bFGF和EGF对胚胎神经干细胞分化为神经元及神经胶质细胞的影响

目的：观察碱性成纤维生长因子（bFGF）和表皮生长因子（EGF）对体外培养胚胎神经管神经干细胞生长和分化的影响。方法：从孕12天大鼠胚胎神经管分离神经干细胞，进行原代培养，分为bFGF组、EGF组、bFGF＋EGF组及对照组：培养过程中观察干细胞的生长，培养2小时做nestin染色鉴定神经干细胞，培养第5天用免疫组化方法检测培养细胞神经元特异烯醇化酶（NSE）和胶质纤维酸性蛋白（GFAP）的表达，以观察神经干细胞分化为神经元及神经胶质细胞的状况。结果：取材细胞大部分为nestin免疫阳性细胞；各实验组均可促进培养细胞的生长和分 化。免疫组化中，EGF使神经干细胞增殖成团，增加GFAP的表达（P＜0．01）；bFGF能明显增加NSE及GFAP的表达（P＜0．01）；两种因子联合应用，神经元和神经胶质细胞均比对照组增多（P＜0．01）。结论：EGF和bFGF两类生长因子均能促进胚胎神经干细胞的生长，在分化方面，EGF倾向于诱导干细胞增并向着胶质细胞分化，bFGF则诱导干细胞分 成更多的神经元。     

电视腹腔镜胆囊切除术胆漏的预防和处理

目的：降低电视腹腔镜胆囊切除术（LC）胆漏的发生率,提高治愈率,防止胆漏对病人的危害。促进愈合。方法：分析1991年12月－1998年12月我院开展LC4000例,出现胆漏29例的原因,用线扎代替钛夹处理胆囊管和胆囊血管,简化了胆囊三角的过多解剖;术中针对性的置放引流管防止胆汁性腹膜炎;特殊情况的胆囊作特殊处理。结果：拓宽了LC的适应范围,大大减少了手术中胆管的损伤、出血。发生胆漏的病人中有41％（12／29）困术中置管引流而未出现胆汁性腹膜炎,并很快康复。术后B超动态观察胆囊窝积液情况,及时引流,胆漏多能自愈。结论：熟练的操作技巧能避免手术损伤,认真线扎处理胆囊管和胆囊血管并针对性置放引流管,能有效防止胆漏和胆汁性腹膜炎;及时发现、及时处理是减少胆漏危害的关键。     

脑室出血的治疗

目的探讨脑室出血的治疗方法。方法选择原发性脑室出血19例,继发性脑室出血21例,其原发出血灶血肿量严格限制在30ml以下,全部病人均采用双侧侧脑室双腔管引流,尿激酶脑室灌注及间断腰穿放液。结果死亡7例,死亡率17．5％,明显低于内科治疗80％的死亡率。结论双腔管双侧脑室引流尿激酶脑室灌注和间断腰穿放液等为目前治疗脑室出血的较为有效的方法。     

改质炉高温炉管运行损伤及剩余寿命分析

对高温运行70000h至90000h改质炉炉管进行试验研究及材料损伤分析,结果表明,炉管的材料性能已严重劣化（脆化）,炉管的内外壁已有微小裂纹萌生,测定了炉管材料在950℃、各种应力水平下的断裂时间,根据时间-温度参数L-M公式,推测炉管的剩余寿命为8510h。     

翅果油树休眠芽和种子的试管萌发

目的：为了扩大珍稀濒危植物翅果油树组织培养的取材范围和研究其种子休眠的原因。方法：以翅果油树一年生枝条的休眠芽（分别于10,11,12,1,2,3,月份取材）和当年生种子为材料,采用MS为基本培养基,附加6－BA,NAA,GA3等外源激素进行试管苗萌发研究。结果：1．休眠芽的萌发率表现为从秋季到冬季逐渐下降和从冬季到春季逐渐提高的规律性变化。其中以3月份取材最佳,休眠芽可萌发为小苗。2．对种子进行试管内和试管外萌发研究,表明翅果油树种子休眠的原因有：中果皮坚硬,种皮革质化,透水透气性差,中果皮和种皮内有抑制物质存在;种仁营养丰富,易引起土壤,空气中微生物的繁殖而烂种;此外,裸露的种仁在试管中的萌发率高达70％,可发育为无菌苗。结论：3月份取材的休眠芽和种仁无菌萌发的实生苗可为组织培养提供新的材料来源。     

Is the placement of jejunostomy tubes in patients with esophageal cancer undergoing esophagectomy associated with increased inpatient healthcare utilization? An analysis of the National Readmissions Database

BackgroundPatients undergoing esophagectomy often receive jejunostomy tubes (j-tubes) for nutritional supplementation. We hypothesized that j-tubes are associated with increased post-esophagectomy readmissions.Study designWe identified esophagectomies for malignancy with (EWJ) or without (EWOJ) j-tubes using the 2010–2015 Nationwide Readmissions Database. Outcomes include readmission, inpatient mortality, and complications. Outcomes were compared before and after propensity score matching (PSM).ResultsOf 22,429 patients undergoing esophagectomy, 16,829 (75.0%) received j-tubes. Patients were similar in age and gender but EWJ were more likely to receive chemotherapy (24.2% vs. 15.1%, p < 0.01). EWJ was associated with decreased 180-day inpatient mortality (HR 0.72 [0.52–0.99]) but not with higher readmissions at 30- (15.2% vs. 14.0%, p = 0.16; HR 0.9 [0.77–1.05]) or 180 days (25.2% vs. 24.3%, p = 0.37; HR 0.94 [0.79–1.10]) or increased complications (p = 0.37). These results were confirmed in the PSM cohort.ConclusionJ-tubes placed in the setting of esophagectomy do not increase inpatient readmissions or mortality.     

胆总管探查内置自行脱落J管一期缝合与T管引流治疗胆总管结石的临床分析

目的 比较腹腔镜胆总管探查放置自行脱落J管一期缝合与T管引流的临床疗效,探讨胆总管一期缝合放置自行脱落J管引流的可行性。方法 回顾性分析2019年3月至2020年10月西安交通大学附属咸阳市中心医院肝胆外科156例行腹腔镜下胆囊切除联合胆总管探查患者的临床资料。按手术方式分为自行脱落J管组（n=80）和T管引流组（n=76）,比较两组患者基线资料、术中术后情况及并发症等。结果 两组手术总时间、术中出血量、术后并发症情况无统计学差异（P＞0.05）。自行脱落J管组较T管引流组术后下床活动时间[（18.2±7.2）h vs（22.1±8.3）h,t=3.139,P=0.002]、术后排气时间[（1.7±0.9）d vs（2.1±1.3）d,t=2.244,P=0.026]、补液总量[（5 634.1±432.8）mL vs（6 351.4±547.9）mL,t=13.56,P＜0.001]、拔管时间[（8.7±3.3）d vs（47.1±13.0）d,t=14.966,P＜0.001]、住院时间[（7.9±2.8）d vs（9.4±3.3）d,t=3.067,P=0.003]、住院总费用[（15 489.2±2 217.1）元 vs（18 136.4±2 251.3）元,t=7.398,P＜0.001]差异有统计学意义。结论 严格掌握手术适应证前提下,自行脱落J管引流扩大了胆总管一期缝合适应证,安全有效,相比T管引流具有加速康复、减少住院费用、缩短住院时间等优势。     

Guidelines for gastrostomy tube placement and enteral nutrition in patients with severe,refractory hypoglycemia after gastric bypass

BackgroundPostbariatric hypoglycemia (PBH) affects up to 38% of Roux-en-Y gastric bypass (RYGB) patients. Severe cases are refractory to diet and medications. Surgical treatments including bypass reversal and pancreatectomy are highly morbid and hypoglycemia often recurs. We have developed a highly effective method of treatment by which enteral nutrition administered through a gastrostomy (G) tube placed in the remnant stomach replaces oral diet: if done correctly this reverses hyperinsulinemia and hypoglycemia, yielding substantial health and quality of life benefits for severely affected patients.ObjectivesTo provide clinical guidelines for placement of a G-tube to treat postRYGB hypoglycemia, including candidate selection, preoperative evaluation, surgical considerations, and post-RYGB management.SettingStanford University Hospital and Clinics.MethodsBased on our relatively large experience with placing and managing G-tubes for PBH treatment, an interdisciplinary task force developed guidelines for practitioners.ResultsA team approach (endocrinologist, dietitian, surgeon, psychologist) is recommended. Appropriate candidates have a history of RYGB, severe hypoglycemia refractory to medical-nutrition therapy, and significantly affected quality of life. Preoperative requirements include education and expectation setting, determination of initial enteral feeding program, and establishing service with a home enteral provider. Close postoperative follow-up is needed to ensure success and may require adjustments in formula and mode/rate of delivery to optimize tolerance and meet nutritional goals. G-tube nutrition must fully replace oral nutrition to prevent hypoglycemia.ConclusionsG-tube placement in the remnant stomach represents a relatively well-tolerated and effective treatment for severe, refractory hypoglycemia after RYGB.     

Colon perforation caused by transanal decompression tube after laparoscopic low anterior resection: A case report

IntroductionThe effectiveness of transanal decompression tube (TDT) to prevent anastomotic leakage after rectal surgery has been widely accepted in recent years. However, a rare complication of intestinal perforation due to TDT has been also reported.Presentation of caseA 88-year-old woman underwent laparoscopic low anterior resection for rectal cancer. An abdominal drainage tube adjacent to the colorectal anastomosis and a TDT were placed. The patient experienced abdominal pain, nausea and elevated inflammatory markers on postoperative day 6. Enema and computed tomography demonstrated colonic perforation due to the TDT, and emergency laparotomy was performed. Perforation of the anterior sigmoid colon located at the proximal side of the colorectal anastomosis was seen, and the TDT was exposed to the abdominal cavity. Therefore, primary closure of the perforation site, peritoneal lavage, drainage tube placement and transverse colostomy was performed.DiscussionIn our case, TDT seemed to compress the anterior wall of the colon and lead to perforation. The looseness of the remaining oral intestinal tract depressed in the pelvis was compressed by the TDT.ConclusionTDTs should be very carefully placed to avoid complication. The length and looseness of the oral intestine and the relationship between the TDT to be inserted might be important.