几丁糖对大鼠术后腹腔粘连的预防作用

目的　探讨几丁糖对术后腹腔粘连的预防作用。方法　将 45只大鼠随机分为对照组 (A组 ) ,右旋糖酐组 (B组 ) ,几丁糖组 (C组 ) ,于腹腔内浆膜损伤部位分别注入 1%乳酸液 ,3 2 %右旋糖酐 -70液 ,2 %几丁糖乳酸液各 2ml ,术后 14d处死动物 ,观察各组腹腔粘连状况并送病理检查。结果　 3组粘连分级有显著性差异 (P <0 .0 1) ;C组粘连发生率较另 2组为低 ,有显著性差异 (P <0 .0 5 )。光镜下C组炎症反应轻微 ,纤维增生不明显 ;电镜下C组纤维细胞分泌胶原能力弱 ,间皮细胞增生活跃。结论　几丁糖可有效地降低大鼠术后腹腔粘连的发生和粘连程度 ,其作用优于右旋糖酐 -70 ,且不影响切口的愈合。     

中医整体排毒疗法对终末期肾功能衰竭的治疗作用

[目的]观察张琪“保元降浊八法”等中医整体排毒疗法对终末期肾功能衰竭(简称肾衰)的治疗作用及对其预后影响。[方法]对肾小球滤过率小于10 mL/min、未进行维持性透析的终末期肾衰患者32例采用中医整体排毒疗法,包括口服中药汤剂、口服中药制剂、中药结肠透析以及对症处理和必要时给予临时透析治疗。观察患者存活情况、中医征候和证型变化情况,检测患者的血生化等指标,并对其中尚存活者与已死亡病例进行对比分析。[结果]终末期肾衰患者未能进行透析等替代治疗者,中医证侯属本虚标实、寒热错杂,病变过程中其证候不断发生改变。经中医整体排毒疗法治疗后,患者3个月存活率为90.6％,半年存活率81.3％,1年存活率71.9％。将其中尚存活病例(存活组)和已病死病例(死亡组)比较,两组年龄、病程、血清肌酐、尿素氮、血红蛋白均无显著性差异(P>0.05),但存活组尿量多于死亡组(P<0.01),血清白蛋白也较高(P<0.05)。[结论]中医整体排毒疗法对于因经济等原因不能接受维持性透析的终末期肾衰患者仍有改善临床症状,稳定血肌酐、尿素氮、血红蛋白、血清白蛋白等作用,是维持终末期患者继续生存的有效疗法;终末期患者的尿量、血清白蛋白水平与能否长期存活有一定的关系。如能有意识地改善这类患者的尿量和营养状况,对延长他们     

胃癌的综合治疗

目的 评价胃癌综合治疗的效果。方法 回顾性分析１９８４年１０月～１９９９年１０月接受治疗的２０４例胃癌病人的临床资料。结果 综合治疗组５年生存率为４１．２％,单纯手术组５年生存率为２０．６％（Ｐ〈０．０１）。结论 以手术为主,辅以腹腔灌注化疗、全身化疗、免疫治疗的综合治疗能显著改善胃癌病人的预后。     

进展期胃癌根治术后的辅助治疗

目的 介绍进展期胃癌根治术后的辅助治疗进展动态。方法 复习相关文献,作综合性报道。结果与结论 对胃癌根治患者有必要行全身静脉化疗,但方案要个体化;腹腔内温热灌注化疗是肯定、副作用较小的局 疗方法;淋巴化疗及免疫化疗有一定的临床效果,主射化疗是效疗的发展趋势。     

Intracolonic Release of Nitric Oxide During Trinitrobenzene Sulfonic Acid Rat Colitis

Nitric oxide is thought to play an importantrole in modulating the inflammatory process. Recently anincrease in the inducible form of nitric oxide synthase(iNOS) has been found in the rat trinitrobenzene sulfonic acid model of experimental colitis,and inhibition of nitric oxide synthase activityresulted in an amelioration of tissue injury. The aim ofour study was to evaluate in vivo intracolonic release of nitric oxide in this model of colitis.Experimental colitis was induced in male Sprague-Dawleyrats by a single intracolonic administration oftrinitrobenzene sulfonic acid. Nitrite levels weredetermined in rectal dialysates by HPLC. The tissuemyeloperoxidase and iNOS and the luminal leukotrieneB₄ were also measured. Nitrite levels weresignificantly increased in rectal dialysates duringcolitis and correlated significantly with tissue myeloperoxidase andiNOS activity. The correlation between nitrite dialysatelevels and wall iNOS activity confirms that nitrite indialysates is produced by inflammatory cells and not by colonic bacterial flora.Determination of nitrite levels in rectal dialysatesseems a valuable method to monitor colonic inflammationin rat trinitrobenzene sulfonic acid colitis.     

原发性肠系膜实体瘤32例分析

目的探讨原发性肠系膜实体瘤的诊断和治疗方法。方法回顾性地分析３２例肠系膜实体瘤的临床资料。结果３２例中恶性２０例（６２５０％）、良性１２例（３７５０％）。病理报告以恶性淋巴瘤为最多,平滑肌肉瘤次之。肿瘤多位于回肠系膜和小肠系膜根部,临床误诊率高（９０６２％）。结论本病术前确诊率低（本组９３８％）,手术切除肿瘤仍为当前主要治疗方法。不能行根治性切除的肿瘤或术后肿瘤复发者,应积极行手术减瘤或再减瘤治疗。恶性淋巴瘤患者,术后辅以放疗和化疗是获得长期生存的有效措施之一。     

腹腔粘连患者腹腔镜胆囊切除术闭合法建立气腹

目的 探讨腹腔粘连患者腹腔镜胆囊切除术（LC）闭合法建立气腹的方法。方法 回顾性分析1991年9月－1999年9月6600例LC中1046例腹腔粘连患者闭合法建立气腹的经过。建立气腹困难分为真性建立气腹困难及假性建立气腹困难2种。由于气腹针穿入腹腔脏器或腹腔广泛粘连导致气体弥散困难引起的建立气腹困难称真性建立气腹困难,需中转开腹手术;由于气腹针位置错误如位于腹膜外脂肪层、肝园韧带或大网膜内引起的建立气腹困难称假性建立气腹困难,调整气腹针位置,均能满意建立气腹。结果 1046例中1028例成功建立气腹。5例因真性建立气腹困难,13例因假性建立气腹困难而中转开腹。本组腹腔粘连患者闭合法建立气腹成功率为98．3％。结论 腹腔粘连患者闭合法建立气腹是安全可行的。缺乏自信、经验不足、误把假性建立气腹困难当作真性建立气腹困难是腹腔粘连患者闭合法建立气腹失败的主要原因。     

Incidence of Fractures Before and After Dialysis Initiation

Fractures are common in dialysis patients, but little is known about the trajectory of incidence rates of different types of fractures before and after dialysis initiation. To address this, we investigated the incidence of major fractures before and after dialysis initiation. We performed a retrospective statistical analysis using the Swedish Renal Registry of 9041 incident dialysis patients (median age 67 years, 67% men) starting dialysis 2005 through 2015 to identify major fractures (hip, spine, humerus, and forearm) occurring during the dialysis transition period from 1 year before until 1 year after dialysis initiation. Using flexible parametric hazard models and the Fine-Gray model, we estimated adjusted fracture incidence rates and predictors of major fractures. We identified 361 cases with primary diagnosis of major fracture, of which 196 (54%) were hip fractures. The crude incidence rate of major fractures before dialysis initiation was 17 per 1000 patient-years (n = 157) and after dialysis initiation it was 24 per 1000 patient-years (n = 204). The adjusted incidence rate of major fractures began to increase 6 months before dialysis initiation, and then stabilized at a higher rate after 1 year. The adjusted incidence rate of hip fractures started to increase sharply 3 months before dialysis initiation, peaked at initiation, and declined thereafter. In contrast, the adjusted incidence rate of non-hip fractures was stable during the transition period and gradually increased over time. Higher age, female sex, and history of previous major fractures were associated with increased fracture incidence both before and after dialysis initiation. We conclude that the incidence of major fractures, especially hip fractures, start to rise 6 months before initiation of dialysis therapy, indicating that heightened surveillance with implementation of preventive measures to avoid fractures is warranted during the transition period to dialysis. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).     

Intracellular Calcium Affects Neutrophil Chemoattractant Expression by Macrophages in Rats with Cerulein-Induced Pancreatitis

Pancreatitis complicated with infection oftenresults in the development of multiple organ failure. Weinvestigated the role of altered intracellular calciumas a priming signal for cytokine-induced neutrophil chemoattractant expression in this process.Agents modulating cytosolic Ca²⁺ wereutilized to study the in vivo and in vitrocytokine-induced neutrophil chemoattractant expressionfor macrophages in rats with cerulein-induced pancreatitis afterintraperitoneal administration of lipopolysaccharide asa septic challenge. Pretreatment with the calciumchannel blocker verapamil significantly reduced serumcytokine-induced neutrophil chemoattractant concentrations inrats with cerulein-induced pancreatitis after septicchallenge. Lipopolysaccharide-stimulated in vitrocytokine-induced neutrophil chemoattractant (CINC)production by peritoneal macrophages was significantlyenhanced by pretreatment with thapsigargin (an inhibitorof the endoplasmic reticulum-resident Ca²⁺-ATPase), but not by A23187 (acalcium-specific ionophore, extracellular Ca²⁺ influx). Pretreatment withU73122 (a phospholipase C inhibitor) inhibitedlipopolysaccharide-stimulated but not basalcytokine-induced neutrophil chemoattractant production,while verapamil (a calcium channel blocker), TMB-8 (an inhibitor ofcalcium release from endoplasmic reticulum), and W7(calmodulin antagonist) completely abrogated thechemoattractant production. Altered intracellularcalcium, due to Ca²⁺ efflux from intracellularstores, may be involved in the priming ofmacrophages to release cytokine-induced neutrophilchemoattractant following triggering withlipopolysaccharide during acute cerulein pancreatitis.