Comfortable suture angle with optimized trocar position aids renorrhaphy during retroperitoneal laparoscopic partial nephrectomy

BackgroundThis study investigated a comfortable suture angle (CSA) with optimized trocar position for closing the defect during renorrhaphy in retroperitoneal laparoscopic partial nephrectomy (LPN). The feasibility, usefulness, and safety of achieving the CSA with modified trocar position were determined for different tumor types.MethodsTwo optimized trocar positions were introduced for different tumor types. A suture angle was based on the tumor plane of the superficial parenchyma defect and the line formed by the needle holder. Preliminary surgical simulations determined a CSA that combined the least suture time with the greatest ease of performance. Achieving the CSA was attempted during renorrhaphy of 106 enrolled patients undergoing retroperitoneal LPN. Patients’ characteristics, operative features, and follow-up information were collected and analyzed.ResultsFor 89 (83.96%) patients, a CSA was successfully reached and parenchyma recovered. The remaining 17 patients were successfully sutured, but the attempt to achieve a CSA failed. For the CSA group, the suture, clamping, and overall operative times were significantly less than that of the non-CSA patients. The groups were similar regarding estimated blood loss, positive surgical margin, and rates of glomerular filtration reduction and complications. Univariable analyses determined that tumor location, growth pattern, and R.E.N.A.L. nephrometry score (RNS) may influence the success of this approach. Multivariable analyses indicated that only tumor location and RNS were independent factors affecting successful achievement of the CSA.ConclusionsThrough different kidney position changes, the CSA could be used to ease the suture process. It is feasible and safe to perform a CSA with optimized trocar position during LPN. Tumor location and RNS may influence the approach to get a CSA.     

IL-2和IFNa对自然杀伤功能的共同增强作用

用改良的单细胞细胞毒试验研究了IL-2和IFN_(?)对人外周血淋巴细胞NK的增强作用及共同增强作用。结果表明,IL-2或IFN_a单独预处理人外周血淋巴细胞(PBL)均不影响淋巴细胞与靶(K_(562))细胞的结合率,但能显著增加与靶细胞结合的淋巴细胞的杀伤率;同时用IL-2和IFN_a预处理人PBL后,淋巴细胞与靶细胞的结合率也没有显著改变,但结合的淋巴细胞的杀伤率显著高于单独用IL-2或IFN_a预处理后淋巴细胞的杀伤率,而且IL-2和IFN_a的增强作用存在加和性。这提示,IL-2和IFN_a能分别激活不同的NK细胞,即,NK细胞在其激活信号方面存在异质性。     

肺癌病理类型的计算机鉴别诊断

肺癌的治疗方案与预后取决于肺癌的病理类型。本文按照概率型的数学模型──最大似然法，建立计算机鉴别肺癌病理类型的数学模型，用ＢＡＳＩＣ语言编制诊断程序。结果表明该方法的诊断正确率高于临床，为肺癌病理类型的分类提供了一种简便、快捷、实用的方法。     

大鼠胸腺不同区域嗜锇性细胞的结构和性质的观察

应用锇黑法、银浸法和酶组织化学法探讨了大鼠胸腺嗜锇性细胞的分布、形态结构和性质。结果显示：嗜锇性细胞主要密集分布于皮髓质交界区，形成一个致密的细胞带以及散在于皮质和髓质中。嗜银性细胞也密布于皮髓质交界区，与此处的嗜锇性细胞相一致。这些细胞呈ＡｃＰ和ＮｓＥ阳性反应，在皮髓质交界区形成一个强阳性反应细胞的致密带。此外，该区的细胞也具有ＰＡＳ阳性反应和含有被醛复红特异性染色的颗粒。以上结果提示：大鼠胸腺     

单侧多节段后部结构切除对腰椎旋转稳定性影响的生物力学研究

目的：研究多节段脊柱后部结构对腰椎旋转稳定性的影响。方法：选用７具成人新鲜尸体脊柱标本（Ｌ１～Ｓ１），采用单侧多节段逐步切除腰椎后部结构的方法，形成７种状态，从单侧多节段开窗至全椎板及双侧小关节切除等。通过脊柱三维运动试验机施加１０Ｎｍ的扭转载荷，使脊柱产生左、右轴向旋转运动。结果：全椎板加双侧小关节部分切除后，腰椎旋转稳定性受到显著影响。结论：除小关节骨性结构及关节囊外，椎板及后部韧带结构对维持腰椎旋转稳定性亦有重要作用     

儿童臀肌挛缩症免疫发病机理的研究

本文对４１例儿童臀肌挛缩症患者外周血及３２例儿童臀肌挛缩症臀肌进行了系统的免疫学研究。结果表明：儿童臀肌挛缩症患者免疫调节功能紊乱，红细胞免疫功能低下，臀肌组织免疫复合物沉积，臀肌小血管数目减少及管壁损伤。由此认为免疫病理因素是儿童臀肌挛缩症的主要发病机理。     

生、制枳实换用的枳实芍药散对便秘型肠易激综合征大鼠“脑-肠-菌”轴功能的影响

目的 从“脑-肠-菌”轴的角度探讨生、制枳实换用的枳实芍药散改善便秘型肠易激综合征（C-IBS）大鼠的作用机制。方法 将80只大鼠随机分为空白组、模型组、匹维溴铵组（15.625 mg·kg^-1）、生枳实芍药散组、清炒枳实芍药散组、麸炒枳实芍药散组、炒炭枳实芍药散组、成品枳实芍药散组（3.75 g·kg^-1）,每组10只。除空白组灌胃常温0.9%氯化钠溶液外,其余各组均灌胃0~4 ℃冰0.9%氯化钠溶液（2 mL·d^-1,共14 d）建立C-IBS大鼠模型。连续给药14 d后检测大鼠粪便含水量、小肠推进率;酶联免疫吸附测定法（ELISA）检测5-羟色胺（5-HT）、血管活性肠肽（VIP）、神经肽Y（NPY）、降钙素基因相关肽（CGRP）、P物质（SP）、二胺氧化酶（DAO）、D-乳酸（D-LA）水平;苏木素-伊红（HE）染色观察结肠组织病理损伤变化;实时荧光定量聚合酶链式反应（Real-time PCR）检测结肠组织环磷酸腺苷（cAMP）、蛋白激酶A（PKA）、水通道蛋白3（AQP3） mRNA的表达及蛋白免疫印迹法（Western blot）检测结肠组织VIP和AQP3蛋白的表达;采用气质联用色谱法（GC-MS）检测短链脂肪酸（SCFAs）含量的变化。结果 与空白组比较,模型组大鼠粪便含水量、小肠推进率显著降低（P<0.01）;血清中5-HT、VIP、CGRP、SP水平显著上升,NPY水平显著下降（P<0.01）;血浆中DAO和D-LA水平显著升高（P<0.01）;结肠组织黏膜上皮轻度破损,杯状细胞减少且腔内颗粒明显减少;结肠组织中AQP3、cAMP、PKA mRNA表达水平和AQP3、VIP蛋白表达水平明显下降（P<0.05,P<0.01）;粪便中SCFAs总量呈明显下降趋势,其中,乙酸、异丁酸、异戊酸、戊酸、己酸含量显著减少,丙酸、丁酸含量明显上升（P<0.05,P<0.01）。与模型组比较,各给药组均明显提高C-IBS大鼠小肠推进率,改善肠黏膜屏障功能,调整模型大鼠血清中脑肠肽水平（P<0.05,P<0.01）,明显升高大鼠结肠组织中AQP3、cAMP、PKA mRNA及VIP、AQP3蛋白的表达水平（P<0.05,P<0.01）,除异丁酸外各给药组对大鼠粪便中短链脂肪酸含量均具有显著回调作用,并且麸炒枳实入药的枳实芍药散的作用稍强于其他炮制品枳实入药的枳实芍药散。结论 生、制枳实换用的枳实芍药散可通过对“脑-肠-菌”轴功能的调节来改善C-IBS,并且使用麸炒枳实入药的枳实芍药散效果更佳。     

低血流心肌缺血诱导GLUT4基因表达

目的：探讨低血流心肌缺血促进葡萄糖摄取增加的机制。方法：采用Northrn印迹法观察缺血心肌葡萄转运子4（GLUT4）mRNA的表达,并利用蛋白质印迹法分析心肌GLUT4多肽的表达,结果：局部心肌低血流缺血后,心肌GLUT4mRNA和GLUT4多肽表达明显增加;同时伴随缺血心肌葡萄糖摄取明显增多。结论：心肌缺血能刺激GLUT4 mRNA和GLUT4多肽表达,使GLUT4数增加,进而促进心肌葡萄糖摄取增多,使缺血心肌能量需求得以平衡,有助于缺血心肌功能的恢复,提示低血流缺 刺激心肌GLUT4表达是一个重要的代偿性保护机制。     

神经移植端侧缝合颈5/7神经根与上干桥接治疗产瘫

目的：探讨一种不影响残存神经自行恢复的产瘫臂丛神经修复新方法。方法：将上干损伤部位行松解,不切除神经瘤,将其近端的颈5或颈7神经根和神经瘤远端的臂丛上干的神经束膜切开窗口,取颈丛皮支或前臂外侧皮神经前成多段（一般每段长约2．0－2．5cm）,两端分别与颈5神经根和上干的神经束膜行端侧缝合,结果：8例患儿经术后1－11年（平均3年）的随访,4例的三角肌和肱二头肌骨力达4级和4^-级,4例达3例。3例后期进行了肩关节松解和旋前圆肌肌腱切断,结论：该方法既提供了可使损伤近端颈5神经根的新生纤维生长至上干的神经通道,又未阻断神经瘤内残存神经纤维的自行恢复,是治疗产瘫特别是Tassin2型的新术式。     

The relationship between plasma apolipoprotein A-Ⅳ levels and coronary heart disease

Objective To evaluate the relationship between plasma apoA-Ⅳ levels and coronary atheros clerosis and to explore its relation to other risk factors.Methods Using ELISA techniques, plasma apoA-Ⅳ levels were quantified in 181 patients w ho underwent coronary angiography (CAG).Patients were divided according to the ir coronary status into a coronary heart disease (CHD) group (stenotic lesion on CAG, n=118) and a control group (normal CAG, n=63).The severity of athero sclerosis was assessed by stenosis scoring of the different lesions.Other para meters, including apoA-Ⅰ,apoB, Lp(a), HDL-C, LDL-C, TG, and T C, were measured as well.Univariate, logistic regression analyses were used to define the relationship between coronary atherosclerosis and plasma apoA-Ⅳ levels.Results When compared with the control group, plasma apoA-Ⅳ levels were found to be lo wer in the CHD group.There was a weak negative correlation between plasma apoA -Ⅳ levels and the severity of coronary atherosclerosis.ApoA-Ⅳ was found to be a relatively independent risk factor for CHD.We also found a positive corr elation between apoA-Ⅳ and triglyceride levels.Conclusions ApoA-Ⅳ may be important in the prediction of CHD and coronary atherosclerosis severity.It may also play an important role in the metabolism of triglycerides .