终末期肝病模型评分在原发性肝癌合并肝硬化脾功能亢进外科治疗中的作用

目的 探讨终末期肝病模型(MELD)评分评估肝储备功能在原发性肝癌合并肝硬化脾功能亢进中确定手术适应证的应用价值.方法 对2001年1月至2007年1月间行肝癌切除联合脾切除(联合术)治疗的40例原发性肝癌合并肝硬化脾功能亢进患者的临床资料进行回顾性分析.通过MELD评分与Child-Pugh分级比较,结合临床资料及术后并发症分析,确定这一方法在评估肝储备功能中的作用.结果 同一Child-Pugh分级的患者MELD评分结果并不一致,在各级别间有交错现象.术后发生肝功能衰竭组(6例)的MELD评分均值为(24.6±6.6).未发生肝功能衰竭组(34例)的MELD评分均值为(16.3±8.5),差异有统计学意义(P<0.05).根据MELD评分分为A组16例(MELD评分<10),B组17例(MELD评分10-20),C组7例(MELD评分>20).A组术后肝功能衰竭发生率为0,B组为11.8%(2/17),C组为57.1%(4/7),差异有统计学意义(P<0.05).根据Child-Pugh分级分为Ⅰ级26例,Ⅱ级14例.Ⅰ级术后肝功能衰竭发生率为15.4%(4/26),Ⅱ级为14.3%(2/14),差异无统计学意义(P>0.05).结论 MELD评分能够较为客观地反映肝储备功能,对外科术式的选择、手术时机的确定有一定的参考作用.     

Retrospective analysis of fetal vertebral defects: Associated anomalies,etiologies, and outcome

Our objectives were to describe fetal cases of vertebral defects (VD), assess the diagnostic yield of fetal chromosomal analysis for VD and determine which investigations should be performed when evaluating fetal VD. We performed a retrospective chart review for fetuses with VD seen between 2006 and 2015. Cases were identified from CHU Sainte‐Justine's prenatal clinic visits, postmortem fetal skeletal surveys, and medical records. Cases with neural tube defects were excluded. Sixty‐six fetuses with VD were identified at a mean gestational age of 20 weeks. Forty‐seven (71.2%) had associated antenatal anomalies, most commonly genitourinary, skeletal/limb, and cardiac anomalies. Thirteen mothers (19.7%) had pregestational diabetes (95% CI [10.1%–29.3%]). Fifty‐three cases had chromosomal analysis. Three had abnormal results (5.6%): trisomy 13, trisomy 22, and 9q33.1q34.11 deletion. Thirty‐four (51.5%) pregnancies were terminated, one led to intrauterine fetal demise and 31 (46.9%) continued to term. Of 27 children who survived the neonatal period, 21 had congenital scoliosis and 3 had spondylocostal dysostosis. Seven had developmental delay. In conclusion, prenatal evaluation of fetuses with VD should include detailed morphological assessment (including fetal echocardiogram), maternal diabetes screening, and chromosomal microarray if non‐isolated. Our findings provide guidance about management and counseling after a diagnosis of fetal VD.     

Autografting of whole muscles in reptiles

Autografting (reimplantation) of the whole gastrocnemius muscle was carried out in turtles (Testudo horsfieldi) weighing 300–500 g. The grafts were investigated 2 weeks to 6 months after transplantation. After 5–6 months the reimplanted muscles were similar in color and shape to the intact symmetrical muscles and they amounted to 77% of their weight. Regeneration was observed in the grafts, but its course was slower than in mammals. Separation of myoblasts from disintegrating muscle fibers of the graft took place rapidly during the first month and continued until 2 months after grafting. Simultaneously, differentiation of myogenic elements into cross-striated muscle fibers and vascularization of the grafts were observed. Most of the grafts by the end of the period of investigation had a muscular type of structure, although considerable variability was observed in the diameter of the muscle fibers.Laboratory of Evolutionary Histology, A. N. Severtsov Institute of Evolutionary Morphology and Ecology of Animals, Moscow. (Presented by Academician of the Academy of Medical Sciences of the USSR A. P. Avtsyn.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 84, No. 7, pp. 94–97, July, 1977.     

Liver and Heart Mitochondrial Succinate Dehydrogenase Activity of Newborn Rats in Anoxic Hypoxia and Starvation

Succinate dehydrogenase activity was determined in the liver and heart of newborn rats after 3 and 48 hours' exposure to anoxic hypoxia (10% O₂) and after 48 hours' starvation. Control determinations were made on newborn animals of corresponding ages, full term foetuses (21 days), infantile (1 and 2 weeks) and full grown animals. Hypoxia for 3 h had no influence on succinate dehydrogenase activity at all in either the heart or liver mitochondria of the newborn animals. After 48 h no difference was observed in the liver between the hypoxic animals and the starved controls of the same age, though starvation itself had resulted in a significant increase in activity, as much as 42%. When liver mitochondrial succinate dehydrogenase in normal mitochondria was activated by preincubation mitochondria with the substrate, the activity increase obtained was greater than that resulting from starvation. The increase in activity in the heart of the hypoxic or starved animals was not significant (< 10%).     

The isolation of adult rat liver parenchymal cells

Summary This report describes procedures for the isolation and maintenance of monolayer culture of adult rat liver hepatic parenchymal cells. Isolation of the cells is accomplished using perfusion in situ with a calcium-free buffer followed by buffered collagenase. Gravity sedimentation and selective media are used to limit the contribution of nonparenchymal cells in the cultures.     

FGF signaling segregates biliary cell-lineage from chick hepatoblasts cooperatively with BMP4 and ECM components in vitro.

Intrahepatic bile ducts (IHBDs) are indispensable for transporting bile secreted from hepatocytes to the hepatic duct. The biliary epithelial cells (BECs) of the IHBD arise from bipotent hepatoblasts around the portal vein, suggesting the portal mesenchyme is essential for their development. However, except for Notch or Activin/TGF-beta signaling molecules, it is not known which molecules regulate IHBD development. Here, we found that FGF receptors and BMP4 are specifically expressed in the developing IHBD and the hepatic mesenchyme, respectively. Using a mesenchyme-free culture of liver bud, we showed that bFGF and FGF7 induce the hepatoblasts to differentiate into BECs, and that BMP4 enhances bFGF-induced BEC differentiation. The extracellular matrix (ECM) components in the hepatic mesenchyme induced BEC differentiation. Forced expression of a constitutively active form of the FGF receptor partially induced BEC differentiation markers in vivo. These data strongly suggest that bFGF and FGF7 promote BEC differentiation cooperatively with BMP4 and ECMs in vivo.     

Monoclonal antibodies against human granulocytes and myeloid differentiation antigens

Monoclonal antibodies (MCA) were obtained by immunizing BALB/c mice with 99% pure granulocytes from normal donors or with a whole leukocyte suspension obtained from a chronic myelogenous leukemia (CML) patient, and then fusing the mouse spleen cells with a 315–43 myeloma cell clone. Four MCA were selected and studied using ELISA, immunofluorescence, cytotoxicity assays, and FACS analysis. Antibodies 80H.1. 80H.3. and 80H.5 (from normals) and 81H.1 (from CML) detected antigens expressed on neutrophils. Antibodies 80H.1 and 80H.3 (lgG) also reacted with monocytes but not with other blood cell subsets. Antibodies 80H.5 and 81H.1 (lgM) were cytotoxic and reacted strongly with most of the cells of the neutrophil maturation sequence. i.e., myeloblasts, promyelocytes, myelocytes, and mature granulocytes. Antibodies 80H.5 and 81H.1 also inhibited BFU-GM and CFU-E. Antigens recognized by 80H.3. 80H.5, and 81H.1 were expressed both on a proportion of cells from HL.60, KG.1, ML.1, and K562 myeloid cell lines, and on a proportion of blast cells isolated from patients with acute myelogenous leukemia. They were not found on lymphoid cell lines or lymphoid leukemia cells. These MCA recognize either late differentiation antigens expressed on mature neutrophils and monocytes (80H.1 and 80H.3) or early differentiation antigens (80H.5 and 81H.1) specific to the granulocytic lineage. They may be useful for a better definition of those antigens specific to hematopoietic stem cells and their relationship with normal or neoplastic hematopoiesis.     

Fetal cervical hyperextension in arthrogryposis

Perhaps the most dramatic position of a newborn after delivery is when there is hyperextension of the neck and spine. It will have been presented in utero and today, almost always, such babies will have been delivered by C‐section. The associated anomalies are variable. The process(es) that can lead to cervical hyperextension is/are largely unknown. The outcome is variable from lethal to completely resolve. Individuals with arthrogryposis and in particular with Amyoplasia appear to have an increased frequency of neck, cervical, and spine hyperextension at birth. We present here 41 cases of arthrogryposis (mainly Amyoplasia) with fetal cervical hyperextension. The outlook is surprisingly good if spinal cord trauma does not occur. Ultrasound late in pregnancy when arthrogryposis is recognized prenatally should determine whether cervical hyperextension has developed, so that appropriate preventive measures can be taken.