糖尿病合并不同程度冠状动脉粥样硬化患者外周血EMP及EPC水平的研究

目的探讨糖尿病患者EMPs、EPCs与不同程度冠状动脉粥样硬化病变及糖代谢异常的关系。方法117例糖尿病患者,根据临床症状、心肌标记物水平以及冠状动脉造影及冠脉内血管超生(IVUS)结果,将患者分为急性冠脉综合症组(A组,n=45)、稳定型心绞痛组(B组,n=27)、冠状动脉病变组(狭窄＜50%,C组,n=45)。采用流式细胞术检测3组患者外周血中CD144⁺/Annexin V+的内皮微颗粒以及CD34⁺/CD39⁺内皮祖细胞的水平,并检测血脂、血糖、糖化血红蛋白、炎性指标、心肌标记物、肝肾功能等各项指标。结果 3组相比,年龄、性别、血压、吸烟、体质量指数、血脂等组间差异均无统计学意义。超敏C反应蛋白、CK-MB、HsTnT均在A组中较高,与其余两组相比差异有统计学意义(P＜0.001)。3组之间空腹血糖、餐后血糖及糖化血红蛋白差异无统计学意义。外周血的CD144⁺/Annexin V+EMPs水平3组间差异有统计学意义,其中A组显著高于B组(P＜0.05),且A、B组CD144⁺/Annexin V+EMPs水平显著高于C组(P＜0.05),EMPs水平与糖化血红蛋白不相关。A、B组外周血CD34⁺/CD39⁺EPCs水平显著低于C组(P＜0.05),而A、B组间无差异,且EPCs水平与糖化血红蛋白呈负相关。结论 糖尿病患者冠脉病变加重是导致外周血CD144⁺/Annexin V+EMPs水平升高的主导损伤因素。糖代谢异常对内皮功能的损伤主要是通过损伤内皮修复功能因素实现的。     

TKA术中假体旋转力线控制的研究进展

近年来,全膝关节置换术(total knee arthroplasty, TKA)作为治疗严重膝关节疼痛、畸形、功能障碍的一种有效的临床术式,在国内外得到了广泛的开展。但其术后并发症的发生率也相对较高,对手术后远期效果和膝关节假体的长期生存率会产生较大的影响。随着对膝关节旋转力线的重视程度的提高和研究技术的发展,笔者查阅近几年有关控制旋转力线的文献,阐述其与术后功能的相关性,综合新技术在旋转控制方面的应用进展,以期为临床进一步研究提供参考。     

Ⅱ型糖尿病与腰椎间盘退变的相关性

目的 :探讨Ⅱ型糖尿病(DM)与腰椎间盘退变的相关性。方法 :选择2013年因腰腿痛至我院脊柱外科门诊就诊并满足入选标准的390例50~60岁患者,详细记录患者DM病史,其中非DM患者123例(非DM组)、血糖控制较好患者140例(A组),血糖控制较差DM患者127例(B组);A组中DM≤10年68例(A1组),DM10年72例(A2组);B组中DM≤10年60例(B1组),DM10年67例(B2组)。用Pfirrmann评分系统对各组患者各节段腰椎间盘退变程度进行评分,用SPSS 19.0统计分析DM与腰椎间盘退变程度的相关性。结果:各组资料均服从正态分布(P0.05)。各组间一般资料无显著性差异(P0.05)。在L1/2~L5/S1每节段上,A1组Pfirrmann评分与非DM组无显著性差异(P0.05);A2、B1及B2组的Pfirrmann评分显著高于非DM组(P0.05)。A2、B2组Pfirrmann评分显著较A1、B1组高(P0.05);B1、B2组Pfirrmann评分均较A1、A2组高(P0.05)。在A、B组中,L1/2~L5/S1每一节段上腰椎间盘退变程度与DM病程呈显著性正相关(P0.05)。结论 :DM10年及血糖控制不良是腰椎间盘退变的危险因素,腰椎间盘退变程度与DM病程呈正相关。     

Short-term Safety and Efficiency of Cryoablation for Renal Sympathetic Denervation in a Swine Model

Background:

Renal sympathetic nerves are involved in the reflective activation of the sympathetic nervous system in circulatory control. Catheter-based renal denervation (RDN) ameliorated treatment-resistant hypertension safely, but 10%–20% of treated patients are nonresponders to radiofrequency denervation. The purpose of this study was to investigate the safety and efficiency of cryoablation for sympathetic denervation in a swine model and to explore a new way of RDN.

Methods:

Seven swines randomly assigned to two groups: Renal cryoablation (CR) group and control group. The control group underwent renal angiogram only. The CR group underwent renal angiogram plus bilateral renal cryoablation. Renal angiograms via femoral were performed before denervation, after denervation and prior to the sacrifice to access the diameter of renal arterial and the pressure of aorta abdominalis. Euthanasia of the swine was performed on 28-day to access norepinephrine (NE) changes of the renal cortex and the changes of renal nerves.

Results:

Cryoablation did not induce severe complications at any time point. There was no significant change in diameter of renal artery. CR reduced systolic blood pressure (BP) from 145.50 ± 9.95 mmHg at baseline to 119.00 ± 14.09 mmHg. There was a slight but insignificant decrease in diastolic BP. The main nerve changes at 28-day consisted of necrosis with perineurial fibrosis at the site of CR exposure in conjunction with the nerve vacuolation. Compared with the control group, renal tissue NE of CR group decreased by 89.85%.

Conclusions:

Percutaneous catheter-based cryoablation of the renal artery is safe. CR could effectively reduce NE storing in the renal cortex, and the efficiency could be maintained 28-day at least.     

Overexpression of Prdx1 in hilar cholangiocarcinoma: a predictor for recurrence and prognosis

Prdx1 is an important member of peroxiredoxins (Prdxs) regulating various cellular signaling and differentiation. Prdx1 confers an aggressive survival phenotype of cancer cells and drug-resistance, yet its role in hilar cholangiocarcinoma is not fully investigated. In present study, we detected the expression profile of Prdx1 in 88 hilar cholangiocarcinoma by tissue arrays and immunohistochemistry. Prdx1 level was down-regulated by specific Prdx1-shRNA in vitro and the possible mechanism was investigated. Overexpression of Prdx1 was observed in 53 of 88 cases (60.2%). Prdx1 expression was significantly associated with tumor invasion, nodal metastasis, advanced disease stage. Down-regulation of Prdx1 inhibited cell proliferation and colony formation of QBC939 cells and reduced the level of SNAT1 expression. Patients with Prdx1 overexpression had a shorter disease-free survival and overall survival than those without Prdx1 expression. Multivariate analysis showed that Prdx1 was an independent prognostic factor for patients with hilar cholangiocarcinoma. The data indicate that Prdx1 may contribute to the development and progression of hilar cholangiocarcinoma, partially through regulating SNAT1 expression, and may be used as a biomarker in predicting the outcome of patients with hilar cholangiocarcinoma.     

妊娠合并妇科恶性肿瘤的管理

妊娠合并恶性肿瘤被定义为在妊娠期间或产后1年内确诊的恶性肿瘤。近年来,随着“二孩”政策的开放和辅助生殖技术的发展,女性生育年龄推迟,孕产妇平均年龄增大,妊娠合并恶性肿瘤的发病率日趋上升。本文总结了常见的妊娠合并妇科恶性肿瘤（宫颈癌、卵巢恶性肿瘤、子宫内膜癌、外阴癌）管理的进展和治疗建议,讨论了妊娠期手术和放化疗的安全性,以及肿瘤和胎儿可能的结局,为制订最优化的诊治方案提供参考。     

无牙下颌固定种植义齿带末端悬臂的应力分析

目的:比较不同悬臂设计下颌种植支持全口义齿的骨及种植体应力分布特点,为临床种植修复提供生物力学分析依据。方法:建立3组下颌6个种植支持全口义齿的三维有限元模型,悬臂分别为3、6、9 mm。在悬臂末端垂直加载100 N的力。结果:种植全口义齿悬臂末端垂直加载时,末端种植体骨应力集中,易发生松动失败;末端种植体及中间种植体颈部应力集中,易发生植入体与基桩连接失败;连梁应力集中在与末端种植体连接处,此处易发生折断。悬臂长度增加骨应力、种植体应力及连梁应力明显增加。结论:悬臂越短越有利于力的均匀分布。6个种植体支持短悬臂修复设计较符合生物力学分布原理。     

腰椎后外侧融合椎弓根钉对相邻节段椎间盘影响的三维有限元分析

目的利用三维有限元法分析腰椎不同运动状态时椎弓根钉的置入位置对邻近节段椎间盘应力的影响。方法利用三维建模软件建立正常人有效性腰骶椎(L_3~S_1)模型。根据椎弓根钉在椎体的位置,分别建立融合模型A、B、C。并根据不同工况对这3种模型施加相应的预载荷及扭矩,分析比较不同腰椎轴向运动时相邻节段椎间盘应力的变化情况。结果成功建立正常有效的L_3~S_1三维有限元模型及椎弓根钉棒系统融合固定三维有限元模型。在后伸状态下,模型A的L_3/L_4椎间盘应力明显增加,而模型B、C较融合前无明显变化;在侧曲状态中,模型B、C的L_3/L_4椎间盘应力变化不大,而模型A显著增加;在其余状态中,3个模型的L_3/L_4椎间盘应力均升高,其中以模型A增加最为明显。3个模型在所有状态下L_5/S_1椎间盘的应力均较融合前略有升高,其中模型B、C应力的变化小于模型A。结论椎弓根钉尖端位于椎体上1/3区域会显著增加融合节段上位邻近椎间盘应力,进而引起相邻节段退变;腰椎融合术不会明显增加邻近下位椎间盘的应力。     

电视胸腔镜手术治疗肺转移瘤38例报告

目的：探讨电视胸腔镜手术（ video-assisted thoracoscopic surgery , VATS ）治疗肺转移瘤的可行性和疗效。方法2004年9月-2012年12月电视胸腔镜手术治疗38例肺转移瘤。均采用双腔气管插管单肺通气,患侧腋中线第7或8肋间做1．5 cm切口为观察孔,置入胸腔镜;胸腔镜引导下分别于腋前线第3或4肋间及肩胛下角线第6或7肋间另做2个操作孔。内镜缝合切割器距肿瘤边缘1．5 cm行楔形切除术,常规清扫或切除区域肿大淋巴结。结果38例行VATS肺楔形切除术。无围手术期死亡,无术后严重并发症,无切口肿瘤种植。1、3、5年累计生存率分别是86．8％、52．6％、31．6％。结论对于有适应证的肺转移瘤采用VATS治疗可行。     

Oncogenic role of Tc17 cells in cervical cancer development

BACKGROUND As one of the subsets of CD8+T cells,Tc17 cells have recently been identified and are characterized by the secretion of interleukin(IL)-17,which is related to inflammatory diseases.AIM To assess the status of Tc17 cells in cervical cancer and investigate the biological function of Tc17 cells in cervical cancer development.METHODS Flow cytometry assay,immunohistochemistry,and immunofluorescence were performed to detect the levels and phenotype of Tc17 cells in blood and tumor samples from patients with cervical cancer.Prior to cell suspension culture,ELISA was carried out to measure the production of IL-6,IL-1β,IL-23,CXCL12,and IL-17 in tumor tissue supernatant and co-cultured supernatant of patients with cervical cancer.In addition,multivariate analysis was performed to identify factors associated with overall survival using the Cox proportional hazards model.RESULTS Compared with normal tissues,Tc17 cells specifically accumulated in tumor tissues of cervical cancer patients.Cancer cells produced a greater amount of IL-6,IL-1β,and IL-23,which in turn promoted Tc17 cell polarization.Unlike the traditional cytotoxic CD8^+T cells,Tc17 cells secreted IL-17,which subsequently promoted CXCL12 expression in tumor cells,eventually enhancing the proliferation and migration of tumor cells.Thus,the ratio of tumor-infiltrating Tc17 cells was highly correlated with poor clinical outcome in patients with cervical cancer.CONCLUSION Our data identified the oncogenic role of Tc17 cells in the development of cervical cancer.We propose that the ratio of Tc17 cells may be a useful index in the prognosis of patients with cervical cancer.