不同型号钛环行端端吻合内瘘手术的临床研究

目的通过对15年来重庆市第三人民医院肾内科收治的596例尿毒症血液透析患者,使用2．5mm和3．0mm两种型号钛环行动-静脉内瘘(AVF)手术的临床观察及分析,了解哪一种型号的钛环更适合于临床。方法随机用2．5mm和3．0mm两种型号钛环行端端吻合内瘘手术,并对内瘘的成熟情况、血流量、管径,使用寿命,以及对左心结构及功能等行彩色多谱勒监测和临床观察。结果两组内瘘成熟情况、使用寿命、并发症等差异无显著性,而内瘘的、血流量、管径,以及心脏结构及功能差异有显著性。结论2．5mm钛环行端端吻合内瘘手术更优越于3．0mm的钛环内瘘手术,因为它使用寿命长,对心脏的副作用少。     

吡柔比星为主联合化疗治疗口腔颌面部晚期恶性肿瘤的临床分析

目的：应用吡柔比星（ＴＨＰ）为主联合化疗与免疫治疗及全身营养支持的综合性治疗口腔颌面部晚期恶性肿瘤。方法：５４例患者进行临床观察分析。结果：常规检查，肿瘤范围，肿瘤直径测量。治疗结果满意，总有效率达６８．５％，同时明显改善了患者营养不良状况。结论：ＴＨＰ治疗口腔颌面部各种恶性肿瘤疗效肯定，辅助免疫治疗及营养支持治疗可提高化疗的效果     

Heme oxygenase-1 alleviates mouse hepatic failure through suppression of adaptive immune responses

Heme oxygenase-1 (HO-1) has protective effects on liver damage induced by noxious stimuli. The mechanism of action of HO-1 is not well understood. In the present study, we investigate the effect of HO-1 in a model of fulminant hepatic failure induced by Propionibacterium acnes and lipopolysaccharide (LPS). The expression of HO-1 mRNA and protein in the liver was increased after repeated administration of the HO-1 inducer cobalt protoporphyrin IX. We found that HO-1 protected mice from acute liver damage induced by P. acnes/LPS and prolonged survival. On the contrary, administration of the HO-1 inhibitor zinc protoporphyrin IX increased liver damage induced by P. acnes/LPS. Subsequently, to investigate the underlying mechanisms of HO-1 in the acute liver injury model, we primed mice with P. acnes only. We found that the expression of HO-1 mRNA and protein in dendritic cells (DCs) was increased after the administration of cobalt protoporphyrin IX. HO-1 decreased the mature markers major histocompatibility complex II and CD80 on liver DCs. The expression of CCR7, CCL2, and CCL22 mRNA, which are expressed by mature DCs, was also reduced. These liver DCs could not efficiently stimulate CD4+ T cell activation and proliferation. Consequently, HO-1 inhibited the activation, proliferation, and T helper 1 polarization of liver-infiltrating CD4+ T cells and reduced the production of serum alanine aminotransferase and proinflammatory cytokines such as interferon-γ and tumor necrosis factor-α. Taken together, our data suggest that HO-1 alleviates P. acnes/LPS-induced fulminant hepatic failure, probably by inhibiting DC-induced adaptive responses.     

3 cm与5 cm胰管支架预防ERCP术后胰腺炎发生的疗效比较

目的 探讨预防性放置3 cm或5 cm胰管支架预防内镜下逆行胰胆管造影术(ERCP)手术后胰腺炎的临床疗效.方法 选取2013年6月至2015年6月该院行ERCP治疗患者220例进行前瞻性研究,随机将入组患者分为3 cm支架组和5 cm支架组,评价其治疗疗效.结果 178例患者成功置入支架,支架放置成功率为81.0％.其中3 cm支架组支架置入成功率为83.0％,5 cm支架组支架置入成功率为79.0％.意向性分析结果显示3 cm支架组和5 cm支架组不良反应发生率分别为6.4％和11.0％,两组比较,差异无统计学意义(P＞0.05).而符合方案集分别显示3 cm支架组胰腺炎发生率为3.3％,明显低于5 cm支架组的10.3％,两组比较,差异有统计学意义(P＜0.05).3 cm支架组和5 cm支架组支架移位中位时间分别为3d和5d,两组比较,差异有统计学意义(P＜0.01).结论 短支架在预防ERCP术后胰腺炎方面优于长支架,由此建议ERCP术后使用3 cm的无凸缘支架.     

肥胖小鼠内脏与皮下脂肪Visfatin基因表达

目的 观察肥胖对小鼠内脏脂肪和皮下脂肪组织Visfatin基因表达的影响.方法 高脂饮食喂养刚断乳雄性c57BL/6小鼠8周,诱导营养性肥胖模型.8周后,筛选肥胖小鼠,普通饲料组作为正常对照,实时荧光定量RT-PCR方法 检测Visfatin的基因表达,分别进行Visfatin基因表达与体质指数、内脏脂肪组织含量及体脂指数相关性的分析.结果 肥胖组小鼠内脏脂肪组织Visfatin表达明显升高,是对照组的4.76倍(95%可信区间为3.68～6.15,P<0.01);腹部皮下脂肪组织Visfatin表达与对照组比较无明显差异(95%可信区间为1.13±1.51,P>0.05).结论 Visfatin在营养性肥胖c57BL/6小鼠内脏脂肪组织中高表达暗示了它可能在肥胖的发生发展中发挥重要的作用,肥胖可能是导致Visfatin基因表达升高的原因之一.     

Characterization of Virus-Responsive Plasmacytoid Dendritic Cells in the Rhesus Macaque

Plasmacytoid dendritic cells (PDC) are potent producers of alpha interferon (IFN-α) in response to enveloped viruses and provide a critical link between the innate and adaptive immune responses. Although the loss of peripheral blood PDC function and numbers has been linked to human immunodeficiency virus (HIV) progression in humans, a suitable animal model is needed to study the effects of immunodeficiency virus infection on PDC function. The rhesus macaque SIV model closely mimics human HIV infection, and recent studies have identified macaque PDC, potentially making the macaque a good model to study PDC regulation. In this study, we demonstrate that peripheral blood PDC from healthy macaques are both phenotypically and functionally similar to human PDC and that reagents used for human studies can be used to study macaque PDC. Both human and macaque PBMC expressed IFN-α in response to herpes simplex virus (HSV), the prototypical activator of PDC, as measured by using an IFN bioassay and IFN-α-specific enzyme-linked immunospot assays. Similar to human PDC, macaque PDC were identified by using flow cytometry as CD123⁺ HLA-DR⁺ lineage⁻ cells. In addition, like human PDC, macaque PDC expressed intracellular IFN-α, tumor necrosis factor alpha, macrophage inflammatory protein 1β/CCL4, and IFN-inducible protein 10/CXCL10 upon stimulation with HSV, all as determined by intracellular flow cytometry. We found that IFN regulatory factor 7, which is required for the expression of IFN-α genes, was, similar to human PDC, expressed at high levels in macaque PDC compared to monocytes and CD8⁺ T cells. These findings establish the phenotypic and functional similarity of human and macaque PDC and confirm the utility of tools developed for studying human PDC in this animal model.     

乌头注射液对不同阶段炎症动物模型的抗炎作用

目的:探讨乌头注射液对多种不同阶段炎症动物模型的影响,初步阐明其抗炎作用机制。方法:Wistar大鼠随机分为模型对照组,低、中、高剂量(0.4、0.8和1.6 mg·kg^-1)乌头注射液组,阳性药对照组(益赛普,10.0 mg·kg^-1);模型对照组和阳性药对照组大鼠于实验第1、4天皮下注射给药;乌头注射液各组大鼠肌肉注射给药,连续7 d。ICR小鼠随机分为空白对照组,低、中、高剂量(0.5、1.0和2.0 mg·kg^-1)乌头注射液组,阳性药对照组(益赛普,14.0 mg·kg^-1);空白对照组和阳性药对照组小鼠于实验第1和4天皮下注射给药;乌头注射液各组小鼠肌肉注射给药,连续7 d。检测乌头注射液作用下大鼠足跖肿胀抑制率、白细胞游出数目、棉球肉芽肿系数、脏器指数和小鼠腹腔毛细血管通透性。结果:与模型对照组比较,中和高剂量乌头注射液组在致炎后1、4、5和6 h角叉菜胶引起的大鼠足跖肿胀率明显降低(P<0.05或P<0.01),中和高剂量乌头注射液组致炎后6~48 h甲醛引起的大鼠足跖肿胀率明显降低(P<0.05或P<0.01),高剂量乌头注射液组大鼠皮下注射羧甲基纤维素后囊中白细胞游出的数目明显减少(P<0.05),低、中和高剂量乌头注射液组大鼠棉球肉芽肿系数明显减少(P<0.05或P<0.01),脏器指数无明显变化(P>0.05)。与空白对照组比较,低、中和高剂量乌头注射液组小鼠腹腔毛细血管通透性均无明显变化(P>0.05)。结论:乌头注射液对多种不同阶段炎症模型均具有明显对抗作用。     

1 048例男性下尿路症状调查以及特点分析

目的 了解成年男性下尿路症状(LUTS)的发生情况、年龄分布与变化规律.方法 采用国际前列腺症状评分问卷表(IPSS)调查2008年参加健康体检的成年男性1 048人,年龄30～80岁,以10岁为一年龄段,分为5个年龄段,评估被调查者的LUTS发生情况.结果 各组LUTS发生的情况为:30岁～为347人,平均IPSS评分(2.48±0.38);40岁～为31 1人,平均IPSS评分(3.80±0.53);50岁～为114人,平均IPSS评分(4.78±1.07):60岁～为207人,平均IPSS评分(5.33±0.68);70～79岁为69人,平均IPSS评分(6.80±1.66).其中各年龄组储尿期症状平均评分分别为:1.20,1.66,2.24,2.57,3.20;排尿期症状平均评分分别为:1.28,2.14,2.54,2.76,3.59;生活质量平均评分为:(1.78±1.42),(1.84±0.30),(1.89±1.04),(2.03±1.08),(2.07±1.92).不同年龄组男性LUTS发生率及症状严重程度与年龄相关(J-T统计量为239743.50,P＜0.001),IPSS总评分、排尿期症状评分及储尿期症状评分与生活质量评分呈正相关,其中储尿期症状比排尿期症状对生活质量影响更大.结论 LUTS症状在成年健康男性中较普遍存在,发病率随年龄增大而增加.LUTS症状越重,对生活质量影响越大,其中储尿期症状较排尿期症状对生活质鼍影响更大.     

微创治疗胆总管结石的术式选择

目的探讨不同条件下胆总管结石(CBDS)的微创手术方案。方法分析近9年间我科治疗的203例CBDS患者的临床资料。据手术方式不同分组:十二指肠镜下乳头气囊扩张取石术(EPBD)组(22例)、十二指肠镜下乳头括约肌切开取石术(EST)组(105例)、腹腔镜胆总管切开取石术(LCBDE)组(76例)。结果 3组的手术成功率、近期并发症发生率、残石率比较差异无统计学意义(P0.05)。手术时间3组比较差异有统计学意义(P=0.000),LCBDE组最短;住院时间3组间差异有统计学意义(P=0.000),EPBD组最短。随访期间结石复发率、反流性胆管炎及乳头狭窄发生率3组间差异有统计学意义(P0.05),LCBDE组与EPBD组相当,EST组最差。结论有适应证的CBDS患者首选EPBD,失败或无适应证者选择LCBDE,EST仅适用于有严格适应证者。