周围神经端侧缝合与神经移植的实验研究

目的　比较周围神经端侧缝合与神经移植的效果。方法　选用体重 2 0 0～ 30 0gWistar大白鼠 ,左侧后肢腓总神经与胫神经端侧缝合 ,右侧腓总神经采用神经移植修复。结果　 3个月后运动神经传导速度分别为2 9.6 8± 5 .34m/s、 30 .87± 6 .0m/s(P >0 .0 5 ) ,潜伏期 2 .1± 0 .1ms ,2 .0± 0 .1ms(P >0 .0 5 ) ,波幅 12 .5± 0 .6mV、13.9± 0 .5mV(P >0 .0 5 ) ,组织切片中 ,两组均可见大量神经纤维和髓鞘 ,有髓神经纤维计数分别为 75 7.2± 2 2 .31、775± 2 1.87(P >0 .0 5 )。结论　①正常神经发出侧芽能通过端侧缝合口长入远端神经 ,使变性神经再神经化 ;②周围神经端侧缝合能取得与神经移植相近的结果。     

The Liver Retransplantation Risk Score: a prognostic model for survival after adult liver retransplantation

High-risk combinations of recipient and graft characteristics are poorly defined for liver retransplantation (reLT) in the current era. We aimed to develop a risk model for survival after reLT using data from the European Liver Transplantation Registry, followed by internal and external validation. From 2006 to 2016, 85 067 liver transplants were recorded, including 5581 reLTs (6.6%). The final model included seven predictors of graft survival: recipient age, model for end-stage liver disease score, indication for reLT, recipient hospitalization, time between primary liver transplantation and reLT, donor age, and cold ischemia time. By assigning points to each variable in proportion to their hazard ratio, a simplified risk score was created ranging 0–10. Low-risk (0–3), medium-risk (4–5), and high-risk (6–10) groups were identified with significantly different 5-year survival rates ranging 56.9% (95% CI 52.8–60.7%), 46.3% (95% CI 41.1–51.4%), and 32.1% (95% CI 23.5–41.0%), respectively (P < 0.001). External validation showed that the expected survival rates were closely aligned with the observed mortality probabilities. The Retransplantation Risk Score identifies high-risk combinations of recipient- and graft-related factors prognostic for long-term graft survival after reLT. This tool may serve as a guidance for clinical decision-making on liver acceptance for reLT.     

动态增强磁共振成像在评估女性乳房乳头乳晕血供的应用

目的探究动态增强磁共振成像(DCE-MRI)用于评估女性乳房乳头乳晕血供特点的可行性,为乳房整形手术提供乳头乳晕的血供参考。方法从2012年3月至2019年10月华中科技大学同济医学院附属同济医院影像数据库中收集女性乳腺DCE-MRI图像资料,选择未发现肿物的正常乳房的DCE-MRI图像进行研究。在西门子工作站将患者乳腺DCE-MRI图像通过图像减影获取乳房血管图像,分别对轴位、冠状位和矢状位的最大密度投影(MIP)图像进行评估,结合三维MIP图像识别所有供应乳头乳晕的血管。乳头乳晕的血供被划分为内上、内侧、内下、外上、外侧、外下、中央、上方和下方9个象限,对各个象限血管进行统计和分析,并测量血管至乳房皮肤表面投影的最大距离。采用SPSS 19.0软件进行统计分析,通过卡方检验分别比较左侧与右侧乳房的乳头乳晕复合体(NAC)血供象限分布构成比。计算血管到皮肤距离的平均值、标准差及95%置信区间,通过方差分析比较各象限血管至皮肤距离的差异。P<0.05为差异具有统计学意义。结果共收集到245例患者490只女性乳房DCE-MRI图像,其中97例患者97只乳房发现有乳腺肿物,其余393只为正常乳房(97例单侧乳房、148例双侧乳房),将其作为研究对象。患者年龄23~72岁,平均43.7岁。393只乳房(左侧200只、右侧193只)共发现有637条(左侧311条、右侧326条)乳头乳晕供应血管。在637条血管中,内上象限269条(42.2%),外上180条 (28.3%),内侧57条(8.9%),下方37条(5.8%),中央30条(4.7%),内下25条(3.9%),外下25条(3.9%),上方11条(1.7%),外侧3条(0.5%)。卡方检验表明左侧乳房和右侧乳房在NAC血供象限分布构成比差异无统计学意义(χ2 =6.4,P=0.602)。除中央象限血管以外,所有血管到皮肤表面投影最大距离的平均值为0.91 cm, 95%置信区间为0.86~0.96 cm。方差分析表明各象限供血血管到皮肤投影的最大距离,差异有统计学意义(F=11.4,P<0.001)。结论 DCE-MRI可以清晰地显示乳头乳晕的血供来源。乳头乳晕血供主要来源于内上象限和外上象限的血管,血管在皮下约1 cm深度走行。     

Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry

Annals of Surgical Oncology - The liver-first approach in patients with synchronous colorectal liver metastases (CRLM) has gained wide consensus but its role is still to be clarified. We aimed to...     

Das akute Koronarsyndrom in der prähospitalen Phase und in der Notaufnahme

Notfall + Rettungsmedizin - Das akute Koronarsyndrom ist der häufigste Grund für einen Rettungsdiensteinsatz in Deutschland. So resultieren in etwa 20–25 % aller Einsätze...     

五种免疫相关性心血管疾病的免疫学研究

对扩张型心肌病、风湿性心脏病，原发性高血压，冠心病及肥厚型心肌病进行外周血清可溶性白细胞介素２受体，Ｔ淋巴细胞亚群及自然杀伤细胞活性的检测，并与健康对照组比较，结果显示：ＤＣＭ组，ＲＨＤ组及ＥＨＴ组的ｓＩＬ－２Ｒ明显高于ＮＣ组，而ＤＣＭ、ＲＨＤ风湿活动组的ＮＫ活性低于ＮＣ组，ＥＨＴ组ＮＫ活性高于ＮＣ组。     

Elucidating chromatin and nuclear domain architecture with electron spectroscopic imaging

Electron microscopy has been the ‘gold standard’ of spatial resolution for studying the structure of the cell nucleus. Electron spectroscopic imaging (ESI) offers advantages over conventional transmission electron microscopy by eliminating the need for heavy-atom contrast agents. ESI also provides mass-dependent and element-specific information at high resolution, permitting the distinguishing of structures that are primarily composed of protein, DNA, or RNA. The technique can be applied to understand the structural consequences of epigenetic modifications, such as modified histones, on chromatin fiber morphology. ESI can also be applied to elucidate the multifunctional behavior of subnuclear ‘organelles’ such as the nucleolus and promyelocytic leukemia nuclear bodies. The authors dedicate this paper to the memory of Ying Ren (1961–2007). We all benefited from knowing her. Our research advanced through the technical creativity she provided.     

Regional hyperthermia combined with high energy shock wave treatment on Dunning prostate tumors

Male Copenhagen rats implanted with Dunning R3327 prostate carcinoma were treated with regional hyperthermia and high energy shock waves (HESW). Twenty-four rats were divided into four equal groups. All rats in one group were matched with the corresponding rats in the other three groups according to tumor size. Hyperthermia was created by the resistive heating of a 22-gauge 1.5-cm needle; HESW were generated by the Dornier XL-1 experimental lithotripter. In two hyperthermia treatments administered 48 hours apart, the tumor was heated to 46.5 degrees C for 2 hours; HESW treatment involved 1,600 shocks at 18 kV. Twenty-nine days after initiation of this study, animals were sacrificed and tumor growth calculated. Tumor growth in group 1 (combined hyperthermia and HESW) was significantly delayed between the 7th and 29th day (p = 0.05). In group 2 (HESW alone), tumor growth was significantly delayed between the 7th and 22nd day (p = 0.01), while tumor growth in group 3 (hyperthermia alone) was delayed between the 3rd and 22nd day (p = 0.02). On day 22, mean percent change in tumor growth in the control group exceeded that of group 1 by 449% (p = 0.015) as well as that of groups 2 and 3, by 350% (p = 0.034) and by 268% (p = 0.049), respectively. As previous reports demonstrate the efficacy of hyperthermia in combination with irradiation or chemotherapy for the treatment of prostate carcinoma, our results indicate hyperthermia in combination with HESW may also be a useful treatment modality.     

哇巴因与地高辛对大鼠肝脏钠泵A亚单位基因表达的影响

目的　观察哇巴因与地高辛对大鼠肝脏钠泵基因表达的影响 .方法　分别给大鼠注射哇巴因 (2 0 μg· kg- 1·d- 1 )、地高辛 (32 μg·kg- 1·d- 1 )和生理盐水 (1m L· kg- 1·d- 1 ) ,观察给药后 6wk大鼠血压的动态变化 ;并分别应用分子生物学 RT- PCR及免疫组织化学技术 ,探讨各组大鼠肝脏钠泵 α1 ,α2 及 α3 亚单位 m RNA及蛋白水平基因表达的改变 .结果　给予哇巴因 2 wk后大鼠血压开始升高 ,至 6 wk时明显高于生理盐水组 (17.7± 1.2 ) vs(15 .4± 1.1) k Pa,P<0 .0 1) ,而实验过程中地高辛组血压与对照组比较差异不明显 .无论是在 m RNA水平还是在蛋白水平 ,哇巴因对大鼠肝脏钠泵α1 亚单位表达无影响 ,而地高辛使α1 亚单位表达增强 ;两组大鼠 α2 亚单位表达均无改变 ;哇巴因使 α3 亚单位蛋白水平表达减弱 ,而 m RNA水平增强 ,地高辛组大鼠肝脏钠泵 α3 亚单位无论在 m RNA水平及蛋白水平表达均增强 .结论　哇巴因在高血压发病中可能起着重要作用 ;哇巴因与地高辛可导致不同的钠泵基因表达改变 ,为进一步揭示内源性哇巴因生理与病理作用以及洋地黄类药物药理与毒理作用的分子机制提供了理论及实验依据     

小鼠补体受体Ⅱ型基因改造后感染EB病毒

通过对小鼠补体受体Ⅱ型基因（CR2）进行定点突变,然后将野生型和突变型小鼠CR2/1（MCR2/1）及人CR2（hCR2)用电穿孔方法导入小鼠SP2/0进行表达,采用免疫组织化学等方法鉴定阳性细胞系。用EB病毒对转染阳性细胞进行感染,EBER-1杂交结果显示,仅转染hCR2和突变型MCR2（mtMCR2)的SP2/0细胞感染了EB病毒,前者感染EB病毒的阳性率较后者高很多。这为进一步研究EB病毒进入细胞的机制及建立EB病毒相关的鼻咽癌动物模型奠定了良好的基础。