激光捕获显微切割结合定量PCR检测NES1 mRNA在胃癌中的表达及其甲基化状态

目的:探讨正常上皮细胞特异性-1基因(NES1)在正常胃组织及胃癌组织中的表达和受甲基化调控的影响。方法:利用激光捕获显微切割(laser capture microdissection,LCM)技术分离胃癌患者活检组织中的癌细胞和正常上皮细胞,采用荧光定量PCR检测其中NES1 mRNA的表达,甲基化特异性PCR观察NES1基因外显子3 CpG岛甲基化状态。结果:荧光定量PCR结果显示,NES1 mRNA在胃癌细胞中的表达明显低于正常胃上皮细胞(P＜0．05)。甲基化特异性PCR检测胃癌组织癌细胞中NES1外显子3 CpG岛甲基化状态发现,大部分肿瘤患者NES1外显子3 CpG岛均存在不同程度甲基化,其中完全甲基化7例(33．3%),不完全甲基化12例(57．14%);而正常细胞中存在不完全甲基化仅为1例(5%),其余19例均不存在甲基化(95%)。结论:激光显微切割结合荧光定量PCR技术可较精确地检测NES1在胃癌组织细胞和正常组织细胞中的表达。NES1在胃癌中表达降低,其表达降低与NES1基因外显子3甲基化有关。     

激光和微波腔内闭合术治疗大隐静脉曲张的临床研究

目的：探讨激光和微波腔内闭合术治疗大隐静脉曲张的疗效和并发症。方法：上海交通大学附属第一人民医院血管外科自2007年9月—2009年8月间收治249例（295条肢体）大隐静脉曲张手术患者,其中138例（163条肢体）实施激光闭合术,111例（132条肢体）实施微波闭合术,对比2组的临床疗效、再通率和并发症发生率。结果：激光组的手术耗时少于微波组（27.5±6.3min比22.7±5.6min,P〈0.01）,激光组的术中出血亦少于微波组（15.8±2.5mL比12.5±2.3mL,P〈0.05）,微波组的3个月及1年再通率低于激光组（0.76%比2%及1.5%比6.5%）,2组的Aberdeen评分改善值和住院天数基本相当,组织灼伤、皮下硬结、瘀斑、表皮麻木等并发症率在2组间无显著差异,2组病例均未出现肺栓塞等严重并发症。结论：微波和激光腔内闭合术都是治疗下肢静脉曲张安全有效的微创手术方法。     

输尿管镜钬激光治疗输尿管结石100例

目的:探讨输尿管镜钬激光治疗输尿管结石的有效性和安全性。方法:采用输尿管镜钬激光技术治疗100例输尿管结石,其中输尿管上段结石17例,中段结石20例,下段结石63例。结果:输尿管上、中、下段结石的排净率分别为88%、95%、100%,并发症为4%。结论:输尿管镜钬激光是治疗输尿管结石有效、安全的方法。     

喉罩联合高频喷射通气在输尿管软镜钬激光碎石术麻醉中的应用

目的评价喉罩联合高频喷射通气应用于输尿管软镜钬激光碎石术的安全性。方法60例拟行输尿管软镜钬激光碎石患者,丙泊酚靶控输注静脉全麻后置入合适喉罩,联合高频喷射通气,比较通气前后平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）、呼末二氧化碳分压（PET CO2）,动脉氧分压（PaO2）、动脉二氧化碳分压（PaCO2）、气道压（Paw）等参数。结果输尿管软镜钬激光碎石术采用丙泊酚靶控输注静脉全麻,置入喉罩联合高频喷射通气,PETCO2、PaCO2、Paw、分别由高频喷射通气前的（32.01±3.31）mmHg,（40.83±2.68）mm-Hg,（14.7±1.74）cmH2O 下降至通气后的（22.07±3.31）mmHg,（33.3±2.29）mmHg,（4.6±1.59）cmH2O;PaO2由（279.7±51.5）mmHg增至（311.78±46.4）mmHg。结论全凭静脉麻醉,采用喉罩联合高频喷射通气,能安全地应用于输尿管软镜钬激光碎石术。     

Efficacy of low-level laser therapy applied at acupuncture points in knee osteoarthritis: a randomised double-blind comparative trial

Objective

To evaluate the efficacy of low-level laser therapy (LLLT) applied to acupuncture points on the knee joint in combination with exercise and advice in patients with knee osteoarthritis.

Design

Randomised, double-blind, comparative clinical trial.

Participants

Forty-nine patients with knee osteoarthritis were assigned at random into two groups: active laser group (n = 26) and placebo laser group (n = 23).

Intervention

Using a gallium aluminium arsenide laser device, patients received either active or placebo LLLT at five acupuncture points on the affected knee during nine sessions.

Outcome measures

Patients were assessed using a visual analogue scale (VAS) and the Saudi Knee Function Scale (SKFS) at baseline, the fifth treatment session, the last treatment session, 6 weeks post intervention and 6 months post intervention.

Results

VAS scores showed a significant improvement in the active laser group compared with the placebo laser group at 6 weeks post intervention [mean difference −1.3, 95% confidence interval (CI) of the difference −2.4 to −0.3; P = 0.014] and 6 months post intervention (mean difference −1.8, 95% CI of the difference −3.0 to −0.7; P = 0.003) using the independent samples test. SKFS scores also showed a significant improvement in the active laser group compared with the placebo laser group at the last treatment session (median difference −15, 95% CI of the difference −27 to −2; P = 0.035) and 6 months post intervention (median difference −21, 95% CI of the difference −34 to −7; P = 0.006) using the Mann–Whitney U test.

Conclusions

The results demonstrate that short-term application of LLLT to specific acupuncture points in association with exercise and advice is effective in reducing pain and improving quality of life in patients with knee osteoarthritis.     

Attention to painful cutaneous laser stimuli evokes directed functional connectivity between activity recorded directly from human pain-related cortical structures

Our previous studies show that attention to painful cutaneous laser stimuli is associated with functional connectivity between human primary somatosensory cortex (SI), parasylvian cortex (PS), and medial frontal cortex (MF), which may constitute a pain network. However, the direction of functional connections within this network is unknown. We now test the hypothesis that activity recorded from the SI has a driver role, and a causal influence, with respect to activity recorded from PS and MF during attention to a laser. Local field potentials (LFP) were recorded from subdural grid electrodes implanted for the treatment of epilepsy. We estimated causal influences by using the Granger causality (GRC), which was computed while subjects performed either an attention task (counting laser stimuli) or a distraction task (reading for comprehension). Before the laser stimuli, directed attention to the painful stimulus (counting) consistently increased the number of GRC pairs both within the SI cortex and from SI upon PS (SI > PS). After the laser stimulus, attention to a painful stimulus increased the number of GRC pairs from SI > PS, and SI > MF, and within the SI area. LFP at some electrode sites (critical sites) exerted GRC influences upon signals at multiple widespread electrodes, both in other cortical areas and within the area where the critical site was located. Critical sites may bind these areas together into a pain network, and disruption of that network by stimulation at critical sites might be used to treat pain.     

Evaluation of afferent pain pathways in adrenomyeloneuropathic patients

Objective

Patients with adrenomyeloneuropathy may have dysfunctions of visual, auditory, motor and somatosensory pathways. We thought on examining the nociceptive pathways by means of laser evoked potentials (LEPs), to obtain additional information on the pathophysiology of this condition.

腔内激光消融术联合泡沫硬化剂注射及多磺酸黏多糖乳膏治疗淤积性皮炎的临床研究

目的 观察腔内激光联合泡沫硬化剂注射及多磺酸黏多糖乳膏治疗下肢淤积性皮炎的疗效。方法 2015年12月至2017年5月在四川省人民医院皮肤科收集下肢淤积性皮炎患者52例,共60条患肢,利用随机数字表及随机数余数分组法将患肢随机分为分为联合组、黏多糖组和对照组,每组20条患肢。3组均先接受大隐静脉主干腔内激光消融术,联合组肢体在激光术中同时注入泡沫硬化剂后,外用多磺酸黏多糖乳膏治疗4周;黏多糖组在激光术后仅外用多磺酸黏多糖乳膏治疗4周;对照组在激光术后仅外用糠酸莫米松乳膏治疗4周。记录3组治疗前、治疗4周后湿疹面积严重程度评分（EASI）、瘙痒视觉模拟评分（VAS）。治疗前后组内比较采用配对t检验,3组间总体比较采用方差分析,两两比较采用LSD检验。结果 联合组、黏多糖组、对照组治疗前EASI（分别为9.64 ± 4.58、9.94 ± 4.18、9.50 ± 4.41）、VAS（分别为7.25 ± 1.29、7.50 ± 1.19、7.45 ± 1.32）差异均无统计学意义（F值分别为0.052、0.218,均P > 0.05）。治疗4周后EASI分别降至3.54 ± 1.57、5.86 ± 2.39、7.04 ± 2.75,VAS分别降至2.35 ± 0.67、3.85 ± 0.67、4.65 ± 1.23,与治疗前相比,差异均有统计学意义（t值为4.30 ~ 18.80,均P < 0.05）。治疗4周后,联合组EASI低于黏多糖组、对照组（均P < 0.05）,黏多糖组与对照组之间差异无统计学意义（P > 0.05）;联合组VAS低于黏多糖组、对照组（均P < 0.05）,黏多糖组低于对照组（P < 0.05）。结论 对于淤积性皮炎,腔内激光消融术联合泡沫硬化剂注射和多磺酸黏多糖乳膏外用短期疗效优于仅联合外用多磺酸黏多糖乳膏或糠酸莫米松乳膏,联用多磺酸黏多糖乳膏对瘙痒的改善优于联用糠酸莫米松乳膏,长期疗效尚需进一步观察。     

Maculopatía bilateral por exposición a puntero láser: hallazgos en la angiografía mediante tomografía de coherencia óptica

Case report

A 36-year-old man went to the emergency department the day after exposure to a laser pointer. Funduscopy revealed dispersed macular pigment alterations, and optical coherence tomography showed a disruption of the retinal layers. The visual acuity was counting fingers in both eyes. Nine months later, optical coherence tomography angiography showed a rarefaction in the choriocapillaris vascular flow in the area of the laser injuries.