高尿酸血症状态下低度炎症的病理特点研究

目的：探讨高尿酸血症（HUA）状态下低度炎症的病理特点。方法：根据体质量随机将迪法克鹌鹑分为正常组、模型组,每组10只。以普通饲料：酵母浸膏粉=4:1制备食饵,并以该食饵喂养模型组鹌鹑,正常组鹌鹑则自由饮食饮水。分别于造模第10、20、30天检测血清尿酸,血清炎症介质白细胞介素-1β（IL-1β）、IL-33、IL-2、IL-13、IL-8、IL-17、IL-6、IL-10、IL-12/P40、IL-16、IL-21、C反应蛋白（CRP）、粒细胞巨噬细胞集落刺激因子（GM-CSF）、肿瘤坏死因子-α（TNF-α）、趋化因子CC配体2(CCL2)及γ干扰素（IFN-γ）、神经突起生长导向因子2（Netrin-2）、五聚蛋白3（Pentraxin 3）,观察各炎症介质强度变化;造模第30天,取鹌鹑肝、回肠、肾各脏器组织,进行HE染色后观察组织病理形态变化;造模第20天,用基因本体（GO）和京都基因与基因组百科全书（KEGG）富集分析差异炎症介质功能及相关信号通路;用Pearson相关性分析方法分析差异炎症介质与血清尿酸水平的相关性。结果：与正常组比较,模型组鹌鹑血清尿酸水平高（P<0.05）,以血清IL-17、IL-6、IL-33等为主的白细胞介素类,以IL-8、CCL2为主的趋化因子类,IFN-γ、TNF-α、CRP及GM-CSF水平均升高（P<0.05）,而IL-13、IL-10水平降低（P<0.05）。造模第20天,GO/KEGG富集分析结果显示,HUA状态下的低度炎症可能是尿酸代谢靶点群,通过IL-17、Janus激酶信号转导和转录激活因子（JAK-STAT）等信号通路激活、细胞因子-细胞因子间相互作用,从而诱导IL-6、TNF-α等炎症介质产生。2组组织病理变化结果显示,与正常组相比,模型组回肠组织黏膜下层可见炎性细胞浸润,肝、肾组织未见明显差异。差异炎症介质与血清尿酸水平的相关性分析结果显示,鹌鹑血清中IL-6、TNF-α、CRP、IL-33、IL-17、IL-8、IFN-γ、CCL2、GM-CSF、IL-1β、IL-2、IL-6水平均与血清尿酸水平正相关,IL-10、IL-13水平与血清尿酸水平负相关。结论：HUA鹌鹑模型存在低度炎症,该低度炎症可能与尿酸代谢靶点群通过IL-17、JAK-STAT等信号通路的激活以及细胞因子间的相互作用,从而调控IL-6、TNF-α等炎症介质的产生有关。     

High Resolution Anoscopy in the Planned Staged Treatment of Anal Squamous Intraepithelial Lesions in HIV-Negative Patients

Anal dysplasia (low-grade squamous intraepithelial lesions, LSIL; high-grade squamous intraepithelial lesions, HSIL) is a challenging disease for the surgeon. We reviewed 42 patients that underwent high-resolution anoscopy (HRA)-targeted surgical therapy of anal dysplasia in the past 10 years. Patients were followed up in the Anal Neoplasia Clinic with physical examination, cytology, HRA, and biopsy if indicated. Patients with disease amenable to local therapy were treated with office-based HRA-directed therapies. There were 30 men (mean age 39 years, range 21–63) and 12 women (mean age 50 years, range 31–71) included in the study. HSIL was present in 33, with four undergoing planned staged treatment due to circumferential disease. HSIL recurred in 45%, and most were re-treated successfully in-office. Progression to HSIL was seen in one patient with LSIL and to squamous cell carcinoma in one patient with HSIL despite therapy. No patients with LSIL had dysplasia at last follow-up. Minor complications occurred in three patients. HRA-targeted surgical therapy coupled with surveillance and re-treatment with office-based therapies offered an effective method in controlling anal dysplasia in the immunocompetent patient. Morbidity is minimal, and our progression to cancer rate is low (2.4%). Presented at the 48th Annual Meeting of the Society for Surgery of the Alimentary Tract, Washington DC, May 21, 2007.     

Cerebral neoplasms initially presenting with massive intracerebral hemorrhage

In three patients, clinically silent brain tumors led to massive intracerebral hemorrhage. These patients represented 0.6% of 497 consecutive patients with primary or secondary brain tumors and 2.5% of 119 patients with hypertensive or spontaneous intracerebral hemorrhage. Examination by computed tomography and angiography provided no evidence suggestive of the presence of neoplasms. All three patients were surgically treated and the lesions were histologically confirmed to be metastatic bronchogenic carcinoma, metastatic clear-cell carcinoma and low-grade astrocytoma, respectively.     

Chemotherapy for diffuse low-grade gliomas in adults

Diffuse low-grade gliomas (LGGs) in adults are progressive brain tumours that are radiologically characterized by slow and continuous growth that precedes anaplastic transformation. Standard treatment includes surgery and radiotherapy though the optimal timing of radiotherapy remains unsettled. Several retrospective and phase II studies have demonstrated that chemotherapy is also an interesting treatment option. However, several questions remain unanswered regarding its optimal use. The present review focuses on past, recent and ongoing developments in LGGs chemotherapy, including response assessment and potential predictive biomarkers of chemosensitivity.     

低级别胶质瘤合并癫痫患者手术治疗的临床疗效分析

目的探析采用外科手术治疗低级别胶质瘤合并癫痫患者的临床疗效及安全性。方法选取2009年2月-2012年3月间收治的60例低级别胶质瘤且合并有癫痫患者为研究对象,根据术中患者是否进行脑电监测对致癫痫的病灶进行有效处理进行分组,将患者分为治疗组与对照组,对照组患者20例,均进行单纯切除肿瘤手术治疗,治疗组患者40例,在切除肿瘤的同时对致癫痫的病灶进行有效处理。结果治疗组有效率为92．5％,高于对照组的80．0％,差异有统计学意义（P〈0．05）。结论采用手术治疗低级别胶质瘤合并癫痫患者过程中应尽可能将肿瘤全部切除,并且配合脑电监测对致癫痫的病灶进行有效处理,此术疗效较满意,值得临床推广应用。     

中药对小儿呼吸系统感染后长期低热的临床疗效观察

目的：探讨小儿呼吸系统感染后长期低热运用中药治疗的临床效果.方法：选取60例小儿呼吸系统感染后长期低热患者,随机将其分成对照组与实验组各30例,对照组采用吸氧、雾化与抗感染等常规治疗,实验组在对照组的基础上加用中药免煎颗粒剂治疗,比较两组临床疗效.结果：实验组的总有效率为93.3％,对照组总有效率为70.0％,两组比较差异有统计学意义（P＜0.05）.结论：中药免煎颗粒剂治疗小儿呼吸系统感染后长期低热疗效满意,值得临床推广应用.     

Malignant potential of pleomorphic xanthoastrocytoma

Pleomorphic xanthoastrocytoma (PXA) is a low-grade astrocytic tumour that occasionally progresses to a higher grade. We have extensively reviewed the literature on the potential for malignant transformation of PXA. An illustrative case of a PXA transforming to glioblastoma multiforme is presented.     

Optimal management of biopsy-proven low-grade gastric dysplasia

Gastric adenocarcinoma generally culminates via the inflammation-metaplasia-dysplasia-carcinoma sequence progression. The prevalence of gastric adenomas shows marked geographic variation. Recently, the rate of diagnosis of low-grade dysplasia(LGD) has increased due to increased use of upper endoscopy. Many investigators have reported that gastric highgrade dysplasia has high potential for malignancy and should be removed; however, the treatment for gastric LGD remains controversial. Although the risk of LGD progression to invasive carcinoma has been reported to be inconsistent, progression has been observed during follow-up. Additionally, the rate of upgraded diagnosis in biopsy-proven LGD is high. Therefore, endoscopic resection(ER) may be useful in the treatment and diagnosis of LGD, especially if lesions are found to have risk factors for upgraded histology after ER, such as large size, surface erythema or depressed morphology. Fatal complications in endoscopic submucosal dissection(ESD) are extremely low and its therapeutic and diagnostic outcomes are excellent. Therefore, ESD should be applied preferentially instead of endoscopic mucosal resection.