半坐卧位和仰卧位对机械通气相关性肺炎影响的研究进展

综述了半坐卧位和仰卧位对机械通气相关性肺炎(VAP)影响的机制,比较两者相关研究的结果以及采用半坐卧位的现状.提出仰卧位是VAP的危险因素,但半坐卧位可预防VAP的理想的床头角度尚无明确答案,需进一步从依从性、伦理性和推广性获取最佳证据.     

选择性前路手术治疗胸腰段或腰段青少年特发性脊柱侧凸的参数分析

目的 探讨Lenke5、6型青少年特发性脊柱侧凸(AIS)患者选择性前路手术的筛选指标.方法 回顾性分析我院1999年3月至2004年5月期间收治的52例Lenke5、6型AIS患者,随访2～4年(平均34个月),评估术前各相关参数.按术后结果 分成两组:满意组(胸弯减小)A组,不满意组(胸弯加重)B组.结果 A组(n=46)术前胸弯平均33°,术后平均18°,腰弯术前平均49°,术后平均21°.B组(n=6)术前胸弯平均38°,术后平均45°.腰弯术前平均46°,术后平均25°.B组患者中2例由于术后脊柱失平衡,进行了后路翻修术.结论 胸椎柔韧性和患者的成熟度决定了该方案外科手术的效果.在各种结构参数中,(TL/L:T)Cobb比率和胸椎柔韧性,是筛选患者的较好指标.     

Amplatz血栓消融术治疗大块肺栓塞——附2例报告

目的 探讨Amplatz血栓消融器治疗大块肺栓塞(PE)的可行性。方法 对2例年轻男性经溶栓无效或贻误有效溶栓时机的大块PE患者行Amplatz血栓消融术。结果 术后肺血流灌注亚急性PE患者明显改善,慢性PE再发患者略有改善。前者PaQ2由术前53．8mmHg升至67．3mmHg,2个月后升至80．0mmHg。7个月后核素肺灌注显像大致正常。后者术中症状明显减轻,术后PaO2由66．4mmHg升至83．6mmHg。3个月后,肺动脉压由53．5mmHg降至24mmHg。仅1例术中轻微左侧胸痛。结论 对大块亚急性PE患者实施Amplatz血栓消融术技术上可行,但需进一步评价。     

急性胰腺炎时胰腺缺血与细胞因子相关性的实验研究

目的探讨大鼠急性胰腺炎(AP)时胰腺缺血和细胞因子过度释放的关系.方法以牛磺胆酸钠诱导大鼠AP,20只为急性水肿性胰腺炎(AEP)模型、20只为急性坏死性胰腺炎(ANP)模型,另取10只正常大鼠作为对照.术后12 h处死各组10只大鼠,取血和胰腺组织,检测肿瘤坏死因子α(TNF-α)和白细胞介素10(IL-10)水平,观察胰腺病理变化,并以多普勒超声仪检测大鼠胰腺血流(PBF).结果AEP大鼠血清和胰腺中TNF-α和IL-10水平均升高,分别为(186±13)、(210±30) pg/ml和(660±29)、(669±62) pg/ml;ANP大鼠两者分别为(337±56)、(443±60) pg/ml和(124±12)、(202±38)     

急性胰腺炎大鼠TNF-α和IL-10mRNA的表达及其意义

目的:探讨急性胰腺炎大鼠胰腺组织中TNF-αmRNA和IL-10 mRNA的表达及其对疾病发展和转归的意义。方法:以牛磺胆酸钠制备大鼠急性水肿性胰腺炎(AEP)模型20只和急性坏死性胰腺炎(ANP)模型20只,另取10只正常大鼠作为对照。造模12h后各处死10只大鼠,检测血清和胰腺组织TNF-α和IL-10水平及其胰腺组织中的mRNA转录水平,并观察胰腺组织的病理变化。结果:正常组、AEP组和ANP组的血清TNF-α水平分别为126pg/ml、186pg/ml和337pg/ml,组织TNF-α水平分别为118pg/ml、210pg/ml和443pg/ml。正常大鼠血清和胰腺组织中无法检测到IL－10,而AEP和ANP组血清IL－10水平为660pg/ml和124pg/ml,组织IL－10水平为669pg/ml和202pg/ml。AEP大鼠组织中IL-10mRNA表达增强,ANP大鼠TNF-α mRNA表达增强。结论:AP大鼠胰腺组织中TNF-α和IL-10 mRNA的表达与其在血清和胰腺组织中的浓度成正比,而急性胰腺炎时胰腺本身可能就是产生细胞因子的主要器官。     

胰腺癌血清肿瘤标记物联合检测的临床研究

目的：观察胰腺癌患者血清肿瘤标记物的表达,寻找对胰腺癌诊断与随访的有价值血清肿瘤标记物。方法：采用免疫分析法和放射免疫法检测92例胰腺癌患者的血清AFP、CEA、CA50、CA15－3、CA19－9、CA72－4、CA125和CA242共8种肿瘤标记物的表达,并与其它恶性肿瘤患者70例和良性疾病患者73例作对照,分析其临床诊断价值。结果：8种肿瘤标记物中CA19－9、CA242、CA50和CA125对胰腺癌诊断的相对价值较高,尤以CA19－9的诊断价值最高,灵敏度和特异度分别为82．6％和81．3％,平行法联合检测提高灵敏度至90．2％,系列法联合检测提高特异度93．5％,25例获手术切除者术后上述四项指标呈下降趋势。结论：血清CA19－9、CA242、CA50和CA125的检测对胰腺癌的诊断和随访是价值的,联合检测可以增加检测效率。     

Radiofrequency ablation for eradication of pulmonary tumor in rabbits

BACKGROUND: Radiofrequency ablation (RFA) has emerged as an alternative for surgery in clinical oncology. This animal experiment was conducted to evaluate the feasibility of RFA in the treatment of pulmonary tumor. METHODS: Eighteen rabbits with pulmonary implantation of VX2 tumors were divided into two groups. Group A (n = 12) was treated with RFA by using a cooled-tip electrode technique. Group B (n = 6) received sham operation. The therapeutic efficacy was evaluated by survival rate, magnetic resonance imaging (MRI), postmortem microangiography, and histology. RESULTS: All animals in group B died within 3 months after tumor implantation. Tumor eradication was achieved in 9 of 12 rabbits (75.0%) in group A, of which 4 rabbits survived longer than 3 months free of disease and another 5 rabbits were found free of viable tumor when sacrificed. One rabbit was subjected to incomplete tumor ablation and two rabbits suffered from local tumor relapse and/or lung metastasis. The 3-month survival rate of RFA-treated rabbits was significantly higher (P < 0.01) than that of control rabbits. The typical MRI appearances of the acute RFA lesion consisted of five characteristic concentric zones, which corresponded to central needle track (zone A), tumor coagulation (zone B), pulmonary parenchyma coagulation (zone C), peripheral hemorrhage (zone D), and inflammatory layer (zone E) on histology. CONCLUSIONS: Eradication of pulmonary tumor could be achieved with current RFA technique in rabbits. MRI is a useful modality for assessment of lung tumor ablation.     

Effect of severe aortic banding above the renal arteries on nitric oxide synthase isotype expression

BACKGROUND: Severe aortic stenosis above the renal arteries leads to a reduction in renal perfusion, increased renin secretion, and elevation of arterial blood pressure above the stenotic site. Nitric oxide (NO) plays an important role in regulation of renal and systemic vascular resistance, renal blood flow, and Na(+) handling. Abdominal aortic banding provides an excellent model for simultaneous testing of the effects of increased and decreased pressure, flow, and shear stress in the same animal. METHODS: We studied protein expressions of endothelial NO synthase (eNOS), inducible NOS (iNOS), and neuroneal NOS (nNOS) isotypes in the renal cortex, renal medulla, heart, brain, and aorta segments above and below the stenosis site three weeks after abdominal aortic banding above the renal arteries. The results were compared with those obtained in the sham-operated controls. NOS isotype proteins were measured by Western blot. RESULTS: Compared with the control group, the banded group showed significant up-regulations of eNOS, iNOS, and nNOS in renal cortex and medulla. Likewise, heart eNOS, brain nNOS, and thoracic aorta eNOS proteins were significantly increased in the banded group. However, eNOS and iNOS expressions were unchanged in the aorta segment below the stenotic site. Likewise, iNOS expression in the heart and thoracic aorta remained unchanged in the banded animals. No significant difference was found in creatinine clearance or urinary protein excretion between the two groups. CONCLUSIONS: These findings clearly demonstrate the up-regulatory action of increased pressure on eNOS expression in the thoracic aorta and heart and of nNOS expression in the brain. These data further show up-regulation of all NOS isotypes in the kidney, which must have helped to mitigate the associated hypoperfusion.     

Recombinant adenovirus mediated prostate-specific enzyme pro-drug gene therapy regulated by prostate-specific membrane antigen (PSMA) enhancer/promoter

Gene directed enzyme pro-drug therapy (GDEPT) is one of the adjuvant therapeutic regimens for advanced prostate adenocarcinoma, and this research intended to explore how to apply targeting therapy of prostate adenocarcinoma under the mediation of a promoter/enhancer of prostate-specific membrane antigen (PSMA(EP)) as a specific regulatory element. Recombinant adenoviruses (Ad-PSMA(E-P)-enhanced green fluorescent protein [EGFP], Ad-CMV-EGFP, Ad-PSMA(E-P)-CD, and Ad-CMV-CD) were constructed and could express cytosine deaminase (CD) or the EGFP reporter gene driven by a PSMA(EP) or cytomegalovirus (CMV) promoter. LNCaP, CL-1, MCF-7, and A549 were infected with CD-produced recombinant adenoviruses and treated with pro-drug 5-fluorocytosine (5-FC) in vivo and vitro; then, the growth inhibition of the cells and the cell cycle variation were assessed by an [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] (MTT) assay and flow cytometry. Growth suppression of the xenograft tumor was also adopted to evaluate the efficiency of the suicide system. Morphologic changes after treatment in vivo were assessed with hematoxylin and eosin staining. In the 4 examined cancer cell lines, PSMA-positive prostate cancer cells LNCap and CL-1 were exclusively sensitive to the Ad-PSMA(E-P)-CD/5-FC system. The S phase of cell cycle arrest was thought to be involved in the cytotoxicity of 5-fluorouracil (5-FU) converted from 5-FC by CD. CL-1 implanted Athymic BALB/c mice showed growth inhibition of tumors when they were treated with the Ad-PSMA(E-P)-CD/5-FC system without systemic conversion toxicity. The PSMA-based, CD-produced adenovirus, deserving further investigation in the future, might be a good candidate for targeting gene therapy of prostate adenocarcinoma.