保留膀胱手术联合动脉插管化疗对高危非肌层浸润性膀胱癌的疗效研究

目的：研究保留膀胱手术联合动脉插管化疗对高危非肌层浸润性膀胱癌的疗效.方法回顾性分析2012年1月至2014年12月于我院行保留膀胱手术的58例高危非肌层浸润性膀胱癌患者的临床资料,58例患者术后随机纳入动脉插管化疗组和膀胱灌注组,定期随访,观察比较两组患者的复发率、进展率、无复发生存率、无肿瘤进展生存率和毒副作用等.结果经过10~46(中位时间25)个月的随访,动脉化疗组(27例,平均随访23.7个月)1例复发,复发率为3.7％,平均无肿瘤复发生存时间为(38.2±0.8)个月;无肿瘤进展,肿瘤进展率为0.膀胱灌注组(31例,平均随访25.7个月)10例复发,复发率为32.3％,平均无肿瘤复发时间为(29.7±2.3)个月;5例肿瘤进展(侵犯肌层或远处转移),进展率为16.1％.两组无复发生存率分别为95.7％、37.0％,无肿瘤进展生存率分别为100％、66.7％,两两比较,差异均有统计学意义(分别P＝0．006,P＝0．030).结论保留膀胱手术的高危非肌层浸润性膀胱癌患者联合动脉插管化疗相比单纯行膀胱灌注化疗能有效降低膀胱癌复发及进展的风险.     

Preoperative anemia is associated with disease recurrence and progression in patients with non–muscle-invasive bladder cancer

Purpose

To evaluate the effect of preoperative anemia (PA) on oncological outcomes in a multicenter cohort of patients with non–muscle-invasive bladder cancer (NMIBC) treated with transurethral resection of the bladder (TURB) and adjuvant intravesical therapies. We hypothesize that PA represents a marker of disease aggressiveness and could be used to improve the discrimination of prognostic tools for the prediction of disease recurrence and progression.

Gender-specific Differences in Clinicopathologic Outcomes Following Radical Cystectomy: An International Multi-institutional Study of More Than 8000 Patients

Background

The impact of gender on the staging and prognosis of urothelial carcinoma of the bladder (UCB) is insufficiently understood.

Objective

To assess gender-specific differences in pathologic factors and survival of UCB patients treated with radical cystectomy (RC).

Design, setting, and participants

Data from 8102 patients treated with RC (6497 men [80%] and 1605 women [20%]) for UCB between 1971 and 2012 were analyzed.

Outcome measurements and statistical analysis

Multivariable competing-risk regression analyses were performed to evaluate the relationship of gender on disease recurrence (DR) and cancer-specific mortality (CSM). We also tested the interaction of gender and tumor stage, nodal status, and lymphovascular invasion (LVI).

Results and limitations

Female patients were older at the time of RC (p = 0.033) and had higher rates of pathologic stage T3/T4 disease (p < 0.001). In univariable, but not in multivariable analysis, female gender was associated with a higher risk of DR (p = 0.022 and p = 0.11, respectively). Female gender was an independent predictor for CSM (p = 0.004). We did not find a significant interaction between gender and stage, nodal metastasis, or LVI (all p values >0.05).

Conclusions

We found female gender to be associated with a higher risk of CSM following RC. However, these findings do not appear to be explained by gender differences in pathologic stage, nodal status, or LVI. This gender disparity may be due to differences in care and/or the biology of UCB.     

癫痫持续状态大鼠内质网应激预适应对海马神经元保护作用的实验研究

目的 探讨2-脱氧葡萄糖诱导内质网应激预适应对癫痫持续状态大鼠海马神经元的保护作用及其可能机制。方法 采用2-脱氧葡萄糖连续腹腔注射诱导内质网应激,并在此基础上制备氯化锂-匹罗卡品癫痫持续状态大鼠模型。Nissl染色观察癫痫持续状态后海马神经元损伤情况、计数海马CA1和CA3区存活神经元数目;免疫组织化学检测海马CA3区内质网应激标志物葡萄糖调节蛋白78（GRP78）和X盒结合蛋白1（XBP-1）表达变化。结果 与癫痫持续状态组相比,癫痫持续状态后第7天时内质网应激预适应组大鼠海马存活神经元数目增加,以CA1区显著（t=5.353,P=0.000）。癫痫持续状态组大鼠发作后6 h,海马CA3区GRP78和XBP-1表达水平升高且高于对照组（均P=0.000）,于发作第2天达峰值水平（均P=0.000）;内质网应激预适应组大鼠发作前海马CA3区GRP78和XBP-1表达即高于对照组（均P=0.000）,GRP78在发作后24 h和2 d时维持在峰值水平（均P=0.000）,XBP-1在发作后24 h达峰值水平（P=0.000）;内质网应激预适应组大鼠海马CA3区GRP78和XBP-1表达在癫痫持续状态前,以及癫痫持续状态后6、12、24 h均高于癫痫持续状态组（均P=0.000）,至第2和7天时与癫痫持续状态组之间差异无统计学意义（P〉0.05）。结论 经2-脱氧葡萄糖诱导的内质网应激预适应对癫痫持续状态大鼠海马神经元具有保护作用,而XBP-1-GRP78信号转导通路的活化可能是其机制之一。     

白血病抑制因子抑制神经元凋亡及促进内源性神经干细胞的增殖**

背景：研究表明白血病抑制因子能提升内源性神经干细胞的增殖及改变其分化方向,但还没有研究证实其是否能影响神经元的凋亡。 目的：观察白血病抑制因子干预下神经元的凋亡及内源性神经干细胞的增殖情况,以及二者是否有一定相关性。 方法：c57BL小鼠32只,随机分为假手术组,白血病抑制因子组,帕金森病组及正常对照组。除正常对照组外,其他3组均接受三维脑立体定向注射6-羟基多巴胺制备小鼠帕金森病模型。造模后2 h,假手术组只接受ALZET锇药物泵导管植入术,但不植入泵导管;白血病抑制因子组接受ALZET锇药物泵导管植入术,经泵导管将白血病抑制因子直接缓慢释放到脑脊液中,帕金森病组给予生理盐水。 结果与结论：与帕金森病组相比,白血病抑制因子组小鼠运动功能明显改善,内源性神经干细胞显著增殖,凋亡细胞数呈显著性下降,二者之间存在相互关系。白血病抑制因子可能是一种能有效重建变性神经系统的神经营养因子。     

Sudomotor dysfunction is frequent and correlates with disability in Friedreich ataxia

Objectives

To evaluate autonomic symptoms and function in Friedreich’s Ataxia (FRDA).

蕲蛇酶联合肝素治疗兔急性下腔静脉血栓的实验研究

目的 探讨蕲蛇酶联合肝素治疗兔急性下腔静脉血栓的有效性及安全性.方法 新西兰大白兔72只建立急性下腔静脉血栓模型后随机分为肝素组(A组)、尿激酶联合肝素组(B组)、蕲蛇酶联合肝素组(C组),每组24只.各组在血栓形成3 d后给药,分别在用药后的3、7、10 d检测各组凝血指标评估其安全性,通过静脉彩超评估其有效性.结果 C组的凝血酶原时间(prothrombin time,PT)延长时间较B组短(P<0.05),纤维蛋白原(fibrinogen,FBG)值较B组小(P<0.05),B组和C组PT延长时间较A组长(P<0.01),FBG值较A组大(P<0.01),B组和C组的D-二聚体值(D-dimer,D-D)均逐渐降至正常,差异无统计学意义(P>0.05).B组和C组的溶栓效果均较A组效果好,B组与A组差异有统计学意义(P<0.01),第10天时,C组与A组差异有统计学意义(P<0.01).B组和C组溶栓效果差异无统计学意义(P>0.05).结论 蕲蛇酶联合肝素治疗兔急性下腔静脉血栓是有效的,并且具有较高的安伞性.     

腹腔镜辅助下全结直肠切除术治疗结直肠多发性疾病

目的:探讨腹腔镜辅助下全结直肠切除术治疗结直肠多发疾病的可行性与安全性。方法:回顾性分析11例在腹腔镜辅助下进行的全结肠切除术患者的临床资料,其中家族性腺瘤性息肉病(FAP)2例,息肉癌变2例,结直肠多发癌3例,慢性溃疡性结直肠炎2例,慢性顽固性便秘2例。结果:11例腹腔镜辅助下全结肠切除术均成功,手术时间约(348±47)m in,术中出血量约(187±68)m l,术后胃肠功能恢复时间(65±18)h,辅助切口3~5 cm,术后无腹腔出血、感染、吻合口瘘等并发症;随访6~24月,大便5~12次/d;无肿瘤复发、转移。结论:在熟练掌握腹腔镜操作技术和开腹大肠切除技巧的前提下,完成腹腔镜辅助下全结直肠切除术是安全可行的。     

人原发性结肠恶性淋巴瘤裸小鼠原位移植肝转移模型的建立

目的 为探讨结肠恶性淋巴瘤的发病机制和实验治疗提供理想的动物模型。方法将结肠恶性淋巴瘤术中原发灶和肝转移灶新鲜瘤组织块植入裸小鼠结肠黏膜层内，观察原位移植的成瘤率，移植瘤的侵袭和转移率。进行形态学（光镜、电镜、免疫组织化学）、染色体核型和流式细胞分析。结果人结肠淋巴瘤原发灶和肝转移灶新鲜瘤组织均获得移植成功。依据WHO新的分类标准，建成1株人结肠原发性（原发灶）非霍奇金B细胞性恶性淋巴瘤裸鼠原位移植高转移模型（HCBL-0303）和1株人结肠原发性（肝转移灶）非霍奇金B细胞性恶性淋巴瘤裸鼠原位移植肝转移模型（HCBL-0304）。移植瘤组织病理学为（非霍奇金B细胞性）高度恶性淋巴瘤；免疫组化显示CDl9、CD20、CD22阳性，CD3、CD7阴性。染色体数目55—59条；流式细胞DI值1．59—1．71，均为异倍体。HCBL-0303肝转移率为63．7％，淋巴结转移率为56．4％；HCBL-0304肝转移率和淋巴结转移率为100％。移植瘤在裸鼠结肠内自主侵袭性生长，发生血液转移、淋巴转移和腹腔内种植性转移。结论HCBL-0303和HCBL-0304是首次成功建立的人结肠恶性淋巴瘤裸鼠原位移植自发性肝转移模型，可用于结肠恶性淋巴瘤的发病机制、侵袭、转移及实验治疗的研究。     

Stage 1 acute kidney injury is independently associated with infection following cardiac surgery

ObjectivesSevere acute kidney injury (AKI) is a known risk factor for infection and mortality. However, whether stage 1 AKI is a risk factor for infection has not been evaluated in adults. We hypothesized that stage 1 AKI following cardiac surgery would independently associate with infection and mortality.MethodsIn this retrospective propensity score–matched study, we evaluated 1620 adult patients who underwent nonemergent cardiac surgery at the University of Colorado Hospital from 2011 to 2017. Patients who developed stage 1 AKI by Kidney Disease Improving Global Outcomes creatinine criteria within 72 hours of surgery were matched to patients who did not develop AKI. The primary outcome was an infection, defined as a new surgical-site infection, positive blood or urine culture, or development of pneumonia. Secondary outcomes included in-hospital mortality, stroke, and intensive care unit (ICU) and hospital length of stay (LOS).ResultsStage 1 AKI occurred in 293 patients (18.3%). Infection occurred in 20.9% of patients with stage 1 AKI compared with 8.1% in the no-AKI group (P < .001). In propensity-score matched analysis, stage 1 AKI independently associated with increased infection (odds ratio [OR]; 2.24, 95% confidence interval [CI], 1.37-3.17), ICU LOS (OR, 2.38; 95% CI, 1.71–3.31), and hospital LOS (OR, 1.30; 95% CI, 1.17-1.45).ConclusionsStage 1 AKI is independently associated with postoperative infection, ICU LOS, and hospital LOS. Treatment strategies focused on prevention, early recognition, and optimal medical management of AKI may decrease significant postoperative morbidity.