经肝圆韧带肝膈面径路施行肝内胆肠吻合术治疗肝胆管结石21例临床观察

报告采用经肝圆韧带肝膈面径路施行肝内胆管空肠吻合治疗肝胆管结石２１例，其中伴医源性胆管损伤５例，左肝管结石８例（伴狭窄７例），肝内泥沙状结石并急性化脓性胆管炎２例，胆总管Ｔ管引流术后左肝管残余结石伴囊状扩张３例，胆管外伤、多次胆管手术后及左肝管结石并出血各１例。患者年龄３２～５０岁占７５．９％。２１例经临床观察，效果尚属满意。作者认为，该手术具有操作具有简便易行，术野暴露满意；创伤性小、保存肝组织、勿须切肝；术后能迅速降压减黄等优点。另外，对手术适应证、吻合方法及操作细节、术中注意事项等问题进行了讨论。     

临床路径对白内障手术患者的应用

根据不同白内障患者的具体情况，建立相应的临床护理路径，制定预期目标，提高临床护理质量，提高患者满意度。     

海绵窦区硬脑膜动静脉瘘的栓塞治疗

目的探讨海绵窦区硬脑膜动静脉瘘的有效治疗方法。方法11例海绵窦区硬脑膜动静脉瘘病人经动脉途径,采用真丝线段或真丝线段加NBCA胶栓塞治疗。其中3例同时经静脉途径采用微弹簧圈(GDC、MDS和游离弹簧圈)或弹簧圈加真丝线段栓塞海绵窦结果本组。11例中有10例临床治愈(症状消失),其中8例解剖治愈(瘘口消失);1例症状明显缓解。结论血管内栓塞是海绵窦区硬脑膜动静脉瘘有效安全的治疗方法。     

Dose and route dependency of metabolism and toxicity of chloroform in ethanol-treated rats

 The effects of a single dose of ethanol on the metabolism and toxicity of chloroform administered to rats per os (p.o.), intraperitoneally (i.p.), or by inhalation (inh) at different doses were investigated. Rats that had been given either ethanol (2 g/kg) or vehicle (water) alone at 4 p.m. on the previous day were challenged with chloroform at 10 a.m. p.o. (0, 0.1, 0.2, or 0.4 g/kg), i.p. (0, 0.1, 0.2, or 0.4 g/kg), or inh (for 6 h each at 0, 50, 100, or 500 ppm). The ethanol treatment, which had no influence on the intake of food and water, increased chloroform metabolism in vitro about 1.5-fold with no significant influence on liver glutathione content. The treatment had a dose-dependent effect on the metabolism and toxicity of chloroform, and the effect differed depending on the route of administration. Compared at the same dose level, the area under the curve (AUC) of blood chloroform concentration was invariably smaller following p.o. than i.p. administration. In accordance with this, chloroform administered p.o. caused more deleterious hepatic damage than the same amount of chloroform administered i.p. Although ethanol treatment had no significant influence on the AUC at any dose by any route of administration, the toxicity of p.o.-administered chloroform was significantly higher in ethanol-treated rats than in control rats at a dose as low as 0.1 g/kg, whereas no significant difference was observed in toxicity between both groups of rats at such a low dose administered i.p. When rats were exposed inh to air containing chloroform vapor, ethanol consumption had no effect on hepatotoxicity until the exposure concentration was raised to 500 ppm, a finding which suggests that a single dose of ethanol (2 g/kg) affects the toxicokinetics of inhaled chloroform in rats only at a concentration as high as 500 ppm. Received: 6 December 1993 / Accepted: 25 May 1994     

垂体腺瘤手术入路选择探讨

目的；更科学更合理地选用垂体瘤切除术式。方法：分别经颅、经蝶垂体腺瘤切除术，比较各入路及优缺点。结果：经颅垂体瘤切除者平均住院日为19d，平均费用为9600元／例，术后并发症多；经口－鼻－蝶入路手术病人平均住院日为14d，费用7000元／例，无并发症。结论：经蝶行垂腺瘤切除术具有适应证广，内分泌紊乱纠正较完全，视力改善理想，并发症少，费用低等优势。     

AKT1表达与非小细胞肺癌临床病理特征及预后的关系

目的探讨丝/苏氨酸蛋白激酶1(AKT1)表达与非小细胞肺癌(NSCLC)病理学特征及预后的关系。方法选取经病理学检查证实的NSCLC患者90例,分别取其癌组织、癌旁组织为NSCLC组和癌旁组,采用免疫组化染色法检测2组标本中的AKT1蛋白表达水平,并分析AKT1蛋白与NSCLC患者TNM分期、淋巴结转移情况、肿瘤分化程度、病灶的大小及预后等指标的关系。结果NSCLC组标本中的AKT1蛋白阳性表达率(58.89%)显著高于癌旁组(11.11%),差异具有统计学意义(P<0.05)。高分化及中分化、TNM分期(Ⅰ期+Ⅱ期)、未发生淋巴结转移的NSCLC组中AKT1蛋白阳性表达率低于低分化、TNM分期(Ⅲ期和Ⅳ期)及发生淋巴结发生转移NSCLC组织(P<0.05),不同年龄、性别、病灶大小及病理学类型的NSCLC组织中AKT1蛋白阳性表达率差异无统计学意义(P>0.05)。NSCLC组标本中的AKT1蛋白阳性表达与阴性表达患者的1年、2年生存率差异无统计学意义(P>0.05),AKT1蛋白阳性表达患者的3年生存率(13.21%)显著低于AKT1蛋白阴性表达患者的37.84%(P<0.05)。结论NSCLC患者癌组织中的AKT1蛋白表达上调,并且与肿瘤进展及不良预后关系密切。     

In vitro evaluation of electrospun silk fibroin/nano-hydroxyapatite/BMP-2 scaffolds for bone regeneration

Bone tissue engineering by using osteoinductive scaffolds seeded with stem cells to promote bone extracellular matrix (ECM) production and remodeling has evolved into a promising approach for bone repair and regeneration. In order to mimic the ECM of bone tissue structurally and compositionally, nanofibrous silk fibroin (SF) scaffolds containing hydroxyapatite (HAP) nanoparticles and bone morphogenetic protein 2 (BMP-2) were fabricated in this study using electrospinning technique. The microstructure, mechanical property, biocompatibility, and osteogenic characteristics were examined. It was found that the HAP nanoparticles were successfully incorporated in the SF nanofibers (diameter, 200–500 nm). The mechanical properties of SF/HAP/BMP-2 composite scaffolds increased with HAP content when it was less than 20 wt%, after which the mechanical properties dropped as HAP content increased. Cell culture tests using bone marrow mesenchymal stem cells (BMSCs) showed that the scaffolds had good biocompatibility and promoted the osteogenic differentiation of BMSCs. Therefore, the electrospun SF/HAP/BMP-2 scaffolds may serve as a promising biomaterial for bone tissue engineering.     

Composite scaffolds of nano-hydroxyapatite and silk fibroin enhance mesenchymal stem cell-based bone regeneration via the interleukin 1 alpha autocrine/paracrine signaling loop

Composite scaffolds of nano-hydroxyapatite (nHAp) and silk fibroin (SF) have been reported to promote bone regeneration mainly through signaling pathways associated with cell–biomaterial interaction. However, it is unclear whether soluble factors also play a role in osteoinduction with nHAp-SF. In this study, we confirmed the biocompatibility and superior osteoinductivity of nHAp-SF scaffolds versus SF scaffolds both in vitro and on a calvarial defect model in vivo. This was followed by further analysis with microarray assay. The cDNA microarray results identified 247 differentially expressed genes in bone marrow mesenchymal stem cells (BMSCs) cultured on SF-nHAp scaffolds versus SF scaffolds. The greatest disparity in gene expression levels were observed with Il1α and Ilr2. Real-time PCR assay validated the results. The addition of IL-1α into cultures of BMSCs with SF significantly increased both Bmp2 and Ilr2 expression. However, with BMSCs alone, the Il1r2 expression increased substantially, whereas Bmp2 expression exhibited a decrease rather than increase. These data suggested that nHAp may exert osteoinductive effects on BMSCs via the secretion of IL-1α in an autocrine/paracrine fashion, and IL-1α activity could be regulated through the synthesis of IL1R2 by BMSCs upon interaction with nHAp. These results complemented our understanding of the underlying mechanisms of biomaterial osteoinductivity.     

Acellular bi-layer silk fibroin scaffolds support functional tissue regeneration in a rat model of onlay esophagoplasty

Surgical management of long-gap esophageal defects with autologous gastrointestinal tissues is frequently associated with adverse complications including organ dysmotility, dysphagia, and donor site morbidity. In order to develop alternative graft options, bi-layer silk fibroin (SF) scaffolds were investigated for their potential to support functional tissue regeneration in a rodent model of esophageal repair. Onlay esophagoplasty was performed with SF matrices (N = 40) in adult rats for up to 2 m of implantation. Parallel groups consisted of animals implanted with small intestinal submucosa (SIS) scaffolds (N = 22) or sham controls receiving esophagotomy alone (N = 20). Sham controls exhibited a 100% survival rate while rats implanted with SF and SIS scaffolds displayed respective survival rates of 93% and 91% prior to scheduled euthanasia. Animals in each experimental group were capable of solid food consumption following a 3 d post-op liquid diet and demonstrated similar degrees of weight gain throughout the study period. End-point μ-computed tomography at 2 m post-op revealed no evidence of contrast extravasation, fistulas, strictures, or diverticula in any of the implant groups. Ex vivo tissue bath studies demonstrated that reconstructed esophageal conduits supported by both SF and SIS scaffolds displayed contractile responses to carbachol, KCl and electrical field stimulation while isoproterenol produced tissue relaxation. Histological (Masson's trichrome and hematoxylin and eosin) and immunohistochemical (IHC) evaluations demonstrated both implant groups produced de novo formation of skeletal and smooth muscle bundles positive for contractile protein expression [fast myosin heavy chain (MY32) and α-smooth muscle actin (α-SMA)] within the graft site. However, SF matrices promoted a significant 4-fold increase in MY32+ skeletal muscle and a 2-fold gain in α-SMA+ smooth muscle in comparison to the SIS cohort as determined by histomorphometric analyses. A stratified squamous, keratinized epithelium expressing cytokeratin 5 and involucrin proteins was also present at 2 m post-op in all experimental groups. De novo innervation and vascularization were evident in all regenerated tissues indicated by the presence of synaptophysin (SYP38)+ boutons and vessels lined with CD31 expressing endothelial cells. In respect to SIS, the SF group supported a significant 4-fold increase in the density of SYP38+ boutons within the implant region. Evaluation of host tissue responses revealed that SIS matrices elicited chronic inflammatory reactions and severe fibrosis throughout the neotissues, in contrast to SF scaffolds. The results of this study demonstrate that bi-layer SF scaffolds represent promising biomaterials for onlay esophagoplasty, capable of producing superior regenerative outcomes in comparison to conventional SIS scaffolds.