三维切除在胸部软组织肉瘤的应用

胸部软组织肉瘤在全身各类型肿瘤中较为少见，组织来源于皮肤肌肉等软组织。胸部软组织肉瘤局部复发率高，是外科手术的难点之一。手术治疗的关键在于对肿瘤的根治性切除。经典手术方式是由Mohs提出的莫氏手术，旨在减少皮肤和皮下组织的损伤，直至Moehrle提出治疗肉瘤的三维手术概念［1］，强调手术切缘的无瘤化。我院在2010年后逐步对胸部肉瘤采用三维手术切除方式。我们回顾性分析了从2009年6月至2014年1月在我院接受外科手术治疗的39例胸部软组织肉瘤患者，现结合文献讨论如下。     

消癖膏治疗乳腺增生病35例临床观察

目的:观察消癖膏治疗乳腺增生病的临床疗效。方法:将70例乳腺增生病患者随机分成2组,每组各35例。对照组予散结乳癖膏外敷,治疗组予消癖膏外敷。观察比较2组血清性激素(E2)的变化以及临床疗效。结果:总有效率治疗组为94.29%,对照组为82.86%,组间比较,差异有统计学意义(P0.05);2组治疗后E2比较,差异有统计学意义(P0.05)。结论:消癖膏外敷治疗乳腺增生病有显著疗效。     

Heme oxygenase-1 expression in rats with acute lung rejection and implication

This study investigated the expression of hemeoxygenase-1 （HO-1） in rats with acute lung rejection and its implication. A valid rat orthotopic left lung transplantation model （SD rat→Wistar rat） was established by using an improved three-cuff anastomosis technique. The rats were divided into control group, CoPP （HO-1 inducer）-treated group and ZnPP （HO-1 inhibitor）-treated group. The severity of acute rejection was graded on the basis of the morphologic changes of the lung samples stained with HE. The expression of HO-1 protein in lung tissue was detected by using immunohistochemistry and Western blot, and HO-1 mRNA activity was assayed by RT-PCR. The results showed that the expression of HO-1 protein was significantly increased with the acute rejection grading in rats （P〈0.01）. As compared with control and ZnPP-treated groups, the severity of acute rejection was not alleviated and the grade not reduced significantly in CoPP-treated group （P〉0.05）. It was concluded that HO-1 protein might be involved in the pathological process of post-graft acute rejection. The expression of HO-1 protein was increased gradually with aggravation of acute rejection, and HO-1 protein might be used as an index to monitor acute rejection after lung transplantation.     

调节性B细胞分型及其在相关疾病中的作用

B淋巴细胞的功能除了产生抗体外,还通过产生细胞因子和抗原呈递作用而激活免疫系统。此外,B淋巴细胞通过不同的调节机制发挥其免疫抑制功能,称为调节性B(Breg)细胞。Breg细胞发挥抑制作用的主要机制是分泌IL-10。最近几年的研究表明,白细胞介素(IL)-35刺激B淋巴细胞产生IL-35并发挥免疫抑制作用。还有人提出,Breg细胞维持自然杀伤细胞(NK)在体内的平衡方面起到至关重要的作用。通过关于自身免疫性疾病的实验和临床研究已经确定了多种Breg细胞亚群,其表现出不同的免疫抑制机制。本文主要描述小鼠和人类不同Breg细胞亚型及其在不同动物模型和疾病环境中的作用机制的最新研究进展。     

短时长吸入一氧化氮预处理对大鼠肺缺血再灌注损伤的保护作用

目的 探讨低浓度一氧化氮(NO)预处理及其吸入时长的不同对肺缺血再灌注损伤(IRI)的影响和机制.方法 成年雄性SD大鼠77只,分为空白组(Sham组)、缺血再灌注组(I/R组)、NO预处理10 min组(NO-10 min组)、NO预处理1 min组(NO-1 min组),NO预处理60 min组(NO-60 min组),分别于不同的再灌注时间点采集标本,检测动脉血氧分压(PaO2),肺组织干/湿重比(W/D),丙二醛(MDA)浓度,髓过氧化酶(MPO)活性,肺损伤组织学评价等指标,比较前3组再灌注后2、6、24 h结果,取IRI最严重时间点,比较各组肺功能指标以及血清和左肺组织NO浓度.结果 再灌注6h肺损伤最严重;与I/R组比较,NO-10 min组各时间点指标明显改善(P＜0.05),NO吸入具有肺保护作用;NO-1 min组肺损伤无改善(P＞0.05);NO-10 min组与NO-60 min组对肺损伤保护作用相似(P＞0.05).结论 短时长吸入低浓度NO预处理可以改善IRI,但是其保护作用不与NO预处理时长成正比.     

电视纵隔镜术的临床应用和体会

目的探讨电视纵隔镜术在胸外科疾病中的应用体会。方法回顾性分析我科2008年3月至2010年10月开展的64例电视纵隔镜术病例,58例患者行颈部纵隔镜术,5例行胸骨旁纵隔镜术,1例大量胸腔积液患者行胸膜纵隔镜活检术,标本分别送冰冻和石蜡病理检查。结果本组63例患者获得明确病理诊断,1例假阴性病例,准确率为98．4％,无手术死亡发生,1例纵隔淋巴结结核患者切口感染,换药后Ⅱ期缝合治愈,余无严重并发症发生。结论电视纵隔镜术是一项创伤性小、安全性好、准确率高的临床诊治方法。     

Differentiation character of adult mesenchymal stem cells and transfection of MSCs with lentiviral vectors

This study examined the differentiation character and pluripotency of mesenchymal stem cells (MSCs) under different conditions. Adult MSCs were initially isolated from the bone marrow of rats, cultured in vitro and identified by flow cytometry. After MSCs were transferred to osteogenic and adipogenic medium respectively, the morphological characterization of induced cells was observed. The expression of marker genes was detected by RT-PCR analysis. Then MSCs were transfected with lenti- viral vectors pGC-FU-Sox9-EGFP. Enhanced green fluorescence protein (EGFP) expression and trans- fection efficiency were determined by fluorescence microscopy. The results demonstrated that EGFP caused no effect on the multilineage potential of adult MSCs. Sox9 gene expression of high level was maintained stable in the transfected MSCs and induced MSCs to differentiate into chondrocytes. Ag- gracan was positive in chondrogenic lineages and the expression of aggracan and type Ⅱ collagenwas significantly increased during MSCs chondrogenic differentiation. It was concluded that Sox9 gene-modified adult MSCs may be promising candidate cells for further studies on tissue engineering. EGFP facilitates the research on MSCs physiological behavior and application in tissue engineering during differentiation both in vitro and in vivo.     

大鼠肺缺血再灌注损伤不同时期基因表达谱的改变

目的 探讨大鼠肺组织缺血再灌诱导的基因表达谱改变,为揭示肺缺血再灌注损伤的发生和保护机制提供新的线索和思路.方法 采用无创血管夹夹闭左肺肺动脉与肺静脉,并于左肺膨胀时扎闭左主支气管构建大鼠肺缺血再灌反应动物模型.运用包含22226个大鼠基因点的Illumina RatRef-12全基因组表达谱微珠芯片检测大鼠肺缺血再灌处理后不同时间点(0、1、3、6、24 h)的基因表达情况,并采用SOM算法将具有相似表达模式的基因进行聚类.结果 缺血后再灌0、1、3、6、24 h分别有648、340、711、1279、641个基因表达发生改变.具有相同表达模式的基因被聚为12类.结论 肺缺血再灌可以诱导肺的基因表达谱发生改变,具有相似表达模式的基因可能具有相似的功能或相似的表达调控机制.     

Gene Expression Profile of Pulmonary Tissues in Different Phases of Lung Ischemia-reperfusion Injury in Rats

In order to provide us new clues to induce some endogenous protective molecular mechanisms, the changes in gene expression profile induced by ischemia-reperfusion in pulmonary tissues of rats were investigated and the dynamic mechanism of pulmonary ischemia-reperfusion injury was elucidated. Thirty male Wistar rats were randomly divided into 6 groups： 5 ischemia-reperfusion （I/R） groups （I/R 0-h, I/R 1-h, I/R 3-h, I/R 6-h, I/R 24-h） and control group （n=5 in each）. An in situ ischemia-reperfusion lung injury rat model was established by occluded hilus of lung. The RatRef-12 Expression Beadchip （22 226 gene probes per array） was used to analyze the pattern of gene expression in all groups. The results showed that 648, 340, 711, 1279 and 641 genes were differentially expressed in I/R 0-, 1-, 3-, 6- and 24-h groups respectively. The differentially expressed genes were classified as following 7 functional categories： cytokine, adhesion molecule, growth factor and apoptosis-related factor, oxidation and antioxidation molecule, metabolic enzyme, ion channel and aquaporin, signal transduction molecule. It was suggested that gene chip technology was an effective and quick method for screening differentially expressed genes. Many differentially expressed genes with different functions interacted each other to result in pulmonary ischemia-reperfusion injury.     

快速康复外科方式在食管癌手术中的应用

近年来,国外出现了一种新的外科模式--快速康复外科(fast track surgery,FIS)[1-2],是将麻醉学、营养护理、疼痛控制及外科手术等方面的新技术、新理论应用在术前、术中及术后,以减少手术应激,降低术后并发症的发生率及病死率,加速病人术后的康复.FIS使得许多疾病的临床治疗模式发生了很大的变化,我们对食管肿瘤手术病人运用FIS方式治疗,现总结报道如下.