低位胆道恶性梗阻性黄疸术前胆红素异常的处理策略探讨(附134例报告)

目的:探讨低位胆道恶性梗阻性黄疸患者术前胆红素异常的处理策略,以提高该类患者的临床疗效。方法:回顾性分析西京医院肝胆外科2008年1月1日-2017年12月31日收治的符合研究条件的134例低位胆道恶性梗阻性黄疸(术前总胆红素≥171μmol/L)患者,按胆红素水平分为中、重度黄疸组,分析和比较两组术前黄疸的处理方法、术后肝功能、并发症情况等。结果:两组患者胆道引流后总胆红素水平均明显低于引流前,而肝功能Child-Pugh分级比较差异均无统计学意义(P0.05);两组行术前胆道引流患者与未行胆道引流患者的围手术期情况比较均无统计学差异(P0.05);两组行术前胆道引流患者与未行胆道引流患者的手术并发症的发生情况比较均无统计学差异(P0.05)。结论:对于低位胆道恶性梗阻性黄疸患者,无论中度黄疸还是重度黄疸,原则上术前不必行胆道引流。对于伴有脏器功能不全、急性炎症或其他暂不宜手术的患者,可先行胆道引流处理,限期手术。若行术前胆道引流,采用PTCD方式,更为简单安全有效。     

复合负压吸引的外固定钢板治疗四肢开放性骨折的应用价值

目的:探讨复合负压吸引的外固定钢板治疗四肢开放性骨折的应用价值。方法:选择2014年1月到2017年1月到我院诊治的胫腓骨中下段开放性骨折患者共68例为研究对象,根据随机信封抽签原则分为观察组与对照组,每组34例。对照组给予负压封闭引流(vacuum sealing drainage,VSD)的常规外固定钢板治疗,观察组给予复合负压吸引的外固定钢板治疗,记录和比较围手术期严重并发症的发生情况、手术时间、骨折愈合时间、临床疗效和创口愈合情况。结果:两组患者都完成手术,围手术期并无严重并发症发生。观察组的手术时间与骨折愈合时间分别为38.24±8.16 min和8.83±1.01周,均明显少于对照组(49.50±9.87min和12.23±0.91周)(P0.05)。术后3个月,观察组和对照组的疗效优良率分别是97.1%、82.4%,观察组明显高于对照组(P0.05);观察组的创口甲级愈合28例,乙级愈合6例,丙级愈合0例;对照组甲级愈合21例,乙级愈合8例,丙级愈合5例,观察组创口愈合情况明细优于对照组(P0.05)。结论:复合负压吸引的外固定钢板治疗四肢开放性骨折能明显缩短手术时间,促进骨折愈合,提高创口愈合质量,提高临床疗效。     

Targeting cholangiocarcinoma

Cholangiocarcinoma (CCA) represents a diverse group of epithelial cancers associated with the biliary tract, and can best be stratified anatomically into intrahepatic (iCCA), perihilar (pCCA) and distal (dCCA) subsets. Molecular profiling has identified genetic aberrations associated with these anatomic subsets. For example, IDH catalytic site mutations and constitutively active FGFR2 fusion genes are predominantly identified in iCCA, whereas KRAS mutations and PRKACB fusions genes are identified in pCCA and dCCA. Clinical trials targeting these specific driver mutations are in progress. However, The Tumor Genome Atlas (TCGA) marker analysis of CCA also highlights the tremendous molecular heterogeneity of this cancer rendering comprehensive employment of targeted therapies challenging. CCA also display a rich tumor microenvironment which may be easier to target. For example, targeting cancer associated fibroblasts for apoptosis with BH3-mimetics and/or and reversing T-cell exhaustion with immune check point inhibitors may help aid in the treatment of this otherwise devastating malignancy. Combinatorial therapy attacking the tumor microenvironment plus targeted therapy may help advance treatment for CCA. This article is part of a Special Issue entitled: Cholangiocytes in Health and Disease edited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen.     

Quantifying effects of soil heterogeneity on groundwater pollution at four sites in USA

Four sites located in the north-eastern region of the United States of America have been chosen to investigate the impacts of soil heterogeneity in the transport of solutes (bromide and chloride) through the vadose zone (the zone in the soil that lies below the root zone and above the permanent saturated groundwater). A recently proposed mathematical model based on the cumulative beta distribution has been deployed to compare and contrast the regions' heterogeneity from multiple sample percolation experiments. Significant differences in patterns of solute leaching were observed even over a small spatial scale, indicating that traditional sampling methods for solute transport, for example the gravity pan or suction lysimeters, or more recent inventions such as the multiple sample percolation systems may not be effective in estimating solute fluxes in soils when a significant degree of soil heterogeneity is present. Consequently, ignoring soil heterogeneity in solute transport studies will likely result in under- or overprediction of leached fluxes and potentially lead to serious pollution of soils and/or groundwater.The cumulative beta distribution technique is found to be a versatile and simple technique of gaining valuable information regarding soil heterogeneity effects on solute transport. It is also an excellent tool for guiding future decisions of experimental designs particularly in regard to the number of samples within one site and the number of sampling locations between sites required to obtain a representative estimate of field solute or drainage flux.     

Cold air drainage flows subsidize montane valley ecosystem productivity

In mountainous areas, cold air drainage from high to low elevations has pronounced effects on local temperature, which is a critical driver of many ecosystem processes, including carbon uptake and storage. Here, we leverage new approaches for interpreting ecosystem carbon flux observations in complex terrain to quantify the links between macro‐climate condition, drainage flows, local microclimate, and ecosystem carbon cycling in a southern Appalachian valley. Data from multiple long‐running climate stations and multiple eddy covariance flux towers are combined with simple models for ecosystem carbon fluxes. We show that cold air drainage into the valley suppresses local temperature by several degrees at night and for several hours before and after sunset, leading to reductions in growing season respiration on the order of ~8%. As a result, we estimate that drainage flows increase growing season and annual net carbon uptake in the valley by >10% and >15%, respectively, via effects on microclimate that are not be adequately represented in regional‐ and global‐scale terrestrial ecosystem models. Analyses driven by chamber‐based estimates of soil and plant respiration reveal cold air drainage effects on ecosystem respiration are dominated by reductions to the respiration of aboveground biomass. We further show that cold air drainage proceeds more readily when cloud cover and humidity are low, resulting in the greatest enhancements to net carbon uptake in the valley under clear, cloud‐free (i.e., drought‐like) conditions. This is a counterintuitive result that is neither observed nor predicted outside of the valley, where nocturnal temperature and respiration increase during dry periods. This result should motivate efforts to explore how topographic flows may buffer eco‐physiological processes from macroscale climate change.     

Classification of macroinvertebrate communities across drainage basins in Victoria, Australia: consequences of sampling on a broad spatial scale for predictive modelling

1. Spatial scale may influence the interpretation of environmental gradients that underlie classification and ordination analyses of lotic macroinvertebrate communities. This could have important consequences for the spatial scale over which predictive models derived from these multivariate analyses can be applied. 2. Macroinvertebrate community data (identified to genus or species) from edge and main-channel habitats were obtained for sites on rivers from 25 of the 29 drainage basins in Victoria. Trends in community similarity were analysed by carrying out separate multivariate analyses on data from the edge habitats (199 sites) and the main-channel habitats (163 sites). 3. Hierarchical classification (UPGMA) showed that the edge data could be placed into 11 site groups and the main-channel data into 12 site groups. 4. Ordination analysis (hybrid multidimensional scaling) showed no sharp disjunctions between site groups in either habitat; overlap was frequent. Correlation of the ordination patterns with environmental variables showed that edge communities varied longitudinally within a drainage basin and from the east to the west of Victoria. These two trends were superimposed on one another to form a single gradient on the ordination. The taxon richness of edge communities was also related to the species richness of macrophytes at a site. Main-channel communities also displayed a longitudinal and a geographic gradient, but these two gradients were uncorrelated on the ordination. 5. Community similarity only weakly reflected geographic proximity in either habitat. A preliminary subdivision of Victoria into a series of biogeographic regions did not match the pattern of distribution of site groups for the edge habitat, illustrating the difficulties of applying to lotic communities a priori regionalizations based on terrestrial features of the landscape. 6. The longitudinal gradients in the two data sets were commonly observed in data gathered at smaller spatial scales in Victoria. The other gradients (geographic, macrophyte), however, were either not consistently repeated or not evident at smaller spatial scales. At small spatial scales (i.e. within a single drainage basin) gradients were related to variables that varied over restricted ranges, e.g. mean particle size of the substratum. 7. Species richness was very variable when plotted against river slope or distance of site from source; both of these are measures of position on the longitudinal gradients. In contrast to suggestions in the literature, species richness did not show a unimodal trend on these gradients, or any other trend. 8. Environmental gradients (apart from longitudinal gradients) that underlie predictive models of macroinvertebrate distribution are reflections of the spatial scale on which the model has been constructed and cannot be extrapolated to different scales. Models must be suited to the spatial scale over which predictions are required.     

Effects of drainage and soil organic content on growth of Spartina alterniflora (Poaceae) in an artificial salt marsh mesocosm

An artificial salt marsh mesocosm was constructed using 680-L polypropylene tanks to determine the effect of soil drainage depth and organic content on growth and rhizome proliferation of the salt marsh smooth cordgrass Spartina alterniflora. Soil drainage depth had no effect on accumulation of aerial or subsurface plant tissue, but tanks that had 2.5% soil organic content supported enhanced aerial tissue and rhizome growth compared to tanks that contained sand alone. We propose a mathematical model for predicting the mass of photosynthetically significant leaf tissue without cutting and drying leaves. Implications of these findings for salt marsh creation projects are discussed.     

比利时北部近海岸草地沙土非饱和水传导特性

用“内排水法”实地测定了比利时北部近海岸草地沙土的非饱和导水率K(θ)和扩散率D(θ).并求得其经验公式。协方差分析表明,0-30.30-60和60-90cm土层的导水率及扩散率回归方程之间无显著差异,但它们分别与90-120cm土层的方程间差异显著,须用两组不同的公式描述。用以描述的幂函数和指数函数类型间无明显差异。