放射治疗骨转移癌疼痛47例临床分析

目的 观察骨转移癌疼痛放射治疗方法对疼痛的缓解效果。方法47例患者60处骨转移灶均采用6 MV X线放射治疗。剂量方案采用两种方法:A方案:30—51 Gy/10～17f/2～4周,B方案:25～30 Gy/5—6f/1～2周。结果分次方案对疼痛缓解率无明显影响,总有效率均为91.5％,但常规分次放疗3～4次后疼痛缓解,而低分割放疗1—2次后疼痛即缓解。结论 骨转移癌放射治疗止痛效果确切、迅速,副作用小,对大部分病例可采用低分割方案。     

麦考酚酸酯及其临床应用进展

目的:麦考酚酸酯(MMF)是一种新型的免疫抑制剂.在临床应用中,MMF的使用也越来越广泛,已不仅仅局限于器官移植,还涉及到系统性红斑狼疮(SLE)、自体免疫风湿性疾病的治疗,以及在糖尿病,肺部血管高压的辅助治疗等诸多方面.肠包衣麦考酚酸钠,是一种新的可抵抗胃溶作用的麦考酚酸肠包衣剂型,药物在肠内释放,可以降低胃肠道(GI)不良反应的发生.     

Directed differentiation of Balb/C mouse embryonic stem cells into pancreatic islet-like cell clusters in vitro: observation by atomic force microscope]

OBJECTIVE: To observe the morphological changes of Balb/C mouse embryonic stem cells following directed differentiation into pancreatic islet-like cell clusters (PICC) in vitro using atomic force microscope (AFM). METHODS: Balb/C mouse embryonic stem cells were first cultured into embryonic bodies (EBs) and allowed to differentiate spontaneously for 4 days. The cells were then transferred to gelatin-coated dishes for the EBs to attach and spread on the tissue culture plates, in the course of which a series of cell growth factors such as basic fibroblast growth factor (bFGF), insulin-like growth factor 1 (IGF-1) and nicotinamide were added into the culture medium at specific time points to induce directed differentiation of the stem cells into PICC. Immunocytochemistry was employed to detect the cells positive for insulin and glucagon, which were observed with AFM. RESULTS: The embryonic stem cells developed into cell clusters of different sizes, in which the cells were tightly arranged. Islet B cells were numerous in the center of clusters and darkly stained, but fewer in the peripherals with lighter stains. Islet A cells expressing glucagon were relatively fewer in the cell clusters, found mainly in the peripherals. Scanning of the insulin-positive clusters by AFM revealed large quantity of tissue fibers resembling nerve fibers that formed a reticular structure in disorderly arrangement. Numerous round granules were observed in the cytoplasm of almost identical sizes ranging from 0.5 to 1.0 mum in diameter. CONCLUSION: The cell clusters obtained by directed differentiation are mature in both morphology and function with also well organized structures.     

《武威汉代医简》"(疒夅)""泔(疒夅)""五(疒夅)"探讨

1972年出土的<武威汉代医简>第9、10两简有"五(疒夅)"及"石(疒夅)"、"血(疒夅)"、"膏(疒夅)"、"泔(疒夅)"的记载.就其病名与症状的描述而言,颇似当今的淋证.本文就两简中的"(疒夅)"、"泔(疒夅)"、"五(疒夅)"进行探讨,认为"(疒夅)"是多义字,有罢病、淋证等含义.同时又是"癃"的省写,故"(疒夅)"字即"癃"字,属"淋证"."泔(疒夅)",为米泔汁样小便,伴小便频数涩痛的症状,类似于当今临床"白浊"的部分表现."五(疒夅)"中的第五淋尚难以确定.     

经腹超声及术中超声在胰腺结石诊断、治疗中的应用

目的:探讨经腹超声及术中超声在胰腺结石诊断、治疗中的价值。材料和方法:对25例胰腺结石患者行经腹和术中超声检查。经腹超声主要观察胰管扩张程度,胰腺结石大小、位置,是否合并胆囊及胆道结石、胰腺假性囊肿等。术中超声观察是否有结石残留。结果:经腹超声显示25例患者主胰管扩张,胰腺实质增粗、增强。结石位于头部9例,位于全胰腺16例,伴有胆道梗阻征象13例,其中合并胆囊及胆道结石8例,并发胰腺假性囊肿3例,合并胰腺癌2例;术中超声形式显示6例未见残留结石,19例有残留结石,手术取出残留结石24枚。结论:经腹超声诊断主胰腺管结石敏感性较高,术中超声在判断残留结石及鉴别胰小管结石与胰腺实质钙化灶方面具有重要价值。     

丹参改善骨骼肌缺血再灌注损伤的超微结构观察

目的:通过透射电镜观察骨骼肌缺血再灌注损伤过程的病理生理变化探讨丹参的干预作用及机制。方法:采用90只清洁级雄性SD大鼠,6只作为健康对照组,84只行左侧提睾肌主滋养动脉夹闭造模,在缺血2.5 h时,丹参组腹腔注射丹参(42只),对照组注射等剂量的生理盐水(42只),两组分别设缺血再灌注10、20、30、40、50、60、90 min观测点(每个观测点6只)。观测结束后,迅速切取提睾肌,放入电镜固定液。电镜下进行组织形态学观察。结果:健康对照组正常情况下,组成肌原纤维的粗、细2种肌丝沿其长轴排列,每条肌原纤维上均可见明暗相间的带,肌浆内见有较多糖原颗粒及少量内质网、线粒体等细胞器,肌浆网纵向分布于肌原纤维周围,线粒体膜及嵴清晰可见,基质着色深,无肿胀、空泡形成等改变,在肌丝之间分布有较多糖原颗粒;骨骼肌缺血再灌注后10、20、30、40、50、60、90 min的2组各观测点,其病理变化较相似,肌丝模糊、凌乱,部分溶解、消失,甚至完全消失,肌浆网不同程度扩张,线粒体变大变圆,基质变淡,嵴变短变少甚至消失,部分线粒体极度肿胀,呈空泡状。丹参组,其病理变化大体相似,肌纤维均有不同程度恢复。结论:骨骼肌缺血再灌注损伤导致线粒体极度肿胀,肌纤维紊乱。丹参能有效地消除线粒体的水肿,恢复肌纤维,减轻骨骼肌缺血再灌注损伤。     

浆膜受侵的结直肠癌术后腹腔化疗联合静脉化疗的临床研究

Objective To compare the clinical efficacy of postoperative intraperitoneal chemotherapy combined with systemic chemotherapy to systemic chemotherapy alone for serosa-involved colorectal cancer. Methods According to the criteria of serosa-involving in colorectal cancer, 332 cases were divided into 2 groups prospectively without randomization. Study group (n=166) was treated with intraperitoneal chemotherapy combined with systemic chemotherapy, and control group (n=166) with systemic chemotherapy alone. Incidence of local recurrence, peritoneal metastasis, hepatic metastasis, other distant metastasis and 3-year, 5-year overall survival (OS) rate of two groups were compared. Results 3-year and 5-year OS rates of stage Ⅱ B in study group were similar to those in control group (χ2=0.612,P=0.434). The above rates of stage Ⅲ in study group were higher than those in control group (χ2=3.989,P=0.046). Either the study group or the control group, the 3-year and 5-year OS rates of patients undergone laparoscopic surgery or open surgery were similar (P=0.839, P=0.172). Incidences of local recurrence, peritoneal metastasis and hepatic metastasis in study group were 1.9%, 3.8% and 3.8% respetively, lower than those in control group (8.2%,9.5% and 10.1%,P<0.05). Distant metastasis rate in study group was similar to that in control group. In study group, intraperitoneal chemotherapy regimen with Oxaliplatin had lower rates of peritoneal metastasis and hepatic metastasis as compared to that with Cisplatin (0.9% vs 8.8% ,P=0.019), while the incidences of local recurrence and other distant metastasis were similar. Conclusions Postoperative intraperitoneal chemotherapy combined with systemic chemotherapy improves 3-year and 5-year overall survival rates in patients with stage Ⅲ serosa-involved colorectal cancer, and decreases local recurrence, peritoneal metastasis and liver metastasis rate, especially when intraperitoneal chemotherapy regimen contains Oxaliphtin. Comparing with open surgery, laparoscopic surgery dose not improve 3-year and S-year overall survival rates in patients receiving combined chemotherapy or systemic chemotherapy alone.