后正中入路和经通道椎旁入路椎间融合术治疗老年Ⅰ~Ⅱ度腰椎滑脱症患者的围术期分析

目的比较后正中入路腰椎椎体间融合术(PLIF)、开放经椎间孔腰椎椎体间融合术(TLIF)和经通道椎旁入路椎间融合术(MIS-TLIF)治疗老年I~Ⅱ°腰椎滑脱症患者围术期差异。方法回顾性分析我院2014年1月至2017年12月因腰椎滑脱症行后路手术的老年患者(年龄≥60岁)68例的临床资料,按手术方式将行PLIF和TLIF手术的患者40例纳入开放组,男12例,女28例;行MIS-TLIF的28例患者为微创组,男6例,女22例。比较两组患者围术期手术时间、出血量、投照次数、术后引流量、尿管留置时间、术后住院天数及并发症差异。结果开放组和微创组患者手术时间为(156±51)min比(153±38)min,(P=0.77);术中出血量(458±272)ml比(157±104)ml(P<0.001);透视次数(6.7±1.5)次比(30.6±6.9)次(P<0.01);术中并发症开放组25.0%(10例),微创组7.1%(2例),差异无统计学意义(P=0.057)。术后引流量开放组患者(664±351)ml多于微创组患者(210±127)ml(P<0.001);尿管留置时间开放组患者(3.7±2.9)d长于微创组患者(2.2±0.8)d(P=0.002),术后住院时间开放组患者(9.2±3.6)d多于微创组患者(6.9±1.7)d(P=0.001)。术后神经并发症分别为7.5%(3例)和14.3%(4例),差异无统计学意义(P=0.365),术后非神经并发症发生率开放组27.5%(11例)高于微创组7.1%(2例),差异有统计学意义(P=0.036)。结论与PLIF和TLIF术比较,MIS-TLIF治疗老年I~Ⅱ°腰椎滑脱症具有出血少、引流量少、尿管留置时间短、住院时间短、非神经并发症较低等优点,但其投照次数较多。     

Risk-based,response-adapted therapy for early-stage extranodal nasal-type NK/T-cell lymphoma in the modern chemotherapy era: A China Lymphoma Collaborative Group study

We aimed to determine the survival benefits of chemotherapy (CT) added to radiotherapy (RT) in different risk groups of patients with early-stage extranodal nasal-type NK/T-cell lymphoma (ENKTCL), and to investigate the risk of postponing RT based on induction CT responses. A total of 1360 patients who received RT with or without new-regimen CT from 20 institutions were retrospectively reviewed. The patients had received RT alone, RT followed by CT (RT + CT), or CT followed by RT (CT + RT). The patients were stratified into different risk groups using the nomogram-revised risk index (NRI). A comparative study was performed using propensity score-matched (PSM) analysis. Adding new-regimen CT to RT (vs RT alone) significantly improved overall survival (OS, 73.2% vs 60.9%, P < .001) and progression-free survival (PFS, 63.5% vs 54.2%, P < .001) for intermediate-risk/high-risk patients, but not for low-risk patients. For intermediate-risk/high-risk patients, RT + CT and CT + RT resulted in non-significantly different OS (77.7% vs 72.4%; P = .290) and PFS (67.1% vs 63.1%; P = .592). For patients with complete response (CR) after induction CT, initiation of RT within or beyond three cycles of CT resulted in similar OS (78.2% vs 81.7%, P = .915) and PFS (68.2% vs 69.9%, P = .519). For patients without CR, early RT resulted in better PFS (63.4% vs 47.6%, P = .019) than late RT. Risk-based, response-adapted therapy involving early RT combined with CT is a viable, effective strategy for intermediate-risk/high-risk early-stage patients with ENKTCL in the modern treatment era.     

局限性肾癌的外科治疗进展

在过去三十年,随着横断面影像学的发展及在临床上的应用增多,使偶然发现的肾肿块数量不断增加,导致无症状、局限性、肾小肿块发生率随之升高。对于临床上发现的局限性肾癌,长期以来根治性肾切除一直是传统治疗的"金标准",但随着早期肾癌检出率的增高以及许多新技术和新观念的出现,应该对肾癌的治疗方式进行重新评估。     

电灼结合中药内服外洗治疗尖锐湿疣的疗效观察

目的观察电灼结合中药内服外洗治疗尖锐湿疣的临床疗效及对患者T淋巴细胞亚群的影响。方法选择从2013年7月至2017年11月山西医科大学附属大同市第三人民医院泌尿外科治疗尖锐湿疣的患者148例,随机分成对照组和观察组两组,每组74例。对照组患者单独采用电灼治疗;观察组患者在采用电灼基础上结合中药内服外洗共同治疗。结果观察组尖锐湿疣患者复发率为10.8%,低于对照组尖锐湿疣患者复发率28.4%,差异具有统计学意义。(P<0.01)。两组治疗后复发组CD3+细胞、CD4+细胞水平、CD4+/CD8+细胞比值较未复发组低,而CD8+细胞水平较未复发组高,差异具有统计学意义。(P<0.05)。治疗后,观察组尖锐湿疣患者CD3+水平、CD4+水平、CD4+/CD8+比值高于对照组尖锐湿疣患者,且观察组尖锐湿疣患者CD8+水平低于对照组尖锐湿疣患者CD8+水平,差异具有统计学意义(P<0.01)。结论电灼结合中药内服外洗能减少尖锐湿疣的复发率。在临床治疗中,监测尖锐湿疣患者外周血T淋巴细胞亚群,对尖锐湿疣患者治疗后的复发预估及相应增强免疫治疗具有重要的指导意义。     

68Ga-DOTA-生长抑素受体PET/CT神经内分泌肿瘤显像操作指南

本指南针对神经内分泌肿瘤患者提出⁶⁸Ga-DOTA-生长抑素受体PET/CT检查的临床适应证、核医学医务人员岗位要求、检查操作规范、报告处理、质量控制及显像过程中的辐射安全问题,为临床进行⁶⁸Ga-DOTA-生长抑素受体PET/CT检查提供相应操作规范,为各种影像学表现提供合理解释和标准的诊断报告。     

通腑茯苓饮联合电针治疗大鼠骶上脊髓损伤后神经源性膀胱的作用机制研究

目的 探究通腑茯苓饮联合电针通过神经生长因子（NGF）-神经生长因子受体（TrkA）信号通路对大鼠骶上脊髓损伤（SSCI）后神经源性膀胱（NB）的影响及其作用机制。方法 采用随机数字表法将45只雌性大鼠分为对照组（8只）和实验组（37只）。实验组37只大鼠先复制SSCI模型,再复制SSCI后NB模型,其中5只大鼠模型复制失败,其余32只大鼠随机分为模型组、通腑茯苓饮组、电针组及联合组,每组8只。通腑茯苓饮组给予通腑茯苓饮6.25 g/（kg·d）灌胃处理;电针组对长强穴和维胞穴进行电针治疗,留针20 min,1次/d;联合组同时予以2种治疗;对照组与模型组给予等量的生理盐水,均连续治疗14 d。检测各组大鼠膀胱重量、残余尿量及尿流动力学指标,苏木精-伊红（HE）染色观察脊髓组织病理变化并进行病理学评分,实时荧光定量聚合酶链反应和Western blotting检测大鼠脊髓组织NGF、TrkA mRNA和蛋白的表达。结果 与对照组比较,模型组、通腑茯苓饮组、电针组及联合组大鼠膀胱重量、残余尿量增加,膀胱漏尿点压力、病理评分升高（P <0.05）,膀胱顺应性降低,膀胱最大容量减少,N...     

高迁移率族蛋白B1对大鼠局灶脑缺血/再灌注后大脑皮质梗死周围区神经干细胞增殖的影响

 目的：探讨高迁移率族蛋白B1（HMGB1）对局灶脑缺血/再灌注大脑皮质梗死周围区神经干细胞增殖的影响。方法：选取雄性SD大鼠48只,分为假手术组、模型组、RNA干扰组和阴性干扰组。采用线栓法制备大鼠局灶脑缺血/再灌注模型,缺血1 h再灌注7 d时观测。用携带大鼠HMGB1 shRNA的慢病毒载体介导RNA干扰抑制脑内HMGB1的表达,通过免疫荧光双标记HMGB1/GFAP和Western blotting法检测RNA干扰效果。通过免疫荧光双标记5-溴脱氧尿嘧啶（BrdU）/神经巢蛋白（nestin）检测大脑皮质梗死周围区神经干细胞的增殖。结果：与假手术比较,再灌注7 d时,模型组大脑皮质梗死周围区HMGB1蛋白表达明显升高（P<0.05）;与模型组比较,RNA干扰有效抑制HMGB1蛋白的表达（P<0.05）。与假手术组比较,模型组的BrdU/nestin双标记细胞明显增多（P<0.05）;与模型组比较,RNA干扰组的BrdU/nestin双标记细胞明显减少（P<0.05）。结论：局灶脑缺血/再灌注后大脑皮质梗死周围区HMGB1蛋白表达水平升高可促进该部位的神经干细胞增殖。     

Molecular magnetic resonance probe targeting VEGF165: preparation and in vitro and in vivo evaluation

A new method for imaging the tumor human vascular endothelial growth factor 165 (VEGF 165) is presented. A magnetic resonance imaging (MRI) probe was prepared by crosslinking ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles to the aptamer for tumor vascular endothelial growth factor 165 (VEGF165‐aptamer). The molecular probe was evaluated for its in vitro and in vivo activities toward VEGF165. Enzyme‐linked immunosorbent assay showed that the VEGF165‐aptamer–USPIO nanoparticles conjugate specifically binds to VEGF165 in vitro. A cell proliferation test showed that VEGF165‐aptamer–USPIO seems to block the proliferation of human umbilical vein endothelial cells induced by free VEGF165, suggesting that VEGF165 is an effective target of this molecular probe. In xenograft mice carrying liver cancer that expresses VEGF165, T₂‐weighted imaging of the tumor displayed marked negative enhancement 3 h after the intravenous administration of VEGF165‐aptamer–USPIO. The enhancement disappeared 6 h after administration of the probe. These results suggest the targeted imaging effect of VEGF165‐aptamer–USPIO probe in vivo for VEGF165‐expressing tumors. This is the first report of a targeted MRI molecular probe based on USPIO and VEGF165‐aptamer. Copyright © 2014 John Wiley & Sons, Ltd.     

邓中甲经验拾零

对邓中甲教授临证经验进行部分归纳,总结为治不孕,突出调理肝肾,重在恢复肝气调达;治遗尿、遗精,突出调理心肾,重在促进心肾相交。