1 临床资料 患者,女,59岁,因咽部异物感6个月就诊,患者6月余前出现咽部异物感,无咽痛、无吞咽困难及声音嘶哑.查体:一般情况可,各浅表淋巴结未触及明显肿大.间接喉镜检查示会厌喉面及左侧杓会厌襞可见一暗红色肿物,表面光滑,未见明显坏死及分泌物.电子喉镜检查示会厌喉面一新生物(图1A).胸腹部CT、甲状腺超声均未见明显异常,颈部CT示左侧声门上区肿块,颈部增强MRI提示左侧杓状会厌皱襞类圆形长T1长T2信号影,左侧声门上区肿块,喉癌?(图 1B、C).

目的 探讨锌指蛋白545(ZNF545)对结直肠癌上皮间质转化(EMT)和迁移侵袭的影响.方法 免疫印迹试验检测ZNF545在结直肠癌细胞系中的表达,并构建过表达和敲低ZNF545的细胞株;采用Transwell小室实验检测细胞的迁移和侵袭能力,免疫印迹试验检测EMT相关分子标志物[E钙黏蛋白(E-cadherin)、磷酸化锌指转录因子(slug)]的表达;细胞免疫荧光检测ZNF545表达变化对结直肠癌细胞E-cadherin表达的影响.结果 内源性ZNF545蛋白在SW480细胞中表达最高,在Lovo、Caco2细胞中的表达次之,在HCT116细胞中表达最低.过表达ZNF545可抑制HCT116细胞的迁移和侵袭能力(均P<0.01),抑制slug的表达(P<0.01),增加E-cadherin的表达(P<0.01);而敲低ZNF545的表达后,SW480细胞的迁移和侵袭能力明显增强(均P<0.01),可增加slug的表达(P<0.01),抑制E-cadherin的表达(P<0.01).在荧光显微镜下,过表达ZNF545可增加E-caherin表达;敲低ZNF545表达后抑制E-caherin表达.结论 ZNF545通过参与结直肠癌EMT过程调控结直肠癌细胞迁移和侵袭能力.

Objective To explore the clinical effect of anti-oxidative damage of cochlea induced by nedaplatin and the regulation of Caspase-3 expression. Methods The eligible patients were randomly divided into observation group and control group,45 cases in each group. The control group was given standard nedaplatin combined with irinotecan(IN) regimen chemotherapy,while the observation group was given AMF on the basis of standard nedaplatin combined with irinotecan(IN) regimen chemotherapy. Clinical observation and analysis were carried out from three levels: functional (clinical symptoms and DPOAE detection),serology (GSH-PX,T-SOD and MDA activity value) and molecular biology (expression of Caspase-3 protein in peripheral blood). Results On Functions,4 patients in the observation group(4/45,8.9%)with varying degrees of tinnitus or ear fullness, significantly lower than the control group in 16 cases(16/45,35.6%),the difference was statistically significant(P<0.05)On DPOAE detections, Compared with the control group,the hearing threshold loss in the observation group decreased gradually from 1000 Hz to 8000Hz,with statistically significant difference(P<0.05),and there is a significant difference in high frequency(P<0.01) On serology,The activity of GSH-PX and T-SOD in the observation group was higher than that in the control group,while the activity of MDA was lower,the difference was statistically significant(P<0.05). On molecular biology,the observation group of peripheral blood Caspase-3 protein expression was significantly reduced compared with the control group, there was statistically significant difference(P<0.01). Conclusion Amifostine can effectively alleviate the cochlear oxidative damage caused by nedaplatin, and the mechanism may be related to reducing the production of oxygen free radicals and lipid peroxides and inhibiting apoptosis.

目的 探讨结直肠癌HOXA11基因启动子异常甲基化及其与临床病理特征之间的关系.方法 从89对结直肠癌组织和配对的正常肠黏膜组织中分别提取基因组DNA,采用甲基化特异PCR(MSP)检测HOXA11基因启动子区甲基化状态,比较结直肠癌及正常肠黏膜组织中HOXA11甲基化的发生率,并统计分析结直肠癌组织中甲基化水平与患者临床病理特征的关系.在体外实验中,采用甲基化转移酶抑制剂5-Aza-dC处理细胞,实时荧光定量PCR检测HOXA11 mRNA表达水平的变化.结果 结直肠癌组织中HOXA11基因启动子甲基化阳性率显著高于配对的正常肠黏膜组织(P<0.01).HOXA11基因启动子异常甲基化与直肠癌淋巴结转移(P<0.01)及TNM分期(P<0.01)密切相关.结直肠癌细胞经5-Aza-dC处理后HOXA11 mRNA表达水平显著增高(P<0.05).结论 在结直肠癌组织中,HOXA11基因启动子区异常甲基化抑制HOXA11基因的转录表达.HOXA11启动子区异常甲基化与结直肠癌患者的淋巴结转移及TNM分期密切相关.

目的 探讨锌指蛋白545(ZNF545)在结直肠癌组织中的表达及临床意义.方法 采用qRT-PCR法检测32对结直肠癌组织及癌旁正常组织中(来自本院行结直肠癌根治术的32例患者)ZNF545 mRNA相对表达量;进一步采用免疫组化法检测136对结直癌组织及配对癌旁正常组织(来自组织芯片)中ZNF545蛋白表达,并分析这一表达与患者临床特征及生存预后的关系.结果 结直肠癌组织中ZNF545 mRNA相对表达量明显低于配对癌旁正常组织,差异有统计学意义(P＜0.05).结直肠癌组织中ZNF545蛋白低表达(免疫组化评分≤3分)率为65.4％,明显高于配对癌旁正常组织的25.7％(P＜0.05);ZNF545蛋白低表达与患者肿瘤直径、浸润深度、TNM分期相关(均P＜0.05),与患者性别、年龄、肿瘤位置、分化程度、淋巴结转移无关(均P＞0.05).Kaplan-Meier生存分析结果显示,与ZNF545蛋白高表达的结直肠癌患者比较,ZNF545蛋白低表达患者的5年生存率明显降低,差异有统计学意义(P＜0.05).结论 ZNF545在结直肠癌组织中呈低表达,与患者肿瘤直径、浸润深度、TNM分期及生存预后有关.

Objective To explore the mechanism of deferoxamine in protecting the cochlear hair cells from oxidative damage and regulating the expression of Caspase-3 in cisplatin. Methods Healthy guinea pigs were randomly divided into DFO group,DDP group,DFO+DDP group and control group,15 cases in each group. The function(Otoacoustic emission(DPOAE)was used to detect the DPOAE hearing map of each animal's binaural 500~8000Hz),morphology(The basement membrane of cochlea was observed under light microscope,and the basement membrane samples of the cochlea were observed by electron microscopy),serology(Detection of MDA,T-SOD and GSH-PX indicators)and molecular biology (Expression of Caspase-3 protein in cochlea)of each group were examined. Results Cisplatin induced oxidative damage of hair cells in cochlea of guinea pig animal model were all successfully detected in DFO group than in the control group,and showed no significant difference(P>0.05),and the blood concentration of cisplatin were not affected by DFO in the control group. Compared with the control group,DDP+DFO group and DDP group,the cell morphological damage was gradually aggravated,and apoptotic bodies were observed in DDP group. Functional comparison of hearing threshold damage gradually worsened,the difference between the groups was statistically significant(P<0.05),and the difference in high-frequency hearing threshold was statistically significant(P<0.01). In serum,GSH-PX and T-SOD activities decreased gradually,MDA activity increased gradually,and there were significant differences between groups(P<0.05);Caspase-3 protein expression increased gradually,there was significant difference among the three groups(P<0.05). Conclusions Deferoxamine can effectively protect the cochlea,reduce the effect of cisplatin on cochlear ototoxicity,and reduce the protection mechanism of free radicals and inhibition of apoptosis.

Objective To compare the clinical efficacy between laparoscopic splenectomy for portal hypertension and splenic masses. Methods 34 cases of laparoscopic splenectomy in the treatment of portal hypertension and spleen accounted for the clinical data,including 12 cases of laparoscopic splenectomy in the treatment of portal hypertension,laparoscopic splenectomy for splenic accounted for 22 cases,retrospective analysis of portal hypertension group and spleen for byte in operative time,bleeding volume,rate of conversion to laparotomy,intraoperative blood transfusion,postoperative drainage, postoperative hospital stay,postoperative complication rate and other indicators,statistical comparisons were performed. Results Portal hypertension group,the operation time was significantly longer than that of the splenic lesions(224.3±34.2min vs 157.6±44.7min,P<0.01),intraoperative hemorrhage volume was higher than that of the splenic lesions(P<0.05),the difference is statistically significant;two groups in open laparotomy rate,intraoperative blood transfusion rate,postoperative drainage,postoperative hospital stay,postoperative complication,and other indicators of differences had no statistical significance(P>0.05). Conclusion Laparoscopic splenectomy for portal anti hypertensive spleen and splenic accounted for all is safe and feasible,but laparoscopic splenectomy for portal hypertension spleen anti operation difficulty is high and indications for surgery complications and contraindications to master control and operation skill and experience is key to control the operation risk.

Objective To investigate the the diagnosis and treatment for severe acute pancreatitis(SAP)complicated with abdominal compartment syndrome(ACS). Methods A retrospective analysis of 160 cases of SAP complicated with intra-abdominal hypertension(IAH)in patients with clinical data,from the cause of disease,abdominal pressure, treatment,prognosis and quantitative index set to its pathophysiological characteristics was performed. Results In 160 cases of SAP complicated with IAH in 17 cases(17/160,10.6%)ACS diagnosis:acute hyperlipidemic pancreatitis in 13 cases (13/17,76.5%),12 cases of primary ACS(12/17,70.6%),5 cases of late-onset ACS(5/17,29.4%),decompressive laparotomy operation was performed in all delayed ACS with no mortalities;primary ACS decompressive laparotomy operation was performed in cases(6/12,50%)with 5 cases of death(5/6,83.3%),conservative treatment was performed in 6 cases(6/12,50%)with 2 cases of death(2/6,33.3%). Conclusion Severe pancreatitis complicated with abdominal compartment syndrome severity,the effect of minimally invasive abdominal puncture decompression is significant,selected decompressive laparotomy operation should be cautious for performing in the primary ACS,delayed ACS decompressive laparotomy operation has a good therapeutic effect .

近些年结直肠癌的发病年龄有年轻化的趋势,但国内外报道老年人依然是结直肠癌的好发人群,尤其是在70岁及以上老年人中发病率较高[1-2].125Ⅰ粒子体内植入内放射治疗恶性肿瘤作为一项新兴的肿瘤辅助治疗方法,近年来逐渐被医务人员接受并使用,取得了较好的疗效.我们运用前瞻、对照、随机的方法,对外科手术结合125Ⅰ粒子体内植入内放射治疗70岁及以上结直肠癌患者的疗效及预后等指标进行相关分析,报道如下.