目的 探讨铜绿假单胞菌注射液治疗甲状腺癌颈部淋巴结清扫术后淋巴漏的方法及效果。方法 笔者所在医院2012年4月至2012年7月期间共治疗甲状腺癌颈部淋巴结清扫术后顽固性淋巴漏患者4例，均采用铜绿假单胞菌注射液治疗。将铜绿假单胞菌注射液（1mL或2mL）通过引流管逆行注射到创腔，夹闭引流管1h后再开放引流管。结果 4例患者注射前1d24h引流量分别为200、350、540及810mL，其中2例患者为乳糜漏，引流时间分别为7d和15d；另2例患者为单纯淋巴漏，引流时间分别为13d和14d。注射1d后，引流量分别减少至20、45、120及255mL，4d后4例患者均顺利拔除引流管。4例患者治疗后均有不同程度的发热，经物理降温后体温恢复；均有不同程度的局部疼痛感，3例患者疼痛能耐受，另1例疼痛剧烈患者予以美洛昔康口服后缓解。结论 铜绿假单胞菌注射液治疗甲状腺癌颈部淋巴结清扫术后顽固性淋巴漏的疗效显著。
目的 对尿液特征组分与糖尿病早期肾损害的关系进行了初步探索。 方法 对2011年12月－2012年5月间28例2型糖尿病组、33例2型糖尿病肾病组及26例健康对照组尿液中尿蛋白含量和几种常见非蛋白氮物质，包括肌酸、尿囊素、肌酐、尿酸和假尿嘧啶核苷的浓度进行测定，采用多种归一化方法对数据进行对比分析，并通过t检验减少高效液相色谱测定的变量信息，保留P＜0.05的检出峰进行主成分分析，获得分类结果。 结果 采用体积归一化方法，发现健康对照组尿液中肌酸、尿囊素和尿酸的含量与2型糖尿病组和糖尿病肾病组相比，差异均有统计学意义（P＜0.05），2型糖尿病组尿液中尿蛋白的浓度与糖尿病肾病组相比，差异有统计学意义（P＜0.05）。 结论 通过肌酸、尿囊素、尿酸和尿蛋白的联合测定为肾脏损伤程度的监测及疗效观察提供依据，为2型糖尿病患者肾功能损坏的早期预防与诊断进行初步判断提供了新的方法。
Objective To discuss the resection extent of primary surgery for papillary thyroid carcinoma （PTC） based on the analysis of the remaining thyroid gland residue and lymph nodes metastasis. Methods The clinical data of 163 patients with PTC received reoperation from January 2009 to September 2011 in our hospital were analyzed retrospectively. Results There were 24 males and 139 females in these patients. The age was 10-75 years old with （38.22±14.57） years old. Among 131 patients received residual thyroid thyroidectomy，88 patients were below 45 years old，and the cancer residual rate was 60.23% （53/88）；the others were over 45 years old，and the cancer residual rate was 76.74% （33/43），which was no significant difference （P?=?0.062）.The lymph nodes metastasis rate was 77.14% （81/105） in the patients below 45 years old and 81.13%?（43/53） in the patients over 45 years old among 158 patients received cervical lymph nodes dissection，which was no significant difference （P?=?0.958）.The cancer residual rate was 74.36%?（58/78），53.66%?（22/41），50.00%?（6/12），and 0 （0/32） in the patients with the tissue less than one lobe resection，lateral lobe （isthmus） resection，lateral lobe plus opposite side subtotal resection，total or subtotal resection，respectively. The total cancer residual rate was 65.65% （86/131） and the bilateral cancer residual rate was 52.76%?（86/163） after reoperation.79.75%?（130/163） of the patients didn’t received lymph nodes dissection in the primary surgery. The lymph nodes metastasis rate was 71.21%?（94/132） and 80.58% （83/103） in the reoperation patients received central region lymph nodes dissection and cervical lateral lymph nodes dissection, respectively. Conclusions Multifocus is an obvious character of PTC. Patients over 45 years old have more opportunities of tumor residual than that of the youngers （below 45 years old），but the result was no statistic value. For the most patients with PTC，a smaller resection extent suggests a larger risk for cancer residual，and total thyroidectomy or subtotal thyroidectomy leads to the least possibility for the risk. Cervical lymph node is a major type for its metastasis. Proper lymph nodes dissection is an essential way to reduce recurrence and reoperation. The Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer （2009） could be a best choice for therapy of PTC. And it is proposed to take central region lymph nodes dissection during primary surgery.
ObjectiveTo investigate the effect and mechanism of silent information regulator 1 (SIRT1)in invasion of human gastric cancer. MethodsThe expressions of SIRT1 protein and vascular endothelial growth factor A (VEGF-A) protein in 46 cases of gastric cancer were tested by immunohistochemical SP method; the effect of expressions of SRIT1 and VEGF-A protein on prognosis of gastric cancer was analyzed by Kaplan-Meier test; the expressions of SRIT1 and VEGF-A protein in human gastric mucosa GES-1 cells and SGC7901 cells were tested by Western blot method; after the interference of siRNA on SIRT1 gene, expressions of SRIT1 and VEGF-A protein were also tested by Western method, and the invasion ability was determined by Transwell test. ResultsCompared with normal gastric mucosa tissues, expression levels of SIRT1 and VEGF-A protein of gastric tissues were both higher (P < 0.050), and survival situation of patients with SIRT1-positive (P=0.001) or SIRT1-positive and VEGF-A-positive (P=0.006) were both bad, but there was no significant difference on the relationship between prognosis of gastric cancer and expression of VEGF-A protein (P=0.091). Expression levels of SITR1 protein (P=0.010) and VEGF-A protein (P=0.020) in GES-1 cells were both higher than those of SGC7901 cells. In siRNA positive group, expressions of SIRT1 and VEGF-A protein (P=0.010) of SGC7901 cells down-regulated, and invasion ability decreased (P=0.000). ConclusionsSIRT1 gene may promote the expression of VEGF-A protein and the invasion ability of gastric cancer, it may be a therapeutic target of invasion inhibition for gastric cancer.
ObjectiveTo explore a new strategy for constructing three-dimensional dermoid tissue in vitro by using cell sheets technology.MethodsRabbit bone marrow mesenchymal stem cells (rBMSCs) were isolated from bone marrow of New Zealand white rabbits and cultured by whole bone marrow adherent method. Human dermal fibroblasts (HDFs) were cultured and passaged in vitro. The 2nd generation rBMSCs and the 3rd generation HDFs were cultured in a culture dish for 2 weeks with cell sheets conditioned medium respectively to obtain a monolayer cell sheets. Human umbilical vein endothelial cells (HUVECs) were inoculated on rBMSCs sheet to construct pre-vascularized cell sheet. During the culture period, the morphological changes of the cell sheet were observed under an inverted phase contrast microscope. At 1, 3, 7, and 14 days, HE staining and CD31 immunofluorescence staining were performed to observe the cell distribution and microvascular network formation. The rBMSCs sheet was used as control. The pre-vascularized cell sheet (experimental group) and rBMSCs sheet (control group) cultured for 7 days were placed in the middle of two HDFs sheets, respectively, to prepare three-dimensional dermoid tissues. After 24 hours of culture, CD31 immunofluorescence staining and collagen type Ⅰ and collagen type Ⅲ immunohistochemical stainings were performed to evaluate cell distribution and collagen expression.ResultsHDFs and rBMSCs sheets were successfully prepared after 2 weeks of cell culture. After inoculation of HUVECs on rBMSCs sheet for 3 days, HUVECs could be seen to rearrange on rBMSCs sheet and forming vacuoles. The reticular structure was visible at 7 days and more obvious at 14 days. The formation of vacuoles between the cell sheets was observed by HE staining, and the vacuoles became more and more obvious, the thickness of the membranes increased significantly with time. CD31 immunofluorescence staining showed the microvascular lumen formation. However, only the thickness of rBMSCs sheet increasing was observed, with no changes in cell morphology or cavitation structure. The three-dimensional dermoid tissue observation showed that the endothelial cells in the experimental group were positive expressions, and the rBMSCs, HDFs, and HUVECs cells were arranged neatly. The endothelial cells were negative expressions and randomly arranged in the control group. The collagen type Ⅰ and collagen type Ⅲ were positive expression in the experimental group and the control group. But compared with control group, experimental group presented a " honeycomb” network connection, where the matrix was distributed regularly, and cells were arranged tightly. The difference in the expression of collagen type Ⅰ and collagen type Ⅲ between the experimental group and the control group was not significant (P>0.05).ConclusionThree-dimensional dermoid tissue is successfully constructed by using cell sheet technology. The cell matrix distribution of the pre-vascularized cell sheet constructed by HUVECs and rBMSCs sheet is relatively regular, which has the potential to form tissue engineered dermis.
Objective To summarize the relationship between IgG4 and IgG4 related thyroid diseases. Methods Domestic and international publications involving the pathological features of IgG4-related thyroid diseases and relationship with IgG4 were retrieved and reviewed. Results IgG4-related disease was a newly recognized class of chronic and systemic lymphocytes disease， which may be solitary or involving multiple body organs， as well as thyroid. The expression of IgG4 was found in leisons of Hashimoto thyroiditis， Riedel thyroiditis， and papillary thyroid carcinoma. Conclusions IgG4-related thyroid disease is a new concept of thyroiditis. The knowledge of this new disease will provide appropriate treatment for patients with thyroiditis.