两种方式注射治疗非静脉曲张性上消化道大出血的疗效研究

目的探讨胃镜下去甲肾上腺素药物喷洒与肾上腺素注射治疗非静脉曲张性上消化道大出血的疗效。方法 160例符合纳入标准的非静脉曲张性上消化道大出血患者按治疗方案分为药物喷洒组(80例)和药物注射组(80例)。所有患者均给予上消化道大出血的常规治疗。药物喷洒组患者在胃镜下给予去甲肾上腺素喷洒治疗,而药物注射组在胃镜下给予肾上腺素注射治疗。观察两组患者治疗疗效、止血时间、再出血率及不良反应发生情况。结果药物注射组的治疗总有效率为95.0%,明显高于药物喷洒组的80.0%(P0.05)。与药物喷洒组相比,药物注射组的止血时间明显缩短,再出血率明显降低(均P0.05)。治疗过程中,两组均未发生严重不良反应,其不良反应发生率在两组间比较差异无统计学意义(P0.05)。结论胃镜下肾上腺素注射是非静脉曲张性上消化道大出血的有效治疗方案,可以提高治疗有效率,缩短止血时间,且不良反应轻,疗效优于去甲肾上腺素喷洒治疗,临床上值得进一步研究。     

关节腔注射氨甲环酸对全膝关节置换术后疗效影响的Meta分析

目的探讨关节腔注射氨甲环酸(tranexamic acid,TXA)在全膝关节置换术(TKA)中应用的安全性和有效性。方法通过计算机检索Pub Med、Cochrane Library、Embase、CNKI、CBM、万方数据库有关TKA术中应用TXA行关节腔注射的随机对照试验(RCT)和半随机对照试验(q RCT),同时手工检索图书馆馆藏期刊。依照纳入标准对文献进行筛选、提取资料后,使用Cochrane系统评价方法评价纳入文献的质量,采用Rev Man 5.2对资料进行Meta分析。结果共纳入9个RCT和1个q RCT,合计846例。Meta分析结果显示:1有效性:与对照组相比,关节腔注射TXA可以减少TKA术后血红蛋白(Hb)的丢失量[SMD=-0.63,95%CI(-0.81,-0.45),P0.000 01]及降低术后输血率[RR=0.28,95%CI(0.20,0.38),P0.000 01];2安全性:与对照组相比,关节腔注射TXA不增加术后发生深静脉血栓(DVT)的风险[RR=0.66,95%CI(0.24,1.84),P=0.43]。结论当前证据表明,TKA术中关节腔注射TXA能有效减少术后失血量,且不增加术后发生DVT的风险,具有良好的临床应用价值。     

丹红注射液对低营养小鼠生理与生化指标的影响

摘要目的观察小剂量丹红注射液对低营养模型小鼠生理及生化指标的影响,并评价其安全性。检验该体系在中药注射剂安全性再评价中的实用价值。方法选取生长期ICR小鼠32只,制备玉米低营养小鼠模型,分为正常对照组（给予0.9%氯化钠溶液）,以及丹红注射液小、中、大3个剂量（0.2,0.4及0.6 mL）组,每组8只;连续腹腔给药7 d,于第8天取血样后处死,完整剖取9种脏器组织,检测相关生理、生化指标。采用损益指数 总积分（BDI GS）体系评价丹红注射液安全性。结果丹红注射液对主要脏器或组织损伤较轻,BDI值均＞0.85,GS值均＞9.0;不同剂量丹红注射液对脾脏及胰腺的BDI值均＞1.0,表现出良好的补益及健康效应,与正常对照组比较差异有统计学意义（P＜0.05或P＜0.01）。同时,表现出良好的降血糖效应。结论丹红注射液在小剂量下用药风险低,安全性良好。同时,低营养模型结合BDI GS体系可以作为临床中药注射剂安全性再评价的一种新方式。     

Migration of endotacker into the bladder 7 years after laparoscopic retroperitoneal burch application

Laparoscopy began to be used widely since the second half of 1990s as an alternative to laparotomy or vaginal approaches in incontinence and pelvic diseases in women, based on its claimed better success rates. Injuries were reported in the bladder, gastrointestinal system and the entry of the Verress cannula in early and late laparoscopic applications. De-novo urging, voiding dysfunctions, marked recurrences and surgical inefficiencies were observed in 5-year follow-ups after laparoscopic incontinence surgery. Although tension-free midurethral sling operations replaced open laparoscopic colposuspensions nowadays, laparoscopic colposuspension is still preferred in cases where simultaneous laparoscopic paravaginal repair or sacrocolpopexy is considered or where synthetic graft implantation is contraindicated. Moreover, meshes and endotackers are still frequently used in many laparoscopic applications in various clinics. The migration of the tacker used in mesh fixation in a patient where retroperitoneal laparoscopic Burch was performed 7 years ago due to stress urinary incontinence and the extraction of the ossified tacker from the bladder will be presented.     

Management of complication after breast augmentation with methacrylate

IntroductionSeveral alloplastic biomaterials are available for injection to the breast, nevertheless not all of them are approved for biomedical use. Although in North America and Western Europe experience with synthetic biomaterials for breast augmentation is very limited, migratory streams might expose physicians worldwide to manage the related complications of these procedures. The aim of this study was to share with other surgeons the case of a patient presenting complications after breast augmentation with an unknown synthetic substance containing methacrylate.Presentation of caseA 33-years old Asian woman presented to our Institution with breast deformities, lumps and chest pain. The patient referred previous breast injection “with hospital fat” performed in China six years before. She was not aware about the details of the procedure, and language barriers limited communication. Clinical examination and ultrasounds revealed the irregular distribution of an unknown substance in both breasts. The material was surgically removed and replaced in the same session with polyurethane implants. Chemical analysis revealed the presence of methacrylate.DiscussionWith a growing demand for non-invasive cosmetic surgery, has been reported a growing population of untrained and unlicensed personnel performing cosmetic surgery in many countries where there are no laws that restrict the use of cosmetic procedures to physicians with appropriate training and with approved materials. Surgical removal of this substances can be extremely challenging and an open procedure with surgical debridement is recommended.ConclusionBreast augmentation with non-absorbable biomaterials can lead to severe complications, in particular for patients intending to breastfeed.     

Rare complication of ventriculoperitoneal shunt. Early onset of distal catheter migration into scrotum in an adult male: Case report and literature review

IntroductionThe role of shunt placement is to divert cerebrospinal fluid from within the ventricles to an alternative location in the setting of hydrocephalus. One of the rare shunt complications is distal catheter migration, and various body sites have been reported, including the scrotum. Although cases of scrotal migration of distal catheter have been reported in pediatric patients, cases in adult patients are rare due to obliterated processus vaginalis. Furthermore, there has not been a case reported for scrotal migration in an adult at an early onset.Presentation of case65-year-old male underwent shunt placement for normal-pressure hydrocephalus-like symptoms. On post-operative day seven patient developed right testicular edema, for which ultrasound was performed, revealing hydrocele along with the presence of distal catheter in the scrotum. On post-operative day nine patient underwent distal catheter trimming via laparoscopic approach with general surgery, with post-operative imaging showing satisfactory location of distal catheter in the peritoneal cavity.Discussion/ConclusionEarly onset of distal catheter migration into scrotum in an adult male is a unique case, as most cases are reported in pediatric patients, and it is the first case reported in the English literature to have occurrence at an early onset during the peri-operative period. As our case demonstrates, early occurrence and detection of scrotal migration of the distal catheter prevent shunt malfunction. Prompt surgical management of catheter repositioning is therefore recommended to avoid the risk of further complications.     

FOSL2蛋白在肺腺癌中调节 TGF-β1信号机制的研究

目的：研究FOSL2蛋白在TGF-β1信号传导通路中的作用及FOSL2在肺腺癌中的作用机制。方法利用质粒转染、免疫沉淀、蛋白印迹等方法验证FOSL2蛋白在TGF-β1信号传导通路中的作用及机制。结果 TGF-β1诱导细胞中FOSL2蛋白的表达水平显著增加,在72 h时表达水平最高,约为对照基线水平的4倍。 FOSL2的表达与p-Smad3的着色呈正相关（ r＝0.85,P＜0.001）。 FOSL2高表达的患者比低表达的患者生存期更短（ P＝0.005）。结论 FOSL2蛋白通过与Smad3蛋白的相互作用促进TGF-β1诱导的迁移,是肺腺癌治疗中的一个潜在靶点。     

miR-98对肝癌 HepG2细胞增殖、凋亡以及侵袭、迁移能力的影响

目的：研究 miR-98对肝癌 HepG2细胞增殖、凋亡和侵袭、迁移能力的影响及其可能机制。方法将 miR-98mimics、mimics-NC、miR-98inhibitor、inhibitor-NC 瞬时转入肝癌 HepG2细胞内,应用噻唑盐( MTT)法、流式细胞仪、Tr-answell 小室实验检测 miR-98对肝癌 HepG2细胞增殖、凋亡以及侵袭、迁移能力的影响,进一步用 Western blot 法检测各组 Bcl-2蛋白的表达水平。结果 MTT 实验表明 miR-98过表达后,肝癌细胞的增殖能力明显低于对照组;Annexin V-FITC / PI 凋亡实验证实上调 miR-98表达后,细胞的凋亡率较对照组升高;Transwell 小室实验表明上调 miR-98可使肝癌细胞的侵袭、迁移能力减弱。而当 miR-98被抑制后,肝癌HepG2细胞的增殖及侵袭、迁移能力则明显增强,凋亡率则下降。 Western blot 实验检测发现 miR-98过表达后,Bcl-2的表达降低。结论 miR-98可能在肝癌的发生、发展中发挥着抑癌基因的作用;miR-98可能通过下调 Bcl-2的表达,促进肝癌 HepG2细胞凋亡。     

微小RNA-320a通过靶向FoxM1调控肝癌细胞迁移

目的：探讨微小RNA-320a (miR-320a)在肝癌细胞中对癌基因FoxM1的靶向调控作用以及对肝癌细胞迁移能力的影响,为肝癌治疗提供新的靶点。方法通过信息学工具网站http：//www.microRNA.org找到可能靶向调控FoxM1表达的微小RNA;利用蛋白印记和双荧光素酶报告基因试验验证miR-320a对FoxM1的调控作用;采用Transwell小室分析miR-320a和FoxM1对肝癌细胞迁移的影响。结果信息学分析表明,miR-320a在FoxM1的3'端非翻译区存在2个潜在结合位点。蛋白印迹实验显示miR-320a降低FoxM1在肝癌细胞中的蛋白水平,双荧光素酶报告基因试验显示miR-320a可以调控FoxM1表达。miR-320a类似物对FoxM1表达有下调作用（P<0.01）,miR-320a抑制物对FoxM1表达有上调作用（P<0.05）。Transwell试验表明miR-320a类似物可抑制肝癌细胞株Huh7、HCC-LM3的迁移能力,miR-320a抑制物可增加Huh7、HCC-LM3的迁移能力。当使用小干扰RNA下调FoxM1在这些细胞株中的表达后,miR-320a类似物和miR-320a抑制物对肝癌细胞迁移能力的调控作用明显减弱。结论 miR-320a有抑制肝癌细胞迁移的作用,这种抑制作用是通过靶向调控癌基因FoxM1来实现的。     

抑制GM130表达对胃癌细胞增殖、侵袭及迁移能力的影响

目的 分析GM130在不同分化人胃癌细胞系的差异表达,利用小干扰RNA技术来沉默GM130基因,研究其对胃癌细胞生物学行为的影响.方法 体外培养3株不同分化程度胃癌细胞系(高分化MKN-28、中分化SGC-7901、低分化MKN-45),Western blot和RT-PCR筛选出高表达的GM130细胞株MKN-45、SGC-7901,设计并化学合成、转染、筛选出针对GM130的小干扰RNA片段.通过MTF、Transwell、Matrigel侵袭实验,观测下调GM130后对胃癌细胞株的生物学行为影响,Western blot检测细胞中MMP-2、MMP-9蛋白的变化.结果 Western blot和RT-PCR检测结果显示,在MKN-45、SGC-7901细胞中GM130蛋白和mRNA水平呈现高表达水平.Westem blot和qRT-PCR结果显示在低分化胃癌MKN-45细胞中,GM130-siRNA-519转染组GM130基因的表达水平显著抑制(P＜0.05).与对照组相比,抑制转染组细胞的增殖、迁移能力明显下降,穿膜细胞数明显减少,MMP-2、MMP-9的蛋白表达水平显著降低(P＜0.05).结论 抑制GM130基因的表达下调可显著降低胃癌细胞的增殖和体外侵袭转移能力.