应用金属夹缝合胃壁全层缺损的动物实验

目的探讨应用金属夹缝合胃全层缺损的可行性、安全性和有效性。方法48只新西兰大白兔按随机数字表法分为4组,每组12只。在胃体部全层切开直径2cm的缺损后,第1组不缝合胃壁缺损．第2组用金属夹夹闭胃壁黏膜层．第3组用金属夹夹闭胃壁全层,第4组用3-0丝线缝合胃壁全层。分别于术后第3天和第7天处死各组动物,大体观察创面愈合情况;测定创面爆破压;并取创面组织,行苏木精-伊红染色和Masson染色,评价创面炎性反应及组织纤维增生情况。结果第1组动物术后34h内全部死亡,其他各组动物均良好存活．所有存活动物无腹腔内出血和感染表现。第2、3组与第4组相比,手术耗时短[（45．8±1．6）min和（42．5±1．5）min比（48．0±1．4）min,P〈0．05];第3天创面爆破压低]（36．9±4．6）mmHg和（39．8±4．1）mmHg比（50．5±4．2）mmHg,P〈0．05];第7天创面爆破压3组间差异无统计尝意义[（95．0±7．9）mmHg、（97．8±6．8）mmHg和（98．5±7．0）mmHg,P〉0．05]。相同时间点创面苏木精．伊红染色显示金属夹缝合组炎性反应较轻,Masson染色反映创面愈合无明显差别。结论应用金属夹缝合胃部全层缺损,无论夹闭胃黏膜层或全层组织,均能达到与手术缝线缝合相同的临床愈合效果和质量。     

The anal fistula claw: the OTSC clip for anal fistula closure

Aim Surgical closure of high or complex anal fistulae is often a difficult challenge. A special Nitinol clip, the OTSC clip (Ovesco AG), was evaluated for fistula closure in a porcine model. Method A total of 20 fistulae were created in 10 animals by seton insertion. Four weeks after fistula induction the setons were removed: one internal fistula opening per animal was left untreated as control whereas the other opening was closed by the OTSC clip using a specially developed transanal clip applicator. The safety and technical feasibility of the clip application were tested. Another 4 weeks later, fistulae were macroscopically assessed for closure. For histological examination, the anorectum including the fistula tract was excised en bloc. Results Four weeks after clip placement, all external and internal fistula openings were macroscopically closed. The clip application site presented with an increased scarring. Microscopically, 40% of residual tracts and a more intense chronic inflammation were seen in the untreated control fistulae. After clip placement, 10% of the fistulae persisted associated with a higher density of collagen fibres indicating a better fistula scarring and healing. No unexpected side‐effects or complications caused by the clip were observed. Conclusion Fistula closure using the OTSC clip represents a promising sphincter‐preserving minimally invasive procedure. This study demonstrated the safety and feasibility of the ‘anal fistula claw’ for fistula closure. In spite of limitations of the porcine model the results justify clinical applications and further investigations.     

Caudate lobectomy by the third porta hepatis anatomical method: a study of 16 cases

BACKGROUND: The treatment for primary tumor in the caudate lobe of the liver is difficult because of its unique anatomical location. This study was undertaken to improve operative techniques and results by a new anatomical method of caudate lobectomy. METHODS: Clinical data of 16 patients who had had caudate lobectomy for the liver from January 1996 to November 2004 were retrospectively analyzed. The third porta hepatis anatomical method was performed in all 16 patients. Operative time, intraoperative blood loss, postoperative complications were recorded. The 1-, 3-, and 5-year survival rates of 13 patients with caudate lobe carcinoma were followed up. Anatomical status, operative routes, operative procedures, liver blood supply were evaluated. RESULTS: The operation was successful in the 16 patients. The operative time was 255±70 minutes and blood loss 740±402 ml. None of the patients died from massive bleeding during the operation, nor did complications such as biliary fistula and liver failure occurred. In 13 patients with malignant tumor, 7 died from recurrence and metastasis of the tumor and the other 6 are still alive at the end of follow-up. One patient has survived for 6 years. The 1-, 3-, and 5-year survival rates in the 13 patients were 83.9%, 58.7% and 39.2%, respectively. CONCLUSION: Caudate lobectomy by the third porta hepatis anatomical method can improve operative effect and increase the resection probability for solitary tumor in the caudate lobe.     

一肾一夹肾血管性高血压动物模型的制作

目的研究一肾一夹(1K1C)肾血管性高血压动物模型的制作。方法选用200~220 g体重的SD大鼠,制作1K1C高血压大鼠模型。随机分为正常对照组、单肾对照组(1K)、1K1C组、1K1C+BEA组。使用药物2-溴乙胺氢溴酸盐(BEA)破坏肾髓质。采用尾动脉袖套法测量各组大鼠血压的变化。结果1K组大鼠血压4周后有明显升高,与正常对照组比较,差异有统计学意义(P<0.05),但是1K组大鼠与正常对照组大鼠4周后血压远未达到肾血管性高血压入选标准;1K1C组大鼠血压在1周后开始升高,2周时已达到本实验高血压入选标准;1K1C+BEA组血压升高更明显,4周时血压与1K1C组比较,差异有统计学意义(P<0.05)。结论本方法制作肾血管性高血压模型简单易行,成功率约80%。     

腹腔镜阑尾切除术中钛夹与丝线的对比研究

目的比较在腹腔镜阑尾切除术（laparoscopic appendectomy,LA）中运用普通丝线及运用钛夹结扎阑尾动脉及阑尾根部的效果。方法回顾性分析54例行LA的阑尾炎患者的临床资料,其中28例使用钛夹（钛夹组）,26例使用丝线（丝线组）。结果手术均获成功,无中转开腹,无并发症发生。钛夹组与丝线组在住院时间、手术时间、术中出血量和手术费用方面均无明显差异（P〉0.05）。结论LA术中使用普通丝线结扎阑尾动脉及根部安全、可靠、经济。     

Identification and cloning of a complementary DNA encoding a vicilin-like proprotein, Jug r 2, from English walnut kernel (Juglans regia), a major food allergen

Background: Walnuts and other tree nuts are important food-allergen sources that have the potential to be associated with life-threatening, IgE-mediated systemic reactions in some individuals. Objective: The purpose of this study was to characterize a complementary (c)DNA clone encoding one of the walnut food allergens. Methods: A cDNA expression library prepared from walnut somatic embryo was screened for IgE reactivity with patient serum. A reactive clone of 2060 bp, which encoded a protein of 593 amino acids in length, was subcloned by excision into the pGEX expression vector. IgE-binding inhibition experiments were performed.Results: A recombinant fusion protein was induced and shown to bind serum IgE from 9 of 15 patients tested, thus identifying a major allergen. This clone, named Jug r 2, exhibited significant homology with genes encoding the vicilin group of seed proteins. An IgE-binding inhibition experiment suggested that the encoded protein undergoes posttranslational modification into at least one major polypeptide (47 kd) and possibly several others, which is similar to the vicilin-like proteins characterized in cocoa bean (Theobroma cacao) and cottonseed (Gossypium hirsutum ). N-terminal sequencing of the 47-kd band, Jug r 2, identified it as a mature protein obtained from the precursor. A second IgE-binding inhibition experiment showed that there is minimal or no cross-reactivity between Jug r 2 and pea vicilin, peanut proteins, or cacao proteins. Conclusion: Jug r 2 is the third vicilin food allergen identified in addition to vicilins from soy and peanut. The availability of recombinant food allergens should help advance studies on the immunopathogenesis and possible treatment of IgE-mediated food hypersensitivity. (J Allergy Clin Immunol 1999;1311-20.)     

无钛夹腹腔镜阑尾切除术150例临床分析

目的:探讨在腹腔镜阑尾切除术(laparoscop ic appendectomy,LA)中运用普通丝线结扎阑尾动脉及阑尾根部的安全性及可靠性。方法:对2005年8月至2006年4月间施行无钛夹LA的150例患者的临床资料进行回顾性分析。结果:手术均获成功,无中转开腹,平均手术时间为25m in,术后平均住院3d,无并发症发生。结论:LA术中使用普通丝线结扎阑尾动脉及根部,安全、可靠、经济。     

Hormone levels before and after tubal sterilization

OBJECTIVE: The aim of this study was to determine whether women experience significant luteal phase hormonal changes following interval tubal sterilization. DESIGN: This is a partly randomized, prospective clinical study. SETTING: This study involved healthy volunteers in an academic research environment. PATIENTS: This study involved 118 fertile women seeking tubal sterilization and 57 fertile controls with at least three normal cyclic menstrual periods before entry into the study. INTERVENTIONS: The patients were randomized to bipolar cautery or Hulka clip as sterilization methods. Barrier contraception or abstinence was used by controls. MAIN OUTCOME MEASURES: The main outcome measures are serum estradiol and progesterone levels and urinary estradiol and pregnanediol levels obtained during the luteal phase before, 1 year and 2 years after sterilization. RESULTS: The women randomized to the bipolar cautery group had higher midluteal progesterone levels measured between Days 5 and 11 postovulation (15.5 ng/mL before sterilization, 14.5 ng/mL at 1 year and 14.5 ng/mL at 2 years) than did the other two groups. The clip group had progesterone levels of 14.1, 12.0 and 12.5 ng/mL at baseline, 1 year and 2 years, respectively, and the control group had levels of 12.0, 11.9 and 11.3 ng/mL for the same periods. Serum estradiol and progesterone and urinary pregnanediol and estradiol were not significantly changed over the 2-year period, nor were there significant differences between the two groups. CONCLUSIONS: There were no significant hormonal changes in sterilized women over a period of 2 years when compared with their baseline levels or when compared with unsterilized age-matched controls.     

SD大鼠钳夹脊髓损伤模型的建立

目的探讨构建一种SD大鼠脊髓钳夹损伤模型,用于脊髓损伤（spinal cord injury,SCI）的研究。方法将36只成年雄性SD大鼠随机分成A、B、C三组,每组12只。脊髓损伤组（A组）：用动脉瘤夹钳夹大鼠第10胸椎对应脊髓。假手术组（B组）：只打开椎板,暴露脊髓,不造成SCI。正常对照组（C组）：正常大鼠,不做任何处理。通过行为学观察（BBB评分）、HE染色和神经电生理检测进行判断。结果HE染色结果：A组可见脊髓正常组织被破坏,损伤区可见血管破裂出血,有大片坏死灶,周围神经细胞肿胀变性,内有炎症细胞浸润。B、C两组基本一致,组织结构正常。BBB评分：B组术后1周功能恢复接近正常,评分20分。A组术后第2周开始恢复,到第3周基本停止,最终BBB评分低于6分,两组比较有明显差异（P〈0．05）。神经电生理（SEP）检测：A组可以明显看到SEP的波峰趋于水平,且潜伏期无限延长,与B组相差显著（P〈0．05）。A组内动物BBB评分、SEP无显著性差异（P〉0．05）。结论通过动脉瘤夹钳夹SD大鼠T10脊髓,能够建立良好的脊髓损伤动物模型。