使用双极射频切除止血设备Habib4X肝切除18例分析

目的 探讨双极射频切除止血设备Habib 4X在肝脏切除手术中的应用效果.方法 使用Habib 4X肝脏切除手术18例(腹腔镜肝切除1例次).原发性肝癌患者9例(其中合并肝硬化3例),胆囊癌3例,左肝内胆管结石,肝内胆管炎,左肝萎缩3例,巨大肝血管瘤3例.在开腹和腹腔镜肝切除手术中,使用手执式一次性射频消融设备Habib 4X,垂直插入肝脏,沿所需路线进行切割.在电极之间所产生可控的射频能量,对肝脏组织包括胆管和血管进行封闭,然后使用手术刀进行肝切除.结果 肝切除过程中均未行肝门血管阻断.术中平均出血量180ml(50～350ml),无输血病例,无胆漏发生,平均手术时间225min,无围手术期死亡病例.结论 严格选择手术适应证的前提下,Habib 4X切除肝脏是安全的,可以作为肝脏切除技术选择.     

肾细胞癌阴茎转移1例

最近,我们经治1例罕见的囊性肾乳头状细胞癌阴茎转移患者,报告如下。     

MRU对肾移植术后原自体无功能肾、输尿管移行细胞癌的诊断价值(附21例报告)

目的：探讨磁共振水成像(Magnetic resistance urography,MRU)在肾移植术后对原自体无功能性肾、输尿管移行细胞癌的诊断价值。方法：对21例肾移植术后临床诊断为肾盂或输尿管移行细胞癌患者进行MRU检查,同时行逆行肾盂输尿管造影;11例行输尿管镜及病理学检查,并行MRU诊断。16例行经尿道输尿管口环形切开、腰部一处切口的肾输尿管全长切除术。结果：术前21例MRU检查均提示肾盂、输尿管有占位性病变,11例配合输尿管镜得出组织学诊断,术前诊断与手术结果一致。21例中,16例采用肾输尿管全长切除术均获得成功。结论：MRU对肾移植术后IVU不显影的原无功能性肾、输尿管移行细胞癌具有重要的临床诊断价值;输尿管口切除、肾输尿管全长切除术对移植肾同侧原肾发生肾盂输尿管癌一样有效。     

药物警戒与药物不良反应监测辨析及其意义

目的 促进我国药物警戒工作的开展.方法 对药物警戒与药物不良反应监测概念及其内涵进行比较,并辨析二者的联系与区别.结果 药物警戒工作与药物不良反应监测工作紧密联合.药物警戒工作是药物不良反应监测的发展趋势,我国政府应该重视药物警戒工作.     

病毒学因素对ALT持续正常的e抗原阴性慢性乙型肝炎病毒感染者肝脏组织学改变的影响

Objective To investigate the correlation between viral factors and liver histological changes of HBeAg-negative chronic hepatitis B patients with persistently normal serum ALT levels (PNAL). Methods HBV DNA level, HBV genotype, basal core promoter (BCP) and precore mutation were exam- ined in 52 HBeAg-negative chronic hepatitis B patients with PNAL (defined as normal ALT measured on at least 3 occasions in the intervals of about two months over a period of 12 months or more prior to the biopsy). Viral factors influencing histological changes of HBeAg-negative chronic hepatitis B patients with per-Results Subjects with both BCP and precore mutations had significantly higher HBV DNA levels than those without mutations [(4.9±1.4) vs (4.1±1.1) log10copies/ml, t = 2.308, P < 0.05]. A higher proportion of patients with histological activity index (HA1)≥ 4 was found in patients with both mutations (32.1% vs 16.7%) than in patients without mutation, however, the proportion of patients with histological activity index (HAl)≥ 3 in patients with mutations was not significantly different from that in patients without mutations (14.3% vs. 12.5%, χ2 = 0.000, P > 0.05). In patients without precore or BCP mutations, there was a strong positive correlation between viral load and liver inflammation as well as fibrosis (precore: r = 0.626, 0.592, P < 0.01; BCP: r = 0.730, 0.641, P < 0.01). In patients without both mutations, HBV DNA has shown a high accuracy for predecting fibrosis (F≥3) (AUC = 0.905, 95% CI: 0.771±1.039, P < 0.05) with the cutoff value of 4.5 log10copies/ml (sensitivity = 1.000, specificity = 0.778, PPV = 42.9%, NPV = 100.0%). Results of both genotypes and mutations were successfully obtained in 40 samples with HBV DNA≥ 104 copies/ml. The higher viral load was observed in the patients with genotype B than genotype C (5.1 vs 4.3 Iog,0copies/ml, t = 2.059, P < 0.05), but no difference was seen of liver pathologic changes between these two genotypes. Conclusions Virus harboring both BCP and precore mutants has the higher replication level than wild type virus. 32.1% and 14.3% of the patients with both mutations have moderate or severe inflammation and fibrosis. There was a strong positive correlation between viral load and liver histological changes in patients without precore or BCP mutations, and viral load shows a high accuracy for predecting sig-nificant fibrosis (F ≥ 3).     

葡萄冻干粉在线粒体应激介导肝细胞凋亡中的作用

目的 了解葡萄冻干粉（FDG）对线粒体应激介导的肝细胞凋亡的阻抑作用,探讨其治疗肝细胞损伤的作用机制。方法用牛磺酸脱氧胆酸（TDCA）诱导Huh7细胞,建立线粒体应激凋亡模型,用不同剂量FDG进行干预。通过MTT、DNA ladder、Western blot、细胞凋亡率检测等方法,了解FDG对Huh7细胞生长、对TDCA诱导的Huh7细胞的凋亡率、凋亡信号蛋白表达的影响。结果FDG（2μg／ml、20μg／ml、200μg／ml、4（10μg／ml和800μg／ml）与Huh7细胞共孵育,FDG可提高Huh7细胞的活力,以FDG400μg／ml时细胞活力最高。用400pMTDCA诱导Huh7细胞,随着诱导时间延长细胞活力下降、凋亡率增加,出现凋亡条带;Caspase-9和7蛋白酶原被活化,PCNA表达下调。用FDG干预TDCA诱导Huh7细胞48h后发现,FDG明显提高Huh7细胞活力、使细胞凋亡减少、凋亡信号蛋白的表达减少。结论TDCA能触发Huh7细胞线粒体氧化应激凋亡,而FDG能促进细胞生长,减轻肝细胞损伤,阻断线粒体氧化应激介导的肝细胞凋亡。     

小儿腮腺腺样囊腺癌的超声表现1例

患儿男,6.5岁.发现左面颊部包块4个月.自发现包块,无红、痛,未予治疗,2003年11 月23日来我院就诊.查体:左侧腮腺区皮肤无红、热,扪及一约2.5 cm×2.0 cm大小实性包块,质中、活动度可,颈部未扪及肿大淋巴结.临床诊断:左侧腮腺包块性质待定.超声检查:见左侧腮腺浅叶中份约2.9 cm×1.9 cm×2.3 cm大小规则实质不均匀回声包块, 内有1.4 cm×0.6 cm大小不规则液性暗区,边界清晰,无包膜线回声,后方回声增强(图1 ),颈部未发现肿大淋巴结.超声提示:左侧腮腺实质不均质包块(1.混合瘤?;2.不排除恶性肿瘤).手术、病理诊断:腮腺腺样囊腺癌.术后5个月超声复查:见左侧腮腺2.5 cm ×2.3 cm×1.6 cm实质低回声包块,边界清晰,颈部左侧血管旁见4枚0.9 cm～1.2 cm低回声结节,有融合征象,诊断左侧腮腺癌复发并颈部淋巴结转移.     

感染性腹泻大便中无活性大肠埃希菌的检测结果分析

目的分析粪便标本分离的无活性大肠埃希菌的鉴定及耐药性。方法对该院2013年1月至2015年6月临床送检的粪便标本进行细菌培养、鉴定和药敏试验。结果共检出61株无活性大肠埃希菌,18株能与志贺菌诊断血清发生凝集反应。阿莫西林和替卡西林耐药率为100%,哌拉西林、头孢噻吩和复方磺胺甲噁唑耐药率为78%,头孢西丁和阿米卡星耐药率为33%,哌拉西林/他唑巴坦、亚胺培南和美罗培南耐药率为0%。结论无活性大肠埃希菌能引起腹泻,容易被误诊为志贺菌;耐药性与普通大肠埃希菌无显著不同。     

糖耐量减低者体内氧化应激水平升高

目的 探讨糖耐量减低患者体内氧化应激状况.方法 选取糖耐量减低（IGT）组45例和糖耐量正常（NGT）组51例,测定其血清超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH）、活性氧（ROS）和丙二醛（MDA）水平.比较IGT组与NGT组的氧化应激状况,并对氧化应激指标进行相关性分析.结果 与NGT组相比,IGT组血清SOD和GSH水平明显下降,而血清ROS和MDA水平明显升高（P＜0.05）;而且经校正性别和年龄后,两组问的差异仍具有统计学意义（P＜0.05）.Spearman相关分析显示,GSH与年龄、BMI、FBG以及TG呈负相关;SOD与年龄、FBG、HOMA-IR以及TC呈负相关;ROS与年龄、BMI、FBG、HOMA-IR以及TG呈正相关;MDA与HOMA-IR和TG呈正相关.结论 此研究结果提示,糖耐量减低者体内存在着高水平的氧化应激状态,但仍有待于更大样本的进一步研究来证实.