麻醉前应用新型抗胆碱药物对失血大鼠肠系膜微循环改变的影响

目的:探讨麻醉前应用新型抗胆碱药物长托宁(盐酸戊乙奎醚)对失血大鼠肠系膜微循环改变的影响。方法:4月龄SD大鼠14只,随机分为长托宁组和对照组(n均=7),分别于5%水合氯醛麻醉前腹腔注射长托宁和生理盐水(0.17ml/100g),麻醉30min后行颈总动脉插管及腹腔侧切口暴露肠系膜,放血前和放血至动脉压恒定于60mmHg时观测两组大鼠肠系膜微血管口径及血液流速,统计学分析比较组间微血管收缩率和微血流速度。结果:失血可致肠系膜微血管显著收缩,血流速度明显减慢,长托宁组大鼠微血管收缩率及血液流速减缓率均明显低于对照组(P0.05)。结论:麻醉前长托宁干预能有效改善大鼠失血性肠系膜微循环障碍。     

Sturge–Weber Syndrome Is Associated with Cortical Dysplasia ILAE Type IIIc and Excessive Hypertrophic Pyramidal Neurons in Brain Resections for Intractable Epilepsy

Sturge–Weber syndrome (SWS) is a rare syndrome characterized by capillary‐venous malformations involving skin and brain. Many patients with SWS also suffer from drug‐resistant epilepsy. We retrospectively studied a series of six SWS patients with epilepsy and extensive neurosurgical resections. At time of surgery, the patients' age ranged from 11 to 35 years (with a mean of 20.2 years). All surgical specimens were well preserved, which allowed a systematic microscopical inspection utilizing the 2011 ILAE classification for focal cortical dysplasia (FCD). Neuropathology revealed dysmorphic‐like neurons with hypertrophic cell bodies reminiscent to those described for FCD type IIa in all cases. However, gross architectural abnormalities of neocortical layering typical for FCD type IIa were missing, and we propose to classify this pattern as FCD ILAE type IIIc. In addition, our patients with earliest seizure onset also showed polymicrogyria (PMG; n = 4). The ictal onset zones were identified in all patients by subdural electrodes, and these areas always showed histopathological evidence for FCD type IIIc. Four out of five patients had favorable seizure control after surgery with a mean follow‐up period of 1.7 years. We concluded from our study that FCD type IIIc and PMG are frequently associated findings in SWS. FCD type IIIc may play a major epileptogenic role in SWS and complete resection of the associated FCD should be considered a prognostic key factor to achieve seizure control.     

Health‐related quality of life and sleep among Chinese children after living donor liver transplantation

LDLT is a well‐established treatment for most terminal liver diseases in children. Survival rates have improved, yet few studies have considered HRQoL or sleep problems in LDLT recipients. In this cross‐sectional study, we enrolled 51 children who had undergone LDLT in Renji Hospital. PedsQL^? 4.0 Generic Core Scales, PedsQL^? 3.0 Transplant Module, and Pediatric Sleep Questionnaire were used to assess outcomes. Of all participants, 11.8% (6/51) reported low total HRQoL scores. Participants’ scores on most HRQoL subscales were comparable to the scores of healthy children. However, compared with solid organ transplant recipients, LDLT recipients scored significantly lower in About My Medicines II (t = 3.092, p = 0.002) and Worry (t = 2.760, p = 0.006). Sleep problems (41.2%) were common among participants. Hierarchical regression analyses showed that SRBD accounted for significant variance in HRQoL on total generic HRQoL (R² = 0.446, p < 0.001), psychosocial health (R² = 0.372, p = 0.001), physical health (R² = 0.345, p = 0.003), total transplant‐specific HRQoL (R² = 0.514, p < 0.001), About My Medicines I (R² = 0.365, p = 0.013), My Transplant and Others (R² = 0.334, p = 0.005), Pain and Hurt (R² = 0.544, p < 0.001), Worry (R² = 0.401, p = 0.001), Treatment Anxiety (R² = 0.526, p < 0.001), How I Look (R² = 0.221, p = 0.040), and Communication (R² = 0.343, p = 0.012). In conclusion, sleep problems are non‐negligible in children after LDLT and predicted significant variance on HRQoL.     

Influence of graft size matching on outcomes of infantile living donor liver transplantation

We aimed to assess the impact of size mismatching between grafts and recipients on outcomes of infants or small children after LDLT. Between October 2006 and December 2014, 129 LDLT recipients weighing no more than 8 kg were retrospectively analyzed. The entire cohort was categorized into three groups by GRWR: GRWR<3.0% (group A, n = 38), 3.0%≤GRWR<4.0% (group B, n = 61), and GRWR≥4.0% (group C, n = 30). Baseline characteristics were similar among groups A, B, and C. Compared with groups A and B, post‐transplant alanine aminotransferase and aspartate aminotransferase within seven days were significantly higher in group C; however, differences between total bilirubin and albumin after transplantation were not prominent. Moreover, incidences of surgical complications, perioperative deaths, infections, and acute rejections were all comparable among the three groups. Five‐yr patient survival rates for groups A, B, and C were 89.5%, 88.9%, and 81.6%, respectively (p = 0.872), and the graft survival rates were 89.5%, 86.6%, and 81.6%, respectively (p = 0.846). In conclusion, GRWR between 1.9% and 5.8% would not cause noticeable adverse events for infantile LDLT recipients ≤8 kg. However, there is still a role for considering reduction in the graft mass as an applicable strategy in selected cases.     

线粒体基因碱基变异与老年2型糖尿病的易感性研究

目的 探讨线粒体基因3243和3426位点碱基变异与老年2型糖尿病的易感性。方法采用聚合酶链反应-限制性片段长度多态性（PCR—RFLP）方法，对186例老年2型糖尿病患者和170例健康对照者的线粒体基因3243和3426位点进行筛选分析，并以DNA测序方法确认。结果 两组均未检出3243A→G变异和3426A→G变异，测序中发现糖尿病组3290T→C变异1例。结论 线粒体基因3243A→G变异和3426A→G变异可能与湖北地区老年2型糖尿病的易感性无关联性。     

化疗免疫“窗口期”对卵巢癌治疗影响的实验研究

目的:采用荷瘤动物模型经化疗联合被动免疫治疗,初步探讨化疗免疫"窗口期"对卵巢癌免疫应答的影响及其可能的免疫学机制。方法:以荷瘤大鼠为研究对象,根据紫杉醇联合卡铂对荷瘤鼠免疫功能改变的不同时期给予CTL(cytotoxic T-lymphocyte)主动免疫治疗。观察荷瘤体积及机体免疫微环境改变。结果:荷瘤鼠紫杉醇和卡铂化疗后不同时期给予CTL转输治疗,其中化疗后第6天即淋巴细胞数最少期,给予免疫治疗,肿瘤生长最缓慢;CT扫描结果示,化疗后6天+免疫治疗组的瘤体积最小,且与其余治疗组有统计学意义。荷瘤鼠免疫功能示,化疗后6天+免疫治疗组中淋巴细胞抗原特异性增殖及CD8+T细胞最明显,而Treg(T-Lymphocytes,Regulatory)细胞明显降低。结论:紫杉醇和卡铂联合CTL治疗肿瘤具有协同作用,其中化疗后6天(即淋巴细胞降到最低期)是CTL免疫治疗的最佳时间点。化疗造成的肿瘤个体免疫功能的低下或是免疫系统空间的释放(所谓的免疫"窗口期")为诱导特异性的抗肿瘤免疫应答提供了可能,免疫状态的检测是保证肿瘤患者化疗联合免疫治疗方案治疗有效性的重要前提之一。     

Role of N-methyl-D-aspartate receptor in hyperoxia-induced lung injury

Glutamate (Glu) N-methyl-D-aspartate (NMDA) receptor is present in the lungs, and NMDA receptor antagonist MK-801 attenuates oxidant lung injury. We hypothesized that Glu excitotoxicity may participate in the pathogenesis of hyperoxia-induced lung injury. To determine possible pulmonary protective effects, we administered 0.05 ml/kg MK-801 or saline intraperitoneally daily to neonatal rats exposed to more than 95% oxygen in air. After 7 days, MK-801 decreased the hyperoxia-associated elevation of wet-to-dry lung weight, total leukocyte and neutrophil counts, total protein and lactate dehydroase in BAL fluid, total myeloperoxidase activity, and lung pathological injury. MK-801 inhibited hyperoxia-associated increments in reactive oxygen species production and NF-kappaB production. Hence, NMDA receptor antagonist MK-801 ameliorates hyperoxia-induced lung injury in neonatal rats, and is associated with decreased reactive oxygen species and NF-kappaB. We conclude that Glu may play an important role in hyperoxia-induced lung injury by activation of NMDA receptor.