小血管套叠粘接吻合法在血液透析者中建立动静脉内瘘的应用

慢性肾病患者常需要建立动静脉内瘘进行透析，常规间断缝合法吻合动静脉难度大、耗时长。为了缩短吻合时间，提高远期通畅率，进行了套叠粘接吻合法建立动静脉内瘘的实验研究，并将这一方法应用于透析患者建立动静脉内瘘的血管吻合。将动脉端套入静脉端，只需吻合两针，用医用胶封闭吻合口。经８个月观察，通畅率达１００％，血流量均超过３００ｍｌ／ｍｉｎ。达到了透析需要。     

Experimental Study on Allogenic Decalcified Bone Matrix as Carrier for Bone Tissue Engineering

The biocompatibility and osteogenic activity of allogenic decalcified bone matrix (DBM) used as a carrier for bone tissue engineering were studied. Following the method described by Urist, allogenic DBM was made. In vitro, DBM and bone marrow stromal cell (BMSC) from rab-bits were co-cultured for 3-7 days and subjected to HE staining, and a series of histomorphological observations were performed under phase-contrast microscopy and scanning electron microscopy (SEM). In vivo the mixture of DBM/BMSC co-cultured for 3 days was planted into one side of muscules sacrospinalis of rabbits, and the DBM without BMSC was planted into other side as con-trol. Specimens were collected at postoperative week 1, 2 and 4, and subjected to HE staining, and observed under SEM. The results showed during culture in vitro, the BMSCs adherent to the wall of DBM grew, proliferated and had secretive activity. The in vivo experiment revealed that BMSCs and undifferentiated mesenchymal cells in the perivascular region invaded gradually and proliferated together in DBM/BMSC group, and colony-forming units of chondrocytes were found. Osteoblasts,trabecular bone and medullary cavity appeared. The inflammatory reaction around muscles almost disappeared at the second weeks. In pure DBM group, the similar changes appeared from the sur-face of the DBM to center, and the volume of total regenerate bones was less than the DBM/BMSC group at the same time. The results indicated that the mixture of DBM and BMSC had good bio-compatibility and ectopic induced osteogentic activty.     

改进后的腹腔镜腹腔内补片术在疝修补中的应用(附316例临床分析)

目的 腹腔镜腹腔内补片植入术(IPOM)，因有补片引起腹内组织粘连引发肠梗阻甚至复发等报道，目前争议较多，未能推广应用。作者改进了以上方法的多个步骤以克服该方法的不足。探讨改进后的方法在成人疝修补中的应用价值。方法 以缝合小儿疝的方法关闭内环口；把补片的中心固定在疝环口的中心：经腹壁用可吸收线代替钉合枪以针织的方法把补片四周牢牢地固定并展平紧贴在腹膜上。利用脐内侧韧带腹膜覆盖网片的内侧：减少网片外露的面积，减少粘连发生。结果 具有容易与腹膜相融合特性的网片能很快地与腹膜融合成一柔韧性组织，加强了疝环薄弱区，极少引起腹内肠管的粘连，更没有肠梗阻的发生，复发率低。结论 作者认为经过改进后的IPOM方法是一种效果确切、创伤少、并发症少、费用低、有微创优点。值得继续探索应用。     

失血性休克大鼠肠上皮细胞线粒体DNA腺苷三磷酸酶6,8基因表达及线粒体功能的改变

目的　探讨失血性休克大鼠肠上皮细胞线粒体DNAATPase 6 ,8基因表达及线粒体功能的改变 ,为阐述休克肠道靶学说和线粒体能量代谢提供分子生物学基础。　方法　 2 4只Wistar大鼠随机分为休克前组和休克 1,2 ,3,4 ,5h组。采用RT -PCR方法观察线粒体ATPase 6 ,8mRNA量的改变。用透射电镜观察、生物体视学测量线粒体形态 ,用Clark氧电极测线粒体呼吸功能。　结果　失血性休克 1,2h ,ATPase 6 ,8基因表达增强 ,以后渐减弱 ,至休克 5h表达最低 ,ATPase 6 ,8基因表达分别降为正常的 6 9.3%和 78.4 % (P <0 .0 1和P <0 .0 5 )。失血性休克 2h和5h ,线粒体平均截面积、长径、面密度、体密度均显著增加 (P <0 .0 1) ,休克 5h时分别为休克前的2 .0 ,1.4 5 ,1.4 7,2 .2 2倍。休克 5h ,线粒体比表面和数密度分别下降 32 %和 2 4 % (P <0 .0 1和P <0 .0 5 ) ,嵴和基质破坏明显。失血性休克后肠上皮细胞线粒体呼吸控制率和氧化磷酸化效率比休克前显著降低 (P <0 .0 1)。　结论　失血性休克时大鼠肠上皮细胞线粒体DNAATPase 6 ,8基因表达下调 ,线粒体呼吸功能出现障碍 ,线粒体超微结构发生了改变     

对诊断PADAM的血清游离睾酮界限值的初探

目的探寻诊断中老年男子部分雄激素缺乏综合征(PADAM)血清游离睾酮(FT)的界限值。方法根据60例45岁以上健康男性完成伊斯坦布尔症状量表(ISS)与视听性刺激(AVSS)时阴茎勃起监测结果进行分组,计算AVSS勃起功能正常组推算的游离睾酮(CFT)值的参考范围。结果AVSS勃起功能正常组CFT的中位数为0．37(0．20～0．52)nmol/L,异常组的中位数为0．25(0．12～0．40)nmol/L,z=2．25,P＜0．05,差别有显著性意义。两组性功能症状的差别也有极显著性意义(P＜0．01)。CFT的界限值是0．20nmol/L。结论研究用ISS和AVSS勃起功能正常对象的血清FT值,可为诊断PADAM建立界限值。     

Effect of N-tosyl-L-phenylalanylchloromethyl Ketone on Tumor Necrosis Factor-alpha -induced NF-κB Activation and Apoptosis in U937 Cell Line

Summary: To investigate the effect of N-tosyl-L-phenylalanylchloromethyl ketone (TPCK) on tumor necrosis factor-alpha-induced NF-κB activation and apoptosis in U937 cell line, changes and subcellular localization of NF-κB/p65 and IκB-α were observed by fluorescencemicroscopy and expression and degradation of IκB-α by flow cytometry. The apoptosis of U937 cells was measured by flow cytometry and electrophoresis of DNA. Immunolfluorescence assay showed that NF-κB/p65,IκB-α only localized in cytoplasm. After TNF-α stimulation, p65 was localized only in nuclei, and IκB-α was only localized in cytoplasm and decreased. The changes of TNF-α stimulation were specifically inhibited by TPCK. Flow cytometry also revealed the downregulation of IκB-α protein during TNF-α-induced apoptosis and the down-regulation was specifically inhibited by TPCK. Flow cytometry also showed the apoptosis of U937 cells after TNF-α induction. DNA ladder can be detected in cells treated by TNF-α. It is concluded that degradation of IκB-α protein and NF-κB/p65 translocation occur during TNF-α-induced apoptosis of U937 cells, suggesting the activation of NF-κB.TPCK-sensitive protease plays an important role in the degradation of IκB-α protein induced by TNF-α in U937 cells. TPCK sensitive protease also plays an important role in the apoptosis of U937 cells induced by TNF-α.     

高敏受者肾移植术前行血浆置换的临床探讨

目的 :探讨高敏受者肾移植术前行血浆置换 (PE)的效果。方法 :12例高敏受者在肾移植术前进行PE治疗 ,37例高敏受者未行PE治疗 ,观察两组肾移植病人排斥反应发生率的差异。结果 :PE组置换前PRA值71.0 %± 19.1% ,置换后 34.3%± 17.9% ,两者有显著性差异 (P <0 .0 1)。术后发生超排 2例 ,急性排斥 2例 ;未行PE组发生超排 2例 ,急性排斥 8例 ,两组间超排和急性排斥的发生率均无显著性差异。结论 :PE对预防超排和降低急性排斥的发生率均无明显作用。PE治疗的主要适应症为PRA大于 80 %的受者 ,能快速降低PRA值 ,有助于HLA抗体特异性分析和HLA配型。     

腰椎间盘突出症治疗方法与肌电图变化的相关性研究

腰椎间盘突出症(lumbar disc herniation，LDH)是导致腰腿痛的主要病因，本研究对具有典型临床症状、相应体征及MR或CT等影像学资料确诊的LDH，采用规范化非手术治疗，经规范化保守治疗无效者选用手术治疗，治疗前后均行肌电图(elec-tromyograptly，EMG)检查，旨在探讨肌电图变化与治     

老年人上消化道出血104例临床分析

分析104例60岁以上的老年人上消化道出血的病因,依次为急性胃粘膜病变,上消化道肿瘤,消化性溃疡及门脉高压。手术治疗效果优于内科保守治疗,而保守治疗又以甲氰咪胍效果较好。