沙利度胺治疗肝癌的实验研究

目的研究沙利度胺对肝癌的治疗作用。方法采用小鼠肝癌移植性模型。观察沙利度胺对实体型和腹水型肿瘤的治疗作用。结果沙利度胺按每日200mg／kg连续给药10d，能明显抑制肝癌实体型肿瘤的生长，不降低小鼠血细胞数及淋巴细胞增殖；对腹水型肿瘤小鼠虽无明显生命延长作用，但沙利度胺与阿霉素联合用药对肝癌实体型及腹水型均有协调抗肿瘤作用，且可阻止阿霉素造成的小鼠血细胞减少、免疫功能降低。沙利度胺日剂量200mg／kg能明显增加肿瘤组织坏死，促进肿瘤组织边缘淋巴细胞侵润。结论沙利度胺对小鼠肝癌有确切治疗作用，与阿霉素联合用药效果更好。     

Wall-eyed bilateral internuclear ophthalmoplegia from lesions at different levels in the brainstem.

Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a rarely reported syndrome. There is dispute about whether WEBINO is caused by a pontine or a midbrain lesion and whether the medial rectus subnuclei are implicated. In a study of the clinical and imaging features of four patients with WEBINO, we found that that three of four lesions involved the midbrain but not necessarily the medial rectus subnuclei.     

p53基因(今又生(R))联合支气管动脉化疗治疗肺癌15例近期疗效观察

目的探讨瘤内注射或经支气管动脉灌注p53基因联合支气管动脉灌注化疗(BAI)治疗肺癌的安全性、疗效和给药途径.方法经病理证实的15例肺癌,首先在CT引导下经皮穿刺瘤内注射或经支气管动脉灌注p53基因(今又生(R)),2～5天后,行BAI灌注化疗药物;然后根据病情变化再次进行基因治疗和/或BAI.治疗后常规使用螺旋CT定期复查,评价治疗效果.结果全部15例患者均完成上述治疗,并接受随访2～11个月.有效率(CR PR)46.7%(7/15),1例肺部肿块消失,6例肺部肿块缩小,3例纵隔淋巴结缩小,1例胸水减少,仅1例观察到肿瘤长大,14例临床症状有不同程度缓解93.3%(14/15).p53治疗后6例出现发热(38℃～40℃),未观察到基因药物的其它严重副作用,无严重操作有关并发症出现.结论本研究结果初步显示,作为肿瘤综合治疗的一部分,p53基因治疗与BAI联合应用,是一种治疗肺癌安全、有效的方法,提高了BAI的治疗效果.经皮瘤内注射p53是否为一种较好的给药途径值得进一步探讨.     

静脉药物配制中心安全管理实践

静脉药物配制中心（PIVAS）是为保证病人的输液质量而对输液进行集中管理、集中配制的新形式。它打破了传统的在开放条件下进行药物配制的工作流程，使操作人员在局部百级洁净区严格按照无菌配制技术集中配制药物，可以防止细菌和微粒的污染，为病人提供无菌、安全、高效的药品，并可减少由于输液反应而引发的医疗纠纷；通过购买大包装的药品，可以降低药晶价格、减少药品浪费、降低医疗成本；临床护士用于药品配制的时间大大缩短，提高了护理质量。虽然PIVAS在医院工作中受到欢迎，但由于运行环节较多，且在我院启用的时间不长，还是一项不成熟的服务模式，我们也发现一些尚待提高和解决的问题。针对存在的安全隐患，制订了一系列防范措施，经过半年多的实践，在实施过程中运行良好。现总结如下。     

Preparation and characterization of intelligent core-shell nanoparticles based on poly(D,L-lactide)-g-poly(N-isopropyl acrylamide-co-methacrylic acid).

New thermo-responsive, pH-responsive, and biodegradable nanoparticles comprised of poly(D,L-lactide)-graft-poly(N-isopropyl acrylamide-co-methacrylic acid) (PLA-g-P(NIPAm-co-MAA)) were developed by grafting biodegradable poly(D,L-lactide) onto N-isopropyl acrylamide and methacrylic acid. A core-shell type nano-structure was formed with a hydrophilic outer shell and a hydrophobic inner core, which exhibited a phase transition temperature above 37 degrees C suitable for biomedical application. Upon heating above the phase transition temperature, PLA-g-P(NIPAm-co-MAA) nanoparticle showed a polarity increase of pyrene in either buffer solution or intra-hepato-carcinoma cells as determined by fluorescence measurement, indicating that the structure of nanoparticles caused leakages from outer shell copolymers aggregation and collapsed. The drug loading level of 5-fluorouracil (5-FU) encapsulated in the PLA-g-P(NIPAm-co-MAA) nanoparticles can be as high as 20%. The release of 5-FU from nanoparticles was strongly controlled by the pH in the aqueous solution. Based on these results, PLA-g-P(NIPAm-co-MAA) nanoparticles can be used as a drug carrier for intracellular delivery of anti-cancer drug.     

长期培养的大鼠原代肝细胞功能和形态学观察

目的：研究大鼠原代肝细胞长期体外培养后功能和形态的变化。 方法： 采用两步胶原酶原位灌流法分离大鼠肝细胞，并用Percoll分离液进行密度梯度离心进一步纯化肝细胞，采用0.4%台盼蓝染色观察细胞活力。然后将细胞接种于HepatoZYME-SFM培养基中培养，定期收集肝细胞培养液上清检测丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶（AST）、白蛋白、尿素氮的水平。采用乙氧基试卤灵O-脱乙基酶活性（EROD）方法检测肝细胞P450的CYPⅠA1功能。 结果： 新鲜分离的大鼠肝细胞总数（2-3）×108cells/whole liver，Percoll分离液纯化后活力和纯度在90%以上。HepatoZYME-SFM培养下肝细胞生长良好并保持正常形态。AST、ALT水平在培养3 d后下降显著，6-9 d后趋于相对稳定的低水平。白蛋白的分泌功能、尿素合成能力在18 d内维持在较高水平。可在3-6 d检测到CYPⅠA1酶活性。 结论： Percoll液纯化新分离肝细胞可提高其活率和纯度，HepatoZYME-SFM培养条件下肝细胞可有效保持良好形态结构和一定的生物合成代谢能力，适合肝细胞的体外长期培养和功能研究。     

双侧自发性气胸伴左膈疝1例

患者,女,52岁,因突发呼吸困难5h入院,既往有肺结核病史20a,慢性支气管炎病史10a。X线表现:右肺外带异常透亮,并见压缩肺组织边缘,肺压缩约50%,压缩之肺组织上部见致密斑点影(见图1)。气管纵隔明显左移,左膈明显升高达左胸中部,经透视证实为左膈疝,疝入胸腔组织为胃(见胃泡)。左肺野上部透亮度明显增加,并见清晰光滑边缘,结合透视证实为左肺自发性气胸。双侧胸廓较对称,未见明显塌陷改变。X线诊断:右肺陈旧TB;双侧自发性气胸伴左膈疝形成。讨论:自发性气胸是指在无外伤和人为因素的情况下,肺组织及脏层胸膜突然破裂而引起的胸腔积气。自发…     

Laparoscopic Local Resection Based on Sentinel Node Evaluation for Early Gastric Cancer: A Preliminary Report

We previously reported that lymphatic mapping using isosulfan blue can be used to identify sentinel nodes (SNs). This study was undertaken to evaluate the feasibility of using the SN technique in treating early gastric cancer and to explore its usefulness for minimal invasive surgery. Twenty-three patients with early gastric cancer who underwent SN biopsy were retrospectively evaluated. Based on SN evaluation, individualized surgery was performed in five patients with T1N0M0 gastric cancer. When pathological examination of frozen sections revealed metastasis in SNs, we performed a standard D2 gastrectomy. Laparoscopic local resection was applied when the SN biopsy was negative. Our results showed that the success rate with SN biopsy in early gastric cancer was 100%, as were the accuracy, sensitivity, and specificity. All five patients with early gastric cancer had SNs negative for metastases both by frozen section and by postoperative pathology. Thus, all these patients underwent laparoscopic local resection without extended lymphadenectomy. We conclude that SN biopsy is a useful tool to individualize the operative procedure, and laparoscopic local resection can be safely performed using SN guidance in selected patients with early gastric cancer.     

血清高水平甲状旁腺激素-非透析慢性肾脏疾病患者的隐形杀手

维持性血液透析患者血清甲状旁腺激素(Parathyroid hormone,PTH)水平显著增高,PTH与患者心功能下降、营养状态恶化以及死亡率的增加密切相关.然而,临床实践发现,部分慢性肾脏疾病(Chronic kidney disease,CKD)3-4期、甚至CKD1期的患者血清PTH水平也增高,PTH对此类患者的影响如何,目前报道较为少见.本文结合文献就FTH对非透析CKD患者的心血管系统、骨代谢、营养状况及预后的影响作一综述.