阻塞性睡眠呼吸暂停综合征发生阻塞部位上呼吸道的CT测量

了解CT测量对阻塞性睡眠呼吸道暂停综合征（obstructive sleep apnea syndrome,OSAS）患者上呼吸道狭窄的定位诊断意义。已知上呼吸道阻塞部位的OSAS患者共35例，将其阻塞部位CT测量资料与年龄性别相近的35名正常对照组比较，结果显示，患者组的各平面气道横截面积，气道前后径，左右径均明显小于对照组，咽喉壁和咽侧壁软组织厚度多大于对照组，发生睡眠期呼吸道阻塞的部位中有72．13％在患者清醒时其气道横截面积低于正常值，研究表明，阻塞部位的CT测量结果与正常对照组比较差异显著，72．13％的病例可以在常规的CT扫描测量中发现呼吸道解剖性狭窄。     

Changes in epidermal growth factor receptor expression in human bladder cancer cell lines following interferon-alpha treatment

PURPOSE: We examined the regulation of epidermal growth factor (EGF) receptor (EGFR) expression in human bladder cancer cell lines by interferon-alpha (IFN-alpha), the ability of IFN-alpha to inhibit cell proliferation and the sensitivity of IFN-alpha pretreated cells to EGF. MATERIALS AND METHODS: Cell proliferation was determined using crystal violet colorimetric and clonogenic assays. EGFR expression was measured by flow cytometry using specific antibody or ligand binding approaches. RESULTS: After IFN-alpha (100 IU/ml) treatment cell surface EGFR expression was upregulated in 6 of 11 and down-regulated in 2 of 11 bladder cancer cell lines. The over expression of cell surface EGFR peaked within 48 to 96 hours and increased by 35% to 241% in individual cell lines. High level cell surface EGFR correlated with intracellular EGFR expression. Cell growth inhibition by IFN-alpha coexisted with EGFR over expression in the 6 lines. IFN-alpha treated cells remained sensitive to EGF treatment. CONCLUSIONS: IFN-alpha transiently up-regulates EGFR expression and inhibits in vitro growth in some human bladder cancer cells. IFN-alpha does not prevent EGFR from binding EGF or signal transduction via the EGF-EGFR pathway. This may have clinical implications for improving treatment based on EGFR targeting in select patients with bladder cancer.     

Atorvastatin reduction of intravascular thrombosis, increase in cerebral microvascular patency and integrity, and enhancement of spatial learning in rats subjected to traumatic brain injury

OBJECT: Atorvastatin, a beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitor, has pleiotropic effects, such as promoting angiogenesis, increasing fibrinolysis, and reducing inflammatory responses, and has shown promise in enhancing recovery in animals with traumatic brain injury (TBI) and stroke. The authors tested the effect of atorvastatin on vascular changes after TBI. METHODS: Male Wistar rats subjected to controlled cortical impact injury were perfused at different time points with fluorescein isothiocyanate (FITC)--conjugated dextran 1 minute before being killed. Spatial memory function had been measured using a Morris Water Maze test at various points before and after TBI. The temporal profile of intravascular thrombosis and vascular changes was measured on brain tissue sections by using a microcomputer imaging device and a laser confocal microscopy. The study revealed the following results. 1) Vessels in the lesion boundary zone and hippocampal CA3 region showed a variety of damage, morphological alterations, reduced perfusion, and intraluminal microthrombin formation. 2) Atorvastatin enhanced FITC-dextran perfusion of vessels and reduced intravascular coagulation. 3) Atorvastatin promoted the restoration of spatial memory function. CONCLUSIONS. These results indicated that atorvastatin warrants investigation as a potential therapeutic drug for TBI.     

Histopathological,Histogenetic, and Immunohistochemical Analysis of Epidermoid Cyst of Spleen

Splenic cysts are encountered not uncommonly, but large cysts occupying a significant portion of the spleen are extremely rare. We report a case of a young female patient presenting with a large epidermoid cyst involving the majority of the spleen. The patient was involved in a motor vehicle accident during which she sustained multiple rib fractures and traumatic internal organ injuries. She subsequently underwent exploratory laparotomy and splenectomy for grade III splenic lacerations. Incidentally, a 13.3 cm in greatest dimension splenic cyst replacing the majority of the splenic parenchyma was identified. Grossly, the inner lining of cyst was gray-white, smooth, and glistening. Histologically, the thick fibrous cyst wall was composed of stratified squamous epithelium, scattered foci of which were denuded. A panel of properly-controlled immunohistochemical stains was performed and showed the squamous epithelium to be strongly and diffusely immunoreactive with carcinoembryonic antigen (CEA), CA 19–9, and cytokeratin 5/6, focally immunoreactive with HBME-1, and negative for calretinin. The histomorphological features and immunohisto-chemical staining pattern were consistent with a diagnosis of an epidermoid cyst of the spleen.     

芒硝外敷联合通腑合剂保留灌肠治疗术后早期炎性肠梗阻的护理

目的 探讨芒硝外敷联合通腑合剂保留灌肠治疗术后早期炎性肠梗阻的疗效及护理方法.方法 按随机数字表法将100例早期炎性肠梗阻患者分为观察组和对照组各50例,观察组在西医常规治疗的基础上,配合使用芒硝外敷及通腑合剂保留灌肠,对照组则配合生理盐水保留灌肠.结果 治疗后观察组肠鸣音恢复时间、肛门排气时间、中医症候疗效指数、住院时间及临床疗效显著优于对照组(P＜0.05,P＜0.01).结论 芒硝外敷联合通腑合剂保留灌肠及西医常规治疗可提高术后早期炎性肠梗阻治疗效果.     

肠道微生态与银屑病的中医研究

银屑病是一种常见的以慢性炎性反应为特征的全身心身疾病,与肠道菌群紊乱密切相关。中医的整体观和恒动观与肠道微生态的整体性、动态性特征相契合;"肺与大肠相表里"、"肺主皮毛"、"肠-脑-皮轴"学说,及已有有关中医药维持肠道微生态稳态的研究,为从肠道微生态角度探索银屑病的中医诊治机制提供了依据。将传统中医证候与客观的微生态学相结合,明确不同中医证型肠道微生态的特征性变化,探究可调节此类肠道微生态失调的中药复方制剂或单味药物,通过肠道菌群与中医"方"和"证"结合研究以寻找中医药治疗银屑病的新思路及新方法。     

鼻咽癌调强放疗致急性放射性口干的剂量学研究

目的 探讨鼻咽癌调强放疗所致急性放射性口干与放疗剂量的关系。方法 收集2013年12月至2014年7月接受调强放疗的109例鼻咽癌患者,分析患者的一般临床资料及双侧腮腺、双侧下颌下腺、双侧涎腺(双侧腮腺+双侧下颌下腺)的照射剂量等数据。在放疗结束时根据口干程度把患者分为非重度口干组(57例)和重度口干组(52例),并对两组之间的一般资料以及相关的剂量学因素进行比较分析。记录双侧腮腺接受15~50 Gy照射剂量的体积百分比,采用Logistic多因素回归法分析急性重度口干的独立预测因子,并用受试者工作特征曲线(ROC)分析其诊断界值点。结果 至放疗结束,所有入组患者重度口干的发生率为47.7%(52/109)。临床因素的分析提示年龄、黏膜炎、化疗方式均与急性重度放射性口干的发生无关。非重度口干组和重度口干组剂量学指标比较的结果显示,两组平均剂量差异均有统计学意义(t=-6.179、-6.055、-2.293,P<0.05)。Logistic回归分析显示,V₃₄是判断急性重度放射性口干的独立预测因素。V₃₄的ROC曲线表明:V₃₄=49%对重度放射性口干预测的敏感度和特异度分别为71.2%和75.4% (OR=1.231,P<0.05,95%CI:1.116~1.357)。结论 在鼻咽癌调强放疗计划中,双侧腮腺的V₃₄是重度急性放射性口干的独立预测因子,可以作为评估发生急性重度放射性口干发生风险的剂量学指标。     

胃癌累及胰腺的外科治疗与预后(附120例报告)

目的探讨胃癌累及胰腺的外科治疗方法与预后的关系。方法回顾性分析我院1984年6月～2003年10月手术治疗累及胰腺的胃癌120例。结果本组120例中,根治切除组41例,姑息切除组23例,未切除组56例。根治组41例中经病理证实胰腺有癌细胞浸润者30例,占73.2%,淋巴结转移率为85.4%。其中No10、11淋巴结转移率为73.1%。术后102例得到随访,随访率为85%,1、3、5年的生存率分别为:根治切除组为73%、37%、17%,姑息切除组为22%、9%、4%,未切除组为9%、2%、0%。根治切除组1,3年生存率明显高于姑息性切除组和未切除组(P<0.05),5年生存率明显高于未切除组(P<0.01),但与姑息性切除组无显著性差异。姑息性切除组和未切除组1、3年生存率无显著性差异,但5年生存率明显高于未切除组(P<0.01)。结论胃癌累及胰腺的根治切除可提高1,3年生存率,选择合适的适应征是关键。姑息切除有助于改善生存质量,对改善预后意义不大。     

表面置换术治疗中青年股骨头缺血性坏死

目的探讨采用表面置换术治疗中青年股骨头坏死的临床效果。方法对11例（14髋）Ficat分期为Ⅲ期或早Ⅳ期的股骨头坏死患者采用股骨头表面置换术，并对假体的形状进行了改进，其中男7例，女4例，年龄35～49岁。对13例（16髋）Ficat分期为Ⅲ期或早Ⅳ期股骨头坏死患者采用全髋表面置换术，其中男8例，女5例，年龄23～48岁。结果股骨头表面置换术患者术后随访1～5年，髋关节Harris评分从术前平均39分增至91分；X线片示假体无松动移位，近段股骨和髋臼无骨吸收和骨溶解，髋关节间隙除1例轻度狭窄外余均无磨损征象，无1例翻修。全髋表面置换术患者术后随访6个月～3年4个月，Harris评分从术前平均30分增至93分，有1例因技术原因术后半年假体松动而进行翻修，评为失败。结论表面置换术是治疗中青年股骨头缺血性坏死较为理想的一种方法。