胰腺癌组织中Bax蛋白和Fas抗原表达及意义

目的研究胰腺癌组织中Ｂａｘ蛋白和Ｆａｓ抗原的表达及意义。方法ＡＢＣ免疫组织化学法。结果胰腺癌３９例中Ｂａｘ蛋白阳性１８例（４６％）和Ｆａｓ抗原阳性２２例（５６％）;高分化（７／２０,８／２０）、组织学分级Ⅰ级（４／１５,５／１５）和未转移（７／２０,８／２０）的胰腺癌Ｂａｘ蛋白和Ｆａｓ抗原阳性率明显低于低分化（１１／１９,１４／１９）、组织学分级Ⅲ级（７／９,８／９）和转移（８／１３,１０／１３）的胰腺癌（Ｐ均＜００５）。结论Ｂａｘ蛋白和Ｆａｓ抗原可能是反映胰腺癌生物学行为和预后的重要标记物,阳性表达者可能恶性度高和预后不良     

类风湿关节炎与骨性关节炎成纤维样滑膜细胞蛋白酪氨酸磷酸化状态的比较

目的 比较类风湿关节炎（ｒｈｅｕｍａｔｏｉｄ ａｒｔｈｒｉｔｉｓ,ＲＡ）与骨性关节炎（ｏｓｔｅｏａｒｔｈｒｉｔｉｓ,ＯＡ）成纤维样滑膜细胞（ｆｉｂｒｏｂｌａｓｔ－ｌｉｋｅ ｓｙｎｏｖｉｏｃｙｔｅｓ,ＦＬＳ）蛋白酪氨酸磷酸化状态的差异。方法滑膜细胞原代培养,流式细胞仪鉴定滑膜细胞型别,提取蛋白进行ＳＤＳ－ＰＡＧＥ单向电泳和ＩＣＥ－ＰＡＧＥ双向电泳分离后,应用抗蛋白酪氨酸磷酸化抗体进行ｗｅｓｔｅｒｎ ｂｌｏｔ检测。结果 滑膜细胞原代培养至第三代时,ＣＤ３、ＣＤ１４、ＣＤ２０、ＣＤ１１ｂ、ｖｏｎ Ｗｉｌｌｉｂｒａｎｄ ｆａｃｔｏｒ阳性细胞比例小于１％,ＲＡ ＦＬＳ蛋白酪氨酸磷酸化程度是ＯＡ ＦＬＳ的４～６倍。结论 滑膜细胞原代培养至第三代时即可以获得型别均一的ＦＬＳ,ＲＡ ＦＬＳ酪氨酸磷酸化程度较ＯＡ ＦＬＳ明显增     

家族性腺瘤性息肉病

作者单位自１９８５年１１月至１９９６年１１月，共收治家族性腺癌性息肉病（ＦＡＰ）１２例，其中６７％有明确家族史，５８％单例息肉＞１００个，ＦＡＰ癌变率为１７％。同时报告一个三代２４口人中９人患ＦＡＰ的典型家系，其ＦＡＰ癌变率６７％。作者分析了ＦＡＰ的遗传倾向与ＦＡＰ分布的关系，指出通过先证者（Ｉｎｄｅｘｃａｓｅ）普查ＦＡＰ患者的重要性。作者强调ＦＡＰ有明确的癌变遗传基础。所以ＦＡＰ的癌变与息肉大小无关，而是一种特定区域性的必然的癌变时相。对于ＦＡＰ外科手术方式，作者提倡无会阴部痛苦的全结肠、直肠切除，永久性回肠造口术。作者对本组病例的遗传倾向、息肉癌变特点及外科手术方式进行了分析讨论。     

血小板激活因子对急性重型胰腺炎肺损伤作用的实验研究

目的　探讨血小板激活因子（ Ｐｌａｔｅｌｅｔ Ａｃｔｉｖａｔｉｎｇ Ｆａｃｔｏｒ, Ｐ Ａ Ｆ） 在急性胰腺炎肺损伤发生发展中的作用。 方法　１７ 只纯种 Ｂｅａｇｌｅ 狗分成三组：（１） 胰腺炎组（ Ｐ 组） ,用牛磺胆酸钠加胰蛋白酶主胰管逆行注射,复制急性胰腺炎模型;（２） 治疗组（ Ｔ 组） ,模型复制后５ 分钟,３ 小时分别静脉注射苦杏内酯 Ｂ（ Ｂ Ｎ５２０２１） ;（３） 对照组（ Ｃ 组） 。分别测定平均肺动脉压值,肺湿重系数,支气管肺泡灌洗液（ Ｂｒｏｎｃｈｉａｌ Ａｌｖｅｏｌａｒ Ｌａｖａｇｅ Ｆｌｕｉｄ , Ｂ Ａ Ｌ Ｆ） 内细胞总数和蛋白含量,肺血管外水量／ 无血干肺重（ Ｅｘｔｒａ Ｖａｓｃｕｌａｒ Ｌｕｎｇ Ｗａｔｅｒ ／ Ｂｌｏｏｄ Ｆｒｅｅ Ｄｒｙ Ｌｕｎｇ , Ｅ Ｖ Ｌ Ｗ／ Ｂ Ｆ Ｄ Ｌ） ,肺组织内 Ｐ Ａ Ｆ含量。 结果　平均肺动脉压值 Ｐ组明显升高,在４ 小时与 Ｃ组、 Ｔ组差异均有显著意义（ Ｐ＜ ００５） 。 Ｐ组肺系数〔（１１２ ±００６） ％ ,珋ｘ ±ｓ ,以下同）〕, Ｅ Ｖ Ｌ Ｗ／ Ｂ Ｆ Ｄ Ｌ（５５９ ±０５３） 及 Ｂ Ａ Ｌ Ｆ中细胞总数〔（２０３ ±００２） ×１０９／ Ｌ〕和蛋白含量〔（４４７ ±     

APTT监测体外循环后肝素中和与反跳

目的：评价激活部分凝血活酸疼时间（ＡＰＴＴ）用于监测体外循环后肝素中和与反跳。方法：择期风心病瓣膜替换术病人２０例，ＣＰＢ后于不同时点测定激活部分凝血活酶时间〖ＡＰＴＴ）和激活全血凝固时间（ＡＣＴ）。结果：鱼精蛋白／肝素为０．５：、和１：１拮抗后ＡＰＴＴ值依次缩短（Ｐ〈０．０５），ＡＣＴ值无明显改变；０．５：１和０．７：１拮据的血浆经体外滴定后，ＡＰ化：１拮抗后３小时和５小时有２例ＡＰＴＴ值明显延     

急性脊髓损伤后磁刺激运动诱发电位及体感诱发电位的诊断意义

目的 研究磁刺激运动诱发电位（ｍｏｔｏｒ ｅｖｏｋｅｄ ｐｏｔｅｎｔｉａｌｓ,ＭＥＰ）对脊髓损伤（ｓｐｉｎａｌ ｃｏｒｄ ｉｎｊｕｒｉｅｓ,ＳＣＩ）后运动传导功能的诊断价值。方法 采用Ｍａｇ－２型磁刺激仪对３２例ＳＣＩ患者进行经颅磁刺激ＭＥＰ检查,分别在双侧外展拇短肌（ａｂｄｕｃｔｏｒ ｐｏｌｌｉｃｉｓ ｂｒｅｖｉｓ,ＡＰＢ）和胫前肌（ａｎｔｅｒｉｏｒ ｔｉｂｉａｌｉｓ,ＡＴ）进行记录。同时检测Ｆ     

凋亡相关基因产物Fas/APO-1和bcl-2蛋白在肾癌组织中的表达及意义

目的研究凋亡相关基因Ｆａｓ／ＡＰＯ－１和ｂｃｌ－２在肾癌发生发展中的作用。方法采用免疫组织化学法对３５例肾癌组织和２６例远离肾癌的正常肾组织Ｆａｓ／ＡＰＯ－１和ｂｃｌ－２蛋白的表达进行检测。结果肾癌组织Ｆａｓ／ＡＰＯ－１蛋白表达率为５７．１４％，明显低于正常肾组织中的表达率（８４．６２％，Ｐ＜０．０５），且表达强度也明显低下；而ｂｃｌ－２蛋白表达率为８０．００％，明显高于正常肾组织中的表达率（５３．８５％，Ｐ＜０．０５）。结论Ｆａｓ／ＡＰＯ－１与ｂｃｌ－２基因共同参与了肾癌的发生和发展。     

不饱和脂肪酸在抗炎症反应中的作用

目的探讨不饱和脂肪酸（ＵＦＡｓ）在炎症反应中的预防作用。方法应用大鼠盲肠结扎穿孔法制作炎症反应模型,研究ＵＦＡｓ对动物细胞膜的影响。结果ＵＦＡｓ明显降低炎症动物磷脂酶Ａ２（ＰＬＡ２）的活力（Ｐ＜０．０５）,恢复膜磷脂（ＰＬ）成分和花生四烯酸（ＡＡ）含量（Ｐ＜０．０１）,降低膜脂相变温度（Ｔ）,增加膜脂流动性（Ｐ＜０．０１）。ＵＦＡｓ减少炎症动物血浆及细胞培养液中的炎性介质（Ｐ＜０．０１）,减轻自由基对细胞膜的损伤（Ｐ＜０．０５）。结论术前给炎症大鼠口服鱼油能减轻动物的炎症反应,表明ＵＦＡｓ对炎症反应有预防作用。     

富含谷氨酰胺二肽的新型氨基酸对全肠外营养短肠综合征大？…

目的 观察富含谷氨酰胺二肽的新型氨基酸对Ｗｉｓｔａｒ大鼠短肠模型血清蛋白和肝功能的影响及探讨其减轻脂肪乳剂引起肝损害的作用机制。方法 ３０只Ｗｉｓｔａｒ雄性在鼠随机分为富含谷氨酰胺二肽新型氨基酸组（２０ＡＡ组）、标准组（１７ＡＡ组）、无氮组,观察不同组动物之间血清总蛋白、白蛋白、前白蛋白（ｐｒｅ－ａｌｂｕｍｉｎ,ＰＡ）、纤维结合蛋白（ｆｉｂｒｏｎｅｃｔｉｎ,ＦＮ）以及丙氨酸转氮酶和胆红素的变化。结     

苯那普利对糖尿病大鼠肾皮质血小板衍化生长因子—B及其β受体 …

目的 探讨血管紧张素转换酶抑制剂（ＡＣＥＩ）苯那普利对单侧肾切除糖尿病大鼠肾皮质血小板衍化生长因子－Ｂ（ＰＤＧＦ－Ｂ）及其β受体表达的影响。方法 苯那普利治疗４周后应用荧光分光光度法检测各组血浆和肾皮,髓质ＡＣＥ活性;用免疫组织化学方法检测肾皮质Ⅳ型胶原,纤维连接蛋白（ＦＮ）及ＰＤＧＦ－Ｂ蛋白表达。用Ｎｏｒｔｈｅｒｎ和Ｗｅｓｔｅｒｎ杂交检测肾皮质ＰＤＧＦ－ＢｍＲＮＡ及细胞膜ＰＤＧＦ－β受体蛋白表达     

Combined molecular and clinical approaches for the identification of families with familial adenomatous polyposis coli

OBJECTIVE: Using an interdisciplinary clinical and molecular approach, the authors identified APC germline mutations in families with familial adenomatous polyposis (FAP). Correlation of mutation site with disease manifestation and the impact of molecular data on clinical proceedings were examined. SUMMARY BACKGROUND DATA: Germline mutations in the APC gene predispose to FAP. Established and proposed genotype-phenotype correlations as well as the influence of mutation site on surgical procedures have been reported. The predictive value of APC mutation analysis for disease manifestation and therapeutic decision making needs to be investigated further. METHODS: One hundred twenty-three kindreds of the local FAP registry were included in this study. CHRPE phenotype was defined as at least one large characteristic lesion or a total of four lesions in both eyes. APC mutations were identified by protein truncation test and automated DNA sequencing from patient lymphocyte DNA and RNA. RESULTS: APC germline mutations were identified in 85/123 families with FAP. They were located between codons 213 and 1581 of the APC gene and displayed distinct genotype-phenotype correlations. CHRPE status facilitated mutation analysis by discriminating regions of interest within the APC coding region. Severe manifestations of desmoids were restricted to mutations between codons 1444 through 1581. Whereas 91% (75/82) of at-risk persons were excluded as mutation carriers, APC germline mutations were detected before clinical examination in 9% (7/82) of at-risk persons. One patient agreed to endoscopy only after mutation detection. CONCLUSIONS: This study supports the feasibility of combined molecular and clinical screening of families with FAP and may provide a guideline for routine presymptomatic molecular diagnostics in a clinical laboratory.     

Familial adenomatous polyposis predisposes to pathologic exposure of the stomach to bilirubin

BACKGROUND: The role of duodenogastric reflux in the genesis of gastric polyps in familial adenomatous polyposis (FAP), although suggested by scintigraphy scanning studies, remains unclear. METHODS: Twenty-four hour intragastric bilirubin monitoring with the Bilitec optoelectronic device was carried out in 25 FAP patients, of whom 19 had gastric polyps (fundic gland in 13, adenomatous in 2, and both histologic types in 4) on endoscopic examination. Gastric exposure to bilirubin was expressed as the percentage of total recording time that absorbance exceeded the threshold of 0.25 and was calculated in reference to values obtained from 25 healthy volunteers. Helicobacter pylori status of the stomach was checked as well. RESULTS: Gastric exposure to bilirubin was pathologic in 14 (56%) patients. Gastric exposure to bilirubin was of longer duration in FAP patients than in healthy volunteers (mean+/-SEM: 19%+/-4% vs 6%+/-2%) (P<.005). It increased from healthy volunteers (6%+/-2%) to FAP patients without gastric polyps (10%+/-3%), and to FAP patients with gastric polyps (22%+/-5%) (P<.004). Bilirubin exposure times were similar in FAP patients with fundic gland polyps only and in those having either adenomatous polyps only or both types of polyps (24%+/-7% vs 17%+/-4%). No patient with pathologic gastric exposure to bilirubin as well as none having gastric polyps, had H. pylori in the antrum. CONCLUSIONS: This study shows that gastric exposure to bilirubin is of longer duration in FAP patients than in healthy volunteers, and in FAP patients with gastric polyps than in those without polyps. This study supports the existence of a direct correlation between pathologic duodenogastric reflux (DGR), the absence of H. pylori in the antrum, and the presence of gastric polyps in FAP patients.     

Familial adenomatous polyposis coli in South Africa--molecular basis and diagnosis.

OBJECTIVE: To determine the molecular basis and establish a routine molecular diagnostic service for familial adenomatous polyposis coli (FAP) families in South Africa. DESIGN: The coding region of the adenomatous polyposis coli (APC) gene in affected FAP kindreds was screened using heteroduplex analysis, single-strand conformation polymorphism analysis and the protein truncation test. SETTING: Department of Human Genetics, University of Stellenbosch, and the Cancer Research Campaign Laboratories, Department of Pathology, University of Edinburgh and Molecular Medicine Centre, Western General Hospital, Edinburgh, Scotland (academic visit of 6 months). SUBJECTS: FAP-affected individuals and at-risk family members in 28 apparently unrelated South African families. RESULTS: A total of nine different APC mutations was identified, allowing DNA-based diagnosis in 20 families. Three of these mutations have not been described previously in other populations. CONCLUSION: Pre-symptomatic diagnosis using direct mutation detection is cost-effective and surgical intervention has the potential to prevent cancer in at-risk individuals from FAP families.     

家族性腺瘤性息肉病17例的诊断与外科治疗

目的：总结家庭性腺瘤性息肉病（FAP）的诊断和外科治疗经验。方法：回顾分析17例FAP的临床病理资料。结果：17例患者中男7例，女10例，平均年龄23．8岁，良性13例，平均年龄19．6岁，癌变4例，平均年龄37．8岁，13例有家庭史。家系调查发现1个家系至少有2例患者，最多可达7例，其中，6个家系中有7人已死于息肉癌变，全部患者均施行了全结肠切除，并分别采用回肠造口，回肠储袋，回肠肛管吻合等术式，随访2－20年，13例良性患者均存活。其中1例术后5年发生癌变，癌变者中1例术后5年发生肺部转移，行肺叶切除术后2年死亡，1例术后3年因广泛转移死亡，另2例为术后2年和6年，仍存活 。结论：FAP易癌变应尽早手术，手术宜选全结肠切除，直肠粘膜剥脱，回肠储袋，回肠肛管吻合术。     

腹腔镜全结肠切除术在家族性腺瘤性结肠息肉病及溃疡性结肠炎中的临床应用

目的:探讨腹腔镜全结肠切除术在家族性腺瘤性结肠息肉病(familial adenomatous polyposis,FAP)及溃疡性结肠炎(ulcerative colitis,UC)治疗中的应用价值。方法:回顾分析2009～2012年为12例患者行腹腔镜全结肠切除术(FAP患者7例,UC患者5例)及18例传统开腹全结(直)肠切除术(FAP患者7例,UC患者11例)的临床资料。结果:腹腔镜组在切口长度、术中出血量、术后止痛药使用量、术后排气时间、拔除导尿管时间、术后住院时间等方面优于开腹组,住院总花费明显高于传统开腹手术。结论:腹腔镜全结肠切除术用于FAP及UC安全、可行,与传统开腹手术相比,具有患者创伤小、康复快等优点,手术效果不亚于传统开腹手术,具有较高的临床应用价值。     

Prä- und postoperative Lebensqualität von Patienten mit Colitis ulcerosa und familiärer adenomatöser Polyposis bei ileoanaler Pouchoperation

After ileal pouch-anal anastomosis in patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP), in addition to postoperative morbidity and functional outcome quality of life is a relevant factor for assessment of the operation's success. Between 1982 and 1997 restorative proctocolectomy was performed in 602 patients (UC: n = 424; FAP: n = 178) at the Department of Surgery, University of Heidelberg. The assessment of pre- and postoperative quality of life was done through a prospective study (before restorative proctocolectomy, before and 1 year after closure of ileostomy). This study (UC: n = 27; FAP: n = 7) revealed a poor preoperative quality of life in patients with ulcerative colitis. Proctocolectomy is the decisive factor for the improvement of quality of life in the surgical treatment in UC. Quality of life could not be further significantly improved by ileostomy closure. Before proctocolectomy, FAP patients showed a quality of life, activity and function similar to that of healthy controls. In FAP patients proctocolectomy led to a significant loss of quality of life. This loss could only partly be regained by ileostomy closure. Quality of life and activity comparable to that of healthy controls can be achieved in UC patients by restorative proctocolectomy.     

Long-term outcome of familial adenomatous polyposis patients after restorative coloproctectomy

BACKGROUND: Restorative proctocolectomy (RPC) eliminates the risk of colorectal adenocarcinoma in familial adenomatous polyposis (FAP) patients, but desmoid tumors, duodenal, and ileal adenomas can still develop. Our aim was to assess the long-term outcome of FAP patients after RPC. PATIENTS AND METHODS: FAP patients who had RPC between 1983 and 1990 were contacted for interview and upper gastrointestinal (GI) and ileal pouch endoscopy. RESULTS: Sixty-two males and 48 females had undergone hand-sewn RPC during this period. One patient died postoperatively (0.9%). Among 96 patients available for a minimal follow-up of 11 years, 7 patients died: 3 from causes unrelated to FAP, 2 from metastatic colorectal cancer, and 2 from mesenteric desmoid tumor (MDT). Thirteen patients had a symptomatic MDT (13.5%). Of 73 patients who had an upper GI endoscopy, 52 developed duodenal and/or ampullary adenomas. Four patients required surgical treatment of their duodenal lesions. Among 54 patients who underwent ileal pouch endoscopy, pouch adenomas were noted in 29. No invasive duodenal or ileal pouch carcinoma were detected. Functional results of RPC were significantly worse in MDT patients. CONCLUSIONS: RPC eliminates the risk of colorectal cancer, and close upper GI surveillance may help prevent duodenal malignancy. MDTs are the principal cause of death, once colorectal cancer has been prevented, and the main reason for worsening functional results.     

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目的 探讨暴发性急性胰腺炎(FAP)早期治疗的效果。方法 2000年1月至2002年3月收治FAP25例。试用非手术和早期手术疗法进行治疗并观察疗效。结果 单纯非手术疗法3例无存活；非手术疗法结合血液通过3例存活1例；非手术治疗无效作早期手术9例存活8例；血滤后手术治疗10例存活7例。总体生存率为64％(16／25)。结论 FAP早期手术治疗能防止MODS的继续发展，采用血滤等综合治疗能为手术和术后恢复创造条件。     

Morbidity of percutaneous tube thoracostomy in trauma patients.

OBJECTIVES: This prospective study was designed to evaluate the complications of percutaneous tube thoracostomy (PTT) performed for chest trauma in our institution and to determine predictive factors. METHODS: One hundred and thirty-four primary PTTs were performed in 128 patients for blunt (83) and penetrating (45) chest traumas. Failure was defined as undrained hemothorax or pneumothorax, post-tube removal complications and empyema. Univariate and multivariate hazard analyses were used to assess the association between potential risk factors and complications. RESULTS: The overall complication rate was 25% including 30 (23%) failures and nine (7%) improper placement with iatrogenic injuries to the lung (n = 4) or subclavian vein (n = 1). Complications were managed with 18 repeat PTTs and ten early thoracotomies for clotted hemothorax (two), persistent air leak (two), fluid collection (three) or a combination (three) at a mean delay of 6.5 +/- 2.4 days. Failure of additional PTT required late decortication for empyema (three) or decortication (three) at a mean delay of 23 +/- 7 days. One patient died postoperatively, the only death directly related to PTT failure among the four (3.1%) deaths that occurred in this study. Hospital length of stay was significantly increased in patients with PTT failure (24 +/- 19 vs. 15 +/- 8 days in uncomplicated PTT, P = 0.004). By univariate analysis, polytraumatism (relative risk (RR) 2.7, P < 0.05), the need for assisted ventilation (RR 2.7, P = 0.003) and tube insertion by emergency physicians (RR 8.7, P < 0.0001) were significantly associated with increased incidence of complications in blunt trauma. Multivariate analysis identified the performance of the procedure by operators other than thoracic surgeons and residents trained in thoracic surgery as the only independent risk factor in both blunt and penetrating trauma (RR 58 and 71, respectively, P < 0.00001). CONCLUSIONS: PTT is associated with significant morbidity and extended hospitalizations, partly related to inappropriate training of all individuals dealing with trauma care. Additional training should be recommended and some conventional indications for PTT should be revised. A prospective study is currently in progress to evaluate the benefit of early videothoracoscopy in trauma and failure of primary PTT.     

暴发性胰腺炎手术指征及手术时机的探讨

目的：探讨暴发性胰腺炎（FAP）的手术指征及最佳手术时机。 方法：回顾性分析2004年8月—2012年8月收治32例接受手术治疗的FAP患者临床资料。 结果：32例FAP患者在不同情况下接受手术治疗,其中13例在最大限度ICU治疗10~14 d后,多器官功能障碍持续存在无好转;8例在最大限度ICU治疗3~5 d后多器官功能无好转,且迅速恶化;11例腹室高压经过一系列非手术治疗后仍持续维持在30 cmH2O（1 cmH2O=0.098 kPa）以上。全组治愈率为78.1%（25/32）,病死率为21.9%（7/32）。19例获随访4~50个月,其中5例患者术后出现胰腺假性囊肿,二次手术治疗治愈。 结论：在进行最大限度ICU治疗后多器官功能仍无好转或进一步恶化,或腹室高压经非手术治疗后仍持续不降的FAP患者,应采取积极手术干预。