17 β雌二醇通过丝裂原活化蛋白激酶抑制前列腺癌细胞系PC3增殖

目的探讨丝裂原活化蛋白激酶在17β雌二醇(E2)抑制前列腺癌PC3细胞生长中的作用。方法检测不同浓度E2作用不同时间后PC3细胞生长抑制率。流式细胞仪分析细胞周期分布,TUNEL染色检测凋亡。Western blot检测ERK1/2,JNK和p38活性。RT-PCR法检测雌激素受体(ER)α、ERβ、P21WAF1和cyclinD1的表达。结果E2抑制PC3细胞增殖,并且可以激活ERK1/2、JNK和p38。处理因素作用48h后,对照组、E2、E2 PD98059、E2 SP600125、E2 SB203580组细胞的凋亡率分别为(0.9±0.1)%;(23.0±1.4)%;(30.0±1.2)%;(10.6±0.8)%和(14.6±0.7)%,(P<0.05)。E2使细胞阻滞在G1期,PD98059、SP600125、SB203580分别预处理1h后细胞分别进一步阻滞在G1期;轻度阻滞在G1期和进入S期。RT-PCR发现PC3细胞表达ERα和ERβ,E2、E2 PD98059、E2 SP600125、E2 SB203580组中cyclinD1、P21WAF1基因表达分别为对照组的(0.42±0.03)、(3.13±0.02)倍;(0.21±0.03)、(3.08±0.05)倍;(0.43±0.01)、(1.31±0.04)倍;(2.81±0.02)、(3.14±0.02)倍(P<0.05)。结论E2激活JNK增加P21WAF1基因表达,并激活p38抑制cyclinD1表达,使细胞阻滞在G1期,JNK和p38通路还介导E2引起PC3细胞凋亡。同时E2又可激活ERK1/2,轻度拮抗上述作用。     

瑞芬太尼对过氧化氢处理脐静脉内皮细胞的抗氧化应激作用

目的以人脐静脉内皮细胞为细胞模型,建立过氧化氢处理的氧化应激模型,研究瑞芬太尼的抗氧化应激保护机制,并确定信号转导通路。方法过氧化氢0.1mol/L孵育原代培养的人脐静脉内皮细胞,建立细胞损伤模型,然后进行瑞芬太尼保护及相关通路研究。实验共分为九组:空白对照组(C组)、过氧化氢组(H1组)、过氧化氢+SP600125组(H2组)、过氧化氢+SB203580组(H3组)、过氧化氢+PD98059组(H4组);过氧化氢+瑞芬太尼组(HR1组)、过氧化氢+瑞芬太尼+SP600125组(HR2组)、过氧化氢+瑞芬太尼+SB203580组(HR3组)、过氧化氢+瑞芬太尼+PD98059组(HR4组)。H1组、H2组、H3组和H4组仅进行MAPK通路阻断实验,HR1组、HR2组、HR3组和HR4组分别加入瑞芬太尼10ng/ml保护1h。随后分别检测超氧化物歧化酶(SOD)活性、丙二醛(MDA)含量及Caspase-3活性,观察瑞芬太尼抗氧化应激作用并初步确定转导通路;利用RT-PCR观察瑞芬太尼10ng/ml处理前后c-Jun的表达水平,确定转导通路的信号分子。结果H1、H2、H3、H4组SOD活性明显低于C组,MDA含量明显高于C组(P0.05);HR1组SOD活性明显高于H1组,MDA含量明显低于H1组(P0.05);HR2组与H2组SOD活性及MDA含量差异无统计学意义;HR3组SOD活性明显高于H3组,MDA含量明显低于H3组(P0.05);HR4组SOD活性明显高于H4组,MDA含量明显低于H4组(P0.05)。H1、H2、H3、H4组Caspase-3活性明显高于C组(P0.05)。H1组和HR1组c-Jun mRNA表达量明显高于C组,且HR1组明显低于H1组(P0.05)。结论瑞芬太尼10ng/ml可激活JNK通路及其下游信号分子c-Jun,上调SOD活性,降低MDA含量,进而起到抗氧化应激作用。     

p38MAPK信号转导通路在七氟烷后处理减轻乳鼠心肌细胞缺氧复氧损伤中的作用

目的 评价p38丝裂原活化蛋白激酶(p38MAPK)信号转导通路在七氟烷后处理减轻乳鼠心肌细胞缺氧复氧损伤中的作用.方法 健康新生SD大鼠,日龄1～3 d,处死后取心室肌组织,培养心肌细胞,随机分为7组:对照组(C组)于CO2培养箱中持续培养3 h;缺氧复氧组(AR组)细胞缺氧2 h,复氧1 h;七氟烷后处理组(SP组)细胞缺氧2 h,复氧开始即刻更换为3%七氟烷饱和的DMEM培养液,孵育20 min,再更换为无血清DMEM培养液,继续复氧40 min;七氟烷后处理+SB203580组(SP+SB组)于七氟烷后处理同时加入SB203580(p38MAPK特异性抑制剂)至5 μmol/L,孵育20 min;七氟烷后处理+二甲亚砜组(SP+DMSO组)于七氟烷后处理同时加入0.1%DMSO,孵育20 min;SB203580组(SB组)于复氧开始时加入SB203580至5 μmol/L,孵育20 min;二甲亚砜组(DMSO组)于复氧开始即刻加入0.1%DMSO,孵育20 min.各组细胞分别接种于24孔培养板(1 ml/孔)、35 mm培养皿(5 mlnd/皿)和50 ml培养瓶(8 ml/瓶)中,每组12孔、6皿和6瓶.于复氧结束后,采用比色法测定细胞培养液乳酸脱氢酶(LDH)活性;采用台盼蓝排斥实验测定细胞存活率;采用流式细胞仪测定细胞凋亡率;采用Western blot法测定磷酸化p38MAPK(p-p38MAPK)表达水平.结果 与C组比较,其余各组LDH活性升高,细胞存活率降低,细胞凋亡率升高,AR组、SP组、SP+SB组、SP+DMSO组和DMSO组p-p38MAPK表达上调(P<0.05);与AR组比较,SP组、SP+SB组和SP+DMSO组LDH活性降低,细胞存活率升高,细胞凋亡率降低,p-p38MAPK表达上调(P<0.05);与SP组比较,SP+SB组、SB组和DMSO组LDH活性升高,细胞存活率降低,细胞凋亡率升高,p-p38MAPK表达下调(P<0.05).结论 七氟烷后处理可通过激活p38MAPK信号转导通路减轻乳鼠心肌细胞缺氧复氧损伤.     

p38丝裂原活化蛋白激酶在罗哌卡因致SH-SY5Y细胞凋亡中的作用

目的 评价p38丝裂原活化蛋白激酶(p38MAPK)在罗哌卡因致SH-SY5Y细胞凋亡中的作用,以探讨罗哌卡因诱发神经毒性的机制.方法 采用随机数字表法,将SH-SY5Y细胞随机分为4组(n=18):正常对照组(C组)、10 μmol/L p38MAPK特异性抑制剂SB203580组(SB组)、3 mmol/L罗哌卡因组(R组)、10 μmol/L SB203580+3 mmol/L罗哌卡因组(SB+R组).C组在细胞培养液中继续培养；SB组在含10 μmol/L SB203580培养液中孵育；R组在含3 mmol/L罗哌卡因的培养液中孵育；SB+R组在含10 μmol/L SB203580的培养液中孵育30 min后,用含3mmol/L罗哌卡因的培养液继续孵育.各组细胞培养或罗哌卡因孵育4 h后采用流式细胞仪检测细胞内活性氧(ROS)水平和细胞凋亡率,采用Western blot法检测p38MAPK和磷酸化p38MAPK(p-p38MAPK)的表达,采用MTT法检测细胞活力.结果 与C组比较,R组和SB+R组ROS水平升高,p-p38MAPK表达上调,细胞活力降低,细胞凋亡率升高(P＜0.01),SB组上述指标差异无统计学意义(P＞0.05)；与R组比较,SB组p-p38MAPK表达下调,细胞活力升高,细胞凋亡率降低(P＜0.01).四组p38MAPK表达水平差异无统计学意义(P＞0.05).结论 罗哌卡因致SH-SY5Y细胞凋亡作用的机制部分与p38MAPK的激活有关.     

JNK和TGF-β信号途径协同介导CTGF在瘢痕疙瘩成纤维细胞中过度表达

目的:比较结缔组织生长因子(CTGF)在瘢痕疙瘩成纤维细胞(KF)和正常真皮成纤维细胞(NF)中的表达以及对血清刺激的反应;研究介导CTGF在KF中表达的信号途径.方法:在血清刺激前30 min给予小分子人工合成的信号通路抑制剂预处理,分别为:P13K抑制剂wortmannin(100nM);ERK抑制剂PD98059(50mM);p38 MAPK抑制剂SB203580(10mM);JNK抑制剂SP600125(25 mM);以及TGF-β I型受体抑制剂SB431542(0.1μM、0.5 μM、1μM和10 μM),空白对照组仅加入溶剂DMSO预处理.使用定量实时反转录聚合酶链反应比较CTGF在瘢痕疙瘩成纤维细胞(KF)和正常皮肤来源的成纤维细胞(NF)中的表达.结果:KF血清刺激后CTGF的表达迅速升高,而在NF血清刺激后仅少量上升.JNK抑制剂SP600125和TGF-β I型受体抑制剂SB431542对CTGF表达的升高具有显著的抑制作用(P＜0.05).结论:KF中的CTGF血清反应需要JNK和TGF-β信号途径的协同作用.     

p38MAPK信号通路在内毒素性休克诱发急性肺损伤大鼠肺组织HO-1表达上调中的作用

目的 评价p38丝裂原活化蛋白激酶(p38MAPK)信号通路在内毒素性休克诱发急性肺损伤大鼠肺组织血红素加氧酶-1(HO-1)表达上调中的作用.方法 雄性SD大鼠48只,8周龄,体重180～ 200g,采用随机数字表法,将其随机分为4组(n=12):对照组(C组)、内毒素性休克组(LS组)、内毒素性休克+ p38MAPK特异性抑制剂SB203580组(LSS组)和SB203580组(SB组).C组和SB组股静脉注射生理盐水0.5 ml;LS和LSS组股静脉注射LPS 10 mg/kg(溶于0.5ml生理盐水)；2h内MAP下降至基础值的75％时,C组和IS组股静脉输注10％二甲基亚砜0.1ml；LSS组和SB组股静脉输注SB203580 5 μmol/kg(溶于0.1 ml 10％二甲基亚砜),输注速率0.01 ml/min.给予LPS或生理盐水后6h时采集动脉血样,进行血气分析,计算氧合指数(PaO2/FiO2)；然后处死大鼠取肺组织,光镜下观察病理学结果,并进行病理学损伤评分,计算肺含水率,测定SOD活性、MDA含量、HO-1 mRNA及其蛋白、p38MAPK蛋白和磷酸化p38MAPK(p-p38MAPK)蛋白的表达.结果 与C组比较,IS组和LSS组氧合指数和SOD活性降低,病理学损伤评分、肺含水率和MDA含量升高,肺组织HO-1 mRNA及其蛋白和p-p38MAPK蛋白的表达上调(P＜0.05),p38MAPK蛋白表达差异无统计学意义,SB组各指标差异无统计学意义(P＞0.05)；与LS组比较,LSS组氧合指数和SOD活性升高,病理学损伤评分、肺含水率和MDA含量降低,肺组织HO-1 mRNA及其蛋白表达上调,p-p38MAPK蛋白表达下调(P＜0.05),p38MAPK蛋白表达差异无统计学意义(P＞0.05).结论 抑制p38MAPK信号通路可导致内毒素性休克诱发急性肺损伤大鼠肺组织HO-1表达上调.     

p38MAPK信号转导通路在大鼠内毒素性急性肺损伤中的作用

目的 探讨p38丝裂原活化蛋白激酶(p38MAPK)信号转导通路在大鼠内毒素性急性肺损伤中的作用.方法 成年雄性SD大鼠60只,体重180～230 g,采用随机数字表法,将大鼠随机分为4组:对照组(C组,n=6)、急性肺损伤组(ALI组,n=24)、p38MAPK特异性抑制剂SB203580+ALI组(SB+ALI组,n=24)和SB203580组(SB组,n=6).ALI组尾静脉注射内毒素5 mg/kg制备大鼠急性肺损伤模型,C组给予等容量生理盐水,SB+ALI组于注射内毒素前30 min经尾静脉注射SB20358010 mg/kg.ALI组和SB+ALI组于注射内毒素后1、3、6 h(T1-3)时随机取8只大鼠,C组和SB组分别于给予生理盐水、SB203580后1 h处死取肺组织,检测磷酸化p38MAPK(p-p38MAPK)蛋白表达.T3时回收支气管肺泡灌洗液(BALF),测定蛋白浓度.计算细胞凋亡指数,观察肺组织病理学结果.另取32只大鼠,采用随机数字表法,将大鼠随机分为2组(n=16):ALI组和SB+ALI组,观察48 h内大鼠生存情况.结果 与C组相比,ALI组和SB+ALI组BALF中蛋白浓度、细胞凋亡指数、肺组织p-p38MAPK蛋白表达水平升高(P＜0.05);与ALI组相比,SB+ALI组上述指标降低(P＜0.05).SB+ALI组病理学损伤程度较ALI组明显减轻.ALI组大鼠生存率较SB+ALI组降低(P＜0.01).结论 p38MAPK信号转导通路参与了大鼠内毒素性急性肺损伤的发生和发展,可能与肺组织细胞凋亡有关.

Abstract：

Objective To investigate the role of p38 mitogen-activated protein kinase (MAPK) signal transduction pathway in lipopolysaccharide (LPS)-induced acute lung injury (ALI).Methods Sixty male SD rats weighing 180-230 g were randomly divided into 4 groups: control group (group C, n = 6), ALI group ( n = 24),p38MAPK specific inhibitor SB203580 + ALI group (group SB + ALI, n = 24), SB203580 group (group SB,n =6). LPS 5 mg/kg was injected intravenously via tail vein in group ALI and SB + ALI, while the equal volume of normal saline was given instead in group C. Group SB + ALI received iv injection of SB203580 10 mg/kg via tail vein 30 min before LPS administration. Group SB received injection of SB203580. The rats were sacrificed at 1, 3 and6 h agter LPS administration (T1-3) in group ALI and SB + ALI (8 rats at each time point) andat 1 h after administration in C and SB groups. The lungs were immediately removed for microscopic examination and determination of phosphorylated p38MAPK (p-p38MAPK) expression, the concentration of protein in bronchoalveolar lavage fluid (BALF) and apoptotic index (AI). Another 32 rats were selected and randomly divided into 2 groups for survival study: ALI group and SB + ALI group ( n = 16 each), and then they were treated as mentioned above and observed for 48 h. Results The concentration of protein in BALF, AI and p-p38MAPK expression were significantly increased in group ALI and SB + ALI compared with group C, while decreased in group SB + ALI compared with group ALI ( P ＜ 0. 05 ). LPS-induced pulmonary histological changes were significantly attenuated in group SB + ALI compared with group ALI. The survival rate was significantly decreased in group ALI compgred with group SB + ALI ( P ＜ 0.01 ). Conclusion p38 MAPK signal transduction pathway is involved in LPS-induced ALI, which may be related to the apoptosis in the cells in the lung.     

氟比洛芬酯对大鼠机械通气所致肺损伤的影响

目的 探讨氟比洛芬酯对大鼠机械通气所致肺损伤的影响.方法 健康成年雄性SD大鼠40只,体重300～350 g,随机分为4组(n=10),常规潮气量通气组(TV组,潮气量8 ml/ks)、大潮气量通气组(HV组,潮气量40 ml/ks)、大潮气量通气+氟比洛芬酯5 ms/kg组(HV+F1组)和大潮气量通气+氟比洛芬酯10 mg/kg组(HV+F2组).HV+F1组和HV+F2组于机械通气前15 min时分别静脉注射氟比洛芬酯5、10 mg/ks.于机械通气4 h时处死大鼠,测定支气管肺泡灌洗液(BALF)肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、血栓素B2(TXB2)和总蛋白浓度,计数白细胞及计算肺组织湿/干重比(W/D),光镜下观察肺组织病理学结果.结果 与TV组相比,HV组BALF TNF-α、IL-6、TXB2、总蛋白浓度、白细胞计数和肺组织W/D升高(P<0.05),肺组织发生病理学损伤;与HV组相比,HV+F1组和HV+F2组BALF TNF-α、IL-6、TXB2、总蛋白浓度、白细胞计数和肺组织W/D降低(P<0.05),肺组织病理学损伤减轻;HV+F2组BALF TNF-α和TXB2浓度低于HV+F1组(P<0.05),其余指标差异均无统计学意义(P>0.05).结论 氟比洛芬酯可通过抑制炎性反应减轻大鼠机械通气所致肺损伤.     

MAPKs信号通路在内皮素-1诱导的牙周膜干细胞成骨分化过程中的作用研究

目的:研究丝裂原激活蛋白激酶(Mitogen-activated protein kinases,MAPKs)信号通路在内皮素-1(Endothelin-1,ET-1)诱导的牙周膜干细胞(Periodontal ligament stem cells,PDLSCs)成骨分化中的调控机制。方法:体外培养牙周膜干细胞,于ET-1处理前分别加入ERK通路抑制剂PD98059,JNK通路抑制剂SP600125,p38α通路抑制剂SB203580。以未作任何处理的牙周膜干细胞为空白对照,以单独加入抑制剂的牙周膜干细胞为阴性对照,用100nMET-1干预不同组牙周膜干细胞14d,通过实时定量PCR及Western blot技术检测细胞Runx2和OCN基因和蛋白的表达情况。结果:ET-1对牙周膜干细胞Runx2和OCN基因及蛋白表达具有显著促进作用,但PD98059抑制了ET-1对牙周膜干细胞Runx2和OCN表达的促进效应,而SP600125和SB203580的抑制作用不显著。结论:ET-1通过ERK信号通路调控牙周膜干细胞Runx2和OCN的表达。     

丝裂原蛋白激酶信号转导通路在机械通气相关性肺损伤中的作用

目的观察机械通气介导肺损伤（VILI）过程中丝裂原蛋白激酶（MAPK）的活性变化以及对细胞因子的影响，从中探讨VILI发生机制和MAPK的作用。方法72只SD大鼠随机分为未处理的对照组（不行机械通气）、正常通气组、过度通气组和采用MAPK抑制剂SP600125（JNK）、SB203580（p38）、PD98059（ERK）分别预处理上述3组。机械通气4h后取大鼠肺组织采用Western blot方法测定各组的总JNK、ERK、p-38蛋白激酶的表达及其磷酸化水平变化。同时以酶联免疫吸附试验（EUSA）方法测定大鼠肺组织、支气管肺泡灌洗液（BALF）和血浆中的肿瘤坏死因子-α（TNF-α）、巨噬细胞炎性蛋白-2（MIP-2）浓度。结果正常和过度机械通气4h后均能激活JNK、ERK、p38激酶，但以过度通气组为著（P〈0．01）。过度通气组大鼠肺组织、BALF、血浆中的TNF-α、MIP-2含量显著高于其他组（P〈0．01）。JNK、ERK、p38抑制剂显著降低肺组织、BALF中的TNF-α、MIP-2含量（P〈0．05或0．01），且JNK和ERK抑制剂作用强于p38抑制剂。结论过度机械通气激活了肺细胞中的JNK、ERK、p38激酶，且JNK、ERK、p38参与了VILI细胞因子的产生，即MAPK信号转导通路的激活可能是VILI发生机制之一。     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.