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目的 下肢静脉曲张及下肢深静脉功能不全病人的左髂总静脉（LCIV）病变的发病情况及其之间的关系。以指导临床治疗。方法 连续为73例（100条患肢）下肢静脉曲张病人行术前患肢深静脉逆行造影及LCIV造影。结果 （1）LCIV总异常率为47.9%,在有左侧下肢静脉曲张的病人中有31例(59.6%),在只有右侧下肢静脉曲张的病人中,仅4例（19.4%),两组间的LCIV异常的比率差异有显著意义（P=0.0017)。LCIV异常包括髂腔静脉交界处压迹,不同程度的狭窄,增宽,充盈缺损和侧支形成。（2）下肢深静脉功能不全67条肢体,占67.0%,在左LCIV造影异常的病斧正中,左侧下肢深列脉Ⅲ或Ⅳ级逆流者14例,在左LCIV造影正常的病例中,左侧下肢深静脉有Ⅲ或Ⅳ级逆流者仅6例,二者间差异也有显著意义（P=0.0205)。结论 Cockett综合征可能是左下肢静脉曲张的原因之一。同时也是左下肢深静脉功能不全的原因之一。     

腹腔镜胆囊切除术治疗复杂性胆囊结石902例分析

目的:总结腹腔镜胆囊切除术治疗复杂性胆囊结石的疗效及手术操作技巧。方法:对比分析单纯性胆囊结石组和复杂性胆囊结石组的手术时间、术后住院时间、中转开腹手术率及并发症发生率。结果:单纯组和复杂组手术时间分别为30.16±17.20min和41.83±26.76min(P<0.01),术后住院时间分别为3.56±1.14d和3.74±1.23d(P>0.05),中转开腹手术率分别为0.21％和2.44％(P<0.01),并发症发生率分别为0.29％和1.66％(P<0.01)。单纯组98％的患者和复杂组95％以上的患者均能经LC治愈。结论:只要正确评估手术难度,腹腔镜外科医师技术娴熟,便能明显降低中转开腹手术率及并发症发生率,获得与单纯组同样的疗效。     

Rosiglitazone down-regulates lipopolysaccharide-induced expression of CD40 and intercellular adhesion molecule 1 in rat peritoneal mesothelial cells through a NF-κB dependent mechanism

Objective To investigate the effect and mechanism by which PPARγ ligand, rosiglitasone, regulates the expression of CD40 and intercellular adhesion molecule 1 (ICAM-1) in the rat peritoneal mesothelial cells (RPMCs) induced by lipopolysaccharide (LPS). Methods RPMCs were harvested from Sprague-Dawley rat peritoneal cavity and maintained under defined in vitro conditions. The cells were randomly divided into groups as follows: medium, LPS (5 mg/L), LPS (5 mg/L)+BAY11-7085(5 μmol/L, NF-κB inhibitor), rosiglitazone (10 μmol/L or 20 μmol/L, peroxisome proliferator-activated receptor γ activator), LPS (5 mg/L)+rosiglitazone (10 μmol/L)+GW9662 (3 μmol/L, peroxisome proliferator-aetivatcd receptor γ antagonist), and LPS (5 mg/L)+vehicle (DMSO 0.2 ml/L). The expressions of CD40 and ICAM-1 RNA in RPMCs were examined by RT-PCR after 3 hour treatment, and the protein expressions of CD40, ICAM-1, p-NF-κB p65 and p-IκBα were examined by Western blot or immunofluorescence after 24 hour treatment. Results Following treatment with LPS, both the expressions of CD40 and ICAM-1 protein in RPMCs were up-regulated significantly (P<0.05), and the phosphoralation of p65 was increased greatly (1.10±0.17 vs 0.55±0.06, P<0.05). BAY11-7085 (5 μmol/L) significantly decreased the protein expression of p-p65 (0.22±0.11 vs 1.10±0.17, P<0.01), CD40 (0.34±0.02 vs 0.50±0.06, P<0.05) and ICAM-1 (0.35±0.16 vs 0.74±0.03, P<0.05). Pretreated with rosiglitazone for 3 h then added with LPS for 1 h, the levels of p-p65, CD40 and ICAM-1 in RPMCs were significantly decreased compared with those of LPS group (0.77±0.08 vs 0.90±0.10, P相似文献   

Suture techniques with high breaking strength and low gliding resistance: experiments in the dog flexor digitorum profundus tendon

We studied the breaking strength and gliding resistance between the pulley and flexor tendon for various suture techniques. Canine flexor digitorum profundus tendons were transected and sutured using one of eight repair techniques: modified Kessler (MK); Tsuge (Tsuge); two variations of a double modified Kessler (DK1, DK2); combined modified Kessler-modified Tsuge (MKT); augmented Becker (Becker); Cruciate (Cruciate); and modified double Tsuge (DT). The force to produce a 1.5 mm gap, ultimate failure load, resistance to gap formation, and gliding resistance were measured. The force to produce a 1.5 mm gap and the ultimate breaking force were higher with the DK1, DK2, MKT, Becker, Cruciate, and DT repairs than they were with the MK and Tsuge repair, while the gliding resistance of the Becker was higher than that of the MK, DK1, DK2, MKT. Cruciate, and UT repairs. In addition to confirming that repair strength increases as the number of strands crossing the repair increases, we also found that these stronger repairs need not produce higher gliding resistance than less robust repairs.     

Tensile properties of suture methods for repair of partially lacerated human flexor tendon in vitro

The decision to treat zone II partially lacerated flexor tendons is challenging, because there can be justification for either repair or no repair, depending on the surgeon's assessment of the strength of the residual intact portion of the tendon. In this study tensile properties of various repair techniques were compared. Cadaveric human flexor tendons (n = 118) were lacerated to 75% of their cross-section and repaired with either a core suture method (Kessler, modified Kessler, Savage, Lee, augmented Becker, or Tsuge all finished with a circumferential running suture), an epitendinous suture alone (circumferential or partial), or the tendons were left unrepaired. Among the core suture methods there was no significant difference (p >.05) in maximum failure force (overall mean, 211.2 N; SD, 53.2) or force to produce a 1.5-mm gap (74.1 N; SD, 49.7). Likewise there was no significant difference (p >.05) in tendon stiffness (41.0 N/mm; SD, 14.0) or resistance to gap formation (52.3 N/mm; SD, 23.1). In comparison, repairs without the core suture, including unrepaired tendons, were significantly weaker (144.7 N, p <.001) and had a marginally lower stiffness (p =.04) but had a similar resistance to gap formation (43.5 N/mm).     

Gliding characteristics of tendon repair in canine flexor digitorum profundus tendons.

The gliding resistance between the flexor digitorum profundus (FDP) tendon and the proximal pulley system was measured using the method of S. Uchiyama, J.H. Coert, L. Berglund, P.C. Amadio, K.N. An (J. Orthop. Res. 13 (1995) 83) in 108 adult dog digits in vitro. The FDP tendons were then lacerated to 80% of their transverse section. Each tendon was repaired with one of the following six suture techniques: Kessler, modified Kessler, Savage, Lee, Becker and simple running suture alone. Each repaired tendon was then tested again using the same method. The Student-Newman-Keuls test for multiple comparisons was performed for statistical analysis. The average gliding resistances of the Kessler, Savage, and Becker repairs were significantly greater than the resistances of the Lee, modified Kessler, and running suture alone repairs (P < 0.05). The Lee suture technique had a significantly greater resistance than the modified Kessler repair and the running suture (P < 0.05). The results of the peak gliding resistance followed the same trends, except that the modified Kessler repair was significantly higher than the running suture alone (P < 0.05). Suture techniques with a multi-strand core suture, with knots located outside the tendon surface, and with multiple-loops on the tendon surface may result in increased gliding resistance between the tendon and pulley system after tendon repair.     

Human parathyroid hormone 1-34 reverses bone loss in ovariectomized mice.

The experimental work characterizing the anabolic effect of parathyroid hormone (PTH) in bone has been performed in nonmurine ovariectomized (OVX) animals, mainly rats. A major drawback of these animal models is their inaccessibility to genetic manipulations such as gene knockout and overexpression. Therefore, this study on PTH anabolic activity was carried out in OVX mice that can be manipulated genetically in future studies. Adult Swiss-Webster mice were OVX, and after the fifth postoperative week were treated intermittently with human PTH(1-34) [hPTH(1-34)] or vehicle for 4 weeks. Femoral bones were evaluated by microcomputed tomography (microCT) followed by histomorphometry. A tight correlation was observed between trabecular density (BV/TV) determinations made by both methods. The BV/TV showed >60% loss in the distal metaphysis in 5-week and 9-week post-OVX, non-PTH-treated animals. PTH induced a approximately 35% recovery of this loss and a approximately 40% reversal of the associated decreases in trabecular number (Tb.N) and connectivity. PTH also caused a shift from single to double calcein-labeled trabecular surfaces, a significant enhancement in the mineralizing perimeter and a respective 2- and 3-fold stimulation of the mineral appositional rate (MAR) and bone formation rate (BFR). Diaphyseal endosteal cortical MAR and thickness also were increased with a high correlation between these parameters. These data show that OVX osteoporotic mice respond to PTH by increased osteoblast activity and the consequent restoration of trabecular network. The Swiss-Webster mouse model will be useful in future studies investigating molecular mechanisms involved in the pathogenesis and treatment of osteoporosis, including the mechanisms of action of known and future bone antiresorptive and anabolic agents.     

胃癌患者及其手术前后红细胞免疫功能与淋巴细胞功能之间的相关性研究

目的探讨胃癌患者及其手术前后红细胞免疫功能的变化及与淋巴细胞免疫功能之间的相关性.方法72例胃癌患者,20例正常人为对照,检测血红细胞C3b受体花环(RBC-C3bRR)和免疫复合物花环(RBC-ICR),T淋巴细胞亚群、B细胞含量;NK细胞活性、血清循环免疫复合物(CIC)、血清免疫球蛋白和补体.结果(1)胃癌患者RBC-C3bRR显著降低,RBC-ICR显著升高(P＜0.01).(2)术后组RBC-C3bRR显著升高,RBC-ICR显著降低(P＜0.01).(3)胃癌患者CD3+、CD4+、CD4+/CD8+,NK细胞活性,B细胞,IgG、IgA均显著降低,CIC显著升高(P＜0.05或P＜0.01);手术后CD3+、CD4+、CD4+/CD8+、NK细胞活性,免疫球蛋白IgA均有显著提高(P＜0.01);胃癌患者术前组及手术前后RBC-C3bRR变化组与CD3+、CD4+、NK细胞组均呈显著正相关(P＜0.01).结论(1)胃癌患者红细胞免疫粘附功能、淋巴细胞免疫功能低下.(2)手术可使胃癌患者红细胞免疫、淋巴细胞免疫功能明显改善.(3)红细胞免疫粘附功能与T淋巴细胞、NK细胞活性之间关系密切.     

Brief pretreatment of radial artery conduits with phenoxybenzamine prevents vasoconstriction long term

Background. Radial artery bypass conduits are prone to early vasospasm or “string sign” with use of vasopressor therapy intraoperatively and postoperatively, causing increased resistance in coronary artery grafts. Current intraoperative treatment with papaverine fails to provide sustained inhibition of vasoconstriction. We tested the hypothesis that a 30-minute pretreatment of radial artery segments with the -adrenergic antagonist phenoxybenzamine (PB) or the putative protein phosphatase 2,3-butadione monoxime (BDM) attenuates vasoconstriction induced by the vasopressors phenylephrine or norepinephrine for as long as 48 hours compared with papaverine.

Methods. Canine radial arteries were harvested, incubated in control buffer or solutions of papaverine 10⁻⁶ M, BDM 10⁻⁶ M or phenoxybenzamine 10⁻⁶ M for 30 minutes, washed, and stored in drug-free culture medium for 2, 24, or 48 hours. After storage, constriction was induced by norepinephrine at incremental concentrations ranging from 0.7 to 3.5 μmol/L or by phenylephrine (0.300 to 1.5 μmol/L) with or without the inhibitors, and the degree of vasoconstriction was quantified in organ chambers. Responses to norepinephrine or phenylephrine were compared to constriction with receptor-independent potassium chloride KC1 (30 mmol/L).

Results. Maximum responses to phenylephrine and norepinephrine were comparable at 2, 24, and 48 hours after harvest in the control group (phenylephrine: 67% ± 4%, 62% ± 6%, 65% ± 6% of KC1 response; norepinephrine: 75% ± 4%, 62% ± 1%, 58% ± 7%, respectively). Papaverine failed to attenuate constriction to phenylephrine and norepinephrine 2, 24, or 48 hours posttreatment. Pretreatment with BDM did not reduce vasoconstriction responses to phenylephrine or norepinephrine 2 hours after incubation but did reduce constriction responses thereafter. In contrast, phenoxybenzamine completely attenuated constriction to both phenylephrine (19% ± 8%, 1% ± 4%, −12% ± 4%) and norepinephrine (7.1% ± 1%, −5% ± 5%, −20% ± 5%) at 2, 24, and 48 hours posttreatment, respectively. Phenoxybenzamine did not alter endothelial function relative to controls at any time point.

Conclusions. Thirty-minute pretreatment of RA conduits with 10⁻⁶ M phenoxybenzamine completely inhibits vasoconstriction to phenylephrine and norepinephrine for as long as 48 hours. Soaking radial artery grafts briefly in phenoxybenzamine solution before implantation may be effective in preventing postoperative vasospasm caused by two common -adrenergic agonists used in postoperative hemodynamic management.     

Neurosurgical trauma in People's Republic of China

An epidemiological investigation for neurological disorders was conducted in the People's Republic of China in 1983 and 1985. The incidence of traumatic neurological injury was 55.4 patients per 100,000 population in the six big cities and 64.1 patients in the 21 rural areas. The mortality rates were 6.3 per 100,000 population (male:female = 1.7:1.0) in the six cities and 9.7 (m:f = 2.5:1) in the rural areas. In the cities, the causes of brain injury were vehicle accidents (31.7%), followed by assaults (23.8%), falls (21.8%), stumbles (15.4%), and others. Brain concussion was 68.4%, contusion was 26.0%, and intracranial hematoma was 5.6%. The incidence of spinal cord injury was 0.67 per 100,000 population in Beijing and 1.37 in Shanghai. Male versus female ratio was 7 to 1 and the peak incidence was found in ages from 20 to 30 years old. In the past decade, vehicle accidents increased along with the increasing number of cars and motor bicycles. As a result of a series of administrative measures, such as improvement of traffic control and safe-driving education, mean mortality decreased from 33.4 per 10,000 motor vehicles in 1990 to 22.0 in 1995. It has been estimated that approximately 50,000 to 60,000 people die from vehicle accidents per year. Among these cases, brain injury accounts for 39% to 57% and spinal cord injury about 10%. Since vehicle accidents are the most common cause for neurotraumatic death, an effort is needed to prevent and to decrease the incidence of these accidental traumatic injuries.