异丙酚联合缺血预处理对大鼠肺缺血再灌注损伤时细胞凋亡的影响

目的 探讨异丙酚联合缺血预处理对大鼠肺缺血苒灌注损伤时细胞凋亡的影响.方法 雄性SD大鼠50只,200～250 g,随机分为5组(n=10):假手术组(S组)、缺血再灌注组(IR组)、异丙酚组(P组)、缺血预处理组(IP组)和异丙酚+缺血预处理组(P+IP组).阻断右肺门1 h后再灌注2 h制备大鼠单肺原位热缺血再灌注模型,P组夹闭右肺门前30 min持续静脉输注异丙酚30 mg·kg-1·h-1;IP组夹闭右肺门前先进行夹闭5 min,再灌注5 min,反复3次的缺血预处理;P+IP组夹闭肺门前30 min静脉输注异丙酚30 mg·kg-1·h-1和缺血预处理.于再灌注2 h时处死大鼠,取右肺下叶肺组织,光镜下观察肺组织病理学结果 ,计算肺损伤定量评价指标(IQA);检测肺凋亡细胞,计算肺细胞凋亡指数(AI);采用免疫组化法检测Bcl-2、Bax蛋白表达;IQA、Bcl-2/Bax蛋白比值与AI作直线相关分析.结果 与S组比较,IR组、P组、IP组和P+IP组再灌注后IQA、AI均明显升高,IR组Bcl-2、Bax蛋白表达上调,Bcl-2/Bax蛋白比值降低(P<0.01);与IR组比较,P组、IP组和P+IP组IQA、AI均明显降低,Bcl-2蛋白表达水平、Bcl-2/Bax蛋白比值升高,IP组、P+IP组Bax蛋白表达下调(P<0.01),P组差异无统计学意义(P>0.05);与P组和IP组比较,P+IP组IQA及AI降低,Bcl-2/Bax蛋白比值升高(P<0.05);IQA与AI呈正相关(r=0.951,P<0.01);AI与Bcl-2/Bax蛋白比值呈负相关(r=-0.851,P<0.01).结论 异丙酚联合缺血预处理可通过调节Bcl-2和Bax蛋白的表达抑制细胞凋亡,减轻肺缺血再灌注损伤.     

舒芬太尼预处理对肠缺血再灌注大鼠急性肺损伤的影响及阿片受体在其中的作用

目的 评价舒芬太尼预处理对肠缺血再灌注大鼠急性肺损伤的影响及阿片受体在其中的作用.方法 成年健康雄性Wistar大鼠48只,体重200 ～ 250 g,采用随机数字表法,将其随机分为6组(n=8):假手术组(S组)、肠缺血再灌注组(I/R组)、舒芬太尼预处理组(SPC组)、COTP+ SPC组、NTD+ SPC组和nor-BNI+ SPC组.I/R组、SPC组、COTP+ SPC组、NTD+ SPC组和nor-BNI+ SPC组采用夹闭肠系膜上动脉45 min,再灌注2h的方法制备肠缺血再灌注模型;S组仅分离肠系膜上动脉,不夹闭.SPC组、COTP+ SPC组、NTD+ SPC组和nor-BNI+ SPC组于缺血前10 min时静脉注射舒芬太尼10μg/kg;COTP+ SPC组、NTD+ SPC组于注射舒芬太尼前10 min时分别静脉注射μ受体拮抗剂COTP 1mg/kg或δ受体拮抗剂NTD 5 mg/kg; nor-BNI+ SPC组于注射舒芬太尼前15 min时静脉注射κ受体拮抗剂nor-BNI 5 mg/kg.于再灌注2h时处死大鼠,取肠组织,观察肠粘膜形态并进行肠粘膜损伤评分;取左肺组织,观察肺组织形态并进行肺损伤评分;采用TUNEL法检测肺组织细胞凋亡情况,计算凋亡指数;采用免疫组化法测定肺组织Bcl-2蛋白和Bax蛋白的表达,计算Bcl-2/Bax比值.结果 与S组比较,I/R组、SPC组、COTP+ SPC组、NTD+ SPC组和nor-BNI+ SPC组肠粘膜损伤评分、肺损伤评分和凋亡指数升高,Bcl-2蛋白和Bax蛋白表达上调,Bcl-2/Bax比值降低(P＜0.01);与I/R组比较,SPC组肠粘膜损伤评分、肺损伤评分和凋亡指数降低,Bcl-2蛋白表达上调,Bax蛋白表达下调,Bcl-2/Bax比值升高(P＜0.01);与SPC组比较,COTP+ SPC组、NTD+ SPC组和nor-BNI+ SPC组肠粘膜损伤评分、肺损伤评分和凋亡指数升高,Bcl-2蛋白表达下调,Bax表达蛋白表达上调,Bcl-2/Bax比值下降(P＜0.01).结论 舒芬太尼预处理可减轻肠缺血再灌注大鼠急性肺损伤,该作用与激活阿片受体有关.     

瑞芬太尼对大鼠肾缺血再灌注时细胞凋亡的影响

目的 评价瑞芬太尼对大鼠肾缺血再灌注时细胞凋亡的影响.方法 健康成年雄性SD大鼠75只,体重220～ 250 g,采用随机数字表法,将其分为3组(n=25)∶假手术组(S组)、肾缺血再灌注组(I/R组)和瑞芬太尼组(R组).I/R组和R组采用夹闭双侧肾动脉45 min时恢复灌注法建立肾缺血再灌注损伤模型.R组于缺血前15 min至再灌注30 min经尾静脉输注瑞芬太尼1.0μg· kg-1·min-1,S组和I/R组给予等容量生理盐水.于缺血前15 min(T0)、再灌注3 h(T1)、6 h(T2)、12h(T3)及24 h(T4)时取肾组织标本.采用流式细胞术检测肾细胞凋亡率及Bax、Bcl-2蛋白表达,采用RT-PCR检测Bax和Bcl-2的mRNA表达,计算Bcl-2/Bax蛋白及mRNA表达比值,采用Paller法行肾小管损伤评分.结果 与S组比较,I/R组和R组T1-4时肾小管损伤评分和肾细胞凋亡率升高,Bcl-2/Bax蛋白及mRNA表达比值T12时升高,T3,4时降低(P＜0.01);与I/R组比较,R组T1-4时肾小管损伤评分和肾细胞凋亡率降低,Bcl-2/Bax蛋白及mRNA表达比值升高(P＜0.05或0.01);与T0时比较,I/R组和R组T1-4时肾小管损伤评分和肾细胞凋亡率升高,Bcl-2/Bax蛋白及mRNA表达比值T1,2时升高,T3,4时降低(P＜0.01).结论 瑞芬太尼减轻大鼠肾缺血再灌注损伤的机制与其调节Bcl-2/Bax蛋白表达,抑制肾组织细胞凋亡有关.     

七氟醚后处理对大鼠心肌缺血再灌注时细胞凋亡的影响

目的 评价七氟醚后处理对大鼠心肌缺血再灌注时心肌细胞凋亡的影响.方法 健康雄性Wistar大鼠45只,体重250～ 280 g,采用随机数字表法,将大鼠随机分为3组(n=15):假手术组(S组)、心肌缺血再灌注组(I/R组)和七氟醚后处理组(Spo组).I/R组和Spo组采用结扎左冠状动脉前降支30 min时进行再灌注120 min的方法制备心肌缺血再灌注损伤模型,S组仅在左冠状动脉前降支下穿线.Spo组进行七氟醚后处理,于再灌注前1 min时吸八七氟醚,呼气末浓度2.5％,持续5min.于再灌注120 min时取左室心肌组织,测定缺血危险区和梗死区体积,计算缺血危险区和梗死区体积百分比.取左室缺血危险区心肌组织,测定心肌细胞凋亡指数,测定凋亡相关蛋白Bcl-2和Bax的蛋白及其mRNA的表达,计算Bcl-2/Bax比值.结果 与S组比较,I/R组心肌梗死区体积百分比和心肌细胞凋亡指数升高,Bcl-2、Bax蛋白及mRNA表达上调,Bcl-2/Bax比值降低(P＜0.05);与I/R组比较,Spo组心肌梗死区体积百分比和心肌细胞凋亡指数降低,Bax蛋白及mRNA表达下调,Bcl-2蛋白及mRNA表达上调,Bcl-2/Bax比值升高(P＜0.05).结论 七氟醚后处理通过上调Bcl-2表达,下调BBax表达,改善Bcl-2/Bax平衡,抑制心肌细胞凋亡,从而减轻大鼠心肌缺血再灌注损伤.     

瑞芬太尼对肝硬化大鼠肝脏缺血再灌注损伤的影响

目的 探讨瑞芬太尼对肝硬化大鼠肝脏缺血再灌注损伤的影响.方法 成年健康雄性SD大鼠30只,体重260～300 g,采用随机数字表法,将其随机分为3组(n=10):肝硬化组(C组)、肝硬化+肝缺血再灌注组(I/R组)和瑞芬太尼组(R组).C组、I/R组和R组采用四因素综合法制备大鼠肝硬化模型,I/R组和R组在肝硬化模型制备成功后1周制备大鼠70％肝脏缺血再灌注模型,R组于缺血前10 min开始静脉输注瑞芬太尼1μg·kg-1·min-至再灌注结束.于再灌注4h时取静脉血样和肝组织,测定血清ALT和AST活性、肝细胞Bcl-2和Bax表达及肝细胞凋亡情况,计算细胞凋亡指数,光镜下观察肝组织病理学结果.结果 与C组比较,I/R组血清ALT和AST的活性升高,肝细胞Bcl-2表达下调,Bax表达上调,细胞凋亡指数升高(P＜0.05);与I/R组比较,R组血清ALT和AST的活性降低,肝细胞Bcl-2表达上调,Bax表达下调,细胞凋亡指数降低(P＜0.05).R组肝组织病理学损伤轻于I/R组.结论 瑞芬太尼可减轻肝硬化大鼠肝脏缺血再灌注损伤,其机制与平衡肝细胞Bcl-2与Bax表达而抑制肝细胞凋亡有关.     

参麦注射液后处理对大鼠心肌缺血再灌注损伤的影响

目的 评价参麦注射液后处理对大鼠心肌缺血再灌注损伤的影响.方法 健康雄性SD大鼠32只,10～ 12周龄,体重240 ～ 260 g,采用随机数字表法,将其随机分为3组(n=12):假手术组(S组)、缺血再灌注组(I/R组)和参麦注射液后处理组(SPO组).I/R组和SPO组采用结扎左冠状动脉前降支30 min,再灌注120 min的方法制备大鼠心肌缺血再灌注模型;S组只穿线不结扎.于缺血30 min时I/R组静脉注射生理盐水9 ml/kg,SPO组静脉注射参麦注射液9 ml/kg.再灌注120 min时,腹主动脉采集血样,测定血清CK活性和cTnI浓度;然后处死大鼠,取心肌组织,观察病理学结果和细胞凋亡情况,计算心肌细胞凋亡指数,采用免疫组化法检测心肌细胞Bcl-2和Bax的蛋白表达.结果 与S组比较,I/R组和SPO组血清CK活性和cTnI浓度升高,I/R组心肌细胞凋亡指数升高,Bcl-2蛋白表达下调,Bax蛋白表达上调,SPO组心肌细胞凋亡指数升高,Bcl-2和Bax的蛋白表达上调(P＜0.01);与I/R组比较,SPO组血清CK活性和cTnI浓度降低,心肌细胞凋亡指数降低,Bcl-2蛋白表达上调,Bax蛋白表达下调(P＜0.01),病理学损伤减轻.结论 参麦注射液后处理可减轻大鼠心肌缺血再灌注损伤,其机制可能与上调Bcl-2蛋白表达,下调Bax蛋白表达,抑制心肌细胞凋亡有关.     

远隔肢体缺血预处理对兔单肺缺血-再灌注损伤细胞凋亡的影响

目的 从细胞凋亡的角度探讨远隔肢体缺血预处理影响兔肺缺血-再灌注(I-R)损伤的可能机制.方法 18只日本大耳白兔随机均分为三组:缺血-再灌注组(I-R组)、肢体缺血预处理组(R组)、假手术组(S组).建立兔在体左肺缺血-再灌注(I-R)损伤模型.通过采用脱氧核苷酸末端转移酶介导的DNA原位末端缺口标记技术(TUNEL)检测再灌注3 h时凋亡指数(AI)的变化,予Westernblotting检测肺组织中Bcl-2、Bax蛋白的表达情况.结果 与S组比较,I-R组肺组织细胞凋亡指数和Bax蛋白显著增高(P＜0.01),而Bcl-2蛋白含量显著降低(P＜0.01),Bcl-2/Bax比值降低(P＜0.05).R组细胞凋亡指数和Bcl-2蛋白表达明显高于I-R组(P＜0.01),而Bax蛋白的含量明显低于I-R组(P＜0.05),Bcl-2/Bax比值增高(P＜0.05).结论 远隔肢体缺血预处理可上调肺组织Bcl-2蛋白,下调Bax蛋白表达,增加Bcl-2/Bax比值,抑制肺组织细胞凋亡,从而对肺缺血-再灌注损伤起到保护作用.     

异丙酚对大鼠心肌缺血再灌注时Pim-1表达的影响

目的 探讨异丙酚对大鼠心肌缺血再灌注时Pim-1表达的影响.方法 健康雄性SD大鼠40只,体重220～250 g,采用随机数字表法,将其随机分为5组(n=8):假手术组(S组)、缺血再灌注组(I/R组)、脂肪乳剂组(I组)、低剂量异丙酚组(P1组)和高剂量异丙酚组(P2组).I/R组、I组、P1组和P2组和采用结扎左冠状动脉前降支30 min再灌注的方法制备心肌缺血再灌注损伤模型.P1组和P2组于缺血前10 min经股静脉输注异丙酚6、12 mg·kg-1·h-1至再灌注120 min,I组给予脂肪乳剂1.2 ml·kg-1 ·h-1.再灌注120 min时,取心肌组织,测定心肌梗死面积、细胞凋亡、Pim-1表达和caspase-3活性.结果 与S组比较,I/R组和I组心肌梗死面积、凋亡指数和caspase-3活性升高,心肌组织Pim-1表达下调(P＜0.01);与I/R组比较,P1组和P2组心肌梗死面积、凋亡指数和caspase-3活性降低,心肌组织Pim-1表达上调(P＜0.01),I组上述指标差异无统计学意义(P＞0.05).结论 异丙酚可减轻大鼠心肌缺血再灌注损伤,其机制与上调Pim-1表达有关.     

依那普利后处理对肢体缺血再灌注诱发大鼠心肌损伤的影响

目的 评价依那普利后处理对肢体缺血再灌注诱发大鼠心肌损伤的影响.方法 健康雄性SD大鼠36只,体重200 ～ 250 g,采用随机数字表法,将其分为3组(n=12)∶假手术组(S组)、缺血再灌注组(I/R组)和依那普利后处理组(EP组).I/R组和EP组采用橡皮带环绕结扎大鼠双后肢根部3h,再灌注3h的方法制备肢体缺血再灌注模型.再灌注前30 min时,EP组经颈内静脉注射依那普利0.04 mg/kg,S组和I/R组经颈内静脉注射等容量生理盐水.再灌注3h时,处死大鼠,取心肌组织,采用TUNEL法检测心肌细胞凋亡,计算细胞凋亡指数;采用免疫组化法测定Bcl-2和Bax的蛋白表达;采用黄嘌呤氧化酶法测定SOD活性;采用硫代巴比妥法测定MDA含量.结果 与S组比较,I/R组和EP组心肌细胞凋亡指数和MDA含量升高,Bax蛋白表达上调,Bcl-2蛋白表达下调,SOD活性降低(P＜0.05);与I/R组比较,EP组心肌细胞凋亡指数和MDA含量降低,Bax蛋白表达下调,Bcl-2蛋白表达上调,SOD活性升高(P＜0.05),心肌病理学损伤减轻.结论 依那普利后处理可减轻肢体缺血再灌注诱发大鼠心肌损伤,其机制可能与减少心肌细胞凋亡和减轻脂质过氧化反应有关.     

帕瑞昔布钠预先给药对大鼠局灶性脑缺血再灌注损伤的影响

目的 评价帕瑞昔布钠预先给药对大鼠局灶性脑缺血再灌注损伤的影响.方法 雄性SD大鼠64只,体重250～300 g,随机分为4组(n=16):假手术组(S组)、缺血再灌注组(I/R组)、缺血再灌注+帕瑞昔布钠5 mg/kg组(P5组)和缺血再灌注+帕瑞昔布钠10 mg/kg组(P10组).I/R组、P5组和P10组采用线栓法进行脑缺血2 h.P5组和P10组在缺血前30 min时分别经颈内静脉注射帕瑞昔布钠5、10 mg/kg.再灌注24 h时进行神经功能缺陷评分,然后取脑组织,测定脑梗死体积、细胞凋亡率、Bc1-2和Bax表达,并计算Bcl-2与Bax的比值(Bcl-2/Bax).结果 与S组比较,I/R组神经功能缺陷评分、细胞凋亡率、Bcl-2及Bax表达均升高,Bcl-2/Bax降低,脑梗死体积增大(P＜0.01).与I/R组比较,P10组神经功能缺陷评分降低,P5组和P10组细胞凋亡率和Bax表达降低,脑梗死体积缩小,Bcl-2表达和Bcl-2/Bax升高(P＜0.05或0.01).与P5组比较,P10组脑梗死体积缩小,细胞凋亡率和Bax表达降低,Bcl-2表达和Bcl-2/Bax升高(P＜0.05或0.01).结论 帕瑞昔布钠预先给药可减轻大鼠局灶性脑缺血再灌注损伤,且与剂量有关,其机制与上调Bcl-2表达、下调Bax表达从而抑制细胞凋亡有关.     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.     

Surgical management of ductal carcinoma in situ in Australia in 1995

Background: In the present paper we describe the presentation and management of ductal carcinoma in situ (DCIS) of the breast in women in Australia in 1995. This representative, national data set provides a historical comparator for studies examining DCIS management that follow. Methods: Surgeons identified by population‐based cancer registries as having treated a new diagnosis of DCIS between 1 April and 30 September 1995 completed a questionnaire on the presentation and management of each case. Results: Two hundred and five surgeons supplied treatment details on 418 DCIS tumours in 415 women . Half of all tumours were detected at BreastScreen clinics and a further 25% were detected at other mammography centres. Twenty‐six percent of tumours were palpable at presentation, 33% were multifocal and 55% were high grade (including comedocarcinoma). Breast conserving therapy (BCT) rather than mastectomy was utilized in 260 (62%) of cases. Tumours that were of low grade, small in size and not multifocal were more likely to be treated by BCT. Surgeons seeing six or more DCIS cases in the 6‐month period were more likely to utilize BCT. Of the conservatively treated cases, 22% were referred for a radiation oncology consultation. The most common reasons for treating DCIS with mastectomy were that the tumour was too extensive or multifocal (63%), it extended to margins of the specimen (42%), or patient concerns about recurrence (34%). Conclusions: In 1995 the majority of DCIS was treated with breast conserving surgery alone. Surgeons treating more DCIS cases were more likely to perform conservative surgery than surgeons treating only one DCIS case in the study period.     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.