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.     

经乙状窦后入路显微手术治疗继发性三叉神经痛37例

目的探讨经乙状窦后入路显微手术治疗桥小脑角占位性病变引起的继发性三叉神经痛的疗效。方法回顾分析我院2000年10月～2006年7月37例继发性三叉神经痛的临床资料，其中胆脂瘤18例，脑膜瘤8例，听神经瘤6例，三叉神经鞘瘤5例，均经乙状窦后入路显微手术切除肿瘤。结果肿瘤全切23例，次全切除10例，部分切除4例。35例疼痛症状消失（32例立即消失，3例术后2个月消失），随访3个月～5年无复发；2例无效。发生暂时性面瘫6例，面部麻木6例，无颅内感染及脑脊液漏。结论经乙状窦后入路显微手术是治疗继发性三叉神经痛安全有效的方法。     

Differential retention of alpha-vitamin E is correlated with its transporter gene expression and growth inhibition efficacy in prostate cancer cells

BACKGROUND: Epidemiological studies showed Vit E has protective effects against prostate cancer (PCa). Interestingly, different prostate cancer cells have different sensitivity to alpha-Vit E or VES treatment. The goal of this study is to determine whether cellular Vit E bioavailability and its transport proteins are important contributing factors. METHODS: alpha-Vit E and its ester form, VES, were used to treat prostate cancer LNCaP, PC3, and DU145 cells, and their growth rates were determined by MTT assay. Cellular levels of Vit E were quantified using HPLC as the index of bioavailability. The expression levels of Vit E transport proteins were determined by real-time PCR. RESULTS: Among these PCa cells, only LNCaP cells were sensitive to 20 microM alpha-Vit E treatment, while both LNCaP and PC3 cells were sensitive to 20 microM VES treatment. Coordinately, cellular levels of alpha-Vit E and VES positively correlated to their inhibitory effects. Further study found expression levels of Vit E transport proteins, including tocopherol associated protein (TAP), scavenger receptor class B type I (SR-BI), alpha-tocopherol transfer protein (TTP), and ATP binding cassette transporter A1 (ABCA1), were different in various PCa cells, which may contribute to cellular Vit E bioavailability. This notion is further supported by the findings that overexpression or knockdown of TTP could coordinately alter cellular alpha-Vit E levels in PCa cells. CONCLUSION: Antiproliferative efficacy of alpha-Vit E is correlated with its cellular bioavailability in PCa cells. Modulating the expression of the efflux or influx transporters could sensitize the growth inhibition efficacy of Vit E in prostate cancer cells.     

肝硬化脾切除术后门静脉血栓形成相关因素的Meta分析

目的 评价肝硬化脾切除术后门静脉血栓形成的相关因素,为脾切除术后血栓的预防提供参考.方法 计算机检索Web of Science、PubMed、EMBASE、Science Direct、CNKI、VIP、CSCD、万方等数据库,检索时间截止2014年4月.并辅以手工检索、文献追溯等方法.纳入有关肝硬化脾切除术后门静脉血栓形成相关因素的病例对照研究,并进行文献质量评价.由两位研究者独立提取数据并采用Stata 12软件进行Meta分析.结果 共纳入24项符合标准的病例对照研究,病例数为4 335例.其中脾切除术后发生血栓的患者1 028例,血栓发生率为25.0％.Meta分析结果显示,肝硬化脾切除术后门静脉血栓的形成与脾脏体积(WMD=13.75,95％ CI:6.47 ～ 21.00)、脾静脉直径(WMD=1.34,95％ CI:0.39～2.30)、手术前后门静脉直径(术前WMD＝ 1.54,95％ CI:0.56～2.52;术后WMD=2.09,95％CI:0.55 ～ 3.64)、手术前后门静脉血流速度(术前WMD=-5.78,95％ CI:-10.46～-1.10;术后WMD=-5.57,95％ CI:-5.92～-5.22)、手术前后门静脉压力差(WMD=1.90,95％CI:1.29～2.50)、腹水(OR=1.83,95％ CI:1.19～2.82)以及术后抗凝干预(OR=0.63,95％CI:0.50 ～0.79)等有关;而与患者的性别、年龄、肝功、血小板计数、术前总胆红素、手术前后门静脉压力、手术前后凝血酶原时间及D-二聚体、手术时间以及糖尿病无关.结论 肝硬化脾切除术后门静脉血栓形成的主要危险因素为脾脏体积、脾静脉直径、门静脉直径、门静脉血流速度、腹水等,与患者基本情况、凝血相关指标、手术时间等无直接相关性.     

Retrospective Evaluation of the Effect of Mycophenolate Mofetil Dosage on Survival of Kidney Grafts Based on Biopsy Results

IntroductionPlasma concentration monitoring is commonly used to adjust immunosuppressant dosage in transplant recipients, but adjustment is often based on clinical experience rather than rigorous quantitative indicators.MethodsWe examined the effect of mycophenolate mofetil (MMF) dosage on graft survival by pathologic and immunologic analysis of 88 kidney recipients who were given a postoperative immunosuppressive regimen of tacrolimus (FK506), MMF, and corticosteroids. Patients were given a conventional dosage (≥1.5 g/d; n = 40) or a reduced dosage (n = 48) of MMF owing to postoperative adverse side effects.ResultsThe reduced-dose group included patients given low doses (≤1.0 g/d; n = 27), ultra-low doses (≤0.5 g/d; n = 15), and those who discontinued MMF (n = 6). The dose reduction group had increased acute rejection, chronic rejection, and graft dysfunction, poorer pathologic scores, and increased cell infiltration of graft tissue (CD4, CD8, CD68, and CD138 positivity) and expression of interleukin-2R and HLA-DR. Finally, hazard analysis indicated that patients given low doses and ultra-low doses of MMF had poorer long-term kidney grafts survival (hazard ratios of 1.52 and 1.78, respectively).ConclusionsThese results indicate the importance of using an appropriate dosage of MMF in kidney transplant recipients.     

内侧半月板退变性损伤的关节镜下分型

 目的 探讨内侧半月板退变性损伤的关节镜下分型及其临床意义。方法 2012年1至12月因内侧半月板退变性损伤接受关节镜手术者122例,不包括因重度滑膜炎需做滑膜切除者。男27例,女95例;年龄37~80岁,平均（61.8±8.9）岁。左膝63例,右膝59例。BMI平均（26.5±3.4） kg/m2,术前Lysholm评分（47.2±15.0）分。关节镜术中依据Outerbridge软骨损伤分级对软骨损伤进行评估,比较不同分型者（后角水平撕裂、后角根部损伤和复杂严重损伤）Ⅳ度软骨退变性损伤所累及的关节面数量及术前Lysholm评分。结果 后角水平撕裂33例,Ⅳ度软骨退变性损伤累及的关节面（1.24±1.48）个,术前Lysholm评分（52.5±14.4）分,其中疼痛评分（7.7±6.5）分;后角根部损伤16例,Ⅳ度软骨退变性损伤累及的关节面（1.13±1.26）个,术前Lysholm评分（37.5±8.4）分,其中疼痛评分（3.1±4.0）分;复杂严重损伤73例,Ⅳ度软骨退变性损伤累及的关节面平均（2.26±1.61）个,术前Lysholm评分平均（46.9±15.3）分,其中疼痛评分（6.8±5.4）分。后角根部损伤者术前Lysholm评分低于后角水平撕裂和复杂严重损伤者,差异有统计学意义;其中疼痛评分的差异也有统计学意义。后角根部损伤者Ⅳ度软骨退变性损伤累及的关节面数量与后角水平撕裂者的差异无统计学意义;均小于复杂严重损伤者,差异有统计学意义。结论 关节镜下内侧半月板退变性损伤可分为三种类型。后角根部损伤和后角水平撕裂的软骨退变性损伤相对较轻,是较早期的关节退变;其中后角根部损伤的临床症状和功能减退较为明显。复杂严重损伤的软骨退变性损伤相对较重,是较晚期的关节退变,但临床症状和功能减退却相对较轻。