特发性胸椎侧凸前路矫形对胸主动脉偏移的影响及意义

目的 比较青少年特发性胸椎右侧凸患者前路开放小切口矫形手术和后路矫形手术对胸主动脉偏移的影响及其意义.方法 29例青少年特发性胸椎右侧凸患者分为两组.A组14例患者行开放小切口前路矫形术,男1例,女13例,平均14.3岁,胸弯Cobb角平均44.9°.B组15例患者行后路钉钩联合矫形术,男3例,女12例,平均14.2岁,胸弯Cobb角平均46.4°.两组患者手术前后均行胸椎T5～T12节段CT扫描,在每个节段测量右侧肋骨头至主动脉后壁的切线与双侧肋骨头连线的夹角(α)、椎管前缘中点与主动脉中心连线和双侧肋骨头连线的夹角(β)、椎体旋转(γ)、主动脉与椎体间距离(a)以及与左侧肋骨头前缘的垂直距离(b)并进行比较.将胸主动脉偏移与侧凸的三维矫形进行相关性分析明确胸主动脉偏移的原因.结果 A组患者手术后置钉安全角α、主动脉相对椎管前缘旋转角β较术前增大,在T8,T9差异有显著性(P＜0.05);椎体旋转γ角减小,在T8,T9差异有显著性(P＜0.05);主动脉与椎体间距离a减小,主动脉后壁与右侧肋骨头间距离b增大,两者和术前相比在T9有显著性差异(P＜0.05).B组手术前后椎体旋转及主动脉与相邻椎体的解剖关系无明显变化.A组α角、β角、b值增加量与γ角减小量呈明显相关性(P＜0.01);a值减少量与β角增加量具有良好相关性(P＜0.05);在顶椎区α角、β角、b值的增加量与顶椎偏移减少量、a值减少量与T5～T12后凸增加量明显相关(P＜0.01).结论 特发性胸椎右侧凸患者行小切口前路矫形术后胸主动脉相对椎体向前方偏移并靠近椎体.发生主动脉偏移的原因包括主动脉松解、椎体去旋转、冠状面和矢状面矫形.     

Apoptosis and regeneration of sinusoidal endothelial cells after extended cold preservation and transplantation of rat liver

BACKGROUND: Sinusoidal endothelial cells (SECs) are particularly susceptible to cold ischemia-reperfusion (I/R) injury. We have examined the process of injury and recovery of graft after cold-preserved liver transplantation, with special focus on the proliferation of SECs and regulatory mechanisms involved. METHODS: Male SD rats were divided into two groups according to length of cold preservation time in University of Wisconsin [UW] solution of graft: UW1h group and UW12h group. Graft function, incidence of apoptosis, proliferation of SECs and the expression of related regulatory factors were assessed after orthotopic liver transplantation (OLT). RESULTS: SECs are more sensitive to apoptosis induced by cold I/R injury compared with hepatocytes. Using bromodeoxyuridine and rat endothelial cell antigen-1 double immunostaining assay, SECs exhibited a delayed proliferation in comparison with hepatocytes, reaching a peak at 72 hr in UW1h group and 96 hr in UW12h group, respectively. Vascular endothelial growth factor increased at 24 hr after reperfusion, and peaked at 72 hr in both groups. Flt-1 and flk-1 expression was found to be mainly limited to SECs, with a peak in expression occurring between 72 and 96 hr, which coincided with the peak in SEC proliferation in UW1h group. However, flt-1 was found to be reduced significantly at any time throughout the experiments in UW12h group compared to sham. CONCLUSION: The delayed recovery of rat liver after extended cold preservation and transplantation correlates with a retarded regeneration of SECs due to increased apoptosis and reduced expression of flt-1. These results suggest that SECs play an important role in cold-preserved liver transplantation.     

肾缺血-再灌注损伤大鼠SDF-1、ICAM-1表达与肾小管坏死评分的相关性研究

目的 探讨肾缺血-再灌注损伤(IRI)大鼠基质细胞衍生因子(SDF)-1、细胞间黏附分子-1(ICAM-1)与肾小管坏死评分的相关性。方法 将60只SD大鼠随机分成手术组、假手术组两组,每组各30只。根据手术后检测时间不同,每组再分为6个不同时段的亚组(1、6、12、24、48、72 h组),每个亚组有5只大鼠。手术组建立大鼠肾IRI模型,假手术组大鼠仅予游离双侧肾动脉后缝合切口。检测各个时间点肾功能、肾小管坏死评分及肾脏组织SDF-1、ICAM-1表达变化。对手术组大鼠肾组织SDF-1、ICAM-1表达与肾功能和肾小管坏死评分进行Pearson直线相关分析。结果 手术组术后血尿素氮(BUN)、血清肌酐(Scr)较术前及相应时间段假手术亚组明显升高(均为P<0.05),且于术后12 h显著升高,高峰期在术后48 h。手术组肾小管坏死评分随时间的延长逐渐增高(均为P<0.05);肾小管坏死评分最高在手术48 h组(P<0.05)。与手术1 h组比较,手术6 h组大鼠肾组织SDF-1、ICAM-1表达开始明显增多(均为P<0.05);手术后48 h达高峰,于手术后72 h开始下降。手术组的肾组织SDF-1、ICAM-1表达与术后各时间段BUN、Scr、肾小管坏死评分呈正相关(r=0.614、0.662、0.751;0.640、0.703、0.785;均为P<0.05)。结论 当大鼠肾组织发生IRI时,SDF-1、ICAM-1表达上调,BUN、Scr升高,肾小管坏死评分升高,而且SDF-1、ICAM-1的表达与BUN、Scr、肾小管坏死评分呈正相关,提示SDF-1、ICAM-1表达增高程度可以作为反映肾IRI后严重程度的指标。     

两种生物免疫诱导方案对肾移植受者的影响

目的 评估肾移植受者中应用两种不同生物制剂进行免疫诱导治疗的疗效和安全性。方法 回顾性分析2008年6月至2013年4月,在解放军第452医院泌尿外科暨成都军区泌尿外科中心应用生物制剂进行免疫诱导治疗的78例尸体肾移植受者的临床资料。根据应用免疫诱导方案不同分为两组,单克隆抗体组(A组,35例,接受巴利昔单抗治疗)和多克隆抗体组[B组,43例,接受抗胸腺细胞球蛋白(ATG)治疗]。另以同期在该院未接受免疫诱导治疗的肾移植受者作为对照组(C组,32例)。分析3组受者术后12周内的人、肾存活情况。监测3组受者术后7、14、30、60 d血清肌酐(Scr)水平变化。比较3组受者急性排斥反应、移植肾功能延迟恢复、感染等并发症的发生率。结果 术后12周,3组受体人、肾存活率分别为 A组100%和100%,B组97.7%和97.7%,C组100%和96.9%,各组间比较差异无统计学意义(均为P>0.05)。术后7、14 d,与C组比较,A组和B组的Scr水平明显下降,差异均有统计学意义(均为P<0.05)。与C组比较,A、B两组受者急性排斥反应发生率均降低,差异有统计学意义(均为P<0.05);3组受者移植肾功能延迟恢复发生率比较,差异无统计学意义(均为P>0.05)。B组受者术后感染发生率高于A组和C组,差异均有统计学意义(均为P<0.05)。结论 免疫诱导治疗在肾移植受者中应用安全有效。     

shRNA-CTGF重组质粒对瘢痕疙瘩Ⅰ型胶原蛋白表达的影响

目的 构建pGPU6/GFP/Neo-shRNA-CTGF重组质粒（简称shRNA-CTGF）,通过RNA干扰（RNAi）技术对结缔组织生长因子（connective tissue growth factor,CTGF）进行体内、体外干预,分析其对瘢痕疙瘩Ⅰ型胶原蛋白（collagen-Ⅰ,COL-Ⅰ）表达的影响.方法 设计并构建特异性shRNA-CTGF重组质粒,RNAi转染体外培养瘢痕疙瘩成纤维细胞（keloid fibroblast,KFB）,检测CTGF基因沉默情况及KFB分泌的COL Ⅰ量;将shRNA-CTGF重组质粒对构建的裸鼠瘢痕疙瘩动物模型进行体内转染,检测CTGF基因沉默情况及COL-Ⅰ基因、蛋白表达水平.结果 成功构建了CTGF重组质粒,其在体内、体外环境下均可成功沉默CTGF表达,其抑制率为86.8％和54.1％;RNA体外干扰KFB定向沉默CTGF的同时可显著抑制COL-Ⅰ表达,其mRNA、蛋白水平抑制率分别为76.8％和65.6％;RNA体内干预实验也可显著降低COL-Ⅰ表达,其mRNA、蛋白水抑制率分别为52.7％和48.0％.结论 shRNA-CTGF重组质粒在体外及体内环境下均可成功沉默CTGF基因表达,沉默CTGF能显著降低瘢痕疙瘩中COL-Ⅰ蛋白含量,提示CTGF基因是病理性瘢痕治疗的潜在靶点.     

Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis

Background

Robotic surgery has been used successfully in many branches of surgery; but there is little evidence in the literature on its use in rectal cancer (RC). We conducted this meta-analysis that included randomized controlled trials and nonrandomized controlled trials of robotic total mesorectal excision (RTME) versus laparoscopic total mesorectal excision (LTME) to evaluate whether the safety and efficacy of RTME in patients with RC are equivalent to those of LTME.

Materials and methods

Pubmed, Embase, Cochrane Library, Ovid, and Web of Science databases were searched. Studies clearly documenting a comparison of RTME with LTME for RC were selected. Operative and recovery outcomes, early postoperative morbidity, and oncological parameters were evaluated.

Results

Eight studies were identified that included 1229 patients in total, 554 (45.08%) in the RTME and 675 (54.92%) in the LTME. Meta-analysis suggested that the conversion rate to open surgery in RTME was significantly lower than in LTME (P = 0.0004). There were no significant differences in operation time, estimated blood loss, recovery outcome, postoperative morbidity and mortality, length of hospital stay, and the oncological accuracy of resection and local recurrence between the two groups. The positive rate of circumferential resection margins (P = 0.04) and the incidence of erectile dysfunction (P = 0.002) were lower in RTME compared with LTME.

Conclusions

RTME for RC is safe and feasible, and the short- and medium-term oncological and functional outcomes are equivalent or preferable to LTME. It may be an alternative treatment for RC. More multicenter randomized controlled trials investigating the long-term oncological and functional outcomes are required to determine the advantages of RTME over LTME in RC.     

抬高患肢和被动运动对脑卒中肩手综合征患者康复效果的影响

目的探讨采取抬高患肢和被动运动训练对脑卒中后肩手综合征患者康复效果的影响。方法将160例脑卒中后肩手综合征患者分为观察组和对照组,各80例。对照组采用常规护理和康复训练;观察组实施抬高患肢及被动运动,连续4周后评价效果。采用Brunnstrom偏瘫上肢功能评价量表、Fugl-Meyer手指运动功能评定表和Barther指数(MBI)进行评价。结果两组患者治疗后上肢功能分级、手指运动功能及ADL评分与治疗前比较有显著改善(均P0.01),观察组效果显著优于对照组(均P0.01)。结论抬高患肢和被动运动训练可有效促进脑卒中患者的手部功能恢复,进而提高日常生活能力。