强脉冲光联合脉冲染料激光治疗鲜红斑痣的临床疗效分析

目的：探讨强脉冲光（IPL）联合脉冲染料激光（PDL）治疗紫红型和增厚型鲜红斑痣的治疗效果。方法：回顾性分析2004年7月-2007年6月在本院整形美容外科用强脉冲光联合脉冲染料激光治疗紫红型和增厚型鲜红斑痣的患者175例，总结其治疗方案、治疗次数、皮损性质等与疗效的关系以及不良反应的发生。结果：175例紫红型和增厚型患者分别先经IPL治疗3次，再用PDL治疗，治疗间隔2～3月，共经过4～8次的治疗，其治疗8次后总有效率和治愈率分别达到51．43％（90／175）和14．29％（25／175），且4～8次的治疗中，治疗次数越多，活疗效果越好（P〈0．05）。175例患者中，1．14％（2／175）出现增生性瘢痕，1．71％（3／175）出现色素减退，2．86％（5／175）出现色素沉着。结论：强脉冲光（IPL）联合脉；中染料激光（PDL）治疗紫红型和增厚型鲜红斑痣疗效可靠。并发症少、是目前治疗紫红型和增厚型鲜红癍痣的最常见的治疗方法。     

RUNX3和CerbB-2在乳腺癌组织中的表达及其意义

目的探讨乳腺癌组织中RUNX3和cerbB-2的表达及其与乳腺癌生物学行为的关系。方法应用免疫组织化学SP法检测55例乳腺癌组织及癌旁乳腺组织中RUNX3、cerbB-2的表达。结果乳腺癌组织中RUNX3蛋白表达(40.0%)显著低于癌旁乳腺组织的表达(98.2%)(P<0.01),且与年龄、组织分化及临床分期呈负相关(均P<0.05),而与肿块大小、淋巴结转移等无关(均P>0.05)。cerbB-2在乳腺癌中的表达(50.9%)显著高于癌旁乳腺组织的表达(29.1%)(P<0.01),且与肿块大小、组织分化、淋巴结转移及临床分期呈正相关(P<0.05),而与年龄无关(P>0.05)。RUNX3在乳腺癌中的表达与cerbB-2呈负相关(P<0.01)。结论乳腺癌中RUNX3蛋白表达降低,其表达与年龄、组织分化及临床分期密切相关,且与cerbB-2表达呈负相关。联合检测RUNX3、cerbB-2有助于提高乳腺癌侵袭转移能力的评估,对乳腺癌的预后判断具有重要的临床意义。     

清开灵注射液对急性肺损伤大鼠肺组织及CD4^＋T细胞数目的影响

目的探讨清开灵注射液对急性肺损伤大鼠免疫功能的影响。方法32只sD雄性大鼠随机分4组（对照组、模型组、治疗组、预防组），每组8只；各组均从尾静脉注药。对照组：注入1mL生理盐水；模型组：注入内毒素5mg／kg；治疗组：注入内毒素5mg／kg，45min后，注入清开灵注射液0.05mL／kg；预防组：注入清开灵注射液0．05mL／kg，45min后，注入内毒素5mg／kg。从第一次注液起5h后，取外周血2mL肝素抗凝，流式细胞仪测大鼠外周血中CD4^＋T细胞、CD8^＋T细胞数目及CD4^＋／CD8^＋的比值。结果CD4^＋T细胞数目、CD4^＋／CD8^＋的比值在各组之间差异均有显著性（P〈0．05）。结论清开灵注射液对大鼠急性肺损伤具有明显的修复作用，其机制可能与增加CD4^＋T细胞数目、改善CD4^＋／CD8^＋比例有关。     

精神分裂症患者认知功能评价及其与精神症状的相关性

目的探讨精神分裂症患者的认知功能及其与精神症状的相关性。方法入组31例精神分裂症患者及31例正常对照者,进行持续操作测验(CPT)、威斯康星卡片分类测验(WSCT)、Stroop色词测验、可反复测查的成套神经心理状态评估工具(RBANS)以及阳性与阴性症状量表(PANSS)评定,对心理测查成绩与精神症状指征进行相关性分析。结果精神分裂症患者组与正常对照组相比,除Stroop色词测验中卡片A(字)、B(色)、C(字色)错误数无明显差异外,各项心理测查指标均明显下降(P<0.05)。多项心理测查成绩,包括CPT测验中正确反应时、WSCT测验中随机错误数、Stroop色词测验中字义干扰时和颜色干扰时、RBANS测验总分和即刻记忆分,与PANSS部分症状评分显著相关(P<0.05)。结论精神分裂症患者记忆、注意、执行及言语功能受损。精神分裂症患者部分认知功能与精神症状显著相关。     

脑灵汤对阿尔茨海默病模型大鼠TGF-β1表达的影响

目的 探讨脑灵汤对阿尔茨海默病(AD)模型大鼠TGF-β1(转化生长因子β1)表达的影响.方法 采用向大鼠海马内注射Aβ1-42(β淀粉样蛋白)建立AD模型,通过Y-电迷宫实验检测各组大鼠学习记忆能力;行HE染色观察海马CA3区神经元形态;采用刚果红染色检测Aβ的沉积;用免疫组化SP法检测TGF-β1的表达情况.结果 脑灵汤能改善模型大鼠的学习记忆能力,减少Aβ的沉积,且脑灵汤组TGF-β1的表达较AD模型大鼠的表达增加,差异有统计学意义(P<0.05).HE染色结果,脑灵汤组大鼠海马CA3区细胞排列较整齐、均匀,结构较清晰,形态、排列、数目较模型组明显改善;刚果红染色结果,正常组、假手术组大鼠脑组织切片中未见A13沉积;模型组大鼠脑组织切片在CA1区与齿状回之问可见明显Aβ1沉积;脑灵汤组未发现明显的Aβ沉积.结论 脑灵汤能增强AD大鼠海马区域TGF-β1的表达,可能通过此机制减少海马AB蛋白的沉积,从而改善模型大鼠学习记忆能力.     

护士锐器损伤调查及防护对策

目的调查2所医院护士锐器损伤发生几率,分析发生原因及探讨防范对策。方法对2所医院450名护理人员进行从事护理工作后发生锐器损伤的调查,发放调查表450份,有效回收428份。结果89.48%的护士发生过锐器损伤,人均4.9次;发生锐器伤的锐器主要是注射器针头(36.7%),其次是玻璃(32.4%)、带翼针头(14.4%)、缝合针(7.2%)。其主要原因为工作超负荷、护理队伍自我防护意识薄弱、操作不熟练、不严格执行操作规程;管理层缺乏人文关怀,损伤后的记录及上报率仅为1.2%。结论医院管理层应高度重视,应制定切实可行的防护管理措施,加强职业防护意识的宣传力度,提高护士工作的安全性。     

短期持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征患者外周动脉硬度的影响

目的 观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠前后外周动脉硬度的变化及短期持续气道正压通气(CPAP)治疗对其的影响.方法 以60例OSAHS患者为试验组,正常人60名为对照组,两组间年龄、性别构成比匹配,分别于入睡前及第二天清晨醒来后按相同方法测定四肢血压及心脏一踝血管指数(CAVI).试验组中的22例重度SAHS患者接受CPAP治疗,并在治疗第1天睡前及醒后、治疗第3天醒后重复测定上述指标.结果 试验组一夜睡眠后CAVI值[(8.0±1.2)m/s]、舒张压[(87±12)mm Hg]及平均压[(101±12)mm Hg]均高于睡前[分别为(7.3±1.0)m/s、(83±13)mm Hg及(98±14)mm Hg](均P<0.05),收缩压无明显改变;对照组相关参数在醒后均呈下降趋势,但差异无统计学意义.试验组经CPAP治疗1晚后,晨起的CAVI值[(7.8±1.0)m/s]、收缩压[(129±19)mm Hg]、舒张压[(84±11)mm Hg]及平均压[(99±13)mmHg]均低于治疗前晨起的相应数值[分别为(8.6±1.1)m/s、(137±23)mm Hg、(89±13)mm Hg、(105±16)mm Hg](均P<0.05);治疗第3天与治疗后第1天相比,晨起后的CAVI值仍继续明显下降,而收缩压、舒张压、平均压虽呈下降趋势,但差异无统计学意义.结论 睡眠可以引起OSAHS患者动脉硬度急性增高,经CPAP治疗可降低,并在3 d的治疗中持续改善.     

Modulation of TLR9 on anti-tumor immune responses of peripheral blood mononuclear cells from patients with non-small-cell lung cancer

OBJECTIVE: To assess the modulation of TLR9 on anti-tumor immune responses in peripheral blood mononuclear cells (PBMC) from patients with non-small-cell lung cancer (NSCLC). METHODS: PBMCs were isolated from 36 NSCLC patients. Lung cancer cells were isolated from these patients and further enriched. PBMCs were cultured in RPMI-1640 medium (blank control group), and medium with cytosine guanine oligodeoxynucleotide (CpG ODN, an TLR9 agonist) or control ODN for 72 h; and then flow cytometry was used to examine the expression of CD69 antigen on the surface of CD3 cells, [3H]-thymidine incorporation method was used to examine the cell proliferation, and the IFN-alpha level in the supernatant was measured. Another PBMCs were cultured in medium with interleukin (IL)-1 and then CpG ODN, control ODN, and CpG ODN + chloroquine or inhibitory ODN were added respectively for 24-48 h. Then the IFN-alpha in the supernatant was measured. Subsets were assessed by flow cytometry and the expression of TLR9-mRNA in freshly isolated PBMC was detected by RT-PCR. The production of interferon (IFN)-alpha in the PBMCs was measured by ELISA. The proliferation of the PBMCs was determined by [3H]-thymidine incorporation. The PBMCs co-cultured with CpG ODN and autologous lung tumor cells treated with mitomycin C were used as effector cells, and K562 cells and autologous tumor cells were used as target cells flow cytometry was used to detect the capacity of PBMCs to kill autologous lung tumor cells and K562 cells. Meanwhile we investigated the intracellular expression of IFN-gamma and IL-4 in CD8+ T. RESULTS: The expression level of TLR9 of the PBMCs from patients was not significantly different from that of the PBMCs from the healthy donors. The proportion of CD69 antigen expressing CD3+ T cells of the CpG ODN group was (39.5 +/- 8.9)%, significantly higher than those of the blank control group [(8.8 +/- 1.2)%, t = 40.30, P = 0.00] ands control ODN group [(10.6 +/- 1.0)%, t = 41.85, P = 0.00]. Examination with beta liquid scintillation counter showed that the cpm value of the CpG ODN group was (1.61 +/- 0.20) x 10(4), significantly higher than those of the blank control group [(0.27 +/- 0.14) x 10(4), t = 20.43, P = 0.00] and control ODN group [(0.34 +/- 0.13) x 10(4), t =20.20, P = 0.00]. Chloroquine and inhibitory ODN dose-dependently inhibited the IFN-alpha levels in the supernatant. The CD4 + T/CD8 + T of the CpG ODN group was (3.44 +/- 0.20), significantly higher than those of the control ODN group (1.73 +/- 0.27, t = 19.85, P = 0.00) and blank control group (1.69 +/- 0.13, t = 29.32, P = 0.00). The IFN-gamma positive CD8 + T cells of the CpG ODN group was (18.5 +/- 4.2)%, significantly higher than those of the control ODN group [(4.2 +/- 1.0)%, t = 24.12, P = 0.00] and blank control group [(3.1 +/- 1.2)%, t = 25.1, P = 0.00]. There was no significant differences in the proportion of IL-4 positive CD8 + T cells among different groups. When the E/T was 40:1 the killing capacity of PBMCs against the K562 cells was (19.5 +/- 1.0), significantly higher than those of the control ODN group (7.9 +/- 1.1, t = 19.9, P = 0.00) and blank control group (5.1 +/- 1.6, t = 21.9, P = 0.00), and the killing capacity of PBMCs against the autologous lung tumor cells was (29.8 +/- 2.1), significantly higher than those of the control ODN group (8.1 +/- 0.9, t = 36.9, P = 0.00) and blank control group (5.7 +/- 1.6, t = 35.7, P = 0.00). CONCLUSION: TLR9 signal takes part in the immunomodulation of PBMCs. The activation of TLR9 results in enhanced anti-tumor response in the PBMCs against autologous lung cancer cells and K562 cells.     

乳腺癌钼靶X线微钙化与C-erbB-2表达关系的对比研究

目的：分析钼靶片中乳腺癌微钙化与人类上皮生长因子受体-2（C-erbB-2）表达及临床病理关系,评价微钙化征象预测C-erbB-2表达的可行性。方法：乳腺癌病例55例,钼靶X线片均由两位有经验的影像诊断医师阅片,明确钙化并根据钙化及相关表现分组。免疫组化采用SP法,根据癌细胞核内染色判断C-erbB-2表达情况。各钙化分组分别与C-erbB-2表达情况进行比较分析。结果：乳腺癌微钙化多见于DCIS及浸润性导管癌,占57．5％（23／42）,是钼靶片中无肿块表现乳腺癌的主要X线征象。乳腺癌钼靶片中微钙化的有无、微钙化数目、钙化类型与癌细胞C-erbB-2表达有相关性（P〈0．05）。结论：微钙化在钼靶片乳腺癌诊断中,特别是在早期癌以及无肿块表现的乳腺癌诊断中具有重要意义,在一定程度上反映了C-erbB-2的表达状态。     

四种不同肝移植手术方式的选择

目的探讨4种不同肝移植手术方式的优缺点及适应证。方法对实施成人尸体全肝移植的135例患者分别采用4种不同术式:A组(22例)采用经典原位肝移植,B组(79例)采用改良背驮式,C组(18例)采用经典背驮式肝移植,D组(16例)采用改良的经典原位肝移植,所有患者术中均未行体外静脉转流,回顾性分析135例患者的术中、术后情况。结果各组间手术时间、无肝期时间和术中出血量差异具有显著性(P<0.05),术后一过性肾功能损害的发生率C组较其他各组显著降低(P<0.05),手术后近期生存率及血管并发症各组间差异无显著性。结论应针对患者具体情况选择不同手术方式,对于一些肿瘤患者或有上腹部手术史的患者,采用改良的经典原位肝移植可以缩短手术时间,尤其是无肝期时间,减少手术难度和术中出血量,改善患者预后。