鼻眶筛骨折手术治疗的临床评价

目的　探讨鼻眶筛骨折的手术入路、骨折复位与坚固内固定及合并眼球内陷的处理方法。方法　对 17例鼻眶筛骨折患者进行回顾性研究 ,根据CT结果与Fedor骨折分型分为三型 ,其中Ⅰ型 1例 ,Ⅱ型 7例 ,Ⅲ型 9例 ;13例选用鼻根正中入路 ,3例鼻旁入路 ,7例需同时附加眶下切口。 8例合并眼球内陷者采用眼球赤道后方碘仿纱条填塞与植骨矫正法。结果　①本组病例平均内眦宽度和内眦宽度 /外眦宽度比例从 ( 35± 7)mm、( 37± 8) %恢复到 ( 32± 4 )mm、( 35± 7) %比较正常水平 ;②面部外形全部恢复到正常或接近正常 ;③ 8例眼球内陷患者术后 6例恢复到基本正常 ,2例术后仍有轻度凹陷 ,5例复视术后全部消失。结论　鼻根正中入路附加眶下切口可充分显露骨折片 ,结合坚固内固定技术可使骨折片解剖复位 ;内眦韧带复位固定是本手术关键所在 ,重建正常眶内容积和眶内容物准确复位 ,以解决眼球内陷和眼球运动受限问题     

乳舒胶囊镇痛、抗炎作用研究

目的：研究乳舒胶囊(RS)的镇痛、抗炎药效。方法：采用RS灌胃给药后，分别用甩尾法、热板法、扭体法研究RS对乳腺增生模型大鼠及小鼠的镇痛作用，分别用二甲苯法、琼脂法研究RS抑制小鼠耳廓炎症及大鼠慢性炎症性肉芽肿的作用。结果：乳舒胶囊能提高乳腺增生模型大鼠和小鼠的痛阈值、能减少醋酸致扭体疼痛小鼠的扭体次数、延长其发生扭体的潜伏期，有明显的镇痛作用；还可以抑制琼脂所致的大鼠肉芽肿和二甲苯致小鼠耳肿胀，有明显的抗炎作用。结论：乳舒胶囊镇痛、抗炎作用明显、疗效确切。     

颅内室管膜下瘤2例报告

目前，室管膜下瘤的组织学起源仍不明确。但很可能来源于室管膜下层的胶质细胞。此类肿瘤呈膨胀性生长．是生长缓慢、非侵袭性的一种低级别胶质瘤，有症状者非常少见．至今国内外文献报道的有症状病例仅百余例。本文报道了我科收治的2例颅内室管膜下瘤患者的临床特点、影像学特点、和手术治疗效果。     

食管平滑肌瘤的微创手术治疗

目的探讨微创手术在食管平滑肌瘤治疗中的临床应用价值. 方法回顾性分析1996年9月～2002年10月26例食管平滑肌瘤采用微创手术治疗的临床资料. 结果电视胸腔镜食管平滑肌瘤摘除术23例,其中3例(2例胸膜腔紧密粘连,1例肿瘤无法定位)中转开胸(胸腔镜辅助小切口);经颈部食管平滑肌瘤摘除术2例;经食管镜食管平滑肌瘤切除1例.26例手术顺利,术后恢复平稳,无手术死亡及严重并发症,术后病理诊断均为平滑肌瘤.随访2～73个月,平均32.3个月,无复发. 结论电视胸腔镜肌瘤摘除术可作为食管固有肌层平滑肌瘤的首选治疗方法,对于食管粘膜肌层的平滑肌瘤,可考虑经食管镜切除.     

周围神经损伤后勃起功能障碍的治疗进展

外伤、手术可因盆神经丛和 (或 )海绵体神经损伤而造成勃起功能障碍。较理想的治疗方法是使损伤神经自我再生修复 ,完全恢复勃起功能。本文综述近年来勃起神经损伤后再生修复方面的研究进展 ,试图寻找出一种促进损伤的勃起神经再生的最佳方法     

Ki67、P53及微血管密度在大肠肿瘤中的表达

目的 研究Ki67、P53及微血管密度(microvessel density,MVD)在大肠肿瘤中的表达,探讨其与大肠肿瘤癌变的关系及作为早期癌变生物学标志物的可能性。方法 采用免疫组化技术分别测定正常大肠黏膜、大肠息肉及大肠癌组织标本中Ki67、P53及MVD值,共80例,分析其变化规律及相关性。结果 在正常黏膜、大肠息肉、大肠癌组中的Ki67标记指数逐渐增高(分别为11.00±10.70、39.64±17.70、52.96±26.40),组间比较差异显著(P=0.0001)。正常黏膜组P53蛋白均为阴性,大肠癌组P53蛋白表达的阳性率明显高于息肉组(P=0.0001)。Ki67、P53蛋白表达与性别、年龄、病程、病变部位、大小、大肠癌的病理类型、Dukes分期均无相关性。正常黏膜、大肠息肉、大肠癌组的MVD值(14.80±5.10、19.70±7.84、36.56±20.40)逐渐上升,3组差别显著(P=0.0001)。大肠癌中Dukes C、D期的MVD值(40.56±3.49)明显高于A、B期(29.50±2.45)(P=0.016)。Ki67与P53在各种组织中的表达呈正相关(r=0.5149,P=0.015)。联合检测Ki67及P53鉴别大肠良恶性病变的敏感度(70.37％)低于单侧Ki67(96.30％),但特异度(94.34％)明显增高。结论 Ki67标记指数可反映细胞增殖状态,指数高的大肠腺瘤易发生癌变。MVD值高的大肠癌易发生转移,MVD可作为判断大肠癌预后的参考指     

Regulation of PTC phenotype and function by TGF-β1: implications for transdifferentiation

Introduction There is now increasing evidence that proximal tubular cells (PTCs) contribute to renal interstitial fibrosis by alteration of matrix turnover and by the generation of pro‐fibrotic cytokines such as TGF‐β1. Recent studies suggest that, through a process of transdifferentiation, the PTCs are one source of the interstitial myofibroblasts that directly drive the fibrotic process. The aim of this work was to examine the role and mechanism by which TGF‐β1 may regulate PTC phenotype and function. Methods Experiments were performed using both primary‐cultures of PTC and the human PTC cell line HK2. All experiments were performed on growth‐arrested cells in the absence of serum. Results TGF‐β1 altered cell phenotype, assessed by light microscopy, with cells appearing elongated and spindle‐shaped. This was associated with loss of cell–cell contact and rearrangement of the actin cytoskeleton, increased formation of stress fibres and focal adhesions. Disruption of the actin cytoskeleton with cytochalasin‐D prevented phenotypic alterations following addition of TGF‐β1. Transient transfection with Smad‐2/‐4 or Smad‐3/‐4 expression vectors did not alter cell phenotype. Previously, we have demonstrated β‐catenin translocation to PTC nuclei and its association with Smad proteins following addition of TGF‐β1, suggesting the possibility that TGF‐β1 may modulate Wnt signalling. Wnt‐responsive Xtwn‐reporter construct was, however, silent in response to TGF‐β1. Similarly, a second Wnt‐/LEF‐1‐regulated element Toplflash, which does not contain Smad‐binding sites, was insensitive to TGF‐β1 signalling. In contrast, phenotypic changes in response to TGF‐β1 were abrogated by inhibitors of the RhoA downstream target ROCK, which also prevented loss of cell–cell contact and adherens junction disassembly. Removal of TGF‐β1 and addition of 1% FCS, however, reverted cell phenotype to a typical cobblestone epitheliod appearance, suggesting that TGF‐β1 did not result in terminal PTC transdifferentiation. Cells grown on tissue culture dishes coated with either type‐I or type‐III collagen also acquired an elongated fibroblastic phenotype; this effect was exaggerated by the addition of TGF‐β1. In contrast to the cells stimulated with TGF‐β1 alone, following stimulation by both TGF‐β1 and exposure to interstitial collagens, cell phenotype was stable in that it was not reversed upon removal of TGF‐β1 and addition of FCS. Addition of TGF‐β1 to cells grown on type‐IV collagen had no greater effect than TGF‐β1 alone. Addition of TGF‐β1 alone had little effect on the expression of α‐SMA. In contrast, cells grown on either type‐I or type‐III collagen, following addition of TGF‐β1, demonstrated marked increased expression of α‐SMA, which appeared to be incorporated into the cell cytoskeleton. Similarly, the combination of interstitial collagen (either type‐I or type‐III) and TGF‐β1 had synergistic effect on the relocation and down‐regulation of the epithelial markers E‐cadherin and cytokeratin. Finally, the results demonstrated synergistic effects of coating with interstitial collagen (either type‐I or type‐III), on cell ‘fibroblastic’ cell function as assessed by cell migration and by the synthesis of type‐III and type‐IV collagen. Conclusion The results of these in vitro experiments suggest that terminal transdifferentiation of proximal tubular epithelial cells is the result of a combination of the effects of the pro‐fibrotic cytokine TGF‐β1 and exposure of the cells to components of the interstitial extra‐cellular matrix to which the cells are not exposed in the absence of damage to the tubular basement membrane.     

颞部-颌下联合进路切除咽旁颞下区巨大肿瘤(附2例报道)

[目的]探讨切除侵犯中颅窝的咽旁颞下区巨大肿瘤安全而彻底的手术进路.利用颞部切口可充分暴露中颅窝底和颞下窝以及颌下进路显露咽旁区解剖的特点,联合进路切除2例咽旁颞下区巨大肿瘤.2例侵犯中颅窝底的咽旁颞下区肿瘤顺利切除,患者术中组织损伤、出血量相对较少,术后无严重并发症.[结论]颞部-颌下联合进路适合于侵犯中颅窝底的咽旁颞下区肿瘤的手术切除.     

Protection of chickens against highly lethal H5N1 and H7N1 avian influenza viruses with a recombinant fowlpox virus co-expressing H5 haemagglutinin and N1 neuraminidase genes

Inactivated whole avian influenza virus (AIV) vaccine provides protection against homologous haemagglutinin (HA) subtype virus, but poor protection against a heterologous HA virus. Moreover, it induces chickens to produce antibodies to cross-reactive antigens, especially nucleoprotein, which is limits AIV serological surveillance. In this study, a recombinant fowlpox virus co-expressing HA (H5 subtype) and NA (N1 subtype) genes of AIV was evaluated for its ability to protect chickens against intramuscular challenge with a lethal dose of highly pathogenic (HP) AIV. Susceptible chickens were also vaccinated by wing-web puncture with the parent fowlpox vaccine virus. Following challenge 4 weeks later with HPAIV, all chickens vaccinated with recombinant virus were protected, while the chickens vaccinated with either the unaltered parent fowlpox vaccine virus or unvaccinated controls experienced 100% mortality following challenge. This protection was accompanied by the high levels of specific antibody to the respective components of the recombinant vaccine. The above results showed that rFPV-HA-NA could be a potential vaccine to replace current inactivated vaccines for preventing AI.     

经直肠超声引导前列腺穿刺活检203例临床分析

目的评估经直肠超声引导的前列腺六针穿刺活检在前列腺癌及前列腺其他疾病的诊断和鉴别诊断的价值。方法对指肛检查阳性，血清PSA〉4pg／L及经直肠超声检查前列腺声像图异常怀疑有占位性病变的203人进行经直肠超声引导的前列腺穿刺活检。结果穿刺活检的203例病理结果：良性前列腺增生（BPH）104例占51．24％，前列腺癌（PCa）95例占46．80％，前列腺结核及前列腺平滑肌肉瘤各2例，分别占0．98％。结论经直肠超声引导的前列腺穿刺活检其操作简单，病人痛苦小，并发症少，较安全。在前列腺癌及其他前列腺疾病的诊断与鉴别诊断中有重要的临床价值。