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南通大学学报（医学版）

南通大学学报（医学版）

Journal of Nantong University(Medical Sciences)
本刊主要刊载本院及教学医院和全国交通系统医疗卫生单位，在基础医学和临床基学、预防医学、中医学和航海医学等方面的最新成果和有一定学术水平的医学论文。高水平的编委会和业务能力较强的编辑部班子是保证本刊质量的关键因素。本刊作为中国科技情报所科技论文统计分析对象被列为国内主要科技期刊。
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  • 国内刊号/CN：32-1807/R
    国际刊号/ISSN：1674-7887
  • 发行周期：双月刊
    邮发代号：28-157
  • 主管单位：江苏省教育厅
    主办单位：南通大学
南通大学学报（医学版）-联系信息
  • 主编：丁斐
  • 电话：0513-85012950 85012951
  • 邮箱：xbbjb@ntu.edu.cn
  • 地址：江苏南通市啬园路9号
  • 邮编：226019
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南通大学学报（医学版） >2023年第4期

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  • 摘要：目的：探讨磷脂酰肌醇蛋白-3(glypican-3，Gpc-3)和肝细胞石蜡抗原(hepatocyte paraffin antigen，HepPar-1)在原发性肝细胞肝癌(hepatocellular carcinoma，HCC)中的诊断价值及临床意义。方法：收集30例经病理诊断为HCC的肝组织标本，用免疫组化法染色，观察Gpc-3及HepPar-1在组织切片中的表达情况，对相关数据进行统计分析。同时分析患者的临床资料，采用χ2检验对Gpc-3及HepPar-1在HCC癌中的表达及其临床病理特征的关系进行研究。收集15例新鲜肝癌标本，采用RT-PCR法检测Gpc-3在HCC癌组织及癌旁组织的表达情况，观察癌及癌旁组织Gpc-3阳性率。结果：(1)免疫组化结果显示：Gpc-3在肝癌组织中的阳性率为83.33%(25/30)，癌旁组织阳性率为23.33%(7/30)，二者相比，差异有统计学意义(P<0.01)；HepPar-1在癌组织中的阳性率为33.33%(10/30)，癌旁组织阳性率为80%(24/30)，二者相比，差异有统计学意义(P<0.05)。应用Kappa统计学方法分析Gpc-3和HepPar-1在癌组织的表达情况，结果实际测得疾病例数与预测例数一致性相当好(Kappa=0.813，P<0.05)。高分化HCC中Gpc-3表达阳性率为73.33%(11/15)，中/低分化癌组织为93.33%(14/15)，高分化与中/低分化病理分化程度之间的Gpc-3表达相比较，差异有统计学意义(P<0.05)。高分化HCC中HepPar-1表达阳性率为33.33%(5/15)，中低分化癌组织为26.67%(4/15)，HepPar-1在不同病理分化程度之间表达相比较，差异无统计学意义(P>0.05)。 Gpc-3阳性表达与性别、年龄、肿块直径、包膜是否完整、淋巴侵犯、门静脉癌栓、谷酰转肽酶(gamma-glutamyl transpeptidase,GGT)、总胆红素(total bilirubin，TBIL)无关(均 P>0.05)，与分化程度、HBSAg、甲胎蛋白(α-fetoprotein，AFP)有关(P<0.05)。 HepPar-1阳性表达与性别、年龄、分化程度、肿块直径、包膜是否完整、门静脉癌栓、AFP、GGT、TBIL 无关(均P>0.05)，与淋巴侵犯、HBSAg有关(P<0.05)。 Gpc-3和 HepPar-1在HCC中的表达无明显相关性(r=0.158，P>0.05)；(2)RT-PCR法结果提示Gpc-3 mRNA在HCC组织中高表达，明显高于癌旁组织(P<0.01)。结论：(1)联合应用Gpc-3和HepPar-1在HCC中的表达，其实际测得疾病例数与预测例数有很好的一致性，准确率为93.75%，因此Gpc-3联合HepPar-1对HCC的诊断具有提高诊出率，减少漏诊率等优点；(2)Gpc-3阳性表达与病理分化程度、HBSAg、AFP有关；HepPar-1阳性表达与淋巴侵犯、HBSAg有关；(3)Gpc-3和HepPar-1在HCC中的表达无明显相关性。两者均可作为HCC的独立预测因素，而两者联合应用，具有较好的临床使用价值。%Objective: To discuss the diagnosis and the clinical significance of glypican-3(Gpc-3) and phosphatidylinositol and hepatocyte paraffin antigen-1(HepPar-1) in hepatocellular carcinoma. Methods: Immunohistochemical method was used in 30 tissue samples of hepatocellular carcinoma(HCC) to observe the Gpc-3 and HepPar-1 expression for statistical analysis. Collection with clinical data of 30 patients, with theχ2 testing the relation of Gpc-3 and HepPar-1 expression in HCC and its clinical pathological features. 15 cases of fresh liver cancer specimens by RT-PCR assay Gpc-3 in HCC tissues and adjacent tissues, the expression of observed cancer and adjacent tissues Gpc-3-positive rate. With 15 cases with fresh liver cancer specimens , the expression of Gpc-3 gene in HCC tissues and adjacent tissues was detected by RT-PCR, and observed the Gpc-3-positive rate . Results: ( 1 ) Immunohistochemical results showed that: the positive rate of Gpc-3 in hepatocellular carcinoma was 83.33%(25/30),the positive rate of adjacent tissues is 23.33%(7/30), respectively. There was a significant difference between the cancer tissues and adjacent tissues(P<0.01). The positive rate of HepPar-1 in hepatocellular carcinoma is 33.33%(10/30), adjacent tissues is 80%(24/30),to compared with each other,there was a significant difference(P<0.05). With Kappa statistical methods to analyze the expression of Gpc-3 combined with HepPar-1 in cancer tissue,the results of the consistency of the actual number of disease cases and prediction of the number of cases is quite good ( Kappa=0 . 813 , P<0.05). The positive expression rate of Gpc-3 in well-differentiated hepatocellular carcinoma is 73.33%(11/15), In poorly differentiated cancer tissue is 93.33%(14/15). It is obviously different between the pathological grade ( P<0 . 05 ) . The positive expression rate of HepPar-1 in well-differentiated hepatocellular carcinoma is 33.33%(5/15), In poorly differentiated cancer tissue is 26.67%(4/15). Between the pathological grade, there was no significant difference(P>0.05). The positive expression of Gpc-3 in hepatocellular carcinoma is no relationship with gender, age, tumor diameter, capsular integrality , lymph node involvement, tumor thrombus in the portal vein, GGT, TBIL(P>0.05), but with the degree of differentiation, HBSAg, and AFP(P<0.05). The positive expression of HepPar-1 is no relationship with gender, age, degree of differentiation, tumor diameter, capsular integrality, portal vein tumor thrombus,AFP,GGT,TBIL(P>0.05),but with lymphatic invasion, HBSAg ( P<0 . 05 ) . Gpc-3 and HepPar-1 expression in HCC had no correlation with each other. (2)Rt-PCR results suggest that,Gpc-3 in hepatocellular carcinoma tissues was significantly higher expression than the adjacent tissues(P<0.01). Conclusions:(1)Combination Gpc-3 with HepPar-1 in human hepatocellular carcinoma, the actual number of disease cases and the number of forecast cases could have a good agreement with an accuracy rate of 93.75%. Therefore Gpc-3 combined with HepPar-1 in the diagnosis of hepatocellular carcinoma can improve the diagnosis of rate and reduce the rate of misdiagnosis. (2)The positive expression of Gpc-3 are relation with pathologic differentiation,HBSAg,AFP. The positive expression of HepPar-1 is relation with lymphatic invasion,HBSAg. (3)Gpc-3 and HepPar-1 in hepatocellular carcinoma has no obvious correlation with each other. Each one can be used as an independent predictor of hepatocellular carcinoma. It will be have a bette rvalue in clinical use if combined the two markers.
  • 摘要：目的：评估环肺静脉电隔离术(circumferential pulmonary vein isolation，CPVA)和环肺静脉电隔离+碎裂电位消融术(CPVA+complex fractionated atrial electro-gram，CPVA+CFAE)两种射频消融术式对心房颤动(房颤)患者左心房形态及功能的影响，为房颤消融术式的评价及消融策略的选择提供临床数据。方法：运用组织多普勒技术测量左房容积、二尖瓣运动曲线上舒张晚期速度峰值(Va)等指标，观察CPVA和CPVA+CFAE两种术式前后上述指标的变化，以此评价不同术式对房颤患者左心房形态及功能的影响。结果：CPVA组左房容积在消融前后的差异无统计学意义，Va值术后高于术前(P=0.001)；CPVA+CFAE组左房容积、Va 值在消融前后的差异均无统计学意义；术后Va值CPVA组高于CPVA+CFAE组(P=0.027)。结论：房颤患者CPVA术后左心房功能有所改善，而CPVA+CFAE术后左心房功能未见明显改善。提示过多的左房基质消融，可能损伤左房功能。
  • 摘要：Objective: To observe the hemodynamics influence of lidocaine by intravenous injection and intratracheal injection during general anaesthesia stage of analepsia. Methods: Sixty patients who will proceed general anaesthesia of tracheal cannula were randomly divide into two groups, 30 patients each group. Group A is medication administration team by vein;group B is medication administration team by homemade catheter trachea;after the operation, medication was administered when the patients start to swallow, to observe about mean arterial pressure(MAP), heart rate(HR), cardiac out-put(CO) five minutes after medication administered and anterior-posterior extubation. Results: Group A, MAP, HR decreased limited(P<0.05) after medication administered, while CO decreased obviously(P<0.05), but MAP, HR, CO step-up obviously(P<0.05) about anterior-posterior extubation;group B, MAP, HR decreased obviously(P<0.05), CO decreased quiet (P>0.05), but MAP, HR, CO changed tiny about anterior-posterior extubation (P>0.05). Conclusion: The hemodynamics influence of lidocaine by intratracheal injection during general anaesthesia’s stage of analepsia is more equability.%目的：分别观察利多卡因静脉注射和气管内注射对全麻苏醒期血流动力学的影响。方法：60例气管插管全麻患者随机分为两组，每组30例。 A组为静脉给药组(利多卡因1 mg/kg)，B组为经自制导管气管内给药组(利多卡因1 mg/kg)，均于手术结束后患者出现吞咽动作时给药，观察给药后5 min内和拔管前、后5 min平均动脉压(mean arterial pressure，MAP)、心率(heart rate，HR)、心输出量(cardiac output，CO)。结果：A 组给药后对 MAP、HR 有一定的降低作用(P<0.05)，CO也明显下降(P<0.05)，但拔管前后MAP、HR、CO升高明显(P<0.05)；B组给药后MAP、HR明显降低(P<0.05)， CO降低不明显(P>0.05)，而拔管前后MAP、HR、CO波动很小(P>0.05)。结论：在全麻苏醒期使用气管内注射1 mg/kg利多卡因的方法可使血流动力学更平稳。
  • 摘要：目的：探讨成人髋关节发育不良(developmental dysplasia of the hip，DDH)患者股骨近端CT三维重建的形态差异和临床意义。方法：通过CT重建测量72例DDH患者(78髋)与54例(54髋)正常股骨近端参数，包括股骨头直径、股骨头高度、头心-干轴距、颈干角、股骨颈前倾角，按Crowe分型标准分为3组，组1：CroweⅠ型(23髋)，组2：CroweⅡ型(31髋)，组3：CroweⅢ型和Ⅳ型共24髋，分别比较3组和正常对照组股骨近端的形态差异。结果：DDH3组均与正常股骨近端形态均有差异，组1股骨头高度[(4.84±0.57) cm]较对照组[(4.45±0.47) cm]高(P=0.013)；组2、组3头心-干轴距分别为(2.66±0.85) cm和(2.39±0.77) cm，均较对照组[(3.16±0.51) cm]小(P均<0.05)；DDH组头心-干轴距随着髋脱位程度增加而逐渐减小。结论：DDH患者股骨近端存在形态异常，在全髋关节置换术前行髋关节的CT扫描和三维重建对术中股骨柄假体的选择和安放角度有指导意义。
  • 摘要：目的：探讨输尿管结石导致肾积水与肾周积液的关系。方法：本院2006年3月-2013年10月间，共有输尿管结石伴肾积水患者1435例，选取其中伴肾周积液的36例作为研究对象，并随访治疗结果，分析肾周积液与肾积水的相关性。结果：伴有肾周积液的输尿管结石36例中，均单侧发病，超声显示肾积水程度为轻中度，表现为肾周月牙形或线条状液性暗区，肾皮质均无明显变薄，当解除梗阻及肾积水后，肾周积液均消失。结论：急性输尿管梗阻会导致肾周积液，肾周积液的发生与输尿管内压力增大相关。
  • 摘要：目的：比较翼状胬肉切除加巩膜暴露术，翼状胬肉切除加带含干细胞结膜瓣移植术及翼状胬肉切除加含干细胞结膜瓣移植加巩膜暴露术治疗翼状胬肉的临床疗效。方法：2009年5月-2013年2月，翼状胬肉120例(122眼)，其中原发性108例(110眼)，复发性12例(12眼)。随机分为A组：翼状胬肉切除加巩膜暴露36例(36眼)；B组：翼状胬肉切除加含干细胞结膜瓣移植41例(41眼)；C组：翼状胬肉切除加含干细胞结膜瓣移植加巩膜暴露43例(45眼)。结果：A、B、C组3种手术治疗翼状胬肉复发率分别为22.22%、7.32%、4.44%，但C组有1例结膜瓣坏死。结论：翼状胬肉3种手术方式中，联合含干细胞结膜瓣移植加巩膜暴露的复发率最低，是一种可靠而新颖的手术方式。
  • 摘要：Objective: To investigate the qualitative analysis of the main components of Yinchenhao decoction(YCHT) by high performance liquid chromatography(HPLC). Methods: The method was established on a Welch-materials XB-C18 column (250 mm ×4.6 mm,5 μm) with mobile phase in gradient elution composed of acetonitrile(A)-0.1%phosphoric acid (B) flowed at 1 mL·min-1. The column temperature was 35 ℃ to test 8 reference substance and the test materials of YCHT on 254 nm, 280 nm, 440 nm wavelengths and compare the chromatograms controls. Results: Eight components in YCHD havebeen iden-tified as gallic acid, chlorogenic acid, aloe Geniposide emodin, rhein, emodin, chrysophanol and physcion were absorbed well at 254 nm. Gallic acid and chlorogenic acid were also absorbed at 280 nm and they were not absorbed at 440 nm. At 280 nm and 440 nm there is no absorption of geniposide. At the 280 nm and 440 nm these five anthraquinones have good ab-sorption. Conclusion: HPLC which chromatographic conditions have been identified at 254 nm, 280 nm, 440 nm wave-lengths, can be used to analyze the major components of YCHT.%目的：通过高效液相色谱法(high performance liquid chromatography，HPLC)对茵陈蒿汤(Yinchenhao de-coction，YCHT)中主要成分的进行定性。方法：采用welch-materials XB-C18(250 mm×4.6 mm，5μm)色谱柱，以乙腈(A)-0.1％磷酸(B)梯度洗脱，流速1.0 mL/min，柱温30℃，分别对8个对照品及YCHT供试品在254、280及440 nm 3个波长下的色谱图进行比较。结果：YCHT中8个有效成分没食子酸、绿原酸、栀子苷及芦荟大黄素、大黄酸、大黄素、大黄酚、大黄素甲醚在254 nm处均有良好吸收；没食子酸、绿原酸在280 nm处亦有吸收，440 nm处无吸收；栀子苷在280 nm和440 nm无吸收；5种蒽醌类成分在280 nm及440 nm处均有良好吸收。结论：采用已确定的色谱条件，对YCHT 254、280及440 nm 3个波长的色谱图的比较，可较全面分析其主要成分。
  • 摘要：目的：探讨奥拉西坦(oxiracetam)对脑梗死大鼠细胞凋亡及神经再生的影响。方法：60只健康成年雄性SD大鼠随机分为假手术组、生理盐水组、奥拉西坦组(n=20/组)。大鼠右侧大脑中动脉阻塞脑缺血模型成功后，生理盐水组给予尾静脉注射无菌生理盐水1 mL，连续14 d；奥拉西坦组尾静脉注射无菌生理盐水配置的奥拉西坦1 mL，注射剂量为200 mg/kg，连续14 d；假手术组仅切开颈部肌肉，暴露颈总动脉后缝合。模型成功后同时给予大鼠腹腔注射BrdU (50 mg/kg)，bid，连续7 d以标记新生细胞。比较各组动物的神经功能评分，用TUNEL荧光标记测定细胞凋亡，BrdU、微管相关蛋白(doublecortin，DCX)免疫荧光技术标记增殖细胞及新生神经元。结果：与假手术组相比，脑梗死(生理盐水组和奥拉西坦组)大鼠的神经功能明显降低(均 P<0.05)；治疗后，奥拉西坦组的大鼠神经功能比生理盐水组明显改善，差异有统计学意义(P<0.05)。脑梗死后，大鼠缺血脑组织的细胞凋亡明显增加，但奥拉西坦组的细胞凋亡明显少于生理盐水组，而增殖细胞及新生神经元显著多于假手术组和生理盐水组(P<0.05)。结论：奥拉西坦可减少细胞凋亡、促进神经再生，从而改善脑梗死大鼠的神经功能。%Objective: To study the effects of oxiracetam on apoptosis and neurogenesis in rat ischemic stroke model. Methods: 60 adult male Sprague Dawley rats were randomly separated into three groups, including sham operation group, saline group, oxiracetam group(n=20/group). Rat right middle cerebral artery transient occlusion(MCAO) model was established. Two separate groups were administered with either oxiracetam or saline via the tail vein immediately after artery occlusion for 14 days . Neck muscles and carotid artery were in sham operation group exposed . And BrdU ( 50 mg/kg ) was performed intraperitoneal injection to all rats twice a day for 7 days to label stem cells. The neural function was compared among the three groups. TUNEL immunofluorescence was used to detect apoptosis , BrdU and DCX immunofluorescence were used to observe neurogenesis in ischemic brain. Results: After MCAO, the neural function in saline group and oxiracetam group obviously decreased(P<0.05) as compared with sham operation group. But the function in oxiracetam group was better than that in saline group after treatment ( P<0 . 05 ) . The number of BrdU and DCX positive cell was significantly higher than those in sham operation group and saline group(P<0.05 respectively), while the TUNEL positive cell in oxiracetam group was less than that in saline group. Conclusion: Oxiracetam may promote neuronal function via reducing apoptosis and stimulating neurogenesis.
  • 摘要：Objective:To explore the clinical efficacy of use of titanium miniplate in cervical single open-door laminoplasty for the treatment of multiple-segment cervical spondylotic myelopathy. Methods: 15 patients who stayed in our hospital were selected from October 2011 to April 2013 and diagnosed of femoral shaft fracture by clinic,X-rays,CT and MRI. All patients were underwent single open-door laminoplasty, open-door side were fixed using titanium miniplate. Surgical complications were recorded. The JOA score, improvement rate and alignment of the cervical spine were analyzed preoperative and postop-erative respectively. Results: All the patients underwent the operation. The average surgery time was 85 min ranging from 70 to 130 min. The average blood loss was 250 mL ranging from 150 to 500 mL. No complication such as irrevisible neurological injury, cerebrospinal fluid leakage, infection and break of internal fixation was noted. There were 2 patients with the occur-rence of axial symptoms. All patients were followed up 6 months to 20 months(mean, 13.4 months), the average JOA score was increased from 8.6 ±1.7 to 13.8 ±2.1. The patients with postoperative neurological deficit improved to different degrees. The JOA improvement rate was 28.3%-75.6%, with a mean of (53.8 ±17.9)%. There was no significant difference between preoperative 18.1°±4.0° and postoperative 17.9°±3.8° cervical curvature angle. No door-reclose was noted during follow- up. Conclusion:Use of titanium miniplate in cervical single open-door laminoplasty was one of safe and effective surgical method to treat multiple-segment cervical spondylotic myelopathy.%目的：探讨颈椎后路单开门椎管扩大成形术加微型钛板内固定治疗多节段脊髓型颈椎病的临床疗效。方法：选择2011年10月-2013年4月本院收治的脊髓型颈椎病15例，所有患者术前均经临床症状、X线、CT及MRI表现诊断，患者均采用颈椎后路单开门椎管扩大成形术，开门侧均使用微型钛板内固定治疗，观察术中和术后并发症发生情况，比较手术前后日本矫形外科协会(Japanese Orthopaedic Association，JOA)评分、神经功能改善率及颈椎曲度变化。结果：所有患者均顺利接受手术，手术时间70～130 min，平均85 min，术中出血量150～500 mL，平均250 mL。术中无不可逆性脊髓损伤，无脑脊液漏、切口感染、内固定断裂等并发症发生，2例患者术后出现轴性症状。随访6～20个月，平均13.4个月，JOA评分由术前平均(8.6±1.7)分提高到术后平均(13.8±2.1)分，所有患者神经功能均得到不同程度改善，神经功能改善率为28.3％～75.6％，平均(53.8±17.9)％，术后颈椎曲度为17.9°±3.8°，与术前18.1°±4.0°比较差异无统计学意义。末次随访未发现再关门现象。结论：颈椎后路单开门加微型钛板内固定术是治疗多节段脊髓型颈椎病的一种安全有效的方法。
  • 摘要：胰脏癌是一个多病因的恶性疾病，其发病机制尚待进一步研究。在胰腺癌发病过程中，S100蛋白家族参与多条相关细胞通路的调节。 S100蛋白家族在体内有着广泛的细胞内外功能，包括蛋白磷酸化和调节酶的活性、钙稳态、调节细胞骨架成分、调节转录因子等。S100蛋白也可与RAGE、p53基因、p21基因等相结合，并在细胞外基质降解和转移、细胞骨架蛋白与质膜结合促进胰腺癌进展和转移等方面发挥重要的作用。此外，S100A11、S100P被认为是胰腺癌的早期肿瘤标志物，S100A6可能是一个独立的预后不良信号。 S100A4和S100P可能与耐药性、分化、转移和预后相关。本文阐述了S100家族在胰腺癌中信号通路及其相关蛋白的作用和意义。%The occurrence an d development of pancreatic cancer is a complex process convoluted by multi-pathogenies , multi-stages, and multi-factors. S100 proteins are members of the S100 family that regulate multiple cellular pathways relat-ing to pancreatic cancer progression and metastasis. S100 proteins have a broad range of intracellular and extracellular func-tion, including regulation of protein hosphorylation and enzyme activity, calcium homeostasis, regulation of cytoskeletal com-ponents and regulation of transcriptional factors. S100 proteins interact with RAGE, p53, p21, which play an important role in degradation of extracellular matrix and metastasis , and also interact with cytoskeletal proteins and plasma membrane in pancreatic cancer progression and metastasis. S100A11 and S100P are significant tumor markers for pancreatic cancer and un-favorable predictors for prognosis of patients who have undergone surgical resection. Recently , S100A2 has been suggested as a negative prognostic biomarker in pancreatic cancer, and the expression of S100A6 may be an independent prognostic impact factor. S100A4 and S100P expressions are associated with drug resistance, differentiation, metastasis, and clinical outcome. This review summarizes the role and significance of S100 family signaling network and its related protein in pancreatic cancer.
  • 摘要：目的：探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy，LC)中转开腹相关因素及预防措施。方法：比较中转开腹者及未中转开腹者两组各41例患者性别、年龄、急性炎症、腹部手术史、糖尿病、体质量指数、总胆红素水平、腹腔镜手术经验、手术时间之间的差异。结果：中转开腹者组上腹部手术史占24.30%、平均年龄(58.67±16.56)岁、急性炎症发生率(43.90%)高于未中转开腹组的48.78%、(48.56±15.67)岁、24.39%(P<0.05)，手术医师操作(48.23±10.34)次低于中转开腹组(102.23±20.38)次，是导致中转开腹的危险因素；两组性别、下腹部手术史、糖尿病、体质量指数、总胆红素水平、手术时间比较差异无统计学意义(P>0.05)。结论：LC存在一定程度的中转开腹，影响因素复杂，应实施针对性措施减少中转开腹。
  • 摘要：自2009年起，《南通大学学报：医学版》启用由中国学术期刊（光盘版）电子杂志社和同方知网技术有限公司联合开发的“科技期刊学术不端文献检测系统”（AMLC），旨在杜绝抄袭、伪造、剽窃、不当署名、一稿多投等学术不端行为，提高期刊内容质量。
  • 摘要：Objective:To explore the clinical effect of endoscopic submucosal dissection treating colorectal lateral spreading tumor. Methods:21 cases of lateral spreading tumor patients were retrospectively collected hospitalized from Jan. 2012 to Aug. 2013 to analyze the rate of whole lesion dessection, the diameter of dessected lesion, the operation time, the complications, the recurrence rate and the healing rate. Results: (1) The rate of whole lesion dessection of colorectal lateral spreading tumor treated with endoscopic submucosal dissection was 90.48%(19/21);the diameter of the lesion was 1.1-10 cm, average(3.7±3.1) cm;the operation time was 10-115 min, average(75±46.5) min;the rate of perforation was 9.5%(2/21), delayed bleeding was 4.8%(1/21). 19 cases were pathologically negative on sliced border and neoplasm infiltration were found in two cases, one of which treated with surgical operation, and the other treated with radiation. All of the 19 cases had been follow-up for 3 to 12 months and none of them had residual lesion or recurrence. Conclusion: The endoscopic submucosal dissection treating col-orectal lateral spreading tumor has high rate of whole lesion dissection, short of operation time and low rate of recurrence.%目的：探讨内镜黏膜下剥离术(endoscopic submucosal dissection，ESD)在切除大肠侧向发育型肿瘤(lateral spreading tumor，LST)中的价值和疗效。方法：回顾性分析2012年1月-2013年8月间我科采用ESD治疗的21例LST患者，分析整块病灶切除率、切除病灶直径、手术操作时间、术中术后并发症、复发率及治愈率。结果：21例行ESD治疗的LST，ESD手术完整切除率为90.48%(19/21)；切除病灶直径1.1~10 cm，平均(3.7±3.1) cm；从黏膜下注射至完整剥离结束时间10~115 min，平均(75±46.5) min；2例出现术中穿孔，1例出现术后迟发性出血，经保守治疗后均好转。其中癌变2例，余均为良性病变。随访3~12个月无病变残留或复发。结论：ESD治疗LST的整切率高，操作时间短，复发率低。
  • 摘要：Objective: To summarize the operation experience of transcranial microsurgery for sellar region tumors and ana-lyze the effect of different approaches in surgery. Methods: A retrospective analysis was made on 80cases of sellar region tu-mor operated from May 2012 to March 2014 in department of neurosurgery of the Affiliated Hospital of Nantong University which all removed by using microsurgical technique with three different surgical approach(trans-pterional, trans-subfronta, and trans-frontal lateral approach) , including 56 cases of meningiomas, 12 cases of pituitary adenoma, 9 cases of cranio-pharyngioma, 2 cases of dermoid cyst, and 1cases of neuroendocrine tumor. The removal rate, surgery effect and complica-tions were analyzed. Results: Trans-pterional approach were adopted in 50 cases and the tumor total resection rate was 66.0%;trans-subfrontal approach were adopted in 16 cases and the tumor total resection rate was 75.0%;trans-frontal lateral approach were adopted in 14 cases and the tumor total resection rate was 71.4%. Conclusion:Microscopic surgery is the main way of remove sellar region tumors. The surgical approach should be chosed following the principle of individual and opti-mization. The choice should be made according to the growth pattern of tumor, the tumor size, the relationship between tumor and surrounding structures, and the habit of surgeon.%目的：总结经颅显微外科切除鞍区肿瘤的经验，探讨经颅切除鞍区肿瘤手术入路的选择。方法：回顾分析南通大学附属医院神经外科自2012年5月-2014年3月手术的鞍区肿瘤80例(脑膜瘤56例、垂体瘤12例、颅咽管瘤9例、皮样囊肿2例、神经内分泌源恶性肿瘤1例)的临床资料；手术入路包括翼点入路、额下入路和额外侧入路，肿瘤采用显微外科技术切除。分析全切除率、手术效果和并发症发生的情况。结果：采用翼点入路者50例，全切除率为66.0%；采用额下入路者16例，全切除率为75.0%；采用额外侧入路者14例，全切除率为71.4%。结论：显微手术是治疗鞍区肿瘤的主要手段，选择手术入路时应根据肿瘤的大小、生长方式以及肿瘤和周围重要结构的关系，遵循最优化和个体化原则，结合手术者的经验来决定。
  • 摘要：降钙素原（procalcitonin，PCT）作为一种新型炎性生物标志物，其在感染诊治中的价值越来越得到肯定。最新的拯救全身性感染运动（ surviving sepsis campaign，SSC）指南[1]也推荐，在无新发感染的情况下可依据低水平的PCT结果停用抗生素治疗。以下就PCT在感染诊治中的应用进展做一综述。
  • 摘要：目的：探讨改良Alvarado评分系统用于诊断婴幼儿阑尾炎的临床价值。方法：回顾性研究我院2008年1月-2012年12月，3岁以下阑尾炎患儿146例的诊治资料，以阵发哭吵腹痛及腹胀压痛替代转移性右下腹痛及右下腹压痛进行改良Alvarado评分，以术后病检结果为金标准，比较改良Alvarado评分与B超及CT的准确率。结果：改良Alvarado评分系统准确率92.5%，B超检查准确率86.6%，CT检查准确率88.1%，经χ2检验三者差异无统计学意义(χ2=2.65， P>0.05)。结论：改良Alvarado评分系统与B超、CT等特检准确率相同，且更经济有效。
  • 摘要：目的：探讨钬激光碎石联合胆道镜在难取肝内外胆管结石中应用的安全性和疗效。方法：2010年3月-2013年6月应用钬激光碎石联合胆道镜治疗22例难取肝内外胆管结石，在直视下接触结石，将结石击碎后注水冲出，或用取石篮套出。结果：22例结石，一次性完全清除18例，2次碎石后取尽3例，大部结石去除1例，小分支胆管有结石残留，本组无胆道损伤、出血。结论：钬激光碎石联合胆道镜取石治疗难取性肝内外胆管结石具有直观、准确、方便、疗效确切的特点，是治疗难取肝内外胆管结石的一种安全、有效的新手段。
  • 摘要：目的：对某高校219例成人水痘患者进行分析，了解其临床特征和治疗方法。方法：收集在2005年1月-2013年12月之间收治的219例成人水痘患者作为研究对象，对其临床资料进行回顾性分析总结。结果：成人水痘临床症状较儿童水痘更为严重，并发症多，病程长，传染性强；疫苗接种是预防成人水痘的有效手段；阿昔洛韦抗病毒作用明显，治疗成人水痘效果良好。结论：成人水痘危害较大，需进一步加强水痘的疫苗接种和诊治工作。
  • 摘要：目的：探索在正畸治疗中使用自锁托槽与传统托槽对支抗要求的比较。方法：选择AngleⅠ类牙列中度拥挤或前牙前突的女性患者32例，随机分成2组，A组16例，使用传统直丝弓托槽，后牙辅助Nance弓加强支抗；B组16例仅使用自锁托槽进行矫治。比较2组总的治疗时间及治疗前后X线头影测量的线距和1-SN的角度差值。结果：(1)A组治疗时间平均为22.7个月，B组治疗时间平均为19.5个月，2组之间的差异有统计学意义；(2)A组支抗磨牙近中移动平均3.42 mm，切牙切缘平均内收4.54 mm，治疗前后1-SN角度的差值为8.78°；B组支抗磨牙近中移动平均3.06 mm，切牙切缘平均内收5.01 mm，治疗前后1-SN角度的差值为9.02°，2组之间的差异有统计学意义。结论：对于需要中度支抗的正畸患者使用自锁托槽可以增强支抗，减少口内的装置，提高患者的舒适度，缩短整个治疗时间。
  • 摘要：目的：使用无血清培养基培养可稳定表达马来丝虫半胱氨酸蛋白酶抑制剂基因(Brugia malayi cystatin， Bm-CPI)的人宫颈癌细胞(Hela)。方法：将已获得的Bm-CPI稳定转染的Hela细胞株，进行无血清培养并观察Hela细胞的维持时间和培养过程中Hela细胞的形态变化。结果：无血清培养基培养Hela细胞可维持细胞的正常生长。结论：无血清培养基可以逐步代替含血清的培养基，为后续Hela细胞扩大培养和Bm-CPI基因重组蛋白纯化提供依据。%Objective:To culture stably expressing Brugia malayi cystatin(Bm-CPI) gene of Hela cells in serum-free medi-um. Methods:The monoclonal cell strains of recombinant plasmid pcDNA3.1(+)-Bm-CPI were cultured in suspension culture with serum-free media, then were observed the maintain time and morphological changes of the Hela cells in culture super-natant. Results:Hela cells cultured in serum-free medium grew well. Conclusion:The medium containing serum can be com-pletely substituted by serum-free medium, which sets up a base for further study of Hela cells being expanded and Bm-CPI recombinant proteins purification.
  • 摘要：目的：通过uPAR特异siRNA靶向下调大肠癌LOVO细胞uPAR的表达，研究大肠癌细胞恶性生物学行为的变化。方法：构建3对uPAR特异siRNA，将其转入大肠癌LOVO细胞，用Western Blot检测uPAR-siRNA干扰效果，选择干扰效率最高的一对siRNA进行后续实验。利用流式细胞术及CCK-8试验检测uPAR-siRNA转染后大肠癌细胞增殖变化，利用Transwell小室实验及划痕实验检测uPAR-siRNA转染后对大肠癌细胞迁移能力变化。结果：大肠癌细胞分别转染3对uPAR-siRNA后，uPAR的表达明显下降，其中uPAR-siRNA-3的干扰效率最高；大肠癌细胞转染uPAR-siRNA-3后，G1期细胞数量明显增加，细胞增殖能力明显下降，细胞迁移数量明显减少及细胞迁移距离明显下降(均P<0.05)。结论：uPAR特异siRNA转染大肠癌细胞LOVO后，明显下调uPAR的表达；uPAR-siRNA转染大肠癌细胞LOVO后，明显抑制大肠癌细胞的增殖和迁移能力。%Objective: To investigate the change of malignant behaviors in colorectal cancer cells(LOVO) through targeted down-regulation the expression of uPAR by the specific uPAR-siRNA. Methods: Three pairs of specific uPAR-siRNA were constructed and transfected into LOVO colorectal cancer cell line. The interference efficiencies of uPAR-siRNAs were detected by Western Blot. The uPAR-siRNA with the highest interference efficiency was selected for the following experiments. The proliferation of colorectal cancer cells after transfection with uPAR-siRNA was detected by flow cytometry and CCK-8 assay. The migration of colorectal cancer cells after transfection with uPAR-siRNA was determinated by Transwell chamber system and Wound healing assay. Results: The expressions of uPAR in the colorectal cancer cells were significantly down-regulated after transfection with uPAR-siRNAs, and uPAR-siRNA-3 caused the most reduction of uPAR. After transfection with uPAR-siRNA-3 into colorectal cancer cells, the number in G1 phase was significantly increased, but the abilities of proliferation and migration were significantly inhibited , compared with the control group (all P<0.05). Conclusions: The expression of uPAR in colorectal cancer cells after transfection with the specific siRNAs of uPAR is significantly down-regulated . Targeted down-regulation of uPAR inhibits the malignant biological behaviors including proliferation and migration of colorectal cancer cells.
  • 摘要：目的：探讨小剂量丙戊酸钠(valproate acid，VPA)对吡柔比星(pirarubicin，THP)抑制儿童急性B淋巴细胞白血病(B-cell acute lymphoblastic leukemia，B-ALL)细胞株Raji细胞生长的增敏作用及其可能机制。方法：应用WST-1法检测不同浓度的VPA、THP单药及二者联合应用时对Raji细胞增殖的影响；将筛选出最佳联合作用浓度的THP与VPA联合作用于Raji细胞，显微镜下观察细胞的增殖情况，TUNEL法检测细胞凋亡，同时通过Real-time PCR、Western Blot检测不同组合药物作用前后细胞凋亡相关蛋白Bax、Bcl-2 mRNA和蛋白水平的表达变化。结果：不同浓度VPA(0.25、0.5、1、2、3、4、5 mmol/L)、THP(0.1、1.0、2.5、5、10μmol/L)对Raji细胞均有一定的增殖抑制作用，呈时间和剂量依赖性；联合用药对细胞的增殖抑制率明显高于THP单药组，也呈时间和剂量依赖性(P<0.05)。联合用药组细胞凋亡率明显高于VPA和THP单药组。Real-time PCR、Western Blot结果显示联合用药组(0.25 mmol/L VPA+2.5μmol/L THP)Bax mRNA和蛋白表达水平显著高于单药组，Bcl-2 mRNA和蛋白表达量显著低于单药组，各组和对照组相比差异均有统计学意义(P<0.05)。结论：VPA及THP对Raji细胞增殖有抑制作用，且有浓度和时间依赖性。低浓度的VPA联合不同浓度THP对Raji细胞增殖抑制作用较单药应用显著增强。 VPA联合THP一定程度上通过促进凋亡进而抑制了Raji细胞的增殖作用。%Objective:To study the effects of low dose of sodium valproate (valproate acid,VPA) of pirarubicin (pirarubicin, THP)inhibition in childhood B-cell acute lymphoblastic leukemia (B-ALL) cell line Raji and investigate their sensitization ef-fect of cell growth and its possible mechanism. Methods:WST-1 was used to detect different concentration of VPA, THP and their joint application of Raji cell proliferation. The optimum concentration of THP and VPA were combined on Real-time cells. Observed the proliferation of cells under the microscope; apoptosis was detected by TNUEL; at the same time , Real-time PCR and Western Blot were used to detect the expression of Bax , Bcl-2 mRNA and protein before and after treated with different combinations of drugs. Results: VPA(0.25, 0.5, 1, 2, 3, 4, 5 mmol/L) and THP(0.1, 1, 2.5, 5, 10 μmol/L) had an inhibitory effect on Raji cells was in a time and dose dependent respectively. The inhibition rate of cell proliferation in combination group was significantly higher than that of THP single drug group, also in a time and dose dependent(P<0.05). Cell apoptosis rate of combination group was obviously higher than that of control group , also higher than that of VPA and THP single drug group. Real-time PCR and Western blot results showed that Bax mRNA and protein expression levels in the combined treatment group(0.25 mmol/L+2.5 mol/L THP) were significantly higher than the single drug group , Bax mRNA and protein expression were significantly lower than drug groups , while Bcl-2 mRNA and protein expression were signifi-cantly higher than drug groups , each group differences were statistical significant ( P<0 . 05 ) . Conclusions: VPA and THP had inhibitory effect on the proliferation of Raji cells , and there were a time and concentration dependent. The inhibition rate of Raji cells proliferation in VPA combined with different concentration of low concentration of THP was significantly more enhanced compared with single drug group. VPA combined with THP inhibited the proliferation of Raji cells , to some extent, by promoting apoptosis.
  • 摘要：乳腺癌是女性发病率最高的恶性肿瘤。近年来，乳腺癌有逐年上升趋势，其发生、发展、远处转移以及预后的情况与原癌基因的激活、抑癌基因的凋亡抑制、基因的异常表达等密切相关。随着分子生物学研究的不断深入，一些乳腺癌相关因子的检测已相继开展，本文对乳腺癌的一些相关预后因子(Ki-67、HER-2、D2-40)的研究现况进行进一步阐述，希望能够提供有价值的预后信息和靶点治疗新思路。
  • 摘要：目的：总结合并心血管疾病骨科手术患者围手术期的管理，旨在提高心血管患者对骨科手术的耐受性和围手术期的安全性，减少术后并发症。方法：收集我院骨科2011年10月-2013年5月住院手术合并心血管疾病患者74例，对上述患者临床资料进行回顾分析，采用SPSS 13.0软件进行数据分析。结果：64例高血压病患者术中血压剧烈升高需要静脉降压者18例；围手术期出现胸闷不适伴心电图心肌缺血者9例；围手术期发生心力衰竭者2例；术前检查发现病态窦房结综合征，行临时起搏器植入术者3例，围手术期无心血管事件发生；术后发生心肌梗死者1例，恶性心律失常伴死亡1例。结论：合并心血管疾病的骨科手术患者围手术期加强心内科和骨科的团队合作，术前充分评估和准备，术中加强监测及管理，术后继续监测和治疗，对提高患者骨科手术耐受性及安全性，降低手术并发症的发生率至关重要。
  • 摘要：目的：对ST段改变判断急性下壁心肌梗死患者梗死相关血管的临床意义进行评价分析，为临床诊断提供可靠的参考依据。方法：抽取在2010年1月-2013年12月间我院收治的急性下壁心肌梗死患者73例，对其心电图Ⅰ、Ⅱ、Ⅲ、aVL、aVR、V5、V6导联ST段偏移情况进行分析，并与冠状动脉造影结果展开对比。结果：本次研究中经心电图ST段偏移判断梗死相关血管为右冠状动脉者59例，为回旋支者14例。结论：经常规12导联心电图ST段偏移对急性下壁心肌梗死患者梗死相关血管进行判断的敏感性和准确性均较高，值得临床推广。
  • 摘要：目的：探讨输尿管软镜下钬激光碎石术治疗上尿路结石的临床疗效。方法：对51例上尿路结石患者行输尿管软镜下钬激光碎石治疗，其中输尿管上段结石14例，肾盂或肾中上盏28例，肾脏下盏结石9例；结石直径0.9~3.0 cm，其中2.0~3.0 cm 6例。结果：33例一次进镜成功，余18例在留置双J管2周后均顺利置入输尿管软镜，总进镜成功率为100.0%；4例行二次软镜下钬激光碎石；钬激光碎石成功率82.3%(42/51)。手术时间20~85 mim，平均55 min。无活动性出血、输尿管穿孔、脓毒血症等并发症发生。结论：输尿管软镜下钬激光碎石术治疗上尿路结石安全有效，损伤小、恢复快，部分较大结石病例可行二次输尿管软镜下碎石治疗。
  • 摘要：目的：观察Q开关Nd：YAG激光治疗面部扁平疣的临床疗效。方法：将103例面部扁平疣患者随机分成两组，观察组52例使用Q开关Nd：YAG激光治疗仪，波长为532 nm；对照组51例使用干扰素乳膏及0.1%维A酸乳膏联合治疗。结果：观察组有效率为86.5%，对照组有效率为68.7%，差异有统计学意义(P<0.05)。结论：Q开关Nd：YAG治疗面部扁平疣疗效高、安全性好，可供临床选用。
  • 摘要：目的：探讨拮抗线粒体穿梭系统关键分子肉毒碱对肝脂肪氧化的影响。方法：野生型C57BJ/6j (wt/wt)鼠腹腔注射0.05%(W/W/d)肉毒碱相似物[3-(2，2，2-trimethyl hydrazinium) propionate dihydrate，THP]拮抗循环肉毒碱，对照鼠以等量生理盐水(0.85%，W/V)注射，2周后以乙醚麻醉处死留取肝组织；油红O染色观察肝组织脂肪积聚，从肝组织提取并以放射法分析长、短链脂酰肉毒碱，游离及总肉毒碱浓度。结果：THP 注射后鼠肝脏质量明显高于对照组(P<0.05)，油红O染色证实模型鼠肝组织出现大量脂肪积聚，高于对照鼠的5~6倍；肝组织总、长链和游离肉毒碱比浓度(nmol/g湿重肝组织)显著高于对照组(P<0.05)，分别为(392.16±53.08) vs (323.78±51.29)、(78.32±9.51) vs (65.80±7.73)和(252.28±28.21) vs (151.46±37.81)，短链脂酰肉毒碱比浓度明显低于对照组(61.56±23.28 vs 106.92±41.16)。结论：肉毒碱是保证脂肪酸进行β-氧化关键分子和代谢的重要因素。%Objectiv e: To explore antagonistic key molecule of mitochondrial carnitine shuttle system on effects of hepatic fatty acid metabolism. Methods: Wild type C57BJ/6j(wt/wt) mice were intraperitoneally injected 0.05% of carnitine analogue [(3-(2,2,2-trimethyl hydrazinium, W/W/d) propionate dehydrate,THP)] to antagonistic carnitine, and the control mice with equal quantity saline (0.85%, W/V), and sacrificed with ether anesthesia after two weeks, and the livers were strained with oil red for observing hepatic fatty accumulation and the levels of different type carnitines including total, free, long, and short-chain were quantitatively analyzed in liver tissues by radiometric method. Results: After the mice injected with THP, the liver weight in the injected group was significantly increased(P<0.05) than that in the control group, with the fatty accu-mulation in hepatocytes. The hepatic specific concentrations(nmol/g wet liver) in the injected group were significantly higher (P<0.05) than those in the control, with (392.16±53.08) vs (323.78±51.29) in total, (252.28±28.21) vs (151.46±37.81) in free, and (78.32±9.51) vs (65.80±7.73) in long chain carnitine, and remarkedly decreased in short-chain carnitine (61.56±23.28 vs 106.92±41.16), respectively. Conclusion: Carnitine is located on inner membrance of mitochondria and one of key enzymes limited β-oxidation process.
  • 摘要：Objective: To establish a reversible rabbit model of obstructive jaundice which was easy to execute internal and external biliary drainage. Methods:36 New Zealand rabbits were randomly divided into three groups:external biliary drainage group(group A), internal biliary drainage group(group B) and sham operation group(group C). In groups A, B, reversible rab-bit model of obstructive jaundice was established, including cutting off common bile duct, putting silica gel duct in hepatic and duodenal ends, fixing both ends by suturing, occluding silica gel duct and then subcutaneously sewing. Rabbits were subjected with operation again at the 7th day postoperatively: external biliary drainage was formed by shearing off silica gel duct and puting vitro, and internal biliary drainage was formed by removing occlusion. In sham operation group, rabbits were subjected with liberating common bile duct and making loose knot. Blood of all animals was collected preoperatively , at 7th day postoperatively and 7th day after second operation. Liver function was detected by automatic biochemistry analyzer. Liver and bile duct were observed by ultrasound postoperatively and at 7th day postoperatively and 7th day after second operation. Liver tissue was collected at 7th day after second operation , and the pathology of liver was observed. Results: The reversible rabbit model of obstructive jaundice was established. There was no significant difference in liver function of groups A, B, C postoperatively. The level of total bilirubin (TB), direct bilirubin (DB), alanine transarninase(ALT) andγ-glutamyl transferase (γ-GT) were higher in groups A, B than those in groups A, B preoperatively and group C at 7th day postoperatively. At 7th day after second operation, the level of TB, DB, ALT and γ-GT after internal and external drainage in groups A, B were decreased, and there was no significant difference in groups A, B, C. It was shown that liver enlarged diffusely, gallbladder enlarged, intra-hepatic and common hepatic duct expanded significantly in groups A, B compared with group C by ultra-sound at 7th day postoperatively, while liver enlarged unconspicuously, gallbladder atrophied, intra-hepatic and common hepatic duct expanded unconspicuously at 7th day after second operation. Meanwhile , it was shown that structure of hepatic lobular recovered basically, hepatic sinus expanded mildly, a few inflammatory cells infiltrated portal area with hyperplasia of fibrous tissue in group A compared with group C, while no inflammatory cell infiltrated portal area in group B at 7th day after second operation. Conclusion: The reversible model of obstructive jaundice had great advantages for it was simple, reliable, effective and repeatable.%目的：建立一种能简便实行胆汁内外引流的可逆型梗阻性黄疸兔模型。方法：新西兰大白兔36只，随机分为3组，胆汁外引流组(A组，n=12)、胆汁内引流组(B组，n=12)及假手术组(C组，n=12)。 A、B组采用切断胆总管后分别向肝与十二指肠方向插入硅胶管，两端缝扎固定，夹闭器夹闭硅胶管并缝于皮下的方法建立可逆型梗阻性黄疸模型，造模后第7天再次手术，剪断硅胶管引至体外形成胆汁外引流，去除夹闭器后恢复胆汁内引流；C组采用分离胆总管后打松结的方法作为对照。所有兔于造模前、造模后第7天、再次手术后第7天时采血检测肝功能指标，B超检查肝胆系统；再次手术后第7天取肝脏组织标本作病理学检查。结果：成功建立了可逆型梗阻性黄疸模型。造模前A、B、C3组间总胆红素(total bilirubin，TB)、直接胆红素(direct bilirubin，DB)、谷丙转氨酶(alanine transarninase，ALT)、γ-谷氨酰转肽酶(γ-glu-tamyl transferase，γ-GT)差异无统计学意义(均P>0.05)；造模后第7天A、B两组TB、DB、ALT、γ-GT较造模前明显增高(均P<0.05)，明显高于C组(P<0.05)；再次手术后第7天A、B两组TB、DB、ALT、γ-GT较造模后第7天明显下降(P<0.05)， A、B、C 3组间差异无统计学意义(P>0.05)。造模后第7天，B超下可见A、B两组肝脏弥漫性肿大，胆囊增大，肝内胆管、肝总管明显扩张；再次手术后第7天，B超下可见A、B两组肝脏无明显肿大，胆囊萎缩，肝内胆管、肝总管无明显扩张。再次手术后第7天，A组肝小叶结构基本恢复正常，肝窦轻度扩大，汇管区少量炎症细胞浸润伴纤维组织增生；B组汇管区无明显炎症细胞浸润。结论：研究建立的可逆型梗阻性黄疸模型具有可靠有效，可重复性强，再通时操作简单等特点，值得在梗阻性黄疸和胆汁内外引流实验中推广。

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