先天性支气管动脉-肺动脉瘘儿童咯血的介入治疗临床分析

目的:总结先天性支气管动脉-肺动脉瘘患儿的临床特点及诊治经验,探讨介入治疗支气管动脉-肺动脉瘘所致咯血的安全性及有效性。方法:回顾性分析我院自2009年7月至2017年6月收治的先天性支气管动脉-肺动脉瘘所致咯血患儿36例,行支气管动脉数字减影血管造影(DSA),选择300-700μm聚乙烯醇(PVA)微栓颗粒或微球颗粒行支气管动脉栓塞术治疗,评价疗效,患者在术后1个月、3个月、半年、1年门诊复查。结果:多层螺旋CT血管造影(MSCTA)显示支气管动脉-肺动脉瘘直接征象的诊出率为55.5%(20/36),16例为假阴性(44.4%),未发现假阳性病例;36例患者栓塞术后治疗即刻成功率为100%,复发率13.9%(5/36),复发时间出现于术后2-6个月,表现为再次咯血,但咯血量较初次封堵前减少,均行二次栓塞术。结论:介入治疗对于支气管动脉-肺动脉瘘所致咯血是一种创伤小、操作简便、疗效明确、并发症少的治疗方法。为进一步减少复发风险,患者术前应仔细进行MSCTA检查,行全面DSA下血管造影,根据患者病变血管情况选择合适的永久栓塞剂,运用恰当的栓塞技术。     

泡沫敷料对结肠造瘘患者造瘘口周渗出液炎性物质的影响

目的:探讨泡沫敷料对结肠造瘘患者造瘘口周渗出液炎性物质的影响。方法:选取我院普外科收治的结肠造瘘术患者104例,采用随机数字表方法将所有患者平均分为两组,各52例,对照组常规清洁造瘘口,造瘘口及周围皮肤涂抹氧化锌软膏后安装肛门袋;治疗组在对照组治疗的基础上,平铺一层多爱肤有边辅料,安装肛门袋,两组患者均每日更换肛门袋一次,连续治疗2周。采用酶联免疫吸附法(ELISA)检测两组患者治疗前后造瘘口周渗出液炎性物质水平;记录两组患者治疗过程中和治疗后皮肤损伤及造瘘口并发症发生情况。结果:1治疗后,两组患者造瘘口渗出液炎性物质水平较治疗前明显降低,且治疗组下降程度高于对照组(P0.05);2治疗后,治疗组造瘘口皮肤完好率明显高于对照组,差异有统计学意义(P0.05);3对照组造瘘口并发症的发生率明显高于治疗组,差异有统计学意义(P0.05)。结论:泡沫敷料能够降低结肠造瘘患者造瘘口周炎性物质的分泌,减少造瘘口周围皮肤的损伤,降低造瘘口并发症的发生,对结肠造瘘口的护理具有重要临床意义。     

微生态肠内营养在消化道瘘治疗中作用

目的探讨微生态肠内营养在消化道瘘治疗中的临床效果。方法将23例消化道瘘患者随机分为微生态制剂肠内营养组(MEN组)和普通肠内营养组(EN组),MEN组12例,EN组11例,检测患者鼻空肠饲养前后血清总蛋白、血清白蛋白、外周血白细胞、中性粒细胞比率、淋巴细胞计数及消化道症状。结果 MEN组与EN组血清总蛋白、血清白蛋白、外周血白细胞、中性粒细胞比率、淋巴细胞计数比较差异无统计学意义(P>0.05),但MEN组与EN组在消化道症状方面差异有统计学意义(P<0.05)。结论早期肠内微生态营养可以明显减轻消化道瘘患者的胃肠道症状,有利于肠道功能的恢复。     

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。     

Co-culture of human fibroblasts,smooth muscle and endothelial cells promotes osteopontin induction in hypoxia

Arteriovenous fistulas (AVFs) are the preferred vascular access for haemodialysis of patients suffering from end-stage renal disease, a worldwide public health problem. However, they are prone to a high rate of failure due to neointimal hyperplasia and stenosis. This study aimed to determine if osteopontin (OPN) was induced in hypoxia and if OPN could be responsible for driving AVF failure. Identification of new factors that participate in remodelling of AVFs is a challenge. Three cell lines representing the cells of the three layers of the walls of arteries and veins, fibroblasts, smooth muscle cells and endothelial cells, were tested in mono- and co-culture in vitro for OPN expression and secretion in normoxia compared to hypoxia after silencing the hypoxia-inducible factors (HIF-1α, HIF-2α and HIF-1/2α) with siRNA or after treatment with an inhibitor of NF-kB. None of the cells in mono-culture showed OPN induction in hypoxia, whereas cells in co-culture secreted OPN in hypoxia. The changes in oxygenation that occur during AVF maturation up-regulate secretion of OPN through cell-cell interactions between the different cell layers that form AVF, and in turn, these promote endothelial cell proliferation and could participate in neointimal hyperplasia.     

祛毒汤联合红光照射治疗促进湿热下注型低位单纯性肛瘘患者术后创面愈合的临床研究

摘要 目的：探讨祛毒汤联合红光照射治疗促进湿热下注型低位单纯性肛瘘患者术后创面愈合的临床疗效。方法：采用随机数字表法将西安市中医医院肛肠科2019年12月至2022年12月期间收治的116例湿热下注型低位单纯性肛瘘患者分为观察组（58例，红光照射、祛毒汤熏洗、常规治疗）和对照组（58例，红光照射、常规治疗）。对比两组临床疗效、创面愈合情况、血清炎症因子、血清生长因子变化情况。结果：与对照组相比，观察组创面愈合率更高，创面愈合时间更短，临床总有效率更高（P<0.05）。与对照组治疗后相比，观察组同时间点视觉模拟评分法（VAS）评分、创面渗出评分、创面肉芽生长情况评分更低，超敏C反应蛋白（hs-CRP）、降钙素原（PCT）、白细胞介素-6（IL-6）更低，碱性成纤维细胞生长因子（bFGF）、表皮生长因子（EGF）、转化生长因子β（TGF-β）更高（P<0.05）。结论：祛毒汤联合红光照射治疗可促进湿热下注型低位单纯性肛瘘患者术后创面愈合，可调节炎症因子和生长因子水平。     

Technical Aspects of the Mouse Aortocaval Fistula

Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta and inferior vena cava (IVC) are exposed. The proximal infrarenal aorta and the distal aorta are dissected for clamp placement and needle puncture, respectively. Special attention is paid to avoid dissection between the aorta and the IVC. After clamping the aorta, a 25 G needle is used to puncture both walls of the aorta into the IVC. The surrounding connective tissue is used for hemostatic compression. Successful creation of the AVF will show pulsatile arterial blood flow in the IVC. Further confirmation of successful AVF can be achieved by post-operative Doppler ultrasound.     

New aspects of the intrafilamental vascular system in gills of a euryhaline teleost,Tilapia mossambica

Summary The non-respiratory vascular system of T. mossambica gill filaments was studied in serial longitudinal and cross sections. Comparatively few scattered vascular communications occur between the afferent filament artery and the central venous sinus (AVA_aff). The efferent filament artery, however, is connected by regularly arranged anastomoses (AVA_eff), directly, and sometimes indirectly via nutritive vessels, to the central sinus. These AVA_eff are about as numerous as lamellae counted on one side of each filament, although they diminish slightly in number towards the filament base. The relation AVA_eff to AVA_aff was 17.6:1 in the distal and 17.8:1 in the basal filamental region, while in the tip region of 7 filaments 126 AVA_eff but only 1 AVA_aff were encountered. No direct connection between the lamellar lacunae and the central sinus was detected. According to these results, non-respiratory intrafilamental blood shunting appears unlikely. AVA_eff are assumed to be the main route for blood entering the central venous sinus which would consequently flow into the branchial veins.The authors wish to express their sincere thanks to Miss Angelika Krauß for her valuable technical assistance and to Miss Erna Finger for making the photographs. Thanks are also due to Mr. W. Zeltmann for drawing Figs. 2, 5, and 8 and to Mr. K. Herzog for Fig. 7.     

Arterio-venöse Kurzschlüsse mit Klappenmechanismen im Bereich der dorsalen Haut der Rattenhinterpfote

Zusammenfassung In der dorsalen Haut der Hinterpfoten von Ratten wurden Klappen am Abgang kleinerer Gefäße von großen Arterien beobachtet. Diese Arterien verlaufen in einer subkutanen, größere Gefäße und Nerven führenden Bindegewebsschichte über den Streckersehnen.Die kleineren Gefäße haben den Wandbau einer Vene und zweigen etwa im rechten Winkel von der Arterie ab. An ihrer Abgangsstelle ist neben den Klappen manchmal ein sphinkterartiger Muskelring ausgebildet.Diese Gefäßabschnitte werden für arterio-venöse Anastomosen gehalten und auf die Bedeutung solcher an dieser Stelle bisher nicht beschriebenen Verschlußeinrichtungen für die Regulation der Kurzschlüsse wird hingewiesen.

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Arteriovenous anastomoses with valve mechanisms in the dorsal skin of the hindpaw of rats

Summary In the dorsal skin of the hindpaws of rats valves were observed at those sites where smaller vessels branched from larger arteries. These arteries run in a subcutaneous layer of connective tissue, which lies above the extensor tendons and in which the larger vessels and nerves are found.These smaller vessels, the walls of which resemble those of veins, were seen branching off at approximate right angles to their artery of origin. Besides the valves a sphincterlike muscle ring was observed in some cases at the point of branching.These vascular segments are held to be arteriovenous anastomoses. Such locking devices at these points have not been described until now and seem to be important in the regulation of arteriovenous shunts.

     

食管癌患者术前营养风险评估及与术后吻合口瘘和住院时间的关系研究

摘要 目的：评估食管癌患者术前营养风险及其影响因素,并分析其与术后吻合口瘘和住院时间的关系。方法：回顾性分析2017年1月至2020年12月在合肥市第二人民医院胸外科行手术治疗的105例食管癌患者的临床资料,患者术前均完善营养风险筛查表-2002（NRS-2002）对其营养风险的评估,根据评估结果分为营养风险组（≥3分,43例）和无营养风险组（＜3分,62例）,采用单因素及多因素Logistic回归分析食管癌患者术前营养风险的影响因素,比较不同术前营养风险状态患者术后吻合口瘘发生率以及住院时间的差异。结果：食管癌患者的术前营养风险较高,营养风险发生率为40.95%（43/105）。单因素分析结果显示,营养风险组年龄≥65岁、入院体质量指数＜18.5 kg/m²、术前接受过新辅助放化疗、过去1周膳食摄入不足、术前白蛋白＜35 g/L的患者比例高于无营养风险组（P＜0.05）。多因素Logistic回归分析结果显示,术前接受过新辅助放化疗、过去1周膳食摄入不足、术前白蛋白＜35 g/L是食管癌患者术前存在营养风险的危险因素（P＜0.05）。营养风险组术后胸腔吻合口瘘、颈部吻合口瘘发生率高于无营养风险组（P＜0.05）,住院时间长于无营养风险组（P＜0.05）。结论：术前新辅助放化疗、过去1周膳食摄入情况、术前白蛋白水平是食管癌患者术前营养风险的影响因素,术前营养风险会增加患者术后吻合口瘘发生风险,延长患者住院时间。