计算机图像分析在评价大鼠急性胰腺炎模型病理变化中的应用

Objective To apply computer digital image analysis to evaluate pathologic changes in rat model with acute pancreatitis, and explore digitalization of the evaluating process. Methods The model was established by injection of 5% sodium taurocholate into the pancreatic duct of Sprague-Dawley rats. Rats were killed 3, 6, 12, 24, and 48 h after the surgery respectively. Paraffin-embedded sections were made and scanned by Virtual Microscopy system. Digital image analysis was applied to analyze necrosis, edema,hemorrhage and infiltration of inflammatory cells in pancreatic tissues. Results As compared with other groups, the pathologic changes of pancreatitis were significantly more severe in 48-h group [inflammatory cell number: (67.00 ±49.49)/200 × field;necrosis: (49.86±21.74)%;hemorrhage: (14 445. 60 ±6940. 35) μm2;edema: 9.58 ±0. 81;P<0. 05];Cohen's kappa statistics showed that digital image analysis had better inter-rater agreement than Schmidt' s evaluation (Kappa coefficient;0. 7vs0. 3). Conclusion Digital image analysis could improve the objectivity, accuracy, and inter-rater agreement in evaluating pathologic changes in rat model with acute pancreatitis.     

急性胰腺炎胰腺腺泡细胞胀亡和巨噬细胞激活的关系

Objective To study the relationship between the oncosis of pancreatic acinar cells and activa-tion of macrophage in rat model of acute pancreatitis (AP). Methods The pancreatic acinar cells were isolated by two-step enzyme digestion, and then they were divided into control group, AP group and test group. Pancreatic acinar cells were cultured with caerulein in AP group, with caerulein and endothelin in test group, and with culture medium in control group. The oncesis rate of the pancreatic acinar cells was detected after acridine orange and ethidium bromide fluorescent staining. The supernatant was collected to detect the release of amylase and lactate dehydrogenase (LDH). The macrophages were cultured with 1 ml of supematant for 6 hours, and then the protein level of tumor necrosis factor-α (TNF-α) was measured by ELISA. Results Few oncotic pancreatic acinar cells were observed in the control group, and the levels of amylase and LDH secreted by pancreatic acinar cells and TNF-α secreted by macrophage were (1175±165)kU/L, (846±118)U/L and (36±5)μg/L, respectively. Oncotic pancreatic acinar cells were observed in AP group, and the levels of amylase, LDH and TNF-α were (7130±680) kU/L, (4262±626) U/L and (155±18) μg/L, respectively, which were significantly higher than those in control group (t = 5.184, 4.277, 3.665, P < 0.05). The levels of amylase, LDH and TNF-α were even higher in test group, and they were (9240±1177) kU/L, (6937±893)U/L and (268±35)μg/L, respectively, which were significantly higher than those in AP group (t = 2.251, 2.825, 2.843, P < 0.05). Conclusions The release of amylase was changed as the oncosis of pancreatic acinar cells occurred. The secretion of TNF-α was along with the degree of oncosis of pancreatic acinar cells. The results of the study indicate that a relationship exists among the inflammatory response of macrophage, the release of contents of pancreatic acinar cells and the oncosis of the pancreatic acinar cells.     

雾化吸人利多卡因对哮喘大鼠肺组织热休克蛋白70、核因子κB表达的影响

Objective To observe the effect of aerosolized lidocaine inhalation on expression of HSP70 and NF-ΚB in lung of asthma rat model. Methods Thirty two Wistar rats were randomly assigned to four groups (n=8 each): control group( group A), asthma model group(group B),dexamethasone group(group C)and lidocaine group(group D). The rats in group B were sensitized by injection of ovalbumin(OA )together with aluminum hydroxide as adjuvants, followed by aerosolized OA challenge two weeks later. The rats in group C and D were sensitized with OA as group B, but exposed to 0.02% aerosol of dexamethasone and 0.04% aerosol of lidocaine 20 ml respectively. In group A saline was used instead of OA. In 24 hours after the last challenge, the lungs were removed for microscopic examination, determination of W/D lung weight radio, the expression of HSP70 and NF-ΚB was studied immunohistochemically.Results①The W/D lung weight radio were 4.08±0.16,3.54±0.10 and 3.66±0.12 respectively in group B,C,D,more than the group A with 3.30±0.12. ② The pulmonary expression of HSP70 were 0.210±0.018,0.138±0.010 and 0.154±0.012 respectively in group B,C,D, higher than the group A with 0.049±0.015. ③The pulmonary expression of NF -KB were 0.199±0.029,0.132±0.010 and 0.150±0.017respectively in group B, C, D, higher than the group A with 0.056±0.022. ④Compared with the group B, the W/D lung weight radio and pulmonary expression of HSP70 and NF -ΚB in group C and D were significantly down -regulated. In animals with asthma the bronchial walls were significantly thicker with inflammatory cell infiltration. Dexamethasone or lidocaine aerosolized inhalation significantly attenuated the pathologic changes induced by asthma. Conclusion Aerosolized lidocaine inhalation has a protective effect on airway inflammation and histology damages resulting from aeroallergen challenge in the asthma model of Wistar rats.     

雾化吸人利多卡因对哮喘大鼠肺组织热休克蛋白70、核因子κB表达的影响

Objective To observe the effect of aerosolized lidocaine inhalation on expression of HSP70 and NF-ΚB in lung of asthma rat model. Methods Thirty two Wistar rats were randomly assigned to four groups (n=8 each): control group( group A), asthma model group(group B),dexamethasone group(group C)and lidocaine group(group D). The rats in group B were sensitized by injection of ovalbumin(OA )together with aluminum hydroxide as adjuvants, followed by aerosolized OA challenge two weeks later. The rats in group C and D were sensitized with OA as group B, but exposed to 0.02% aerosol of dexamethasone and 0.04% aerosol of lidocaine 20 ml respectively. In group A saline was used instead of OA. In 24 hours after the last challenge, the lungs were removed for microscopic examination, determination of W/D lung weight radio, the expression of HSP70 and NF-ΚB was studied immunohistochemically.Results①The W/D lung weight radio were 4.08±0.16,3.54±0.10 and 3.66±0.12 respectively in group B,C,D,more than the group A with 3.30±0.12. ② The pulmonary expression of HSP70 were 0.210±0.018,0.138±0.010 and 0.154±0.012 respectively in group B,C,D, higher than the group A with 0.049±0.015. ③The pulmonary expression of NF -KB were 0.199±0.029,0.132±0.010 and 0.150±0.017respectively in group B, C, D, higher than the group A with 0.056±0.022. ④Compared with the group B, the W/D lung weight radio and pulmonary expression of HSP70 and NF -ΚB in group C and D were significantly down -regulated. In animals with asthma the bronchial walls were significantly thicker with inflammatory cell infiltration. Dexamethasone or lidocaine aerosolized inhalation significantly attenuated the pathologic changes induced by asthma. Conclusion Aerosolized lidocaine inhalation has a protective effect on airway inflammation and histology damages resulting from aeroallergen challenge in the asthma model of Wistar rats.     

SURGICAL TREATMENT OF PAIN IN CHRONIC PANCREATITIS： STUDIES OF 111 PATIENTS

Objective Evaluation of the efficacy of pancreatic resections for the treatment of chronic pains during chronic pancreatitis. Methods Retrospective study of inpatients for chronic pan- creatitis between 1982 to 2000. Purpose of admission, morphological changes, treatments and results were evaluated. Results 142 patients were admitted for chronic pancreatitis. 111 patients suffered from chronic pains, due to morphological changes such as pseudocysts, inflammatory masses in the head, dilated pancreatic ducts, biliary or duodenal compressions. Denervations were never efficient, pancreatic resections achieved relief of pain in up to 75% of cases and drainages were efficient in 52% of cases. Conclusions Pancreatic resections during chronic pancreatitis seem to be the most efficient treatment of chronic pains. New techniques such as duodenum-preserving head resection or total pancreatectomy with islet autotransplantation should improve these results.     

大黄素诱导细胞凋亡对不同类型急性胰腺炎腺泡死亡方式的影响

Objective To investigate the effect of Chinese medicine emodin on death patterns of pancreaticacinar cells in different types of aute pancreatitis and explore its possible mechanism. Methods Rat acute edematous pancreatitis models and acute necrotic pancreatitis models were estab-lished and treated with emodin. Alternations of apoptosis, NF-κB mRNA, Pax mRNA and TNF-α mRNA expression in pancreatic tissue were studied with in situ TUNEL and RT-PCR. Results Nega-tive correlation was found between apoptosis and the severity of pancreatic damage. Following the treatment with emodin, more apoptosis than necrosis was observed in all treaded groups of acute pan-creatitis and the severity of pancreatic histological pathologic damage was dramatically improved. Local expression of NF-κB mRNA and Bax mRNA increased. Conclusion Pancreas aeinar death patterns of apoptosis are induced by emodin. Emodin might regulate the acinar cell death patterns by changing the activation of NF-κB and the expression of bax to lessen the severity.     

大黄素诱导细胞凋亡对不同类型急性胰腺炎腺泡死亡方式的影响

Objective To investigate the effect of Chinese medicine emodin on death patterns of pancreaticacinar cells in different types of aute pancreatitis and explore its possible mechanism. Methods Rat acute edematous pancreatitis models and acute necrotic pancreatitis models were estab-lished and treated with emodin. Alternations of apoptosis, NF-κB mRNA, Pax mRNA and TNF-α mRNA expression in pancreatic tissue were studied with in situ TUNEL and RT-PCR. Results Nega-tive correlation was found between apoptosis and the severity of pancreatic damage. Following the treatment with emodin, more apoptosis than necrosis was observed in all treaded groups of acute pan-creatitis and the severity of pancreatic histological pathologic damage was dramatically improved. Local expression of NF-κB mRNA and Bax mRNA increased. Conclusion Pancreas aeinar death patterns of apoptosis are induced by emodin. Emodin might regulate the acinar cell death patterns by changing the activation of NF-κB and the expression of bax to lessen the severity.     

大黄辅助早期肠内营养对急性坏死性胰腺炎病程影响的研究

Objective To investigate the effect of rhubarb assisted early enteral nutrition (EEN) on acute necrotizing pancreatitis(ANP) in rats. Methods A total of 48 Wistar rats were ran-domized into 4 groups(n=12) including ANP group (group A), rhubarb group (group B), EEN group (group C) and rhubarb assisted EEN (RAEEN) group (group D). The rats in group B, C and D were infused with rhubarb, enteral nutrient solution and enteral nutrient solution plus rhubarb by enteral nutrient canal after establishing the model, respectively. The remaining living animals in each group were sacrificed 48 hours after ANP models were developed to determine the tumor necrosis fac-tor-alpha (TNF-α), endotoxin, D-lactate, maleic dialdehyde (MDA), angiotensin Ⅱ (Ang Ⅱ) in ser-um. The intestinal secretory IgA (SIgA), the amount of ascitic fluid and the wet-dry weight ratio of ileum, the pancreatic Myeloperoxidase (MPO) activity as well as the wet-dry weight ratio of pancreas were determined and the pathologic changes of pancreas were analyzed by histopathologic grading and scoring of the severity of pancreas. Results Compared with group A, group B, C and D had signifi-cant difference in every index (P<0. 05). Furthermore, compared with rhubarb and EEN, RAEEN significantly increased the level of intestinal SIgA but reduced the other data obviously (P<0. 05). Conclusion Administration of RAEEN can effectively protect the intestinal barrier function, improve the organismic immunity, inhibit the systemic inflammatory reaction and ameliorate the microcirculato-ry disorders in ANP. The combined strategy is more safe and effective than either one alone.     

大黄辅助早期肠内营养对急性坏死性胰腺炎病程影响的研究

Objective To investigate the effect of rhubarb assisted early enteral nutrition (EEN) on acute necrotizing pancreatitis(ANP) in rats. Methods A total of 48 Wistar rats were ran-domized into 4 groups(n=12) including ANP group (group A), rhubarb group (group B), EEN group (group C) and rhubarb assisted EEN (RAEEN) group (group D). The rats in group B, C and D were infused with rhubarb, enteral nutrient solution and enteral nutrient solution plus rhubarb by enteral nutrient canal after establishing the model, respectively. The remaining living animals in each group were sacrificed 48 hours after ANP models were developed to determine the tumor necrosis fac-tor-alpha (TNF-α), endotoxin, D-lactate, maleic dialdehyde (MDA), angiotensin Ⅱ (Ang Ⅱ) in ser-um. The intestinal secretory IgA (SIgA), the amount of ascitic fluid and the wet-dry weight ratio of ileum, the pancreatic Myeloperoxidase (MPO) activity as well as the wet-dry weight ratio of pancreas were determined and the pathologic changes of pancreas were analyzed by histopathologic grading and scoring of the severity of pancreas. Results Compared with group A, group B, C and D had signifi-cant difference in every index (P<0. 05). Furthermore, compared with rhubarb and EEN, RAEEN significantly increased the level of intestinal SIgA but reduced the other data obviously (P<0. 05). Conclusion Administration of RAEEN can effectively protect the intestinal barrier function, improve the organismic immunity, inhibit the systemic inflammatory reaction and ameliorate the microcirculato-ry disorders in ANP. The combined strategy is more safe and effective than either one alone.     

二氢青蒿素对胰腺癌生长的抑制作用

Objective To investigate the anti-tumor activity of dihydroartemisinin in pancreatic cancer in vitro and in vivo. Methods For cultured cells,cell growth was determined by the MTT assay and apoptosis was evaluated by flow cytometry analysis stained with Annexin V-FITG/PI. The protein expression in BxPC-3 cells was analyzed by Western blot assay. BxPC-3 cells were injected subcutaneously into nude mice to establish pancreatic xenograft tumors and the tumor volume was monitored after exposure to dihydroartemisinin. Ki-67 staining and TUNEL assay were used to assess tumor cell proliferation and apoptosis in tumor tissue. Results After treatment by dihydroartemisinin in vitro, the proliferative inhibition rates of pancreatic cancer cells BxPC-3 and AsPC-1 reached up to (76.2 ± 3.5) % and (79.5 ± 2.9) %, and the apoptosis rates were up to (55.5 ± 3.2)% and (40.0 ± 3.5)%, the differences were significantly (P ＜ 0.01) compared with control [(2.0 ± 1.3) % and (0.9 ± 0.4) %]. Dihydroartemisinin inhibited the growth of pancreatic xenograft tumors in nude mice. The proliferation index and apoptusis index were (49.1 ± 3.9)% and (50.2 ± 4.4)% respectively in dihydroarternisinin 50 mg/kg treatment group, compared to those of (72.1 ± 3.3) % and (9.4 ± 2.9) % in control, the differences were significantly (P ＜0.01). Western blot assay indicated that dihydroartemisinin up-regulates expression of proliferation-associated protein p21WAF1 and down-regulates expression of PCNA, increases expression of apoptosis-associated protein Bax and decreases expression of Bcl-2 and activates caspase-9 in BxPC-3 cells. Conclusions Dihydroartemisinin exerts anti-tumor activity in pancreatic cancer both in vitro and in vivo by proliferation inhibition and apoptusis induction. Dihydroartemisinin can be used as a potential anti-tumor drug in pancreatic cancer.     

目前国内普通外科临床科研中存在的主要问题

自1978年恢复研究生招生工作以来,同其他临床医学学科一样,普通外科的临床科研工作取得了长足进步,获得了一些有创造性的科研成果,为推动我国普通外科事业的发展作出了较大的贡献。近年,我国普通外科领域的科研论文数量增长较快,但不可否认的是,目前我国普通外科研究领域仍存在     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Changes in neuroendocrine elements in bronchial mucosa in chronic lung disease in adults.

BACKGROUND--It is not clear whether there is any association between metaplasia of the bronchial epithelium and changes in the distribution of neuroendocrine cells. This study examined, by immunohistological techniques, the distribution of neuroendocrine cells and juxtamucoscal nerve fibres in bronchial biopsies showing metaplastic changes. METHODS--Bronchial biopsies from 12 subjects with epithelial metaplasia associated with bronchiectasis and diffuse pulmonary fibrosis were examined by conventional light microscopy and immunohistological techniques for protein gene product 9.5 (PGP), chromogranin A and B (CAB), serotonin, vasoactive intestinal peptide (VIP), substance P (SP), calcitonin gene-related peptide (CGRP), calcitonin (CT), and gastrin releasing peptide (GRP). RESULTS--Regions of non-metaplastic epithelium contained numerous PGP and serotonin immunoreactive cells. Sub-populations of these cells displayed CAB, CGRP, CT, and GRP immunoreactivity. Metaplastic epithelium contained only a few weakly stained PGP, serotonin, CAB, GRP, CT and CGRP immunoreactive cells in six cases. Metaplastic epithelium was characterised by a high number of CAB-containing cells in six cases and in these biopsies prominent PGP-containing nerve bundles were seen in the subepithelial layer beneath the metaplastic epithelium. CONCLUSIONS--The distribution patterns of neuroendocrine cells and neuronal elements vary between areas of normal and metaplastic epithelium and within areas of metaplastic epithelium. Neuronal hyperplasia was associated with an increase in the number of CAB-containing cells within the metaplastic epithelium.     

Disparities in Amputations in Minorities

Background  

As a result of the impact of health disparities on the healthcare system such as their influence on arenas significant to healthcare distribution, including cost, quality, and access, identification and resolution of health disparities is a primary national agenda item. Resolution of disparities in amputation is an area of opportunity that warrants further consideration.