尿液结合性胆红素的纯化

OBJECTIVES: To develop a simple, practical method with fine yield and purity for separating conjugated bilirubin(Bc) from a sustainable and facile material in order that it could serve as a calibrator for total and direct bilirubin determination. METHODS: Isolating Bc from urine of patients with obstructive jaundice by CHCl3: CH3CH2OH(1:1, V/V) followed by CNBr activated Sepharose 4B-HAS affinity chromatography, we analyzed the products by the use of Doumas J-G diazo method and HPLC, respectively. RESULTS: Determined by J-G diazo method, the crude product extracted by CHCl3: CH3CH2OH(1:1, V/V) yields 90.2 +/- 5.4%(n = 3) of urine Bc, the ratio of Bc to total dry weight being 67.9 +/- 6.4%(n = 3). The final product purified by affinity chromatography with the ratio of separation of 1.5, 1.737 and analyzed by HPLC has the yield of 46.9% and purity of 94.7%(BDG of 76.2%, BMG of 18.5%). CONCLUSION: The above data demonstrate that urine conjugated bilirubin can be successfully purified by CHCl3: CH3CH2OH extraction followed by Sephrose-HSA affinity chromatography with sufficient purity and output.     

8例大血管手术围手术期麻醉处理体会

大血管手术一般都有较大难度 ,围手术期一般都要求控制性降压、降温等特殊措施 ,有较特殊的血流动力学改变 ,因此对麻醉的要求较高 ,围手术期有其较特殊的处理方法 ,作者近期成功完成 8例大血管手术的麻醉 ,现将体会报告如下。1　临床资料1.1　一般资料　大血管手术 8例 ,男 5例 ,女 3例 ,年龄 40～ 6 8岁 ,平均 5 6岁。其中腹主动脉瘤切除、人工血管植入术4例 ,降主动脉假性巨大动脉瘤切除术 2例 ,肾癌根治、下腔静脉巨大癌栓取出术 2例 ,手术历时 2 6 0～ 6 5 0ｍｉｎ ,平均 380ｍｉｎ ,术中失血 3 5 0 0～ 92 0 0ｍｌ,平均 480 0ｍｌ。输…     

A comprehensive reconstruction strategy for moderate to severe faciocervical scar contractures

The focus of treatment of faciocervical scar contractures includes cervical reconstruction and elimination of hypertrophic scars. Unfortunately, most previous studies have neglected the esthetic appearance of scars. In this study, we tried to combine surgical therapy and ultrapulse fractional CO₂ laser (UFCL) to eliminate facial scars while restoring neck reconstruction and to establish the optimal conventional management for faciocervical contracture. Thirty-eight individuals were enrolled and divided into two groups. After received cervical release surgeries, comprehensive UFCL therapy group received treatment of UFCL at 3-month intervals, silicone sheets, and pressure garments, while another group only received treatment of silicone sheeting and compression. Twelve months after the termination of therapy, faciocervical scars of both two groups were assessed by two uninvolved physicians according to the Vancouver Scar Scale (VSS), and patients’ satisfaction survey was also recorded by the study participants using a patient four-point satisfaction scale. Thirty-six patients completed the treatment and follow-up. The results show that the VSS scores of both two groups decreased after 12 months, but comprehensive UFCL therapy group dropped more significantly than the conventional treatment group at follow-up session, which was statistically significant (P?<?0.001), and the patient satisfaction was higher than that of the conventional treatment group. This comprehensive treatment combined of surgery, UFCL, silicone sheets, and pressure garments works as an effective and esthetic reconstruction for moderate to severe postburn faciocervical scar contractures.

     

完全腹腔镜根治性膀胱切除加体内改良回肠通道术的学习效果分析

目的分析术者对完全腹腔镜根治性膀胱切除(LRC)+改良回肠通道术(MIC)的学习效果。方法回顾性分析首都医科大学附属北京朝阳医院2014年4月至2019年10月42例接受完全LRC+MIC患者的临床资料。男34例,女8例;年龄(63.4±9.1)岁。其中术者1行34例手术,术者2行8例。将术者1的34例按时间顺序分为3组,第1~12例为A组,第13~23例为B组,第24~34例为C组;术者2实施的8例为D组。4组中有腹部手术史者分别为0、1、4、3例,差异有统计学意义(P<0.05);4组年龄、体质指数、美国麻醉医师协会评分等差异均无统计学意义(P>0.05)。改良术式的重要步骤包括光源透射下离断肠系膜、输出袢固定的条件下行输尿管-输出袢反流性对端吻合、缝合后腹膜缺口。比较各组患者手术时间、构建回肠通道时间、出血量、并发症发生比例、淋巴结清扫数量、切缘阳性比例等重要手术指标。结果各组手术均顺利完成,均无中转开放手术。A~C组手术时间分别为330.0(320.0,360.0)、300.0(250.0,308.0)、270.0(216.0,324.0)min,差异有统计学意义(P=0.010);3组构建回肠通道时间分别为136.5(131.3,147.5)、92.0(79.0,119.0)、79.0(72.0,115.0)min,差异有统计学意义(P<0.001)。手术时间和构建回肠通道时间组间两两比较,A、B组,A、C组差异均有统计学意义(P<0.05),B、C组差异无统计学意义(P>0.05)。3组出血量[200.0(125.0,300.0)、100.0(100.0,150.0)、200.0(100.0,400.0)ml]、并发症发生比例[4/12、4/11、3/11]、淋巴结清扫数量[(19.0±10.7)、(16.0±9.8)、(23.3±8.5)枚]、切缘阳性比例(1/12、1/11、2/11)的比较,差异均无统计学意义(P>0.05)。D组手术时间420.0(350.0,450.0)min,与A组比较差异有统计学意义(P<0.05)。D组出血量200.0(112.5,350.0)ml,并发症发生比例2/8,淋巴结清扫数量(13.8±7.1)个,切缘阳性比例1/8,与A组比较差异均无统计学意义(P>0.05)。结论完全LRC+MIC学习效果明显,随着手术例数的增加,手术时间及构建回肠通道时间显著下降;该术式具有较好的可重复性和安全性。     

Podocyte EGFR Inhibits Autophagy Through Upregulation of Rubicon in Type 2 Diabetic Nephropathy

Renal epidermal growth factor receptor (EGFR) signaling is activated in models of diabetic nephropathy (DN), and inhibition of the EGFR signaling pathway protects against the development of DN. We have now determined that in cultured podocytes, high glucose led to increases in activation of EGFR signaling but decreases in autophagy activity as indicated by decreased beclin-1 and inhibition of LC3B autophagosome formation as well as increased rubicon (an autophagy inhibitor) and SQSTM1 (autophagy substrate). Either genetic (small interfering [si]EGFR) or pharmacologic (AG1478) inhibition of EGFR signaling attenuated the decreased autophagy activity. In addition, rubicon siRNA knockdown prevented high glucose–induced inhibition of autophagy in podocytes. We further examined whether selective EGFR deletion in podocytes affected the progression of DN in type 2 diabetes. Selective podocyte EGFR deletion had no effect on body weight or fasting blood sugars in either db/db mice or nos3^−/−; db/db mice, a model of accelerated type 2 DN. However selective podocyte EGFR deletion led to relative podocyte preservation and marked reduction in albuminuria and glomerulosclerosis, renal proinflammatory cytokine/chemokine expression, and decreased profibrotic and fibrotic components in nos3^−/−; db/db mice. Podocyte EGFR deletion led to decreased podocyte expression of rubicon, in association with increased podocyte autophagy activity. Therefore, activation of EGFR signaling in podocytes contributes to progression of DN at least in part by increasing rubicon expression, leading to subsequent autophagy inhibition and podocyte injury.     

新生儿缺氧缺血性脑病CT诊断对评估疗效的影响

目的：分析新生儿缺氧缺血性脑病（ＨＩＥ）治疗前后ＣＴ分度的变化,探讨ＨＩＥＣＴ诊断在评估疗效中的作用和影响。方法：选取１９９２－１９９９年在我院住院的ＨＩＥ患４００例,按不同的年龄段分组,所有病例均在发病时和治疗后分别行薄层ＣＴ扫描,对ＨＩＥ进行ＣＴ诊断分度,分析其统计数据。结果：不同程度、不同年龄组的ＨＩＥ患儿治疗后加重或减轻的比例也明显不同,结论：新生儿缺氧缺血性脑病按不同的年龄段分组,及其ＣＴ诊断严格分度,是对准确判断ＨＩＥ疗效的有力补充。     

药物中微量元素的测定

目的：检测营养制剂善存片中各种微量元素的含量,并就样品前处理及测定进行方法学探讨。方法：采用３ 种不同方法处理善存片样品,然后用电感耦合等离子体发射光谱仪优化测试条件后,测定铁、镁、锌、锰、铬、钼、钙等１１ 种微量元素的含量。结果：各种微量元素的含量与药盒所标数据基本一致。结论：确定了先用硝酸消化,再用石墨炉灰化为最佳样品处理方法。测定时选４ 点作标准工作曲线,既不会使操作太复杂,又能保证测定的精密度     

颈椎椎间盘与后部结构断层解剖及影像学研究

选用43具青年尸体,蛛网膜下腔注入铸型造影剂,低温冷冻,以椎间盘为中心制作断层标本,同时选取40例正常健康人进行超声、CT及MR扫描图像分析.发现同组中不同椎间盘水平测量数据的大小不同;解剖学与影像学各测量结果进行比较无显著性差异.