17-二甲基胺乙基-17-去甲氧基格尔德霉素对人胃癌裸鼠移植瘤血管内皮生长因子表达的抑制作用

目的:观察热休克蛋白90(HSP90)抑制剂17-二甲基胺乙基-17-去甲氧基格尔德霉素(17-DMAG)对人胃癌裸鼠移植瘤生长的影响,探讨17-DMAG对胃癌生长和血管生成的抑制作用。方法:用人胃癌细胞HGC-27接种于裸鼠皮下,建立裸鼠胃癌移植瘤模型;将荷瘤裸鼠随机分为3组,每组8只:17-DMAG组(腹腔注射17-DMAG 25 mg/kg)、5-氟尿嘧啶(5-FU)组(腹腔注射5-FU20 mg/kg)及对照组(腹腔注射生理盐水10mL/kg),4周后测量裸鼠移植瘤的体积及重量,HE染色观察形态学变化,同时采用免疫组化方法检测肿瘤组织中CD31(以阳性细胞数计算肿瘤微血管密度)及血管内皮生长因子(VEGF)的表达,采用Western blotting法检测VEGF的表达。结果:17-DMAG组移植瘤体积为(288.10±23.32)mm3,5-FU组移植瘤体积为(366.37±26.42)mm3,对照组移植瘤体积为(957.66±117.51)mm3,前二者与对照组比较,均差异显著(P0.05)。移植瘤重量与对照组比较,17-DMAG组(0.41±0.02)g明显低于对照组(1.12±0.08)g,P0.05;5-FU组(0.48±0.05)g也明显低于对照组(1.12±0.08)g,P0.05;17-DMAG组和5-FU组抑瘤率分别63%和57%,2组抑瘤率无明显差异。17-DMAG组微血管密度(21.72±1.24)比对照组(37.78±1.68)明显减少,P0.05;5-FU组(36.70±1.51)和对照组(37.78±1.68)之间没有显著差异;17-DMAG组肿瘤组织中VEGF的表达(15.39±4.37)明显低于对照组(36.45±7.45)和5-FU组(26.11±6.26)。结论:热休克蛋白90抑制剂17-DMAG可通过降低胃癌组织中血管内皮细胞生长因子的表达抑制肿瘤新生血管的生成,进而抑制裸鼠移植瘤的生长。     

胃癌同时合并腹水的临床病理特点及D2根治手术对预后的影响

目的分析182例胃癌同时合并腹水患者的临床病理资料,探讨D2根治术对预后的影响。方法回顾性分析我科1994年9月-2009年9月182例胃癌同时合并腹水及胃癌无腹水1 124例的临床病理资料和随访状况。结果胃癌同时合并腹水与卵巢瘤、盆底结节、浸润深度、转移淋巴结、腹膜种植、肝转移、BORRMANN分型、脏器侵犯、CEA〉5μg/L有关,有显著统计学意义（P〈0.01）,而性别、年龄、WHO组织学分型、分化程度与胃癌同时合并腹水无关（P〉0.05）,Logistic回归分析发现盆底结节（P=0.005）、腹膜种植（P=0.000）及脏器侵犯（P=0.000）与胃癌同时合并腹水关系最密切。胃癌同时合并腹水行D2根治术后1、3、5年累积生存率达45%、34%、26%,未行D2根治术1、3、5年的累积生存率只有17%、5%、1%（P=0.000、0.000、0.000）。结论胃癌同时合并腹水是胃癌晚期事件,胃癌同时合并腹水预后比无腹水的患者差;胃癌合并腹水推荐行标准的D2根治术,可改善胃癌同时合并腹水患者的远近期生存率。     

缺血性中风发病的时间节律

疾病的发生遵循一定规律,研究时间节律对探讨其发病机制、预防和降低发病率有重要意义。缺血性中风具有年节律和日节律的特点,发病有集中的倾向,在冬春季和清晨高发。现代医学根据人体生理活动昼夜交替而周期变化的特点,通过科研调查不断探索中风发生发展及防治的规律。中医时间医学依据阴阳五行学说和天人相应理论,认识中风的好发规律和发病高峰,制定出因时制宜的时辰防治原则。     

下瘀血汤中大黄生熟互换对热结血瘀模型大鼠血管内皮功能及微循环的影响

目的 研究下瘀血汤中大黄生熟互换对热结血瘀模型大鼠血管内皮功能及微循环的影响。方法 采用ig 热性中药结合sc 盐酸肾上腺素的方法,复制热结血瘀大鼠模型。大鼠ig 热性中药28 d,第22 天起sc 盐酸肾上腺素,并ig 相应的药物。第29 天,眼眶取血检测检测血管内皮素（ET）、一氧化氮（NO）、前列环素（PGI₂）、血管性血友病因子（vWF）;股动脉取血,检测血液流变学各项指标。结果 含生大黄（复方A）和熟大黄（复方B）下瘀血汤均具有改善热结血瘀模型大鼠血液流变学、血管内皮细胞损伤和微循环的作用;与复方A 相比,复方B 各剂量组对血液流变学各指标、ET、NO、PGI₂、vWF 因子水平具有显著的改善作用（P<0.05、0.01）。结论 含熟大黄下瘀血汤的活血化瘀作用更强,可能是通过调节ET、NO、PGI₂、vWF 因子水平而实现的。     

下呼吸道感染的抗菌药物应用分析

目的 调查和评价下呼吸道感染抗菌药物的使用情况,以指导临床合理用药.方法 回顾性分析某医院2008年1月-2010年12月405例下呼吸道感染患者的抗菌药物治疗情况.结果 头孢菌素类、喹诺酮类、大环内酯类是下呼吸感染使用最多的3大类抗菌药物;抗菌药物单用的101例占24.94％,二联应用280例占69.14％,三联应用24例占5.93％;405例患者中有158例送痰标本做细菌培养,送检率为39.01％,其中只有38例阳性,阳性率为24.40％.结论 该医院下呼吸道感染的治疗,以经验性抗感染治疗为主,病原学检查重视不够,应加强管理.     

胃癌腹膜种植临床病理特征及手术对预后的影响

目的了解不同区域腹膜种植胃癌临床病理特征及手术治疗对预后的影响。方法中山大学附属第一医院1994年8月至2006年3月共收治107例胃癌伴单纯腹膜种植,分析其临床病理参数并评估外科治疗对预后的影响。依种植区域分为结肠上区(SC)、结肠下区(IC)、全腹膜种植(TPS)3组。结果TPS组的年龄较单区域种植组小(P<0.05),SC和TPS组发生脏器侵犯的比例高于IC组(P<0.05)。病灶全切除、病灶姑息性切除较旁路或造口手术、探查活检术的存活期明显延长(P<0.05),手术方式为独立预后因素。淋巴结清扫组较未清扫组的存活期显著延长(P<0.01)。全胃切除(TG)、部分胃切除(PG)较未切胃(NG)的存活期明显延长(P<0.05)。结论低龄胃癌病人容易发生远处腹膜种植,结肠上区和全腹腔种植者易发生局部脏器浸润,病灶全切除和姑息性切除、适度淋巴清扫可提高病人存活期,在满足病灶切除条件下,应首选部分胃切除而不是全胃切除。     

艾灸“肾俞”早期干预去卵巢合D-半乳糖注射AD样大鼠效应中的特异性

ObjectiveTo observe the effect of the early intervention with moxibustion at “Shènshū (肾俞 BL23) ” on learning and memory of Alzheimer's disease (AD) rats modeled by ovariectomy and D-Galactose (D-Gal) injection and the effect on Ca²⁺/CaMKII/CREB signaling pathway so as to provide the evidence for the acupoint selection in the early intervention with acupuncture and moxibustion for AD.MethodsSixty female SD rats at the age of 3 months were selected and randomly divided into a normal group, a sham-operation group, a model group, a “BL23” group, a “Wèishū” (胃俞BL21) group, and a non-acupoint group, 10 rats in each group. Except in the normal group and the sham-operation group, bilateral ovaries were removed in the other 4 groups. 3 days after the operation, D-Gal was injected intraperitoneally at a dose of 150 mg/kg/d for 90 days to establish AD rat model. In the sham-operation group, only the peripheral fat of ovarian was removed and 0.9% normal saline was injected intraperitoneally of the same dose for 90 days. In the “BL23” group, the “BL21” group and the non-acupoints group, since the 2nd day after ovariectomy, moxibustion was applied at 9:00 a.m. every day in the rats. The rats were fixed on a fixed table, the mild moxibustion with self-prepared moxa stick was applied to bilateral “BL23” “BL21” and the non-acupoint of each rat, the ignited end of moxa stick was 2 cm to 3 cm far from skin surface. The infrared thermometer was adopted to measure the temperature of the epidermis of each acupoint from time to time so as to maintain the local temperature to be (41 ± 0.5) °C. Mild moxibustion lasted for 10 min each time, consecutively for 5 days a week and at an interval of 2 days. The total consecutive intervention duration was 12 weeks. In the normal group and the sham-operation group, no moxibustion intervention was performed, but the rats were restricted in a same way during the experiment. At the end of modeling and intervention, water maze test was adopted to detect the learning and memory abilities of rats in each group. The western blotting was used to detect the expressions of p-CREB, p-CaMKII, CaMKII and CREB in hippocampus of rats in each group.Results(1)Navigation test: since Day 72, compared with the sham-operation group, the escape latencies in all of the consecutive 5 days were longer in the model group (all P < 0.05). Since Day 73, compared with the normal group, the escape latency in all of the consecutive 4 days was shorter in the “BL23” group (all P < 0.05). (2) Times across platform: compared with the normal group, the number of times consecutively crossing the platform was lower in the model group (P < 0.05). After moxibustion, compared with the model group, the number of times across platform was higher in the “BL23” group, indicating a statistical significance (P < 0.05). (3)Moving track of water maze spatial probe: the “tendency” strategy was displayed in the normal group and the sham operation group. The “marginal” strategy, which is commonly seen in the AD rats, was displayed in the model group. The “random” strategy was displayed in the “BL23” group. The “marginal” strategy was presented in the “BL21” group and the non-acupoint group. (4) Expressions of hippocampal P-CAMKII, CAMKII, CREB and P-CREB in the rats: compared with the normal group, the phosphorylation degrees of CAMKII and CREB were significantly reduced (both P < 0.05) in the model group. In 12 weeks of moxibustion, compared with the model group, the levels of P-CAMKII and P-CREB were increased in the “BL23” group and the “BL21” group (all P < 0.05) and the levels in the “BL23” group were higher than that of the “BL21” group and the non-acupoint group (all P < 0.05).ConclusionMoxibustion at “BL23” achieves a better effect in improving the learning and memory of AD rats modeled by ovariectomy and D-Gal injection as compared with moxibustion at “BL21” and the non-acupoint. The effect mechanism is potentially related to the effective activation of Ca²⁺/CaMKII/CREB signaling pathway.     

应用Amplatzer血管塞封堵动脉导管未闭及初步疗效评价

目的:应用Amplatzer血管寨封堵动脉导管未闭(PDA)并对其疗效进行评价.方法:全组共11例,年龄4.0-17.0(10.09±5.17)岁,体重15～63(35.05±16.20)kg.PDA长度为8.4～20.9(14.09±3.50)mm,最狭窄处均位于肺动脉侧,直径为1.0～2.0(1.48±0.35)mm;经导管置入Amplatzer血管塞封堵PDA.封堵后5～10 min行胸主动脉造影评价疗效,术后24 h、1个月、3个月及1年进行随访观察有无残余分流及再通.结果:全组技术成功率为100%,无任何并发症.术后10 min胸主动脉造影示11例动脉导管均完全闭合,无残余分流;5例完成1年随访,PDA完全闭合,未见再通.结论:应用Amplatzer血管塞封堵类似于长管状的PDA是一种安全、有效的非手术方法,技术成功率高,即刻效果好,近、中远期随访疗效可靠.     

脑出血后脑水肿的治疗

按病理形态和发病机制脑水肿分细胞毒性、血管源性和间质性三种 ,脑出血后脑水肿一般以前二者为主。脑出血后血肿压迫引起周围脑组织缺血以及血液循环障碍、酸中毒和和代谢紊乱 ,血浆和细胞中的血管活性物质引起血管痉挛、血管扩张或通透性改变 ,红细胞毒性效应和血红蛋白裂解产物导致的水肿形成与血脑屏障破坏促进了出血区脑水含量的增加[1] ,血浆中的白蛋白、膜性成分及胞内大分子物质经组织间隙渗透入脑组织 ,加重脑水肿 ,促进颅内压增高 ,甚至产生脑疝。因此 ,积极治疗脑水肿是改善脑出血预后的关键。现就脑出血后脑水肿的治疗综述如下…     

Hybrid技术一期经胸矫治小婴儿主动脉缩窄合并室间隔缺损

作者对4例主动脉缩窄合并室间隔缺损的小婴儿,首次尝试经升主动脉径路,一期球囊血管成形术加室间隔缺损修补术,现报告如下.