异体甘油保存皮与自体微粒皮复合移植的临床应用

目的：寻找深度大面积\烧伤的早期治疗方法。方法:大面积深度烧伤于4－5天即行切痂，以异体甘油皮为支架，将有限的自体皮制作成微粒皮后均匀地复合植于创面。结果：对5例共12个肢体2个躯干进行早期切痂后异体甘油皮＋自体微粒皮的复合移植，成活后的创面平堤，外观平整，颜色淡红或近拟正常皮肤，触饮，收缩少，结论：异体甘油保存皮＋自体微粒皮复合移植是大面积深度烧伤较理想的治疗方法。     

无创伤性测定门静脉压力与肝血流二法联合应用研究肝硬化的价值

目的　为临床研究肝硬化提供有价值的手段。方法　采用99mTc -RBC测定 93例肝硬化患者肝血流 ,选择峰时 (Tmax) ,半廓清时 (T1/2 )、廓清率 (K值 )、肝血流 (LBF)等作为观察指标 ,与正常对照组比较 ;同时用99mTc-MIBI经直肠给药测定其中 5 4例患者门静脉压力 (PVP) ,以心 /肝 (H/L)比值作为分流指数。结果　肝硬化组Tmax、T1/2 、K及LBF分别为 1.2 6± 0 .99(93)min、5 .75± 3.38(93)min、0 .15 4± 0 .116 (93)及 0 .6 10± 0 .2 89(93)L/min ,除Tmax外 ,与对照组均有非常显著性差异 ;Child -A、B、C级各组之间 (除Tmax外 )也均有非常显著性差异或显著性差异 ;Child -A、B、C级各组H/L分别为 0 .49± 0 .18(2 1)、0 .6 9± 0 .16 (15 )、0 .91± 0 .2 1(18) ;PVP分别为 2 .2 2± 0 .5 7(2 1)kPa、2 .85± 0 .38(15 )kPa及 3.5 4± 0 .6 5 (18)kPa。而对照组的H/L及PVP分别为 0 .30± 0 .12 (16 )及 1.6 1± 0 .38(16 )kPa。Child -A、B、C级各组分别与对照组及各组之间比较 ,除Child -B与C级组PVP无显著性差异 (P >0 .0 5 )外 ,其余均有非常显著性差异 (P <0 .0 1)及显著性差异 (P <0 .0 5 )。结论　本法测定肝血流及门脉压力方便 ,无创伤 ,对分析病情 ,判断疗效 ,指导制订治疗方案 ,估计预后等均有较     

On the Role of Proteasomes in Cell Biology and Proteasome Inhibition as a Novel Frontier in the Development of Immunosuppressants

The proteasome, a large protease complex in cells, is the major machinery for protein degradation. It was previously considered a humble garbage collector, performing housekeeping duties to remove misfolded or spent proteins. Until recently, the interests of immunologists in proteasomes were focused largely on its role in antigen processing. Its real importance in cell biology has only been revealed contemporarily due to the availability of relatively specific inhibitors. It has now become increasingly clear that many aspects of immune responses highly depend on proper proteasome activity. Recently, a proteasome inhibitor has been successfully used to prevent acute as well as ongoing heart allograft rejection in mice. Such inhibitors are also efficacious in treating several autoimmune diseases, such as arthritis, psoriasis, and probably type I diabetes, in animal models. Phase II and III clinical trials of proteasome inhibitors in treating various tumors have shown promising results, and the side-effects of these drugs are tolerable. Therefore, proteasome inhibition represents a new and promising frontier in immunosuppressant development.     

Cranial nasal bone grafts

Reconstitution of the nasal scaffolding with maintainence of soft tissue proportions either following severe facial trauma or as a sequela to aesthetic rhinoplasty misadventures frequently is best achieved using the stability afforded by bone grafts. Split cranial bone grafts offer many advantages and may be the donor site of choice, and may even allow such surgery to be performed on an outpatient basis in some cases. The use of miniplate or screw osteosynthesis, now commonly accepted as a superior technique in craniomaxillofacial procedures, may simplify fixation of these calvarial nasal bone grafts with an apparent decrease in the risk of resorption.     

自体大隐静脉移植治疗周围血管损伤22例分析

目的：探讨周围血管损伤自全大隐静脉移植治疗的方法。适应证和治疗效果。方法：回顾性分析22例周围血管损伤自体大隐静脉移植治疗的临床资料，并阐述了术中注意事项，提出最佳手术时机及预后情况。结果：22例均采用自体大隐静脉移植，痊愈19例（86.4%)。截肢3例（13.6%），22例患者无死亡，随访2-9年，20例肢体功能恢复满意，2例移植段狭窄，但肢体功能良好。结论：自体大隐静脉移植是治疗周围血管损伤行之有效的方法之一。血管吻合的时间应在24h以内，最佳为8h以内。     

耳垂复合组织游离移植修复鼻小柱过短畸形

目的 探讨因鼻小柱过短所致鼻尖低平畸形的矫治方法.方法 对8例鼻尖低平伴鼻小柱过短者,采用鼻小柱切口,首先应用肋软骨或Medpor行支撑杆移植矫正撑起鼻尖,鼻小柱切口的继发创面采用耳垂复合组织游离移植修复.结果 8例游离移植的耳垂复合组织均成活良好,随访1～2年形态满意,色泽与周围组织无明显差别,供区无明显继发畸形.结论 应用耳垂复合组织游离移植修复鼻小柱过短畸形,不仅适用于外伤性缺损修复,而且也适用于鼻部的美容性修复,是一种患者容易接受、操作简单安全、疗效好、供区无后遗明显继发畸形的修复方法.     

Thyroid Hormone in the Treatment of Post-transplant Acute Tubular Necrosis (ATN)

Delayed graft function (DGF) in cadaver kidney transplants is a common problem and is often due to acute tubular necrosis (ATN). DGF in transplants may have a deleterious effect on long-term graft survival. Since thyroid hormone has been shown to hasten recovery from ATN in experimental models, we designed a trial to determine if a defined course of triiodothyronine (T3) would improve the short- or long-term outcome of patients with DGF in cadaveric transplants. A prospective, randomized, placebo controlled, double blind trial of T3 was carried out in patients with DGF in cadaveric renal transplants. End-points were percentage requiring dialysis, percentage recovering function, time to recovery and length of hospital stay. Long-term outcomes were percentage grafts functioning at 1 year and mean serum creatinine at 1 year. Forty-four patients were randomized to receive either T3 or placebo. Three patients were dropped from each group when early biopsies disclosed that DGF was due to rejection. The groups were well matched by age, cold ischemia time of the graft, and percentage reactivity to a random panel of antigens. Baseline thyroid function studies, including T3, reverse T3 (rT3), and thyroid stimulating hormone (TSH) levels, were similar between the two groups and typical of 'euthyroid-sick syndrome'. T3 had no effect on percentage requiring dialysis, time to recovery, percentage recovering function, or length of stay. At 1 year follow-up, graft function was similar in both groups and significantly lower than that seen in patients with good initial function. Thyroid hormone, given early in the course of DGF in cadaver kidney recipients, had no effect on the course of DGF. Long-term graft function is impaired in patients who experience post-transplant DGF compared to those who have good initial function.     

7例睾丸静脉和2例卵巢静脉变异的解剖学研究

目的：了解睾丸静脉和卵巢静脉的变异。方法：观测了73具（146侧）成人尸体（男58，女15）两种静脉的形态结构。结果：发现两种静脉有变异者7例，其中睾丸静脉5例，卵巢静脉2例，另外，作者还对变异与国内文献作了比较。结论：本研究为探讨睾丸静脉和卵巢静脉曲张发生原因及治疗等提供解剖学资料。     

The Broad Spectrum of Quality in Deceased Donor Kidneys

The quality of the deceased donor organ clearly is one of the most crucial factors in determining graft survival and function in recipients of a kidney transplant. There has been considerable effort made towards evaluating these organs culminating in an amendment to allocation policy with the introduction of the expanded criteria donor (ECD) policy.
Our study, from first solitary adult deceased donor transplant recipients from 1996 to 2002 in the National Scientific Transplant Registry database, presents a donor kidney risk grade based on significant donor characteristics, donor–recipient matches and cold ischemia time, generated directly from their risk for graft loss. We investigated the impact of our donor risk grade in a naïve cohort on short- and long-term graft survival, as well as in subgroups of the population.
The projected half-lives for overall graft survival in recipients by donor risk grade were I (10.7 years), II (10.0 years), III (7.9 years), IV (5.7 years) and V (4.5 years). This study indicates that there is great variability in the quality of deceased donor kidneys and that the assessment of risk might be enhanced by this scoring system as compared to the simple two-tiered system of the current ECD classification.     

Partial Portal Vein Ligation Plus Thioacetamide: A Method to Obtain a New Model of Cirrhosis and Chronic Portal Hypertension in the Rat

To obtain a new model of chronic portal hypertension in the rat, two classical methods to produce portal hypertension, partial portal vein ligation and the oral administration of thioacetamide (TAA), have been combined. Male Wistar rats were divided into four groups: 1 (control; n?=?10), 2 [triple partial portal vein ligation (TPVL); n?=?9], 3 (TAA; n?=?11), and 4 (TPVL plus TAA; n?=?9). After 3 months, portal pressure, types of portosystemic collateral circulation, laboratory hepatic function tests (aspartate aminotransferase, alanine aminotransferase, bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase) and liver histology were studied. The animals belonging to group 2 (TPVL) developed extrahepatic portosystemic collateral circulation, associated with mesenteric venous vasculopathy without hepatic destructurization or portal hypertension. Animals from group 3 (TAA) developed cirrhosis and portal hypertension but not extrahepatic portosystemic collateral circulation, or mesenteric venous vasculopathy. Finally, the animals from group 4 (TPVL?+?TAA) developed cirrhosis, portal hypertension, portosystemic collateral circulation, and mesenteric venous vasculopathy. The association of TPVL and TAA can be used to obtain a model of chronic portal hypertension in the rat that includes all the alterations that patients with hepatic cirrhosis usually have. This could, therefore, prove to be a useful tool to study the pathophysiological mechanisms involved in these alterations.