糖尿病肾病肾脏微小血管病变实验研究

目的:观察微血管损伤在糖尿病肾病中发病的关键作用。方法:以单侧肾切除并链脲佐菌素尾静脉注射建立糖尿病肾病模型,测定动态观察4、8、12、16、20周肾小管周围毛细血管网(PTC)、血管内膜厚度、肾小球硬化指数、肾小球毛细血管袢、肾小球体积、细胞外基质等指标。结果:随造模时间延长,糖尿病肾病组大鼠肾小球毛细血管袢开放面积减少,肾小球体积增大,肾间质PTC网减少,动脉内膜增厚,肾小球硬化指数、系膜基质增加。与假手术组比较均有统计学意义(P<0.05或P<0.01)。结论:肾间质PTC网与肾小球硬化呈明显负相关,PTC网越少,肾小球毛细血管褂开放面积减少,肾小球硬化更严重;同时PTC网减少导致肾缺血也是肾间质纤维化和肾乳头坏死的原因。     

Phenylthiocarbamide taste sensitivity revisited: complete sorting test supports residual family resemblance

Phenylthiocarbamide (PTC) taste thresholds were determined in 100 nuclear families using the complete sorting test. Segregation analysis using the mixed model suggested that the variability in PTC thresholds is controlled by a major locus with incomplete dominance as well as by a multifactorial component with significant residual heritability. Such a model explained nearly 96% of the variance, leaving only 4% of the variance in thresholds arising from measurement error and other environmental factors.     

Behavior genetic differences within and between defined human populations

The small populations of the Caucasus offer a unique opportunity to consider concepts, such as heritability, which are often considered properties of a trait but which are really properties of a population. A comprehensive strategy is outlined for studying intra-and interpopulation genetic structure across a wide range of traits and environments. A threewway association is demonstrated between 12 of 16 psychophysiological traits, attitude, and thet allele for PTC sensitivity. Differences between populations and traits are evaluated in theoretical terms for morphological, physiological, and psychological measures. While decreases in performance with inbreeding are often predicted, in these small, isolated populations the effects are minimal.     

The relationship between taste sensitivity to phenylthiocarbamide and anhedonia

It has been proposed that taste sensitivity to bitter compounds such as, phenylthiocarbamide (PTC) and 6-n-propylthiouracil (PROP), represents a genetic marker for an increased vulnerability to depressive illness. Previous explorations of this idea have proven equivocal. This study refines and further explores this idea by focusing specifically on anhedonia (diminished hedonic capacity), a key symptom in some depressive illness, linked also with sensory pleasure. It is hypothesized that diminished PTC taste sensitivity will be associated with more general decrements in hedonic capacity (anhedonia). An opportunity sample of 198 university students were assessed using paper strips impregnated with PTC, the same participants also completed a widely used assessment of hedonic capacity, the Snaith-Hamilton Pleasure Scale (SHAPS). Hedonic capacity scores positively correlated with PTC taste sensitivity; specifically, heightened hedonic capacity was associated with heightened sensitivity to the bitter taste of PTC. Furthermore, modest differences were observed between those least (non-tasters) and most (supertasters) sensitive to PTC, with non-tasters reporting significantly lower hedonic capacity scores than supertasters. PTC taste sensitivity may represent a peripheral risk factor for anhedonia.     

肝门部胆管癌的影像学诊断进展

随着影像学技术进步,肝门部胆管癌检出水平不断提高,但总体诊断率仍然低下,尤其是早期诊断率。超声、CT、MRI、MRCP、PTC、ERCP、PET等检查是诊断肝门胆管癌的主要方法,各有特点。今后的研究可能着重在用造影或增强方法,以期清晰显示肿瘤与周围组织的境界,尤其是清晰显示肿瘤与血管及邻近结构的关系,提供全面准确的术前评估信息。     

超声引导下经皮肝穿胆道造影及胆管内置管引流在梗阻性黄疸中临床应用

本文报告１０例超声引导下经皮肝穿胆道造影，胆管内置管引流成功经验。１０例病人均为恶性梗阻性黄疸。成功９例，１例因肝内胆管畸形改变未成功。９例成功引流的病人均行手术治疗，术后无一例并发症。进行超声引导下行胆道造影，胆管内置管引流准确性及成功率高，明显减少术后并发症，是值得推广的一种方法。     

Hilar cholangiocarcinoma: resectability and radicality after routine diagnostic imaging

Background/Purpose

En-bloc resection has contributed to the improvement of long-term survival in patients with hilar cholangiocarcinoma. In addition, attenuation of intraoperative traumatization of the tumor may decrease tumor spread. The objective of this study was to assess the importance of a routine diagnostic workup for the surgical strategy, radicality, and results in patients with hilar cholangiocarcinoma.

Methods

Between September 1997 and December 2002, 82 patients with hilar cholangiocarcinoma were treated at our department. Preoperative diagnostic workup included endoscopic retrograde cholangiography (ERC), percutaneous transhepatic cholangiography (PTC), computed tomography (CT), and magnetic resonance imaging (MRI). The results of preoperative and retrospective (blinded) assessment of diagnostic data concerning the tumor growth along the bile ducts were compared with the results of surgery.

Results

The resection rate was 75%, and the hospital mortality, 7%. The prospective assessment of the resection to be performed was correct in 81% of cases. In ERC, magnetic resonance cholangiography (MRC), and PTC, tumor assessment was precise in 29%, 36%, and 53%, of cases, respectively. Overestimation occurred more frequently than underestimation. The 3-year survival of patients with formally curative or palliative en-bloc resection was 61% and 15%, respectively. For the 9 patients with hilar resection, the 3-year survival was 25%. Survival of patients was comparable, regardless of whether their tumor had been correctly assessed or over- or underestimated. In the multivariate analysis, R0 resection was the only significant prognostic factor (P = 0.011).

Conclusions

Our routine diagnostic approach led to high resection and survival rates. Obviously a sophisticated diagnostic workup is not an absolute prerequisite for adequate surgery.