一氧化氮在大鼠单侧睾丸扭转复位后对侧睾丸早期损伤中的作用

目的：了解单侧睾丸扭转后对侧睾丸早期的病理改变及组织中一氧化氮（NO）含量的变化，阐明NO与对侧睾丸早期损伤之间的关系。方法：将56只青春期前SD大鼠随机分为假手术组和扭转组，每组28只。假手术组将左侧阴囊打开分离暴露睾丸后，不予扭转，即将睾丸再固定于阴囊壁上，并缝合阴囊。扭转组则依Turner法建立左侧睾丸扭转模型，均于扭转4h后复位。两组分别于复位后1h、4h、24h、1周各处死大鼠7只，取右侧睾丸行一氧化氮合酶（NOS）活性、NO含量、丙二醛（MDA）含量检测及病理评分。结果：与假手术组比较，扭转组对侧睾丸的MDA含量、NO含量、NOS活性、病理评分等均有不同程度升高，且生精细胞层数结合精细小管直径所示的预后情况亦较差。结论：单侧睾丸扭转后对侧睾丸早期即可出现继发性损伤，过量NO在单侧睾丸扭转复位后对侧睾丸早期损伤中起主导作用。     

舒尼替尼及联合顺铂对小儿睾丸卵黄囊瘤荷瘤鼠模型的抗肿瘤作用

目的 探讨舒尼替尼(Sunitinib)、顺铂(CDDP)及两者联合用药对小儿睾丸卵黄囊瘤(TYST)异种移植荷瘤鼠模型的抗肿瘤作用及相关作用机制.方法 肿瘤标本来自本实验室的小儿睾丸卵黄囊瘤裸鼠第17代模型,并接种在雄性裸鼠单侧腹股沟皮下区,成瘤后随机分成4组(n=5):对照组、CDDP组、Sunitinib组和Sunitinib+CDDP组.绘制肿瘤体积和裸鼠体重变化曲线图,计算肿瘤消退率;HE染色观察肿瘤组织形态学变化;免疫组织化学法检测AFP、Ki-67、Glypican-3、CD105在各组肿瘤中的表达:CD105测定微血管密度(MVD),Ki-6表示细胞增殖率(PI);TUNEL法检测肿瘤细胞凋亡率(AI);实时荧光定量PCR(RT-qPCR)验证靶向因子的mRNA表达变化.结果 各治疗组均能显著抑制肿瘤生长,并能消退肿瘤体积.在治疗后肿瘤体积上,除顺铂组与舒尼替尼组间无统计学差异外(41.61±7.61比67.15±5.39,P＞0.05),其余各组间都有统计学差异:对照组与顺铂(651.72±121.16比41.61±7.61,P＜0.05),对照组与舒尼替尼组(651.72±121.16比67.15±5.39,P＜0.05),对照组联合舒尼替尼±顺铂组(651.72±121.16比23.03±2.37,P＜0.05),舒尼替尼组与联合舒尼替尼+顺铂组(67.15±5.39比23.03±2.37,P＜0.05),顺铂组与联合舒尼替尼+顺铂组(41.61±7.61比23.03±2.37,P＜0.05);在裸鼠体重上,相比对照组,除舒尼替尼组无统计学差异外(25.90±0.75比26.66±0.65,P＞0.05),其余各组间差异均有统计学意义:对照组与顺铂组(25.90±0.75比18.90±0.63,P＜0.05),对照组与联合舒尼替尼+顺铂组(25.90±0.75比18.26±1.20,P＜0.05);AFP、Glypican-3在各治疗组阳性表达面积(Pixels)均少于对照组(AFP:对照组与顺铂组,1.26×106土1.48×105比5.54×105±8.14×104,P＜0.05;对照组与舒尼替尼组,1.26×106±1.48×105比7.09×105±6.64×104,P＜0.05;对照组与联合舒尼替尼+顺铂组,1.26×106±1.48×105比3.62×105±4.83×104,P＜0.05.Glypican-3:对照组与顺铂组,9.68×105±7.63×104比4.04×105±5.04×104,P＜0.05;对照组与舒尼替尼组,9.68×105±7.63×104比4.59×105±2.32×104,P＜0.05;对照组与联合舒尼替尼+顺铂组,9.68×105±7.63×104比1.89×105±2.55×104,P＜0.05).两者在顺铂组与舒尼替尼组的比较中差异无统计学意义(P＞0.05);PI和AI在各治疗组中相比对照组,差异都具有统计学意义(PI和AI:对照组与顺铂组,58.97土1.38比42.36±1.28和1.69±0.20比54.62±2.49,P＜0.01;对照组与舒尼替尼组,58.97±1.38比43.48±1.00和1.69±0.20比47.32±2.00,P＜0.01;对照组与联合舒尼替尼+顺铂组,58.97±1.38比33.34±1.19和1.69±0.20比63.41土2.23,P＜0.01).顺铂组相比联合舒尼替尼+顺铂组,PI:P=0.001,AI:P=0.002;舒尼替尼组相比联合舒尼替尼+顺铂组,PI和AI:P＜0.001;顺铂组相比舒尼替尼组,PI.P=0.597,AI:P=0.059;RT-qPCR证实M-CSFR、PDGFR-β、RET、VEGFR-2的mRNA表达受到抑制.结论 Sunitinib能显著抑制小儿睾丸卵黄囊瘤的生长,并消退肿瘤体积:主要通过直接抑制肿瘤细胞的生长和肿瘤血管的新生,从而诱导肿瘤细胞凋亡,同时伴有直接细胞毒作用引起坏死;Sunitinib相比CDDP具有更轻的毒副作用,且联合CDDP具有增强抗肿瘤作用.

Abstract：

Objective To study the antitumor effects of Sunitinib or Sunitinib combind with cis - diamminedichloroplatinum (CDDP) on an athymic mouse human testicular yolk sac tumor xenograft model. Methods The athymic mouse human testicular yolk sac tumor xenograft model was established by subcutaneous injection of 17th passage pediatric testicular yolk sac tumor cells in the unilateral inguinal region of the male nude mice. The mice of control group didn't receive any treatment. The tumor bearing mice were treated with either CDDP, or Sunitinib group, or Sunitinib combined with CDDP. The tumor-bearing nude mice were divided into 4 groups (5 in each) according the treatment they underwent. The tumor volumes and mice weight were measured to calculate the regression rate of tumor. The tumor was collected for H&E staining and immunohistochemical staining of AFP, Ki-67,Glypican-3 and CD105. Microvessel density (MVD) was measured by analyzing the CD105 expression. The tumors' proliferation index (PI) was studied by analyzing Ki-67 expression. The apoptosis of the tumor was quantitated using TUNEL staining. The mRNA expressions of cytokines were determined by quantitative real-time PCR (RT-qPCR). Results The tumor volumes were significantly decreased after chemotherapy. No difference of tumor volume was found between CDDP group and Sunitinib group (41.61 ± 7. 61 vs. 67. 15 ± 5. 39, P＞0. 05). Significant differences of tumor volumes were found between CDDP group and CDDP+ Sunitinib group (41.61 ± 7. 61 vs. 23. 03 ± 2. 37, P＜0. 05), and between Sunitinib group and CDDP+ Sunitinib group (67. 15 ± 5. 39 vs. 23.03 ± 2. 37, P＜0. 05). Of the body weight of tumor-bearing mice, no difference was found between controls and Sunitinib group (25. 90 ± 0. 75 vs. 26. 66 ± 0. 65, P＞0. 05). And significant differences of the body weight were noted between controls and CDDP group (25.90 ± 0. 75 vs. 18. 90 ± 0. 63, P＜0. 05),controls and CDDP+ Sunitinib group (25. 90 ± 0. 75 vs. 18. 26 ± 1.20,P＜0. 05). The positive areas (pixels) of AFP in the mice with chemotherapy were less than those of control mice (Control vs. CDDP: 1.26 × 106±1.48 × 105 vs. 5. 54 × 105 ± 8. 14 × 104 , P＜0. 05. Control vs. Sunitinib: 1.26 × 106 ± 1.48 × 105 vs. 7. 09 × 105 ± 6. 64 × 104, P＜0. 05. Control vs. CDDP + Sunitinib: 1.26 × 106 ± 1.48 × 105 vs. 3. 62 × 105 ± 4. 83 × 104, P＜0. 05). The positive areas (pixels) of Glypican-3 in the mice with chemotherapy were less than those of control mice (Control vs. CDDP: 9. 68 × 105 ± 7. 63 × 104 vs. 4. 04 × 105 ± 5. 04 × 104 , P＜0. 05. Control vs. Sunitinib: 9. 68 × 105 ± 7. 63 × 104 vs. 4. 59 × 105 ± 2. 32 × 104 , P＜0. 05. Control vs. CDDP + Sunitinib: 9. 68 × 105 ± 7. 63 × 104 vs. 1.89 × 105 ± 2. 55 × 104, P＜0. 05). However, there were no statistical differences of the positive areas (pixels) of AFP and Glypican-3 between CDDP and Sunitinib groups (P＞0. 05). The PI was significantly decreased after chemotherapy (Control vs. CDDP: 58. 97 ± 1.38 vs. 42. 36 ± 1.28, P＜ 0. 01. Control vs.Sunitinib: 58. 97 ± 1.38 vs. 43. 48 ± 1.00, P＜0. 01. Control vs. CDDP+ Sunitinib: 58. 97 ± 1.38 vs.33. 34 ± 1.19, P＜0. 01 ). The apoptosis index (AI) was also significantly increased after chemotherapy (Control vs. CDDP: 1.69 ± 0. 20 vs. 54. 62 ± 2. 49, P＜0. 01. Control vs. Sunitinib: 1.69 ± 0. 20vs. 47. 32 ± 2. 00, P＜0. 01. Control vs. CDDP + Sunitinib: 1.69 ± 0. 20 vs. 63. 41 ± 2. 23, P＜0. 01). Significantly differences of PI and AI were found between CDDP and CDDP + Sunitinib groups (P＜0. 01 ), and Sunitinib and CDDP + Sunitinib (P＜0. 01 ). RT-qPCR study confirmed that the mRNA expressions of M-CSFR, PDGFR-β, RET and VEGFR-2 were decreased in the mice underwent chemotherapy. Conclusions Sunitinib is effective to suppress the pediatric testicular yolk sac tumor growth, and reduce the tumor volume. Sunitinib can inhibit the angiogenesis in tumor, induce apoptosis of tumor cells, and kill the tumor cells directly. Sunitinib is less toxic than CDDP, and synergistic with the antitumor effect of CDDP.     

过敏性鼻炎的治疗进展

过敏性鼻炎又称为变应性鼻炎,是常见病和多发病。通过概述近几年国内外治疗方法,从而明确各方法的优势和不足,完善过敏性鼻炎的治疗方案,指导临床应用。     

MRCP在小儿先天性胆总管囊肿术前诊断的临床价值

目的分析先天性胆总管囊肿(CCC)术前的影像学表现,并与需鉴别疾病相比较,旨在提高对本病的认识,避免误诊。方法对20例经过手术病理证实的CCC进行影像学分析,所有病例术前均行MRCP检查。结果男性4例,女性16例,年龄4～13岁,10岁以内发病为13例,胆管囊肿I型17例,IV型3例。所有病例均表现为肝内和(或)外胆管薄壁囊性扩张,最大直径3.5～25cm不等,其囊壁厚度不均,肿块无包膜。大多数形态呈类圆形(15/20),部分为梭型(5/20)。过半数患儿同时存在胆胰合流异常(11/20),部分合并胆囊结石(6/20),与术中所见相符合。术后病理与术前影像学诊断相符,并证实所有患儿均存在胆囊及囊肿壁的不规则增厚及炎性细胞浸润,提示存在慢性炎症。结论明确胆总管囊肿的部位、形态及并发症特点是进行诊断及鉴别诊断的首要条件,MRCP能无损伤地显示囊肿及周围组织的情况,并能准确提示包括胰胆管合流异常在内的各种合并症,能有效、安全地为临床医师做出术前评估。     

青春期前大鼠单侧睾丸扭转对健侧睾丸生精能力的影响

目的 观察青春期前大鼠一侧睾丸扭转后健侧睾丸在青春期前及青春期后的组织学改变以及精子生成情况,以推测大鼠成熟后的生殖能力.方法 取28只健康雄性SD大鼠,随机分为假手术组和扭转组,每组14只.假手术组将左侧阴囊打开分离暴露睾丸后不予扭转,再固定于阴囊壁上,并缝合阴囊.扭转组则依Turner法建立左侧睾丸扭转模型,于扭转4h后复位.两组大鼠分别于术后1、8周时各处死7只,取右侧睾丸标本,测定丙二醛(MDA)含量,并行组织病理学观察,同时取附睾尾部行精子计数及活动率测定.结果 与假手术组比较,术后1周时扭转组MDA含量明显升高(P＜0.05),术后8周时两组间MDA含量无明显差异(P ＞0.05);扭转组大鼠在术后1、8周时生精上皮层数、平均曲细精管直径、睾丸组织结构评分与假手术组的差异有统计学意义(P＜0.05),同时附睾精子密度与活动率明显下降(P＜0.05).结论 青春期前大鼠一侧睾丸扭转后,健侧睾丸组织损害明显,精子生成显著减少.     

应用DWI早期发现SD大鼠单侧睾丸扭转后对侧睾丸损伤的研究

目的证明单侧睾丸扭转后对侧睾丸存在损伤,寻找有效、无创的影像学方法了解对侧损伤情况。方法40只SD大鼠随机分为假手术组和扭转组,每组20只。二组于术后1h、4h、24h、1周各取5只行磁共振扩散加权成像（DWI）并记录表现扩散系数值,其后处死大鼠,取对侧睾丸行病理评分。结果与假手术组比较,扭转组对侧ADC值、病理评分等指标均有不同程度升高,且两者经Pearson法证实存在正相关。结论单侧睾丸扭转后,对侧睾丸早期即可出现损伤。DWI能有效、连续、无创地评估对侧损伤程度,可协助临床诊治。     

2型糖尿病肾虚证基因表达谱研究

目的结合表达谱芯片技术从2型糖尿病肾虚证入手进行研究探索肾虚因素在2型糖尿病发病作用。方法将中医肾虚证作为共性特征与糖尿病结合起来,设立肾虚证糖尿病组与非肾虚证糖尿病组,另设健康对照组为对照,以表达谱芯片研究手段,对其结果通过数据库进行分析,并选择差异明显的部分基因进行PCR检测验证。结果肾虚组与正常对照组相比,上调基因134条,下调1038条,肾虚组与非肾虚组比较,上调基因45条,下调61条。肾虚糖尿病与非肾虚糖尿病差异表达基因通过在GO数据库中搜索发现,主要归于三类:分子功能,细胞组成和生物学过程,涉及通路主要为白细胞内皮迁移过程,溶酶体作用,细胞的紧密连接作用等。荧光定量PCR检测结果初步确定基因CTNNB1、SMURF1、RUNX1T1在肾虚证糖尿病组中的表达水平与非肾虚证糖尿病组相比较,前者较后者具有表达上调的趋势,但差异不显著(P0.05)。结论糖尿病是一种与机体代谢机能紊乱相关的疾病,肾虚证是糖尿病人群的基础表现证型,肾虚证更多的是体现个体组织细胞结构及蛋白表达的差异表达,在细胞水平上的差异造就了肾虚证的证候。     

段渠治疗化妆品皮炎经验

吾师段渠教授,师从川派中医外科第四代传人艾儒棣教授,从事中医美容和中医外科临床、科研和教学工作20余年,对治疗各种外科疾病尤其损美性疾病有独到见解,经验丰富。笔者有幸跟随其学习,获益匪浅,现将其治疗化妆品皮炎的经验做一简要介绍。     

射频联合银质针治疗"顽固性腰腿痛"的护理体会

目的:总结65例射频热凝靶点联合银质针治疗顽固性腰腿痛患者的护理体会.方法:术前做好健康宣教,心理护理,物品准备;术中注意观察病情变化,严密配合医生,熟练操作设备,并做好针眼护理;术后督促患者进行功能锻炼,安抚患者情绪,并鼓励患者坚持治疗.结果:本组治疗优39例,良9例,可7例,无效10例.优良率73.8%.无不良事件发生.以上结果平均随访26.8月.结论:在"顽固性腰腿痛"的处置过程中,心理护理显得尤为重要.护理人员在熟悉治疗方案的基础上,配合医生及时解决患者的疑惑,突显人文关怀,可提高患者治疗的依从性,提高治愈率.     

日间手术模式下经大阴唇外侧隐匿切口入路治疗女孩腹股沟斜疝

目的探讨日间手术模式下经大阴唇外侧隐匿切口入路治疗女孩腹股沟斜疝的可行性及安全性。方法选择日间病房收治的40例经大阴唇外侧隐匿切口（大阴唇外侧入路组）和60例经传统腹股沟皮纹切口（传统入路组）行疝囊高位结扎术的女性腹股沟斜疝患儿为研究对象,比较两组患儿手术时间、切口长度、术中出血量、切口满意度、术后并发症及术后复发率。结果两组患儿手术时间、切口长度、术中出血量比较,差异均无统计学意义（均P＞0.05）。大阴唇外侧入路组切口满意度为100.0%,明显高于传统入路组的83.3%（P＜0.05）。两组患儿均未出现术后并发症;术后随访3个月~1年,均未见复发。结论日间手术模式下经大阴唇外侧隐匿切口入路治疗女孩腹股沟斜疝患儿安全、可行,且切口隐蔽、美观,可在临床推广。