肝细胞肝癌的发病机制与治疗进展

全球肝细胞肝癌(HCC)的疾病负担正逐年增加。根据临床和组织病理特征,HCC可分为增生型和非增生型2类。HCC的发生发展与遗传和表观遗传改变密切相关,然而其发病机制尚不明确。CT/MRI是临床上常用的HCC影像学诊断方法。巴塞罗那临床肝癌分期系统是目前使用最为广泛的分期系统。HCC的治疗手段包括外科手术、肝移植、消融治疗、经动脉疗法和全身疗法。本文将着重阐述HCC发病机制和治疗方面的研究进展。     

无管化微通道经皮肾镜取石术对肾结石患者的疗效及对CRP、IL-6、PCT水平的影响

目的研究无管化微通道经皮肾镜取石术对肾结石患者的疗效及对CRP、IL-6、PCT水平的影响。方法回顾性分析2015年4月至2017年4月本院收治的肾结石患者463例,按手术方式的不同分成研究组109例和对照组354例。对照组采用标准通道经皮肾镜取石术治疗,研究组予以无管化微通道经皮肾镜取石术治疗。分别比较两组结石清除率,各项手术指标水平,治疗前后血清CRP、IL-6、PCT水平,术后并发症发生情况,手术前后生活质量评分情况。结果研究组结石清除率高于对照组,但组间差异无统计学意义(P>0.05)。研究组手术时间、术中出血量、术后置管时间、住院时间均明显低于对照组(P<0.05)。术后研究组血清CRP、IL-6、PCT水平(0.92±0.31)nmol/L、(42.73±13.69)ng/L、(0.72±0.25)ng/L,均明显低于对照组的(1.33±0.40)nmol/L、(51.20±15.04)ng/L、(0.97±0.66)ng/L(P<0.05)。研究组术后并发症发生率为4.59%(5/109),明显低于对照组的18.93%(67/354)(P<0.05)。术后研究组各项SF-36评分均明显高于对照组,组间对比差异有统计学意义(P<0.05)。结论无管化微通道经皮肾镜取石术可能成为治疗肾结石的有效手段之一,对患者早日康复,减少并发症的发生以及改善预后均可能具有一定的积极促进作用。     

Rolling-translated EGFR variants sustain EGFR signaling and promote glioblastoma tumorigenicity

Background Aberrant epidermal growth factor receptor (EGFR) activation is observed in over 50% of cases of adult glioblastoma (GBM). Nevertheless, EGFR antibodies are ineffective in clinical GBM treatment, suggesting the existence of redundant EGFR activation mechanisms. Whether circular RNA (circRNA) encodes a protein involved in EGFR-driven GBM remains unclear. We reported an unexpected mechanism in which circular EGFR RNA (circ-EGFR) encodes a novel EGFR variant to sustained EGFR activation.Method We used RNA-seq, Northern blot, and Sanger sequencing to confirm the existence of circ-EGFR. Antibodies and a liquid chromatograph tandem mass spectrometer were used to identify circ-EGFR protein products. Lentivirus-transfected stable cell lines were used to assess the biological functions of the novel protein in vitro and in vivo. Clinical implications of circ-EGFR were assessed using 97 pathologically diagnosed GBM patient samples.Results The infinite open reading frame (iORF) in circ-EGFR translated repeating amino acid sequences via rolling translation and programmed −1 ribosomal frameshifting (-1PRF) induced out-of-frame stop codon (OSC), forming a polymetric novel protein-complex, which we termed rolling-translated EGFR (rtEGFR). rtEGFR directly interacted with EGFR, maintained EGFR membrane localization and attenuated EGFR endocytosis and degradation. Importantly, circ-EGFR levels correlated with the EGFR signature and predicted the poor prognosis of GBM patients. Deprivation of rtEGFR in brain tumor-initiating cells (BTICs) attenuated tumorigenicity and enhanced the anti-GBM effect.Conclusion Our findings identified the endogenous rolling-translated protein and provided strong clinical evidence that targeting rtEGFR could improve the efficiency of EGFR-targeting therapies in GBM.     

Imaging characteristics of Rosai-Dorfman disease in the central nervous system

Background and purpose

Rosai-Dorfman disease (RDD) is a rare, lymphoproliferative disorder of uncertain etiology. The Central Nervous System (CNS) is a very rare site for RDD and only a few imaging appearances have been described. The purpose of this study is to present the largest series of cases in the CNS imaging literature to increase familiarity with this entity and further identify features that may distinguish RDD from meningioma.

Materials and methods

Findings from imaging examinations in 10 patients with pathologically confirmed RDD were retrospectively reviewed. Two radiologists evaluated the lesion location, shape, size, number, edge, cerebral edema, homogeneous or heterogeneous appearance, attenuation and signal intensity, degree of enhancement, and the relation between lesions and meninges.

Results

RDD in CNS showed similar features in imaging: an extra-axial, well-circumscribed, dura-based mass, isodense or hyperdense on CT, isointensity on T1-weighted imaging and isointensity with hypointensity on T2-weighted imaging. The mass enhanced markedly and homogeneously after the administration of contrast agent and demonstrated dural tail sign in all cases. Significant perifocal edema was associated with the masses. Remarkably, seven patients (77.8%) showed strong hypointensity within isointensity on T2-weighted or FLAIR images and no calcification was observed in CT images or pathologic specimens.

Conclusions

Although RDD in the CNS is a rare process, it should be considered in the differential diagnoses for meningioma. We believe that a typical representation of hypointensity irrelevant to calcification on T2-weighted or FLAIR images can suggest the diagnosis of RDD.     

大黄素次酸对皮肤黑素细胞一氧化氮合酶的调控作用及意义

背景:在影响黑素细胞功能的诸多信号介导途径中,一氧化氮被认为是一种极为重要的信号分子。大黄有效成分大黄素次酸可以影响黑素细胞的增殖及调节细胞中酪氨酸酶的活性。目的:观察大黄有效成分大黄素次酸对豚鼠皮肤黑素细胞的一氧化氮合酶表达的影响,以期确定大黄在活体皮肤中对黑素细胞的黑素合成的有效作用浓度和作用机制。设计:完全随机分组设计,对照实验。单位:泸州医学院附属医院皮肤科。材料:实验于2004-01/06在泸州医学院附属医院传染科实验室和泸州医学院组织学与胚胎学实验室完成。选用成年健康雄性封闭群豚鼠24只。随机将豚鼠分为6组:对照组,大黄素次酸2,5,10,20,40mg/L组,每组4只。方法:①将大黄素次酸用二甲基亚砜溶解稀释为2,5,10,20,40mg/L,分别对大黄素次酸(中国生物医学制品检定所提供,该药品为实验室提取的白色粉末纯品)2,5,10,20,40mg/L组豚鼠臀部、背部两处局部皮肤进行相应质量浓度皮下注射处理,注射量均为1mL。24h后对其中一处皮肤加注1mL相同浓度大黄素次酸一次。48h后取材,常规石蜡切片(取对照组及大黄素次酸组未注射药物处皮肤作实验对照组)。②免疫组织化学方法法显示一氧化氮合酶的表达,用光学显微镜在高倍镜下观察,识别黑素细胞,观察细胞胞质的染色及特点。用MLAS-1000图像分析仪,每组随机选择5张切片,每张切片检测20个细胞,由计算机处理系统计算出各组黑素细胞胞质中阳性免疫产物的平均吸光度(A值)。③计量资料差异比较采用方差分析,并且用SNK-q进行组间比较。主要观察指标:免疫组织化学方法显示黑素细胞内一氧化氮合酶的表达,用光学显微镜和图像分析仪获得实验结果。结果:黑素细胞胞质中阳性免疫产物的平均A值:大黄素次酸2,5,10,20,40mg/L组明显低于实验对照组(0.126±0.118,0.103±0.082,0.118±0.097,0.122±0.095,0.112±0.078,0.196±0.066,P<0.05);大黄素次酸各质量浓度组间差异不明显(P>0.05)。结论:①大黄素次酸对黑色素细胞一氧化氮合酶的表达具有调节作用,提示大黄对黑素细胞的调节通过一氧化氮信号传导通路。②大黄素次酸在2～40mg/L的质量浓度内,一氧化氮合酶的表达不随大黄素次酸的质量浓度改变而发生变化。     

面神经分支运动传导检测评估颊支和颞支运动传导功能恢复的差异

目的:运用面神经运动传导检查比较面神经颊支和颞支运动传导功能恢复的异同。方法:2001-09/2003-07来源于成都中医药大学附属医院、四川大学华西医院、绵阳市中医院、四川省人民医院等4个临床研究中心的贝尔麻痹患者480例,经过4周治疗,愿意接受并完成面神经颊支和颞支运动传导检查的患者分别有205、246例。其中,采用西药常规治疗的有69、83例,采用西药常规治疗加针灸治疗的有66、80例,采用针灸治疗的有70、83例。分别进行治疗前后以及患健侧面神经颊支和面神经颞支运动传导检查比较。结果:①患侧治疗后面神经颊支动作电位潜伏期明显缩短[(2.95±0.68),(3.08±0.69)ms,P<0.05],治疗后动作电位波幅未见明显改善(P>0.05)。②治疗后面神经颞支动作电位波幅明显增高[(518.85±496.57),(391.47±468.69)μV,P<0.01],潜伏期无明显改善(P>0.05)。结论:贝尔麻痹患者患侧治疗后面经神经颊支动作电位潜伏期改善明显,动作电位波幅未见明显改善;治疗后面神经颞支动作电位波幅改善明显,而潜伏期无明显改善。面神经运动传导动作电位波幅是反映神经轴索变性的客观指标,贝尔麻痹治疗后面神经颊支轴索恢复不如颞支好,与临床表现一致。     

经皮穿刺置管引流治疗细菌性肝脓肿的观察与护理

细菌性肝脓肿是由细菌感染引起的一种起病急、病情重的化脓性疾病。传统的治疗方法是药物治疗和手术治疗。我院自2002年10月—2005年2月在CT引导下采用美国Bard公司产的穿刺引流装置经皮穿肝、抽脓、冲洗救治10例细菌性肝脓肿危重病人,取得了满意效果。现介绍如下。1临床资料细菌性肝脓肿病人10例,均经CT或B超检查确诊。其中男7例,女3例;年龄30岁~77岁,平均56.5岁;发病时间3 d~20d;6例为胆源性细菌性肝脓肿,3例为肠源性细菌性肝脓肿,1例为外伤后继发细菌性肝脓肿;4例合并糖尿病,3例合并反应性胸腔积液;7例术前高热达39℃以上;5例病情危重…     

经体外高热联合液体培养净化的自体骨髓移植治疗成人急性白血病

用体外高热联合液体培养净化骨髓移植物后作自体骨髓移植（ＡＢＭＴ），治疗７例成人急性白血病和１例骨髓受侵的霍奇金病，移植后除１例早期死于败血症，其余皆造血重建。６例持续完全缓解（ＣＣＲ），中位缓解１８８天，１例ＣＣＲ４个月后死于非病意外，作者认为本法近期疗效较好，远期疗效尚需更多病例的长期随访证实。