缺血预处理-后处理对大鼠肠缺血再灌注损伤的影响

目的 评价缺血预处理.后处理对大鼠肠缺血再灌注损伤的影响.方法 清洁级成年雄性SD大鼠40只.体重225～275 g,随机分为5组(n=8):假手术组(S组)仅分离肠系膜上动脉(SMA),不夹闭;肠缺血再灌注组(IIR组)采用夹闭SMA 60 min,再灌注60 min的方法制备肠缺血再灌注损伤模型;缺血预处理组(IPr组)夹闭SMA 10 min,再灌注10 min,余同IIR组;缺血后处理组(IPo 组)夹闭SMA 60 min后,再灌注30 s,缺血30 s,反复3次,再灌注60 min;缺血预处理.后处理组(IPr-IPo组)先行缺血预处理,再行缺血后处理,操作过程同IPr组和IPo组.于再灌注60 min时各组取肠粘膜组织,观察肠粘膜形态并行Chiu评分,检测丙二醛(MDA)含量,超氧化物歧化酶(SOD)及髓过氧化物酶(MPO)活性,同时采集动脉血样检测血浆肿瘤坏死因子α(TNF-α)及白细胞介素6(IL-6)浓度.结果 与S组比较,其余各组Chiu评分、MDA含量、MPO活性、血浆TNF-α与IL-6浓度升高,SOD活性降低(P<0.05).与IIR组比较,IPr组、IPo组及IPr-IPo组Chiu评分、MDA含量、MPO活性、血浆TNF-α和IL-6浓度降低.SOD活性升高(P<0.01).与IPr组和IPo组比较,IPr-IPo组Chiu评分和MDA含量降低,SOD活性升高(P<0.05).IPr组与IPo组各指标比较差异无统计学意义(P>0.05).结论 缺血预处理-后处理可减轻大鼠肠缺血再灌注损伤,较单独应用时效果好.     

白细胞介素12在大鼠肺缺血再灌注损伤中的作用

目的 评价白细胞介素12(IL-12)在大鼠肺缺血再灌注损伤中的作用.方法 健康成年雄性SD大鼠24只,8-10周龄,体重250-280 g,采用随机数字表法,将大鼠随机分为3组(n=8):假手术组(S组),肺缺血再灌注损伤组([/R组),IL-12单克隆抗体组(IL-12组).S组只分离肺门不夹闭；I/R组夹闭肺门60 min后,恢复灌注2 h；IL-12组于夹闭肺门前1h尾静脉注射IL-12单克隆抗体200μg/kg.于再灌注结束时采集血样和肺绀织,测定血浆TNF-α浓度、辅助性T细胞(Th)1和Th2水平、肺组织湿干重(W/D)比、髓过氧化物酶(MPO)活性、MDA含量及动脉血氧分压(PaO2)及二氧化碳分压(PaCO2).光镜下观察肺组织病理学改变.结果 与S组比较,I/R组和IL-12组肺组织W/D比、MDA含量、MPO活性、血浆TNF-α浓度升高,I/R组PaO2降低,PaCO2、Th1水平和Th1/Th2升高(P＜0.01),Th2水平差异无统计学意义(P＞0.05),IL-12组PaO2、PaCO2、Th1、Th2水平及Th1/Th2差异无统计学意义(P＞0.05)；与I/R组比较,IL-12组PaCO2、肺组织W/D比、MDA含量、MPO活性、血浆TNF-α浓度、Th1水平和Th1/Th2降低,Th2水平和PaO2升高(P＜0.01).I/R组肺组织损伤明显,IL-12组肺组织损伤程度明显减轻.结论IL-12通过使Tn1/Th2失衡而参与肺缺血再灌注损伤.     

异丙酚联合机体低氧预处理对大鼠肺缺血再灌注损伤的影响

目的 探讨异丙酚联合机体低氧预处理对大鼠肺缺血再灌注损伤的影响.方法 健康雄性SD大鼠90只,体重250～320 g,随机分为5组(n=18):假手术组(S组)、肺缺血再灌注组(IR组)、异丙酚组(P组)、机体低氧预处理组(WBHP组)和异丙酚联合机体低氧预处理组(PW组).IR组采用阻断左肺门45 min后再灌注的方法制备大鼠单肺缺血再灌注损伤模型,P组夹闭左肺门前30 min持续静脉输注异丙酚30 mg·kg-1·h-1;WBHP组夹闭左肺门前先行机体低氧预处理;PW组夹闭左肺门前30 min持续静脉输注异丙酚30 mg·kg-1·h-1和机体低氧预处理.分别于再灌注0.5、1、4 h时测定肺组织TNF-α、IL-1、IL-6和MDA的含量,SOD活性,计算肺湿干重比(W/D).结果 与S组比较,IR组、P组、WBHP组和PW组T1～3时肺组织TNF-α、IL-1、IL-6和MDA的含量及W/D升高,SOD活性降低(P＜0.05);与IR组比较,P组、WBHP组和PW组T1～3时TNF-α、IL-1、IL-6和MDA的含量及W/D降低,SOD活升高(P＜0.05);与P组和WBHP组比较,PW组T2,3时TNF-α和IL-6的含量及W/D降低,SOD活性升高,T3时IL-1和MDA的含量降低(P＜0.05).P组与WBHP组各指标差异无统计学意义(P＞0.05).结论 异丙酚联合机体低氧预处理减轻肺缺血再灌注损伤的作用较单独应用时强,可能与联合应用时抑制炎性反应的作用增强和抗氧化能力提高有关.     

七氟醚对在体大鼠肺缺血-再灌注损伤的影响

目的研究七氟醚对在体大鼠肺缺血-再灌注(I-R)损伤的影响。方法40只Wistar大鼠建立在体大鼠肺I-R模型,随机分为四组,每组10只:A组,假手术组,开胸后机械通气120 min;B组,I-R组,阻断左肺门60 min,开放再通气60 min;C组,七氟醚加I-R组,缺血前吸入1 MAC七氟醚30 min,开放再通气同时吸入1 MAC七氟醚60 min;D组,七氟醚组,持续吸入1 MAC七氟醚120min。观察各组实验结束时肺组织的湿/干重比(W/D)、肺丙二醛(MDA)、超氧化物歧化酶(SOD)和肺组织病理学的改变。结果B组及C组肺W/D较A组和D组显著升高(P<0.01,P<0.05),SOD含量显著低于A组和D组(P<0.05);B组肺MDA含量较A组和D组显著升高(P<0.01),C组肺MDA含量较B组低(P<0.05);C组肺W/D、肺MDA显著低于B组(P<0.05),SOD高于B组(P<0.05);病理切片见B组、C组部分肺泡结构破坏,肺泡间隔增宽,肺泡腔内水肿并有出血,以B组改变较为严重,炎症积分显著高于C组(P<0.01)。结论七氟醚对在体大鼠肺I-R损伤有一定的保护作用。     

丙泊酚对大鼠全肝缺血-再灌注后肺损伤的影响

目的 探讨丙泊酚对大鼠全肝缺血-再灌注(I-R)后肺损伤的影响及可能机制.方法 32只SD大鼠随机均分为四组,Ⅰ组:全肝缺血前10 min腹腔注射丙泊酚50 mg/kg,再灌注前10min腹腔注射生理盐水50 ml/kg; Ⅱ组:缺血前10 min注射生理盐水50 ml/kg,再灌注前10 min注射丙泊酚50 mg/kg;Ⅲ组:I-R前10 min均注射生理盐水50 ml/kg;Ⅳ组:假手术后在对应时点注射生理盐水50 ml/kg.I-R 1 h后取肺组织,测定肺组织髓过氧化物酶(MPO)活性、丙二醛(MDA)含量、超氧化物歧化酶(SOD)活性及W/D比值;在光镜下观察肺组织形态学及细胞凋亡情况.结果 与Ⅰ、Ⅱ、Ⅳ组比较,Ⅲ组大鼠肺W/D比值、MDA含量、MPO活性与细胞凋亡指数均增高(P<0.05或P<0.01),SOD活性降低(P<0.01);光镜检查示Ⅲ组大鼠肺组织损伤严重,大量炎性细胞浸润.结论 丙泊酚对大鼠肝I-R后肺损伤具有保护作用,其机制可能与抗氧化、抗炎及抗细胞凋亡有关.     

依达拉奉对大鼠小肠缺血-再灌注所致肺损伤的保护作用

目的探讨依达拉奉对大鼠小肠缺血-再灌注所致肺损伤的保护作用。方法雄性SD大鼠18只,随机均分为假手术组(Sham组),缺血-再灌注组(IR组)和依达拉奉组(E组)。Sham组只分离肠系膜上动脉,不做其他处理;IR组分离肠系膜上动脉,从大鼠尾静脉注射与E组等量的生理盐水后,用无创动脉夹夹闭120min后移去动脉夹,再灌注120min;E组在缺血-再灌注前静脉注射依达拉奉6mg/kg。再灌注120min后采集标本。肺组织HE染色后病理学检测,采集腹主动脉血液检测大鼠血清中TNF-α和IL-6浓度,取肺组织检测髓过氧化物酶(MPO)活性和丙二醛(MDA)浓度。结果与Sham组比较,IR组肺泡上皮细胞广泛水肿、炎性细胞浸润、肺泡肺萎陷、肺毛细血管扩张出血;E组肺组织病理改变较IR组明显改善,肺泡炎性渗出减少;E组病理评分为(2.1±0.7)分,明显低于IR组的(5.7±1.1)分,IR组病理评分明显高于Sham组的(1.5±0.2)分(P0.01);血清中TNF-α和IL-6的浓度明显少于IR组,肺组织中MPO活性和MDA浓度明显低于IR组(P0.01)。结论依达拉奉能够明显改善小肠缺血-再灌注性肺损伤。     

烟碱预处理对大鼠心肌缺血-再灌注损伤的保护作用

目的 探讨烟碱预处理对大鼠心肌缺血-再灌注损伤的保护作用及其可能机制.方法 30只健康雄性Sprague-Dawlay大鼠,体重200～250g,随机均分为缺血-再灌组(I-R组)、烟碱预处理组(N组)、假手术组(Sham组).测定三组血浆肌酸激酶同工酶(CK-MB)活性、丙二醛(MDA)含量和超氧化物岐化酶(SOD)活性,心肌组织中髓过氧化物酶(MPO)活性,电镜下观察缺血区心肌超微结构变化.结果 与Sham组比较,I-R组血浆CK-MB活性、MDA含量及心肌组织MPO活性均升高、血浆SOD活性降低(P<0.05或P<0.01);与I-R组比较,N组血浆CK-MB活性、MDA含量及心肌组织MPO活性均降低,血浆SOD活性升高(P<0.05或P<0.01),心肌病理学损伤减轻.结论 烟碱预处理可减轻大鼠心肌缺血-再灌注损伤,其机制可能与减少氧自由基生成、增强心肌抗氧化能力有关.     

异氟醚预处理对大鼠肝脏缺血再灌注损伤的影响

目的 探讨异氟醚预处理对大鼠肝脏缺血再灌注损伤的影响.方法 成年雄性SD大鼠24只,体重180～220 g,随机分为3组(n=8):假手术组(S组)吸人纯氧30 min,间隔30 min后仅开腹;肝脏缺血再灌注组(IR组)吸入纯氧30 min,间隔30 min后行肝脏缺血60 min,再灌注4 h;异氟醚预处理组(Iso组)吸入1.4%异氟醚30 min,间隔30 min后行肝脏缺血60 min,再灌注4 h.于再灌注4 h时处死大鼠,留取肝脏及腹主动脉血5ml.测定血清谷丙转氨酶(ALT)和谷草转氨酶(AST)浓度,血清及肝组织匀浆上清液中肿瘤坏死因子α(TNF-α)的浓度,肝组织髓过氧化物酶(MPO)、超氧化物歧化酶(SOD)活性及丙二醛(MDA)含量,观察肝组织病理学改变.结果 与S组比较,IR组、Iso组血清ALT、AST和TNF-α水平明显升高,肝组织TNF-α含量升高,肝组织MPO活性升高,MDA含量升高,SOD活性降低(P＜0.05或0.01),肝组织病理损伤明显;与IR组比较,Iso组血清ALT、AST和TNF-α水平降低,肝组织TNF-α含量降低,肝组织MPO活性降低,MDA含量降低,SOD活性升高(P＜0.05或0.01),肝组织病理损伤程度减轻.结论 1.4%异氟醚预处理可明显减轻大鼠肝脏缺血再灌注损伤,其机制可能与抑制TNF-α的释放、减少中性粒细胞在肝组织的浸润有关.     

七氟烷后处理对大鼠肺缺血再灌注损伤的影响

目的 探讨七氟烷后处理对大鼠肺缺血再灌注(IR)损伤的影响及其可能机制.方法 健康SPF级雄性SD大鼠96只,体重270～330 g.随机分为4组(n=24):假手术组(S组)、缺血再灌注组(IR组)、七氟烷预处理组(SPr组)和七氟烷后处理组(SPo组).采用阻断左肺门45 min后再灌注的方法 制备大鼠单肺原位IR模型.SPr组吸入七氟烷,呼气末浓度2.1%,30 min后制备肺IR模型;SPo组于再灌注前即刻吸入七氟烷30 min,呼气末浓度2.1%.分别于再灌注30 min、1、2、4 h时测定支气管肺泡灌洗液(BALF)肿瘤坏死因子α(TNF-α)、白细胞介素1(IL-1)、IL-6浓度,并进行白细胞分类计数,计算多形核白细胞占白细胞的百分比(PMN百分比),同时测定肺组织TNF-α、IL-1、IL-6含量及细胞凋亡指数,光镜、电镜下观察肺组织病理学结果 并行损伤评分.结果 与S组比较,IR组肺组织和BALF中TNF-α、IL-1、IL-6水平、细胞凋亡指数、白细胞计数、PMN百分比和肺组织损伤评分均升高,SPr组和SPo组肺组织TNF-α、IL-1、IL-6含量升高(P<0.01);与IR组比较,SPr组和SPo组上述指标均降低(P<0.05或0.01);SPr组与SPo组各指标差异无统计学意义(P>0.05).结论 七氟烷后处理可减轻大鼠肺IR损伤,效果与其预处理无差异,其肺保护作用的机制可能与降低肺组织炎性反应,抑制细胞凋亡有关.     

亚甲蓝预处理对大鼠肝缺血再灌注肺损伤的保护作用

目的研究肝缺血再灌注后肺损伤的机制以及亚甲蓝的保护作用。方法 36只SD大鼠随机分为假手术组（S组,n=12）、缺血再灌注组（I/R组,n=12）和亚甲蓝处理组（MB组,n=12）。阻断肝门30分钟后开放血流,建立大鼠全肝缺血再灌注模型。I/R组与MB组分别于肝门阻断前10分钟腹腔注射亚甲蓝10mg/kg或相应剂量生理盐水,于再灌注1小时取血、处死动物。假手术组不阻断肝门,于上述相应时间点注射生理盐水与取血、处死动物。肝肺病理切片光镜观察、肺干湿重比、肺组织丙二醛（MDA）含量、髓过氧化物酶（MPO）活力、血清TNF-α和IL-8含量。结果病理结果显示,亚甲蓝组缺血再灌注后肺损害程度较缺血再灌注组减轻。缺血再灌注组较假手术组肺组织干湿重比、MDA含量、MPO活性和血清TNF-α和IL-8含量升高（P〈0.01）,而亚甲蓝组较缺血再灌注组肺组织干湿重比和血清TNF-α和IL-8含量（P〈0.01）,MDA含量和MPO活性（P〈0.05）均有下降。结论肝缺血再灌注会导致肺损伤,缺血前给予亚甲蓝对大鼠肝I/R后肺损伤具有有保护作用。     

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。     

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.     

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.     

Single center experience in single-incision laparoscopic surgery in children in Turkey

Purpose

Minimally invasive surgery has evolved into single-incision laparoscopic surgery (SILS) in the recent years. Few reports have addressed the practicality of SILS in children. Our current experience with regard to feasibility and effectiveness of SILS in children is presented.

Methods

A retrospective review of the operative database for patients operated on using SILS in our department from March 2009 to July 2010 was performed. Data regarding the type of the procedure, age, sex, operative performance, hospital stay, and complications were collected.

Main Results

Among 43 patients, cholecystectomy was performed in 11; appendectomy, in 10; unroofing for ovarian cysts, in 5; unroofing for splenic cysts, in 4; oophorectomy, in 6 (ovarian torsion, 2; teratoma, 4); ovary-preserving teratoma excision, in 1; splenectomy, in 1; gonadectomy, in 3; and varicocelectomy, in 2. There were no conversions to standard laparoscopic or open techniques. The only postoperative complication was a wound infection that occurred after an appendectomy.

Conclusion

Although currently more expensive, SILS can be performed in children in almost every pediatric surgical procedure that can be accomplished with conventional laparoscopic techniques. The most significant contribution of SILS procedure is cosmesis. Postoperative pain and length of hospital stay were not improved.