Mediastinal microdialysis in the diagnosis of early anastomotic leakage after resection for cancer of the esophagus and gastroesophageal junction

Background

Anastomotic leakage (AL) after gastroesophageal resection for cancer is a serious complication. The aim was to evaluate mediastinal microdialysis in the detection of AL before clinical symptoms.

Methods

Sixty patients were included. Samples were collected every 4 hours in the 1st 8 postoperative days and analyzed for several metabolites.

Results

Forty-four patients had an uncomplicated postoperative recovery, 7 developed anastomotic-related complications, and 5 developed major nonanastomotic-related complications. Six patients were excluded (early catheter malfunction and reoperation). Logistic regression model on several metabolites demonstrated a 100% sensitivity, specificity, and positive and negative predictive values regarding the diagnosis of anastomotic complications within postoperative day 7. However, as independent markers, none of the measured metabolites were able to predict AL.

Conclusion

The diagnosis of anastomotic-related complications before clinical symptoms seemed possible by mediastinal microdialysis, but the diagnosis should be based on an interpretation of several metabolic events.     

钠钾镁钙葡萄糖注射液术中输注对患者肝肾功能、血电解质、血糖、血乳酸及凝血功能的影响

目的 评估钠钾镁钙葡萄糖注射液（sodium potassium magnesium calcium and glucose,SPMCG）术中输注对患者肝肾功能、血电解质、血糖、血乳酸及凝血功能的影响.方法 择期拟在全身麻醉下行普外科或骨科手术的患者80例,美国麻醉医师协会（ASA）分级Ⅰ级～Ⅱ级,采用随机数字表法分为实验组和对照组,每组40例.实验组给予SPMCG,对照组给予乳酸钠林格注射液.两组均以15 ml·kg-1·h-1的速度输注500 ml液体后行麻醉诱导,诱导后以10 ml·kg 1·h-1的速度维持输液2h,之后以8 ml·kg-1h-1的速度维持至手术结束.输液前后测定患者的肝肾功能、血电解质以及凝血功能,并监测输液前即刻、诱导前即刻、诱导后1、2h和输液结束时即刻各时间点的血乳酸和血糖值.结果 两组患者输注相应液体后,丙氨酸氨基转移酶（alanine aminotransferase,ALT）、天门冬氨酸氨基转移酶（aspartateaminotransferase,AST）、白蛋白（albumin,ALB）、总胆红素（total bilirubin,TBIL）、血尿素氮（blood urea nitrogen,BUN）和血肌酐（serum creatinine,Cr）与输液前比较差异无统计学意义,组间比较差异无统计学意义.电解质方面,输液后2组Na＋、K＋、Cl-、Ca2＋的浓度差异无统计学意义,但实验组输液后Mg2浓度较对照组高[（0.48±0.21） mmol/L vs（0.71±0.31） mmol/L（P＜0.05）].手术过程中2组患者血糖均逐渐上升,术后又下降至输液前水平.两种液体输注后,凝血酶原时间（prothrombin time,PT）和部分凝血活酶时间（activated partial thromboplastin time,APTT）无显著变化.结论 在术中输注SPMCG,对患者肝肾功能、血电解质、血糖、血乳酸及凝血功能无明显不良影响,并且相对于乳酸钠林格注射液,SPMCG能更好地维持血镁水平.     

LDH enzyme activity in human saliva: The effect of exposure to cigarette smoke and its different components

ObjectiveAldehydes and reactive nitrogen species (RNS) are important chemically active agents in cigarette smoke (CS). Salivary lactate dehydrogenase (LDH) originates predominantly from oral epithelium and was identified as an oral state marker. Its activity in saliva decreases after CS exposure. The aims of the current study were to identify the specific damaging agents in CS responsible for this activity reduction and to understand the mechanisms participating in CS oxidative damage to the salivary enzymes.MethodsPurified and salivary LDH samples were exposed to different levels of CS, pure acrolein, acetaldehyde, peroxynitrite and RNS donors. Each response of the isolated agent to the exposure was examined by a spectrophotometric enzyme activity assay and a Western blot.ResultsCS exposure caused a 34% reduction in LDH activity. Isolated treatment with unsaturated-aldehydes (acrolein, 10 μmol) caused a 61% reduction, while saturated-aldehydes (acetaldehyde, 200 μmol), peroxynitrite (200 μM) and RNS donor (SIN-1, 2 mM) caused no substantial effect. All five LDH isoenzymes reacted similarly. The carbonyl immunoblotting assay revealed a fourfold increase in carbonyl content when treated with CS and a sevenfold increase when treated with acrolein.Conclusionα,β-Unsaturated-aldehydes were identified as the main CS ingredient responsible for salivary LDH activity diminution. The effect of saturated-aldehydes and RNS donors was negligible. Unsaturated-aldehydes are capable of introducing carbonyl group into proteins, causing their dysfunction. This provides a molecular explanation for a decrease in LDH enzymatic activity in saliva.     

乳酸环丙沙星氯化钠注射液无菌检查法的验证

目的：验证乳酸环丙沙星氯化钠注射液的无菌检查方法。方法：采用中国药典2005年版二部附录无菌检查法项下薄膜过滤法。结果：确定大肠埃希菌为乳酸环丙沙星氯化钠注射液无菌检查的敏感菌株。结论：经方法学验证，该方法准确可靠，可作为乳酸环丙沙星氯化钠注射液的无菌检查方法。     

锡兰绿茶中黄酮类成分对缺氧人脑上皮细胞的治疗作用

为研究从锡兰绿茶（Dilmah）提取纯化的黄酮类有效成分对缺氧人脑上皮细胞的治疗作用，体外培养人脑上皮细胞（HBEC），给与锡兰绿茶黄酮提取物治疗后造缺氧模型，检测锡兰绿茶中的黄酮类化合物的抗氧化活性及脑细胞的生存情况，探究其对缺氧脑细胞氧化应激的影响。生化检测显示锡兰绿茶提取物的自由基的清除抑制率（ABTS）为68％±2．8％，次氯酸漂白邻苯三酚红抑制率为79％±4．5％。缺氧后，空白对照组细胞生存率为29％±2．3％，而锡兰绿茶黄酮提取物治疗组为41％±4．7％，氯沙坦治疗组为39％±3．1％。同时，黄铜提取物与氯沙坦治疗组LDH释放分别减少75％±3．7％和79％±3．5％。锡兰绿茶的黄酮提取物治疗使细胞抗氧化酶活力显著增强，SOD：（1．5±0．6）μmol／min／mg蛋白，CAT：（0．61±0．06）μmol／min／mg蛋白，GPx：（2．6±0．41）μmol／min／mg蛋白，GST：（6．0±2．4）μmol／min／mg蛋白，显著高于缺氧对照组，其酶活力分别为：（0．5±0．52，51±0．04，1．2±0．35，3．1±1．6）μmol／min／mg蛋白。研究结果表明，锡兰绿茶有很大的临床应用价值。饮用锡兰绿茶可能成为预防中风的有效新方法，并能减少现代疾病对生命的威胁，提高人类生活质量。     

三七皂苷对氧化低密度脂蛋白损伤血管内皮细胞保护作用的研究

目的:研究三七皂苷(PNS)对氧化低密度脂蛋白(Ox-LDL)损伤血管内皮细胞的保护作用。方法:体外培养人脐静脉内皮细胞(HUVEC),加入100mg·L-1Ox-LDL造成细胞损伤,同时加入不同浓度PNS进行干预。观察形态学变化;采用MTT法测定细胞活性;比色法检测细胞上清液中乳酸脱氢酶(LDH)的释放量;硝酸还原法和放射免疫法分别测定HUVEC培养上清液中一氧化氮(NO)、内皮素(ET)含量。结果:各剂量PNS可使作用Ox-LDL的HUVEC形态趋于正常。与正常对照组比较,HU-VEC经Ox-LDL作用后,细胞活性显著下降,LDH的释放量显著升高;300、100、30mg·L-1PNS显著升高细胞活性,抑制LDH释放。HUVEC经Ox-LDL作用后,与正常对照组比较,培养上清液中NO含量显著降低,ET含量显著升高;300、100mg·L-1PNS显著升高NO含量,300mg·L-1PNS显著降低ET含量。结论:PNS对Ox-LDL损伤的血管内皮细胞具有一定的保护作用,可调节内皮细胞活性物质NO、ET的分泌。     

乳酸左氧氟沙星片的生物等效性研究

目的：建立人血浆中乳酸左氧氟沙星的HPLC-MS测定方法,研究乳酸左氧氟沙星在正常人体内的药代动力学行为,评价我公司生产的乳酸左氧氟沙星片与上市产品来立信的生物等效性。方法：人体实验采用双交叉设计,22名健康受试者交叉口服两个厂家生产的乳酸左氧氟沙星片,服药后0.33h～24h内间隔取血,用HPLC-MS法测血浆中的左氧氟沙星浓度,计算主要药动学参数,以上市样品为参比制剂,估算我公司生产的样品的相对生物利用度,判断生物等效性。结果：我公司研制的乳酸左氧氟沙星片相对生物利用度为108.1%～123.3%。结论：本实验建立的分析方法灵敏、准确、简便,统计学结果表明两种制剂生物等效。     

1,2-二氯乙烷对大鼠肝细胞内游离钙离子浓度的影响

目的了解1，2-二氯乙烷染毒24h对大鼠肝细胞的损伤及其机理。方法运用显微荧光术测定了大鼠肝细胞内游离钙离子浓度，同时，测定了大鼠肝细胞培养上清液乳酸脱氢酶（LDH）活力作为大鼠肝细胞受损的指标。结果所有剂量组的1，2-二氯乙烷的大鼠肝细胞内游离钙离子浓度与对照组比较差异均无显著性（P〉0．05）；LDH活力仅在浓度为5mmol／L的1，2-二氯乙烷染毒组与对照组比较差异也无显著性（P〉0．05）；而1，2-二氯乙烷其他染毒组（即浓度为10mmol／L和20mmol／L）与对照组比较差异均有显著性（P〈0．01）。结论较高浓度（10mmol／L和20mmol／L）的1，2-二氯乙烷能损伤大鼠肝细胞，损伤的途径不是通过破坏肝细胞内钙稳态机制。