循证护理在结肠造口早期并发症护理中的应用

目的探讨减少和护理结肠造口近期常见并发症的最佳途径。方法将80例患者根据时间分成两组,对照组40例按护理常规进行护理,观察组40例运用循证护理。比较两组效果。结果观察组的造口皮肤黏膜分离和粪性皮炎的发生率明显低于对照组,差异有统计学意义（P〈0．05）。结论循证护理减少了与护理密切相关的造口并发症,减轻了医生负担,密切了医护关系、护患关系。     

腹腔镜经盆腔途径肛提肌外腹会阴联合切除术治疗低位进展期直肠癌

目的:探讨腹腔镜经盆腔途径肛提肌外腹会阴联合直肠切除术(ELAPE)治疗低位进展期直肠癌的安全性及可行性?方法: 回顾性分析2013年8月—2015年4月徐州医学院附属医院胃肠外科30例低位进展期直肠癌患者行腹腔镜经盆腔途径ELAPE手术,术中根据肿瘤侵犯肛提肌程度,经盆腔途径直视下个体化切除肛提肌范围,所有患者常规经腹关闭盆底腹膜,会阴部操作不改变体位,未行盆底重建?记录患者手术情况,术后早期并发症及临床效果?结果:全部患者手术操作顺利,无术中并发症及中转开腹,所有标本切除肛提肌均附于远端直肠系膜,环周切缘均为阴性,平均手术时间(193.0 ± 31.5)min,术中平均出血量(90.5 ± 24.2)mL?术后随访3~18个月,未见肿瘤复发及转移?结论: 腹腔镜经盆腔途径ELAPE术治疗低位进展期直肠癌是可行的,操作简单,创伤小,手术时间短,近期并发症少?     

Lin28A过表达对胃癌细胞糖酵解的抑制作用及其机制

目的　探讨Lin28A基因对胃癌细胞糖酵解的作用及其分子机制。方法　利用慢病毒载体建立Lin28过表达胃癌BGC-823细胞株,以生物化学法检测细胞培养液乳酸含量,酶联免疫吸附试验（ELISA）法检测细胞内磷酸果糖（PFK）含量,蛋白质印迹法检测Lin28A、缺氧诱导因子1α（.HIF-1α）、葡萄糖转运蛋白1（GLUT-1）、丙酮酸激酶M2（PKM2）蛋白水平表达,反转录（RT）-PCR法检测let-7a RNA水平,膜联蛋白(Annexin)Ⅴ-别藻蓝蛋白（APC）单染法检测细胞凋亡。.结果　Lin28A蛋白在转染组的表达水平明显高于对照组和空载组（均P＜0.001）。转染组let-7a RNA表达水平（0.602±0.017）明显低于空载组（1.001±0.063）（P=0.005 2）。转染组HIF-1α、GLUT-1、PKM2蛋白的表达水平明显低于其他两组（均P＜0.001）。对照组、空载组、转染组细胞培养液乳酸含量分别为（1.71±0.13）、（1.53±0.11）、（1.24±0.04）mmol/L,转染组明显低于对照组和空载组（.P=0.017 0、0.031 0）;细胞内PFK含量分别为（3.71±0.13）、（3.49±0.14）、（1.79±0.05）mmol/L,转染组明显低于对照组和空载组（P=0.014 0、0.036 0）;凋亡率分别为5.02 %±0.14 %、7.16 %±0.21 %、10.39 %±0.37 %,转染组凋亡率明显高于对照组和空载组（P=0.000 5、0.000 7）。 结论　Lin28A过表达可以抑制let-7a表达,并通过抑制细胞的糖酵解促进人胃癌细胞凋亡。     

Multi-parameter prediction of HLA class Ⅰ restricted cytotoxic T lymphocyte epitopes for human proliferating cell nuclear antigen

Objective To predict the HLA class Ⅰ restricted cytotoxic T lymphocyte epitopes for human proliferating cell nuclear antigen (PCNA). Methods By using 3 epitope prediction databases which including MHC binder ( BIMAS and SYFPEITHI databases) and proteasome cutting site ( PAProC databases), the epitopes of PCNA were predicted by analyzing several parameters and methods. Results After comprehensive analysis,we have obtained two possible HLA-A0201 restricted CTL epitopes SMSAD-VPLV (228-236, score 447 633. 595 ) and LINEACWDI ( 22-28, score 127 966.779);two HLA-A24 re-stricted CTL epitopos DYEMKLMDL ( 113-121, score 563 994.9 ) and EFARICRDL ( 143-151, score 40 540.7);two HLA-A1101 restricted CTL epitopes LTSMSKILK (72-80, score 1334. 2680 ) and DVPLV-VEYK (232-240,score 736.9236). Conclusion The multi-parameter epitope prediction method is feasi-ble for cytotoxic T lymphocyte epitope prediction.     

Multi-parameter prediction of HLA class Ⅰ restricted cytotoxic T lymphocyte epitopes for human proliferating cell nuclear antigen

Objective To predict the HLA class Ⅰ restricted cytotoxic T lymphocyte epitopes for human proliferating cell nuclear antigen (PCNA). Methods By using 3 epitope prediction databases which including MHC binder ( BIMAS and SYFPEITHI databases) and proteasome cutting site ( PAProC databases), the epitopes of PCNA were predicted by analyzing several parameters and methods. Results After comprehensive analysis,we have obtained two possible HLA-A0201 restricted CTL epitopes SMSAD-VPLV (228-236, score 447 633. 595 ) and LINEACWDI ( 22-28, score 127 966.779);two HLA-A24 re-stricted CTL epitopos DYEMKLMDL ( 113-121, score 563 994.9 ) and EFARICRDL ( 143-151, score 40 540.7);two HLA-A1101 restricted CTL epitopes LTSMSKILK (72-80, score 1334. 2680 ) and DVPLV-VEYK (232-240,score 736.9236). Conclusion The multi-parameter epitope prediction method is feasi-ble for cytotoxic T lymphocyte epitope prediction.     

依达拉奉对小移植肝大鼠再灌注损伤的保护作用

目的 探讨依达拉奉对小移植肝大鼠再灌注损伤的保护作用及其可能机制.方法 建立40%小体积大鼠肝移植模犁.32只成年雄性SD大鼠随机分为对照组(C组)和依达拉奉治疗组(ED组),每组16只.检测再灌注后6 h血清AST和ALT水平及组织病理学变化;检测肝组织中丙二醛(MDA)和超氧化物歧化酶(SOD)含量;TUNEL法检测术后6 h移植肝细胞凋亡情况.结果 与C组比较,ED组术后6 h AST和ALT水平明显下降[(1188.03±124.04)U/L vs.(825.50±72.87)U/L和(988.66±91.07)U/L vs.(687.40±72.21)U/L](P<0.01).组织病理学显示,C组术后6 h肝细胞明显空泡样变性伴局部坏死,肝小叶结构破坏;门脉周围水肿、充血,炎症细胞浸润明显;而ED组肝损伤减轻;与C组比较,ED组肝组织中MDA水平显著下降(1.83±0.32)nmol/mgprot vs.(1.08±0.21)nmol/mg prot,而SOD含量(384.58±23.64)U/mg prot vs.(551.71±62.06)U/mg prot则明显增加(P<0.01).ED组肝脏细胞凋亡指数明显降低(19.14±3.24) vs.(9.33±1.82)(P<0.01).结论 依达拉奉对小移植肝大鼠术后早期再灌注损伤有明显的保护作用,其机制可能部分是通过增强抗氧化能力、抑制脂质过氧化、抑制肝细胞凋亡密切相关.     

Multi-parameter prediction of HLA class Ⅰ restricted cytotoxic T lymphocyte epitopes for human proliferating cell nuclear antigen

Objective To predict the HLA class Ⅰ restricted cytotoxic T lymphocyte epitopes for human proliferating cell nuclear antigen (PCNA). Methods By using 3 epitope prediction databases which including MHC binder ( BIMAS and SYFPEITHI databases) and proteasome cutting site ( PAProC databases), the epitopes of PCNA were predicted by analyzing several parameters and methods. Results After comprehensive analysis,we have obtained two possible HLA-A0201 restricted CTL epitopes SMSAD-VPLV (228-236, score 447 633. 595 ) and LINEACWDI ( 22-28, score 127 966.779);two HLA-A24 re-stricted CTL epitopos DYEMKLMDL ( 113-121, score 563 994.9 ) and EFARICRDL ( 143-151, score 40 540.7);two HLA-A1101 restricted CTL epitopes LTSMSKILK (72-80, score 1334. 2680 ) and DVPLV-VEYK (232-240,score 736.9236). Conclusion The multi-parameter epitope prediction method is feasi-ble for cytotoxic T lymphocyte epitope prediction.     

转染增殖细胞核抗原肽表位融合白细胞介素-18基因的树突状细胞对T细胞增殖的影响

目的 观察转染增殖细胞核抗原(PCNA)肽表位、白细胞介素(IL)-18融合基因的树突状细胞(DCs)对T淋巴细胞增殖的诱导作用.方法 实验分为DCs组、空载体组、PCNA肽表位基因转染组、PCNA肽表位融合IL-18基因转染组共4组,分别将空质粒(pIPES-EGFP)、PCNA肽表位质粒[pIPES-EGFP-PCNA(6)]和PCNA肽表位融合IL-18基因质粒[pIRES-EGFP-PCNA(6)/IL-18]通过脂质体转染DCs.每组按照DCs∶T淋巴细胞1∶1、1∶10、1∶20、1∶40、1∶80的比例分为4个浓度梯度,将DCs与T淋巴细胞共培养.采用CCK-8法检测T细胞增殖.结果 各组DCs均能刺激T淋巴细胞增殖,DCs∶T为1∶10时,转染pIPES-EGFP-PCNA(6)/IL-18的DCs刺激指数为2.62,优于DCs组(1.70)、空载体组(1.78)和pIPES-EGFP-PCNA(6)组(1.93).结论 转染pIRES-EGFP-PCNA(6)/IL-18的DCs刺激T淋巴细胞增殖的作用最强,DCs:T为1∶10时最佳.     

过氧化物酶体增殖物激活受体γ激动剂15-脱氧前列腺素J2对小移植肝再灌注损伤的保护作用

目的 探讨过氧化物酶体增殖物激活受体γ(PPARy)激动剂15-脱氧前列腺素J2(15d-PGJ2)对小移植肝大鼠再灌注损伤的保护作用及其机制.方法 将108只SD大鼠随机分为3组:(1)15d-PGJ2预处理组;(2)15d-PGJ2+GW9662组;(3)生理盐水对照组(NS组).检测术后6、24、72 h血清丙氨酸转氨酶(ALT)和天门冬氨酸氨基转移酶(AST)水平;检测术后24 h肝组织中丙二醛(MDA)和超氧化物歧化酶(SOD)含量;检测肝组织中髓性过氧化物酶(MPO)活性以反映中性粒细胞的浸润;酶联免疫吸附试验(ELISA)检测肝组织中肿瘤坏死因子(TNF)-α水平;观察术后24h光镜下肝组织病理学变化.结果 与NS组和15d-PGJ2+GW9662组比较,15d-PGJ2预处理组术后6、24、72 h血清ALT和AST水平明显降低(P＜O.01);术后24h SOD活性明显升高而MDA含量降低,差异有统计学意义(P＜0.01);肝组织中TNF-α含量及MPO活性亦明显降低,差异有统计学意义(P＜0.01);苏木素-伊红(HE)染色显示:NS组和15d-PGJ2+GW9662组术后24 h,表现为明显的肝细胞空泡变性,肝窦扩张,炎症细胞浸润;15d-PGJ2组较其他两组肝组织损伤轻微.结论 PPARγ激动剂15d-PGJ2对小移植肝术后再灌注损伤有明显的保护作用,其保护机制可能与提高机体抗氧化能力,抑制脂质过氧化及减轻炎症反应密切相关.

Abstract：

Objective To investigate the protective effect of peroxisome proliferator-activated receptor γ (PPARγ) agonist 15d-PGJ2 against reperfusion injury in small-for-size liver grafts and its probable mechanisms. Methods 108 adult male SD rats were randomly divided into three groups: ( 1 ) 15d-PGJ2 group; (2) 15d-PGJ2 + GW9662 group; (3) NS control group. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels at 6, 24 and 72 h after reperfusion and histopathological changes were analyzed, the contents of malondialdehyde (MDA) and superoxide dismutase (SOD) in liver grafts after 24 h were determined, myeloperoxidase (MPO) activity was examined to assay neutrophil infiltration into the grafts at 24 h after reperfusion, and transforming growth factor (TGF)-α levels at 24 h after reperfusion were measured by using enzyme-linked immunosorbent assay ( ELISA method). Results As compared with NS control group and 15d-PGJ2 + GW9662 group, serum AST and ALT levels were significantly reduced at 6, 24 and 72 h after reperfusion in 15d-PGJ2 group (P ＜0. 01 ). Histopathological analysis revealed apparent bulb-like degeneration, hepatic sinusoid dilation, and inflammatory cell infiltration in periportal area at 24 h in NS group and 15d-PGJ2 + GW9662 group after transplantation, while in the 15d-PGJ2 group, minimal damage was observed at 24 h after transplantation under the light microscopy, the contents of MDA were lower and SOD levels were higher than in other groups ( P ＜0. 01 ). As compared with NS group and 15d-PGJ2 + GW9662 group, TNF-α levels and MPO activity at 24 h after transplantation were also significantly decreased in 15d-PGJ2 group (P ＜ 0. 01 ). Conclusion PPARγagonist 15d-PGJ2 could ameliorate reperfusion injury in small-for-size liver grafts significantly, which was mediated in part by increasing antioxidant ability, inhibiting lipid peroxidation, and down-regulating inflammatory reaetion.     

胃癌组织中调节性T淋巴细胞浸润与预后的关系

目的 探讨胃腺癌组织中调节性T细胞(Tregs)浸润及其分布与胃腺癌患者预后的关系.方法 免疫组织化学链霉菌抗生物素蛋白-过氧化物酶(SP)法检测106例胃腺癌组织中叉头样转录因子3(Foxp3)表达,结合随访资料分析胃癌组织中Tregs浸润数量及分布与患者预后的关系.结果 癌组织中浸润的Tregs数量[(7.36±8.06)个]明显高于癌旁黏膜浸润的Tregs数量[(2.10±2.97)个,P＜0.01],癌间质中浸润的Tregs数量[(8.01±10.01)个]明显高于癌巢中浸润的Tregs数量[(0.47±1.49)个,P＜0.01];癌组织中浸润的Tregs与总生存时间(OS)无明显相关(P＞0.05);癌组织中癌巢浸润Tregs与OS呈正相关(P＜0.01).结论 胃癌组织中存在Tregs浸润且分布具有差异,检测癌巢内浸润Tregs的水平有助于判断胃癌良好预后.