Total protein output during rapid reduction of bile salt secretion rates in man.

An investigation was undertaken to study the effect of bile salt secretion on total biliary protein secretion in man. Bile was collected in eight patients from a tube in the bile duct. Collection was started after a meal and continued for six hours, in order to obtain bile salt secretion rates over the entire physiological range. Total protein secretion rates did not vary with change in bile salt secretion or bile flow. The protein pattern assessed by SDS-PAGE did not vary with bile salt secretion. The results indicate that bile salt secretion has little influence on biliary protein secretion under these conditions in man. Changes in bile salt secretion were associated with linear change in bile flow, but there was no relationship between bile flow and protein secretion rates. This argues against convective sieving of plasma proteins into bile.     

Defining the post-operative morbidity index for distal pancreatectomy

Background

Accurate assessment of complications is critical in analysing surgical outcomes. The post-operative morbidity index (PMI), derived from the Modified Accordion Severity Grading System and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), is a quantitative measure of post-operative morbidity. This study utilizes PMI to establish the complication burden for a distal pancreatectomy (DP).

Methods

From 2005–2011, nine centres contributed ACS-NSQIP complication data for 655 DPs. Each complication was assigned an Accordion severity weight ranging from 0.11 for grade 1 to 1.00 for grade 6 (death). The PMI is the sum of complication severity weights divided by the total number of patients.

Results

ACS-NSQIP complications occurred in 177 patients (27.0%). The non risk-adjusted PMI for DP is 0.087. Bleeding/Transfusion and Organ Space Infection were the most common complications. Frequency and burden differed across Accordion grades. While grade 4–6 complications represented only 15.4% of complication occurrences, they accounted for 30.4% of the burden. Subgroup analysis demonstrates that the PMI did not vary based on laparoscopic versus open approach or the performance of a splenectomy.

Discussion

This study uses two validated systems to quantitatively establish the morbidity of a DP. The PMI allows estimation of both the frequency and severity of complications and thus provides a more comprehensive assessment of risk.     

Unani treatment and leech therapy saved the diabetic foot of a patient from amputation

Every 30 seconds, a lower limb amputation is carried out due to diabetes throughout the world. The mortality rate due to diabetic foot gangrene is just next to that of cancer. As tissue death cannot be reversed, surgical removal of the affected tissue (debridement) or amputation of the limb is the only treatment option left when gangrene has advanced. The present case study illustrates an option to treat poorly healing diabetic wounds with Unani medicine (blood purifier and deobstruent) besides hirudotherapy. The study was performed on a 60‐year‐old woman suffering from diabetic foot (on the left) grade 5 and facing the prospect of imminent amputation. The patient was having severe pain (80 mm on a 100 mm visual analogue scale) in the gangrenous foot and foul‐smelling with necrosed areas. Wound dressing was done with unripe papaya as it has a very good role in clearing necrotising area and hirudotherapy was also used in poorly healing wounds. The pain score decreased to 0–10 mm on a 100 mm visual analogue scale within 20 days and no further pain relieving medication was required. Over a time interval of nearly 3·5 months, necrotic areas disappeared and the wound was completely healed.     

犯罪青少年家庭教养方式的特征

目的:分析犯罪青少年家庭教养方式与正常青少年群体父母教养方式的差异,以及犯罪青少年父母教养方式的一致性问题。方法:于2004-11/2005-02以某省少年教养管理所在册的少教学员86名作为观察组,同期随机抽取初中和高中在校学生86名作为对照组。采用父母教养方式评价量表和自编一般家庭情况问卷对两组被试评分进行比较。父母教养方式量表包括父亲和母亲两个量表。父亲教养方式包括6个因子:情感温暖、理解,惩罚、严厉,过分干涉,偏爱被试,拒绝、否认,过度保护。母亲教养方式包括5个因子:情感温暖、理解,过分干涉、过度保护,拒绝、否认,惩罚、严厉,偏爱被试。测试包括从不、偶尔、经常、总是4个等级(分数越高表明父母教养方式各方面越突出)。结果:共发放问卷200份,回收有效问卷172份。①观察组父亲教养方式中情感温暖与理解、过分干涉评分低于对照组[(44.86±9.61),(51.41±8.25)分;(22.21±6.97),(33.30±3.49)分,P均<0.01],惩罚严厉、偏爱被试等评分高于对照组[(21.48±7.64),(14.21±4.74)分;(11.74±3.87),(8.56±4.29)分,P均<0.01];观察组母亲教养方式中情感温暖与理解评分低于对照组[(42.98±11.84),(52.97±9.05)分,P<0.01],拒绝否认、过分干涉与保护、惩罚严厉等评分高于对照组[(14.41±5.10),(9.02±2.84)分;(37.40±8.91),(33.97±5.90)分;(14.48±4.80),(12.94±3.45)分,P<0.01,P<0.05]。②观察组父母教养方式在偏爱被试、过度干涉保护、惩罚严厉以及拒绝否认贬低等方面存在严重分歧[(12.03±3.99),(9.50±3.68)分;(21.85±6.82),(37.78±8.3)分;(21.12±7.59),(14.44±5.03)分;(9.68±2.87),(14.26±4.91)分,P均<0.01]。对照组父母在情感温暖理解、过度干涉保护、惩罚严厉等方面存在分歧[(52.00±8.31),(53.08±9.18)分;(33.27±3.41),(34.77±6.12)分;(14.21±5.03),(13.22±3.82)分,P<0.05,P<0.01]。结论:犯罪青少年的父母教养方式存在3个明显不足,即缺少情感温暖、沟通和理解;极端化;父母教养方式严重分歧。母亲的过分干涉保护可能是青少年犯罪的一个重要相关因素。     

硬膜外超前镇痛对全髋置换手术患者血儿茶酚胺影响的特征

目的:观察超前硬膜外镇痛对全髋置换手术患者血儿茶酚胺的影响,评价其镇痛效果。方法:选择2004-06/2005-05经新乡医学院一附院骨外科检查确诊拟行全髋置换手术的患者40例。随机分为超前镇痛组和对照组,每组各20例。超前镇痛组硬膜外导管输入0.2%罗哌卡因5mL/h,对照组输注生理盐水。采用硬膜外麻醉,术毕开始病人自控硬膜外镇痛,药物为0.2%罗哌卡因5mL/h。记录局麻药用量、按压次数。采用100mm视觉模拟积分法,记录放置硬膜外导管前、到手术室后、术毕、术后1,2,3,6,9,12,24h的视觉模拟评分。用高效液相色谱法测定血浆去甲肾上腺素、肾上腺素、多巴胺。结果:所有病例手术中麻醉效果完善,40例患者均进入结果分析,中途无脱落。①两组术前的罗哌卡因用量差异显著[(140.37±38.20),0mg,P<0.01];与硬膜外穿刺前及对照组进手术室后比较,超前镇痛组进手术室后的视觉模拟评分降低显著[(32.15±9.51),(31.13±11.28),(96.26±4.86)分,P<0.01]。②对照组病人自控硬膜外镇痛的按压次数明显多于超前镇痛组[(38.36±12.30),(24.48±9.50)次,P<0.01];两组术后罗哌卡因用量差异显著[(288.13±38.20),(384.61±67.44)mg,P<0.01]。③两组患者去甲肾上腺素、肾上腺素、多巴胺含量在术毕显著高于术前(P<0.01),术后24h超前镇痛组去甲肾上腺素、肾上腺素显著低于对照组。两组均没有发生明显的局麻药毒副作用。结论:超前硬膜外镇痛能有效抑制术后儿茶酚胺的增高反应,用于髋关节置换患者的镇痛效果良好。     

Resection of Tumors of the Neck of the Pancreas with Venous Invasion: the “Whipple at the Splenic Artery (WATSA)” Procedure

Introduction  

Tumors of the neck of the pancreas may involve the superior mesenteric and portal veins as well as the termination of the splenic vein. This presents a difficult problem since the pancreas cannot be transected through the neck as is standard in a Whipple procedure. Here, we present our method of resecting such tumors, which we term “Whipple at the Splenic Artery (WATSA)”.     

聚己内酯-聚乙二醇共聚物复合软骨细胞构建组织工程化软骨

目的:观察聚己内酯-聚乙二醇共聚物与兔关节软骨细胞在体外复合培养以及体内植入后异位成软骨情况。方法:实验于2006-01/06在北京积水潭医院骨科研究所完成。①实验材料:3周龄新西兰白兔1只,SPF级4～6周龄BALB/C-nu/nu裸鼠7只,雌雄不限,聚己内酯-聚乙二醇嵌段共聚物(由清华大学机械系提供)。②实验干预:取兔双膝及股骨头关节软骨,通过酶消化法获取软骨细胞,进行原代和传代培养;将聚己内酯-聚乙二醇载体材料切成小块,乙醇浸泡并三蒸水冲洗后晾干,60Co辐照灭菌;收集第3代软骨细胞,以3×10~(10)L-1浓度接种于6片材料上,孵箱中培养1周。③实验分组:将7只裸鼠随机分为材料细胞复合组5只,背部植入培养1周的材料细胞复合物,单纯材料组2只,植入单纯材料。④实验评估:对第3代软骨细胞通过甲苯胺蓝染色进行鉴定;通过倒置显微镜和扫描电镜观察软骨细胞在载体材料上的生长增殖情况;材料种植于体内6周后取材,进行大体观察和组织学观察。结果:①关节软骨细胞形态学观察和鉴定:1～3代软骨细胞形态基本一致,大多呈多角形,少数为梭形,核圆且清晰可见,3代以后软骨细胞形态变宽变扁。甲苯胺蓝染色证实第3代软骨细胞胞浆内呈蓝紫色异染颗粒。②软骨细胞在载体材料上的生长增殖情况:细胞接种于材料1d后,倒置显微镜下观察,可见细胞以单个、多层或团状形式吸附在材料表面。电镜观察:细胞形状为圆球形,贴附在材料表面。③体内植入物大体和组织学观察:体内植入6周后,材料细胞复合组材料孔隙间形成透明软骨组织,单纯材料组材料孔隙间为纤维组织充填。结论:聚己内酯-聚乙二醇共聚物可以作为软骨细胞生长的支架载体,可以异位构建组织工程化软骨,材料的降解性还需要继续观察。     

The Effect of External Pituitary Irradiation on Elevated Serum Prolactin Levels in Patients with Pituitary Macroadenomas

The response of serum prolactin to external radiotherapy wasstudied in 58 patients (32 women) with pituitary tumours, agedbetween 16 and 75 years. Forty-four patients underwent pituitarysurgery before radiotherapy. Six Patients were irradiated witha regimen of 20 Gy in eight fractions over 10–11 daysand the remainder received 35–42.5 Gy in 15 fractionsover 20–22 days. Following radiotherapy, 44 patients receivedadditional treatment with dopaminergic agonists. Prolactin levelsranged from 1078 to 491000 mU/I (median 11750 mU/I) before radiotherapyand all but three patients showed a fall in serum prolactin(measured 4 weeks after stopping bromocriptine in those on dopamineagonist therapy) during observation over periods of up to 154months. All patients had evidence of pituitary fossa erosionor expansion at presentation and large tumours (Hardy-VezinaGrade 3–4) were more common in male patients (²=10.08,p<0.01). The rate of fall of serum prolaetin levels was greaterin patients with true prolactin-secreting tumours when comparedwith those who had stalk or hypothalamic damage (p< 0.005).The rate of decline of serum prolactin was also significantlyrelated to the pre-radiotherapy value (p=0.519, p<0.01).A serum prolactin level. <500 mU/I was achieved in 31 outof 44 patients treated with radiotherapy and dopaminergic agonistbut only nine remained normoprolactinaemic when medication wasdiscontinued for 4 weeks or more. The serum prolactin levelfell permanently to <500 mU/I in two of 14 patients treatedwith radiotherapy only. Actuarial analysis of data from allpatients indicated a 50 per cent probability that prolactinwould be reduced to <500 mU/I by 10 years; this increasedto 58 per cent for patients with smaller tumours (Hardy-Vezinagrade 2). Fourteen of 19 women of premenopausal age were amenorrhoeicbefore radiotherapy, but despite bromocriptine, menstruationwas restored in only five. A separate group of nine patientswith primary suprasellar, non-prolactin-secreting tumours andelevated prolactin levels was also studied. Prolactin concentrationsranged between 1016 and >4600 mU/I intially and were reducedby radiotherapy at a rate indistinguishable from that of patientswith pituitary adenomas associated with disconnection hyperprolactinaemia.None achieved permanent reduction of serum prolactin to <500mU/I. External radiotherapy is effective in reducing serum prolactinlevels in patients with pituitary macroadenomas, particularlywhere the hyperprolactinaemia is due to true tumour hypersecretion,but normal levels may take over 10 years to achieve. Radiation-inducedhypothalamic damage probably contributes to the hyperprolactinaemiapersisting after therapy and together with tumour-associatedor radiation-induced hypopituitarism accounts for the poor prospectsfor fertility in female patients.     

肝损伤Balb—c小鼠用于细胞移植治疗的有效亚致死放疗剂量

目的:探索肝损伤Balb-c小鼠适合的亚致死性放疗剂量,为细胞移植治疗用于肝病动物模型提供预处理方案。方法:实验于2004-10/2005-06在中山大学附属第一医院神经科实验室和中山大学实验动物中心完成。供体鼠为48只雄性Balb-c小鼠,受体鼠为24只雌性Balb-c小鼠。24只雌性受体鼠以2-乙酰氨基芴法建立肝损伤模型,根据γ射线照射剂量按随机数字表法分为4组,即γ射线8Gy,7Gy,6Gy和5Gy照射组,每组6只。放疗后当天接受带有CM-Dil荧光标记的供体雄性小鼠骨髓干细胞移植,每只受体小鼠移植骨髓干细胞1.0×107个。移植后追踪12周,观察受体鼠的一般情况及移植物抗宿主病反应,检测干细胞示踪剂CM-DiI(积分吸光度值)和供体雄性Sry基因(Sry与β-actin扩增产物积分吸光度比值)在受体鼠肝脏中的表达,以明确供体细胞在受体鼠肝脏存活情况。结果:放疗后γ射线8Gy照射组小鼠在放疗后4～10d内全部死亡,γ射线7Gy照射组死亡4只,共14只小鼠进入结果分析。①移植后受体鼠的移植物抗宿主病情况比较:γ射线7Gy照射组移植后第1周时移植物抗宿主病症状明显,4周后完全消失;γ射线5,6Gy照射组移植物抗宿主病症状轻微,持续3周消失。②各组受体小鼠肝脏中的CM-DiI分布情况比较:γ射线5,6,7Gy照射组CM-DiI积分吸光度值分别为2.86±0.72,2.65±0.55,2.53±0.42,3组相比差异无显著性意义(P>0.05)。③各组受体小鼠肝脏中雄性Sry基因的表达情况比较:γ射线7,6和5Gy照射组Sry与β-actin扩增产物积分吸光度比值分别为0.194±0.015,0.213±0.031,0.208±0.027,各组间差异无显著性意义(P>0.05)。结论:鉴于外周血细胞被供体细胞取代量随着放疗剂量增加而增加的理论,肝损伤Balb-c小鼠模型用于细胞移植研究的适合亚致死性放疗剂量是6Gy。