颈部放射性溃疡的治疗

目的:探讨颈部放射性溃疡的手术方法。方法:彻底或姑息性切除颈部放射性溃疡组织后,根据颈部组织损伤程度的不同,分别用同侧胸三角皮瓣或胸大肌肌皮瓣进行颈部缺损的修复,供区使用全厚皮片修复。结果:11例胸三角皮瓣、3例胸大肌肌皮瓣全部成活,愈合良好,术后患者生活质量明显改善。结论:胸三角皮瓣与胸大肌肌皮瓣血运可靠,是修复颈部放射性溃疡的有效、简单和安全的方法。     

Evaluation of vertical traction radiography for predicting the outcome of moderate to severe rigid scoliosis correction

Objective: To determine the efficacy of imaging patients in a state of traction (“traction imaging”) for selection of upper and lower vertebrae to undergo instrumentation (UIV and LIV, respectively) to correct moderate to severe, rigid scoliosis. Methods: Twenty‐seven patients aged 11–21 years (average, 15.5 years) who had been treated at our institution for scoliosis of the thoracic spine between 2004 and 2008 were retrospectively analyzed. All patients were treated with the third multiple hook‐screw and rod instrumentation system. Standardized radiographic measurements (anteroposterior, sagittal, bending, fulcrum, traction) were taken and Cobb's angles, apical vertebra translation (AVT), and traction‐stable vertebrae determined. Results: All patients were followed for 6–36 months (average, 14.7 months). The Cobb's angles under preoperative vertical traction correlated positively with those measured postoperatively in standing anteroposterior film (P < 0.01). Preoperative AVT under vertical traction was significantly different from that measured postoperatively in standing anteroposterior film (P < 0.01). The traction radiography‐determined UIV slant angles were significantly different from those preoperatively without traction and the postoperative values, whereas traction radiography‐determined LIV values were not significantly different from those found preoperatively without traction (P > 0.05). Conclusions: Traction radiographic imaging is an effective, feasible preoperative assessment for determining which vertebrae are stable, designing the surgical strategy and choosing the UIV and LIV for correcting moderate to severe, rigid scoliosis.     

Functional MR imaging of kidneys in patients with lupus nephritis

Objective To evaluate the functional magnetic resonance (MR) imaging in the assessment of renal involvement and pathological changes in patients with lupus nephritis (LN). Methods Seventeen patients with LN and 10 healthy controls underwent coronal echo?planar diffusion?weighted (DW) MR imaging and blood oxygen level dependent (BOLD) MR imaging of the kidneys with a single breath?hold time of 16 s. The apparent diffusion coefficient (ADC) and R2* value of the kidneys were calculated with high b values (b=500 s/mm2). The correlation between the renal injury variables and the ADCs or R2* values was evaluated. Results The mean ADC value of kidneys in patients with LN was (2.43±0.24)×10-3 mm2/s, the mean R2* values of the renal cortex and medulla were (11.72±2.35)/s and (13.07±2.35)/s respectively, which were all significantly lower than those in volunteers (P=0.045,P=0.048 and P=0.001, respectively). In the patients with LN, the mean ADC values were positively correlated with estimated glomerular filtration rate (eGFR) (r=0.558, P<0.05). There was a negative correlation between the ADC values of the right kidneys and pathological chronic indexes (r=-0.493, P<0.05). Moreover, the R2*values of the renal medulla were negatively correlated with 24 hours proteinuria, serum creatinine, pathological active indexes. The patients were assigned to group A (class Ⅲ, Ⅳ, Ⅴ, n=8) and group B (class Ⅴ+Ⅲ and Ⅴ+Ⅳ, n=9). The tubulointerstitial lesions in group B were more severe than those in group A, while the mean ADC values and R2* values of the renal cortex in group B were lower as compared to group A. Conclusion DW MR imaging and BOLD MR imaging may be used to non?invasively monitor the disease activity and evaluate the efficacy in lupus nephritis.     

两种胶体预充液用于心肺转流的临床研究

目的研究羟乙基淀粉和琥珀酰明胶用于心肺转流(CPB)预充时对患者凝血功能及胶体渗透压的影响。方法 60例先天性非紫绀心脏病患者,随机均分为两组:羟乙基淀粉组以6%羟乙基淀粉130/0.4预充,琥珀酰明胶组以4%琥珀酰明胶预充。手术室及ICU根据分组情况亦分别输注羟乙基淀粉和琥珀酰明胶。于CPB前、给鱼精蛋白后、ICU6h测定激活凝血时间(ACT)、凝血速率(CR)及血小板功能(PF);于CPB前、CPB中、CPB后、ICU2h和6h测定胶体渗透压。结果给鱼精蛋白后和ICU6h,羟乙基淀粉组PF明显高于琥珀酰明胶组(P<0.05),其余指标差异无统计学意义。结论 6%羟乙基淀粉130/0.4与4%琥珀酰明胶作为胶体预充液在心肺转流中使用安全性相似。     

改良Proseal喉罩与改良普通喉罩在无痛纤维支气管镜检查中的气道管理

目的比较改良Proseal喉罩和改良普通喉罩在无痛纤维支气管镜检查中气道管理的效果。方法选择行纤维支气管镜检查患者40例,随机均分为两组:改良Proseal喉罩组(P组)和改良普通喉罩组(L组)。全麻诱导后徒手插入喉罩,接麻醉机,控制或辅助通气。记录两组麻醉前(T0)、插入喉罩即刻(T1)、插入喉罩3min(T2)的SBP、DBP、HR和SpO2,同时记录喉罩插入时间和并发症,并进行喉罩通气评估、纤维支气管镜评估和气道密封压测定。结果两组患者喉罩插入时间及各时点的SBP、DBP、HR和SpO2差异均无统计学意义;P组气道密封压明显高于L组(P<0.01);P组喉罩通气、纤维支气管镜评分优良率均为100%,明显高于L组的85%、80%(P<0.01);术毕P组1例喉罩粘血,明显少于L组的7例(P<0.05)。结论改良Proseal喉罩在气密性、通气评估、纤维支气管镜评估等方面好于改良普通喉罩,但对血流动力学的影响两者无明显差异。     

膝关节前交叉韧带翻修及影响首次重建疗效的相关因素分析

目的总结影响关节镜下前交叉韧带重建疗效的相关因素。方法回顾性分析135例前交叉韧带翻修病例的相关临床资料,进行膝关节Lysholm评分综合分析。结果膝关节继发性疾患、骨隧道位置、移植物的张力、髁间窝撞击、所移植肌腱的固定和术后康复训练6大因素是影响关节镜下膝关节前交叉韧带重建疗效的关键因素。结论高度重视以上6方面因素并正确处理,能有效提高关节镜下膝关节前交叉韧带重建的成功率和治疗效果。     

Evaluation of thymosin β4 in the regulation of epithelial-mesenchymal transformation in urothelial carcinoma

ObjectivesTo study the underlying alteration in the expression of epithelial markers involved in epithelial-mesenchymal transition (EMT), and elucidate the potential mechanism(s) for Tβ4-induced EMT-like phenotypic changes in bladder cancer cells.Materials and methodsAll tissue samples in this study were obtained from clinical patients of the Union Hospital of Tongji Medical College, and were confirmed by surgery and pathology. Of these, normal bladder tissues (control), primary urothelial carcinoma of different grades (Stage pTa, Stage pT3), bladder paracancerous tissues, accompanied with 2 bladder cancer cell lines (BIU-87 and T24), were divided into 6 groups. Quantitative RT-PCR, Western blotting, and immunohistochemical study of adhesion molecules Tβ4, ILK, E-cadherin, and β-catenin involved in EMT were carried out. A lentiviral gene transferring vector containing the RNA polymerase III-dependent U6 promoter to express short hairpin RNA (shRNA) directed against Tβ4 was also applied. In the present study, all agents were evaluated using commercial kits.ResultsA strong correlation between the expression levels of Tβ4, ILK, E-cadherin, and β-catenin was found in the bladder transitional cell carcinoma (TCC) patients. In the BIU-87 and T24 bladder cancer cells overexpressing Tβ4, which were accompanied by a loss of E-cadherin as well as a cytosolic accumulation of β-catenin, up-regulation of ILK was also revealed. The inhibition of the Tβ4 expression with lentiviral shRNA vector could raise EMT-like phenotypic changes, significantly depressed motility, and subsequent invasiveness of bladder cancer cells.ConclusionsOur results imply that the Tβ4 is likely to play a crucial role in EMT progression, and that inhibition of the Tβ4 expression or interactions with other genes should be novel therapeutic targets for bladder cancers with high invasive and metastatic potential.     

人羊水间充质干细胞对乙型肝炎肝衰竭患者外周血Th1／Th2的体外调节

目的探讨人羊水间充质干细胞（human amniotie fluid—derived mesenchymal stem cells,h-AFMsc）对乙型肝炎肝衰竭患者外周血Th1／Th2的体外调节作用。方法选择2011年2—5月中山大学附属第三医院6例乙型肝炎肝衰竭患者和6名健康志愿者,提取外周血单个核细胞（peripheral blood mononuelear cells,PBMC）,同时从孕妇中期羊水中提取h-AFMSC。将h-AFMSC分别与乙型肝炎肝衰竭患者和健康捐献者的PBMC共培养72h,乙型肝炎肝衰竭患者和健康捐献者的PBMC单独培养组作为对照。应用流式细胞仪检测共培养前后不同组PBMCIFNγ（Th1）和IL-4（Th2）的变化情况,计算Th1／Th2比值。对共培养前后数据进行Mauchly球形检验,P〉0．1满足球形假设检验则采用重复测量方差分析。结果共培养72h,乙型肝炎肝衰竭患者PBMC与h—AFMSC共培养组的Th1细胞比例与其PBMC单独培养组比较无明显差异（F=0．82,P〉0．05）,但Th2细胞比例明显下降（F=10．24,P〈0．05）,从而导致Th1／Th2比值显著上升（F=17．28,P〈0．01）。健康捐献者PBMC与h-AFMSC共培养组的Th1、Th2和Th1／Th2比值与其PBMC单独培养组比较差异均不明显（F值分别为0．54、0．68和0．74,P值均〉0．05）。结论h-AFMSC对乙型肝炎肝衰竭患者的Th1／Th2有体外调节作用,具有作为移植种子来源移植治疗乙型肝炎肝衰竭的可能性。     

产褥期重症甲型H1N1流感一例的救治及护理

重症甲型H1N1流感是甲型H1N1流感病毒侵袭肺脏而产生的一种急性呼吸道传染性疾病,患者表现为持续高热、剧烈咳嗽、痰多、胸闷、口唇发紫,甚至出现呼吸衰竭及多器官功能损伤,导致死亡。孕产妇处于低免疫状态,如感染甲型H1N1流感病毒,容易发展成为肺炎型或重症甲型H1N1流感。     

输尿管软镜钬激光碎石术治疗ESWL失败后的输尿管上段结石(附15例报告)

目的 介绍输尿管软镜钬激光碎石术治疗ESWL失败后的输尿管上段结石的临床经验.方法 回顾性分析2011年9月至2012年8月收治的15例曾行ESWL治疗但未能成功排石的输尿管上段结石患者的临床资料.对所有患者均补救输尿管软镜钬激光碎石术,术后辅以抗炎排石治疗.结果 所有患者均顺利完成手术,手术时间为65±20分钟,术中合并输尿管炎性息肉6例,均采用钬激光切除,无输尿管穿孔、大出血等并发症发生.术后导尿管留置时间为4±2天,1例患者出现寒战、高热,血培养提示大肠埃希菌感染,经亚胺培南西司他丁钠(泰能)治疗后症状消失.术后1个月复查KUB平片或B超示结石清除率为100％.结论 输尿管软镜钬激光碎石术治疗ESWL失败后的输尿管上段结石有效,结石清除率高,可作为输尿管上段结石ESWL失败后的一种有效补救性治疗措施之一.