腹腔镜下原位回肠新膀胱术后并发症的护理

膀胱肿瘤是泌尿系统最常见的肿瘤，在我国发病率居泌尿系肿瘤首位。目前腹腔镜膀胱全切除原位回肠新膀胱术已成为无远处转移的浸润性膀胱癌的首选治疗方法。患者在进行根治性切除后，用其回肠段制成一个新膀胱，让患者保留经原尿道排尿的功能，使患者术后能从尿道自控排尿。     

Chronic stress increases experimental pancreatic cancer growth,reduces survival and can be antagonised by beta-adrenergic receptor blockade

Background/objectivesChronic stress could promote tumour growth and reduce survival of pancreatic cancer patients via beta-adrenergic receptors of tumour cells. We have tested the impact of chronic acoustic and restraint stress on tumour development in an orthotopic syngeneic murine model of pancreatic cancer.Methods and resultsTumour-bearing C57BL/6 mice exposed to chronic stress had 45% (p = 0.0138) higher circulating steroid and 111% (p = 0.0052) higher adrenal tyrosine hydroxylase levels. Their immune response was significantly suppressed: The in vitro LPS response of splenocytes was significantly reduced regarding Th1- and Th2-cytokines including IFN-gamma, IL-6, IL-10 and MCP-1 (0.0011 < p < 0.043). Also, tumours of stressed mice showed a tendency towards fewer total CD4 cells, more regulatory T cells (Treg), less T cell/tumour cell contacts and a reduction of CTLA-4 in CD4 cells (p > 0.05). TGF-beta in vitro was increased by 23.4% using catecholamines (p < 0.012) and in vivo employing chronic stress (p < 0.001). After 5 weeks tumour volumes were 130% (p = 0.0061) larger and median survival reduced by 13.5% (p = 0.0058). Tumours expressed more VEGF (p = 0.0334), had greater microvessel densities (p = 0.047), and an increased MMP-9 expression (p = 0.0456). Beta-catecholamines increased proliferation in tumour cells by 18% (p < 0.0001) and migration by 78% (p = 0.0348) whereas the beta-blocker propranolol reduced these effects by 25% (p < 0.0001) and 53% (p = 0.045), respectively. When stressed tumour-bearing animals were treated with propranolol tumour volumes were reduced by 69% (p = 0.0088) and survival improved by 14% (p < 0.0058).ConclusionsThe potential treatment with beta-blockers of patients with pancreatic cancer or other malignancies should be further evaluated as an adjuvant anti-neoplastic agent in clinical trials.     

卵巢肿瘤原位移植动物模型的建立

目的:建立能够模拟临床肿瘤发展过程的卵巢癌动物模型。方法:将处于对数生长期的人卵巢癌细胞株SKOV3(2×106个/只)、A2780多水平细胞数(2×106个/只、5×106个/只、1×107个/只、1.5×107个/只和2×107个/只)裸鼠皮下注射,A2780(1.5×107个/只)腹腔注射。取SKOV3第3代连续传代皮下瘤组织进行裸鼠右侧卵巢包膜下移植。结果:卵巢癌细胞株SKOV3皮下注射、组织块原位移植成瘤率均100%。原位移植卵巢癌裸鼠6～8周时剖腹探查见局部形成较大包块,与周围组织发生粘连,腹腔暗红色血性积液伴脏器广泛性转移,淋巴结转移。卵巢癌A2780细胞株多水平细胞数皮下注射均未成瘤;腹腔注射8周时剖腹探查见腹腔内生成2～3 mL无色澄清腹水,双侧卵巢增大,脾脏明显增大,未能发现任何腹腔瘤块。结论:成功建立了临床转移模式的SKOV3卵巢癌肿瘤细胞原位移植动物模型;卵巢癌A2780细胞接种未能成瘤,可能是因其对宿主体内非特异性免疫反应较敏感。     

蒿甲醚对SD大鼠原位脑胶质瘤的抑瘤实验

目的探讨蒿甲醚（Artemether）对SD大鼠原位脑胶质瘤的抑瘤作用。方法采用四甲基偶氮唑蓝(MTT)法测定不同浓度蒿甲醚对大鼠C₆脑胶质瘤细胞株的生长抑制作用,计算半数抑制浓度(IC₅₀)。立体定位仪对48只（雌、雄各半）SD大鼠建立脑胶质瘤原位模型,随机分为6组：对照组;模型组,蒿甲醚33.3 mg/（kg·d）、50.0 mg/（kg·d）、66.6 mg/（kg·d）;联合用药组,蒿甲醚50.0 mg/（kg·d）+ 硫酸亚铁1.5 mg/（kg·d）;阳性药对照组。采用灌胃给药法连续给予各组SD大鼠用药10天,对照组给予0.9%氯化钠溶液。肿瘤体积按a²bπ∕6(a为肿瘤的短径,b为肿瘤的长径)计算。全脑标本用4%多聚甲醛固定。肿瘤组织做病理观察。结果蒿甲醚抑制大鼠C₆脑胶质瘤细胞增殖,其抑制作用呈剂量和时间依赖性;模型组和联合用药组对SD大鼠原位脑胶质瘤的抑瘤率分别为：54.5%、61.0%、64.5%和69.8%;模型组组间比较,蒿甲醚66.6 mg/（kg·d）用药组的抑瘤率明显高于蒿甲醚33.3 mg/（kg·d）用药组;各实验组间比较,联合用药组的抑瘤率显著高于模型组33.3 mg/（kg·d）。结论口服蒿甲醚对SD大鼠脑部原位接种C₆脑胶质瘤有明显的抑瘤作用。     

4种人肾细胞癌原位移植裸鼠模型建立方法的比较

背景与目的:肾细胞癌是最常见的肾脏恶性肿瘤,起病隐匿,恶性程度高.研究旨在建立成功率高、稳定的人肾细胞癌原位动物造模方法.方法:采用人肾细胞癌细胞(786-0、ACHN)进行细胞悬液原位注射法、皮下成瘤后引瘤原代细胞悬液原位注射法、皮下成瘤后引瘤组织块原位移植肾包膜下法及皮下成瘤后引瘤组织块原位移植肾周筋膜内法建立原位移植裸鼠模型,采用PET/CT、H-E染色、免疫组织化学染色及血清生化检测等手段观察成瘤率及肿瘤生长情况,评估4种方法的建模效果.结果:人肾细胞癌皮下移植瘤裸鼠模型,ACHN组成瘤率(90%)高于786-0组(30%);人肾细胞癌原位移植裸鼠模型,786-0原位注射组、ACHN原位注射组、ACHN皮下移植瘤引瘤后原代细胞原位注射组、ACHN组织块肾包膜下包埋组和ACHN组织块肾周筋膜内包埋组的成瘤率分别为33%、80%、90%、100%和20%,其中以ACHN皮下成瘤后引瘤组织块原位移植肾包膜下法成瘤率最高,影像学及病理组织学检查结果显示符合低分化肾细胞癌.结论:成功建立4种人肾细胞癌原位移植裸鼠模型,其中以ACHN皮下成瘤后引瘤组织块原位移植肾包膜下法成瘤效果最佳,为肾细胞癌发病机制及靶向治疗的进一步研究提供理想的动物模型.     

Combined orthotopic heart transplantation followed by autologous stem cell transplantation in a patient with light chain amyloidosis and isolated cardiac involvement

We present a case of amyloidosis AL with isolated myocardial involvement. Because of a refractory heart failure picture, patient underwent orthotopic heart transplant (OHT). The replaced heart showed an important midwall infiltration. Ten months after he underwent autologous stem-cell transplantation (ASCT) with a favorable outcome. The case demonstrates that OHT followed by ASCT in highly selected patients with light chain amyloidosis is a life-saving procedure.     

Hepatitis E virus infection in the liver transplant recipients:Clinical presentation and management

Hepatitis E virus(HEV) is an emerging pathogen and an increasingly recognized cause of graft hepatitis, especially in the post-orthotopic liver transplantation immunocompromised population. The exact incidence and prevalence of HEV infection in this population remains unclear but is certainly greater than historical estimates. Identifying acute HEV infection in this population is imperative for choosing the right course of management as it is very difficult to distinguish histologically from acute rejection on liver biopsy. Current suggested approach to manage acute HEV involves modifying immunosuppression, especially discontinuing calcineurin inhibitors which are the preferred immunosuppressive agents post-orthotopic liver transplantation. The addition of ribavirin monotherapy has shown promising success rates in clearing HEV infection and is used commonly in reported cases.     

Vascular complications following liver transplantation: A literature review of advances in 2015

Although vascular complications(VCs) following orthotopic liver transplantation(OLT) seldom occur, they are the most feared complications with a high incidence of both graft loss and mortality, as they compromise the blood flow of the transplant(either inflow or outflow). Diagnosis and therapeutic management of VCs constitute a major challenge in terms of increasing the success rate of liver transplantation. While surgical treatment used to be considered the first choice for management, advances in endovascular intervention have increased to make this a viable therapeutic option. Considering VC as a rare but a major and dreadful issue in OLT history, and in view of the continuing and rapid progress in recent years, an update on these uncommon conditions seemed necessary. In this sense, this review comprehensively discusses the important features(epidemiological, clinical, paraclinical, prognostic and therapeutic) of VCs following OLT.     

Replicating and identifying large cell neuroblastoma using high-dose intra-tumoral chemotherapy and automated digital analysis

PurposeLarge cell neuroblastomas (LCN) are frequently seen in recurrent, high-risk neuroblastoma but are rare in primary tumors. LCN, characterized by large nuclei with prominent nucleoli, predict a poor prognosis. We hypothesize that LCN can be created with high-dose intra-tumoral chemotherapy and identified by a digital analysis system.MethodsOrthotopic mouse xenografts were created using human neuroblastoma and treated with high-dose chemotherapy delivered locally via sustained-release silk platforms, inducing tumor remission. After recurrence, LCN populations were identified on H&E sections manually. Clusters of typical LCN and non-LCN cells were divided equally into training and test sets for digital analysis. Marker-controlled watershed segmentation was used to identify nuclei and characterize their features. Logistic regression was developed to distinguish LCN from non-LCN.ResultsImage analysis identified 15,000 nuclei and characterized 70 nuclear features. A 19-feature model provided AUC > 0.90 and 100% accuracy when > 30% nuclei/cluster were predicted as LCN. Overall accuracy was 87%.ConclusionsWe recreated LCN using high-dose chemotherapy and developed an automated method for defining LCN histologically. Features in the model provide insight into LCN nuclear phenotypic changes that may be related to increased activity. This model could be adapted to identify LCN in human tumors and correlated with clinical outcomes.     

How do we manage post-OLT redundant bile duct?

AIM: To address endoscopic outcomes of post-Orthotopic liver transplantation (OLT) patients diagnosed with a "redundant bile duct" (RBD). METHODS: Medical records of patients who underwent OLT at the Liver Transplant Center, University Texas Health Science Center at San Antonio Texas were retrospectively analyzed. Patients with suspected biliary tract complications (BTC) underwent endoscopic retrograde cholangiopancreatography (ERCP). All ERCP were performed by experienced biliary endoscopist. RBD was defined as a looped, sigmoid-shaped bile duct on cholangiogram with associated cholestatic liver biomarkers. Patients with biliary T-tube placement, biliary anastomotic strictures, bile leaks, bile-duct stonessludge and suspected sphincter of oddi dysfunction were excluded. Therapy included single or multiple biliary stents with or without sphincterotomy. The incidence of RBD, the number of ERCP corrective sessions, and the type of endoscopic interventions were recorded. Successful response to endoscopic therapy was defined as resolution of RBD with normalization of associated cholestasis. Laboratory data and pertinent radiographic imaging noted included the pre-ERCP period and a follow up period of 6-12 mo after the last ERCP intervention. RESULTS: One thousand two hundred and eighty-two patient records who received OLT from 1992 through 2011 were reviewed. Two hundred and twenty-four patients underwent ERCP for suspected BTC. RBD was reported in each of the initial cholangiograms. Twentyone out of 1282 (1.6%) were identified as having RBD. There were 12 men and 9 women, average age of 59.6 years. Primary indication for ERCP was cholestatic pattern of liver associated biomarkers. Nineteen out of 21 patients underwent endoscopic therapy and 2/21 required immediate surgical intervention. In the endoscopically managed group: 65 ERCP procedures were performed with an average of 3.4 per patient and 1.1 stent per session. Fifteen out of 19 (78.9%) patients were successfully managed with biliary stenting. All stents were