肺部原发骨肉瘤的临床特点和诊治现状

肺原发骨肉瘤是一种极其罕见的恶性肿瘤,预后差.大多数患者在发病后1年内死亡.手术是该病的主要治疗手段,多学科综合治疗可能改善预后.肿瘤大小是影响预后的最主要因素.     

Assembly and molecular order of two-dimensional peptoid nanosheets through the oil–water interface

Peptoid nanosheets are a recently discovered class of 2D nanomaterial that form from the self-assembly of a sequence-specific peptoid polymer at an air–water interface. Nanosheet formation occurs first through the assembly of a peptoid monolayer and subsequent compression into a bilayer structure. These bilayer materials span hundreds of micrometers in lateral dimensions and have the potential to be used in a variety of applications, such as in molecular sensors, artificial membranes, and as catalysts. This paper reports that the oil–water interface provides another opportunity for growth of these unique and highly ordered peptoid sheets. The monolayers formed at this interface are found through surface spectroscopic measurements to be highly ordered and electrostatic interactions between the charged moieties, namely carboxylate and ammonium residues, of the peptoid are essential in the ability of these peptoids to form ordered nanosheets at the oil–water interface. Expanding the mechanism of peptoid nanosheet formation to the oil–water interface and understanding the crucial role of electrostatic interactions between peptoid residues in nanosheet formation is essential for increasing the complexity and functionality of these nanomaterials.Recent advances in the design, synthesis, and characterization of 2D nanomaterials with atomic precision have given rise to ultrathin materials with unprecedented functionality (1). Specifically, organic 2D nanomaterials hold promise as biocompatible materials that can be chemically tailored and built from the bottom up, through the self-assembly of small molecule, protein, or polymer building blocks (2–5). Polymer-based 2D nanomaterials, in particular, hold promise as templates for bottom-up assembly of circuits, semiconductors, and organic–inorganic composite materials (6–8) as well as high surface area membranes for filtration, catalysis, and sensing (9, 10). Material properties, such as precisely defined porosity, metal or protein recognition sites, and other reactive groups (5, 11, 12), can be patterned directly into the polymer sequence. Peptoids are a highly designable class of polymer, recently designed to assemble into 2D peptoid nanosheets (13–15). Synthesized from a chemically diverse set of cheap, commercially available building blocks (16), peptoids have an exact monomer sequence that can direct chain folding into higher order nanostructures. Peptoid nanosheets span hundreds of micrometers in lateral dimensions, are only 3 nm thick, and are freely floating in water. The outer surfaces of the nanosheet can be readily functionalized with a controlled spatial density of binding sites (5), and the nanosheets are stable across a wide range of temperatures and pH values (14), making peptoid nanosheets a rugged, highly designable platform for bottom-up assembly of 2D nanomaterials and composite materials.Peptoid nanosheets have previously been made through a unique assembly mechanism involving the organization of molecular units at the air–water (air–H₂O) interface (15, 17). Here we report that peptoid nanosheets can also form at an oil–water interface. A key intermediate in the nanosheet assembly pathway is the formation of a peptoid monolayer. Adsorption at a 2D fluid interface preorganizes the linear peptoid chains into the orientation needed for bilayer formation, with aromatic groups preferentially displayed on the nonpolar side of the monolayer and polar groups on the aqueous side (Fig. 1). Upon compression, the monolayer buckles into a bilayer, where the nonpolar side of the monolayer becomes the interior, structural core of the nanosheet. Aromatic–aromatic interactions on the nonpolar side of the monolayer likely contribute to the nanosheet’s ordered atomic structure and stability. Importantly, the spacing between peptoid chains in the monolayer mirrors the spacing observed in the resultant nanosheet. Thus, the lateral assembly of the chains in the peptoid monolayer is crucial for dictating the structure and stability of the resultant peptoid nanosheets. Substituting oil in place of air, as the nonpolar phase, opens up opportunities to engineer the nanosheet structure and production method. For example, the oil phase could contain chemical reagents, serve to minimize evaporation of the aqueous phase, or enable microfluidic production of nanosheets.Fig. 1.Schematic illustration of the assembly pathway for peptoid nanosheet formation at the oil–water interface.Engineering peptoid nanosheet structure requires precise control of the monolayer intermediate. Thus, a molecular level understanding of the monolayer is required. For example, the chemical cross-linking of neighboring chains, as a means of improving nanosheet stability, requires knowledge of the chain conformation. Ultimately, a true understanding of the relationship between monomer sequence and nanosheet structure requires atomic-level structural data. To date, most of the structural data on nanosheets are from scattering and microscopy measurements (13–15), which provide excellent information on the nanoscale ordering, but little on chain conformation. The study of chain conformation and supramolecular interaction between neighboring chains in the monolayer intermediate requires surface-sensitive spectroscopic techniques. To this end, we use total internal reflection (TIR) vibrational sum frequency (VSF) spectroscopy (18) and interfacial tension measurements to study peptoid assembly at the carbon tetrachloride–aqueous (CCl₄–H₂O) interface. VSF spectroscopy is a well-established surface-selective technique that produces vibrational spectra of interfacial molecules (19). As with traditional vibrational spectroscopic techniques, peak center frequencies and widths of VSF spectra are sensitive to the chemical environments of the functional groups, and can thus provide details about specific intermolecular forces at play during the assembly of a monolayer. VSF spectroscopy additionally has the capability of probing molecular orientation; signal is only generated when molecules adsorb to the interface with their functional groups aligned in a net orientation relative to the plane of the interface. Based on these merits, VSF spectroscopy is an optimal technique to study the molecular-level structural and conformational details of the key peptoid monolayer intermediate.To elucidate the role of polymer side-chains in the supramolecular assembly, we take advantage of the precision sequence control of peptoid polymers. Exact peptoid sequences can be designed and synthesized using the submonomer solid-phase method (20). The ability to synthesize an exact polymer sequence enables atomic-level control over molecular design parameters, such as polymer chain length, sequence patterning, and side-chain chemistry. Thus, peptoid polymers serve as convenient building blocks for the systematic study of structure–property relationships between molecular design and nanosheet material properties. In this work, we compare the interfacial adsorption and assembly of a previously reported (5, 14) peptoid 1 (Fig. 2A) with its carboxyl analog, peptoid 2 (Fig. 2B), wherein the amine residues of 1 have been replaced with carboxyl groups. Peptoid 1 was found to be more stable than an alternating charge structure (14). In this way, we isolate the contribution of the charged functional groups from the aromatic groups, and show that the charged functional groups play an important role in the sequence design and 2D assembly of 1.Fig. 2.Chemical structures of (A) peptoid 1 and (B) peptoid 2 investigated in this work. Peptoid 1 formed nanosheets whereas 2 did not.     

Glisson蒂横断式解剖性肝切除120例治疗体会

目的探讨Glisson蒂横断式解剖性肝切除术的应用价值。方法回顾性分析临沧市人民医院2014年1月至2017年3月行Glisson蒂横断式解剖性肝段切除术120例患者的临床资料。其中原发性肝癌65例,胆管细胞癌4例,肝门部胆管癌4例,胆囊癌6例,肝内胆管结石33例,肝血管瘤8例,肝寄生虫病10例。采用Glisson蒂横断式解剖性肝切除Ⅰ段切除3例,Ⅰ+Ⅱ段切除1例,Ⅰ+Ⅱ+Ⅲ+Ⅳ段切除1例,Ⅰ+Ⅱ+Ⅲ+Ⅳ+Ⅴ+Ⅷ段切除1例,Ⅱ+Ⅲ+Ⅳ+Ⅷ段切除1例,Ⅱ+Ⅲ+Ⅴ+Ⅵ+Ⅶ+Ⅷ段切除1例,左外叶(Ⅱ+Ⅲ段)切除33例,左半肝(Ⅱ+Ⅲ+Ⅳ段)切除22例,左三叶(Ⅱ+Ⅲ+Ⅳ+Ⅴ+Ⅷ段)切除3例,Ⅳb+Ⅴ段切除6例,Ⅳ+Ⅴ+Ⅷ段切除3例,右半肝切除(Ⅴ+Ⅵ+Ⅶ+Ⅷ段)25例,右三叶切除(Ⅳ+Ⅴ+Ⅵ+Ⅶ+Ⅷ段)3例,右前叶(Ⅴ+Ⅷ段)切除5例,Ⅵ段切除2例,右后叶切除术(Ⅵ+Ⅶ段)4例,Ⅶ段切除2例,Ⅷ段切除4例。其中9例同时行肝管空肠RouxY吻合术。结果全组均完成手术。术中平均出血量630 mL。平均手术时间3.7 h。术后发生并发症34例(28.33%),为胆漏、胸腔积液、多重耐药菌感染等。结论 Glisson蒂横断式解剖性肝切除术操作简便,快速安全,能明显减少出血,提高疗效,是一种可选择的手术方式。     

聚肌胞对小鼠前列腺癌的抑制作用

目的：观察聚肌胞对小鼠前列腺癌的抑制作用。方法：将16只C₅₇BL6/J纯系荷瘤小鼠按瘤重采用区组随机分组方法分为对照组和聚肌胞组,每组8只,每隔2日分别瘤内注射生理盐水和聚肌胞,第7次后切除瘤灶,称瘤重,计算瘤重抑制率,绘制前列腺癌生长曲线及荷瘤鼠生存曲线。前列腺癌组织HE染色观察形态学变化。结果：对照组和聚肌胞组瘤重分别为（4.14±1.56）和（1.58±0.67）g,两组瘤重比较差异具有显著性（P<0.05）;聚肌胞组瘤重抑制率为67.85%;前列腺癌生长曲线显示,聚肌胞组小鼠前列腺癌生长较慢;聚肌胞组荷瘤小鼠的生存时间较对照组长(P<0.05);病理显示对照组较聚肌胞组前列腺癌细胞增殖活跃。结论：聚肌胞可以减慢小鼠前列腺癌的生长,延长荷瘤小鼠生存时间。     

新生儿呼吸机相关性肺炎发病的危险因素Logistic回归分析

目的 研究新生儿呼吸机相关性肺炎发病的相关危险因素.方法 将我院2011年1月至2012年12月间50例新生儿呼吸机相关性肺炎患儿定义为观察组,选取同一时期进行呼吸机治疗未发生呼吸机相关性肺炎的100例新生儿为对照组,采用单因素和多因素Logistic回归分析对两组的临床资料进行比较分析.结果 ①观察组中吸痰次数＞6次/d、机械通气时间＞6d的患儿例数明显多于对照组,差异有统计学意义(P＜0.01).②多因素分析发现,吸痰次数＞6次/d (OR=24.56,95％CI:0.756～4.595),机械通气时间＞6d (OR=6.757,95％CI:1.345 ～ 8.753)是新生儿呼吸机相关性肺炎发病的危险因素.结论 吸痰次数过多和机械通气时间过长是导致新生儿呼吸机相关性肺炎发病的危险因素.     

矿物药青礞石对PTZ点燃癫痫大鼠脑组织、血浆中金属元素的影响

目的 研究青礞石对戊四氮（PTZ）点燃癫痫大鼠脑组织、血浆中金属元素的影响,探讨青礞石可能的效应物质基础。方法 采用PTZ点燃法建立癫痫大鼠模型,运用电感耦合等离子体质谱法（ICP-MS）和电感耦合等离子体发射光谱法（ICP-OES）测定空白组、模型组、卡马西平组（0.1 g·kg^-1）和青礞石组（2 g·kg^-1）大鼠脑组织、血浆中的金属元素含量,实验数据用SPSS 18.0软件进行统计学分析。结果 与空白组比较,模型组大鼠脑组织中Sr,Sb,Ba含量明显上升（P<0.05,P<0.01）;Zn,Fe,Cu,K,Li,Co,Sn,Pb含量明显下降（P<0.05,P<0.01）。与模型组比较,青礞石组大鼠脑组织中Zn,Fe,K,Li,Co,As,Pb含量明显上升（P<0.05,P<0.01）;Sr,Sb含量显著下降（P<0.01）。说明青礞石对大鼠脑组织中金属元素含量向正常水平的调节具有积极作用,干预效果明确,且总体效果优于卡马西平组。与空白组比较,模型组大鼠血浆中K,Sr,Cd含量明显上升（P<0.05）;Li,Al,Ti,Cr含量明显下降（P<0.05）。与模型组比较,青礞石组大鼠血浆中Ca,K,Li,Al,V含量明显上升（P<0.05,P<0.01）;Fe,Ti,Sr,Cd含量明显下降（P<0.05,P<0.01）。各组间金属元素相关性分析显示,大鼠脑组织中有17对元素存在显著正相关性,2对元素存在显著负相关性,大鼠血浆组织中有8对元素存在显著正相关性,6对元素存在显著负相关性。结论 以Zn,Fe,K,Li,Co,As,Pb,Sr,Sb,Ca,Al,V,Ti,Cd为代表的金属元素群可能是青礞石干预PTZ点燃癫痫模型大鼠的效应物质基础,作用机制可能与这些金属元素群干预影响神经递质的释放及神经元的电平衡、调节离子（Na⁺,K⁺,Ca²⁺等）通道失常诱发的异常同步放电及干预癫痫相关代谢通路等有关,使兴奋与抑制活动相互牵制,最终达到神经元、细胞电平衡等趋于正常生理状态。青礞石组的干预作用总体优于卡马西平组。     

恩替卡韦初治ALT小于2ULN的HBeAg阴性慢性乙型肝炎患者的2年疗效观察

目的研究恩替卡韦治疗ALT小于2ULN(正常值上限)的HBe Ag阴性慢性乙型肝炎患者2年的疗效观察。方法前瞻性研究37例HBe Ag阴性慢性乙型肝炎患者,其中17例是ALT小于2ULN(A组),20例是ALT大于2ULN(B组),均接受恩替卡韦治疗,检测基线、24周、48周、96周时2组的HBV DNA和HBs Ag水平,同时比较治疗前及96周的无创纤维化评分(SZFibro S模型)。结果治疗24周时A组、B组的病毒学应答(HBV DNA<100 IU/m L)分别是15/17、18/20,2组48,96周后病毒学应答没有进一步提高,2组比较无显著性差异。A组治疗前和治疗96周时,HBs Ag水平分别是(3.766±0.775)log10IU/m L和(3.207±0.415)log10IU/m L(P=0.041)。B组治疗前和治疗96周时,HBs Ag水平分别是(3.966±0.665)log 10IU/m L和(3.251±0.385)log10IU/m L(P=0.002)。但2组24周、48周、96周时HBs Ag下降的幅度无显著性差异。A组治疗前和治疗96周的SZFibro S评分分别是(5.75±0.42)和(5.70±0.54)(P=0.752)。B组治疗前和治疗96周的SZFibro S评分分别是(5.96±0.65)和(5.51±0.22)(P=0.007)。结论 ALT水平不影响恩替卡韦治疗HBe Ag阴性慢性乙型肝炎患者的病毒学应答及HBs Ag的下降。ALT水平可能与纤维化评分改善相关。     

鸡枞菌粉提取物镇痛抗炎作用的研究

目的:研究鸡枞菌粉提取物的镇痛抗炎作用。方法:采用醋酸扭体实验,甲醛致痛模型,二甲苯致耳肿胀模型及角叉菜胶致足肿胀模型观察鸡枞菌粉及其提取物镇痛抗炎作用。同时对小鼠炎症渗出液中PGE2,SOD,MDA,NO和NOS进行测定。结果:鸡枞菌粉提取物均能降低小鼠醋酸引起的扭体次数,减少甲醛致痛实验中小鼠舔足时间;抑制二甲苯致小鼠耳肿胀及角叉菜胶引起的小鼠足肿胀。对炎症介质也有较好的抑制作用。结论:鸡枞菌粉提取物具有明显镇痛抗炎作用。     

血胱抑素与肾功能损伤程度的相关性研究

目的观察血胱抑素C（cysC）在不同程度急性。肾损伤（AKI）及终末期肾病（ESRD）患者血清中的浓度变化,探讨其对AKI的早期诊断价值及其与肾功能损伤程度的相关性。方法搜集ICUAKI患者,“5．12”汶川地震伤员,ESRD患者及健康对照者的血清、尿液及临床表现等资料;按照RIFLE标准,分为轻度AKI组20例、中重度AKI组30例,另外,地震外伤组48例、ESRD组32例和健康对照组20例;采用微粒子增强免疫比浊法检测血清cysC,比色法检测尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG酶）,酶法检测血肌酐（Scr）;对血cysC与Scr的相关性进行统计学分析,并绘制受试者工作特征曲线（ROC曲线）,评价血cysC在AKI早期诊断中的敏感性和特异性及其与肾功能损伤程度的相关性。结果与健康对照组比较,轻度AKI组、中重度AKI组和ESRD组血cysC均有明显升高（P〈0．05或P〈0．01）,其中ESRD组升高更明显（P〈0．01）;血cysC与Scr呈正相关关系（P〈0．01）;地震外伤组血清cysC较健康对照组升高（P〈0．05）,且血cysC在AKI诊断中的ROC曲线下面积为0．931（P〈0．01）。结论AKI发生时检测血cysC有助于AKI的早期临床诊断;血cysC与肾功能损伤程度呈正相关关系,能准确反应肾功能变化。