改良直置式套管针替代导入鞘法在新生儿PICC置入中的应用

目的评价改良直置式套管针替代安全型撕裂式导入鞘法置入新生儿PICC的可行性和安全性。方法对135例新生儿应用20G直置式套管针置入PICC(观察组),与应用导入鞘置入PICC的128例新生儿(对照组)进行对比,比较两组穿刺时间、第1次换药时间、穿刺成功率及留置时间。结果两组穿刺时间、穿剌成功率及导管留置时间比较,差异无统计学意义(均P>0.05);观察组较对照组第1次换药时间延长(P<0.01)。结论在新生儿PICC置管中,经济简便的直置式套管针可以替代安全型撕裂式导入鞘使用。     

右美托咪啶超前镇痛对乳腺癌根治术后围拔管期疼痛的影响

目的评价右美托咪啶超前镇痛对乳腺癌保乳根治术术后围拔管期疼痛的影响。方法选择ASAⅠ～Ⅱ级择期在全麻下进行乳腺癌保乳根治术的女性患者42例,随机分为右美托咪啶超前镇痛组和对照组,每组各21例。前者于手术前给予右美托咪啶1μg/kg,后者给予等容量的生理盐水。分别记录手术时间、苏醒时间、拔管时间、围术期血压、心率;观察两组患者术后30分钟内的视觉模拟评分（VAS）和要求追加镇痛药物的时间和剂量以及有无恶心呕吐不良反应。结果 1）右美托咪啶组在围拔管期各时点的VAS评分、需要追加镇痛药物的人次均明显低于对照组;2）使用右美托咪啶患者在围术期心率和血压相较对照稳定;3）两组在拔管时间、恶心呕吐发生率无明显差别。结论右美托咪啶超前镇痛可安全有效地减轻乳腺癌保乳根治术患者的围拔管期疼痛。     

Metastatic renal cell carcinoma presenting as gastric polyps: A case report and review of the literature

INTRODUCTIONRenal cell carcinoma (RCC) accounts for approximately 3% of adult malignancies and is responsible for over 13,000 deaths in the U.S. annually. The fatalities are largely due to distant metastasis, with lung, liver, bone and brain being most commonly affected organs. Gastric metastasis from RCC is a rare event (less than 20 cases reported in the English language literature) and usually presents as a large, solitary mass or ulcer (average size of 4.8 cm) resembling primary gastric cancer. Here we report the first case of metastatic RCC presenting as small gastric polyps.PRESENTATION OF CASEThe patient was a 60-year-old African American woman with a history of clear cell RCC (pT1bNX). She underwent esophagogastroduodenoscopy and colonoscopy 5 months after nephrectomy due to anemia. Two non-ulcerated, 0.6-cm benign-appearing polyps were found at the greater curvature of the gastric body, which were subsequently removed endoscopically. Unexpectedly, histopathologic examination of the gastric polyps revealed nested collections of vacuolated epithelioid cells in a background of delicate, arborizing vasculature, immediately beneath the congested and hyperplastic foveolar epithelium. A diagnosis of metastatic RCC was rendered after confirming the renal epithelial origin by immunohistochemical stains.DISCUSSIONGastric metastasis from RCC usually presents as a large, solitary mass or ulcer, but it can be subtle and present as multiple, small benign-appearing polyps.CONCLUSIONA careful follow up and thorough endoscopic and histopathologic examinations should be conducted in patients with a history of RCC who present with gastrointestinal manifestations.     

酒精性肝炎自噬关键基因的筛选及生物信息学分析

目的 筛选酒精性肝炎（AH）的自噬关键基因,探讨AH潜在的生物标志物和治疗靶点。 方法  采用基因表达综合数据库（GEO）中的2个AH基因芯片和从MSigDB、GeneCards数据库中获得的自噬相关数据集,通过加权基因共表达网络分析（WGCNA）获取关键基因。对筛选的关键基因进行基因本体（GO）、京都基因和基因组百科全书（KEGG）功能富集分析,蛋白质相互作用（PPI）分析,免疫浸润分析,构建信使RNA（mRNA）-微小RNA（miRNA）网络,进行酒精性肝病不同分期的自噬相关关键基因的表达差异分析,并进一步通过实时荧光定量逆转录聚合酶链反应（RT-qPCR）在AH患者和小鼠肝脏组织中验证。 结果  本研究筛选得到了11个与AH自噬相关的基因（EEF1A2、CFTR、SOX4、TREM2、CTHRC1、HSPB8、TUBB3、PRKAA2、RNASE1、MTCL1、HGF）,均为上调基因。在AH患者和小鼠肝脏组织中,SOX4、TREM2、HSPB8、PRKAA2在AH组中的相对表达量均高于对照组。 结论  SOX4、TREM2、HSPB8、PRKAA2可能是AH潜在的生物标志物和治疗靶点。     

Differences between the Vastus Lateralis and Gastrocnemius Lateralis in the Assessment Ability of Breakpoints of Muscle Oxygenation for Aerobic Capacity Indices During an Incremental Cycling Exercise

In recent years, breakpoints (Bp) of muscle oxygenation have been measured in local muscles using near infrared spectroscopy (NIRS) to assess (predict) systemic aerobic capacity indices [lactate threshold (LT), gas exchange threshold (GET) and maximal oxygen uptake (VO_2peak)]. We investigated muscular differences in the assessment (predictive) ability of the Bp of muscle oxygenation for aerobic capacity indices during incremental cycling exercise on the aerobic capacity indices. Thirty-one active college students were recruited for an incremental cycling exercise test, during which NIRS muscle oxygenation in the vastus lateralis (VL) and gastrocnemius lateralis (GL), blood lactate concentration and cardiopulmonary variables were measured simultaneously in a multi-modality approach. A linear regression model was used to analyse the relationship between the Bp of the muscle oxygenation index (OI) and the systemic aerobic capacity indices. The Bp of the muscle OI in both the VL (BpVL) and GL (BpGL) were significantly correlated with the aerobic capacity indices. Additionally, the BpVL had a better goodness-of-fit [higher coefficient of determination (R², p < 0.001) and lower root mean squared error (RMSE, p < 0.03)] in the linear regressions and occurred earlier than the BpGL. In conclusion, both the BpVL and the BpGL could be measured by NIRS to assess the systemic aerobic capacity indices; however, there were muscular differences in the assessment ability of the Bp of muscle oxygenation.

Key points

• The breakpoints (Bp) of muscle oxygenation index in both vastus lateralis (VL) and gastrocnemius lateralis (GL) could be detected to indicate the breaking up of the oxygen supply-consumption balance by NIRS.
• The Bp of muscle oxygenation index in both VL (BpVL) and GL (BpGL) were significantly correlated with the systemic aerobic capacity indices.
• The BpVL owned higher assessment (predictive) ability when the Bp (BpVL and BpGL) of muscle oxygenation index was used to assess (predict) systemic aerobic capacity indices.

Key words: Maximal incremental exercise test, aerobic capacity index, assessment ability, near infrared spectroscopy, linear regression.     

机器人辅助腹腔镜下根治性膀胱切除加尿流改道术的临床分析

目的 探讨采用da Vinci S机器人系统完成机器人辅助腹腔镜下根治性膀胱切除(robotic-assisted laparoscopic radical cystectomy,RARC)加尿流改道术的临床可行性,并总结技术特点和临床效果. 方法 2007年12月至2012年3月膀胱尿路上皮癌患者22例,男20例,女2例.年龄37～ 72岁,平均62岁.体质指数22.5 ～ 30.1 kg/m2,平均26.1 kg/m2.麻醉评分1～2分.术前肿瘤活检病理诊断为浸润性或高危的非肌层浸润性膀胱尿路上皮痛,术前检查均未发现有其他邻近脏器浸润、盆腔淋巴结转移或远处转移,临床分期均低于T2N0M0.全麻下行RARC加尿流改道术,其中行体外尿流改道术15例(原位新膀胱2例,回肠膀胱术13例),行完全腹腔镜下尿流改道术7例(回肠膀胱术2例,原位新膀胱5例). 结果 本组22例手术均获得成功.手术时间300 ～ 667 min,平均480 min;出血量100 ～ 1200 ml,平均550 ml;淋巴结清扫数目6～ 25枚,平均15枚.术后2～3d下地活动,3～4d肠功能恢复,术后住院时间8～35 d,平均16d.行原位新膀胱的患者术后1个月行膀胱造影确定无吻合口漏后拔除尿管和双侧输尿管支架管.术后随访4 ～ 49个月,平均32个月,复发2例,死亡1例,出现肾积水2例,其余病例肾功能均正常,尿控较满意. 结论 根据初期的手术操作过程和随访结果,RARC加尿流改道术在临床上是可行的.更多的操作经验、长期和随机的对照研究将有助于对这一技术进行评估和推广.     

右美托咪定在神经阻滞和椎管内麻醉的应用进展

背景：右美托咪定为高效、高选择性的a2-肾上腺素能激动剂,具有镇静、镇痛、抗焦虑、催眠等作用。作为麻醉辅助药已广泛的应用于临床。目的：就右美托咪定在神经阻滞和椎管内麻醉的应用进展作简人介绍。内容：探讨右美托咪定在神经阻滞和椎管内麻醉中应用的效果及相关作用机制。趋向：右美托咪定应用于神经阻滞和椎管内麻醉中,有良好的镇静作用,对呼吸系统影响小,对术中遗忘有增强作用。具有较广泛的应用前景,而在其给药方式,剂量及作用机制方面还需进一步研究。     

高剂量D- 半乳糖复制C57BL/6J 衰老小鼠模型的研究

目的 探讨高剂量D- 半乳糖复制C57BL/6J 衰老小鼠模型的效果。方法 选用30 只9 周龄雄 性C57BL/6J 小鼠,随机分为3 组：500 mg/（kg·d）D- 半乳糖组、1 000 mg/（kg·d）D- 半乳糖组及对照 组,持续皮下注射8 周后解剖小鼠,测定血液和组织中超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSHPx） 及丙二醛（MDA）等,Western blotting 检测组织中血红素加氧酶-1（HO-1）的表达,并对部分组织行 苏木精- 伊红染色。结果 1 000 mg/（kg·d）D- 半乳糖组小鼠出现不同程度的脱毛现象。D- 半乳糖组小 鼠的SOD 和GSH-Px 低于对照组（P <0.05）,而MDA 和HO-1 高于对照组（P <0.05）。D- 半乳糖组小鼠肝、 脑组织有不同程度的衰老相关病理学改变。结论 D- 半乳糖可以成功诱导小鼠衰老,是复制小鼠衰老模型 的较好选择。     

先天性肾积水患儿尿水通道蛋白-1、内皮素-1表达水平及临床意义

目的 分析先天性肾积水患儿尿水通道蛋白（AQP-1）及内皮素-1（ET-1）的表达水平,并探索其临床意义。方法 选取40例先天性肾积水患儿作为实验组,并根据肾积水严重程度分为轻、中、重度积水。另选无泌尿系疾患儿童40例作为对照组。收集实验组术前晨尿、术中肾盂尿和术后第7天晨尿,以及对照组晨尿。测定实验组及对照组尿液AQP-1及ET-1表达水平,并进行尿AQP-1、ET-1水平的组间比较,及实验组术前、术中、术后尿AQP-1水平的组内比较。结果 轻度肾积水患儿尿AQP-1水平与对照组比较,差异无统计学意义（P?>0.05）;中度、重度肾积水患儿尿AQP-1水平则低于对照组（P?<0.05）;实验组患儿术中尿AQP-1水平低于术前水平（P?<0.05）;术后尿AQP-1水平高于术前水平（P?<0.05）;先天性肾积水患儿尿ET-1阳性率高于对照组（P?<0.05）。结论 尿AQP-1及ET-1水平可作为先天性肾积水患儿的辅助诊断指标。尿AQP-1水平还可作为肾积水患儿术后恢复的监测指标。     

皮损间充质干细胞中相关细胞因子异常分泌对银屑病的临床意义

目的 探讨表皮生长因子（EGF）、转化生长因子β（TGF-β）及干细胞因子（SCF）在银屑病发生、发展中的作用。方法 体外分离培养银屑病患者（观察组）与健康皮肤患者（对照组）皮肤间充质干细胞,采用流式细胞仪检测鉴定皮肤间充质干细胞,显微镜下观察成脂及成骨诱导分化后的皮肤间充质干细胞,采用ELISA检测皮肤间充质干细胞中EGF、TGF-β1及SCF的水平。结果 观察组与对照组的皮肤间充质干细胞显微镜下形态相似;观察组表面抗原CD73、CD44、CD90、CD105、以及CD29表达阳性,而HLA-DR、CD34以及CD45表达阴性;成脂及成骨诱导分化能力相似;观察组皮肤间充质干细胞中EGF、TGF-β1及SCF的水平与对照组比较,差异有统计学意义（P?<0.05）,观察组皮损处皮肤间充质干细胞中EGF及SCF水平表达升高,而TGF-β1水平降低。结论 银屑病患者皮损间充质干细胞EGF、TGF-β1及SCF分泌异常。