应激性溃疡大出血的治疗体会

目的 总结外科手术后应激性溃疡大出血的临床特点和治疗经验。方法 回顾分析1997～2003年期间我院治疗的32例应激性溃疡大出血患者的临床资料。结果 28例患者采用非手术治疗，其中12例患者接受急诊胃镜检查；手术治疗4例。奉组患者总的治愈率为87．50％．死亡率为15．62％。结论 急诊胃镜检查有助于明确诊断及止血治疗，应激性溃疡大出血首选非手术治疗，无效者可选择于术治疗。     

鱼豆粉喂养婴儿试验——与“5410”代乳粉的比较

本实验根据“5410”代乳粉的营养成分,配出鱼豆代乳粉,并分析比较了两种代乳粉的营养成分,包括蛋白质、必需氨基酸、脂肪、醣、热能、钙、磷及粗纤维。以年龄53～148天的女婴12名分成两组喂以“5410”及鱼豆代乳粉,观察四个月,实验期间婴儿平均每人每日每公斤体重摄入100～120千卡热量。食用代乳粉婴儿生长发育良好,原来发育稍差的婴儿经食用代乳粉后身长增长曲线坡度大,很快进入正常值范围。血清蛋白及血钙恢复效果良好,但碱性磷酸酶活力及无机磷还是偏低,但没有佝偻病患者那种过高现象,钙及磷比值正常。蛋白质表观消化率两组比较接近,在80%左右。鱼豆代乳粉同“5410”代乳粉一样能满足婴儿营养需要。     

水溶性脂聚体介导NR2B siRNA治疗神经病理性痛的实验研究

目的 探讨水溶性脂聚体(WSLP)介导含2B亚基的N-甲基-D-天冬氨酸受体小干扰RNA(NR2B siRNA)治疗大鼠神经病理性痛的可行性.方法 健康雄性SD大鼠100只,周龄6周,体重180～200 g,采用随机数字表法,将大鼠随机分为5组(n=20):对照组(C组)、假手术组(S组)、神经病理性痛组(NP组)、WSLP-NR2B siRNA组(W组)、WSLP-阴性对照NR2B siRNA(WN组).采用坐骨神经分支部分结扎法制备大鼠神经病理性痛模型.C组不予任何处理;S组仅暴露坐骨神经,不牵拉和损伤神经;NP组于制备模型后即刻鞘内注射生理盐水20μl;W组和WN组于制备模型后即刻分别鞘内注射相应的siRNA 20μl.于模型制备前1 d及制备后3、7、14和21 d时测定机械缩足反应阈值(MWT)及热缩足反应持续时间(TWD),模型制备后3 d,痛阈测定结束后,每组取10只大鼠,取L4-6节段背根神经节,测定NR2B mRNA及其蛋白的表达水平.结果 与S组比较,NP组、W组和WN组MWT降低,TWD延长,NR2B mRNA及其蛋白表达上调(P＜0.05或0.01),C组上述指标差异无统计学意义(P＞0.05);与NP组比较,W组MWT升高,TWD缩短,NR2B mRNA及其蛋白表达下调(P＜0.01),WN组上述指标差异无统计学意义(P＞0.05).结论 WSLP不仅成功介导NR2B siRNA,抑制NR2B的表达,还可减轻大鼠神经病理性痛.

Abstract：

Objective To investigate the feasibility of NR2B small interference RNA(NR2B siRNA)carried by water-soluble lipopolymer(WSLP)for treatment of neuropathic pain in rats.Methods One hundred healthy male SD rats weighing 180-200 g were randomly divided into 5 groups(n=20 each):normal control group (group C),sham operation group(group S),neuropathic pain group(group NP),group WSLP-NR2B siRNA (group W)and group WSLP-negative NR2B siRNA(group WN).Neuropathic pain was induced by partial ligation of sciatic nenre.WSLP-NR2B siRNA complex was formed by binding WSLP and NR2B siRNA.Normal saline.WSLP-NR2B siRNA complex and WSLP-negative NR2B siRNA 20μl were injected intrathecally after operation in NP,W and WN groups respectively.Mechanical withdrawal threshold(MWT)and thermal withdrawal duration (TWD)were measured before(baseline)and at 3,7,14 and 21 days after operation.Ten animals in each group were sacrificed on the 3rd day after operation and the lumbar segment(L4-6)of the dorsal root ganglia was removed for determination of the expression of NR2B mRNA and protein using RT-PCR and Western blot analysis.Results Sciatic nerve ligation significantly decreased MWT and prolonged TWD and increased NR2B mRNA and protein expression in group NP as compared with group C.WSLP-NR2B siRNA complex significantly reduced sciatic nerve ligation-induced hyperalgesia and decreased NR2B mRNA and protein expression in group W as compared with group NP.Conclusion WSLP not only mediates NR2B siRNA successfully and inhibits the expression of NR2B,but also reduces neuropathic pain in rats.     

超声对创伤骨科下肢近端急性亚急性深静脉血栓的诊断价值

创伤骨科围手术期下肢深静脉血栓形成临床较常见,而下肢近端急性血栓多发生隐匿,诊断棘手,预后凶险。本组对深静脉血栓形成高危的创伤骨科患者进行围手术期彩色多普勒超声检仓,探讨其在下肢近端急性亚急性深静脉血栓中的诊断价值。     

Vimentin significantly promoted gallbladder carcinoma metastasis

Background  The precise molecular mechanisms underlying the gallbladder carcinoma (GBC) metastasis has not been fully elucidated.

Methods  In the present study, metastasis-associated proteins were identified by comparative proteomic analysis. The functional study of the candidate protein vimentin was further investigated. First, a pair of higher and lower metastatic sublines (termed GBC-SD/M3 and GBC-SD, respectively), originated from the same parental cell line, was screened by spontaneous tumorigenicity and metastasis in vivo in animal study and further characterized by metastatic phenotypes analysis in vitro. Subsequently, a proteomic approach comprised two-dimensional gel electrophoresis analysis and mass spectroscopy was used to identify and compare the protein expression patterns between higher metastatic GBC-SD/M3 and lower metastatic GBC-SD cell lines. Then twenty-six proteins were identified.

Results  Among the 26 proteins identified, fourteen proteins were up-regulated and 12 proteins were down-regulated in GBC-SD/M3. Vimentin was identified and found to be overexpressed in GBC-SD/M3 as compared with GBC-SD. This result was further confirmed by quantitative PCR and Western blotting analysis. Furthermore, the cell migration and invasion potency of GBC-SD/M3 in vitro was remarkably suppressed after small interference RNA-mediated knockdown of vimentin. Moreover, immunoblot and immunohistochemical analysis on 12 human GBC specimens showed consistently increased vimentin expression in metastases compared with primary tumors.

Conclusion  Tumor vimentin level may reflect the pathological progression in some GBC and may be a useful marker for predicting tumor metastasis and a therapeutic target for the treatment of GBC patients with metastases.

     

切除脾血管保留脾脏的胰体尾切除术后胃脾区血流情况的改变

目的 观察切除脾血管保留脾脏的胰体尾切除术后胃脾区血流情况的改变.方法 上海交通大学医学院附属新华医院于2005年7月-2010年3月间对11例患者行切除脾血管保留脾脏的胰体尾切除术,于术后第3、12个月进行上腹部CT血管造影(CTA)成像和纤维胃镜检查,观察脾脏大小、胃食管及周围静脉情况.结果　术后平均随访(37.4±17.7)个月.术后3个月时CTA检查示,脾脏肿大4例(4/11),胃周静脉曲张3例(3/11),胃黏膜下静脉曲张1例(1/11).术后12个月时复查CTA示,4例脾脏肿大患者中,1例缓解,3例基本保持稳定,无新发脾脏肿大;3例胃周静脉曲张患者的情况稳定无进展,无新发胃周静脉曲张;1例胃黏膜下静脉曲张患者的情况稳定无明显进展.术后3个月胃镜检查示胃壁静脉曲张1例,术后12个月复查胃镜示胃壁静脉曲张无进展.结论　切除脾血管保留脾脏的胰体尾切除术后脾胃区血流发生改变,但无证据证实上消化道出血是其远期并发症.     

乙肝疫苗母-婴阻断失败者病毒全基因变异分析

Objective To determine the factors responsible for failed postnatal immunoprophylaxis for hepatitis B virus(HBV) in Qidong, China. Methods Eleven children who developed into chronic HBV infection after receiving HBIG and HBV recombinant vaccines were recruited into the study. Eleven paired mothers with chronic hepatitis and other 6 mothers whose children successfully generated anti-HBs after im-munoprophylaxis were included as the control in the study. Full-length HBV DNA was amplified through ser-um sample by PCR method and underwent cloning and sequencing. HBV DNA level was quantified by real-time PCR. Results The mean levels of HBV DNA in mothers who had HBV DNA positive children and healthy children were ( 1.2 ×107± 3.1 × 106 ) copies/ml and ( 1.6× 107±8.8×106 ) copies/ml, respec-tively. There was no significant difference between the groups (P >0.05). Meanwhile, viral load in chil-dren was unrelated to that in their mothers (r2 =0.2429). In 11 HBV DNA positive children, 4(36.4% ) demonstrated amino acid substitutions in HBsAg "a" determinant region with 6 different types, I.e. T125A, I126T, Q129H, M133V, D144V and G145A. All of the mothers showed the wild-type sequence in "a" epitope, indicating surface escape mutants were not acquired from the initial infection, but developed under the immune pressure. The mutation rates after immunoprophylaxis for preS1, preS2, S, X, preC/C and P genes were 0.38%, 0. 22%, 0.27%, 0.17%, 0.11%, and 0.11%, respectively, nt2999-3157 in preS1, nt529-677 in S, nt1955-2016 in C, nt923-1001 and nt2489-2602 in P genes were among the hottest muta-tional spots throughout the HBV genome. Conclusion HBV mutation may occur in all the open readingframes after passive and active immunoprophylaxis. In addition to S gene, HBV preS and P genes could alsoassociate with the escape mutants.     

她为何不停上厕所

<正>女孩一天反复上厕所达20余次一个表情严肃的母亲带着一个21岁的女孩来到我的诊室。女孩的主要症状是不停地上厕所,自述白天总有尿意,可反复上厕所达20余次,严重影响其白天的学习。每天晚上睡觉前也如此,直到很晚才能睡着,不过,晚上她只起夜两次,睡眠质量还可以。女孩每月来两次月经。母亲已经带这女孩反复     

Tat-LK15运载NR2B siRNA治疗慢性炎性疼痛的效果

目的 探讨大鼠鞘内注射细胞穿透肽Tat-LK15介导NR2B siRNA治疗大鼠慢性炎性疼痛的可行性.方法 健康雄性SD大鼠72只,6周龄,体质量180~200 g,采用随机数字表法分为4组(n=18):空白对照组(C组)、慢性炎性痛模型组(CFA组)、Tat-LK15/NR2B siRNA组(siTat-LK15组)和Tat-LK15/阴性对照siRNA组(ncTat-LK15组).除C组不给予任何处理外,其余大鼠右后趾皮下注射完全弗氏佐剂(CFA)制作慢性炎性痛模型.CFA组、siTat-LK15组及ncTat-LK15组于模型制备后第1、3、5天分别鞘内注射生理盐水、Tat-LK15/NR2B siRNA及Tat-LK15/阴性对照siRNA 10μL.每组取12只大鼠于造模前1 d及鞘内注射后3、7、14、21 d时测定机械缩足反应阈(PWMT)和热缩足反应潜伏期(PWTL).每组取6只大鼠于鞘内注射后7 d处死后取脊髓,检测鞘内注射对大鼠脊髓NR2B蛋白表达的影响.结果 鞘内注射后7 d,siTat-LK15组大鼠脊髓NR2B蛋白表达下调.鞘内注射后3、7、14及21 d,siTat-LK15组PWMT与PWTL与CFA组相比明显升高,差异有统计学意义(P<0.01),而ncTat-LK15组PWMT与PWTL较CFA组相比差异无统计学意义(P>0.05).结论 鞘内注射Tat-LK15/NR2B siRNA可有效减轻CFA所致大鼠慢性炎性疼痛.     

乙型肝炎表面抗原携带与肝癌关系的前瞻调查

关于自然人群中乙型肝炎表面抗原(HBsAg)携带者和非携带者的前瞻观察调查,国内尚未见报道。自1976年以来,我们对启东县某公社自然人群中的HBsAg携带者进行了前瞻(配对)调查,以验证“大部分肝癌的发生可能都经历