Characteristic Echocardiographic Manifestations of Behçet's Disease

The objective of this study was to determine the characteristic echocardiographic manifestations of Behçet's disease. Ninety-seven Behçet's patients admitted to our hospital from January 2002 to December 2016 were retrospectively analyzed. There were 63 patients (64.9%) with cardiac involvement; these included 47 men (74.6%) and 16 women (25.4%). Of these 63 patients, most (74.6%) exhibited valvular lesions, especially aortic regurgitation. The primary characteristic manifestations of valves were cusp prolapse with aneurysmal changes, vegetation-like lesions and echo-free spaces within the annulus. Second (30.0%) were aortic lesions, including aortic dilation or aneurysm formation, aortic pseudoaneurysm and coronary sinus aneurysm. Other manifestations, such as cardiac thrombosis, coronary arterial pseudoaneurysm, pulmonary aneurysm and pericardial effusion, were rare. Cardiac involvement is not uncommon in Behçet's patients, especially in males, and it is characterized by valvular disease, especially aortic regurgitation. The diagnosis of Behçet's disease should be considered when evaluating patients with these characteristic echocardiographic manifestations.     

白细胞介素2基因转染细胞因子诱导的杀伤细胞对恶性黑素瘤细胞的杀伤作用

目的 探讨白细胞介素2(IL-2)基因转染细胞因子诱导的杀伤细胞(CIK)对恶性黑素瘤的杀伤能力.方法 提取小鼠脾细胞,分离淋巴细胞,培养CIK细胞,用携带IL-2的质粒PEGF-N1-IL-2转染CIK细胞,荧光显微镜观察质粒转染情况,反转录-聚合酶链反应(RT-PCR)鉴定IL-2基因的表达.将效应细胞(CIK细胞或IL-2转染CIK细胞)和靶细胞(B16黑素瘤细胞)分别按照效靶比10∶1、20∶1和40∶1混合培养,采用4h乳酸脱氢酶释放测定法,检测两种CIK细胞对B16细胞的细胞毒活性.按照效靶比40∶1混合,采用酶联免疫吸附测定法(ELISA)检测两种CIK细胞IL-2、干扰素γ(IFN-γ)和肿瘤坏死因子α(TNF-α)水平.建立小鼠黑素瘤模型,将28只模型小鼠平均分为4组:对照组(瘤旁注射0.2 ml生理氯化钠溶液)、IL-2组(瘤旁注射100 IU IL-2)、CIK组(瘤旁注射细胞数约1×106 CIK细胞悬液)、IL-2转染CIK组(瘤旁注射细胞数约1×106 IL-2转染CIK细胞悬液),通过肿瘤形态学和抑瘤率、细胞凋亡率来评价荷瘤小鼠肿瘤生长情况.两组正态分布计量资料的比较行t检验,多组计量资料的比较采用方差分析,两两间多重比较采用LSD-t检验.结果 荧光显微镜及RT-PCR均显示IL-2转染CIK细胞成功.效靶比实验显示,40∶1时IL-2转染CIK细胞对B16细胞的毒性最强,IL-2转染CIK细胞组分泌IL-2 (1107.26±6.49 pg/ml)、IFN-γ(50.01±3.35 pg/ml)和TNF-α(39.86±3.25 pg/ml)的能力明显高于CIK细胞组(分别为51.09±3.85、32.71±2.43、30.11±3.08 pg/ml),两组比较,t值分别为442.60、14.93和6.89,差异均有统计学意义(P＜0.01).动物实验显示,与干预前相比,干预后对照组小鼠肿瘤体积明显增大(P＜0.05),而IL-2组、CIK组和IL-2转染CIK组小鼠肿瘤体积明显减小(P＜ 0.001),且IL-2转染CIK组肿瘤体积显著小于其他3组(均P＜0.01),但IL-2组和CIK组差异无统计学意义(P＞0.05).CIK组、IL-2组和IL-2转染CIK组的细胞凋亡率均显著大于对照组(P＜0.01),IL-2转染CIK组的细胞凋亡率及抑瘤率均显著大于IL-2组和CIK组(P＜ 0.01),而IL-2组和CIK组细胞凋亡率及抑瘤率差异无统计学意义(P＞0.05).结论 IL-2转染CIK细胞对恶性黑素瘤有更强的杀伤作用.     

Accumulation of tissue advanced glycation end products correlated with glucose exposure dose and associated with cardiovascular morbidity in patients on peritoneal dialysis

ObjectivesAccumulation of tissue advanced glycation end products (AGEs) is a marker of cumulative glycemic and/or oxidative stress. Cutaneous AGEs levels measured by skin autofluorescence correlate well with cardiovascular outcomes in diabetes and hemodialysis (HD) patients. The present study aimed to compare tissue AGEs levels with peritoneal dialysis (PD) and HD patients and to evaluate the relationship between skin autofluorescence and cardiovascular morbidity in patients on PD.MethodsA total of 2388 maintenance dialysis patients (613 PD and 1775 HD) were enrolled in this cross-sectional study. Skin autofluorescence was measured non-invasively with an autofluorescence reader. Cardiovascular morbidity was defined as clinically diagnosed ischemic heart disease, heart failure, stroke or peripheral vascular disease from initiation of dialysis.ResultsMore than 90% of patients on both PD and HD had met current dialysis adequacy targets. Compared to HD group, PD patients receiving conventional glucose-containing dialyzate had significantly higher skin autofluorescence values in each category of age and dialysis duration, irrespective of the presence or absence of diabetes. In PD patients, skin autofluorescence values were strongly correlated with the duration of PD and glucose exposure dose and independently associated with cardiovascular morbidity. Multivariate analysis revealed that glucose exposure dose and skin autofluorescence were the strongest risk factors for cardiovascular morbidity in PD patients after adjustment by age, gender, and other classic- or uremic-related risk factors.ConclusionsAccumulation of tissue AGEs provides a potential link between PD exposure of metabolic stress and progression of cardiovascular disease in patients on PD.     

Comparision of modified and conventional delta-shaped gastroduodenostomy in totally laparoscopic surgery

AIM:To evaluate the safety and feasibility of a modified delta-shaped gastroduodenostomy(DSG)in totally laparoscopic distal gastrectomy(TLDG).METHODS:We performed a case-control study enrolling 63 patients with distal gastric cancer(GC)undergoing TLDG with a DSG from January 2013 to June 2013.Twenty-two patients underwent a conventional DSG(Con-Group),whereas the other 41 patients underwent a modified version of the DSG(Mod-Group).The modified procedure required only the instruments of the surgeon and assistant to complete the involution of the common stab incision and to completely resect the duodenal cutting edge,resulting in an anastomosis with an inverted T-shaped appearance.The clinicopathological characteristics,surgical outcomes,anastomosis time and complications of the two groups were retrospectively analyzed using a prospectively maintained comprehensive database.RESULTS:DSG procedures were successfully completed in all of the patients with histologically complete(R0)resections,and none of these patients required conversion to open surgery.The clinicopathological characteristics of the two groups were similar.There were no significant differences between the groups in the operative time,intraoperative blood loss,extension of the lymph node(LN)dissection and number of dissected LNs(150.8±21.6 min vs 143.4±23.4 min,P=0.225for the operative time;26.8±11.3 min vs 30.6±14.8mL,P=0.157 for the intraoperative blood loss;4/18 vs3/38,P=0.375 for the extension of the LN dissection;and 43.9±13.4 vs 39.5±11.5 per case,P=0.151 for the number of dissected LNs).The anastomosis time,however,was significantly shorter in the Mod-Group than in the Con-Group(13.9±2.8 min vs 23.9±5.6min,P=0.000).The postoperative outcomes,including the times to out-of-bed activities,first flatus,resumption of soft diet and postoperative hospital stay,as well as the anastomosis size,did not differ significantly(1.9±0.6 d vs 2.3±1.5 d,P=0.228 for the time to outof-bed activities;3.2±0.9 d vs 3.5±1.3 d,P=0.295for the first flatus time;7.5±0.8 d vs 8.1±4.3 d,P=0.489 for the resumption of a soft diet time;14.3±10.6 d vs 11.5±4.9 d,P=0.148 for the postoperative hospital stay;and 30.5±3.6 mm vs 30.1±4.0 mm,P=0.730 for the anastomosis size).One patient with minor anastomotic leakage in the Con-Group was managed conservatively;no other patients experienced any complications around the anastomosis.The operative complication rates were similar in the Con-and ModGroups(9.1%vs 7.3%,P=1.000).CONCLUSION:The modified DSG,an alternative reconstruction in TLDG for GC,is technically safe and feasible,with a simpler process that reduces the anastomosis time.     

3D打印技术辅助切开复位内固定与常规手术治疗髋臼骨折疗效的Meta分析

目的 通过Meta分析比较3D打印技术辅助切开复位内固定（ORIF）与常规手术治疗髋臼骨折的临床疗效差异。方法 通过计算机检索建库至2022年7月1日PubMed、EMBASE、Cochrane Library、知网、万方和维普数据库中3D打印技术辅助ORIF与常规手术治疗髋臼骨折的相关文献,根据纳入与排除标准筛选符合的临床对照试验,利用Cochrane评价手册和渥太华纽卡斯尔量表（NOS）对纳入研究进行质量评价,采用RevMan 5.3软件对两组术式临床疗效结果进行统计分析。结果 共纳入6篇随机对照试验,14篇非随机对照试验,研究对象821例（3D打印手术组372例,常规手术组449例）。Meta分析结果显示：在手术时间[MD=-43.41,95%CI(-56.19,-30.62),P<0.000 01]、术中出血量[MD=-216.47,95%CI(-298.39,-134.56),P<0.000 01]、术中透视次数[MD=-5.43,95%CI(-7.71,-3.15),P<0.000 01]、术中器械安装时间[MD=-27.31,95%CI(-31.29,-...     

心肌缺血再灌注损伤模型大鼠心肌组织及血清肌钙蛋白Ⅰ表达和心肌肿瘤坏死因子α与重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白的干预

背景：心肌缺血再灌注时生成大量的肿瘤坏死因子α直接造成心肌的收缩功能下降。目的：观察药物重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白对大鼠缺血再灌注心肌损伤的影响。方法：成年雄性Wistar大鼠建立心肌缺血再灌注模型。药物干预组在再灌注前注射重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白,模型组给予生理盐水,并设立不造模的假手术组。再灌注后立即测量心肌梗死面积,ELISA检测再灌注后的心肌肿瘤坏死因子α及血清肌钙蛋白Ⅰ的含量,实时PCR检测心肌肿瘤坏死因子αmRNA的表达。结果与结论：与假手术组相比,模型组与药物干预组大鼠心肌肿瘤坏死因子α及其mRNA和肌钙蛋白的水平明显升高（P〈0.05）;与模型组相比,药物干预组心肌肿瘤坏死因子α及血清肌钙蛋白Ⅰ水平明显升高（P〈0.05）,心肌梗死体积与肿瘤坏死因子αmRNA的表达减少（P〈0.05）。提示重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白能够减轻心肌缺血/再灌注损伤作用,改善大鼠的心功能。     

Antitumoral Activity of Rapamycin Mediated Through Inhibition of HIF-1alpha and VEGF in Hepatocellular Carcinoma

Rapamycin (RAPA) inhibits tumor growth and angiogenesis in hepatocellular carcinoma (HCC). The molecular mechanism underlying the antitumoral effects of RAPA remains unclear. Here we established a chemical-induced rat HCC model to investigate the signaling pathways mediating RAPA’s antitumor activity. We found that RAPA exposure significantly diminished tumor growth, angiogenesis, and metastasis of HCC. Meanwhile, the antitumor drug dramatically decreased expression of HIF-1alpha and VEGF, either at mRNA or protein levels. Moreover, the low-dose of RAPA (1.5 mg/kg/day) was effective enough to markedly inhibit tumor progression of HCC. The preliminary results suggested that the antitumoral effects of RAPA might be at least partially mediated through downregulation of HIF-1alpha and VEGF, and low-dose RAPA-based regimens exhibited a promising future in treatment of HCC.     

肿瘤多极射频消融术50例护理体会

目的:探讨50例多极射频消融术患者的术前、术中及术后护理方法。方法:CT引导下定位,对50例肿瘤患者实施射频消融治疗,加强术前准备、术中及术后护理。结果:本组2例出现少量气胸,经对症处理,自行吸收后痊愈,余均未发生其它并发症。结论:射频消融术适应证广,患者痛苦小、恢复快、并发症少、住院时间短、费用低,加强围术期护理是提高手术成功率的保证。     

方丝弓固定矫治Ⅱ类Ⅰ分类错[牙合]后的功能间隙变化分析

目的 观察固定矫治对生长发育期Ⅱ类[牙合]功能间隙变化的影响。方法 选择生长发育期非拔牙Ⅱ类[牙合]青少年患者11例，以方丝弓矫治技术完成治疗，在专业软件下观测功能间隙的变化。结果 治疗后口腔功能间隙面积增大，但无统计学意义；结论 与功能间隙变化相关的项目为N—ME、S-Go，提示促进Ⅱ类[牙合]垂直方向的生长可以改善其功能间隙。