肝移植患者围手术期的营养支持

肝移植患者的营养状况对改善患者预后具有重要影响,但此类患者的营养支持不同于其他营养不良的患者,本文对终末期肝病患者营养状况、肝移植前围手术期及移植后的营养支持治疗进行了论述。     

动脉时辰化疗治疗大肠癌肝转移的临床研究

目的:研究动脉时辰化疗在治疗大肠癌肝转移中的临床意义。方法:将42例病人随机分为两组,分别行动脉时辰化疗及动脉恒速化疗,观察其临床副反应及疗效。结果:两组患者重度恶心呕吐和肝功能损害发生的频率具有显著性差异(P<0.05),动脉时辰化疗较恒速化疗副反应降低,近期疗效无明显差异(P>0.05)。结论:动脉时辰化疗较常规动脉恒速化疗副反应轻微,耐受性好,是治疗大肠癌肝转移的有效方法。     

雏凤精对小鼠免疫功能的影响

正常小鼠肌肉注射环磷酰胺(CTX)或醋酸氢化泼尼松(HPA)造成免疫低下模型,通过巨噬细胞(Mφ)吞噬功能试验,淋巴器官重量测定,外周血淋巴细胞α-醋酸萘酯酶染色,溶血素测定及PFC试验,观察雏凤精对小鼠免疫系统的影响。结果表明:雏凤精能完全或部分对抗免疫抑制剂的免疫抑制作用,对细胞及体液免疫功能均有一定保护和促进作用。     

周围型肺癌的CT诊断价值

目的：研究ＣＴ在周围型肺癌诊断中的价值。材料与方法：对６３例经手术和／或病理证实的周围型肺癌行常规肺部ＣＴ扫描，并在病灶处用薄层高分辨力重建方式加扫。结果：周围型肺癌表现为肺内肿块或结节，形状为椭圆形或不规则形。其中４７例肿块直径≥３ｃｍ，其密度不均，少数肿瘤内可见钙化、坏死、液化和空洞。１６例肿瘤直径＜３ｃｍ，其密度不均，呈分叶状，薄层扫描时可见空泡征。肿瘤病灶边缘可见毛刺、棘突、支气管血管纠集、胸膜粘连和胸膜凹陷征等。胸膜粘连多见于肿块较大的肺癌，胸膜凹陷征多见于肿块较小的肺癌。结论：ＣＴ诊断周围型肺癌比常规Ｘ线检查提供更多的信息；若ＣＴ发现肺部周围结节或肿块有分叶、毛刺及胸膜凹陷征等应考虑为肺癌，肺门、隆突下及纵隔淋巴结肿大且无钙化时，要考虑肺癌向淋巴结转移。     

决明子水煎剂对营养性肥胖大鼠体质量增长抑制作用的量效关系

背景决明子具有降血压、降血脂、保肝及抑菌等活性,其减肥效应值得进一步探讨.目的观察大鼠生理状态下自然饮用决明子水煎剂对营养性肥胖大鼠体质量的影响.设计完全随机分组设计,对照实验,多组间比较采用方差分析和q检验.单位河南科技大学第二附属医院心血管病研究室.材料实验于2004-03/2004-09在河南科技大学第二附属医院心血管病研究室完成.选用雄性SD大鼠27只.将大鼠随机分为3组正常对照组、模型对照组和决明子组,每组9只.方法[1]正常对照组喂基础饲料(蛋白质、脂肪、碳水化合物含量分别是18.2%,4.5%,55.2%,每克含14.54 kJ热量),自然饮水;模型对照组喂高营养性饲料(蛋白质、脂肪、碳水化合物含量分别是23.7%,21.6%,39.0%,每克含19.56 kJ热量),自然饮水;决明子组喂高营养性饲料,自然饮不同浓度的决明子水煎剂.决明子水煎剂的浓度从10 g/L(相当于每毫升含决明子生药10 mg)开始,每天增加一个百分比浓度(即10 g/L)直到第6天增至60g/L,从第7天开始保持60g/L的浓度不变直至实验第7周结束.[2]每天定时记录进食量和饮水量,计算摄入热量(进食质量×每克所含热量),每周定时测体质量.第7周末,测量大鼠体长,计算Lee's指数3√体质量(g)×103/体长(cm)].[3]多组间比较采用方差分析和q检验.主要观察指标决明子对营养性肥胖大鼠体质量、Lee,s指数、进食量、摄入热量和饮水量的影响.结果大鼠27只均进入结果分析.[1]体质量实验第3～7周模型对照组的明显高于正常对照组(P＜0.05～0.01).实验第2～7周决明子组明显低于模型对照组(P＜0.05～0.01).[2]Lee's指数实验第7周模型对照组和决明子组大鼠明显大于正常对照组[(358.60±8.55),(341.84±7.29),(322.00±6.89)g/cm,P＜0.05～0.01],决明子组明显低于模型对照组(P＜0.05).[3]进食量模型对照组和决明子组明显低于正常对照组(P＜0.05～0.01);决明子组与模型对照组相近(P＞0.05).[4]摄入热量模型对照组和决明子组明显高于正常对照组(P＜0.05～0.01).决明子组与模型对照组相近(P＞0.05).[5]饮水量决明子组基本与和模型对照组正常对照组相近(P＞0.05).模型对照组与正常对照组相近(P＞0.05).这表明60 g/L'质量浓度的决明子水煎剂不影响食欲.结论质量浓度60g/L的决明子水煎剂既能明显抑制营养性肥胖大鼠体质量的增加,且不影响食欲.     

Pregnancy in patients on maintenance hemodialysis: seven cases report and 169 reported cases review

Objective To analyze and summarize the cases of pregnancy on maintenance hemodialysis (MHD), and review the literature. Methods Seven cases of pregnancy and childbirth in patients on MHD in the First Affiliated Hospital of Zhejiang University from Jan 2009 to Dec 2017 were analyzed, and the literature about pregnancy in patients on MHD reported in Pubmed and Web of Science database was retrieved. Both maternal and fetal outcome were studied. Results There are seven pregnant MHD patients in this center, among whom six patients went through a smooth pregnancy and one patient had intra-uterine fetal death at 14 weeks of pregnancy. The six patients had preterm labor. Among six fetuses, four grew in good health and developed well, one had physical development retardation and one had heart malformation at born. In the literature, 169 cases reported pregnant patients and 182 fetuses were evaluated, of which 145 live infants were delivered, 79.67% overall fetal survival rate, with gestational age of (32.94±3.34) weeks. In 164 delivered fetuses, 147 were preterm labor (89.63%). The weight of live births was (1824±609) g. There were no maternal deaths. Fetal survival rate was zero in＜20 weeks of gestational age, 20-24 weeks was 14.29%, 25-27 weeks was 45.45%, ≥28 weeks was 94.44%. The fetal survival rate was higher in pregnant woman receiving hemodialysis≥28 hours weekly compared to women receiving ＜16 hours weekly (92.31% vs 52.94%, P=0.02). Conclusions There are still a very high maternal and fetal complication rate in hemodialysis patients, especially in fetus. Gestational age≥28 weeks has a high fetal survival rate. Intensive dialysis during pregnancy may benefit higher fetal survival rate.     

自体成肌细胞修复周围神经缺损

目的:观察自体成肌细胞在神经再生室中的作用,探讨其作为组织工程的种子细胞修复周围神经缺损的可行性。方法:实验于2002-08/2003-08在北京军事医学科学院基础医学研究所九室完成。①成年Wistar大鼠30只,采用随机数字法分成成肌细胞组、细胞外基质凝胶组和生理盐水组,每组10只。②切除大鼠右坐骨神经6mm,断端分别套入硅胶管,使神经两断端在硅胶管内相距13mm。③成肌细胞组:快速分离骨骼肌成肌细胞,差速贴壁法纯化、增殖,按1×109L-1细胞浓度与细胞外基质凝胶混合,植入神经再生室内;细胞外基质凝胶组:神经再生室内植入细胞外基质凝胶;生理盐水组:神经再生室内植入生理盐水。④术后4,8,12周进行大鼠坐骨神经功能指数测定;术后12周进行大体观察、电生理检测、腓肠肌湿重、神经组织学及超微结构观察。结果:30只大鼠全部进入结果分析。①结蛋白免疫组织化学:阳性细胞平均达98.01%。②大体观察:术后12周,成肌细胞组和细胞外基质凝胶组均可见再生神经,外形似正常神经,直径较正常的神经干细,成肌细胞组略粗于细胞外基质凝胶组。生理盐水组导管内无再生神经通过间隙。③坐骨神经功能指数:术后8,12周,成肌细胞组显著高于细胞外基质凝胶组(8周:-71.788±3.569,-76.986±2.266;12周:-61.847±2.914,-69.527±1.765;P均<0.01)。④电生理检查:术后12周,成肌细胞组的运动神经传导速度及波幅明显高于细胞外基质凝胶组,成肌细胞组、细胞外基质凝胶组腓肠肌肌电图呈部分失神经电位表现,生理盐水组则为完全失神经电位。⑤腓肠肌湿重恢复率:成肌细胞组明显好于细胞外基质凝胶组和生理盐水组。⑥组织学检查:术后12周,成肌细胞组、细胞外基质凝胶组的再生神经纤维排列整齐、密集,神经导管交界处无瘢痕,成肌细胞组的再生神经纤维多且直径较粗大,排列更为规则。⑦透射电镜观察:成肌细胞组和细胞外基质凝胶组均见再生的有髓神经纤维。⑧再生神经纤维图像分析:术后12周,在有髓神经纤维密度、神经纤维有效面积、有髓神经纤维数量、直径及髓鞘厚度等指标上成肌细胞组均优于细胞外基质凝胶组。结论:自体成肌细胞能够促进周围神经再生,可以作为种子细胞应用于外周神经组织工程。     

经内镜逆行性胆管活检技术的方法学研究

目的 探讨内镜下逆行性胆管活检的可行性、安全性及敏感性,获取胆管粘膜组织病理学,指导临床治疗.方法 在传统的影像学方法如CT、MRCP等基础上,对非结石引起的梗阻性黄疸患者共16例进行常规ERCP,并直接将活检钳送入胆管病变处活检,送病理科检查.结果 16例患者中有14例获得病理组织,成功率为87.5%,无并发症发生.病理诊断为胆管癌5例、胰腺癌2例、转移癌2例、肝细胞癌1例、炎性表现4例.阴性结果4例,阳性结果10例.结论 内镜下逆行性胆管活检术虽受设备及内镜医生技术影响,但它的确是一种准确可靠获取组织病理学检查的途径,对指导胆管梗阻性黄疸患者治疗非常有帮助.     

Quantitative amino acid analysis using a Beckman system gold HPLC 126AA analyzer

BACKGROUND: The Beckman 6300/7300 analyzer, which was widely used for amino acid (AA) analysis, is no longer commercially available. METHODS: To set up an affordable AA analysis program, a Beckman system gold HPLC 126AA analyzer and Pickering Laboratories reagents were used. Two quantitative AA analysis programs were developed. One was an 18-min short program quantitating seven AAs from plasma and dried blood spots (DBS) specimens using Lithium eluents Li-365 and Li-375 at 70 degrees C column temperature. The short program could be used for diagnosis and follow-up dietary management for phenylketonuria (PKU), maple syrup urine disease (MSUD), tyrosinemia and homocystinuria patients. The second program was a 118-min long AA screening panel quantitating 40 AAs using Lithium eluents Li-275, Li-365 and Li-375 at 32, 48 and 72 degrees C column temperatures from plasma and urine specimens. RESULTS: The values obtained from DBS specimens were in good agreement with certified results from the Centers for Disease Control and Prevention. The values obtained from plasma and urine samples were in good correlation with those obtained from Beckman 6300 analyzer (0.9076 < or = r < or = 0.999). CONCLUSIONS: Amino acid quantitation from physiological samples using a Beckman 126AA Analyzer and Pickering Laboratories reagents was useful for clinical diagnosis and monitoring of aminoacidopathies.     

组织多普勒评价室壁肥厚与左室局部及整体舒张功能的关系

目的　应用脉冲组织多普勒( TDI)技术分析左室肥厚( L VH)患者局部室壁厚度、室壁不对称性与左室局部及整体舒张功能间的相关关系。方法　左室肥厚患者4 2例,包括肥厚型心肌病( HCM) 1 6例和高血压性心脏病( HHD)左室肥厚2 6例;正常对照( NC) 2 0例。二维超声测量并计算左室8个节段室壁厚度( r WT)、总厚度( t WT)及室壁不对称指数( CVw) ;TDI测量8个心肌节段的舒张期运动速度比( r E/ A)和等容舒张时间( r IVRT) ;另外分别应用TDI和脉冲波多普勒测量二尖瓣环和二尖瓣口的舒张期参数m E/ A、m IVRT和PVE/ PVE,IVRT作为整体舒张功能指标。结果　( 1 ) L VH者室壁总厚度及其不对称指数、局部等容舒张时间及其舒张不同步性均高于NC组;( 2 )室壁肥厚的程度及其不对称性与左室整体舒张功能相关( r值的绝对值0 .1 8～0 .4 1 ,P<0 .0 5 ) ;( 3 )局部r WT与r E/ A、r IVRT相关( r值- 0 .4 6 ,0 .4 1 ,P<0 .0 5 )。结论　肥厚型心肌病和高血压性心肌肥厚患者的局部室壁肥厚程度与左室局部舒张功能减低及等容舒张期延长有关;左室壁不对称性肥厚通过影响左室局部心肌早期舒张的速度和同步性间接导致左室整体早期充盈异常;TDI技术用于非创伤性评价左室局部及整体舒张功能有一定价值