腹主动脉瘤合并需外科手术的消化系统疾病六例的临床分析

目的：探讨腹主动脉瘤（AAA）合并需外科手术之消化系统疾病（DSD）的治疗方法。方法：总结自1999年3月至2001年10月6例AAA合并需手术治疗之DSD的处理经验。AAA直径为4.8-11cm，平均7.1cm。AAA和DSD同期手术治疗3例（胆囊切除2例，乙状结肠癌根治1例），AAA腔内隔绝术后行结肠肝曲癌和食道下端癌根治术2例。先行胃癌根治术后行AAA修复1例。结果：食管胃吻合口瘘术后第2天死亡1例，胃瘫1例经治疗30d后胃功能恢复，未发生移植人工血管感染。5例存活，随访6-42个月，平均19个月，无吻合口动脉瘤及支架内漏发生。结论：只要患者全身及局部情况许可，AAA和DSD可同期手术，反之分期进行，AAA腔内隔绝术可作为该类患者首先进行治疗之有效措施。     

Aortic Valve Replacement with Biological Substitute

Abstract In the quest for an ideal aortic valve substitute, homografts and autografts are well-established options. We reviewed our results with homografts and autografts for aortic valve replacement during the last 5 years. From March 1992 through July 1997,189 patients (138 male and 51 female), age 8 months to 68 years (mean 31.0 2 4.2 years), underwent aortic valve replacement with a human biological substitute. Of these, 93 patients received a cryopreserved or antibiotic-preserved aortic/pulmonary homograft, whereas 96 patients underwent a Ross procedure. Etiology was rheumatic in 143 (75.6%) patients, bicuspid aortic valve in 40 (21.2%, Marfan's disease in 5 (2.6%), and myxomatous aortitis in 1 (0.5%). Among the homograft group, a scalloped subcoronary implantation technique was used in 54 patients, whereas 32 patients underwent root replacement. Five patients required aortic root and ascending aortia replacement for annuloaortic ectasia. In all patients undergoing the Ross procedure, a root replacement technique was used. Operative mortality was 7.4% (14 patients). Late mortality was 5.3% (10 patients). Follow-up ranged from 1 to 46 months postoperatively. In patients with homograft aortic valve replacement, 76 patients (91.5%) had trivial to mild aortic regurgitation, while 7 patients (8.4%) had important aortic regurgitation. In patients with the Ross procedure, 78 patients (89.6%) had trivial to mild regurgitation. Moderate to severe aortic regurgitation was present in 9 patients (10.3%). all of whom had rheumatic heart disease and were young (< 30 years at surgery). We conclude that homografts and autografts provide an excellent substitute for the diseased aortic valve. Young age (< 30 years) with rheumatic etiology is a major risk factor for early progressive aortic regurgitation in patients undergoing the Ross procedure.( J Card Surg 1998;13:1–8)     

核因子-κB靶向性寡核苷酸"圈套"策略对创伤性炎症大鼠肝脏损伤的作用

目的 探讨核因子-κB(NF-κB)靶向性寡核苷酸(ODN)“圈套”策略对创伤性炎症大鼠肝脏损伤的作用。方法 Wistar大鼠96只，随机分成对照组、创伤性炎症组、“圈套”ODN组和变异“圈套”ODN组，各组动物分别于术后3、6、12、24、48和72h分批处死。运用凝胶迁移变动分析(EMSA)检测创伤性炎症术后肝脏组织NF-κB的活性及合成“圈套”ODN的体外竞争抑制试验。检测血清转氨酶水平，在光镜下观察肝细胞损伤程度，电镜下观察肝脏超微结构改变，以线粒体的肿胀程度作为肝细胞损伤的评价指标。结果 创伤性炎症后3h肝脏NF-κB的活性开始升高，12h达高峰，72h后基本恢复正常。“圈套”ODN在体外能有效地抑制NF-κB活性。血清ALT含量在伤后明显上升，于24h达高峰，肝细胞出现明显的水肿、变性和坏死，肝小叶结构破坏明显。“圈套”ODN治疗6h后，大鼠血清ALT水平明显降低，肝小叶结构损伤明显好转，线粒体的肿胀明显减轻。结论 NF-κB靶向性“圈套”ODN通过特异性抑制NF-κB活性，可以有效地减轻创伤性炎症大鼠肝脏结构和功能的损伤。     

芹菜叶对自发性高血压大鼠内皮型一氧化氮合酶及长链非编码RNA-sONE的影响研究

背景　高血压是心血管疾病和全因死亡的重要危险因素。研究表明,长链非编码RNA（LncRNA）的异常表达与心血管疾病的发生密切相关。目的　探讨芹菜叶对自发性高血压大鼠内皮型一氧化氮合酶（eNOS）、LncRNA-sONE的影响。方法　2015年9月,将购买的48只（雌雄各24只）10周龄、SPF级、自发性高血压大鼠正常饮食（0.25%的NaCl饲料）饲养2周后,随机分为高盐组、正常盐组和高盐芹菜叶组,每组16只（雌雄各半）。高盐组给予5.00%的NaCl饲料饲养12周;正常盐组给予0.25%的NaCl饲料饲养12周;高盐芹菜叶组先予5.00%的NaCl饲料饲养8周后,再予5.00%的NaCl饲料+10.00%芹菜叶饲养4周;此外,各组予以足量其他饮食。比较3组大鼠干预前及干预4周、8周、12周体质量、收缩压。采用Western blotting法检测eNOS蛋白表达水平,qPCR法检测LncRNA-sONE、eNOS mRNA表达水平。结果　高盐组、高盐芹菜叶组大鼠干预8周、12周体质量均低于正常盐组（P<0.05）。高盐组、高盐芹菜叶组大鼠干预4周、8周、12周收缩压高于正常盐组（P<0.05）;高盐芹菜叶组大鼠干预12周收缩压低于高盐组（P<0.05）。高盐组大鼠干预12周eNOS蛋白表达水平低于正常盐组,LncRNA-sONE、eNOS mRNA表达水平高于正常盐组（P<0.05）;高盐芹菜叶组大鼠干预12周eNOS蛋白、eNOS mRNA表达水平高于正常盐组（P<0.05）;高盐芹菜叶组大鼠干预12周eNOS蛋白、eNOS mRNA表达水平高于高盐组,LncRNA-sONE表达水平低于高盐组（P<0.05）。结论　芹菜叶能升高自发性高血压大鼠eNOS蛋白及其mRNA表达水平,降低LncRNA-sONE表达水平;同时eNOS、LncRNA-sONE可能参与了芹菜叶的降压机制。     

TGFβ1、VEGF在自体移植静脉中的表达状况及意义

目的 探讨自体静脉移植后率生长因子β１（ＴＧＦβ１）和血管内皮细胞生长因子（ＶＥＧＦ）表达的动态变化及其与内膜增生的关系。方法 １００只Ｗｉｓｔａｒ大鼠,分为１０组,第１组为对照组,第２～９组为自体静脉移植模型组。应用原位杂交和免疫组化方法,观察大鼠自体移植静脉后不同时期,移植静脉的内膜增生情况、ＴＧＦβ１ ｍＲＮＡ、ＴＧＦβ１和ＶＥＧＦ蛋白表达的变化动态。结果 自体静脉移植后２周,移植静脉内膜明     

Thoracoabdominal Aneurysm Repair: Spinal Cord Protection Using Profound Hypothermia and Circulatory Arrest

Between January 1991 and February 1993,14 patients (11 male, 3 female) between 21 and 79 years of age (median 50 years) underwent reconstruction of the thoracic (n = 7) and thoracoabdominal aorta (n = 7). Four patients had previously undergone operation of the ascending aorta, and In three patients coronary artery bypass grafting had previously been performed. All patients were operated on via a posterolateral thoracotomy using cardiopulmonary bypass wlth continuous blood cardloplegla and hypothermlc circulatory arrest (11 °C naso-pharyngeal temperature, flat-EEG). All patent lower intercostal and lumbar arteries (T3 to L5) were reimplanted. The 30-day mortality after repair of the thoracic aorta was 0%; after replacement of the thoracoabdomlnal aorta, mortality was 28.5% (n = 2). One patient died 70 days after replacement of the thoracic aorta as a consequence of a perioperative stroke. None of the surviving 11 patients developed a permanent neurological deficit or renal or cardiac dysfunction. The average Intensive care stay was 6 days for patients after replacement of the thoracic aorta and 18 days for patients after replacement of the thoracoabdominal aorta. Our results suggest that use of elective hypothermia and circulatory arrest for spinal cord protection is highly effective. We, therefore, recommend this method for complex reconstructions of the thoracoabdominal aorta. (J Card Surg 1994;9:679–684)     

Response of digital arteries to endothelium dependent and independent vasodilators in patients with Raynaud's phenomenon

Abstract. The cause of the digital artery spasm seen in Raynaud's phenomenon (RP) is unclear. A dysfunction of endothelium-dependent vasodilation might contribute to the development of this spasm. We studied the digital artery responses to endothelium-dependent and independent vasodilators in eight Raynaud's phenomenon patients and eight sex-matched controls. A sequential series of infusions alternating with physiological saline were administered at a rate of l mL min^-1 via the radial artery. The infusions contained acetylcholine chloride (ACh) 110 nm mL^-1 and 550 nm mL^-1, L-arginine 50 μmol mL^-1, prostacyclin (PGI₂) 2.5 ng mL^-1 and glyceryl trinitrate (GTN)4.5 nm mL^-1. Digital artery diameter (DAD) and cutaneous temperature were measured. DAD was measured using a high frequency A-mode ultrasound scanner. There was no significant difference in mean brachial artery pressure, digital cutaneous temperature and DAD between the two groups at the start of the study. Comparing responses in the groups, there was a significantly greater increase in DAD and cutaneous temperature to Ach (endothelium-dependent vasodilator) at both concentrations in controls. A significantly greater increase in DAD was obtained in response to GTN (endothelium-indepen-dent vasodilator) in the RP subjects. There was no significant difference in response to L-arginine and PGI2 between the groups. These results suggest that a dysfunction of endothelium-dependent vasodilation is present in RP patients.