左肺反向循环逆转终末期肺动脉高压

目的 探讨反向肺循环逆转终末期肺动脉高压的机制.方法 选杂种犬30只,随机分成正常对照组(n=10)、肺动脉高压组(n=10)和肺高压反向组(n=10).观察各组的血流动力学参数、动脉血气、外周血一氧化氮(NO)、一氧化氮合酶(eNOS)、内皮素及其肺组织mRNA表达的变化.结果 终末期肺高压模型犬上行左肺反向循环手术后,平均肺动脉压(MPAP)降低[(17.3±3.5)mm Hg,P<0.01],但与正常犬MPAP[(12.6±4.2)mm Hg]相比仍偏高(P<0.05);动脉血氧分压上升到(96.5±6.4)mm Hg(P<0.01),血浆中eNOS升高[(1.53±0.56)μg/ml,P<0.01],NO分泌量增加[(36.25±6.94)μmol/L,P<0.01],ET的含量减少[(21.37±3.82)pg/ml,P<0.01].eNOS-mRNA在术后表达上调,PEET-mRNA在肺高压时表达上调,而在术后表达下调.结论 左肺反向循环具有可行性,可能通过转换血气交换的解剖位置、提高血氧含量、抑制血管收缩因子的产生,增加血管舒张因子的产生降低肺动脉高压.     

G蛋白不同亚型在严重烫伤小鼠补体活化巨噬细胞分泌功能中的作用

目的观察严重烫伤后活化的补体对小鼠腹腔巨噬细胞(PM)分泌一氧化氮(NO)和肿瘤坏死因子(TNF)α的影响,探讨信号传递途径中不同G蛋白亚型的作用。方法血浆采集分组:补体血浆组,采用小鼠18%TBSAⅢ度烫伤模型;去补体血浆组,先在小鼠腹腔注射眼镜蛇毒素因子(CVF)去补体后再按上述标准烫伤。伤后6h分别收集两组小鼠全血制备血浆,用于培养正常小鼠的PM及经抑制型G蛋白(Gi)阻断剂百日咳毒素(PT)预处理的PM、经刺激型G蛋白(Gs)激活剂霍乱毒素(CT)预处理的PM,观察各组细胞培养上清液中NO及TNF-α含量的变化。结果补体血浆组培养上清液中的NO和TNF-α含量分别为(80±12)μmol/L和(46±6)%,明显高于去补体血浆组的(34±5)μmol/L和(26±5)%(P<0.01).PT预处理后补体血浆组PM产生的NO明显下降[(45±10)μmol/L,P<0.01],而TNF-α活性[(58±10)%]增加(P<0.05),CT预处理后补体血浆组PM产生的NO增加[(105±18)μmol/L,P<0.05],TNF-α的活性[(27±6)%]降低(P<0.01).结论严重烫伤后活化补体引起PM分泌NO和TNF-α增多这一现象,至少部分是通过G蛋白途径实现的。其中对PM生成NO的调控主要是通过Gi蛋白途径发挥作用,对PM分泌TNF-α的调控则以Gs蛋白信号通路为主。     

极化液对严重烫伤伴多器官功能障碍综合征大鼠炎性细胞因子水平及预后的影响

目的观察早期极化液治疗对烫伤伴多器官功能障碍综合征(MODS)大鼠炎性细胞因子水平及预后的影响,探讨其防治机制。方法将120只SD大鼠造成30%TBSAⅢ度烫伤,伤后2h腹腔注射内毒素,制作烫伤伴MODS大鼠模型,随机分为极化液组、葡萄糖组和盐水组,每组40只。观察3组大鼠伤后1~7d血浆中血糖、乳酸、肿瘤坏死因子α(TNF-α)、一氧化氮(NO)以及白细胞介素6(IL-6)含量的变化;并计算伤后7d内各组大鼠的死亡率。结果极化液组大鼠伤后1~7d血糖、乳酸、TNF-α、IL-6和NO含量均明显低于其他组(P<0.01),伤后6~7d其TNF-α、IL-6和NO含量达到最低值,分别为(2.37±0.54)μg/L、(0.28±0.17)μg/L及(29±9)μmol/L;葡萄糖组血糖、乳酸含量明显高于盐水组(P<0.01),而两组TNF-α、IL-6和NO含量相近(P>0.05).极化液组伤后7d内死亡率为20.0%,明显低于葡萄糖组与盐水组(分别为37.5%、47.5%,P<0.05).结论极化液通过改善烫伤引起的糖代谢障碍,降低机体炎性细胞因子水平,可作为防治烫伤伴MODS的辅助措施。     

吸入伊洛前列素和一氧化氮治疗先天性心脏病术后肺动脉高压

目的 探讨吸入伊洛前列素对先天性心脏病(CHD)术后早期机械通气和持续吸入一氧化氮(NO)的基础上,仍合并肺动脉高压(PH)病儿的疗效及对预后的影响,并初步探讨其作用机制.方法 30例CHD根治手术后在机械通气和持续一氧化氮(NO)吸入的基础上仍合并PAH的病儿,随机分为试验(T)组和对照(C)组.在原治疗基础上,T组给予伊洛前列素100 ng·kg-1·min-1,吸入10 min,C组给予0.9%NaCl 4ml吸入.每4h一次,连续治疗48 h.超声和心电监测观察病儿的血流动力学和呼吸机条件的改变.对比首次吸药前后血浆环磷酸腺苷(cAMP)和环磷酸鸟苷(cGMP)浓度变化.结果 T组停止吸入伊洛前列素后20min,肺动脉收缩压(sPAP)和肺动脉收缩压/主动脉收缩压(sPAP/sBP)明显下降,分别为:(43.23±11.72)mm Hg(1 mm Hg=0.133 kPa)和0.48±0.13,均小于C组(53.13±13.60)mm Hg和0.60 ±0.15,P<0.05.停止吸药120 min,T组sPAP/sBP仍然小于C组(0.48±0.09对0.59±0.14,P<0.05).连续治疗24 h和48 h,T组sPAP和sPAP/sBP继续下降,均明显小于C组(P<0.01).停止首次吸药后20 min,T组cAMP(578.68±193.05)pg/dl较治疗前(406.64±179.18)pg/dl明显升高(P<0.01),也明显大于C组(392.26±94.46)pg/dl(P<0.01).C组2例因肺高压危象(PHC)死亡,T组无死亡.结论 CHD双心室矫正术后早期机械通气和持续吸入NO仍合并PH病儿,吸入伊洛前列素后可明显降低sPAP和sPAP/sBP.伊洛前列素可能减少肺高压危象(PHC)导致的死亡.其扩血管作用可能与血浆cAMP浓度升高有关.     

红景天对大鼠动脉内皮细胞及阴茎海绵体平滑肌细胞NO生成作用的研究

目的探索中药红景天有效成分—红景天甙在促进NOS的活性及增加老龄大鼠阴茎组织NO含量中的作用。方法通过对不同年龄大鼠主动脉内皮细胞(RAEC)和大鼠阴茎海绵体平滑肌细胞(RPCSMC)的培养及鉴定,综合运用不同方法测定NO、NOS在不同细胞、不同年龄阶段、不同药物干预浓度和时间作用下的表达。结果以48h为例,2、8、12月龄大鼠阴茎海绵体平滑肌细胞NO含量和NOS活性以及大鼠动脉内皮细胞NO含量和NOS活性间存在显著差异(P<0.01)。在红景天有效药物作用浓度(2.5mg)和有效作用时间(48h、12月龄为72h)下,老龄大鼠(8、12月龄)RPCSMC和RAEC释放NO的量(97.677±5.153)μmol/L,(97.457±3.594)μmol/L及(98.248±5.0851)μmol/L和NOS的量(1.778±0.066)U/mL,(1.738±0.074)U/mL,(1.773±0.044)U/mL和(1.792±0.046)U/mL,较正常年龄(2月龄)大鼠NO和NOS的量还略有升高(P<0.01)。结论(1)阴茎组织中海绵体平滑肌细胞中存在大量NOS,说明阴茎勃起与其自身海绵体产生NO有关;(2)年龄相关性ED与NOS不断减少从而引起NO释放减少密切相关;(3)红景天对AEC及SMC产生NO有积极促进作用,特别是对老龄大鼠细胞作用显著。     

先心病肺高压病儿血浆内皮素与肺组织Ⅰ、Ⅲ型胶原含量的相关研究

目的探讨先天性心脏病(先心病)肺动脉高压病儿血浆内皮素-1(ET-1)和胶原增生的相互关系及其在先心病肺动脉高压形成中的作用.方法 20例左向右分流型先心病病儿分为肺动脉高压组(PH组)和无肺动脉高压组(对照组),用放射免疫学方法测定两组病儿血浆ET-1水平,用SDS-间断聚丙烯酰胺凝胶电泳(SDS-PAGE)测定肺组织I、III型胶原含量.结果与对照组相比,PH组血浆ET-1水平和肺组织I、III型胶原含量明显增加(P＜0.01).PH组血浆ET-1水平与肺组织I、III型胶原含量呈显著正相关.结论先心病肺动脉高压的形成可能与ET-1水平升高,诱导肺组织I、III型胶原增生有关.     

HHcy ED大鼠血浆内Hcy的含量对阴茎海绵体CO/HO-2影响的研究

目的:研究高同型半胱氨酸血症(HHcy)勃起功能障碍大鼠体内一氧化碳/血红素加氧酶2(CO/HO-2)体系的变化。方法:雄性4周龄Wistar大鼠40只,体重280～310 g,正常喂养1周后,随机分为正常对照组(A组,10只),余30只给予3%蛋氨酸饲料4周后,测定尾静脉血Hcy,将Hcy>16.0μmol/L的大鼠确定为HHcy,由此确定造模成功。将模型组随机均分为B组(HHcy大鼠模型组,继续给予3%蛋氨酸饲料喂养),C组(HHcy盐酸甜菜碱治疗组,每天继续给予3%蛋氨酸饲料喂养,下午定时给予60 mg/kg甜菜碱,0.3 ml生理盐水溶液灌胃)和D组[每日给与锌卟啉IX腹腔内注射45μmol/(kg.d)],4周后处死大鼠提取标本血检测Hcy含量、阴茎海绵体中Hcy的含量及阴茎组织CO测定。分别于4周和8周2个时间点进行阿朴吗啡实验。结果:比较4组大鼠血浆Hcy浓度、阴茎勃起次数、阴茎海绵体组织CO浓度及阴茎组织血管中HO-2阳性细胞数量的检测结果,与A组[(12.55±0.82)μmol/L、(1.88±0.05)次、(10.55±1.73)μmol/L、6 059±1 257]比较,B组[(25.01±0.94)μmol/L、(0.70±0.05)次、(9.51±1.52)μmol/L、2 595±514]血浆中Hcy水平显著上升(P<0.05),阴茎勃起次数、CO的含量与HO-2阳性细胞均下降(P<0.05或P<0.01),并且Hcy与阴茎勃起次数呈负相关性(P<0.01);C组[(14.37±0.47)μmol/L、(1.18±0.08)次、(10.36±1.56)μmol/L、6 295±1 156]与B组比较,阴茎海绵体内Hcy含量下降,而CO与HO-2含量明显升高,阴茎勃起次数明显升高,有统计学意义(P<0.05或P<0.01)。结论:阴茎海绵体中的CO含量及阴茎海绵体HO-2表达减低可能是导致HHcy大鼠勃起功能障碍的原因之一。甜菜碱降低血浆Hcy浓度,增加阴茎海绵体中CO含量,是治疗HHcy勃起功能障碍的机制之一。     

硝普钠在预防肺缺血再灌注损伤中的作用及机制

目的探讨硝普钠在预防肺缺血再灌注损伤中的作用及其机制。方法将14头猪随机平均分为对照组和实验组。对照组:在去除肺动脉阻断,恢复自体血流前,给予控制性再灌注[用35℃-37℃再灌注液(去白细胞:改良Buckberg液=4:1),灌注压18 mm Hg,灌注时间10min]。实验组:在去除肺动脉阻断,恢复自体血流前,给予控制性再灌注;后经肺动脉注入硝普钠1.0μg·kg-1·min-1 ×10min。0.5、1和2 h后测两组的血氧分压、肺血管阻力、肺顺应性及肺氧合功能变化;实验结束后,取肺组织测一氧化氮(NO)含量、丙二醛(MDA)含量及肺含水量。结果实验组的左肺氧合功能和肺顺应性明显好于对照组(P<0.05)。肺循环阻力、MDA含量及肺含水量均低于对照组(P <0.01)。实验组和对照组肺组织中NO含量分别为:(114.41±6.77)μmol/L和(56.67±7.42) μmol/L,实验组较对照组明显升高(P<0.01)。结论硝普钠可使肺组织中NO含量显著升高,有效的预防了肺缺血再灌注损伤。     

重组人内皮型一氧化氮合酶基因转染对增生性瘢痕成纤维细胞的影响

目的 了解重组人内皮型一氧化氮合酶(eNOS)基因转染人增生性瘢痕成纤维细胞(HSFb)的可行性,以及转染后一氧化氮(NO)的生成和Ⅰ、Ⅲ型胶原的合成情况. 方法体外构建人eNOS真核表达载体.取体外培养的人HSFb进行转染实验,根据细胞培养液中所加质粒不同分为pcDNA3.0空载体组、pcDNA3.0-eNOS转染组.另设未转染组,细胞按常规培养.采用实时荧光定量PCR法检测各组细胞eNOS及Ⅰ、Ⅲ型胶原mRNA表达.硝酸还原酶法测定NO含量. 结果细胞转染后eNOS显著表达,pcDNA3.0-eNOS转染组eNOS mRNA相对表达量为5.92±0.21,明显高于pcDNA3.0空载体组(0.98±0.13,P<0.05);pcDNA3.0-eNOS转染组Ⅰ型胶原mRNA相对表达量为0.76±0.15,Ⅲ型胶原mRNA相对表达量为0.79±0.08,均明显低于pcDNA3.0空载体组(0.98±0.15、1.02±0.12,P<0.05).pcDNA3.0-eNOS转染组NO含量为(36.1±0.8)μmol/L,明显高于pcDNA3.0空载体组(28.4±1.0)μmol/L和未转染组[(27.7±1.3)μmol/L,P<0.01]. 结论 HSFb可作为eNOS基因转染的靶细胞,转染的细胞能表达eNOS并产生NO,并且对细胞的胶原合成功能有抑制作用.     

室间隔缺损伴肺动脉高压患者血浆内皮素、一氧化氮与肺细小动脉形态变化的关系

目的　探讨内皮素 ( ET- 1)、一氧化氮 ( NO)在肺动脉高压 ( PH)发生、发展过程中的作用。　方法　 60例室间隔缺损患者分为两组 ,无 PH组 :2 0例 ,不合并 PH,平均肺动脉压 ( MPAP) <2 0 mm Hg( 1k Pa=7.5 mm Hg) ;PH组 :4 0例 ,合并 PH,MPAP>2 0 mm Hg。测定两组血浆 ET- 1和 NO含量 ,作肺组织活检 ,观察肺血管的病理改变及测定肺细小动脉显微形态指标。　结果　全部肺标本按阮英茆的 级分类进行病理分级 :无 PH组患者肺血管无明显病理改变 ,PH组患者 级 7例、 级 13例、 级 2 0例 ,未见 级病理改变。随着肺血管病理改变分级的增加 ,血浆ET- 1、NO、血流动力学指标及肺细小动脉显微形态指标测定均呈阶梯样变化 ,除 NO、血管腔面积 /血管总面积 ( EA/ TA)逐渐减小 ,其它指标均逐渐增高 ,ET- 1、NO、MPAP、肺血管阻力 ( PVR)、肺细小动脉中膜厚度 ( m MTPA)、血管壁面积 /血管总面积 ( WA/TA)、EA/ TA和肌型肺细小动脉 /微动脉总数的比值 ( TWPV) ,无 PH组与 PH组 级、PH组 级与 级、 级与 级之间差别均有显著性意义 ( P<0 .0 5 ,0 .0 1) ;血浆 ET- 1与 MPAP、PVR、m MTPA、WA/ TA和 TWPV均呈显著正相关 ,血浆 NO均呈显著负相关 ;血浆 ET- 1与 EA/ TA呈显著负相关 ,血浆 NO呈显著正相关 ( P<0 .0     

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。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.     

Surgical management of ductal carcinoma in situ in Australia in 1995

Background: In the present paper we describe the presentation and management of ductal carcinoma in situ (DCIS) of the breast in women in Australia in 1995. This representative, national data set provides a historical comparator for studies examining DCIS management that follow. Methods: Surgeons identified by population‐based cancer registries as having treated a new diagnosis of DCIS between 1 April and 30 September 1995 completed a questionnaire on the presentation and management of each case. Results: Two hundred and five surgeons supplied treatment details on 418 DCIS tumours in 415 women . Half of all tumours were detected at BreastScreen clinics and a further 25% were detected at other mammography centres. Twenty‐six percent of tumours were palpable at presentation, 33% were multifocal and 55% were high grade (including comedocarcinoma). Breast conserving therapy (BCT) rather than mastectomy was utilized in 260 (62%) of cases. Tumours that were of low grade, small in size and not multifocal were more likely to be treated by BCT. Surgeons seeing six or more DCIS cases in the 6‐month period were more likely to utilize BCT. Of the conservatively treated cases, 22% were referred for a radiation oncology consultation. The most common reasons for treating DCIS with mastectomy were that the tumour was too extensive or multifocal (63%), it extended to margins of the specimen (42%), or patient concerns about recurrence (34%). Conclusions: In 1995 the majority of DCIS was treated with breast conserving surgery alone. Surgeons treating more DCIS cases were more likely to perform conservative surgery than surgeons treating only one DCIS case in the study period.     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.