GCC mRNA和hTERT mRNA在腹腔镜结直肠癌根治术患者外周血中的表达及意义

目的:探讨腹腔镜和开腹手术对结直肠癌根治术患者外周血鸟苷酸环化酶C(GCC)m RNA和人端粒酶逆转录酶(h TERT)m RNA表达的影响及其意义。方法:按照随机数字表法将2009年8月-2014年4月我院收治的结直肠癌患者分为腹腔镜组和开腹手术组,通过逆转录-聚合酶链反应技术(RT-PCR)检测并比较两组患者外周血GCC m RNA和h TERT m RNA的表达情况。结果:与开腹手术组相比较,腹腔镜组患者手术时间长、术中出血量少、术后排气早、住院时间短,差异有统计学意义(P0.01);两组患者手术前GCC m RNA和h TERT m RNA阳性率无显著差异(P0.05);两组患者手术后GCC m RNA和h TERT m RNA阳性率显著升高,差异有统计学意义(P0.05)。结论:腹腔镜和开腹手术均会增加结直肠癌患者血行微转移,但腹腔镜结直肠根治术不会增加术后肿瘤血循环微转移的危险性。     

The complexity of DNA double strand break is a crucial factor for activating ATR signaling pathway for G2/M checkpoint regulation regardless of ATM function

DNA double strand break (DSB) repair pathway choice following ionizing radiation (IR) is currently an appealing research topic, which is still largely unclear. Our recent paper indicated that the complexity of DSBs is a critical factor that enhances DNA end resection. It has been well accepted that the RPA-coated single strand DNA produced by resection is a signaling structure for ATR activation. Therefore, taking advantage of high linear energy transfer (LET) radiation to effectively produce complex DSBs, we investigated how the complexity of DSB influences the function of ATR pathway on the G2/M checkpoint regulation. Human skin fibroblast cells with or without ATM were irradiated with X rays or heavy ion particles, and dual-parameter flow cytometry was used to quantitatively assess the mitotic entry at early period post radiation by detecting the cells positive for phosphor histone H3. In ATM-deficient cells, ATR pathway played a pivotal role and functioned in a dose- and LET-dependent way to regulate the early G2/M arrest even as low as 0.2 Gy for heavy ion radiation, which indicated that ATR pathway could be rapidly activated and functioned in an ATM-independent, but DSB complexity-dependent manner following exposure to IR. Furthermore, ATR pathway also functioned more efficiently in ATM-proficient cells to block G2 to M transition at early period of particle radiation exposure. Accordingly, in contrast to ATM inhibitor, ATR inhibitor had a more effective radiosensitizing effect on survival fraction following heavy ion beams as compared with X ray radiation. Taken together, our results reveal that the complexity of DSBs is a crucial factor for the activation of ATR pathway for G2/M checkpoint regulation, and ATM-dependent end resection is not essential for the activation.     

The relationship between albumin, other plasma proteins and variables, and age in the acute phase response after liver resection in man

Summary. A large series of plasma albumin (ALB, g/dl) and simultaneous blood and clinical measurements were prospectively performed on 92 liver resection patients, and processed to assess the correlations between ALB, other plasma proteins, additional variables and clinical events. The measurements were performed preoperatively and at postoperative day 1, 3 and 7 in all patients, and subsequently only in those who developed complications or died. In patients who recovered normally ALB was 4.3 ± 0.4 g/dl (mean ± SD) preoperatively, 3.7 ± 0.7 at day 1 and 3, and 3.9 ± 0.4 at day 7. In patients with complications its decrease was more prolonged. In non-survivors it was 3.4 ± 0.4 preoperatively, 3.0 ± 0.4 at day 1, and then decreased further. Regression analysis showed direct correlations between ALB and pseudo-cholinesterase (CHE, U/l, nv 5300-13000), cholesterol (CHOL, mg/dl), iron binding capacity (IBC, mg/dl), prothrombin activity (PA, % of standard reference) and fibrinogen, an inverse correlation with blood urea nitrogen (BUN, mg/dl) for any given creatinine level (CREAT, mg/dl), and weaker direct correlations with hematocrit, other variables and dose of exogenous albumin. An inverse relationship found between ALB and age (AGE, years) became postoperatively (POSTOP) also a function of outcome, showing larger age-related decreases in ALB associated with complications (COMPL: sepsis, liver insufficiency) or death (DEATH). Main overall correlations: CHE = 287.4(2.014)^ALB, r = 0.73; CHOL = 16.5(1.610)^ALB (1.001)^ALKPH, r = 0.71; IBC = 68.6(1.391)^ALB, r = 0.64; PA = 13.8 + 16.0(ALB), r = 0.51; BUN = 21.3 + 20.2(CREAT) – 6.2(ALB), r = 0.91; ALB = 5.0–0.013(AGE) – {0.5 + 0.003(AGE) _COMPL + 0.012(AGE) _DEATH } _POSTOP , r = 0.74 [p < 0.001 for each regression and each coefficient; ALKPH = alkaline phosphatase, U/l, nv 98-279, independent determinant of CHOL; discontinuous variables in italics label the change in regression slope or intercept associated with the corresponding condition]. These results suggest that altered albumin synthesis (or altered synthesis unable to compensate for albumin loss, catabolism or redistribution) is an important determinant of hypoalbuminemia after hepatectomy. The correlations with age and postoperative outcome support the concept that hypoalbuminemia is a marker of pathophysiologic frailty associated with increasing age, and amplified by the challenges of postoperative illness.     

静脉全麻联合超声引导下前锯肌平面+肋间神经阻滞应用于胸腔镜肺楔形切除术效果分析

摘要 目的：探讨静脉全麻联合超声引导下前锯肌平面+肋间神经阻滞应用于胸腔镜肺楔形切除术效果。方法：选择2021年10月至2022年12月来我院诊治的60例行胸腔镜肺楔形切除术患者,根据随机数字表法,将60例患者分为对照组（30例）与观察组（30例）,对照组30例患者行全麻联合胸椎旁阻滞+肋间神经阻滞的麻醉方法,观察组30例患者行全麻联合前锯肌＋肋间神经阻滞的麻醉方法。对比两组患者监测入室时（T0）、插管即刻（T1）、手术切皮时（T2）、拔管即刻（T3 ）时的平均动脉压及心率,对比两组患者术后2 h、4 h、12 h、24 h、48 h的静息、咳嗽状态下的疼痛评分,对比两组患者T0-T3点的应激反应指标,对比两组患者术中血管活性药的使用剂量,对比两组患者围术期的不良反应发生率。结果：与T0点相比,观察组在T1、T2、T3时的平均动脉压、心率均有明显增加（P<0.05）,而在T1点时,两组比较无差异（P>0.05）;T2、T3点时观察组的平均动脉压、心率明显较对照组低（P<0.05）。随着术后时间延长,两组静息、咳嗽状态下的疼痛评分明显降低（P<0.05）,而同时间点组间对比无统计学意义（P>0.05）。与T0点相比,观察组在T1、T2、T3时的肿瘤坏死因子、白介素6、白介素10水平均有明显增加（P<0.05）,而同时间点观察组与对照组对比无统计学意义（P>0.05）。观察组术中血管活性药的使用剂量明显较对照组低（P<0.05）。观察组的不良反应发生率16.77%低于对照组23.33%,但组间对比无统计学意义（P>0.05）。结论：行静脉全麻联合超声引导下前锯肌平面+肋间神经阻滞的胸腔镜肺楔形切除术者血流动力学更加稳定,术中所需血管活性药物用量明显降低。     

Helicobacter pylori Eradication Therapy May Facilitate Gastric Ulcer Healing After Endoscopic Mucosal Resection: A Prospective Randomized Study

Background and Aim: It remains unclear whether Helicobacter pylori eradication therapy affects the healing rate of iatrogenic ulcers following endoscopic mucosal resection (EMR) for gastric tumors. The aim of our study was to prospectively evaluate the effect of H. pylori eradication therapy on gastric ulcer healing after EMR. Methods: After EMR, patients were randomly assigned to either the H. pylori eradication group (Hp group) (lansoprazole 30 mg, amoxicillin 1000 mg, and clarithromycin 500 mg, twice a day for 7 days) or the noneradication group (proton pump inhibitor, PPI group) (lansoprazole 30 mg, twice a day for 7 days). Four weeks after EMR, the ulcer stages and size were compared between the two groups. Moreover, ulcer‐related symptoms, bleeding rates, adverse effects, and drug compliance were compared. Results: A total of 64 patients were enrolled. Of these, 17 patients were excluded from the study. The two groups were comparable in terms of baseline clinicopathologic characteristics. Four weeks after EMR, the two groups did not differ with respect to ulcer stage (p = .475) or ulcer‐related symptoms (p = .399). However, the ulcer reduction ratio was significantly higher in the Hp group (0.028 ± 0.024 vs. 0.065 ± 0.055, p < .05). No differences were observed between the two groups with regard to drug compliance, adverse drug event rates, or bleeding rates. Conclusions: Our results suggest that H. pylori eradication therapy might improve the ulcer healing rate after EMR.     

Nucleolytic degradation of 3′-ending overhangs is essential for DNA-end resection in RecA-loading deficient recB mutants of Escherichia coli

Degradation of a 5′-ending strand is the hallmark of the universal process of DNA double strand break (DSB) resection, which results in creation of the central recombination intermediate, a 3′-ending overhang. Here we show that in Escherichia coli recB1080/recB1067 mutants, which are devoid of RecBCD's nuclease and RecA loading activities, degradation of the unwound 3′ tail is as essential as is degradation of its 5′-ending complement. Namely, a synergistic action of ExoI, ExoVII, SbcCD and ExoX single-strand specific exonucleases (ssExos) of 3′-5′ polarity was essential for preserving cell viability, DNA repair and homologous recombination in the recB1080/recB1067 mutants, to the same extent as the redundant action of 5′-tail trimming ssExos RecJ and ExoVII. recB1080 derivatives lacking 3′-5′ ssExos also showed a strong induction of the SOS response and greatly increased SOS-dependent mutagenesis. Furthermore, we show that ExoI and ExoVII ssExos act synergistically in suppressing illegitimate recombination in the recB1080 mutant but not in a wt strain, while working in concert with the RecQ helicase. Remarkably, 3′-5′ ssExos show synergism with RecQ helicase in the recB1080 mutant in all the assays tested. The effect of inactivation of 3′-5′ ssExos in the recB1080/recB1067 mutants was much stronger than in wt, recD, and recB strains. These results demonstrate that the presence of a long, reactive 3′ overhang can be as toxic for a cell as its complete absence, i.e. it may prevent DSB repair. Our results indicate that coupling of helicase and RecA-loading activity during dsDNA-end resection is crucial in avoiding the deleterious effects of a long and stabile 3′ tail in E. coli.     

靶控输注静脉麻醉和腰硬联合麻醉对直肠癌根治术患者免疫功能的影响研究

目的：探讨靶控输注静脉麻醉和腰硬联合麻醉对直肠癌根治术患者免疫功能的影响。方法：选择在我院行直肠癌根治术的72例患者,将其分为观察组和对照组各36例,其中观察组给予靶控输注静脉麻醉,对照组采用腰硬联合麻醉,对两组患者手术时间、术中出血量以及免疫球蛋白水平（IgG、IgA、IgM）、血清白介素-6水平（IL-6）、肿瘤坏死因子α水平（TNF-α）以及T细胞亚群（CD3、CD4）水平进行对比。结果：观察组手术平均时间为（130．5±11．7）min,术中平均出血量为（271.3±37．8）ml,与对照组比较差异均无统计学意义（P〉0．05）;两组IgG、IgA及IgM,在T1、T2、T3及T4时刻水平比较差异均无统计学意义（P〉0．05）;两组IL-6、TNF-α、CD3及CD4在麻醉后较T1时均有明显变化,比较差异均有统计学意义（P〈0．05）,且观察组变化较对照组更为明显,两组比较差异有统计学意义（P〈0．05）。结论：靶控输注静脉麻醉和腰硬联合麻醉对直肠癌根治术患者免疫功能均存在抑制作用,且以抑制细胞免疫功能为主,而腰硬联合麻醉抑制作用较低,值得推广应用。     

香砂六君子汤辅助化疗对腹腔镜结肠癌根治术后患者细胞免疫功能和血清肿瘤标志物的影响

摘要 目的：观察香砂六君子汤辅助化疗对腹腔镜结肠癌根治术后患者细胞免疫功能和血清肿瘤标志物的影响。方法：前瞻性选取2019年3月-2021年3月期间来南京医科大学附属江宁医院接受治疗的85例结肠癌患者,均接受腹腔镜结肠癌根治术治疗。分组方法选用随机数字表法,分为对照组（给予化疗治疗,n=42）和研究组（给予香砂六君子汤辅助化疗治疗,n=43）。对比两组疗效、中医证候积分、细胞免疫功能、血清肿瘤标志物和不良反应发生率。结果：与对照组比较,研究组的临床总有效率明显升高（P<0.05）。两组不良反应发生率组间对比无差异（P>0.05）。研究组治疗结束后CD3⁺、CD4⁺/CD8⁺、CD4⁺高于对照组（P<0.05）。研究组治疗结束后血清癌胚抗原（CEA）、癌抗原125（CA125）、甲胎蛋白（AFP）、CD8⁺水平低于对照组（P<0.05）。研究组治疗结束后腹痛、食少纳呆、腹胀、大便脓血评分低于对照组（P<0.05）。结论：香砂六君子汤辅助化疗治疗腹腔镜结肠癌根治术后患者,可有效促进症状改善,阻止肿瘤细胞扩散,减轻免疫抑制,具有一定的临床价值。     

内镜下黏膜切除术治疗大肠息肉的临床疗效及术后出血的影响因素分析

摘要 目的：研究内镜下黏膜切除术（EMR）治疗大肠息肉的临床疗效及术后出血的影响因素。方法：将我院从2016年1月～2019年12月收治的大肠息肉患者500例纳入研究,所有患者均接受EMR治疗。分析其临床疗效以及术后出血发生情况,并对术后出血的影响因素实施单因素、多因素Logistic回归分析。结果：500例患者临床治疗总有效率为97.80%（489/500）,术后出血发生例数为17例,出血发生率为3.40%（17/500）。治疗后患者各项生活质量评分均高于治疗前（均P<0.05）。经单因素分析发现：大肠息肉患者经EMR治疗后其切除息肉数、术后进食时间、息肉外观、息肉分叶均与术后出血有关（均P<0.05）;而年龄、性别、息肉部位以及病理类型均与术后出血无关（均P>0.05）。经多因素Logistic回归分析可得：切除息肉数≥4枚、术后48 h内进食、息肉外观潮红/糜烂以及息肉分叶均是大肠息肉患者经EMR治疗后出血的危险因素（均P<0.05）。结论：EMR治疗大肠息肉患者的临床疗效较佳,可改善其生活质量,其中切除息肉数、术后进食时间、息肉外观以及息肉分叶均和术后出血有关,值得临床关注。