Liver Manipulation Causes Hepatocyte Injury and Precedes Systemic Inflammation in Patients Undergoing Liver Resection

Background Liver failure following liver surgery is caused by an insufficient functioning remnant cell mass. This can be due to insufficient liver volume and can be aggravated by additional cell death during or after surgery. The aim of this study was to elucidate the causes of hepatocellular injury in patients undergoing liver resection. Methods Markers of hepatocyte injury (AST, GSTα, and L-FABP) and inflammation (IL-6) were measured in plasma of patients undergoing liver resection with and without intermittent inflow occlusion. To study the separate involvement of the intestines and the liver in systemic L-FABP release, arteriovenous concentration differences for L-FABP were measured. Results During liver manipulation, liver injury markers increased significantly. Arterial plasma levels and transhepatic and transintestinal concentration gradients of L-FABP indicated that this increase was exclusively due to hepatic and not due to intestinal release. Intermittent hepatic inflow occlusion, anesthesia, and liver transection did not further enhance arterial L-FABP and GSTα levels. Hepatocyte injury was followed by an inflammatory response. Conclusions This study shows that liver manipulation is a leading cause of hepatocyte injury during liver surgery. A potential causal relation between liver manipulation and systemic inflammation remains to be established; but since the inflammatory response is apparently initiated early during major abdominal surgery, interventions aimed at reducing postoperative inflammation and related complications should be started early during surgery or beforehand. Marcel C. G. van de Poll, Joep P. M. Derikx contributed equally to this work.     

腹腔镜门静脉高压症贲门周围血管离断术的风险评估

目的 探讨腹腔镜在外科治疗门静脉高压症手术风险及手术技巧.方法 自 2011 年 6 月以来,46 例诊断为肝炎肝硬变、门静脉高压症、食管胃底静脉曲张,肝功能分级 Child A 级 32 例,B 级 14 例.术前胃镜检查了解食管胃底静脉曲张;门静脉彩超,了解门静脉有无血栓;上腹部 CT 增强扫描,了解脾脏大小,脾动、静脉走行,二级脾蒂分叉部位,脾门以及胃底、贲门周围曲张静脉分布情况.采用 4 孔法,取脐上 10 mm 戳孔为腹腔镜观察孔,左锁骨中线约与脐平线 12 mm 戳孔,为主操作孔;剑突左侧肋缘下 2 cm 处 5 mm 戳孔、左腋前线约与脐平线 12 mm 戳孔为辅操作孔,术者、一助均位于患者右侧.LS 技术操作我们采用前入路与侧入路结合方法,离断脾动脉、胃短血管时用前入路,游离脾肾、脾膈韧带,离断脾蒂时运用侧入路;贲门周围血管离断采用前入路.结果 全腹腔镜成功实施 38 例肝硬化门静脉高压症脾切除加贲门周围血管离断术,7 例术中出现不可控出血中转,1 例慢性胰腺炎术中无法分离出脾动脉中转.手术时间 142 ～ 218 min,平均（ 167 ± 44 ） min,术中出血80 ～ 280 ml,平均（ 113 ± 76 ） ml.采用预先结扎脾动脉,Endo Cut 闭合切割一级脾蒂或二级脾蒂,无出血、胰漏并发症,无死亡病例.术后第 2 天拔除胃管,第 3 天拔除腹腔引流管,术后 7 ～ 12 d 出院.结论 通过上腹部 CT,谨慎进行贲门周围血管离断术手术风险评估,正确的操作步骤,准确的分离层面,娴熟的腹腔镜下分离技巧,处理脾蒂血管动作精细,预防出血,保持视野清晰,尽管风险很大,腹腔镜手术治疗门静脉高压症还是安全、可行的.     

Canine MHC-class II antigens on B and T lymphocytes

MHC-class II antigens on canine lymphoid cells were detected with monoclonal antibodies (Mabs). On the basis of reactivity with resting or activated T lymphocytes two groups of Mabs were reported earlier. Non-activated T lymphocytes expressed MHC-class II antigens recognized by the first group whereas the second group recognized only MHC-class II antigens on activated T lymphocytes. In this study we analysed the reactivity pattern of both groups of Mabs with purified canine B lymphocytes. One- and two-colour immunoflowcytometric analysis, immunoprecipitation, immunohistology and MLC inhibition were performed. The Mabs which only reacted with activated T lymphocytes appeared to stain also purified sIg+ lymph node cells. Two-colour fluorescence and immunohistology confirmed the reactivity of these Mabs with B lymphocytes. Immunoprecipitation showed the bimolecular structure of these antigens. It was concluded that two subsets of MHC-class II antigens can be detected on canine lymphoid cells. One subset showed an aberrant distribution being expressed on both nonactivated and activated T and on B lymphocytes. The second subset of MHC-class II antigens could only be detected on B lymphocytes and activated T lymphocytes, a distribution pattern similar to that found in most other species, for instance man.     

经皮瘤内注射艾迪注射液对兔移植性VX2肝肿瘤VEGF表达的影响

目的：探讨超声引导下复方中药艾迪注射液瘤内注射治疗兔移植性VX2肝肿瘤的作用效果及机制。方法建立新西兰大白兔肝VX2移植性肿瘤模型28只,随机分为3组,即艾迪注射液局部注射治疗组（12只）、经皮无水乙醇注射（percutaneous ethanol injection ,PEI）组（8只）、生理盐水局部注射治疗组（8只）。全部动物在接种2周后每隔3天向肿瘤内注入治疗药物,4次后处死。于术前术后兔耳缘静脉抽血行血生化检查,同时行64排螺旋C T 扫描测量并计算肿瘤体积、肿瘤增长率及肿瘤坏死率,以及进行免疫学、组织细胞学与细胞超微结构的观察。结果各实验组病灶均进行性增大,但艾迪注射液治疗组肿瘤增长率及坏死率最小,与生理盐水组比较差异均有统计学意义（ P ＜0．05）,与无水乙醇治疗组比较差异无统计学意义;艾迪注射液治疗组血管内皮生长因子（vascular endothelial growth factor ,VEGF）蛋白表达水平最低,低于无水乙醇治疗组和生理盐水组,有显著差异性（ P ＜0．05）;同时,艾迪注射液治疗组有1例出现肝内转移灶,而无水乙醇及生理盐水治疗组分别有4例和5例出现转移灶,有显著差异性（ P ＜0．05）;艾迪注射液治疗组AST 、ALT、ALP、BUN及白细胞计数治疗前后均无明显差异,组内及组间比较无统计学意义（ P ＞0．05）。结论艾迪注射液能明显抑制兔肝移植性VX2肿瘤VEGF蛋白的表达。     

Human immunodeficiency virus-type 1 replication can be increased in peripheral blood of seropositive patients after influenza vaccination

Despite considerable evidence that cell activation enhances human immunodeficiency virus-type 1 (HIV-1) replication in vitro, there is very little data on the role of immune activation on in vivo HIV-1 replication. In this study, we examined the effect of influenza vaccination on HIV-1 replication in the peripheral blood of 20 study subjects, and in 14 control subjects who did not receive influenza vaccination. Blood was obtained from each subject on three occasions during the month before vaccination and again on three occasions during the following month. Over the study period, there was little change in levels of proviral DNA in peripheral blood mononuclear cells (PBMCs). However, peak PBMC viral RNA levels after influenza vaccination were significantly increased over the mean of prevaccination values. This change was not observed to the same extent in unvaccinated controls. Therefore, this is the first report showing that HIV-1 replication can increase in temporal association with influenza vaccination. Our results suggest that continued immunologic (antigenic) stimulation may result in increased virus load in vivo. To address the appropriateness of influenza vaccination in HIV-infected patients, expanded studies will be required to examine specific and generalized immune responses to vaccination, and differences in patient response based on disease stage.     

血浆Adropin水平与急性心肌梗死患者心功能关系的相关性研究

目的探讨急性心肌梗死（AMI）患者血浆Adropin水平与心功能的关系。方法选择108例AMI患者（AMI组）及60例健康对照者（对照组）。使用Killip心功能分级标准评价AMI患者的心功能,采用超声心动图测量AMI患者的左心室射血分数（LVEF）,使用ELISA法测定两组的血浆Adropin水平。结果AMI组患者血浆Adropin水平（11．46±159）ng／mI,较对照组（628±072）ng／ml明显增高（P〈0．01）。血浆Adropin水平随Killip心功能分级的增加而增高（r=0318,P〈005）,而与LVEF值呈负相关（r=-0．225,P〈0．01）。结论血浆Adropin水平越高的AMI患者心功能越差,Adropin是预测AMI患者心功能的一个潜在的生物学标记物。