(足母)甲瓣切取术后供区创面覆盖的方法选择

目的探讨[足母]甲瓣切取术后供区修复的方法，减少供区并发症的发生。方法对[足母]甲瓣切取术后25例[足母]趾创面，采用三种不同的方法处理，其中采用游离皮瓣移植修复9例，采用足背或足底局部带蒂皮瓣修复12例，采用第二足趾皮甲瓣修复4例。结果移植皮瓣全部成活，术后平均随访10个月，其中2例游离皮瓣在术后6个月进行二期削薄，外观和功能满意。第二趾皮甲瓣修复后的功能在3种方法中效果最好。结论根据[足母]甲瓣供区的缺损情况，采用不同的手术方法进行即时修复，能最大限度减少供区并发症的发生。     

Interrupting reperfusion as a stroke therapy: ischemic postconditioning reduces infarct size after focal ischemia in rats.

Cerebral ischemic preconditioning protects against stroke, but is clinically feasible only when the occurrence of stroke is predictable. Reperfusion plays a critical role in cerebral injury after stroke; we tested the hypothesis that interrupting reperfusion lessens ischemic injury. We found for the first time that such postconditioning with a series of mechanical interruptions of reperfusion significantly reduces ischemic damage. Focal ischemia was generated by permanent distal middle cerebral artery (MCA) occlusion plus transient bilateral common carotid artery (CCA) occlusion. After 30 secs of CCA reperfusion, ischemic postconditioning was performed by occluding CCAs for 10 secs, and then allowing for another two cycles of 30 secs of reperfusion and 10 secs of CCA occlusion. Infarct size was measured 2 days later. Cerebral blood flow (CBF) was measured in animals subjected to permanent MCA occlusion plus 15 mins of bilateral CCA occlusion, which demonstrates that postconditioning disturbed the early hyperemia immediately after reperfusion. Postconditioning dose dependently reduced infarct size in animals subjected to permanent MCA occlusion combined with 15, 30, and 60 mins of bilateral CCA occlusion, by reducing infarct size approximately 80%, 51%, and 17%, respectively. In addition, postconditioning blocked terminal deoxynucleotidyl transferase-mediated uridine 5'-triphosphate-biotin nick end labeling-positive staining, a marker of apoptosis, in the penumbra 2 days after stroke. Furthermore, in situ superoxide detection using hydroethidine suggested that postconditioning attenuated superoxide products during early reperfusion after stroke. In conclusion, postconditioning reduced infarct size, most plausibly by blocking apoptosis and free radical generation. With further study it may eventually be clinically applicable for stroke treatment.     

Comparative study of renal sodium transport between ouabain-hypertensive rats and ouabain-nonhypertensive rats

Objective: To compare renal sodium transport, using fractional excretions of lithium(FELi) as a marker of proximal tubule sodium reabsorption, between hypertensive and non-hypertensive ouabain-treated rats and further to elucidate the role of ouabain in pathogenesis of hypertension. Methods: Thirty male Sprague-Dawley rats weighting 180-200 g were randomly divided into normal control group and ouabain treated group. Rats were infused with 1 ml/kg·d normal saline or 27. 8μg/kg·d ouabain in-traperitoneally once a day respectively. Systolic blood pressure (SBP), heart rate and body weight were recorded weekly. Rats were sacrificed 6 weeks after treatment. Blood and 24-hour urine sample were collected to measure the serum and urinary concentration of sodium, trace lithium and creatinine. Endogenous creatinine clearance rate(Ccr), fractional excretions of sodium (FENa), fractional excretions of lithium (FELi) and fractional reabsorption of sodium in the postproximal tubules (FDRNa) were calculated. Ouabain levels of plasma and renal tissue, plasma renin activity, angiotensin I and aldosterone concentration were determined. Results: 65% of the ouabain-treated rats achieved significantly higher SBP after 4 weeks, compared with that of the saline control groups or self baseline (P<0. 01). But in the other 35% of the ouabain-treated rats, their SBP was similar with control group during the experiment (P>0. 05). The body weight, heart rate and food intake between the 3 groups were no significant differences (P> 0. 05). FELi and FDRNa were significantly lower in ouabain-hypertensive group compared with ouabain-non-hypertensive group and control group(P<0. 01 and P<0. 05). The FEu and FDRn, of ouabain-nonhyper-tensive groups were similar with control group(P>0. 05). Ccr and FENa were comparable between the 3 groups (P>0. 05). Plasma and renal tissue ouabain levels, plasma renin activity, angiotensin I and aldosterone contents in ouabain-hypertensive rats were comparable with ouabain-nonhypertensive rats. Conclusion: Increase of proximal tubule sodium reabsorption play an important role in the pathogenesis of ouabain-hypertensive rats. The change of renal sodium transport may result from regulation to renal Na+ , K + -ATPase by ouabain.     

阻塞性黄疸大鼠肾脏自分泌内皮素的变化及其与肾功能损害的关系

目的　探讨阻塞性黄疸时肾脏自分泌内皮素 (ET)的变化及其与肾功能损害的关系。方法　结扎胆总管(BDL)制备阻塞性黄疸大鼠模型 ,作为实验组 ,对照组鼠仅行假手术。分别于术后 5、1 0及 1 5d ,两组各取 1 0只大鼠检测其肾脏对氨基马尿酸清除率 (CPAH)、菊粉清除率 (CIN)和钠排泄分数 (FENa+) ,并用鲎试剂法测定血浆内毒素 (EX)水平 ,放射免疫法测定肾动、静脉血浆及肾组织中ET 1含量。结果　①实验组术后 5d仅FENa+明显高于对照组 (P<0 .0 1 ) ,术后 1 0d起 ,CPAH、CIN及FENa+呈进行性下降 ,术后 1 5dFENa+已较对照组低 ,与对照组比较差异有显著性 (P<0 .0 1 ) ;②实验组术后血浆EX水平呈进行性升高 ,与对照组比较差异有显著性 (P<0 .0 1 ) ;③实验组术后肾动脉血浆ET 1水平呈持续性降低 ,而肾静脉血浆及肾组织中ET 1含量呈持续性升高 ,与对照组比较差异有显著性 (P<0 .0 1 ) ;④血浆EX水平与肾组织ET 1含量呈正相关 (r =0 .762 4 ,P<0 .0 1 ) ,肾组织ET 1含量与CPAH和CIN呈负相关 (r=- 0 .883 2 ,P<0 .0 1 ;r =- 0 .945 2 ,P<0 .0 1 )、与FENa+呈正相关 (r=0 .873 4 ,P<0 .0 1 )。结论　内毒素血症及其诱导的肾内ET分泌增加在阻塞性黄疸所致大鼠肾损害中可能具有重要作用     

重组耻垢分枝杆菌-Sj26GST疫苗的免疫保护作用研究

目的初步研究重组耻垢分枝杆菌疫苗rMc-Sj26GST(recombinant M.smegmatis mc2155-Sj26GST)对小鼠的免疫保护作用.方法用耻垢分枝杆菌重组疫苗rMc-Sj26GST免疫雄性BALB/c小鼠,检测小鼠淋巴细胞刺激指数(SI),腹腔巨噬细胞培养上清释放NO量,小鼠血清IFN-γ、IL-2的含量,并计数小鼠肝、肺活细菌数.结果小鼠脾淋巴细胞刺激指数(SI)为2.64±1.37,与Mc组(载体组)1.28±0.41相比,差异具有显著性;小鼠血清IFN-γ为196.43 pg*ml-1,与Mc组112.57 pg*ml-1相比,差异有显著性,较对照组高41%;小鼠血清中IL-2的浓度较对照组高.经rMc-Sj26GST疫苗免疫的小鼠受结核杆菌攻击后其肺、肝脏结核杆菌数较对照组少.结论耻垢分枝杆菌重组疫苗rMc-Sj26GST增强了小鼠细胞免疫功能,并使小鼠能抵抗结核杆菌的攻击.     

斑点免疫金渗滤法的改进

目的 :改进斑点免疫金渗滤法的渗滤装置 ,降低成本 ,使之更适用于现场操作。方法 :用自制的圆形渗滤片替代塑料渗滤盒 ,并比较二者的效果。结果 :自制的渗滤片体积更小 ,成本更低 ,为一次性使用材料 ;检测抗体的效果与塑料渗滤盒法一致。结论 :自制的渗滤片优于常用的塑料渗滤盒     

异丙酚无痛人工流产时静脉注射缩宫素可致血液循环严重波动

目的　观察异丙酚无痛人工流产时静脉注射缩宫素对血压和心率的影响。　方法　将 90例Ⅰ级 (美国麻醉协会麻醉术前分级 )早期宫内妊娠的患者随机分为 3组 :A组 30例 ,应用 2～ 3mg/kg异丙酚和 1μg/kg枸橼酸芬太尼进行无痛人工流产术 ,手术后期注射缩宫素 1ml,于注射后的 3min内观察收缩压、舒张压和心率变化 ;B组 30例 ,用相同麻醉方法进行无痛人工流产 ,术中不用缩宫素 ,观察指标与方法同于A组 ;C组 30例 ,不用任何麻醉药物进行人工流产 ,在与A组相同的时间注射缩宫素 ,观察指标与方法同于A组。　结果　A组在注射缩宫素后 0 5min ,血压显著下降 ,心率显著增加 ,注射后 2 .5min时 ,血压和心率基本恢复到注射前水平。B组和C组无明显血压下降。　结论　异丙酚无痛人工流产时注射常规剂量缩宫素后可致血液循环短暂严重波动 ,应引起临床妇产科医师高度重视 ,特别是对心功能储备较差的患者更应关注。     

骨髓细胞移植上调血管内皮生长因子及其受体的表达并改善缺血心脏功能

目的：通过骨髓细胞移植对心肌梗死大鼠模型血管内皮生长因子及其受体表达的影响，探讨骨髓细胞移植改善缺血心脏功能的可能机制。方法：利用左前降支冠状动脉结扎术制备大鼠心肌梗死模型，然后行异体骨髓细胞移植；分别于术后1d，3d，7d，14d和28d取材；利用免疫荧光和RT—PCR技术分析细胞移植对血管内皮生长因子(VEGF)及其受体(Flk一1)表达的影响和移植细胞的分化情况；通过免疫组化计算血管数量；应用血流动力学检测大鼠心脏功能在术后各时间点的变化。结果：VEGF和Flk-1在移植组动物的心肌梗死区残存细胞、梗死周边区细胞以及部分移植细胞内表达。移植组VEGF和Flk-1的mRNA表达明显高于对照组。分别于术后3d和14d达到高峰，以后逐渐减弱。术后7d，14d和28d移植组血管数量较同期对照组明显增加，移植组心脏功能较对照组明显改善。术后14d可在部分移植细胞中检测到心肌细胞或血管内皮细胞特异性蛋白的表达。结论：骨髓细胞移植通过上调移植细胞及受者内源性VEGF和Flk—1的表达，促进血管新生，进而改善缺血心脏功能。     

肝细胞癌综合治疗

肝细胞癌（hepatocellular carcinoma，HCC）是第5位常见的恶性肿瘤，各种方法治疗后的总体5年生存率仅为7％左右．全世界每年由于肝细胞癌所致的死亡人数可达60万。既往肝癌疗效极差很大程度上是由于早期诊断困难，随着对肝癌高危人群的筛选，CT、MRI及PET等影像技术的提高，目前已能精确诊断并定位0．5cm左右的早期肝癌。而肿瘤生物学研究的不断深入，对肝癌的发生、发展、转移和复发的分子机制有了新的理解。因此，近年肝癌的诊断及治疗有了很大提高，对传统的治疗手段不断也有新的认识．基于生物学研究的进步而发展的生物治疗也越来越受到关注。