行。就诊时病程1～240个月,平均43．8个月。同时收集患者治疗前的JOA评分、VAS评分[包括腰痛（VAS-LBP）、下肢痛（VAS-Leg Pain）和下肢麻木感（VAS-Numb）3项评分]以及MR检查的最狭窄部位硬膜囊横断面积（minimum cross-sectional area,mCSA）。采用SPSS12．0进行统计学分析。结果LP及P_37潜伏期分别为（23．0±2．0）ms和（40．1±3．1）ms。JOA评分平均为16．5分。15例（35．9％）出现感觉障碍,19例（43．6％）肌力减弱。VAS评分中VAS-LBP、VAS-Leg Pain和VAS-Numb评分平均为6．0分、6．9分和7．8分。出现跛行前的行走距离为3-1000m,平均246．8m。mCSA为0．18-1．06cm^2,平均0．44cm^2。LP潜伏期与VAS-Numb评分有显著相关性,当VAS-Numb评分≥8分时LP潜伏期显著性延长。P_37、LP潜伏期与VAS-LBP、VAS-Leg Pain评分,JOA评分与步行能力、感觉及肌力障碍、有无腰椎退变性滑脱、单节段还是多阶段受累和单侧还是双侧肢体症状无相关性。结论凹潜伏期变化可反映患者的主观麻木症状,可作为LSS临床评价的参考。     

Pancreatic pseudocyst arising from ectopic pancreas and isolated intestinal duplication in mesocolon caused hydronephrosis in a girl with horseshoe kidney

Ectopic pancreas is a relatively common congenital anomaly and is usually asymptomatic. Pancreatitis in the ectopic site and pseudocyst formation is extremely rare. To date, only 2 cases have been reported. We present a case of a 3-year-old girl with recurrent pancreatitis and unilateral hydronephrosis of the horseshoe kidney, which was produced by pancreatic pseudocyst arising from ectopic pancreas and isolated intestinal duplication in mesocolon. This is the first case of pancreatic pseudocyst that expanded to the retroperitoneal space and caused urinary tract obstruction.     

Augmentation ureterocystoplasty in children: 7-years follow-up

OBJECTIVES: We retrospectively reviewed our experience of augmentation ureterocystoplasty in children to evaluate its long-term results. MATERIALS AND METHODS: From February 1996 to March 1999 four children (2 boys and 2 girls) with neurogenic bladder had augmentation cystoplasty using dilated ureter in our institute. After trans-uretero-ureterostomy the lower two thirds of the unilateral ureter was used to perform the augmentation cystoplasty. Follow-up varied between 59 and 96 months (mean 85). RESULTS: In early post-operative period bladder volume and compliance increased from 96 (64-150) to 113 (40-220) ml and from 2.7 (1.3-5.8) to 4.5 (2.0-11.0) ml/H2O respectively. Incontinence was improved in all children and two had dry interval of 3-hour catheterization. Although bladder volume and compliance kept increasing gradually (239 (237-241) ml, 11.5 (5.7-18.5) ml/H2O respectively) over 5 years postoperatively, 2 elder patients had repeat augmentation cystoplasty using gastrointestinal tract because of hydronephrosis and deterioration of renal function. CONCLUSION: Our long-term result of ureterocystoplasty was no good. Ureter is not an ideal material to provide adequate bladder capacity and compliance for elder children unless their bladder becomes as large as that of adults early post-operatively.     

Gastric foveolar metaplasia with dysplastic changes in Brunner gland hyperplasia: possible precursor lesions for Brunner gland adenocarcinoma

Cases of adenocarcinomas developed in Brunner gland hyperplasia (BGH) have been sporadically reported. Herein, we report the morphologic spectrum of hyperplastic changes culminating into dysplasia and carcinoma in 722 cases of BGH listed in our files. Fifteen of these cases showed dysplastic changes, with 8 graded as low-grade dysplasia, 5 as high-grade dysplasia, 11 as atypical hyperplasia, and 2 as invasive carcinoma, although each frequently coexisted in the same tumor. In two carcinomas, one had high-grade dysplasia in the mucosa, and another had only atypical hyperplasia. Interestingly, hyperplastic glands around dysplastic foci were associated with gastric foveolar metaplasia and papillary configuration in 13 cases, 11 of which showed a gradual increase in nuclear atypism in the transition from metaplastic to dysplastic glands. All of the metaplastic gastric glands showed diffuse and strong immunopositivity for gastric foveolar mucin (MUC5AC). Immunohistochemical profiles also supported the concept of a continuous spectrum in carcinogenesis from gastric foveolar hyperplasia through atypical hyperplasia or dysplasia and eventually to frank adenocarcinoma. The results of our study suggest, therefore, that dysplastic and/or carcinomatous change does occur in BGH, that they form the continuous morphologic spectrum, and that papillary foveolar metaplasia may be a precursor lesion in the process of carcinogenesis with a background of BGH.     

miR-21通过下调PTEN表达促进肝癌细胞增殖、侵袭及迁移

目的 探讨miR-21在肝癌组织中的表达、临床意义及可能的分子机制。方法 实时定量PCR检测miR-21在肝癌及癌旁组织中的表达,MTT法检测MHCC-97H细胞的增殖,Transwell实验检测MHCC-97H细胞的侵袭及迁移,Westernblot法检测miR-21下游潜在靶点PTEN的表达。结果 miR-21在肝癌组织中表达水平显著高于相应癌旁组织;肝癌组织中miR-21高表达与肿瘤大小、TNM分期、门静脉侵犯及Edmondson分级显著相关;高表达miR-21患者3年生存率明显低于低表达组;miR-21可显著促进MHCC-97H细胞的增殖、侵袭及迁移,并下调PTEN的蛋白水平。结论 miR-21在肝癌组织中表达显著上调并与肝癌恶性临床病理特征有关,miR-21促进肝癌细胞增殖、侵袭及迁移的作用可能与下调PTEN表达有关。     

前列腺癌肿瘤血管生成的研究

目的：探讨肿瘤微血管与前列腺癌生长,转移的关系。方法：应用免疫组化技术结合放射免疫测定检测第Ⅷ因子相关抗原和前列腺特异性抗原（PSA）在19例前列腺癌和40例前列腺增生中的表达和平均值及其相关关系。结果：前列腺癌组织中微血管密度（MVD）和PSA值明显高于前列腺增生,转移性前列腺癌MVD和PSA值高于非转移性前列腺癌,前列腺癌MVD与PSA呈正相关,结论：血管形成与前列腺癌的发生,发展和转移密切相关,肿瘤的增长和转移有赖于肿瘤血管的生成。     

非水介质中明胶水凝胶电场驱动行为的研究

研究了明胶水凝胶在绝缘硅油中的电场响应行为。结果表明,在硅油中,明胶水凝胶在外加高压直流电场作用下可发生运动,其运动由转动和平动两部分组成。存在一个运动所需的最小阈值电场,只有外加电场在此阈值以上时,才可观察到水凝胶明显的运动。水凝胶的运动速度随外加电场的增大而增大,其运动可通过外加电场的大小来调控。由硅油很稳定且在电场中会电解,因此避免了传统电场驱动水凝胶在水介质中响应时不可避免的电解缺点,为建立一种新的电响应凝毅然驱动方式提供了可能。     

I型内皮素受体反义寡聚核苷酸抑制VSMC增殖及内膜增生

目的　观察 型内皮素受体 (ETA)反义寡核苷酸(ODN)对血管平滑肌细胞 (VSMC)增殖和内膜增生的抑制作用 .方法　 1细胞培养 :取家兔主动脉中膜消化后培养传代 ,经抗 α- actin鉴定后使用第 4～ 6代传代细胞 ;2人工合成ODN:经 Genbank检索筛选 ,合成含 18bp ETA- ODN片段 ,再对 5 端硫代修饰以增加稳定性 ,同时行地高辛标记以检测反义片段的细胞膜穿透性 ;3 MTT分光光度法检测 ETA-ODN对 VSMC增殖的抑制作用 ;4运用放射受体结合分析法 (1 2 5I- ET- 1)了解 ODN对 ETA蛋白表达的抑制作用 ,以探讨其反义作用 ;5兔颈动脉空气干燥模型在体研究 ODN对血管内膜增生的抑制作用 :应用 F- 12 7凝胶载体携带 ETA-ODN(3.0μmol· L- 1 )导入血管周围 ,术后不同时间观察增生内膜相对厚度 .结果　 ODN于培养后 12 h进入细胞内 ,并逐渐增加 ;15 μmol· L- 1 ETA- ODN对 VSMC增殖具有抑制作用 ,2 4h后即有显著作用 ;ETA- ODN对 ETA表达亦有明显的抑制作用 ,表现为 CPM于 2 4h逐渐减少 ;ETA- ODN导入后 ,血管增生内膜相对厚度减少 .结论　 ETA- ODN以浓度和时间依赖方式抑制 ETA蛋白表达以及 VSMC的增殖 ;反义寡核苷酸是通过反义机制实现对 ETA蛋白和 VSMC增殖的抑制作用