同种异体气管移植的研究及展望

学术背景:同种异体气管移植是气管移植研究的热点,新观点、新进展不断涌现.目的:总结分析近年来气管移植的现状及进展,介绍气管移植研究的新方法、新观点.检索策略:作者应用计算机检索,以网络数据库资源为主,查询 Science Direct,Pubmed,Springer等数据库 1990-01/2007-07有关同种异体气管移植方面的文章,检索词为"tracheal,allotransplantation,allograft",并限定文章语言种类为English.同时应用计算机检索CNKI数据库1994-01/2007-07有关同种异体气管移植方面的文章,限定文章种类为中文,检索词"同种异体,气管,移植".初检得到328篇文献,140篇符合纳入标准,取其中有关气管移植的30篇文献进行归纳总结.纳入标准:文章所述重点与气管移植相关.排除标准:重复性文章.文献评价:30篇文献中7个实验分析了移植气管的血运建立问题;17个实验分析了气管的免疫排斥问题;6个实验分析了移植气管组织细胞的再生与组织诱导因子问题.资料综合:通过文献回顾,发现决定同种异体气管移植成败的关键集中于以下3方面:①移植气管的血运建立.②移植气管的免疫原性及免疫反应强度.③移植气管组织细胞的再生.结论:在同种异体气管移植中各种相关因素的重要性及相互间的影响还需要进行深入分析.期望将来通过对各种组织诱导因子及局部应用的免疫抑制缓释剂的研究,在同种异体气管移植的研究领域中取得新突破.     

思维导图在胸腔局部解剖教学中的有效运用及实效评估

正随着胸腔镜的推广和普及,胸腔镜手术已取代了越来越多的开放手术而成为主流。胸腔镜手术是"无手"的操作,没有手的触感,基本凭借图像的引导和器械完成,可能在临床上接触到的术式、操作和理念与书本里的知识大相径庭~([1]),当视野放大和集中在某个局部时,新手医生经常感到迷茫和不适应。鉴于此,胸腔局部解剖学的熟练掌握是初学者必备的基础,然而胸腔脏     

食管鳞癌中ABCG2和V-ATPase的表达及其临床意义

目的:探讨APT结合转运蛋白G家族2(ABCG2)、囊泡型H+-ATPase(V-ATPase)蛋白在食管鳞癌及其病理分级、TNM分期中表达的差异性和两蛋白表达相关性临床意义.方法:采用免疫组化免疫法检测ABCG2和V-ATPase在66例食管鳞癌中的表达,统计学分析表达的差异性及2蛋白表达相关性.结果:CG2和V-ATPase表达主要定位于胞膜和胞质中.ABCG2、V-ATPase总阳性率分别为66.67%、68.18%,在分级、TNM分期各三组间差异性均非常显著(P<0.01);ABCG2在分级、TNM分期各两组间比较除Ⅱb与Ⅲ分期组间外(P=0.341)差异性均显著(P均<0.01);V-ATPase在分级、TNM分期各两组间比较除Ⅱ与Ⅲ、Ⅱb与Ⅲ组间外(P>0.05)差异性均显著(P均<0.05).ABCG2、V-ATPase在转移组与非转移组间表达的差异性均很显著(P=0.000).在总的食管癌及其分级、TNM分期中ABCG2和V-ATPase的表达均有很好的相关性(P均≤0.001),相关系数rs均高于0.7.结论:ABCG2、V-ATPase在食管鳞癌中高表达,表达的高低与病理分级、TNM分期高低及转移与否有关联性,可能与耐药、转移有关;两种蛋白表达存在相关性,可能有相互作用的现象.     

汉中农村人口18年冠心病和脑卒中死亡率变动趋势

目的 :探讨冠心病和脑卒中的死亡率在汉中农村人口中的变动趋势。方法 :按照 WHO MONICA方案进行冠心病和脑卒中的死亡监测。结果 :18年间 （1983～ 2 0 0 0 ）冠心病的平均死亡率为 5 3.4 / 10万 ,呈明显下降的趋势 （P<0 .0 1） ,脑卒中的平均死亡率为 115 .9/ 10万 ,无明显下降的趋势 （P>0 .0 5 ） ,冠心病和脑卒中的死亡率有随着年龄的增加而上升的趋势 （P<0 .0 1） ,男性的死亡率显著高于女性 （P<0 .0 1）。结论 :汉中农村人口中冠心病和脑卒中的死亡率随年龄增大而增加 ,且男性高于女性 ,老年男性应是预防的重点人群。     

胸部爆震伤致兔急性呼吸窘迫综合征模型的建立及相关因素分析

目的 构建室内胸部爆震伤致兔急性呼吸窘迫综合征(ARDS)模型并分析其发生机制及早期死亡原因,为研究肺爆震伤早期预警体系和治疗方法提供依据.方法 按照不同炸药量和致伤距离所产生的压强,将60只新西兰大白兔按随机数字表法分为5个致伤组和1个无致伤对照组.伤后观察存活率和组织病理学,并监测病理生理学指标、肺含水量.结果 冲击波压强低于1 210.5 mm Hg(1 mm Hg=0.133 kPa,A、B组)时,肺损伤较轻,表现为点状肺挫伤,肺简明损伤评定分级法(ALS)均在2级内,动物伤后24 h内全部恢复,长期存活无并发症.冲击波压强高于2 036.1 mm Hg(D、E组)时,肺损伤过重,表现为广泛的肺挫伤、肺门撕裂伤和肺内大血肿,AIS均大于5级,动物于伤后1 h内全部死亡.冲击波压强为1 917.3 mm Hg(C组)时,肺表现为广泛而恒定的挫伤,累及4个肺叶以上,AIS 4～5级,伤后6 h内出现动脉氧分压下降;肺组织可见肺泡壁水肿,部分肺泡壁断裂,肺泡融合;肺泡内充满大量炎性细胞,偶见透明膜形成.与对照组比较,C组兔致伤6 h肺湿/干重比值即显著升高(6.46±0.24比3.98±0.19,P＜0.01),血浆及支气管肺泡灌洗液(BALF)中肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)即明显升高[血浆TNF-α(ng/L):328.89±6.26比62.12±2.98,BALF TNF-α(ng/L):164.87±4.59比29.51±1.12;血浆IL-6(ng/L):128.51±4.13比19.32±1.53,BALF IL-6(ng/L):94.97±1.14比22.72±0.19,均P＜0.05].结论 在1 917.3 mm Hg爆炸压强的密闭环境下,冲击伤可诱导兔发生ARDS;TNF-α及IL-6参与爆震伤致ARDS的形成与发展;特定环境下,肺脏破裂致气胸为早期死亡原因,而冲击波致循环系统功能紊乱也是引起早期死亡的重要原因.

Abstract：

Objective To reproduce acute respiratory distress syndrome (ARDS) model in rabbit induced by chest blast injury and to analyze the pathogenesis and causes of early death in order to provide the basis for the early diagnosis of lung blast injury and its early-warning system to facilitate an early treatment.Methods Sixty healthy New Zealand white rabbits were divided into six groups according to the different explosion distance with the random number table method. The survival rate and its resulting pathological changes were observed and patho-physiological indexes and lung fluid content were determined at sequential time points post-explosion. Results Shock wave pressure less than 1 210. 5 mm Hg (1 mm Hg=0. 133 kPa,group A, B) resulted in limited injury to the lung within grade-2 as assessed with the abbreviated injury scale (AIS). The rabbits in these groups recovered soon and survived without any complication. Shock pressure higher than 2 036. 1 mm Hg (group D, E) caused severe injuries to the lung, including deep laceration, disruption of lung hilus and large hematoma in the lung, and the injury severity of lungs was assessed above grade-5 as assessed with AIS. All rabbits died within 1 hour post-explosion. The groups described above failed to meet the demand of an ARDS model for the present study. Shock wave pressure at 1 917. 3 mm Hg (group C) produced extensive contusion from grade-4 to grade-5 as assessed with AIS. The rabbits survived in poor general condition, and arterial partial pressure of oxygen (PaO2) lowered within 6 hours. Pathological examination showed extensive and constant multi-focal bleeding involving more than four lobes. The alveolar wall was edematous, with partial rupture and alveolar fusion in lung tissues was observed in the group C. Alveoli were filled with inflammatory cells, and hyaline membrane was formed occasionally. Compared with control group, the wet to dry weight ratio (W/D) in lungs increased obviously (6.46±0. 24 vs. 3. 98±0. 19, P＜ 0. 01) in group C within 6 hours postinjury. The contents of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in plasma and bronchoalveolar lavage fluid (BALF) were also increased distinctly compared with the control group [TNF-α (ng/L) in plasma: 328. 89± 6.26 vs.62.12±2. 98, TNF-α (ng/L) in BALF: 164.87±4.59 vs. 29. 51±1.12; IL-6 (ng/L) in plasma: 128. 51±4.13 vs. 19.32±1.53: IL-6 (ng/L) in BALF: 94.97±1.14 vs. 22.72±0. 19, all P＜0. 05]. Conclusion In an airtight environment, rabbit ARDS model can be reproduced successfully by blast injury with 1 917.3 mm Hg explosion pressure; TNF-α and IL-6 are involved in the pathogenesis and development of ARDS in blast injury. Pneumothorax as a result of lung rupture is the chief reason for early death and dysfunction of circulatory system is also an important reason in producing early death.     

小儿原发性纵隔肿瘤和囊肿的诊治

目的 探讨小儿原发性纵隔肿瘤和囊肿的诊断及治疗.方法 回顾性分析79例小儿原发性纵隔肿瘤和囊肿的临床资料.所有病例均经手术和病理证实.结论 本组病例中,小儿原发性纵隔肿瘤和囊肿占同期我科收治的原发性纵隔肿瘤及囊肿的13.96%(79/566).其中神经源性肿瘤21.5%(18/79)、肠源性囊肿15.2%(12/79)、畸胎瘤17.7%(14/79),其他肿瘤和囊肿44.30%(35/79).无临床症状而于查体时发现12例,占15.19%.手术切除74例,手术切除率93.7%(74/79),经治疗后康复出院76例,死亡3例.结论 小儿纵隔肿瘤和囊肿的术前诊断依据胸部X线、CT扫描及超声检查,必要时可以结合MRI扫描判断病变范围,而确诊则依赖于术中所见及术后病理检查.其病情复杂,变化快,可危及患儿生命,除淋巴瘤外宜选手术治疗.

Abstract：

Objective To investigate the diagnosis and treatment of primary mediastinal tumors and cysts in children.Methods The data of 79 patients admitted from 1966 to 2009 with primary mediastinal tumors and cysts were retrospectively reviewed.All patients underwent surgery and pathological examination.Results The primary mediastinal tumors and cysts in children accounted for 13.96% of primary mediastinal tumors and cysts at the same period.In these 79 patients,neurogenic tumors were diagnosed in 18 (21.5%)patients,gastrointestinal cyst was 15.2%(12/79),teratoma was 17.7%(14/79),and the others were 44.30%(35/79).Twenty-two patients without clinical symptoms were diagnosed by health checkup,accounting for 15.2% in all cases.Tumors in 74 patients(93.7%)were resected,and the mortality rate was 3.8%(3/79).Conclusions The preoperative diagnosis of mediastinal tumors and cysts in children primarily bases on chest X ray,CT scan,ultrasonography,and MRI scan in some cases,but the final diagnosis depends on the intraoperative findings and pathologic examination.Except of lymphoma,primary mediastinal tumors and cysts should be treated by surgery appropriately.     

兔油酸ARDS模型72h内炎性因子及凝血情况分析

目的 探讨兔油酸(OA)急性呼吸窘迫综合征(ARDS)模型72 h内NF-κB、IL-10、GR、PT、APTT、Fib含量变化的意义.方法 健康新西兰大耳白兔30 只随机分为5组,每组6只,实验组(n=24)耳缘静脉注射油酸(0.1 mL/kg)建立ARDS模型,对照组(n=6)注射等量生理盐水.分别检测对照组6 h和实验组6、24、48、72 h(n=6)血浆和支气管肺泡灌洗液(BALF)核因子(NF-κB)、白细胞介素-10(IL-10)、糖皮质激素受体(GR)含量与血浆凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(Fib)的变化.结果 (1)注射油酸48 h内,实验组氧合指数PaO2/FiO2<200 mmHg达到ARDS的诊断标准;72 h后呼吸功能有所改善,PaO2/FiO2>200 mmHg达不到ARDS的诊断标准.(2)与对照组相比,各实验组血浆及支气管肺泡灌洗液NF-κB、IL-10、GR含量升高(P<0.05或P<0.01).肺泡灌洗液中NF-κB、IL-10、GR含量均比血浆中略低.(3)与对照组相比,OA 6、24 h 组PT明显增加(P<0.01);各实验组APTT均见明显升高(P<0.01),OA 6 h 组Fib明显降低(P<0.01).结论 兔油酸构建ARDS模型48 h内符合ARDS诊断标准,72 h后未能达到ARDS诊断标准.促炎/抗炎系统平衡可能影响ARDS的发展进程.ARDS时凝血功能下降.