门静脉高压症胃黏膜血管内皮生长因子的变化

目的探讨血管内皮生长因子(VEGF)在门静脉高压性胃病变(PHG)中的作用.方法分析44例肝硬化门静脉高压症病人的PHG发生率,病变部位和严重程度,以及病变部位VEGF的变化.结果 PHG者胃黏膜VEGF明显高于无胃病者及对照组(P＜0.01),其中重度胃病者VEGF明显高于轻度胃病者(P＜0.01).结论 VEGF可能是造成PHG胃黏膜损害的重要因素之一.     

门静脉高压症患者肝外血管平滑肌细胞增生与c-myc基因表达的相关性研究

目的　研究门静脉高压症患者肝外血管平滑肌细胞增生与c mycmRNA表达的关系。方法　应用RT PCR和免疫组化法对 2 8例门静脉高压症患者的脾静脉、12例正常血管分别进行c mycmRNA和增殖细胞核抗原 (PCNA)的检测。结果　门静脉高压症患者脾静脉PCNA蛋白表达阳性指数为 (2 9 8± 4 2 ) % ;c mycmRNA在PCNA蛋白表达阳性组和阴性组分别为 (7.6 1± 1 0 4 ) %和(3 82± 0 92 ) % ,正常对照组血管中PCNA蛋白无表达、c mycmRNA表达为 (1 0 4± 0 2 1) % ,两者同时与对照组比较 ,差异有显著意义 (P <0 0 1)。结论　c myc基因是门静脉高压症患者肝外血管平滑肌细胞增殖的起动基因 ,门静脉血流动力学紊乱激活脾静脉壁平滑肌细胞中原癌基因 ,促使血管平滑肌细胞增殖、迁移和表型改变 ,导致脾静脉血管重塑 ,使血管对缩血管物质反应降低。     

血管内皮生长因子在门静脉高压症胃病中的变化

门静脉高压症胃病 (PHG)是引起门静脉高压症患者上消化道出血的重要原因。本研究旨在观察PHG胃黏膜损害的发生发展过程 ,可能对其治疗或预防提供更具针对性的线索。一、材料与方法1.一般资料 :实验组门静脉高压症患者共 44例 ,其中男 3 4例、女 10例 ,年龄 2 7～ 65岁 ,平均 (4 8.41± 9.0 4)岁 ,均为住院患者 ,经临床、病理和 /或影像学检查明确诊断。对照组 12例无肝脏病变及其他重要脏器病变 ,并经胃镜检查证实无胃部病变者 ,其中男 7例、女 5例 ,年龄 2 8～ 66岁 ,平均 (4 4 .83±11.19)岁。2 .实验试剂及仪器 :免疫组织化学试剂盒购…     

一氧化氮在门静脉高压症发病中的作用

目的　探讨一氧化氮在门静脉高压症发病中的作用。　方法　 75例门静脉高压症患者 ,术中胃网膜静脉插管测定门静脉压力 ,检测外周动静脉和门静脉血中内毒素和NO2 -/NO3-的含量。　结果　 ( 1)门静脉高压症患者的血中内毒素和NO2 -/NO3-的水平 [( 0 2 4 9± 0 112 )Eu/ml和( 5 5 9± 2 6 2 ) μmol/L]均显著高于对照组 ,且门静脉血中水平最高。 ( 2 )门静脉高压症患者门静脉压力[( 3 5 5± 4 4 )cmH2 O]与门静脉血NO2 -/NO3-的水平呈显著正相关 (n =2 5 ,r =0 5 5 ,P <0 0 1) ,二者在术后的变化量也呈正相关 (r =0 5 7,P <0 0 5 )。 ( 3 )门静脉高压症患者白蛋白水平与NO2 -/NO3-呈负相关 (n =75 ,r=- 0 3 5 ,P <0 0 1) ,且有腹水组的NO2 -/NO3-水平 [( 72 4± 2 0 3 ) μmol/L]较无腹水组 [( 5 0 3± 2 1 0 ) μmol/L]为高。　 结论　门静脉高压症患者血中内毒素和NO的水平升高 ,后者可能参与了门静脉压力的异常升高且与肝功能损害有关。     

门静脉高压症大鼠断流术后胃黏膜缺氧诱导因子-1α和血管内皮生长因子的表达

目的 观察缺氧诱导因子-1α（HIF-1α）和血管内皮生长因子（VEGF）在断流术前后肝前性门静脉高压症（PHPH）大鼠胃黏膜的表达，探讨HIF-1α和VEGF在门静脉高压胃病（PHG）的发生发展的作用。方法 取Wistar大鼠制备PHPH模型80只，设假手术组（SO）60只，在术后3周施断流术。检测HIF-1α、VEGF和CD34在大鼠胃壁组织中的表达。结果 断流术前PHPH组大鼠胃壁中HIF-1α（5．8±1．3）和VEGF（12．0±3．0）的表达均明显高于SO组[HIF-1α（0．03750±0．05175），VEGF（0．7±0．1），P〈0．01]。术后HIF-1α、VEGF和MVD均有升高趋势。结论 HIF-1α和VEGF可能参与了PHG的发生发展，断流术本身能通过某种机制影响HIF-1α和VEGF的表达，加重PHG。     

血管内皮生长因子在门静脉高压脾血管病变中的表达及意义

目的:探讨血管内皮生长因子(VEGF)在肝硬化门静脉高压症患者脾脏及脾血管病变中的表达及意义。方法:2017年6月至2019年3月,手术治疗的肝硬化门静脉高压症脾肿大患者(门静脉高压组)及同期行脾切除的外伤脾破裂患者(对照组)手术切除的脾静脉及脾脏标本,比较免疫组化方法染色脾静脉及脾脏组织中VEGF的表达情况。结果:门静脉高压组脾静脉壁VEGF染色更深,阳性细胞数更多,染色指数显著高于对照组(3.68±1.45 vs 1.56±0.73,P0.01),门静脉高压组脾脏组织VEGF染色更深,阳性细胞数更多,染色指数显著高于对照组(5.11±1.56 vs 2.19±0.83,P0.01)。结论:肝硬化门静脉高压症患者脾静脉壁及脾脏组织中VEGF高表达,可能是导致肝硬化门静脉高压、脾肿大及脾血管病变的原因之一。     

大网膜包肾术自然分流在门静脉高压症治疗中的临床价值

目的　探讨大网膜包肾术 (ORP)对门静脉高压症患者行贲门周围血管离断术 (PCDV )后门静脉血流动力学的影响 ,及其自然分流作用的效率。方法　比较PCDV ,PCDV ORP和PCDV 门腔H型分流术 (PCDV PCS)患者手术后门静脉向肝血流速度 (PFR)和门静脉平均血流量 (PVF )变化 ,以及上消化道再出血、门静脉高压性胃病和肝性脑病的发生情况。结果　PCDV ORP组与PCDV PCS组比较 ,PFR分别为 14 .0 5± 3 .75和 8.64± 2 .86( P <0 .0 1) ,PVF分别为 714 .3 5± 10 2 .65和 42 3 .5 2± 2 82 .61(P <0 .0 1)。PCDV ORP上消化道再出血率与PCDV PCS组比较无显著性差异 ( 5 .5 6%比 4.3 5 % ,P >0 .0 5 ) ;肝性脑病发生率PCDV ORP组与PCDV组比较亦无显著性差异 ( 2 .78%比 3 .2 3 % ,P >0 .0 5 )。术后门静脉高压性胃黏膜损害的发生率PCDV ORP组 ( 2 7.78% )与PCDV组比较( 66.74% )差异显著 (P <0 .0 1)。结论　PCDV ORP手术既能维持手术后门静脉向肝血流 ,又能安全有效地自然分流 ,降低了断流术和分流术的远期并发症 ,具有临床推广价值     

胃癌组织中血管表皮生长因子C表达与血管和淋巴管生成及淋巴转移的关系

目的探讨胃癌组织中血管表皮生长因子C(VEGF C)表达与血管和淋巴管密度及肿瘤淋巴转移的关系。方法采用免疫组化SP法检测 6 8例胃癌组织中VEGF C、CD 31及淋巴管内皮标记物VEGFR 3,计算VEGF C表达的阳性率及肿瘤微血管和微淋巴管密度。结果淋巴结阳性组中VEGF C阳性率 (70 % )显著高于淋巴结阴性组 (30 % ) ,P <0 0 5 ;与VEGF C阴性组 (2 4 4±2 1 )比较 ,VEGF C阳性组淋巴管密度 (2 9 6± 3 0 )明显增高 ,P <0 0 5 ,而微血管密度在两组之间差异无显著意义 ,P >0 0 5 ;与淋巴结阴性组比较 ,在淋巴结转移阳性组淋巴管密度 (31 6± 2 1 )、微血管密度 (4 0 2± 2 3)均有显著提高 ,P <0 0 5。结论VEGF C主要通过调节胃癌组织微淋巴管的生成而影响胃癌淋巴结转移 ;微淋巴管密度与微血管密度均为胃癌淋巴结转移的重要影响因素     

断流术与分流术对门静脉高压性胃病的不同影响

目的　探讨断流术与分流术对门静脉高压性胃病 (PHG)的影响。方法　实验分对照组 9例、断流术组 14例和分流术组 12例 ,采用术前及术后 3个月胃镜检查 ,原位末端标记(TUNEL)染色测凋亡指数 (AI)和逆转录 聚合酶链反应 (RT PCR)法测定Caspase 3mRNA表达量。结果　对照组AI值为 (2 .3 1± 0 .11) % ,Caspase 3mRNA表达量为0 .5 1± 0 .0 3 ,其他组与对照组比较 ,AI值增加差异有统计学意义 (P <0 .0 1) ,Caspase 3mRNA表达量显著增加 (P <0 .0 5 )。断流术后AI值由术前的 (12 .83± 1.5 4) %增加到 (16.2 4± 1.68) % (P <0 .0 5 ) ,PHG患者 2例由轻转重 ,PHG病变程度加重 (P <0 .0 5 ) ;相反 ,分流术后AI值从术前的 (12 .18± 1.3 2 ) %回降至 (8.5 8±0 .72 ) % (P <0 .0 5 ) ,术后PHG患者 1例由重转轻 ,4例痊愈 ,PHG病变程度得到缓解 (P <0 .0 5 )。Caspcse 3mRNA表达量与AI值有类似改变两者间呈正相关(r =0 .86,P <0 .0 5 )。结论　PHG胃黏膜细胞凋亡增加 ,断流术后凋亡加剧 ,PHG病变程度加重 ;分流术后凋亡改善 ,PHG病变程度缓解。     

血管生成在肝门部胆管癌发生发展中作用的研究

目的　探讨血管内皮细胞生长因子 (vascularendothelialgrowthfactor,VEGF)和血管生成与肝门部胆管癌发生发展的关系。方法　应用逆转录多聚酶链反应 (RT PCR)和免疫组化技术对2 6例肝门部胆管癌、癌周组织及 12例正常组织中VEGFmRNA和蛋白及微血管密度 (MVD)进行检测。结果　 2 6例肝门部胆管癌组织中VEGFmRNA阳性表达率为 77% (2 0 / 2 6 ) ;癌周组织阳性表达率为2 7% (7/ 2 6 ) ;正常组织表达率为 8% (1/ 12 ) ,三者差异有显著性 (P <0 0 1)。VEGFmRNA阳性表达与VEGF蛋白表达具有一致性 ;VEGFmRNA阳性者MVD值显著高于阴性者 (P <0 0 1) ;VEGFmRNA表达和MVD与肝门部胆管癌的分化程度、浸润转移密切相关 (P <0 0 5 ) ,而与肿瘤发生部位、病理类型、大小、临床分型无关 (P >0 0 5 )。结论　VEGF在肝门部胆管癌的发生和浸润转移过程中发挥重要作用 ,肿瘤血管生成与肝门部胆管癌浸润转移密切相关。     

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。     

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。     

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.     

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.