陈旧性鼻骨骨折的治疗

目的：讨论陈旧性鼻骨骨折的诊疗方案。方法：对76例患者鼻骨骨折在2周左右及大于2周行鼻骨骨折手法复位或切开鼻骨成形术。结果：35例患者鼻部外观无塌陷无歪鼻畸形,鼻道通畅,鼻功能恢复良好,无并发症。结论：鼻骨骨折手法复位及鼻骨成形术治疗陈旧性鼻骨骨折效果满意。     

320排CT灌注检查在肝移植后肝动脉狭窄合并缺血性胆道病变中的应用价值

目的 通过应用320排CT灌注(CTP)成像技术检查肝移植后肝动脉狭窄(HAS)患者的移植肝血流灌注情况,以明确HAS与缺血性胆道病变(ITBL)的关系,为HAS的治疗提供依据.方法 收集肝移植后经320排CT血管成像(CTA)检查证实为中重度HAS的患者13例,根据经皮经肝胆管造影(PTC)检查是否有ITBL,将HAS患者分为无ITBL组(5例)和ITBL组(8例).分别对两组患者进行CTP检查,定量检测其肝动脉灌注量(HAP)、门静脉灌注量(PVP)、总肝灌注量(TLP),并计算肝动脉灌注指数(HPI),比较两组间各灌注量的差异.结果 ITBL组与无ITBL组的HAP分别为(59.8±19.9)和(35.1±4.9)ml·min-1·100 ml-1,PVP分别为(125.4±27.3)和(166.2±21.1)ml·min-1·100ml-1,TLP分别为(185.2±27.9)和(201.3±23.6)ml·min-1·100 ml-1,HPI分别为(33.6±10.9)％和(18.2±1.9)％,两组间比较,HAP、PVP及HPI差异均有统计学意义(P＜0.05),TLP的差异无统计学意义(P＞0.05).结论 CTP成像通过定量检测肝动脉、门静脉的血流灌注量,无创性地反映了移植肝的血流动力学变化情况 ;当肝移植后HAS患者的HAP和HPI升高及PVP降低时,应警惕ITBL的发生,为临床及时治疗HAS,预防ITBL的发生提供客观依据.     

桡动脉腕部皮支穿支蒂皮瓣修复手部创面

目的 报告桡动脉腕部皮支穿支蒂皮瓣修复手部皮肤软组织缺损的方法及疗效.方法 2008年1月至2011年6月,对15例手部皮肤软组织缺损患者,根据皮肤软组织缺损情况,应用桡动脉腕部皮支穿支蒂皮瓣修复,皮肤缺损面积为2.5 cm×2.8 cm～4.6 cm× 9.5 cm,皮瓣切取面积为2.8 cm× 3.0 cm～ 4.8 cm×9.7cm.结果 术后1例皮瓣出现蒂部卡压症状,经行血管探查、减压术后存活,余14例皮瓣及供区植皮全部存活.随访时间为6～ 12个月,皮瓣外形良好,质地及功能满意.结论 桡动脉腕部皮支穿支蒂皮瓣血管相对恒定,外形美观,手术操作简便,是修复手部皮肤软组织缺损的有效手术方法之一.     

Scale‐up of MSC under hypoxic conditions for allogeneic transplantation and enhancing bony regeneration in a rabbit calvarial defect model

To realize the therapeutic potential of mesenchymal stem cells (MSCs), we aimed to develop a method for isolating and expanding New Zealand rabbit MSCs in a great scale. Rabbit MSCs expanded under hypoxic and normoxic conditions were compared in terms of replication capacity, differentiation potential, and the capacity for allogeneic transplantation in a calvarial defect model. The cells from all tested rabbits were expanded more rapidly when plated at low‐density under hypoxic conditions compared to under normoxic conditions. Moreover, cells expanded under hypoxic conditions increased in the potential of osteoblastic, adipocytic, and chondrocytic differentiation. More importantly, radiographic analysis and micro‐CT measurement of bone volume revealed the hypoxic cells when transplanted in the calvarial defects of another rabbit increased in the ability to repair bone defect compared to the normoxic cells. Six weeks after allogeneic transplantation of hypoxic MSCs, histological analysis revealed a callus spanned the length of the defect, and several bone tissues spotted in the implant. At 12 weeks, new bone had formed throughout the implant. Using BrdU labeling to track the transplanted cells, the hypoxic cells were more detected in the newly formed bone compared to the normoxic cells. For defects treated with allogeneic MSCs, no adverse host response could be detected at any time‐point. In conclusion, we have developed a robust method for isolation and expansion of rabbit MSCs by combining low‐density with hypoxic culture, which can be applied for the design of clinical trials in allogeneic transplantation of MSCs for bone healing. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:1213–1220, 2012     

Evaluation of the CEL‐100 videolaryngoscopeTM for double‐lumen tracheal tube insertion after failure using the Macintosh laryngoscope

We prospectively evaluated the CEL‐100 videolaryngoscope^TM for insertion of double‐lumen tracheal tubes in 48 consecutive patients who had been found to have an unanticipated Cormack and Lehane grade 3 (n = 43) and grade 4 (n = 5) laryngeal view and in whom two attempts at tracheal intubation using the Macintosh laryngoscope had failed. When the CEL‐100 was subsequently employed, the glottic view improved in 45 (94%) patients. The view improved by one grade in 15 (31%) patients and by two grades in 30 (63%) patients, compared with the Macintosh blade (p < 0.001). Double‐lumen tracheal tube insertion was successful when using the CEL‐100 in 43 out of 48 patients (90%; 95% CI 81–98%). This occurred on the first attempt in 27 (56%) patients, 14 (29%) on the second and two (4%) on the third. We conclude that the CEL‐100 videolaryngoscope is an effective device in this context, and we therefore propose that this device can be used in circumstances when double‐lumen tube insertion proves difficult.     

Evaluation of thymosin β4 in the regulation of epithelial-mesenchymal transformation in urothelial carcinoma

ObjectivesTo study the underlying alteration in the expression of epithelial markers involved in epithelial-mesenchymal transition (EMT), and elucidate the potential mechanism(s) for Tβ4-induced EMT-like phenotypic changes in bladder cancer cells.Materials and methodsAll tissue samples in this study were obtained from clinical patients of the Union Hospital of Tongji Medical College, and were confirmed by surgery and pathology. Of these, normal bladder tissues (control), primary urothelial carcinoma of different grades (Stage pTa, Stage pT3), bladder paracancerous tissues, accompanied with 2 bladder cancer cell lines (BIU-87 and T24), were divided into 6 groups. Quantitative RT-PCR, Western blotting, and immunohistochemical study of adhesion molecules Tβ4, ILK, E-cadherin, and β-catenin involved in EMT were carried out. A lentiviral gene transferring vector containing the RNA polymerase III-dependent U6 promoter to express short hairpin RNA (shRNA) directed against Tβ4 was also applied. In the present study, all agents were evaluated using commercial kits.ResultsA strong correlation between the expression levels of Tβ4, ILK, E-cadherin, and β-catenin was found in the bladder transitional cell carcinoma (TCC) patients. In the BIU-87 and T24 bladder cancer cells overexpressing Tβ4, which were accompanied by a loss of E-cadherin as well as a cytosolic accumulation of β-catenin, up-regulation of ILK was also revealed. The inhibition of the Tβ4 expression with lentiviral shRNA vector could raise EMT-like phenotypic changes, significantly depressed motility, and subsequent invasiveness of bladder cancer cells.ConclusionsOur results imply that the Tβ4 is likely to play a crucial role in EMT progression, and that inhibition of the Tβ4 expression or interactions with other genes should be novel therapeutic targets for bladder cancers with high invasive and metastatic potential.     

酒精性肝炎自噬关键基因的筛选及生物信息学分析

目的 筛选酒精性肝炎（AH）的自噬关键基因,探讨AH潜在的生物标志物和治疗靶点。 方法  采用基因表达综合数据库（GEO）中的2个AH基因芯片和从MSigDB、GeneCards数据库中获得的自噬相关数据集,通过加权基因共表达网络分析（WGCNA）获取关键基因。对筛选的关键基因进行基因本体（GO）、京都基因和基因组百科全书（KEGG）功能富集分析,蛋白质相互作用（PPI）分析,免疫浸润分析,构建信使RNA（mRNA）-微小RNA（miRNA）网络,进行酒精性肝病不同分期的自噬相关关键基因的表达差异分析,并进一步通过实时荧光定量逆转录聚合酶链反应（RT-qPCR）在AH患者和小鼠肝脏组织中验证。 结果  本研究筛选得到了11个与AH自噬相关的基因（EEF1A2、CFTR、SOX4、TREM2、CTHRC1、HSPB8、TUBB3、PRKAA2、RNASE1、MTCL1、HGF）,均为上调基因。在AH患者和小鼠肝脏组织中,SOX4、TREM2、HSPB8、PRKAA2在AH组中的相对表达量均高于对照组。 结论  SOX4、TREM2、HSPB8、PRKAA2可能是AH潜在的生物标志物和治疗靶点。     

腹腔镜技术在治疗成人先天性胆总管囊肿中的应用

目的 探讨完全腹腔镜下成人先天性胆总管囊肿切除、肝总管空肠Roux-en-Y吻合术的可行性、安全性及其临床应用价值.方法 回顾性分析2008年5月至2011年2月期间收治的采用完全腹腔镜囊肿切除、肝总管空肠Roux-en-Y吻合手术治疗的7例成人先天性胆总管囊肿患者的临床资料.结果 所有手术顺利,无中转开腹.平均手术时间210 min,出血量80 ml.术后第1日患者离床活动,平均2.4d排气或排便.除1例术后有少量胆汁漏外,无严重术后并发症发生,均恢复顺利,平均住院时间8.1d.术后随访3～30个月,无腹痛、发热或黄疸等症状.结论 完全腹腔镜成人先天性胆总管囊肿切除、肝总管空肠Roux-en-Y术安全可行,具有创伤小、恢复快的优点,值得推广.     

电针刺激足三里和肺俞穴对兔内毒素休克诱发急性肺损伤的影响

目的 评价电针刺激足三里和肺俞穴对兔内毒素休克诱发急性肺损伤的影响.方法 健康雄性新西兰大白兔60只,体重1.5 ～ 2.0 kg,2月龄,采用随机数字表法,将其随机分为6组(n=10):假手术组(S组)、血红素加氧酶-1(HO-1)抑制剂锌原卟啉-Ⅸ组(Z组)、内毒素组(L组)、电针刺激穴位+内毒素组(EL组)、电针刺激非穴位+内毒素组(SEL组)、电针刺激穴位+锌原卟啉-Ⅸ+内毒素组(ELZ组).EL组和ELZ组电针刺激双侧足三里和肺俞穴,疏密波,频率15 Hz,刺激强度以兔出现轻微肌颤为宜,1次/d,15 min/次,连续5d;SEL组刺激足三里和肺俞穴旁开0.5 cm处.停止电针刺激后24 h,L组、EL组、SEL组和ELZ组静脉注射脂多糖5 mg,/kg,S组和Z组给予等容量生理盐水0.5ml.Z组和ELZ组给予脂多糖后2h腹腔注射锌原卟啉-Ⅸ10 μmol/kg,其他4组给予等容量NaHCO3 1 ml.注射脂多糖后6h时处死兔,取肺组织,进行肺损伤评分,测定肺泡上皮细胞凋亡指数、HO-1和HO-1 mRNA表达.结果 与S组比较,Z组肺损伤评分、肺泡上皮细胞凋亡指数、HO-1和HO-1 mRNA 表达差异无统计学意义(P＞0.05),其他4组肺损伤评分和肺泡上皮细胞凋亡指数升高,HO-1和HO-1 mRNA表达上调(P＜0.01);与L组比较,EL组肺损伤评分和肺泡上皮细胞凋亡指数降低,HO-1 和HO-1 mRNA表达上调(P＜0.01),其他2组上述指标差异无统计学意义(P＞0.05);与EL组比较,ELZ组肺损伤评分和肺泡上皮细胞凋亡指数升高,HO-1和HO-1 mRNA表达下调(P＜0.01).结论 电针刺激足三里和肺俞穴可减轻兔内毒素休克诱发急性肺损伤,其机制与上调肺组织HO-1表达,抑制肺泡上皮细胞凋亡有关.     

下肢腱鞘巨细胞瘤的MRI诊断及临床应用

目的:分析腱鞘巨细胞瘤的MRI表现,探讨其MRI的诊断价值。方法:回顾性分析经手术病理证实的腱鞘巨细胞瘤20例的MRI检查资料。男8例,女12例;年龄15～61岁,平均35.5岁。所有病例行MRI检查。结果:病变位于膝关节16例,足趾关节和踝关节各2例。其中局限性19例,弥漫性1例,MRI均表现为下肢骨关节旁软组织肿块,肿瘤与骨骼肌相比,T1WI上15例接近于骨骼肌信号,5例稍低于骨骼肌信号;在T2WI上4例介于骨骼肌与皮下脂肪信号之间,13例接近于骨骼肌信号,3例稍低于骨骼肌信号。16例行T1WI增强扫描,5例呈均匀强化,11例呈不均匀强化。4例伴邻近骨质破坏。结论:MRI能明确显示下肢关节旁腱鞘巨细胞瘤病变的部位、形态及内部信号特征,对临床诊断、指导临床治疗和随访具有重要价值。