The sinusoidal pressure during ischemia-reperfusion injury in perfused mouse liver pretreated with or without L-NAME

BACKGROUND: Hepatic ischemia-reperfusion (I/R) is accompanied by liver weight gain and ascites formation possibly caused by an increase in the sinusoidal pressure, a determinant of hepatic transvascular fluid movement. However, changes in the sinusoidal pressure during hepatic I/R in mice are not known. It is also controversial whether nitric oxide (NO) exerts a beneficial or detrimental effect on hepatic I/R injury. We determined the changes in hepatic sinusoidal pressure and liver weight, and the effect of a NO synthase inhibitor, N(G)-nitro-L-arginine methyl ester (L-NAME) on I/R injury of isolated mouse liver. MATERIALS AND METHODS: Isolated liver from 20 male outbred ddY mice was perfused portally with diluted blood (Hct 3%). After pretreatment with L-NAME (100 microm) or D-NAME (100 microm), ischemia was induced at room temperature by occlusion of the inflow line of the portal vein for 1 h followed by 1-h reperfusion in a recirculating manner. The sinusoidal pressure was assessed by the double vascular occlusion pressure (Pdo), and pre- and postsinusoidal resistance was determined. Liver injury was assessed by blood levels of alanine aminotransferase (ALT). RESULTS: In the d-NAME group (n=7), immediately after reperfusion, the portal pressure increased by 2.8 +/- 0.1 (SE) mmHg, which was accompanied by an increase in Pdo of 1.5 +/- 0.1 mmHg, indicating increases in pre- and postsinusoidal resistance to a similar degree. Then, presinusoidal, but not postsinusoidal, resistance sustained increased until 60 min after reperfusion. Liver weight increased to 0.14 +/- 0.04 g/g liver after reperfusion, followed by a gradual return to baseline. Blood ALT levels increased at 60 min after reperfusion. There were no significant differences in changes in the variables between the D- and L-NAME (n=7) groups. In the time-matched non- I/R control group (n=6), no changes in variables were observed for 2 h. CONCLUSIONS: Mouse hepatic I/R causes marginal liver weight gain associated with a small and transient increase in the sinusoidal pressure, and nitric oxide does not play any significant roles in this injury.     

CD14+单核细胞人类白细胞抗原DR表达率与脓毒症关系的研究

目的了解烧伤延迟复苏时CDl4^＋单核细胞人类白细胞抗原DR（HLA—DR）表达率的变化，分析其与脓毒症的关系。方法选择烧伤面积大于30％TBSA的25例烧伤延迟复苏患者，于伤后1、3、7、14、28d取外周血，其中7例患者住院期间并发脓毒症，于脓毒症发生后连续2d亦取其外周血。另取20例健康体检者外周血作为对照。流式细胞仪检测CD14^＋单核细胞HLA．DR表达率，酶联免疫吸附测定法检测血浆中肿瘤坏死因子α（TNF—α）、白细胞介素10（IL-10）的浓度。结果非脓毒症患者伤后1、3、7、14、28dCD14^＋单核细胞HLA—DR表达率分别为（15±6）％、（74±5）％、（264±17）％、（284-16）％、（474-16）％，明显低于健康体检者[（924±10）％，P〈0．01]；脓毒症患者发生脓毒症后1、2d，该指标亦明显低于健康体检者及非脓毒症患者伤后1、7、14、28d（P〈0．01）。脓毒症患者TNF—d检出率及TNF—α、IL-10浓度，均高于非脓毒症患者和健康体检者（P〈0．05或P〈0．01）。伤后1、7、28d，外周血CD14^＋单核细胞HLA—DR表达率与IL—10浓度呈显著负相关（r分别为-0．9963、-0．7459、-0．8474，P〈0．01）。结论烧伤延迟复苏患者免疫功能低下，促炎性介质释放量增加，并发脓毒症时则更为严重。外周血CD14^＋单核细胞HLA—DR表达率可作为动态检测患者免疫功能状态的有效指标。     

兴奋胆碱能通路对内毒素血症和肠缺血/再灌注动物肝脏功能的保护作用

目的:观察不同方式激活胆碱能受体途径对内毒素血症和肠缺血/再灌注动物肝脏功能的保护作用.方法:静脉注射内毒素(LPS,10 mg/kg和5 mg/kg)复制大鼠内毒素血症模型(每组10只),肠系膜上动脉夹闭1 h后松夹复制肠缺血/再灌注模型(每组6只),兔肠系膜上动脉部分阻断后4 h恢复血流复制兔肠部分缺血/再灌注模型(每组5只).内毒素血症大鼠分别施与迷走神经刺激或电针副交感神经相关穴位(后三里穴),并分别设模型组、假手术组和迷走神经切断组或电针假穴组;肠缺血/再灌注动物经肠袋(距离回盲部15 cm处起始,向空肠端作一个长约10 cm肠袋,保留血液供应)给予卡巴胆碱(大鼠:0.1 mg/kg;兔:3μg/kg),并设假手术组和模型组.各组大鼠于实验结束时、各组兔于上动脉阻断0、2、4、6、8 h及1、2、3 d取股动脉血测定血浆丙氨酸转氨酶(ALT)活性.结果:与模型组、迷走神经切断组或电针假穴组比较,采用迷走神经刺激或电针刺激副交感神经相关穴位(后三里穴)明显降低内毒素血症大鼠早期血浆ALT活性(P＜0.05或P＜0.01);肠缺血及再灌注后大鼠ALT明显升高,肠袋给予卡巴胆碱后ALT水平均有明显改善.肠袋输注卡巴胆碱兔血浆ALT活性在缺血/再灌注早期较缺血前增加,再灌注后逐渐恢复,伤后3 d基本接近正常水平,而模型组则逐渐升高.结论:通过刺激副交感神经或局部给予拟胆碱药的方式激活胆碱能受体途径对内毒素血症和肠缺血/再灌注动物肝脏功能具有不同程度的保护作用.     

Extended Lateral Supramalleolar Flap for Very Distal Foot Coverage: A Case With Arteriovenous Malformation

Arteriovenous malformation of the foot is very uncommon, and surgical closure after its treatment with embolization and total excision may be challenging for the foot surgeon, particularly in distally localized lesions. A popular method to cover these difficult wounds is free-tissue transfer, which is a highly demanding procedure. Alternatively, distally based regional flaps have been occasionally reported for clinical use in such distant foot defects. Herein, we present a 36-year-old female patient with a diagnosis of arteriovenous malformation arising in the distal medial plantar and dorsal surfaces of the right foot. After surgical resection of the vascular lesion preceded by a misapplied embolization procedure, an extended lateral supramalleolar flap was successfully transferred to the defect area, covering it completely. Functional and aesthetic outcome was satisfactory after 6 months follow-up. Extended lateral supramalleolar flap is a useful and reliable choice for distal foot reconstructions.     

Recurrent peripheral embolism following nonunion of the clavicle

Vascular complications in closed clavicular fractures are uncommon, with an incidence of only 0.4%. Subclavian artery injury can present acutely or can have a delayed presentation with arm ischemia. We report the case of an undetected subclavian pseudoaneurysm in a patient with a nonunion fracture clavicle who was referred with persistent ischemia following attempted brachial embolectomy at another center, along with a review of literature to support the hypothesis that in addition to repair of the aneurysm, treatment of the psuedarthrosis by fixation of the clavicle is essential.     

米非司酮调控乳腺癌细胞增殖的研究

目的研究米非司酮对乳腺癌细胞系MCF-7和T47D的增殖抑制作用。方法采用四甲基偶氮唑盐(MTT)法检测米非司酮对乳腺癌细胞系MCF-7和T47D的半数抑制浓度(IC50)。不同浓度米非司酮(0.25、2.5、25和50μmol/L)分别处理人乳腺癌细胞系MCF-7和T47D1、2、3d后,观察细胞形态变化,以及检测各组细胞生长曲线。结果米非司酮对乳腺癌MCF-7和T47D细胞均有抑制作用,其抑制率均随着米非司酮浓度的增加而变化,存在明显的量效关系。通过对两种细胞抑制率(IR)值直线回归分析,米非司酮对MCF-7细胞的IC50为51.21μmol/L,对T47D细胞的IC50为54.29μmol/L。形态学观察发现,各组细胞体积变小,细胞间的链接消失,细胞内明显有黑色小颗粒聚集。25和50μmol/L浓度米非司酮对MCF-7乳腺癌细胞株生长抑制作用明显,特别是50μmol/L干预24h后在高倍镜下可见明显的核质浓缩。结论米非司酮对病理分型、激素受体型不同的乳腺癌MCF-7和T47D细胞均具有抑制增殖的作用,并呈时间和剂量依赖效应。     

Correlation between pathological types of parathyroid and clinical manifestations in patients with renal secondary hyperparathyroidism

Objective To analyze the correlation between the pathological types of parathyroid and clinical manifestations in patients with renal secondary hyperparathyroidism (SHPT), so as to improve the efficacy and safety of treatment. Methods The pathological and clinical data of 130 patients with renal SHPT and maintenance hemodialysis (MHD) who had undergone total parathyroidectomy with autotransplantation (TPTX+AT) were collected. A total of 545 parathyroid glands were obtained and 998 slices were made and read. According to the pathological types of parathyroid hyperplasia, the patients were divided into diffuse hyperplasia (DH) group, diffuse between hyperplasia and nodular hyperplasia (DH/NH) group as well as nodular hyperplasia (NH) group. The clinical and biochemical characteristics of different groups before and after operation (1-, 3-, 6-, 9-, 12-month) were compared and analyzed by statistical tests. Results (1) The preoperative status: the dialysis age, serum calcium as well as incidence of bone pain, skin itching and shorten height in the NH group were significantly higher than those in the DH group (all P＜0.05), and the serum phosphorus and iPTH in the NH group were significantly higher than those in DH and DH/NH group (all P＜0.05). (2) The postoperative status: the serum calcium of the NH group at 1-month was lower than that of the DH group, and the incidence of hypocalcemia of the NH group at 1-month was higher than that of the DH group (P＜0.05); the serum phosphorus at 3-, 6-, 9-month and iPTH at 1-, 3-month of the NH group were significantly lower than that of the DH group (all P＜0.05), and the serum phosphorus at 3-month and iPTH at 1-month of the NH group were lower than that of the DH/NH group (all P＜0.05). Among the 3 groups the serum phosphorus change from 1 to 12 months had difference (F=3.241, P=0.042), while the differences of serum calcium and iPTH changes were statistically insignificant. Conclusions The clinical manifestations, serum calcium, phosphorus and iPTH in patients with renal SHPT before and after TPTX+AT are closely related to the pathological types of parathyroid hyperplasia. Compared with the DH patients, before the operation the NH patients have longer dialysis age, more serious the clinical symptoms such as bone disease, higher calcium, phosphorus and iPTH, while greater reduction of the serum calcium, phosphorus and iPTH in the short term after operation.     

多元实验室开放训练提升医学生临床技能的实践研究

目的 为提升医学生临床技能,探索多元实验室开放训练的实施方案及效果。方法 选取2015级808名临床医学本科生,在第5、6、7学期进行多元实验室开放训练。采取多元化预约方式：个人自主网络预约、书面预约、“挂号式”网络预约;多元化开放模式：学生自主练习、“工作坊”式专项操作培训、团队补课;多元化练习模块：基本技能、专科技能、综合技能。对学生多元实验室开放训练和实习结束后两阶段进行问卷调查的结果分析;比较2015级与2014级毕业技能考试成绩。采用SPSS 20.0软件进行t检验。结果 多元化实验室开放后,92.61%（664/717）的学生对开放模式满意;93.58%（671/717）的学生对预约方式满意;94.42%（677/717）的学生认为其能促进学习动力;97.35%（698/717）的学生认为其能激发学习兴趣;96.51%（692/717）的学生认为其能帮助知识和技能的掌握。实习后返校问卷显示：98.02%（741/756）的学生认为能提升临床技能;92.33%（698/756）的学生认为能培养临床思维;95.63%（723/756）的学生认为能增强实习自信心;94.18%（712/756）的学生认为能增加职业归属感。2015级临床医学生的毕业技能考试成绩[（90.33±5.59） vs. （82.22±7.19）]和单项技能成绩均优于2014级,差异有统计学意义（P<0.001）。结论 多元实验室开放训练可激发学生学习兴趣、提高学习动力,有助于提升学生临床技能和临床思维,能增强学生实习信心和职业归属感。     

中国肥厚型心肌病患者血栓栓塞事件风险预测模型的构建研究

背景 血栓栓塞（TE）事件是肥厚型心肌病（HCM）的重要并发症。目前针对HCM患者TE事件的风险预测,仅国外学者构建了两个模型：HCM Risk-CVA及French HCM score,然而,现有研究发现HCM Risk-CVA模型对于中国HCM患者的临床价值较为有限。目的 本研究拟构建适合中国HCM患者的TE事件风险预测模型。方法本研究系回顾性队列研究,收集2010—2018年在四川大学华西医院就诊的537例HCM患者的病例资料。本研究通过电话随访或电子病历系统查询患者就诊记录,每6～12个月随访1次,直至出现终点事件或死亡或研究拟定的评估日期（2019-12-31）,终点事件定义为复合性TE事件。采用单因素和多因素Cox回归分析构建风险预测模型,并使用自助重抽样的方法进行内部验证。结果 537例患者中,24例患者有不同程度的数据缺失,最终纳入513例患者。中位随访时间为4.2(1.3,6.2)年,随访过程中42例（8.18%）发生TE事件,年发病率为2.10%[95%CI(1.47%,2.73%)]。根据多因素Cox回归模型构建TE事件风险预测模型,最终纳入年龄、既往TE事件、心...