γ-氨基丁酸B型受体对结肠癌HCT116细胞周期的影响

目的利用人结肠癌细胞株HCT116细胞为研究模型,探究γ-氨基丁酸B型受体（GABABR）/糖原合成激酶3β（GSK-3β）/核转录因子（NF-κB）信号通路对结肠肿瘤细胞HCT116周期的影响,明确GABABR调控结肠癌细胞增殖的机制。 方法使用人结肠癌细胞株HCT116细胞为模型,构建针对GABABR的shRNA,流式细胞仪检测不同刺激条件下HCT116细胞周期分布,四甲基偶氮唑盐微量酶反应比色法（MTT）、5-溴脱氧尿嘧啶核苷（Brdu）法检测细胞的增殖能力变化。 结果GABABR可调控HCT116细胞的增殖。GABABR激动剂巴氯芬将HCT116细胞滞留在G1期,GSK-3β激动剂wort能逆转巴氯芬对结肠癌的该作用;GSK-3β抑制剂SB216763处理后,HCT116细胞增殖得到抑制,而NF-κB激动剂PMA可以阻断此作用;NF-κB激动剂PDTC能够回救敲低GABABR所引起的HCT116细胞增殖抑制,Akt抑制剂MK-2206 2HCl能逆转巴氯芬、SB216763对HCT116细胞增殖的抑制作用。 结论GABABR/GSK-3β/NF-κB信号通路可以调控结肠癌细胞增殖,通过抑制GSK-3β的活性,抑制NF-κB信号通路的激活,将HCT116细胞滞留在G1期。GABABR/GSK-3β/NF-κB信号通路可以作为临床预防和治疗结肠癌的潜在药物靶点之一。     

Gamma 3型髓内钉和动力髋螺钉内固定治疗高龄股骨粗隆间骨折的临床研究

目的探讨Gamma 3型髓内钉(Gamma 3钉)和动力髋螺钉(DHS)内固定治疗高龄股骨粗隆间骨折的临床效果。方法对82例高龄(年龄大于75岁)股骨粗隆间骨折采用手术治疗,其中44例采用Gamma 3钉内固定(Gamma 3钉组),38例采用DHS内固定(DHS组)。比较两组手术时间、术中出血量、术前和术后1周肌酸激酶、术后髋关节Harris评分。结果 Gamma 3钉组平均手术时间、术中出血量、术后7 d血清肌酸激酶含量较DHS组低,差异有统计学意义(P<0.05)。Gamma 3钉组术后1周、6个月Harris评分较DHS组高,但术后12个月两组差异无统计学意义(P>0.05)。结论Gamma 3钉较DHS在内固定治疗高龄股骨粗隆间骨折时具有手术时间短、出血少、创伤小、术后短期恢复快的优点。两种内固定术后都能够获得良好的骨折愈合和远期临床治疗效果。     

Extravascular chest wall technetium 99m diethylene triamine penta-acetic acid: implications for the measurement of renal function during renography

Measurement of individual kidney glomerular filtration rate (IKGFR) from the gamma-camera technetium 99m diethylene triamine penta-acetic acid (^99mTc-DTPA) renogram requires a continuous measurement of arterial activity. This is usually based on a region of interest (ROI) placed over the cardiac blood pool on the posterior view, with the assumption of negligible contamination from activity in the extravascular space of the chest wall. By injecting a small dose of technetium 99m human serum albumin (HSA) before the^99mTc-DTPA in 12 patients undergoing routine renography, the contribution of extravascular activity to the total signal recorded over the cardiac blood pool was calculated to be 11.0% (SE 2.1%) 1.5 min after DTPA injection, rising to 35.1% (SE 2.5%) at 15 min. Subtraction of the time-activity curve recorded from a ROI of the same size over the right lung generated a pure blood signal as shown by almost identical HSA/DTPA signal ratios recorded in blood samples taken 5 min after HSA and 15 min after DTPA and from the gamma-camera at the corresponding times. The effect of using a cardiac blood pool time-activity curve uncorrected for extravascular activity was to overestimate IKGFR by an average factor of 1.17 (SE 0.03). Offprint requests to: A.M. Peters     

氚水诱发小鼠胎肝嗜多染红细胞微核细胞率变化的比较研究

本研究选用10～12周龄NIH小鼠, 妊娠10天对每天以恒定剂量分别接受氘永和⁶⁰Coγ射线照射, 连续照射3天。停照后12小时脱颈椎活杀孕鼠, 制备胎肝涂片, 计数嗜多染红细胞(PCE)微核细胞率。     

伽玛刀照射后正常大鼠脑形态学变化的观察

为研究伽玛刀照射后正常大鼠脑组织形态学变化与时间和剂量的关系，并探讨晚期放射性坏死的发生机制，以大鼠右侧尾状核头部为照射靶点，伽玛刀照射剂量分别为20、50、75、160Gy，准直器直径4mm，应用HE、Nissl、Luxol Fast Blue染色和免疫组化方法观察从伽玛刀照射开始到晚期坏死发生过程中的形态学变化。结果显示，在晚期坏死灶出现之前的潜伏期内，靶区内病变主要包括两个方面：①微血管系统改变，即毛细血管增生、微血管腔扩张、管壁增厚、血管周围组织间隙水肿；②星形胶质细胞肥大、增生。研究表明，大鼠靶区内的形态学变化具有时间和剂量依赖性，微血管系统改变和星形胶质细胞的损伤都可能导致晚期坏死的发生。     

Experience in the use of the long Gamma nail for 16 femoral shaft fracture that have occurred following initial Asian Pacific Gamma nail fixation for pertrochanteric fractures

From January 1993 to September 2002, 931 patients suffered from intertrochanteric fracture and subrochanteric fracture received open reduction and internal fixation with APGN in our institute. Among these patients, 16 patients (1.7%) developed a femoral shaft fracture after the initial fixation with APGN. Removal of the APGN, closed reduction and fixation with long Gamma nail (LGN) was performed in all the 16 patients. The patients were followed for 12-60 months (average, 39.8 months). The union time of fracture was 12-24 weeks (average, 18.5 weeks) for femoral shaft fractures and 12-20 weeks (average, 16 weeks) for peritrochanteric fractures. Two early complications were noted, including one superficial (6%) infection and one deep (6%) infection. Two malunions (12.5%) developed with no definite functional impairment. The functional results using the Harris hip score were good to excellent. In conclusion, closed reduction and internal fixation with a LGN is very effective in the management of a femoral shaft fracture, a complication of a previous APGN that had been initially used for stabilisation of a pertrochanteric fracture.     

γ刀照射三叉神经的剂量-效应关系研究

目的 探讨伽玛刀不同剂量照射大鼠三叉神经(感觉根)后对照射范围内三叉神经组织的损伤以及对周围临近脑干组织和脑桥的影响,为优化伽玛刀照射剂量提供理论依据。方法 选用成年雄性SD大鼠65只,分别以不同照射剂量(20、40、80、160 Gy)照射三叉神经,观察照射后1周、2周、4周大鼠行为学变化,取全脑组织进行HE、Nissl、MAPLC3B、53BP1、XRCC1染色观察细胞形态学和自噬以及DNA损伤和修复等变化。结果 所有剂量组照射大鼠均存活。20和40 Gy组均无行为学和病理学改变;80和160 Gy组均出现了照射部位毛发脱落;HE、Nissle、LC3B、53BP1及XRCC1染色发现,受照部位组织在80和160 Gy照射后,可见神经元细胞固缩、膨胀,神经元细胞发生自噬以及DNA损伤明显,160 Gy组DNA损伤明显加重。40 Gy照射后,神经元发生DNA损伤修复的程度较其他剂量增高。结论 伽玛刀照射三叉神经根对神经元有明显的剂量-效应关系。     

Repeated treatment of vestibular schwannomas after gamma knife radiosurgery

Purpose  When gamma knife radiosurgery (GKS) does not achieve control of the growth of a tumour, the need to repeat treatment is considered. The results and risks of repeat treatment of patients with a vestibular schwannoma were reviewed to assess its efficacy and safety. Methods  Between 1992 and 2001, we treated 351 patients with a vestibular schwannoma by GKS, control of the growth of the tumour was not achieved in 32. 26 patients underwntrepeat GKS and five patients had an open microsurgical operation and one stereotactic aspiration of a tumour cyst. Results  Twenty-four of 26 patients were followed up after the repeat GKS for a median of 43 months. 15 tumours became smaller, seven remained unchanged and two enlarged. After the second GKS one patient’s hearing deteriorated, one developed facial weakness and three facial spasms. One patient required insertion of ventriculo-peritoneal drainage. An operation to radically resect the tumour was performed in five patients after the first GKS and for a subtotal removal in one after repeated GKS. Conclusions  In the small proportion of patients (9%) in whom initial GKS does not control the growth of a vestibular schwannoma, most can be controlled by further GKS with a very low risk of a complications.     

股骨粗隆间骨折3种不同手术方式的病例对照研究

目的：分析单边外固定支架、动力髋螺钉（dynamic hip screw,DHS）与Gamma钉内固定治疗股骨粗隆间骨折的疗效,为临床选择适当的治疗方法提供依据。方法：2001年1月至2006年10月,采用单边外固定支架、DHS、Gamma钉内固定3种方法治疗198例股骨粗隆间骨折患者。采用回顾性方法,分析临床资料及疗效。其中单边外固定支架固定治疗（单边外固定支架组）51例,DHS内固定治疗（DHS组）57例,Gamma钉内固定治疗（Gamma钉组）90例,经门诊复诊及通讯方式随访。从骨折愈合、负重时间、并发症发生率、手术过程、平均住院时间及髋关节功能恢复情况（优良率）等方面对3种不同治疗方法进行比较评价,并作统计学分析。结果：3组病例均获随访,随访时间8～51个月,平均36个月。骨折愈合时间比较,差异无统计学意义（P〉0.05）;负重时间及并发症比较,差异有统计学意义（P〈0.05）。3种方法中,切口长度以DHS组最长,单边外固定支架组最短;手术时间DHS组最长,单边外固定支架组最短;出血量以DHS组最多,单边外固定支架组最少;引流量以DHS组最多,单边外固定支架组最少;Gamma钉组适中。平均住院时间3组比较差异无统计学意义（P〉0.05）。髋关节功能比较,Gamma钉组优于DHS组（P〈0.05）和单边外固定支架组（P〈0.01）。结论：Gamma钉治疗股骨粗隆间骨折,负重时间早,髋关节功能恢复好,并发症率低,是治疗粗隆间骨折的较好方法。     

Does an additional antirotation U-Blade (RC) lag screw improve treatment of AO/OTA 31 A1-3 fractures with gamma 3 nail?

IntroductionPoor bone quality and unstable fractures increase the cut-out rate in implants with gliding lag screws. The U-Blade (RC) lag screw for the Gamma3^® nail was introduced to provide monoaxial rotational stability of the femoral head and neck fragment. The purpose of this study was to evaluate whether the use of the U-Blade (RC) lag screw is associated with reduced cut-out in patients with OTA/AO 31A1-3 fractures.Material & methodsBetween 2009 and 2014, 751 patients with OTA/AO 31A1-3 fractures were treated with a Gamma3^® nail at our institution. Out of this sample 199 patients were treated with U-blade (RC) lag screws. A total of 135 patients (117 female, 18 male) with standard lag screw (treatment group A) were matched equally regarding age (±4 years) sex, fracture type and location to 135 patients with U-blade (RC) lag screw (treatment group B). Within a mean follow up of 9.2 months (range 6–18 months) we assessed the cut-out rate, the calTAD, lag screw migration, the Parker's mobility score and the Parker’s ratio at postoperatively, six and 12 months following surgery. Furthermore we recorded all complications, ASA-Score, hospital stay and duration of surgery retrospectively.ResultsThe most common fracture among group B with a cut-out of the lag screw were AO/OTA 2.3 and 3.2 fractures whereas in group A cut-out was most commonly seen in AO/OTA 2.1, 2.2 and 2.3 fractures, there was no significant reduction of the cut-out rate in group B 2.2% (n = 3) compared to group A 3.7% (n = 5). The duration of surgery was significantly shorter in group A (p < 0.05). There was no significant difference in lag screw placement, the Parker’s ratio and mobilization.ConclusionIn our study the U-Blade (RC) lag screw did not reduce the cut-out in treatment of OTA/AO 31A1-3 fractures at all. Considering the longer duration of surgery and the higher costs of the U-Blade (RC) lag screw, our results do not justify its use. However, further prospective randomized studies will be necessary.