巩固性重复射频消融对甲胎蛋白阴性肝细胞癌射频消融后局部肿瘤进展的疗效

目的 探讨甲胎蛋白(AFP)阴性肝细胞癌(HCC)患者在射频消融(RFA)获得影像学完全消融后,以安全边界(SM)≥1 cm为目标的巩同性重复RFA(CRRFA)对于局部肿瘤进展的影响.方法 课题组在2002年7月至2009年7月间,共收治152例完全消融的AFP阴性HCC.其中,影像学分析显示肿瘤周边部分区域SM＜1 cm者110例,所有区域SM≥1 cm者42例.在SM＜1 cm的110例患者中,59例在首次RFA后6个月内接受了CRRFA,其余51例选择了临床观察随访.然后,据此将符合纳入标准的病例分为窄SM-CRRFA组(n=41)和窄SM-单次RFA组(n=37).此外,还从42例SM≥1.0 cm者,选择符合纳入标准的病例纳入宽SM-单次RFA组(n=30).对三组患者的局部无瘤生存率进行了比较.结果 窄SM-CRRFA组1年、2年、3年、4年和5年局部无瘤生存率分别为97.1%、90.9%、69.6%、47.2%和33.0%;窄SM-单次RFA组分别为85.9%、66.5%、43.5%、15.8%和0.0%;宽SM-单次RFA组分别为92.7%、83.7%、59.3%、36.9%和9.2%.三组间局部无瘤生存率差异有统计学意义(χ2=14.789,P=0.001).两两比较结果 显示,窄SM-CRRFA组和宽SM-单次RFA组的累积局部无瘤生存率均明显高于窄SM-单次RFA组(χ2分别为9.353和5.375,P值分别为0.002和0.020);窄SM-CRRFA组与宽SM-单次RFA组局部无瘤生存率差异无统计学意义(χ2=1.785,P=0.182).结论 对于直径3～5 cm的AFP阴性HCC,RFA治疗后SM≥1 cm是影响局部肿瘤控制效果的重要因素;对于SM＜1 cm者,CRRFA可显著提高局部无瘤生存率.

Abstract：

Objective To retrospectively evaluate the role of consolidative repeat radiofrequency ablation (CRRFA) based on safety margin (SM) analyses in local tumor control for alpha-fetoprotein (AFP) negative hepatocellular carcinoma (HCC) patients who had been shown to have radiological complete ablation (CA) with radiofrequency ablation (RFA). Methods From July 2002 to July 2009,152 AFP negative HCC patients who were shown to have radiological CA with RFA therapy were retrospectively analyzed. Among them, 110 patients had a SM of less than 1 cm and the other 42 patients had a SM of 1cm or more. Among 110 patients with SM less than 1 cm, fifty nine patients accepted CRRFA within 6 months after the first RFA and 51 did not. From these patients, a narrow SM-CRRFA group (n=41) and a narrow SM-single RFA group (n=37) were enrolled respectively. The wide SM-single RFA group (n= 30) was enrolled from the 42 patients with a SM of 1 cm or more.The LTP (local tumor progression)-free survival rate of the 3 groups were compared with a log-rank test. Results One-, two-, three-, four-, and five-year LTP-free survival rates respectively were 97. 1%, 90.9%, 69.6%, 47.2%, and 33. 0% in the narrow SM-CRRFA patients. 85.9%, 66. 5%,43.5%, 15.8%, and 0. 0%, in the narrow SM-single RFA patients, and were 92.7%, 83.7%,59.3%, 36. 9%, and 9.2% in the wide SM-single RFA patients. There were statistically significant differences (χ2 = 14. 789, P= 0. 001) between the groups. Conclusions An ablation zone with an SM of 1 cm or greater was the most important factor for local control of AFP negative HCC ranging from 3 to 5 cm in diameter. For these patients with a SM of less than 1 cm, CRRFA improved the overall local control outcomes.     

芪参益气滴丸治疗慢性肺源性心脏病的系统评价

目的:采用Meta分析的方法评价芪参益气滴丸治疗肺源性心脏病的临床疗效.方法:计算机检索数据库,搜集在西药常规治疗的基础上加用芪参益气滴丸治疗肺源性心脏病的RCT,检索时限均从建库至2016年9月30日.由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法后,采用RevMan 5.3软件进行Meta分析.共纳入6个RCTs,共490例慢性肺源性心脏病患者.结果:经分析显示,芪参益气滴丸+常规治疗组(治疗组)与常规治疗组(对照组)相比:可提高临床治疗有效率;改善心功能.结论:在常规西药治疗的基础上加用芪参益气滴丸可有效改善慢性肺源性心脏病患者的心功能,提高临床总有效率,且不良反应少,耐受性好.虽然本研究所纳入文献数量较少,研究样本量有限,更需大量研究证据支持,但目前的结果已经可以显示芪参益气滴丸在肺源性心脏病方面的疗效与裨益,值得进一步深入研究与临床推广.     

丙型肝炎病毒核心蛋白对Wnt信号抑制因子SFRPs甲基化修饰的影响

目的 探讨丙型肝炎病毒核心蛋白是否通过对Wnt信号抑制因子SFRPs的甲基化修饰,从而活化Wnt信号通路.方法 将编码HCV核心蛋白的腺病毒(AdCore)或GFP对照腺病毒(AdGFP)感染SMMC-7721细胞,采用逆转录PCR(RT-PCR)方法检测SFRPs基因mRNA的表达;用5-氮杂-2′-脱氧胞苷(DAC)对AdCore或AdGFP腺病毒感染的SMMC-7721细胞进行去甲基化处理,进一步采用甲基化特异性PCR (MSP)和DNA甲基化测序,检测SFRPs基因启动子区CpG岛的甲基化程度,Western blot检测甲基化转移酶Dnmts的表达.结果 在HCV核心蛋白过表达的SMMC-7721细胞系中,SFRP2和SFRP5基因mRNA的表达量与对照组相比明显降低(P＜0.05);甲基化分析结果表明:SFRP5基因启动子区CpG岛呈现高甲基化修饰;甲基化转移酶Dnmt1、Dnmt3a表达量增加(P＜0.05).结论 HCV核心蛋白可以促进SFRP5基因启动子区CpG岛的甲基化修饰,参与HCV相关疾病的发生.     

同时表达4种癌基因的大肠癌患者3年生存率分析

目的 :同时检测癌基因蛋白EGFR、C erbB 2、CD44v6和P5 3在大肠癌中的表达 ,分析不同表达水平患者组的 3年生存率差异。方法 :对 6 3例存档大肠癌石蜡组织标本进行重新切片 ,采用EGFR、C erbB 2、CD44v6和P5 34种单克隆抗体分别进行免疫组化染色 (SABC法 )。所有病例均随访 3年以上。结果 :全部 6 3例大肠癌中除 4例(6 .3% )无任何 1种癌基因蛋白表达外 ,11例 (17.5 % )表达 1种癌基因蛋白的患者 3年生存率 88.8% ;19例 (30 .2 % )表达 2种癌基因蛋白的患者 3年生存率 70 .5 % ;15例 (2 3.8% )表达 3种癌基因蛋白的患者 3年生存率 5 7.8% ;14例 (2 2 .2 % )表达全部 4种癌基因蛋白的患者 3年生存率 2 2 .2 % ,与前 3组患者的 3年生存率比较差异均有显著性 (P <0 .0 1)。结论 :4种癌基因蛋白同时表达与大肠癌不良预后密切相关。     

减重手术治疗2型糖尿病研究进展

肥胖与糖尿病的发生发展有着密切关系。许多患者术后体质量改变的同时血糖也明显改善。随着腹腔镜越来越多地应用于临床,权衡手术适应证和风险-效益评估,减重手术治疗糖尿病变得越来流行。患者血糖的改变是在体质量改变之前,减重手术改善血糖的机制目前还不是十分明确,现就减重手术治疗2型糖尿病的进展及可能的作用机制综述如下。     

下丘脑弓状核微量注射NMDA受体拮抗剂和蛋白激酶抑制剂对神经病理性痛觉过敏的抑制作用

目的观察大鼠下丘脑弓状核（ARC）内微量注射NMDA受体拮抗剂及受体后蛋白激酶抑制剂对神经病理性痛觉过敏的影响,探索脊髓上水平痛觉过敏的中枢敏感化机制。方法建立大鼠坐骨神经部分结扎（PSL）神经病理性疼痛模型,采用压爪缩腿法和辐射热缩腿法测定大鼠的机械痛阈和热痛阈,观测ARC内微量注射MK801（NMDA受体非竞争性拮抗剂）、APV（NMDA受体竞争性拮抗剂）、PP2（Src家族蛋白酪氨酸激酶抑制剂）、GF109203X（蛋白激酶C抑制剂）后70min内PSL模型大鼠痛阈的变化。结果 PSL模型大鼠术后数小时痛阈即明显降低（P〈0.05）,出现机械痛敏和热痛敏。ARC内微量注射MK801（5nmol）、APV（1.5nmol）后,大鼠机械痛阈和热痛阈明显升高,痛敏现象明显减轻（P〈0.05）;ARC内注射PP2（5nmol）、GF109203X（0.04nmol）后,痛阈升高幅度更大,痛敏现象也明显减轻（P〈0.05）。结论下丘脑弓状核内的NMDA受体及受体后蛋白酪氨酸激酶、蛋白激酶C在痛觉过敏的脊髓上中枢敏感化的形成和维持过程中可能起重要的作用。     

经皮肾镜钬激光碎石与双导管超声碎石的比较研究

目的：比较经皮肾镜钬激光碎石与双导管超声碎石的疗效及安全性。方法回顾性分析2012年10月~2014年12月我院泌尿外科采用经皮肾镜碎石术治疗136例肾结石患者的临床资料,按碎石取石方式不同分为钬激光碎石组(A组66例)和双导管超声碎石组(B组70例),比较两组患者手术时间、失血量、术后感染发生率、Ⅰ期清石率的差异。结果A组手术时间为(85.36±21.52)皂蚤灶,术中出血量为(154.18±33.25)皂蕴,术后感染发生率为13.64豫,Ⅰ期清石率为90.91豫;月组手术时间为(76.15±20.36)皂蚤灶,术中出血量为(85.66±27.68)皂蕴,术后感染发生率为2.86%,Ⅰ期清石率为92.86%。两组手术时间、失血量、术后感染发生率比较差异有统计学意义(孕<0.05),Ⅰ期清石率比较差异无统计学意义(孕>0.05)。结论经皮肾镜双导管超声碎石术治疗肾结石手术时间短,术后感染、出血并发症少,疗效及安全性优于经皮肾镜钬激光碎石术。     

2种麻醉方式对小儿腹腔镜手术应激反应的干预

目的 探讨有效调控腹腔镜手术患儿围手术期应激反应的麻醉方式.方法 1～3岁ASA Ⅰ-Ⅱ腹腔镜手术患儿40例,按随机数宁表法分为全麻组(GA组)和全麻复合硬膜外阻滞组(GEA组),各20例.术中监测HR、MAP、SpO2、PrrCO2、并于麻醉前5 min(T0)、气腹前5 min(T1)、气腹开始后5 min(T2)、气腹开始后30 min(T3)、气腹结束后30min(T4)及气腹结束后24 h(T5),抽血测肾上腺素(E)、去甲肾上腺素(NE)、IL-6及IL-10浓度.结果 ①与T0比较全麻组HR、MAP在T2、T3、T4时显著升高;GEA组内比较差异无统计学意义(P>0.05),2组间比较差异有统计学意义(t=4.749,t=10.349,t=13.632,t=10.051,P<0.01).② E、NE均随手术进行逐渐升高,T5时E仍高于T0时,GEA组NET5时已明显下降.GEA组在T2、T3、T4、T5各时点E和NE含量均明显低于GA组,差异有统计学意义(P<0.05).③2组IL-6水平与T0时比较,T2、T3、T4时升高,T5时开始下降,差异有统计学意义(P<0.05),组间比较差异无统计学意义(P>0.05).2组IL-10随手术时间升高与T0相比差异有统计学意义(P<0.05),且GEA组较GA组T3～T5时增高有统计学意义(P<0.05).结论 小儿腹腔镜手术可致明显的应激反应,全麻复合硬膜外阻滞麻醉方式较全麻具有改善血流动力学、患儿苏醒快且有效抑制应激反应程度的优势.     

TIMI血流计帧法测定冠状动脉血液流速在急性心肌梗死再灌注治疗中的应用

目的 :评价计帧法测定冠状动脉血流速度在急性心肌梗死 (AMI)再灌注治疗中的临床意义。方法 :90例急性心肌梗死患者行直接经皮冠状动脉成形术 (PTCA)、溶栓失败后的挽救性PTCA治疗和延迟PTCA治疗 ,梗死相关动脉成功再通 ,心肌梗死溶栓实验 (TIMI)血流分级 2级或 3级 ,用计帧法法测定梗死相关动脉(IRA)帧数 ,结合IRA长度测定血流速度 ,观察帧数、血流速度和心功能、近期临床预后的关系。结果 :IRA平均长度为 (119 30± 2 5 2 6 )mm ,平均CTFC为 (37 36± 19 70 )帧 ,平均流速为 (10 0 33± 4 1 92 )mm/s ,左室射血分数(LVEF)和IRA帧数负相关 (r =- 0 6 4 ,P =0 0 1) ,LVEF和IRA血流速度正相关 (r =0 74 ,P =0 0 0 )。住院期间有心脏不良事件组和无不良事件组间血流速度有统计学差异 (16 7 2 0± 36 75vs 10 5 78± 30 85 ,P <0 0 5 ) ,CT FC >30祯和 <30帧组间射血分数、住院期间心脏不良事件发生率有显著性差异 (P <0 0 5 )。Logistic多元回归分析发现血流速度是心脏不良事件的独立相关因素 (OR =2 4 1,95 %CI =1 95～ 2 83,P =0 0 0 )。结论 :计帧法测定IRA帧数和血流速度是一种较好的评价冠状动脉血流的方法 ,其结果和心功能、临床近期预后密切相关。     

Treatment of hemangioma by transfection of antisense VEGF gene

The effect of transfection of antisense vascular endothelial growth factor （VEGF） gene on the growth of hemangioma was studied. A total of 49 cases of capillary hemangiomas of the skin were collected. Immunohistochemical method was used to detect the expression of PCNA in hemangioma tissues. According to the finding, 49 cases of hemangiomas fell into proliferating phase （27 cases） and involuting phase （22 cases） respectively. Another 5 cases of normal skin tissues adjacent to the tumor tissues served as control. Immunohistochemical staining was performed to detect the expression of VEGF in the tumor tissues and the normal tissues. The average absorbance （A） values and the average positive area rate of VEGF were measured by image analysis system （HPIAS-2000）. Endothelial cells from the tumor tissues in proliferating phase were cultured. Eukaryotic expression vector was constructed by sub-cloning, and transfected into human hemangioma endothelial cells by using cation liposome as vector. The expression of VEGF mRNA and protein was detected by RT-PCR and indirect immunofluorescence assay （IFA）, respectively, and the biological characteristics of the transfected endothelial cells were examined by MTT assay and flow cytometry （FCM） after transfection. Immunohistochemical results showed that the expression of VEGF in proliferating endothelial cells was remarkably higher than those in involuting endothelial cells and normal endothelial cells （P〈0.01）, but there was no significant difference in the expression of VEGF between involuting endothelial cells and normal ones （P〉0.01）. Electrophoresis and sequencing indicated that the eukaryotic expression vector containing antisense VEGF gene, i.e. pcDNA3.1-VEGF, was success- fully constructed. After VEGF antisense RNA recombinant was transfected into hemangioma endothelial cells, RT-PCR revealed that the expression of VEGF mRNA in pcDNA-VEGF （V） group and blank group was obviously higher than that in pcDNA-VEGF （A） group, and that the expression of endogenous VEGF mRNA in pcDNA-VEGF （A） group was significantly inhibited. Immunohistochemical result demonstrated that, compared with blank group, there was statistically significant difference between pcDNA-VEGF （A） and pcDNA-VEGF （V） groups （P〈0.01）, but there was no significant difference between pcDNA-VEGF （V） group and blank group （P〉0.05）. The activity of endothelial cell proliferation was reduced significantly after transfection, and obvious apoptosis occurred in hemangioma endothelial cells after transfection of antisense VEGF. It was suggested that VEGF plays an important role in the pathological change of hemangiomas by promoting endothelial cell proliferation and angiogenesis. Antisense VEGF gene transfection could effectively inhibit the growth of hemanioma endothelial cells.