尿流改道及膀胱重建术的现状与展望

膀胱全切术后尿液的贮存与排出一直是未能满意解决的问题。自从1852年Simon报道输尿管乙状结肠吻合以来，经过一个多世纪的不断改进与创新，特别是1982年Kock用去管重建法制作贮尿囊的可控膀胱以来，尿流改道与膀胱重建术有了跨时代的进步和发展，显地提高了患术后生活质量。     

A cyclic peptide–polymer probe for the detection of Clostridium botulinum neurotoxin serotype A

A Botulinum neurotoxin serotype A (BoNT/A) ELISA detection system was developed based upon an 11-mer cyclic peptide, termed C11-019, that was identified through peptide phage display technology. The assay employs a sandwich format using the C11-019 cyclic peptide attached to a PEMA (poly(ethylene maleic anhydride)) matrix as the capture phase and anti-BoNT/A polyclonal antibodies as the detection phase. Results reported demonstrate that the C11-019 peptide–polymer can specifically bind to BoNT/A with no cross-reactivity to other serotypes examined in assay buffers and a variety of body fluids and foodstuffs. When a highly sensitive chemiluminescent substrate was engaged, the detection of 1 pg/mL could be readily achieved within 3 h with a linear range of 0.1–1 ng/mL. These results demonstrate that an inexpensive peptide–polymer-based capture ELISA system can be used for rapid, sensitive and highly specific BoNT detection.     

Triptolide inhibits T cell activation and proliferation via multiple pathways

Triptolide is potent immunosuppressive has been reported to inhibit autoimmunity, compound isolated from Chinese herbal medicine. Triptolide allograft attributed to the suppression of T cells via NF - kB rejection and GVHD, and its efficacy was previously pathway and apoptosis. In the present study, we detailedly analyzed Triptolide＇ s function on murine primary T cell. We found that Triptolide could inhibit T cell activation and proliferation by dramatically down - regulating cell division and cell cycle. Triptolide inhibited T cell activation in a dose- dependent manner, and the inhibition was mediated by both NF- kB pathway and AP - 1 pathway.     

胰岛素强化治疗对严重创伤患者炎性反应及预后的影响

Objective To investigate the effects of intensive insulin therapy on inflammatory re-sponse and prognosis of patients with severe trauma. Methods Eighty severely injured patients were di-vided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2 -4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6 -8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-α, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed. Results High fever appeared in 9 patients in IT group, and WBC exceeded 10.0×109 for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 pa-tients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5% ). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-α and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3 - 7 ( P<0.05 or P<0.01 ), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group ( P<0.05 or P<0.01 ). Plasma levels of TNF-α ( 1.3±0.6 μg/L) and CRP (55±16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0±0.8μg/L, 89±20 mg/L, respectively, P <0.01 ). Conclusions Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.     

深静脉血栓形成患者凝血因子ⅩⅢ Val34Leu基因多态性检测

目的:探讨凝血因子ⅩⅢ(FⅩⅢ)Val34Leu基因多态性与中国人群深静脉血栓形成(DVT)发病的相关性.方法:利用聚合酶链反应和限制性片段长度多态性(PCR-RFLP)方法,检测了103例DVT患者与106例正常对照的FⅩⅢVal34Leu基因多态,并加以对照分析.结果:103例DVT患者FⅩⅢVa134Leu基因型均为野生型V/V,未见突变类型;106例对照组中发现1例突变杂合子V/L.2组基因型频率、等位基因频率相互比较,差异均无统计学意义(P＞0.05).结论:FⅩⅢVal34Leu对中国人群DVT有保护作用的可能性极小.     

高频超声引导定位前臂浅静脉穿刺

目的探讨高频超声引导定位穿刺前臂浅静脉的应用价值。方法对40例常规浅静脉穿刺失败，采用高频探头在同一体表区域寻找并标记浅静脉走行及深度，确认进针方向后再次静脉穿刺，必要时采用实时引导。结果11例经高频超声标记、29例经高频超声实时引导静脉穿刺均一次成功。结论高频超声引导下静脉穿刺的成功率高，无并发症，是一种简便有效的方法，值得在临床推广应用。     

A comparative study of using comet assay and gammaH2AX foci formation in the detection of N-methyl-N'-nitro-N-nitrosoguanidine-induced DNA damage.

Comet assay is a useful technique in the detection of DNA damages, particularly DNA strand breaks; and it has been utilized to show that a potent carcinogen N-methyl-N'-nitro-N-nitrosoguanidine (MNNG), can induce such damages. Recently, gammaH2AX foci formation has been suggested as another sensitive way to detect DNA double strand breaks (DSBs). However, there is no systematic comparison being conducted to evaluate the consistency of these two methods. Using MNNG as a model chemical, the sensitivity of neutral comet assay and gammaH2AX foci formation in detecting MNNG-induced damage was studied. It was found that at concentrations of 0.1 and 1 microg/ml, both methods can detect MNNG-induced damage in human amnion FL cells. However, at 0.1 microg/ml, comet assay revealed more percentage of cells with DNA damage than gammaH2AX fluorescence revealed. On the other hand, while gammaH2AX foci were readily formed at very early times by 10 microg/ml MNNG treatment, neutral comet assay did not detect any significant DNA damage at the same time points. In addition, 10 microg/ml MNNG induced a distinct whole nuclei staining pattern of gammaH2AX, a type of DNA damage which was not detected by neutral comet assay but could be detected by alkaline comet assay. Therefore, gammaH2AX may be used as a sensitive indicator for DNA damage.     

肝移植术后胆道并发症的介入治疗

目的 探讨原位肝移植术后胆道并发症的介入治疗疗效。方法 回顾性分析我院2002年6月至2005年9月诊治的173例原位肝移植患者的临床资料。结果 术后出现胆道并发症14例（8．1％），其中胆管狭窄6例．胆管狭窄合并胆漏1例，胆泥淤积或结石3例，肝断面胆漏2例（劈离式肝移植患者），T管拔除后胆漏1例，Oddi括约肌功能失常1例。除1例胆道狭窄再次行肝移植，因发生严重感染导致肝功能衰竭死亡外．其余患者经介入治疗均获得满意的效果。结论 介入治疗是诊断和治疗肝移植术后胆道并发症的首选方法。     

肝移植围手术期出凝血功能障碍的防治

目的　探讨肝移植围手术期出凝血功能障碍的防治。方法　回顾性分析我院 2 0 0 2年 6月～ 2 0 0 3年 12月施行的 6 1例肝移植病例。结果　 6 1例肝移植术前肝功能ChildC级 35例 (5 7 4 % ) ,ChildB级 2 6例 (4 2 6 % ) ,ChildC组的患者术中凝血指标 (INR)的变化程度大于ChildB组 (P <0 0 5 )。与凝血有关的并发症中大出血 5例 (8 2 % ) ,肾衰 6例 (9 8% ) ,肝动脉血栓形成 5例 (8 2 % ) ,手术开展两阶段对比 ,第二阶段主要因限制了大量凝血药及血制品的使用 ,并发症明显减少。结论　掌握好不同时期、不同患者出血和血栓形成的平衡是防治肝移植围手术期出凝血功能障碍的关键     

Serial CT findings of Paragonimus infested dogs and the Micro-CT findings of the worm cysts.

OBJECTIVE: To investigate the serial CT findings of Paragonimus westermani infected dogs and the microscopic structures of the worm cysts using Micro-CT. MATERIALS AND METHODS: This study was approved by the committee on animal research at our institution. Fifteen dogs infected with P. westermani underwent serial contrast-enhanced CT scans at pre-infection, after 10 days of infection, and monthly thereafter until six months for determining the radiologic-pathologic correlation. Three dogs (one dog each time) were sacrificed at 1, 3 and 6 months, respectively. After fixation of the lungs, both multi-detector CT and Micro-CT were performed for examining the worm cysts. RESULTS: The initial findings were pleural effusion and/or subpleural ground-glass opacities or linear opacities at day 10. At day 30, subpleural and peribronchial nodules appeared with hydropneumothorax and abdominal or chest wall air bubbles. Cavitary change and bronchial dilatation began to be seen on CT scan at day 30 and this was mostly seen together with mediastinal lymphadenopathy at day 60. Thereafter, subpleural ground-glass opacities and nodules with or without cavitary changes were persistently observed until day 180. After cavitary change of the nodules, the migratory features of the subpleural or peribronchial nodules were seen on all the serial CT scans. Micro-CT showed that the cyst wall contained dilated interconnected tubular structures, which had communications with the cavity and the adjacent distal bronchus. CONCLUSION: The CT findings of paragonimiasis depend on the migratory stage of the worms. The worm cyst can have numerous interconnected tubular channels within its own wall and these channels have connections with the cavity and the adjacent distal bronchus.