桡动脉掌浅支腕横纹皮瓣在虎口修复中的应用

目的：总结桡动脉掌浅支（ SPBRA)腕横纹部逆行岛状皮瓣在虎口软组织缺损修复中的应用及疗效。方法回顾性分析2012年1月—2013年3月徐州仁慈医院手足显微外科收治的8例虎口软组织缺损患者的临床资料。其中男5例、女3例,年龄15~63岁。开放伤5例,虎口挛缩松解术后创面3例。创面范围2．5 cm ×3 cm~3．5 cm ×7 cm,平均3．1 cm ×4．8 cm。开放伤均在一期创面彻底清创止血后行负压封闭引流（VSD),二期行创面修复。8例患者均采用大小为3．0 cm ×3．5 cm~4．0 cm ×7．5 cm的SPBRA腕横纹岛状皮瓣带蒂逆行转移修复虎口软组织缺损;供区直接缝合。术后观察皮瓣成活、伤口愈合情况,随访观察皮瓣质地、虎口功能及供区功能情况。结果本组8例,术中1例因血管变异改行其他术式,其余7例均顺利完成手术。7例患者术后皮瓣均完全成活,供、受区创面均Ⅰ期愈合;术后随访6~13个月,平均9．5个月,皮瓣颜色及质地与周围皮肤相似,外形满意,皮瓣恢复部分浅感觉,拇指可完成外展及对掌功能,供区瘢痕轻微,无功能影响。术后6个月7例患者虎口宽度距离为5．2~6．1 cm,平均5．8 cm,虎口宽度为健侧的72%~96%（平均87%),拇指可完成外展及对掌功能。重建虎口功能评定：优5例,良1例,中1例。腕部供区功能评定：优6例,良1例。结论 SPBRA腕横纹部逆行岛状皮瓣带蒂转移修复虎口软组织缺损,具有手术简便、血运可靠、术后功能、外观恢复好等优点,是修复虎口创面的理想方法之一。     

以手部皮神经伴行血管为蒂的岛状皮瓣的临床应用

目的应用手部皮神经伴行血管蒂岛状皮瓣修复手指指背软组织缺损。方法采用手部桡神经浅支、尺神经手背支伴行血管蒂的岛状皮瓣，即拇指桡、尺侧皮神经伴行血管岛状皮瓣修复拇指；第一掌背皮神经伴行血管岛状皮瓣修复示指；第三、四掌背皮神经伴行血管岛状皮瓣修复中、环指；小指尺背侧皮神经伴行血管岛状皮瓣修复小指。共５种１５块，修复指部皮肤缺损１５例。皮瓣切取的最大面积达５ｃｍ×３ｃｍ。结果１５例皮瓣全部成活，效果满意。结论该类皮瓣血供可靠，创伤小，操作简单。特别适用于一期修复伴有伸肌腱缺损的指背创面     

Detection of renal allograft dysfunction with characteristic protein fingerprint by serum proteomic analysis

This study aimed to diagnose renal allograft dysfunction with specific biomarkers by serum proteomic analysis. Surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) and bioinformatics (support vector machine and leave-one cross validation) were used to analyze serum proteome. Enrolled patients included 38 biopsy-proved acute rejection (BPAR), 10 acute tubular necrosis (ATN), 24 subclinical rejection (SCR) and 29 stable control recipients verified by protocol biopsy. A characteristic protein profile can be detected in each renal allograft dysfunction group. BPAR patients were differentiated from stable patients with markers of 9710.1, 4971, 6675.5, 8563.8, 6709.2, 9319 and 4476.7 Da with high sensitivity and specificity. ATN can be clearly distinguished from BPAR and stable control. Subclinical rejection differentiated from stable control with markers of 9193.1, 2759.1, 8464.6 Da. The independent blind test yielded with high specificity and sensitivity for each group. Serum proteome analysis by SELDI-TOF MS combined with bioinformatics in renal allograft dysfunction is valuable and promising. Specific markers were detected in each group. Identification of these proteins may prove useful as diagnostic markers for allograft dysfunction and better to elucidate the mechanism of acute rejection.     

基于慢病毒的SHARP-2特异的RNA干扰延长肾移植受者大鼠存活时间

Objective To investigate if rat enhancer of split- and hairy-related protein-2 (SHARP-2) short hairpin RNA interference (shRNAi) prolongs the survival time of rat kidney transplant recipients. Methods Gene recombinant procedures, transfection and co-transfection were carried out to introduce short hairpin RNA interference sequences target for SHARP-2 into 3rd generation self-inactivated lentiviral-ViraPower packaging mix. Limiting dilution method was used for viral titration. Real-time PCR was employed for quantification of gene expression. Rat kidney transplantation was utilized to investigate the effect of SHARP-2 gene silence on the recipient survival. Results A lentiviral-based shRNAi construct LV-SHARP-2iC showed 84% SHARP-2 gene silence efficiency in normal rat kidney cells. At multiplicity of infection 20, 57% T cells could be transfected by lentivirus with spinoculation method. In activated T cells, SHARP-2 g ene silence resulted in 61.3% and 68.7% reduction of intedeukin 2 (IL-2) and interferon γ (IFN-γ) gene expression. When donor kidney was perfused with 5×107 TU LV-SHARP-2iC, the median survival time prolonged for 4-5 days as compared to blank and scramble control groups. Conclusions A recombinant lentivirus LV-SHARP-2iC that effectively silence SHARP-2 gene expression is constructed successfully, leading to the inhibition of IL-2 and IFN-γ. LV-SHARP-2iC treatment can prolong the survival time of rat kidney transplant recipients.     

血管紧张素转换酶基因多态性和血管紧张素Ⅱ受体—1基因多态性与原发性高血压

目的 探讨血管紧张素转换酶(angiotensin converting enzyme，ACE)基因多态性和血管紧张素Ⅱ受体—1(ATlR)基因多态性与原发性高血压(Essential Hypertension，EH)的关系，以及这两种基因多态性对于EH的发病是否有协同作用。方法 对740名开滦集团公司职工进行10年的纵向研究，应用聚合酶链反应和限制性酶切方法检测ACE基因第16位内含子插入/缺失(I/D)多态性分布及ATlR基因All66C多态性分布。结果 10年前或10年后EH组的ACE各基因型及等位基因频率与同期正常血压组比较无显著差异。10年前或10年后EH组的AT1R各基因型及等位基因频率与同期正常血压组比较无显著差异。10年前或10年后EH组中同时具有DD基因型和AC基因型的频率分布与同期正常血压组比较均无显著差异。10年前或10年后的男性EH亚组中，同时具有DD基因型和AC基因型的频率分布与同期正常血压组比较有统计学差异。结论 血管紧张素转换酶基因的I/D多态性和血管紧张素Ⅱ受体—1基因All66C多态性与原发性高血压无关，DD基因型和AC基因型联合作用时对男性原发性高血压的发生可能有协同作用。     

Ⅱ型糖尿病患者肺通气功能改变及其临床意义

目的:通过研究2型糖尿病患者肺通气功能的改变探讨其临床意义。方法:采用德国耶格(JAEGER)公司生产的M aster ScreenPET肺功能仪,分别测定50例2型糖尿病患者及50例健康人的肺通气功能并进行对比分析。结果:糖尿病患者的FVC、VC、MMEF、FEV1、FEF25、FEFSO、FEF75、PEF与健康人比较差异有显著性(P<0.01、P<0.05)。结论:2型糖尿病患者存在不同程度的阻塞性通气功能障碍。     

Lack of therapeutic effects of gabexate mesilate on the hepatic encephalopathy in rats with acute and chronic hepatic failure

Background and Aim: Inflammation plays a pivotal role in liver injury. Gabexate mesilate (GM, a protease inhibitor) inhibits inflammation by blocking various serine proteases. This study examined the effects of GM on hepatic encephalopathy in rats with acute and chronic liver failure. Methods: Acute and chronic liver failure (cirrhosis) were induced by intraperitoneal TAA administration (350 mg/kg/day for 3 days) and common bile duct ligation, respectively, in male Sprague‐Dawley rats. Rats were randomized to receive either GM (50 mg/10 mL/kg) or saline intraperitoneally for 5 days. Severity of encephalopathy was assessed by the Opto‐Varimex animal activity meter and hemodynamic parameters, mean arterial pressure and portal pressure, were measured (only in chronic liver failure rats). Plasma levels of liver biochemistry, ammonia, nitrate/nitrite, interleukins (IL) and tumor necrosis factor (TNF)‐α were determined. Results: In rats with acute liver failure, GM treatment significantly decreased the plasma levels of alanine aminotransferase (P = 0.02), but no significant difference of motor activity, plasma levels of ammonia, IL‐1β, IL‐6, IL‐10 and TNF‐α or survival was found. In chronic liver failure rats, GM significantly lowered the plasma TNF‐α levels (P = 0.04). However, there was no significant difference of motor activity, other biochemical tests or survival found. GM‐treated chronic liver failure rats had higher portal pressure (P = 0.04) but similar mean arterial pressure in comparison with saline‐treated rats. Conclusions: Chronic GM treatment does not have a major effect on hepatic encephalopathy in rats with TAA‐induced acute liver failure and rats with chronic liver failure induced by common bile duct ligation.     

Simvastatin effects on portal‐systemic collaterals of portal hypertensive rats

Background and Aim: Portal‐systemic collateral vascular resistance and vasoconstrictor responsiveness are crucial in portal hypertension and variceal bleeding control. Statins enhance vasodilators production, but their influence on collaterals is unknown. This study aimed to survey the effect of simvastatin on collaterals. Methods: Partially portal vein‐ligated rats received oral simvastatin (20 mg/kg/day) or distilled water from ?2 to +7 day of ligation. After hemodynamic measurements on the eighth postoperative day, baseline perfusion pressure (i.e. an index of collateral vascular resistance) and arginine vasopressin (AVP, 0.1 nM–0.1 µM) responsiveness were evaluated with an in situ perfusion model for collateral vascular beds. RT‐PCR of endothelial NO synthase (eNOS), inducible NOS (iNOS), cyclooxygenase‐1 (COX‐1), COX‐2, thromboxane A₂ synthase (TXA₂‐S) and prostacyclin synthase genes was performed in parallel groups for splenorenal shunt (SRS), the most prominent intra‐abdominal collateral vessel. To determine the acute effects of simvastatin, collateral AVP response was assessed with vehicle or simvastatin. SRS RT‐PCR of eNOS, iNOS, COX‐1, COX‐2 and TXA₂‐S, and measurements of perfusate nitrite/nitrate, 6‐keto‐PGF1_α and TXB₂ levels were performed in parallel groups without AVP. Results: Acute simvastatin administration enhanced SRS eNOS expression and elevated perfusate nitrite/nitrate and 6‐keto‐PGF1_α concentrations. Chronic simvastatin treatment reduced baseline collateral vascular resistance and portal pressure and enhanced SRS eNOS, COX‐2 and TXA₂‐S mRNA expression. Neither acute nor chronic simvastatin administration influenced collateral AVP responsiveness. Conclusion: Simvastatin reduces portal‐systemic collateral vascular resistance and portal pressure in portal hypertensive rats. This may be related to the enhanced portal‐systemic collateral vascular NO and prostacyclin activities.     

Impact of the Tokyo guidelines on the management of patients with acute calculous cholecystitis

Background and Aim: Prompt treatments for acute calculous cholecystitis can reduce both mortality and morbidity. The aim of this retrospective study was to assess the impact of the Tokyo guidelines on management of patients with acute cholecystitis. Methods: The records of patients admitted due to acute calculous cholecystitis were collected between January 2007 and June 2008. Exclusion criteria included acalculous, hepatobiliary malignancy, younger than 18 years old and mortality unrelated to cholecystitis. These 235 patients were classified into three groups; grade I, grade II and grade III, according to the severity grading in the Tokyo guidelines for acute cholecystitis. They were further classified into two subgroups; those compatible with and incompatible with managements suggested in the Tokyo guidelines, for comparison. Results: Lower levels of platelets, lower blood pressure, higher levels of C‐reactive protein, blood urine nitrogen, prothrombin time, bilirubin, alkaline phosphatase, and more incidences of positive microorganisms cultured in bile or blood, were found in patients as the severity of disease progressed. Shorter mean length of hospital stay was compatible with the Tokyo guidelines, but no significant differences in outcomes, including incidences of survival, post‐surgery complications and mortality, were found between the two subgroups. Conclusion: No significant benefit of the application of the Tokyo guidelines in the management of patients was found between the two subgroups except for reduced mean length of hospital stay. The application of the Tokyo guidelines for improving the outcomes of patients with acute cholecystitis needs further investigation and evaluation.