Cellular basis of diabetic nephropathy: 1. Study design and renal structural-functional relationships in patients with long-standing type 1 diabetes.

This study was designed to elucidate the cellular basis of risk of or protection from nephropathy in patients with type 1 diabetes. Entry criteria included diabetes duration of > or =8 years (mean duration, 22.5 years) and glomerular filtration rate (GFR) >30 ml x min(-1) x 1.73 m(-2). Patients were classified, on the basis of the estimated rate of mesangial expansion, as "fast-track" (upper quintile) or "slow-track" (lower quintile). A total of 88 patients were normoalbuminuric, 17 were microalbuminuric, and 19 were proteinuric. All three groups had increased glomerular basement membrane (GBM) width and mesangial fractional volume [Vv(Mes/glom)], with increasing severity from normoalbuminuria to microalbuminuria to proteinuria but with considerable overlap among groups. Vv(Mes/glom) (r = 0.75, P < 0.001) and GBM width (r = 0.63, P < 0.001) correlated with albumin excretion rate (AER), whereas surface density of peripheral GBM per glomerulus [Sv(PGBM/glom)] (r = 0.50, P < 0.001) and Vv(Mes/glom) (r = -0.48, P < 0.001) correlated with GFR. Vv(Mes/glom) and GBM width together explained 59% of AER variability. GFR was predicted by Sv(PGBM/glom), AER, and sex. Fast-track patients had worse glycemic control, higher AER, lower GFR, more hypertension and retinopathy, and, as expected, worse glomerular lesions than slow-track patients. Thus, there are strong relationships between glomerular structure and renal function across the spectrum of AER, but there is considerable structural overlap among AER categories. Given that normoalbuminuric patients may have advanced glomerulopathy, the selection of slow-track patients based on glomerular structure may better identify protected patients than AER alone.     

酸性微环境下大蒜素增强大鼠自然杀伤细胞的功能活性

Objective To investigate the role of allicin on rat nature killer (NK) cell activity in vitro under acidic microenvironment, and its possible mechanism. Methods CD3- NKR-P1+ NK cells isolated from the rat spleen were cultured in the complete RPMI 1640 medium ( pH 5. 6, pH 6. 5, or pH 7. 2 respectively), and treated with allicin at final concentration of 30 mg/L. Enzyme linked immunosorbent assay (ELISA) was used to determine supernatant interferon (IFN)-γ levels. The percentage of NK cells proliferation and apopotosis was analyzed by flow cytometry. NK cell cytotoxicity toward YAC-1 tumor cells was detected by LDH release assay. Results Proliferation and cytotoxicity of NK cells were significantly suppressed by acidic microenvironment in vitro. Under the cultured condition of acidic pH below 7. 2, allicin seemed to promote NK cells proliferation, which reached to highest level of 33% at pH 5. 6 cultured for 16 h. Correspondingly, at pH of 5. 6, allicin induced a marked increase of IFN-γ concentration in the supernatant from (50. 07 ± 0. 38) (cultured for 4 h) to (64. 59 ± 0. 09) ng/L ( cultured for 16 h). The cytotoxicity of NK cells toward YAC-1 tumor cells was also found strongest under the condition of pH 5. 6 cultured for 16 h. Conclusion Allicin favored to enhance the cytotoxicity of NK cells under the acidic cultured condition, which might be related to the increase of IFN-γ production.     

复杂腔静脉恶性肿瘤的手术治疗

目的探讨手术治疗复杂重症腔静脉恶性肿瘤的方法及其效果。方法回顾性分析2004年12月至2008年7月收治的9例次腔静脉恶性肿瘤手术患者的临床资料。其中7例患者8次在体外循环或右心房插管灌注下手术切除下腔静脉肿瘤或/和延及右心房/室内肿瘤;1例下腔静脉平滑肌肉瘤术后局部复发行下腔静脉人工血管置换术;1例上腔静脉肿瘤延及左右无名静脉行上腔静脉重建。人工血管置换3例,下腔静脉补片2例。术前CT或MRI检查均已除外远处转移。结果除1例术后2个月死于肝衰竭,其余8例患者术后症状均缓解并顺利出院,平均随访时间为18(5～45)个月,其中3例术后随访14～24个月,无复发;1例术后5个月死于肝衰竭;4例术后分别于4、5、11及32个月后原位复发并全身多处转移,其中1例是罕见的下腔静脉多形性恶性纤维组织细胞瘤,5个月后复发并右肾上腺转移癌,9个月后再次切除下腔静脉及右心房/室内肿瘤,术后2个月再次复发死于心衰。另3例复发者未再次手术,其中1例术后7个月行化疗后症状缓解;1例上腔静脉肿瘤患者11个月后发现脑转移,15个月后死亡;1例45个月后失访。结论充分的术前准备及多学科的合作,复杂腔静脉恶性肿瘤如未发现其它部位转移积极手术治疗,仍可明显改善患者近期生存质量。     

普里灵疝装置在局麻下腹股沟疝无张力修补术中的应用

目的探讨局麻下普里灵疝装置(PHS)在腹股沟疝无张力修补中应用的临床经验和疗效。方法回顾性分析38例患者经腹股沟切口腹膜前间隙置入普里灵疝装置(PHS)进行腹股沟疝修补术的病例,观察麻醉效果、手术时间、住院时间、住院费用及随访观察术后并发症及复发情况。结果全部采用局麻,单侧手术时间35～50 min,平均45 min,术后切口疼痛较明显的3人,均为中年患者。平均住院时间2～4 d。术后平均随访6～10个月无复发,无明显异物感,阴囊血肿2例。结论应用普里灵疝装置(PHS)修补腹股沟疝手术针对耻骨肌孔进行修补,具有手术修补范围大、术后恢复快、并发症少、住院时间短、术后复发率低等优点,与传统手术相比是一种更为理想的手术方式。     

3种肠道清洁方法效果比较

目的 探讨顺产儿脐部护理中修剪法配合Orem自理模式的应用效果。方法 将100名顺产新生儿随机分为对照组和观察组各50名。对照组按常规进行脐部护理；观察组择期行脐部修剪，同时根据Orem自理模式进行全补偿、部分补偿及支持一教育护理模式进行护理。观察两组脐带出血、脱落及疑似感染情况。结果 两组均未出现脐带出血情况；两组出生后9d回访时脐带脱落比较，差异有显著性意义（P〈0．05）。结论 修剪法配合Orem自理模式进行脐部护理，能促进新生儿脐带早脱落。     

输尿管镜治疗输尿管结石梗阻并发急性肾功能衰竭

目的:探讨治疗上尿路结石性梗阻并发急性肾功能衰竭的方法。方法:用输尿管镜直视下气压弹道碎石术治疗输尿管结石梗阻并急性肾功能衰竭患者18例。结果:术后患者血清BUN、Cr均恢复正常或接近正常,尿量恢复。结论:输尿管镜诊治上尿路结石性梗阻并发急性肾功能衰竭,具有安全、疗效可靠、损伤小等优点,能同时处理双侧输尿管病变,可作为首选治疗方法。     

阴囊皮瓣修复阴茎缺损的临床应用

目的探讨阴囊皮瓣修复阴茎大部分缺损的临床效果。方法对由不同原因引起阴茎缺损的17例患者，采用阴囊皮瓣进行修复。在阴囊根部两侧阴囊前动脉之间的无血管区剥离一腔隙，将延长后的阴茎海绵体经腔隙转移至阴囊皮瓣的下方，以包绕海绵体创面，皮瓣缝合后瘢痕在阴茎腹侧。结果切口均Ⅰ期愈合。术后随访患者1～9年，未出现皮瓣坏死现象，阴茎的外观及功能恢复较好。结论阴囊皮瓣的血运丰富、组织柔软、弹性好、伸缩性强，而且此手术切口隐蔽，是修复阴茎缺损较理想的皮瓣。     

胰腺癌外周血mdr1及其转录区域结合位点甲基化的检测和临床意义

目的：研究胰腺癌肿瘤组织及外周血有核细胞多药耐药基因1（mdr1）及其转录区域结合位点甲基化的表达及其相关性,探索适用于临床观察多药耐药性变化的有效手段。方法：应用免疫组织化学法和FQ-PCR技术、MSP方法分别检测胰腺癌肿瘤组织及其对应外周血标本中的mdr1的表达和转录区域结合位点甲基化程度,并通过Pearson统计学方法分析两者的相关性。结果：胰腺癌P-gp的表达与mdr1mRNA表达明显相关,并与mdr1基因转录区域结合位点甲基化程度显著相关。外周血中mdr1及其转录区域结合位点甲基化的表达与肿瘤组织中的表达存在显著相关性（P〈0.01）。结论：mdr1转录区域结合位点的甲基化与胰腺癌的多药耐药性密切相关;检测外周血mdr1及其甲基化的表达可动态监察胰腺癌病人化疗前后多药耐药性的变化,为临床治疗方案的决择提供依据。     

夹板固定与石膏固定治疗桡骨远端关节外骨折的疗效比较

我院自2002年1月-2005年5月,对126例桡骨远端关节外骨折分别采用石膏固定和小夹板外固定,并对这两组治疗方法和疗效进行回顾性分析。1资料与方法1.1临床资料本组126例,男42例,女84例;年龄23～82岁,平均54.4岁。致伤原因:车祸伤15例,滑倒或高处坠落伤96例,其他伤15例。左侧46例,     

无胸膜损伤微创经皮肾镜取石术并发胸腔积液成因的初步研究

目的：探讨微创经皮肾镜取石术（MPCNL）并发胸腔积液的成因。方法：对285例上尿路结石患者行MPCNL治疗,其中输尿管上段结石91例,肾结石167例,输尿管上段结石并肾多发性结石27例;均为单侧结石。结石大小1.2～4．5cm,平均2．3cm。术中在超声引导下于第12肋下腋中线至肩胛线之间穿刺,明确避开胸膜后建立经皮肾通道取石。用含0．1％中华墨汁的生理盐水作为灌洗液。术后行胸部X线及B超检查,必要时行CT检查。并发胸腔积液较多者在B超定位后行胸腔穿刺抽液并抽取外周血进行镜检,寻找有无碳颗粒,对相关数据进行分析。结果：手术均获得成功,术中无胸膜损伤及气胸等并发症发生。术后B超检查发现16例并发胸腔积液,CT检查发现5例并发少量胸腔积液。其中13例抽出术侧胸腔积液,离心后提取沉淀物镜检可见碳颗粒,而抽取外周血镜检未见碳颗粒。胸腔积液组结石大小、数目、术中冲洗液灌洗时间、灌洗压力和用量明显高于无胸腔积液组（P〈0．05）,其中灌洗时间、术中灌洗压和灌洗液用量是胸腔积液发生的独立影响因素（P〈0．05）。结论：无胸膜损伤MPCNL并发胸腔积液,可能因术中灌洗液量大、灌洗时间长和灌洗压力高导致术中灌洗液外渗至腹膜后间隙和（或）腹腔,再通过膈肌进入胸腔形成。