电针督脉后海穴对血管性痴呆大鼠学习记忆能力及海马CA1区JNK蛋白表达的影响

目的 :观察电针后海穴对血管性痴呆大鼠学习记忆能力及海马CA1区c-Jun氨基末端激酶(JNK)蛋白表达的影响。方法:将24只SD大鼠随机分为假手术组、模型组、电针后海组、电针非穴组,每组6只,采用双侧颈总动脉永久性结扎(2-VO)方法制备血管性痴呆模型,电针后海穴3个疗程后,采用Morris水迷宫检测各组大鼠学习记忆能力,免疫组化检测海马CA1区JNK蛋白表达情况。结果:与假手术组比较,模型组大鼠平均逃避潜伏期明显延长、穿越平台次数减少、海马CA1区JNK蛋白表达增高(P0.05);与模型组比较,电针后海组的平均逃避潜伏期缩短、穿越平台次数增多、海马CA1区JNK蛋白表达降低(P0.05),而电针非穴组未见显著性差异。结论:电针后海穴可改善血管性痴呆大鼠的学习记忆能力,其机制可能与海马CA1区JNK蛋白表达降低有关。     

腰椎板开窗术后微小骨粒回植模型的建立及意义

目的 建立兔腰椎板开窗术后微小骨粒回植模型,为临床提供实验依据。方法 将18只雄性新西兰兔,分为两组。对照组在全麻后以L5棘突为中心,充分显露左侧L5椎板,用微型小枪钳慢慢咬去椎板、黄韧带,进行开窗术,暴露约0.8 x 0.3 cm大小骨窗后直接缝合处理。实验组在L5左侧开窗后将开窗咬下的碎骨粒剪碎,然后将碎骨粒镶嵌于医用胶原蛋白海绵,塑成拱桥形,放置于硬膜外开窗处,缝合切口,术后观察椎板开窗位置CT及组织学变化。结果 CT检查示术后8周实验组开窗处微小骨粒形成菲薄的骨板,12周后形成的骨板较厚,骨梁连续,椎管形态及容积无明显变化,未见脊髓受压。对照组开窗处在8、12周局部有少量骨质增生,周围黏连组织侵入椎管,椎管未重建。结论 兔椎板开窗处再植自体微小骨粒的骨重建,形成的骨板可遮挡疤痕侵入椎管,减少椎管内黏连。     

亮蓝光成像与联动成像在早期食管癌内镜诊断中的应用价值

目的　评价亮蓝光成像（blue light imaging?bright,BLI?bright）和联动成像（linked color imaging,LCI）用于早期食管癌内镜诊断中的临床价值。方法　采用回顾性队列研究,以2018年5月—2020年8月在福建中医药大学附属福鼎医院行内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）治疗,术前使用了蓝激光胃镜3种模式［BLI?bright、LCI和白光成像（white light imaging,WLI）］进行详细检查,且ESD术后病理证实为早期食管癌的63例连续病例作为观察对象。主观可视性分析由6名内镜医师完成,按年资分成高年资组和低年资组,每组各3名,主要观察指标为可视性评分（ranking score,RS）。客观色差分析主要比较3种模式下早期食管癌癌灶与周边黏膜的总色差（ΔE）,色差采用国际照明委员会的1976 L*a*b*系统。结果　6名研究者的RS总体评分WLI模式下为（2.57±0.81）分,明显低于LCI模式下的（3.25±0.67）分（t=9.71,P<0.001）和BLI?bright模式下的（3.18±0.67）分（t=9.31,P<0.001）。亚组分析发现：高年资组的RS评分WLI模式下为（2.71±0.80）分,明显低于LCI模式下的（3.33±0.66）分（t=7.16,P<0.001）和BLI?bright模式下的（3.42±0.62）分（t=8.09,P<0.001）;低年资组的RS评分WLI模式下为（2.40±0.90）分,亦明显低于LCI模式下的（3.15±0.83）分（t=9.62,P<0.001）和BLI?bright模式下的（2.89±0.92）分（t=5.69,P<0.001）,且LCI模式下评分还明显高于BLI?bright模式（t=4.07,P<0.001）。WLI模式下早期食管癌癌灶与周边黏膜的ΔE为11.52±3.40,明显低于LCI模式下的16.64±4.70（t=7.10,P<0.001）和BLI?bright模式下的15.72±3.84（t=7.88,P<0.001）。结论　与WLI模式相比,应用BLI?bright模式和LCI模式都能增加早期食管癌癌灶与周边黏膜的色差,提高早期食管癌可视性。其中,LCI模式更有利于低年资内镜医师检出早期食管癌。     

Recurrence hazard rate in patients with hepatocellular carcinoma and bile duct tumor thrombus: a multicenter observational study

BackgroundPatients with hepatocellular carcinoma (HCC) bile duct tumor thrombus (BDTT) have a high rate of postoperative recurrence. We aimed to describe the patterns and kinetics of recurrence in BDTT patients and provide management options accordingly.MethodsThis retrospective study included 311 HCC patients with BDTT who underwent surgery from 2009 to 2017 at five centers in China. The hazard rate of recurrence was calculated using the hazard function.ResultsThe hazard rate of intrahepatic recurrence was higher than that of extrahepatic recurrence (0.0588 vs. 0.0301), and both showed a decreasing trend, and the intrahepatic recurrence and extrahepatic recurrence risk decreased to a lower level after 40 and 20 months, respectively. Patients who underwent anatomic resection had a consistently lower hazard rate of recurrence than patients who underwent nonanatomic resection, whereas patients who received postoperative adjuvant transarterial chemoembolization (TACE) mainly had a lower hazard rate of recurrence in the first year than patients who did not.ConclusionThe follow-up of BDTT patients should be at least 40 months because of its high rate of recurrence, in parallel with the need for vigilance for extrahepatic recurrence within 20 months. Anatomic hepatectomy and adjuvant TACE are recommended to improve BDTT patient outcomes.     

Association of robotic approach with patient-reported outcomes after pancreatectomy: a prospective cohort study

BackgroundRobotic-assisted pancreatectomy continues to proliferate despite limited evidence supporting its benefits from the patient's perspective. We compared patient-reported outcomes (PROs) between patients undergoing robotic and open pancreatectomies.MethodsPROs, measured with the FACT-Hep, FACT-G, and HCS, were assessed in the immediate postoperative (i.e., preoperative to discharge) and recovery (i.e., discharge to three months postoperative) periods. Linear mixed models estimated the association of operative approach on PROs. Minimally important differences (MIDs) were also considered.ResultsAmong 139 patients, 105 (75.5%) underwent robotic pancreatectomies. Compared to those who underwent open operations, those who underwent robotic operations experienced worse FACT-Hep scores that were both statistically and clinically significant (mean difference [MD] 8.6 points, 95% CI 1.0–16.3). Declines in FACT-G (MD 4.3, 95% CI ?1.0 to 9.6) and HCS (MD 4.3, 95% CI 0.8–7.9) scores appeared to contribute equally in both operative approaches to the decline in total FACT-Hep score. Patients who underwent robotic versus open operations both statistically and clinically significantly improved due to improvements in HCS (MD 6.1, 95% CI 2.3–9.9) but not in FACT-G (MD 1.2, 95% CI ? 5.1-7.4).ConclusionThe robotic approach to pancreas surgery might offer, from the patient's perspective, greater improvement in symptoms over the open approach by three months postoperatively.     

Exosomal microRNA-25 released from cancer cells targets SIK1 to promote hepatocellular carcinoma tumorigenesis

BackgroundHepatocellular carcinoma (HCC) is recognized as a leading cause of cancer-associated fatality worldwide. Our study here aimed to probe the mechanism by which exosomes secreted by CSQT-2, an HCC cell line, affected the progression of HCC.MethodsExosomes were extracted from CSQT-2 cells. Colony formation, Transwell, sphere formation and flow cytometric analyses were applied to assess cell biological activities. Microarray analysis detected the change of microRNA (miRNA) expression after exosome treatment, followed by RT-qPCR validation. Luciferase reporter was applied to detect the binding between SIK1 and miR-25. Xenograft studies in nude mice manifested tumor growth and metastatic ability of miR-25 and SIK1.ResultsThe exosome treatment enhanced cell malignant phenotype in vitro and tumor growth and liver and lung metastases in vivo. The exosomes elevated miR-25 expression in HCC cells. miR-25 targeted SIK1 which was decreased in the exosomes-treated cells. miR-25 inhibitor reduced cell malignant phenotype and attenuated tumorigenesis and metastasis in vivo. SIK1 silencing reversed the effect of miR-25 inhibitor. The exosome treatment potentiated the Wnt/β-catenin pathway in cells, whereas miR-25 inhibitor blunted the pathway activity.ConclusionMiR-25 shuttled through CSQT-2-derived exosomes promoted the development of HCC by reducing SIK1 expression and potentiating the Wnt/β-catenin pathway.     

疏水性低共熔溶剂对水中5种非甾体抗炎药物的萃取研究

目的 建立一种以疏水性低共熔溶剂为萃取溶剂的分散液液微萃取方法,以提取水中的酮洛芬、布洛芬、洛索洛酚钠、萘普生、双氯酚酸钠五种非甾体抗炎药物。方法 以五种非甾体抗炎类药物的萃取率为指标,考察了疏水性低共熔溶剂种类和体积、氢受体/氢供体比例、分散剂的种类和体积及氯化钠的浓度对萃取效率的影响,确定了最佳萃取条件。结果 通过条件筛选,得到的最佳萃取条件为以DES（甲基三辛基氯化铵/癸酸比例=1：5）为萃取溶剂,以乙腈为分散剂,DES的体积为300μL,乙腈的体积为650μL,氯化钠的浓度为13.5%。结论 在最佳条件下,酮洛芬、布洛酚、洛索洛芬钠、萘普生、双氯酚酸钠的萃取率为89.7%,80.3%,77.1%,92.6%和91.4%。     

UPLC同时测定清热止咳颗粒中7种黄酮类成分含量

目的 建立同时测定清热止咳颗粒中芸香柚皮苷、柚皮苷、橙皮苷、新橙皮苷、黄芩苷、木蝴蝶素A-7-葡萄糖醛酸苷、汉黄芩苷含量的方法。方法 采用超高效液相色谱法。采用ACQUITY UPLC BEH C₁₈色谱柱（2.1 mm×100 mm,1.7 μm）,流动相乙腈-0.1%甲酸水溶液(梯度洗脱) ,流速0.3 mL·min^-1,检测波长280 nm,柱温30 ℃。结果 芸香柚皮苷、柚皮苷、橙皮苷、新橙皮苷、黄芩苷、木蝴蝶素A-7-葡萄糖醛酸苷、汉黄芩苷分别在0.324～6.480（r=0.999 9）,1.337～26.75（r=0.999 7）,0.687～13.80（r=0.999 6）,1.347～26.95（r=0.999 8）,2.770～55.40（r=0.999 2）,0.330～6.600（r=0.999 8）,0.242～4.840（r=0.999 6）μg·mL^-1范围内与峰面积呈良好的线性关系;并且芸香柚皮苷、柚皮苷、橙皮苷、新橙皮苷、黄芩苷、木蝴蝶素A-7-葡萄糖醛酸苷、汉黄芩苷平均加样回收率分别为99.41%、101.80%、99.42%、98.47%、101.71%,102.27%和97.64%,RSD范围分别是2.32%、1.69%、2.38%、2.45%、1.24%、1.77%和1.91%。结论 建立的超高效液相色谱(UPLC)方法操作简便、稳定、准确且可行,可用于清热止咳颗粒的质量控制。     

基于GC-TOF-MS代谢组学研究栝楼桂枝汤对脑缺血大鼠的作用机制

目的 研究栝楼桂枝汤对脑缺血MCAO模型大鼠的神经保护作用机制。方法 运用气相色谱-飞行时间质谱联用的代谢组学技术及多元统计分析方法分析正常组、模型组和栝楼桂枝汤给药组大鼠血清中内源性代谢物的变化,筛选差异代谢物,并分析差异代谢物代谢途径。结果 代谢组学研究结果显示各组间大鼠代谢谱出现显著差异,在大鼠血清质谱图中共筛选鉴定得吲哚乙酸、丙二酸、乙醇胺、肉豆蔻酸、鸟氨酸等13个差异代谢物,涉及的相关的代谢途径包括糖-葡萄糖醛酸相互转化途径,色氨酸代谢途径,嘧啶代谢和甘油磷脂代谢途径。结论 栝楼桂枝汤可使造模后大鼠的体内代谢物有不同程度的恢复,其对缺血性脑卒中的保护作用主要反映在能量代谢、脂质代谢、氨基酸代谢等代谢途径的变化,改善大鼠脑缺血再灌注损伤症状。