河南“4.26”60Co源辐射事故一例受照者患非霍奇金淋巴瘤的病因探讨

关于电离辐射是否可诱发非霍奇金淋巴瘤（NHL）,目前的研究结果尚未获得一致结论。笔者报道了河南“4.26” 60Co源辐射事故中1例中度骨髓型急性放射病患者受照后第13年患NHL的病例,结合患者的受照史、病史特点、诊断及国际多项大型研究,从流行病学资料和影响因素两方面分析了患者“天”患非霍奇金淋巴瘤与电离辐射的关系,为电离辐射致NHL提供辐射流行病学依据。     

弯角穿刺针椎体成形术治疗骨质疏松性胸腰椎骨折的疗效及预后研究

目的 探讨弯角穿刺针椎体成形术(PVP)治疗骨质疏松性胸腰椎骨折疗效及预后.方法 前瞻性研究2017年1月—2019年6月北京大学民航临床医学院骨科收治骨质疏松性胸腰椎骨折患者100例,按照随机数字表法分为普通穿刺PVP组和弯角穿刺针PVP组,各50例.普通穿刺PVP组行常规双侧穿刺PVP治疗,男性12例,女性38例;年龄65～82岁,平均68.8岁;扭伤30例,摔伤20例.弯角穿刺针PVP组行弯角穿刺针PVP治疗,男性10例,女性40例;年龄64～83岁,平均69.7岁;扭伤27例,摔伤23例.采用视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评价疼痛程度和胸腰椎功能状况,比较两组患者手术情况(手术时间、术中出血量、骨水泥注入量、骨水泥渗漏率)、手术前和手术后VAS、ODI、伤椎相对高度和伤椎Cobb角.随访12个月,观察预后情况.结果 与普通穿刺PVP组比较,弯角针穿刺PVP组患者手术时间缩短[(41.08±5.36)min vs.(50.14±6.27)min],术中出血量减少[(5.25±0.93)mL vs.(6.58±1.22)mL],骨水泥注入量减少[(3.94±0.95)mL vs.(4.70±0.81)mL],骨水泥渗漏率降低(4.0％vs.16.0％),两组患者比较差异均有统计学意义(P<0.05).与术前相比,两组患者术后1周及术后3个月VAS降低[普通穿刺PVP组(7.42±0.63)分、(2.54±0.56)分、(2.18±0.45)分;弯角针穿刺PVP组(7.61±0.70)分、(2.47±0.49)分、(2.05±0.46)分],ODI降低[普通穿刺PVP组(40.55±4.81)％、(19.68±3.85)％、(18.70±3.23)％;弯角针穿刺PVP组(40.17±4.64)％、(19.13±3.62)％、(17.86±3.19)％],伤椎相对高度增加[普通穿刺PVP组(40.94±9.52)％、(45.63±8.38)％、(47.50±8.11)％,弯角穿刺针PVP组(39.85±9.16)％、(46.27±8.59)％、(48.24±8.05)％],伤椎Cobb角减小[普通穿刺PVP组(18.26±1.12)°、(5.14±0.69)°、(3.45±0.54)°;弯角穿刺针PVP组(17.95±1.06)°、(4.93±0.66)°、(3.27±0.50)°],差异均有统计学意义(P<0.05).术后1周及术后3个月时,两组患者VAS、ODI、伤椎相对高度和伤椎Cobb角组间比较差异无统计学意义(P>0.05).随访12个月,两组患者均未出现椎体高度丢失、继发性后凹畸形、神经损伤等并发症,预后良好.结论 骨质疏松性胸腰椎骨折患者,应用弯角穿刺针PVP治疗在取得明显改善疼痛症状、恢复胸腰椎相对高度及恢复胸腰椎功能的疗效和良好预后的同时,能够缩短手术时间,减少术中出血量,减少骨水泥注入量,降低骨水泥渗漏率.     

Deficiency of Fibroblast Growth Factor-Inducible 14 (Fn14) Preserves the Filtration Barrier and Ameliorates Lupus Nephritis

TNF ligand superfamily member 12, also known as TNF-related weak inducer of apoptosis (TWEAK), acts through its receptor, fibroblast growth factor-inducible 14 (Fn14), to mediate several key pathologic processes involved in tissue injury relating to lupus nephritis. To explore the potential for renal protection in lupus nephritis by targeting this pathway, we introduced the Fn14 null allele into the MRL-lpr/lpr lupus mouse strain. At 26–38 weeks of age, female Fn14-knockout MRL-lpr/lpr mice had significantly lower levels of proteinuria compared with female wild-type MRL-lpr/lpr mice. Furthermore, Fn14-knockout mice had significantly improved renal histopathology accompanied by attenuated glomerular and tubulointerstitial inflammation. There was a significant reduction in glomerular Ig deposition in Fn14-knockout mice, despite no detectable differences in either serum levels of antibodies or splenic immune cell subsets. Notably, we found that the Fn14-knockout mice displayed substantial preservation of podocytes in glomeruli and that TWEAK signaling directly damaged barrier function and increased filtration through podocyte and glomerular endothelial cell monolayers. Our results show that deficiency of the Fn14 receptor significantly improves renal disease in a spontaneous lupus nephritis model through prevention of the direct injurious effects of TWEAK on the filtration barrier and/or modulation of cytokine production by resident kidney cells. Thus, blocking the TWEAK/Fn14 axis may be a novel therapeutic intervention in immune-mediated proliferative GN.     

血液回收自体输血用于肿瘤大手术的研究进展

术中血液回收自体输血现已成为"血液保护"的重要措施之一,但其在肿瘤手术中的应用一直存在争议。主要担忧在于引起肿瘤细胞的播散。我们从肿瘤细胞清除能力及肿瘤复发和转移的临床研究等方面,对血液回收自体输血在肿瘤大手术中应用的安全性进行了探讨,并对其适用范围提出建议。总之,目前研究提示,血液回收自体输血可以安全用于某些肿瘤手术,其合理的术前评估系统有待进一步建立。     

Suppression of human hepatocellular cancer cell proliferation by Brucea javanica oil-loaded liposomes via induction of apoptosis

Introduction

Hepatocellular carcinoma (HCC) is a type of malignancy with high incidence and poor prognosis. Brucea javanica is extracted from Simaroubaceae plants. It is found to have low toxicity but high anti-cancer efficiency. The aim of this study is to determine the effects of Brucea javanica oil-loaded liposomes (BJOL) on human hepatocellular cancer cell line HepG2. The related molecular mechanisms were determined.

Material and methods

Morphologic changes of HepG2 cells were observed by transmission electron microscope after treatment with BJOL in vitro. Cell proliferation was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay after cell treatment with different doses of BJOL. Flow cytometry was performed. Nude mice were divided into 4 groups randomly and treated with different doses of BJOL. The apoptosis hepatocellular carcinoma was detected by TUNEL.

Results

Proliferation of HepG2 was inhibited significantly by BJOL in a dose-dependent manner (2.5 mg/l or 5 mg/l). Compared with the animal models treated with the negative control, the animal models in the BJOL group had higher weight and lower metastasis rates (p < 0.01). The rate of apoptosis in hepatocellular carcinoma tissue of the BJOL groups was increased when compared with the control group (p < 0.05).

Conclusions

Brucea javanica oil-loaded liposomes inhibits proliferation of HepG2. The effect appears to be dose-dependent, possibly by inducing apoptosis of cancer cells.     

胃肠超声造影对胃底静脉曲张的诊断价值

食管胃静脉曲张是肝硬化门静脉高压的常见并发症。近年来,超声造影在胃肠疾病诊断中的应用日益受到关注。目的：探讨胃肠超声造影对胃底静脉曲张的诊断价值。方法：收集2009年3月-2011年9月于河北省玉田县医院接受胃镜和口服胃肠超声造影检查的肝硬化门静脉高压患者79例,回顾性分析胃肠超声造影的声像图特征,并以胃镜检查结果为“金标准”,评价其对胃底静脉曲张的诊断价值。结果：79例肝硬化门静脉高压患者中41例经胃镜检查证实胃底静脉曲张,其中33例胃肠超声造影显示特征性声像图表现,曲张静脉内径（12．6±8．9）mm,血液流速（13．9±2．7）cm／s。胃肠超声造影诊断胃底静脉曲张的敏感性、特异性、准确率分别为80．5％（33／41）、100％（38／38）、89．9％（71／79）。结论：胃肠超声造影在胃底静脉曲张的诊断中具有较高应用价值,有望成为肝硬化门静脉高压患者胃底静脉曲张的初步筛查手段推广使用。     

Hepatectomy in Elderly Patients: Does Age Matter?

Background

With the increase in average life expectancy in recent decades, the proportion of elderly patients requiring liver surgery is rising. The aim of the meta-analysis reported here was to evaluate the safety and efficacy of hepatectomy in elderly patients.

Methods

An extensive electronic search was performed for relevant articles that compare the outcomes of hepatectomy in patients ≥70 years of age with those in younger patients prior to October 2012. Analysis of pooled data was performed with RevMan 5.0.

Results

Twenty-eight observational studies involving 15,480 patients were included in the analysis. Compared with the younger patients, elderly patients experienced more complications (31.8 vs 28.7 %; P = 0.002), mainly as a result of increased cardiac complications (7.5 vs 1.9 %; P < 0.001) and delirium (11.7 vs 4.5 %; P < 0.001). Postoperative major surgical complications (12.6 vs 11.3 %; P = 0.55) and mortality (3.6 vs 3.3 %; P = 0.68) were comparable between elderly and younger patients. For patients with malignancies, both the 5-year disease-free survival (26.5 vs 26.3 %; P = 0.60) and overall survival (39.5 vs 40.7 %; P = 0.29) did not differ significantly between the two groups.

Conclusions

Postoperative major surgical complications, mortality, and long-term results in elderly patients seem to be comparable with those in younger patients, suggesting that age alone should not be considered a contraindication for hepatectomy.