碱性成纤维细胞生长因子在治疗吸入性损伤中的疗效观察

目的：观察碱性成纤维细胞生长因子（BFGF）对吸入性损伤后气道粘膜及肺泡上皮的修复作用。方法：依据纤支镜结果将中、重度吸入性损伤分别随机分为BFGF治疗组与对照组。在相应时段进行纤支镜支气管肺泡灌洗术,摄像记录纤支镜所见及检测支气管肺泡灌洗液（BALF）中蛋白质含量、胶体渗透压（COP）与细胞分类计数。结果：在中、重度吸入性损伤中,其气道修复时间BFGF治疗组比对照组平均提前4．5天与3．3天;发生出血、气管支气管狭窄等并发症的机率平均降低64．65及31．9％。BFGF治疗组的BALF中总蛋白（TP）、白蛋白（ALb）、COP以及细胞总数、中性粒细胞、淋巴细胞数量均比对照组明显降低（P＜0．05）。结论：BFGF治疗中、重度吸入性损伤,能促进气道粘膜及肺泡上皮的修复。     

螺旋CT动态扫描对肝癌大血管侵犯的对比研究

目的 :进一步认识肝癌大血管侵犯的螺旋CT表现特征。方法 :75例肝癌伴大血管侵犯的病例中 ,2 6例前瞻性设计了动脉期同层面扫描加全肝门静脉期扫描的程序 ,选择兼顾病变及门静脉的靶平面 ,并与 31例双期扫描和 18例单纯门静脉期扫描的病例作对照。结果 :动脉期同层面扫描在动 静脉瘘和门静脉早显方面优于双期扫描 ,动脉期对显示大血管侵犯征象有特征性 ,癌栓在动脉期总强化率为 66 67% ( 38/ 5 7例 ) ,单纯门静脉期扫描不能显示动 静脉瘘和癌栓新生血管。结论 :动脉期同层面扫描能显示肿瘤和大血管侵犯引起的血流动力学异常 ,有助于定性和发现动 静脉瘘     

pCD-rbFGF重组质粒的构建及其在成骨细胞中的表达

为了构建碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)真核表达质粒,并探讨应用bFGF基因治疗骨科各种疾患的可能性,将鼠碱性成纤维细胞生长因子cDNA克隆至真核表达载体pcDNA3中,构建了重组质粒pCD-rbFGF.通过Liofectin介导将pCD-rbFGF转染兔成骨细胞,经免疫组化检测证实兔成骨细胞获得了bFGF的瞬时表达.提示该bFGF真核表达质粒有效,可用于进一步基因治疗研究.     

ALPPS与采用不同栓塞材料PVE对肝再生及手术切除率影响研究

目的 比较不同栓塞材料的门静脉栓塞术（PVE）与联合肝脏分隔和门静脉结扎的二步肝切除术（ALPPS）对剩余肝体积（FLR）增长速率的影响,比较各组FLR的增长速率,二期手术切除率、术中数据和术后并发症。方法 采用单中心、前瞻性、非随机对照的对比研究。2014年11月至2019年12月,海军军医大学第三附属医院共126例因FLR不足导致无法切除的肝细胞癌（HCC）或肝内胆管癌（ICC）病人,将其分为4组：ALPPS组及分别采用氰基丙烯酸正丁酯（NBCA）、微球、明胶海绵作为栓塞材料的PVE组。主要终点为FLR增长速率和二期手术切除率。结果 各组的手术切除例数及二期手术切除率分别为：ALPPS组38例（99.4%）,NBCA组32例（76.2%）,明胶海绵组20例（60.6%）,微球组10例（83.3%）。ALPPS组、NBCA组、微球组的FLR增长速率分别为15.1 mL/d,10.0 mL/d和 8.5 mL/d,均高于明胶海绵组（3.7 mL/d）。结论 采用NBCA及微球作为栓塞材料的PVE导致FLR增长速率低于ALPPS,两种栓塞材料的PVE二期手术切除率相当。使用NBCA作为栓塞材料的PVE其FLR增长速率高于微球,且这两种栓塞材料的栓塞效果均优于明胶海绵。     

Functional transition: Inconsistently parallel to the increase in future liver remnant volume after preoperative portal vein embolization

BACKGROUNDPreoperative portal vein embolization (PVE) is a widely used strategy to enable major hepatectomy in patients with insufficient liver remnant. PVE induces hypertrophy of the future liver remnant (FLR) and a shift of the functional reserve to the FLR. However, whether the increase of the FLR volume (FLRV) corresponds to the functional transition after PVE remains unclear.AIMTo investigate the sequential relationship between the increase in FLRV and functional transition after preoperative PVE using 3-dimensional (3D) computed tomography (CT) and ^99mTc-galactosyl-human serum albumin (^99mTc-GSA) single-photon emission computed tomography (SPECT) fusion images. METHODSThirty-three patients who underwent major hepatectomy following PVE at the Department of Gastroenterological Surgery I, Hokkaido University Hospital between October 2013 and March 2018 were enrolled. Three-phase dynamic multidetector CT and ^99mTc-GSA SPECT scintigraphy were performed at pre-PVE, and at 1 and 2 wk after PVE; 3D ^99mTc-GSA SPECT CT-fused images were constructed from the Digital Imaging and Communications in Medicine data using 3D image analysis system. Functional FLRV (FFLRV) was defined as the total liver volume × (FLR volume counts/total liver volume counts) on the 3D ^99mTc-GSA SPECT CT-fused images. The calculated FFLRV was compared with FLRV.RESULTSFFLRV increased by a significantly larger extent than FLRV at 1 and 2 wk after PVE (P < 0.01). The increase in FFLRV and FLRV was 55.1% ± 41.6% and 26.7% ± 17.8% (P < 0.001), respectively, at 1 wk after PVE, and 64.2% ± 33.3% and 36.8% ± 18.9% (P < 0.001), respectively, at 2 wk after PVE. In 3 of the 33 patients, FFLRV levels decreased below FLRV at 2 wk. One of the three patients showed rapidly progressive fatty changes in FLR. The biopsy at 4 wk after PVE showed macro- and micro-vesicular steatosis of more than 40%, which improved to 10%. Radical resection was performed at 13 wk after PVE. The patient recovered uneventfully without any symptoms of pos-toperative liver failure.CONCLUSIONThe functional transition lagged behind the increase in FLRV after PVE in some cases. Evaluating both volume and function is needed to determine the optimal timing of hepatectomy after PVE.     

The beneficial impacts of splanchnic vasoactive agents on hepatic functional recovery in massive hepatectomy porcine model

BackgroundExcessive portal pressure after massive hepatectomy can cause hepatic sinusoidal injury and have deleterious impacts on hepatic functional recovery, contributing to developing post-hepatectomy liver failure. This study aimed to assess the effects of splanchnic vasoactive agents on hepatic functional recovery and regeneration while clarifying the underlying mechanism, using a 70% hepatectomy porcine model.MethodsEighteen pigs undergoing 70% hepatectomy were involved in this study and divided into three groups: control (n=6), terlipressin (n=6), and octreotide (n=6). Terlipressin (0.5 mg) and octreotide (0.2 mg) were administered 3 times a day for each group with the first dose starting just before surgery until the 7th postoperative day, at which time the surviving pigs were sacrificed. During the period, portal pressure, liver weight, biochemical analysis, histological injury score, and molecular markers were evaluated and compared between groups.ResultsThe 7-day survival rates in the octreotide, terlipressin, and control groups were 100%, 83.3%, and 66.7%, respectively. The portal pressures decreased in both terlipressin and octreotide groups than the control group at 30 minutes, 1 hour and 6 hours after hepatectomy. The amount of regeneration measured by liver weight to body weight ratio at the time of sacrifice in the terlipressin group was smaller than that in the control group (117% vs. 129%, P=0.03). Serum aspartate aminotransferase (AST) and total bilirubin levels at 1 and 6 hours after hepatectomy and prothrombin time/international normalized ratio (PT/INR) at 6 hours after hepatectomy were significantly improved in the terlipressin and octreotide groups compared to the control group. Serum endothelin-1 (ET-1) was significantly lower in the terlipressin group than that in the control group 6 hours after hepatectomy (P<0.01). The histological injury score in the control group was significantly higher than that in the terlipressin group on the 7th postoperative day (P<0.01).ConclusionsSplanchnic vasoactive agents, such as terlipressin and octreotide, could effectively decrease portal pressure and attenuate liver injury after massive hepatectomy.     

The parabiliary venous system

Summary The parabiliary venous system originates from the pancreatico-duodenal and pyloro-duodenal veins, runs along the common bile-duct and the hepatic artery, and divides in the liver hilum into a venous network within the hilar plate. Embryologically, this system, apparently independent of the portal vein, develops together with the bile-ducts and the hepatic artery: these three structures are within the substance of the vasculo-biliary sheaths, and the whole complex invades the liver well after the distribution of the portal vein has been established. It should be pointed out that segments I and IV also appear rather late. Seventy-four specemins with injection of the system have been studied. The hilar plexus sends branches to the veins of the segments adjacent to the hilum. Some vessels directly supply the inferior surface of the quadrate lobe or the caudate lobe, or the left lobe. In 46.50% of specemins, part of the cystic veins are anastomosed with the Parabiliary system.

---

Le système veineux parabiliaire

Résumé Le système veineux parabiliaire prend origine dans les veines pancréatico-duodénales et pyloro-duodénales, monte le long de la voie biliaire et l'artère hépatique, et se termine dans le hile dans un lascis veineux situé dans la plaque hilaire. Embryologiquement il semble étranger à la formation de la veine porte, se constitue en même temps que les canaux biliaires et les artères intra-hépatiques: ces trois éléments sont situés dans la texture même des enveloppes vasculo-biliaires, et le tout envahit le foie bien après la pénétration de la veine porte. L'étude porte sur 74 foies dans lesquels le système s'est trouvé injecté. Le plexus hilaire envoie des collatérales qui se jettent dans les veines des segments adjacents au hile. Mais certaines branches irriguent directement la face inférieure du lobe carré, ou le lobe gauche. Dans 46,50% des cas, une partie des veines cystiques se jettent dans ce système.

     

bFGF、FGF受体I在HEp-2喉癌和MGE803胃癌细胞株中表达的检测

目的　通过对碱性成纤维细胞生长因子 (basicfibroblastgrowthfactor ,bFGF) ,成纤维细胞生长因子受体 1(fibroblastgrowthfactorreceptor 1,FGFR 1)的检测 ,揭示两者在体内外的表达以及与肿瘤形成的关系。　方法　采用免疫组织化学的检测方法 ,检测了体外培养的HEP 2喉癌细胞和MGE80 3胃癌细胞以及由两者在裸鼠皮下形成的实体瘤组织中bFGF和FGFR 1的表达情况。　结果　在体外培养的这两种肿瘤细胞中bFGF的阳性染色存在于整个细胞。FGFR 1的染色主要存在于细胞核。在两种肿瘤细胞形成的实体瘤组织中bFGF和FGFR 1阳性染色细胞主要是围绕于坏死区的肿瘤细胞。　结论　此两种肿瘤细胞在体内外均能表达bFGF和FGFR 1。bFGF与其高亲和力受体FGFR 1结合后进入细胞核 ,并在细胞核内发挥其生物功能 ,参与了肿瘤组织的形成和发展。     

Vitreoretinal toxicity of basic fibroblast growth factor

Basic fibroblast growth factor (b-FGF) is one of the multifunctional growth factors with important therapeutic potential in the field of ophthalmology. It is also implicated in pathogenesis of vitreoretinal proliferative diseases. In the present study, we evaluated its vitreoretinal toxicity by means of clinical observation, electroretinography (ERG), and histopathology after injection of different doses of b-FGF into the vitreous of rabbit eyes. Doses of b-FGF up to 2 g per eye caused no toxicity; however, injection of 4 g or more resulted in sight-threatening vitreoretinal proliferative changes. This information is important for studies aimed at evaluating the therapeutic potential of b-FGF in retinal diseases.Despite some degree of vitreous organization and opacification, retinal folds, and small areas of traction retinal detachment, the amplitudes of ERGs were normal or even increased (hyperpolarization) in eyes which received 8 g of b-FGF.