腹腔镜与开腹胰十二指肠切除术治疗胰头癌的疗效对比及术后肿瘤早期复发的随访研究

摘要 目的：对比腹腔镜与开腹胰十二指肠切除术治疗胰头癌的疗效,并分析术后肿瘤早期复发的影响因素。方法：选择2019年3月~2020年4月期间四川大学华西空港医院普外科收治的15例及四川大学华西医院胰腺外科收治的65例共计80例胰头癌患者,根据手术方式的不同分为开腹组和微创组,例数分别为32例和48例,对比两组围术期相关临床指标、并发症发生率和随访期间的肿瘤早期复发率。采用多因素Logistic回归分析术后早期复发的影响因素。结果：微创组的手术时间长于开腹组,住院费用多于开腹组,术中出血量少于开腹组,下床活动时间、术后排气时间、开始进食时间、术后住院时间短于开腹组（P<0.05）。两组并发症发生率对比无差异（P>0.05）。两组术后肿瘤早期复发率对比差异无统计学意义（P>0.05）。单因素分析结果显示,胰头癌患者术后肿瘤早期复发与年龄、肿瘤最大直径、有无淋巴结转移、有无脉管癌栓、有无神经侵犯、术前白蛋白、术前糖类抗原125（CA125）、术前癌胚抗原（CEA）水平、术后有无放化疗有关（P<0.05）。多因素Logistic回归分析显示：淋巴结转移、脉管癌栓、神经侵犯、术后未放化疗以及术前CA125水平较高是胰头癌患者术后肿瘤早期复发的危险因素（P<0.05）。结论：相较于传统开腹手术,腹腔镜下行胰十二指肠切除术治疗胰头癌,可缩短住院时间,促进患者术后恢复,但两者间并发症发生率和术后早期复发率无显著差异。胰头癌术后肿瘤早期复发受到淋巴结转移、脉管癌栓、神经侵犯、术后放化疗、术前CA125水平等多种因素的影响。     

应用奥曲肽预防胰十二指肠切除术后胰漏作用的研究

目的:预防性使用奥曲肽是否能减少胰十二指肠切除术后胰漏发生率存在着争议。本研究旨在研究奥曲肽在不同胰腺情况下预防胰十二指肠切除术后胰漏发生的作用。方法:本研究将"软胰腺"、"细胰管"作为术后胰漏发生的高危险因素,将184例胰十二指肠切除术病例分为4组:低危险/非奥曲肽组、低危险/奥曲肽组、高危险/非奥曲肽组、高危险/奥曲肽组。观察术后胰漏等术后并发症情况。结果:共发生术后胰漏35例(19%),其中高危险组胰漏发生率是低危险组2倍以上(27%versus 10%,P<0.01)。在胰漏发生低危险胰腺情况下,奥曲肽组与非奥曲肽组术后胰漏发生无显著差别;在胰漏发生高危险胰腺情况下,奥曲肽能显著降低术后胰漏发生率。结论:在胰十二指肠切除术围手术期应根据胰腺的具体情况选择性使用奥曲肽既能有效预防术后胰漏的发生,又能避免不必要的浪费。     

应用奥曲肽预防胰十二指肠切除术后胰漏作用的研究

目的：预防性使用奥曲肽是否能减少胰十二指肠切除术后胰漏发生率存在着争议。本研究旨在研究奥曲肽在不同胰腺情况下预防胰十二指肠切除术后胰漏发生的作用。方法：本研究将＂软胰腺＂、＂细胰管＂作为术后胰漏发生的高危险因素,将184例胰十二指肠切除术病例分为4组：低危险/非奥曲肽组、低危险/奥曲肽组、高危险/非奥曲肽组、高危险/奥曲肽组。观察术后胰漏等术后并发症情况。结果：共发生术后胰漏35例（19%）,其中高危险组胰漏发生率是低危险组2倍以上（27%versus 10%,P〈0.01）。在胰漏发生低危险胰腺情况下,奥曲肽组与非奥曲肽组术后胰漏发生无显著差别;在胰漏发生高危险胰腺情况下,奥曲肽能显著降低术后胰漏发生率。结论：在胰十二指肠切除术围手术期应根据胰腺的具体情况选择性使用奥曲肽既能有效预防术后胰漏的发生,又能避免不必要的浪费。     

胰十二指肠切除术后并发症相关因素分析

目的:探讨胰十二指肠切除术(pancreatoduodenectomy,PD)术后并发症及其危险因素。方法:回顾2000年至2009年第四军医大学西京医院258例行胰十二指肠切除术病人临床资料,并通过单因素分析和多因素分析术后并发症危险因素。结果:本组术后并发症发生率为22.1%(57/258)。多见的并发症包括胰漏、胆漏、腹腔感染,出血等。Logistic回归分析显示,与并发症有关的因素包括术前血清总胆红素>171μmol/L、术前血清白蛋白<30g/L,术中出血量>800 ML,年龄>60岁,术前血红蛋白<100g/L。结论:术前血清总胆红素>171μmol/L,术前血清白蛋白<30g/L和术中出血量>800 ML是胰十二指肠切除术术后并发症的高危因素,其次的危险因素为年龄>60岁、术前血红蛋白<100g/L。手术者应掌握好手术时机,加强围手术期处理,从而降低胰十二指肠切除术术后并发症。     

肝圆镰状韧带一体化包裹加强技术在质软胰腺胰十二指肠切除术中的应用分析

摘要 目的：探讨质软胰腺胰十二指肠切除术（PD）中应用肝圆镰状韧带一体化包裹加强技术的临床价值。方法：回顾性分析哈尔滨医科大学附属肿瘤医院2016年1月至2021年12月实施开腹PD或保留幽门的胰十二指肠切除术（PPPD）质软胰腺病人的临床资料。根据是否应用肝圆镰状韧带一体化包裹加强技术分为无包裹加强组（2016.1-2018.12,246例）及包裹加强组（2019.1-2021.12,244例）,比较两组病人基本临床特征、术中资料、术后资料、胰腺术后出血（PPH）病人治疗措施及转归。结果：术前基本临床资料中,两组病人在年龄、性别、术前高血压及糖尿病史、美国麻醉医师协会（ASA评分）、术前丙氨酸氨基转移酶、术前总胆红素、术前血清白蛋白、术前胆道引流、肿瘤位置及性质方面差异无统计学意义（P>0.05）。术中资料中,两组病人在手术时间、术中出血量、术中输血量、切除类型、PV 或SMV切除重建、主胰管直径方面差异无统计学意义（P>0.05）。术后资料中,两组病人在术后总体并发症、临床相关胰瘘（CR-POPF）及腹腔感染发生率、腹腔穿刺引流率、晚期腔外PPH及C级晚期腔外PPH发生率、PPH相关再手术率、总体再手术率、术后住院时间方面差异有统计学意义（P<0.05）;两组病人在术后胆瘘、延迟性胃排空障碍、早期PPH、晚期腔内PPH、A级及B级晚期腔外PPH、围手术期死亡率方面差异无统计学意义（P>0.05）。PPH病人治疗措施及转归资料中,两组PPH病人侵袭性治疗率差异有统计学意义（P<0.05）;两组PPH病人在不同侵袭性治疗措施及PPH病死率方面差异无统计学意义（P>0.05）。结论：肝圆镰状韧带一体化包裹加强技术能够降低质软胰腺PD术后总体并发症发生率、CR-POPF及晚期腔外PPH、C级晚期腔外PPH的发生率,同时降低病人腹腔感染发生率、腹腔穿刺置管引流率及再手术率,并缩短术后住院时间。     

胰十二指肠切除术后并发症相关因素分析

目的：探讨胰十二指肠切除术（pancreatoduodenectomy,PD）术后并发症及其危险因素。方法：回顾2000年至2009年第四军医大学西京医院258例行胰十二指肠切除术病人临床资料,并通过单因素分析和多因素分析术后并发症危险因素。结果：本组术后并发症发生率为22.1%（57/258）。多见的并发症包括胰漏、胆漏、腹腔感染,出血等。Logistic回归分析显示,与并发症有关的因素包括术前血清总胆红素〉171μmol/L、术前血清白蛋白〈30g/L,术中出血量〉800 ML,年龄〉60岁,术前血红蛋白〈100g/L。结论：术前血清总胆红素〉171μmol/L,术前血清白蛋白〈30g/L和术中出血量〉800 ML是胰十二指肠切除术术后并发症的高危因素,其次的危险因素为年龄〉60岁、术前血红蛋白〈100g/L。手术者应掌握好手术时机,加强围手术期处理,从而降低胰十二指肠切除术术后并发症。     

直肠癌患者术后血清C反应蛋白、白蛋白、单核细胞趋化蛋白的表达及对吻合口瘘的预测价值

摘要 目的：探讨直肠癌患者术后血清C反应蛋白、白蛋白、单核细胞趋化蛋白的表达及对吻合口瘘的预测价值。方法：选择2017年4月至2019年4月于我院进行直肠癌手术患者102例患者进行研究,其中42例发生术后吻合口瘘,设为试验组,剩余60例未发生吻合口瘘作为对照组。分析患者术后血清C反应蛋白、白蛋白、单核细胞趋化蛋白水平变化情况,采用受试者工作特征曲线分析血清C反应蛋白、白蛋白、单核细胞趋化蛋白对术后发生吻合口瘘的预测价值。结果：试验组术后血清C反应蛋白、单核细胞趋化蛋白水平显著高于对照组,白蛋白水平显著低于对照组,差异显著（P＜0.05）;行预防性造口组术后血清C反应蛋白、单核细胞趋化蛋白水平显著低于未预防性造口组,白蛋白水平显著高于未预防性造口组,差异显著（P＜0.05）;血清C反应蛋白预测术后吻合口瘘的临界值为39.69 mg/L,灵敏度为71.47%,特异度为83.14%,AUC为0. 824,血清白蛋白预测术后吻合口瘘的临界值为29.76 g/L,灵敏度为61.20%,特异度为79.40%,AUC为0. 746,血清单核细胞趋化蛋白预测术后吻合口瘘的临界值为200.09 pg/mＬ,灵敏度为61.18%,特异度为80.45%,AUC为0. 605,联合检测较单独检测具有更高的灵敏度和特异度,分别为77.56%、86.38%。结论：术后血清C反应蛋白、白蛋白、单核细胞趋化蛋白水平对直肠癌患者术后吻合口瘘具有较好的预测价值。     

血清AIb、PA、NLR水平在直肠癌术后发生吻合口瘘评估中的应用

摘要 目的：探讨血清白蛋白（AIb）、前白蛋白（PA）、中性粒细胞与淋巴细胞比值（NLR）水平在直肠癌术后发生吻合口瘘评估中的应用。方法：选择2018年6月至2019年12月于我院进行直肠癌手术患者90例患者进行研究,其中38例发生术后吻合口瘘,设为研究组, 52例未发生吻合口瘘作为对照组。分析患者术后血清AIb、PA、NLR水平变化情况,采用受试者工作特征曲线分析血清AIb、PA、NLR对术后发生吻合口瘘的评估作用。结果：研究组血清AIb、PA水平显著低于对照组,NLR水平显著高于对照组,差异显著（P＜0.05）;造口组术后血清AIb、PA水平显著高于未造口组,NLR水平显著低于未造口组,差异显著（P＜0.05）;ROC结果显示,血清AIb预测术后吻合口瘘的AUC为0.967,灵敏度为81.25%,特异度为90.14%,截断值为33.06 g/L;血清PA预测术后吻合口瘘的AUC为0.772,灵敏度为80.36%,特异度为89.56%,截断值为119.04 mg/L;血清NLR预测术后吻合口瘘的AUC为0.991,灵敏度为85.62%,特异度为93.23%,截断值为6.86。结论：监测血清AIb、PA、NLR水平有助早期发现直肠癌患者术后吻合口瘘。     

肺癌胸腔镜术后肺部感染的危险因素探讨及术前CRP/Alb、PCT、SAA对感染风险的预测价值

摘要 目的：分析肺癌胸腔镜术后肺部感染的危险因素并探讨术前C反应蛋白/白蛋白比值（CRP/Alb）、降钙素原（PCT）、血清淀粉样蛋白A（SAA）对感染风险的预测价值。方法：选取2019年3月～2021年10月在徐州医科大学附属医院接受胸腔镜手术治疗的360例肺癌患者,根据肺癌胸腔镜术后72 h是否发生肺部感染分为肺部感染组57例和非肺部感染组303例。收集患者临床资料,术前1d检测患者血清CRP/Alb、PCT、SAA水平。通过单因素和多因素Logistic回归分析肺癌胸腔镜术后肺部感染的危险因素,受试者工作特征（ROC）曲线分析术前血清CRP/Alb、PCT、SAA水平对肺癌胸腔镜术后肺部感染的预测价值。结果：单因素分析显示,肺部感染组年龄≥60岁、吸烟史、糖尿病、手术时间≥3 h、术中出血量≥200 mL、机械通气时间≥12 h、胸腔引流时间≥5 d比例和血清CRP/Alb、PCT、SAA水平高于非肺部感染组（P＜0.05）。多因素Logistic回归分析显示,年龄≥60岁、吸烟史、糖尿病、手术时间≥3 h、机械通气时间≥12 h、胸腔引流时间≥5 d和血清CRP/Alb、PCT、SAA升高为肺癌胸腔镜术后肺部感染的独立危险因素（P＜0.05）。ROC曲线分析显示,术前血清CRP/Alb、PCT、SAA水平联合预测肺癌胸腔镜术后肺部感染的曲线下面积大于各指标单独预测。结论：年龄、吸烟史、糖尿病、手术时间、机械通气时间、胸腔引流时间和CRP/Alb、PCT、SAA升高为肺癌胸腔镜术后肺部感染的危险因素,术前血清CRP/Alb、PCT、SAA联合预测肺癌胸腔镜术后肺部感染的价值较高。     

乳腺癌患者术后PICC导管相关性感染的危险因素及血清C反应蛋白、降钙素原对感染发生风险的预测价值

摘要 目的：分析乳腺癌患者术后经外周静脉置入中心静脉导管（PICC）相关性感染的危险因素并探讨血清C反应蛋白（CRP）、降钙素原（PCT）对感染发生风险的预测价值。方法：选取2019年1月～2022年1月我院收治的150例乳腺癌改良根治术后接受PICC置管的乳腺癌患者,根据是否发生PICC导管相关性感染分为感染组34例和非感染组116例,收集患者临床资料,采用化学发光法检测置管前血清CRP、PCT水平。通过单因素和多因素Logistic回归分析乳腺癌患者术后PICC导管相关性感染的危险因素,绘制受试者工作特征（ROC）曲线分析血清CRP、PCT水平单独与联合检测对乳腺癌患者术后PICC导管相关性感染的预测价值。结果：单因素分析显示,与非感染组比较,感染组高血压病、糖尿病、TNM分期Ⅲ期、穿刺次数≥3次、化疗次数≥5次、导管留置时间≥6个月、敷料更换频率≥7 d/次比例和血清CRP、PCT水平更高（P＜0.05）。多因素Logistic回归分析显示,糖尿病、TNM分期Ⅲ期、化疗次数≥5次、导管留置时间≥6个月、敷料更换频率≥7 d更换1次、CRP（较高）、PCT（较高）为乳腺癌患者术后PICC导管相关性感染的危险因素（P＜0.05）。ROC曲线分析显示,血清CRP、PCT水平联合预测乳腺癌患者术后PICC导管相关性感染的曲线下面积（AUC）大于单独预测。结论：糖尿病、TNM分期、化疗次数、导管留置时间、敷料更换频率、血清CRP、PCT与乳腺癌患者术后PICC导管相关性感染相关,置管前血清CRP、PCT水平联合预测乳腺癌患者术后PICC导管相关性感染发生风险的价值较高。     

六种藓类植物茎的比较解剖学研究

通过对6种藓类植物,即褶叶青藓(Brachythecium salebrosum(Web.et Mohr.)B.S.G.)、湿地匐灯藓(Plagiomnium acutum(Lindb.)Kop.)、侧枝匐灯藓(Plagiomnium maximoviczii(Lindb.)Kop.)、大凤尾藓(Fissidensnobilis Griff.)、大羽藓(Thuidium cymbifolium(Doz.et Molk.)B.S.G.)和大灰藓(Hypnum plumaeforme Wils.)嫩茎和老茎的石蜡切片和显微观察发现,同一藓类植株的嫩茎和老茎,茎结构稳定,不同种藓类植物茎横切面具有不同特征.植物体茎横切面形状、表层细胞的层数、细胞大小和细胞壁厚薄、皮层细胞大小和形状、中轴的有无以及比例等特征可以作为藓类植物的分科分类依据之一.     

Photoregulation of seed germination of wild-type and of an aurea-mutant of tomato

Seed germination of an aurea mutant of tomato ( Lycopersicon esculentum Mill.) is promoted by continuous irradiation with red, far-red or long-wavelength far-red (758 nm) light as well as by cyclic irradiations (5 min red or 5 min far-red/25 min darkness). Far-red light applied immediately after each red does not change the germination behaviour. Seed germination of the isogenic wild-type, cv. UC-105, is promoted by continuous and cyclic red light while it is inhibited by continuous and cyclic far-red light and by continious 758 nm irradiation. Far-red irradiation reverses almost completely the promoting effect of red light. The promoting effect (in the aurea mutant) and the inhibitory effect (in the wild-type) of continuous far-red light do not show photon fluence rate dependency above 20 nmol m⁻² s⁻¹. It is concluded that phytochrome controls tomato seed germination throgh low energy responses in both the wild type and the au mutant. The promoting effect of continuous and cyclic far-red light in the au mutant can be attributed to a greater sensitivity to P_fr.     

真菌类遗传学分析的知识结构教学

本文以认知结构理论为指导,讨论了真菌类遗传分析与高等动植物遗传分析的内在联系,认为利用这种内在联系进行教学可收到好的效果并说明了作者的具体教学过程。 Abstract:In the paper, the relationship between genetic analysis of Fungi and genetic analysis of high animal and plant was discussed.A good results were obtained when we adopted this method in the teaching.     

Cause of Senescence of Nine Sorts of Flowers

The levels of endogenous phytohormones and respiratory rate in nine sorts of flowers such as Cymbidium faberi Rolfe, Nopalxochia ackermannii Kunth and others were investigated both at full bloom and senescence and meanwhile the effect of exogenous phytohormones on prolonging the blossoms and promoting ethylene production were tested. There is a high content of endogenous ethylene in all the long-lived flowere, about 3–16 folds higer than the short-lived ones. There is a high level of ABA at full blooming flowers of short-lived flowers, in which there is no or only some cytokinins in it, but the ratio of CTK (6BA+zeatin)/ABA is smaller(l.7). The endogenous ABA reached a much higher level at senescence in all nine sorts of flowers, so it is reasonable to consider that it is ABA which plays an important role of regulation in controlling flower's senescence. There is a much higher level of GA3 and zeatin in the long-lived flowers which is not demonstrated in the shortlived ones. The respiratory rate is one of the factors controtling the longevity of flowers, but it does not play a decided role. Application of 6BA and zeatin prolongs distinctly orchid’s longevity, however exogenous IAA through the promotive action on ethylene production, evidently extends the longevity of the flowers of the Nopalxochia ackermannii Kunth.     

Interconnection of parameters of regulation system of lipid peroxidation and of morphophysiological parameters of mouse liver

A complex analysis of seasonal fluctuations of the mean group parameters of the system of regulation of lipid peroxidation has been performed in liver of Balb/c mice. Association of lipid characteristics and morphophysiological parameters is studied in the Balb/c mouse liver. An inter-connection is revealed between the liver index and the amount of lysoforms of phospholipids, the scale and character of the interconnection differing essentially depending on proportion of phos-phatidylcholine in mouse liver phospholipids.     

龙胆科药用植物化学成分的研究现状

龙胆科植物在我国的分布范围很广,且多数为药用植物,其多数种属的药用植物,至今其化学成分尚未被系统研究。综述了目前龙胆科药用植物的化学成分的研究现状及一般提取方法,对近年来发现的环烯醚萜及裂环烯醚萜类化合物进行了总结,为本科药用植物的更深入研究提供了参考。     

Physiological characteristics of various species of strains of carboxydobacteria

Seven strains of aerobic carbon monoxide-oxidizing bacteria (carboxydebacteria) when growing on CO as sole source of carbon and energy had doubling times which ranged from 12–42 h. The activity profiles obtained after discontinuous sucrose density gradient centrifugation indicated that the CO-oxidizing enzymes are soluble and the hydrogenases are membrane-bound in all strains examined. The CO-oxidizing enzymes of Pseudomonas carboxydohydrogena, Pseudomonas carboxydoflava, Comamonas compransoris, and the so far unidentified strains OM2, OM3, and OM4 had a molecular weight of 230,000; that of Achromobacter carboxydus amounted to 170,000. The molecular weights of the CO-oxidizing and H₂-oxidizing enzymes turned out to be identical. The cell sonicates were shown to catalyze the oxidation of both CO and H₂ with methylene blue, thionine, phenazine methosulfate, toluylene blue, dichlorophenolindophenol, cytochrome c or ferricyanide as electron acceptors. Methyl viologen, benzyl viologen, FAD⁺, FMN⁺, and NAD(P)⁺ were not reduced. The spectrum of electron acceptors was identical for all strains tested. Neither free formate, hydrogen nor oxygen gas were involved in the CO-oxidation reaction. Methylene blue was reduced by CO at a 1:1 molar ratio. The results indicate that CO-oxidation by carboxydobacteria is catalyzed by identical or similar enzymes and that the reaction obeys the equation CO+H₂OCO₂+2H⁺+2e^- as previously shown for Pseudomonas carboxydovorans.Dedicated to Otto Kandler remembering almost three decades of enjoyable cooperation     

Modulation of allostery of pyruvate kinase by shifting of an ensemble of microstates

Since the introduction of the concepts of allostery about four decades ago, much advancement has been made in elucidating the structure-function correlation in allostery. However, there are still a number of issues that remain unresolved. In this review we used mammalian pyruvate kinase (PK) as a model system to understand the role of protein dynamics in modulating cooperativity. PK has a triosephosphate isomerase (TIM)(α/β)₈ barrel structural motif. PK is an ideal system to address basic questions regarding regulatory mechanisms about this common (α/β)₈ structural motif. The simplest model accounting for all of the solution thermodynamic and kinetic data on ligand-enzyme interactions involves two conformational states, inactive E^T and active E^R. These conformational states are represented by domain movements. Further studies provide the first evidence for a differential effect of ligand binding on the dynamics of the structural elements, not major secondary structural changes. These data are consistent with our model that allosteric regulation of PK is the consequence of perturbation of the distribution of an ensemble of states in which the inactive E^T and active E^R represent the two extreme end states. Sequence differences and ligands can modulate the distribution of states leading to alterations of functions. The future work includes: defining the network of functionally connected residues; elucidating the chemical principles governing the sequence differences which affect functions; and probing the nature of mutations on the stability of the secondary structural elements, which in turn modulate allostery.