siRNA沉默fas基因减轻大鼠肝移植供肝冷保存和缺血再灌注损伤

目的：探讨针对fas的siRNA对大鼠原位肝移植供肝冷保存和缺血再灌注损伤的拮抗作用及机制。方法:（1）化学合成针对大鼠fas基因的3对siRNA，转染大鼠正常肝细胞(BRL细胞)，筛选抑制效果最高的siRNA序列。（2）对SD大鼠用水压注射法转染fas siRNA，48 h 后取肝，供肝冷保存2、4、6 h 后行细胞凋亡指数及fas表达检测。（3）对照组、fas siRNA组各25对SD雄性大鼠，供肝冷保存 3 h 后行原位肝移植,再灌注后1、3、6、12和 24 h 每组各处死5只大鼠，查血谷丙转氨酶(ALT)；取供肝查fas mRNA表达、Fas蛋白水平和细胞凋亡计数。结果:315位点的siRNA抑制BRL细胞fas基因效率最高。供肝冷保存实验中，fas　siRNA组冷保存2、4、6 h 的肝脏fas表达与细胞凋亡指数低于对照组（P<0.01）。大鼠肝移植复流后，fas siRNA组各检测点的fas基因表达、蛋白水平均明显低于、凋亡细胞少于、血清ALT低于对照组。结论:针对fas的siRNA对大鼠肝移植中的供肝冷保存和缺血再灌注损伤有一定的拮抗作用。     

地震后四肢开放伤口的治疗策略

【目的】探讨地震后四肢开放伤口的治疗策略。【方法】本组伤员包括16人23处地震后四肢开放伤口,采用清创封闭负压引流处理伤口,伤口清洁后采用直接缝合、游离植皮术、邻位皮瓣和带蒂皮瓣转移闭合伤口。截肢感染残端的处理采用尽早彻底敞开伤口,充分引流,伤口清洁后立刻缝合伤口,必要时缩短残端。同时根据伤口创面分泌物培养结果选用敏感抗生素,对伤员的心理创伤、贫血、脱水和并发症积极治疗。【结果】本组伤员包括16人23处四肢开放伤口除1例91岁伤员外全部愈合。【结论】地震后四肢开放伤口采用正确的治疗策略,可以加速伤口愈合,尽快恢复肢体功能。     

西罗莫司对人肝癌裸鼠肝脏移植瘤生长的影响

Objective To study the effects of sirolimus (SRL) on the growth of transplanted human hepatocellular carcinoma (HCC) in nude mice. Methods HepG2 cells were Implanted into the liver of nude mice. The implanted mice were then treated with SRL and tacrolimus (FK506). The expression of vascular endothelial growth factor (VEGF) and proliferating cell nuclear antigen (PCNA) was detected by immunohistology, microvessel density (MVD) was counted by immunostaining with anti-CD34 antibody for endothelial cells. Tumor apoptosis was detected by terminal deoxynuclcotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay. Results The tumor weight was (352±38) mg, (683±53) mg and (675±45) mg in SRL, FKS06 and control group respectively. The tumor weight was significantly decreased in SRL group (P < 0.0 I), and there was no difference between FKS06 group and control group. The expression of VEGF and PCNA protein was remarkably down-regulated in SRL group compared to control group (P < 0.05), and it was not significantly different between FK506 group and control group (P > 0.05). Compared to the control group, MVD was significanly decreased in SRL group, and the apoptosis index of tumor cell was significantly higher in SRL group (P < 0.01). Conclusion SRL inhibits transplanted HCC tumor growth by reducing tumor angiogenesis, inhibiting tumor proliferation and inducing tumor apoptosis.     

外周血嗜酸性粒细胞升高对肝移植后急性排斥反应的诊断价值

目的 评价外周血嗜酸性粒细胞升高对肝移植后急性排斥反应(AR)的诊断价值.方法 回顾性分析肝移植受者的临床资料,将术后具有完整肝活检和肝活检当天或前1天血常规和肝功能等临床数据的101例受者纳入研究.根据肝活检结果将受者分为AR组和非急性排斥反应(NAR)组,比较两组嗜酸性粒细胞绝对值和百分率等指标的差异.比较白细胞分类与发生AR的相关性.采用ROC分析确定嗜酸性粒细胞绝对值和百分率的最佳截断值,并分析其诊断AR的敏感性和特异性等.结果 AR组嗜酸性粒细胞绝对值和百分率分别为(0.127±0.161)×109/L和(2.8±7.3)％,均显著高于NAR组的(0.071±0.100)×109/L和(1.0±1.1)％(P＜0.05) ;外周血嗜酸性粒细胞升高与AR的发生呈明显正相关(P＜0.05).ROC分析显示,嗜酸性粒细胞绝对值和百分率的最佳截断值分别为0.145×109/L和2.35％,此时约登指数最高(分别为0.17和0.185),诊断AR的敏感性和特异性分别为28.6％和88.4％、28.6％和89.9％.结论 肝移植后外周血嗜酸性粒细胞的升高与AR的发生有关,对诊断AR具有较高的特异性,但敏感性较低.     

肝动脉灌注化疗联合阿替利珠单克隆抗体与贝伐珠单克隆抗体一线治疗晚期肝细胞癌的临床疗效

晚期肝癌治疗手段有限, 预后不佳, 严重危害人民健康。局部联合系统性治疗模式在晚期肝细胞癌患者治疗中愈发重要。临床研究证实:阿替利珠单克隆抗体联合贝伐珠单克隆抗体可以为晚期肝细胞癌患者带来更好的生存获益。笔者报道1例中国肝癌分期Ⅲa期肝癌患者行肝动脉灌注化疗局部治疗联合阿替利珠单克隆抗体+贝伐珠单克隆抗体转化治疗的临床经验。其研究结果显示:患者成功转化后行手术切除, 取得良好效果。