基于人工智能的骨龄辅助评价系统对四川地区完全性生长激素缺乏症患儿骨龄研究

目的 探讨采用基于“人工智能(AI)的骨龄辅助评价系统(上海初云医疗科技有限公司与四川大学华西第二医院合作开发)”(以下简称为AI系统)对完全性生长激素缺乏症(CGHD)患儿诊断及骨龄评价准确性。方法 选择2014年7月至2019年11月,于四川大学华西第二医院确诊的66例来自四川地区CGHD患儿为研究对象,纳入研究组。选择同期于病例收集医院儿童保健科进行骨龄测定的67例来自四川地区身高达标儿童作为对照,纳入对照组。对每例受试儿进行左手腕关节正位X射线摄片骨龄测定,由2位医师采用《TW₂骨龄评分法中国未成年人南方标准》(以下简称为TW₂CHN)》与《TW₃骨龄评分法标准》(以下简称为TW₃),盲法评价受试儿TW₂CHN-桡、尺、掌指骨(RUS)与TW₂CHN-腕骨(carpal)、TW₂CHN-20、TW₃-RUS及TW₃-carpal骨龄(以下简称为5种传统骨龄),以及以同性别、年龄身高达...     

人血清催乳素的放射免疫测定

利用本室标记的人催乳素,采用非平衡温育程序,对238例正常成人血液催乳素进行了测定。不同性别、年龄组间未见明显差别,总均值18.9ng/ml,m±2SD范围0.5～37.3 ng/ml。对292例不同病理状态者血样进行了测定,Klinefelter氏综合征Sheehan氏综合征、侏儒症、糖尿病(Ⅰ型及Ⅱ型),续发性闭经、Cushing氏综合征等,血催乳素均在正常范围。男性女乳、甲状腺低功、不孕症、泌乳闭经综合征、垂体瘤等,血液催乳素显著增高。正常人在应激状态时血催乳素亦显著升高。     

冷适应过程中大鼠脑垂体、下丘脑和血浆生物活性肽的变化及其对免疫功能的影响

我们采用RP-HPLC方法研究了SD纯系雄性大鼠冷适应期间脑垂体(P)、下丘脑(HT)和血浆(BP)生物活性肽变化。冷适应期间P、HT和BP肽类(MW≤30000)RP-HPLC图谱均出现一些新的肽洗脱峰。而且,所有这些肽类都能增强淋巴细胞(LC)转化活性。在P和HT肽类刺激下,脾LC[~3H]-TdR参入分别增加725 cpm(P<0.01)和1274 cpm(P<0.001)。将这些肽类进一步经Sep-Pack C_(18)柱纯化后仍分别增加[~3H]-TdR参入cpm值597(P<0.05)和333。这些结果表明了免疫系统(ImS)与神经内分泌系统(NES)双向调节环路的一个方面:NES作用于ImS。     

PTTG、p16和cyclinD1的表达与垂体腺瘤侵袭性的关系

目的通过对垂体腺瘤中垂体瘤转化基因(pituitarytumortransforminggene,PTTG)、周期素依赖激酶抑制因子p16(cyclin-de-pendentkinaseinhabitor,p16Ink4)mRNA和蛋白以及细胞周期素D1(cyclinD1)蛋白表达的检测和相关性比较,探讨PTTG、p16和cyclinD1的表达与垂体腺瘤细胞周期调控和侵袭性之间的关系。方法将30例垂体腺瘤手术标本分为侵袭组和非侵袭组,采用RT-PCR法检测PTTG和p16mRNA的表达,免疫组化检测PTTG、P16和cyclinD1蛋白的表达,分析侵袭组和非侵袭组PTTG、p16和cyclinD1表达水平的差异和相关性。结果在垂体腺瘤中,p16mRNA表达缺失或低下的发生率为73.3%,以p16mRNA缺失和表达分组,PTTGmRNA的表达水平在垂体腺瘤p16mRNA缺失组和表达组之间无显著性差异;侵袭组垂体腺瘤的PTTG、cyclinD1蛋白表达较非侵袭组显著性增高;且二者表达程度呈正相关;P16蛋白的表达在侵袭组垂体腺瘤显著减低,并与PTTG和cyclinD1蛋白表达程度呈负相关。结论p16mRNA在垂体腺瘤表达的缺失或低下与垂体腺瘤侵袭性无关。PTTG、p16和cyclinD1蛋白表达的差异与细胞周期调控相关,可作为垂体腺瘤侵袭性的评估指标。     

Gender differences in the expression of galanin and vasoactive intestinal peptide in oestrogen-induced prolactinomas of Fischer 344 rats

We have previously described a sexual dimorphism in oestrogen-induced anterior pituitary tumorigenesis in Fischer 344 rats, with female tumours averaging twice the size of those of males. Neonatal androgenization of female Fischer 344 rats with 100 micro g of testosterone propionate reverted that effect, causing a 'male-like' phenotype. The peptides galanin and vasoactive intestinal peptide (VIP) are possible mediators of oestrogen effects on the anterior pituitary, including hyperprolactinemia and lactotroph proliferation. To further extend our previous findings, we investigated the expression of galanin and VIP in the anterior pituitary of control and oestrogenized male, female and neonatally androgenized female Fischer 344 rats. At 3 months of age, rats were deprived of their gonads and divided into control and diethylstilbestrol (DES)-treated groups. In the anterior pituitary of control rats, galanin and VIP immunoreactive cells were absent. However, in DES-treated rats, pituitaries from normal ovariectomized females showed higher number of galanin and VIP positive cells than pituitaries from neonatally androgenized ovariectomized females and gonadectomized males. This pattern correlated with changes in anterior pituitary weight and serum prolactin. Our study suggests that sexual differences in oestrogen-induced pituitary tumorigenesis could be due to the differential expression of galanin and VIP. Furthermore, our data support the fact that neonatal exposure to androgens, as in normal males and androgenized females, may condition the response of the pituitary gland to oestrogens in adult life.     

右美托咪定联合硝酸甘油在经鼻微创垂体瘤切除术的应用效果

目的:研究右美托咪定在经鼻微创垂体瘤切除手术的临床应用,评价其有效性、安全性及实用性。方法:将择期全麻经鼻微创垂体瘤切除术患者40例,随机均分成D组与C组。D组为右美托咪定组,麻醉诱导前10 min微量注射泵静脉输注负荷剂量1 μg·kg-1·10 min-1,10 min后以0.4 μg·kg-1·h-1泵速维持;C组为对照组,按照相同的方式输注0.9%氯化钠注射液。所有患者应用硝酸甘油,将平均动脉压维持于60~70 mmHg;微量注射泵静脉输注丙泊酚,并在脑电双频指数监测下,调整泵注速度,维持脑电双频指数40~50。观察患者不同时刻血压、心率的变化,记录术中Fromme术野质量评分、手术时间与出血量、丙泊酚及硝酸甘油平均用药量,记录术后患者自主呼吸恢复时间、苏醒时间、清醒拔管时间,拔管时、拔管后1 h及2 h的Ramsay镇静评分以及拔管后2 h内寒战、过度镇静的发生情况。结果:与C组比较,D组出血量少、Fromme术野质量评分较低、手术时间缩短(P<0.05~P<0.01),且控制性降压期间的心率较低(P<0.01),气管插管、拔管时平均动脉压及心率波动小,血流动力学较平稳(P<0.01);D组较C组的丙泊酚及硝酸甘油的平均用药量均显著降低(P<0.01);2组术后苏醒时间及拔管时间差异均无统计学意义(P>0.05);D组患者在拔管时刻的Ramsay镇静评分高于C组(P<0.01),拔管后1 h的Ramsay镇静评分低于C组(P<0.05),拔管后2h,2组的Ramsay镇静评分差异无统计学意义(P>0.05);拔管后2h内,D组患者的寒战发生率低于C组(P<0.05)。结论:右美托咪定联合硝酸甘油用于经鼻微创垂体瘤切除术,能显著改善术野评分,缩短手术时间;同时可有效维持血流动力学稳定,术后镇静效果好且无过度镇静现象,具有临床有效性、实用性与安全性。     

垂体腺瘤放射治疗后继发鞍区纤维肉瘤1例并文献复习

目的探讨垂体腺瘤放射治疗后继发鞍区纤维肉瘤的临床及病理学特点。方法对1例垂体腺瘤手术加放射治疗后8年继发纤维肉瘤患者的临床及病理学特点进行分析,并结合文献复习进行讨论。结果继发肿瘤经蝶窦手术切除,术后病理学检测证实为高分化纤维肉瘤(NCI分级Ⅰ级)。术后患者临床症状得到显著缓解,但1年后复发,病理类型为低分化纤维肉瘤(NCI分级Ⅲ级),恶性度升高。免疫组化结果示肿瘤细胞Vimentin(+),pan-CK(-),S-100(-),SMA(-),GFAP(-),CD117(-),GH(-),PRL(-),LH(-),FSH(-),TSH(-),ACTH(-)。结论垂体腺瘤放射治疗后可继发鞍区纤维肉瘤,但比较罕见,诊断须有严格的标准。接受过放射治疗的患者若突然出现新的临床症状或影像学提示有颅内占位时需考虑放射治疗后继发肿瘤的可能。继发肿瘤易复发,预后较差。     

让垂体瘤的治疗更趋完善

垂体瘤患者术后进行垂体功能的评估可以及时地对垂体功能减退者进行合适的替代治疗.但我们当前的临床现实是能够接受恰当的术后评估的患者还不到50％.只有加强内分泌科与神经外科医师的技术互补协作以及三级医院医师和基层医院医师的密切联系,提供以患者为中心的治疗才能弥补当前垂体瘤治疗存在的缺陷.     

Effect of long-term physical training on plasma testosterone,androstenedione, luteinizing hormone and sex-hormone-binding globulin capacity

The effect of 6-months' physical training on plasma testosterone, androstenedione and luteinizing hormone levels and the binding capacity of sex-hormone-binding globulin (SHBG capacity) were studied in thirty-nine army recruits. Highly significant increases in mean plasma testosterone (21 %), androstenedione (25%) and LH (25%) were observed during the training period and were associated with a mean 16% increase in the estimated maximal oxygen uptake. The mean increases in hormone levels tended to be greater in the well conditioned group than in the poorly conditioned group. The mean ratio of testosterone to SHBG capacity increased by 32% (P<0.05), which may be in relationship with the various training-induced effects.