三房心的诊断和治疗

近６年来，经手术治疗７例三房心病人。发病率高于其他文献报告。７例病人均伴有房间隔缺损，尚有２例伴其他心内畸形。超声心动图在三房心的诊断中有较高价值；心血管造影也有助于诊断。三房心手术治疗可获得满意结果。     

19例三房心的病理解剖和外科治疗

为探讨三房心的病理解剖特点和外科治疗经验，总结１９８３年１２月至１９９５年７月，１９例三房心病人施行外科治疗的结果。年龄为１０个月～２４岁，术前确诊率为７３．７％，合并其他心内畸形１８例（９４．７％），手术死亡１例，手术死亡率为５．３％。作者认为，三房心是一种罕见的心脏畸形，多合并各种心内畸形，手术切除左心房内隔膜并同期矫治各种合并心内畸形是有效的治疗方法。     

三房心37例的诊断和外科治疗

三房心是一种少见的先天性心脏病(先心病)，仅占先心病的0．1％-0.4％。1979年1月—2003年5月，我院共手术治疗三房心37例，占同期先心病手术的0.25％，效果良好，现报道如下。     

三房心的诊断及外科治疗

三房心的诊断及外科治疗苏丕雄柳克晔陈英淳三房心是一种临床上罕见的心脏畸形，因胚胎期肺静脉干未能与固有左心房融合，左心房被异常纤维肌肉隔膜分为与肺静脉相连的副房及与左心耳、二尖瓣口相连的主房［１］。我院从１９９１～１９９５年间共手术治疗８例，报告如下。...     

三房心外科治疗十例

目的总结三房心的外科治疗经验,以提高手术疗效。方法1994年10月～2006年7月,对10例三房心患者行外科手术治疗,其中完全型9例,部分型1例;9例患者合并的其他心脏畸形,包括房间隔缺损、动脉导管未闭等均同期矫正。结果9例患者痊愈出院,死亡1例,为三房心＋VSD＋肺动脉高压患者,术中出现低心排血量综合征,经辅助循环275min后出现多器官功能衰竭死亡。随访9例患者,随访时间1.0～12.8年,1例完全型三房心患者术后2年时因原重建的副真房交通口狭窄至0.5cm,原补片垂直于交通口造成压迫,再次手术扩大交通口至3cm,重新进行心包补片修补,术后恢复满意。9例患者随访至今心功能均为级。结论外科手术治疗三房心疗效满意;把握三房心患者的病理解剖特点,有利于制定手术方案,防止或减轻术后低心排血量综合征的发生。     

三房心的外科治疗

目的 总结18例三房心的外科治疗经验。方法 1988年2月～2002年5月，18例三房心患者在全身麻醉体外循环下行三房心纠治术，对合并的心脏畸形一并处理。结果 除1例合并房室管畸形患者在术后早期死亡外，其余患者均存活。术后复查心脏超声心动图示纤维隔膜消失。结论 三房心是一种罕见的先天性心脏畸形，一经确诊即应在全身麻醉体外循环下行纠治术，早期诊断、治疗能降低患者的死亡率。     

三房心及合并心脏畸形的外科治疗(附37例报告)

目的　总结三房心的临床分型、合并畸形、诊断要点及外科治疗方法。方法　 1979年 1月至 2 0 0 3年 5月对 37例三房心病人行手术治疗 ,其中男 2 1例 ,女 16例 ;年龄 0 6～ 35 0岁 ,平均 (9 8±8 6 )岁。Gasul分型 :I型 2例 ,IIa型 9例 ,IIb型 2 4例 ,III型 2例 ;完全型 31例 ,不完全型 6例。其中 32例合并其他心内畸形。 16例病人术前经超声心动图或心导管检查确诊 ,2 1例术中探查确诊。手术经右房切口进入左房 ,完整切除三房心隔膜 ,所有心内合并畸形均同期纠治。结果　手术死亡 3例 (8 11% )。手术成功 34例。术后随访 3～ 180个月 ,疗效满意。结论　三房心是一种少见的先天性心脏病 ,临床上采用双分型法 ,对合并心脏畸形者强调术中探查 ,手术关键在于纠治合并畸形 ,手术治疗效果良好。     

12例儿童三房心的外科治疗

本文报道12例三房心的外科治疗。病理类型:单纯型5例,合并VSD及继发孔ASD各2例,合并原发孔ASO和VSD、完全性房室通道及四联症各1例。11例隔膜型,1例沙漏型。本组无手术死亡,随访情况良好。 作者指出多普勒二维超声对三房心确立有较高诊断价值;术中右房径路能良好显露和容易切除左房隔膜,并可用补片重建房隔及纠治合并畸形。     

三房心合并房缺室间隔膜部瘤室缺1例

三房心合并房缺室间隔膜部瘤室缺１例胡振华，任群，贾国英病儿女，７岁。生后４０余天因肺炎查体发现心脏杂音。哭闹时口唇发绀，活动后心慌气短，易患感冒，发育差。查体：血压１０／６ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ），口唇略绀，轻度杵状指（趾），心前区隆起、心...     

右心粘液瘤的诊治

目的　探讨右心粘液瘤的诊治及疗效。方法　自 1984年 8月至 1999年 6月 ,16例右心粘液瘤病人接受外科治疗 ,术前超声心动图明确右房粘液瘤 11例 ,右室粘液瘤 5例 ,4例右房粘液瘤同时合并左房粘液瘤。均在体外循环下行粘液瘤摘除术 ,1例同时行三尖瓣置换术。结果　无围术期死亡 ,1例术后出现左心功能衰竭 ,运用左心辅助装置治疗后好转。随访 1个月到 15年 ,平均 4 8年。 1例术后13年粘液瘤原位复发再次手术治疗 ,复发率 6 .2 5 %。结论　右心粘液瘤一经确诊应立即手术 ,且效果好、安全。超声心动图对右心粘液瘤的诊断具有极其重要的作用。     

Reversal of experimental renal fibrosis by BMP7 provides insights into novel therapeutic strategies for chronic kidney disease

Bone morphogenic protein-7 (BMP7) is a morphogen that is important for kidney development and which is also an integral part of the kidney's physiological response to repair of acute kidney injury. Several studies demonstrate that preexisting renal BMP7 pathways can be utilized by administering recombinant BMP7 to protect the kidney in experimental models of chronic kidney disease (CKD). Effectiveness of recombinant BMP7 in animal studies raises the possibility that the BMP7 pathway could be equally utilized to treat patients with CKD and interstitial fibrosis. However, regulation of BMP7 activity in the kidney is complex. BMP7 activity in the kidney is not only determined by availability of BMP7 itself, but also by a balance of agonists, such as Kielin/chordin-like protein (KCP) or BMP receptors, and antagonists including gremlin, noggin, or uterine sensitization-associated gene-1 (USAG-1). Presence of BMP7 agonists and antagonists has to be considered when recombinant BMP7 is supplemented to treat injured kidneys. Here we summarize recent insights into the role of BMP7 in acute and chronic kidney injury and discuss the implications for future directions of antifibrotic therapies.     

A case of thoracoscopic medial basal segmentectomy

IntroductionIsolated resection of the medial basal segment (S7) is uncommon because of its small volume, and S7 segmentectomy is considered to be difficult due to anatomical variation. We report a case of successful thoracoscopic S7 segmentectomy.Presentation of caseA 56-year-old man was referred to our hospital with suspected pulmonary metastasis of rectal cancer. A 6-mm nodule was detected in S7. A7 and B7 branched from the basal segmental artery and bronchus, respectively, to run ventral to the inferior pulmonary vein. This made it possible to isolate A7 and B7 by an approach via the interlobar fissure.In addition, V7a and V7b were easily isolated from inferior pulmonary vein. The intersegmental plane was indicated by V7b and was transected along a demarcation line identified by using selective oxygenation via B7.DiscussionB7 most commonly branches from the basal bronchus and A7 from the basal artery to run ventral to the inferior pulmonary vein. With this anatomical type, when the surgeon approaches via the interlobar fissure during surgery, A7 is identified first, B7 is seen behind A7, and the IPV is posterior to B7. Since the intersegmental plane is located ventral to the IPV, segmentectomy can be completed via the interlobar fissure approach.ConclusionIn patients with this pattern of pulmonary artery and bronchial anatomy, isolated S7 segmentectomy is a feasible treatment option.     

B7-H1与移植免疫

B7-homolog1（B7-H1）是迄今发现的B7家族中较新的共刺激分子。它对T细胞具有双重效应,可以激活初始T细胞,抑制活化的效应T细胞。参与多种免疫过程的发生。在一些动物器官移植模型研究中,发现B7-H1在抑制免疫排斥,诱导免疫耐受,保护移植物中有重要的作用。以B7-H1为靶点的干预方法在未来可能成为器官移植后免疫抑制治疗的有效方法。本文就B7-H1在移植免疫中作用的研究进展做一综述。     

Die Wertigkeit des 2005 modifizierten Gleason-Gradings in der urologischen Diagnostik von Prostatakarzinomen

In several consensus conferences of the International Society of Urological Pathology (ISUP), the Gleason grading system of prostatic carcinomas was modified and adapted to the routine histological diagnostics of specimens of core needle biopsies and radical prostatectomies. The main results are the documentation of all histological patterns (primary, secondary, tertiary) and a shifting of the maximal Gleason score of biopsies from 6 to 7a (3+4) and of radical prostatectomies from 6 and 7 to 7a and 7b (4+3). Score 2 to 4 carcinomas do not exist in the peripheral prostate. pT2 prostatic carcinomas with good prognosis have a maximal score of 7a; pT3 carcinomas with poor prognosis have a most frequent score of 7b. The agreement of the Gleason scores of core needle biopsies and radical prostatectomy specimens is more than 80%. Inter- and intraobserver reproducibility is better than after the conventional Gleason grading. The prognostic value of scores 6 and 7a may be similar. The border between low- and high-grade prostatic carcinoma may be probably Gleason score 7a and 7b. The prognostic value of score 6 should be changed to score 7a in the different therapeutic options for prostatic carcinomas.     

Production of recombinant human matrix metalloproteinase 7 (Matrilysin) with potential role in tumor invasion by refolding from Escherichia coli inclusion bodies and development of sandwich ELISA of MMP-7

Metastatic potential of prostate cancer is thought to correlate with the degradation of basement membrane components by matrix metalloproteinases (MMPs). The MMP-7 (matrilysin) gene is overexpressed in prostate cancer as well as colorectum and brain cancer. In order to clarify the relation of MMP-7 to clinical stages of prostate cancer, recombinant human MMP-7 was produced to prepare antibodies for immunohistochemistry and immunoassay. Preproform of human MMP-7 was produced in Escherichia coli as inclusion bodies that could be solubilized and refolded to yield an activatable proenzyme. PreproMMP-7 (Mr 31,000) solubilized from inclusion bodies was converted to proMMP-7 (Mr 30,000) during the refolding steps. The refolded proMMP-7 was purified to about 80% homogeneity as MMP-7 by sequential ion-exchange and molecular-sieve chromatography. The active, mature form of MMP-7 (Mr 20,000) could be produced from proforms of MMP-7 by treatment with p-aminophenylmercuric acetate. Activated MMP-7 was shown to have proteolytic activity to fibronectin, casein, and diazotized, denatured collagen (Azocoll). Specific activity, as assayed with the denatured collagen as substrate, was measured to be about 3,100 units/mg protein of mature enzyme. Using recombinant proMMP-7 as antigen, monoclonal and polyclonal antibodies were prepared. A sandwich ELISA was developed using monoclonal antibody as the capture antibody and rabbit anti-proMMP-7 polyclonal IgG conjugated with biotin as the detection antibody; MMP-7 at 10 ng/ml was significantly detectable. The assay system is applicable on the measurement of MMP-7 levels in the clinical and pathologic specimens including serum from patients with different stages in malignancy of prostate cancer. These antibodies are useful for the retrospective analyses of prostate cancer on the basis of immunohistochemical evaluation.     

颈5～7神经根性撕脱后神经电生理表现及临床意义

目的 分析臂丛颈5～7神经根性撕脱伤后相应皮区感觉神经动作电位(sensory nerve action potential,SNAP)、体感诱发电位(somatosensory evoked potential,SEP)的神经电生理表现及其临床意义.方法 随机选择20例经手术探查证实为臂丛颈5～7神经根撕脱的患者,回顾性统计分析术前神经电生理检测所得颈5(三角肌皮区)、颈6(拇指及前臂背外侧、桡骨上至虎口区)、颈7(示指)皮区SNAP和SEP的指标.结果 20例臂丛颈5皮区SNAP均未引出.臂丛颈5.6皮区SNAP、SEP检测结果 显示:SNAP、SEP均未引出各3例;臂丛颈6皮区SNAP、SEP均可引出10例,其SEP潜伏期较健侧延长14.3%,波幅较健侧降低54.4%.臂丛颈7皮区SNAP、SEP均可引出8例,其SEP潜伏期较健侧延长13.1%,波幅较健侧降低51.8%;臂丛颈6皮区SNAP可引出,SEP未引出7例.臂丛颈7皮区9例.结论 三角肌皮区的SNAP未引出可定性为臂丛颈5神经根性完全损伤,需综合其他神经根性损伤证据共同判别颈5神经根性撕脱与否.SNAP、SEP均未引出提示神经损伤均较为严重,可伴有神经节的损毁或臂丛神经多平面损伤.臂丛颈6、7皮区SNAP、SEP均可引出的患者中,SEP潜伏期较对侧延长大于15%或波幅下降大于55%可作为判别神经根节前损伤的佐证.只有不到50%的患者出现SNAP可引出、SEP未引出的典型电生理表现.对臂丛颈6神经根,拇指或前臂背外侧、桡骨上至虎口区中任有一项表现为SNAP可引出、SEP未引出,即有判断神经撕脱的指征.     

Interactions between angiotensin-(1-7)and angiotensin II in isolated rat portal vein

Our preliminary data show for the first time the interaction between angiotensin-(1-7) (Ang-(1-7)) and angiotensin II (Ang II, 10 nM) in isolated rat portal vein. Very low concentrations (10 nM) of Ang-(1-7) have marked functional antagonizing effects on Ang II-induced contractions. High concentrations of Ang-(1-7) (1-10 mM) do not affect the effects of Ang II. The effects of low concentration Ang-(1-7) might be associated to the interaction with Ang-(1-7) specific receptors and the own contractile effects (approximatively 28%) at high concentrations might be assign to the interaction with angiotensin specific receptors AT1. But, the lack of effects of Ang-(1-7) high concentrations on Ang II-induced contractions hardly might be associated to the interaction with AT1 receptors. Although losartan was entirely blocking the Ang-(1-7) effects, there is in the literature a series of data showing that Ang-(1-7) specific receptors (or a subtype of Ang-(1-7) receptors) might be sensible (with possible high affinity) to losartan. Additional experiments are thus necessary to further clarify these interactions.     

Development of angiotensin (1-7) as an agent to accelerate dermal repair

Angiotensin II has been shown to be a potent agent in the acceleration of wound repair. Angiotensin (1-7), a fragment of angiotensin II that is not hypertensive, was found to be comparable to angiotensin II in accelerating dermal healing. This activity was evaluated in four models: rat and diabetic mouse full-thickness excisional wounds; rat random flap; and guinea pig partial thickness thermal injury. In all models, angiotensin (1-7) was comparable to angiotensin II. Angiotensin (1-7) accelerated the closure of wounds in diabetic mice and rats. In diabetic mice the resultant tissue at day 25 after injury was more comparable to normal tissue than the fibrotic scar observed in placebo-treated wounds. In the random flap model, angiotensin (1-7) was comparable to angiotensin II in maintaining flap viability (approximately 82%) and flap survival (40%). Finally, angiotensin (1-7) increased proliferation in the hair follicles at the edge of the wound and site of thermal injury, and the number of patent blood vessels on day 7 after partial thickness thermal injury. These data may be partially explained by the effect of angiotensin II and angiotensin (1-7) on keratinocyte proliferation. While platelet-derived growth factor had no effect on keratinocyte proliferation, angiotensin II and angiotensin (1-7) significantly increased keratinocyte proliferation. These data show that angiotensin(1-7) is comparable to angiotensin II in accelerating skin repair. Furthermore, the hypertensive and wound healing effects can be separated within the family of angiotensin peptides.     

颈5～7神经根性撕脱后神经电生理表现及临床意义

目的 分析臂丛颈5～7神经根性撕脱伤后相应皮区感觉神经动作电位(sensory nerve action potential,SNAP)、体感诱发电位(somatosensory evoked potential,SEP)的神经电生理表现及其临床意义.方法 随机选择20例经手术探查证实为臂丛颈5～7神经根撕脱的患者,回顾性统计分析术前神经电生理检测所得颈5(三角肌皮区)、颈6(拇指及前臂背外侧、桡骨上至虎口区)、颈7(示指)皮区SNAP和SEP的指标.结果 20例臂丛颈5皮区SNAP均未引出.臂丛颈5.6皮区SNAP、SEP检测结果 显示:SNAP、SEP均未引出各3例;臂丛颈6皮区SNAP、SEP均可引出10例,其SEP潜伏期较健侧延长14.3%,波幅较健侧降低54.4%.臂丛颈7皮区SNAP、SEP均可引出8例,其SEP潜伏期较健侧延长13.1%,波幅较健侧降低51.8%;臂丛颈6皮区SNAP可引出,SEP未引出7例.臂丛颈7皮区9例.结论 三角肌皮区的SNAP未引出可定性为臂丛颈5神经根性完全损伤,需综合其他神经根性损伤证据共同判别颈5神经根性撕脱与否.SNAP、SEP均未引出提示神经损伤均较为严重,可伴有神经节的损毁或臂丛神经多平面损伤.臂丛颈6、7皮区SNAP、SEP均可引出的患者中,SEP潜伏期较对侧延长大于15%或波幅下降大于55%可作为判别神经根节前损伤的佐证.只有不到50%的患者出现SNAP可引出、SEP未引出的典型电生理表现.对臂丛颈6神经根,拇指或前臂背外侧、桡骨上至虎口区中任有一项表现为SNAP可引出、SEP未引出,即有判断神经撕脱的指征.     

颈5～7神经根性撕脱后神经电生理表现及临床意义

目的 分析臂丛颈5～7神经根性撕脱伤后相应皮区感觉神经动作电位(sensory nerve action potential,SNAP)、体感诱发电位(somatosensory evoked potential,SEP)的神经电生理表现及其临床意义.方法 随机选择20例经手术探查证实为臂丛颈5～7神经根撕脱的患者,回顾性统计分析术前神经电生理检测所得颈5(三角肌皮区)、颈6(拇指及前臂背外侧、桡骨上至虎口区)、颈7(示指)皮区SNAP和SEP的指标.结果 20例臂丛颈5皮区SNAP均未引出.臂丛颈5.6皮区SNAP、SEP检测结果 显示:SNAP、SEP均未引出各3例;臂丛颈6皮区SNAP、SEP均可引出10例,其SEP潜伏期较健侧延长14.3%,波幅较健侧降低54.4%.臂丛颈7皮区SNAP、SEP均可引出8例,其SEP潜伏期较健侧延长13.1%,波幅较健侧降低51.8%;臂丛颈6皮区SNAP可引出,SEP未引出7例.臂丛颈7皮区9例.结论 三角肌皮区的SNAP未引出可定性为臂丛颈5神经根性完全损伤,需综合其他神经根性损伤证据共同判别颈5神经根性撕脱与否.SNAP、SEP均未引出提示神经损伤均较为严重,可伴有神经节的损毁或臂丛神经多平面损伤.臂丛颈6、7皮区SNAP、SEP均可引出的患者中,SEP潜伏期较对侧延长大于15%或波幅下降大于55%可作为判别神经根节前损伤的佐证.只有不到50%的患者出现SNAP可引出、SEP未引出的典型电生理表现.对臂丛颈6神经根,拇指或前臂背外侧、桡骨上至虎口区中任有一项表现为SNAP可引出、SEP未引出,即有判断神经撕脱的指征.