小檗碱对早期ACM大鼠治疗效果及机制的研究

目的:观察小檗碱(BBR)对早期酒精性心肌病(ACM)大鼠的治疗作用,探讨其作用机制。方法:每日白酒灌胃以建立SD大鼠早期ACM模型,将已建模成功的28只SD大鼠随机分为小檗碱治疗组(14只)、安慰剂组(14只),并随机抽取10只正常SD大鼠作为正常对照组。干预4周后应用超声心动图测定两组大鼠心脏结构及功能参数,RT-PCR法检测心肌组织中MMP-2mRNA、TIMP-2 mRNA表达。结果:与对照组比较,安慰剂组LVEDD、LVESD、LA增大,左室舒张功能减低,心肌组织中的MMP-2 mRNA表达水平明显上升,TIMP-2mRNA表达水平下降,差异有统计学意义(P<0.05);与安慰剂比较,小檗碱组LVEDD、LVESD、LA减小,左室舒张功能有所改善,心肌组织中的MMP-2 mRNA表达水平显著下降,TIMP-2 mRNA表达显著升高(P<0.05)。结论:BBR逆转早期ACM大鼠心室重构,改善心功能,可能与减少心肌组织MMP-2表达有关。     

长白仔猪血常规及生化指标正常值探讨

目的探讨2-3月龄长白仔猪的血常规及生化指标的正常值，为长白仔猪用于实验研究提供实验依据。方法采用实验室评价方法对40头长白仔猪的主要血常规和生化指标进行检测，并与巴马小型猪的参考值进行对比。结果长白仔猪的血常规及生化指标无性别差异（P〉0．05），长白仔猪的WBC、ALT、Ca^2＋的平均值与巴马小型猪相似，两者之间差异无显著性（P〉0．05），其RBC、HGB、HCT、PLT、TP、Alb、BUN、AMY的平均值均低于巴马小型猪的相应值，而AST、TBIL、DBIL、Crea、CK-MB明显高于巴马小型猪，具有显著性差异（P〈0．01）。结论长白仔猪有其独特的生理生化特性。     

以循证医学指导阻断感染垂直传播的研究

乙型肝炎病毒(HBV)感染是严重的公共卫生问题,我国慢性携带者多达1.2亿,成为慢性肝炎、肝硬化、肝癌的重要原因,对人民健康及国民经济发展构成了严重的威胁.由于缺乏特效药物,慢性感染难以根治,故关键在于预防.随着献血管理的加强和乙肝疫苗的逐步推广,感染在普通人群中水平传播的势头已经得到遏制,而垂直传播成为导致慢性感染的主要途径之一.     

肩胛骨骨折的手术治疗

目的探讨肩胛骨骨折的手术治疗方法、优点及术中应注意的事项。方法全麻侧卧,Judet后入路,切口自肩峰背侧偏内1 cm,沿肩胛冈向内侧延伸,下至肩胛体下角,离断三角肌,沿骨面剖离,将三角肌和冈下肌翻向外侧;骨折复位,用钢板和螺钉固定。结果术后随访8个月~2年,16例骨折全部愈合,愈合时间为1.5~4.5个月,平均2.5个月。按Dolfi评分系统评定:优9例,良5例,可1例,差1例。优良率87.5%。结论手术治疗肩胛骨折能及时清除积血,使骨折能达到良好复位、固定,减少粘连和畸形愈合。     

针对Egr-1mRNA的10-23脱氧核酶抑制大鼠动脉损伤后内膜增生的研究

目的探讨针对Egr-1mRNA的10-23脱氧核酶对大鼠动脉损伤后内膜增生的影响和可能的机制。方法制备大鼠颈动脉球囊损伤模型,96只大鼠随机分为4组,A组为假手术组;B组为1mmol/LMgCl2对照组;C组为FuGENE6对照组;D组为FuGENE6介导的ED5转染组;每组再按术后3,7,14和21d,分为4个亚组,每组6只。术后3、7、14、21d各处死每组动物6只,分别应用RT-PCR和Western-blot技术检测血管组织Egr-1mRNA水平及蛋白合成情况;HE染色观察损伤血管内膜的增生情况;免疫组织化学染色观察PCNA的表达。结果与B组和C组比较,D组各时间点血管内膜、中膜的厚度和管腔的狭窄率均显著减小(P<0.01);正常血管组织有微量Egr-1表达,术后Egr-1mRNA和蛋白水平逐渐增高,而D组血管组织E-gr-1mRNA和蛋白水平较B组和C组均降低(P<0.01);免疫组织化学染色显示,术后3dPCNA表达开始增加,7d达高峰,14d开始下降,D组血管壁PCNA阳性细胞百分比明显低于B组和C组(P<0.01)。B组和C组之间相比较,以上各指标差异均无显著性(P>0.05)。结论ED5可能通过抑制Egr-1和PCNA的表达,而减轻血管损伤后内膜增生。     

血清标志物在需手术治疗的新生儿坏死性小肠结肠炎患儿中的变化

目的 分析C-反应蛋白（CRP）、降钙素原（PCT）、血小板（PLT）及清蛋白等血清标志物在需手术治疗的新生儿坏死性小肠结肠炎（NEC）中的变化情况及临床意义,从而为临床最佳手术时机的选择提供参考。方法 回顾性分析2015年6月至2019年6月在安徽医科大学第一附属医院新生儿科收治的67例确诊为NEC（Bell分期II以上）的患儿病例资料,根据是否经过手术治疗,分为手术组（n=26）与非手术组（n=41）,对两组患儿保守治疗前和保守治疗后（24~48 h）外周静脉血的PCT、CRP、PLT、清蛋白水平进行对比分析。结果 保守治疗后,手术组与非手术组CRP、PCT水平均高于治疗前（P<0.05）,手术组PLT、清蛋白水平均低于治疗前,差异均有统计学意义（P<0.05）;保守治疗后,手术组PCT、CRP水平高于非手术组（P<0.05）,PLT水平低于非手术组,差异均有统计学意义（P<0.05）。保守治疗后的CRP、PCT水平对NEC外科手术具有预测价值,最佳临界值分别为27.685 mg/L、14.675 mg/L,灵敏度和特异度分别为84.6%、68.3%和73.1%、82.9%。结论 PCT、CRP等血清标志物对NEC最佳手术时机的选择具有指导价值,CRP、PCT水平明显升高、PLT及清蛋白水平明显较前降低提示NEC患儿可能需要手术。     

荷包包埋法在胃癌根治术十二指肠残端处理中的临床意义

Objective To explore the clinical effect of pockets embedding in duodenal stump closure after gastrectomy for gastric cancer. Methods A total of 2034 patients undergoing gastrectomy from January 1995 to December 2009 at our hospital were reviewed. Among them, Group A ( n = 465 ) underwent pockets embedding for duodenal stump, Group B (n =835) line-cutting stapler and hand-sewing while Group C (re = 734) double layer hand-sewing. The operation cost, processing time of duodenal stump,recent post-operative complications (within 1 month), blood loss volume and post-operative recovery status were compared between 3 groups. Results No patient died of operation. Ninety-five cases (4. 7% )suffered recent post-operative complications. The most frequent complications included wound infection (36 cases, 37.9%), intra-abdominal hemorrhage (18 cases, 18.9%) and anastomotic leakage (14 cases,14.7% ). There was no significant difference in intra-abdominal bleeding, anastomotic leakage, abdominal infection, wound infection or duodenal stump leakage among 3 groups. There was no duodenal stump leakage in Group A. The difference was apparent in comparisons with Groups B (6 cases, 0. 72% ) and C (5 cases,0.68%). The operation costs of Groups A [(9902 ±312)RMB] and C [(9896 ±281)RMB] were significantly lower than that of Group B [(13 129 ± 237) RMB, P =0. 0001]. And there was no difference between Groups A and C. The processing time of duodenal stump in Groups A [(7. 1 ±0. 9) min] and B [(7.6±0. 8)min] were lower than that of Group C [(11.5 ±1.4)min, P=0.0001]. And there was no difference between Groups A and B. There was no significant difference in blood loss volume or postoperative recovery status among 3 groups. Conclusion The post-gastrotomic closure of duodenal stump with pockets embedding for gastric cancer has a short operation time, a low operation cost and a low rate ofduodenal stump leakage. It is a simple, prompt, promising and safe surgical procedure for gastric neoplasms.     

腹腔镜手术与开腹手术在肝细胞癌中应用的Meta分析

目的评价腹腔镜手术与开腹手术治疗肝细胞癌的疗效及安全性。方法应用循证医学的系统评价方法,对2002年1月至2012年12月在国内外医学期刊发表的有关围术期腹腔镜手术与开腹手术在肝细胞癌中的临床病例对照研究进行质量评价。结果纳入19个病例对照研究的疗效,纳入文献的总体方法学质量较高。Meta分析结果显示,与开腹手术相比较,腹腔镜肝切除术未能显著缩短手术时间(SMD=-0.39,95%CI-0.94^-0.15,P=0.15),减少术中出血量(SMD=-0.76,95%CI-0.92-0.15,P=0.15),减少术中出血量(SMD=-0.76,95%CI-0.92^-0.59,P=0.03),缩短住院时间(SMD=-0.86,95%CI-1.31-0.59,P=0.03),缩短住院时间(SMD=-0.86,95%CI-1.31^-0.98,P<0.00001),减少肛门排气时间(SMD=-0.87,95%CI-1.18-0.98,P<0.00001),减少肛门排气时间(SMD=-0.87,95%CI-1.18^-0.56,P<0.00001)。结论腹腔镜手术能够最大限度地降低手术对患者内环境的影响,患者的出院时间、肛门排气时间均显著少于开腹切除组。     

枝化状聚乙二醇交联改善猪去细胞主动脉瓣的力学性能比较

Objective Branched polyethylene glycols (PEG) with different molecular weight were cross-linked to the porcine decellularized aortic valve (DAV) and the effects of PEG cross-linking on the mechanical properties were investigated. Methods A total of 25 porcine DAVs were randomly assigned into 5 groups: PEG3400, PEG8000, PEG12000, PEG20000 and control. The reactive time was 4 h at room temperature. The efficiency of crosslinking was calculated by measuring the residual thiol group. The mechanical properties were obtained by static tensile test. Results The efficiency of crosslinking was 92. 40% , 89. 88% , 87. 87% and 87. 46% in PEG3400, PEG8000, PEG12000, PEG20000 groups, respectively. As compared with other groups, the PEG3400 group had significantly greater increase in the crosslinking degree (P ＜ 0. 05). Tensile test showed the tensile strength of PEG12000 and PEG20000 groups was (3. 22 ±0.41) and (3. 19 ±0. 15) MPa, respectively, and significantly different from that in control group (P ＜ 0. 05). The tensile strength and young' s modulus had a positive correlation with the molecular weight of PEG. Conclusion Branched PEG with the molecular weight of 12 000 Da and 20 000 Dacan effectively crosslink to the porcine decellularized aortic valves and improve their mechanical behaviors, and has the potential to be used as the material of fabricating new hybrid scaffold of tissue engineering heart valves.     

Protective effect of glutamine-enriched early enteral nutrition on intestinal mucosal barrier injury after liver transplantation in rats

Background

The effect of glutamine-enriched early enteral nutrition (Gln-EEN) on intestinal mucosal barrier injury after liver transplantation (LT) remains uncertain.

Methods

The Wistar-to-Wistar rat LT model was used to explore the protective effect of Gln-EEN. Morphologic changes of intestinal mucosa, levels of intestinal malondialdehyde and secretory immunoglobulin (sIgA), plasma endotoxin, D-lactic acid, serum tumor necrosis factor-α (TNF-α), rates of bacterial translocation, and expression of intestinal nuclear factor-κB, TNF-α, and intercellular adhesion molecule-1 were determined.

Results

After LT, intestinal mucosa was damaged seriously. At 12, 24, and 48 hours posttransplantation, levels of intestinal sIgA were decreased; levels of malondialdehyde, endotoxin, D-lactic acid, and TNF-α, the ratio of bacterial translocation, and the expression of intestinal nuclear factor-κB, TNF-α, and intercellular adhesion molecule-1 all were increased. However, changes in earlier-mentioned parameters in recipients treated with Gln-EEN were attenuated remarkably at 24 to 48 hours.

Conclusions

Our data show that Gln-EEN is a potent protectant against intestinal mucosal barrier injury after LT.