阑 尾 低 级 别 黏 液 瘤 ( low-grade appendiceal mucinous neoplasms,LAMN) [1 - 2] 是一种罕见异质性疾病,其瘤体分化良好,最危险的常见并发症为自发性或医源性破裂而发生转移,导致腹壁假性黏液瘤或远处转移,危及生命. 我院近期收治以腹水为主要表现误诊为肝源性腹水的阑尾低级别黏液瘤1 例,现报道如下.

目的 探讨转移性肝癌的临床特点、影像学表现及误诊原因.方法 回顾性分析误诊为肝脓肿的转移性肝癌1例临床资料.结果 本例因上腹部疼痛2周,加重1 d入院.行肝胆脾CT平扫+增强扫描等检查,疑诊为肝脓肿,予抗感染、抑酸、营养支持等治疗.为进一步明确病变性质,行超声引导下肝穿刺病理检查,结果显示肝肿物内见腺癌细胞浸润,后行电子胃镜及结肠镜检查,确诊为胃癌肝转移.家属商议后要求出院.出院1个月,患者出现进行性腹痛、进食困难.结论 转移性肝癌易与肝脓肿相混淆,及时行肝脏穿刺病理检查有助于早期确诊,避免或减少误诊误治.

目的 探讨腹膜假性黏液瘤的临床表现、诊断及治疗方法.方法 回顾性分析1例腹膜假性黏液瘤患者的临床资料,复习相关文献,总结其临床特点,分析诊断及治疗方法.结果 患者以腹胀、消瘦及双下肢水肿为主要表现,腹部CT可见腹盆腔内巨大囊性病变影,边缘较清,其内密度均匀并可见分隔,亦可见到"网膜饼" "贝壳样"压积现象,术前癌胚抗原及糖类抗原125升高.行腹腔肿瘤减灭、输液港植入术,术后规律经输液港行腹腔内5-氟尿嘧啶热灌注化疗,症状改善.结论 该病临床罕见,无特异性临床表现,CT检查对了解病变累及范围、选择治疗方法具有一定价值;如能早期诊断,早期行肿瘤减灭术联合腹腔热灌注化疗术,术后规律行腹腔热灌注化疗,可大大改善患者的预后及生活质量.

脾梗死是脾动脉或其分支阻塞导致的脾脏组织缺血坏死,其发生与局部解剖学和脾动脉分支特点有关.脾动脉分支是没有相互交通的终末动脉,易发生栓塞[1].脾梗死发病率较低,并且缺乏特殊的临床表现,易漏诊、误诊,大多数是由于血液系统良恶性病以及左心系统血栓引起.现报道1例肝脏恶性肿瘤并发的脾梗死.

With the rapid development of society and gradual thoroughness of medical and health care reform,the cultivation of humanistic quality of the medical workers becomes the inevitable requirement of hospital infrastructure and long?term development.As the reserve force of hospital,It′s necessary to possess the humanistic quality for medical students which meanwhile is a precondition for the future career in the medical profession, especially in today's increasingly tense doctor?patient contradiction. How to possess a reasonable communication with the patients in order to obtain sufficient trust, then to achieve successful progress of the effective medical remains vital in diagnositics teaching.Humanities occupy a pivotal position, thus the cultivation of humanistic quality education is a thorny problem to medical colleges. Diagnostics as a cornerstone of clinical work,is a connecting pivot of basic course and clinical course for medical students. Integrating humanistic quality curriculum in medical diagnostics teaching would be the key to cultivate high quality talents in medical and health field,and also is the critical point for the medical education reform. In order to provide a relevant reference schemes for the medical colleges and cultivate the excellent elites for China′s medical field, the significance of medical students′ humanistic quality cultivation and specific practice measures for medical were explored.

目的:探讨正常足月妊娠妇女与非孕妇女侧卧位及仰卧位腰段硬膜外腔压力以及注射局麻药后硬膜外腔压力的变化.方法:选取ASA分级Ⅰ～Ⅱ级正常足月妊娠妇女(P组)20例和非孕妇女(NP组)15例,于L2-3间隙行脊麻-硬膜外联合麻醉.分别测定侧卧位时穿刺针进入硬膜外腔瞬间(T0)、穿刺针进入硬膜外腔30 s(T1)、60 s(T2)、90 s(T3),仰卧位后30 s(T4)、60s(T5)、90 s(T6)以及硬膜外腔给予2％利多卡因5ml后30 s(T7)、60 s(T8)、90 s(T9) 10个时间点硬膜外腔压力.结果:T0～T9各时间点硬膜外腔压力均为正值.正常足月妊娠妇女T3、T6时间点硬膜外腔压力为(14.1±2.1) mmHg、(21.3±4.0)mmHg;非孕妇女T3、T6时间点硬膜外腔压力为(11.1±4.6) mmHg、(17.0±5.3)mmHg.T2、T3、T5、T6、T8、T9时间点硬膜外腔压力P组大于NP组,差异有统计学意义.各组T6与T7时间点硬膜外腔压力比较差异有统计学意义.T6与T8、T9时间点硬膜外压力比较差异无统计学意义.结论:正常足月妊娠妇女与非孕妇女侧卧位及仰卧位时腰段硬膜外腔压力为正值,并非传统观点所认为的负压.侧卧位及仰卧位时足月妊娠妇女硬膜外腔压力高于非孕妇女.仰卧位时,以0.5 ml/s的速度通过硬膜外导管推注2％利多卡因5 ml,硬膜外压力增高不超过90 s.

Objective To study the different positive end-expiratory pressure(PEEP) on pulmonary shunt fraction and oxygenation during one-lung ventilation(OLV),and to explore the best PEEP value in OLV.Methods Thirty patients with ASA Ⅰ-Ⅱ level elective thoracotomy with OLV were selected.The blood gas analysis were performed in the lateral position at ventilation 30 min(T1),OLV 30 min(T2),5 cmH2O OLV PEEP 30 min(T3),and 10 cmH2O OLV PEEP 30 min(T4).At each time point,the PaO2,PaCO2,SaO2,pH,HR,mean arterial pressure(MAP),and peak airway pressure(Ppeak) were recorded,and the intrapulmonary shunt(Qs / Qt) was calculated.Results Compared with two-lung ventilation,the PaO2 was decreased and the Qs / Qt was increased significantly(P0.05),the PaO2 was increased from(200.20 ± 145.25) mmHg to(299.55±138.83) mmHg(P0.05) and the Qs / Qt was decreased(P0.05) at the duration of T2 to T3;the PaO2 was decreased from(299.55 ± 138.83) mmHg to(237.30 ± 135.57) mmHg(P0.05) and the Qs / Qt was increased(P0.05) at the duration of T3 to T4;the Ppeak value was increased from T2(21.15±3.60) cmH2O to T4(27.20±3.78) cmH2O(P0.05) in OLV.Conclusion During OLV,5 cmH2O PEEP applied in ventilated lung can increase the PaO2,decrease the Qs / Qt and prevent the occurrence of hypoxemia.It is more appropriate PEEP value.

开胸手术因创伤大,术后疼痛剧烈,可使呼吸运动、咳嗽、排痰功能受到影响,使术后呼吸功能受损,增加术后并发症[1]。临床证据表明上述改变可通过有效的镇痛技术来预防[2,3]。本研究应用舒芬太尼病人自控镇痛,以视觉模拟评分（VAS）,血浆皮质醇和C-反应蛋白浓度和术后肺功能（用力肺活量（FVC）、1秒用力呼气量（FEV1）、最大呼气中段流量（MMEF））作为指标评价综合评价舒芬太尼病人自控镇痛临床效果,指导开胸术后镇痛的临床应用。

Objective: This study investigates the position of the lower end of the spinal cord conus in Chinese adults with low backache using MRI, to locate the safe puncture site for spinal anesthesia. Methodology: Eight hundreds adults suffering from low backache were included in the study. Magnetic resonance imaging was used to localize the lower end of the spinal cord conus. Results: Adult females' conus positions were slightly lower than the males (median: L1:lower, quartile: L1: middle-L1:upper for females; median: L1: lower, quartile: L1: upper-L2 for males; P < 0.001). In addition our data showed that in 23.25% of patients the tip of the conus was located at the upper 1/3 level of L3. Pearson's correlation analysis showed that when the study population was divided by age group (Group A = 30 years of age; Group B = 30-60 years old; Group C = more than 60 years of age), cone position was significantly lower in older patients (r = 0.113, P < 0.05). Conclusion: Spinal puncture should not be performed higher than the L3-L4 intervertebral space in Chinese patients having low backache unless the position of the lower end of the spinal cord is identified by prior MRI.

The objectives of this study are to compare the effectiveness of different proportions of ketamine and propofol in ketamine-propofol single-syringe combination (ketofol), and to compare the effectiveness of ketofol with propofol-fentanyl and propofol alone in termination of pregnancy. Randomized, double-blind, controlled study of 100 female American Society of Anesthesiologists (ASA I or II) patients of age 18 to 40 years undergoing abortion was used. Patients were randomly divided into 5 groups of 20. Groups K21, K31, and K41 were given ketofol intravenously in the ratios of propofol: ketamine, 2: 1, 3: 1, and 4: 1, respectively in small aliquots; group PF was given 1.5 to 2 mg/kg propofol and 50 mcg fentanyl, whereas group P was given only 2 mg/kg propofol. Blood pressure, heart rate, oxygen saturation; surgery, anesthesia, sedation, recovery, and discharge times were recorded. There was significant difference ( P<0.05) in anesthesia, sedation, and discharge times. Group K21 had higher sedation, recovery, and discharge times than the other groups. All ketofol groups had high incidence of postoperative dizziness, whereas the non-ketofol groups had high incidence of intraoperative respiratory depression. Ketofol groups required less dosage of propofol than the non-ketofol groups with group P requiring the highest (3.5 +/- 0.6 mg/kg). Ketofol is as effective as propofol-fentanyl combination, especially in the ratios 3:1 and 4:1 (propofol: ketamine) for abortion.

Mycobacterium tuberculosis continues to be a leading cause of human deaths due to an infectious agent. The ESAT-6 protein of Mycobacterium tuberculosis (M.tb) is an important structural and functional protein, which has been known to be involved in the virulence, pathogenesis as well as proliferation of the pathogen, however, little is still known about the host factors that interact with ESAT6. Therefore, a yeast two-hybrid screening of a human lung complementary deoxyribonucleic acid (cDNA) library, using ESAT6 as bait, was performed to identify ESAT-6 interaction with host protein. A vascular endothelial growth factor (VEGF) was found to interact specifically with the ESAT6 protein. Subcellular localization and glutathione S-transferase (GST)-pull down assays were used in an attempt to further confirm the interaction of VEGF and esat-6. All our data suggest that the interaction of VEGF with a structural protein of M. tuberculosis may be important for modulation of virulence of M. tuberculosis.

Objective To study the inhibitory effect of Bcl-2,C-Raf and double target RNAi plasmid on the proliferation of human colorectal carcinoma HCT-8 cells.Methods Design and synthesize a double-stranded RNA consisting of 63 nucleotides using Bcl-2 and C-Raf as target separately and construct plasmids pSilencer 3.1-H1/Bcl-2,pSilencer 3.1-H1/C-Raf and pSilencer 3.1-H1/Bcl-2/C-Raf.Transfect HCT-8 cells with the three constructed plasmids respectively and determine the inhibitory effect on proliferation of cells by MTT.Test the transcription of Bcl-2 and C-Raf mRNA by RT-PCR.Results All the survival rates of HCT-8 cells transfected with the three constructed plasmids decreased.However,the survival rate of HCT-8 cells transfected with pSilencer 3.1-H1/Bcl-2/C-Raf was significantly lower than those with pSilencer 3.1-Hl/Bcl-2 and pSilencer 3.1-H1/C-Raf.RT-PCR proved that the expression levels of Bcl-2 and C-Raf genes in HCT-8 cells transfected with pSilencer 3.1-H1/Bcl-2/C-Raf decreased significantly as compared with blank control.Conclusion Bcl-2,C-Raf and double target RNAi plasmid inhibited the proliferation of HCT-8 cells.

Objective To study the significance of MMP-2、MMP7 protein expression and the relationship with invasion、 differentiation and and metastasis in human gastric carcinoma.Methods MMP-2、MMP-7 expression were examined by immunobistochemical S-P staining method in 87 cases of human gastric carcinoma、para-carcinoma and normal tissue.Results MMP-2、MMP-7 were negtive of in the normal tissue,and low expression in para-carcinoma,respectively18.4%、21.8%.The overexpression of MMP-2 、MMP-7protein were found in gastric carcinoma,and the expression was highly related with lymphonode metastasia、differentiation and invasion degree(P0.05).Conclusion MMP-2、MMP-7 were highly expressed in gastric carcinoma,and the expression of MMP-2 was significantly correlated with MMP-7.Expression of MMP-2,MMP-7 is strongly associated with tumour progression、differentiation and and lymphonode metastasis in gastric cancer.Therefore MMP-2 、MMP-7 may be clinically useful as predictor of patients surviva1.

Objective To study the significance of MMP-7、MMP9 protein expression and the relationship with invasion、 differentiation and and metastasis in human gastric carcinoma.Methods MMP-7、MMP-9 expression were examined by immunobistochemical S-P staining method in 87 cases of human gastric carcinoma、para-carcinoma and normal tissue.Results MMP-7、MMP-9 were negtive of in the normal tissue ,and low expression in para-carcinoma,respectively21.84%,17.24%.The overexpression of MMP-7、MMP-9protein were found in gastric carcinoma,and the expression was highly related with lymphonode metastasia、differentiation and invasion degree(P0.05).Conclusion MMP-7、MMP-9were highly expressed in gastric carcinoma,and the expression of MMP-7 was significantly correlated with MMP-9.Expression of MMP-7,MMP-9 is strongly associated with tumour progression、differentiation and and lymphonode metastasis in gastric cancer.Therefore MMP-7、MMP-9 may be clinically useful as predictor of patients surviva1.

To observe the clinical effects of Qizhi Weitong plus omeprazole triple therapy in the treatment of peptic ulcer,30 Hp-relevant peptic ulcer patients in treatment group were treated with this Granule and omeprazole triple therapy and 20 cases in control group were just given omeprazole triple therapy,with a course of 28 days. The Hp eradicative rate,ulcerative healing rate and symptom improvement were observed. Results:The Hp eradicative rate, ulcerative healing rate and symptom improvement were significantly better in treatment group than in control group(P 0.05). It is showed that this Granule can complement with omeprazole triple therapy in the treatment of peptic ulcer.

以往临床上在无麻醉的状态下进行的胃镜检查所致咽部不适、呛咳、疼痛、恶心、躁动等因素易诱发心脑血管意外[1,2].近年文献报道采用介于全麻和局麻之间的清醒镇静,但其不能完全消除镜检刺激引起的交感神经兴奋对老年患者心血管系统影响[3].单独使用丙泊酚或联合使用咪唑安定取得了满意效果[4],但是丙泊酚用量偏大,有出现呼吸循环抑制等副作用.本研究探讨联合应用小剂量芬太尼、丙泊酚和咪唑安定在老年患者胃镜检查中的效果,为临床广泛开展无痛内镜提供一种经济、安全和有效的方法.

Objective To observe the antihepatofibrosis function of oxymatrine and to discuss the mechanism.Methods This experiment is based on the model of kunming mouse hepatic fibrosis (CCl_4),and normal group,model group,oxymatrine prevent group and therapy group were set up.After that,ALT,ALB,Tbil,HA,LN,PC-Ⅲ,IV-CL were measured separately,simultaneously hepatic tissue pathology and immunohistochemistry dyeing were used.Results Oxymatrine prevention group and therapy group were more distinct than those of model group on hepatic function,the indexs of hepatic fibrosis,pathology changes and the result of immunohistochemistry dyeing(P0.05).And compared with therapy group,prevention group had markedly difference(P0.05) in those indexes.Conclusion Oxymatrine can restrain the production of collagen,decrease the expression of CTGF and inhibit the abnormal hyperplasia of hepatic extracellular matrix,so it has the function of antihepaticfibrosis.

通过椎管、全身及脑室给乙酰胆碱类药物能调节痛阈,参与镇痛作用[1].脑干网状结构(mPRF)是重要脑部功能区域,参与调节睡眠、镇静、麻醉和镇痛作用[2].很多麻醉药物都与脑干网状结构内乙酰胆碱的释放有关[3].然而,脑干网状结构内胆碱能神经兴奋的镇痛作用及其与M胆碱能受体亚型之间的关系还不清楚.为此,本研究通过建立大鼠脑干网状结构内置管的动物模型,微量注射胆碱酯酶抑制剂新斯的明于脑干网状结构内,探讨脑干网状结构胆碱能神经兴奋在疼痛信号传导中的作用及机制.

Objective: To investigate the effect of adenosine triphosphate-sensitive potassium channel (K+ATP) on the antinociception of adenosine agonist R-phenylisopropyladenosine (R-PIA) administered into intrathecal (IT) on conscious rats. Methods: Sprague-Dawley rat was inserted intrathecal catheter (PE-10, 8.5 cm) to the lumbar subarachnoid space under pentobarbital anesthesia. After one week of recovery from surgery, antinociceptive effect was tested by tail-flick latency method after R-PIA injection into IT with K+ATP opener nicorandil or inhibitor glibenclamide. Results: Microinjection of R-PIA into IT produced a significant does- and time-dependent antinociceptive action (P ＜0.05). The intrathecal administration of 5μg nicorandil and 2μg glibenclamide alone did not produce any antinociceptive effect (P ＞0.05), but nicorandil did strengthen the antinociception induced by intrathecal R-PIA,glibenclamide did weaken the antinociception induced by intrathecal R-PIA respectively (P ＜0.05). Conclusions:The present results suggest that adenosine agonist R-PIA administered into IT produce the antinociceptive effect on painful stimulation via K+ATP channel activation at the spinal cord level.