Kv1.3钾通道调节人脐静脉内皮细胞 LOX-1受体摄取oxLDL

目的 观察Kv1.3钾通道在LOX-1摄取oxLDL中的作用,并探讨其机制。方法 分别以慢病毒载体shRNA-Kv1.3-LV3-pGLV-h1-GFP-puro和Kv1.3-LV5-EF1a-GFP-Puro转染人脐静脉内皮细胞(HUVECs),以获得HUVECs细胞中下调和上调表达Kv1.3蛋白。利用全细胞膜片钳技术记录Kv1.3蛋白过表达和下调的HUVECs Kv1.3 I/V曲线。以oxLDL与HUVECs共孵育后,分别应用免疫比色法和Fluo-3/AM荧光标记法测定细胞内胆固醇和钙离子相对含量。经Western blot法测定Kv1.3、LOX-1、p38、p38磷酸化水平。结果 shRNA950转染组HUVECs Kv1.3 mRNA和蛋白表达量较空白对照组显著降低(P<0.05),过表达转染组Kv1.3 mRNA和蛋白表达量较空白对照组显著升高(P<0.05)。Kv1.3表达上调后, I/V曲线上移,该效应可被奎尼丁抑制;Kv1.3表达下调后,I/V曲线下移。Kv1.3过表达组胆固醇相对水平明显高于对照组(P<0.05),shRNA950+oxLDL组胆固醇的相对含量低于oxLDL组(P<0.05)。Western blot法检测显示,Kv1.3过表达组的LOX-1蛋白表达量较对照组升高(P<0.05),Kv1.3敲低组的LOX-1蛋白水平较对照组减低(P<0.05);Kv1.3过表达组磷酸化p38与p38蛋白水平的比值高于对照组二者的比值(P<0.05),Kv1.3敲低组磷酸化p38与p38蛋白表达量的比值低于对照组两者的比值(P<0.05)。结论 Kv1.3钾通道经p38信号通路参与调节HUVECs LOX-1受体摄取oxLDL。该研究为阐明LOX-1结合oxLDL的电荷依赖性机制增添了新的实验依据。     

复合植皮治疗功能部位烧伤感染创面

大面积烧伤患者抢救后期均存在感染的肉芽创面 ,一般常以自体刃厚皮片移植来覆盖创面 ,但愈合后常出现明显瘢痕 ,特别是功能部位 ,瘢痕挛缩、粘连、牵拉导致功能障碍。很多患者不得不再次手术。为此 ,在治疗中要求尽可能在功能部位植皮时使用厚皮片。但对于大面积烧伤患者 ,有时很难达到。近年来 ,有数种真皮替代材料用于整形手术中。能否在大面积烧伤治疗中使用真皮替代材料 ,结合自体刃厚皮片移植以改善创面愈合以后的状况 ,预防畸形的发生、保留完好的功能是需要解决的问题。目前 ,可见到的数种真皮替代材料均注明 :创面有感染存在时禁用…     

后路显微内窥镜（METRx^TM）下钙化型腰椎间盘突出症的治疗

目的探讨经后路显微内窥镜椎间盘切除手术系统（MED）治疗钙化型腰椎间盘突出症的适应证选择及手术技巧。方法2000年12月至2008年6月,使用后路显微内窥镜系统治疗钙化型腰椎间盘突出症25例,详细介绍了手术过程、手术适应证及操作技巧。治疗组钙化型腰椎间盘突出症与一组单纯腰椎间盘突出症MED手术组进行手术时间、术中出血量、术后住院时间、术后下地活动时间、恢复日常生活时间及住院费进行术后短期项目比较。结果术后短期疗效评价依照Nakai分级,优良率91．7％。治疗组有2例脑脊液漏,其中1例转为开放手术,余无严重并发症。钙化型腰椎间盘突出症与单纯腰椎间盘突出症组比较除手术时间和术中出血量差异有统计学意义（P〈0．05,P〈0．01）外,其余项目均无统计学意义（P〉0．05）。治疗组行腰、腿疼平均目测视觉类比评分法（VAS评分）显示术前与术后3、6、12个月明显下降。Oswestry功能指数（ODI）术前与术后3个月比较,从术前平均45．6降至术后22．4（P〈0．01）。结论对钙化型腰椎间盘突出类型进行分类,术前评估,严格掌握适应证,熟练操作技巧是钙化型腰椎间盘突出症行MED治疗成功的关键。     

术前局部放射治疗与术中灌注化疗对Ⅱ、Ⅲ期中低位直肠癌术后局部复发的影响

目的：探讨术前局部放射治疗与术中灌注化学治疗对Ⅱ、Ⅲ期中低位直肠癌术后局部复发的影响。方法：将96例Ⅱ、Ⅲ期中低位直肠癌患者随机分为综合治疗组（n=48,采用术前局部放射治疗与术中灌注化学治疗）和传统治疗组（n=48,采用传统手术治疗）,比较二组患者术后并发症发生率和局部复发率。结果：96例患者中有3例患者因行姑息性手术而被排除。二组患者术后并发症的发生率及吻合口瘘的发生率差异无统计学意义（χ2=0.288,P=0.592;χ2=0.189,P=0.664）,综合治疗组患者术后局部复发率为4.25%（2/47）,明显低于传统治疗组的局部复发率19.6%（9/46）（χ2=5.225,P=0.022）。结论：术前局部放射治疗与术中灌注化学治疗可明显降低Ⅱ、Ⅲ期中低位直肠癌术后的局部复发率,是安全可行的。     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

后型尿道下裂二期膀胱黏膜半管状重建尿道术的临床研究

目的探讨采用二期膀胱黏膜半管状重建尿道术治疗后型尿道下裂的临床研究。方法81例后型尿道下裂病例采用二期手术：一期手术将阴茎海绵体完全伸直,阴茎包皮内板和背侧皮肤预置于阴茎腹侧;二期手术采用半管状阴茎阴囊皮肤＋半管状膀胱黏膜成形尿道术。结果81例后型尿道下裂患者矫形后形态几乎接近正常。手术成功率为86．4％（70／81）,尿瘘发生率为13．6％（11／81）,8例（9．9％,8／81）发生尿道狭窄,经尿道扩张治疗后痊愈。结论二期膀胱黏膜半管状重建尿道术治疗后型尿道下裂的手术成功率较高,值得临床推荐。     

胰腺癌破裂出血合并多原发癌1例

胰腺癌是一种恶性程度较高的消化系统肿瘤,5年生存率小于5%。多层螺旋CT灌注成像及腹部超声造影等检查显示,胰腺癌的血流供应较少,其血流量约为正常胰腺组织的1/3。     

胆道数字成像技术在活体肝移植肝内胆道解剖分型及胆道切面确定中的应用

目的 评价术中胆道数字成像技术在活体肝移植(living donor liver transplantation,LDLT)肝内胆道解剖分型和胆道切面确定中的作用及临床价值.方法 66例LDLT供者,通过术中胆道数字减影了解胆道分型及变异,结合金属标志物准确选择胆道离断位置,与手术结果比较,分析其在LDLT供者术中胆道解剖描述及切面确定中的作用.结果 所有供者均采用胆道数字成像技术对肝内胆道解剖进行分型,Ⅰ型(经典型)45例(68.2%),Ⅱ型(三叉型,胆总管由右前肝管、右后肝管、左肝管汇合而成)7例(10.6%),Ⅲ型(无右肝管主干,右后肝管汇入肝总管)13例(19.7%),Ⅳ型(无右肝管主干,右后肝管汇入左肝管)1例(1.5%),Ⅴ型(复杂分型)0例(0%).Ⅰ型所有供者均形成单一吻合口;Ⅱ型7例供者中4例形成2个吻合口,3例经成形或非成形后形成1个吻合口;Ⅲ型13例供者中9例形成2个吻合口,4例经成形后形成1个吻合口;Ⅳ型1例供者,2个胆道吻合口.所有供者都完成活体右半肝切取术.结论 术中胆道数字减影结合金属标志物可以精确显示肝内胆道解剖及变异并准确定位肝管切面,减少胆道吻合口数目,有助于供肝的安全获取和移植.

Abstract：

Objective To evaluate biliary digital imaging technology in determining the type of the intrahepatic bile duct anatomy and the transection plane of the duct in right lobe living donor liver transplantation(LDLT). Methods Mobile digital subtraction angiography was performed to show the intrahepatic bile duct anatomy of 66 liver transplant donor candidates. Combined with metal markers, the bile duct transection plane was defined. Comparing with the actual results, the effect of digital imaging technology in determining the intrahepatic anatomical variations and transection plane of the duct in LDLT was evaluated. Results Intrahepatic bile duct anatomical variations were showed in all donors by using digital imaging technology. type Ⅰ (classical type) was identified in45 cases (68.2%), type Ⅱ (with triple confluence, the simultaneous emptying of the right anterior segmental duct, right posterior segmental duct and left hepatic duct into the common hepatic duct) in 7 cases ( 10.6% ), type Ⅲ (no right hepatic duct stem, right posterior segmental duct draining into common hepatic duct) in 13 cases ( 19. 7% ), type Ⅳ (no right hepatic duct stem, right posterior segmental duct draining into left hepatic duct) in 1 case (1.5%), and type Ⅴ (complex variation ) in no case (0%). As a result, cases of type Ⅰ form a single anastomosis. In type Ⅱ, four cases formed double anastomoses, three cases formed single anastomosis with or without ductoplasty. In type Ⅲ, two anastomoses were formed in 9 cases, single anastomosis in 4 cases with ductoplasty. The case of type Ⅳ had double anastomoses. In all cases right lobe liver were harvested.Conclusions Biliary digital subtraction image combined with metal markers accurately defines intrahepatic bile duct anatomy and the transection plane, helping to reduce number of bile duct anastomosis, and contributes to safe graft harvesting.     

慢性马兜铃酸肾病大鼠肾组织微血管损伤机制及温阳活血方的干预作用

目的:研究慢性马兜铃酸肾病大鼠肾组织微血管损伤机制及温阳活血方对其干预作用,探讨温阳活血方对慢性马兜铃酸肾病的保护作用机制.方法:将48只雄性SD大鼠随机分为5组.(1)正常对照组(n=8):予生理盐水灌胃;(2)模型组(n=10):按关木通水煎液10 ml·kg-1·d-1(相当于关木通40 g·kg-1·d-1,马兜铃酸A 2.6 mg·kg-1·d-1)给大鼠灌胃;(3)中药组(n=10):在模型组基础上,再予温阳活血方30 g·kg-1·d-1灌胃;(4)西药组(n=10):在模型组基础上,再予科素亚33.3 mg·kg-1·d-1灌胃;(5)中西药结合组(n=10):在模型组基础上,再予温阳活血方30 g·kg-1·d-1 科素亚33.3 mg·kg-1·d-1灌胃.20周末,光镜观察肾脏病理,采用CD 34免疫组化染色来反映肾组织微血管的损伤情况,实时PCR检测肾组织中Ang-1、Ang-2、Tie-2和VEGF mRNA的表达.结果:(1)与正常对照组比较,模型组大鼠肾组织CD34表达明显降低(P＜0.01);而治疗组大鼠肾组织CD34表达较模型组明显升高(P＜0.05),其中尤以中药组明显(P＜0.01);(2)与正常对照组比较,模型组大鼠肾组织Ang-1、Tie-2、VEGF mRNA表达明显降低(P＜0.05,P＜0.01),Ang-2表达明显升高(P＜0.01);而治疗组大鼠肾组织Ang-1、Tie-2、VEGF mRNA表达较模型组明显升高(P＜0.05,P＜0.01),中西药结合组Ang-2表达明显减少(P＜0.01).结论:慢性马兜铃酸肾病大鼠肾组织存在微血管的损伤,其损伤机制可能与Ang-1、Tie-2和VEGF mRNA的下调,Ang-2 mRNA上调有关,温阳活血方能明显改善微血管的损伤,对慢性马兜铃酸肾病大鼠肾脏具有保护作用.