多节孢属Nodulisporium sp.真菌中一个新的生物碱类化合物

多节孢属真菌代谢产物结构多样。该研究通过正相硅胶色谱、反相制备液相色谱等方法,从一株多节孢属真菌的固体发酵提取物中分离鉴定4个代谢产物,包括1个新化合物;根据理化性质和波谱数据,分别鉴定为2-羟基-1,1-二甲基-1,2,3,9-四氢-4H-咔唑-4-酮(1)、酪醇(2)、羟基酪醇(3)和羟基酪醇乙酸酯(4),其中1为新化合物。     

Notch2基因在大鼠肝移植术后胆管损伤中的表达及其意义

目的 探讨大鼠肝移植术后损伤胆管中Notch 2基因的表达及其意义.方法 将96只健康雄性SD大鼠随机分为3组,A组:未手术组;B组:假手术组;C组:采用改良"二袖套"法建立大鼠肝移植.于术后1、7、14、28 d检测总胆红素(TBIL)、γ-GT、谷丙转氨酶(ALT),同时处死大鼠取肝组织,苏木素-伊红(HE)染色观察病理改变,免疫组织化学、Western blot检测Notch 2基因的表达.结果 大鼠肝移植术后TBIL(32.05±3.28)μmol/L,γ-GT(118.30±17.40)μmol/L明显升高(P＜0.05),HE染色显示损伤胆管增生(14 d),部分胆管破坏、消失(28 d).免疫组织化学显示,A和B组胆管细胞Notch 2染色阴性,C组胆管细胞Notch 2染色强阳性,Western blot检测显示Notch 2蛋白在C组肝组织中呈逐渐升高的强表达(P＜0.05).结论 大鼠肝移植术后随胆管损伤加重,Notch 2基因表达显著升高,该基因可能参与了胆管损伤.

Abstract：

Objective To investigate the expression and clinical significance of Notch 2 expression in postoperative injured bile duct of rat liver transplantation. Methods Ninety-six healthy male SD rats were divided into three groups randomly: un-operation group (A), Sham operation group ( B), and group of liver transplantation model by modified "two-muff" techniques (C). Total bilirubin (TBIL), γ-GT and alanine aminotransferase (ALT) were determined at 1st, 7th, 14th, 28th day after transplantation and the expression of Notch 2 in the liver was detected by immunohistochemisty and Western blotting at the same time. Results TBIL (32. 05 ±3. 28) μmol/L, and γ-GT ( 118.30 ± 17.40) μmol/L were increased obviously after liver transplantation ( P ＜ 0. 05 ). Hematoxylin-eosin ( HE ) staining showed the injured bile ducts obviously proliferated after 14 days, and partly posttransplanted bile ducts were destructed and vanished after 28 days. Immunohistochemisty revealed that Notch 2 staining in bile ducts was negative in groups A and B, but Notch 2 staining in hyperplasitic bile ducts was strong positive in group C. Western blotting confirmed that Notch 2 protein was upregulated gradually in the damaged bile ducts after rat liver transplantation (P ＜ 0. 05 ). Conclusion Bile duct injury is aggravated after rat liver transplantation, and Notch 2 gene expression is up-regulated remarkably.     

腹股沟疝传统修补术与疝环充填式无张力疝修补术、平片式无张力疝修补术的临床对比

腹股沟疝的手术治疗经历了传统疝修补术、低张力疝修补术、无张力疝修补术几个阶段，现在无张力疝修补术已在国内外普及。主要有平片修补（Lichtenstein）、疝环充填式修补（mesh—plug＆patch）以及双层补片修补技术（Gilbert）等。这些技术均获得了非常满意的治疗效果。我国自1997年开始推广无张力疝修补术，以疝环充填式无张力疝修补术为主要术式。本文通过对传统疝修补术、平片无张力疝修补术、充填式无张力疝修补术治疗腹股沟疝的术后效果进行对比研究，旨在探求选择更合理的个体化腹股沟疝手术治疗方法。     

Cdc42基因在表皮生长因子促进HepG2细胞丝状伪足形成中的作用

目的:探讨表皮生长因子(EGF)对HepG2细胞丝状伪足形成和细胞体外侵袭能力的影响以及细胞分裂周期蛋白42(Cdc42)在其中的作用.方法:将Cdc42 siRNA转染HepG2细胞株,RT-PCR和Western blot检测EGF组、EGF+siRNA干扰组、siRNA干扰组及空白对照组细胞Cdc42 mRNA转录以及蛋白的表达水平,微丝绿色荧光探针(actin-tracker green)染色检测HepG2细胞丝状伪足形成,侵袭小室检测细胞体外侵袭能力.结果:经EGF处理后HepG2细胞可见明显丝状伪足形成,EGF组细胞Cdc42 mRNA及总蛋白(Total-Cdc42)表达量无显著变化,但活性Cdc42(Active-Cdc42)显著增高(0.713±0.021vs0.423±0.015,P<0.05),siRNA干扰细Cdc42表达及活性受到明显抑制(0.118±0.017 vs 1.128±0.024;0.351±0.021 vs 0.936±0.024,均P<0.05),并抑制EGF诱导的细胞丝状伪足形成,EGF组细胞体外侵袭能力显著高于其余各组(98.43+3.11vs61,09±3.58,50.53±2.34,62.73±2.64,均P<0.05).结论:EGF通过激活Cdc42诱导HepG2细胞丝状伪足形成并增强其体外侵袭能力.     

Initial 12-h operative fluid volume is an independent risk factor for pleural effusion after hepatectomy

Pleural effusion after hepatectomy is associated with significant morbidity and prolonged hospital stays. Several studies have addressed the risk factors for postoperative pleural effusion. However, there are no researches concerning the role of the initial 12-h operative fluid volume. The aim of this study was to evaluate whether the initial 12-h operative fluid volume during liver resection is an independent risk factor for pleural effusion after hepatectomy. In this study, we retrospectively analyzed clinical data of 470 patients consecutively undergoing elective hepatectomy between January 2011 and December 2012. We prospectively collected and retrospectively analyzed baseline and clinical data, including preoperative, intraoperative, and postoperative variables. Univariate and multivariate analyses were carried out to identify whether the initial 12-h operative fluid volume was an independent risk factor for pleural effusion after hepatectomy. The multivariate analysis identified 2 independent risk factors for pleural effusion: operative time [odds ratio (OR)=10.2] and initial 12-h operative fluid volume (OR=1.0003). Threshold effect analyses revealed that the initial 12 h operative fluid volume was positively correlated with the incidence of pleural effusion when the initial 12-h operative fluid volume exceeded 4636 mL. We conclude that the initial 12-h operative fluid volume during liver resection and operative time are independent risk factors for pleural effusion after hepatectomy. Perioperative intravenous fluids should be restricted properly.     

胆道高压对Oddi括约肌动力学的影响

目的和方法：探讨胆道压力对Ｏｄｄｉ括约肌的影响和急性梗阻性化脓性胆管炎（ＡＯＳＣ）时胆道高压的形成机制，采用家兔复制急性胆道盲囊加压模型。结果：胆道加压至８ｋＰａ（６０ｍｍＨｇ）的数分钟内，Ｏｄｄｉ括约肌电活动明显增强；Ｏｄｄｉ括约肌压力显著升高（Ｐ＜００５），甚至出现持续痉挛；同时伴有右内脏大神经放电频率增强和动脉血压的进行性下降（Ｐ＜００５）。而用０６％利多卡因阻滞右腹腔神经丛后，再行胆道加压则以上反应不能发生。若在加压后行腹腔神经丛阻滞术，Ｏｄｄｉ括约肌收缩或痉挛也可逐渐缓解。结论：急性胆道梗阻可能诱发Ｏｄｄｉ括约肌收缩增强，使胆道内压进一步升高，形成恶性循环，机制可能与内脏神经活动有关     

胆道高压对内脏大神经的影响及其意义

为了探讨胆道高压对内脏大神经的影响及其在重症急性胆管炎(ACST)发病机理中的意义。本实验采用自制“盲囊”加压装置制成家兔急性胆道加压模型,同步动态记录内脏大神经放电频率和血压变化,结果表明:在150mmHg(20kPa)加压条件下,内脏大神经放电频率于1分钟内即明显增加(P<0.01),且右侧远较左侧明显(P<0.01),同时血压也明显下降(P<0.01)。如迅速减压,则放电频率和血压均在短期内恢复至加压前水平。阻断右侧内脏大神经,则血压下降不明显(P>0.05)。实验结果提示,内脏大神经活动与重症急性胆管炎早期的血压下降有关,值得深入探讨。     

Mirizzi综合征的术前诊断与治疗

目的：探讨Mirizzi综合征的术前诊断和有关治疗方法。方法：结合前人资料及临床病例对Mirizzi综合征的临床特征及治疗手段进行总结，根据Mirizzi综合征分类对不同类型Mifizzi综合征的治疗方案的选择。结果：所有病人术后都无胆漏及胆管狭窄等严重并发症。结论：Mirizzi综合征是可以在手术之前进行诊断的，而不同类型的Mirizzi综合征可有不同的治疗方案，Mirizzi综合征并不是腹腔镜手术的绝对禁忌证。     

纳米技术介导的光动力疗法治疗肝细胞癌的研究进展

肝脏恶性肿瘤包括原发性和转移性肿瘤,肝细胞癌又是肝脏恶性肿瘤中最常见的类型。然而,目前临床上常用的治疗手段在提高不宜手术的晚期肝细胞癌患者生存率方面取得的进展有限。因此,肝细胞癌的临床治疗除了手术、放化疗、经动脉化疗栓塞治疗、射频消融治疗、介入治疗、靶向治疗以及免疫治疗外,急需一种新的治疗方式。光动力疗法(PDT)是治疗晚期癌症的一种新策略,其为患者提供了一种微创、低毒副作用的潜在治疗方法,且在整个治疗过程是无痛、可重复的。因此,光动力疗法被认为是治疗晚期肝细胞癌的有效姑息疗法。纳米技术介导的光动力治疗可以有效的提高光敏剂在体内的靶向性,从而提高治疗效果。本文就纳米技术介导的光动力治疗在肝细胞癌中的应用作一综述。     

肝切除术后胆漏危险因素的多元回归分析北大核心CSCD

目的探讨肝切除术后并发胆漏的危险因素。方法前瞻性的收集和回顾性分析我院2011年1月至2012年12月469例肝切除患者的临床资料,利用单因素回归分析筛选肝切除术后胆漏的相关因素,再用多元回归分析法对相关因素进行分析,明确独立危险因素。结果469例肝切术患者中术后胆漏106例,占22．6％。经单因素分析术后胆漏相关因素,包括男性、门静脉高压、脂肪肝、肝硬化、Child分级、术前腹水、手术时间、手术日总输液量、术中失血量、肝门阻断时间、术中微波热凝、术中淋巴结清扫、肝肿瘤数量、肿瘤边界、肿瘤包膜、肿瘤直径大小、肿瘤侵犯血管和腹腔引流管数量。多元回归分析发现,肝硬化[OR=13．2（2．3,76．9）,P=0．004]、脂肪肝[OR=73．1（17．7,301．5）,P〈0．001]、手术日总输液量[OR=1．0（1．0,1．0）,P=0．019]和肿瘤最大直径[OR=1．2（1．1,1．3）P=0．003]是术后胆漏的独立危险因素。结论肝硬化,脂肪肝,手术日总输液量,和肿瘤最大直径是肝切除术后胆漏的独立危险因素。