AMPK信号通路在非酒精性脂肪肝病中的研究进展

腺苷酸活化蛋白激酶（AMP?activated protein kinase,AMPK）是细胞的“能量感受器”,具有调控和维持能量动态平衡的作用,激活的AMPK可以抑制肝内甘油三酯、糖异生、胆固醇和脂肪酸的合成代谢。非酒精性脂肪肝病（nonalcoholic fatty liver disease,NAFLD）已成为我国最常见的慢性肝病之一,其发病机制复杂,胰岛素抵抗（insulin resistance,IR）、氧化应激等可能是其发病的关键因素,而AMPK的活化可作用于这些因素从而改善NAFLD。文章就AMPK信号通路如何在NAFLD的发生中发挥作用简要进行综述。     

中医三联疗法联合腹腔镜手术治疗输卵管性不孕的临床观察

目的：观察中医三联疗法联合腹腔镜手术治疗输卵管性不孕的临床疗效。方法：将159例输卵管性不孕症患者随机分为对照组（n=79）和观察组（n=80）。对照组采用腹腔镜下盆腔粘连分离、输卵管疏通术;观察组在对照组的基础上,联合中医三联疗法（本科室协定方口服,中药保留灌肠,直流电药物离子导入）连续治疗3个月。随访6个月,记录2组患者术后中医证候积分、中医体征积分、输卵管通畅情况及术后妊娠情况,采用卡方检验评估其疗效差异。结果：观察组中医证候总有效率（97.50%）相比对照组（81.01%）有显著差异（P<0.05）;观察组中医体征总有效率（95.00%）相比对照组（78.50%）有显著差异（P<0.05）;观察组输卵管通畅率（83.75％）优于对照组（65.82%）,2组差异有统计学意义（P<0.05）;观察组宫内妊娠率（62.50％）明显高于对照组（41.77％）,2组差异有统计学意义（P<0.05）;观察组临床疗效总有效率（96.25%）优于对照组（83.54%）,2组有显著差异（P<0.05）。结论：中医三联疗法联合腹腔镜手术治疗输卵管性不孕能改善中医证候、体征有效率,促进输卵管再通,提高宫内妊娠率,从而提高临床总有效率,具有重要的临床价值。     

股骨头坏死的不同治疗手段对血流动力学及预后的影响*

目的 探讨不同治疗手段对股骨头坏死患者血流动力学及预后的影响。方法 选取2016年1月—2017年5月十堰市太和医院收治的67例股骨头坏死患者作为研究对象。根据采用手术方法的不同将患者分为研究组（髓芯减压微创植骨术）和对照组（全髋关节置换术）。统计患者收缩压（SBP）、舒张压（DBP）、心率（HR）的变化情况,并采用VAS评分法评价治疗前后疼痛程度,采用Harris评分评价患者髋关节的功能和疼痛情况,采用WHO生存质量测定量表对患者治疗前及治疗后生活质量进行评价,并记录并发症发生情况。结果 研究组患者治疗后10 min、12 及72 h的SBP、DBP、HR水平均高于对照组（P?<0.05）,两组间的LVEF及SpO2均无差异（P?>0.05）,研究组患者治疗后疼痛VAS评分低于对照组（P?<0.05）,而治疗后Harris评分却高于对照组（P?<0.05）,研究组患者治疗后心理领域、生理领域、环境领域、社会关系领域评分均高于对照组（P?<0.05）,研究组患者出现感染、再次手术、褥疮、下肢血管栓塞、肺栓塞的比例均低于对照组（P?<0.05）。结论 髓芯减压微创植骨术对股骨头坏死患者血流动力学影响较小,并预后较好,值得在临床推广应用。     

Blood Utilization After Primary Total Joint Arthroplasty in a Large Hospital Network

Background

Since a study in orthopedic hip fracture patients demonstrated that a liberal hemoglobin (Hb) threshold does not improve patient morbidity and mortality relative to a restrictive Hb threshold, the standard of care in total joint arthroplasty (TJA) should be examined to understand the variability of red blood cell (RBC) transfusion following TJA.

Questions/purposes

The study aimed to answer the following questions: (1) What is the blood utilization rate after primary TJA for individual surgeons within a large hospital network? (2) What is the comparison of hospital charges, length of stay (LOS), and discharge locations among TJA patients who were and were not transfused?

Methods

A retrospective study was conducted on 3,750 primary total knee arthroplasties (TKAs) and 2,070 primary total hip arthroplasties (THAs), and data was retrospectively collected over a 15-month period on the number of RBCs transfused per patient, along with demographic and cost details. The number of patients who received at least 1 RBC unit and the number of RBCs transfused per patient was calculated and stratified by surgeon.

Results

In the postoperative period, 19.3% TKA patients and 38.5% THA patients received a RBC transfusion. Transfusion rates following TJA varied widely between surgeons (TKA 4.8–63.8%, THA 4.3–86.8%). Transfused TKA patients received an average of 1.65 ± 0.03 RBCs, and THA patients received an average of 1.97 ± 0.14 RBCs. LOS and hospital charges for blood transfusion patients were higher than nontransfused patients.

Conclusion

Blood utilization after primary TJA varies greatly among surgeons, suggesting that resources may be misallocated. These findings highlight the need to standardize RBC transfusion practice following TJA.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-013-9327-y) contains supplementary material, which is available to authorized users.     

Spatial and temporal expression of germ cell nuclear factor in murine epididymis

Aim:To investigate the spatial and temporal expression of germ cell nuclear factor (GCNF) in mouse and rat epididymis during postnatal period.Methods:The epididymal sections from different postnatal days were stained for GCNF by the indirect immunofluorescence technique and digital photographs were taken by a Carl Zeiss confocal microscope.Results:GCNF was first detected on day 12 in mouse epididymis and day 14 in rat epididymis.The highest expression of GCNF was observed on day 35 in both mouse and rat epididymis.In adults,GCNF exhibited a region-specific expression pattern,i.e.,it was expressed predominantly in the initial segment,caput and proximal corpus of rat epididymis and was abundant in the proximal corpus of mouse epididymis.GCNF could be found in the nuclei of the principal,apical,narrow,clear and halo cells.Conclusion:GCNF may play an important role in epididymal differentiation and development and in sperm maturation.(Asian J Andro12004 Mar,6:23-28)     

护理干预对HIV/AIDS患者自我管理疾病能力的影响

目的 探讨护理干预对HIV/AIDS患者自我管理疾病能力的影响.方法 将100例HIV/AIDS患者按住院号分成干预组和对照组各50例,对照组给予常规治疗及护理,干预组在常规治疗及护理基础上,由专职的责任护士从心理、认知、行为方面进行全面系统干预.于出院后6个月复查时采用自行设计的自我管理疾病能力调查表进行问卷调查.结果 干预组自我管理能力总分、疾病认知水平、症状管理、用药依从性、生活行为方式、获得社会支持方面评分显著高于对照组(均P＜0.01).结论 全面系统的护理干预,可明显提高HIV/AIDS患者自我管理疾病能力.     

Hepaticoduodenostomy versus hepaticojejunostomy after resection of choledochal cyst: A systematic review and meta-analysis

Background

Excision has been established as a standard management practice for choledochal cysts in the last few decades. The two most commonly performed methods of reconstruction after excision are hepaticoduodenostomy (HD) and Roux-en-Y hepaticojejunostomy (HJ), of which the HJ is favored by most surgeons. Evidence concerning the optimal method of reconstruction is, however, sparse.

Materials and Methods

Studies comparing outcomes from HD and HJ after choledochal cyst excision were identified by searching Medline, Ovid, Search Medica, Elsevier Clinicalkey, Google Scholar and Cochrane library. Suitable studies were chosen and data extracted for meta-analysis. Outcomes evaluated included operative time, hospital stay and incidence of postoperative bile leak, cholangitis, reflux/gastritis, anastomotic stricture, bleeding, intestinal obstruction and re-operative rate. Pooled odds ratios (OR) were calculated for dichotomous variables; pooled mean differences (MD) were measured for continuous variables.

Results

Six retrospective studies were included in this meta-analysis, comprising a total of 679 patients, 412 of whom (60.7%) underwent HD, and the remainder, 267(39.3%) underwent HJ. Although, HD group had slightly shorter hospital stay (MD: 0.30; 95% CI: −0.22–0.39; P < 0.00001) it showed a higher incidence of postoperative reflux/gastritis (OR: 0.08; 95% CI: − 0.02–0.39; P = 0.002). However, the other outcomes such as bile leak, cholangitis, anastomotic stricture, bleeding, operative time, reoperation rate and adhesive intestinal obstruction did not differ between HD and HJ groups.

Conclusions

HD shows higher postoperative reflux/gastritis than HJ but a shorter hospital stay. There are few good-quality studies that compare the outcomes from HD and HJ, meaning that caution should be exercised in the generalization of the results of this meta-analysis, which suggests HD to be comparable with HJ in terms of other complications, operative benefits and outcomes.     

Inflammatory mechanisms contributing to pancreatic cancer development

OBJECTIVE: Pancreatic cancer is the most deadly of all gastrointestinal (GI) malignancies, yet relatively little is known regarding mechanisms of tumor development including the role of inflammation. SUMMARY BACKGROUND DATA: Chronic pancreatitis (CP) increases the risk of developing cancer by 10- to 20-fold; mediators of the chronic inflammatory process and the surrounding fibrotic stroma likely support a transformation to malignancy, yet the exact mechanisms remain undefined. The purpose of our present study was to determine potential inflammatory components in epithelial and stromal cells that may contribute to both CP and pancreatic cancers. METHODS: Specimens of normal pancreas, CP, and pancreatic cancer were examined using laser-capture microdissection (LCM), gene array, and immunohistochemistry. RESULTS: Gene array analysis from LCM-dissected tissues demonstrated: (i) increased expression of interleukin-8 (IL-8), an activator of the inflammatory factor nuclear factor-kappaB (NF-kappaB), and (ii) decreased expression of IkappaB (an inhibitor of NF-kappaB) in CP ductal cells compared with normal ducts. Compared with CP, cancers demonstrated: (i) increased expression of tumor related genes including S100A4, cyclin E1, and epidermal growth factor (EGF) receptor, and (ii) expression of matrix metalloproteinase 2, a pro-invasive factor for tumor cells, which was not present in the CP stroma. Increased staining of both the p50 NF-kappaB subunit and IKKalpha kinase (a protein that allows activation of NF-kappaB) was noted in CP and cancers. CONCLUSIONS: Our results demonstrate that similar inflammatory components and downstream effectors are present in CP and pancreatic cancers. Importantly, these findings suggest that a common pathway for pancreatic cancer development may be through a chronic inflammatory process including stroma formation. These findings may lead to novel strategies for pancreatic cancer prophylaxis based on inhibition of inflammatory mediators.     

Extracorporeal High Intensity Focused Ultrasound Ablation in the Treatment of Patients with Large Hepatocellular Carcinoma

Background: High intensity focused ultrasound (HIFU) is a noninvasive treatment modality that induces complete coagulative necrosis of a deep tumor through the intact skin. The current study was conducted to determine the safety, efficacy, and feasibility of extracorporeal HIFU in the treatment of patients with hepatocellular carcinoma (HCC).Methods: A total of 55 patients with HCC with cirrhosis were enrolled in this prospective, nonrandomized clinical trial. Among them, 51 patients had unresectable HCC. Tumor size ranged from 4 to 14 cm in diameter with mean diameter of 8.14 cm. According to tumor, node, metastasis (TNM) classification, 15 patients corresponded to stage II, 16 to stage IIIA, and 24 to IIIC. All patients had HIFU, and the median number of HIFU session was 1.69. Safety and efficacy of HIFU were assessed in this trial.Results: No severe side effect was observed in the patients treated with HIFU. Follow-up imaging showed an absence of tumor vascular supply and the shrinkage of treated lesions. Serum -fetoprotein returned to normal level in 34% of patients. The overall survival rates at 6, 12, and 18 months were 86.1%, 61.5%, and 35.3%, respectively. The survival rates were significantly higher in patients in stage II than those in stage IIIA (P = .0132) and in stage IIIC (P = .0265).Conclusion: As a noninvasive therapy, HIFU appears to be effective, safe, and feasible in the treatment of patients with HCC. It may play an important role in the ablation of large tumors.     

Contemporary management of penile cancer including surgery and adjuvant radiotherapy: an experience in Taiwan

This retrospective study reports on the treatment outcomes of 45 men with penile cancer and seeks to address the issue concerning the treatment of inguinal lymph nodes (LN). Of these 45 patients, five had verrucous carcinoma and the other 40 had squamous cell carcinoma. Eighteen patients had inguinal lymph nodes (LNs) metastasis and received treatments of inguinal LNs involving bilateral inguinal LN dissection or unilateral inguinal LN dissection with or without postoperative radiotherapy. The median follow-up was 37 months. The ultimate local and regional controls for patients with verrucous carcinoma were 100 and 100%, respectively. Among the 40 patients with squamous cell carcinoma, the overall local control rate was 90%. The 5-year overall survival (OS) and disease-free survival (DFS) rates of patients without or with pathological inguinal LN metastasis were 70 vs. 22% (p=0.01), and 55 vs. 16% (p=0.004), respectively. The regional failure rates after inguinal LN dissection for pathological inguinal LN metastasis were 11% (1/9) and 60% (3/5) in patients with and without adjuvant radiotherapy. This study demonstrates that verrucous carcinoma shows excellent treatment outcomes following surgery alone. Squamous cell carcinoma of the penis is associated with a high incidence of inguinal lymph node metastasis. Elective groin dissection is indicated for all penile cancer patients except those with verrucous carcinoma and pT1 cancer with well-differentiated tumor. For patients with pathologically positive inguinal LN metastasis, adjuvant radiotherapy can increase inguinal control in this study. It warrants further prospective trial to prove the value of adjuvant radiotherapy in patients with pathological documented inguinal LN metastasis in penile cancer.