As2O3碘油栓塞对兔VX2肝癌移植瘤凋亡、 增生及血管形成的影响

目的观察肝动脉As2O3碘油栓塞对兔肝移植瘤凋亡及增生细胞核抗原表达及微血管密度(MVD)的影响.方法 32只家兔肝内肿瘤种植后2周,随机分4组,经肝动脉插管分别给予不同处理,实验设生理盐水灌注组(A组)、单纯碘油栓塞组(B组)、阿霉素碘油栓塞组(C组)及As2O3碘油栓塞组(D组).治疗后1周,免疫组化方法测定肿瘤区的MVD值及增生细胞核抗原的表达,原位末端标记法检测肿瘤的凋亡指数.结果治疗后1周,单纯碘油栓塞及阿霉素碘油栓塞组,残余肿瘤区的MVD略有升高,与生理盐水对照组相比,统计学无显著性意义;As2O3碘油栓塞组残余瘤区MVD减低,与其他组相比差异具有显著性意义.各组凋亡指数和增殖指数分别为1.53±0.42、2.66±0.54、2.91±0.32、3.44±0.65和60.8±15.5、42.4±11.2、40.6±8.8、28.5±5.7,两者存在负相关.结论 As2O3碘油栓塞可以通过诱导肿瘤细胞凋亡,抑制肿瘤细胞增生发挥抗肿瘤效应,As2O3碘油栓塞可以抑制残余肿瘤的血管新生.     

纳米羟基磷灰石碘油混合物栓塞治疗兔VX2肝肿瘤

目的评价纳米羟基磷灰石(nHAP)碘油混合物治疗兔VX2肝肿瘤的效果。方法将荷瘤兔随机分成3组:A:生理盐水组,B:碘油组,C:nHAP-碘油组,每组20只,开腹经肝动脉注入生理盐水、碘油、nHAP-碘油,比较术后3组肿瘤大小及生长率,ALT、AST水平及瘤兔存活期的差异。结果术后1、2周C组肿瘤体积及生长率明显小于B组和A组,且差异均有统计学意义(P< 0.05);术后1、3、5 d,C组和B组ALT、AST水平高于A组,且差异有统计学意义(P<0.05),术后7 d,各组差异无统计学意义(P>0.05);C组瘤兔的生存期(55.0±9.1)d与A组(38.0±6.4)d、B组(45.5±7.6)d,差异均有统计学意义(P<0.05)。结论nHAP-碘油混合物能降低肿瘤生长率,延长瘤免的生存时间,且该混合物无明显肝毒副作用。     

肝脏肿瘤肝切除术前选择性门静脉栓塞的临床应用

目的 探讨选择性门静脉栓塞技术细节及其在残余肝容积不足患者肝切除术前应用的临床意义.方法 2008年1月至2012年7月,6例肝脏肿瘤因残余肝容积不足,二期肝切除术前行选择性门静脉栓塞术.结果 6例选择性门静脉栓塞术均成功.无手术并发症,栓塞对肝功能影响轻微.术前,6例残余肝容积平均(474.33 ±89.19) cm3,术后6周,平均(722.67±151.51) cm3,术前术后残余肝容积比较差异有统计学意义(t=-5.587,P=0.003).术前6例肝脏肿瘤负荷(瘤体总体积)平均(134±181) cm3,栓塞术后6周,肿瘤负荷平均为(270±346) cm3,栓塞前后肿瘤负荷比较差异无统计学意义(t=-1.64,P=0.16).5例二期肝切除术顺利.1例未行肝切除术.随访中位时间为37个月,4例存活(2例无瘤生存),1例死亡.结论 门静脉选择性栓塞是肝切除前增加残余肝容积的有效技术手段;经同侧(患侧)人路并选择弹簧圈作为栓塞材料简单易行、安全、有效.门静脉栓塞前,应以化疗或选择性肝动脉化疗栓塞等手段有效控制肿瘤生长.     

羟基磷灰石纳米粒子瘤内注射对兔肝VX2种植瘤生长的影响

目的 研究羟基磷灰石纳米粒子瘤内注射对兔肝VX2种植瘤生长的影响.方法 将接种VX2肝肿瘤的新西兰白兔随机分成4组,每组10只.A组:肝种植瘤内注入含0.2%羧甲基纤维素钠的生理盐水1 ml;B组:注入20 mg/ml 5-Fu 1 ml;C组:注入20 mg/ml Nano-HAP溶胶1 ml;D组:注入同样浓度5-Fu和Nano-HAP混合液2 ml.四组实验动物于注药后7、14、21 d行肝脏B超扫描,记录生存时间,取肝肿瘤组织病理学检查.结果 术后7、14、21 d A组平均肿瘤体积分别为(4.93±0.76)cm3、(15.67±2.75)cm3和(52.36±10.57)cm3 ; B组为(4.16土0.33)cm3、(10.26±1.60)cm3和(18.89±4.65)cm3;C组为(1.43±0.13)cm3、(3.69±0.77)cm3和(9.51±2.09)cm3;D组为(2.80±0.46)cm3、(3.77±0.91)cm3和(8.46±0.95)cm3.B、C、D三组肿瘤体积均小于同期对照组,D组肿瘤体积最小.四组动物中位生存期分别为34、41、51和44 d.B、C、D三组生存期较对照A组延长.超声监测显示C、D组羟基磷灰石纳米粒子溶胶瘤内注射时可见肿瘤内强回声光点.多次注射后瘤体内可见钙化样强回声光团.HE染色后光镜下观察见A组和B组肿瘤组织出现多处片状坏死,C、D组注射区域呈片状坏死,被条索状或片状钙化灶分隔.结论 羟基磷灰石纳米粒子瘤内注射治疗兔VX2肝肿瘤是安全、可行的,对肿瘤生长有明显的抑制作用,未见毒性反应.     

兔肝癌肝动脉栓塞后肿瘤血管生成的变化

目的　观察肝癌肝动脉栓塞后肿瘤组织血管生成的变化。方法　建立兔肝癌模型 ,随机分栓塞组 (n =10 )和对照组 (n =10 )。于接种后 14d经肝动脉注入超液化碘油 (栓塞组 )或等量生理盐水 (对照组 )。栓塞后第 7天取肿瘤 ,免疫组织化学方法检测肿瘤组织微血管密度 (MVD)及血管内皮生长因子 (VEGF)蛋白的表达 ,逆转录 聚合酶链反应 (RT PCR)检测VEGFmRNA的表达。结果　栓塞组MVD (2 8.6± 10 .6)与对照组 (16.3± 6.9)比较差异有非常显著性 (t =3 .0 83 ,P <0 .0 1) ;栓塞后VEGF蛋白 (t =3 .0 75 ,P <0 .0 1)及VEGF165mRNA (t =3 .95 4,P <0 .0 0 1)表达水平显著增高 ;在栓塞组和对照组 ,VEGF蛋白表达均与MVD呈正相关 (r分别为 0 .69和 0 .72 ,P <0 .0 5 )。结论　肝动脉栓塞术可通过促使肿瘤细胞VEGF表达上调 ,从而促进肿瘤的血管生成 ,如果将介入栓塞与抗血管生成治疗相结合 ,可望提高栓塞治疗效果     

TFPI-2对胰腺癌细胞体内和体外侵袭能力的影响

目的 研究组织因子途径抑制物-2(TFPI-2)基因对人胰腺癌细胞系Panc-1细胞侵袭能力的影响.方法 通过脂质体法将TFPI-2基因转染到Panc-1细胞, 用RT-PCR和Western blot分别检测转染前、后TFPI-2 mRNA和相应蛋白的表达.Boyden小室法测定Panc-1-TFPI-2、Panc-1-V和Panc-1-P 3组细胞的体外侵袭能力的变化,同时将3组细胞分别接种裸鼠,观察其体内肿瘤生长及转移情况.结果 转染成功的Panc-1细胞有TFPI-2 mRNA及相应蛋白的表达; Panc-1-TFPI-2组、Panc-1-V组和Panc-1-P组细胞穿膜细胞数分别为(24.4±3.5)个、(61.3±4.1)个和(60.2±3.9)个,前者明显少于后两者(P＜0.05),提示Panc-1-TFPI-2组细胞的体外侵袭能力下降.3组细胞分别接种裸鼠,Panc-1-TFPI-2组肿瘤体积为(438.0±69.8) mm3,与Panc-1-V组的(852.0±102.9) mm3和Panc-1-P组的(831.0±78.1) mm3相比明显缩小,差异有统计学意义(P＜0.05); 镜下见Panc-1-V组和Panc-1-P组肿瘤组织浸润到肌层,有肝、肺转移灶,而Panc-1-TFPI-2组未见肌层浸润及肝、肺转移.结论 TFPI-2基因表达可抑制胰腺癌细胞系Panc-1的侵袭转移能力,为胰腺癌的基因治疗提供了实验依据.     

亚砷酸化疗对肝移植大鼠肝癌复发的抑制作用

目的 探讨亚砷酸全身化疗对大鼠肝移植术后肝癌复发的影响.方法 采用联合免疫抑制与循环肿瘤细胞攻击大鼠肝脏建立肝移植术后肝癌复发模型,40只Sprague-Dawley大鼠经门静脉注射肝癌Walker-256细胞株并随机分成对照组和化疗组.两组术后均给予免疫抑制剂,化疗组术后同时给予亚砷酸(1 mg/kg)全身化疗,观察大鼠存活和肿瘤复发情况,免疫组织化学染色法检测肝癌组织内增殖细胞核抗原(PCNA)的表达.比较两组生存时间和肿瘤肝内复发情况、荷瘤肝质量、荷瘤肝体质量比、肿瘤肝外转移及肿瘤组织中PCNA表达的差异.结果 对照组和化疗组大鼠存活时间分别为(17.2±7.3)d和(28.3±5.3)d,long-rank法显示差异有统计学意义(χ2=13.06,P<0.01),肝内复发率分别为100%(20/20)和95%(19/20, χ2=1.026, P>0.05), 荷瘤肝质量分别为(14.6±0.3)g和(12.7±0.3)g (t=2.205, P<0.05), 荷瘤肝体质量比分别为(7.21±0.12)%和(6.24±0.09)% (t=2.440, P<0.05),肿瘤肝外转移率分别为40%(8/20)和10%(2/20, χ2=4.80, P<0.05), PCNA指数分别为(80.8±2.1)%和(61.3±1.0)%(t=3.209,P<0.05).结论 静脉使用亚砷酸对肝移植术后肝癌复发大鼠肿瘤的恶性生长及肝外转移有一定的抑制作用.     

局部应用ADV-TK基因防止裸鼠肝癌切除后转移复发的实验研究

目的 探讨ADV-TK基因局部应用防止裸鼠肝癌根治性切除后转移复发的机制.方法 建立裸鼠肝癌模型后,行根治性切除,同时各组(对照组10只、肝断面注射基因组11只、腹膜后注射基因组11只)分别注射ADV-TK基因50μl,24h后腹腔注射更昔洛韦50μg/10g体重.治疗组各取1只注射含绿色荧光蛋白标记基因的裸鼠,24h后处死裸鼠,观察基因转染情况.6周后,处死其余裸鼠,分别检查肝内及腹腔内其他脏器、肺等转移、复发情况,测量复发肿瘤的体积.结果 (1)各器官均可见该基因转染.(2)肝内复发情况:复发肿瘤数目、体积及涉及肝叶数对照组为(8.7±6.5)、(2933±597)mm3、(4.3±2.2),肝断面注射基因组为(0±0)、(0±0)mm3、(0±0),腹膜后注射基因组为(2.2±1.3)、(265±109)mm3、(2.1±1.3),基因注射组各指标明显降低,分别与对照组比较,差异有统计学意义(x2=3.05,P<0.01,x2=5.32,P<0.01).(3)肿瘤的肺及远处转移情况:肺转移率、涉及器官数和AFP值对照组为(10/10)、(7.2±5.3)、(1322±702),肝断面注射基因组为(2/10)、(3.2±1.5)、(322±102),腹膜后注射基因组为(1/10)、(1.8±1.2)、(268±133),分别与对照组比较,差异有统计学意义(X2=4.33,P<0.01,x2=7.15,P<0.01).结论 ADV-TK基因局部注射可以转染裸鼠各内脏器官并可以抑制肝癌根治性切除后的转移、复发.     

兔肝肿瘤介入栓塞后血清VEGF早期改变的实验研究

目的：探讨对兔VX2肝肿瘤模型进行胃十二指肠动脉介入栓塞术,早期血清VEGF的改变及意义。方法：将40只接种VX2肿瘤组织2周的荷瘤兔随机分为两组：碘油组（n=20）和对照组（n=20）,通过超选择插管胃十二指肠动脉分别给予超液化碘油（0．3mL／只）、生理盐水（1mL／只）。1周后,应用酶联免疫吸附法（ELISA）测定兔血清VEGF的变化,免疫组织化学法（ABC）检测残余肿瘤组织的蛋白表达,定量PCR检测VEGFmRNA的表达改变。结果：介入栓塞后,碘油组血清VEGF1．42±0．29ng／mL,对照组1．12±0．21ng／mL,二者相比差异有统计学意义（P〈0．01）。碘油组残余肿瘤细胞VEGF的表达明显高于对照组（P〈0．01）,VEGFmRNA表达也高于对照组（P〈0.05）。结论：应用碘油介入栓塞兔VX2肝肿瘤术后,残余肿瘤组织表达VEGF明显升高,可作为预测残余肿瘤细胞转移复发的有效指标之一。     

WTp53基因联合双自杀基因介入途径治疗肝癌的实验研究

目的 探讨经介入途径多疗法、多基因联合治疗肝癌的可行性.方法 分别制备pCMV-p53质粒-脂质体复合物及浓缩的TK-CD逆转录病毒上清.新西兰大白兔50只建立兔肝癌模型.根据B超及CT扫描结果,选取肿瘤直径约2 cm的荷瘤兔45只,随机分为5组,每组9只.第1组为单纯生理盐水治疗组(对照组);第2组为单纯超液化碘油栓塞组;第3组为超液化碘油+p53组;第4组为超液化碘油+TK/CD组;第5组为超液化碘油+p53+ TK/CD组.经股动脉肝动脉插管成功并造影确定靶血管后,1.2F微导管超选择插管至肿瘤供血动脉,透视监视下按分组缓慢灌注实验药品.各组瘤兔分别于介入术前、术后10 d行B超和CT扫描,检测肿瘤最大径(a)和最小径(b),计算肿瘤体积(V=ab2/2)及肿瘤生长率.介入手术后8周,动物脱颈处死(包括观察期内自然死亡的),行常规病理检查及生存期的观测.结果 成功建立兔肝癌模型,插管及介入治疗顺利.治疗前各组肿瘤体积无统计学差异(P＞0.05).介入治疗后10 d对肝脏肿瘤体积变化进行分析显示,与对照组比较,各治疗均对肿瘤的生长具有显著抑制作用(P＜0.05),其中碘油栓塞+联合基因治疗组的效果最为显著.2×2析因分析表明:p53基因、TK/CD基因与碘油栓塞结合均有明显的抑制肿瘤生长的作用,但二者之间无交互协同作用(P=0.793).与对照组比较各治疗组动物生存期延长,差异均有统计学意义(P＜0.01),其中多疗法、多基因联合治疗组效果最为明显.结论 介入疗法可以为基因治疗提供理想的给药方法及途径.碘油栓塞、WTp53基因与TK/GCV、CD/5-Fc系统联合应用可以有效抑制肿瘤生长,延长动物生存期.     

Selective adenosine-A2A activation reduces lung reperfusion injury following transplantation

Background: The adenosine-A_2A receptor on the neutrophil is responsible for several anti-inflammatory actions. We hypothesized that DWH-146e, a selective adenosine-A_2A agonist, would reduce lung reperfusion injury following transplantation.MethodsWe used an isolated, whole blood–perfused, ventilated rabbit lung model. Donor rabbits underwent lung harvest after pulmonary arterial PGE₁ injection and Euro-Collins preservation solution flush, and lungs were preserved for 18 hours at 4°C. Group I lungs (n = 9) served as control subjects. Group II lungs (n = 9) were reperfused with whole blood that was first passed through a leukocyte-depleting filter. In group III (n = 9), DWH-146e was added to the blood reperfusate (25 μg/kg) immediately before reperfusion and was administered throughout the reperfusion period (1 μg/kg/min). All lungs were reperfused for 30 minutes.ResultsArterial oxygenation in group II and group III was significantly higher than that of group I after 30 minutes of reperfusion (514.27 ± 35.80 and 461.12 ± 43.77 vs 91.41 ± 20.58 mm Hg, p < .001). Pulmonary vascular resistance was significantly reduced in group III (22,783 ± 357 dynes · s · cm⁻⁵) compared to both group II and group I (31,057 ± 1743 and 36,911 ± 2173 dynes · s · cm⁻⁵, p < .001). Airway compliance was improved in groups II and III when compared to group I (1.68 ± 0.08 and 1.68 ± 0.05 vs 1.36 ± 0.13, p = .03). Microvascular permeability in group III was reduced to 106.82 ± 17.09 compared with 165.70 ± 21.83 ng Evans blue dye per gram of tissue in group I (p = .05). Group III myeloperoxidase activity was 39.88 ± 4.87 compared with 88.70 ± 18.69 ΔOD/g/min in group I (p = .03); group II myeloperoxidase activity was 56.06 ± 7.46.ConclusionsDWH-146e reduced lung neutrophil sequestration and dramatically improved pulmonary graft function. Neutrophils are important components of the inflammatory cascade of reperfusion injury and their source may include both the circulating blood and the lung graft itself. Selective adensosine-A_2A activation interrupts the neutrophil-mediated inflammatory response and reduces lung reperfusion injury following transplantation.     

Effect of peak inspiratory flow on gas exchange, pulmonary mechanics, and lung histology in rabbits with injured lungs

Purpose The aim of this study was to evaluate, using a rabbit model, the little-known effect of different levels of peak inspiratory flow on acutely injured lungs. Methods Fourteen male rabbits (body weight, 2711 ± 146 g) were anesthetized and their lungs were injured by alveolar overstretch with mechanical ventilation until Pa_O2 was reduced below 300 mmHg. Injured animals were randomly assigned to: the P group—to receive pressure-regulated volume-control ventilation (PRVCV; n = 7); and the V group—to receive volume-control ventilation (VCV; n = 7). Other ventilator settings were: fraction of inspired oxygen (FI_O2), 1.0; tidal volume, 20 ml·kg⁻¹; positive end-expiratory pressure (PEEP) 5 cmH₂O; and respiratory rate, 20 min⁻¹. The animals were thus ventilated for 4 h. Throughout the protocol, ventilatory parameters and blood gas were measured every 30 min. After the protocol, the lung wet-to-dry ratio and histological lung injury score were evaluated in the excised lungs. Results Throughout the protocol, peak inspiratory flow and mean inspiratory flow values in the P group were significantly higher than those in the V group (26.7 ± 5.0 l·min⁻¹ vs 1.2 ± 0.2 l·min⁻¹, and 4.3 ± 0.3 l·min⁻¹ vs 1.1 ± 0.1 l·min⁻¹; P < 0.05). The wet-to-dry ratio in the P group was also significantly higher than that in the V group (7.7 ± 0.9 vs 6.3 ± 0.5; P < 0.05). More animals in the P group than in the V group had end-of-protocol Pa_O2/FI_O2 ratios below 200 mmHg (43% vs 0%; P = 0.06). Conclusion In rabbits with injured lungs, high peak inspiratory flow with high tidal volume (V_T) reduces the Pa_O2/FI_O2 ratio and increases the lung wet-to-dry ratio.     

Percutaneous thermal ablation of primary and secondary lung tumors: Comparison between microwave and radiofrequency ablation

PurposeThe purpose of this study was to retrospectively compare microwave (MWA) and radiofrequency (RFA) ablation in the percutaneous treatment of primary and secondary lung tumors.Material and methodsA total of 115 patients with a total of 160 lung tumors (primary, n = 41; secondary, n = 119) were retrospectively included. There were 56 men and 59 women with a mean age of 67.8 ± 12.7 (SD) years (range: 42–89 years) who underwent either MWA (61 patients; 79 tumors) or RFA (54 patients; 81 tumors). The primary study endpoints were local recurrence during follow-up and the incidence of complications during and following thermal ablation. The MWA and RFA groups were compared in terms of treatment efficacy and complication rates.ResultsDemographics were similar in the two groups. Mean tumor diameter was smaller in RFA group (13.1 ± 5.1 [SD] mm; range: 4–27 mm) than in MWA group (17.1 ± 8.3 [SD] mm; range: 5–36 mm) (P < 0.001). Ablation volumes at one month were 24.1 ± 21.7 (SD) cm³ (range: 2–97.8 cm³) in RFA group and 30.2 ± 35.9 (SD) cm³ (range: 1.9–243.8 cm³) in MWA group (P = 0.195). During a mean overall follow-up duration of 488 ± 407 (SD) days (range: 30–1508 days), 9/160 tumors (5.6%) developed local recurrence: six (6/79; 7.6%) in the RFA group and three (3/81; 3.7%) in the MWA group (P = 0.32). Pneumothoraces were more frequent in the RFA group (32/79; 40.5%) than in the MWA group (20/81; 24.7%) (P = 0.049). The mean length of hospital stay was 4.5 ± 3.7 (SD) days (range: 1–25 days) in the RFA group and 4.7 ± 4.6 (SD) days (range: 2–25 days) in the MWA group (P = 0.76).ConclusionsMWA favorably compares with RFA and can be considered as an effective and safe thermal ablation technique for lung tumors, especially in situations where RFA has limited efficacy.     

Improvement of arterial oxygenation by selective infusion of prostaglandin E1 to ventilated lung during one-lung ventilation

Background:One-lung anesthesia provides a better surgical field for thoracic procedures but also impairs the arterial oxygenation and venous admixture. During one-lung ventilation, pulmonary vasoconstriction is assumed to be present within both ventilated and collapsed lungs. We propose that arterial oxygenation could be optimized by offsetting the vasoconstriction within the microcirculation of ventilated lung. Method:In an anesthetized dog model, incremental doses of prostaglandin E₁ (PGE₁) were selectively infused into the main trunk of the pulmonary artery of the ventilated lung after one-lung ventilation for 60 min (PGE₁ group, n=9). Arterial oxygenation and calculated venous admixture (Qs/Qt) was also assessed in a time-course control group (Control group, n =5). During two-lung ventilation (FIO₂: 0.66), arterial PO₂ and venous admixture was 44.22 ± 3.5 kPa and 10.7±2.3%, respectively. One-lung ventilation (FIO₂: 0.66) with left lung collapsed reduced arterial PO₂ to 11.6±1.7 kPa and increased venous admixture to 40.7±5.8% (P<0.001). Venous O₂ tension also decreased from 6.3±0.7 kPa to 5.0±0.6 kPa with a slight increase in mean pulmonary artery pressure and pulmonary vascular resistance (P <0.05). Results: During selective infusion of PGE₁ at a dose of 0.04 to 0.2 μg kg^-1 min^-1, there was a dose-dependent improvement in arterial PO₂ with a parallel reduction of venous admixture during one-lung ventilation. Arterial PO₂ increased to a maximum of 23.0±4.3 kPa, and the venous admixture decreased significantly to a minimum of 27.4±4.2% by PGE₁ at a dose of 0.04-0.4 μg kg^-1 min^-1 (P<0.01). PGE₁ resulted in a small increase in cardiac output and decreases of pulmonary pressure and pulmonary vascular resistance at a relatively high dose of 0.4 μg kg^-1 min^-1 during selective infusion (P<0.05). Conclusion: These results suggest that a selective pulmonary artery infusion of PGE₁ to the ventilated lung within the dose range of 0.04-0.4 μg kg^-1 min^-1 is practical and effective to improve arterial oxygenation and reduce venous admixture during one-lung ventilation.     

Impaired skeletal muscle mitochondrial function in morbidly obese patients is normalized one year after bariatric surgery

BackgroundObesity and type 2 diabetes are associated with impaired skeletal muscle mitochondrial metabolism. As an intrinsic characteristic of an individual, skeletal muscle mitochondrial dysfunction could be a risk factor for weight gain and obesity-associated co-morbidities, such as type 2 diabetes. On the other hand, impaired skeletal muscle metabolism could be a consequence of obesity. We hypothesize that marked weight loss after bariatric surgery recovers skeletal muscle mitochondrial function.MethodsSkeletal muscle mitochondrial function as assessed by high-resolution respirometry was measured in 8 morbidly obese patients (body mass index [BMI], 41.3±4.7 kg/m²; body fat, 48.3%±5.2%) before and 1 year after bariatric surgery (mean weight loss: 35.0±8.6 kg). The results were compared with a lean (BMI 22.8±1.1 kg/m²; body fat, 15.6%±4.7%) and obese (BMI 33.5±4.2 kg/m²; body fat, 34.1%±6.3%) control group.ResultsBefore surgery, adenosine diphosphate (ADP)-stimulated (state 3) respiration on glutamate/succinate was decreased compared with lean patients (9.5±2.4 versus 15.6±4.4 O₂ flux/mtDNA; P<.05). One year after surgery, mitochondrial function was comparable to that of lean controls (after weight loss, 12.3±5.5; lean, 15.6±4.4 O₂ flux/mtDNA). In addition, we observed an increased state 3 respiration on a lipid substrate after weight loss (10.0±3.2 versus 14.0±6.6 O₂ flux/mtDNA; P< .05).ConclusionWe conclude that impaired skeletal muscle mitochondrial function is a consequence of obesity that recovers after marked weight loss.     

Protective effects of new femoral reaming techniques (Reamer irrigator aspirator,RIA I and II) on pulmonary function and posttraumatic contusion (CT morphology) – results from a standardized large animal model

IntroductionThe effects of reaming for preparation of intramedullary fixation in long bone fractures have been widely studied. We compared pulmonary and systemic effects between conventional reaming with reamer irrigator aspirator and unreamed nailing in an acute porcine trauma model with a standardized femur fracture.Materials and MethodsIn a standardized porcine model, (moderate blunt chest trauma, abdominal injury and femoral shaft fracture), the femur was submitted to intramedullary nailing after resuscitation and normalization of pulmonary function. The treatment groups included 3 reamer types (Group RFN: conventional reaming with Synream; group RIA1; reamer irrigator aspirator, version 2005; group RIA 2; reamer irrigator aspirator, version 2019) and were compared to unreamed femoral nailing (Group UFN). Pulmonary function measurements included arterial partial carbon-dioxide pressure (paCO₂ [kPa]) (baseline, post reaming, 2,4,6 h) and volumetric measures of contusion in chest computer tomography (CT) (at 6 hrs.). Systemic inflammatory response was measured at baseline and every second hour until six hours after trauma.ResultsThis study included 24 male animals, mean weight 50.76 ± 4.1 kg n = 6 per group). Group RFN developed a significantly higher partial CO₂ (pCO₂) at one hour after reaming when compared with all other groups (7.4 ± 0.4 kPa versus 5.4 ± 0.6 RIA 1, 5.6 ± 0.4 RIA 2, and 5.5 ± 0.5 UFN, p < 0.001), along with a had lower pO₂ (12.3 ± 1.3 kPa versus 17.2 ± 1.9 RIA 1, 17.4 ± 1.6 RIA 2, and 16.4 ± 0.7 UFN, p < 0.001) and the degree of pulmonary hyperdense changes in the CT analysis was higher in RFN (485.2 ± 98.5 cm³ versus 344.4 ± 74.4 cm³ RIA 1 and 335.2 ± 58.1 cm³ RIA 2, p < 0.01). The inflammatory reaction was lowest in both RIA groups when compared with group RFN or UFN (p < 0.001).ConclusionBoth RIA 1 and RIA 2 protect the lung from reaming induced dysfunction and have no systemic inflammatory effects, while the negative effects were more sustained after reamed or unreamed nailing. Both RIA 1 and RIA II appear to be of value in terms of a Safe Definitive Surgery (SDS) strategy.     

18F-FDG PET/CT在胆道系统恶性肿瘤中的应用

目的探讨~(18)F-FDG PET/CT诊断胆道系统恶性肿瘤的价值。方法回顾性分析34例临床疑似胆道恶性肿瘤患者的PET/CT影像资料,均获得术后病理结果,其中12例经手术切除淋巴结或淋巴结穿刺活检对18枚淋巴结获得病理诊断;与病理结果对照,计算PET/CT对胆道恶性病变原发灶、淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值及准确率。结果 34例中,31例为恶性病变,3例为良性病变。PET/CT诊断胆道恶性肿瘤原发灶的灵敏度100%(31/31),特异度66.67%(2/3),阳性预测值96.88%(31/32),阴性预测值100%(2/2),准确率97.06%(33/34)。胆道恶性病变原发灶最大标准摄取值(SUV_(max))为8.42±4.27;3例胆道良性疾病SUV_(max)分别为12.90、2.00及1.90。共18枚淋巴结获得病理结果,包括转移性淋巴结13枚,良性增生5枚。PET/CT诊断淋巴结转移的灵敏度76.92%(10/13),特异度60.00%(3/5),阳性预测值83.33%(10/12),阴性预测值50.00%(3/6),准确率72.22%(13/18)。结论 PET/CT对胆道系统恶性肿瘤的诊断具有重要价值。     

18F-FDG PET/CT动态评价单纯125I粒子植入或联合顺铂化学治疗兔VX2肺癌效果

目的 分析¹⁸F-FDG PET/CT动态观察单纯¹²⁵I粒子植入术及联合化学治疗（化疗）对兔VX2肺癌的干预效果的价值。方法 将VX2肿瘤组织接种于3~4月龄新西兰大耳白兔右肺下叶,制成兔VX2肺癌模型。将30只模型兔随机分为3组,每组10只。对A组通过治疗计划系统（TPS）植入25.9 MBq（0.7 mCi）¹²⁵I粒子,B组经耳缘静脉注射顺铂7 mg/kg体质量,C组予以上2种干预。分别于治疗前及治疗后第3、7、14天对实验兔行全身PET/CT扫描,于右肺肿瘤部位及肝右叶勾画ROI,检测其最大标准摄取值（SUV_max）,计算肿瘤SUV_max/肝脏SUV_max（SUV_T/L）;于治疗前及治疗后第3、7天完成PET/CT检查后分别处死2只,治疗后第14天PET/CT检查后处死4只动物,取肿瘤组织进行病理学检查。结果 3组间及A、B组内治疗前及治疗后不同时间点肿瘤最大径差异均无统计学意义（P均>0.05）。C组治疗后第14天肿瘤最大径较治疗前缩小（P<0.05）。治疗后第7、14天,C组SUV_T/L值较A、B组均降低（P均<0.05）;A、B组治疗后第7、14天SUV_T/L值均较治疗前降低,C组治疗后第3、7、14天SUV_T/L值均较治疗前降低（P均<0.05）。病理学检查发现3组治疗后肿瘤细胞均逐渐减少,A、C组炎症细胞及肿瘤坏死区较B组更多;C组治疗后第14天仅见少量肿瘤细胞,炎症细胞及纤维组织增多。结论 ¹⁸F-FDG PET/CT可动态监测并早期评价单纯¹²⁵I粒子植入术及联合化疗对兔VX2肺癌的干预效果。     

Enhancement of port site metastasis by hyaluronic acid under CO2 pneumoperitoneum in a murine model

Background

The mechanism underlying the development and progression of port site metastasis after laparoscopic surgery for cancer is still not understood. Hyaluronic acid secreted from mesothelial cells is thought to be a key factor that causes adhesion between cancer cells and mesothelial cells. Using a murine model of carbon dioxide (CO₂) pneumoperitoneum, we evaluated the effect of exogenous hyaluronic acid on port site metastasis.

Methods

BALB/c mice were injected with 5×10⁶ human gastric carcinoma (MKN45) cells and divided into four groups treated with or without hyaluronic acid and with or without pneumoperitoneum. Three weeks later, the frequency and weight of port site metastases were determined. The effects of hyaluronic acid on tumorigenicity and tumor with MKN45 cells.

Results

Port site metastasis occurred significantly less frequently in the pneumoperitoneum-only group than in the pneumoperitoneum-with-hyaluronic-acid group (75% vs 100%, p<0.05). The port site metastatic tumor weighed significantly less in the control group (anesthesia only) than in the hyaluronic acid group (89±17 vs 288±35mg, p<0.05); it also weighed less in the pneumoperitoneum-only group than in the pneumoperitoneum-with-hyaluronic-acid group (87±24 vs 298±51 mg, p<0.05). The frequency and weight of tumors in the subcutaneous tissue were not significantly different between groups with or without hyaluronic acid injection (95% vs 90%, 331±128 vs 322±115 mg).

Conclusions

Under CO₂ pneumoperitoneum, exogenous hyaluronic acid increased the frequency and weight of port site metastasis in a murine model. Hyaluronic acid secreted from mesothelial cells may be associated with the formation of port site metastasis after laparoscopic surgery for cancer under pneumoperitoneum.