Neuroendocrine,epigenetic, and intergenerational effects of general anesthetics

The progress of modern medicine would be impossible without the use of general anesthetics (GAs). Despite advancements in refining anesthesia approaches, the effects of GAs are not fully reversible upon GA withdrawal. Neurocognitive deficiencies attributed to GA exposure may persist in neonates or endure for weeks to years in the elderly. Human studies on the mechanisms of the long-term adverse effects of GAs are needed to improve the safety of general anesthesia but they are hampered not only by ethical limitations specific to human research, but also by a lack of specific biological markers that can be used in human studies to safely and objectively study such effects. The latter can primarily be attributed to an insufficient understanding of the full range of the biological effects induced by GAs and the molecular mechanisms mediating such effects even in rodents, which are far more extensively studied than any other species. Our most recent experimental findings in rodents suggest that GAs may adversely affect many more people than is currently anticipated. Specifically, we have shown that anesthesia with the commonly used GA sevoflurane induces in exposed animals not only neuroendocrine abnormalities (somatic effects), but also epigenetic reprogramming of germ cells (germ cell effects). The latter may pass the neurobehavioral effects of parental sevoflurane exposure to the offspring, who may be affected even at levels of anesthesia that are not harmful to the exposed parents. The large number of patients who require general anesthesia, the even larger number of their future unexposed offspring whose health may be affected, and a growing number of neurodevelopmental disorders of unknown etiology underscore the translational importance of investigating the intergenerational effects of GAs. In this mini review, we discuss emerging experimental findings on neuroendocrine, epigenetic, and intergenerational effects of GAs.     

股骨转子间骨折GAMMA钉治疗临床分析

目的：评价GAMMA钉治疗股骨转子间骨折的效果。方法：对32例股骨转子间骨折采用GAMMA钉治疗。结果：经6～18月随访，所有病例均获骨性愈合，下肢功能及关节活动良好。其中1例为粉碎性骨折内固定后出现髋内翻，按X线评分标准90％病人满意。结论：GAMMA钉治疗股骨转子间骨折效果满意。     

伽玛刀治疗颅底良性脑膜瘤临床研究

目的探讨伽玛刀放射外科治疗良性颅底脑膜瘤中长期疗效和不良反应。方法选取了1998-2003年治疗的获得完全随访资料的颅底脑膜瘤患者166例,全组患者肿瘤体积0.42- 43.4cm3,平均(7.2±3.9)cm3,给予周边剂量平均(12.4±2.6)Gy,中心剂量平均(27.9±5.9)Gy,其中12例患者采用肿瘤体积分割二阶段治疗。对治疗前后的影像学改变、KPS评分和神经功能缺损评估。结果平均随访期为(55.4±18.2)个月(36-96个月)。总体控制率为95.2%(158/166);KPS评分得到显著提高,神经症状总体满意率为94.5%(157/166),主要副作用是放射性脑水肿11例(6.6%),有5例(3%)患者出现新的神经缺损。结论伽玛刀放射外科可以作为有手术禁忌或拒绝手术治疗体积较小脑膜瘤患者的首选性治疗,也可以作为颅底较大脑膜瘤开颅术后的辅助性治疗,能够较长期控制肿瘤复发,提高或保持患者的生存质量。     

星形胶质细胞瘤伽玛刀治疗的疗效与影响因素

目的分析星形胶质细胞瘤伽玛刀(γ-刀)治疗的疗效与影响因素.方法回顾性分析48例星形胶质细胞瘤病人的γ-刀治疗结果.以性别、有无普通放疗经过、有无化疗经过、边缘剂量、病灶的平均直径、病变的病理等级、影像学上有无相对较清楚的边界为治疗结果影响因素,判定标准以病灶缩小为有效,采用logistic回归模型,确定多因素条件下治疗结果的影响因素.结果有效32例(66.7%),logistic回归模型分析表明:病理等级和病灶平均直径为与肿瘤控制有关的影响因素.结论γ-刀对星形胶质细胞瘤的治疗有一定的意义.     

伽玛刀治疗垂体大腺瘤临床分析(附30例报告)

目的 研究伽玛刀治疗垂体大腺瘤的效果及影响疗效的因素。方法 30例垂体大腺瘤病人用1．0T磁共振定位，Gamma-plan计划系统规划，等剂量曲线45％～60％(平均49．7％)，周边剂量12～35Gy(平均22.9Gy)，中心剂量24～70Gy(平均45．4Gy)．Leksell伽玛刀实施放射外科治疗。分析治疗后垂体大腺瘤病例，总结其疗效和影响疗效的因素。结果 随访12～60个月，平均28个月，肿瘤完全消失6例(20％)，肿瘤缩小19例(63．3％)，无变化5例(16．7％)；19／20(95．5％)功能性垂体腺瘤内分泌症状改善，临床症状好转，1例过早绝经(年龄36岁)；5／10(50％)无功能性垂体腺瘤体积缩小．症状改善。结论 伽玛刀对于垂体大腺瘤仍是一种有效的治疗方法，其疗神与腺瘤的举类型、体积、照射剂量、剂量体剂、MRI信号特征密切相姜。     

伽玛刀治疗功能性垂体瘤初步报告

目的 对伽玛刀治疗分泌型垂体瘤的疗效和并发症发生的相关因素进行探讨。方法 1997年9月至2001年11月，248例垂体瘤经伽玛刀治疗。其中．73例年龄在16至61岁的分泌型垂体瘤获得详细随访，53例为PRL型，11例GH型，2例为ACTH型，6例为PRL合并GH型，1例为PRL合并ACTH型。7例为术后复发和残留。23例曾接受过嗅隐亭治疗。平均肿瘤容积为5．83cm^3(0．14～25．20cm^3)。边缘剂量为8～35Gy。结果 平均随访时间21个月。36例(49.3％)内分泌恢复正常。内分泌恢复正常的比率3个月后1．4％，6个月后16．4％．1年后45．2％，2年后49．3％。3例(4、1％)发生垂体瘤功能低下。1例复发二次治疗。无病例发生视路受损。结论 伽玛刀治疗分泌型垂体瘤是安全有效的治疗方法。其长期疗效和并发症的发生仍需进一步的随访观察。     

伽玛刀治疗高危前列腺增生症的临床应用

目的探讨伽玛刀在不适合开放手术或经尿道电切术的高危前列腺增生患者治疗中的应用。方法采用深圳奥沃公司生产的OUR-QGD型立体定向全身伽玛刀治疗20例高危前列腺增生患者。应用国际前列腺症状评分(IPSS)、前列腺重量、最大尿流率(Qmax)、残余尿量作为评价指标。观察上述数据在治疗前后的改变及其临床意义。结果术后随访6个月,IPSS评分由治疗前29分降至19.6分(P<0.01)。前列腺重量平均值均由治疗前的(56.4±4.4)g减少至(54.8±4.3)g(P>0.05)。最大尿流率平均值由治疗前的(6.7±1.8)ml/s增加至(11.5±1.7)ml/s(P<0.01),残余尿量平均值由治疗前的(85.1±27.8)ml降至(50.9±15.6)ml(P<0.01)。结论立体定位体部伽玛刀治疗高危前列腺增生症患者具有简便、安全、无创、痛苦小、并发症少、疗效好,可不需住院等优点,对不愿意接受手术或不宜手术的高危前列腺增生患者不失为一种良好的治疗方法,但费用较高。     

The distribution and possible function of gamma interferon-immunoreactive cells in normal endometrium and myometrium

Summary T-lymphocytes are present in normal endometrium, where they may have a role in the control of glandular maturation. T-cell activity could be related to the local secretion of cytokines such as gamma interferon, which has an anti-proliferative effect on endometrial epithelial cells in vitro. We have examined gamma interferon immunoreactivity and T-cell distribution in 24 normal pre-menopausal uteri. Endometrial appearances were representative of all stages of the menstrual cycle. Most cells in the lymphoid aggregates in the stratum basalis were stained by T-cell and gamma interferon antisera. T-lymphocytes were also scattered in glandular epithelium and throughout the stroma of basal and functional layers; immunoreactivity for gamma interferon was less consistent in these cells. There was no alteration in the intensity or distribution of gamma interferon staining in different phases of the menstrual cycle. Endometrial granulocytes (K-cells) present mainly in the late secretory endometria were not reactive with the gamma interferon antiserum. In addition to endometrial staining, T-cells were distributed in all areas of the myometrium in most uteri, and many myometrial lymphocytes were gamma interferon positive. These results support a role for gamma interferon in endometrial physiology, possibly as an inhibitor of epithelial proliferation.     

血清谷氨酰转肽酶含量测定在慢性乙型肝炎中的临床意义

目的探讨血清谷氨酰转肽酶（GGT）含量变化在慢性乙型肝炎（CHB）不同程度肝脏病理损害中的变化规律及临床意义。方法测定70例CHB患者血清ALT、AST、GGT水平，同时行肝活体组织检查，对肝脏进行炎症分级和纤维分期。分析ALT、AST、GGT与CHB之间的关系。结果（1）ALT、AST、GGT随炎症程度和纤维化程度的上升而上升，但到G4和s4后则下降。GGT随ALT、AST的升高而升高，ALT、AST和GGT的相关系数分别为：0．322、0．328（P〈0．05）。在保肝治疗后，ALT较快降至正常且GGT保持在一个较低水平的为轻度CHB，而随着ALT下降，GGT仍持续在一个较高水平的为中度及重度CHB，其中重度CHB的GGT水平有所波动。结论血清GGT比ALT、AST更准确的反映肝脏的炎症程度，GGT的活动度给临床判断慢乙肝的炎症提供了重要的判断依据。