内毒素预处理对内毒素血症大鼠肺的作用及机制探讨

目的 观察内毒素预处理对内毒素血症大鼠肺的作用及其机制。方法 将雄性Wistar大鼠84只随机分为7组：生理盐水(NS)组,内毒素脂多糖(LPS)2h、4h、6h组和LPS预处理2h、4h、6h组,每组12只。LPS预处理各组大鼠经腹腔注射LPS0．25mg／kg,24h后再注射LPS0．5mg/kg,NS组和LPS各组在上述时间均给予等容量NS;第2次腹腔注射72h后,LPS各组和LPS预处理各组大鼠经静脉注入(静注)LPS 10mg／kg,NS组注射等量NS。NS组在静注NS后6h,LPS2h、4h、6h组和LPS预处理2h、4h、6h组在静注LPS后2、4、6h时各取6只大鼠取血,行血气分析;取左侧肺组织检测细胞间黏附分子-1(ICAM-1)mRNA及抑制性κB-α(IκB-α)蛋白表达;计数右肺支气管肺泡灌洗液(BALF)中白细胞数,测蛋白含量。上述7组另取6只大鼠,在上述相同时点取全肺,计算肺体指数,测定髓过氧化酶(MPO)。结果 LPS各组大鼠较NS组大鼠肺体指数、BALF中白细胞数和蛋白及肺组织MPO含量均增加,氧分压和HCO3^-下降;而LPS预处理各组大鼠上述各指标变化明显减轻。肺组织ICAM-1 mRNA在LPS2h、4h和6h组表达递增,而在LPS预处理各组表达显著减少;LPS2h组肺组织IκB-α蛋白表达较NS组减少,而LPS预处理2h组较LPS2h组表达增加。结论 内毒素预处理可防止内毒素血症时的肺损伤,可能与内毒素预处理使肺组织IκB-α蛋白生成增加和(或)消耗减少有关。     

核因子-κB介导脂多糖诱导急性肺损伤大鼠高迁移率族蛋白B1的表达

目的探讨核因子(NF)-κB在脂多糖诱导大鼠急性肺损伤过程中对肺组织高迁移率族蛋白B1(HMGB1)表达的影响。方法采用腹腔注射脂多糖(LPS)致大鼠脓毒症急性肺损伤模型。取健康SPF级雄性SD大鼠72只,体重180~220g,采用随机数字表法,分为对照组(C组,n=6)、急性肺损伤组(L组,n=30)、吡咯烷二硫代氨基甲酸盐(PDTC)溶剂对照组(P组,n=6),PDTC治疗组(LP组,n=30)。各组分别给予腹腔注射磷酸盐缓冲液(PBS)(C和P组)或LPS(L和LP组);P组和LP组在PBS或LPS注射前15min,给予腹腔注射PDTC 100mg/kg。C组和P组腹腔注射PBS后的16h,L组和LP组注射LPS后的16h后各取6只大鼠检测其肺湿/干重比(W/D);C组和P组腹腔注射PBS后的16h,L组和LP组注射LPS后的4h(T1)、8h(T2)、16h(T3)、24h(T4)和48h(T5)时各取6只大鼠经处理后采用ELISA法检测支气管肺泡灌洗液(BALF)中髓过氧化物酶(MPO)和白细胞介素6(IL-6)水平,Western blot法检测肺组织HMGB1的表达水平,苏木精-伊红(HE)染色观察肺组织的病理变化。结果与C组比较,L组肺组织W/D、BALF中MPO和IL-6水平明显升高(P0.01),病理切片显示严重肺组织损伤,T2~T4时肺组织中HMGB1的表达水平明显升高(P0.05);使用PDTC治疗后,与L组比较,肺组织W/D、BALF中MPO和IL-6水平明显降低(P0.01),病理示肺损伤程度明显减轻;T2~T4时肺组织HMGB1表达水平明显降低(P0.05)。结论在脂多糖诱导急性肺损伤中,被激活的NF-κB通过介导晚期炎症因子HMGB1的表达来参与急性肺损伤的发生与发展过程。     

L-精氨酸对内毒素诱导急性肺损伤大鼠肺表面活性物质的影响

目的 评价L-精氨酸对内毒素(LPS)诱导急性肺损伤大鼠肺表面活性物质的影响.方法 健康雄性SD大鼠48只,随机分为4组:正常对照组(C组,n=16)、LPS组(n=16)、LPS 3 h+L-精氨酸治疗组(L1组,n=8)和LPS 6 h+L-精氨酸治疗组(L2组,n=8).LPS组、L1组和L2组静脉注射LPS 5mg/kg,C组给予等容量生理盐水.L1组和L2组分别于给予LPS后3 h或6 h腹腔注射L-精氮酸500 mg/kg.L1组和L2组于给予L-精氨酸后3 h(C组和LPS组分别于给予生理盐水或LPS后6、9 h)取8只大鼠,取肺组织,测定表面活性物质结合蛋白A(SP-A)mRNA的表达水平、肺泡灌洗液(BALF)中总磷脂(TPL)和总蛋白(TP)浓度,光镜下观察肺组织病理学结果.结果 与C组比较,LPS组SP-A mRNA表达下调,BALF中TPL浓度降低,TP浓度升高(P＜0.01).与LPS组比较,L1组SP-A mRNA表达上调,BALF中TPL浓度升高,TP浓度降低(P＜0.05或0.01);L2组上述指标差异无统计学意义(P＞0.05).L1组肺损伤程度轻于LPS组和L2组.结论 L-精氨酸可促进肺表面活性物质合成,从而对大鼠内毒素诱导急性肺损伤具有治疗作用.     

富氢液对脂多糖致小鼠急性肺损伤的影响

目的 评价富氢液对脂多糖(LPS)致小鼠急性肺损伤的影响.方法 成年雄性C57BL/6小鼠32只,体重20 ～ 25 g,采用随机数字表法,将其分为4组(n=8):对照组(C组)、富氢液组(H2组)、急性肺损伤组(ALI组)和急性肺损伤+富氢液组(ALI+ H2组).ALI组和ALI+ H2组分别雾化吸入LPS25 μg(溶于PBS中)制备ALI模型,C组和H2组分别雾化吸入无菌PBS 50μl.H2组和ALI+H2组雾化吸入PBS或LPS后1和12 h时腹腔注射0.6 mmol/L富氢液5 ml/kg.LPS或PBS处理后24 h时,机械通气15 min,行动脉血气分析,计算氧合指数.然后收集支气管肺泡灌洗液(BALF),测定蛋白浓度,计数中性粒细胞(PMN).采用ELISA法检测BALF中TNF-α、IL-1β、IL-6和高迁移率族蛋白1(HMGB1)的浓度.然后处死小鼠,取肺组织,行病理学损伤评分,测定湿重/干重(W/D)比、髓过氧化物酶(MPO)和caspase-3的活性,计算细胞凋亡指数(AI).结果 与C组比较,H2组氧合指数、BALF总蛋白、TNF-α、IL-1β、IL-6和HMGB1的浓度和PMN计数、肺组织病理学损伤评分、W/D比、MPO和caspase-3的活性以及AI差异均无统计学意义(P＞0.05),ALI组和ALI+H2组氧合指数降低,BALF蛋白、TNF-α、IL-1β、IL-6和HMGB1的浓度、PMN计数、肺组织病理学损伤评分、W/D比、MPO和caspase-3 的活性以及AI均升高(P＜0.05);与ALI组比较,ALI+ H2组氧合指数升高,BALF总蛋白、TNF-α、IL-1β、IL-6和HMGB1的浓度、PMN计数、肺组织病理学损伤评分、W/D比、MPO和caspase-3的活性以及AI均降低(P＜0.05).结论 富氢液可减轻LPS致小鼠急性肺损伤,可能与其抗炎和抗凋亡作用有关.     

白细胞介素-10通过降低脂多糖诱导大鼠急性肺损伤高迁移率组蛋白1释放产生保护作用

目的 旨在研究白细胞介素（interleukin,IL）-10对高迁移率组蛋白l（high mobility group protein 1,HMGB1）释放的影响及其肺保护作用,进而探讨IL-10在治疗急性肺损伤中的可能机制. 方法 采用腹腔注射脂多糖（lipopolysaccharide,LPS）致大鼠脓毒症急性肺损伤模型,健康SPF级雄性SD大鼠72只,体重180 g～220 g,采用随机数字表法,随机分为对照组即磷酸盐缓冲液（phosphate buffered solution,PBS）组（P组,6只）、急性肺损伤组即LPS组（L组,30只）、PBS＋IL-10组（PI组,6只）、LPS＋IL-10组（LI组,30只）.P组和PI组腹腔注射等体积PBS的同时分别经由气道滴注5 ml的PBS和IL-10,L组和LI组腹腔注射LPS的同时分别经由气道滴注等体积的PBS和IL-10.L组和LI组注射LPS后的4、8、16、24 h和48 h分别检测各组大鼠肺湿/干重比（wet/dry weight ratio,W/D）和支气管肺泡灌洗液（bronchoalveolar lavage fluid,BALF）中总蛋白浓度,酶联免疫吸附实验法检测BALF中炎性因子肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）和IL-6水平,苏木精-伊红（hematoxylin-eosin,HE）染色观察肺组织的病理变化,Western Blot分析肺组织中HMGB1表达水平. 结果 腹腔注射LPS后,L组大鼠肺组织W/D和BALF中总蛋白浓度分别为（5.68±0.12） mg/L和（254±105） mg/L,与P组比较,分别增加了12％和297％（P＜0.05）,BALF中TNF-α和IL-6水平明显增加（P＜0.05）,HE染色显示在注射LPS后4h肺组织的细胞浸润达到峰值随后减少,肺组织中HMGB1水平升高（P＜0.05）;使用IL-10后,LI组肺组织W/D和BALF中总蛋白浓度分别为（5.28±0.14） mg/L和（109±48） mg/L,与L组比较,分别降低了7％和57％ （P＜0.05）,BALF中炎性因子水平降低（P＜0.05）,肺组织细胞浸润改善,HMGB1表达下调（P＜0.05）. 结论 IL-10对急性肺损伤具有保护作用,其机制可能为降低BALF中炎性因子的水平,下调晚期炎症介质HMGB1的表达,从而改善肺组织的细胞?     

p38MAPK信号转导通路在大鼠内毒素性急性肺损伤中的作用

目的 探讨p38丝裂原活化蛋白激酶(p38MAPK)信号转导通路在大鼠内毒素性急性肺损伤中的作用.方法 成年雄性SD大鼠60只,体重180～230 g,采用随机数字表法,将大鼠随机分为4组:对照组(C组,n=6)、急性肺损伤组(ALI组,n=24)、p38MAPK特异性抑制剂SB203580+ALI组(SB+ALI组,n=24)和SB203580组(SB组,n=6).ALI组尾静脉注射内毒素5 mg/kg制备大鼠急性肺损伤模型,C组给予等容量生理盐水,SB+ALI组于注射内毒素前30 min经尾静脉注射SB20358010 mg/kg.ALI组和SB+ALI组于注射内毒素后1、3、6 h(T1-3)时随机取8只大鼠,C组和SB组分别于给予生理盐水、SB203580后1 h处死取肺组织,检测磷酸化p38MAPK(p-p38MAPK)蛋白表达.T3时回收支气管肺泡灌洗液(BALF),测定蛋白浓度.计算细胞凋亡指数,观察肺组织病理学结果.另取32只大鼠,采用随机数字表法,将大鼠随机分为2组(n=16):ALI组和SB+ALI组,观察48 h内大鼠生存情况.结果 与C组相比,ALI组和SB+ALI组BALF中蛋白浓度、细胞凋亡指数、肺组织p-p38MAPK蛋白表达水平升高(P＜0.05);与ALI组相比,SB+ALI组上述指标降低(P＜0.05).SB+ALI组病理学损伤程度较ALI组明显减轻.ALI组大鼠生存率较SB+ALI组降低(P＜0.01).结论 p38MAPK信号转导通路参与了大鼠内毒素性急性肺损伤的发生和发展,可能与肺组织细胞凋亡有关.

Abstract：

Objective To investigate the role of p38 mitogen-activated protein kinase (MAPK) signal transduction pathway in lipopolysaccharide (LPS)-induced acute lung injury (ALI).Methods Sixty male SD rats weighing 180-230 g were randomly divided into 4 groups: control group (group C, n = 6), ALI group ( n = 24),p38MAPK specific inhibitor SB203580 + ALI group (group SB + ALI, n = 24), SB203580 group (group SB,n =6). LPS 5 mg/kg was injected intravenously via tail vein in group ALI and SB + ALI, while the equal volume of normal saline was given instead in group C. Group SB + ALI received iv injection of SB203580 10 mg/kg via tail vein 30 min before LPS administration. Group SB received injection of SB203580. The rats were sacrificed at 1, 3 and6 h agter LPS administration (T1-3) in group ALI and SB + ALI (8 rats at each time point) andat 1 h after administration in C and SB groups. The lungs were immediately removed for microscopic examination and determination of phosphorylated p38MAPK (p-p38MAPK) expression, the concentration of protein in bronchoalveolar lavage fluid (BALF) and apoptotic index (AI). Another 32 rats were selected and randomly divided into 2 groups for survival study: ALI group and SB + ALI group ( n = 16 each), and then they were treated as mentioned above and observed for 48 h. Results The concentration of protein in BALF, AI and p-p38MAPK expression were significantly increased in group ALI and SB + ALI compared with group C, while decreased in group SB + ALI compared with group ALI ( P ＜ 0. 05 ). LPS-induced pulmonary histological changes were significantly attenuated in group SB + ALI compared with group ALI. The survival rate was significantly decreased in group ALI compgred with group SB + ALI ( P ＜ 0.01 ). Conclusion p38 MAPK signal transduction pathway is involved in LPS-induced ALI, which may be related to the apoptosis in the cells in the lung.     

高迁移率族蛋白1在内毒素性急性肺损伤大鼠肺血管重构中的作用

目的 评价高迁移率族蛋白1 (HMGB1)在内毒素性急性肺损伤大鼠肺血管重构中的作用.方法 健康清洁级雄性Wistar大鼠30只,体重220 ～ 250 g,采用随机数字表法,将大鼠随机分为3组(n=10)∶对照组(C组)、内毒素性急性肺损伤模型组(M组)和HMGB1抗体组(H组).C组尾静脉输注生理盐水5 ml/1.5 h;M组输注生理盐水3 ml/1.0h,再输注LPS 2 ml(1 mg/kg)/0.5 h;H组于注射LPS后12、24和36 h时尾静脉注射HMGB1抗体2 mg/kg.于注射LPS后72 h时处死取肺,光镜下观察肺组织病理学结果,采用图像分析软件测量并计算肺小动脉中膜/血管面积百分比,免疫组化法检测肺血管增殖细胞核抗原(PCNA)表达,Western bolt法检测HMGB1表达.结果 与C组比较,M组和H组肺小动脉中膜/血管面积百分比、PCNA和HMGB1表达水平升高(P＜0.05),肺组织急性炎症细胞增多,血管壁明显增厚；与M组比较,H组肺小动脉中膜/血管面积百分比、PCNA和HMGB1表达水平降低(P＜0.05),肺组织急性炎症和血管壁增厚明显减轻.结论 HMGB1可能是诱发内毒素性急性肺损伤大鼠肺血管重构的重要因素.     

利多卡因对LPS诱导大鼠腹腔巨噬细胞NF-κB活性的影响

目的 探讨利多卡因对LPS诱导大鼠腹腔巨噬细胞NF-κB活性的影响.方法 取wistar大鼠腹腔巨噬细胞,以2 × 106/ml的密度接种于12孔培养板,每孔1 ml.纯化处理后随机分为5组,每组10孔.正常对照组(C组)加入RPMI-1640培养液1 ml,L组加入含100 ng/ml LPS的RPMI1640培养液1 ml,LL1组、LL2组和LL3组分别加入含有2、20、200μg/ml利多卡因+100 ng/ml LPS的RPMI-1640培养液1 ml.孵育24 h后,收集上清液,测定高迁移率族蛋白B1(HMGB1)浓度;取细胞沉淀,测定HMGBl mRNA表达水平和NF-κB活性.结果 与C组比较,其他各组HMGB1浓度、HMGB1mRNA表达和NF-κB活性均升高(P＜0.05);与L组及LL1组比较,LL2组和LL3组上述指标降低(P＜0.05).LL3组HMGB1 mRNA表达水平低于LL2组(P＜0.05).结论 利多卡因可抑制LPS诱导大鼠腹腔巨噬细胞NF-κB活化,从而抑制HMGB1的合成与释放.     

糖皮质激素受体在大鼠内毒素性急性肺损伤中的作用

目的 评价糖皮质激素受体(GR)在大鼠内毒素性急性肺损伤中的作用及可能机制.方法 成年雄性SD大鼠60只,体重180 ～ 230 g,采用随机数字表法,将其随机分为4组:对照组(C组,n=6)、RU486组(GR特异性拮抗剂组,R组,n=6)、急性肺损伤组(ALI组,n=24)、RU486+ ALI组(RA组,n=24).ALI组尾静脉注射内毒素(LPS)5 mg/kg制备大鼠急性肺损伤模型,C组给予等容量生理盐水,R组皮下注射GR拮抗剂RU486 20 mg/kg,RA组注射RU486 20 mg/kg 90 min后注射LPS.ALI组及RA组分别于注射LPS后1、3和6 h(T1～3)时,各组随机取8只大鼠,C组与R组于注射生理盐水、RU486 1 h后处死取肺,检测p-p38MAPK、丝裂原活化蛋白激酶磷酸酶-1(MKP-1)的表达.T3时回收支气管肺泡灌洗液(BALF),测定蛋白和TNF-α的浓度;计算细胞凋亡指数;观察肺组织病理学结果.另取32只大鼠,体重180 ～ 230 g,采用随机数字表法,将其随机分为2组(n=16):急性肺损伤组(ALI1组)、RU486+ ALI组(RA1组),处理方法同上.观察48 h内大鼠生存情况.结果 与C组相比,ALI组、RA组BALF蛋白浓度和TNF-α浓度、细胞凋亡指数升高(P＜0.05)、病理学损伤加重;T1～3时p-p38MAPK表达上调,ALI组T2,3时MKP-1表达下调,RA组T1-3时MKP-1表达下调(P＜0.05);与ALI组相比,RA组BALF蛋白浓度和TNF-α浓度、细胞凋亡指数增加,T1～3时p-p38MAPK表达上调(P＜0.05),T2.3时MKP-1表达差异无统计学意义(P＞0.05),RA1组大鼠生存率低于ALI1组(P＜0.05).结论 GR参与大鼠内毒素急性肺损伤的发生发展,其机制与抑制p38MAPK信号转导通路,降低肺组织细胞凋亡有关.     

雷公藤甲素对内毒素致大鼠急性肺损伤的影响

目的 评价雷公藤甲素对内毒素(LPS)致大鼠急性肺损伤的影响.方法 雄性SD大鼠65只,体重200 ～ 250 g,采用随机数字表法,将其随机分为5组,对照组(C组,n=5):尾静脉注射生理盐水,同时腹腔注射1％二甲基亚砜(DMSO);LPS组(L组,n=15)和不同剂量雷公藤甲素组(TP1～3组,n=15):尾静脉注射LPS 5 mg/kg,同时腹腔分别注射1％ DMSO和雷公藤甲素25、50、100μg/kg.于给药前1h和给药后1、3、6、12 h时行动脉血气分析;给药后12 h时心脏采血后处死大鼠,取肺组织,收集支气管肺泡灌洗液(BALF),采用ELISA法测定血清和BALF中TNF-α浓度;测定肺组织湿重(W)和干重(D),计算W/D比;光镜下观察肺组织病理学结果,并进行弥漫性肺泡损伤评分(DAD评分);采用荧光定量PCR法测定肺组织Toll样变体4(TLR4) mRNA表达;采用Western blot法测定肺组织TLR4蛋白表达.结果 与C组相比,L组和TP1～3组给药后3、6和12 h时PaO2下降,DAD评分及W/D比升高,L组、TP1组和TP2组血清和BALF中TNF-α浓度升高,肺组织TLR4 mRNA及其蛋白表达上调,TP3组血清和BALF中TNF-α浓度降低,肺组织TLR4mRNA及其蛋白表达下调(P＜0.05).与L组和TP1组相比,TP2组和TP3组给药后6和12 h时PaO2升高,DAD评分、W/D比、血清和BALF中TNF-α浓度降低,肺组织TLR4 mRNA及其蛋白表达下调(P＜0.05).与TP2组相比,TP3组血清和BALF中TNF-α浓度降低,肺组织TLR4 mRNA及其蛋白表达下调(P＜0.05).L组和TP1组间、TP2组和TP3组间血气指标、DAD评分及W/D比较差异无统计学意义(P＞0.05).TP1～3组肺组织病理学损伤较L组减轻.结论 雷公藤甲素可减轻LPS诱发的大鼠急性肺损伤,且与剂量有关,其机制与抑制TLR4表达的上调,减少TNF-α的释放有关.     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.     

Surgical management of ductal carcinoma in situ in Australia in 1995

Background: In the present paper we describe the presentation and management of ductal carcinoma in situ (DCIS) of the breast in women in Australia in 1995. This representative, national data set provides a historical comparator for studies examining DCIS management that follow. Methods: Surgeons identified by population‐based cancer registries as having treated a new diagnosis of DCIS between 1 April and 30 September 1995 completed a questionnaire on the presentation and management of each case. Results: Two hundred and five surgeons supplied treatment details on 418 DCIS tumours in 415 women . Half of all tumours were detected at BreastScreen clinics and a further 25% were detected at other mammography centres. Twenty‐six percent of tumours were palpable at presentation, 33% were multifocal and 55% were high grade (including comedocarcinoma). Breast conserving therapy (BCT) rather than mastectomy was utilized in 260 (62%) of cases. Tumours that were of low grade, small in size and not multifocal were more likely to be treated by BCT. Surgeons seeing six or more DCIS cases in the 6‐month period were more likely to utilize BCT. Of the conservatively treated cases, 22% were referred for a radiation oncology consultation. The most common reasons for treating DCIS with mastectomy were that the tumour was too extensive or multifocal (63%), it extended to margins of the specimen (42%), or patient concerns about recurrence (34%). Conclusions: In 1995 the majority of DCIS was treated with breast conserving surgery alone. Surgeons treating more DCIS cases were more likely to perform conservative surgery than surgeons treating only one DCIS case in the study period.     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.