闭合性颅脑损伤脑内白蛋白的免疫组化研究

应用免疫组化ＡＢＣ法对脑损伤后脑内各个部位组织中白蛋白的分布进行系统研究。结果发现白蛋白不仅出现于脑挫伤出血局部，在挫伤区邻近及远离挫伤部位的非损伤区域（包括丘脑、中脑、桥脑、延脑等部位）的部分神经细胞、神经纤维、星形胶质细胞及软化灶内格子细胞亦有白蛋白出现。在远离挫伤部位的非出血区还可见小灶性阳性染色，边界不规则，个别案例见阳性反应区呈条带状分布；部分血管内皮细胞、红细胞膜及血管周围腔隙染呈棕色。作者认为白蛋白的免疫组化染色可作为脑损伤（包括脑干损伤）的早期标志之一，尤其对于出血不明显的脑损伤的诊断具有重要价值。     

上皮样血管肉瘤临床病理学观察

目的:探讨上皮样血管肉瘤(epithelioid angiosarcoma,EA)的临床病理学特征、诊断及鉴别诊断要点。方法:对1例原发皮下软组织的EA进行组织形态、免疫组化分析。结果:镜下肿瘤细胞弥漫成片,瘤细胞呈上皮样特征,异型性显著。瘤组织之间见相互吻合大小不等的不规则血管腔隙,血管内衬异型肿瘤细胞,可见单个或多个瘤细胞围成管腔,腔内含红细胞。免疫组化示异型肿瘤细胞CD31强阳性,CD34局灶阳性,F8阴性,CKP+/-,CKL+/-。结论:EA是血管肉瘤的一种特殊类型,免疫组化检测有助于确定肿瘤细胞的血管内皮分化。熟悉其形态特征对避免误诊有重要意义。     

重视人血白蛋白的临床应用及管理

白蛋白是血浆中含量最高的蛋白质,占血浆总蛋白的50%一60%,循环中半衰期为18～20天.肝脏是人类血浆白蛋白的主要合成场所,正常情况下,白蛋白的合成和降解呈稳态过程,输注外源性白蛋白后2小时,约有10%的白蛋白开始进人血管外组织间隙,约20天后达到平衡.它是血液总渗透压的主要调节物质,具有维持血液正常渗透压、运输、解毒和抗休克等作用,也是组织修复再生的必要成分.     

脑膜癌病1例临床病理报告

1例肺部腺癌转移至蛛网膜下腔继而浸润脑膜成脑膜癌。病理改变的特点是1.癌细胞在脑膜及蛛网膜下腔呈弥漫性浸润,硬脑膜内面颅神经周围及其内均有癌细胞浸润。2.脑实质内见有小而散在的癌细胞浸润且与周围脑组织界限不清,癌细胞从蛛网膜下腔沿血管周围间隙向脑皮质浸润,致使邻近脑组织水肿,神经细胞缺血性改变。3.右侧脑室轻度扩大,脑室系统室管膜及脉络丛组织亦有癌细胞浸润。4.癌细胞排列以腺样结构为主。     

脑外伤患者AQP4的表达及其与临床预后的关系

目的 对比检测不同程度脑外伤患者的水通道蛋白4(AQP4)的表达差异,探讨AQP4与临床预后的关系.方法 选取87例脑外伤患者根据GCS评分分为3组,中度损伤组(GCS 9~12分)33例,重度损伤组(GCS 4~8分)37例,特重度损伤组(GCS 3分)17例,取手术清除的创伤区脑组织标本,用免疫组化法检测不同组别的AQP4的表达情况.结果 ①中度脑外伤组中,脑组织细胞和血管内皮细胞轻度肿胀;在重度、特重度脑外伤组中,脑组织细胞肿胀明显,血管内皮细胞肿胀明显,血管周围间隙明显扩大,血脑屏障受损严重.②脑组织中细胞膜或细胞浆棕黄色染色为AQP4阳性表达.随损伤程度加重,AQP4表达逐渐增强,在特重度损伤组AQP4表达最强,其次为重度损伤组,中度损伤组,且比较差异有统计学意义(P<0.05).结论 AQP4表达强度与病情程度呈正相关,会提示患者预后情况,抑制AQP4的活性有可能减轻脑水肿,改善预后.     

卡波西形血管内皮瘤1例报道并文献复习

目的 探讨卡波西形血管内皮瘤(Kaposiform hemangioendothelioma,KHE)的临床病理学诊断及鉴别诊断.方法 对1例发生于幼儿骨的多发性KHE的组织病理学特征和免疫表型的观察,结合临床资料和影像学资料进行分析并复习相关文献.结果 该例患儿以下肢跛行为症状,影像学示骨多发不规则骨破坏区,周围见硬化,骨皮质中断,软组织影向外突出.临床未见卡梅综合征(Kabasach-Merritt syndrome,KMS).光镜下肿瘤由增生的小血管和梭形细胞构成,呈不规则结节状或分叶状分布,浸润性生长,梭形细胞呈束状排列,并见上皮样细胞和梭形细胞排列呈巢,似肾小球样结构,后者边缘有月牙状血管裂隙形成.免疫表型:瘤细胞呈CD31、CD34强阳性表达,部分细胞SMA和D2-40阳性,上皮样细胞CK阴性.结论 KHE是一种罕见的好发于儿童和婴幼儿的低度恶性的血管源性肿瘤,诊断主要靠病理组织学及免疫组化确诊,须与卡波西肉瘤和梭形细胞血管内皮瘤等鉴别,病变彻底切除是治疗KHE的最佳手段.     

卵巢癌血管生成拟态形态学观察和基质金属蛋白酶表达

目的:在卵巢癌腹腔移植瘤模型中进行卵巢癌血管生成拟态的形态学观察并检测基质金属蛋白酶2(MMP2)的表达情况。方法:卵巢癌细胞SKOV3接种裸鼠腹腔,建立卵巢癌腹腔移植瘤模型,在同一张切片上以抗鼠CD34标记鼠血管内皮细胞,PAS染色行基底膜样结构标记。并应用免疫组化和RT-PCR方法比较MMP2在卵巢癌腹腔移植瘤中央和边缘区域组织的表达差异。结果:卵巢癌腹腔移植瘤中央区域可见卵巢癌细胞围成管状结构,中间可见红细胞,未见CD34阳性细胞出现,PAS阳性物质呈颗粒状弥散分布在卵巢癌细胞浆内,有的贴附在管腔内侧。免疫组化提示MMP2蛋白阳性表达率在肿瘤中央区域组织比肿瘤边缘区域明显增高,RT-PCR分析显示肿瘤组织中央区域MMP2表达与边缘区域相比有显著性差异。结论:卵巢癌细胞分泌PAS阳性物质,可能参与构建肿瘤的血管基质重塑。卵巢癌中央区域可见血管生成拟态,肿瘤中央区域MMP2表达高于肿瘤边缘区域,MMP2表达是否与卵巢癌血管生成拟态形成有关,仍需今后进一步研究。     

丙氨酰谷氨酰胺在胃癌患者术后的应用

目的研究丙氨酰谷氨酰胺在胃癌术后应用对肝功能、血浆蛋白和免疫功能的影响。方法研究组和对照组胃癌术后均连续给予9d肠外营养支持,其中研究组另加给予丙氨酰谷氨酰胺20g/d,比较两组患者治疗前后肝功能、总蛋白、白蛋白、IgA、IgG、IgM、CD3、CD4及CD4/CD8比值。结果研究组术后第8天血浆总蛋白和白蛋白值较对照组高,但差异无统计学意义;肝功能指标两组间差异不明显;研究组IgA、IgG、IgM含量和CD3、CD4百分比及CD4/CD8比值均明显高于对照组（P〈0.05）。结论丙氨酰谷氨酰胺在胃癌术后患者使用是安全有效的,能明显提高胃癌术后患者的免疫功能,有助于改善胃癌术后患者血浆总蛋白和白蛋白的含量,但对肝功能的影响较小。     

脾脏硬化性血管瘤样结节性转化的临床病理分析

目的探讨脾脏硬化性血管瘤样结节性转化（SANT）的临床病理表现、诊断及治疗方法。方法对3例SANT的病理学、免疫组化特征以及影像学表现进行分析。结果 3例SANT患者的临床表现无特异性。CT表现为脾脏占位性病变。病理学检查示病灶呈灰白色结节,边界不清;镜下见多发性血管瘤样结节,结节中央可见裂隙样或窦样血管腔,血管腔隙周围散在卵圆形的组织细胞,结节周围围绕着致密的向心性分布的平滑肌或胶原纤维。免疫组织化学显示结节内为CD34阳性表达呈枝芽状的毛细血管及窦腔样腔隙的内皮细胞,少量CD8阳性表达的窦性腔隙,CD31阳性表达的内皮细胞且构成复杂的网状结构,局灶性内衬细胞CD68亦为阳性。此外,SMA（＋）细胞成簇分布在血管腔隙之间,结节间梭形细胞局灶性act（＋）。而CD21、CD35、Des,S-100、CK和EMA均（-）。术后随访,患者均未发现病变复发和转移。结论 SANT是一种罕见的良性增生性病变,易与脾脏恶性肿瘤相混淆,诊断依靠病理组织学表现及免疫组化特点。行脾切除术可治愈,预后良好。     

CD10、Nestin蛋白在皮肤附属器肿瘤组织中的表达及意义

目的:探讨白细胞分化抗原簇10(CD10)、巢蛋白(Nestin)在皮肤附属器肿瘤组织中的表达及意义。方法:收集2018年1-12月本院收治的40例皮肤附属器肿瘤患者的肿瘤组织标本,另选择5例乳腺癌根治手术切除标本中远离肿瘤的皮肤为正常皮肤对照。免疫组织化学标记CD10、Nestin蛋白,观察各例肿瘤CD10、Nestin蛋白的表达情况、阳性细胞的类型和分布。结果:汗腺肿瘤、毛分化肿瘤及皮脂腺肿瘤中的CD10蛋白表达情况比较,差异有统计学意义(P=0.000),但Nestin蛋白的表达情况比较差异无统计学意义(P=0.277)。CD10在正常皮肤的皮脂腺、汗腺周围的肌上皮细胞呈阳性表达,在小汗腺和大汗腺上皮呈阴性;Nestin在正常皮肤的皮脂腺外围基底样细胞、汗腺分泌部上皮细胞呈弱阳性表达,在分化的皮脂细胞呈阴性,肌上皮细胞阳性表达。多数类型汗腺肿瘤CD10阴性,部分病例显示瘤细胞胞质内CD10阳性表达。汗管瘤的Nestin为阴性;螺旋腺瘤肌上皮部分Nestin阳性。透明细胞汗腺瘤腺腔样结构腔膜缘细胞显示Nestin颗粒状阳性。乳头状汗腺腺瘤肌上皮细胞Nestin阳性。多数类型毛分化肿瘤表达CD10及Nestin:毛母细胞瘤间质细胞CD10阳性表达,Nestun弱阳性;毛母质瘤瘤细胞CD10阳性,Nestin阳性;毛囊瘤瘤细胞CD10阳性,角化细胞Nestin阳性。皮脂腺瘤和皮脂腺癌的CD10多呈阳性表达,各例皮脂腺瘤和皮脂腺癌的Nestin表达类似,多显示为阴性或呈弱阳性表达,部分病例显示个别瘤细胞胞质内颗粒状阳性表达。结论:CD10是毛分化、皮脂腺分化皮肤附属器肿瘤的特异性标记物,干细胞标记物Nestin在这些肿瘤的表达方式可以作为肿瘤成分分化特点的参考。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.