ERCP训练模型的现况与问题及未来发展设想

内镜逆行胰胆管造影术（ERCP）是临床上常用的胆胰系统疾病的诊断方法和治疗手段。为了缩短训练期限和减少因操作问题产生的手术并发症的发生,操作者需要通过训练模型大量训练才能达到能够独立完成1次手术的水平。在此,笔者总结分析了目前国内外投入使用的模型类型的现状与存在的问题：机械模拟操作模型和计算机模拟模型具有灵活性、可视性等特点,适合初学者了解操作流程,但真实性不如其他模型;活体动物模型具有可以进行完整的操作训练和并发症的处理的优点,但价格相对昂贵,且没有完全匹配人体结构适合训练的动物品种;离体动物模型价格低廉,具有较好真实性,适用于进阶学习与初步开展并发症的应对训练。最后,笔者根据不同模型的特点,创新性提出一种阶段性联合ERCP训练方案—五阶段法,并提出ERCP训练模型发展迭代的新方向。     

佛波酯对人视网膜神经母细胞瘤Y79细胞株表达CD133的调节作用

目的研究佛波酯（PMA）对人视网膜神经母细胞瘤表达CD133的影响。方法以人视网膜神经母细胞瘤Y79细胞株为研究对象,采用流式细胞术、RT-PCR方法检测PMA刺激后Y79细胞株CD133的表达。结果5ng／ml PMA显著增加CD133的表达,其作用在PMA刺激48h后最为明显。但与此同时,CD133mRNA表达较刺激前明显下降。H-7抑制PMA对Y79细胞的作用。结论PMA能够诱导人视网膜神经母细胞瘤Y79细胞株CD133蛋白表达增加。这一作用主要通过活化蛋白激酶C（PKC）通路来实现,而CD133抗原表达可能是转录后进行调节。     

hrHPV阳性TCT阴性的妇女2年后随访研究

目的评估北京社区中高危型人乳头瘤病毒(hight risk human papillomavirus,hrHPV)阳性、宫颈细胞学(thinprep cytology test,TCT)阴性的已婚女性患者2年后hrHPV感染的转归及引起宫颈病变的发生、发展情况。方法对筛查为hrHPV(+)/TCT(-)的女性患者2年后进行随访,重复行妇科检查、细胞学检查、宫颈组织病理学检查及hrHPV检测。计算HPV清除率、持续感染率,分析影响因素,评估2年后宫颈病变发生、发展情况。结果hrRHPV(+)/TCT(-)的妇女2年后随访,62.5% hr HPV被清除,37.5%持续感染;68.2%宫颈组织学正常,24.0%发生宫颈上皮内瘤样病变Ⅰ级(cervical intraepithelial neoplasia,CINⅠ),7.8%发生CIN Ⅱ及以上宫颈病变。CIN Ⅱ及以上宫颈病变者100%存在hrHPV持续感染。合并细菌感染的女性与无细菌感染者相比2年后HPV转归(χ²=2.84,P=0.092)及宫颈病变发生率差异无统计学意义(χ²=0.93,P=0.628)。结论HPV的持续感染是宫颈病变发生的重要因素,无论TCT结果如何,hrHPV都可能引起宫颈病变的发生发展。检测短期内hrHPV感染的持续性对于临床评价hrHPV感染引起的CINⅡ~Ⅲ风险是很有意义的。     

粒细胞集落刺激因子受体在非小细胞肺癌中的表达及意义

目的 研究粒细胞集落刺激因子受体(G-CSFR)在qP4,细胞肺癌(NSCLC)中的表达及在NSCLC发生、发展中的作用.方法 应用免疫组化SP法检测35例NSCLC及9例肺良性病变组织中G-CSFR的表达;PI单标流式细胞术检测肺腺癌细胞株A549上G42SFR的表达;BRDU标记法检测rhG-CSF对A549细胞的增殖影响及Annexin V-FITC/PI法检测细胞的凋亡.结果 NSCLC中有明显的G-CsFR蛋白表达,并高于肺良性病变组织(P<0.05);G-CSFR 阴性表达与年龄、性别及肿瘤病理分期无关,而与肿瘤大小有关(P<0.05).A549细胞高表达G-CSFR;rhG-CSF对A549细胞的增殖无明显影响,但可抑制其凋亡.结论 G-CSFR在NSCLC中的表达较肺良性病变组织明显上调,G-CSFR的阳性表达与肿瘤大小有关,其表达可能对肿瘤细胞的凋亡有抑制作用,进而促进肿瘤的发生发展.     

Knowledge of Cervical Cancer Among 25–54-Year-Old Women in Beijing

The purpose of this study is to examine knowledge of cervical cancer and the relationship between knowledge of human papillomavirus (HPV) infection and cervical disease in a largely representative Beijing population. A questionnaire-based survey was conducted in a Beijing population sample of married women ages 25 to 54 years (n = 6,339), evaluating knowledge and relevant factors with regard to cervical cancer. Knowledge levels were low; only 52.5% (n = 3,328) of the respondents knew that cervical cancer can be detected in its early stage. Only 26.9% reported that human HPV infections were risk factors for cervical cancer. The level of knowledge was lower among older, with less education, less income, unstable profession, and non-Beijing Hukou women (all P < 0.01). An increasing level of knowledge may impact positively on intentions to participate in cervical cancer screening. Education schemes to improve knowledge of cervical cancer should be performed in a multimodel, multichannel method.     

BIM induction of apoptosis triggered by EGFR-sensitive and resistance cell lines of non-small-cell lung cancer

We sought to improve the understanding of oncogene-dependent and independent non-small-cell lung cancer (NSCLC), which could provide insight into mechanism of sensitivity and/or resistance to tyrosine kinase inhibitors or chemotherapeutics. NSCLC cell lines with different EGFR genotypes were used in this study; MTT assay and flow cytometry were applied to study the sensitivities of these cell lines to gefitinib and cisplatin. Western blot was performed to determine the expression levels of BIM and other Bcl-2 family proteins pre- and pro-treatment. Gefitinib provoked apoptosis of caspase activation via the intrinsic pathways and significantly up-regulated expression of BIM protein in drug-sensitive PC-9 cell line, but not resistant PC-9/BB4 cell line. The knockdown of BIM expression by RNA interference virtually eliminated gefitinib-induced cell killing in PC-9 cells in vitro. Cisplatin could induce apoptosis of the cell lines, including H1299, A549, PC-9, and PC-9/BB4 cells, but which was not associated with overexpression of BIM. BIM is involved in TKI-induced apoptosis in sensitive EGFR-mutant cell line. Down-regulation of BIM and resistance to gefitinib were both seen in the acquired resistant PC-9/BB4 cell line. The induction of BIM may have a role in the treatment of TKI-resistant tumors.     

Serum cytokine levels in patients with advanced non-small cell lung cancer: correlation with treatment response and survival

To investigate whether expression of several cytokines affected clinical outcome in non-small cell lung cancer patients. A total of 86 stage IIIB/IV non-small cell lung cancer patients, treated with platinum-based doublets, were examined expression levels of IL-1, IL-2R, IL-5, IL-6, IFN-γ, TNF-α pre- and post-chemotherapy. Enzyme-linked immunosorbent assay technique was performed. Kaplan–Meier analysis and Cox regression analyses were used to adjust for possible confounding variables. IL-6 expression levels were significantly decreased due to chemotherapy in patients with stable disease (P = 0.041). IL-2R expression levels were significantly increased due to chemotherapy in patients with progression disease (P = 0.010). Patients with high concentrations of TNF post-chemotherapy had a significantly longer survival (P = 0.009, 17 months versus 11 months) than low levels. Multivariate analysis showed that sex, response rate, IL-1 and TNF-α were significantly predictive of the survival. Serum IL-6 and IL-2R levels correlated with chemoresponse in advanced non-small cell lung cancer, serum IL-1 and TNF-α can be predictive factors in advanced non-small cell lung cancer.     

宋铁玎健脾柔肝治疗小儿抽动秽语综合征

宋铁玎认为小儿抽动秽语综合征与先天禀赋不足、外邪侵袭、情志失调及劳倦过度等因素有关;主张以健脾柔肝法为主,佐以熄风止痉,扶正祛邪,降镇肝熄风汤合四君子汤化裁为健脾熄风之方,强调饮食调节必不可少,禁食辛辣、芳香、冰冷及煎炸食品。