高频彩色多普勒超声监测维持性血透内瘘功能的临床应用现状

该文综述了应用高频彩色多普勒超声在血透患者动静脉内瘘（ AVF）术前进行目标血管的选择,检查、筛选与定位,术后可用于监测动静脉内瘘（ AVF）功能、流量、流速与各种并发症,以利于提高血透患者的生活质量与生存率。     

Mesenchymal stromal cells from adipose tissue attached to suture material enhance the closure of enterocutaneous fistulas in a rat model

Background aimsSurgical treatment for enterocutaneous fistulas (EF) frequently fails. Cell therapy may represent a new approach to treatment. Mesenchymal stromal cells (MSCs) have high proliferative and differentiation capacity. This study aimed to investigate whether MSCs could adhere to suture filament (SF), promoting better EF healing.MethodsMSCs, 1 × 10⁶, from adipose tissue (ATMSCs) were adhered to a Polyvicryl SF by adding a specific fibrin glue formulation. Adhesion was confirmed by confocal and scanning electron microscopy (SEM). A cecal fistula was created in 22 Wistar rats by incising the cecum and suturing the opening to the surgical wound subcutaneously with four separate stitches. The animals were randomly allocated to three groups: control (CG)—five animals, EF performed; injection (IG)—eight animals 1 × 10⁶ ATMSCs injected around EF borders; and suture filament (SG): nine animals, sutured with 1 × 10⁶ ATMSCs attached to the filaments with fibrin glue. Fistulas were photographed on the operation day and every 3 days until the 21st day and analyzed by two observers using ImageJ Software.ResultsConfocal and SEM results demonstrated ATMSCs adhered to SF (ATMSCs-SF). The average reduction size of the fistula area at 21st day was greater for the SG group (90.34%, P < 0.05) than the IG (71.80%) and CG (46.54%) groups.ConclusionsATMSCs adhered to SF maintain viability and proliferative capacity. EF submitted to ATMSCs-SF procedure showed greater recovery and healing. This approach might be a new and effective tool for EF treatment.     

Bile acids regulate hepatic gluconeogenic genes and farnesoid X receptor via G��i-protein-coupled receptors and the AKT pathway

Bile acids are important regulatory molecules that can activate specific nuclear receptors and cell signaling pathways in the liver and gastrointestinal tract. In the current study, the chronic bile fistula (CBF) rat model and primary rat hepatocytes (PRH) were used to study the regulation of gluconeogenic genes phosphoenolpyruvate carboxykinase (PEPCK) and glucose-6-phosphatase (G-6-Pase) and the gene encoding short heterodimeric partner (SHP) by taurocholate (TCA). The intestinal infusion of TCA into the CBF rat rapidly (1 h) activated the AKT (∼9-fold) and ERK1/2 (3- to 5-fold) signaling pathways, downregulated (∼50%, 30 min) the mRNA levels of PEPCK and G-6-Pase, and induced (14-fold in 3 h) SHP mRNA. TCA rapidly (∼50%, 1–2 h) downregulated PEPCK and G-6-Pase mRNA levels in PRH. The downregulation of these genes by TCA was blocked by pretreatment of PRH with pertussis toxin (PTX). In PRH, TCA plus insulin showed a significantly stronger inhibition of glucose secretion/synthesis from lactate and pyruvate than either alone. The induction of SHP mRNA in PRH was strongly blocked by inhibition of PI3 kinase or PKCζ by specific chemical inhibitors or knockdown of PKCζ by siRNA encoded by a recombinant lentivirus. Activation of the insulin signaling pathway appears to be linked to the upregulation of farnesoid X receptor functional activity and SHP induction.     

女性尿道阴道瘘数字化三维重建在临床治疗中的初步应用

目的:基于CT扫描图象建立精确的女性尿道阴道瘘数字化模型,探讨其在临床诊断及治疗中的应用。方法:选择1例女性尿道阴道瘘病例,进行尿道CT连续断层扫描,扫描结果导入Mimics软件中进行三维重建,利用三维重建模型指导临床。结果:建立女性尿道阴道瘘及周围结构的三维立体模型,可以方便地从任意角度和方向观察瘘管情况,测量有关的数据;还可以在数字化模型上进行手术设计。结论:女性尿道阴道瘘的数字化三维模型能够更直观、准确地反映病变部位的三维立体结构。对女性尿道阴道瘘的诊断、手术规划等有较大帮助。     

Detection of oesophageal course during left atrial catheter ablation

BackgroundOesophageal changes and injuries were recorded after atrial fibrillation(AF) ablation procedures. The reduction of power in the posterior left atrial(LA) wall(closest to the oesophagus) and the monitoring of temperature in the oesophagus(OE) reduced oesophageal injuries. The intracardiac-echocardiography(ICE) with a Cartosound module provides two-dimensional imaging (2D) to assess detailed cardiac anatomy and its relationship with the OE. The aim of this study was to highlight the safety and feasibility of 3D-reconstruction of the oesophageal course in left atrial catheter ablation(CA) procedures without OE temperature probe or quadripolar catheter to guide ICE OE reconstruction.Methods180 patients(PT) underwent left atrial ablation. AF ablation were 125(69.5%); incisional left atrial tachycardias(IAFL) were 37(20.6%); left atrial tachycardias(LAT) were 19(10.6%). The LA and pulmonary vein anatomies were rendered by traditional electroanatomic mapping(EAM) and merged with an ICE anatomic map. In 109 PT ICE imaging was used to create a geometry of the OE(group A). A quadripolar catheter was used in 71 PT to show OE course associated to ICE(group B).ResultsAblation energy delivery was performed outside the broadest OE anatomy borders. The duration of procedures was longer in group B vs group A Fluoroscopy time was lower in Group A than Group B(Group A 7 ± 3.2 vs 19.2 ± 2.4 min; p < 0.01).ConclusionsOE monitoring with ICE is safe and feasible. Oesophageal anatomy is complex and variable. Many PT will have a broad oesophageal boundary, which increases the risk of untoward thermal injury during posterior LA ablation. ICE with 3D construction of the OE enhances border detection of the OE, and as such, should decrease the risk of oesophageal injury by improving avoidance strategies without intra-oesophageal catheter visualization.     

肛周脓肿和肛瘘患者的病原菌分布及其与血清MMP-2、IL-17A水平的相关性

目的分析肛周脓肿与肛瘘患者的病原菌分布及其与血清基质金属蛋白酶-2(MMP-2)、白细胞介素-17A(IL-17A)的相关性。方法收集2017年3月至2019年11月在我院收治的肛周脓肿和肛瘘患者共69例,分为肛周脓肿组(n=23)、肛瘘病程90 d组(n=20)、肛瘘病程90～180 d组(n=17)、肛瘘病程180 d组(n=9)。收集患者脓液或瘘管分泌物进行细菌培养,同时采集血清标本检测MMP-2、IL-17A水平,分析病原菌分布与MMP-2、IL-17A表达的相关性。结果 69份标本中有66份标本培养出细菌,阳性率为95.65%(66/69)。共分离出68株细菌,其中有2份标本出现2种细菌同时生长,混合感染率为3.03%,其余64份标本均为单一细菌生长。68株细菌中革兰阴性菌58株(85.29%),革兰阳性菌8株(11.76%),真菌2株(2.94%)。各组患者血清MMP-2、IL-17A阳性率比较差异有统计学意义(均P0.05)。单一病原菌感染患者血清MMP-2、IL-17阳性率差异无统计学意义(均P0.05)。血清MMP-2与IL-17A水平呈正相关(r=0.325,P=0.009)。结论肛周脓肿与肛瘘患者以单一病原菌感染为主。患者血清MMP-2与IL-17A水平呈正相关。     

湿润烧伤膏对肛瘘术后造模大鼠创面修复的影响

摘要 目的：探究湿润烧伤膏（MEBO）对肛瘘术后造模大鼠创面修复的影响。方法：将45只SPF级SD大鼠随机分为模型组（Model组）、MEBO组、易孚组，每组15只。建立全层皮肤缺损开放感染模型。观察肛瘘创面组织一般情况。分别在给药第3、7、14天测定并计算创面愈合率。苏木精-伊红（HE）染色观察大鼠创面组织病理学变化。酶联免疫吸附实验（ELISA）检测各组大鼠创面肉芽组织中炎症因子指标[肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）]水平。采用碱性磷酸酶（SAP）免疫组化法对创面肉芽组织进行染色，观察表皮生长因子（EGF）、基质金属蛋白酶-2（MMP-2）水平。蛋白质印迹（Western Blot）法检测各组大鼠创面肉芽组织B细胞淋巴瘤/白血病-xL基因（Bcl-xl）、B细胞淋巴瘤/白血病-2基因拮抗剂（Bak）蛋白表达水平，计算Bcl-xl/Bak比值。结果：与Model组相比，MEBO组大鼠创面愈合率（干预7、14 d后）、创面肉芽组织中EGF、MMP-2水平、Bcl-xl、Bak蛋白表达水平均显著升高（P＜0.05），创面分泌物和水肿评分、创面肉芽组织生长评分、创面肉芽组织中TNF-α、IL-6水平、Bcl-xl/Bak比值均显著降低（P＜0.05）。大鼠创面组织出血减少、细胞间渗出液减少，血管扩张减轻，炎性细胞浸润减轻，可见大量的新生毛细血管和成纤维细胞。结论：MEBO可能通过抑制炎症反应，改善创面微循环和促进组织再生对肛瘘术后大鼠创面修复。     

De novo deletion of chromosome 20q13.33 in a patient with tracheo-esophageal fistula, cardiac defects and genitourinary anomalies implicates GTPBP5 as a candidate gene

BACKGROUND

Tracheo‐esophageal fistula (TEF) with/or without esophageal atresia (EA) is a common congenital malformation that is often accompanied by other anomalies. The causes of this condition are thought to be heterogeneous but are overall not well understood.

CASE REPORT

We identified a patient with a TEF/EA, as well as cardiac and genitourinary anomalies, who was found to have a 0.7 Mb de novo deletion of chromosome 20q13.33. One gene within the deleted interval, GTPBP5, is of particular interest as a candidate gene.

CONCLUSIONS

GTPBP5 bears further study as a cause of TEF/EA accompanied by other malformations. Birth Defects Research (Part A) 2011. © 2011 Wiley‐Liss, Inc.