丙氨酸转氨酶正常且HBVDNA阴性代偿期肝硬化患者的肝组织病理特征及病毒载量分布

丙氨酸转氨酶（ALT）正常、实时PCR检测HBVDNA载量低于1000拷贝／mL的代偿期乙型肝炎肝硬化患者临床上相对少见。对于这些患者是否需要抗病毒治疗,目前存在很多争议。本研究通过对这些患者进行肝脏病理组织学、Cobas HBV DNA定量基线检查,了解其肝脏炎症、纤维化和病毒载量分布情况,为进一步治疗提供依据。     

经腹腹腔镜联合肾镜治疗马蹄肾UPJO并肾结石1例报告并文献复习

目的:探讨经腹腹腔镜肾盂成形术联合肾镜碎石取石术一期治疗马蹄肾肾盂输尿管连接部狭窄(UPJO)合并肾结石的可行性和临床疗效。方法:2013年5月,我院采用经腹腹腔镜肾盂成形术联合肾镜碎石取石术一期治疗马蹄肾UPJO合并肾结石患者1例。具体方法是采用经腹腔入路,在腹腔镜下先分离出肾盂并切开,然后使肾镜通过腹腔镜穿刺通道进入肾盂肾盏行碎石取石术,再在腹腔镜下行离断式肾盂成形术。结果:手术过程顺利,手术时间180min。术后21小时肛门排气,5天后拔除腹腔引流管,10天后出院。术后3个月随访,肾盂输尿管连接部通畅,未发现明显结石残留。结论:经腹腹腔镜肾盂成形术联合肾镜碎石取石术一期治疗马蹄肾UPJO并肾结石安全、有效。     

大鼠肾移植模型手术改良技巧探讨

目的  探讨大鼠肾移植模型手术的改良方法。方法  供体Sprague-Dawley(SD)大鼠21只, 受体Wistar大鼠42只。采用双侧供肾。受体左肾切除后借助自制导管, 行受体肾动脉与供体肾动脉、受体肾静脉与供体下腔静脉端端吻合, 供体输尿管带膀胱瓣与受体膀胱吻合, 最后切除右肾, 腹腔内注入头孢米诺10 mg, 关腹。记录手术时间, 动、静脉吻合时间, 冷、热缺血时间等手术数据; 术后大鼠存活3 d认为模型建立成功, 计算建模成功率, 分析死亡原因。结果  供体手术时间为(32.7±5.6)min, 供肾修整时间为(4.2±1.1)min。受体手术时间为(42.3±4.9)min, 其中动脉吻合时间为(10.1±3.2)min, 静脉吻合时间为(13.9±2.5)min, 尿路重建时间为(6.3±1.4)min。热缺血时间为(5.4±1.8)s, 冷缺血时间为(56.2±7.3)min。42只受体大鼠中, 建模成功40只, 成功率为95%。另2只受体大鼠死亡, 其中1只死于血管吻合口出血, 1只死于尿瘘引致的腹膜炎。结论  采用改良的血管端端吻合法建立大鼠肾移植模型具有操作简单、手术时间短、成功率高的特点。     

Migration Inhibitory Factor Enhances Inflammation via CD74 in Cartilage End Plates with Modic Type 1 Changes on MRI

Background

Type 1 Modic changes are characterized by edema, vascularization, and inflammation, which lead to intervertebral disc degeneration. Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine closely related to the inflammatory cytokines detected in degenerative intervertebral disc tissues. However, the existence and role of MIF and its receptor CD74 in intervertebral disc degeneration have not been elucidated.

Questions/purposes

We asked whether (1) MIF and its receptor CD74 are expressed in cartilage end plates with Type 1 Modic changes, (2) MIF is associated with cartilage end plate degeneration, (3) the MIF antagonist (S, R)-3(4-hydroxyphenyl)-4, 5-dihydro-5-isoxazole acetic acid methyl ester (ISO-1) suppresses MIF-induced inflammatory cytokine release, and (4) inflammatory cytokines are released by cartilage end plate chondrocytes via CD74 by activating the CD74 antibody (CD74Ab).

Methods

We examined MIF and CD74 expression by human cartilage end plate chondrocytes and tissues with Type 1 Modic changes from eight patients using immunocytofluorescence and immunohistochemistry. MIF production by the chondrocytes was assessed by ELISA and PCR. We compared cytokine release by chondrocytes treated with MIF in the presence or absence of exogenous ISO-1 by ELISA. Cytokine release by chondrocytes after treatment with CD74Ab was determined by ELISA.

Results

MIF was expressed in degenerated human cartilage end plate tissues and chondrocytes. Lipopolysaccharide and tumor necrosis factor α (TNF-α) upregulated MIF expression and increased MIF secretion in chondrocytes in a dose-dependent manner. MIF increased the secretion of IL-6, IL-8, and prostaglandin E2 (PGE2) in a dose-dependent manner. ISO-1 reduced the secretion of IL-6, IL-8, and PGE2. CD74Ab activated CD74 and induced release of inflammatory cytokines.

Conclusions

Chondrocytes in cartilage end plate with Type 1 Modic changes express MIF and its receptor CD74. MIF might promote the inflammatory response through CD74. MIF-induced cytokine release appears to be suppressed by ISO-1, and CD74Ab could induce cytokine release.

Clinical Relevance

The MIF/CD74 pathway may represent a crucial target for treating disc degeneration since inhibiting the function of MIF with its antagonist ISO-1 can reduce MIF-induced inflammation and exert potent therapeutic effects.     

吻合器痔上黏膜环形切除钉合术治疗重度混合痔的并发症分析

目的 分析吻合器痔上黏膜环形切除钉合术（PPH）治疗重度混合痔的并发症发生情况.方法 回顾性分析2005年1月至2013年12月南京医科大学附属杭州医院收治的550例重度混合痔患者的临床资料.重度混合痔患者单纯使用PPH或联合外痔切除术进行治疗,对患者并发症发生情况进行分析.采用定期门诊和电话进行随访,随访时间截至2014年6月.结果 550例患者顺利完成手术,手术时间为（15 ± 10）min,住院时间为（4.2±1.8）d.445例患者获得随访,随访时间为6～60个月,中位随访时间为28个月.患者总并发症发生率为14.61％（65/445）,其中肛门疼痛45例,痔复发12例,出血7例,精细排便功能障碍5例,吻合口狭窄4例,直肠肛周感染2例.12例痔复发患者中,5例经生活指导和药物治疗后症状好转,7例再次行PPH或痔切除术痊愈;4例吻合口狭窄患者中,2例通过定期扩肛缓解,1例通过行肠镜下球囊扩张术症状缓解,1例因狭窄严重保守治疗无效,术后半年行狭窄环形切开术;2例直肠肛周感染患者中,1例经静脉和局部用药后好转,1例并发单纯低位肛瘘经手术治疗后好转;其余患者均经对症处理有不同程度改善或痊愈.结论PPH治疗重度混合痔安全、有效,并发症发生率较低;以肛门疼痛为主的并发症,经对症支持治疗后能够改善或痊愈.     

利伐沙班预防全膝关节置换术后静脉血栓栓塞症的临床研究

目的探讨利伐沙班和那曲肝素在预防人工膝关节表面置换术（TKA）术后静脉血栓栓塞症（VTE）的疗效和抗凝并发症方面的差异。方法接受初始单侧膝关节表面置换手术的骨关节炎患者75例,随机分为利伐沙班组（n=50）和那曲肝素组（n=25）。监测术后1、3、5 d血常规并记录异体血输血率和输血量,测量术前和术后1、3和5 d大腿周径,了解肢体肿胀程度。观察切口愈合情况,记录切口并发症。同时,根据肢体肿胀程度查下肢血管超声诊断或排除VTE。结果利伐沙班组发生1例股深静脉血栓（2.00%）,那曲肝素组无VTE发生,VTE发生率无组间统计学差异（P〉0.05）。两组均无大出血事件发生。利伐沙班组5例发生小出血事件,那曲肝素组为2例,小出血事件发生率无组间统计学差异（P〉0.05）。利伐沙班组2例切口乙级愈合,那曲肝素组全部甲级愈合,切口感染率无组间统计学差异（P〉0.05）。利伐沙班异体输血率54.00%,输血量（286.00±302.38）ml,相对那曲肝素组无统计学差异（P〉0.05）。利伐沙班组与那曲肝素组患者术后大腿周径变化总体无组间统计学差异（P〉0.05）。结论本组数据显示利伐沙班预防TKA术后VTE的疗效和出血并发症与那曲肝素大致相当。     

对出院2型糖尿病患者团队干预的效果

目的探讨团队干预对出院2型糖尿病患者血糖水平的影响。方法选择糖化血红蛋白≥10%的出院2型糖尿病患者60例按住院号的单双号分成对照组与观察组各30例。对照组给予常规门诊健康教育和每个月1次的电话随访;观察组由运动专家、神精科(心理)医生、营养师以及糖尿病专科的医护人员等组成干预团队,分别对患者出院后定期的电话随访进行运动指导、营养治疗、心理支持及用药指导和血糖监测等方面的健康教育。结果干预6个月后,观察组餐后2h血糖水平显著低于对照组(P0.05)。两组糖化血红蛋白仍高于7%,差异无统计学意义(P0.05)。结论团队干预有利于出院2型糖尿病患者血糖的控制,应将本干预常态化,以获得更满意的效果。     

四手操作对窝沟封闭术疗效的影响研究

目的:对比分析在窝沟封闭术操作过程中四手操作和医生独立操作对工作效率和疗效的影响。方法:将229名7~9岁儿童458例无龋病的下颌第一恒磨牙随机分为四手操作组和医生独立操作组进行窝沟封闭治疗,1年后复查比较工作效率和封闭剂脱落率,并进行相关统计学分析。结果:两组工作效率和封闭剂脱落率之间存在显著统计学差异。结论:四手操作技术可以缩短患者治疗时间,提高工作效率,降低封闭剂脱落率。     

Glutamine downregulates TLR-2 and TLR-4 expression and protects intestinal tract in preterm neonatal rats with necrotizing enterocolitis

Background/Purpose

Toll-like receptor (TLR)-4 and TLR-2 play an essential role in the pathogenesis of necrotizing enterocolitis (NEC). In this study, we investigated the protective effect of glutamine (Gln) in an NEC neonatal rat model, and the potential association with TLR-4 and TLR-2 expression in local intestinal tissues.

Methods

Preterm neonatal rats were randomly divided into 3 groups: normal control; NEC model; and NEC plus Gln intervention. NEC was induced by feeding with artificial milk substitutes, plus exposure to hypoxia and cold stress. All preterm rats were sacrificed at 3 days after birth. The intestinal tissues were taken for pathological analysis. Protein and mRNA expression of TLR-2, TLR-4, and caspase-3 was examined by immunohistochemistry and real-time RT-PCR, respectively.

Results

Compared with the normal control, the NEC neonatal rats showed mucosal injury and upregulated mRNA and protein expression of TLR-2, TLR-4, and caspase-3 in ileum and colon. Gln intervention significantly reduced the mucosal injury and suppressed the upregulated expression of TLR-2, TLR-4, and caspace-3 in the ileum and colon of NEC neonatal rats.

Conclusions

Gln protects the intestinal tract of NEC neonatal rats, which may be associated with the reduction of TLR-2 and TLR-4 expression in intestines     

Antihyperalgesic effects of ginseng total saponins in a rat model of incisional pain

Background

The aim of this study was to assess whether intraperitoneal administration of ginseng total saponins (GTS) has antihyperalgesic effects in a rat model of incisional pain. The proinflammatory responses and reversal of the antihyperalgesic effect of GTS by N-methyl-d-aspartate (NMDA) or naloxone were also evaluated.

Materials and methods

Rats were injected intraperitoneally with 0.9% saline vehicle or various doses of GTS before or after a plantar incision. Paw withdrawal in response to application of the von Frey filament with the lowest bending force marked the mechanical withdrawal threshold (MWT). Blood samples were collected for the assessment of serum interleukin (IL)-1β and IL-6 levels. The IL levels were measured using an enzyme-linked immunosorbent assay kit. Rats were injected intraperitoneally with NMDA or naloxone before the GTS injection to assess the reversal of the antihyperalgesic effect of GTS.

Results

The MWT measured 2 h after the plantar incision increased significantly after the postincision administration of 50, 100, or 200 mg/kg of GTS compared with the MWT at 2 h after plantar incision. The MWT also increased significantly after the preincision injection of 100 or 200 mg/kg of GTS compared with the MWT of the vehicle control. Administration of GTS suppressed the postincision rise in serum IL-1β levels and NMDA inhibited the increase in the MWT compared with GTS alone.

Conclusions

Intraperitoneal administration of GTS before or after surgery induces antihyperalgesic effects in a rat model of incisional pain. The effects on mechanical hyperalgesia may be associated with anti-inflammatory cytokines and NMDA signaling.