腹腔镜胆囊切除术治疗老年急性胆囊炎的疗效分析

目的探讨分析腹腔镜胆囊切除术治疗老年急性胆囊炎的临床疗效。方法回顾性分析2008年3月～2011年12月间在笔者所在医院治疗的74例急性胆囊炎老年患者的临床资料。结果治疗组的术中平均出血量、手术时间、住院时间均少于对照组,差异有统计学意义(P<0.01);治疗组的不良反应发生率为5.41%,明显低于对照组的27.03%,差异有统计学意义(P<0.01)。结论腹腔镜胆囊切除术治疗老年急性胆囊炎临床疗效显著,具有推广价值。     

大鼠肠道菌群对长梗冬青苷体外代谢的影响

摘 要 目的：探究体外孵育的大鼠肠道菌群对长梗冬青苷的代谢转化规律。方法: 将长梗冬青苷与大鼠肠道菌群在厌氧条件下共孵育,分别于0,4,8,12,24,48 h时取样,经乙酸乙酯萃取后采用HPLC法进行定性和定量分析。结果: 在与大鼠肠道菌群共孵育48 h后,90.8%的长梗冬青苷被代谢转化为M₂,M₂与铁冬青酸对照品通过HPLC分析时色谱行为一致,故确定M₂为铁冬青酸。结论:长梗冬青苷可以被体外孵育的大鼠肠道菌群代谢转化为铁冬青酸。     

原发性闭角型青光眼对角膜内皮细胞的影响

青光眼是全球第二大致盲性眼病,除了损伤视神经、视野外还会影响虹膜、晶状体。临床观察和实验研究都表明青光眼可引起角膜内皮细胞数量减少,从而导致角膜透明性下降。我国以原发性闭角型青光眼患者居多,约占世界闭角型青光眼患者的一半,本文从原发性闭角型青光眼疾病本身、抗青光眼药物、手术及激光治疗等方面对角膜内皮细胞的影响进行综述。     

引线硅胶管植入术治疗单纯泪小点狭窄或闭锁的疗效观察

目的:观察引线硅胶管植入术治疗单纯泪小点狭窄或闭锁的临床疗效。方法:单纯泪小点狭窄或闭锁患者42例72眼,按照年龄分成60岁以上及以下两组。局部麻醉下行引线硅胶管植入术,术后给予局部消炎抗感染治疗。术后冲洗泪道1次/wk,共4次,1～3mo后拔管,计算治愈率,并行卡方检验。结果:所有患者术中均成功植入引线硅胶管。平均观察14mo。治愈59眼(82%),好转8眼(11%),无效5眼(7%)。60岁以上组治愈率、有效率均较60岁以下组低。结论:引线硅胶管植入术治疗单纯泪小点狭窄或闭锁,操作简便、创伤小、效果好、值得临床推广。     

急性视网膜坏死综合征全玻璃体切除的治疗效果

目的 探讨急性视网膜坏死综合征(ARNS)全玻璃体切除手术的治疗效果.方法 对2003年3月至2006年10月,共连续17例(17只眼)ARNS患者在我科做了玻璃体手术.伴有视网膜脱离13例,无视网膜脱离4例.所有患者均采用全玻璃体切除术,剥离视网膜前膜和坏死视网膜,部分病人做了松解性视网膜切开或切除,用重水压平视网膜后眼内光凝或直接眼内光凝,气液交换后,用C3F8填充2例和用硅油填充15例.取出以前环扎带1例和做环扎1例.结果 追踪时间至少半年,除膨胀气体填充的2例手术失败外,其余15例患者在术后1～12月顺利取出硅油,视网膜保持复位.最后一次随访最好矫正视力:光感至指数4例,0.2～0.3者5例,0.5～0.7者5例,≥1者3例.结论 全玻璃体切除术、眼内光凝和硅油填充治疗ARNS具有良好地手术效果.     

转化生长因子β1对肠道上皮-间质转分化影响的体外研究

目的通过体外实验探讨转化生长因子β1(TGF-β1)对肠道上皮-间质转分化(EMT)的影响。方法以浓度为10 ng/ml的TGF-β1刺激肠道上皮细胞株DLD-1,分别在24、48或72 h时,提取细胞总RNA和总蛋白;分别用real-time PCR和Western-blot法检测细胞E-钙黏蛋白(E-cadherin)、N-钙黏蛋白(N-cadherin)、波形蛋白(vimentin)、纤维连接蛋白(fibronectin)、α-平滑肌肌动蛋白(α-SMA)在mRNA和蛋白水平的表达变化。结果TGF-β1刺激后各个时间点E-cadherin表达显著下降,而N-cadherin、vimentin、fibronectin、α-SMA的表达则明显上调,差异均有统计学意义(P<0.05)。结论 TGF-β1可促进肠上皮细胞EMT过程,可能参与肠道纤维化发病机制。     

血管活性肠肽对肺损伤大鼠Toll样受体mRNA表达的影响

目的 探讨血管活性肠肽(vasoactive intestinal peptide,VIP)对内毒素(脂多糖,lipopolysaceberide,LPS)致休克大鼠肺损伤后Toll样受体(Toll-like receptor,TLR)2和TLR4 mRNA表达的影响.方法 40只SD大鼠,随机分为LPS组(16只)、LPS+VIP组(16只)和对照组(8只).LPS组尾静脉注射LPS(E.coli O_(55)B_5)10 mg/kg;LPS+VIP组尾静脉注射LPS 10 ms/kg后注射VIP 5 nmol/kg;对照组尾静脉注射等容量生理盐水.分别于注射后6 h和24 h处死,留取肺标本,RT-PCR检测肺TLR2/4 mRNA表达,并观察24 h时肺组织病理变化.结果 (1)肺组织病理改变:制模24 h时.光镜和透射电镜下,LPS组见肺泡间隔弥漫性增宽、炎性细胞浸润,隔内毛细血管不同程度充血,肺泡壁增厚,肺泡腔结构破坏、炎性细胞浸润、出血、间质水肿、细胞器破坏,LPS+VIP组病变较轻.(2)TLR2/4 mRNA表达:注射LPS后6 h、24 h,肺组织TLR2/4 mRNA表达升高(F=16.638,P=0.000;t=5.876,P=0.000);24 h时LPs+VIP组TLR2/4 mRNA表达低于LPS组(F=16.676,P=0.000;t=3.9,16,P<0.001).结论 LPS致休克大鼠肺损伤时,肺组织TLR2/4 mRNA表达增强.VIP可减轻LPS所致肺损伤,其机制可能与下调重要炎症基因TLR2/4 mRNA表达有关.     

Fetal stroke and cerebrovascular disease: Advances in understanding from lenticulostriate and venous imaging,alloimmune thrombocytopaenia and monochorionic twins

Fetal stroke is an important cause of cerebral palsy but is difficult to diagnose unless imaging is undertaken in pregnancies at risk because of known maternal or fetal disorders. Fetal ultrasound or magnetic resonance imaging may show haemorrhage or ischaemic lesions including multicystic encephalomalacia and focal porencephaly. Serial imaging has shown the development of malformations including schizencephaly and polymicrogyra after ischaemic and haemorrhagic stroke. Recognised causes of haemorrhagic fetal stroke include alloimmune and autoimmune thrombocytopaenia, maternal and fetal clotting disorders and trauma but these are relatively rare. It is likely that a significant proportion of periventricular and intraventricular haemorrhages are of venous origin. Recent evidence highlights the importance of arterial endothelial dysfunction, rather than thrombocytopaenia, in the intraparenchymal haemorrhage of alloimmune thrombocytopaenia. In the context of placental anastomoses, monochorionic diamniotic twins are at risk of twin twin transfusion syndrome (TTTS), or partial forms including Twin Oligohydramnios Polyhydramnios Sequence (TOPS), differences in estimated weight (selective Intrauterine growth Retardation; sIUGR), or in fetal haemoglobin (Twin Anaemia Polycythaemia Sequence; TAPS). There is a very wide range of ischaemic and haemorrhagic injury in a focal as well as a global distribution. Acute twin twin transfusion may account for intraventricular haemorrhage in recipients and periventricular leukomalacia in donors but there are additional risk factors for focal embolism and cerebrovascular disease. The recipient has circulatory overload, with effects on systemic and pulmonary circulations which probably lead to systemic and pulmonary hypertension and even right ventricular outflow tract obstruction as well as the polycythaemia which is a risk factor for thrombosis and vasculopathy. The donor is hypovolaemic and has a reticulocytosis in response to the anaemia while maternal hypertension and diabetes may influence stroke risk. Understanding of the mechanisms, including the role of vasculopathy, in well studied conditions such as alloimmune thrombocytopaenia and monochorionic diamniotic twinning may lead to reduction of the burden of antenatally sustained cerebral palsy.     

肾损伤因子在肾脏疾病中的应用

中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-assocliated lipocalin,NGAL)是脂质运载蛋白家族的新成员,存在于人类的一些正常组织中.近年来研究表明NGAL与肾脏疾病有一定的关系.NGAL是急性肾损伤的早期标志物,与传统的急性肾功能不全(ARF)实验室指标血肌酐相比,NGAL可以更早且准确地诊断ARF;NGAL在慢性肾脏疾病中也发挥着一定的功能,可体现慢性肾脏疾病的进展程度及治疗效果;在终末肾病中,NGAL可以作为血液透析以及疗效的指标.