卵巢成熟性畸胎瘤伴甲状腺肿类癌1例及文献复习

目的:探讨1例卵巢成熟性畸胎瘤伴甲状腺肿类癌的临床病理特征。方法:对1例诊断为卵巢成熟性畸胎瘤伴甲状腺肿类癌患者的临床资料、组织学形态及免疫组化结果进行分析,并对相关文献进行复习。结果:本例为卵巢成熟性畸胎瘤伴甲状腺肿类癌,病理学检查除成熟性畸胎瘤成分外,另见由甲状腺和类癌组织混合成的结节一枚,类癌细胞较小且大小相仿,染色质均匀,核分裂少见,免疫组化:甲状腺滤泡上皮细胞TG(+)、TTF-1(+),类癌细胞CD99(+)、Cg A(+)、Syn(+)、CK7(-)。结论:卵巢成熟性畸胎瘤伴甲状腺肿类癌为罕见的病变,临床患者多无典型症状,且类癌成分多与甲状腺组织混杂于畸胎瘤中,容易漏诊,故应广泛取材并提高对卵巢成熟性畸胎瘤伴甲状腺肿类癌组织学特征及免疫表型的认识,对累积资料,避免临床误诊、漏诊具有重要的价值。     

基于规则化位移场的弹性减影成像研究

目的：提出一种新的基于规则化位移场的弹性减影成像方法,探讨其在消融损伤成像监控中应用的可行性。方法分别进行有限元仿真和离体实验研究,对压缩量不同情况下的位移场进行规整化和减影处理,处理后的位移场在深度方向进行微分获得弹性减影图像。结果仿真和离体实验数据显示,在消融治疗中,基于规则化位移场的弹性减影成像在压缩量变化的情况下,可获得效果较好的弹性图像,比传统弹性成像更好地反映了损伤区域的情况。结论基于规则化位移场的弹性减影成像方法实现压缩量不同情况下的弹性减影成像,优于传统弹性成像方法,可以用于消融治疗的损伤监控。     

Effects of Moderate Hyperventilation on Jugular Bulb Gases under Propofol or Isoflurane Anesthesia during Supratentorial Craniotomy

Background:

The optimal ventilated status under total intravenous or inhalation anesthesia in neurosurgical patients with a supratentorial tumor has not been ascertained. The purpose of this study was to intraoperatively compare the effects of moderate hyperventilation on the jugular bulb oxygen saturation (SjO₂), cerebral oxygen extraction ratio (O₂ER), mean arterial blood pressure (MAP), and heart rate (HR) in patients with a supratentorial tumor under different anesthetic regimens.

Methods:

Twenty adult patients suffered from supratentorial tumors were randomly assigned to receive a propofol infusion followed by isoflurane anesthesia after a 30-min stabilization period or isoflurane followed by propofol. The patients were randomized to one of the following two treatment sequences: hyperventilation followed by normoventilation or normoventilation followed by hyperventilation during isoflurane or propofol anesthesia, respectively. The ventilation and end-tidal CO₂ tension were maintained at a constant level for 20 min. Radial arterial and jugular bulb catheters were inserted for the blood gas sampling. At the end of each study period, we measured the change in the arterial and jugular bulb blood gases.

Results:

The mean value of the jugular bulb oxygen saturation (SjO₂) significantly decreased, and the oxygen extraction ratio (O₂ER) significantly increased under isoflurane or propofol anesthesia during hyperventilation compared with those during normoventilation (SjO₂: t = −2.728, P = 0.011 or t = −3.504, P = 0.001; O₂ER: t = 2.484, P = 0.020 or t = 2.892, P = 0.009). The SjO₂ significantly decreased, and the O₂ER significantly increased under propofol anesthesia compared with those values under isoflurane anesthesia during moderate hyperventilation (SjO₂: t = −2.769, P = 0.012; O₂ER: t = 2.719, P = 0.013). In the study, no significant changes in the SjO₂ and the O₂ER were observed under propofol compared with those values under isoflurane during normoventilation.

Conclusions:

Our results suggest that the optimal ventilated status under propofol or isoflurane anesthesia in neurosurgical patients varies. Hyperventilation under propofol anesthesia should be cautiously performed in neurosurgery to maintain an improved balance between the cerebral oxygen supply and demand.     

二十二碳六烯酸改善棕榈酸诱导的C2C12细胞胰岛素抵抗作用

目的 观察二十二碳六烯酸(DHA)对棕榈酸诱导的C2C12细胞胰岛素抵抗的影响.方法 将C2C12细胞诱导分化成熟,加棕榈酸及DHA处理,通过实时聚合酶链反应(real-Time qPCR)及免疫印迹检测C2C12细胞葡萄糖转运体4(GLUT4)、胰岛素受体-β(IR-β)、胰岛素受体底物-1(IRS-1)、单核细胞趋化蛋白-1(MCP-1)、白细胞介素-6(IL-6)、诱导型一氧化氮合酶(iNOS)表达;谷胱甘肽检测试剂盒检测超氧化物岐化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)活性,荧光分光光度计检测活性氧(ROS);[3H]-2-脱氧-D-葡萄糖检测C2C12细胞葡萄糖摄取量.结果 棕榈酸组与对照组比较,磷酸化胰岛素受体底物-1(P-IRS-1)的表达上调[(2.9±0.3)比(1.1±0.1),P＜0.05];磷酸化胰岛素受体-β(p-IRβ)表达下调[(0.87 ±0.09)比(1.58±0.21),P＜0.05];GLUT4表达下调[(1.1±0.3)比(3.3±0.4),P＜0.05];炎症分子MCP-1、IL-6、iNOS表达明显上升:[MCP-1:(27.2±0.6)比(1.0±0.1),P＜0.001;IL-6:(94.9 ±6.5)比(0.8±0.0),P＜0.001;iNOS:(288.0±15.6)比(1.8±0.6),P＜0.001].C2C12细胞氧化应激标志物ROS升高2.1倍(P＜0.05),SOD、GSH-Px活性分别下降63％及49％(P＜0.05);DHA组与棕榈酸组比较,p-IRS-1的表达下调[(1.3±0.2)比(2.9±0.3),P＜0.05],p-IRβ表达上调[(1.3±0.2)比(0.9±0.1),P＜0.05],GLUT4表达明显升高[(2.8±0.4)比(1.1±0.3),P ＜0.05];炎症分子MCP-1、IL-6、iNOS表达均明显下调[MCP-1:(18.5±0.3)比(27.2 ±0.6),P＜0.001;IL-6:(1.7±0.4)比(94.9±6.5),P＜0.001;iNOS:(5.0±0.9)比(288.0 ±15.6),P＜0.001],氧化应激标志物ROS下降55％(P＜0.05),SOD、GSH-Px活性升高72％及64％ (P ＜0.05).结论 DHA通过激活C2C12细胞的胰岛素信号通路,减少细胞的炎症反应及氧化应激而改善胰岛素抵抗.     

Proteomic analysis of exosomes derived from human lymphoma cells

Background

Exosomes secreted by tumor cells contain specific antigens that may have immunotherapeutic purposes. The aim of this study was to characterize the proteomic content of lymphoma cell-derived exosomes (LCEXs).

Methods

In this study, exosomes derived from Raji cells (EXO_Raji) were purified and proteins of EXO_Raji were separated by one-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis. Protein bands were identified by mass spectrometry. The protein components of EXO_Raji were analyzed using shotgun technology, and the function proteins of EXO_Raji were defined and described using the Gene Ontology (GO) database and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis.

Results

A total of 197 proteins were identified in EXO_Raji; 139 proteins were also identified in Raji cells, showing an overlap of 70.56% of the total proteins in EXO_Raji. Interestingly, the remaining 58 proteins were unique to EXO_Raji. The GO database and KEGG were used to define and describe the function of proteins. The data showed that some important proteins involved in antigen procession and presentation as well as cell migration and adhesion were also identified in EXO_Raji, such as MHC-I and II, HSC70, HSP90, and ICMA-1.

Conclusions

LCEXs express a discrete set of proteins involved in antigen presentation and cell migration and adhesion, suggesting that LCEXs play an important role in the regulation of immunity and interaction between lymphoma cells and their microenvironment. LCEXs harbor most of the proteins of lymphoma cells and could be one of the sources of lymphoma-associated antigens for immunotherapeutic purposes.     

宋校本《千金要方》增补文献初考

本文通过《千金要方》宋校本与《新雕孙真人千金方》的对校研究,发现宋人整理《千金要方》时增补了大量新文献,其中有些与宋校《重广补注〈黄帝内经素问〉》、《金匮要略方论》、《脉经》、《针灸甲乙经》等书中的相关内容相合,推断宋人校订这5本医书的时间虽异,但其内容是相互关联的,推测是宋人搜集了大量相关文献资料,用以修订、补充其所校之医书,此为考察宋人整理中医古籍的原则与方法提供一定的参考.     

超声吸引刀联合双极电凝与射频凝血器肝切除术的临床比较

目的探讨超声吸引刀(cut-ultrasound aspiration,CUSA)联合双极电凝与射频凝血器(radiofrequency coagulation device,RFA)行肝切除术的临床应用效果。方法回顾性分析我院2012年1月至2013年12月期间肝胆外科治疗的108例肝切除术患者的临床资料,根据术中采用断肝方式不同分为两组:射频凝血器组(RFA组)55例和超声吸引刀联合双极电凝组(CUSA组)53例。比较两组肝门阻断率、手术时间、术中出血量、输血率、术后肝功能、术后并发症发生率、术后住院时间的差异,进行分析评价。结果两组患者围术期均无死亡病例;射频凝血器切肝肝断面形成1.5~2 cm的消融凝固带,而超声吸引刀联合双极电凝切肝肝断面损伤厚约0.5 cm肝组织。与CUSA组比较,射频凝血器组肝门阻断率低、手术时间短、术中出血少、输血率低(P<0.05)。两组术后肝功能、并发症发生率、术后住院时间差异无统计学意义(P>0.05)。结论应用射频凝血器与超声吸引刀联合双极电凝行肝脏切除都是安全有效的,可根据各自优缺点选择应用。     

带线锚钉及锁骨钩钢板固定治疗胸锁关节脱位的疗效比较

目的比较利用带线锚钉及锁骨钩钢板两种不同内固定方式手术治疗胸锁关节脱位的疗效。方法回顾性分析2005年1月~2013年1月在我科住院治疗胸锁关节脱位患者30例的手术资料,分别采用切开复位带线锚钉固定(A组)及锁骨钩钢板内固定(B组)治疗。比较两组的手术时间、切口长度、术中出血量、临床愈合时间、术后并发症、术后功能恢复程度等方面指标和疗效。结果 30例患者切口均愈合良好,影像学检查提示所有患者复位满意及内固定位置良好。所有患者获得完整的随访,随访时间6~18个月,平均14个月。依据Rockwood评分法进行术后胸锁关节功能评定,所有患者外观及功能均获得良好的恢复。未出现再脱位及其它副损伤,术后均恢复正常的解剖形态。结论对胸锁关节脱位采用锚钉固定能达到锁骨钩钢板固定效果,而且锚钉固定系统具有切口小、手术时间短、固定可靠、避免再次手术取出内固定等特点。     

Juniper哮喘生命质量问卷在中国哮喘患者中的初步应用

目的通过分析我国哮喘患者Juniper哮喘生命质量问卷(AQLQ)资料,总结Juniper AQLQ应用于我国哮喘患者的初步经验。方法慢性哮喘患者96例,66例用AQLQ中文自我测试版本的普通版,30例用AQLQ标准版,共210例次生命质量评估数据,分析受哮喘限制的活动选择频度、AQLQ总分及4个能区(症状、活动受限、情感功能及环境刺激)与第1秒钟用力呼气容积(FEV1)占预计值的百分比的相关性,不同程度肺功能的患者间AQLQ总分及4个能区是否有差别?观察前后生命质量发生变化时FEV1占预计值的百分比及呼气峰流速(PEF)是否发生了相应的变化?结果AQLQ总分及4个能区除环境刺激外均与FEV1占预计值的百分比呈弱相关(相关系数：0．201～0．284)。不同程度的FEV1占预计值的百分比的AQLQ总分及各能区评分可以很好地反映肺功能的差异。观察前后比较,AQLQ的变化与相应的FEV1占预计值的百分比的变化之间无相关性。AQLQ症状的变化与晨间或晚间PEF的变化相关(相关系数0．301～0．353);情感功能变化与晚间PEF的变化相关;而AQLQ总分与PEF的变化无相关性。结论Juniper AQLQ评分与肺功能相关,在反映病情变化方面可能比肺功能更敏感和更全面。Juniper AQLQ同样也适用于我国的哮喘患者。