大鼠淋巴瘘动物模型的制作

腹膜炎、严重烧(创)伤时,细菌移位(bacteria translocation)是造成脓毒症、MODS的主要因素之一.其中,一个重要途径就是淋巴途径,细菌、内毒素以及炎症因子可以经肠系膜淋巴管、胸导管直接进入体循环,早在1948年Bollman就报道了大鼠肝、小肠、胸导管淋巴液的收集方法,但是该方法技术要求高,重复性差,收集淋巴量少,此后实验方法不断改进,其中Girardet 1975年利用分流术和侧瘘术来测量胸导管流量和淋巴内细胞[1],但是重复性也不是很好.到现在为止尚未见到实用的淋巴瘘模型报道.因此建立理想的淋巴瘘直接对淋巴进行研究具有重要的意义.本实验利用显微外科手段,对40只大鼠进行了胸导管、肠系膜淋巴管的解剖、插管等探索.     

高氧液对严重烧伤休克期羊淋巴循环TNF-α、IL-6、IL-8水平的影响

目的：研究高氧液对严重烫伤休克期羊淋巴循环TNF-α、IL-6、IL-8水平的影响。方法：将20只成年雌性羊随机分为2组,A高氧液组（10只）和B对照组（10只）,2组均造成30%TBSAⅢ度烧伤,分别输入高氧液和平衡盐液,经股前淋巴管插管收集淋巴液,用放射免疫分析法检测伤后6、24、48h淋巴液TNF-α、IL-6、IL-8水平的变化,同时测定血氧饱和度（SaO2）。结果：烧伤休克期A组各时相点淋巴液TNF-α、IL-6、IL-8水平显著低于B组。A组SaO2明显高于B组。结论：高氧液对严重烧伤休克期羊淋巴循环有改善作用,降低淋巴液中TNF-α、IL-6、IL-8的水平。     

神经生长因子前体在病理性瘢痕中的表达

目的观察神经生长因子前体(proNGF)在病理性瘢痕中的表达。方法收集增生性瘢痕23例和瘢痕疙瘩20例作为病理性瘢痕组,正常皮肤20例作为对照组,采用免疫组织化学技术检测proNGF在3种组织中的表达和分布,Western blotting检测3种组织中proNGF蛋白表达量的差异。结果 proNGF在正常皮肤、增生性瘢痕和瘢痕疙瘩中的表达均呈阳性,表达位于3种组织的表皮和成纤维细胞,免疫组化结果显示,增生性瘢痕和瘢痕疙瘩中proNGF的阳性表达均低于正常皮肤组织(χ2=8.23,P<0.05;χ2=8.29,P<0.05),Western blotting结果同样显示增生性瘢痕和瘢痕疙瘩中proNGF的蛋白表达量低于正常皮肤组织(t=14.02,P<0.01;t=20.80,P<0.01)。结论病理性瘢痕中proNGF的含量低于正常皮肤,病理性瘢痕组织的增生性可能与proNGF的低表达有关。     

颞下颌关节前脱位的改良口外复位法治疗体会

颞下颌关节前脱位是口腔科常见急症,患者髁状突的运动超出正常范围,越过关节结节并被卡在其前下方,不能自动回到关节窝。治疗常采用手法复位,一般可分为口内法、口外法及口内口外结合法。笔者自2007年以来采用改良口外法对486位前脱位患者进行复位,现报道如下。     

兔股动脉和静脉预构轴型扩张皮瓣的实验观察

Objective To study the microcirculation and structural changes, surviving area of expanded prefabricated flaps. Methods A total of 40 New Zealand rabbits were divided randomly into expanded prefabricated, expender lined, simple prefabricated and free flap groups, each consisting of 10 rabbits. For the expanded prefabricated, expender lined and simple prefabricated groups, after the femoral artery and vein were transplanted into subcutaneous tissues of abdomen, and expanders were implanted into the deeper dartos. The free flap group was a blank control group. For the expanded prefabricated group, the expansion was carried out on 7th day postoperatively. On postoperative day 52, when the expander was fully expanded, island flaps with the prefabricated vessels as the pedicles were formed. The flaps were measured by laser Doppler flowmetry, light microscopy and digital re-cording of survival arca. Results When compared with the other groups, the perfusion volume of mi-crocirculation enhanced, flaps survival improved (97.54±2.73) %, blood capillary were stronger, to-gether with microscopic changes were significant in the expanded prefabricated groups (P<0.05). Conclusion Expandedprefabricated flaps can increase the survival size of the flaps and the safety of flap transplantation.     

兔股动脉和静脉预构轴型扩张皮瓣的实验观察

Objective To study the microcirculation and structural changes, surviving area of expanded prefabricated flaps. Methods A total of 40 New Zealand rabbits were divided randomly into expanded prefabricated, expender lined, simple prefabricated and free flap groups, each consisting of 10 rabbits. For the expanded prefabricated, expender lined and simple prefabricated groups, after the femoral artery and vein were transplanted into subcutaneous tissues of abdomen, and expanders were implanted into the deeper dartos. The free flap group was a blank control group. For the expanded prefabricated group, the expansion was carried out on 7th day postoperatively. On postoperative day 52, when the expander was fully expanded, island flaps with the prefabricated vessels as the pedicles were formed. The flaps were measured by laser Doppler flowmetry, light microscopy and digital re-cording of survival arca. Results When compared with the other groups, the perfusion volume of mi-crocirculation enhanced, flaps survival improved (97.54±2.73) %, blood capillary were stronger, to-gether with microscopic changes were significant in the expanded prefabricated groups (P<0.05). Conclusion Expandedprefabricated flaps can increase the survival size of the flaps and the safety of flap transplantation.     

兔股动脉和静脉预构轴型扩张皮瓣的实验观察

Objective To study the microcirculation and structural changes, surviving area of expanded prefabricated flaps. Methods A total of 40 New Zealand rabbits were divided randomly into expanded prefabricated, expender lined, simple prefabricated and free flap groups, each consisting of 10 rabbits. For the expanded prefabricated, expender lined and simple prefabricated groups, after the femoral artery and vein were transplanted into subcutaneous tissues of abdomen, and expanders were implanted into the deeper dartos. The free flap group was a blank control group. For the expanded prefabricated group, the expansion was carried out on 7th day postoperatively. On postoperative day 52, when the expander was fully expanded, island flaps with the prefabricated vessels as the pedicles were formed. The flaps were measured by laser Doppler flowmetry, light microscopy and digital re-cording of survival arca. Results When compared with the other groups, the perfusion volume of mi-crocirculation enhanced, flaps survival improved (97.54±2.73) %, blood capillary were stronger, to-gether with microscopic changes were significant in the expanded prefabricated groups (P<0.05). Conclusion Expandedprefabricated flaps can increase the survival size of the flaps and the safety of flap transplantation.     

烧伤大鼠淋巴液细胞因子及淋巴结T淋巴细胞亚群的变化

目的 观察烧伤对大鼠淋巴液细胞因子及淋巴结T淋巴细胞亚群的影响. 方法 取18只Wistar大鼠,将每只鼠单侧后腿浸于70℃热水30 s,造成约4％ TBSA深Ⅱ度烫伤(烧伤组);对侧后腿浸于22℃温水30 s模拟烫伤(假伤组).分别于伤后6、24、72 h按随机数字表法取6只大鼠,收集2组髂总淋巴结及其输出淋巴管内的淋巴液,ELISA法检测淋巴液中TNF-α、γ干扰素、IL-4水平并计算γ干扰素/IL-4比值,流式细胞术检测淋巴结中CD4+、CD8+T淋巴细胞百分比并计算CD4 +/CD8+比值.对数据进行t检验. 结果 (1)大鼠伤后6、24、72 h,烧伤组淋巴液TNF-α水平分别为(51.6±5.4)、(27.4±2.6)、(23.0±2.7)pg/mL,明显高于假伤组的(17.8±1.6)、(16.4±1.2)、(17.2±2.0)pg/mL,t值分别为15.346、11.854、4.189,P值均小于0.01.(2)伤后6、24、72 h,烧伤组与假伤组γ干扰素水平比较,差异无统计学意义(t值分别为2.059、-0.805、-0.415,P值均大于0.05);烧伤组IL-4水平明显高于假伤组(t值分别为9.141、11.669、6.940,P值均小于0.01),γ干扰素/IL-4比值(2.27±0.34、1.54±0.19、1.60±0.16)明显低于假伤组(3.33±0.25、3.34±0.22、2.52±0.24,t值分别为-6.298、-11.313、-8.893,P值均小于0.01).(3)伤后6、24 h,烧伤组与假伤组CD4+、CD8+T淋巴细胞百分比及CD4 +/CD8+比值比较,差异无统计学意义(t值为- 2.486 ～-0.215,P值均大于0.05).伤后72 h,烧伤组CD4+T淋巴细胞百分比及CD4 +/CD8+比值分别为(38.6±2.3)％、2.13±0.16,明显低于假伤组的(48.9±2.9)％、2.68±0.12,t值分别为-7.551、-5.068,P值均小于0.01;CD8+T淋巴细胞百分比与假伤组比较,差异无统计学意义(t=0.845,P＞0.05). 结论 烧伤能够引起大鼠局部引流淋巴液γ干扰素/IL-4比值和局部引流淋巴结内CD4+/CD8+比值降低,抑制其局部免疫功能.     

丙泊酚持续小剂量镇静对大面积烧伤患者CD14~+单核细胞HLA-DR表达的影响

目的 探讨大面积烧伤患者CD14+单核细胞HLA-DR抗原的表达规律及丙泊酚持续小剂量镇静对HLA-DR抗原表达的影响.方法 选取2010年3月-2011年11月收治的烧伤而积大于30％ TBSA的严重烧伤患者30例,其中17例给予常规治疗(常规治疗组),13例除常规治疗外还应用丙泊酚持续小剂量镇静治疗(丙泊酚治疗组),分别于镇静治疗前及治疗后第1、3、5、7天抽取外周静脉血,流式细胞仪检测CD14+单核细胞表面HLA-DR抗原表达情况.另取20例健康体检者作为健康对照.结果 大面积烧伤患者入院24h内CD14+单核细胞表面HLA-DR抗原表达率(25.07％±14.83％)显著低于健康对照组(76.45％±7.96％,P＜0.01).常规治疗组治疗后第3、5天CD14+单核细胞表面HLA-DR抗原表达率(分别为27.76％±11.36％、27.11％±14.49％)明显低于丙泊酚治疗组(分别为35.44％±11.55％、37.47％±15.46％),差异有统计学意义(p＜0.05),治疗前及治疗后第1、7天两组比较无统计学差异.结论 丙泊酚可能通过抑制应激激素的过度释放而减轻烧伤患者的过度应激反应,进而改善大面积烧伤患者的免疫功能.     

人食管鳞状细胞癌标本中乳头状瘤病毒DNA的检测

目的食管鳞状细胞癌有明显的地域性差异,它的发生与遗传、环境、饮食和某些微生物的感染有密切的关系,本研究通过检测食管鳞状细胞癌和相应正常食管组织中HPV-11型和HPV-16型的DNA,阐明HPV与食管鳞状细胞癌的关系.方法用PCR的方法检测22位食管鳞状细胞癌患者手术切除的癌组织和相应癌旁正常食管粘膜(共44例标本)中的HPV-11型和HPV-16型DNA的存在情况,并对其中一例HPV阳性肿瘤标本的HPV序列进行测定. 结果在本组所涉及的22位患者共计44例标本中,对于HPV-11型,12例癌组织为阳性;有7例癌旁组织为阳性;癌组织和癌旁组织均为阳性的有6例.对于HPV-16型,6例癌组织为阳性;6例癌旁组织为阳性;癌组织和癌旁组织均为阳性的有3例.序列分析结果表明所测定的序列与GeneBank登录的NC001525.1(HPV-11)、M14119.1(HPV-11)和AF217526.1(HPV-11)的同源性极高,均为99%.结论通过实验结果分析,我们认为食管鳞状细胞癌与HPV-11型和HPV-16型主要衣壳蛋白L1基因密切相关,HPV可能在一定的地域环境中与食管鳞状细胞癌的发生具有相关性.马群风,男,1961-01-04生,贵州省贵阳市人,汉族.1983年遵义医学院医疗系本科毕业,1993年第四军医大学普胸外科专业硕士毕业.主要从事普胸外科疾病的临床和研究工作.发表论文4篇项目负责人马群风,710038,陕西省西安市,中国人民解放军第四军医大学唐都医院胸外科.