淋巴细胞绝对数减少在非霍奇金淋巴瘤中的临床意义

目的:探讨非霍奇金淋巴瘤(NHL)患者初发时淋巴细胞绝对数(ALC)与其临床特征的相关性,并探讨其预后参考价值。方法:回顾性分析2007年1月-2010年10月间我院新确诊的210例NHL患者的临床特征,结合随访资料,分析不同ALC水平与NHL患者各临床特征及其预后的相关性。结果:在本组NHL病例中,中位年龄58岁,结外淋巴瘤占有一定比例(47.1%)。ALC中位数为1.2(0.1～13.9)×109/L,25%～75%的置信区间分界值为(0.7～1.8)×109/L。我们发现,ALC<1.2×109/L时,其与患者的年龄、性别、淋巴瘤类型、临床分期、IPI预后指数、骨髓浸润、贫血等临床特征并无显著相关性,但常伴有LDH水平的升高,且表现B症状,而此类患者临床缓解率相对较低,死亡率较高(P<0.05)。继续以ALC<1.0×109/L作为分界点时,除上述特点外,年龄差异开始具有统计学意义,ALC减少更多见于老年淋巴瘤患者(P<0.01)。最后以ALC<0.7×109/L作为临床分界点时,ALC减少的NHL患者除了涵盖上述临床特点外,T细胞淋巴瘤所占比例也明显升高(P<0.01),此类患者临床分期更晚,IPI积...     

上皮性卵巢癌组织中EGFR、KRAS的表达变化及意义

目的观察表皮生长因子受体（EGFR）、鼠Kirsten肉瘤病毒致癌基因（KRAS）蛋白在上皮性卵巢癌（下称卵巢癌）组织中的表达变化,并探讨其临床意义。方法采用免疫组化SP法检测45例卵巢癌组织中的EGFR、KRAS蛋白,另选18例卵巢良性肿瘤组织和30例正常卵巢组织为对照。结果卵巢癌组织中EGFR、KRAS蛋白表达明显高于卵巢良性肿瘤和正常卵巢组织（P均〈0．05）。EGFR阳性表达率与卵巢癌临床分期有关（P〈0．05）,KRAS蛋白阳性表达率与卵巢癌临床分期、分化程度有关（P〈0．05）;卵巢癌组织中EGFR与KRAS蛋白表达呈正相关（r=0．613,P〈0．05）。结论卵巢癌组织中EGFR、KRAS蛋白表达明显上调,且两者呈正相关关系,在卵巢癌的发生、发展中起重要作用;KRAS蛋白可能为卵巢癌发生发展的始动因素,可作为卵巢癌的早期诊断指标之一。     

普伐他汀联合髓芯减压术治疗激素性兔股骨头坏死的实验研究

目的研究普伐他汀联合髓芯减压术治疗激素性兔股骨头坏死对组织病理学、骨形态发生蛋白2(BMP2)和血管内皮生长因子(VEGF)mRNA表达水平的影响。方法 45只实验大白兔制作成激素性股骨头坏死模型后随机分为三组:髓芯减压术治疗组(A组),普伐他汀联合髓芯减压术治疗组(B组)和模型组(C组),每组各15只。观察各组各时期兔股骨头毛细血管数、管径、骨陷窝空缺百分比以及BMP2、VEGFmRNA表达水平。结果 A、B两组第4周BMP-2、VEGFmRNA表达水平(7.4±1.1,8.0±1.0;0.118±0.027,0.129±0.023)与C组比较无统计学差异(7.2±0.8;0.117±0.024)(P>0.05)。而B组第8周和第12周BMP-2、VEGFmRNA表达水平(10.5±2.4,13.8±3.2;0.341±0.047,0.562±0.059)明显高于A组(8.0±1.7,8.8±2.0;0.137±0.033,0.149±0.048)、C组(7.6±1.6,7.7±1.8;0.126±0.035,0.131±0.041)(P<0.05);且随治疗时间延长,B组BMP-2、VEGFmRNA表达水...     

Self-efficacy, physical activity and health-related quality of life in middle-aged meniscectomy patients and controls

Our purpose was to examine self-efficacy of knee function, physical activity (PA) and health-related quality of life (HRQoL) in post-meniscectomy patients and controls as well as to explore the impact of gender and the association between outcomes. Ninety-nine post-meniscectomy patients (27% women), mean age 44.5 years, mean (range) of follow-up time 3 (1-5) years, and 94 controls (34% women), mean age 45 years, completed the following questionnaires: the Knee Self-Efficacy Scale (K-SES(ABC) ), the Physical Activity Scale (PAS) and the Short Form-36 (SF-36). Patients scored lower than controls in K-SES(ABC) and in the SF-36 subscales Physical Functioning and Bodily Pain (P≤0.002). Forty-six percent of the patients had resumed pre-injury PA, but current PA did not differ between the groups. In the patients, K-SES(ABC) correlated strongly with four physical SF-36 subscales and one mental scale (Vitality) (r(s) =0.56-0.85, P<0.001) and moderately with three subscales: (r(s) =0.35-0.46, P<0.001) and with PAS (r(s) =0.42, P<0.001). Females scored lower than males in K-SES(ABC) (P=0.006) and in four SF-36 subscales (P<0.04), but reported similar PA as men. We conclude that meniscectomy in middle-aged individuals may lead to lower self-efficacy of knee function, a sedentary lifestyle and poorer HRQoL.     

In vivo transport of Gd-DTPA(2-) in human knee cartilage assessed by depth-wise dGEMRIC analysis

Purpose:

To investigate the transport of Gd‐DTPA^2? in different layers of femoral knee cartilage in vivo.

Materials and Methods:

T₁ measurements (1.5 Tesla) were performed in femoral knee cartilage of 23 healthy volunteers. The weight‐bearing central cartilage was analyzed before contrast and at eight time points after an intravenous injection of Gd‐DTPA^2?: 12–60 min (4 volunteers) and 1–4 h (19 volunteers). Three regions of interest were segmented manually: deep, middle, and superficial.

Results:

Before contrast injection, a depth‐wise variation of T₁ was observed with 50% higher values in the superficial region compared with the deep region. In the deep region, the uptake of Gd‐DTPA^2? was not detected until 36 min and the concentration increased until 240 min, whereas in the superficial region, the uptake was seen already at 12 min and the concentration decreased after 180 min (P < 0.01). There was a difference between medial and lateral compartment regarding bulk, but not superficial Gd‐DTPA^2? concentration. The bulk gadolinium concentration was negatively related to the cartilage thickness (r = ?0.68; P < 0.01).

Conclusion:

The depth‐wise and thickness dependent variations in Gd‐DTPA² transport influence the interpretation of bulk dGEMRIC analysis in vivo. In thick cartilage, incomplete penetration of Gd‐DTPA² will yield a falsely too long T₁. J. Magn. Reson. Imaging 2011;. © 2011 Wiley Periodicals, Inc.

     

颅外脑膜瘤的CT和MRI表现

目的:评价颅外脑膜瘤的CT和MRI表现特征及诊断价值.方法:回顾性分析6例经手术病理检查证实的颅外脑膜瘤的CT和MRI表现.其中,仅行CT检查者2例;仅行MRI检查者1例;CT及MRI均查者3例.结果:6例颅外脑膜瘤的CT及MRI表现为:①病变位于咽旁间隙者3例,咀嚼肌间隙者1例,眼眶者2例;②平扫CT上病变均表现为软组织密度肿块,其中3/5病变含有沙粒样钙化.平扫MRI上,病变在T2WI上均表现为不均匀高信号(“椒盐”征);③增强CT和MRI上,病变均呈明显强化表现;④位于咽旁间隙的病变推移(2例)或包绕(1例)颈内动脉,咽侧壁呈受压改变;⑤4/6例病变表现为与颅内脑膜瘤相连,相邻颅骨和眶壁表现为骨质增厚(4例)或吸收(1例).结论:颅外脑膜瘤的CT和MRI表现以软组织肿块内含钙化、“椒盐”征和邻骨受侵为特点.该病变的CT和MRI表现能为相关鉴别诊断提供有价值信息.     

利多卡因对脓毒症大鼠肺组织高迁移率族蛋白B1mRNA表达的影响

目的 探讨利多卡因对脓毒症大鼠肺组织高迁移率族蛋白B1( HMGB1) mRNA表达的影响.方法 雄性Wistar大鼠50只,体重200 ～ 250 g,采用随机数字表法,将其随机分为5组(n＝10):假手术组(S组)、脓毒症组(L组)、低、中和高剂量利多卡因组(LL1组、LL2组和LL3组).除S组外,其他4组采用盲肠结扎穿孔术制备大鼠脓毒症诱发急性肺损伤模型.LL1组、LL2组和LL3组分别于术毕、术后1、2h时腹腔注射利多卡因5、10、20 mg/kg,S组和L组给予等容量生理盐水.分别于术后24、48 h时处死5只大鼠,取肺组织,测定HMGB1 mRNA表达、髓过氧化物酶(MPO)活性和NF-κB活性,光镜下观察肺组织病理学结果.结果 与S组比较,其他4组肺组织HMGB1 mRNA表达上调,MPO活性升高(P<0.05);与L组比较,LL1组、LL2组和LL3组肺组织HMGB1 mRNA表达下调,MPO活性降低(P<0.01);LL1组、LL2组和LL3组肺组织HMGB1 mRNA表达依次下调,MPO活性依次降低(P<0.05).LL1组、屿LL2和LL3组肺组织NF-κB活性逐渐降低,肺组织损伤程度逐渐减轻.结论 利多卡因减轻脓毒症大鼠急性肺损伤的机制与下调肺组织HMGB1基因表达有关,其下调HMGB1基因表达的机制与抑制NF-κB活化有关.     

A randomized,placebo‐controlled trial of aprotinin to reduce primary graft dysfunction following lung transplantation

Herrington CS, Prekker ME, Arrington AK, Susanto D, Baltzell JW, Studenski LL, Radosevich DM, Kelly RF, Shumway SJ, Hertz MI, Bittner HB, Dahlberg PS. A randomized, placebo‐controlled trial of aprotinin to reduce primary graft dysfunction following lung transplantation.
Clin Transplant 2011: 25: 90–96. © 2010 John Wiley & Sons A/S. Abstract: Purpose: Severe primary graft dysfunction (PGD) is the major early problem following lung transplantation. Aprotinin, a serine protease inhibitor, has many anti‐inflammatory properties that might reduce or prevent lung injury. Our hypothesis was that the incidence of PGD could be reduced by a combination of donor lung perfusion and systemic administration of aprotinin to recipients. Methods and Materials: The study was randomized and placebo controlled. Donor lungs were perfused during procurement with 4 L Perfadex containing aprotinin (280 mg load + 70 mg/hL) or placebo. Aprotinin or placebo was also administered peri‐operatively to the recipients. The study was powered to detect a 10% improvement in the primary endpoint of developing ISHLT grade III PGD anytime within 48 hr following the transplant procedure. Results: There were 48 patients randomized. Diagnosis and the use of bypass were different between groups. The study was stopped prematurely at the planned interim analysis point because of published concerns about renal toxicity of aprotinin. There was no difference in the occurrence of the primary endpoint between groups of patients. The median change from the baseline creatinine level at 24, 48, 72 hr; 7 and 30 d following the transplant was not associated with the administration of aprotinin. Conclusions: There was no statistically significant difference in the incidence of the primary endpoint between groups in the study. Excess renal failure related to aprotinin administration in a patient population at high risk for the event was not observed.     

Caring assessment in the Swedish ambulance services relieves suffering and enables safe decisions

This study has a health care science approach and explores pre-hospital emergency care with emphasis on assessment. Health care science is focused on the patient with the general aim to describe care that strengthens and supports health. Assessment in the ambulance services has not been explored earlier from this perspective, despite the emphasis on ‘coming close’ to the acute suffering patient. The aim of the study is to describe and analyse assessment in caring situations. Data was collected by participant observations. The major findings point out the importance of professional carers’ recognition of the patient’s lifeworld as an essential part of assessment. The carers’ openness to the situation and to the patient’s suffering and needs vary from being of minor interest to complete focus of the assessment. It seems that assessments that focus solely on a patient’s medical condition can be an obstacle to a full understanding of the individual, and thereby the illness per se. A caring assessment based on an encounter and a dialogue between patient and carer, characterised by inviting the patient to participate, adds further dimensions to the objective data. Therefore, the inclusion of the patient perspective relieves suffering and enables more safe decisions.