ACUTE PSEUDO-OBSTRUCTION OF THE COLON FOLLOWING LEFT-SIDED TOTAL HIP REPLACEMENT: AN ANALYSIS OF FIVE PATIENTS

We report five cases of acute large bowel pseudo-obstruction following left-sided total hip replacement. All five cases presented with a similar sequence of clinical symptoms and physical signs. Acetabular trauma and heat generation from bone cement may lead to an imbalance of the autonomic nervous supply of the colon. We discuss a possible explanation for this phenomenon. We conclude that this condition is probably more common after total hip replacement than is currently diagnosed.     

老年患者无保护左主干冠状动脉旋磨及支架治疗

治疗无保护左主干冠状动脉(LMCA)狭窄，过去是经皮腔内冠状动脉血管成形术(PTCA)的禁忌证，因其手术风险大、病死率高。随着技术、器械的改进，尤其是冠状动脉内支架的应用，使得一些无保护LMCA的PTCA相对安全、可行，但仍需很好的技术和策略。而对于无保护LMCA严重钙化病变及开口病变的冠状动脉旋磨却鲜见报道，现报道6例无保护LMCA旋磨术实施情况。     

构建大肠癌细胞相关基因Nrf3融合蛋白真核表达载体及其体外转染的初步功能分析

目的：应用基因芯片生物信息学分析思路筛查大肠癌细胞相关基因Nrf3，构建融合蛋白真核表达载体，检测其对体外转染癌细胞周期与凋亡的影响。方法：实验于2004—01／2006—07在南方医科大学病理解剖教研室及肿瘤研究所与中国农业大学农业生物技术国家重点实验室完成。①实验材料：大肠癌细胞组织及其配对的正常大肠黏膜各3例，由解放军总医院病理科提供：大肠癌LoVo细胞系由南方医科大学肿瘤研究所提供；肝癌SMMC7721细胞系由解放军军事医学科学院放射医学研究所提供；真核表达载体pEGFP-N1（Clontech公司）。②实验方法：分别应用Excel表、Affymetrix Microarray Suite Software5．0分析软件和STATA7．0分析软件，对基因芯片表达谱数据行交集补集分析、秩和检验及T检验，筛选“最重要的大肠癌细胞差异表达基因＆ESTs”，差异表达P〈0．05，差异倍数〉2。应用文献轮廓法进一步分析确定首选研究基因为Nrf3，提取组织样品总RNA，cDNA合成，PCR扩增产物经琼脂糖凝胶电泳分离后回收纯化，插入T载体中，SalⅠ和BamHⅠ双酶切后连接到pEGFP-N1载体．获得重组pEGFP-N1-Nrf3质粒。LoVo细胞在体外加入含体积分数为0．1小牛血清、100u／mL青链霉素的RPMI-1640培养基，置于37℃、体积分数为0．05的CO2饱和湿度培养箱中，待转染质粒pEGFP-N1-Nrf3与阴性对照质粒pEGFP-N1转染36h后，荧光显微镜观察候选基因亚细胞定位，FCM分选术观察其在体外对LoVo细胞周期和凋亡的影响。同法观察重组pEGFP-N1-Nrf3质粒体外转染对SMMC7721细胞周期和凋亡的影响。结果：①首选研究大肠癌细胞相关基因的确认：多种统计学方法分析获得最重要的大肠癌细胞相关基因17个，文献轮廓法进一步确认Nrf3为首选研究基因。②Nrf3基因表达：RT-PCR法检测Nrf3在3例大肠癌细胞组织均有表达，而在与其相配对的正常黏膜中表达较弱或不表达，与芯片检测结果基本一致；Nrf3在LoVo细胞中有表达。③Nrf3亚细胞定位：重组pEGFP-N1-Nrf3质粒转染的LoVo细胞其绿色荧光主要分布于细胞核内，提示Nrf3可能定位于细胞核内。（少Nrf3在体外对癌细胞周期与凋亡的影响：体外培养36h后与未转染LoVo细胞的空白对照比较，重组pEGFP-N1-Nrf3质粒转染的LoVo细胞S＋G2／M期所占比例明显减低，G2／M期下降尤为显著，G—G，期细胞所占比例明显增加。Nrf3转染作用于LoVo细胞后，未观察到明显“亚G1”峰（即凋亡峰）的出现。Nrf3体外转染的SMMC7721细胞周期及凋亡情况与LoVo细胞基本相似。结论：大肠癌细胞相关基因Nrf3在体外能够抑制LoVo细胞、SMMC7721细胞的DNA合成和有丝分裂，促使癌细胞阻滞于G0/G，期，抑制其生长增殖的同时不影响细胞凋亡，可作为大肠癌细胞候选分子标志物。     

O~6-甲基鸟嘌呤-DNA甲基转移酶甲基化状态和同期放化治疗与中国香港胶质母细胞瘤患者生存的相关性研究

背景与目的:胶质母细胞瘤(GBM)是一种恶性程度最高的星形细胞瘤,其主要的治疗方法是外科手术和放射疗法,2005年批准使用替莫唑胺,化学疗法的效果才得以确定。本文比较中国香港原发性GBM患者接受同期放化治疗或单纯放疗的生存时间,探讨GBM肿瘤组织中O6-甲基鸟嘌呤-DNA甲基转移酶(MGMT)的甲基化状态在预后评价的价值。方法:回顾性分析2005年3月至2007年6月期间35例经手术后病理确诊并接受过同期放化治疗或单纯放疗的中国香港GBM患者的资料,从石蜡包埋的GBM肿瘤组织中分离出基因组DNA,采用甲基化特异性聚合酶链反应方法(MSP)检测基因MGMT甲基化状态。采用Kaplan Meier方法计算总生存时间(OS)和无进展生存时间(PFS),比较同期放化治疗或单纯放疗和MGMT甲基化或非甲基化状态对生存时间的影响。结果:35例患者中,男性27例,女性8例,平均年龄50.4岁。35例患者的中位PFS和中位OS分别是4.7个月(3.1~6.2个月)和11.7个月(6.5~16.6个月),其中18例仅接受单纯放疗患者的中位PFS和中位OS分别是4.2个月(3.4~5.0个月)和5.8个月(2.0~9.6个月),17例接受同期放化治疗患者的中位PFS和中位OS分别是6.0个月(2.0~10个月)和13.2个月(8.1~18.3个月),P值>0.05。15例(43%)肿瘤组织中存在MGMT甲基化,MGMT甲基化和非甲基化患者的中位OS分别是16.9个月(12.7~21.1个月)和10个月(5.8~14.1个月),P值>0.05。结论:尽管差异无统计学意义,但与单纯放疗比较,接受了同期放化治疗的GBM患者显示出了更长的总体生存趋势,MGMT甲基化可能是GBM的明显预后较好的因素。     

Esophageal stents in benign and malignant diseases

Esophageal stenting was originally offered to patients with advanced esophageal malignancy, for whom it was considered as a costly modality of palliation. Advances in stent design and technology have resulted in more varieties of stents like the fully covered and removable metallic stents as well as self expanding plastic stents. As a result, the use of esophageal stents has been expanded to various benign conditions as well as to neoadjuvant settings in malignancy. This article tries to outline the current status of stenting in a variety of benign and malignant conditions of the esophagus.     

Experimental therapies for repair of the central nervous system: stem cells and tissue engineering

Several stem cell‐based therapeutic tools are currently being investigated for the regeneration of central nervous system (CNS) injuries. This review focuses on innovative approaches for CNS tissue repair via the use of implantable cellular devices. These devices are supported by biopharmaceuticals and conventional physiotherapy for the restoration of lost neuronal circuits and CNS function. This paper further reviews new and promising tools currently in pre‐clinical and clinical tests for the treatment of CNS diseases where substantial loss of cellular and extracellular components of neural tissue has occurred such as stroke, encephalopathy and traumatic neural injuries. We also discuss selected 3D bioscaffolds co‐cultured with clinically applicable human mesenchymal stem cells. Recent advances in neural tissue engineering and stem cell differentiation methods have shown promise for their clinical application in treating yet incurable CNS deficits. Copyright © 2012 John Wiley & Sons, Ltd.     

Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter,prospective, cohort study

Introduction

Contemporary information on mechanical ventilation (MV) use in emerging countries is limited. Moreover, most epidemiological studies on ventilatory support were carried out before significant developments, such as lung protective ventilation or broader application of non-invasive ventilation (NIV). We aimed to evaluate the clinical characteristics, outcomes and risk factors for hospital mortality and failure of NIV in patients requiring ventilatory support in Brazilian intensive care units (ICU).

Methods

In a multicenter, prospective, cohort study, a total of 773 adult patients admitted to 45 ICUs over a two-month period requiring invasive ventilation or NIV for more than 24 hours were evaluated. Causes of ventilatory support, prior chronic health status and physiological data were assessed. Multivariate analysis was used to identifiy variables associated with hospital mortality and NIV failure.

Results

Invasive MV and NIV were used as initial ventilatory support in 622 (80%) and 151 (20%) patients. Failure with subsequent intubation occurred in 54% of NIV patients. The main reasons for ventilatory support were pneumonia (27%), neurologic disorders (19%) and non-pulmonary sepsis (12%). ICU and hospital mortality rates were 34% and 42%. Using the Berlin definition, acute respiratory distress syndrome (ARDS) was diagnosed in 31% of the patients with a hospital mortality of 52%. In the multivariate analysis, age (odds ratio (OR), 1.03; 95% confidence interval (CI), 1.01 to 1.03), comorbidities (OR, 2.30; 95% CI, 1.28 to 3.17), associated organ failures (OR, 1.12; 95% CI, 1.05 to 1.20), moderate (OR, 1.92; 95% CI, 1.10 to 3.35) to severe ARDS (OR, 2.12; 95% CI, 1.01 to 4.41), cumulative fluid balance over the first 72 h of ICU (OR, 2.44; 95% CI, 1.39 to 4.28), higher lactate (OR, 1.78; 95% CI, 1.27 to 2.50), invasive MV (OR, 2.67; 95% CI, 1.32 to 5.39) and NIV failure (OR, 3.95; 95% CI, 1.74 to 8.99) were independently associated with hospital mortality. The predictors of NIV failure were the severity of associated organ dysfunctions (OR, 1.20; 95% CI, 1.05 to 1.34), ARDS (OR, 2.31; 95% CI, 1.10 to 4.82) and positive fluid balance (OR, 2.09; 95% CI, 1.02 to 4.30).

Conclusions

Current mortality of ventilated patients in Brazil is elevated. Implementation of judicious fluid therapy and a watchful use and monitoring of NIV patients are potential targets to improve outcomes in this setting.

Trial registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01268410","term_id":"NCT01268410"}}NCT01268410.