同时性结直肠癌肝转移临床病理因素分析

目的探讨结直肠癌发生肝转移与其临床病理因素的关系.方法分析比较有肝转移117例与Dukes C或D期无肝转移50例结直肠癌病人的临床特点、血清CEA水平、转移淋巴结、以及原发灶的病理类型和静脉侵犯.结果以肝转移灶为首诊原因的有21例,伴肝转移结直肠癌患者远距离淋巴结转移及镜下静脉侵犯发生率升高,与对照组比较差异显著(P＜0.05).结论要重视结直肠癌肝转移的早期诊断,远距离淋巴结转移或镜下静脉侵袭均预示大肠癌发生肝转移的危险性的增加.     

医院职能部门管理成本核算和控制的难点及对策

医院职能部门是医院运营中不可缺少的部门。据资料统计,我国医院管理成本约占总成本的20％～30％因此做好医院职能部门管理成本的核算和控制具有重要意义。     

Celsior液与UW液对无心跳大鼠供肝保存效果的比较

Objective To compare the effects of Celsior (CS) solution vs University of Wisconsin (UW) solution on preservation of non-heart- beating donor (NHBD) livers in rats. Methods The healthy male SD rats were taken as donors and recipients. The thoracic descending aorta and supradiaphragmatic inferior vena cava were cross-clamped for 10 min to induce ischemia as a NHBD model. After flushed with the cold CS or UW solution, NHBD livers were stored at 4℃ for 8 h or 16 h. Then they were transplanted using the two-cuff technique with arterial reconstruction. Accordingly, the recipients were divided into four groups: CS 8 h, UW 8 h, CS 16 h and UW 16 h groups. The bile discharge, liver enzymes (ALT and AST), ET-1, IL-1 and TNF-alpha levels in serum at 1, 3, and 6 h after reperfusion were measured. Histopathological examination was carried out by HE staining, and the 7-day survival rate was observed. Results As compared with a homogenous appearance in the NHBD livers perfused with CS solution, the NHBD livers perfused with UW solution showed a heterogenous appearance, with more or less mottling. In the CS 8 h group there were more bile discharge at 1 h, lower ALT and AST levels at 1, 3 and 6 h, and lower serum ET-1, IL-1 and TNF-alpha ? levels at 1 and 3 h after reperfusion than the UW 8 h group (P<0.05). Histopathological examination showed a well-preserved hepatic architecture, milder portal congestion and inflammatory infiltration in CS 8 h group as compared with UW 8 h group. The 7-day survival rate in CS 8 h and UW 8 h groups was 58.3% and 25.0% respectively (P<0.05). There were no significant differences in bile discharge, ALT, AST, ET-1, IL-1 and TNF-alpha ? levels at different time points between CS 16 h and UW 16 h groups (P>0.05), and histopathological examination showed no much difference in the tissue damage between two groups; all recipients died within 3 days (P>0.05). Conclusion CS was more effective than UW in preserving NHBD livers after 8 h of cold storage, which may be due to the better perfusion of CS and inhibition of Kupffer cells, but it had better preserve NHBD livers with CS no more than 16 h.     

Celsior液与UW液对无心跳大鼠供肝保存效果的比较

目的 比较Celsior(CS)液与UW液对大鼠无心跳供者(NHBD)供肝的保存效果.方法 选取健康雄性SD大鼠作为肝移植的供、受者.通过阻断大鼠主动脉和膈上下腔静脉10 min的方法,制备和获取NHBD供肝,并采用不同的器官保存液灌注和冷保存供肝.随机将受者分为4组.CS8 h组:受者采用经CS液灌注和冷保存8 h的供肝移植;UW8 h组:受者采用经UW液灌注和冷保存8 h的供肝移植;CS16 h组:受者采用经CS液灌注和冷保存16 h的供肝移植;UW16 h组:受者采用经UW液灌注和冷保存16 h的供肝移植.受者门静脉开放前、开放后1、3及6 h,取各组受者的静脉血检测血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、内皮素1(ET-1)、白细胞介素1(IL-1)及肿瘤坏死因子α(TNF-α)水平;观察和比较各组受者的胆汁生成量、移植肝组织病理学改变及术后7 d内的存活率.结果 NHBD供肝经UW液灌注后呈"花斑"状,肝叶边缘灌注不良,经CS液灌注后肝叶边缘灌注良好.CS8 h组和UW8 h组受者的胆汁生成量分别为(0.21±0.01)ml和(0.10±0.02)ml(P<0.05).门静脉开放后1、3及6 h,CS8 h组受者的血清ALT及AST水平明显低于UW8 h组(P<0.05),门静脉开放后1、3h,CS8 h组受者的血清ET-1、IL-1及TNF-α水平均明显低于UW8 h组(P<0.05);CS8 h组受者移植肝肝窦扩张、门静脉充血及炎症细胞浸润等病理学改变明显轻于UW8 h组,CS8 h组和UW8 h组受者术后7 d的存活率分别为58.3%和25.0%(P<0.05).CS16 h组和UW16 h组受者各时点的胆汁分泌量、血清ALT、AST、ET-1、IL-1及TNF-α水平的比较,差异均无统计学意义(P>0.05),两组受者均在术后3 d内死亡,两组受者移植肝组织病理学改变无明显差异.结论 CS液对大鼠NHBD供肝的保存效果优于UW液,这可能与UW液较CS液粘稠及CS液能够减少枯否细胞的激活有关;NHBD供肝的冷保存时间不宜超过16 h.     

UNC-112相关蛋白1基因在结肠癌中的表达及其意义

目的 探讨UNC-112相关蛋白1(URP1)基因在结肠癌发生发展中的意义.方法 应用定量聚合酶链反应(PCR)技术检测15例结肠癌中URP1 mRNA表达,应用组织芯片和免疫组织化学技术检测203例结肠癌中URP1蛋白表达.结果 URP1 mRNA在66.67%(10/15)的结肠癌中较相应正常结肠组织表达上调2倍以上.URP1蛋白在结肠癌中高表达率显著高于相应正常结肠组织(60.10%比14.78%).URP1蛋白表达增高与结肠癌淋巴结转移(P<0.01)、AJCC分期(P<0.01)显著相关.结论 URP1基因表达增高可能是结肠发生发展过程中的重要分子事件.     

输注外源性白细胞介素13延长同种肝移植大鼠的存活时间

目的 探讨外源性重组白细胞介素13(rIL-13)抑制同种肝移植大鼠的排斥反应和延长大鼠存活时间的作用及其机制.方法 以Lewis大鼠为供鼠,BN大鼠为受鼠,采用重建肝动脉的大鼠肝移植方法建立同种大鼠原位肝移植模型.采用随机数字表法将受鼠分为两组,实验组于术后第1、2、3、4和5天经尾静脉注射rIL-13 10μg/d,同期对照组注射等体积生理盐水.术后第7天,检测两组移植肝功能,测定移植肝组织病理改变、细胞因子表达及CD8+T淋巴细胞浸润等情况,并根据Banff标准计算排斥活动指数(RAI),观察术后2周的存活率.结果 与对照组相比,实验组肝功能明显改善,肝组织肿瘤坏死因子α(TNF-α)与E选择素的表达明显降低(P＜0.05),CD8+T淋巴细胞浸润明显减少(P＜0.05),术后2周存活率明显提高(P＜0.05).实验组的RAI为4.8±1.2,明显低于对照组的7.5±1.2(P＜0.05).结论 外源性重组rIL-13可减少促炎症因子TNF-α的释放和抑制E选择素的表达,减少移植物CD8+T淋巴细胞的浸润,从而减轻肝移植后急性排斥反应,延长大鼠的存活时间.     

基于CRITIC法的医疗工作质量综合评价

目的 全面客观地评价医院医疗质量,为医院制定工作计划提供科学的决策依据.方法 运用CRITIC方法,选取7项医疗工作指标,对某医院2006～2011年的医疗工作质量进行综合评价.结果 评价结果与医院实际情况相符,评价指标中出院人数的权重最大,2011年的医疗工作质量最好.结论 CRITIC法在医疗工作质量综合评价中具有较好的应用价值.     

冻存对大量分离的人肝细胞色素氧化酶P4503A4活性的影响

成功的冻存使人肝细胞有可能用于暂时替代肝脏治疗急性肝衰竭和多次、反复治疗肝代谢性疾病.P4503A4是肝细胞色素P450氧化酶系中重要成分,在内外源化合物的代谢中起重要作用,包括环孢霉素、FK506[1].所以,该酶可衡量肝细胞冻存后功能保存,对肝移植后肝功能检测有重要意义.我们用高效液相色谱法(HPLC)测定P450A4酶活性,观察冻存对大量分离的人肝细胞P4503A4酶活性的影响.     

应用功效系数法综合评价医院医疗工作质量

目的 全面客观地评价医院医疗质量,为医院制订合理的工作计划提供科学的决策依据.方法 运用功效系数法,选取9项医疗工作指标,对某医院2005-2010年的医疗工作质量进行综合评价.结果 从总体看,医院的医疗质量呈逐年上升趋势.结论 功效系数法具有原理简单,易于理解的特点,在医疗工作质量综合评价中具有较好的应用价值.     

Celsior液与UW液对无心跳大鼠供肝保存效果的比较

Objective To compare the effects of Celsior (CS) solution vs University of Wisconsin (UW) solution on preservation of non-heart- beating donor (NHBD) livers in rats. Methods The healthy male SD rats were taken as donors and recipients. The thoracic descending aorta and supradiaphragmatic inferior vena cava were cross-clamped for 10 min to induce ischemia as a NHBD model. After flushed with the cold CS or UW solution, NHBD livers were stored at 4℃ for 8 h or 16 h. Then they were transplanted using the two-cuff technique with arterial reconstruction. Accordingly, the recipients were divided into four groups: CS 8 h, UW 8 h, CS 16 h and UW 16 h groups. The bile discharge, liver enzymes (ALT and AST), ET-1, IL-1 and TNF-alpha levels in serum at 1, 3, and 6 h after reperfusion were measured. Histopathological examination was carried out by HE staining, and the 7-day survival rate was observed. Results As compared with a homogenous appearance in the NHBD livers perfused with CS solution, the NHBD livers perfused with UW solution showed a heterogenous appearance, with more or less mottling. In the CS 8 h group there were more bile discharge at 1 h, lower ALT and AST levels at 1, 3 and 6 h, and lower serum ET-1, IL-1 and TNF-alpha ? levels at 1 and 3 h after reperfusion than the UW 8 h group (P<0.05). Histopathological examination showed a well-preserved hepatic architecture, milder portal congestion and inflammatory infiltration in CS 8 h group as compared with UW 8 h group. The 7-day survival rate in CS 8 h and UW 8 h groups was 58.3% and 25.0% respectively (P<0.05). There were no significant differences in bile discharge, ALT, AST, ET-1, IL-1 and TNF-alpha ? levels at different time points between CS 16 h and UW 16 h groups (P>0.05), and histopathological examination showed no much difference in the tissue damage between two groups; all recipients died within 3 days (P>0.05). Conclusion CS was more effective than UW in preserving NHBD livers after 8 h of cold storage, which may be due to the better perfusion of CS and inhibition of Kupffer cells, but it had better preserve NHBD livers with CS no more than 16 h.