16层螺旋CT及其三维重建与多平面重组在胫骨平台骨折诊断中的应用

目的探讨16层螺旋CT(16层SCT)及其三维重建(3-D)与多平面重组(MPR)在胫骨平台骨折诊断中的应用价值。方法39例胫骨平台骨折病例经膝关节常规X线平片检查后，采用16层SCT进行膝关节的多层面螺旋CT扫描，在工作站上作3D及MPR影像后处理，就胫骨平台骨折的平片与16层SCT影像进行比较及综合分析。结果39例胫骨平台骨折中，X线平片漏诊1例髁间隆突骨折、1例内髁骨折及1例双髁骨折，此3例(7．69％)平片漏诊的骨折均为16层SCT予以诊断。16层SCT的3-D影像可清晰显示胫骨平台骨折的立体形态；MPR影像则可明确显示胫骨平台内部的骨质损伤情况如骨折的具体部位、关节面碎裂及塌陷程度、骨折移位距离。结论16层SCT能够显示X线平片难于诊断的胫骨平台隐匿性骨折；3-D及MPR成像技术十分有利于全面观察胫骨平台骨折的形态变化，是16层SCT横轴位扫描的重要补充。     

关木通引起慢性间质性肾炎7例报告

目的　观察关木通所致慢性肾损伤的临床和病理改变特点。方法　本组 7例中 ,男 5例 ,女 2例。 3例服关木通汤药 ,4例服含关木通成药。分析服用时间、累积总量与肾损害首发症状及症状出现时间、肾功能和肾病理改变的关系。结果　汤药组 :服药时间平均 3 3 3个月 ,累积总量平均 82 9 3 g ,首发症状为乏力 3例 ,夜尿增多 2例 ,平均时间为 8 3个月 ,Cr平均 40 2 μmol/L。肾病理 :3例均为重度寡细胞性肾间质纤维化 ,肾小管广泛萎缩。成药组 :服药时间平均 7 5个月 ,累积总量平均 13 6g ,乏力 3例 ,夜尿增多 1例 ,恶心呕吐、头痛头晕 1例 ,平均18 8个月 ,Cr 3 62 8μmol/L。肾病理为重度寡细胞性间质纤维化和灶状纤维化各 2例 ,肾小管灶状萎缩 3例 ,广泛萎缩 1例。结论　汤药组关木通积累大 ,发病时间早 ,肾病理改变重。提示关木通所致肾损其临床表现、病理改变与服用关木通时间、剂量相关。     

21例心内直视术后急性心包填塞的临床分析

目的:分析21例心内直视术后急性心包填塞的临床特点,探讨其发生原因、预防、救治及其二次开胸的早期指征。方法:对1991年1月-2005年12月心内直视术(共1096例)后21例急性心包填塞二次开胸(发生率1．92％)病例进行总结分析。结果:急性心包填塞患者经二次剖胸解除心包填塞后17例痊愈出院,4例死亡,二次剖胸手术死亡率为19．05％。二次剖胸手术者所患疾病包括先天性心脏病6例,瓣膜病13例,大血管手术1例,心脏移植1例。结论:减少心内直视术后出血、渗血是避免术后发生急性心包填塞的关键,早期诊断并尽早行二次剖胸手术可明显降低围手术期死亡率。     

组织工程小血管摩擦力测量方法的研究与应用

目的设计一套用于组织工程小血管内壁摩擦力测量的装置并对组织工程血管的材料进行初步的测量,以验证装置的可靠性和相关结论。方法根据血液动力学的原理,对血管的力学模型进行分析,确定组织工程血管内皮细胞摩擦力的测量方法,从而设计完成整套装置并对弹性元件进行测量,并进行组织工程降解材料聚羟基乙酸PGA构成的管状支架进行摩擦力的测量。结果设计完成了测量组织工程血管内壁摩擦力的实验装置,弹性元件的牵拉力与位移的关系呈良好的线性关系。聚羟基乙酸PGA管状支架的摩擦力随流速的增加而增加。结论测量组织工程血管内壁摩擦力的实验装置是可行的,聚羟基乙酸PGA管状支架的摩擦力与流速基本呈现线性关系。     

前列腺癌新辅助治疗临床分析（附32例报告）

目的 总结32例前列腺癌患者新辅助治疗（NHT）的作用。方法 32例前列腺癌患者中药物去势17例，手术去势15例，并联合抗雄激素治疗3个月，统计NHT前后前列腺癌体积、肿瘤大小、PSA、FSH、LH和睾酮水平变化。结果 2组NHT后前列腺体积明显变小、肿瘤变小、变软，甚至消失，PSA和睾酮明显下降，药物去势组睾酮水平在耻骨后前列腺癌根治术（RRP）术后2～3个月可恢复正常，而手术去势组RRP术后睾酮呈持续低水平。结论 NHT可明显缩小前列腺体积，降低PSA，有利于手术操作。药物去势对内分泌影响是可逆的，而手术去势内分泌改变不可逆。     

Flavonoids modulate monocarboxylate transporter-1-mediated transport of gamma-hydroxybutyrate in vitro and in vivo.

The objective of this study was to determine the effects of flavonoids on the in vitro monocarboxylate transporter 1 (MCT1)-mediated transport and in vivo disposition of the drug of abuse, gamma-hydroxybutyrate (GHB). The uptake of GHB in rat MCT1 gene-transfected MDA-MB231 cells was significantly decreased in the presence of the flavonoids apigenin, biochanin A, chrysin, diosemin, fisetin, genistein, hesperitin, kaempferol, luteolin, morin, narigenin, phloretin, and quercetin, but was not affected by the flavonoid glycosides phloridzin and rutin. The IC(50) values for luteolin, morin, and phloretin were 0.41 +/- 0.14, 6.41 +/- 2.01, and 2.57 +/- 0.48 microM, with the inhibition mechanism for luteolin being competitive. [(3)H]Kaempferol and [(3)H]biochanin A did not exhibit MCT1-mediated uptake, suggesting that these flavonoids are not substrates for MCT1. The combination of luteolin and phloretin inhibited the uptake of GHB in a synergistic manner; however, the combination of luteolin and morin was antagonistic. GHB 1000 mg/kg was administered to rats by i.v. bolus, with or without the concomitant administration of luteolin 10 mg/kg i.v. After luteolin treatment, the renal and total clearances of GHB were significantly increased, probably because of inhibition of the MCT1-mediated renal reabsorption of GHB, and the sleep time significantly decreased (121 +/- 5 min versus 165 +/- 10 min) compared with control rats. Overall, the results of this study indicate that flavonoids from food or herbal products may significantly alter the pharmacokinetics and pharmacodynamics of MCT substrates.     

微创经皮肾镜取石术治疗上尿路结石

目的 探讨微创经皮肾镜取石术治疗上尿路结石的有效性和安全性.方法上尿路结石患者368例,平均年龄57岁.其中输尿管上段结石116例,结石大小(2.1±0.8)cm;肾结石252例,结石大小(4.6±1.4)cm,其中非鹿角形结石190例,结石大小(3.2±1.1)cm,鹿角形结石62例,结石大小(7.6±1.6)cm.均采用微创经皮肾穿刺,输尿管镜下气压弹道或联合钬激光碎石治疗,对结石清除率和并发症等进行统计分析.结果 368例患者中单通道取石356例(96.7%),双通道12例(3.3%).一期取石344例(93.5%),二期取石24例(6.5%).总结石取净率为88.6%(326/368).平均手术时间73 min.一期取净结石者住院时间4～8 d,平均6 d.术后发热14例(3.8%);输血5例(1.4%);2例肾结石术后出血严重者经输血及超选择性肾动脉栓塞后治愈.结论 微创经皮肾镜取石术损伤小、住院时间短、术中出血及并发症少、结石清除率高、可重复取石,是治疗上尿路结石有效的微创手段.     

Angiopoietin1/Tie2 and VEGF/Flk1 induced by MSC treatment amplifies angiogenesis and vascular stabilization after stroke.

Bone marrow stromal cells (MSCs) increase vascular endothelial growth factor (VEGF) expression and promote angiogenesis after stroke. Angiopoietin-1 (Ang1) and its receptor Tie2 mediate vascular integrity and angiogenesis as does VEGF and its receptors. In this study, we tested whether MSC treatment of stroke increases Ang1/Tie2 expression, and whether Ang1/Tie2 with VEGF/ vascular endothelial growth factor receptor 2 (VEGFR2) (Flk1), in combination, induced by MSCs enhances angiogenesis and vascular integrity. Male Wistar rats were subjected to middle cerebral artery occlusion (MCAo) and treated with or without MSCs. Marrow stromal cell treatment significantly decreased blood-brain barrier (BBB) leakage and increased Ang1, Tie2, and occludin (a tight junction protein) expression in the ischemic border compared with MCAo control. To further test the mechanisms of MSC-induced angiogenesis and vascular stabilization, cocultures of MSCs with mouse brain endothelial cells (MBECs) or astrocytes were performed. Supernatant derived from MSCs cocultured with MBECs significantly increased MBEC expression of Ang1/Tie2 and Flk1 compared with MBEC alone. Marrow stromal cells cocultured with astrocytes also significantly increased astrocyte VEGF and Ang1/Tie2 expression compared with astrocyte culture alone. Conditioned media from MSCs alone, and media from cocultures of MSCs with astrocytes or MBECs, all significantly increased capillary tube-like formation of MBEC compared with control Dulbecco's modified Eagle's medium media. Inhibition of Flk1 and/or Ang1 significantly decreased MSC-induced MBEC tube formation. Knockdown of Tie2 expression in MBECs significantly inhibited MSC-induced tube formation. Our data indicate MSC treatment of stroke promotes angiogenesis and vascular stabilization, which is at least partially mediated by VEGF/Flk1 and Ang1/Tie2.     

The upregulation of glial glutamate transporter-1 participates in the induction of brain ischemic tolerance in rats.

Glial glutamate transporter-1 (GLT-1) plays an essential role in removing glutamate from the extracellular space and maintaining the glutamate below neurotoxic level in the brain. To explore whether GLT-1 plays a role in the acquisition of brain ischemic tolerance (BIT) induced by cerebral ischemic preconditioning (CIP), the present study was undertaken to observe in vivo changes in the expression of GLT-1 and glial fibrillary acidic protein (GFAP) in the CA1 hippocampus during the induction of BIT, and the effect of dihydrokainate (DHK), an inhibitor of GLT-1, on the acquisition of BIT in rats. Immunohistochemistry for GFAP showed that the processes of astrocytes were prolonged after a CIP 2 days before the lethal ischemic insult, which could protect pyramidal neurons in the CA1 hippocampus against delayed neuronal death induced normally by lethal ischemic insult. The prolonged processes extended into the area between the pyramidal neurons and tightly surrounded them. These changes made the pyramidal layer look like a 'shape grid'. Simultaneously, the prolonged and extended processes showed a great deal of GLT-1. Western blotting analysis showed significant upregulation of GLT-1 expression after the CIP, especially when it was administered 2 days before the subsequent lethal ischemic insult. Neuropathological evaluation by thionin staining showed that DHK dose-dependently blocked the protective role of CIP against delayed neuronal death induced normally by lethal brain ischemia. It might be concluded that the surrounding of pyramidal neurons by astrocytes and upregulation of GLT-1 induced by CIP played an important role in the acquisition of the BIT induced by CIP.     

老年人与青年人皮肤血流量比较研究

目的 判定增龄对皮肤血流量的影响。方法 用PIM2-LDPI检测皮肤血流量。结果 老年组前额、左手指背、命门穴部位皮肤血流量分别为:(1.94±0.86)V,(1.92±0.52)V和(0.71±0.19)V,与青年组比较差异无显著性。但是,老年男性在命门穴的皮肤血流量明显高于青年男性(P<0.05),老年女性前额的皮肤血流量明显降低(P<0.01)。男性比女性的皮肤血流量高。结论 皮肤血流量的差异无年龄相关性,男性组的皮肤血流量比女性组高。