超声造影微血管成像与常规超声靶向引导前列腺癌穿刺活检的比较研究

ObJective To evaluate the value of contrast-enhanced ultrasonography microflow imaging (MFI) in detecting prostate cancer. Methods Sixty-five patients with serum prostate-specific antigen levels higher than 4.00 μg/L were evaluated with transrectal gray-scale,power Doppler,and MFI ultrasonography and then biopsy guided by ultrasonography. Biopsy was performed at twelve sites in the base,the mid gland and the apex in each patient. In these three transverse sections, when any of the three methods showed abnormality,the biopsy site was directed to the abnormal foci. Diagnostic efficiency of the three methods for prostate cancer detection was compared based on biopsy results according to patient and biopsy site. Results Overall prostate cancers were detected in 230 (29.5 %) of 780 specimens in 36(55.4%) of 65 patients. MFI could detect more patients(34) than gray-scale(26) and power Doppler(28) (P = 0.021, P = 0.031), 6(16.7%)of the 36 patients diagnosed with cancer were identified only by MFI. By biopsy site, MFI had higher sensitivity and overall accuracy (80.0% and 83.0%) than gray-scale (47.0% and 76.8%) and power Doppler (37.4% and 74.6%) ultrasonography(P <0.001, P<0.001 ; P = 0.001, P <0.001), while the specificity of MFI was 84.4%, lower than gray-scale (89.3%) and power Doppler (90.2%) ultrasonography(P = 0.009, P < 0.001). Conclusions MFI could detect more patients and improve sensitivity and overall accuracy by biopsy site than conventional uhrasonography.     

雷帕霉素洗脱支架对吻术与单支架术对冠状动脉分叉病变疗效的影响

目的比较雷帕霉素洗脱支架对吻技术与单支架技术对真性分叉病变的近、远期疗效的影响。方法 200名分叉病变患者,随机分为对吻支架术和单支架术两组。随访1年,观察两组节段内再狭窄率、死亡率、非致死性心肌梗死率、靶病变再次血运重建率和支架内血栓形成率。结果术后1年,单支架组与对吻支架组相比,再狭窄率、死亡率、心肌梗死发生率、靶病变再次血运重建率、支架内血栓发生率及严重心血管不良事件发生率差异均无统计学意义（P〉0.05）;分支预扩张后,出现夹层的患者分析提示单支架与对吻支架组节段内再狭窄率、靶病变再次血运重建率及严重心血管不良事件发生率差异有统计学意义（P〈0.05）,而支架内血栓率、死亡率及心肌梗死率差异无统计学意义（P〉0.05）。结论对于直径较大的分叉病变患者,对吻支架技术的近、远期疗效与单支架术相近。预扩张后分支出现夹层应采用对吻支架术,没有夹层则应采用单支架植入。     

醋酸去氨加压素辅助治疗食管胃底静脉曲张破裂出血的临床效果观察

目的探讨醋酸去氨加压素对食管胃底静脉曲张破裂出血患者的临床治疗效果。方法将86例食管胃底静脉曲张破裂出血患者随机分为观察组(醋酸去氨加压素治疗)与对照组(垂体后叶素治疗),每组43例,治疗3d后对比分析两组的临床效果。结果观察组患者中显效28例,有效11例,无效4例,总有效39例,总有效约为90.70%。对照组患者中显效21例,有效10例,无效12例,总有效31例,总有效约为72.09%。观察组患者总有效率显著优于对照组,两组患者之间比较差异性显著(P<0.05),具有统计学意义。结论相对垂体后叶素而言,醋酸去氨加压素对于食管胃底静脉曲张破裂出血临床疗效更加显著,值得临床借鉴应用。     

新天然来源抗生素-抗霉素A18的抗肿瘤活性及其产生菌107A-01824的生物学特征

目的 检测抗霉素A18的体外抗肿瘤活性并对其产生菌107A-01824的形态及培养特征,生理生化特征等进行研究方法用MTT法检测抗霉素A18的肿瘤细胞生长抑制作用,用流式细胞术测定其对细胞周期的影响:按分类学常规方法研究株107A-01824的形态及部分生理生化特征.结果 抗霉素A18能够抑制人肝癌细胞HepG2、人口腔上皮癌细胞KB的生长:这个细胞株均被阻滞在细胞周期的S期.菌株I07A-01824的形态及培养特征与己知种-黄白链霉菌(Streptomyces albidofavus)一致.结论 红树林内生放线菌是新抗生素的重要来源.     

关节镜辅助微创手术治疗Pilon骨折33例

目的 探讨关节镜辅助下微创经皮钢板内固定(MIPPO)手术治疗Pilon骨折的临床疗效.方法 33例Pilon骨折患者按Ruedi-Allgower分型,采用关节镜辅助下MIPPO手术治疗,术后随访时间12～84个月.结果 优22例,良8例,可3例,优良率为90.9％.结论 关节镜辅助下MIPPO手术治疗Pilon骨折是一种有效方法,具有愈合好、创伤小、并发症少等优点.     

原发性十二指肠肿瘤的诊断和治疗

目的 探讨原发性十二指肠肿瘤的诊断和术式选择.方法 回顾性分析中国医科大学附属第一医院2001-2007年间124例原发性十二指肠肿瘤患者的临床资料,其中良性肿瘤10例,恶性肿瘤114例.结果 本组原发性十二指肠肿瘤常见的临床表现有上腹痛、黄疸、体重下降以及纳差等.肿瘤位于十二指肠球部9例(7.3%),降部107例(86.3%),水平部7例(5.7%),升部1例(0.8%).术前纤维内镜确诊率为90.5%,ERCP确诊率为94.1%,超声内镜确诊率为100%,胃肠气钡双重造影发现率为78.6%,MRI发现率为80.5%,CT发现率为75.7%,B超发现率为40.6%.10例原发性十二指肠良性肿瘤中5例行肿瘤局部切除术,2例行标准胰十二指肠切除术,1例行十二指肠节段切除术,2例未手术,5年生存率为100%;114例原发性十二指肠恶性肿瘤中47例行标准胰十二指肠切除术,3例行保留幽门的胰十二指肠切除术,5年生存率为35.8%;6例行局部肿瘤切除术,12例行十二指肠节段切除术,5年生存率为16.7%;22例行旁路手术,均死于术后5～16个月;2例行支架介入术,2例行经皮肝胆道穿刺引流术,死于术后3～11个月;其余未手术,死于术后1～11个月.结论 原发性十二指肠肿瘤缺乏特异性临床表现,经内镜、超声内镜以及ERCP等联合检查可提高术前诊断率.对良性肿瘤可行局部肿瘤切除术或十二指肠节段切除术,对恶性肿瘤首选胰十二指肠切除术,对晚期肿瘤患者可采用旁路手术以提高生存率及生存质量.     

突触素在人食管胃连接部的表达

目的 探讨突触素在人食管胃连接部各类环行平滑肌中的分布情况.方法 选取河北医科大学第四医院胸外科收治的高位食管中段癌患者8例,在行根治性食管癌切除食管胃吻合术时切除食管胃连接部,分离出食管下括约肌的套索纤维和钩状纤维,以及部分远端食管环行肌和胃底环行肌,应用免疫印迹(western blot)检测突触素在各类环行平滑肌组织中的表达.结果 套索纤维、钩状纤维、食管环行肌和胃底环行肌等平滑肌中突触素表达的积分光密度值分别为284.45±73.69,265.39±87.12,248.40±70.80和317.17±96.25,组间差异无统计学意义(F=1.101 8,P＞0.05).结论 人食管下括约肌的套索纤维和钩状纤维,以及远端食管环行肌和胃底环行肌中均有突触素表达,但其表达水平无差异.     

18F-fluorodeoxyglucose positron emission tomography does not predict malignancy in thyroid nodules cytologically diagnosed as follicular neoplasm

OBJECTIVE: The objective of this study was to evaluate the usefulness of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in predicting malignancy in thyroid nodules cytologically diagnosed as follicular neoplasm. PATIENTS AND METHODS: A total of 46 patients with thyroid nodules larger than 1 cm in diameter cytologically diagnosed as follicular neoplasm at Asan Medical Center (Seoul, Korea) were included. FDG-PET images were taken in all patients before surgical resection, and the maximum standardized uptake value (SUVmax) of each nodule was measured. RESULTS: FDG-PET showed hypermetabolic activity of all nodules compared with normal thyroid tissue. Thirty-six patients underwent surgery, whereas 10 refused immediate operation. Fifteen patients had cancer: 11 with follicular and two each with Hürthle cell and follicular variants of papillary cancer. Twenty-one patients had benign nodules: 11 follicular adenomas, eight adenomatous hyperplasias, and two Hürthle cell adenomas. SUVmax did not differ significantly between malignant and benign nodules (3.6 +/- 3.5 vs. 3.4 +/- 3.2; P = 0.83) or among subtypes of benign nodules (P = 0.23). However, SUVmax differed significantly among subtypes of malignant nodules (P = 0.02). CONCLUSIONS: On FDG-PET, the glucose metabolic activities of benign thyroid follicular nodules were as high as those of malignant nodules. These findings suggest that FDG-PET has limited value for selecting candidates for surgery among patients cytologically diagnosed as follicular neoplasm.     

86例原发性甲亢的手术治疗效果观察

目的探讨原发性甲亢的临床诊断特点及手术治疗效果。方法对我院自2005年5月-2008年5月收治的86例原发性甲状腺机能亢进症患者的临床资料进行回顾性分析。结果所有病人均在气管内麻下行双甲状腺次全切除术,残留腺体量约4-6g,除2例因麻醉插管3次导致喉头水肿,其余84例均无任何并发症发生。结论在严格掌握适应征的前提下,手术治疗原发性甲亢是一种较好的治疗方法,同时也适合于青少年。     

塔克拉玛干沙漠来源链霉菌Streptomyces sp. 90次级代谢产物的研究

摘要：目的 研究塔克拉玛干沙漠来源链霉菌Streptomyces sp. 90的次级代谢产物。方法 采用反相硅胶柱色谱、葡聚糖凝胶Sephadex LH-20、半制备HPLC方法分离纯化该菌株的发酵粗提物,通过ESI-MS、NMR等波谱数据分析并与文献对比确定化合物的结构,采用琼脂扩散法和稀释法分别追踪化合物抗菌活性及评价化合物1的最低抑菌浓度(minimal inhibitory concentration, MIC),利用LC-MS法初步研究光照和温度因素对化合物1稳定性的影响。结果 从Streptomyces sp. 90中分离得到6个化合物,通过质谱和核磁共振等方法确定了化合物的结构,分别为已知化合物collismycin A(1)、collismycin B(2)、pyrisulfoxin A(3)、SF2738C(4)、SF2738D(5)和SF2738F(6);化合物1对表皮葡萄球菌表现出较明显的抑制作用,MIC值在8~16 μg/mL之间,对甲氧西林耐药的金黄色葡萄球菌(MRSA)表现出一定抑制作用,MIC在32~64 μg/mL,而对革兰阴性菌抑制活性较弱。化合物1在溶液状态下对光照敏感,而对温度较稳定。结论 化合物1为放线菌Streptomyces sp. 90主要活性物质,但对光照不稳定。