不同营养支持途径对老年消化道肿瘤病人术后营养免疫状况的影响

目的　比较肠内(enteralnutrion,EN)、肠外营养(parenteralnutrition, PN)联合应用(EN+PN)和单用肠外营养(PN)对老年消化道肿瘤病人术后营养免疫状况的影响。方法　将40例老年消化道肿瘤病人随机分为肠内、肠外营养联合应用(EN+PN)组和肠外营养(PN)组,每组20例。术后第1天开始给予同热量、等氮量的营养支持一周,并检测术前和术后第8天营养指标、免疫指标。结果　两组病人术后第8天的体重均较术前下降,两组间无差异(P>0. 05),两组病人经营养支持后营养指标明显升高, (P<0. 05)。T淋巴细胞亚群在EN+PN组术后8天基本恢复到术前水平,而PN组与术前相比,尚有差异。结论　老年消化道肿瘤病人术后EN+PN或PN都能改善营养及免疫状态,EN+PN在提高机体免疫功能方面优于PN。术后早期EN是安全、可行和有效的。     

子宫颈小细胞癌的临床病理特征及治疗

目的　研究子宫颈小细胞癌 (SCCC)的临床病理特征、预后的影响因素、化疗疗效及其对生存期的影响。方法　分析 12例SCCC患者的临床病理资料。全部标本均行上皮性细胞免疫标记物和与神经内分泌细胞相关的免疫标记物的检测 ,呈阳性反应。临床分期Ⅰb1期 2例 ,Ⅰb2 期 4例 ,Ⅱa期 3例 ,Ⅱb期 1例 ,Ⅲb期 1例 ,Ⅳb期 1例。 9例早期SCCC患者中 ,5例患者术前接受新辅助化疗 ,3例接受术后辅助化疗 ;3例晚期患者接受同步放化疗。结果　早期SCCC患者术后病理证实盆腔淋巴结阳性者占 4 4 .4 % ,淋巴结阳性与阴性的平均无瘤生存期为 16 .1∶2 5 .7个月 ,总生存期为 19∶32个月。 5例接受新辅助化疗者手术成功率为 10 0 % ,其中 1例完全缓解 ,3例肿瘤缩小 >5 0 % ,总有效率为 80 % ,术后病理提示化疗反应者 6 0 % ,平均无瘤生存期为 2 3.4个月 ,总生存期为 2 5 .5个月 ,2年生存率为 80 %。 3例术后辅助化疗者平均无瘤生存期为 17.3个月 ,总生存期为 2 8个月 ,2年生存率为 6 6 .2 %。 3例中晚期患者平均无瘤生存期为 18个月 ,总生存期为 2 7.2个月 ,2年生存率为 6 6 .2 %。结论　同时检测与神经内分泌细胞相关的几种免疫标记 ,可以提高诊断SCCC的准确率。早期SCCC患者死亡率高与淋巴道转移和高危因素的发生率高有关。     

Synovial sarcoma: dynamic contrast-enhanced MR imaging features

Objective. To determine whether previously described so-called malignant dynamic contrast-enhanced magnetic resonance (MR) imaging features – early start, peripheral enhancement and early plateau or washout phase – occur consistently in synovial sarcoma. Design and patients. Dynamic contrast-enhanced MR images of 10 patients with histologically proven synovial sarcoma were reviewed. The start, pattern and progression of tumor enhancement were assessed and correlated with histopathology. Results. In all patients, the time interval between arterial and early tumor enhancement was less than 7 s (mean 4.40 s, SD 2.09 s). Six synovial sarcomas showed enhancement with a subsequent rapidly progressive linear increase in signal intensity followed by a plateau in one lesion and washout in five. Four lesions showed a late sustained increase in enhancement after the initial rapid increase in enhancement. The pattern of initial enhancement was peripheral in only two lesions, diffuse in four and heterogeneous in four lesions. Conclusions. Enhancement of tumor within 7 s after arterial enhancement is, of the three parameters described previously, the only sign that occurs consistently in synovial sarcoma. Received: 2 May 2000 Revision requested: 26 July 2000 Revision received: 19 September 2000 Accepted: 21 September 2000     

Alzheimer disease pathology in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is characterized by degeneration of upper and lower motor neurons. In some ALS patients, dementia or aphasia may be present (ALS-D). The dementia is most commonly a frontotemporal dementia (FTD), and many of these cases have ubiquitin-positive, tau-negative inclusions in neurons of the dentate gyrus and superficial layers of the frontal and temporal lobes. Identical inclusions have been found in cases presenting with FTD and have been designated motor neuron disease (MND)-inclusions. Cases of ALS-D without MND-inclusions have been reported to show neocortical gliosis, neuronal loss, and superficial spongiosis, but there have also been scattered case reports of ALS with Alzheimers disease (AD). To determine whether AD pathology may play a role in the dementia or aphasia syndromes in ALS, we reviewed 30 cases of sporadic ALS diagnosed at the University of Pittsburgh Medical Center. A clinical history of ALS-D was found in 24.1% of the cases, of which 57% had MND-inclusions. Although the ALS-D cases with MND-inclusions typically had amyloid-beta (A) plaques, there were no neuritic plaques. Three cases of ALS-D had no MND-inclusions, and two of these fulfilled pathological criteria for AD. One ALS-D case showed severe amyloid angiopathy but no neuritic plaques or MND-inclusions. MND-inclusions were not found in any ALS case without dementia; however, four patients without dementia or aphasia showed moderate or frequent numbers of neuritic plaques. In conclusion, we found that approximately 30% of ALS cases with dementia have AD and that some ALS cases without frank dementia have significant AD pathology.     

The 6sigma quality approach for quantitative arteriography performance improvement

Quantitative angiography is a medical application where the user requires tools whose operational results in term of accuracy, precision, robustness and reliability must be extensively assessed and validated for clinical use. In this study, the 6 methodology has been applied to analyze the performances of the General Electric QA software method. In particular, the catheter calibration procedure was identified as the weakest function in term of sensitivity to procedure parameters, like point-spread-function, field-of-view, catheter dimensions. It was therefore improved by following a design for 6 scheme, and the main parameters that govern the QA accuracy and precision were put under quantifiable control.     

Small Airway Pathology and Bronchoreversibility in Advanced Emphysema

ABSTRACT

Background: Poorly reversible airflow obstruction is a hallmark feature of chronic obstructive pulmonary disease (COPD). However, some COPD patients demonstrate significant bronchodilator reversibility (BDR). The pathologic features associated with the presence or absence of this phenomenon are not known. Methods: We analyzed 67 patients with advanced upper lobe predominant emphysema who underwent lung volume reduction surgery and divided them into 2 groups: the reversible group [BD(+)] had a >12% and >200 mL increase in FEV₁ or FVC with bronchodilator; the irreversible group [BD(?)] had a ≤12% and ≤20 mL increase in FEV₁ and FVC. We measured the epithelial height (EH) and areas of epithelium (EA), subepithelium (SEA), smooth muscle (SMWA), and total wall (TWA) of the small airways (<2 mm in internal diameter) in the resected specimens, and adjusted these measurements for basement membrane area (BMA) or perimeter (BMP). Results: Despite similar baseline characteristics, the BD(+) group had a smaller EH (0.036 mm vs. 0.042 mm, p = 0.005) and EH/BMP (0.012 vs. 0.014, p = 0.007), and a greater SMWA/BMA (0.491 vs. 0.430, p = 0.034) compared to the BD(?) group. In addition, EA trended to be smaller in the BD(+) group when compared to the BD(?) group (0.160 mm² vs. 0.184 mm², p = 0.06). In a subset of patients with consistent patterns of BDR on serial testing, the BD(+) group had greater SMWA/BMA (0.518 vs. 0.433, p = 0.049) and TWA/BMA (1.405 vs. 1.266, p = 0.036) compared to the BD(?) group. Conclusions: Small airway smooth muscle mass may play a role in determining BDR in severe emphysema.     

C-Deoxyglucose mapping of the monkey brain during reaching to visual targets

The strategies used by the macaca monkey brain in controlling the performance of a reaching movement to a visual target have been studied by the quantitative autoradiographic ¹⁴C-DG method.Experiments on visually intact monkeys reaching to a visual target indicate that V1 and V2 convey visuomotor information to the cortex of the superior temporal and parietoccipital sulci which may encode the position of the moving forelimb, and to the cortex in the ventral part and lateral bank of the intraparietal sulcus which may encode the location of the visual target. The involvement of the medial bank of the intraparietal sulcus in proprioceptive guidance of movement is also suggested on the basis of the parallel metabolic effects estimated in this region and in the forelimb representations of the primary somatosensory and motor cortices. The network including the inferior postarcuate skeletomotor and prearcuate oculomotor cortical fields and the caudal periprincipal area 46 may participate in sensory-to-motor and oculomotor-to-skeletomotor transformations, in parallel with the medial and lateral intraparietal cortices.Experiments on split brain monkeys reaching to visual targets revealed that reaching is always controlled by the hemisphere contralateral to the moving forelimb whether it is visually intact or ‘blind'. Two supplementary mechanisms compensate for the ‘blindness' of the hemisphere controlling the moving forelimb. First, the information about the location of the target is derived from head and eye movements and is sent to the ‘blind' hemisphere via inferior parietal cortical areas, while the information about the forelimb position is derived from proprioceptive mechanisms and is sent via the somatosensory and superior parietal cortices. Second, the cerebellar hemispheric extensions of vermian lobules V, VI and VIII, ipsilateral to the moving forelimb, combine visual and oculomotor information about the target position, relayed by the ‘seeing' cerebral hemisphere, with sensorimotor information concerning cortical intended and peripheral actual movements of the forelimb, and then send this integrated information back to the motor cortex of the ‘blind' hemisphere, thus enabling it to guide the contralateral forelimb to the target.     

Ⅱ°烧烫伤模型大鼠体内TGF-β、p38MAPK、IL-1β的表达分析

目的:探讨Ⅱ°烧烫伤模型大鼠体内转化生长因子β(TGF-β)、p38丝裂原活化蛋白激酶(MAPK)和白细胞介素1β(IL-1β)的表达情况。方法:取大鼠分为4组,每组14只,分别为正常对照组、NaOH烧伤组、水烫伤组和乙醇烧伤组,分别建立相应的Ⅱ°烧烫伤模型,24 h后观察各组大鼠病理变化,酶联免疫吸附剂测定法检测各组大鼠建模后第1、4、7天血清中TGF-β、p38 MAPK和IL-1β的水平。结果:与正常对照组比较,其余3组大鼠均可见表皮及真皮有不同程度的缺损或坏死,炎性细胞向肌层组织浸润,其中水烫伤组和乙醇烧伤组大鼠皮下水肿明显;NaOH烧伤组大鼠血清中TGF-β和p38 MAPK水平在第4、7天均明显升高(P<0.05或P<0.01),IL-1β表达无明显变化;水烫伤组大鼠血清中TGF-β水平在第1、4、7天均明显升高(P<0.05),p38 MAPK和IL-1β水平在第4、7天明显升高(P<0.05或P<0.01);乙醇烧伤组大鼠血清中TGF-β水平在第4天明显升高(P<0.05),p38 MAPK和IL-1β水平在第1、4、7天均明显升高(P<0.05或P<0.01)。结论:水烫伤和乙醇烧伤可致大鼠Ⅱ°烧烫伤模型中TGF-β、p38 MAPK和IL-1β水平均有不同程度的升高,并可能激发TGF-β、p38 MAPK和IL-1β参与的炎症信号通路。     

龈交穴点刺放血治疗痔疮21例

目的:观察龈交穴点刺放血治疗痔疮的临床疗效.方法:21例痔疮患者在上唇系带中寻找阳性反应点,局部常规消毒后,以三棱针对准阳性反应点点刺放血1～3滴.7天治疗1次,一般治疗1～3次,半年后观察疗效.结果:治愈14例,好转6例,无效1例,总有效率为95.3％( 20/21).结论:龈交穴点刺放血治疗痔疮疗效显著.     

Pathological morphology alteration of the splanchnic vascular wall in portal h ypertensive patients

目的：研究门静脉高压症患内脏血管壁的病理形态学改变。方法：50例门静脉高压症患在行脾切除和贲门周围血管离断术时,取脾动脉、静脉和胃冠状静脉,行光镜和电镜观察。免疫组化法分析脾动脉壁诱导型一氧化氮合成酶（iNOS）的表达。结果：脾动脉的内弹力膜和中膜内弹力纤维断裂和变性。脾动脉平滑肌细胞可见萎缩、凋亡和表型改变。平滑肌细胞的胞浆内可见iNOS阳性表达。肝硬化患可见内脏静脉内膜增生,静脉壁有广泛的附壁血栓,类粥样硬化斑块形成,平滑肌细胞肥大,静脉肌纤维明显增粗和增厚,管壁细胞外基质增加。结论：门静脉高压症可合并内脏动脉和静脉的血管病变,在门静脉高压症的发病机制中,门静脉高压、内脏高动力循环和内脏血管病变之间具有相互影响的关系。