RNA干扰下调p53抑制因子iASPP表达对膀胱癌细胞的影响

Objective To discuss the effects of silencing of iASPP gene on human bladder cancer cells. Methods RNAi silencing of iASPP gene in bladder cancer cell 5637 and T24 cells were used by lentiviral mediated interfering short hairpin RNAs. Cell proliferation was tested by MTT assay, and rate of colony was tested by colony formation assay. Cell cycles were tested by using fluorescence-activated cell sorting. Results Down-regulation of iASPP could inhibit the growth and proliferation of human bladder cancer cells (P＜0.05). iASPP know-down could decrease the colony formation of 5637 and T24 cells (P＜0, 05). Knocking down of iASPP in 5637 and T24 cells showed cell arrested at G1. Conclusions Silencing of iASPP gene could inhibit proliferation and colony formation of bladder cancer, iASPP might be an important target for gene therapy of bladder cancer.     

应用OPA-K直丝弓矫治器双颌减数治疗安氏Ⅱ~1类错的临床研究

目的：评价OPA-K直丝弓矫治器双颌减数治疗安氏Ⅱ1类错的临床疗效,并探讨其机制和使用方法。方法：临床选择15～23岁安氏Ⅱ1类错患者22例,应用OPA-K直丝弓矫治器进行双颌减数治疗,并对治疗前后X线头影测量值的变化进行分析。结果：矢状方向上,U1-NA和U1-SN分别减小14.26°和10.32°,U1-NA（mm）减小4.16mm,U1-L1增加17.06°,以上差异均具有统计学意义（P〈0.05）,而SNA、SNB、ANB、L1-NB、L1-MP的变化均无显著性（P〉0.05）。垂直方向上,SN-MP和Y轴的变化均无显著性（P〉0.05）。结论：应用OPA-K直丝弓矫治器治疗安氏Ⅱ1类错可取得令人满意的临床效果。     

Prestige LP颈椎椎间盘置换术后“张口不良”原因分析

目的探讨Prestige LP颈椎椎间盘置换术术后＂张口不良＂原因。方法 2008年2月～2010年3月行PrestigeLP颈椎椎间盘置换术26例。通过对患者术前及术后颈椎正侧位、动力位X线片及三维CT影像学资料的搜集和对比,分析Prestige LP颈椎椎间盘置换术术后＂张口不良＂原因,并对患者颈椎功能障碍指数（neck disability index,NDI）及颈部、上肢疼痛视觉模拟量表（visual analogue scale,VAS）评分,以及依据动力位X线片测量手术节段单间隙矢状面屈伸运动度进行统计学分析。结果 8例患者发生置换椎间盘＂张口不良＂。正常患者与＂张口不良＂患者术后VAS评分及NDI的差异无统计学意义（P〉0.01）,但＂张口不良＂患者术后颈椎活动度小于正常组,差异有统计学意义（P〈0.01）。出现置换椎间盘＂张口不良＂患者中,1例术前存在颈椎结构性后凸,术后颈椎后凸无改善;5例置入椎间盘与上下相邻椎间隙不平行,提示椎间隙处理不准确;1例椎间隙处理中椎体后缘骨质切除过多导致置换椎间盘＂张口不良＂。结论 Prestige LP颈椎椎间盘置换手术操作较简单方便,但手术依赖术者主观性和经验性较多,手术本身客观性和精确性较少,易出现局限性后凸和椎间盘＂张口不良＂。术后椎间盘＂张口不良＂不影响患者症状改善,但影响术后颈椎活动度;要获得满意的间盘动-静态平衡,需要严格掌握适应证、遵循手术关键原则和一个较长的学习曲线。     

Total Endovascular Debranching of the Aortic Arch

Background

Significant morbidity and mortality are related to conventional aortic replacement surgery. Endovascular debranching techniques, fenestrated or branched endografts are time consuming and costly.

Objective

We alternatively propose to use endovascular approach with parallel grafts for debranching of aortic arch.

Methods

Under general anesthesia, 12 F sheaths were inserted in the femoral, axillary and common carotid arteries for vascular accesses. ViaBahn grafts 10 – 15 cm in length were placed into the aortic arch from right common carotid, left common carotid and left axillary arteries, until the tip of each graft reached into the ascending aorta. Through one femoral artery, the aortic stent –graft was positioned and delivered. Soon after, the parallel grafts were sequentially delivered. Self-spanding Wallstents^R were used for parallel grafts reinforcement. Ballooning was routinely used for parallel grafts and rarely for aortic graft.

Results

This technique was used in 2 cases. The first one was a lady with 72 years old, with an aortic retrograde dissection from left subclavian artery and involving remaining arch branches. Through right common carotid artery a stent-graft was placed in the ascending aorta and through the left common carotid artery a ViaBahn was inserted parallel to the former. A thoracic endograft then covered all the aortic arch dissection extending into the ascending aorta close to the sinu –tubular junction. The second case was a 82 year old male patient with a 7 cm aortic arch aneurysm. Through both common carotid arteries ViaBahn grafts were introduced and positioned into the ascending aorta. Soon after, the deployment of the thoracic stent graft covered all parallel grafts of the aortic arch, excluding the aneurysm. Both cases did not have neurologic or cardiac complications and were discharged 10 days after the procedure.

Conclusions

This technique may be a good minimal invasive off-the-shelf technical option for aortic arch ‘‘debranching’’. More data and further improvements are required before this promising technique can be widely advocated.     

背侧入路筋膜瓣覆盖钢板治疗桡骨远端粉碎性骨折

2006年8月-2009年8月,笔者采用背侧入路筋膜瓣覆盖T形钢板治疗桡骨远端粉碎性骨折30例,疗效满意。1材料与方法1.1病例资料本组30例,男8例,女22例,年龄51-82岁。左侧7例,右侧23例。按Melon分类：Ⅳ型12例,Ⅴ型18例。均为闭合骨折。     

重症患者两种撤机方式的比较

目的 比较SmartCare/PS(SC)和压力支持通气(PSV)模式在重症患者中的撤机效果.方法 将41例行机械通气的重症患者,在满足临床撤机条件后,随机分为SC组(n=21)和PSV组(n=20),分别采用SC和PSV模式撤机.记录撤机时间、总通气时间(TVT)、人工操作次数,以及再插管率、气管切开率、气胸发生率和呼吸机相关肺炎(VAP)发生率.结果 SC组撤机时间、TVT较PSV组明显缩短(P<0.05);SC组人工操作次数较PSV组明显减少(P<0.05);两组再插管率、气管切开率、气胸发生率和VAP发生率差异无统计学意义.结论 SC模式可缩短重症患者的撤机时间、TVT和减轻医务人员工作量.     

Stage migration and therapy modification after thoracoscopic internal mammary lymph node dissection in breast cancer patients

Although internal mammary lymph node (IMN) status is a major prognostic factor in breast cancer, it is not routinely assessed. To evaluate the impact of IMN status on staging and treatment of breast cancer, we enrolled 50 consecutive patients with inner or central tumors who received IMN dissection by video-assisted thoracoscopic surgery (VATS) after breast surgery. Of the 50 patients, 20 (40%) had IMN metastases. Of the 20 patients, 6 (12%) were upstaged from N0 to N2b and 5 (10%), 3 (6%) and 6 patients (12%) were upstaged from N1a, N2a, and N3a, respectively, to N3b. Because of the upstaging, 6 patients (12%) with only IMN metastases received more aggressive adjuvant chemotherapy. Because the whole IMN chain was removed in all patients, radiotherapy on IMN field was not required in our cohort independent of IMN status. In conclusion, VATS IMN dissection might lead to stage migration and therapy modification.     

Surgical treatment of developmental dysplasia of the hip presenting in children above 10 years

Background  

Management of developmental dysplasia of the hip in older children remains controversial. The objective of this study was to evaluate the results of surgical treatment of developmental dysplasia of the hip in children older than 10 years.     

翼状韧带悬吊矫正先天性重度上睑下垂

目的 探讨翼状韧带悬吊矫正重度先天性上睑下垂的临床效果.方法 2010年1～11月,应用翼状韧带悬吊法治疗先天性重度上睑下垂患者15例15只眼,按照切开重睑术术式,打开眶隔,在距睑板上缘5 mm处剪断上睑提肌腱膜进入到上睑提肌下层,向结膜上穹窿分离,在上直肌前1/3和上睑提肌之间找到翼状韧带,用3-0丝线同上睑提肌缝合于睑板上缘,悬吊矫正上睑下垂,缝合形成重睑.结果 经过3～11个月随访,15只眼矫正良好,眼裂均在15～30 d基本闭合,无其他并发症发生,重睑弧度形态自然,外观满意.结论 翼状韧带悬吊治疗重度先天性上睑下垂疗效可靠,用翼状韧带代替上睑提肌,生理运动方向一致,术后眼睑外形动态与静态均较自然.

Abstract：

Objective To evaluate the clinical result of check ligament suspension for correction of congenital severe blepharoptosis. Methods Since Jan. 2010 to Nov. 2010, 15 eyes in 15 cases with congenital severe blepharoptosis were treated with the check ligament suspension. Palpebralis aponeurosis was exposured by opening fascia palpebralis during blepharoplasty. Palpebralis aponeurosis was cut off about 5 mm above the tarsus. The check ligament was seen in the intermuscular space between the segment of levator and the anterior one third of superior rectus attached to the conjunctival fornix. Congenital blepharoptosis could be corrected by suturing the check ligament and levator palpebrae superior to the upper margin of tarsal plate with 3-0 silk thread. Double eyelid plasty was carried out in the end. Results The follow-up period was 3-11 months with good cosmetic result. All the cases could close their eyes in 15 to 30 days with no complication. Conclusions In conclusion, this technique is quite successful in raising the level of the upper eyelid in severe congenital blepharoptosis. The check ligament moves in a similar direction as the natural movement of levator muscle, so both the postoperative static and dynamic appearance of the upper lid is more natural.     

直肠癌远端移形黏膜COX-2及BCL-2蛋白的表达与临床意义

目的探讨直肠癌远端移形黏膜COX-2及BCL-2蛋白的表达情况,判断直肠癌远端移形黏膜是否为癌前病变。方法应用高铁二胺-阿辛蓝染色检测54例直肠癌远端2cm处黏膜．将远端黏膜分为移形黏膜（TM）组及非移形黏膜（NTM）组,通过免疫组织化学染色检测TM中COX-2和BCL-2蛋白的表达．比较TM与NTM、肿瘤组织以及正常黏膜组织（20例直肠良性息肉旁肠黏膜组织）内BCL-2以及COX-2的表达的差异。结果54例直肠癌远端2cm黏膜处组织中有19例存在TM．35例为NTM。COX-2蛋白在肿瘤组织、TM、NTM、正常组织中的阳性率分别为81．5％（44／54）、21．1％（4／19）、17．1％（6／35）、10．0％（2／20）;BCL-2蛋白在上述4种组织中的阳性率分别为77．8％（42／54）、21．1％（4／19）、22．9％（8／35）、5．0％（1／20）。TM内的COX-2及BCL．2蛋白的表达与肿瘤组织相比,差异有统计学意义[（0．737±0．895）比（3．519±1．998）;（0．632±0．955）比（2．833±1．756）,均P〈0．01];与NTM、正常肠黏膜组织相比,差异无统计学意义（均P〉0．05）。结论直肠癌远端TM内的COX-2和BCL-2蛋白的表达无特异性．TM是癌前病变的证据不足。