应用杂交技术修补切口疝临床疗效分析(附58例报告)

目的总结应用杂交技术修补腹壁切口疝的有效性、安全性及临床疗效。方法对上海交通大学医学院附属第六人民医院2011年1月至2016年1月,应用杂交技术修补腹壁切口疝58例患者的临床资料进行回顾性分析。结果手术时间40~160(92±30)min,缺损最大径为2~25(8±6)cm,补片大小为150~600(273±108)cm2。术后住院时间为6~15(9.3±2.1)d,切口浅表感染3例(5.8%),浆液肿2例(3.4%),术后早期腹壁疼痛8例(13.7%)。无肠道损伤、肠梗阻、伤口出血、补片感染和补片膨出等并发症,术后随访3~53个月,无复发病例。结论应用杂交技术修补腹壁切口疝安全可靠、疗效确切、术后恢复快,尤其适用于复杂、巨大腹壁切口疝。     

Large animal models of human cauda equina injury and repair: evaluation of a novel goat model

Previous animal studies of cauda equina injury have primarily used rat models, which display significant differences from humans. Furthermore, most studies have focused on electrophysiological examination. To better mimic the outcome after surgical repair of cauda equina injury, a novel animal model was established in the goat. Electrophysiological, histological and magnetic resonance imaging methods were used to evaluate the morphological and functional outcome after cauda equina injury and end-to-end suture. Our results demonstrate successful establishment of the goat experimental model of cauda equina injury. This novel model can provide detailed information on the nerve regenerative process following surgical repair of cauda equina injury.     

Increased activity of Rho kinase contributes to hemoglobin-induced early disruption of the blood-brain barrier in vivo after the occurrence of intracerebral hemorrhage

This study is to examine whether the activation of Rho kinase (ROCK) accounts for hemoglobin (Hb)-induced disruption of blood-brain barrier (BBB) after the occurrence of intracerebral hemorrhage. A model of intracerebral injection of Hb was established in rats. Changes in the levels of mRNA of RhoA, ROCK2 and matrix metalloproteinase-9 (MMP-9) were measured using quantitative real-time polymerase chain reaction. Protein expression of RhoA, ROCK2, claudin-5 and MMP-9, as well as ROCK activity, were determined using Western blotting. Immunohistochemical assay was performed to visualize the expression of RhoA, ROCK2, claudin-5 and MMP-9 in endothelial cells. Hb injection produced a significant increase in BBB permeability and water content in the brain. Significant reduction of claudin-5 expression was detected by Western blotting and immunofluorescence in Hb group. The levels of RhoA and ROCK2 were significantly up-regulated from 6 h to 12 h after Hb injection and were concomitant with the increase in ROCK activity. Immunofluorescence double staining showed enhanced p-myosin light chain immunoreactivity but diminished claudin-5 staining in endothelial cells. Significant up-regulation of MMP-9 expression was detected after Hb injection, and statistical analyses further confirmed a positive correlation of MMP-9 expression with ROCK activity. The results showed that ROCK was activated in endothelial cells by Hb. This may account for the early disruption of the BBB via up-regulation of p-myosin light chain expression and aggravation of injuries to TJ proteins. The activation of ROCK may also increase MMP-9 expression, thereby leading to further BBB disruption.     

Progression of targeted therapy in advanced cholangiocarcinoma

It is necessary to establish an effective therapy to improve the survival of patients with advanced cholangiocarcinoma (CCA). Recently, with the development of pathology research in CCA, a lot of special bio-markers such as EGFR, VEGF, HER2, and MEK et al. could be over expression or mutations in CCA patients. According to their changes, combinations of targeted therapy plus chemotherapy are now recognized as effective therapies for advanced CCA. The aim of this paper is to analyze recent promising studies about targeted therapy alone or combination with each other or with chemotherapies.     

影像诊断技术在心血管疾病诊断上的应用

各种影像诊断技术的产生和发展使我们能无创造性地直接观察心脏大血管的形态结构、功能和血液动力学改变。现就X 线CT、磁共振显像(MRI)、超声显像和放射性核素显像在心血管疾病诊断上的应用现况及前景作一综述。X 线CT X 线CT 在成像过程中,人体在某一部位的密度可以通过它对交叉投射的X 线吸     

肾移植术后人类微小病毒B19感染致纯红细胞再生障碍性贫血2例并文献复习

目的探讨肾移植术后人类微小病毒(HPV)B19感染致纯红细胞再生障碍性贫血(纯红再障)的诊断和治疗特点。方法总结南方医科大学南方医院器官移植科收治的2例肾移植术后HPV B19感染致纯红再障的病例,结合文献复习讨论该病的临床特点、诊断方法、治疗过程及预后。结果两例肾移植受者术后早发严重贫血且进行性加重,输血治疗无效。排除导致贫血的其他原因,综合骨髓穿刺活检、荧光聚合酶链反应(PCR)检测HPV DNA等方法诊断为HPV B19感染致纯红再障。经调整免疫抑制方案、静脉注射用免疫球蛋白(IVIG)等治疗后2例患者贫血症状明显改善。结论对于肾移植术后早期不明原因、进行性加重的贫血患者,特别是伴随网织红细胞缺乏者,应考虑HPV B19感染致纯红再障的可能性。骨髓穿刺及荧光PCR检测结果是诊断纯红再障的主要依据,免疫抑制剂减量和应用IVIG治疗是主要治疗措施。经治疗后,患者预后较好,但易复发。     

甲状腺术中喉返神经的损伤和预防

喉返神经损伤是甲状腺术后严重的并发症之一,单侧损伤引起声音嘶哑、双侧损伤则导致呼吸困难,甚至发生危及生命的声门梗阻.分析甲状腺损伤的原因:喉返神经与甲状腺下动脉紧密复杂的关系、喉返神经存在分支及分支的变异、喉不返神经、以及甲状腺Zuckerkandl结节的存在等解剖因素造成其易损伤;喉返神经本身的脆弱性造成其易损;未能合理使用能量手术器械造成神经的热损伤.预防喉返神经损伤可从以下方面努力:在甲状腺术中解剖显露喉返神经,使其“可视化”;术中精细化解剖喉返神经,解剖程度适中;掌握能量器械的性能,安全使用能量器械以减少神经的热损伤;合理使用术中神经监测,使用连续性神经监测,有助于降低喉返神经损伤的风险.