The adverse effect of treatment prolongation in cervical cancer by high-dose-rate intracavitary brachytherapy.

BACKGROUND AND PURPOSE: The potential risk of prolongation of treatment time in cervical cancer has been reported for many low-dose rate (LDR) studies, with an estimated loss of local control ranging from 0.3 to 1.6% per day of treatment prolongation. Since the treatment schedule for fractionated high-dose rate intracavitary brachytherapy (HDRICB) is not directly comparable with that for low-dose rate studies, this report aims to evaluate the adverse effect of treatment prolongation specifically for cervical cancer treated with HDRICB. MATERIAL AND METHODS: From September 1992 to December 1997, 257 patients diagnosed with uterine cervical cancer (35 Ib, 26 IIa, 122 IIb, 10 IIIa, 57 IIIb, 7 IVa), who underwent external radiotherapy combined with between two and four courses of HDRICB and a minimum of 3 years of follow-up (median 57 months), were analyzed. Treatment consisted of irradiation of the whole pelvis with 44-45 Gy consisting of 22-25 fractions by 5 weeks, with the dose boosted to 54-58 Gy (with central shielding) for patients diagnosed as FIGO stage IIb-IVa bilateral parametrial disease. HDRICB was performed using an Ir-192 remote afterloading technique at 1-week intervals. The standard prescribed dose for each course of HDRICB was 7.2 Gy to point A for three insertions (before July 1995), or 6.0 Gy to point A for four insertions (after July 1995). Total prescribed point A doses (external beam radiotherapy+HDRICB) ranged from 58 to 71.6 Gy (median, 65.6 Gy) for stage IB-IIA, while analogous dosage for larger lesions (stage IIb-IVa) ranged from 59 to 75.6 Gy (median, 65.6 Gy). Kaplan-Meier and multivariate analyses were used to test the effect of treatment time on pelvic control rate (PCR) and cause-specific survival (CSS) at 5 years. RESULTS: Median treatment time was 63 days. For all stages of disease, the 5-year CSS and PCR were significantly different comparing treatment times of less than and greater than or equal to 63 days [83% and 65% (P=0.004], 93% and 83% (P=0.02), respectively]. These associations were also significant for stage Ib/IIa [97% and 79% (P=0.01), and 100% and 87% (P=0.02), respectively), but not for stage IIb [75% and 72% (P=0.79), and 93% and 87% (P=0.83), respectively] or stage III [66% and 49% (P=0.2), and 83% and 72% (P=0.21), respectively]. Multivariate analysis identified three prognostic factors for CSS, stage (P<0.001), tumor response to external RT (P=0.001), and overall treatment time (OTT; P=0.006). Prognostic factors for pelvic failure were stage (P<0.001), tumor response to external RT (P=0.001), and OTT (P=0.03). Prolongation of treatment time resulted in a daily decrease in pelvic control rate of 0.67% overall, and 0.43% for stage Ib-IIa, 0.57% for stage IIb, and 0.73% for stage III patients. CONCLUSION: Analysis of the data from the current study demonstrates that the adverse effect of treatment prolongation was observed later in the treatment course for the high-dose rate (HDR) series compared to the LDR analog, however, treatment-time prolongation still negatively influenced the cause-specific survival and pelvic control rate for both dosage groups.     

Ⅰ期全身麻醉下快速牵引复位及前路减压融合治疗下颈椎脱位

目的探讨Ⅰ期全身麻醉下快速牵引复位在治疗下颈椎脱位中的作用. 方法本组135例, 男101例,女34例;平均年龄44.4岁.单纯脱位81例,脱位伴骨折54例.单侧小关节脱位56例,双侧79例.53例采用全身麻醉下冠状颅骨牵引复位,38例采用床旁牵引复位,44例未行术前牵引复位. 结果 52例全身醉麻下复位成功,1例失败,成功率98.1%;18例床旁牵引复位成功,20例失败,成功率47.4%.复位成功的70例均行颈前路间盘或椎体次全切除、植骨、前路钛板固定;未复位65例中,33例采取前后联合入路手术,17例采取后路关节突切除、复位、关节突钢板固定术,15例行颈前路间盘或椎体次全切除、植骨、前路钛板固定.所有患者均无术后神经损伤加重. 结论全身麻醉下颅骨牵引复位可以显著提高复位成功率,且脊髓损伤概率小,对手术方式有着重要影响.     

火药爆炸复合烧伤大鼠血浆CK-MB与心肌MDA变化

目的 探讨烟花火药爆炸复合烧伤大鼠血浆肌酸激酶心肌同工酶(CK—MB)与心肌丙二醛(MDA)含量的变化。方法 Wistar大鼠128只，随机分为正常对照组(n=8)、烧伤组(n=40)、爆炸伤组(n=40)和复合伤组(n=40)，分别致伤形成大鼠20％体表面积Ⅲ度烧伤、火药爆炸伤和两者复合伤。动态观察大鼠伤后1、3、6、12、24h血浆CK—MB，心肌MDA含量并进行相关分析。结果 复合伤组较单因素致伤组大鼠血浆CK—MB升高明显，心肌组织MDA含量呈类似变化，CK—MB与MDA有相关性。结论 烟花火药爆炸复合烧伤对大鼠心肌的损害较单纯烧伤或爆炸伤更为严重，提示烧伤和爆炸伤有协同致伤作用，氧自由基代谢紊乱参与烟花火药爆炸复合烧伤后心肌的损伤。     

难治性癫痫皮层电极监测的观察和护理：附14例报告

癫痫是由于脑灰质内某些高兴奋性细胞群过度重复放电所引起的一种l临床征象，其中大约20％不能通过药物控制发作，称为难治性癫痫，需手术治疗。致痫灶的精确定位是保证癫痫手术效果的关键。随着医疗技术的不断发展，一种具有脑电记录灵敏度高、定位精确等优点的长程视频脑电监测技术已经诞生并应用于l临床。该监测技术避免了头皮、颅骨等不良介质的影响和肌电、身体活动等因素的干扰，可以直接记录大脑皮层和深部脑组织的脑电活动，已在临床中广泛采用。     

女性控尿解剖学机制的MRI研究

目的探讨女性控尿的解剖学机制在MRI（磁共振成像）的表现和观察方法。方法对20例正常控尿的成年女性进行MRI扫描，采用八通道体部线圈、快束自旋回波（FSE）扫描序列进行扫描，采集静息时盆腔横断面、矢状面和冠状面影像。结果MRI显示，女性的尿道分三层结构，与病理学对照，由内向外依次为黏膜及黏膜下组织、肌肉、外膜组织，但无法区分平滑肌与括约肌；与控尿有关的盆底肌肉也能够清楚显示。结论MRI能够清楚观察到女性控尿的有关解剖结构，是观察女性控尿解剖结构的较理想影像方法。     

降调节对卵子质量的影响

近10余年来，在体外受精一胚胎移植（IVF-ET）周期中应用促性腺激素释放激素激动剂（GnRH-a）进行控制性卵巢刺激（COS）已成为普遍采用的方法，其主要原因是GnRH-a可以促进卵巢内多个卵泡同步发育和成熟，抑制内源性黄体生成素（LH）峰，阻遏卵泡过早黄素化及卵子早熟。由于GnRH-a在IVF-ET进行降调节COS中的应用不同，可将COS方案分为长方案和短方案。[第一段]     

为“性”福生活充电

有些事情是一生难忘的：你的第一份薪水，终于拥了梦寐以求的爱车，还有那个绝妙的激情夜晚……难忘时刻已经成为过往，当你渴望再造那一激情澎湃的珍贵氛围时，听听她们的“珍藏”，给你的“性”福生活充充电吧。[编者按]     

Long-term application of diethylstilbestrol upregulates expressions of μ- and m-calpains in pituitary intermediate lobe of female Wistar rats

BACKGROUND: During formation of prolactin neoplasia, how cells and its structure in adenohypophysis affect prolactin cells should be further studied. Intermediate lobe can be regarded as a driving region to release prolactin (PRL) and may promote formation of prolactin neoplasia in pituitary anterior lobe. OBJECTIVE: To observe the effect of diethylstilbestrol (DES) on the expressions of μ and m-calpains in pituitary intermediate lobe of female Wistar rats. DESIGN: Observational contrast animal study. SETTING: Beijing Neurosurgical Institute. MATERIALS: A total of 21 female Wistar rats, 3 weeks old weighing 70–80 g were housed with free access to tap water and standard pellet food. They were kept in a CL-grade condition, at (24±1)℃ and a humidity of (55±5)%, and with a 12 hours day-night cycle. Caprine anti-μ- and m-calpains antibodies were provided by Santa Cruz Biotechnology, CA, USA; rabbit-anti-PRL antibodies by Dako, Denmark; rabbit-anti-ACTH antibody by Boster Company, Wuhan. METHODS: The experiment was carried out in Pathophysiological Department and Animal Laboratory, Beijing Neurosurgical Institute from August 2006 to January 2007. ① Rats were randomly divided into groups with 7 in each group, including vehicle control group, in which rats were injected intraperitoneally with sun-flower seed oil (1 mL/kg, twice a week) for 16 weeks; DES group, where animals were administered with DES (5 mg/kg, twice a week) for 16 weeks; DES + vehicle control group, in which DES was administered for 12 weeks at the same dose with those in DES group, and then was discontinued and replaced by sun-flower seed oil (1 mL/kg, twice a week) for the following 4 weeks. ② At 16 weeks later, pituitary tissue was dealt with HE staining and PRL immunohistochemical examination to observe evoke of tumor; meanwhile, immunohistochemical examination was used to observe expression of PRL of pituitary anterior lobe, expressions of μ- and m-calpains of pituitary intermediate lobe and distribution of adrenocorticotropin. MAIN OUTCOME MEASURES: ① Expression of PRL of pituitary anterior lobe, expressions of μ- and m-calpains of pituitary intermediate lobe and distribution of adrenocorticotropin. ② Morphological observation of pituitary tissue. RESULTS: All 21 rats were involved in the final analysis. ① Results of immunohistochemical examination: Morphological changes of neoplasia in DES group were strongly positive to PRL, and this suggested that formation of prolactin adenoma was observed in pituitary tissue. As compared with vehicle control group, expression of adrenoeorticotropic hormone (ACTH) was increased in both DES group and DES + vehicle control group. In addition, expressions of μ- and m-calpains in pituitary intermediate lobe were higher in DES group than that in vehicle control group. Otherwise, expressions of m-calpains in pituitary intermediate lobe was decreased in DES + vehicle control group, but expression of μ-calpains was still increased. ② Morphological observation of pituitary tissue: Gland tubes were orderly arranged in rats in vehicle control group. Anterior pituitary gland in rats of DES group demonstrated an apparent disappearance of gland tubes and a relatively large-scaled vasculature formation, namely the vascular lake lined by tightly arranged endothelial cells. Local integrated tumor cell arrangements were also detected. In addition, the border between the IL and the anterior lobe was locally blurred. The definite tumor-like changes in pituitary tissues were confirmed in 6 of 7 female Wistar rats in DES group, and one spontaneous occurrence of tumor formation was found in vehicle control group. In DES + vehicle control group, DES withdrawal led to the subtile emergence of gland tube cavity, although tumor-like cells still existed in 4 of 7 rats, suggesting occurrence of the tumor regression due to the withdrawal of DES. CONCLUSION: A long-term application of DES can enhance the expressions of ubiquitours neutral cysteine protease in pituitary intermediate lobe and this suggests that both of them play a key role in release of hormone and formation of prolactin neoplasia through directly promoting PRL expression and release of neighboring pituitary intermediate lobe.     

冠心病指南中有关心电图的解读

有关冠心病的国际指南主要有5个：①ACC／AHA处理ST段抬高型心肌梗死指南（1999年第1版，2004年修改）；②ACC／AHA处理不稳定型心绞痛和非ST段抬高型心肌梗死指南（2000年第1版，2002年第2版，2007年再修改）；③ACC／AHA的处理慢性稳定型心绞痛指南（1999年第1版，2002年修改）；     

AN-132 block of cardiac sodium channels: A gate-related receptor analysis

Summary Based on the gate-related receptor hypothesis, an analysis of kinetics of AN-132, a new antiarrhythmic agent, blockade of cardiac sodium channels and the gate-related receptor which is bound by the drug was performed by computer simulation. Model-predicted apparent rates of onset of AN-132 (30 μmol/L) blocking were 0.051, 0.038, and 0.034 AF⁻¹ at stimulation frequencies of 1.0, 2.0 and 3.0 Hz, respectively. The time constant of recovery from block by AN-132 at resting potential -90 mV was 39.5 s. These findings are in agreement with those experimental data documented. The analysis of gate-related receptor shows that AN-132 binds the inactivation gate-related receptor, and the binding and unbinding are modulated by the inactivation process.