大肠重复癌MMR、p53、Bax、PCNA表达及微卫星不稳定性研究

目的探讨微卫星不稳定性 (MSI)在大肠重复癌与单发癌中的变化规律 ,及MMR、p5 3、Bax、PCNA表达与MSI的关系。 方法采用免疫组化、PCR SSLP法对 38例大肠重复癌患者的 5 1处癌灶及 35例单发大肠癌分别进行MMR、p5 3、Bax、PCNA表达的检测和 5个微卫星位点MSI检测。结果重复癌组复制错误阳性率为 5 3% (2 7/ 5 1) ,单发癌组为 17% (6 / 35 ) ,差异有显著性意义 (χ2 =11 2 5 ,P <0 0 1)。重复癌组中 ,RER 与MMR表达缺失有密切的相关性 ;RER 与 p5 3表达呈负相关 ;RER 组PCNA标记指数显著低于RER-组 ;RER 与低分化、近端大肠癌密切相关。结论MSI在大肠重复癌的发生上起着重要作用 ,MSI可作为预测大肠重复癌发生的重要标志。     

局部性尤文肉瘤综合治疗临床分析

目的　探讨局部性尤文肉瘤的综合治疗效果。方法　收集经综合治疗的 2 5例尤文肉瘤患者的临床资料 ,采用Kaplan Meier法进行分析、Logrank法检验 ,分析治疗方式和化疗周期对疗效的影响。结果　综合治疗局部性尤文肉瘤的有效率为 92 % (2 3 /2 5 )。治疗结束后病灶完全消退组患者的 1、3、5年生存率 (10 0 %、93 .8%和 81.3 % )明显高于病灶未完全消退组 (10 0 %、75 .0 %和 5 0 .0 % ) (均P <0 .0 5 )。行 6个周期化疗的患者 1、3、5年生存率 (10 0 %、93 .8%和 66.7% )高于 3个周期者 (88.9%、77.8%和 5 5 .6% ) (均P <0 .0 1)。局部采用手术或放疗对疗效无明显影响 (P >0 .0 5 )。结论　经综合治疗 ,局部性尤文肉瘤病灶完全消退者生存期明显延长 ,化疗周期的次数是影响疗效的重要因素。     

磨损微粒诱导的局部生物学反应

人工髋关节置换失败的主要原因是假体的无菌性松动。研究表明 ,这和假体长期磨损产生的微粒作用于周围的巨噬细胞而诱发的生物学反应有关。磨损微粒激活假体周围组织细胞释放前炎症介质 ,诱导破骨细胞的活化和分化 ,引发假体周围的骨溶解。充分地认识这个过程 ,对减少人工关节无菌性松动 ,延长假体使用寿命具有重要意义。     

Bone Mineral Density in the Proximal Femur and Contralateral Knee After Total Knee Arthroplasty

Osteoarthrosis (OA) is often associated with pain and disability, which are relieved after total knee arthroplasty (TKA), but the nature of bone changes associated with OA is controversial. We examined preoperative hip and contralateral knee bone mineral density (BMD) in patients requiring TKA and monitored the BMD changes postoperatively. Sixty-nine patients, scheduled to have TKA for osteoarthrotic knees, had both hips and contralateral knee BMD measured by dual-energy X-ray absorptiometry (DXA) at the time of operation (baseline) and at 1 yr after operation. X-rays of the knee joints were also taken to evaluate the severity of OA. Preoperatively, 27% and 38% of the patients had total hip BMD Z-score more than 1 SD in the operated side and contralateral hips, respectively. In all regions of interest (ROI), the mean baseline BMD of the affected side proximal femur was significantly lower than that of the contralateral side (p < 0.0005-0.019). The severity of OA was not associated with BMD. During 1-yr follow-up, the postoperative knee status and the physical activity of the patients (AKS score) improved. However, neither the hip nor the nonoperated knee BMDs increased. Knee OA is associated with significantly lower BMD values in the affected side compared with the contralateral hip, and these levels remained similar or decreased during a 1-yr follow-up. We conclude that improved mobility after TKA does not improve the effects of preoperative disuse-associated bone loss in the short term.     

中国原发性肝癌临床分期预测肝癌肝移植预后的临床研究

目的评价“中国原发性肝癌临床分期”对肝癌肝移植疗效的预测价值。方法对1993年4月至2003年1月我科59例采用肝移植治疗的肝癌病人临床资料进行回顾性分析,按中国原发性肝癌临床分期原则进行分期,比较各期间肝癌肝移植疗效。结果Ⅰb、Ⅱa、Ⅱb、Ⅲa和Ⅲb期移植术后1年生存率分别为83·33%、66·67%、50·00%、35·71%和16·67%,各期间术后累计生存率有统计学差异(P<0·01);Ⅰb~Ⅱb和Ⅲa~Ⅲb期移植术后1年生存率分别为66·67%和25·00%,2年生存率分别为45·71%和25·00%,两组间术后累计生存率有统计学差异(P<0·05)。结论中国原发性肝癌临床分期适用于肝癌肝移植术前分期。     

Clinical Observation on the Efficacy of Babaodan Combined with Interventional Therapy for Primary Hepatocellular Carcinoma

Objective To observe the clinical effect of Babaodan combined with transcatheter arterial chemoembolization （TACE） therapy for primary hepatocellular carcinoma. Methods Selected patients were randomly assigned to two groups. One group accepted TACE only and the other group accepted TACE and took 2 Babaodan capsules orally 3 times a day for 8 weeks. Results After 8 weeks＇ treatment, the size of the tumors and the alpha foetal protein （AFP） concentration in all the patients in the two groups diminished and was not significantly different between the two groups （P〉0.05）. The ratio of stability and improvement in the traditional Chinese medicine （TCM） syndrome was higher in the Babaodan plus TACE group than it was in the TACE only group （P〈0.05）. There were more complications in the TACE only group than in the Babaodan plus TACE group. The one-year survival rate in the Babaodan plus TACE group was higher than in the TACE group （P〈0.05）. Conclusion Babaodan can improve TCM syndrome, reduce complications and prolong survival of patients with primary hepatocellular carcinoma.     

TDP局部照射用于治疗儿童髋关节一过性滑膜炎的疗效观察

目的:探讨加速儿童髋关节一过性滑膜炎疾病的愈合.方法:随机性分析2005年1月～2006年4月共100例髋关节一过性滑膜炎患儿的治疗效果,把病人随机分为治疗组及对照组.治疗组按常规方法治疗加TDP灯局部照射,对照组仅按常规方法治疗.结果:治疗1周后,治疗组B超检查增厚滑膜厚度变化差值、关节腔间隙宽度变化值、关节腔积液好转率、"4"字试验阴性率均明显优于对照组(P＜0.05).结论:TDP灯用于治疗儿童髋关节一过性滑膜炎能加速疾病愈合,提高治疗效果.     

我国普及初级心肺复苏术（C PR）的倡议

初级心肺复苏术是针对呼吸心跳骤停的病人所采取的一种紧急抢救措施,不言而喻其关乎我们每个公民的生命.本文先给出心肺复苏术的概念,紧接着从各个方面剖析论述我国心肺复苏术的现状并给出对比资料和调研数据进一步为我们敲响了警钟,然后引出普及心肺复苏术这个主题并强调其必要性和可行性,同时唤醒了人们沉睡的意识,最后详细具体的给出各种改变我们落后现状实现普及心肺复苏术这个目标的措施.     

影响原发性肝癌肝移植治疗的预后因素分析

目的分析影响肝癌肝移植术后生存率和无瘤生存率的危险因素,探讨国内肝移植治疗肝癌的选择标准。方法对67例接受同种异位原位肝移植治疗的原发性肝癌病人的基本资料和肿瘤相关资料包括术前病情分级、血清AFP水平、术前辅助治疗以及肝癌大小、数目、pTNM分期、肿瘤恶性程度分级等因素进行单因素和多因素分析。结果术后1年、2年累积生存率为77%、67%,6个月和12个月无瘤生存率为66%和58%。单因素分析显示对肝癌肝移植术后累积生存率影响有统计学意义的因素为CHILD分级(MELD积分)和肝外大血管侵犯;多因素分析影响肝癌肝移植术后无瘤生存率有统计学义的因素是肿瘤大小、大血管侵犯和肿瘤分化程度。结论影响肝癌肝移植术后生存率的因素仍是术前患者肝功能状态。对存在大血管侵犯的肝癌患者需严格控制肝移植术适应证,而无血管侵犯的患者在选择肝移植治疗时肿瘤大小指标可较米兰标准适当放宽。     

后路小切口人工全髋关节置换治疗老年人股骨颈骨折

目的:观察后路小切口人工全髋关节置换术(小切口-THA)治疗老年股骨颈骨折的临床效果。方法:本组24例65岁以上股骨颈骨折患者,女13例,男11例;年龄65～78岁,平均73.4岁。均为外伤后股骨颈头下型骨折,位线差,其中Garden分型为Ⅲ型10例,Ⅳ型14例,全部应用后路小切口技术行全髋关节置换术。结果:术后所有病例随访10～24个月,平均13个月。平均手术时间80min,手术切口平均长8.0cm,平均输血300ml,无局部及全身并发症出现。按UCLA(UniversityofCaliforniaLosAngeles)髋关节功能评分标准,本组UCLA评分由术前平均(11.0±3.8)分升至术后平均(24.3±4.5)分(P<0.01)。本组优17例,良4例,一般3例,优良率为87.5%。结论:后路小切口技术具有创伤小、出血少、恢复快的特点,可获得与常规后路相同的治疗效果,尤其适合老年股骨颈骨折患者。