胸段食管癌切除术患者的预后分析

Objective To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. Methods From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the n, mher of lymph node metastases (0, 1 and ≥ 2), a new modification of the TNM classification was suggested: stage Ⅱ a (T2N0M0 and T3N0M0), stage Ⅱb [T1N1M0 and T2N1 (1) M0], stage Ⅲ a [T2N1 (2)M0 and T3N1 (1)M0] and stage Ⅲ b [T3N1 (2)M0 and T4NanyMO]. Results According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and ≥2 positive metastatic lymph nodes was 59.1%, 32.0% and 8.9%, respectively. The 5-year survival rate of the patients with stage T2N1M0 and stage T3N1M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P<0.01). The 5-year survival rate of the modified stage Ⅱa, Ⅱb, Ⅲa and Ⅲb was56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0. 01). Conclusion The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophngectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the S-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, ≥2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.     

人α-防御素-1(α-HNP-1)基因真核表达载体的构建及在大鼠骨髓间充质干细胞中的转染表达

目的构建人α-防御素-1(α-HNP-1)基因的真核表达载体,并且转染大鼠骨髓间充质干细胞。方法提取人外周血粒细胞中的总RNA,反转录为cDNA作为模板,采用PCR的方法扩增得到人α-防御素-1(α-HNP-1)的基因片断。将扩增产物连接入pGEM-T载体,转化大肠杆菌DH5α感受态细胞,蓝白筛选,对PCR及酶切鉴定含有目的片断的克隆进行测序。经测序证实无误后,将获得的pGEM-T-HNP-1重组质粒上的α-HNP-1基因亚克隆到真核表达载体pcDNA3.1(-)上,构建HNP-1的真核表达载体pcDNA3.1-HNP-1。将真核表达载体pcDNA3.1-HNP-1用脂质体法转染原代大鼠骨髓间充质干细胞,用免疫组化法检测α-HNP-1的表达。结果获得预期大小为303bp的RT-PCR产物;经PCR、酶切鉴定和DNA测序分析证实重组质粒载体pcDNA3.1-HNP-1构建正确;免疫组化法显示转染细胞呈阳性反应。结论成功构建HNP-1基因的真核表达载体,并且在大鼠骨髓间充质干细胞中能成功表达。     

李赛美教授运用麻黄升麻汤加减临床验案举隅

<正>李赛美为广州中医药大学第一临床医学院伤寒教研室教授、博士研究生导师。李教授从事医教研工作20余年,学识渊博、医术精湛,擅用经方。笔者有幸师从学习,屡观其在临床运用麻黄升麻汤加减治疗寒热错杂之内科疾病,效果颇好,兹录验案3则,与同道探讨。     

双相情感障碍患者血清紧密连接蛋白5连蛋白水平及其临床意义

目的 探讨双相情感障碍患者血清紧密连接蛋白5、连蛋白水平及其临床意义。方法 将96例双相情感障碍患者按疾病类型分为缓解组(49例)和发作组(47例),检测缓解组、发作组和对照组(96名健康志愿者)血清紧密连接蛋白5、连蛋白水平,采用蒙哥马利抑郁量表、杨氏躁狂状态评定量表评定抑郁、躁狂严重程度,并比较3组检测结果和量表评分。采用Pearson相关分析探讨血清紧密连接蛋白5、连蛋白水平与抑郁、躁狂严重程度的关系,绘制受试者工作特征曲线并计算曲线下面积,分析血清紧密连接蛋白5、连蛋白对双相情感障碍的诊断价值。结果 缓解组及发作组血清紧密连接蛋白5、连蛋白水平显著高于对照组(P<0.05),缓解组与发作组血清紧密连接蛋白5、连蛋白水平比较差异无统计学意义(P>0.05)。发作组蒙哥马利抑郁量表、杨氏躁狂状态评定量表评分显著高于缓解组、对照组(P<0.05),缓解组显著高于对照组(P<0.05)。双相情感障碍患者血清紧密连接蛋白5水平与蒙哥马利抑郁量表、杨氏躁狂状态评定量表评分呈显著正相关(P<0.05或0.01);血清连蛋白水平与杨氏躁狂状态评定量表评分呈显著负相...     

胸段食管癌切除术患者的预后分析

Objective To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. Methods From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the n, mher of lymph node metastases (0, 1 and ≥ 2), a new modification of the TNM classification was suggested: stage Ⅱ a (T2N0M0 and T3N0M0), stage Ⅱb [T1N1M0 and T2N1 (1) M0], stage Ⅲ a [T2N1 (2)M0 and T3N1 (1)M0] and stage Ⅲ b [T3N1 (2)M0 and T4NanyMO]. Results According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and ≥2 positive metastatic lymph nodes was 59.1%, 32.0% and 8.9%, respectively. The 5-year survival rate of the patients with stage T2N1M0 and stage T3N1M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P<0.01). The 5-year survival rate of the modified stage Ⅱa, Ⅱb, Ⅲa and Ⅲb was56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0. 01). Conclusion The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophngectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the S-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, ≥2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.     

当归及阿魏酸钠对内皮细胞中细胞因子表达改变的影响

目的 :检测高脂血清对内皮细胞中转化生长因子 β1 (ＴＧＦβ1 )、碱性成纤维细胞生长因子 (ｂＦＧＦ)表达的影响 ,并观察当归、阿魏酸钠的作用。方法 :实验分四组 ,即 :正常对照组 ;高脂血清损伤组 ;当归 高脂血清组 ;阿魏酸钠 高脂血清组。用培养人脐静脉内皮细胞 (ＥＣＶ30 4 )为研究对象 ,以高脂血清为损伤因子 ,观察当归及阿魏酸钠的作用。实验中用扫描电镜观察内皮细胞形态变化 ,用免疫细胞化学方法观测培养细胞中ＴＧＦβ1 及ｂＦＧＦ的表达改变。结果 :高脂血清能明显使内皮细胞的超微结构受损 ,细胞表面干裂 ,有孔隙 ;微绒毛分布…     

043 当归及阿魏酸钠对内皮细胞中TGFβ1及bFGF表达的影响

目的: 检测高脂血清对内皮细胞中转化生长因子β1(TGFβ1)、碱性成纤维细胞生长因子(bFGF)表达的影响, 并观察当归、阿魏酸钠的作用. 方法: 实验分四组, 即: 正常对照组; 高脂血清损伤组; 当归+高脂血清组; 阿魏酸钠+高脂血清组. 用培养人脐静脉内皮细胞(ECV304)为研究对象, 以高脂血清为损伤因子, 观察当归及阿魏酸钠的作用. 实验中用扫描电镜观察内皮细胞形态变化, 用免疫细胞化学方法观测培养细胞中TGFβ1及bFGF的表达改变. 结果: 高脂血清能明显使内皮细胞的超微结构受损. 细胞表面干裂, 有孔隙; 微绒毛分布不规则, 减少甚至消失. 细胞中TGFβ1的表达明显增高, 而bFGF的表达降低. 结论: 当归及阿魏酸钠对内皮细胞TGFβ1、 bFGF表达的影响可能为其抗动脉粥样硬化的机理之一; 阿魏酸钠可能为当归的有效成分之一.     

缺血预处理对缺血/再灌注大鼠心脏有关酶保护作用的研究

目的 :在在体大鼠模型上原位观察比较了经典缺血预处理对缺血 /再灌注大鼠心肌有关酶活性的影响 ,以期进一步探讨预处理保护作用的机制。方法 :将 2 4只体重 2 0 0～2 5 0 ｇ的雄性ＳＤ大鼠分为 4组 ,即 :Ⅰ组 ,假手术组 ;Ⅱ组 ,缺血 /再灌注组 ,左冠状动脉前降支结扎使心肌缺血 30ｍｉｎ后恢复再灌 2 0ｍｉｎ ;Ⅲ组 ,经典缺血预处理组 ,按Ｍｕｒ ｒｙ法进行 ;Ⅳ组 ,去甲肾上腺素预处理组 ,在缺血前 15ｍｉｎ开始由舌静脉在 5ｍｉｎ内缓慢滴入ＮＥ 1.6 μｇ。再灌结束后原位观察过氧化氢酶、5’ 核苷酸酶及Ｃａ2 ＡＴＰ酶活性及琥珀酸脱…     

远程医疗中的通信问题

通信问题是远程医疗系统必须解决的关键技术之一,本文根据远程医疗系统的通信需求,较全面地讨论了远程医疗中遇到的通讯问题,比较了当前几种远程数据通信技术对远程医疗的支持,并提出了ＭＰＥＧ—２ 音／视频＋ ＴＣＰ／ＩＰ协议＋ ＡＴＭ通信网的远程医疗系统模型     

尿脱落细胞及CK20免疫组化检测对膀胱癌的早期诊断价值

目的　探讨早期诊断膀胱癌简便、敏感的检测指标。方法　用脱落细胞(HE染色)及细胞角蛋白20(CK20)免疫组化技术检测23例已确诊的膀胱移行细胞癌患者和30例非肿瘤患者(对照组)尿脱落细胞,观察脱落细胞形态和CK20阳性情况。结果　30例对照组患者仅1例细胞学(HE染色)可疑阳性,23例膀胱癌患者细胞学(HE染色)阳性14例,阳性率60.87%,免疫组化CK20检测有15例阳性,阳性率为65.22%,两者联合检测阳性率为91.30%,特异性为96.67%。结论　脱落细胞(HE染色)联合CK20免疫组化检测方法简单,敏感度高,对早期筛查膀胱癌有一定临床价值。