高龄供肝对肝移植术后并发症的影响——148例受者预后分析及思考

目的研究高龄供肝对肝移植术后移植物功能及受者生存率的影响及其干预策略。方法根据供者年龄≥或<60岁1:1配对选取2016年1月—2017年6月期间行肝移植手术患者为研究对象,分为高龄供者(elderly donor,ED,n=74)组和非高龄供者(non-elderly donor,NED,n=74)组。比较分析受者肝功能恢复情况、并发症、移植物及受者生存率。结果ED组移植物早期功能不全发生率为47.3%,显著高于NED组的28.4%(P=0.018);ED组胆道并发症发生率为21.6%,显著高于NED组的9.5%(P=0.041);ED组移植物存活率显著低于NED组(P=0.023)。ED组冷缺血时间>12 h者移植物早期功能不全发生率显著高于<12 h者(70.6%比40.4%,P=0.003)。结论高龄供肝的使用会影响移植物早期功能恢复及其1年存活率,缩短冷缺血时间可以显著降低EAD的发生率,改善受者预后。     

急危重症患者ECMO支持下院内转运的护理

报告1例感染性心内膜炎继发二尖瓣腱索断裂患者在ECMO支持下进行院内转运的护理体会,其要点包括转运前积极充分准备、转运途中合理分工实施监护及高效的基础生命支持和转运后交接。     

乌司他丁对老年肾移植围术期细胞因子的影响

目的：观察乌司他丁对老年肾移植患者围手术期细胞因子释放的影响,探讨其促进移植。肾功能早期恢复的机制。方法：选择30例慢性肾炎肾功能衰竭的老年患者（年龄≥60岁）,随机分为对照组（C组）和乌司他丁组（U组）,每组15例。U组于手术开始后至循环开放前静滴50万IU乌司他丁,术后5d继续每天静注30万IU两组分别在术前（T0）、术毕即时（T1）、术后第1天（T2）、术后第3天（T3）、术后第5天（T4）、术后第7天（T5）等时点测定血清超氧化物歧化酶（SOD）、丙二醛（MDA）、肿瘤坏死因子-α（TNF-α）、白介素（IL）-6、IL-8及IL-10的浓度。同时术后第1～30天每天查血肌酐,记录肌酐恢复正常所需天数,记录各组发生延迟肾功能恢复和急性排斥反应的例数。结果：乌司他丁治疗组于T1、T2、T3、T4、T5的SOD、IL-10值高于对照组（P〈0．05）,而MDA、TNF-α、IL-6、IL-8值低于对照组（P〈0．05）。血肌酐恢复正常水平时间,两组比较差异有统计学意义（P〈0．05）。结论：乌司他丁能够减轻移植。肾的缺血-再灌注损伤和排斥反应引起的组织损伤,促进移植肾功能早期恢复。     

Apoptosis and oxidative injury of donor islets during isolation and purification

<正>Objective To observe the changes of islet cell apoptosis and oxidation - antioxidation before transplantation,and to explore pathways of islet protection. Methods Fifteen human pancreases were perfused with Hanks solution containing collagenase,then digested and isolated.     

Dual roles of commensal bacteria after intestinal ischemia and reperfusion

The roles of commensal bacteria after intestinal ischemia and reperfusion (IIR) are unclear. In current study, we aim to investigate the effects and underlying mechanisms of commensal bacteria in injury and epithelial restitution after IIR. Commensal gut bacteria were deleted by broad-spectrum antibiotics in mice. IIR was induced by clamping superior mesenteric artery. Intestinal injury, permeability, epithelial proliferation, and proinflammatory activity of mesenteric lymph were investigated. Commensals deletion improved mice survival in the early phase, but failed to improve the overall survival at 96 h after IIR. Commensals deletion reduced proliferation of intestinal epithelial cells (IEC) and augmented proinflammatory activity of mesenteric lymph after IIR. Lipopolysaccharides (LPS) supplement promoted IEC proliferation and improved survival in mice with commensals deletion after IIR. LPS induced production of prostaglandin E2 (PGE2) in mucosa via toll-like receptor 4-NFκB-cyclooxygenase 2 pathway. PGE2 enhanced IEC proliferation in vivo, which was preceded by activation of Akt and extracellular signal-regulated kinase (ERK) 1/2. Blocking of EGFR, PI3K/Akt activity abolished LPS-induced IEC proliferation. Commensal bacteria are essential for epithelial restitution after IIR, which enhance IEC proliferation via induction of PGE2.     

SCHIP1促进Hippo通路的激活抑制结肠癌的发生发展

目的:检测SCHIP1在结肠癌的组织和细胞中的表达水平以及其在结肠癌中对Hippo通路的影响。方法:利用TCGA数据库分析SCHIP1在结肠癌中的表达情况;免疫组化的方法检测SCHIP1在结肠癌组织标本中的表达情况;采用Transwell试验、集落实验及MTS检测对细胞迁移和增殖能力进行检测;采用Western blot检测YAP、P-YAP、CTGF在结肠癌中的表达情况。结果:TCGA数据库显示结肠腺癌中SCHIP1的表达低于正常组织;SCHIP1在结肠癌组织及细胞系中表达较低;SCHIP1过表达抑制了RKO细胞迁移和增殖能力;SCHIP1低表达促进了RKO细胞的迁移和增殖;过表达SCHIP1的RKO细胞明显抑制了YAP、CTGF的表达,促进了P-YAP的表达。低表达SCHIP1的RKO细胞促进了YAP、CTGF的表达,抑制了P-YAP的表达。结论:SCHIP1增强了结肠癌中Hippo通路活性,抑制结肠癌的发生进展;SCHIP1可能作为结肠癌治疗的一个潜在靶向分子。     

Mesenchymal stem cells suppress CD8+ T cell‐mediated activation by suppressing natural killer group 2, member D protein receptor expression and secretion of prostaglandin E2, indoleamine 2, 3‐dioxygenase and transforming growth factor‐β

Bone marrow mesenchymal stem cells (BMSCs) inhibit immune cell responsiveness, and especially of T lymphocytes. We showed that BMSCs markedly inhibited the proliferation and cytokine production by CD8⁺ T cells by a cell‐to‐cell contact phenomenon and secretion of soluble factors. BMSCs down‐regulate the expression of natural killer group 2, member D protein (NKG2D) receptors on CD8⁺ T cells when co‐cultured with them. Moreover, CD8⁺ T cells that express low levels of NKG2D had impaired proliferation after triggering by a mitogen. The major histocompatibility complex (MHC) class I chain‐related (MIC) A/B molecule, which is a typical ligand for NKG2D, was expressed on BMSCs, and caused dampening of cell proliferation. Monoclonal antibody blocking experiments targeted to MIC A/B impaired CD8⁺ T cell function, as evaluated by proliferation and cytokine production. In addition, the production of prostaglandin E₂ (PGE₂), indoleamine 2, 3‐dioxygenase (IDO) and transforming growth factor (TGF)‐β1 were increased when BMSCs were co‐cultured with CD8⁺ T cells. The addition of specific inhibitors against PGE₂, IDO and TGF‐β partially restored the proliferation of CD8⁺ T cells. Our results suggest that BMSCs suppress CD8⁺ T cell‐mediated activation by suppressing NKG2D expression and secretion of PGE₂, IDO and TGF‐β. Our observations further confirm the feasibility of BMSCs as a potential adoptive cellular therapy in immune‐mediated diseases such as graft‐versus‐host disease (GVHD).     

大分割三维适形放射治疗肺癌单发脑转移

目的探讨大分割三维适形(3D-CRT)方法治疗肺癌单发脑转移的疗效。方法 87例患者接受大分割3D-CRT治疗。方法 3～4Gy/次,1次/d,5次/周,共8～12次。整个治疗期间配合脱水治疗以降低颅压。结果有效率71.2%,87例患者中位生存期为11个月,生活质量提高。结论大分割3D-CRT治疗肺癌单发脑转移是一种行之有效的治疗方法。     

腹腔镜辅助再次手术治疗先天性巨结肠及巨结肠同源病的临床分析

目的 探讨腹腔镜辅助再次手术治疗先天性巨结肠（HD）或巨结肠同源病（HAD）的临床价值.方法 选择2010年6月至2013年6月于华中科技大学同济医院附属同济医院经手术治疗及保守治疗无效的30例HD或HAD患儿为研究对象,对其进行腹腔镜辅助再次手术治疗.本研究遵循的程序符合华中科技大学同济医学院附属同济医院人体试验委员会所制定的伦理学标准,得到该委员会批准,征得受试对象监护人的知情同意,并与之签署临床研究知情同意书.结果 本研究30例患儿再次手术均成功完成（100.0％）,其中,腹腔镜辅助再次手术成功为27例（90.0％）,因腹腔肠管粘连严重而行中转开腹治疗成功患儿为3例（10.0％）.30例患儿随访结果显示,术后无任何异常症状患儿为16例（53.3％）,术后出现污粪、便秘症状患儿为14例（46.7％,经保守治疗症状缓解）.结论 对经手术和保守治疗无效的HD或HAD患儿进行腹腔镜辅助再次手术具有手术创伤小、术后恢复快、手术效果确切、短期随访疗效满意等优势,但对该类患儿再次手术术式的选择,仍需要综合考虑患儿病情及首次根治术术式,采取个体化治疗方案,以达到最佳治疗效果.