结肠透析治疗慢性肾功能衰竭的临床研究

目的 观察结肠透析配合中药加活性碳保留灌肠治疗慢性肾功能衰竭(CRF)的临床疗效.方法 将60例CRF患者按随机方法分成两组,对照组采用常规西药及辨证口服中药汤剂治疗;治疗组在此基础上,采用结肠透析配合中药加活性碳保留灌肠治疗.观察治疗前后两组临床症状的改善以及血肌酐、尿素氮、血红蛋白水平的变化.结果 两组患者症状均有改善,治疗组改善更明显.治疗组的总有效率为86.7%,对照组的总有效率为53.3%,两组相比有显著性差异(P＜0.05).结论 结肠透析配合中药加活性碳保留灌肠治疗慢性肾功能衰竭有较好疗效.     

结肠镜在结直肠外科疾病中的诊治

目的探讨应用结肠镜(内镜)对常见结直肠外科疾病的诊治,以提高利用内镜进行诊治的安全性及疗效。方法回顾2001~2005年间1231例行内镜诊治的病人,其中行内镜治疗76例,包括大肠息肉62例、乙状结肠扭转4例、假性结肠梗阻5例及急性结肠出血5例。总结操作体会,分析疗效及并发症的原因。结果内镜下治疗62例大肠息肉,共132枚,无并发继发性出血及迟发性穿孔。21例结肠梗阻病人行内镜检查,19例明确梗阻原因及部位。对4例乙状结肠扭转行内镜下复位,3例成功,另1例经二次复位后仍复发,予以手术治愈。对5例假性结肠梗阻行内镜下减压,随访3个月,4例治愈。5例急性结直肠出血,4例发现出血灶,4例内镜下止血成功。结论内镜提高了结直肠外科疾病的诊治水平,创伤小,应用中要严格掌握适应证,改进操作技术,减少并发症。     

二烯丙基二硫对人结肠癌HT-29细胞周期的阻滞作用

[目的]探讨二烯丙基二硫(DADS)对人结肠癌HT-29细胞周期的阻滞作用及其分子机制.[方法]应用MTF法及细胞计数法测量HT-29细胞生长抑制,流式细胞术检测细胞时相分布,免疫细胞法测定p21、C-myc、Cyclin E表达.[结果]MTT法显示,不同浓度DADS作用HT-29细胞12、24、48h后,细胞生长抑制率及细胞群体倍增时间呈浓度、时间依赖性增加.流式细胞仪分析,30、60pmol/LL DADS阻滞HT29细胞在G1期,与对照组相比,可使G1期细胞增加约2倍,而90、120μmol/L DADS显著地将细胞阻滞在G2/M期.免疫细胞化学分析表明在细胞周期阻滞的同时有p21wafl蛋白表达上调,Cyclin E、C-myc蛋白表达下降.[结论]DADS对HT-29细胞的抑制增殖作用可能与细胞周期阻滞有关,DADS对HT-29细胞周期阻滞的分子机制可能与调节p21wafl、Cyclin E、C-myc表达相关.     

左半结肠癌急性梗阻一期切除吻合的安全保证——彻底快速而无污染的肠减压术(英文)

目的研究一种彻底快速而毫不污染手术野的术中肠减压方法,以便提高手术的安全性。方法游离系膜后,钳夹下将拟切除肠段的下端先切断,将其近侧断端置入并固定于粘附在手术床边的塑料袋中;松开肠钳,肠内容物自由流入袋内;双手交替推挤膨胀的肠段,由近而远,由小肠向大肠,直至大、小肠的内容物彻底排空。钳夹下切断上端,移除切下的肠段和充满粪便的塑料袋。结果使用本法行肠减压术,一期切除急性梗阻的左结肠癌31例,均未发生吻合口漏,创口一期愈合。另有6例肝段切除同时切除未作肠道准备的结肠癌亦取得同样结果。同法亦用于各种急性小肠梗阻,均未造成腹腔污染。结论本法可推荐为术中肠减压的首选方法。     

ATP通过P2受体调节大鼠近端结肠纵行肌的舒张与收缩反应(英文)

目的腺苷三磷酸(ATP)对大鼠离体远端结肠纵行肌运动的影响已明确,对近端结肠纵行肌的影响可能不同,但未有报告,为此对此进行观察并探讨其受体机制。方法观察静息张力时或预收缩时0.1μmol·L-1～1mmol·L-1ATP和1～100μmol·L-1腺苷对大鼠近端结肠纵行肌的抑制和兴奋作用。结果在静息张力下,1μmol·L-1～1mmol·L-1ATP对大鼠近端结肠纵行肌产生3种效应,即抑制自发性收缩反应,一过性轻度降低基础张力(0.05～0.08g),随后产生浓度依赖性收缩反应(0.04～0.44g)。0.1μmol·L-1河豚毒素不影响ATP的上述作用。在静息张力下,1～100μmol·L-1腺苷对近端结肠纵行肌未产生明显的收缩反应。应用5羟色胺(5HT)或乙酰胆碱(ACh)预收缩标本时,1μmol·L-1～1mmol·L-1ATP产生明显的浓度依赖性舒张反应(23.2%～94.6%,5HT预收缩;24.8%～92.4%,ACh预收缩),而腺苷引起的舒张反应明显小于ATP。结论在大鼠离体近端结肠纵行肌,ATP主要通过嘌呤嘧啶(P)2受体介导收缩反应,部分通过P1受体介导舒张反应。     

99mTc标记的大肠癌单克隆抗体在小鼠体内分布特点的研究

目的：研究^99m-Tc标记的大肠癌单克隆抗体(^99mTc—ACCmAb)在正常小鼠和荷瘤裸鼠体内的分布及在荷瘤裸鼠体内SPECT成像的研究。方法：将^99m-Tc和^99mTc—ACCmAb分别注射入正常小鼠、荷L010-16人结肠癌裸鼠，按不同时间点采取小鼠的脏器进行同位素放射性活度的测定；并在不同时间测定荷L010-16人结肠癌裸鼠注射^99mTc—ACCmAb的SPECT显像。结果：注射^99mTc后正常小鼠体内6h5min血液中的放射性活度与30min相比下降了76．6％，是30min的23．4％；肝脏中6h5min的放射性活度为30min的27．2％，下降了72．8％。尾静脉注射^99mTc-ACCmAb的正常小鼠，6h5min在血液中的放射性活度与30min血液中的放射性活度比较下降了68．4％，是30min的31．6％，24h为6h5min的6．1％，下降了93．9％；荷瘤裸鼠体内^99mTc-ACCmAb在24h血液中的放射性活度是6h5min的2．1％，下降了97．9％。SPECT显像结果表明，虽然在注射^99mTc-ACCmAb20h血液与肿瘤的比值为最高，但在24h的成像结果仍然好于其他的时间点。结论：^99m-Tc标记的大肠癌单克隆抗体可特异性浓聚于荷L010-16人结肠癌裸鼠模型中，可能成为大肠癌根除手术中使用的手术导向体内诊断用药，保证手术切除肿瘤的彻底性。     

Anatomical basis of laparoscopic medial‐to‐lateral mobilization of the descending colon

In laparoscopic colorectal resection, the medial‐to‐lateral approach has been largely adopted. This approach can be initiated by the division of either the inferior mesenteric artery (IMA) or the inferior mesenteric vein (IMV). This cadaveric study aimed to establish the feasibility of IMV dissection as the initial landmark of medial‐to‐lateral left colonic mobilization for evaluating the size of the peritoneal window between the IMV at the lower part of the pancreas and the origin of the IMA (IMA‐IMV distance) and the point of origin of the IMA compared to the lower edge of the third part of the duodenum (IMA‐D3 distance). These distances were recorded on 30 fresh cadavers. The IMA‐D3 distance was 0.4 ± 2.2 cm (mean ± SD). The IMA originated from the aorta at the level of or below the D3 in 21 cases (70%). The IMA‐IMV distance was 5.5 ± 1.8 cm and was greater or equal to 5 cm (large window) in 21 cases (70%). IMA‐IMV distance was correlated with IMA‐D3 showing that a large window was inversely correlated with a low IMA origin (P < 0.001). IMA‐D3 distance was not correlated with weight, height and sex. IMA‐IMV distance was largerin male (6.7 ± 0.9 vs. 4.9 ± 1.8, P = 0.001) and correlated with weight, (r = 0.60, 95%CI = 0.03–0.10, P < 0.001) and height (r = 0.54, 95%CI = 0.05–0.21, P = 0.002). IMV can be used as the initial landmark for laparoscopic medial‐to‐lateral dissection in two‐thirds of cases. A too‐small window can require first IMA division. The choice between the two different medial‐to‐lateral approaches could be made by evaluating the anatomical relationship between IMA, IMV, and D3. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.     

The prognostic value of polycomb group protein B‐cell‐specific moloney murine leukemia virus insertion site 1 in stage II colon cancer patients

The aim of this study was to investigate the prognostic value of B‐cell‐specific moloney murine leukemia virus insertion site 1 (BMI1) protein expression in primary tumors of stage II colon cancer patients. BMI1 protein expression was assessed by immunohistochemistry in a retrospective patient cohort consisting of 144 stage II colon cancer patients. BMI1 expression at the invasive front of the primary tumors correlated with mismatch repair status of the tumors. Furthermore, BMI1 expression at the luminal surface correlated with T‐stage, tumor location, and the histological subtypes of the tumors. In a univariate Cox proportional hazard analysis, no statistical significant association between risk of relapse and BMI1 protein expression at the invasive front (HR: 1.12; 95% CI 0.78–1.60; p = 0.53) or at the luminal surface of the tumor (HR: 1.06; 95% CI 0.75–1.48; p = 0.70) was found. Likewise, there was no association between 5‐year overall survival and BMI1 expression at the invasive front (HR: 1.12; 95% CI 0.80–1.56; p = 0.46) or at the luminal surface of the tumor (HR: 1.16; 95% CI 0.86–1.60; p = 0.33). In conclusion, BMI1 expression in primary tumors of stage II colon cancer patients could not predict relapse or overall survival of the patients, thus having a limited prognostic value in stage II colon cancer patients.     

Program

The main objective of this study was to investigate the role and the underlying mechanism of Na-H exchanger-3 (NHE-3) expression in spontaneously hypertensive rat (SHR) intestine. Expression of colonic and ileal NHE-3 isoform, its regulatory factor-1 (NHERF-1) and cyclic GMP kinase II (cGKII) were examined using western blot analysis. Since NHE-3 activity is regulated by its abundance on the plasma membrane, its levels were also examined in lipid rafts-enriched membrane fractions. The lipid rafts fractions were characterized by examining the concentration of flotillin-1 and caveolin-1, total protein, and cholesterol. Twelve-weeks-old SHR used in this study developed significant hypertension, proteinuria, and renal and cardiac hypertrophy. These changes were significantly reversed by captopril treatment. There was a significant decrease in the levels of NHE-3 and NHERF-1 proteins, and sodium pump activity, but an increase in the cGKII levels in both tissues from SHR. Reduction in NHERF-1 levels was reversed by captopril but not of the other proteins. Cholesterol profile was significantly different in SHR colon as compared to normo-tensive Wistar Kyoto rats. These findings suggest that suppression of NHE-3 in intestine is a counteracting mechanism of hypertension and is regulated by NHERF-1 through cGKII activation in SHR. NHE-3 suppression together with decrease in the sodium pump activity would accumulate intracellular Na⁺ and may contribute to the reported hypertension-induced tissue damage in the GI-tract.