HALS与LAP用于直肠癌根治术患者的临床疗效及其对血清炎性因子水平的影响

目的:探讨手辅助腹腔镜手术(hand-assisted laparoscopic surgery,HALS)与全腹腔镜手术(laparoscopic surgery,LAP)用于直肠癌根治术患者的临床疗效及其对血清炎性因子水平的影响。方法:选取2013年3月～2018年3月在我院行直肠癌根治术的患者61例进行回顾性分析,按照手术方式不同分为手辅助腹腔镜手术组(HALS组)和全腹腔镜手术组(LAP组)。比较两组患者的手术相关指标、术后恢复指标和治疗前后血清炎性因子水平的变化。结果:HALS组的手术时间、术中出血量和副损伤显著低于LAP组(P0.05),两组中转开腹率相比无统计学差异(P0.05);两组患者术后肠功能恢复时间、进食时间、下床时间和住院时间比较均无显著性差异(P0.05);两组患者术后1 h和术后1 d血清白细胞介素-10(interleukin-10, IL-10)、C-反应蛋白(C reactive protein,CRP)和α肿瘤坏死因子(Tumor Necrosis Factor-α,TNF-α)水平均较术前显著升高,且HALS组显著低于LAP组(P0.05),术后1 w血清IL-10、CRP和TNF-α水平与术前相比无统计学差异(P0.05)。结论:HALS直肠癌根治术对患者的手术创伤小,炎性反应轻,且不影响患者的预后,利于患者的康复。     

肝癌乙型肝炎病毒感染患者术后恩替卡韦抗病毒治疗的临床疗效及安全性评价

目的:探讨肝癌乙型肝炎病毒(HBV)感染患者根治性切除术后采用恩替卡韦抗病毒治疗的临床疗效及安全性。方法:收集2015年1月-2017年8月在我院行根治性切除术的肝癌HBV感染患者279例为研究对象,以血清HBV-DNA载量10~5 copies/ml为界限,分为高病毒复制组128例,低病毒复制组151例,按照随机数字表法将高病毒复制组分为高-治疗组64例、高-对照组64例,将低病毒复制组分为低-治疗组76例、低-对照组75例。高-治疗组和低-治疗组术后给予恩替卡韦0.5 mg/d,高-对照组和低-对照组未行抗病毒治疗。比较手术前、术后7 d各组的血清HBV-DNA水平,血清白蛋白(ALB)、谷丙转氨酶(ALT)、前白蛋白(PA),以及术后并发症的发生情况。结果:高-治疗组、高-对照组、低-治疗组、低-对照组术后血清ALB、PA均较治疗前降低,血清ALT均较治疗前升高,且高-治疗组或低-治疗组术后血清ALB、PA均高于高-对照组或低-对照组,血清ALT水平均低于高-对照组或低-对照组,差异均有统计学意义(P0.05);高-治疗组或低-治疗组术后血清HBV-DNA水平均低于治疗前,且均低于同期高-对照组或低-对照组,差异均有统计学意义(P0.05)。高-治疗组与高-对照组、低-治疗组与低-对照组患者术后并发症发生率均无统计学差异(P0.05)。结论:恩替卡韦能显著改善肝癌HBV感染患者术后的血清HBV-DNA载量水平和肝功能,安全性高,值得临床推广。     

手术切除与介入栓塞治疗肝癌术后复发患者的临床对比研究

目的:比较手术切除与介入栓塞治疗肝癌术后复发患者的临床疗效。方法:选择2010年6月到2011年6月本院收治的92例肝癌手术切除术后复发患者,按随机数字表法分为手术切除组和介入栓塞组,各46例。手术切除组患者给予再次切除治疗,介入栓塞组患者给予介入栓塞治疗。记录并比较两组患者治疗后1年、3年及5年的生存率。检测并比较两组患者治疗前后血清肝纤维化指标,包括血清透明质酸(HA)、层黏蛋白(LN)、人Ⅲ型前胶原(HPC-Ⅲ)及IV型胶原(IV-C)水平。检测并比较两组患者治疗前后血清白细胞(WBC)、甲胎蛋白(AFP)及癌胚抗原(CEA)水平。结果:手术切除组患者治疗后1年、3年、5年的生存率均明显高于介入栓塞组,差异均具有统计学意义(P0.05)。治疗后,介入栓塞组血清HA、LN、HPC-Ⅲ及IV-C明显高于治疗前,且均明显高于手术切除组,差异均具有统计学意义(P0.05)。两组患者治疗后血清WBC、AFP及CEA水平均明显低于治疗前,且手术切除组患者血清WBC明显高于介入栓塞组,而血清AFP、CEA水平明显低于介入栓塞组,差异均具有统计学意义(P0.05)。结论:手术切除治疗肝癌术后复发能够明显提高患者生存率,降低肝纤维化程度,改善血清AFP及CEA水平,值得在临床上推广应用。     

不同剂量右美托嘧啶对胸腔镜下食管癌根治术患者心肌氧供及血流动力学的影响

目的:探讨不同剂量右美托嘧啶(DEX)对胸腔镜下食管癌根治术患者心肌氧供及血流动力学的影响。方法:选取66例我院拟行腔镜下食管癌根治术患者,随机分为三组,每组各22例:低剂量右美托嘧啶组(L组)(0.5μg/kg)、高剂量右美托嘧啶组(H组)(1.0μg/kg)、对照组(N组)(与L组和H组同等速率输注生理盐水),而后H组和L组均以0.5μg/kg/h维持输注DEX。记录各组输注前(T1)、输注后5 min(T2)、输注后10 min(T3)、输注后15 min(T4)、输注后30 min(T5)各组血流动力学指标:心率(HR)、收缩压(SBP)、平均动脉压(MAP)、每搏输出量(SV)、中心静脉压(CVP)、心排量(CO),计算HR与SBP的乘积RPP,抽取挠动脉和肺动脉血进行动脉血气分析,采用反向FICK法计算氧供(DO2)和氧耗(VO2)。结果:HR:H组和L组患者HR随时间的推移呈下降趋势,H组T3、T4、T5时间点HR较T1时间点显著降低(P0.05);与N组相比,H组和L组T3、T4、T5时间点HR显著降低(P0.05)。MAP:H组T3、T4、T5时间点MAP显著低于L组(P0.05);H组T3、T4时间点MAP显著低于N组(P0.05);H组T5时间点MAP显著低于同组T1、T2时间点(P0.05)。SBP:H组T3、T4、T5时间点SBP与L组和N组比较显著降低(P0.05);H组T5时间点SBP较同组T1、T2时间点显著降低(P0.05)。RPP:H组T3、T4、T5时间点RPP与同组T1、T2时间点和N组比较显著降低(P0.05)。DO2:H组T5时间点DO2与L组和N组比较显著降低(P0.05)。VO2:L组患者VO2T3、T4、T5时间点与组内T1、T2时间点和N组相比显著降低(P0.05);H组VO2T3、T4、T5时间点与组内T1、T2时间点和N组相比显著降低(P0.05)。结论:小剂量(0.5μg/kg)输注DEX能降低胸腔镜下食管癌患者心肌氧耗,维持血流动力学稳定,高剂量(1.0μg/kg)输注DEX降低心肌氧耗的同时会降低心肌氧供,存在一定风险,对于患有冠心病以及心肺功能低下的老年患者,建议给予小剂量输注DEX,并监测血流动力学指标,及时调整DEX用量。     

The effect of two teeth resection procedures on the welfare of piglets in farrowing crates. Part 1

Teeth resection is a method of controlling the injurious effects of the aggression displayed when newborn piglets fight to establish a teat order. Recent European legislation discourages the practice. The objective of this study was to assess the effect of clipping and grinding piglets’ needle teeth, compared to leaving them intact, on the welfare of piglets in farrowing crates.

Six days pre-partum, 60 sows were assigned to one of three treatments. Litters had their teeth clipped (C), ground (G) or left intact (I) at birth. The time taken to carry out each procedure was recorded. Piglet weights and facial lesions, which were scored according to severity, were recorded on days 1, 4, 11, 18 and 27. Piglet weights were also recorded at birth. Mouth lesions were recorded on days 1, 4 and 27. Instantaneous scan samples of piglet behaviour were carried out for 30 min post-teeth resection procedure (1 min intervals), and for 6 h on days 1, 4, 8, 14, 21 and 26 (5 min intervals). One male and one female piglet per litter were chosen as focal animals and observed for 5 min each post-procedure and for 10 min each twice per day on days 1, 5, 12, 20 and 26. Mortalities were recorded throughout lactation.

Grinding took significantly longer than clipping the teeth or leaving them intact (F = 638.87, P < 0.001). I piglets had higher facial lesion scores than C and G piglets (F = 10.58, P < 0.001). A smaller proportion of piglets in I litters than C and G litters and a smaller proportion of piglets in G litters than C litters had at least one mouth lesion (F = 4.74, P < 0.001). During 30 min post-procedure, I piglets were active on the heatpad in more observations than C and G piglets (F = 3.49, P < 0.05). During 5 min post-procedure C piglets spent longer chomping than I piglets (F = 5.92, P = 0.05). On day 21, I piglets were active in more observations than G piglets (F = 2.11, P < 0.05). On day 26, G piglets were inactive in more observations than C and I piglets (F = 5.02, P < 0.05). On days 14 and 26, C piglets were sleeping in more observations than G piglets (F = 2.87, P = 0.05). There was a tendency for a larger proportion of I than C piglets to die due to overlying (F = 2.68, P = 0.08).

In conclusion, although all three options were associated with welfare problems, grinding can be recommended in preference to clipping or leaving the teeth intact.     

Genomic and chromatin features shaping meiotic double-strand break formation and repair in mice

The SPO11-generated DNA double-strand breaks (DSBs) that initiate meiotic recombination occur non-randomly across genomes, but mechanisms shaping their distribution and repair remain incompletely understood. Here, we expand on recent studies of nucleotide-resolution DSB maps in mouse spermatocytes. We find that trimethylation of histone H3 lysine 36 around DSB hotspots is highly correlated, both spatially and quantitatively, with trimethylation of H3 lysine 4, consistent with coordinated formation and action of both PRDM9-dependent histone modifications. In contrast, the DSB-responsive kinase ATM contributes independently of PRDM9 to controlling hotspot activity, and combined action of ATM and PRDM9 can explain nearly two-thirds of the variation in DSB frequency between hotspots. DSBs were modestly underrepresented in most repetitive sequences such as segmental duplications and transposons. Nonetheless, numerous DSBs form within repetitive sequences in each meiosis and some classes of repeats are preferentially targeted. Implications of these findings are discussed for evolution of PRDM9 and its role in hybrid strain sterility in mice. Finally, we document the relationship between mouse strain-specific DNA sequence variants within PRDM9 recognition motifs and attendant differences in recombination outcomes. Our results provide further insights into the complex web of factors that influence meiotic recombination patterns.     

DNA end resection is needed for the repair of complex lesions in G1-phase human cells

Repair of DNA double strand breaks (DSBs) is influenced by the chemical complexity of the lesion. Clustered lesions (complex DSBs) are generally considered more difficult to repair and responsible for early and late cellular effects after exposure to genotoxic agents. Resection is commonly used by the cells as part of the homologous recombination (HR) pathway in S- and G2-phase. In contrast, DNA resection in G1-phase may lead to an error-prone microhomology-mediated end joining. We induced DNA lesions with a wide range of complexity by irradiation of mammalian cells with X-rays or accelerated ions of different velocity and mass. We found replication protein A (RPA) foci indicating DSB resection both in S/G2- and G1-cells, and the fraction of resection-positive cells correlates with the severity of lesion complexity throughout the cell cycle. Besides RPA, Ataxia telangiectasia and Rad3-related (ATR) was recruited to complex DSBs both in S/G2- and G1-cells. Resection of complex DSBs is driven by meiotic recombination 11 homolog A (MRE11), CTBP-interacting protein (CtIP), and exonuclease 1 (EXO1) but seems not controlled by the Ku heterodimer or by phosphorylation of H2AX. Reduced resection capacity by CtIP depletion increased cell killing and the fraction of unrepaired DSBs after exposure to densely ionizing heavy ions, but not to X-rays. We conclude that in mammalian cells resection is essential for repair of complex DSBs in all phases of the cell-cycle and targeting this process sensitizes mammalian cells to cytotoxic agents inducing clustered breaks, such as in heavy-ion cancer therapy.     

Ileo-caecal resection induced pancreatic growth in rats

The effect of ileo-caecal resection on pancreatic growth was studied in rats four weeks after the operation. The results were compared with an identical control group who had undergone laparotomy alone. Pancreatic wet weight in ileo-caecal resectioned rats was 1.4 times greater than that found in control rats. Protein, DNA, RNA contents in the pancreas, pancreatic wet weight per 100 micrograms DNA and RNA/DNA ratio were also found significantly elevated in experimental group as opposed to the control group. Basal plasma levels of cholecystokinin (CCK) and gastrin were measured to delineate the influence of hormonal response on the pancreatic growth in ileo-caecal resected rats and were found not significantly increased after ileo-caecal resection. The data suggest that the enlargement of pancreas in ileo-caecal resected rats may be due to hyperplasia and hypertrophy of pancreatic cells; alternatively, the pancreatic growth may have been influenced by the bile acid deficiency and the reduction or release of an inhibitory factor present in the ileum of rats.