损伤控制性手术与战伤救治

损伤控制性手术是近二十年来创伤外科领域中提出来的一个极有实用价值的外科原则。许多原来临床上认为已无法挽救的许多多发伤病人,在贯彻损伤控制手术理念后,能得到成功救治。故损伤控制外科的原则应在临床一线广泛推广。我国战伤救治过程中采用的是分级救治原则,伤员经过战伤分类、早期救治后,进行后送。在分级救治过程中,对严重创伤及复合伤,通过早期简略的手术,解决患者当时的主要矛盾,最后有计划选择时间,再次行确定性手术,有利于提高严重伤患者生存率,贯彻实施的是损伤控制理念。     

第三代腺病毒载体的改良与应用

腺病毒载体是一种非常有效的转基因载体,具有高效率、低致病性、高滴度及不整合入宿主细胞染色体等优点,广泛应用于基因治疗.第一、二代腺病毒载体仍有许多不足之处,在其基础上发展了第三代腺病毒载体.第三代腺病毒载体与前者相比,具有低免疫原性及高容量等优点,在基因治疗中表现出独特优势.然而,由于辅助病毒污染的存在及病毒产量有待提高,第三代腺病毒载体的临床应用仍面临一定困难.     

肠系膜上静脉血栓形成的诊断和治疗

目的 探讨肠系膜上静脉血栓形成的诊断及治疗。方法 总结１２例ＭＶＴ的诊治经验,从病因,诊断和治疗等方面进行分析。结果：１２例均经手术病理证实,初诊多数表现为急腹症,症状和体征不相符,９例误诊,３例术前确诊,全部行手术治疗,８例治傅,４例死亡。结论该病少见,症状和体征无特异性,难以做出准确的诊断,Ｂ超和ＣＴ是较敏感的检查,对诊断有积极的作用。     

失血性休克猪输注不同剂量游离血红蛋白后血清白细胞介素-12及γ-干扰素的含量变化及意义

目的 观察失血性休克猪输注不同剂量游离血红蛋白(FHb)后血清白细胞介素(IL)-12及γ-干扰素(IFN-γ)的含量变化,探讨FHb对休克动物免疫功能的影响.方法 30头家猪随机分为5组,分别给予不同剂量FHb(0、2.5、5、10、15 ms/ks体蕈),监测动物生命体征、各重要脏器功能变化以及多器官功能障碍综合症(MODS)的发生率,检测休克动物在输注不同剂量FHb后血清IL-12、IFN-γ的含情变化.结果 失血性休克猪在输注FHb后血清IL-12及IFN-γ含量明显下降(P<0.01),它们的变化趋势与FHb剂量呈负相关.其中输注FHb 15 ms/kg体重组动物MODS发生率与休克对照组比较明显增加(P<0.05).结论 FHb能明显抑制失血性休克动物抗原提呈细胞(APCs)的功能,使细胞免疫功能受到抑制;输注高剂量FHb(>15 mg/kg体重)会增加失血性休克动物MODS发生率.     

Clinical management of abdominal trauma

Objective： To improve the prognosis of patients with abdominal trauma.
Methods： Between January 1993 and December 2005, 415 patients were enrolled in this research. The patients consisted of 347 males and 68 females with mean age of 36 years （ranging from 3-82 years）. All abdominal traumas consisted of closed traumas （360 cases, 86.7%） and open traumas （55 cases, 13.3%）.Results： A total of 407 cases （98.1%） were fully recov- ered from trauma and the other 8 cases （1.9%） died of mul- tiple injuries. The mean injury severity score （ISS） of all patients was 22 while the mean ISS of the patients who died in hospital was 42. Postoperative complications were seen in 9 patients such as infection of incisional wounds （6 cases）, pancreatic fistula （2 cases） and intestinal fistula （1 case）. All these postoperative complications were cured by the conservative treatment. Conclusion： Careful case history inquisition and physical examination are the basic methods to diagnose abdominal trauma. Focused abdominal ultrasonography is always the initial imaging examination because it is non-invasive and can be performed repeatedly with high accuracy. The doctors should consider the severity of local injuries and the general status of patients during the assessment of abdominal trauma. The principle of treatment is to save lives at first, then to cure the injuries. Unnecessary laparotomy should be avoided to reduce additional surgical trauma.     

携带小鼠白细胞介素-12基因的增殖型腺病毒对胃癌细胞的作用

目的观察携带小鼠白细胞介素12(mIL12)基因的增殖型腺病毒载体对胃癌细胞的杀伤作用及mIL12表达情况。方法以携带目的基因的增殖型腺病毒CNHK200mIL12感染人胃癌细胞株SGC7901、人正常肝细胞株L02。首先,通过荧光显微镜下观察、细胞杀伤实验等观察病毒对细胞的杀伤能力;其次,通过Westernblot分析及双抗体夹心法(ELISA)检测mIL12表达情况。结果CNHK200mIL12感染SGC7901后,当MOI=10时即可杀伤大部分的肿瘤细胞,与ONYX015相当,而对正常细胞无明显杀伤。ELISA检测表明mIL12基因表达量达(267.2±34.6)ng/5×105个细胞/48h,较复制缺陷型腺病毒载体高近百倍。结论CNHK200mIL12能在胃癌细胞中复制及增殖杀死胃癌细胞,并高水平表达目的基因。     

腹部创伤后胃肠道损伤的院内救治

腹部创伤后胃肠道损伤是指贲门到腹膜反折以上直肠的空腔脏器及其系膜的损伤,在腹腔内脏器损伤中列第三位[1].现就我院1993-2005年收治的121例胃肠道损伤患者的诊治情况报告如下.     

化疗对CD133+结肠癌细胞的作用效果

目的 观察化疗前后结肠癌细胞株HT29、SW620中CD133+结肠癌细胞的数量变化,探讨化疗对CD133+结肠癌细胞的作用效果.方法 取对数生长的结肠癌细胞株HT29、SW620,采用80 mg/L 5-氟尿嘧啶(5-Fu)和25 mg/L奥沙利铂(Oxaliplatin)分别作用8 h,并设对照组,利用CD133抗体进行标记后再用流式细胞仪进行检测,观察化疗前后CD133+细胞的比例.结果 流式细胞仪检测结肠癌细胞株HT29,80 mg/L 5-Fu处理8 h组中CD133+肿瘤细胞为45.00%,与未处理组(32.80%)比较结果差异有统计学意义(P＜0.01);25 mg/L奥沙利铂处理8 h组中CD133+肿瘤细胞为55.30%,与未处理组和80 mg/L 5-Fu处理8 h组比较结果差异有统计学意义(P＜0.01).流式细胞仪检测结肠癌细胞株SW620,80 mg/L 5-Fu处理8 h组中CD133+肿瘤细胞为47.10%,与未处理组(33.90%)比较结果差异有统计学意义(P＜0.01);25 mg/L奥沙利铂处理8 h组中CD133+肿瘤细胞为56.50%,与未处理组和80 mg/L 5-Fu处理8 h组比较结果差异有统计学意义(P＜0.01).结论 CD133+结肠癌细胞能明显抵抗化疗.

Abstract：

Objective To observe the changes of quantity of CD133 + cells in HT29 and SW620 cell lines before and after chemotherapy, and detect the effect of chemotherapy on CD133 + cells. Methods HT29 and SW620 cells in logarithmic growth phase were separately treated with 80 mg/L 5-fluorouracil(5-Fu) and 25 mg/L oxaliplatin for 8 h, and analyzed by flow cytometry after being marked by CD133 antibody. The proportion of CD133 + cells before and after chemotherapy was measured. Results For HT29 cells, the proportion of CD133 + cancer cells in the group treated with 80 mg/L 5-Fu for 8 h was 45.00% with the difference being remarkable ( P ＜ 0. 01 ) compared to the non-treatment group ( 32. 80% ). The proportion of CD133 + cancer cells in the group treated with 25 mg/L oxaliplatin for 8 h was 55.30% with the difference being remarkable ( P ＜ 0. 01 ) compared with both the non-treatment group and the group treated with 80 mg/L 5-Fu for 8 h. For SW620 cells, the proportion of CD133 + cancer cells in the group treated with 80 mg/L 5-Fu for 8 h was 47. 10% with the difference being remarkable ( P ＜0. 01 ) compared with the non-treatment group (33.90%). The proportion of CD133 + cancer cells in the group treated with 25 mg/L oxaliplatin for 8 h was 56. 50% with the difference being remarkable ( P ＜ 0. 01 ) compared with both the non-treatment group and the group treated with 80 mg/L 5-Fu for 8 h. Conclusion CD133 positive colon cancer cells have anti-chemotherapy activity obviously.     

胃癌与细胞凋亡

细胞凋亡有其独特的形态学特点和生物学特点．肿瘤细胞也存在自发的细胞凋亡,只不过是肿瘤细胞凋亡与增殖的比例发生失调．肿瘤细胞存在的自发细胞凋亡受到药物、放射线、细胞因子、激素、基因编码等因素的影响［１］．细胞凋亡已成为肿瘤治疗的新途径．胃癌是消化道常见...     

外科感染耐药问题与对策

40年代．在青霉素尚未广泛应用于临床治疗之前．就发现对青霉素耐药的大肠杆菌．目前耐药菌株越来越多．重视外科感染耐药问题．对外科医生具有重要意义。一、外科感染细菌耐药的变迁。70年代以前外科感染以革兰氏阴性杆菌为常见。随着广谱抗生素．特别是第三代头抱类抗生素的应用,90年代以来耐药的革兰氏阳性球菌也变得常见．包括凝固酶阳性葡萄球菌、金黄色葡萄球菌及肠球菌等。致病菌的另一个重要变化趋势是多重耐药菌株普遍出现．如耐苯唑青霉素的金黄色葡萄球菌、耐万古霉素的类肠球菌、克雷伯菌属、肠杆菌属等。腹腔感染和大面积烧伤…