白藜芦醇通过激活PI3K/AKT通路抑制内皮细胞凋亡的研究

目的观察白藜芦醇对脂多糖作用下人脐静脉血管内皮细胞凋亡的影响,并探讨其作用机制。方法体外培养人脐静脉血管内皮细胞,实验分为5组:空白组给予单纯培养基培养;模型组培养基中加入1000 ng/mL脂多糖孵育24 h;5μmol/L白藜芦醇组和10μmol/L白藜芦醇组培养基中分别先加入5μmol/L、10μmol/L白藜芦醇孵育12 h,再加入1000 ng/mL脂多糖孵育24 h;PI3K抑制剂组培养基中先加入10μmol/L白藜芦醇和10μmol/L PI3K抑制剂LY294002共处理12 h,再加入1000 ng/mL脂多糖孵育24 h。使用CCK-8试剂盒检测各组细胞的增殖能力;流式细胞术检测各组细胞凋亡率;DHE荧光探针检测各组细胞中活性氧(ROS)含量;ELISA检测各组细胞培养液中一氧化氮(NO)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平;Western blot法检测各组AKT的磷酸化情况。结果与空白组相比,模型组细胞增殖能力明显降低,细胞凋亡率和细胞中ROS含量及TNF-α、IL-6水平均明显升高,NO水平及P-AKT/AKT表达水平明显降低,差异均有统计学意义(P均<0.05)。与模型组和PI3K抑制剂组相比,10μmol/L白藜芦醇组细胞增殖能力明显升高,细胞凋亡率和细胞中ROS含量及TNF-α、IL-6水平明显下降,NO水平及P-AKT/AKT表达水平明显升高,差异均有统计学意义(P均<0.05)。结论白藜芦醇能够提升脂多糖作用下人脐静脉血管内皮细胞的增殖能力,抑制细胞凋亡,减轻细胞的氧化应激和炎性反应,恢复细胞的分泌功能,可能与其激活PI3K/AKT通路而发挥保护作用有关。     

良性阵发性位置性眩晕复位短期疗效不佳的分析

目的探讨短期内多次手法复位疗效不佳的良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)的影响因素。方法回顾性分析2014年1月-2015年6月39例在本院耳鼻喉门诊首诊,2周以内经反复(3次以上)手法复位疗效不佳的BPPV患者其2周后的临床表现、治疗及随诊结果,探讨其影响因素。结果此类患者占同期全部BPPV患者的9.8%(39/396),其中,男15例,女24例,年龄26岁~81岁,平均63.0±14.5岁,60岁以上的28例,占71.8%。单侧后半规管BPPV 5例,单侧后半规管嵴顶BPPV 7例,单侧水平半规管BPPV 7例,单侧水平嵴顶BPPV 10例,上半规管BPPV 3例,混合型BPPV 7例。其中特发性的25例,继发性的14例(头部外伤7例,梅尼埃病2例,前庭神经炎1例,突发性耳聋1例,中耳炎1例,偏头痛2例)。所有患者均经过超过2周3次以上的手法复位,后半规管及后半规管壶腹嵴受累者采用Epley+Semont法,水平半规管及水平壶腹嵴顶受累者多采用Barbecue+Gufoni或Casani+强迫健侧卧位法,上半规管受累者采用Yacovino法进行复位,39例中28例结合Brandt-daroff体位训练及其药物辅助治疗。2周后-1个月内眩晕和变位性眼震能够完全缓解的19例,1个月后能够完全缓解的26例,2个月后和3个月后能够完全缓解的分别为31例和34例,随诊1年手法复位完全无效的5例,完全缓解的34例中1年内复发的21例(占61.8%)。结论 2周内经历多次手法复位疗效欠佳的BPPV患者多为60岁以上的老年患者,嵴顶结石、多管受累、头部外伤、梅尼埃病等内耳疾病是可能是其复位效果不佳的影响因素。此类患者一次手法复位难以成功,多数需要联合多种复位方法,结合体位训练和药物辅助治疗;个别患者手法复位完全无效;复位有效者,部分容易复发。     

水平半规管良性阵发性位置性眩晕

良性阵发性位置性眩晕(Benign Paroxysm Positional Vertigo,BPPV)是一种阵发性、由头位变动引起的伴有特征性眼震的短暂发作性眩晕,是最常见的前庭疾病。后半规管BPPV(Benign Paroxysmal Positional Vertigo ofPosterior Semicircular Canal,PSC-BPPV)是最常见的BPPV类型,临床上推荐Dix-Hallpike试验作为诊断PSC-BPPV的"金标准",Epley法是目前治疗PSC-BPPV最有效的复位方法。水平半规管BPPV(Benign Paroxysmal Positional Vertigoof Horizontal Semicircular Canal,HSC-BPPV)发病机制复杂,是仅次于PSC-BPPV的常见BPPV亚型,其实际发病率可能被低估。临床实践中,HSC-BPPV其诊断与复位治疗方法与PSC-BPPV均不相同。本文即围绕HSC-BPPV研究的发展史及流行病学、分类、病因、发病机制、诊断及治疗复位方法的相关进展做一综述。     

Relationship between obesity and hearing loss

Conclusion: Underweight and severe obesity were associated with an increased prevalence of hearing loss in a Korean population.

Objective: The relationship between weight and hearing loss is unclear. This study, therefore, analyzed the relationship between hearing loss and body mass index (BMI) in a Korean population.

Methods: The prevalence and severity of hearing loss were assessed in 61 052 subjects who underwent health screening examinations, including hearing tests. Subjects were divided into five groups according to BMI (underweight, normal, overweight, obese, and severely obese). The relationships between the prevalence and severity of hearing loss and BMI were analyzed, after adjusting for the effects of age.

Results: The rates of mild or greater hearing loss in the underweight, normal, overweight, obese, and severely obese groups were 24.9%, 20.4%, 21.8%, 21.2%, and 24.1%, respectively. Mild severity of hearing loss was the most common in all five groups, followed by moderate, moderately severe, and severe hearing loss, in that order. Multivariate analysis, showed that the odds ratios of hearing loss in the severely obese, and underweight groups, compared with the normal group, were 1.312 and 1.282, respectively.     

Metastatic Lymph Node Ratio of Central Neck Compartment Has Predictive Values for Locoregional Recurrence in Papillary Thyroid Microcarcinoma

ObjectivesThis study aimed to evaluate the significance of metastatic lymph node ratio (the ratio between the metastatic lymph node and the harvested lymph nodes; MLNR) in the central neck for the prediction of locoregional recurrence in patients with papillary thyroid microcarcinoma.MethodsAfter reviewing medical records of papillary thyroid microcarcinoma patients who received total thyroidectomy with central neck node dissection, 573 consecutive adult patients were enrolled in this study, with a follow-up period of more than 36 months. Regarding the risk of recurrence, multivariate analyses were performed with the following variables; sex, age, multiplicity of the primary tumor, presence of pathological extrathyroidal extension, the level of postoperative stimulated serum thyroglobulin, the number of harvested lymph nodes, the number of lymph node metastasis and MLNR.ResultsThe MLNR showed a predictive significance for the locoregional recurrence (P<0.05). Most recurrences were occurred in the lateral neck (n=12, 80%) with a median interval of 20 months. The lowest cutoff value of the MLNR for a meaningful separation of disease recurrence was 0.44 (hazard ratio, 8.86; 95% confidence interval, 1.49 to 52.58; P=0.001).ConclusionWhen the MLNR is higher than 0.44, there is an increased risk of locoregional recurrence mostly in the lateral neck. Therefore, MLNR of the central neck in a permanent or frozen biopsy may be helpful in decision making in the extent of thyroidectomy and/or the need for contralateral central neck lymph nodes dissection.     

Correlation of nasal obstruction with nasal cross-sectional area measured by computed tomography in patients with nasal septal deviation

Objectives: The objective of the present study was to investigate the relationship between the subjective sensation of nasal obstruction and the corresponding cross-sectional area for nasal airflow in patients with a deviated septum. Methods: Seventy-one patients with a diagnosis of unilateral nasal obstruction due to a deviated nasal septum were evaluated by preoperative computed tomography. Anterior anatomic characteristics (the internal nasal valve angle and the cross-sectional areas at the external nasal valve, the head of the inferior turbinate, and the head of the middle turbinate) and posterior anatomic factors (the cross-sectional areas at the openings of the frontal sinus, maxillary sinus, and end of the nasal septum) were examined. Associations between the computed tomography measurements and the subjective severity of nasal obstruction were analyzed with a visual analog scale (VAS). Results: Anterior and posterior anatomic characteristics were associated with the subjective severity of nasal obstruction. Anterior anatomic factors were related to the VAS scores of patients with anterior septal deviation, and posterior anatomic factors were related to the VAS scores of patients with posterior septal deviation. Conclusions: This study indicated that the anterior and posterior parts of the nasal cavity are both related to nasal obstruction. In some patients, the posterior part of the nasal cavity was more important than other locations in causing nasal obstruction.     

阿奇霉素对慢性鼻-鼻窦炎患者术腔黏膜中NF-kBp65IL-8表达的影响

目的 观察阿奇霉素对慢性鼻-鼻窦炎患者术腔黏膜中NF-kBp65、IL-8表达的影响,探讨阿奇霉素治疗术腔慢性炎症的机制。方法 将45例慢性鼻-鼻窦炎术后2周的患者随机分成阿奇霉素组、头孢菌素组和对照组进行随访治疗,所有患者均应用布地奈德喷鼻、生理盐水冲洗术腔,阿奇霉素组加用阿奇霉素500mg口服,每日1次;头孢菌素组加用头孢菌素500mg口服,每日1次;对照组继续同前治疗,连续3周后,取术腔病变黏膜作为实验标本,应用免疫组织化学PV-6000二步法检测各组治疗前后及三组间术腔黏膜上皮细胞、炎性细胞中NF-kBp65和IL-8表达的情况,计数阳性细胞数。结果 慢性鼻-鼻窦炎患者术腔黏膜呈慢性炎症表现,NF-kBp65主要表达在术腔黏膜的黏膜上皮细胞、炎性细胞的胞浆和部分胞核。IL-8主要表达在黏膜的上皮细胞、炎性细胞的胞浆。三组治疗后NF-kBp65和IL-8在上皮细胞和炎性细胞中的表达均较治疗前减少(P<0.05);阿奇霉素组治疗后术腔黏膜上皮细胞和炎性细胞中NF-kBp65、IL-8的表达均较头孢菌素组、对照组明显减少(P<0.05);头孢菌素组与对照组治疗后上皮细胞和炎性细胞中NF-kBp65、IL-8的表达无明显差别(P>0.05)。结论 阿奇霉素联合应用布地奈德抑制慢性鼻-鼻窦炎患者术腔黏膜上皮细胞、炎性细胞中NF-kBp65、IL-8的表达,较单独应用布地奈德明显,可能是阿奇霉素治疗慢性炎症的机制之一,对慢性鼻-鼻窦炎患者术腔黏膜慢性炎症的转归具有促进作用。     

健康成年人咽部吞咽功能客观参数的测量

目的 通过吞咽动力学研究了解并初步建立成年国人咽部吞咽功能相关参数的客观数值.方法 对年龄20～60岁的男女各40例健康成人志愿者进行X线动态吞咽造影检查并录像,然后通过图像分析测量软件Avidemux 2.5及Image J计算测量在吞咽过程中与咽部吞咽功能密切相关的客观参数,如舌骨的最大移动距离、钡剂通过咽腔的时间、咽腔的收缩率及食管入口的最大开放程度.结果 在80例志愿者中,舌骨的最大移动平均距离(x±s,下同)为(1.91 ±0.48) cm,钡剂通过咽腔的时间为(0.82±0.15)s,咽腔的缩窄率为94.9％±3.41％,食管入口的最大开放程度为(0.91 ±0.05)cm.进一步分组分析发现,男性舌骨的最大移动距离(2.04±0.46)cm,明显大于女性(1.78 ±0.47)cm,差异具有统计学意义(t=2.44,P=0.017),但男女之间及男女不同年龄组之间钡剂通过咽腔的时间、咽腔收缩率及食管入口的最大开放程度差异均无统计学意义(P值均＞0.05).结论 本研究初步建立了成年国人咽部吞咽功能相关参数的客观数值,为更进一步地客观评估咽部吞咽障碍提供了研究基础.     

颈内动脉颈段迂曲和扭结的临床资料分析

目的 阐述颈内动脉颈段走行异常的临床表现特点及影像学研究方法.方法 回顾性分析2004年5月至2011年4月7例颈内动脉颈段走行异常患者的临床资料,其中2例为术中直接探查颈段颈内动脉,3例采用影像后处理工作站对颈动脉CT血管造影(CT angiography,CTA)原始水平位图像行最大密度投影,2例行MRA检查.结果 颈内动脉颈段走行异常中5例患者无相关临床症状,1例表现为咽部异物感,另外1例表现为咽痛.查体4例患者可见鼻咽、口咽或喉咽咽壁的搏动性肿物,表面光滑.观察颈内动脉共12条,均有颈内动脉颈段走行异常,其中血管迂曲5条,发生扭结7条.有影像学资料的5例患者中双侧颈内动脉颈段均受累,其中2例双侧均为迂曲,2例双侧均为扭结,1例两侧分别为迂曲和扭结同时发生.结论 颈内动脉颈段走行异常的临床症状不典型,查体或可发现咽部隆起,或出现异常搏动.CTA和MRA可直观显示颈内动脉颈段走行异常,以避免术中损伤.     

细胞ELISA检测血清抗内皮细胞抗体

用培养的人脐带静脉内皮细胞作为抗原，经ＥＬＩＳＡ检测了ＳＬＥ患者血清抗内皮细胞抗体，目的在于建立ＥＬＩＳＡ检测抗内皮细胞抗体的方法，并与细胞毒试验比了比较，结果表明，ＥＬＩＳＡ及细胞毒试验检测抗内皮细胞抗体，阳性率分别为７３％和５１％，差异显著显著；阳性血清用红细胞及淋巴细胞吸收后，抗内皮细胞抗体活性无明显降低，提示该法特异、灵敏、且重复性较好，可进行大批量标本筛选，为研究抗内皮细胞抗体特征及其致