目的 探讨滑石粉胸膜固定术治疗慢性阻塞性肺疾病(COPD)并发难治性气胸的作用机制.方法 回顾性分析25例COPD合并难治性气胸患者,经胸腔镜胸腔内喷洒滑石粉混悬液后,观察患者术前及术后静脉血白细胞、中性粒细胞、血沉、C-反应蛋白(CRP)、动脉血气分析、肝功能、肾功能及心肌酶谱的变化.结果 胸腔内喷洒滑石粉混悬液治疗后,患者血WBC、中性粒细胞、血沉、CRP均显著升高(P＜0.05),但动脉血气分析、肝、肾功能及心肌酶谱无显著变化(P＞0.05).结论 滑石粉胸膜固定术治疗COPD并发难治性气胸,对患者动脉血气分析、肝肾功能及心肌酶谱等无明显影响,安全性好.滑石粉胸膜固定术后患者静脉血中炎性指标明显升高,提示炎症反应可能是其治疗和发生并发症的机制之一.

Objective: To assess the therapeutic effect of red and blue light phototherapy combined with medicated mask in the treatment of mild and moderate acne. Methods: Ninety six patients were divided into two groups randomly. Fifty patients in the experiment group were treated with medicated mask combined with red and blue light. Forty six patients in the control group were treated with medicated mask only. The therapeu-tic effect was assessed by global acne grading system ( GAGS) before and after treatment. Results: The total effective rates of the experiment group and control group were 88.00% and 47.83% respectively, with a signifi-cant difference ( P<0.01) . There were no significant side effects in both groups. Conclusion: Red and blue light phototherapy combined with medicated mask is safe and effective in the treatment of mild and moderate acne.

Objective:To determine the common allergens in 229 patients with contact allergic dermatitis in our hospital. Methods:Two hundred and twenty-nine patients with contact allergic were tested with topical patch-testing diagnostic box ( 19 kinds of allergens) . Results: Two hundred and three cases were positive, with a positivity rate of 88.65%. One hundred and fifty-two cases were allergic to at least two antigens. Among the 19 kinds of allergens, the first 10 common contact allergens were nickel salfate ( 42. 36%) , rubber II (23.65%), rubber IV (21.67%), perfume I (21.18%), perfume II (19.70%), potassium dichromate (16.75%), paraphenylenediamine (11.33%), formaldehyde (10.34%), white precipitate (10.34%) and rosin (8.37%). Conclusion:The mostly common contact allergens were nickel salfate, rubber, perfume and potassium dichromate in the patients visited to our hospital.

难治性气胸是指自发性气胸后患者经胸腔闭式引流或持续负压吸引超过1周仍存在漏气，或复发性气胸（2次以上）［1］。其多发生于老年气胸、肺大泡患者，尤其是合并有慢性阻塞性肺疾病（COPD）的患者［2-3］。当COPD患者合并难治性气胸，常因其心肺功能差而无手术条件，因此胸膜固定术是其常见的治疗方法［4］。作者近年来采用经纤维支气管镜胸腔内肺表面直接喷洒滑石粉混悬液治疗COPD并发难治性气胸患者21例，取得了较好的疗效。

Objective To evaluate the diagnostic value of multiple lung biopsy on elderly patients with suspected lung cancer at Ⅰ ～ ⅢA stage.Methods 151 elderly patients with suspected lung cancer at Ⅰ ～ ⅢA stage were given TBLB,CT or CDU-guided needle biopsy.The pathological results were compared.Results The diagnostic rate of the combination of the three ways of biopsy was significantly higher than any one single biopsy method(P 0.05).Conclusion Multiple lung biopsy application can significantly improve the diagnostic rate on elderly patients with suspected lung cancer at Ⅰ ～ ⅢA stage.

目的探讨NB-UVB对黑素细胞和角质形成细胞干细胞因子（SCF）、Kit、MITF表达的调控作用。方法建立黑素细胞和角质形成细胞共培养体系,用NB-UVB照射共培养细胞3d,RT-PCR法检测对照组和照射组酪氨酸酶、SCF、c-Kit、MITFmRNA的表达。NB-UVB照射角质形成细胞3d后免疫组织化学法检测对照组和照射组SCF蛋白的表达。黑素细胞爬片培养,加入经UVB照射3d后的角质形成细胞上清液,免疫组织化学法检测对照组和照射组MITF蛋白的表达。结果对照组和照射组提取细胞总RNA经RT-PCR检测,结果发现照射组SCF、c-Kit、MITF、酪氨酸酶mRNA表达较对照组明显增高。NB-UVB照射后的角质形成细胞SCF免疫组织化学结果与对照组比较差异有统计学意义（P=0.000）,加入经NB-UVB照射后的角质形成细胞培养上清液后的黑素细胞MITF免疫组织化学结果与正常培养黑素细胞比较差异有统计学意义（P=0.024）。结论 NB-UVB照射能促进角质形成细胞分泌SCF,进而上调MITF的表达,促进酪氨酸酶表达增加。

Objective To establish coculture system of direct cell-to-cell contact between normal human epidermal keratinocytes and melanocytes in vitro.Methods Keratinocytes and melanocytes were cultured respectively,and then the coculture model of direct cell-to-cell contact between keratinocytes and melanocytes was established in vitro.methyl thiazolyl tetrazolium(MTT) assay,UV spectrophotometry,levoDopa(L-Dopa) staining,immunohistochemical staining and transmission electron microscopy observation were employed to biologically identify the melanocytes and keratinocytes in the coculture system.Results Keratinocytes were round and grew in "cobblestone" pattern while melanocytes in bipolar or multi-level dendritic growth pattern when they were cultured separately.The 2 kinds of cells proliferated rapidly when they cocultured in a certain proportion.Melanocytes with 3 to 5 dendrites grew in crumb pattern with dozens of keratinocyte,similar to the structure of melanin unit.Melanocytes and keratinocytes in the coculture system exhibited normal biological functions.Conclusion Coculture system of direct cell-to-cell contact between normal human epidermal keratinocytes and melanocytes provides a model closer to physiological condition for melanocytes study in vitro.

Objective To investigate the influence of hypoxia on the methylation level of genomic DNA in human small cell lung cancer H446 cells.Methods H446 cells were cultured under the hypoxic condition(3%O2) for different time periods(0,12,24,48 and 72 h respectively).Those cultured under normal condition served as control.The genomic DNA methylation level was detected by methylation sensitivity random primers PCR(MA-AS-PCR) after DNA extraction.Results Compared with the normoxic control group,the quantity and fluorescence intensity of amplified products of hypoxic experimental group were much higher,especially after 24 h.This indicated that the genomic DNA methylation level in the H446 cells was significantly changed when were treated by hypoxia,and represented mainly as multifocal abnormal methylation.Conclusion Hypoxia might be one of the key causer inducing unbalanced methylation in cancer cells.

目的 分析慢性阻塞性肺疾病并发自发性气胸的临床特点及误诊原因,减少误诊率.方法 对解放军324医院2001-03-2010-09诊治87例慢性阻塞性肺疾病并发自发性气胸患者的临床资料进行回顾性分析.结果 87例慢性阻塞性肺疾病并发自发性气胸中有21例误诊,误诊率24.13%,其中非专科医生误诊率39.19%,专科医生误诊率18.75%.一线医生误诊率24.13%,上级医生误诊率9.19%.结论 慢性阻塞性肺疾病并发自发性气胸临床表现不典型,误诊高,提高慢性阻塞性肺疾病并发自发性气胸临床表现特点认识、重视体检、注意影像学检查等是减少慢性阻塞性肺疾病并发自发性气胸误诊的有效措施.

Objective To obverse the regulated roles of psoralen on SCF/Kit/MITF expression in melanocytes and keratinocytes.Methods Direct contact co-culture of melanocytes and keratinocytes were constructed.The co-culture cells were dealled with psoralen of 2mg/mL finally concentration once a day for 3days.Then the expression of tyrosinase,SCF,c-kit and MITF mRNA were detected by reverse transcriptase-polymerase chain reaction both in psoralen group and normal control group.The expression of SCF protein was detected by immunohistochemical method in both groups.After joining with keratinocytes supernatant dealed with psoralen,the expression of MITF protein was detected by immunohistochemical method in both groups.Results The results of cell total RNA RT-PCR showed that the mRNA expression of SCF,c-kit,MITF and the tyrosinase of psoralen group had significant increased than that in normal control group(P=0.000).The SCF immunohistochemical results showed that the psoralen dealing keratinocytes group had significant difference compared with normal control group(P=0.000).The MITF immunohistochemical results showed that the melanocytes group mixed with keratinocytes supernatant dealed with psoralen had significant difference compared with the normal melanocytes group(P=0.007).Conclusion The psoralen could promote the expression of SCF and MITF in keratinocytes and increased secrete of tyrosinase.

慢性阻塞性肺疾病(COPD)并发自发性气胸,起病急,病情进展快,常易导致严重呼吸、循环衰竭,甚至危及生命,而临床常因症状、体征不典型,易误诊.本文对我院2005年10月至2011年4月收治的COPD并发自发性气胸51例患者的临床资料进行回顾性分析,探讨COPD并发气胸的临床特点和有效治疗方法.

<正>临床资料患者男性,64岁。因"反复咳嗽、咳痰16年,活动后气促9年,双下肢水肿2年,再发3 d",于2010年6月10日入院。既往有明确的"慢性阻塞性肺疾病(COPD)、慢性肺源性心脏病、双肺肺大疱、右侧自发性气胸"病史。入院查体:体温36.4℃,脉搏130次/min,呼吸

目的:探讨无创正压通气(NPPV)在急性左心衰(ALHF)合并呼吸衰竭治疗中的地位。方法:将我院2008年前入院的ALHF合并呼吸衰竭患者20例定为对照组,2008年以后入院的20例ALHF并呼吸衰竭患者定为无创组。对照组行常规吸氧、镇静、强心、利尿、扩血管、对症治疗,无创组在以上常规治疗同时使用BiPAP无创通气。观察两组患者治疗后2h、6h、12h生命体征、氧合指数变化情况,以及24h病情好转率、插管率、病死率。结果:与对照组比较,无创组临床指标改善快,好转率高,插管率低。结论:在常规治疗基础上加用BiPAP无创正压通气治疗急性左心衰合并呼吸衰竭取得良好疗效,值得临床推广。

目的 探讨一次性使用抽液器联合持续负压吸引治疗自发性气胸的临床效果.方法 将一次性使用抽液器联合持续负压吸引进行闭式引流.结果 治愈率87.5%.结论 一次性使用抽液器联合持续低负压吸引治疗自发性气胸,具有安全有效、操作简便、经济的优点,值得临床推广应用.

Objective As a reversible regulation progress,demethylation therapy has become the most promising strategy of tumor prevention and treatment.5-Aza-CdR has showed certainly antitumor activity in several tumors including non-small cell lung cancer,but its effect in small cell lung cancer needs further research.Methods After H446 cells treated with 5-Aza-CdR in vitro,the cell morphological changes was observed with light microscope.the proliferation ability and drug sensitivity were measured with MTT assay.The activity of caspase-3/7,efficacy of drug exclusion and cell cycle was assessed by luminometer and FACs.The genome DNA methylation status was examined by methylation-sensitive arbitrarily primed PCR(MS-AP-PCR).Results H446 cells genome DNA methylation level apparently decreased after 5-Aza-CdR treatment.5-Aza-CdR could inhibit growth of H446 cells in the dose-dependent manner,induce the arrest of H446 cells in G1 phase(from 56.3±2.5 to 73.75±2.47,P0.05),increase the caspase-3/7 activity(from 257510.5±12861.5 to 538585.5±10897.2) and efficacy of drug exclusion(from 11.5±2.3 to 23.8±3.0,P0.05).Conclusion 5-Aza-CdR has a strong antitumor activity to H446 cells in vitro.The low methylation cytotoxic effect including cell growth-inhibit,G1 phase arrest and apoptosis and expression restoration of tumor suppressor gene might play an important role.

Objective To study the correlation between genomic DNA methylation and acquired multidrug-resistance of human small cell lung cancer (SCLC) cell line H446/CDDP. Methods Genomic DNA was extracted from H446/CDDP cells and their parental cells H446. Genomic DNA methylation was detected by methylation-sensitive arbitrarily primed PCR (MS-AP-PCR). Results The amplified bands of H446/CDDP cells were significantly more than those of H446 cells and their fluorescence intensity was higher than that of H446 cells after enzymolysis, indicating that the genomic DNA methylation level is higher in H446/CDDP cells than in H446 cells. Conclusion The acquired multidrug-resistance of H446/CDDP cells is correlated with the high genomic DNA methylation level.

目的:探讨床边纤维支气管镜(简称纤支镜)引导下经鼻气管插管抢救慢性阻塞性肺部疾病(COPD)呼吸衰竭的临床价值。方法:总结48例喉镜经口插管和床旁纤维支气管镜引导经鼻气管插管所需时间、对生命体征影响、插管成功率、插管结束后并发症。结果:A组和B组插管所需时间差异无显著性(P>0.05)。A组和B组插管结束后并发症(P<0.01)。A组和B组插管成功率差异无显著性(P>0.05)。A组和B组插管前后呼吸频率增加(P<0.05)。A组和B组插管前后心率增加差异有非常显著性(P<0.01)。A组和B组插管前后血压增加差异有显著性(P<0.05)。A组和B组插管前后SPO2降低差异有非常显著性(P<0.01)。结论:纤维支气管镜引导下经鼻气管插管抢救COPD呼吸衰竭,操作简单、快速、准确、安全,值得临床推广应用。

肺癌晚期常见并发胸腔积液,因胸液增长快,胸液量大,严重影响患者的生活质量.本院自2006年3月～2007年5月对31例肺癌胸腔积液患者实施了一次性使用抽液器引流术,临床效果好,现报道如下.

Objective:To investigate the expression and clinical significance of connective tissue growth factor(CTGF)in fibroblast of bronchus of rats with chronic obstructive pulmonary disease(COPD)in vitro.Methods:Cultured fibroblasts were got from normal and COPD rats,respectively.The content of hydroxyproline was detected by colorimetry.Immunohistochemistry staining,Western Bolt and RT-PCR were used to examine the protein activity and mRNA level of CTGF.Results:The content of hydroxyproline in COPD group was higher than that in the control group.In the experiment group,CTGF expressed significantly,the protein activity and mRNA level of CTGF increased significantly with a time-dependence.Conclusion:The high level of expression of CTGF in the fibroblast maybe plays an important role in the occurrence and progress of COPD.