静脉应用长托宁对高血压患者血压、心率的影响

目的：通过比较术前静脉注射长托宁或肌内注射阿托品对高血压患者心率、血压的影响,以确定高血压患者静脉注射长托宁的临床效果。方法：60例高血压患者随机分成两组,每组30例。分别于全麻诱导前30min静脉注射长托宁（实验组）或肌内注射阿托品（对照组）,记录患者给药前（T0）、给药后10min（T1）、20min（T2）、诱导前（T3）及气管插管后（T4）的血压、心率。结果：给药后实验组的血压、心率在各时点均低于对照组。与基础值比较实验组T1、T2、T3时点的血压、心率较基础值有下降趋势,但无统计学差异（P〉0.05）,T4时点的血压、心率增高,统计学差异显著（P〈0.05）。对照组T1、T2、T3时点的血压、心率较基础值升高（P〈0.05）,T4时点的血压、心率增高明显（P〈0.01）。结论：长托宁具有中枢镇静作用,可保护心率双向调节机制,更适用与高血压患者术前用药,值得临床推广应用。     

咪达唑仑联合舒芬太尼辅以硬膜外麻醉临床观察

硬膜外麻醉是临床常用的麻醉方法,但患者清醒和阻滞不全、牵拉反应常给手术和患者带来不必要的麻烦和痛苦,我们采用咪达唑仑、舒芬太尼辅以硬膜外麻醉取得满意效果,现报告如下。1资料与方法1.1一般资料本组病例共计500例,男218例,女272例,年龄18-76岁,体重44-86kg,ASA分Ⅰ级-Ⅱ级。其中胆囊切除4例,结肠直肠癌根治15例,阑尾切除62例,疝修补术54例,妇科手术309例,泌尿系手术56例。     

Omission of concurrent chemoradiation after a response to neoadjuvant chemotherapy in locally advanced rectal cancer with a synchronous liver metastasis: a note of caution

There is clear evidence to support the use of pre-operative concurrent chemo-radiotherapy (CRT) in locally advanced rectal cancer. In the UK, most patients are selected for treatment if the resection margin is predicted to be involved. The selection criteria used includes primary tumours that threaten the resection margins on high-resolution pelvic MRI and low tumours requiring abdominoperineal excision. There is no consensus, however, to guide the treatment of patients who present with advanced rectal disease and synchronous, potentially resectable, metastatic disease. This case illustrates the potential risk of omitting radiation following a good response to neoadjuvant systemic chemotherapy.     

近端型上皮样肉瘤临床病理研究

目的 探讨近端型上皮样肉瘤(PES)的临床病理特点、诊断及鉴别诊断依据.方法 收集5例PES患者资料,免疫组织化学EnVision法染色.第一抗体选用细胞角蛋白(CK)、波形蛋白、上皮细胞膜抗原(EMA)、CD34、β-catenin、S-100蛋白、平滑肌肌动蛋白(SMA)、肌调节蛋白(MyoD1)、结蛋白、HMB45、CK7及CK20,观察和分析其临床病理学形态及免疫表型特征.结果 5例PES中女1例,男4例;发病年龄19-46岁,发生部位分别为:会阴部2例,下腹部、髂前上棘和臀部各1例,均表现为进行性增大的无痛性单发肿块.光镜下肿瘤细胞呈结节状排列,浸润性生长,瘤细胞大部分由相对独特的上皮样细胞组成,胞质丰富,嗜酸性;核卵圆形,肿瘤中心常见坏死.免疫组织化学染色示5例瘤细胞均表达波形蛋白,4例表达CK、EMA,3例表达β-catenin、CD34,1例表达S-100蛋白;而SMA、MyoD1、结蛋白、HMB-45、CK7及CK20均阴性.结论 根据PES组织学和病理学特征,结合免疫组织化学染色结果可以做出明确诊断.     

AIDS相关性乌型细胞内分枝杆菌性肠病一例

患者男,24岁.因腹泻50 d于2009年1月入院检查.50 d前无明显诱因出现腹泻,大便为黄色水样便含有食物残渣,量200 g/次,最多每天达7～8次,无大便带血及黏液脓血便.同时伴有纳差、乏力,食欲不振,体重下降10 kg.     

FRNK高表达诱导HSC凋亡后MMP-2及TIMP-2的变化

目的 探讨黏着斑激酶相关非激酶（FRNK）诱导肝星状细胞（HSC）凋亡后基质金属蛋白酶-2及其抑制剂的变化。方法 在体外,以纤维连接蛋白（FN）刺激HSC增殖,在脂质体介导下用FRNK表达质粒瞬时转染HSC,应用膜联蛋白/碘化丙啶双标记流式细胞术和透射电镜检测细胞的凋亡,Western blot检测FRNK、FAK、p-FAK（Tyr397）、MMP-2、TIMP-2蛋白表达。结果 FRNK表达质粒成功转染HSC,在翻译后水平抑制FAK磷酸化。与空质粒组比较,FRNK表达质粒转染HSC 48 h后,HSC凋亡率由9.28%±1.05%增加至25.37%±1.92%（P<0.01）;同时,FRNK在翻译水平上调MMP-2表达、抑制TIMP-2表达。结论 在脂质体介导下瞬时转染FRNK表达质粒可诱导HSC发生凋亡,MMP-2/TIMP-2比值上调可能参与了该调节过程。     

大鼠肝纤维化组织中PTEN蛋白的定位分布

目的 探讨大鼠纤维化肝组织中PTEN蛋白的定位分布及其在肝纤维化病理过程中的作用。方法 结扎胆总管建立大鼠肝纤维化模型;用免疫组织化学染色测定大鼠肝组织中PTEN及α-SMA 蛋白的分布及表达;免疫荧光双标记共聚焦激光扫描显微术测定大鼠肝组织中活化肝星状细胞（HSC）的PTEN蛋白分布及表达。结果 随着肝纤维化的发展,大鼠肝纤维化组织中α-SMA阳性细胞明显增多(P<0.01),PTEN阳性表达细胞逐渐减少(P<0.01);PTEN蛋白在活化HSC广泛表达,主要表达于细胞质,随着肝纤维化的加重,表达PTEN的活化HSC占总的活化HSC的比例逐渐减少(P<0.01)。 结论 大鼠肝纤维化组织中PTEN阳性表达细胞减少,减少程度与HSC的活化、增殖呈负相关。     

稳定过表达p50基因细胞株的构建及鉴定

目的 筛选出稳定过表达p50基因的细胞克隆株ECV-p50,为研究dynei-n-dynactin复合体在登革病毒逆行性运输中的作用奠定基础.方法 将构建的pRe-p50质粒稳定转染至ECV304细胞,通过间接免疫荧光染色和免疫印迹实验进行鉴定.结果 经间接免疫荧光染色和免疫印迹实验验证,稳定过表达p50基因的细胞克隆株命名为ECV-p50.结论 成功建立了稳定过表达p50基因的细胞克隆株ECV-p50,为后续研究积累了有价值的实验资料.     

遗忘型轻度认知损害患者海马三维磁共振影像特点

Objective To identify the characteristics of hippocampal 3-dimensional MRI in patients diagnosed as having subtypes of amnestic mild cognitive impairment(aMCI)using hippocampal surfacebased analytic technique.Methods Fifry aMCI patients and 16 healthy controls who were equivalent in age and education(NC)were recruited.Every subiect carried out a 3-dimensional MRI scan.After the imaging data were acquired.the borders of the hippocampus were manually traced in coronal vlew using the software of InsightSNAP1.4.1. Hippocampal volume was computed automatically and statistically analysed.Hippocampal 3-dimension MRI were transformed into 3-dimension parametric surface mesh models of 400×200 prids.Hippocampal radial distance measures which was the distance from the surface point to the central axis were statistically compared between two groups.The radial atrophy significance maps were acquired and adjusted for multiple comparisons.Hippocampal morphological difference maps of aMCI in contrast with NC were acquired.Results The average normalized volume of left hippocampus were(3247.5±600.2)mm3 in aMCI patients and(3467.9±451.3)mm3 in NC subjects.The average normalized volume of right hippocampus were(3416.8±699.1)mm3 in aMCI patients and(3469.1±358.9)mm3 in NC subjects.Comparison of hippocampal volume did not differ significantly between aMCI patients and NC subjects(t=1.161,P=0.255;U=0.178,P=0.859).By using hippocampal surface-based morphologic analytic technique,3-dimension hippocampal morphological difference maps between two groups were acquired,showing significant atrophy on the lateral and inferior hippocampal surface which corresponded to CA1 and subiculum hippocampal subfields bilaterally in aMCI patients compared with NC subjects. Conclusions aMCI patients do not have significant volume loss in the hippocampus. Through hippocampal surface-based morphologic analyses, partial regional atrophy of hippocampus at some degree is found, mainly localizing in the lateral and inferior hippocampal regions which correspond to CA1 and subiculum hippocampal subfields bilaterally in aMCI compared with NC. These results may reflect the early image marker in aMCI.     

药物难治性癫痫外科治疗展望

癫痫是危害较大的神经系统疾病,其发病率在4‰～6‰.在我国有近600万癫痫患者,其中20%～30%患者对内科药物治疗效果不佳,是癫痫外科治疗的主要目标[1,2].近二十年来,随着神经电生理技术和神经影像学的飞速发展,药物难治性癫痫患者的术前定位和评估取得了明显的突破,外科手术已成为癫痫治疗的一种重要手段[2].同时,随着外科麻醉和手术技巧的不断改进,尤其是显微神经外科技术的应用,使癫痫的外科治疗越来越安全有效,外科治疗已成为治疗药物难治性癫痫患者的主要手段[2,3].