二尖瓣置换术后左心室破裂2例并文献复习

目的：总结二尖瓣置换术后左心室破裂2例临床经验教训,方法：回顾性分析我院2006,1．2009,12二尖瓣置换术后左心室破裂2例的临床资料,两例均在监护室里发生突然大出血,紧急输血,输液,机械呼吸,抗休克治疗,并行开胸手术。结果：一例心外修补抢救成功,术后2周顺利出院,一例CPB下心内外修补,因低心排综合症死亡。结论：左心室破裂是二尖瓣置换术最严重的并发症,一旦发生死亡率极高,因此预防,避免其相关因素更关键：     

马凡综合征合并急性Standford A 型夹层的外科治疗

目的:评价外科治疗马凡综合征合并急性Standford A型夹层的效果。方法:回顾性分析2007年7月至2010年7月外科治疗12例马凡综合征合并急性Standford A型夹层病例的临床资料。采用改良Mini-root手术方式代替Bentall手术。结果:主动脉阻断时间69～103 min,平均(78.7±28.6)min,体外循环时间79～122 min,平均(98.3±23.8)min。术后早期存活11例,死亡1例,死亡率8.3%。术后随访时间2～37个月,平均(18.2±8.6)个月,其中1例术后24月发生急性腹主动脉夹层,予以实施腔内支架隔绝术成功以治愈出院。术后与术前左心室舒张末径分别为45～58 mm,平均(50.2±5.6)mm和53～69 mm,平均(61.3±4.6)mm(P<0.01)。结论:马凡综合征合并急性Standford A型夹层一经确诊则需急诊手术,及时的外科手术是治疗该病的有效方法,而且应用改良Mini-root手术方式疗效满意。     

Predominance of Th2 response in human abdominal aortic aneurysm: mistaken identity for IL-4-producing NK and NKT cells?

Abdominal aortic aneurysm (AAA) is a complex remodeling process that involves both synthesis and degradation of extracellular matrix proteins in the aortic wall, leading to decreased tensile strength, progressive dilation and eventual rupture. Chronic inflammation, increased local production of elastin-degrading proteases by inflammatory cells and destruction of medial elastic lamellae play important roles in aneurysm progression. Neovascularization in all layers of the arterial wall is prominent and angiogenesis can facilitate chronic inflammation. It is still unclear what initiates aneurysmal dilation and what determines its progression. The complex nature of the process has defied elucidation. Apart from macrophages, the predominant immune cell infiltrates reported so far are CD3(+)T cells that express CD4 and CD8. Infiltrates of type 2 Th cells and their production of IL-4 and IL-5 have been implicated in AAA development. However, NKT and NK cells have a Th0 cytokine profile and can also produce type 2 as well as type 1 (IL-2 and IFNgamma) cytokines. We have demonstrated the presence of NK and NKT cells in AAA tissue. With their growing importance in autoimmunity and transplantation, they may play a role in AAA development. Therefore, there is a need to use a combination of T and NK markers to fully characterize both innate and adaptive lymphoid cell subsets in local inflammatory infiltrates in order to elucidate their roles in AAA progression.     

Blocked stomodeal valve of the insect vector: similar mechanism of transmission in two trypanosomatid models

The regurgitation of metacyclic stages from the sand fly cardia is thought to be the prevailing mechanism of Leishmania transmission. This regurgitation may result through damage of the stomodeal valve and its mechanical block by the parasites. We found this phenomenon in three sand fly-Leishmania models and also in avian trypanosomes transmitted by Culex mosquitoes. Phlebotomus duboscqi, Phlebotomus papatasi, Lutzomyia longipalpis, and Culex pipiens were membrane-fed on blood containing Leishmania major, Leishmania chagasi (syn. infantum) and an unidentified avian Trypanosoma from Trypanosoma corvi clade, respectively. Females with the late-stage infections were processed for the optical and transmission electron microscopy. Localization of the parasites and changes to the stomodeal valve were in some aspects similar in all vector-parasite pairs studied: (i) a large plug of flagellates was observed in cardia region, (ii) parasites were attached to the chitin lining of the stomodeal valve by the formation of zonal hemidesmosome-like plaques. Leishmania promastigotes were found both attached to the valve as well as unattached in the lumen of midgut. The stomodeal valve of infected sand flies was opened, its chitin lining was destroyed and the unique filamentous structures on the apical end of cylindrical cells were degraded. In the Culex-Trypanosoma model, the whole population of epimastigotes was found in close contact with the chitin lining, and degenerative changes of the valve were less pronounced. We suggest that the phenomenon involving a blocked valve facilitating the regurgitation of parasites into the vertebrate host may occur generally in heteroxenous trypanosomatids transmitted by the bite of nematoceran Diptera.     

体外肿瘤微血管生成模型的建立

本研究以体外微血管培养模型为基础,用鼠尾胶原包埋大鼠动脉环,并将包埋的动脉环转移到种有人肺癌A549细胞单层的培养皿中,用MCDB 131无血清培养液对动脉环和肿瘤细胞进行共培养,从而建立肿瘤微血管体外生成模型。大鼠动脉环于培养后第3天从血管壁长出微血管芽,第6至10天长成微血管丛,两周后新生微血管开始萎缩;没有肿瘤细胞刺激的条件下,大鼠动脉环新生微血管数量明显减少。结果表明人肺癌A549细胞能够促进血管生成。体外大鼠动脉环肿瘤微血管培养模型操作简单、灵敏度高,适合研究肿瘤血管新生及其机制。     

静脉桥狭窄家兔动物模型的建立

目的建立冠心病冠状动脉旁路移植术后移植静脉桥狭窄的动物模型。方法取3.0～3.5 kg普通新西兰兔8只,取同侧颈外静脉与颈总动脉进行端端吻合,吻合时采用间断缝合的方法。结果术后2周、4周取下静脉桥及对侧颈外静脉,光镜下见静脉桥新生内膜形成,中膜增厚,弹力纤维减少;胶原纤维不均匀性增厚。结论本模型能反映冠状动脉旁路移植术后静脉桥狭窄的情况,可满意模拟人冠状动脉旁路移植术后大隐静脉桥的病理变化。     

Fibroblast nemosis induces angiogenic responses of endothelial cells

Increasing evidence points to a central link between inflammation and activation of the stroma, especially of fibroblasts therein. However, the mechanisms leading to such activation mostly remain undescribed. We have previously characterized a novel type of fibroblast activation (nemosis) where clustered fibroblasts upregulated the production of cyclooxygenase-2, secretion of prostaglandins, proteinases, chemotactic cytokines, and hepatocyte growth factor (HGF), and displayed activated nuclear factor-κB. Now we show that nemosis drives angiogenic responses of endothelial cells. In addition to HGF, nemotic fibroblasts secreted vascular endothelial growth factor (VEGF), and conditioned medium from spheroids promoted sprouting and networking of human umbilical venous endothelial cells (HUVEC). The response was partly inhibited by function-blocking antibodies against HGF and VEGF. Conditioned nemotic fibroblast medium promoted closure of HUVEC and human dermal microvascular endothelial cell monolayer wounds, by increasing the motility of the endothelial cells. Wound closure in HUVEC cells was partly inhibited by the antibodies against HGF. The stromal microenvironment regulates wound healing responses and often promotes tumorigenesis. Nemosis offers clues to the activation process of stromal fibroblasts and provides a model to study the part they play in angiogenesis-related conditions, as well as possibilities for therapeutical approaches desiring angiogenesis in tissue.     

Structure and formation of the adventitious tube of the Japanese watering-pot shell Stirpulina ramosa (Bivalvia, Anomalodesmata, Clavagellidae) and a comparison with that of the Penicillidae

Abstract. Stirpulina ramosa is the only extant endobenthic representative of the Clavagellidae and is restricted to the waters of Japan. A single intact adventitious tube of this species has been obtained and its structure is described. The right valve is 16 mm long and located within the adventitious tube. It has an opisthodetic ligament located on resilifers. There are anterior and posterior adductor muscle scars, a thick pallial line, and pallial and pedal gape (right valve only) sinuses. The left shell valve is but 9 mm long and is united into the fabric of the adventitious tube via the intermediary of a shelly saddle. Internally, only the anterior adductor muscle scar and a small element of the pallial line scar are identifiable on the left valve. The posterior adductor and the rest of the pallial line scar (including a pallial sinus) are, remarkably, located on the adventitious tube beyond the shell valve margin. The adventitious tube of S. ramosa is formed in a manner wholly dissimilar from that of Brechites vaginiferus (Penicillidae). In B. vaginiferus, the tube is secreted as a single entity from the general outer mantle surface, including the siphons, covering the body. As a consequence, both shell valves are incorporated into the structure of the tube and the watering pot is bilaterally symmetrical. In S. ramosa, the tube and watering pot are secreted from the mantle margin and surface surrounding and extending from the left shell valve, so that only the left valve is incorporated into its structure. A dorsally derived mantle element is progressively extended over to the right side of the body, meeting a ventrally derived counterpart that passes beneath it, forming a pleat in the calcareous structure of the right side of the tube that they secrete. This pleat extends into the complex of watering‐pot tubules and forms the pedal gape. The watering pot is thus Ω shaped. The ventrally derived mantle element forms a sinusoidal crest on the right‐hand base of the watering pot, creating a pedal gape sinus scar on the right valve. The Clavagellidae radiated widely in the Mesozoic, leaving behind a rich fossil record for Stirpulina. Only S. ramosa, however, has survived until the present. In contrast, the Cenozoic Penicillidae has a poor fossil record, but there is a rich variety of extant endobenthic watering‐pot shells. It has been argued hitherto that the two families represent a remarkable example of convergent evolution. In view of the success of the Penicillidae and thus the endobenthic, tube‐dwelling lifestyle, however, it is hard to understand why Stirpulina has largely died out—even S. ramosa being known by but one or two specimens. A study of the anatomy of S. ramosa might one day answer this question.