鼠源性血管抑素对裸鼠种植性肿瘤的抑制作用

目的　探讨鼠源性血管抑素转染入人肝癌细胞SMMC 772 1后对裸鼠种植性肿瘤的影响。　方法　建立鼠源性血管抑素基因的人肝癌SMMC 772 1细胞株 ,实验动物分 3组 :空白对照组种植SMMC 772 1细胞 ,空载体组种植SMMC 772 1/pcDNA3 1(+)细胞 ,血管抑素组种植SMMC 772 1/pcDNA3 1 mAST细胞。比较各组裸鼠肿瘤体积、重量和肿瘤微血管密度 (MVD)。　结果　在肿瘤细胞种植 35d时裸鼠肿瘤体积 :空白对照组 (35 38 1± 6 43 3)mm3 ,空载体组 (312 8 5± 5 46 6 )mm3 ,血管抑素组 (75 5 8± 198 2 )mm3 ;肿瘤重量 :空白对照组 (6 0± 0 7)g,空载体组 (5 9± 0 5 )g ,血管抑素组(2 1± 0 5 )g;肿瘤MVD :空白对照组 5 2 2± 6 6 ,空载体组 49 4± 7 0 ,血管抑素组 2 5 5± 4 1。血管抑素组裸鼠肿瘤体积、重量和MVD显著小于空白对照组和空载体组 (P均 <0 0 1) ,肿瘤的抑制率达78 6 %。　结论　转染血管抑素基因的人肝癌细胞SMMC 772 1在裸鼠体内的致瘤力明显降低 ,肿瘤的体积、重量和微血管密度显著低于对照组 ,表明血管抑素可通过抑制肿瘤血管生成而显著抑制肿瘤生长     

个体化的“分步”血流阻断法在巨大肝癌切除术中的应用研究

目的 在复杂肝切除中,外科血管阻断控制出血与最小化缺血再灌注损伤之间存在矛盾.为更好寻求解决方案,该研究介绍一种新的个性化“分步”血流阻断法.方法 自2011年4月至2014年4月,对拟行手术治疗的巨大肝癌病人,按照“个性化阻断准备”、“分步阻断实施”进行肝切除血流控制.统计病人术中血流阻断时间、术中出血量、术后并发症等临床资料并与同类文献资料进行统计学比较.结果 154例病人中,依据术前评估分别对154、101、51例病人行第一肝门(PT),肝下下腔静脉(IIVC),肝上下腔静脉(SIVC)的个性化阻断准备.肝切除过程中,依据具体出血情况分别对116、73、21例病人实施PT,PT+ IIVC,PT+ IIVC+ SIVC阻断.PT、IIVC、SIVC平均阻断时间分别为(10.8±3.4)min、(8.1±2.6) in、(4.0±0.9)min.术中平均出血量为(352.2±162.9) ml,14例(9.1％)接受输血治疗.无病人出现严重并发症或死亡.与同类研究相比,该技术控制出血效果良好且缩短了肝脏热缺血时间.结论 个体化的“分步”血流阻断法能够安全、有效地满足巨大肝癌切除术中的出血控制.     

Association between red cell distribution width and mortality in patients undergoing continuous ambulatory peritoneal dialysis

Objective To investigate the association of red cell distribution width (RDW) with all-cause and cardiovascular disease (CVD)-related mortality in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods A retrospective analysis was performed on 207 patients who initiated CAPD for more than 3 months between July 2005 and March 2016 in the First Hospital Affiliated to Zhengzhou University. Baseline data on demographic, clinical and biochemical variables as well as comorbidities were obtained; medications and clinic outcomes were recorded. According to receiver operator characteristic curve (ROC) analysis, patients were divided into high RDW (RDW＞15.1%) and low RDW (RDW≤15.1%) groups. The data of two groups were compared and Spearman's correlation analysis was used to explore the association of RDW with clinical and biochemical parameters. Survival curves were calculated using Kaplan-Meier method. Cox regression model was employed to analyze risk factors of all-cause and CVD-related mortality. Results In this study, 207 CAPD patients were enrolled. The overall median survival time was 80 months. And the median survival time of high RDW group (68 patients) and low RDW group (139 patients) were 59 months and 96 months, respectively. There were statistical differences in diastole pressure, hemoglobin, hematocrit, serum albumin, intact parathyroid hormone (iPTH), eGFR, cholesterol, lipoprotein a, 4-hour dialysate-to-plasma ratio for creatinine (4hD/Pcr), total Ccr (P＜0.05, respectively); the two groups also varied in the proportion of chronic obstructive pulmonary disease, cardiovascular disease and hyperlipidemia, as well as in the use of iron supplements, angiotensin-converting enzyme (ACE) inhibitors or angiotensin Ⅱ receptor blockers (ARB), and beta-receptor blockers (P＜0.05, respectively). Cardiovascular event was a leading cause of mortality. Kaplan-Meier survival curves showed that the high RDW group had higher all-cause and CVD-related mortality compared with the low RDW group (P＜0.01). The 1-year, 3-year, and 5-year patient survivals of the high RDW and low RDW group were 87.97% vs 97.01%, 58.02% vs 81.53%, and 41.62% vs 67.96%, respectively, demonstrating significant differences (P=0.001). Multivariate Cox regression analysis showed that high RDW was independent risk factor for all-cause mortality (HR=1.212, 95%CI: 1.007-1.458, P=0.042) and CVD-related mortality (HR=1.697, 95%CI:1.030-2.795, P=0.038). Conclusion RDW is associated with mortality risks in CAPD patients and can be stratified as a valuable indicator for the risk of death.     

Association between metabolic syndrome and prognosis in patients with peritoneal dialysis

Objective To investigate the incidence situation of metabolic syndrome (MS) in patients with continuous ambulatory peritoneal dialysis (CAPD), and analyze the correlation between MS and prognosis of patients. Methods The patients who received peritoneal dialysis from June 1, 2002 to April 30, 2018 and followed up regularly were divided into MS group and non-MS group according to the diagnostic criteria of MS. Follow-up was until July 31, 2018. The differences of clinical data, metabolic indexes and clinical outcomes between the two groups were compared. The survival rates of the two groups were compared by Kaplan-Meier survival curve, and the risk factors of all-cause death and cardiovascular disease (CVD) death were analyzed by Cox regression analysis. Results A total of 516 patients with CAPD were enrolled in this study, including 340 males (65.9%) and 176 females (34.1%). Their age was (47.29±12.20) years. The median follow-up time was 20 (9, 39) months. According to the diagnostic criteria of MS, the patients were divided into MS group (210 cases, 40.7%) and non-MS group (306 cases, 59.3%). At baseline, there was no significant difference in age, educational background, duration of peritoneal dialysis, smoking history and drinking history between the two groups (P＞0.05), but the patients in MS group were more exposed to high glucose peritoneal dialysate (P＜0.05). The body mass index (BMI), blood phosphorus, blood glucose, blood potassium, triglyceride, cholesterol and systolic blood pressure in MS group were significantly higher than those in non-MS group (all P＜0.05), and HDL-C level was significantly lower in MS group than in non-MS group (P＜0.05). There were no significant differences in other indicators between the two groups (P＞0.05). Kaplan-Meier survival curve showed that the cumulative survival rate in MS group was significantly lower than that in non-MS group, and the difference was statistically significant (Log-rank χ2=14.87, P＜0.001). If CVD death was taken as the end event, the cumulative survival rate in the non-MS group was significantly higher than that in the MS group (Log-rank χ2=14.49, P＜0.001). Multivariate Cox regression analysis showed that MS and high 4 h dialysate creatinine/serum creatinine ratio (4hD/Pcr) were independent risk factor for all-cause death (HR=1.982, 95%CI 1.240-3.168, P=0.004; HR=3.855, 95%CI 1.306-11.381, P=0.015) and CVD death (HR=2.499, 95%CI 1.444-4.324, P=0.001; HR=5.799, 95%CI 1.658-20.278, P=0.006) in patients with CAPD. Conclusion The prevalence of MS in patients with CAPD is high, and MS and high 4hD/Pcr are independent risk factor for all-cause and CVD death in CAPD patients. They can be used as valuable indicators to predict the treatment outcomes and long-term prognosis of patients with CAPD.     

Stanford B型主动脉夹层胸主动脉腔内修复术术后内脏动脉血供改善情况分析

目的探讨Stanford B型主动脉夹层患者覆膜支架腔内修复术后受累内脏动脉血供改善情况。方法回顾性分析绵阳市中心医院2013年1月至2014年3月35例Stanford B型主动脉夹层患者行胸主动脉腔内修复术(TEVAR)的临床资料,其中男30例、女5例,年龄45~82(62.5±10.0)岁。35例共140支腹部主要内脏动脉(腹腔干、肠系膜上动脉、双肾动脉)中79支血流受影响,其中完全真腔供血但狭窄36支,真假腔供血18支,假腔供血18支,无供血7支。分析腹部主要内脏动脉供血情况的改变情况。结果全组手术均成功,无死亡病例;手术时间97.8(68~147)min,住ICU时间12~34 h,住院时间10~21 d。术后无脑梗塞、急性肾功能衰竭、夹层破裂、支架移位等并发症发生。受累血管血流情况均有不同程度改善。结论 TEVAR治疗Stanford B型主动脉夹层能成功封堵夹层破口,改善腹部主要内脏动脉血供情况,杜绝或有效减少动脉血运减少和内脏缺血并发症发生。     

端侧缝合修复周围神经损伤研究进展

周围神经端侧缝合是将损伤神经远端缝合到邻近正常神经的侧方.多数研究表明再生神经来源于吻合口部供体神经的侧支发芽,并获得功能恢复;再生机制可能与神经营养因子、许旺细胞和细胞外基质等有关;理论上这一方法既不牺牲供体神经,又可使受损神经获得功能恢复.研究还发现端侧缝合后供体神经纤维发生了变性,供体神经对肌肉的双重支配也可能发生.端侧缝合的临床应用结果并不一致,但有望为长段神经缺损、仅存神经远端的患者提供一种新的治疗方法.     

早期吸吮棒棒糖对腹部术后患儿胃肠功能恢复的影响

目的探讨早期吸吮棒棒糖对促进腹部手术后患儿胃肠功能恢复的效果。方法将纳入研究的93例腹部术后患儿按随机数字表法分为观察组(47例)和对照组(46例),对照组术后按常规进行护理,麻醉清醒后早期行肢体被动和主动活动,病情允许的情况下鼓励患儿早期下床活动;观察组在常规护理的基础上,麻醉清醒后早期吸吮草莓味棒棒糖,每4小时1次,每次20~30min,直到经口恢复饮食为止。结果观察组患儿术后肠蠕动恢复时间、肛门排气时间及排便时间显著早于对照组(均P0.01)。结论腹部术后患儿早期吸吮棒棒糖有助于肠蠕动恢复,缓解术后腹胀,促进胃肠功能的恢复。     

Variation of CD4+CD25+Foxp3+ Regulatory T Cells and Th17 Cells in the Peripheral Blood of Human Liver Allograft Patients With Long-term Survival

Background

Monitoring of peripheral blood (PB) lymphocyte subpopulation counts may be useful to underlie immune status after liver transplantation (LT). We aimed at exploring the variation of regulatory cells and Th17 in the PB of liver allograft patients with long-term survival.

神经导航在经蝶垂体腺瘤手术中的应用

目的 总结神经导航下经蝶手术治疗垂体腺瘤的经验,并讨论其适应证.方法 对2006年1月至2010年12月138例神经导航下经蝶垂体腺瘤手术病例进行回顾性分析.手术适应证包括:既往经蝶手术后复发性垂体腺瘤36例,侵袭型垂体腺瘤45例,位于垂体侧方或深部的微腺瘤45例,蝶窦气化不良4例,颅底异常增厚3例,双侧颈内动脉间距狭窄4例,鼻中隔偏曲1例.结果 复发性垂体腺瘤全切除12例,次全切除9例,术后出现瘤腔血肿2例,脑脊液漏4例,其中3例合并颅内感染,2例合并交通性脑积水,永久性动眼神经麻痹1例,垂体功能低下者3例;治愈9例,缓解8例.侵袭型垂体腺瘤全切除5例,次全切除27例,术后出现脑脊液漏并颅内感染1例,瘤腔血肿1例;治愈2例,缓解22例;侵袭型激素分泌型垂体腺瘤30例均未治愈缓解.微腺瘤45例均为激素分泌型,均全部切除,治愈38例.颈动脉间距狭窄4例和鼻中隔偏曲1例均全切除和治愈.蝶窦气化不良肿瘤全切除2例,次全切除2例,治愈1例.颅底异常增厚肿瘤全切除2例,次全切除1例,治愈1例.结论 神经导航可以使部分经蝶垂体腺瘤切除手术更加准确、安全、有效,在一定程度上扩大了经蝶手术的适应证.

Abstract：

Objectives To summarize the experiences in clinical application of neuronavigation in transsphenoidal microsurgery of specific pituitary adenomas, and to discuss its indications. Methods From January 2006 to December 2010,138 cases of transsphenoidal microsurgery for specific pituitary adenomas under neuronavigation were reviewed. The indications for neuronavigation in transsphenoidal microsurgery includes: recurrent or regrowth of residual pituitary adenomas after former transsphenoidal surgery in 36 cases, invasive pituitary adenomas in 45 cases, extremely laterally or deeply situated microadenomas in 45 cases, poor pneumatization of the sphenoid in 4 cases, skull base anomalies due to osteodysplasia fibrosa in 3 cases, narrow space between bilateral internal carotid arteries in 4 cases, distortion of nasal septum in 1 case. Results In the recurrence group, 12 were totally removed, 9 subtotally removed;postoperative complications included hematoma within the tumor cavity in 2 cases, cerebrospinal fluid (CSF) leakage in 4 cases among which 3 developed intracranial infection and 2 communicating hydrocephalus, oculomotor paralysis in 1 case and hypopituitarysm in 3 cases;9 were cured and 8 remission. In the invasive group, 5 were totally removed, 27 subtotally removed;postoperative complications included hematoma within the tumor cavity in 1 case, CSF leakage and intracranial infection in 1 case;2 were cured and 22 remission. None of the 30 invasive hormone-secreting adenomas were cured or remission. The 45 cases of hormone-secreting microadenomas were all totally removed, among which 38 were cured. Among the poor sphenoid pneumatization group, total and subtotal tumor removal were achieved in 2 cases respectively with only one cured. In the skull base anomaly group, 2 were totally removed and 1 subtotally removed, with only one cured. For the cases with narrow space between bilateral internal carotid arteries and distortion of nasal septum, all were totally removed and cured. Conclusions Transsphenoidal microsurgery under neuronavigation can be applied for pituitary adenomas in above specific indications. It is an accurate, safe and effective approach for specific pituitary adenomas, which can not only expand the indication of transsphenoidal microsurgery for pituitary adenomas, but also reduce the harmful exposure of X-rays for the operating staff.