小肠黏膜下层对牙周膜干细胞体外增殖、骨向分化的影响

目的 观察小肠黏膜下层 (SIS)与人牙周膜干细胞(PDLSCs)的生物相容性及其作为支架材料对PDLSCs的骨向分化诱导作用。方法 体外分离培养 PDLSCs,分别用四唑盐比色法（MTS）、茜素红染色法、碱性磷酸酶(ALP)和逆转录聚合酶链式反应（RT-PCR）方法观察 SIS 生物材料对PDLSCs增殖活性和骨向分化能力的影响。结果 SIS 显著地刺激体外培养的PDLSCs增殖,诱导了细胞的矿化和提高细胞ALP活性。RT-PCR结果显示SIS诱导后细胞 mRNA 水平表达骨涎蛋白(BSP)和骨钙素（OCN)。结论 体外培养条件下,SIS与PDLSCs有良好的生物相容性,能够诱导PDLSCs骨向分化。     

Comparison of midterm results of endovascular aneurysm repair for ruptured and elective abdominal aortic aneurysms

ObjectiveEndovascular aneurysm repair (EVAR) became an increasingly preferred modality for abdominal aortic aneurysm (AAA) repair both in elective AAA repair (el-EVAR) and EVAR of a ruptured AAA (r-EVAR) setting. Ruptured AAAs usually have more hostile anatomies and less time for planning. Consequently, more complications may arise after r-EVAR. The purpose of this study was to compare mi-term outcomes between r-EVAR and el-EVAR.MethodsA retrospective cohort analysis of patients undergoing EVAR from 2000 to 2015 at a tertiary institution was performed. Patients with previous aortic surgery, nonatherosclerotic AAA and isolated iliac aneurysms were excluded. In-hospital casualties or patients who were intraoperatively converted to open repair were also excluded. For the midterm outcome analysis, only patients with at least two postoperative examinations (a 30-day computed tomography scan and a second postoperative examination performed 6 months or later) were considered. The primary end point was freedom from aneurysm-related complications (a composite of type I or III endoleak, aneurysm sac growth, migration of more than 5 mm, device integrity failure, AAA-related death, late postimplant rupture, or AAA-related secondary intervention). Freedom from secondary interventions, neck-related events (defined as a composite of type IA endoleak, migration of more than 5 mm, or preemptive neck-related secondary intervention) and late survival were secondary end points. The impact of device instructions for use (IFU) compliance on neck events was also assessed.ResultsThe study included 565 patients (65 r-EVAR and 500 el-EVAR). Eighty-two patients were treated outside proximal neck IFU, 13 in the r-EVAR group (21.3%) and 69 (14.5%) in the el-EVAR (P = .16). During the index hospitalization, there were more complications (12.3% vs 3.2%; P = .001) and reinterventions (12.3% vs 2.8%; P < .001) in the r-EVAR group. After discharge, median clinical follow-up time was 4.3 years (interquartile range, 2.1-7.0 years) without differences between both groups. Five-year freedom from AAA-related complications was 53.9% in the r-EVAR group and 65.4% in the el-EVAR (P = .21). In multivariable analysis the r-EVAR group was not at increased risk for late complications (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.54-1.61; P = .81). Five-year freedom from neck-related events was 74% in r-EVAR and 82% in the el-EVAR group (P = .345). Patients treated outside neck IFU were at greater risk for neck-related events both in r-EVAR (HR, 6.5; 95% CI, 1.8-22.9; P = .004) and el-EVAR group (HR, 2.6; 95% CI, 1.5-4.5; P < .001). Freedom from secondary interventions at 5 years was 63.0% for r-EVAR and 76.9% for el-EVAR (P = .16). Survival at 5 years was 68.8% in the r-EVAR group and 73.3% in the el-EVAR group (P = .30).ConclusionsDurable and sustainable midterm outcomes were found for both r-EVAR and el-EVAR patients who survived the postoperative period. Patients treated outside the IFU are at greater risk for late complications. Surveillance protocols may be tailored according to individual anatomy and IFU compliance rather than timing of repair.     

静脉输液对同侧肢体毛细血管血糖测量值的影响

目的探讨静脉输液对同侧肢体毛细血管血糖值的影响。方法选取入住神经外科重症监护室的96例危重患者,采用自身配对法,于一侧肢体输液末使用快速血糖仪测量患者两侧肢体毛细血管血糖。结果两侧肢体毛细血管血糖值差异无统计学意义(P0.05);回归分析显示,R2=0.968,β=1.036(P=0.000)。结论静脉输液对同侧毛细血管血糖值无统计学影响,临床护理中可选择输液侧肢体检测血糖。     

Sero‐prevalence and epidemiology of peste des petits ruminants in Libya

We conducted a cross‐sectional study during 2013 to quantify the serological prevalence of peste des petits ruminants ( PPR) infection and to investigate host factors associated with PPR infection in small ruminants in Libya. A two‐stage sampling design was carried out. A total number of 148 flocks owning at least 100 heads each were randomly selected. Sixteen to forty‐eight samples were collected from each selected flock. A total number of 3,508 serum samples from unvaccinated animals were collected and analysed at IZSLER Brescia, Italy, by using competitive ELISA, IDvet innovative diagnostics (IDvet 310, France). The overall serological prevalence among SR was 33% (95% CI: 31.4–34.5). Significant differences between the prevalence in the geographical branches were observed. The lowest prevalence level was observed in Zawiyah branch (16.1%), whereas the highest value was obtained for the Sabha branch (56.8%). Considering the age, a serological prevalence of 24.7%, 31.5% and 42.1% was observed in SR <1 year, between 1 and 2 years and more than 2 years, respectively. Statistically significant differences (p  <  .001) in the sero‐prevalence levels were also observed between the age groups. Our findings suggest that the southern part of Libya could be more exposed to the infections coming from the neighbouring countries and this should be better investigated to correctly identify wherever specific entry points can be considered at higher risk than others. The results also confirmed the endemic status of PPR in Libya, with a constant exposure to the infection of the animals during their life. In the framework of the global strategy for control and eradication of PPR, our results, even if obtained by a preliminary study, can contribute to the assessment of the epidemiological situation of PPR in Libya as required by the Stage 1 of the plan.     

Targeted therapies in cancer

Cytotoxic chemotherapy has traditionally provided the backbone of medical care for cancer. While chemotherapy remains the treatment of choice for many types of cancer, so-called ‘targeted therapies’ are now increasingly available within the clinic across a broad range of tumour types. Targeted therapies can inhibit specific molecular targets implicated in cancer or single oncogenic drivers, rather than affecting cell division or DNA synthesis. While often better tolerated, they can be associated with adverse events, which require specialist multidisciplinary management. Targeted therapies have changed cancer care, with tailoring to an individual patients' tumour, new approaches to dosing and disease assessment, but with an increasing burden on health economics. Rather than a disease-specific approach, these novel therapies may be of benefit in multiple cancer types. There are three main categories of targeted therapies: small molecule inhibitors, monoclonal antibodies and immunotherapies, which will be considered in this article.     

腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤146例临床分析

目的 探讨StanfordB型主动脉夹层动脉瘤腔内治疗的手术指征、术前评估方法、手术操作技巧、并发症防治原则及临床应用前景。方法 对146例行Stanford B型主动脉夹层动脉瘤腔内隔绝术患者的临床资料进行回顾性分析。术前采用CT血管造影(CTA)或磁共振血管造影(MRA)对主动脉夹层动脉瘤进行评估,术中在数字减影血管造影(DSA)监视下经股动脉或髂动脉将移植物导入胸主动脉封闭夹层裂口。结果 术中移植物成功释放145例,1例移植物无法释放而转行开胸手术。119例仅使用移植物封闭夹层近端裂口,26例同时封闭夹层近端及远端裂口,46例远端夹层裂口旷置。围手术期死亡6例,其余病例术后无心、肺、肾功能衰竭及截瘫等严重并发症。术后11个月猝死1例,2例分别于术后14、24个月再发Stanford A型胸主动脉夹层动脉瘤而行升主动脉人工血管置换术(Bentall手术),其余患者未出现与夹层动脉瘤及手术相关的并发症。结论 腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤是一种创伤小、恢复快的新方法,短期的随访结果表明该技术安全、有效。内漏是该方法的主要并发症并可能导致术后患者死亡,远期疗效有待继续随访。     

以股后皮神经营养血管为蒂的岛状皮瓣的临床应用

目的　探讨以股后皮神经营养血管为蒂的岛状皮瓣修复手术的应用。方法　采用以股后皮神经营养血管为蒂的岛状皮瓣修复臀部、窝及股内、外侧创面共 11例 12个创面 ,皮瓣最大面积 8 3cm× 16 6cm ,最小面积 4 0cm× 7 8cm。结果　 11例 12个创面中 ,9个创面皮瓣完全成活 ,创面一期愈合 ,3个因静脉回流障碍 ,皮瓣远端出现皮肤坏死 ,但皮下成活 ,经皮片移植后创面愈合 ,随访 8～ 19个月不等 ,皮瓣质地、外观及功能满意。结论　这一皮瓣的动脉血供可靠 ,不牺牲主干血管 ,解剖恒定 ,充分利用“浅静脉—皮神经营养血管系统” ,皮瓣蒂部保留“彗星尾”状皮肤组织是转移后皮瓣成活的重要保证。     

Alteration of intestinal intraepithelial lymphocytes after massive small bowel resection

BACKGROUND: Intraepithelial lymphocytes (IEL) comprise the inner most layer of the gut immune system, and play a critical role in protecting the host from enteric organisms. Massive small bowel resection (MSBR) is one such clinical condition where patients are at particularly high risk for the development of such enteric infectious complications. Because of this, we hypothesized that the IEL may change significantly after the formation of a MSBR. To address this, a mouse model of MSBR was created and the acute phenotypic and functional characteristics of the IEL were studied. MATERIALS AND METHODS: Mice underwent a 70% mid-small bowel resection. After 7 days, IEL were isolated and analyzed for phenotypic changes by flow cytometry. IEL cytokine expression was performed with semiquantitative polymerase chain reaction techniques. To assess the functional significance of these changes, IEL proliferative response was assessed in vitro.Results. MSBR led to significant decreases in specific IEL subpopulations: CD 44+ (used as a marker of cell maturity); CD 8alphabeta+ (marker of thymic derivation), and CD 69+ (marker of T cell activation). Compared with controls, IEL TNF-alpha mRNA expression increased 84%, while IL-2 and IL-10 mRNA expression decreased by 69 and 72%, respectively. Spontaneous proliferation of IEL in the MSBR group was significantly higher than controls, however, proliferation failed to increase with T cell stimulation.Conclusion. These changes suggest a shift to a more immature and possibly less activated cell population. It is possible that such alterations may play an important role in the increase in enterically derived infections in patients with MSBR.     

H亚型血管与骨质疏松症

目前,骨质疏松症的传统治疗方法主要集中于抑制骨破坏和促进骨形成方面,但此单一的治疗方法很难彻底解决多重因素致病的骨质疏松症。近来,许多文献报道血管形成与骨形成之间存在偶联关系,其中骨骼中新发现的H亚型血管成为骨质疏松治疗的新焦点。根据骨骼血管内皮细胞位置和功能的区别,可分为H亚型血管和L亚型血管,而H亚型血管可促进其周围骨祖细胞的分化与增殖。H亚型血管主要分布于干骺端和骨膜下,表现为血小板-内皮细胞粘附分子抗体(CD31)和内皮粘蛋白抗体(endomucin,EMCN)强阳性;而L亚型血管表现为两种内皮细胞抗体(CD31或EMCN)弱阳性,分布于骨干区。实验表明,H亚型内皮细胞与周围的骨祖细胞数量会随着小鼠的老龄化呈正比例下降,而且小鼠体内缺氧诱导型转录因子1α缺失后会出现H亚型内皮细胞和骨祖细胞数量明显降低,这些均提示H亚型血管与骨形成存在偶联关系。笔者着重对H亚型内皮细与骨形成之间存在的偶联关系及其机制进行综述,探讨H亚型内皮细胞与骨质疏松症的关系,以进一步加深对骨质疏松症发生、发展的认识,为骨质疏松症治疗提供新的思路与方法。