Transvaginal natural orifice transluminal endoscopic surgery in the diagnosis of ascites of unknown origin

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前入路绕肝提拉法与常规法在右半肝切除术中的应用对比研究

目的:比较前入路绕肝提拉法和常规法肝切除在右半肝切除术中应用的安全性和临床可行性。方法:选择2008年1月—2011年6月间收治的拟行右半肝切除患者40例,随机分为常规肝切除组(n=20)和前入路绕肝提拉法肝切除组(n=20),比较两组患者术前情况、肝切除范围、术中情况、术后并发症及各项生化指标的变化。结果:两组患者术前一般资料和肝切除范围具有可比性;术中大出血发生率两组间无差异(P>0.05),但绕肝提拉法组术中出血量和输血量均明显少于常规法组[(340.0±241.4)mLvs.(725.0±386.6)mL;(290.0±397.2)mL vs.(615.0±722.7)mL,均P<0.05],且绕肝提拉法组中未输血患者比例明显高于常规法组(16/20 vs.10/20,P<0.05);两组患者ICU时间、住院时间及术后并发症发生率无差异(均P>0.05);两组间术前及术后第1天肝功能指标[总胆红素(TBIL),谷丙转氨酶(ALT),谷草转氨酶(AST),前白蛋白(PA),凝血酶原时间(PT)]差异均无统计学意义(均P>0.05),但常规法组术后第1天C反应蛋白(CRP),术后第3,5,7天TBIL,ALT,AST,PT均明显高于前入路绕肝提拉法组,PA明显低于前入路绕肝提拉法组(均P<0.05);两组间肾功能指标(尿素氮,肌酐)术前、术后均无明显差异(均P<0.05)。结论:前入路绕肝提拉法应用于右半肝切除术较常规法在术中安全及保护术后肝功能方面更有优势。     

Postmortem heart weight: relation to body size and effects of cardiovascular disease and cancer

BackgroundGender, body weight, and cardiovascular disease (CVD) are all variables known to influence human heart weight. The impact of cancer is less studied, and the influence of age is not unequivocal. We aimed to describe the relationship between body size and heart weight in a large autopsy cohort and to compare heart weight in patients with cancer, CVD, and other diseases.Methods and ResultsRegistered information, including cause of death, evidence of cancer and/or CVD, heart weight, body weight, and height, was extracted from the autopsy reports of 1410 persons (805 men, mean age 66.5 years and 605 women, mean age 70.6 years). The study population was divided in four groups according to cause of death; cancer (n=349), CVD (n=470), mixed group who died from cancer and CVD and/or lung disease (n=263), and a reference group with patients who did not die from any of these conditions (n=328). In this last group, heart weight correlated only slightly better with body surface area than body weight, and nomograms based on body weight are presented. Compared to the reference group (mean heart weight: 426 g and 351 g in men and women, respectively), heart weight was significantly lower (men: P<.05, women: P<.001) in cancer patients (men: 392 g, women: 309 g) and higher (P<.001) in patients who died from CVD (men: 550 g, women: 430 g). Similar results were obtained in linear regression models adjusted for body weight and age. Among CVD, heart valve disease had the greatest impact on heart weight, followed by old myocardial infarction, coronary atherosclerosis, and hypertension. Absolute heart weight decreased with age, but we demonstrated an increase relative to body weight.ConclusionThe weight of the human heart is influenced by various disease processes, in addition to body weight, gender, and age. While the most prevalent types of CVD are associated with increased heart weight, patients who die from cancer have lower average heart weight than other patient groups. The latter finding, however, is diminished when adjusting for body weight.SummaryThe present study demonstrates that the weight of the human heart is influenced by various disease processes like cancer and CVD, in addition to body weight, gender and, possibly, age.     

Evaluation of a porcine model of early aortic valve sclerosis

BackgroundCalcific aortic valve disease (CAVD) is associated with significant cardiovascular morbidity. While late-stage CAVD is well-described, early pathobiological processes are poorly understood due to the lack of animal models that faithfully replicate early human disease. Here we evaluated a hypercholesterolemic porcine model of early diet-induced aortic valve sclerosis.MethodsYorkshire swine were fed either a standard or high-fat/high-cholesterol diet for 2 or 5 months. Right coronary aortic valve leaflets were excised and analyzed (immuno)histochemically.ResultsEarly human-like proteoglycan-rich onlays formed between the endothelial layer and elastic lamina in the fibrosa layer of valve leaflets, with accelerated formation associated with hypercholesterolemia (P<.05). Lipid deposition was more abundant in hypercholesterolemic swine (P<.001), but was present in a minority (28%) of onlays. No myofibroblasts, MAC387-positive macrophages, or fascin-positive dendritic cells were detected in 2-month onlays, with only scarce myofibroblasts present at 5 months. Cells that expressed osteochondral markers Sox9 and Msx2 were preferentially found in dense proteoglycan-rich onlays (P<.05) and with hypercholesterolemia (P<.05). Features of more advanced human CAVD, including calcification, were not observed in this necessarily short study.ConclusionsEarly aortic valve sclerosis in hypercholesterolemic swine is characterized by the formation of proteoglycan-rich onlays in the fibrosa, which can occur prior to significant lipid accumulation, inflammatory cell infiltration, or myofibroblast activation. These characteristics mimic those of early human aortic valve disease, and thus the porcine model has utility for the study of early valve sclerosis.     

肝硬化患者肝功能Child-Push分级与乏力评分的相关性分析

目的通过Chalder乏力评分量表研究乏力与肝硬化Child-Push分级的关系。方法选择肝硬化患者58例,慢性肝病无肝硬化患者15例,健康体检者12例作为研究对象,对肝硬化患者进行Child-Push分级,对所有患者进行Chalder乏力评分量表自评,并分析乏力与肝功能Child分级的相关性。结果 Chalder乏力评分与肝病程度有明显相关性,疲倦和需要更多的时间休息与肝病程度呈正相关,感到精力充沛和感到手脚都很有力量和与肝病呈负相关。Chalder乏力评分与肝硬化Child分级有明显相关性,感到疲倦、需要更多时间休息、虚弱、感到着手做事情有困难的分值随着Child分级的升高而显示出升高的趋势,感到精力充沛和手脚很有力量的分值则呈现下降的趋势。结论乏力在肝硬化和慢性肝病患者中的临床表现可以不尽相同,这些症状的评分与健康人群存在明显差异,其中部分条目与肝硬化Child分级的相关性有统计学意义。     

高海拔地区军人胃肠疾病与幽门螺杆菌感染的相关性研究

目的探讨高海拔地区军人胃、十二指肠等胃肠疾病的高发病率与幽门螺杆菌(H.pylori)感染的相关性。方法对2011年长期驻扎在西藏那曲地区申扎县军人,经申扎县人民医院门诊并确定有胃肠疾病的412例患者,行胃镜及胃黏膜病理组织学检查,采用美蓝染色检测H.pylori感染情况,观察胃黏膜组织炎症活动程度。结果 412例患者H.pylori总感染率为71.6%。胃溃疡、十二指肠溃疡、糜烂性胃炎患者H.pylori感染率分别为81.5%、93.9%、89.1%,萎缩性胃炎、肠化、异型增生患者H.pylori感染率分别为63.8%、67.4%、73.3%,明显高于浅表性胃炎患者的49.1%(P<0.05)。士兵入伍后的前3年,随军龄的增加,H.pylori感染率逐渐增加(P<0.05),3年以上军龄者H.pylori感染率无明显差异。所有慢性胃炎患者胃黏膜组织炎症活动从轻度(+)→中度(++)→重度(+++),其H.pylori感染率逐级增加,分别为42.7%、56.2%、76.2%,差异有统计学意义(P<0.05)。结论高海拔地区的军人胃、十二指肠等胃肠疾病患者H.pylori感染率高,军人的军营生活特点可能促使H.pylori感染。     

自噬、炎症反应及免疫功能异常在急性胰腺炎中的研究进展

急性胰腺炎(acute pancreatitis,AP)是临床较常见的由不同原因引起的一种急危重病,其发病机制复杂多样,易并发多脏器损伤,导致死亡率升高,故充分了解AP的发病机制可为临床早期干预、准确治疗及判断预后提供重要的参考价值。虽然启动该病发生和影响其进展的机制复杂多样,并且目前对AP的病理生理方面的认识已取得很大进步,但关键问题是其机制中精确而关键的分子机制尚不清楚,目前尚无特效的治疗方法。由于胰腺的解剖位置和担心获取人胰腺组织的操作会加重胰腺炎的严重程度而无法取样,因此,实验动物模型的研究证明,自噬、炎症反应和免疫功能异常在AP发病机制中的作用尤为重要。为此,本文探讨上述机制在AP中的作用,可能为AP的缓解及治疗提供新的靶点。     

A new assay system detecting antibody production and delayed-type hypersensitivity responses to trinitrophenyl hapten in an individual mouse

A new assay system detecting antibody production and delayed-type hypersensitivity (DTH) responses to trinitrophenyl hapten in an individual mouse (AS-DAD) was established. BALB/c mice were immunized intraperitoneally with varying amounts of 2,4,6-trinitrophenylated sheep red blood cells (TNP-SRBC) on day 0. Venous blood was collected on days 2, 4, 6, 8 and 10. Levels of anti-TNP IgM and IgG in serum were assayed by enzyme-linked immunosorbent assay (ELISA). After series of bleeding the mice were challenged with 2,4,6-trinitrobenzene sulfonic acid (TNBS) solution in the footpad on day 14. Footpad swelling was measured 24 or 48 h after the challenge. Peak responses of the anti-TNP IgM and IgG production were detected 4 or 6 days after the immunization with 10⁹ TNP-SRBC. Maximum DTH response was also observed with 10⁹ TNP-SRBC 24 h after the challenge on day 14. The antibody and DTH responses were also induced in other normal inbred strains such as C3H/He and DBA/1 but not BALB/c nu/nu mice. To evaluate AS-DAD in immunopharmacological studies, various immunomodulating agents were examined in BALB/c mice by subcutaneous administration on days 0, 1, 2 and 3. Cyclosporin or cyclophosphamide at 100 mg/kg/day completely inhibited not only the anti-TNP IgM and IgG production but also the TNP-specific DTH response. Prednisolone at 0.5 mg/kg/day had no significant effect on the IgM and IgG production, whereas it inhibited the TNP-specific DTH response. Interestingly, histamine-added mouse γ-globulin at 150 mg/kg/day clearly enhanced the anti-TNP IgM and IgG production, while it showed a suppressive effect on the TNP-specific DTH response. Levamisole at 5.0 mg/kg/day showed suppressive effects on the anti-TNP IgG production without affecting the IgM production and the DTH response. These results suggest that AS-DAD is useful for evaluating the immunopharmacological action of various agents.     

The structure and ligand interactions of CD2: implications for T-cell function

Considerable progress has recently been made in understanding the structure and ligand interactions of the T-cell antigen CD2, to the extent that CD2 is now a useful paradigm for considering the structural basis of cell-cell recognition. Here, Simon Davis and Anton van der Merwe review the new data and consider their implications for T-cell function in the context of CD2-knockout experiments.