膀胱浆细胞样尿路上皮癌临床病理观察

目的探讨膀胱浆细胞样尿路上皮癌的临床病理特征、诊断与鉴别诊断、治疗与预后。方法应用常规HE染色、免疫组化ABC法及光镜观察1例膀胱浆细胞样尿路上皮癌,通过临床随访及结合文献复习进行讨论。结果膀胱内肿物2枚,位于右侧壁者为浆细胞样尿路上皮癌,肿瘤细胞呈显著的浆细胞样特征,细胞圆形或卵圆形,胞质丰富、嗜酸性,核偏位;部分区域肿瘤细胞胞质呈空泡状,核位于一端呈印戒样。肿瘤细胞弥漫浸润膀胱黏膜固有层及肌层,多个脉管内可见癌栓。位于膀胱三角区的肿物为普通型尿路上皮乳头状癌,蒂部肿瘤侵及膀胱黏膜下,未侵及肌层。免疫组化:浆细胞样肿瘤细胞CK7、CEA、CD138和β-hCG(+),LCA、kappa、lambda、Syn、NSE和E-cadherin(-)。术后给予抗肿瘤免疫治疗及膀胱灌注表阿霉素治疗,随访5个月,无瘤存活。结论膀胱浆细胞样尿路上皮癌非常少见,具有特殊的组织病理学特征,周围可伴有普通型尿路上皮癌或尿路上皮原位癌成分,需要与其他具有浆细胞样形态学特征的肿瘤鉴别,免疫组化有助于鉴别诊断。     

Genetics of multiple sclerosis [published erratum appears in Hum Mol Genet 1997 Nov;6(12):2189]

Multiple Sclerosis (MS) is a common chronic central nervous system disease in young adults. Relative familial risk appears to be determined largely by genes while population risk is strongly influenced by environmental factors. This is supported by genetic epidemiological studies which also suggest an oligogenic inheritance of susceptibility. The HLA DRB1*1501, DQA1*0102, DQB1 0602 haplotype is associated with the disease but HLA contributes only modestly to overall susceptibility. The results of three genomic searches are concordant with the genetic epidemiology and imply a number of genes with interacting effects will be found. Importantly, no single region has been identified with a major influence on familial risk.      

毛细管电色谱测定复方丹参注射液中原儿茶醛和原儿茶酸的含量

 目的 建立毛细管电色谱分离测定复方丹参注射液中原儿茶醛(PAH)和原儿茶酸(PA)的内标定量测定方法。方法 用ODS柱为固定相,甲醇和2 mmol·L^-1磷酸缓冲液(pH 3.0)为流动相,电压为-8kV,流速为10μL·min^-1,压力为6766.59kPa,紫外检测波长为255 nm,4-羟基苯甲酸为内标。结果 原儿茶醛和原儿茶酸的线性范围分别是0.2-2.5ng和0.042-0.52 ng;相关系数分别为0.999 96和0.999 97;加样回收率分别为98.02%(RSD=3.42％)和100.0％(RSD)=0.93％);检测限分别为0.085 ng和0.036 ng;精密度实验RSD分别为0.52％和0.33％;重现性实验RSD分别为0.27％和0.34％;稳定性实验RSD分别为0.37％和0.32％:柱效分别为113246和257901;PA与PAH的分离度为4.854,PAH与4-羟基苯甲酸的分离度为4.620。结论 该方法简便,快速,准确,灵敏度高,重现性好,样品用量少,适用于丹参及含丹参制剂的样品中原儿茶醛和原儿茶酸的分离测定。     

复方五仁醇胶囊保肝作用的实验与临床研究

目的 考察复方五仁醇胶囊对损伤肝细胞的保护作用及对慢性肝炎的治疗效果.方法 以SD大鼠为供体制备复方五仁醇胶囊含药血清,CCl4诱导大鼠原代培养肝细胞损伤模型,采用血清药理学方法考察含药血清对损伤肝细胞增值(MTT法)和培养上清液中丙氨酸氨基转移酶(ALT)的影响;将446例慢性乙型肝炎患者随机分成治疗组和对照组,以临床症状、体征、肝功能为主要指标,考察复方五仁醇胶囊的治疗效果.结果 与模型组比较,含药血清组MTT值明显升高,上清液中ALT均显著下降,体系中加入10%含药血清效果最佳;治疗组、对照组临床症状、体征及肝功能指标均明显得到改善,复方五仁醇胶囊的疗效优于阳性对照药护肝片.结论 复方五仁醇胶囊对肝细胞损伤具有明显保护作用,对慢性肝炎有较好治疗作用.     

医学人文教育对住培生心理状态的影响

住院医师培养基地医生(住培生)是我国为探索医科大学毕业生接受临床继续教育而产生一类特殊群体。医学是一门培养应用型人才的科学,随着我国社会经济快速发展及社会开放与文明程度的提高,医学生的独立意识和自我价值的实现,要求医院对毕业后的医学生除了医学专业的教育外,必须增加更为广博的人文教育。为了让医学生将来更好为患者服务,成为称职的住院医师,2005年我国卫生部逐步在全国建立住院医师培养基地,进一步规范住院医师培养基地医生(住培生)制度,而有关住培生的人文教育尚处于探索之中,尤其是对住培生人文教育与住培生相关心理因素的分析。     

NM-3对裸鼠移植胃癌组织VEGF—C、VEGF—D和VEGF—R-3表达的影响

目的：探讨NM-3对裸鼠移植人胃癌组织微淋巴管生成的影响及可能机制。方法：28只未分化人胃腺癌SGC-7901移植BALB／C裸鼠随机分为4组，每组7只，分别腹腔内注射生理盐水、NM-3、卡铂及NM-3加卡铂，每周2次，剂量为NM-310mg／kg，卡铂5mg／kg。于第8周末处死裸鼠，取下肿瘤组织，定量免疫组化染色检测移植瘤组织VEGF—C、VEGF—D和VEGF—R-3表达。结果：各组VEGF—C免疫组化染色阳性面积（μm^2）为：卡铂组（1647．83±501．70）、NM-3组（2106．01±437．11）及联合给药组（1825．61±277．24），均较生理盐水对照组（2962．84±519．77）显著下降（P〈0．05），各治疗组之间无显著差别。VEGF—D值：NM-3组（1032．25±460．44）及联合给药组（1009．08±370．13），较生理盐水组（1882．15±359．38）及卡铂组（1854．00±322．07）均显著下降（P〈0．05），卡铂组较生理盐水组下降，但是差别无显著意义。VEGF—R-3值：NM-3组（1222．05±470．80）及联合给药组（1103．34±265．94）较生理盐水组（2123．05±117．99）下降，并有显著意义（P〈0．05），而卡铂组（1668．30±256．34）与生理盐水组比较差异无显著性；各治疗组之间无显著差别。结论：NM-3能够抑制胃癌微淋巴管生成，并能增强卡铂的抗肿瘤作用。     

Internal-external percutaneous transhepatic biliary drainage for malignant biliary obstruction: a retrospective analysis

When percutaneous transhepatic biliary drainage (PTBD) is required for the management of malignant biliary obstruction, the local policy favours the use of internal–external drains. Regular planned drain exchanges are scheduled, and patients have open access back into the system to minimise complications. The aim of this study was to evaluate the success and complication rate of this method for the palliation of malignant biliary obstruction. The hospital records of 43 consecutive patients who underwent PTBD for malignant biliary obstruction at a single institution between 1 February 2004 and 31 January 2006 were reviewed. Outcomes were examined until January 2008. Biliary decompression was achieved in all 43 patients. The level of obstruction was defined as distal in 24 patients and perihilar in 19 patients. There was one procedure-related death. There were 91 routine outpatient drain exchanges performed at a median interval of 45 (range 21–64) days. Overall, 24/43 patients encountered 80 discrete complications related to biliary drainage. Fifty-two non-scheduled drain exchanges (accounting for 65% of all complications) were performed on an outpatient basis. Fourteen patients were readmitted on a median of one (range 1–3) occasion for a median duration of 3 (range 1–12) days. Median survival was 71 (range 7–850) days. PTBD can be performed with low mortality, but long-term morbidity remains high despite an aggressive approach to maintaining biliary patency. Providing patients with an open-access service means the majority of complications can be dealt with on an outpatient basis.     

过敏性紫癜中医证治

过敏性紫癜小儿多见,也有部分成人发病。病因有外感和内伤,病机有虚实,实则热毒迫血妄行,虚则阴虚内热伤络,气虚失于统摄;病情迁延则气虚致瘀,瘀血阻络又易导致血液溢于脉外而复发。小儿外感因素居多,成人与饮食、情志和劳伤等因素更密切。发病无明显季节性,外感风、寒、暑、湿、燥、火均可致病。有阳络伤和阴络伤以及伤经络和伤脏腑不同＂,阳络伤则血外溢,阴络伤则血内溢＂＂,斑出阳明,疹出太阴＂。临床证型有热毒伤络、阴虚火旺、气不摄血和瘀血阻络等,热毒伤络型带有明显外感特征,其余三个证型则表现为内伤特征。前者多以疏风清热或清热解毒联合凉血止血方法,其余三个证型则滋阴清热或降火、健脾益气摄血或活血化瘀止血等。治疗体现止血、消瘀、宁血、养血总纲。