大肠癌肝转移射频消融后局部复发影响因素的分析

目的 探讨射频消融（radiofrequency ablation,RFA）治疗大肠癌肝转移后局部肿瘤复发的风险因素。方法 回顾性研究213例347个肿瘤实施RFA治疗后局部复发的临床资料,对可能影响RFA局部治疗效果的临床因素进行统计学处理。结果 175例（82.2%）298个肿瘤（85.9%）得到CT或MRI随访资料。大肠癌肝转移灶RFA后肿瘤局部复发率为36.9%（110/298）,局部复发的平均时间为16.4月（2～57个月）。单因素分析显示肝脏转移灶的部位、大小和射频针类型与肿瘤射频后的局部复发相关（P值分别为P=0.000,P=0.021和P=0.026）,但Cox多因素分析则显示只有瘤大小和转移灶部位是大肠癌肝转移射频消融后局部复发的独立预后因素（χ^2=8.522,P=0.000;χ^2=1.321,P=0.022）。结论 肝脏肿瘤的大小和部位是RFA治疗效果的独立影响因素,正确的电极选择和布针是获得肿瘤完全坏死的关键。     

鸟牌呼吸机故障及排除三例

呼吸机在国内外医院广泛应用，详细介绍鸟牌呼吸机在临床上3例常见的故障和排除方法。     

Hepatic pseudotumor in long-standing biliary atresia patients undergoing liver transplantation.

A pseudotumor, giant regenerative nodule, or macroregenerative nodule is an unusual benign hepatic lesion in biliary atresia (BA) patients. This tumor may mimic malignant transformation and may preclude liver transplantation (LT). The clinical and imaging surveillance of patients after the Kasai procedure is therefore an important aspect of management of BA patients. Our objective is to report our experience and describe the incidence, imaging, and pathologic features of pseudotumors in BA patients awaiting LT. From August 1990 to December 2006, 133 LTs for BA were performed. Five (3.8%; 4 female, 1 male) patients were diagnosed with pseudotumor. The patients' records were reviewed. The diagnostic imaging modalities used were abdominal ultrasound (US), computed tomography (CT) scan, and magnetic resonance imaging (MRI). Histologic confirmation of the lesions was obtained in all cases. All underwent the Kasai operation in early infancy. Six of 7 lesions in 4 of 5 patients were demonstrated by pretransplant imaging. Two of 7 tumors were detected by US. Five of 7 lesions were detected by CT, and 5 of 7 lesions were demonstrated by MRI. In 1 patient, the lesion was not seen in the US, CT, or MRI but was found during surgery and confirmed by histology. An additional tumor was found incidentally during histologic examination in a patient previously diagnosed to have 2 tumors by CT and MRI. In another patient diagnosed to have 2 tumors on imaging, pathology revealed only a single tumor. In conclusion, although unusual, pseudotumor should be included in the differential diagnosis of liver masses in BA children.     

正常人在静态和运动状态下"死腔/潮气"估测值和实测值的比较

目的研究正常人静态及运动状态下死腔/潮气(VD/VT)估测值和实测值的关系.方法23名受试者行心肺运动试验,同步实时测定摄氧量和二氧化碳排出量,分别在运动前及运动高峰时抽取动脉血,根据Bohr的公式,得出VD/VT实测值,同时再用呼气末CO2分压(PetCO2)代替PaCO2,计算VD/VT,得出VD/VT估测值.结果根据病史、体检、肺功能和运动前后的心电图判断23名受试者均为正常受试者.静态时的VD/VT估测值和VD/VT实测值分别为0.359±0.109和0.354±O.106,两者无显著性差异(P=0.710),相关分析显示两者高度相关(r=0.911,P＜0.001).运动高峰时的VD/VT估测值和VD/VT实测值分别为0.234±0.070和0.248±0.094,两者无显著性差异(P=0.748),相关分析表明两者显著相关(r=0.783,P＜0.001).与静态时比较,运动时估测和实测VD/VT均明显下降.结论对于正常成人,无论是在静态或最大运动状态下,可用无创方法计算VD/VT代替VD/VT实测值.     

颈椎不稳症的影像诊断(附50例报告)

目的探讨颈椎不稳症的影像学诊断。方法回顾性分析50例经临床证实的颈椎不稳症患者的X线平片、CT和MRI检查资料。结果50例中上颈椎不稳16例,其中,寰枕关节不稳2例,表现为枕底—齿突线和斜坡—齿突线不连续,14例为寰枢关节不稳,其中,寰枢关节脱位7例;下颈椎不稳34例,其中,前屈不稳20例,后伸不稳14例。结论X线平片、CT和MRI综合分析能对颈椎不稳症作出准确的诊断。     

高脂肪膳食对大鼠增食欲素及瘦素系统的影响

目的研究高脂肪膳食诱导的胰岛素抵抗(IR)大鼠下丘脑及脂肪组织中增食欲素和瘦素系统的变化,分析其可能的调控因素。方法IR大鼠模型采用高脂肪膳食诱导并经钳夹技术证实;应用RT-PCR技术检测增食欲素及其受体(OX1R、OX2R)和瘦素受体(LR)以及脂肪组织中瘦素基因mRNA的表达;采用生化比色法测定血清游离脂肪酸(FFA)、放射免疫法测定血清肿瘤坏死因子α(TNF-α)。结果钳夹技术中葡萄糖输注率明显低于对照组;高脂肪膳食诱导的IR大鼠下丘脑中前增食欲素原mRNA的表达较对照组减少约80%(P<0.01);OX1R、OX2R分别增加3.4及3.2倍(P<0.01);瘦素mRNA增加约8倍(P<0.01);LR减少78%;血清FFA和TNF-α均明显高于对照组(P<0.01)。结论高脂肪膳食可诱导大鼠体内IR,并导致增食欲素和瘦素系统平衡状态的破坏;增食欲素和瘦素是机体能量平衡调节网络中的一对重要物质,两者相互作用共同维持机体能量代谢的稳定。血清FFA和TNF-α均可能参与该系统的调控,合理膳食在这一调控中至关重要。     

Intraoperative blood loss is a risk factor for complications in donors after living donor hepatectomy.

Complications in a donor are a distressing but inevitable occurrence, since graft procurement is a major undertaking. Although the technique for procurement has some similarities to hepatic resection, a donor is very unlike a patient with malignancy. The risk factors identified in these patients cannot be extrapolated to donors. Donor hepatectomy carried out from June 1995 to March 2005 in Chang Gung Memorial Hospital, Kaohsiung Medical Center was reviewed with the aim of identifying risk factors for complications. There were 204 living donor liver transplants, with 205 donor hepatectomies, as 1 living donor liver transplantation was a dual graft. Ten donors (4.88%) suffered complications. There was no difference in terms of age, gender, body weight, operation, and parenchymal time between those who had complications and those who did not. There was also no difference in liver function tests between the 2 groups of donors, but the total bilirubin was significantly higher in donors with complications. The graft weight and remnant liver volume were also similar. The proportion of donors with fatty liver was the same between the 2 groups. The mean blood loss in donors with complications was 170 +/- 79 mL, and that for donors without complications was 95 +/- 77 mL. There was a statistically significant greater blood loss in donors with complications (P < 0.05). The number of segments removed in donors with complications was also higher compared to donors without complications (P < 0.03). Using multivariate analysis, intraoperative blood loss and the number of segments removed were found to be independent risk factors for donor complications. Intraoperative blood loss during graft procurement must be kept low to minimize complications in donors.     

红藻氨酸作用后海马神经元胞膜表面的超微结构的原子力显微镜观察

目的 观察原代培养神经元在红藻氨酸(KA)作用下细胞表面形态的三维构像变化。方法 利用原子力显微镜(AFM)对大鼠海马神经元经不同浓度的KA(25和250μmol／L，50和100nmol／L)分别作用10min和100min后的表面结构进行纳米级水平扫描和观测。结果 正常海马神经元表面光滑，起伏均匀、规律；KA作用后神经元呈退行性改变，表现为胞体肿胀，胞膜表面粗糙，出现隆起和“孔洞”样结构，并且其变化程度分别与作用时问和KA浓度呈量-效关系。结论 KA对海马神经元毒性作用后胞膜表面超微结构所产生的明显变化，可借助AFM清晰观察，并定量分析。     

骨肉瘤细胞特异性结合短肽的筛选

目的：获得与骨肉瘤细胞株os-732特异结合的短肽，作为骨肉瘤靶向治疗的先导化合物。方法：以骨肉瘤细胞os-732为靶细胞，成骨细胞为吸附细胞对噬菌体12肽库进行差减筛选，用细胞ELISA、免疫组化鉴定阳性噬菌体克隆并测序。结果：经三轮筛选，从随机挑选的20个噬菌体克隆中得到9个特异性与骨肉瘤细胞os-732结合，而不与正常成骨细胞结合的阳性克隆。但其氨基酸序列无同源性。结论：得到多个序列不同的特异性结合骨肉瘤的噬菌体克隆，提示骨肉瘤细胞表面结构复杂，具多个骨肉瘤抗原表位。本实验获得的短肽具有一定的亲合力和肿瘤特异性，为针对不同位点的靶向药物设计提供了实验依据。     

乳腺肿块的超声表现与病理对照研究

目的研究超声对乳腺肿块的鉴别诊断价值及其病理基础。方法选取由超声诊断，并经手术病理证实的74例乳腺肿块，分析其二维超声的形态、边缘轮廓、包膜、边界及内部回声、肿块后方回声及侧方声影等表现特征，结合肿块内部及周边的血流情况，将其分为良恶性，并与病理结果对照。结果二维超声诊断乳腺肿块良恶性的准确率为81．2％，二维超声联合彩色多普勒超声及能量多普勒超声后诊断乳腺肿块良恶性的准确率提高为89．1％。结论二维超声结合彩色多普勒超声及能量多普勒超声检查，可提高乳腺良恶性肿块的诊断正确率。