低分子肝素钙联合银杏达莫治疗急性心源性脑栓塞患者临床疗效观察

目的 观察低分子肝素钙联合银杏达莫治疗急性心源性脑栓塞患者的临床疗效.方法 选取解放军第八五院神经内科2015年7月至2016年7月收治的急性心源性脑栓塞患者80例,经患者知情和家属同意,采用平均分组的方式将80例患者分为观察组和对照组,每组40例,2组患者在入院之后均给予相同的基础治疗和预防并发症治疗,观察组采用低分子肝素钙联合银杏达莫治疗,对照组仅给予低分子肝素钙治疗.比较2组患者治疗前后的神经功能缺损恢复情况及临床疗效,同时观察2组患者不良反应发生情况.结果 治疗后观察组患者的神经功能缺损评分明显高于对照组,差异有统计学意义(P<0.05);观察组患者总有效率为97.5%,明显高于对照组患者的67.5%,差异有统计学意义(P<0.05);2组患者不良反应发生率比较差异无统计学意义(P>0.05).结论 低分子肝素钙联合银杏达莫治疗急性心源性脑栓塞较单用低分子肝素钙效果更明显.     

紫杉醇影响TGF⁃β1诱导的原代人肺成纤维细胞向肌成纤维细胞转化

目的：研究紫杉醇（paclitaxel,PTX）对重组人转化生长因子?β1（recombinant human transform growth factor?β1,rhTGF?β1）诱导人肺成纤维细胞（human lung fibroblasts,HLFs）向肌成纤维细胞转化的影响及其相关机制。方法：培养HLFs,药物处理分为对照组、TGF?β1组（5 ng/mL）、TGF?β1+PTX（0.01 nmol/L）组、TGF?β1+ PTX（0.1 nmol/L）组、TGF?β1+ PTX（1 nmol/L）组、PTX组（1 nmol/L）。采用CCK8法测定细胞活性;显微镜下观察并分析细胞形态学变化;Transwell实验检测细胞迁移能力;免疫荧光观察细胞内α?平滑肌肌动蛋白（α?SMA）表达及分布情况;real?time PCR和Western blot检测各组α?SMA、纤连蛋白（fibronectin）、Ⅰ型胶原蛋白（collagen Ⅰ）、Ⅲ型胶原蛋白（collagen Ⅲ）mRNA水平及蛋白含量;Western blot检测各组细胞内p?Smad3、Smad3、p?p38和p38蛋白含量。结果：CCK8结果显示,1 nmol/L PTX对细胞无毒性作用,0.01 nmol/L PTX不能抑制TGF?β1诱导的HLFs活性增加,0.1和1.0 nmol/L PTX可以抑制TGF?β1诱导的HLFs活性增加;细胞形态学结果显示,0.01 nmol/L PTX不能抑制TGF?β1诱导的HLFs胞体宽度增加,0.1、1.0 nmol/L PTX可以抑制TGF?β1诱导的HLFs胞体宽度增加;Transwell实验结果显示,0.01 nmol/L PTX不能抑制TGF?β1诱导的HLFs迁移,0.1、1.0 nmol/L PTX可以抑制TGF?β1诱导的HLFs迁移;免疫荧光结果显示,0.01 nmol/L PTX不能降低TGF?β1诱导的HLFs内α?SMA荧光强度,0.1、1.0 nmol/L PTX可以降低TGF?β1诱导的HLFs内α?SMA荧光强度;real?time PCR和Western blot结果显示,0.01 nmol/L PTX不能降低TGF?β1诱导的HLFs表型转化标志物α?SMA、fibronectin、collagenⅠ、collagenⅢ含量及p38的磷酸化水平,0.1、1.0 nmol/L PTX可以降低TGF?β1诱导的HLFs表型转化标志物α?SMA、fibronectin、collagenⅠ、collagen Ⅲ含量以及Smad3和p38的磷酸化水平。结论：紫杉醇可以抑制TGF?β1诱导原代HLFs向肌成纤维细胞表型转化,这种作用可能与抑制TGF?β/Smad/MAPK信号通路激活有关。     

蟾蜍灵通过程序性坏死途径诱导人胃癌细胞SGC-7901死亡

目的 探讨蟾蜍灵（Bufalin）诱导人胃癌SGC-7901细胞死亡过程中程序性坏死途径的发生机制。方法 体外培养SGC-7901细胞,于对照组加入RPMI 1640培养液,实验组加入不同浓度的蟾蜍灵（50、100、150、200 nmol/L）,对照组与实验组细胞继续培养48 h。MTT法检测细胞活性,DAPI染色法观察细胞核形态改变,透射电镜观察细胞膜及细胞核改变,流式细胞术检测细胞坏死率,Western blotting法检测程序性坏死关键蛋白受体相互作用蛋白激酶1（receptor interacting protein kinase 1,RIP1）的表达。结果 MTT实验结果表明,蟾蜍灵对SGC-7901细胞的生长具有显著的抑制作用（P<0.05）。通过透射电镜可以观察到细胞坏死时的特征性改变,如细胞膜破裂、细胞内空泡的产生以及细胞器的崩解。DAPI染色显示,蟾蜍灵（100 nmol/L）处理细胞48 h后,无明显细胞凋亡特征性改变,如细胞核固缩、核碎裂、凋亡小体形成。与对照组相比细胞坏死率升高（P<0.05）。蟾蜍灵对程序性坏死途径关键蛋白RIP1的表达有促进作用（P<0.05）。结论 蟾蜍灵通过程序性坏死途径诱导SGC-7901细胞死亡。     

胆管癌与肝炎病毒感染相关性研究

目的:调查胆管癌患者血清中肝炎病毒标志物检出率,探讨胆管癌发生与肝炎病毒感染的相关性.方法:收集天津地区11年间3所医院305例胆管癌的临床资料,统计其中肝炎病毒感染率和肝炎病毒危险因素接触状况,调查住院期间血清肝炎病毒标志物检出情况.调查了同期住院的480例良性胆道疾病患者作为对照.结果:胆管癌和良性胆道疾病患者既往乙型肝炎病毒(HBV)感染率分别为3%和2.5%;29%的胆管癌病例可以检出HBV的血清标志物,而良性胆道疾病病例HBV血清标志物的检出率为21%,二者有显著差异.丙型肝炎病毒(HBV)的血清标志物检出率在胆管癌为4.3%,在良性胆道疾病为5.6%,二者比较无差别.结论:胆管癌患者中并发HBV感染率较高,HBV感染与胆管癌的发生可能存在一定的关系.由于HCV的检测指标单一,目前尚不能排除胆管癌发生与HCV感染无关.     

Preoperative Zung depression scale predicts outcomes in older patients undergoing short-segment fusion surgery for degenerative lumbar spinal disease

Purpose

To identify the relationship between depression measured by Zung depression rating scale (ZDRS) and postoperative outcomes (including the patients reported outcomes [PRO] and clinical outcomes) two years after short-segment fusion surgery for degenerative lumbar spinal disease in older patients (aged 75 years and older).

Methods

We enrolled patients who underwent short-segment fusion surgery for lumbar degenerative disease from May 2018 to June 2020. All patients were assessed for depression using the ZDRS. Patients were included in the depression group and not-depressed group based on their scores. Preoperative baseline data were collected on characteristics, comorbidities, laboratory data, pain levels (visual analogue scale [VAS]), functional status (Oswestry Disability Index [ODI]), and surgery-related variables. The primary outcomes were PRO measures, including VAS, ODI and satisfaction two years after lumbar fusion surgery. Other outcomes included postoperative complications, the length of stay, and reoperation. Univariate and multivariate analyses were performed to identify the risk factors for poor satisfaction.

Results

A total of 231 patients (201 in not-depressed and 30 in depressed group) were enrolled in this study. There were no significant differences between the two groups for baseline data. Depressed group had higher rates of choices for dissatisfaction (36.7% vs. 14.0%, p = 0.015), higher VAS scores of low back pain (2.8 ± 2.3 vs. 1.6 ± 1.7, p = 0.012), and worse functional status (31.5 ± 22.5 vs 21.8 ± 19.9, p = 0.015) than the not-depressed group. Depressed patients reported significantly higher rates of postoperative complications and readmissions. Multivariate regression analysis revealed that depression (p = 0.001) was independently associated with postoperative dissatisfaction.

Conclusion

Preoperative depression was a risk factor for postoperative dissatisfaction, worse functional status, readmission, and complications in older patients undergoing lumbar fusion surgery. Preoperative screening using the Zung depression scale helps inform decision-making when considering fusion surgery for patients aged 75 and older.

     

Effect of laparoscopic pancreaticoduodenectomy on the incidence of surgical-site wound infection: A meta-analysis

A meta-analysis was conducted to assess the impact of robotic and laparoscopic pancreaticoduodenectomies on postoperative surgical site wound infections. A comprehensive computerised search of databases, such as PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Data, was performed to identify studies comparing robotic pancreaticoduodenectomy (PD) with laparoscopicPD. Relevant studies were searched from the inception of the database construction until April 2023. The meta-analysis outcomes were analysed using odds ratios (OR) with corresponding 95% confidence intervals (CI). The RevMan 5.4 software was used for the meta-analysis. The findings of the meta-analysis showed that patients who underwent laparoscopic PD had a significantly lower incidence of surgical-site wound (16.52% vs. 18.92%, OR: 0.78, 95% CI: 0.68–0.90, P = .0005), superficial wound (3.65% vs. 7.57%, OR: 0.51, 95% CI: 0.39–0.68, P < .001), and deep wound infections (1.09% vs. 2.23%, OR: 0.53, 95% CI: 0.34–0.85, P = .008) than those who received robotic PD. However, because of variations in sample size between studies, some studies suffered from methodological quality deficiencies. Therefore, further validation of this result is needed in future studies with higher quality and larger sample sizes.     

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 …

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８０．０％,明显高于正常肾组织中的表达率（５     

Physical activity patterns in chronic hemodialysis patients: comparison of dialysis and nondialysis days.

OBJECTIVE: To determine physical activity patterns in chronic hemodialysis patients with a specific emphasis on the difference between dialysis and nondialysis days. Design A cross-sectional single-center study. SETTING: Vanderbilt University Outpatient Dialysis Unit. PATIENTS: Twenty current chronic hemodialysis patients: 10 male, 10 female; 15 black, 5 white; mean age, 50.1 +/- 9.9 years; height, 164.5 +/- 10.9 cm; weight, 82.5 +/- 15.4 kg; length on dialysis, 57.3 +/- 45.3 months. METHODS: Minute-by-minute physical activity was assessed over a 7-day period using a triaxial accelerometer, which consists of raw numbers or counts calculated by the 3 axes of the accelerometer (PA counts). PA counts were extrapolated on a daily and hourly basis. Physical functioning tests included: sit-to-stand, 6-minute walk, and 1-repetition maximal leg press exercise. Laboratory values for serum concentrations of albumin, prealbumin, C-reactive protein, and cholesterol were also collected. MAIN OUTCOME MEASURE: PA counts. RESULTS: Total PA counts were significantly lower on dialysis days when compared with nondialysis days (128,279 +/- 74,009 versus 168,744 +/- 95,168, respectively, P = .025). The average PA counts during the 4-hour dialysis time period were significantly lower on dialysis days when compared with nondialysis days (3,086 +/- 3,749 versus 11,070 +/- 7,695, respectively, P = .001). At postdialysis hours 1 and 2, PA counts on dialysis days were significantly higher than on nondialysis days (11,410 +/- 5,340 versus 9,082 +/- 6,646, P = .008, and 14,048 +/- 9,728 versus 8,662 +/- 6,433, P = .016, respectively). By postdialysis hour 4, PA counts on dialysis days had significantly decreased when compared with nondialysis days (6,068 +/- 6,268 versus 10,512 +/- 7,420 PA counts, P = .01, respectively). From postdialysis hours 5 to 20, there was no significant difference in PA counts between dialysis and nondialysis days. CONCLUSION: This study shows that physical activity is lower on dialysis days when compared with nondialysis days, and this decrease is caused by the lack of activity during the 4-hour hemodialysis procedure. New behavior modification strategies involving physical activity, both during hemodialysis and on nondialysis days, must be examined in this patient population.     

术后疼痛大鼠切口组织Toll样受体4及其下游细胞因子表达的变化

目的 探讨术后疼痛大鼠切口组织Toll样受体4(TLR4)及其下游细胞因子IL-1β、IL-6和TNF-αmRNA表达的变化. 方法 健康成年雄性SD大鼠74只,体重200～250 g,建立大鼠术后疼痛模型.于术前1d、术后0.5,1,2,6,12h及1,2,3,5,7d测定术侧与非术侧机械缩足反射阈值(PMWT);于术前1d、术后2,8h、1,2,3,5,7d采用荧光定量PCR法检测皮肤切口组织TLR4、IL-1β、IL-6和TNF-α mRNA的表达. 结果 与术前比较,大鼠术侧术后0.5 h～5 dPMWT降低,术后2h术侧切口组织TLR4mRNA表达下调,之后逐渐升高,IL-1β、IL-6和TNF-αmRNA于术后2,8h、1,2,3,5d表达上调(P＜0.05),非术侧PMWT差异无统计学意义(P＞0.05);术侧PMWT术后6h最低,之后逐渐升高,术侧切口组织TLR4mRNA术后2d表达水平最高,IL-1β、IL-6和TNF-α mRNA分别于术后2h、1d、3d表达水平最高(P＜0.05).TLR4、IL-1β、IL-6和TNF-αmRNA表达水平与术侧PMWT呈负相关(r=-0.501,-0.743,-0.893,-0.657,P＜0.05),IL-1β、IL-6和TNF-αmRNA与TLR4 mRNA表达水平呈正相关(r =0.764,0.283,0.667,P＜0.05). 结论 术后疼痛大鼠切口组织TLR4及其下游炎性因子IL-1β、IL-6、TNF-α mRNA表达上调,该变化可能参与了术后疼痛的产生和维持.