肾嫌色细胞癌的诊治（附4例报告）

目的 提高肾嫌色细胞癌的诊治水平。方法 回顾性分析4例肾嫌色细胞癌患者的临床资料。男3例，女1例，年龄34—76岁，平均52岁。结果 3例患者行肾癌根治术，1例行肾部分切除术。术后病理诊断为肾嫌色细胞癌，病理分期：pT1aNxMo 1例，pT1bNoMo3例。病理分级：G1 3例，G2 1例。免疫组织化学染色：CK8（低分子量细胞角蛋白）阳性，Vimentin（波型蛋白）阴性，Hale胶体铁阳性。随访4个月至8年，平均4年。4例患者均健在，无肿瘤复发或转移。结论 肾嫌色细胞癌是一种低度恶性的肾细胞癌，影像学检查对其诊断有重要帮助，确诊有赖于组织病理学检查，手术治疗后预后较好。     

The impact of prior radical prostatectomy in men with metastatic castration recurrent prostate cancer: a pooled analysis of 9 Cancer and Leukemia Group B Trials

PURPOSE: A prior report suggested that radical prostatectomy may confer a survival advantage to patients with metastatic castration recurrent prostate cancer. Therefore, a pooled analysis of 9 trials performed by Cancer and Leukemia Group B was done to determine if men with metastatic castration recurrent prostate cancer who underwent prior prostatectomy had improved clinical outcomes, such as overall, prostate specific, progression-free and PSA progression-free survival, than men who did not undergo prior prostatectomy. MATERIALS AND METHODS: Data from 9 multi-institutional trials performed by Cancer and Leukemia Group B were combined. Eligible patients had progressive prostate cancer during androgen deprivation therapy, Eastern Cooperative Oncology Group performance status 0-2, and adequate hematological, renal and hepatic functions. The proportional hazards model was used to assess the prognostic importance of radical prostatectomy for predicting clinical outcomes. RESULTS: Of 1,238 men 310 (25%) underwent prostatectomy. Median survival was 14.7 (95% CI 12.9-16.7) and 14.5 months (95% CI 13.5-15.7) in men who did and did not undergo prostatectomy, respectively. The HR for death was 1.03 (95% CI 0.90-1.19, p = 0.65) in men with vs without prostatectomy. CONCLUSIONS: Prior prostatectomy in men with metastatic castration recurrent prostate cancer who were subsequently enrolled on clinical trials for cancer treatment had similar survival compared to men who did not undergo prior prostatectomy. These data do not support another report suggesting that prior prostatectomy confers a subsequent survival advantage in men with castration recurrent prostate cancer.     

AO锁骨钩钢板固定与改良Weaver法治疗急性肩锁关节脱位（Ⅲ～Ⅵ型）

目的探讨AO锁骨钩钢板固定与改良Weaver法治疗急性Ⅲ～Ⅵ型肩锁关节脱位的疗效。方法55例Ⅲ～Ⅵ型肩锁关节脱位患者采用AO锁骨钩钢板固定或改良Weaver法进行治疗,其中23例（Ⅲ型7例,Ⅳ型11例,Ⅴ型4例,Ⅵ型1例）应用一期修复喙锁韧带锁骨钩钢板治疗,32例（Ⅲ型2例,Ⅳ型9例,Ⅴ型17例,Ⅵ型4例）应用改良Weaver法一期重建喙锁韧带,回顾性分析其效果及预后。结果根据Karlsson标准,总体优良率96．3％,修复喙锁韧带锁骨钩钢板固定组总体优良率95．6％;改良Weaver法喙锁韧带重建组总体优良率96．8％。结论一期修复喙锁韧带锁骨钩钢板固定及改良Weaver法一期重建喙锁韧带对于治疗急性Ⅲ～Ⅵ型肩锁关节脱位均能取得满意的疗效。     

Early prophylactic pulmonary artery banding in isolated congenitally corrected transposition of the great arteries

Objective: Mid-term evaluation of an aggressive surgical management of isolated congenitally corrected transposition of the great arteries (ccTGA) by pulmonary artery (PA) banding in early infancy. Methods: Between 2001 and 2009, 11 asymptomatic patients (seven neonates and four infants) underwent a dilatable, partially adjustable, homemade PA banding for ccTGA with intact ventricular septum. PA band circumference was correlated to body weight (22 mm + 1 mm kg⁻¹) and ideally adjusted to obtain flat septal geometry. Mean age at operation was 1.5 ± 1.4 months. Results: There was no hospital mortality. Mean ventilation time and intensive care unit (ICU) stay were 20 ± 9 h and 2.6 ± 1.5 days, respectively. Five patients required postoperative inotropic support. One late death occurred suddenly at 4 months; normal biventricular function and no tricuspid regurgitation were noted at last follow-up, 1 week before death. Mean follow-up was 21.5 ± 26 months. Mean band velocity increased over time from 2.65 ± 0.7 m s⁻¹ postoperatively to 3.7 ± 0.3 at 6 months and 4.5 ± 0.4 m s⁻¹ at 2 years. Tricuspid regurgitation remained stable in seven patients, decreased in three and worsened in one. Flat septal geometry was obtained in all patients after the third postoperative month. One patient underwent a double-switch procedure at 7 years due to suprasystemic morphologically left ventricular pressure. The postoperative course was uneventful. Conclusions: In neonates with isolated ccTGA, prophylactic PA banding is safe and carries a low morbidity. At mid-term evaluation, tricuspid valve function is stabilised or improved and systemic competence of the left ventricle is maintained, thus allowing double switch if indicated.     

Linear quadratic regulator control of multi‐agent systems

This paper considers a collection of agents performing a shared task making use of relative information communicated over an information network. The designed suboptimal controllers are state feedback and static output feedback, which are guaranteed to provide a certain level of performance in terms of a linear quadratic regulator (LQR) cost. Because of the convexity of the LQR performance region, the suboptimal LQR control problem with state feedback is reduced to the solution of two inequalities, with the minimum and maximum eigenvalues of the Laplacian matrix as the coefficients. The advantage of the method is that the LQR control problem of network multi‐agent systems can be converted into the LQR control of a set of single‐agent systems, and the structure constraint on the feedback gain matrix can be eliminated. It can be shown that the size of the LQR control problem will not increase according to the number of the node in the fairly general framework. The method can be extended to the synthesis of the static output feedback, which is derived from the weighting matrices in LQR. Through some coordinate transformation and the augmentation of the output matrix, the LQR synthesis is provided on the basis of the output measurements of the adjacent agents. Numerical examples are presented to illustrate the proposed method. Copyright © 2013 John Wiley & Sons, Ltd.     

Efficacy of Re-188-labelled sulphur colloid on prolongation of survival time in melanoma-bearing animals

In this study, the effectiveness of a 188Re labeled sulfur colloid with two particle size ranges was used to evaluate the effectiveness of this agent on melanoma tumors in mice in terms of animal lifespan. METHODS: Two separate group of animals were used for investigating biodistribution and survival time. A total of 188 B16F10-melanoma-bearing BDF(1) mice were injected intraperitoneally with 3.7 MBq (0.1mCi)/2mL of radiolabeled sulfur colloid ten days after intraperitoneal inoculation of 5x10(5) B16F10 melanoma cells/2ml. For group 1, 30 mice were sacrificed at 1, 4, 24, 48 and 72 hours for biodistribution studies. In group 2, 158 mice were divided into 9 groups (n=16 approximately 18/groups)each receiving respectively tumor alone, tumor with normal saline, cold colloid or hot colloid with 16, 23, 31, 46, 62, or 124 MBq activity. Each of these colloid groups was further divided into two groups, one receiving smaller particle sizes (<3 microm:80.4 +/-7.2%, colloid 1) and the other receiving larger particle sizes (<3 microm:12.3+/-1.0%, colloid 2). The animals were checked daily until death and their survival recorded. RESULTS: Colloid 2 showed higher accumulation in almost all tissues, the highest accumulation organ was tumor ( approximately 40%), then spleen ( approximately 20%), stomach ( approximately 15%), diaphragm ( approximately 3%), and liver ( approximately 2%). There was a significant increase in survival time with increasing amount of the larger-particle-size colloid. Administered levels of 16-31 MBq/mouse were most efficacious and with higher amounts the survival times decreased significantly below that of the controls. There was a significant difference in the dose-response curves for the two preparations. Protection factors (1/Relative-risk) of nearly 5 were achieved using the larger colloid size, and nearly 30 using the smaller colloid size. An amount of 16-31 MBq of the colloid 2 was the optimal activity in these studies. On the one hand, the survival data agreed well with the biodistribution data, where higher accumulation was found in tumor with colloid 2. CONCLUSION: Rhenium-188 offers on-site availability, medium half-life, higher beta-particle energy of 2.12 MeV for therapy and emission of 155keV gamma photon suitable for imaging. The present study demonstrated that 188Re-sulfur colloid is an effective agent in controlling tumor cells in the abdominal cavity in animals.     

利多卡因对缺氧/复氧后肝细胞Bcl-2、Caspase-3蛋白表达及细胞凋亡的影响

目的探讨利多卡因预处理对肝细胞缺氧/复氧后Bcl-2、Caspase-3蛋白表达及细胞凋亡的影响。方法将体外培养的肝细胞分为三组:缺氧/复氧组(Ⅰ组)、利多卡因预处理组(Ⅱ组)和正常对照组(Ⅲ组),每组10份。检测肝细胞缺氧/复氧培养后细胞培养液中谷丙转氨酶(ALT)、谷草转氨酶(AST)浓度,肝细胞Bcl-2、Caspase-3蛋白表达、肝细胞凋亡率及超微结构变化。结果Ⅰ、Ⅱ组细胞培养液中ALT、AST浓度、肝细胞Caspase-3蛋白表达和肝细胞凋亡率较Ⅲ组均升高(P<0.05),透射电镜示肝细胞损伤,可见凋亡细胞;Ⅱ组细胞复氧后培养液中ALT、AST浓度、肝细胞Caspase-3蛋白表达和细胞凋亡率均低于Ⅰ组(P<0.05),而肝细胞Bcl-2蛋白表达较Ⅰ组升高(P<0.05),透射电镜观察也显示Ⅱ组肝细胞比Ⅰ组损伤轻微。结论利多卡因预处理可以在一定程度上减轻缺氧/复氧后肝细胞损伤,降低细胞凋亡率,保护机制可能与Bcl-2、Caspase-3蛋白表达有关。     

Effect of l-carnitine supplementation on renal anemia in patients on hemodialysis: a meta-analysis

International Urology and Nephrology - l-carnitine is an amino acid derivative that is thought to be helpful for treating renal anemia in hemodialysis patients. However, the mechanism remains to be...     

Alternate methods for laparoscopic management of adnexal masses greater than 10 cm in diameter.

PURPOSE: We describe alternate laparoscopic methods for inspection and removal of large adnexal masses, and report our experience with 18 cases in which these methods were used. PATIENTS AND METHODS: Between April 1994 and January 2000, the first author performed operative laparoscopy on 18 patients, each of whom had at least one adnexal mass with maximum diameter greater than 10 cm. Mean patient age was 32 years (range 11 to 82). Seventeen of the 18 patients were premenopausal. All procedures were performed at one of two community hospitals in Seattle or at Yuan's General Hospital in Taiwan. Preoperative screening included pelvic exam, tumor markers, and ultrasound. RESULTS: One 82-year-old patient underwent planned laparoscopic bilateral oopherectomy. In the other 17 cases the operative goal was cystectomy or unilateral oopherectomy with conservation of reproductive function. Cystectomy was successfully performed in five of these cases (29.4%). The remaining 12 patients underwent either unilateral oopherectomy (10 cases, 58.8%), or unilateral salpingo oopherectomy (2 cases, 8.8%) due to the extent of their mass. Sixteen of the 18 cases in this series were successfully managed by a single laparoscopic surgery, one case required a second-look laparoscopy, and in one case a malignancy was found by histological analysis of permanent section, which required a second laparoscopy for staging and debulking. CONCLUSIONS: Large adnexal masses can be successfully managed with minimal hospital stay using laparoscopic techniques, when care is taken to avoid rupture and spillage of cyst contents, and thorough inspection of the mass and abdominal cavity is made possible. The probability of finding an unexpected malignancy is low. In those cases where a malignancy is found, appropriate cytoreductive staging surgery can be performed immediately.