瑞芬太尼、氯胺酮合剂在小儿外科手术中的应用

目的探讨瑞芬太尼联合氯胺酮在小儿外科手术中的应用。方法选择60例ASAⅠ、Ⅱ级手术患儿,术前0.5h肌注阿托品0.02 mg/kg,地西泮0.2~0.4 mg/kg,入手术室后静脉注射氯胺酮2 mg/kg,不行气管内插管,面罩吸氧2 L/min。用微量泵输注"氯-瑞"合剂,开始10 min注速5~15 mL/h,随后根据术中情况调节注药速度。结果患儿术中安静入睡,咽喉反射存在,无躁动、喉痉挛及恶心、呕吐,无明显呼吸抑制现象,分泌物很少,镇痛完善。术毕苏醒时间缩短。结论瑞芬太尼联合氯胺酮用于小儿外科手术是一种很好的联合用药方法。     

十二指肠血管压迫综合征的诊断及外科治疗

十二指肠血管压迫综合征是指肠系膜上动脉或其分支结肠中动脉压迫十二指肠水平段引起的恶心、呕吐和腹胀等一系列临床症状;上消化道钡餐造影、CT、腹部彩色多普勒超声是常用的检查方法;外科治疗首选十二指肠空肠吻合术,腹腔镜手术得到初步尝试并获成功,其远期疗效有待进一步评估。     

Adenovirus-mediated GM-CSF gene and cytosine deaminase gene transfer followed by 5-fluorocytosine administration elicit more potent antitumor response in tumor-bearing mice.

Antitumor effects of combined transfer of suicide and cytokine genes were investigated in this study. Adenovirus harboring E. coli cytosine deaminase gene (AdCD) and adenovirus harboring murine granulocyte-macrophage colony-stimulating factor gene (AdGMCSF) were used simultaneously for in vivo gene transfer in melanoma-bearing mice. Growth inhibition of established tumors and prolongation of survival period were observed more significantly in tumor-bearing mice after transfection with AdGMCSF and AdCD followed by continuous injection of prodrug 5-fluorocytosine (5FC) when compared with mice treated with control adenovirus AdlacZ/5FC, AdCD/5FC or AdGMCSF alone (P < 0.01). After combined therapy the expression of MHC-I (H-2Db) and B7-1 molecules on freshly isolated tumor cells increased greatly and more dendritic cells and CD8+ T cells infiltrated into the tumor mass. The activity of specific cytotoxic T lymphocytes was also found to be induced more significantly after the combined therapy. Further experiments showed that apoptosis of tumor cells and induction of antitumor immune response might be involved in the mechanisms of the tumor cell killing by the combined therapy. Our results demonstrated that combined transfer of the GM-CSF and CD suicide genes, being able to inhibit the growth of melanoma synergistically and induce specific antitumor immune response efficiently, thus addressing the drawbacks of suicide gene therapy or cytokine gene therapy which were proved to be not satisfactory when used alone, might be of therapeutic potential for gene therapy of cancer.     

Bioadhesive poly(methyl methacrylate) microdevices for controlled drug delivery.

Oral delivery is the preferred route of drug administration. However, the breakdown of molecules and low levels of absorption in the gastrointestinal system render the oral delivery of proteins and peptides ineffective. Bioadhesive delivery devices can be used to circumvent these problems by protecting the drug from gastrointestinal denaturation, localizing and prolonging a drug at a specific target site, and maintaining direct contact with the intestinal cells, thereby increasing the drug concentration gradient. Microfabrication technology may offer some potential advantages over conventional delivery technologies. The benefits of microfabrication include the ability to tailor the size, shape, reservoir volume, and surface characteristics of the drug delivery vehicle. In this study, bioadhesive properties were introduced to microfabricated poly(methyl methacrylate) (PMMA) microdevices by attachment of lectins, a group of proteins capable of specifically targeting cells in the gastrointestinal tract. In this process, the PMMA microdevices were chemically modified by aminolysis to yield amine-terminated surfaces. Avidin molecules were covalently bound to the surface of the particles using a hydroxysuccinimide catalyzed carbodiimide reagent and then incubated in an aqueous solution of biotinylated lectin. The lectin-modified microdevices were examined in vitro in terms of their bioadhesive characteristics.     

Diagnosis of solid breast lesions by elastography 5-point score and strain ratio method

Purpose

To compare the diagnostic performance of 5-point scoring system and strain ratio by sonoelastography in the assessment of solid breast lesions.

Material and methods

One hundred and eighty-seven solid masses in 155 patients were scanned by two-dimensional ultrasonography and sonoelastography. Elasticity scores were determined with a 5-point scoring method, and the strain ratio was based on the comparison of the average strain measured in the lesion with the adjacent breast tissue in the same depth. Pathological results were taken as gold standards to compare the diagnostic efficacy of two methods with clinical diagnostic test and receiver operating characteristic (ROC) curves.

Results

Among 187 lesions, 130 were benign and 57 were malignant. The mean scores (1.62 ± 0.69 vs 4.07 ± 0.26, P < 0.05) and strain ratios (2.06 ± 1.27 vs 6.66 ± 4.62, P < 0.05) were significantly higher of malignant than benign lesions. The area under the curve for the 5-point scoring system and for strain ratio-based elastographic analysis was 0.892 and 0.909, respectively (P > 0.05). For 5-point scoring, sonoelastography had 84.2% sensitivity, 84.6% specificity, 84.5% accuracy, 70.6% positive predictive value and 92.4% negative predictive value. When a cutoff point of 3.06 was used, sensitivity, specificity, accuracy, positive and negative predictive values were 87.7%, 88.5%, 88.2%, 76.9% and 94.3%, respectively for the strain ratio (P > 0.05).

Conclusions

The 5-point scoring system and strain ratio has similar diagnostic performance, and the strain ratio could be more objective to differentiate the masses when those masses were difficult to be judged by using 5-point scoring system in sonoelastographic images.     

Quantitative chemical exchange sensitive MRI using irradiation with toggling inversion preparation

Chemical exchange (CE) sensitive MRI contrast acquired with an off‐resonance irradiation pulse is affected by other relaxation mechanisms, such as longitudinal and transverse relaxations. In particular, for intermediate CEs, the effect of transverse relaxation often dominates CE contrast. Since water relaxation rates can change significantly in many pathological conditions or during physiological challenge, it is crucial to separate these relaxation effects in order to obtain pure CE contrast. Here we proposed a novel acquisition scheme in which a toggling inversion pulse is applied prior to the off‐resonance irradiation. By combined acquisition of irradiation images with and without an inversion pulse at both the labile proton frequency and the reference frequency, longitudinal and transverse relaxation contributions are cancelled, and the quantification of CE parameters, such as the exchange rate and the labile proton concentration, can be simplified. Furthermore, the CE‐mediated relaxation rate can be readily determined with a relatively short irradiation pulse and without approaching the steady state, therefore, reducing the limitations on hardware and specific absorption rate requirements. The signal characteristics of the proposed method are evaluated by numerical simulations and phantom experiments. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc.     

宫腔镜与阴道超声检查子宫腔内病变临床价值探讨

目的对比宫腔镜检查（HS）与阴道超声检查（TVS）诊断子宫腔内病变的价值。方法对235例患者同时采用HS和TVS，并与最后的病理结果对照。结果HS对子宫内膜息肉和子宫内膜增生的敏感性和特异性分别是94．37％、81.7％和90．74％、98％；均高于TVS的71.2％、63％和77.2％、94％。TVS对子宫内膜癌诊断的敏感性是100％，高于HS的敏感性84.62％，但其特异性仅为66．67％，低于HS的敏感性91．67％。结论HS结合直视下活检是宫内疾病诊断的金标准。而TVS因其无创、低价、重复性好，可作为初筛方法。     

抑制糜酶活性对动脉粥样硬化早期仓鼠腹主动脉血流动力学的影响

目的 探讨抑制糜酶活性对仓鼠动脉粥样硬化病变腹主动脉血流动力学的影响。方法 42只8周龄雄性叙利亚金黄仓鼠随机分为A、B、C三组，各14只。A组为高脂对照组，B组采用高脂喂养＋曲尼司特灌胃，C组为正常对照组。分别在第0周和第12周末进行血脂检测，并应用多普勒超声检测各组仓鼠腹主动脉收缩期峰值血流速度（SV）、舒张末期血流速度（DV）、平均血流速度（MV）、搏动指数（PI）和阻力指数（RI）。第12周末处死仓鼠，采用体外灌流技术检测腹主动脉的糜酶活性及血管紧张素转换酶（ACE）活性。结果 12周后，A、B两组与C组比较，总胆固醇、甘油三酯、低密度脂蛋白均显著增高（P〈0.01）。多普勒超声检测显示，B组较A组SV、MV、PI和RI显著降低（P〈0．01），DV显著增高（P〈0．05）。A、B两组腹主动脉糜酶活性均较C组显著增高（分别升高63％、20％，P〈0．01），B组糜酶活性与A组比较显著降低26％（P〈0．01），ACE活性轻度增高，但组间比较差异无统计学意义（P〉（0．05）。糜酶活性与血流动力学指标SV、PI和RI呈正相关（r分别为0．47、0．60和0．61，P〈0．01）。结论 抑制糜酶活性可显著改善仓鼠动脉粥样硬化病变腹主动脉的血流动力学水平，进而延缓动脉粥样硬化病变的发展。     

Predictive role of CHADS2 and CHA2DS2-VASc scores on stroke and thromboembolism in patients without atrial fibrillation: a meta-analysis

Objective: CHA₂DS₂-VASc is the extension of the CHADS₂ score developed by Birmingham 2009. This risk stratification schema is often used in clinical setting when considering additional risk factors for developing stroke in AF patients. However, its role in the non-AF population is unknown. This study was designed to evaluate the accuracy of the CHADS₂ and the CHA₂DS₂-VASc scoring systems.

Methods: Studies designed for CHADS₂ and CHA₂DS₂-VASc score in stratifying the risks for stroke development in non-AF patients were included.

Results: Among the 114 studies identified, six trials were chosen finally and included for meta-analysis. The pooled diagnostic odds ratio (DOR) for CHADS₂ and CHA₂DS₂-VASc was 2.86 (95% CI =1.83–4.28) and 2.80 (95% CI =1.83–4.28), respectively. CHA₂DS₂-VASc score was of better sensitivity than CHADS₂ score (0.920 vs. 0.768). However, both scores were showed to have inherent heterogeneity and poor specificity.

Conclusions: Though having good diagnostic accuracy, the clinical application of the CHADS₂ and CHA₂DS₂-VASc scores in predicting risk of stroke development in non-AF patients still needs further validation.

• Key message

• The overall diagnostic accuracy of CHADS₂ and CHA₂DS₂-VASc in stroke-risk stratification was good in patients with non-atrial fibrillation.

     

卵巢癌综合治疗后18F-FDG PET/CT随访的临床价值

目的:探讨18F-FDG PET/CT显像在卵巢癌综合治疗后随访的应用价值及对临床治疗决策的影响.方法:回顾性分析在本中心接受PET/CT显像的152例卵巢癌治疗后患者,收集及分析临床资料、CA125及常规影像学结果.将患者按不同的PET/CT检查指征分为5组,与临床随访结果进行对比,分析PET/CT在卵巢癌治疗随访的应用价值及对临床治疗决策的影响.结果:137例有随访结果者纳入本研究,其中105例复发、32例无复发.PET/CT诊断卵巢癌复发的总体敏感度、特异度、准确率、阳性预测值、阴性预测值分别为:98.3％、91.2％、96.8％、97.5％、93.9％.PET/CT可为临床疑有复发、病情评估及疗效评价患者制定准确的治疗决策.结论:PET/CT检查对卵巢癌复发有着极高的诊断效率,可为临床提供最优化的治疗方案.