腹腔镜与开腹手术治疗门脉高压症的对比研究

目的探讨腹腔镜与开腹手术行脾切除联合贲门周围血管离断术治疗门脉高压症的手术效果。 方法回顾性分析2013年3月至2018年12月因门脉高压、脾大、脾功能亢进及食管胃底静脉曲张行脾切除术联合贲门周围血管离断术的患者资料,其中腹腔镜下手术21例(腹腔镜组),开腹手术50例(开腹组)。应用GraphPad Prism 6.0软件对所有数据进行分析。术中、术后相关指标采用( ±s)表示,独立样本t检验;并发症发生率采用χ²检验。P<0.05为差异有统计学意义。 结果与开腹组比较,腹腔镜组手术时间较长(P<0. 05),而术中出血量、切口长度、术后排气时间、镇痛药物使用次数、引流管拔除时间、术后住院时间、术后切口感染率均少于开腹组(P<0. 05);两组间的腹腔出血、腹、盆腔积液、肺部感染、胰瘘以及门静脉血栓形成差异无统计学意义(P>0.05)。 结论腹腔镜手术治疗门脉高压症行脾切除联合贲门周围血管离断术具有手术创伤小、术中出血少、术后恢复快、术后切口感染率低、住院时间短等优点,腹腔镜手术治疗门脉高压症是安全、可行的。     

A combination of Sinomenine and Methotrexate reduces joint damage of collagen induced arthritis in rats by modulating osteoclast-related cytokines

ObjectiveTo analyze the combination therapy of Sinomenine (SIN) and Methotrexate (MTX) in rheumatoid arthritis (RA), we herein demonstrated the combination effect of SIN and MTX on collagen-induced arthritis (CIA) in rats through their modulation on osteoclast-related cytokines.MethodsCIA was induced by the immunization of type II collagen (CII) in SD rats. SIN and MTX were administrated alone or in combination after the onset of arthritis. Arthritis index and histological analysis were used to evaluate the effect of treatments. Effects of SIN and MTX on expression of receptor activator of NF-κB ligand (RANKL) and osteopontin (OPN) in synovial tissues were assayed by immunohistochemistry. RANKL, osteoprotegerin (OPG), IL-6, IL-17 and matrix metalloproteinases (MMPs) in rat serum were measured by ELISA. The expression of osteoclast-related cytokines in fibroblast-like synoviocytes (FLS) from RA patients was assayed by RT-PCR.ResultsSIN and MTX combination additively reduced the inflammatory symptoms and joint damage in CIA. Combination of SIN and MTX significantly repressed synovial RANKL and OPN production. SIN and MTX exhibited complementary and synergistic effect upon down-regulating RANKL, IL-6, IL-17 and MMPs in rat serum. SIN and MTX also modulated the expression of RANKL and OPG in RA-FLS.ConclusionSIN and MTX have additive effects, decreasing inflammation and joint damage in CIA rats by modulating osteoclast-related cytokines. These results are indicative of the combined effect of SIN and MTX for anti-arthritic treatment in RA.     

Prompt surgery is effective for acute type A aortic dissection with cerebral ischemia

BackgroundAcute type A aortic dissection (aTAAD) with preoperative cerebral ischemia (CI) is common and lethal, but the timing and treatment method remain uncertain. We retrospectively reviewed our aTAAD patients with CI and analyzed the outcomes and related risk factors.MethodsFrom January 2011 to December 2019, 1,173 patients diagnosed with aTAAD from Nanjing Drum Tower Hospital were enrolled. Among them, 131 patients had CI preoperatively (CI group), and 1,042 patients were in the non-CI group. One hundred eight in the CI group and 984 in the non-CI group received central repair surgery. Fifteen patients had postoperative cerebral complications (CC) and 93 had non-CCs. ROC curves were used to identify the safe duration of preoperative CI.ResultsThe CI group was older (56.3 vs. 53.2 years, P=0.013) and had lower rates of pain, chest pain and back pain (77.9% vs. 94.4%, 75.4% vs. 87.5% and 30.8% vs. 42.3%, respectively) than the non-CI group. The CI group had a higher rate of preoperative hypotension and tamponade (13.7% vs. 6.0%, 26.9% vs. 10.4%, respectively; P=0.000). More patients in the CI group did not receive central repair surgery, and the CI had higher mortality (28.2% vs. 15.9%). CI without central repair surgery was a strong risk factor for mortality. CI patients with CC after central repair had a higher mortality, and preoperative coma was the strongest risk factor for postoperative CC.A duration between CI symptoms and central repair surgery of less than 12.75 hours is recommended.ConclusionsPrompt surgery is effective for aTAAD with CI, and preoperative coma and a safe duration longer than 12.75 hours would predict worse outcomes.     

RUNX3、RASSF1A启动子高甲基化与胃癌进展转移的关系

目的:探讨胃癌RUNX3、RASSF1A基因启动子甲基化在胃癌进展转移中的作用及意义.方法:RT-PCR和MSP检测62例胃癌标本及56例正常胃黏膜组织RUNX3、RASSF1A基因mRNA表达及甲基化状况,免疫组织化学检测VEGF在RUNX3、RASSF1A甲基化与非甲基化胃癌组织及20例正常组织中的表达,并分析RUNX3、RASSF1A甲基化与VEGF表达的关系.结果:胃癌组织RUNX3与RASSF1A表达较正常组织均明显降低(0.629±0.461 vs 0.893±0.543,0.653±0.476 vs 0.858±0.581,均P<0.05),且RUNX3与RASSF1A甲基化率均高于正常组织(69.4%VS 26.8%,66.1%vs 23.2%.均P<0.01).胃癌组织中RUNX3、RASSF1A甲基化组mRNA表达量较非甲基化组明显降低(0.545±0.299 vs 0.736±0.291,0.562±0.208 vs 0.674±0.185,均P<0.05).RASSF1A甲基化与肿瘤TNM分期及浸润深度相走RUNX3甲基化与肿瘤淋巴结转移、血管侵犯及TNM分期相关(P<0.05).RUNX3甲基化组胃癌组织VEGF蛋白表达高于非甲基化组(86.0%vs57.9%),RUNX3甲基化与VEGF表达相关(P<0.05).结论:RUNX3、RASSF1A启动子高甲基化可能是导致其表达降低的原因,并与胃癌进展演变相关.RUNX3甲基化可能参与胃癌血管、淋巴管转移.     

BrdU作为脂肪干细胞标记示踪法的可行性

目的:研究BrdU标记猪脂肪干细胞(adipose-derived stem cells,ADSCs)的最佳剂量及时间,探讨其作为干细胞标记示踪方法的可行性.方法:自中华实验猪背部提取脂肪组织,采用贴壁法分离培养ADSCs,取第3代细胞以终浓度分别为10、15、20、25及30 μmol/L BrdU进行标记:另一孔不含BrdU作为对照组,分别培养12、24、48、72及96 h.免疫荧光法检测各组细胞BrdU标记率,找出BrdU的最佳标记方法,通过台盼蓝排斥试验、MTT及细胞凋亡检测,观察BrdU对ADSCs生长情况的影响.对第3代的ADSCs采用最佳标记方法后更换普通培养基继续培养,适时传代,连续检测第4、5、6、7、8代ADSCs的BrdU标记率.结果:原代培养的ADSCs的形态主要为长梭形,第3代ADSCs经BrdU标记后胞核呈红色荧光,随浓度的升高及时间的延长,BrdU阳性标记率逐渐升高,以终浓度20μmol/L BrdU标记48 h后阳性率达90%以上,且连续传5代标记率仍达40%.MTT、台盼蓝排斥试验及细胞凋亡检测发现BrdU对ADSCs生长增殖基本无影响.结论:BrdU标记ADSCs的最佳剂量和时间为20 μmol/L和48 h,该方法标记率高,对细胞影响小,可用于动态研究ADSCs在移植体内生长、分化.     

猪肝细胞与骨髓间充质干细胞最适共培养体系的建立

目的：建立猪肝细胞与骨髓间充质干细胞（MSCS）最适宜共培养体系,为生物人工肝的构建提供理想的细胞来源。方法：抽取中华实验猪（n=3）髂前上棘骨髓,采用密度梯度离心法分离单个核细胞,贴壁传代培养至第3代;采用原位两步胶原酶法分离猪肝细胞后与MSCS按1∶1,2∶1,5∶1和10∶1的比例混合培养,观察各组共培养肝细胞形态和功能的变化水平。结果：所获肝细胞纯度>99%,存活率>95%。共培养组肝细胞迅速黏附于MSCS表面,在三维空间呈球形聚集生长;肝细胞与MSCS间出现细胞连接,超微结构与正常肝细胞接近。肝细胞/MSCS 以2∶1共培养组的肝细胞清蛋白分泌水平、尿素合成能力和细胞色素P450为各组中之最佳,自第1天培养起均显著高于对照组（P<0.05）,并在第2天达到高峰,而且下降趋势较缓慢。结论：猪肝细胞/MSCS 按2∶1组成的最适共培养体系可最大程度地维持肝细胞功能,为构建功能性生物人工肝提供高效细胞材料。     

与食管癌5-FU化疗效果相关分子标记的研究进展

不同个体的食管癌对氟尿嘧啶（Fluorouracil,5-FU）药物疗效存在差异。药物遗传学和药物基因组学的快速发展,使得分子标记指导下的食管癌个体化化疗成为可能,本文对食管癌5-FU疗效预测相关分子标记作一综述。