胆囊切除术医源性胆管损伤的处理

目的:探讨开腹胆囊切除术医源性胆道损伤的诊断、手术时机和手术方式的选择。方法:对18例胆道损伤进行分析总结:分别施行了胆管修补、T管引流术10例,保守治疗2例,Roux-en-Y胆肠吻合术6例。结果:3例术后过早拔管发生吻合口狭窄,再次手术。1例因梗阻性胆管炎并发肝功能衰竭、多器官功能衰竭死亡。1例因胆肠吻合术后并发消化道出血、肝昏迷死亡。余术后良好。结论:尽早发现及正确处理对提高疗效和预防术后胆管狭窄起着决定性的作用。术中发现胆管损伤立即行端端吻合加T管引流;术后数天发现或多次胆道修补术失败者,则宜行规范的Roux-en-Y胆肠吻合术。     

Mitochondria and autoimmunity in primary biliary cirrhosis

Primary biliary cirrhosis is an enigmatic autoimmune liver disease that predominantly affects women and is characterized by antimitochondrial antibodies and specific destruction of small bile ducts. Interestingly, patients with this disease not only have high titer antibodies to mitochondria, but also highly directed, liver-specific CD4 and CD8 cells directed at the same mitochondrial autoantigens. These mitochondrial autoantigens are all members of the 2-oxo dehydrogenase complex family and include the E2 component of pyruvate dehydrogenase as the major autoantigen. Moreover, the epitopes recognized by CD4, CD8 T cells and autoantibody, are all directed within the same region, namely the lipoyl domain of pyruvate dehydrogenase complex-E2. All cells in the body have mitochondria but there appear to be specific destruction of biliary cells. We believe that this specific destruction is secondary to a highly directed mucosal response that focuses on biliary cells because of the involvement of a polymeric immunoglobulin receptor, the presence of immunoglobulin A in mucosal secretions, and the unique apoptotic properties of biliary epithelium.     

Tetraether-linked membrane monolayers in <Emphasis Type="Italic">Ferroplasma</Emphasis> spp: a key to survival in acid

Ferroplasma acidarmanus thrives in hot, extremely low pH, metal-rich solutions associated with dissolving metal sulfide ore deposits. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and thin layer chromatography analyses of F. acidarmanus membranes indicate that tetraether lipids predominate, with at least three core lipid structures. NMR measurements indicate that the cytoplasmic pH of F. acidarmanus is ~5.6. The optimal growth pH is ~1.2, and the lowest growth pH is ~0.0. Thus, these organisms maintain pH gradients across their membranes that approach 5 pH units. Tetraether lipids were originally thought to be specifically associated with thermophiles but are now known to be widely distributed within the archaeal domain. Our data, in combination with recently published results for thermophilic and mesothermophilic acidophilic archaea, indicate that there may be a stronger association between tetraether lipids and tolerance to acid and/or large metal ion gradients.     

Spinnokinetic analyses of blood disposition and biliary excretion of nitric oxide (NO)-Fe(II)-N-(dithiocarboxy)sarcosine complex in rats: BCM-ESR and BEM-ESR studies

Nitric oxide (NO) is well known to have a wide variety of biological and physiological functions in animals. On the basis of the fact that Fe(II)-dithiocarbamates react with NO, a Fe(II)-N-(dithiocarboxy)sarcosine complex (Fe(II)-DTCS) was proposed as a trapping agent for endogenous NO. However, quantitative pharmacokinetic investigation for NO-Fe(II)-dithiocarbamate complexes in experimental animals has been quite limited. This paper describes the results on the quantitative pharmacokinetic features of a NO-Fe(II)-N-DTCS in both the blood and bile of rats following intravenous (i.v.) administration of the complex. For this purpose, we applied two in vivo methods, i.e. (1) in vivo blood circulation monitoring-electron spin resonance (BCM-ESR) which previously developed, and (2) in vivo biliary excretion monitoring-electron spin resonance (BEM-ESR). We monitored real-time ESR signals due to nitrosyl-iron species in the circulating blood and bile flow. The ESR signal due to NO-Fe(II)-DTCS was stable in biological systems such as the fresh blood and bile. In in vivo BCM- and BEM-ESR, the pharmacokinetic parameters were calculated on the basis of the two-compartment and hepatobiliary transport models. The studies also revealed that the compound is widely distributed in the peripheral organs and partially excreted into the bile. We named a kinetic method to follow spin concentrations as spinnokinetics and this method will be useful for detecting and quantifying the endogenously generated NO in Fe(II)-DTCS administered animals.     

STRUCTURE AND FUNCTION OF BENTHIC ALGAL COMMUNITIES IN AN EXTREMELY ACID RIVER1

The composition of algal species and pigments and the structural and functional characteristics of the algal community were investigated in an acid stream of southwestern Spain, the Río Tinto. The algal community had low diversity and showed few seasonal differences. It was mainly made up of Klebsormidium flaccidum Kütz. (Silva, Mattox & Blackwell) that produced long greenish or purplish filaments, Pinnularia acoricola Hust. (producing brown patches) and Euglena mutabilis Schmitz. The algal filaments made up a consistent biofilm that also included fungal hyphae, iron bacterial sheaths, diatoms, and mineral particles. HPLC analyses on Río Tinto samples showed that undegraded chl accounted for 67% of the total chl in the filamentous patches but were a minority in the brown patch (2.6%). The brown patch had a concentration of carotenoids eight times lower than that observed in the green patch. When chl concentrations were weighted for the proportion of the different patches on the streambed, undegraded chl a accounted for 89.2 mg chl a·m ^{? 2} of stream surface area (5.4 g C·m ^{? 2}). This high algal biomass was supported by relatively high nutrient concentrations and by a high phosphatase activity (V_max = 137.7 nmol methylumbelliferyl substrate·cm ^{? 2}·h ^{? 1} 1 Received 15 July 2002. Accepted 17 February 2003. , K_m = 0.0045 μM). The remarkable algal biomass in Río Tinto potentially contributed to the bacterial–fungal community and to the macroinvertebrate community and emphasizes the role that the algae may have in the organic matter cycling and energy flow in extreme systems dominated by heterotrophic microorganisms.     

Fluxes of nitrous oxide and methane from drained peatlands following forest clear-felling in southern Finland

Drainage of waterlogged sites has been part of the normal forestry practice in Fennoscandia, the Baltic countries, the British Isles and in some parts of Russia since the early 20^th century, and currently, about 15 million hectares of peatlands and other wetlands have been drained for forestry purposes. The rate of forest clear-felling on drained peatlands will undergo a rapid increase in the near future, when a large number of these forests approach their regeneration age. A small-scale pilot survey was performed at two nutrient-rich and old peatland drainage areas in southern Finland to study if forest clear-felling has significant impacts on the exchange of nitrous oxide (N₂O) and methane (CH₄) between soil and atmosphere. The average N₂O emissions from the two drainage areas during three growing seasons following clear-felling were 945 and 246 g m^–2 d^–1. The corresponding CH₄ fluxes were –0.07 and –0.52 mg m^–2 d^–1. Clear-felling had impacts on the environmental factors known to affect the N₂O and CH₄ fluxes of peatlands, i.e. clear-felling raised the water table level and increased the peat temperature. However, no substantial changes in the fluxes of CH₄ following clear-felling were observed. The results concerning N₂O indicated a potential for increased emissions following clear-felling of drained peatland forests, but further studies are needed for a critical evaluation of the impacts of clear-felling on the fluxes of CH₄ and N₂O.     

Advances in biotreatment of acid mine drainage and biorecovery of metals: 1. Metal precipitation for recovery and recycle

Acid mine drainage (AMD), an acidic metal-bearingwastewater, poses a severe pollution problem attributedto post mining activities. The metals usuallyencountered in AMD and considered of concern for riskassessment are arsenic, cadmium, iron, lead, manganese,zinc, copper and sulfate. The pollution generated byabandoned mining activities in the area of Butte, Montanahas resulted in the designation of the Silver Bow Creek–ButteArea as the largest Superfund (National Priorities List) sitein the U.S. This paper reports the results of bench-scalestudies conducted to develop a resource recovery basedremediation process for the clean up of the Berkeley Pit.The process utilizes selective, sequential precipitation (SSP)of metals as hydroxides and sulfides, such as copper, zinc,aluminum, iron and manganese, from the Berkeley Pit AMDfor their removal from the water in a form suitable foradditional processing into marketable precipitates and pigments.The metal biorecovery and recycle process is based on completeseparation of the biological sulfate reduction step and themetal precipitation step. Hydrogen sulfide produced in the SRBbioreactor systems is used in the precipitation step to forminsoluble metal sulfides. The average metal recoveries usingthe SSP process were as follows: aluminum (as hydroxide) 99.8%,cadmium (as sulfide) 99.7%, cobalt (as sulfide) 99.1% copper(as sulfide) 99.8%, ferrous iron (sulfide) 97.1%, manganese(as sulfide) 87.4%, nickel (as sulfide) 47.8%, and zinc (as sulfide)100%. The average precipitate purity for metals, copper sulfide,ferric hydroxide, zinc sulfide, aluminum hydroxide and manganesesulfide were: 92.4, 81.5, 97.8, 95.6 , 92.1 and 75.0%, respectively.The final produced water contained only calcium and magnesiumand both sulfate and sulfide concentrations were below usablewater limits. Water quality of this agriculturally usable watermet the EPA's gold standard criterion.     

超声引导下经皮穿刺置管引流治疗重症急性胰腺炎急性胰周液体积聚的临床疗效

目的:探讨超声引导下经皮穿刺置管引流(PCD)治疗重症急性胰腺炎(SAP)急性胰周液体积聚的的临床疗效。方法:收集2009年3月~2013年10月我院收治的经临床确定的SAP急性胰周液体积聚患者51例,按随机数字表法分为观察组(26例)和对照组(25例),观察组患者给予超声引导下经皮穿刺置管引流术治疗,对照组采用剖腹引流的经典引流。比较两组患者血淀粉酶恢复至时间、住院时间、治愈率、并发症发生率。结果:观察组血淀粉酶恢复时间及住院时间均小于对照,差异有统计学意义(P0.05);观察组患者总有效率位96.2%(25/26),高于对照组的68.0%(17/25),两组比较组间差异有统计学意义(P0.05);观察组治疗后病死、腹腔出血、胰瘘发生率高于对照组(均P0.05);两组脓毒症及多器官功能障碍综合症(MODS)的比较差异无统计学差异(P0.05)结论:超声引导下经皮穿刺置管引流术治疗SAP急性胰周液体积聚效果良好,并发症的低,安全可靠,具有较大的临床推广价值。     

高血压基底节区脑出血患者血清CXCL1、CXCL10与神经损伤指标和微创穿刺引流术后预后的关系研究

摘要 目的：探讨高血压基底节区脑出血（HBGH）患者血清CXC趋化因子配体1（CXCL1）、CXC趋化因子配体10（CXCL10）与神经损伤指标和微创穿刺引流术后预后的关系。方法：选取2020年2月~2023年4月聊城市人民医院东院区收治的行微创穿刺引流术治疗的HBGH患者162例纳入研究组，选取体检健康的志愿者110例纳入对照组。检测对比两组血清CXCL1、CXCL10和神经损伤指标[神经元特异性烯醇化酶（NSE）、胶质纤维酸性蛋白（GFAP）、S100β蛋白]水平。采用Pearson检验分析血清CXCL1、CXCL10与神经损伤指标的相关性。所有患者均随访3个月，根据改良Rankin量表（mRS）评分分为预后良好组和预后不良组。采用多因素Logistic回归模型分析HBGH患者微创穿刺引流术后预后的影响因素。结果：研究组的血清CXCL1、CXCL10水平高于对照组（P<0.05）。研究组的血清NSE、GFAP、S100β蛋白水平高于对照组（P<0.05）。Pearson检验分析结果显示，血清CXCL1、CXCL10与NSE、GFAP、S100β蛋白均呈正相关（P<0.05）。单因素分析结果显示，预后不良与年龄、甘油三酯（TG）、低密度脂蛋白（LDL）、凝血酶原时间（PT）、C反应蛋白（CRP）、血肿破入脑室、血肿体积、术后24 h内血肿清除率、尿激酶冲管次数、术后颅内出血再发、CXCL1、CXCL10有关（P<0.05）。多因素Logistic回归分析结果显示，年龄偏大、LDL偏高、血肿体积偏大、术后24 h内血肿清除率偏低、尿激酶冲管次数偏多、CXCL1偏高、CXCL10偏高是HBGH患者微创穿刺引流术后预后不良的危险因素（P<0.05）。结论：HBGH患者血清CXCL1、CXCL10水平升高可能导致神经损伤和不良预后。年龄、LDL、血肿体积、术后24 h内血肿清除率、尿激酶冲管次数、CXCL1、CXCL10是HBGH患者术后预后不良的危险因素，值得引起重视。