肝癌组织中Raf激酶抑制蛋白的表达及其临床意义

目的 探讨Raf激酶抑制蛋白(Raf kinase inhibitor protein,RKIP)在肝癌中的表达及其临床意义.方法 采用RT-PCR方法 检测肝细胞癌、癌旁组织及正常肝组织中RKIP mRNA的表达;采用组织芯片的免疫组织化学方法 检测RKIP蛋白和磷酸化的RKIP蛋白的表达,并分析RKIP蛋白和磷酸化的RKIP的表达与肝细胞癌临床病理学特征的关系.结果 RKIP mRNA在肝细胞痛组织、癌旁肝组织及正常肝组织的表达差异无统计学意义(P>0.05).肝细胞癌、癌旁肝组织及正常肝组织中RKIP蛋白表达的阳性率分别为22.2%、86%、93.8%,磷酸化的RKIP蛋白表达的阳性率分别为29.2%、84%、93.8%;肝癌组织中RKIP和磷酸化的RKIP蛋白表达均显著低于癌旁及正常肝组织(P<0.05);RKIP和磷酸化的RKIP蛋白表达与肿瘤大小、AFP水平及有无门静脉或胆管癌栓无关(P>0.05);RKIP和磷酸化的RKIP蛋白表达与肝细胞癌分化程度及有无肝内或淋巴转移有关,中高分化组RKIP和磷酸化的RKIP蛋白表达高于低分化组,无肝内或淋巴转移组高于有肝内或淋巴转移组(P<0.05).结论 RKIP和磷酸化的 RKIP 蛋白表达的减少或缺失与肝癌的发生、发展、侵袭转移密切相关.     

不同剂量6%HES 130/0.4容量治疗对失血性休克大鼠肺损伤的影响

Objective To evaluate the effects of volume therapy with different doses of 6% hydroxyethyl starch 130/0.4 (6% HES 130/0.4) on lung injury in a rat model of hemonhagic shock.Methods Twenty-four male SD rats weighing 220-300 g were randomly divided into 4 groups ( n = 6 each) : group I sham operation (group S); group II Ringer's solution (group RS); group HI and IV 2 HES groups (group H1, H2 ). The animals were anesthetized with intraperitoneal 1% sodium pentobarbital 45 ing/kg. Right common carotid artery (CCA) and left femoral vein were cannulated for blood letting, MAP monitoring, fluid administration and blood sampling. Hemonhagic shock was induced by withdrawing blood from right CCA in group II , III and IV . MAP was reduced to 35-45 mmHg which was maintained for 90 min. In group RS, hemorrhagic shock was resuscitated with Ringer's solution 3 times of the volume of blood withdrawn, while group H1 and H2 received HES 33 and 50 ml/kg respectively and Ringer' s solution (the total volume was equal to 3 times of the volume of blood removed) . Arterial blood samples were taken before blood letting (T0 , baseline), and at 2, 3 h after volume therapy (T1,2) for blood gas analysis and PaO2/FiO2 was calculated. The animals were then sacrificed by exsanguination and the lungs were immediately removed for microscopic examination and determination of protein concentration in broncho-alveolar lavage fuid (BALF), W/D lung weight ratio and TNF-α, IL-1 β and IL-10 contents in the lung.Results TNF-α, IL-1β and IL-10 content in the lung, protein concentration in BALF and W/D ratio were significantly higher in group RS, H1 and H2, while PaO2/FiO2 was significantly lower at T,2 in group RS and at T2 in group H2 than in group S (P < 0.05). TNF-α and IL-1β contents in the lung, protein concentration in BALF and W/D ratio were significantly lower in group H1 and H2 , while PaO2/FiO2 was significantly higher at T,i2 in group H1 and at T1 in group H2 than in group RS (P <0.05) . PaO2/FiO2 at T2 and IL-10 content in the lung were significantly lower in group H2 than in group H, ( P < 0.05) . The lung damage was significantly ameliorated in group H1 and H2 especially in group H, as compared with group RS. Conclusion Volume therapy with 6% HES 130/0.4 33 or 50 ml/kg can attenuate lung injury in a rat model of hemorrhagic shock and the efficacy of 33 ml/kg is better.     

脊髓血管母细胞瘤的MRI诊断与鉴别诊断

目的：分析脊髓血管母细胞瘤MRI影像学特征及鉴别诊断。方法：回顾性分析11例脊髓血管母细胞瘤MRI平扫及增强表现,探讨MRI特征,并分析Von Hippel—Lindau综合征（VHL综合征）及非VHL综合征血管母细胞瘤MRI表现的差异。结果：11例中8例为单发肿瘤（72．7％）,3例VHL综合征均为多发肿瘤（27个）。MRI表现多与肿瘤大小相关。除体积较小（上下径≤1cm）者多位于颈髓外,以胸髓多见,邻近背侧软脊膜。肿瘤边界清楚,强化明显。≤1cm的肿瘤呈点状或结节状,为均匀等T1、稍长T2信号,强化均匀;〉1cm的肿瘤多呈香肠状、葫芦形或不规则形,多以稍长T1、稍短T2为主的混杂信号,不均匀强化。肿瘤常继发大范围脊髓囊性改变（77．8%）及水肿,与肿瘤大小无相关性。〉1cm的肿瘤内部及周围常见流空血管影（100％）。除VHL综合征患者常发生多发、体积小的肿瘤,VHL综合征与非VHL综合征患者在MRI表现中无明显差异。结论：脊髓血管母细胞瘤的MRI影像学表现具有特征性,MR检查是首选方法。     

社区综合干预对精神分裂症患者社会康复效果的对照研究

目的观察社区综合干预措施对精神分裂症患者出院后社会康复的疗效。方法采取随机抽样法,将284例出院的精神分裂症患者随机分为干预组（143例）和对照组（141例）,对干预组进行健康教育、用药指导、技能训练、家庭治疗等综合干预,持续1年;对照组仅进行门诊随访。在入组时、半年末、一年末分别对两组患者采用社会功能缺陷筛选量表（SDSS）、阳性与阴性症状量表（PANSS）进行评估和比较。结果入组时干预组与对照组的SDSS、PANSS评分差异无显著性;干预1年后,干预组SDSS评分（7．54±2．11）明显低于对照组（9．77±2．74）,差异具有非常显著性（P〈0．01）。干预组PANSS评分（38．88±9．58）、阳性量表评分（7．40±1．12）、阴性量表评分（11．32±5．92）,一般精神病理量表评分（20．16±5．19）均低于对照组（46．884±16．37、8．60±3．19、13．52±7．81、24．76±8．08）,差异具有非常显著性（P〈0．01）。干预组复发率18．18％（26例）低于对照组34．75％（49例）,差异有非常显著性（χ^2=10．03,P〈0．01）。结论综合干预措施有利于出院后精神分裂症患者的社会康复。     

双相Ⅰ型障碍躁狂发作患者血浆孤啡肽水平的初步测定

目的:初步探讨双相Ⅰ型障碍躁狂发作患者的血浆孤啡肽(OFQ)水平.方法:应用放射免疫分析(RIA)法分别测定26例双相Ⅰ型障碍躁狂发作患者和31例正常人血浆OFQ浓度.结果:躁狂组血浆OFQ水平[(11.29±3.28)pg/ml]低于对照组[(13.92±4.53)pg/ml],P＜0-05.躁狂组OFQ水平与Bech-Rafaelsen躁狂量表总分呈负相关(r=-0.75,P＜0.01).血浆OFQ水平的影响因素主要有工作、接触、敌意/破坏行为、性兴趣、睡眠、意念飘忽、患者的受教育程度(β=-1.121,-0.969,0.265,0.455,0.407,0.333,-0.123;P均＜0.01).结论:孤啡肽可能参与双相Ⅰ型障碍躁狂发作的发生机制.     

miRNA与神经细胞

miRNA是一组非常特别的小RNA分子,几乎存在于所有的细胞中,它具有非常广的调控 范围。包括对RNA的修饰作用和对蛋白质合成的调控作用,在哺乳动物的神经细胞中也存在一些miRNAs,它们对于神经分化具有相当重要的作用,而对于学习与记忆的也很有可能起着同样重要的作用。在这篇文章中,我们分析了miRNA与神经细胞的作用,尤其是在树突、轴突和神经可塑性上起着关键的作用。     

促进医疗机构合理用药的对策

目的:促进医疗机构合理用药。方法:分析导致医疗机构不合理用药的技术因素与非技术因素,提出促进合理用药的对策。结果与结论:"新药辈出"、用药技能欠缺、药师的作用难以发挥、管理水平不高是导致不合理用药的技术因素,医师的"利益环境"与"利益动机"是导致不合理用药的非技术因素。建议通过制度和信息化等手段整治和净化临床用药的"利益环境";通过宣传教育、正面引导以及信息化支持有效压制处方者"利益动机";通过提高全员合理用药技能和实施多学科协作,强化药师的作用,从而促进医务人员合理用药技术素质和水平的提高;通过加强医务人员职业道德教育以防范药物治疗差错或事故发生,从而促进医疗机构合理用药。     

细丝蛋白A抑制荷人结肠腺癌细胞SW480裸鼠移植瘤的生长

目的:探讨细丝蛋白A(fi lamin A,FLNa)基因对人结肠腺癌SW480细胞在裸鼠体内成瘤的影响及其可能的机制。方法:将重组载体质粒pcDNA3.1/V5-His-TOPO/FLNa通过脂质体介导的方式转染到SW480细胞中,RT-PCR和蛋白质印迹法检测SW480/FLNa细胞中FLNa mRNA和蛋白的表达,MTT法检测细胞的体外增殖能力。将SW480/FLNa、SW480/pcDNA3.1和SW480细胞接种于裸鼠皮下,观察移植瘤的生长情况,计算抑瘤率,HE染色观察移植瘤组织的形态学变化,RT-PCR和蛋白质印迹法检测移植瘤组织中基质金属蛋白酶-9(matrix metalloproteinases-9,MMP-9)mRNA和蛋白的表达水平。结果:FLNa基因在SW480细胞中获得稳定表达,SW480/FLNa、SW480/pcDNA3.1和SW480细胞的体外增殖能力相似;SW480/FLNa组移植瘤的生长速度和质量低于SW480组,抑瘤率为(88.7±3.5)%(P=0.000);SW480/FLNa组移植瘤组织出现退变坏死,MMP-9mRNA和蛋白的表达水平(0.11±0.02和0.02±0.00)均低于SW480组(1.12±0.02和1.25±0.05),差异均有统计学意义(P=0.012,P=0.025)。结论:FLNa基因具有抑制人结肠腺癌SW480细胞在裸鼠体内的生长作用,其作用机制可能与下调MMP-9的表达有关。     

食管癌二野淋巴结清扫术后复发规律探讨

目的 分析胸段食管癌二野淋巴结清扫术后局部复发规律,为术后放疗提供帮助.方法 搜集本科2004-2009年收治的134例胸段食管鳞癌术后局部复发患者的临床资料,依据放疗前定位CT分析复发类型及各区域淋巴结转移情况.结果 食管癌术后淋巴结转移占94.0%,吻合口复发占9.7%,食管原瘤床复发占3.7%.126例淋巴结转移患者中纵隔、锁骨上、腹部的分别占80.2%、43.7%、13.5%(χ2=113.15,P=0.000).淋巴结转移上纵隔占73.8%,左喉返神经区(1L区、2L区、4L区、5区)占38.9%,右喉返神经区(1R区)占43.7%,隆突下占34.1%,奇静脉占15.1%,锁骨上占43.7%[右锁骨上多于左锁骨上(31.7%和16.7%;χ2=7.81,P=0.005)].结论 淋巴结转移是胸段食管癌术后局部复发最主要的类型,原瘤床和吻合口复发少见.锁骨上、喉返神经区、奇静脉淋巴结及隆突下淋巴结是二野淋巴结清扫术后淋巴结转移的高发区.

Abstract：

Objective To investigate the local-regional recurrence in thoracic esophageal cancer after radical surgery including two-field lymph node dissection and provide evidence for postoperative radiotherapy. Methods We reviewed local-regional recurrence for 134 cases with esophageal squamous cell carcinoma after radical surgery from 2004 to 2009. Results In 134 cases, lymph node metastasis rate,anastomosis recurrence rate and tumor bed recurrence rate was 94. 0%, 9. 7% and 3.7%, respectively. As to the 126 cases with lymph node metastasis, significant difference was detected between mediastinal metastasis, supraclavicular metastasis and abdominal lymph node metastasis (80. 2%, 43.7% and 13.5%,respectively, χ2= 113. 15, P = 0. 000). Furthermore, the relative metastasis rate in upper mediastinum,middle mediastinum and the lower mediastinum was 73.8%, 39.7% and 1.6%, respectively, the difference was statistically significant ( χ2 = 139. 11, P = 0. 000 ). Significant difference was identified between right and left supraclavicular lymph node metastasis (31.7% vs 16. 7%, χ2= 7. 81, P = 0. 005 ).To confirm the analysis above,lymph node metastasis rate of left recurrent laryngeal nerve nodes, (including region 1L, 2L, 4L and 5) ,right recurrent laryngeal nerve nodes, azygos nodes, subcarinal nodes, and 2R region was 38.9%, 43.7%, 15.1%, 34.1% and 25.4%, respectively. Conclusions The main characteristics of local-regional recurrence may be lymph node metastasis for esophageal squamous cell carcinoma after radical surgery. On the contrary, tumor bed recurrence is rare. Dangerous regions include supraclavicular nodes, recurrent laryngeal nerve nodes, azygos nodes as well as subcarinal nodes.