内镜下乳头括约肌小切开联合气囊扩张术对胆总管结石患者的疗效观察

目的 观察乳头括约肌小切开联合气囊扩张术对胆总管结石( CDS)患者的疗效.方法 将我院2010年1月至2011年9月间的161例CDS患者分为3组,54例行内镜下乳头括约肌切开术(EST组),54例行内镜下乳头气囊扩张术(EPBD组),53例行内镜下乳头括约肌小切开联合气囊扩张术(sEST+EPBD组),均根据实际情况在乳头治疗后行取石篮取石和(或)气囊取石,部分患者以碎石篮碎石后取石.结果 与EST组比较,sEST+EPBD组术后并发症的发生率显著降低,出血发生减少,较EPBD组提高了一次取石的成功率,明显降低了术后高淀粉酶血症的发生率.结论 应用乳头括约肌小切开联合气囊扩张术治疗胆总管结石,术后并发症减少,在胆总管结石取石治疗中更为有效、安全.     

Functional quality of life following open valve surgery in high-risk octogenarians

Abstract Aim: The aim of this study was to determine the midterm functional quality of life in octogenarians after open valvular surgery. Methods: One hundred and eighty‐five consecutive patients above age 80 had valvular surgery with or without coronary artery bypass grafting (CABG). Using the Karnofsky Performance score and Barthel Index, patients were evaluated for functional autonomy, living disposition, and leisure activity by a single telephone interview. Subgroup analysis was performed on the 49 cases of isolated aortic valve replacement (AVR). Results: Mean age of octogenarians undergoing valvular surgery was 82.7 years (range 80 to 92 years). Actuarial survival at one and three years was 71% and 59%, respectively, for the entire group, compared to 84% and 71%, respectively, for isolated AVRs. After a mean follow‐up of 38 months there were 110 survivors (59.5%). Among survivors, 66% were autonomous, 26% semiautonomous, and 8% deemed dependent. Seventy‐two percent were living at home, 19% in a residence, and 9% in a supervised nursing facility. Over 90% of patients pursued leisure activities in the social, cognitive, and physical domains. Conclusions: Valvular surgery in high‐risk octogenarians, can be performed with acceptable mortality rates, and provide patients with functional autonomy and an excellent quality of life. (J Card Surg 2012;27:408‐414)     

Internalization of antibodies by endothelial cells via fibronectin implicating a novel mechanism in lupus nephritis

BACKGROUND: One of the crucial events in lupus nephritis is the glomerular deposition of immunoglobulins (Igs), of which pathogenic properties have been proposed mostly to be either type IIor type III allergic reactions. Some of IgG3-producing hybridoma clones established from an MRL/MpTn-gld/gld (MRL/gld) lupus mouse generate wire loop-like lesions in glomeruli resembling lupus nephritis when injected into SCID mice. These clones are useful for analyzing the mechanisms of glomerular deposition of antibodies in lupus nephritis at the monoclonal level. METHODS: Glomerular lesions of SCID mice injected with the hybridoma clones, 17H8a or 1G3 as control were analyzed by light and electron microscopy. Interaction of the antibodies with human glomerular endothelial cells (HGECs) and human umbilical vein endothelial cells (HUVECs) in vitro was studied by fluorescence microscopy, electron microscopy, and flow cytometry. RESULTS: Both antibodies did not show any antigen specificity for mouse glomeruli. The glomerular lesions generated by 17H8a, but not by 1G3, contained electron-dense deposits not only in subendothelial regions but also in the cytoplasm of endothelial cells, suggesting internalization of the 17H8a antibodies by endothelial cells. In cell culture studies, internalization of only 17H8a antibodies by HGECs and HUVECs was observed, but the antibodies did not have antigen specificity for both types of endothelial cells. The internalization by HUVECs was mediated by actin polymerization, and it was inhibited by RGDS (Arg-Gly-Asp-Ser) tetrapeptide, antihuman fibronectin and antihuman integrin beta1 monoclonal antibodies. CONCLUSION: The interaction between particular antibodies and endothelial cell surface integrins via fibronectin may be involved in their subsequent internalization by endothelial cells leading to antibody deposition in glomeruli. This may be one of the mechanisms of glomerular injury in lupus nephritis.     

Effects of barium concentration on the radiopacity and biomechanics of bone cement: experimental study

Purpose  This study was undertaken to evaluate the changes in the radiopacity and mechanics of polymethylmethacrylate (PMMA) bone cement with the addition of barium. Materials and methods  Barium sulfate powder was added to a PMMA bone cement with an initial 10% barium concentration. The changes in radiopacity and strength were evaluated by testing cement blocks containing four barium concentrations (10%, 20%, 30%, 40%). Radiopacity was evaluated by measuring the computed tomography (CT) values of the bone cement, and strength was evaluated by compressive, three-point bending, and impact load tests. Results  CT values increased in proportion to the barium concentration. The compressive load test showed that cement with a 40% barium concentration was significantly more fragile than cement with lower barium concentrations. The three-point bending load test showed that the cement became more fragile in proportion to the barium concentration. The impact load test showed that cement with 30% and 40% barium concentrations was significantly more fragile than cement with 10% and 20% barium concentrations. Conclusion  Radiopacity is increased and strength is reduced by adding increasing concentrations of barium powder to bone cement. The results of the present study suggest that adding barium permits the radiopacity and strength of bone cement to be adjusted in clinical practice.     

Terazosin therapy for chronic prostatitis/chronic pelvic pain syndrome: a randomized,placebo controlled trial

PURPOSE: We evaluate terazosin therapy for chronic prostatitis/chronic pelvic pain syndrome. MATERIALS AND METHODS: The study included 100, 20 to-50-year-old subjects who met the consensus criteria for chronic prostatitis/chronic pelvic pain syndrome and had not received previous alpha-blockers. Subjects were randomized to receive terazosin with dose escalation from 1 to 5 mg. daily or placebo for 14 weeks. The primary criterion for response was scoring 2 or less ("delighted-to-mostly satisfied") on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) quality of life item. The secondary criterion for response was greater than 50% reduction in NIH-CPSI pain score at 14 weeks. Other outcomes included total and NIH-CPSI domain scores, International Prostate Symptom Score, peak urinary flow rate, post-void residual urine and adverse effects. RESULTS: Using the primary criterion 24 of 43 evaluable subjects (56%) responded in the terazosin group compared to 14 of 43 (36%) in the placebo group (p = 0.03). Using the secondary criterion 26 of 43 subjects (60%) responded in the terazosin group compared to 16 of 43 (37%) in the placebo group (p = 0.03). The terazosin group had greater reductions (p <0.05) in NIH-CPSI total score, individual domain scores and International Prostate Symptom Score than the placebo group. There was no difference in peak urinary flow rate or post-void residual. In the terazosin group 18 patients (42%) had side effects compared to 9 (21%) in the placebo group (p = 0.04). CONCLUSIONS: Terazosin proved superior to placebo for patients with chronic prostatitis/chronic pelvic pain syndrome who had not received alpha-blockers previously.     

Methodical placement of mesh during endoscopic extraperitoneal inguinal hernioplasty

Endoscopic extraperitoneal inguinal hernioplasty has been gaining in popularity worldwide recently. Placement of mesh remains a technically challenging part of the procedure. This paper describes a systematic method for the placement of mesh during endoscopic inguinal hernioplasty. To broaden the endoscopic view and maximize working space, the mesh should be kept far from the telescope within the limited extraperitoneal space. Unfolding the mesh requires prior stabilization of the mesh at one point, to avoid uncontrolled migration of the whole mesh and subsequent loss of mesh orientation. Mastering the skill of two‐handed technique is essential for coordinated manipulation and expeditious mesh placement. Before concluding the procedure, a trial of deflation can help to ensure appropriate repositioning of the peritoneum without displacement of the mesh. Chinese Abstract

Figure Chinese Abstract Open in figure viewer PowerPoint

Volume 6 , Issue 1 February 2002

Pages 18-21     

Osteopontin inhibits macrophage nitric oxide synthesis to enhance tumor proliferation

BACKGROUND: Interactions between tumor cells and their host environment can play a major role in regulating survival programs required for tumor progression. Osteopontin (OPN) is a glycophosphoprotein overexpressed by tumors, and is a key molecule for tumor progression and metastasis. OPN also inhibits expression of autocrine and paracrine inducible nitric oxide synthase (iNOS). Given the cytotoxic effects of macrophage NO expression, we hypothesized that tumor-derived OPN inhibits expression of local macrophage iNOS to potentiate tumor survival. METHODS: We used a coculture system of murine CT26 colorectal cancer cells with RAW264.7 murine macrophage cells. CT26 expresses OPN at high levels. RNA interference was utilized to produce long-term specific silencing of OPN in CT26. RESULTS: Inhibition of constitutive OPN synthesis in CT26 upregulates local NO production with inhibition of CT26 proliferation and promotion of CT26 apoptosis. Macrophage iNOS expression is accompanied by increased binding activity of nuclear factor-kappaB DNA. When the CT26 culture media were examined for a panel of proinflammatory cytokines, elevated concentrations of granulocyte colony-stimulating factor (G-CSF) were found. Subsequently, in CT26 cells treated with antisense-G-CSF, NO levels in CT26-RAW cocultures were significantly decreased. CONCLUSION: In our system of CT26-RAW264.7 coculture, we conclude that inhibition of OPN synthesis in CT26 results in G-CSF-mediated induction of macrophage iNOS expression with resultant inhibition of CT26 proliferation via increased apoptosis. Our results suggest that tumor-derived OPN may enhance tumor survival by down regulating expression of NO in the local microenvironment. This is one mechanism by which OPN may potentiate cancer survival and progression.