Anterior mediastinal immature teratoma with precocious puberty in a child with Klinefelter syndrome.

ABSTRACT: Klinefelter syndrome occurs in approximately 1 in 1000 males. A 4-year-old boy presented with precocious puberty and an anterior mediastinal mass. Serum alpha-fetoprotein and human chorionic gonadotropin levels were mildly increased. Computed tomography revealed a germ cell tumor (GCT) of the mediastinum. Complete resection of the tumor was performed. Histologic analysis revealed an immature teratoma. Males with Klinefelter syndrome develop GCTs at a rate 50 times higher than unaffected males. This case report calls attention to the need to rule out Klinefelter syndrome in boys who present with precocious puberty and a mediastinal GCT.     

一种较好的RNA分离制备方法及其在人胚RNA提取中的应用

以钒基核苷酸复合物为核酸酶抑制剂,从人胚组织中制备总RNA,所得产品几乎不含DNA和蛋白质,经过分离Poly(A)~ mRNA,证明制品有合成cDNA的完整功能,方法比较简捷,适于大量制备以满足分离mRNA 之需,并讨论了此法的优缺点。     

胰岛素强化治疗在2型糖尿病骨折患者围手术期的应用

Objective To investigate the best way to control the blood sugar level during the perioperation of bone fracture patients with type 2 diabetes(T2DM).Methods Bone fracture patients with T2DM were randomly divided into three groups:continuous subcutaneous insulin infusion group(insulin aspart,group CSII,n=20),glargine treatment group(insulin aspart+insulin glargine,group GA,n=20),and NPH treatment(insulin aspart+rh-insulin,group NA,n=20).The levels of fasting plasma glucose(FPG)and the 2 hours postprandial glucose(2h PG),blood glucose fluctuation(BGF),insulin dosage(ID),good effective time(GET),incidence of hypoglycemia,dawn phenomenon and infection,average time of stitches removal(ATSR),average hospitalized length(AHL)of three groups were compared.Results FPG and 2hPG,ID in group CSII[(6.32±1.18)mmol/L,(7.72±1.53)mmol/L,(35.40±1.60)IU]and group GA [(6.25±0.88)mmol/L,(7.32±1.17)mmol/L,(36.20±0.80)IU]were significantly lower than those of group NA [(7.44±1.36)mmol/L,(8.52±0.76)mmol/L,(40.50±2.40)IU,all P<0.05],simulaneously,BGF,GET incidence of complications,ATSR,AHL of group CSII and GA were significantly lower than those of group NA(all P<0.05).There were not significant difference between group CSII and group GA.Compared with group CSII,group GA had less costs in-hospital and better practicability.Conclusion Both CSII and insulin glargine combined with insulin aspart can effectively,safely,rapidly and stablely control hyperglycemia.and might be the first choice to control blood sugar for bone fracture patients with T2DM in perioperation.     

腹腔镜肝右后叶囊肿开窗引流术35例报告

目的：探讨肝右后叶肝囊肿的腹腔镜处理方法。方法：1998年1月～2005年12月对35例有症状的肝右后叶囊肿（21例主要位于Ⅵ段，14例主要位于第Ⅶ段）采用四孔法行囊肿开窗引流术。囊肿位于肝右后叶上段者采用肝上入路，胆囊牵引钳或三叶钳推压肝脏使其向前向下，暴露肝后囊肿，囊肿开窗，修剪带蒂大网膜放入囊肿。囊肿位于肝右后叶下段者采用肝下入路，超声刀切开肝结肠韧带，右三角韧带及肝肾间疏松组织，胆囊牵引钳抬起肝脏，囊肿开窗，大网膜放入囊腔引流。结果：35例肝右后叶肝囊肿均在腹腔镜下完成肝囊肿开窗引流术，无中转开腹手术。15例采用肝上入路，20例采用肝下入路。手术时间30～95min，平均46min。无手术并发症。35例病理检查结果均为先天性肝囊肿。术后症状均消失。术后住院2～5d，平均3．8d。35例随访6～36个月，平均34个月，33例无复发，2例（为肝上入路病例）囊肿未完全消失，但较术前明显缩小，无明显症状，观察半年未见增大。结论：肝下及肝上入路囊肿开窗引流是腹腔镜下处理肝右叶肝囊肿的有效方法。     

Late atrioventricular block after heart transplantation.

Bradyarrhythmia requiring permanent pacing after heart transplantation remains a common problem. Sinus node dysfunction is the most common indication, and late onset of atrioventricular (AV) block has rarely been reported. We report the case of a patient who developed advanced AV block at 41 months after transplantation. Right bundle branch block with progressive increase of QRS complex duration was noted in serial electrocardiograms. At the time of late AV block development, the patient did not have acute rejection and coronary angiogram was normal. The mechanism of late onset of AV block is unclear, but it may be caused by progressive conduction.     

肱骨近端骨密度的测量及其与年龄和体质量指数的相关性研究

目的 建立一种肱骨近端骨密度(BMD)的测量方法,研究肱骨近端BMD与年龄和体质量指数(BMI)的关系,探讨肱骨近端BMD在预报骨质疏松症的敏感性.方法 选择绝经后健康女性志愿者,使用Hologie DELPHI-A双能X射线骨密度仪及本研究设计的肩部定位器和前臂定位器测虽肱骨近端BMD.研究第一部分包括30名忐愿者,每人连续测量右侧肱骨近端BMD 2次,根据测量结果计算短期精密度RMS SD和RMS CV;第二部分包括92名志愿者,记录其年龄、身高、体重,测量右侧肱骨近端BMD,分析肱骨近端BMD与年龄和BMl的相关性.结果 本研究肱骨近端BMD测量方法的短期精密度:RMS SD=0.011 g/cm2,RMS CV=2.4%.本研究92名志愿者平均(60.2±6.4)岁,平均身高(159.5±5.4)cm,平均体质晕(59.4±7.5)kg,平均BMI 23.3±2.7,平均肱骨近端BMD(0.543±0.083)g/cm2,肱骨近端BMD 同年龄呈负相关,同BMI无显著相关.结论 本研究建立了一种测苗肱骨近端BMD的方法;年龄越人肱骨近端BMD越低;由于BMI对BMD的影响会掩盖骨质的丢失,而非负重区域即肱骨近端会最大程度地减少BMI对BMD的影响程度.     

2003年胶州市苯作业场所空气中苯的危害监测

近几年来随着青岛地区经济的发展,大量鞋革箱包及玩具制造,家具制造企业涌现于胶州.在这些企业里,普遍使用含有苯的强挥发性胶水粘合剂.苯系化合物已被WHO确定为强致癌性物质，由于苯系物属芳香烃类，无色透明易挥发，使人一时不易警觉其毒性。人在短时间内吸入高浓度的苯，会出现中枢神经麻醉的症状，轻者头晕、胸闷、恶心、乏力、呕吐。     

胰岛素瘤的超声诊断:与其他诊断方法比较

目的:探讨超声等方法对胰岛素瘤的定位诊断价值。材料和方法:对42例经过手术和病理证实的胰岛素瘤患者术前定位诊断的各种方法进行回顾性分析,并与其他诊断方法对比分析其各自的定位符合率。结果:定位诊断符合率分别为B超31%(13/42)、EUS55.6%(5/9)、IOUS100%(10/10)、超声引导下PTPC100%(3/3)、CT59.5%(25/42)、MRI50%(6/12)、选择性DSA27.3%(3/11)及ASVS90%(9/10)。彩超(CDUS)对胰岛素瘤良、恶性有鉴别作用。结论:遵循循序渐进原则,先后选用B超(含CDUS)、EUS、CT等已可解决80%以上的定位诊断,然后再做MRI及ASVS;对仍未作出定位者,只要定性诊断明确即有手术探查指征,因为IOUS能提供可靠的定位信息。     

Enantioselective metabolism and cytotoxicity of R-ifosfamide and S-ifosfamide by tumor cell-expressed cytochromes P450.

The anticancer prodrug ifosfamide (IFA) contains a chiral phosphorous atom and is administered in the clinic as a racemic mixture of R-IFA and S-IFA. Hepatic cytochrome P450 (P450) enzymes exhibit enantioselective preferences in the metabolism of R-IFA and S-IFA; however, the impact of this selectivity on P450-dependent anticancer activity is not known. Presently, the metabolism and cytotoxicity of R-IFA and S-IFA were determined in 9L gliosarcoma and Chinese hamster ovary tumor cells expressing an IFA-activating P450 enzyme and by in vitro steady-state kinetic analysis using cDNA-expressed P450 enzymes. Tumor cells expressing P450 enzyme CYP3A4 were the most sensitive to R-IFA cytotoxicity, whereas tumor cells expressing CYP2B1 or CYP2B6 were most sensitive to cyclophosphamide (CPA), an isomer of IFA. Correspondingly, CYP3A4-expressing cells and cDNA-expressed CYP3A4 metabolized R-IFA to yield the active, 4-hydroxylated metabolite at a 2- to 3-fold higher rate than they metabolized S-IFA or CPA. CYP2B cells and cDNA-expressed CYP2B enzymes metabolized CPA almost exclusively by 4-hydroxylation, whereas R-IFA and S-IFA were substantially converted to inactive, N-dechloroethylated metabolites. Further investigation revealed that CYP3A1, a rat enzyme, exhibited superior kinetic properties compared with the human enzyme CYP3A4, with R-IFA and S-IFA both metabolized with high catalytic efficiency by 4-hydroxylation and with a K(m) value of 200 microM, approximately 5-fold lower than CYP3A4. Based on these kinetic parameters and metabolic profiles, R-IFA is expected to exert greater anticancer activity than S-IFA or CPA against tumors that express CYP3A enzymes, whereas tumors expressing CYP2B enzymes may be more sensitive to CPA treatment.