胃癌前哨淋巴结临床意义的研究

目的 观察胃癌前哨淋巴结的分布，探讨其临床意义。方法 回顾性分析288例胃癌前哨淋巴结术中染色后显影的范围及特征。术中向肿瘤边缘的正常胃壁浆膜下肌层、黏膜下层注射亚甲蓝，观察淋巴结显影的情况；切取各站淋巴结行病理检查。结果 288例胃癌术后病理诊断为T1期102例，T2期126例，T3期60例。术中成功显影270例，阳性率为93．8％。102例患者有淋巴结转移，其中前哨淋巴结（SNs）与非前哨淋巴结（non—SNs）均有转移者66例，仅前哨淋巴结有转移者18例，仅非前哨淋巴结有转移者18例。结论 通过前哨淋巴结，术中能准确预测胃癌淋巴结转移状况。在手术治疗淋巴结转移阴性的胃癌患者中，前哨淋巴结术中标识有望免除常规淋巴清扫。     

IL-1Ra和IL-10真核表达质粒载体的构建及其表达检测

目的:构建人IL-1Ra和人IL-10真核表达质粒载体并检测其表达。方法:用双酶切方法切取PCDI-IL-1Ra和PCDI-IL-10质粒中包含人IL-1Ra和人IL-10 CDS全长序列的cD-NA片段,并分别连接到真核表达质粒pcDNA3.1上,然后用壳聚糖转染上述质粒到原代软骨细胞,RT-PCR检测其mRNA水平的表达。结果:成功将人IL-1Ra和IL-10 CDS全长序列的cDNA片段克隆到真核表达载体,mRNA水平检测到目的基因的表达明显提高。结论:真核表达质粒可以用于外源基因的原代软骨细胞导入和表达,为进一步的基因治疗研究提供依据。     

还原型谷胱甘肽联合甘草酸二铵对腹部开放伤后海水浸泡犬肝功能损伤的治疗作用

Objective To investigate effect of reduced glutathione and diammonium glycyrrhizinate on the treatment of hepatic damage in experimental dogs following open abdominal injuries coupled with seawater immersion. Methods Twenty-four dogs with open abdominal injuries were randomly divided into 3 groups: the control group (given with simple observation after 1.5 h seawater immersion); the routine treatment group (given routine care and fluid transfusion after 1.5 h seawater immersion) ; the hepatic treatment group (given routine are, fluid transfusion and hepatic treatment as well, after 1.5 h seawater immersion). Each group consisted of 8 dogs. Blood samples were taken at different time points to measure total bilirubin (TB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), prothromin time (PT), endotoxin, tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), and pathological examination was also made at the same time. Results For the control group, contents of TB, ALT, AST and LDH increased significantly and survival time was less than 24 hours. Contents of TB, ALT, AST and LDH of the routine treatment group also increased significantly, but survival time of all the experimental animals was mere than 24 hours. Reduced glutathione and diammonium glycyrrhizinate could reduce the extent of lesion quite significantly 12～24 hours following open abdominal injuries. Conclusions Reduced glutathione and diammonium glycyrrhizinate seemed to have good effects on the treatment and prevention against hepatic damage induced by trauma coupled with seawater immersion. It could be used as a primary means for the treatment of such kind of hepatic damage.     

Implant wear induces inflammation, but not osteoclastic bone resorption, in RANK(-/-) mice.

Signaling of RANK (receptor activator of nuclear factor kappa B) through its ligand RANKL appears critical in osteolysis associated with aseptic loosening (AL). The purpose of this study was to investigate the role of RANK in a murine osteolysis model developed in RANK knockout (RANK(-/-)) mice. Ultra high molecular weight polyethylene (UHMWPE) debris was introduced into established air pouches on RANK(-/-) mice, followed by implantation of calvaria bone from syngeneic littermates. Wild type C57BL/6 (RANK(+/+)) mice injected with either UHMWPE or saline alone were included in this study. Pouch tissues were collected 14 days after UHMWPE inoculation for molecular and histology analysis. Results showed that UHMWPE stimulation induced strong pouch tissue inflammation in RANK(-/-) mice, as manifested by inflammatory cellular infiltration, pouch tissue proliferation, and increased gene expression of IL-1beta, TNFalpha, and RANKL. However, the UHMWPE-induced inflammation in RANK(-/-) mice was not associated with the osteoclastic bone resorption observed in RANK(+/+) mice. In RANK(+/+) mice subjected to UHMWPE stimulation, a large number of TRAP(+) cells were found on the implanted bone surface, where active osteoclastic bone resorption was observed. No TRAP(+) cells were found in UHMWPE-containing pouch tissues of RANK(-/-) mice. Consistent with the lack of osteoclastic activity shown by TRAP staining, no significant UHMWPE particle-induced bone resorption was found in RANK(-/-) mice. A well preserved bone collagen content (Van Gieson staining) and normal plateau surface contour [microcomputed tomography (microCT)] of implanted bone was observed in RANK(-/-) mice subjected to UHMWPE stimulation. In conclusion, this study provides the evidence that UHMWPE particles induce strong inflammatory responses, but not associated with osteoclastic bone resorption in RANK(-/-) mice. This indicates that RANK signaling is essential for UHMWPE particle-induced osteoclastic bone resorption, but does not participate in UHMWPE particle-induced inflammatory response.     

以失用为主要表现的胼胝体梗死

目的探讨胼胝体梗死的临床表现、病因及鉴别诊断特点。方法对2005年7月收治的1例53岁男性胼胝体梗死患者的临床表现、影像学特点、病因机制及其治疗过程进行回顾分析。结果临床主要表现为发作性黑蒙、言语不利,既往有高血压、糖尿病、脑梗死、吸烟、饮酒史,体格检查以失用为主要表现。头部MRI检查可见左侧脑室旁、胼胝体梗死,右侧基底节、脑桥陈旧性腔隙性梗死;脑血管造影检查显示为多发性血管狭窄,其中以左侧大脑中动脉、右侧颈内动脉及基底动脉最为严重。经颈内动脉内膜剥离术及颈内动脉支架植入术治疗,临床症状缓解。结论失用可以是胼胝体梗死的主要表现,其病因是在脑动脉粥样硬化基础上的血流动力学改变,患者预后良好。     

Fas/FasL在各阶段婴幼儿血管瘤中的表达及意义

目的 检测Fas／FasL在各阶段婴幼儿血管瘤组织中的表达，探讨Fas／FasL在婴幼儿血管瘤细胞凋亡中的作用。方法 应用EnVision法免疫组化染色和RT-PCR检测Fas／FasL蛋白及mRNA在各阶段血管瘤组织中的表达。结果 ①增生早期和增生中期，部分血管瘤细胞表达Fas；增生晚期，阳性细胞明显增多，Fas mRNA表达最强；消退早期，仍有少量微血管内皮细胞表达Fas，之后Fas表达迅速减弱。②最早期细胞团中没有FasL（＋）细胞；增生中期，血管瘤组织中出现少量FasL（＋）细胞；增生晚期FasL（＋）细胞显著增多，FasL mRNA表达最强；消退早期之后，FasL（＋）细胞迅速减少以至消失。结论 Fas／FasL与婴幼儿血管瘤演变过程有密切联系，Fas／FasL介导的血管瘤细胞凋亡可能是婴幼儿血管瘤自行消退的重要原因。     

X线及MRI对聚丙烯酰胺凝胶隆胸后乳腺病变诊断价值的评价与比较

目的对聚丙烯酰胺凝胶(PAG)注射式隆胸术后,出现并发症或合并乳腺其他病变的X线与MRI的诊断价值进行评估。方法回顾性分析26例PAG隆胸术后钼靶X线与MRI的影像表现。结果钼靶X线及MRI能显示充填物位置、形态,合并乳腺病变4例,X线全部漏诊,MRI能检出病灶。结论钼靶X线是PAG隆胸术后普查、随访的首选方法,但出现并发症或者合并乳腺病变时,MRI具有无法比拟的优越性,在临床诊断与治疗中发挥了重要作用。     

主动呼吸控制技术(ABC)在肺癌放射治疗中的应用

目的：使用主动呼吸控制技术（aetive brething control,ABC）治疗非小细胞肺癌患者，评价呼吸运动时肺部肿瘤动度的影响及ABC技术的优势和可行性，并评价近期疗效和急性放射反应。方法：选择9例使用ABC技术联合三维造型放疗技术治疗的非小细胞系癌患者进行分析。CT定位扫描时分别采集ABC和自由呼吸（free breath.FB）状态下的图像，评价呼吸运动对肺部肿瘤动度和PTV边界的影响唾弃；并比较两种计划的DVH，放疗剂量为54-60Gy/18-20次。3Gy/次，1次/天，5天/周，定期随访，评价近期疗效及急性放射反应。结果：应用ABC技术后，隔肌的平均位移从FB时的43.5mm（20.0-32.0mm）降低为3.6mm（0.5-72.mm）,胸壁的侧方位移从FB时的3.2mm（2.8-4.0mm）降低为1.2mm（0.5-1.6mm）.PTV边界可以从FB时的1.5mm减少为0.75cm;肺的V20从21.8%降低为15.0%,减少了30.6%.中位随访6个月时,9例患者中有6例CR,3例PR.急性放射副反应都很轻微,仅为I-II.结论：在肺癌的精确放射治疗中,呼吸动度的影响不可忽视.而ABC系统可以有效的降低呼吸运动时治疗的影响,提高放疗的精确性,减少副反应.,但该系统使用较为复杂,延长了治疗的时间,个别患者不能忍受.     

增强子Ⅰ对乙型肝炎病毒DNA疫苗免疫应答的影响

目的 研究乙型肝炎病毒（HBV）自身增强子I（enhancerI，ENHI）对HBV DNA疫苗免疫应答的影响。方法 采用PCR法以HBVadr亚型全基因DNA序列为模板分别扩增表面抗原（HBsAg）和HBsA-ENHI基因片段，重组到载体VR1012中，构建两种HBV DNA疫苗，转染CADS-7细胞及HepG2细胞并免疫BALB／c小鼠。采用蛋白印迹、ELISA、ELISPOT等方法检测其在COS-7和HepG2细胞内的表达及小鼠的体液及细胞免疫应答效果。结果 转染的HepG2和COS-7细胞均表达HBsAg;连接ENHI的HBV DNA疫苗转染HepG2细胞后HBsAg表达量明显升高，两种疫苗转染COS-7细胞表达HBsAg无明显差异；免疫小鼠后第2周产生HBsAb及HBsAg特异性细胞毒T淋巴细胞（CTL），两种疫苗免疫产生的HBsAb及HBsAg特异性CTL无明显差异。结论ENHI可使HBV DNA疫苗转染HepG2细胞表达HBsAg明显增加，对转染COS-7细胞表达HBsAg及接种BALB／C小鼠引起的免疫应答无明显影响。     

醋酸精氨酸对创烧伤患者预后的影响及安全性分析——86例多中心、随机、双盲、安慰剂对照试验

目的观察服用醋酸精氨酸对创烧伤患者预后的影响及可能出现的不良反应。方法采用多中心、随机、双盲、安慰剂平行对照的研究方法,将96例创烧伤患者(实际完成86例)随机分为治疗组和对照组,治疗组41例,服用醋酸精氨酸0．4 g·kg-1·d-1;对照组45例,服用安慰剂酪氨酸,剂量同前,均连用7 d。两组患者采用等氮、等热量的营养支持疗法。比较患者创面(切口)愈合时间、住院时间及不良反应发生情况。结果创伤患者治疗组(29例)创面(切口)愈合时间和住院时间分别为(11．1±2．8)、(19±6)d,明显短于对照组(13．2±5．5)、(22±6)d(33例,P< 0．05);烧伤患者治疗组(12例)创面愈合时间和住院时间各为(20±5)、(28±6)d,与对照组(22±8)、(29±8)d(12例)比较,差异无统计学意义(P>0．05)。在整个试验过程中,患者出现的不良反应为恶心、腹泻,其中治疗组1例占2．44％,对照组1例占2．22％,两组比较差异无统计学意义(P= 1．000)。以上不良反应停药后消失。结论服用醋酸精氨酸能显著促进创伤患者创面(切口)愈合,缩短住院时间,且无明显不良反应,但对烧伤患者的预后无明显改善,这可能与病例数较少有关,其确切疗效有待于通过大样本的临床试验予以确定。