人体生物敷料在腹腔开放治疗中的临床疗效

目的 探讨人体生物敷料（灭活的同种异体皮肤）作为腹腔开放临时覆盖物的临床疗效.方法 回顾性分析2011年1月至2014年1月南京军区南京总医院收治的44例因外伤行腹腔开放治疗患者的临床资料.所有患者腹腔开放后以改良三明治法作为临时关腹技术.2011年1月至2012年12月共33例行腹腔开放治疗患者采用凡士林纱布为腹腔临时覆盖物,设为凡士林纱布组（33例）;2013年1月至2014年1月共11例行腹腔开放治疗患者采用人体生物敷料为腹腔临时覆盖物,设为人体生物敷料组（11例）.采用门诊和电话随访,随访时间截至2014年10月.比较两组患者肠道空气瘘发生率、植皮时间、术前和术后2周内血液感染学指标（WBC、中性粒细胞所占比例、降钙素原及C反应蛋白）,住院时间、住院费用以及总体预后.计量资料比较采用独立样本t检验和重复测量方差分析;率或构成比的比较采用Fisher确切概率法.结果 凡士林纱布组患者中,肠道空气瘘发生率为42.4％（14/33）,人体生物敷料组患者中无一例出现肠道空气瘘,两组比较,差异有统计学意义（P＜0.05）.凡士林纱布组植皮时间为（15±6）d,人体生物敷料组为（11±3）d,两组比较,差异有统计学意义（t =2.10,P＜0.05）.凡士林纱布组患者术前、术后第1、3、7、14天降钙素原分别为（1.20±0.60） μg/L、（2.50±0.90） μg/L、（1.70±0.30） μg/L,（1.90±0.40） μg/L、（2.70±0.60）μg/L,显著高于人体生物敷料组的（0.90 ±0.30） μg/L、（1.80±0.60） μg/L、（1.30 ±0.50） μg/L、（0.60±0.20） μg/L、（0.30±0.07） μg/L,两组比较,差异有统计学意义（F=8.50,P＜0.05）;两组患者WBC、中性粒细胞所占比例和C反应蛋白分别由术前的（13.8±2.4）×10^9/L和（12.9±2.1）×10^9/L、0.90±0.09和0.88 ±0.06、（81±19） mg/L和（136±28） mg/L变化为术后第14天的（16.2±3.3）×10^9/L和（7.9±3.0）×10^9/L?     

腹腔镜输尿管膀胱吻合术治疗内在型输尿管子宫内膜异位症12例

目的 评价腹腔镜输尿管膀胱吻合术治疗输尿管子宫内膜异位症（内异症）合并重度肾积水的有效性和安全性.方法 回顾性分析2012年2月至2013年12月在中山大学附属第一医院妇科收治的12例合并重度肾积水的深部浸润型内异症（DIE）患者的临床资料,包括患者的术前症状、术前肾积水直径、手术时间、术中出血量、切除病变输尿管长度、病灶距离膀胱的长度、术后住院天数和并发症等.结果 12例患者均在腹腔镜下完成患侧输尿管狭窄部分节段切除术并输尿管膀胱吻合术和盆腔内异症根治术.术前肾积水直径平均为8.85 cm,手术时间为平均361 min,术中出血量平均为429ml,切除输尿管的长度平均为2.26 cm,病灶距离膀胱的长度平均为4.36 cm,平均术后住院天数为12.45 d.发生并发症5例（41.67％）.术后全部患者疼痛症状明显减轻或消失,肾盂积水明显好转.结论 腹腔镜输尿管膀胱吻合术治疗输尿管内异症合并重度肾积水预后良好,但需警惕并发症的发生.     

Temperature-Acclimated Brown Adipose Tissue Modulates Insulin Sensitivity in Humans

In rodents, brown adipose tissue (BAT) regulates cold- and diet-induced thermogenesis (CIT; DIT). Whether BAT recruitment is reversible and how it impacts on energy metabolism have not been investigated in humans. We examined the effects of temperature acclimation on BAT, energy balance, and substrate metabolism in a prospective crossover study of 4-month duration, consisting of four consecutive blocks of 1-month overnight temperature acclimation (24°C [month 1] → 19°C [month 2] → 24°C [month 3] → 27°C [month 4]) of five healthy men in a temperature-controlled research facility. Sequential monthly acclimation modulated BAT reversibly, boosting and suppressing its abundance and activity in mild cold and warm conditions (P < 0.05), respectively, independent of seasonal fluctuations (P < 0.01). BAT acclimation did not alter CIT but was accompanied by DIT (P < 0.05) and postprandial insulin sensitivity enhancement (P < 0.05), evident only after cold acclimation. Circulating and adipose tissue, but not skeletal muscle, expression levels of leptin and adiponectin displayed reciprocal changes concordant with cold-acclimated insulin sensitization. These results suggest regulatory links between BAT thermal plasticity and glucose metabolism in humans, opening avenues to harnessing BAT for metabolic benefits.     

A case of a bleeding benign gastrocolic fistula in 2014

INTRODUCTION

In the era of proton pump inhibitors in the treatment of peptic ulcer disease, the incidence of a gastrocolic fistula arising from unoperated gastric ulcers is extremely low.

PRESENTATION OF CASE

We present the case of a 68-year old farmer who presented with melaena and was found to have a benign gastrocolic fistula in the setting of untreated peptic ulcer disease, chronic NSAID ingestion and heavy alcohol intake. The diagnosis was made by gastroscopy. En bloc surgery was undertaken due to the size of the fistula and concomitant significant bleeding of the ulcer which would not have made it amenable to medical management.

DISCUSSION

The symptoms of a gastrocolic fistula are undifferentiated and the diagnosis can easily be missed in the setting of other complications such as bleeding or perforation of a hollow viscus. Barium enamas are the most accurate for the diagnosis but gastroscopy with biopsy is usually performed to rule out malignancy. The mainstay of treatment is usually surgical, though patients can be medically managed if he/she is not a surgical candidate.

CONCLUSION

Benign gastrocolic fistulas are rare and its diagnosis is easily missed.     

Epsilon-aminocaproic Acid Improves Postrecirculation Hemodynamics by Reducing Intraliver Activated Protein C Consumption in Orthotopic Liver Transplantation

Background

Activated protein C (APC) is related to regulating the inflammatory response and hemodynamic stability upon reperfusion in cardiac operations and orthotopic liver transplantation (OLT). Epsilon-aminocaproic acid (EACA) is frequently used to treat fibrinolysis during OLT. It also has inhibitory effects related to the inflammatory response. However, it remains to be determined whether EACA can attenuate intraliver APC consumption and improve hemodynamic stability after reperfusion during OLT.

Methods

Fifty-nine recipients were randomized to receive either EACA (150 mg kg^?1 given intravenously prior to incision, followed by 15 mg kg^?1 h^?1 infusion until 2 h after the graft reperfusion) or the same volume of saline. Blood samples to assess plasma APC and protein C were obtained immediately before and after reperfusion from the inferior caval effluent or the portal veins for calculation of transliver differences (Δ). Hemodynamics and vasoactive medication use during the reperfusion period were observed in both groups.

Results

No transhepatic changes in protein C were found in either group. Immediately after reperfusion, a marked intraliver consumption of APC was noted in all recipients (P < 0.001), and intraliver consumption of APC in the control group was greater than that in the EACA-treated group (P < 0.05). Fewer requirements for vasoactive medication use after reperfusion and better initial graft function were noted in the EACA-treated group (P < 0.05).

Conclusions

EACA can attenuate intraliver APC consumption and improve hemodynamic stability after reperfusion and initial graft function during OLT.     

胰岛素瘤的诊断与治疗

目的 总结胰岛素瘤的临床特点和诊治经验,并讨论其诊治方法.方法 回顾性分析了1997年1月至2012年1月间收治的32例胰岛素瘤的临床表现和辅助检查等特点,并结合文献讨论胰岛素瘤诊治的有关问题.结果 32例患者均有Whipple三联征,术前B超、CT、数字减影血管造影（DSA）定性诊断的准确率分别为28.1％ （9/32）、64.0％ （16/25）、90.0％ （9/10）,术中B超为100％ （9/9）.肿瘤局部摘除术20例,胰体尾切除术7例（加做脾切除3例）,胰尾切除术4例,原发性肝癌并胰腺部分切除术1例.结论 准确的术前定位及定性检查有助于术中选择合理的手术方式,术中超声是胰岛素瘤最有效的定位诊断方法.胰岛素瘤一经确诊,须尽快手术治疗.行肿瘤摘除术是治疗良性胰岛素瘤的最佳方式,能够降低术后并发症发生率.     

紫杉醇影响TGF⁃β1诱导的原代人肺成纤维细胞向肌成纤维细胞转化

目的：研究紫杉醇（paclitaxel,PTX）对重组人转化生长因子?β1（recombinant human transform growth factor?β1,rhTGF?β1）诱导人肺成纤维细胞（human lung fibroblasts,HLFs）向肌成纤维细胞转化的影响及其相关机制。方法：培养HLFs,药物处理分为对照组、TGF?β1组（5 ng/mL）、TGF?β1+PTX（0.01 nmol/L）组、TGF?β1+ PTX（0.1 nmol/L）组、TGF?β1+ PTX（1 nmol/L）组、PTX组（1 nmol/L）。采用CCK8法测定细胞活性;显微镜下观察并分析细胞形态学变化;Transwell实验检测细胞迁移能力;免疫荧光观察细胞内α?平滑肌肌动蛋白（α?SMA）表达及分布情况;real?time PCR和Western blot检测各组α?SMA、纤连蛋白（fibronectin）、Ⅰ型胶原蛋白（collagen Ⅰ）、Ⅲ型胶原蛋白（collagen Ⅲ）mRNA水平及蛋白含量;Western blot检测各组细胞内p?Smad3、Smad3、p?p38和p38蛋白含量。结果：CCK8结果显示,1 nmol/L PTX对细胞无毒性作用,0.01 nmol/L PTX不能抑制TGF?β1诱导的HLFs活性增加,0.1和1.0 nmol/L PTX可以抑制TGF?β1诱导的HLFs活性增加;细胞形态学结果显示,0.01 nmol/L PTX不能抑制TGF?β1诱导的HLFs胞体宽度增加,0.1、1.0 nmol/L PTX可以抑制TGF?β1诱导的HLFs胞体宽度增加;Transwell实验结果显示,0.01 nmol/L PTX不能抑制TGF?β1诱导的HLFs迁移,0.1、1.0 nmol/L PTX可以抑制TGF?β1诱导的HLFs迁移;免疫荧光结果显示,0.01 nmol/L PTX不能降低TGF?β1诱导的HLFs内α?SMA荧光强度,0.1、1.0 nmol/L PTX可以降低TGF?β1诱导的HLFs内α?SMA荧光强度;real?time PCR和Western blot结果显示,0.01 nmol/L PTX不能降低TGF?β1诱导的HLFs表型转化标志物α?SMA、fibronectin、collagenⅠ、collagenⅢ含量及p38的磷酸化水平,0.1、1.0 nmol/L PTX可以降低TGF?β1诱导的HLFs表型转化标志物α?SMA、fibronectin、collagenⅠ、collagen Ⅲ含量以及Smad3和p38的磷酸化水平。结论：紫杉醇可以抑制TGF?β1诱导原代HLFs向肌成纤维细胞表型转化,这种作用可能与抑制TGF?β/Smad/MAPK信号通路激活有关。     

湿细针穿刺细胞学检查对乳腺癌的诊断意义

目的探讨乳腺癌术前最佳病理学诊断方法. 方法对68例怀疑乳腺癌者用 7号针头、10 ml注射器进行湿细针穿刺细胞学检查. 结果 19例穿刺阳性找到癌细胞,无假阳性.余49例穿刺阴性中46例行乳腺区段切除, 1例术后石蜡切片为乳腺纤维肉瘤,其余均为良性病变;3例未行手术者随访 11～ 20个月均未发现乳腺癌.敏感性95.0%(19/20),特异性100%(48/48),准确率98.5%(67/68),假阴性率5.0%(1/20),假阳性率为0(0/48). 19例穿刺阳性无一例出现针道种植癌.无任何并发症. 结论湿细针穿刺细胞学检查具有安全、经济、方便、快速、痛苦小、准确率高的特点,可作为诊断乳腺癌的首选方法.     

Identification of a novel missense mutation in angiogenin in a Chinese amyotrophic lateral sclerosis cohort

Abstract Angiogenin (ANG) gene mutations have been identified in both familial and sporadic amyotrophic lateral sclerosis (ALS) patients from multiple European and North American populations. However, no ANG mutation has yet been reported in Asian ALS populations. Here, we screened for ANG mutations in a Chinese ALS cohort. The entire coding region of the ANG gene was sequenced in 10 familial ALS pedigrees, 202 sporadic ALS patients, and 151 healthy controls. All patients were negative for SOD1, FUS, and TARDBP mutations. We identified a novel missense mutation, c.379G > A (p.V103I), in one sporadic ALS patient, but not in the controls. No mutations were found in the familial ALS patients. A novel missense variant, c.323A > G (p.H84R), was detected in one healthy individual. We identified the presence of the known single nucleotide polymorphism, rs11701 (T/G), in both ALS cases and controls. However, no significant association of the G allele with ALS susceptibility was demonstrated. In conclusion, ANG mutations accounted for 0.5% of our SOD1-, FUS-, TARDBP- mutation-negative ALS cohort. Our findings highlight that the genetic background of ALS differs between different populations, and suggest that ANG mutation may be involved in the aetiology of ALS in the Han Chinese population.     

Sedating patients undergoing mechanical ventilation in the intensive care unit--winds of change?

The majority of mechanically ventilated patients in the intensivecare unit (ICU) require sedation to reduce anxiety, encouragesleep and to increase tolerance to tracheal tubes and the ventilator.Sedative and analgesic drugs are amongst the most commonly prescribedmedications in the ICU.¹ The choice of agent and the way inwhich they are used varies widely between and within ICUs. Ina survey of 164 ICUs in the US,² 18 different sedative agentswere used, the commonest of which were the opiates and benzodiazepines.A more recent study³ revealed substantial differences in theclinical use of drugs for sedation and analgesia in the westernEuropean countries surveyed.  These differences in clinical practice can have an importantimpact on patient outcome and cost of care: excessively deep