Demarcation of arteriopulmonary segments: a novel and effective method for the identification of pulmonary segments

ObjectiveEach pulmonary segment is an anatomical and functional unit. However, it is fundamentally difficult to precisely distinguish every pulmonary segment using the conventional pulmonary intersegmental planes from computed tomography images. Building arteriopulmonary segments is likely to be an effective way to identify pulmonary segments.MethodsThe thoracic computed tomography images of 40 patients were collected. The anatomic structures of interest were extracted in the transverse, sagittal, and coronal planes using the semi-automated segmentation tools provided by Amira software. The intrapulmonary vessels were subsequently segmented and reconstructed. The distributions of the pulmonary arteries, veins, and bronchi were observed. In patients with pulmonary masses, the mass was also reconstructed.ResultsThe three-dimensional reconstructed images showed the branches of the pulmonary artery ramified up to their eighth order covering the entire lung as well as evident intersegmental gaps without pulmonary arteries. The segmental artery was closely accompanied by the segmental bronchi in 486 pulmonary segments (90% of total number of segments). The size and spatial location of the pulmonary mass within a pulmonary segment were also clearly visible.ConclusionsDemarcation of arteriopulmonary segments can be used to precisely distinguish every pulmonary segment and provide its detailed anatomical structure before pulmonary segmentectomy.     

输尿管镜电子动能碎石182例报告

目的：探讨输尿管镜下电子动能碎石术治疗输尿管结石的疗效。方法：对182例(198侧)输尿管结石患者采用输尿管镜下电子动能碎石术治疗。结果：一次性碎石成功率为95.0%(188／198)，并发症发生率为4.0%(8／198)，其中穿孔2侧。结论：输尿管镜下电子动能碎石术是治疗输尿管结石的一种安全、疗效确切的方法。     

Subthreshold oscillations generated by TTX-sensitive sodium currents in dorsal cochlear nucleus pyramidal cells

During intracellular recordings in rodent brainstem slice preparations, dorsal cochlear nucleus (DCN) pyramidal cells (PCs) exhibit characteristic discharge patterns to depolarizing current injection that depend on the membrane potential from which the responses are evoked. When depolarized from hyperpolarized potentials, PCs can respond with a short-latency action potential followed by a long silent interval (pauser) or a train of action potentials with a long latency (buildup). During the silent intervals in a pauser or a buildup response, the membrane potential slowly depolarizes towards spike threshold, often exhibiting distinct voltage oscillations of 1–2 mV before the first spike. The subthreshold voltage oscillations were investigated using whole cell recordings from DCN PCs in rat pup (P10–14) brainstem slices. The oscillations were unaffected by excitatory and inhibitory neurotransmitter antagonists, and were not temporally locked to the onset of the depolarization. The oscillations typically became larger as spike threshold was approached, and had a characteristic frequency between 40 and 100 Hz. In the presence of tetrodotoxin (TTX, 500 nM), the oscillations were significantly suppressed, and could not be evoked at any voltage below or above spike threshold. The oscillations were not blocked by phenytoin or Cd²⁺, but they were affected by prior activity in the neuron for approximately 1 s. We conclude that voltage-gated Na⁺ channels are required to generate membrane oscillations during the buildup phase. We suggest that the subthreshold oscillations play a role in controlling spike timing in PCs when the membrane potential slowly approaches, or hovers near, spike threshold.     

Prevalence of neutralizing antibodies to adenoviral serotypes 5 and 35 in the adult populations of The Gambia, South Africa, and the United States

One of the major limitations of the use of adenoviruses as gene therapy vectors is the existence of preformed immunity in various populations. Recent studies have linked failure of adenoviral gene therapy trials to the presence of antiadenoviral neutralizing antibodies (NAb). Understanding the distribution and specificity of such antibodies will assist in the design of successful recombinant adenoviral gene therapies and vaccines. To assess the prevalence of NAb to adenovirus serotypes 5 and 35 (Ad5 and Ad35), we analyzed serum samples from adult immunocompetent individuals living in The Gambia, South Africa, and the United States by using a neutralization assay. Serum samples were incubated with A549 lung carcinoma cells and adenoviruses encoding enhanced green or yellow fluorescent proteins; results were analyzed by fluorescence microscopy and flow cytometry. Using this technique, we found a high prevalence of NAb against Ad5 in Gambian, South African, and U.S. subjects at both low and high titers. Conversely, all subjects displayed a low prevalence of NAb to Ad35; when present, anti-Ad35 NAb were seen at low titers. Because of the ability of adenoviruses to elicit systemic and mucosal immune responses, Ad35 with its low NAb prevalence appears to be an attractive candidate vector for gene therapy applications.     

利用酵母双杂交技术筛选鉴定STCH与RanBP9的相互作用

以人应激和分子伴侣蛋白(STCH)为诱饵蛋白,利用酵母双杂交技术在高严格条件下筛选人脑cDNA文库。在SD/-4培养基上共获得156个阳性克隆,将酵母菌扩增后抽提质粒,转化大肠杆菌,进行序列分析,并经过回复杂交验证,潜在的与STCH相互作用的蛋白有:VDAC、MBP2、ZNF251、RanBP9、Phosophate glycolase、β-tubulin、up1、up2和WW adaptor蛋白。基于各候选蛋白与神经系统疾病的关系,选择RanBP9作进一步验证实验。经体外GST-Pulldown和体内免疫共沉淀实验证实RanBP9和STCH能够相互作用,明确RanBP9的羧基端为相互作用的最小功能域。此结果为我们进一步揭示STCH作用的分子机制提供了线索。     

二妙散对DBA/1小鼠胶原诱导型关节炎中Th17/Treg细胞分化的影响

目的 观察古代经典名方二妙散（EMS）对DBA/1小鼠胶原诱导型关节炎（CIA）中辅助性T细胞17（Th17）/调节性T细胞（Treg）分化的影响。方法 按体质量将20只DBA/1小鼠随机分为正常组、CIA组,EMS（5.4 g·kg^-1）组及甲氨蝶呤（MTX,0.5 mg·kg^-1）组。CIA组、EMS组及MTX组在第1天以等体积牛Ⅱ型胶原和完全弗氏佐剂免疫DBA/1小鼠,于第21天以等体积牛Ⅱ型胶原和不完全弗氏佐剂于尾根部有别于第1次免疫部位免疫DBA/1小鼠建立CIA模型（此为第2次免疫）,并于第2次免疫当天开始灌胃给药,除MTX为每周3次外,其余每天1次,共给药28 d。第22天开始观察CIA小鼠的关节红肿等症状并进行关节炎评分,第49天取材后,采用苏木素-伊红（HE）染色观察CIA小鼠关节滑膜炎症的情况;免疫荧光（IF）双标法检测CIA小鼠关节中CD4⁺T细胞中Th17细胞标志物白细胞介素-17（IL-17）和Treg细胞标志物叉头框转录因子P3（FoxP3）在关节滑膜中的表达情况;流式细胞术检测小鼠脾脏及淋巴结中Th17和Treg的细胞比例情况。结果 与正常组比较,CIA组小鼠关节滑膜炎症情况明显,小鼠关节结构严重紊乱,关节软骨及骨破坏明显,骨侵蚀严重（P<0.01）;小鼠关节组织中Th17/Treg值显著升高（P<0.01）;小鼠脾脏及淋巴结中Th17的细胞表达比例显著增高（P<0.01）,Treg细胞表达比例显著减少（P<0.01）;与CIA组比较,EMS组和MTX组两组小鼠关节结构均相对正常,骨侵蚀、骨破坏较轻,关节面相对完整光滑;EMS组和MTX组两组中Th17/Treg值显著降低（P<0.01）;小鼠脾脏及淋巴结组织中,EMS组、MTX组Th17细胞表达比例显著降低（P<0.01）,Treg细胞的表达比例显著增加（P<0.01）。结论 EMS通过调节Th17/Treg平衡,抑制CIA小鼠中Th17细胞的表达,促进Treg细胞的表达,进而治疗RA。     

全科医生社区卫生服务中的工作范畴与方式的探讨

社区卫生服务对象以老人、妇女、儿童为主 ,疾病所涉及的面广 ,以慢性疾病为主。我们选用全科医生从事此项工作 ,依靠三级甲等省级医院的技术优势 ,立足于本社区 ,开展预防保健 ,巡诊随访 ,开办家庭病房等项目 ,从心理护理到疾病治疗的整体服务方式。使儿童计划免疫率达 10 0 %。做好科普宣传 ,杜绝管区内甲类传染病的发生 ,为管区居民建立健康档案 ,沟通与居民的联系 ,做到小病在社区 ,大病到医院。在心脑血管急症发作时 ,可就地抢救后护送到省医院进一步治疗 ,由于抢救及时 ,使死亡率有所下降。对慢性疾病 ,开设家庭病房 ,在达到与住院相同治疗效果 ,减少病人的经济负担 ,同时也降低了病人再次住院率     

茯苓化学成分的研究

从茯苓的乙醚、乙醇萃取物中分得8个化合物。通过理化性质和光谱分析，Ⅰ～Ⅷ分别鉴定为3β－羟基－16-α－乙酸氧基－羊毛甾7，9（11），24－三烯－21－酸（Ⅰ），O－乙酰茯令酸（Ⅱ），3β－羟基－羊毛甾－7，9（11），24－三烯－21－酸（Ⅲ），β－香树脂醇乙酸酯（Ⅳ），O－乙酰茯苓酸－25醇（Ⅴ），O－乙酰茯苓酸甲酯（Ⅵ），茯苓酸甲酯（Ⅶ），ganodericacid（Ⅷ）。Ⅳ和Ⅷ系首次从裁等中分得，Ⅵ和Ⅶ系首次从天然产物中分得，Ⅰ和Ⅴ为2种新化合物。并首次报道了Ⅰ，Ⅱ，Ⅲ，Ⅴ，Ⅵ，Ⅶ的~(13)CNMR数据。     

新形势下医疗欠费成因及防范措施

近几年,医疗欠费逐年上升,已经成为制约医院发展的重要原因之一,本文通过对当前医疗欠费的外因和内因分析,探讨了政府、社会、医院、患方共同防范医疗欠费的措施,对在新形势下医院应对医疗欠费有一定的启发作用。     

A phase II randomized trial evaluating gefitinib intercalated with pemetrexed/platinum chemotherapy or pemetrexed/platinum chemotherapy alone in unselected patients with advanced non-squamous non-small cell lung cancer

Current pemetrexed/platinum chemotherapy does not produce a satisfactory therapeutic response in advanced lung cancer patients. The aim of this study was to determine whether the administration of gefitinib, a tyrosine kinase inhibitor (TKI), intercalated with pemetrexed/platinum could improve the efficacy in chemotherapy-naïve patients with advanced non-squamous NSCLC without subsequent gefitinib maintenance therapy. Treatment-naïve patients with stage IIIB or IV NSCLC were randomly assigned to receive pemetrexed (500 mg/m² d1) and either cisplatin (75 mg/m² d1) or carboplatin (AUC = 5 d1) plus gefitinib (250 mg/d on days 3 to 16 of a 3-week cycle) (PC-G) or pemetrexed–platinum (PC) alone. Randomization was stratified according to the tobacco smoking status and EGFR mutational status of the patients. The primary endpoint was the non-progression rate (NPR) at 12 weeks. Secondary endpoints included progression-free survival (PFS), overall response rate (ORR), overall survival (OS), and biosafety. The NPR at 12 weeks was 84.5% for the PC-G treatment arm and 83.1% for the PC treatment arm (P = 0.87). Median PFS was 7.9 months for the PC-G arm and 7.0 months for the PC arm (P = 0.57). The ORR was 50.0% for the PC-G arm and 47.4% for the PC arm (P = 0.78). Median survival was 25.4 mo for the PC-G arm and 20.8 mo for the PC arm (P = 0.54). The incidence of adverse events was similar between the two treatment arms, except for a higher incidence of skin rash with PC-G. Predefined subgroup analyses demonstrated that PC-G significantly increased the PFS compared with the PC regimen in patients with EGFR mutations (P = 0.017). Although gefitinib intercalated with pemetrexed/platinum chemotherapy did not improve the NPR at 12 weeks compared with chemotherapy, an improvement in the PFS for the intercalated treatment arm was seen in the subgroup of patients with EGFR mutations.