肝部分切除+定容失血性休克大鼠肝脏cDNA表达谱芯片结果分析

目的 利用cDNA表达谱芯片分析肝部分切除+定容失血性休克前和休克后24小时大鼠肝脏差异基因,并初步分析差异基因信号通路和网络调控. 方法 11只大鼠接受肝左外叶切除和2.5ml/100g体重定容失血性休克,选其中3只存活大鼠麻醉后失血前切除肝左外叶(A组),对于存活24小时的大鼠再次取肝脏(B组)行cDNA表达谱芯片(含21793个基因)分析.对差异基因行Pathway、Go、Network分析.使用RT-PCR对两组中基因Aldh1a1、Aldh1a7、Aoc3、Cyp26a1、Hdc1、Ephx2和Beta-actin进行分析,验证cDNA芯片的准确性. 结果 4只大鼠存活24小时,表达谱芯片筛查出两组差异表达下调基因634个,表达上调基因513个.差异基因涉及主要信号通路包括胆固醇代谢、细胞外刺激反应、甾醇代谢、激素刺激反应、甾体类激素刺激反应、类固醇代谢、内源性刺激反应、氧化还原反应、有机物质反应、脂肪酸代谢.结论 氧化还原和脂代谢信号通路在创伤失血性休克病理过程中起重要作用.     

Endothelial progenitor cells modulated by IL-1β in multiple organ dysfunction syndrome in porcine

Objective To investigate the modulation of EPCs by interleukin 1β (IL-1β) and p38 mitogen activated protein kinase (p38MAPK) and the pathogenesis resulting from their dysdifferenfiation after trauma.Method Thirty pigs were divided into a control group (n = 15) and a multiple organ dysfimction syndrome (MODS) group (n = 15), the latter of which were subjected to a "two-hit" injury including hemon'hagic shock and endotoxemia. Phosphorylation of p38MAPK in peripheral blood mononuclear cells was monitored by western blotting. The concentration of IL-1β in peripheral blood plasma was determined by ELISA and the numbers of EPCs with FCM in peripheral blood plasma were monitored. The morbidity rates in the two groups were compared by chi square test. The levels of phosphorylation of p38MAPK in peripheral blood mononuclear cells, the concentmtions of IL-1β in peripheral blood plasma and the numbers of EPCs in the peripheral blood were compared between groups using with Student's t lest. Results The level of p38MAPK phosphorylation was more augmented and the concen-tration of IL-1β higher in peripheral blood mononuelear cells and plasma from MODS pigs compared with those from control pigs; nevertheless the mauler of EPC conspicuously decreased in the peripheral blood (P <0.01). The morbidity rate in the MODS group was much higher than that in the control group (P < 0.01). There were fewer EPCs in the peripheral blood of animals in group M than in the peripheral blood of animals in group C (P <0.01). Conclusions p38MAPK phosphorylation is important for the pathogenesis of MODS. p38MAPK phospho-rylation might cause the concentration of IL-1β in the peripheral blood plasma to rise and could cause a drop in the numbers of EPCs, thereby aggravating the inflanmmatory reaction in MODS.     

内镜乳头括约肌切开术后出血的原因及外科处理

目的探讨内镜下乳头括约肌切开(endoscopic sphincterotomy,EST)取石术后大出血的原因及外科处理方法.方法Kocher切口游离十二指肠降部并纵行切开之,显露乳头创面出血点,检查出血原因,细丝线缝扎止血后缝闭十二指肠切口,行减压性胃造瘘.结果在本组1030例EST患者中,术后出现出血398例,需外科手术处理的2例,均为细小动脉出血,其中1例为切开部位出现变异血管,1例为切开部位有误,均经手术止血后而治愈.结论EST术后出现持续性出血多为动脉性出血,保守治疗无效者及时外科手术是必要的.     

提高股疝手术成功率的临床策略(附97例报告)

目的探讨股疝诊断要点和手术方法。方法 对我院经治的97例股疝临床资料进行回顾性总结。本组均经查体触及腹股沟韧带下方肿块及影像学检查确诊,除1例急诊死亡,其余均行手术治疗。经腹股沟上入路手术87例,经腹股沟下入路1例,经下腹部探查切口8例。68例(70.83%)行McVay疝修补术;13例(13.54%)行单纯高位结扎;14例(14.58%)行无张力疝修补术;1例(1.04%)采用经腹股沟下股疝修补术。所有患者术后常规应用抗生素。结果本组96例手术者中,94例痊愈,2例因术后心、肺功能衰竭而死亡,病死率3.09%。94例随访6个月～5年,1年后复发1例,余病例未见异常。结论股疝嵌顿绞窄发生率较高,仔细查体和超声检查可明确诊断,尽早手术是治疗股疝的有效手段,以减少并发症及死亡率。     

化疗对CD133+结肠癌细胞的作用效果

目的 观察化疗前后结肠癌细胞株HT29、SW620中CD133+结肠癌细胞的数量变化,探讨化疗对CD133+结肠癌细胞的作用效果.方法 取对数生长的结肠癌细胞株HT29、SW620,采用80 mg/L 5-氟尿嘧啶(5-Fu)和25 mg/L奥沙利铂(Oxaliplatin)分别作用8 h,并设对照组,利用CD133抗体进行标记后再用流式细胞仪进行检测,观察化疗前后CD133+细胞的比例.结果 流式细胞仪检测结肠癌细胞株HT29,80 mg/L 5-Fu处理8 h组中CD133+肿瘤细胞为45.00%,与未处理组(32.80%)比较结果差异有统计学意义(P＜0.01);25 mg/L奥沙利铂处理8 h组中CD133+肿瘤细胞为55.30%,与未处理组和80 mg/L 5-Fu处理8 h组比较结果差异有统计学意义(P＜0.01).流式细胞仪检测结肠癌细胞株SW620,80 mg/L 5-Fu处理8 h组中CD133+肿瘤细胞为47.10%,与未处理组(33.90%)比较结果差异有统计学意义(P＜0.01);25 mg/L奥沙利铂处理8 h组中CD133+肿瘤细胞为56.50%,与未处理组和80 mg/L 5-Fu处理8 h组比较结果差异有统计学意义(P＜0.01).结论 CD133+结肠癌细胞能明显抵抗化疗.

Abstract：

Objective To observe the changes of quantity of CD133 + cells in HT29 and SW620 cell lines before and after chemotherapy, and detect the effect of chemotherapy on CD133 + cells. Methods HT29 and SW620 cells in logarithmic growth phase were separately treated with 80 mg/L 5-fluorouracil(5-Fu) and 25 mg/L oxaliplatin for 8 h, and analyzed by flow cytometry after being marked by CD133 antibody. The proportion of CD133 + cells before and after chemotherapy was measured. Results For HT29 cells, the proportion of CD133 + cancer cells in the group treated with 80 mg/L 5-Fu for 8 h was 45.00% with the difference being remarkable ( P ＜ 0. 01 ) compared to the non-treatment group ( 32. 80% ). The proportion of CD133 + cancer cells in the group treated with 25 mg/L oxaliplatin for 8 h was 55.30% with the difference being remarkable ( P ＜ 0. 01 ) compared with both the non-treatment group and the group treated with 80 mg/L 5-Fu for 8 h. For SW620 cells, the proportion of CD133 + cancer cells in the group treated with 80 mg/L 5-Fu for 8 h was 47. 10% with the difference being remarkable ( P ＜0. 01 ) compared with the non-treatment group (33.90%). The proportion of CD133 + cancer cells in the group treated with 25 mg/L oxaliplatin for 8 h was 56. 50% with the difference being remarkable ( P ＜ 0. 01 ) compared with both the non-treatment group and the group treated with 80 mg/L 5-Fu for 8 h. Conclusion CD133 positive colon cancer cells have anti-chemotherapy activity obviously.     

胃癌远端胃次全切除联合脾切除的根治术

胃癌等疾病行远端胃次全切除术时,因残胃主要供血来源于胃短动脉而常规保留脾脏.但是在手术中有时因脾脏损伤或合并脾脏疾病等原因而无法保留脾脏时,常迫不得已须行全胃切除术.能否在切除脾脏后,仍保留近端胃而行远端胃次全切除术,是一个值得探讨的问题.本文结合我科4例行远端胃次全切除术联合脾脏切除术的病例,对该术式的意义进行讨论.     

男性乳腺癌41例临床诊治分析

目的 探讨男性乳腺癌(MBC)的诊治经验.方法 回顾性总结长海医院21年间收治的41例男性乳腺癌患者的临床资料;分析临床及病理因素与生存率的关系.40例接受手术治疗,其中根治术11例,改良根治术25例,单纯乳腺切除术4例.结果 临床TNM分期Ⅰ,Ⅱ,Ⅲ,Ⅳ期分别为8,19,11,3例.除2例失访外,其余39例(95.1%)随访1～20年(中位7.2年),5年生存率为65.9%.其中单纯乳腺切除术,改良根治术,根治术的5年生存率分别为25%,72%和72.7%.结论 改良根治术为MBC首选手术方式,手术方式、腋窝淋巴结情况、病理分期、病理类型及ER情况等因素影响预后.     

胃癌腹腔化疗毒副反应的观察和处理

目的 评价胃癌腹腔化疗的毒副反应，并探讨其处理方法。方法 将156例胃癌病人进行随机分组。分为术中即时低渗温热腹腔化疗联合术后早期腹腔化疗组（治疗组），单纯术中即时低渗温热腹腔化疗组（对照组1），未行腹腔化疗组（对照组2），共三组，观察化疗的安全性和毒副反应。结果 治疗组化学性腹膜炎、消化道反应、骨髓抑制和肝功能异常的发生率明显高于两个对照组。结论 应用术中即时，低渗温热腹腔化疗联合术后早期腹腔化疗时化学性腹膜炎的防治不容忽视。     

RNA干扰在胃癌治疗中的研究进展

RNA干扰(RNAi)是近几年发展起来的一种新兴的基因沉默技术,他是由双链RNA介导的靶向基因序列特异性转录后沉默机制.目前,RNAi技术已被广泛应用于各种肿瘤研究,结果发现其可特异地抑制癌基因、癌相关基因或突变基因的过度表达,从而抑制肿瘤的发生、发展.同时RNAi技术在胃癌治疗方面也进行了许多积极的探索,取得了一些突破性进展.RNAi技术可直接作用于胃癌的靶向基因,也可通过抑制肿瘤血管新生间接治疗胃癌,并且他对胃癌化疗多药耐药也有作用.     

男性股疝11例误诊分析

股疝约占腹外疝的5％，多见于中老年妇女，男性股疝临床少见，不足腹外疝总数的1％。故此方面诊治经验相对较少，特别是年轻医生，不熟悉股疝的解剖结构，只拘泥于临床表现，盲从医技检查结果，容易误诊或漏诊。我院1989年6月～2009年6月共收治男性股疝67例，其中术前误诊11例，误诊率16．4％。现分析误诊原因如下。