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全身性炎性反应综合征的基础与临床

多年来，对脓毒症（sepsis）的病理生理变化研究虽有显著的进展，但其名词与概念上有很多混淆之处。长期以来，临床上都把发热、白细胞增高、神志改变、血流动力学及内环境紊乱，进而发生器官功能障碍者作为全身性感染即脓毒症的特征性临床表现。但各家描述所含的症状、诊断标准及名称均不一致，也不能反映该病的本质。临床发现，脓毒症虽大部分是由微生物引起，但仍有30%具有该症状群而未能发现感染病灶。这种症状群也可由非细菌感染因素引起，如创伤、急性胰腺炎、免疫反应和药物反应等。由于以上原因，为了使脓毒症有更清晰的层次概念，1991年美国急诊医学会（ACCP）和胸科医学会一致提出全身性炎性反应综合征（systimic inflammational respones syndrome, SIRS）一词，并对SIRS、sepsis以及与sepsis有关的临床情况作了一定的解释。按照新的概念，SIRS是指非感染性侵害引起的全身性炎性反应，并具有两个以上SIRS所应有的临床特征，而sepsis则是来自有感染的全身性炎性反应。SIRS的诊断标准： ①体温gt;38 ℃或lt;36 ℃； ②心率gt;90次/分； ③呼吸gt;20次/分或PaCO2lt;4.26 kPa(32 mm Hg)； ④白细胞计数gt;12×109/L或lt;4×109/L，或中性幼稚粒细胞gt;10%。凡符合上述两项以上指标者可诊断为SIRS。但在诊断时要注意它是急性的临床表现，应排除其它因素引起的上述症状，如化学治疗所致的白细胞减少。

IntraAbdominal Hypertension and Abdominal Compartment Syndrome

ObjectiveTo study the concepts and pathophysiology of intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS). MethodsRelevant information was gathered from previous original articals,and by checking the latest issues of appropriate journals. Meantime computerised MEDLINE search from 1998 to August 2001 was conducted using the Medical Subject Heading and textwords “abdominal”, “compartment syndromes”, “intraabdominal” and “hypertention” and “pressure”.Then the literature in the recent two years about the advances of IAH and ACS were reviewed. Especially the concepts, pathophysiology and clinical application of IAH and ACS were mainly summarized.ResultsAkin to compartment syndrome, the pathophysiological effects of increased intraabdominal pressure developed well before any clinical evidence of compartment syndrome. These changes included ①reduction of gastrointestinal blood flow，②increase of respiratory airway pressure whereas decrease of pulmonary compliance，③decline in cardiac output but rise in peripheral vascular pressure，④oliguria even anuria，⑤increase of intracranial pressure，⑥decrease of hepatic blood flow，⑦decrease of abdominal wall compliance.ACS can be defined as dysfunction of various organs caused by a progressive unphysiologic increase of the intraabdominal pressure. Clinically the syndrome is characterised by inadequate ventilation, tensely distended abdomen and oliguria or anuria.Early decompression by simple laparotomy and delayed closure is the treatment of choice. ConclusionThe concepts of IAH and ACS have been increasingly accepted. They mainly affects the respiratory,cardiovascular and renal systems; secondarily affect gastrointestinal, central nervous systems,liver and abdominal wall. The reduction of cardiac output and pulmonary compliance are probably promoting factors inducing organ dysfunction.

原发性便秘的外科治疗

A Ciinicopathphysioiogicai and Prognostic Analysis of Basaioid Squamous Carcinoma of Esophagus

Abstract:Objective To investigate the clinicopathological features and prognostic aspect of basaloid squamous carcinoma （BSC）. Methods From July 2000 to May 2003, the clinical data of 1 257 documented cases that underwent potentially curative resection on esophageal carcinoma in our department were retrospectively analysed, and 18 cases of BSC （BSC group） were detected. And 54 cases of typical squamous carcinoma of esophagus（ESC） were randomly selected as control （ESC group）, to analyse the clinicopathological and prognostic parameters of BSC patients. Results The age of BSC group patients was higher than that of ESC group （61. 56 ± 7. 62 years vs. 56.11± 10. 58 years; t=-2. 012,P=0. 048）, and the ratio of T4 stage was much higher than that in ESC group （27.8% vs. 5.6%;x2= 6. 750, P= 0. 020）. The follow-up showed that, comparing with ESC group, the ratio of metastasis was higher（62.5% vs. 25.0%, P=0. 047）, and mean survival time（P〈0.05） was significantly shorter in patients of BSC group after curative resection. There were no statisticaly differences in patient gender （P = 0. 494）, or ratio of recurrence （P=0. 887） between two groups. Conclusion The BSC is a rare carcinoma involving esophagus, which occurs in elder patients. Both invasiveness and metastasis of BSC are more usual than those of typical ESC.

EXPERIMENTAL STUDY OF PATHOPHYSIOLOGICAL CHANGES FOR PERIPHERAL NERVE AFTER NEUROLYSIS

OBJECTIVE: To investigate the changes of regeneration and conduction function for peripheral nerve after neurolysis by nerve special staining and electrophysiology. METHODS: Sixty Sprague-Dawley male rats were randomly divided into four groups(n = 15), four methods were designed on rats models of sciatic nerve compression. There were simple decompression as group A, internal neurolysis after decompression as group B, lemithason(0.5 mg/kg) injected in the epineurium after decompression as group C, and lemithason(0.5 mg/kg) injected around the epineurium after decompression and internal neurolysis as group D. Motor nerve conduction velocity(MNCV) and motor latency (Lan) were monitored at 1,2,3,4,5 weeks after decompression, sections were regularly taken from the previously compressed area to perform morphometric analysis. RESULTS: After 2 weeks of decompression, the significant recovery were observed in both MNCV and Lan of four groups. Up to the 5th week of decompression, recovery of electrophysiology was significantly faster in group C and D than that of group A and B, particular in group C(P lt; 0.05), while group A compared with group B, there was no statistical difference in both MNCV and Lan(P gt; 0.05). Morphometric analysis showed that a lot of neural regeneration fibers were observed in group C and D after 3 weeks of decompression. CONCLUSION: Decompression can improve nerve conduction function significantly, while injection of lemithason in epineurium after decompression can promote the structure and function recovery of injured nerve.

ABSTRACTSTHE OBSERVATION OF PATHOPHYSIOLOGY OF THE CIRCULATION OF SUPER THIN SKIN FLAP

The super thin skin flaps were designed on the abdominal wall of pig.The flap were divided into6 groups. The general oppoarances,such as the color,swelling,survival of the flaps,and the bloodflow measurement of the flape were used to oherve the postoperative pathophysiology changes of theblood supply of the flaps.It、was noted that:(1)the blood flow of the flape Was increasedcompensatorily as early as 3 days after oporation and reached its highest on 5th to 7th days,thers wasgradually ...

Network of multiple factors and cascades: hotspots of mechanism studies for diabetic retinopathy

The pathogenesis of diabetic retinopathy is complicated. The vast network of multiple factors including unifying mechanism, inflammatory reaction, neuron degeneration and metabolic memory of glucose, and the four established pathogenic molecular pathways are hotspots of mechanism research for diabetic retinopathy. Nevertheless, these researches may be only one corner of the ldquo;icebergrdquo; of DR mechanism, and we still face enormous challenges in DR mechanism research. Collaboration with multiple disciplines to study the relationship between DR and diabetes and other systemic diseases, search novel therapy targets may increase the result in an unexpected windfall for DR basic research.

The effects of mtDNA oxidative damage on retinal vessel of diabetic rats

Objective To observe the oxidative damage of mtDNA, apoptosis and expression of adhesion molecules in retinal capillary cells of diabetic rat with different disease courses. Methods One hundred Sprague-Dawley rats were randomly divided into the control group and the experimental group. The rats of experimental group were induced with streptozotocin (STZ) injection creating a diabetic model. Then they were divided into DR1m, DR2m DR3m group according to disease courses. The rats of control group were divided into NR1m, NR2m, NR3m group. Rat retinal capillaries were prepared, and then the contents of undamaged mtDNA were examined by Southern blot combined with Fpg. The expression of cyclooxygenase (COX)-1 encoded by mtDNA and transcription factors A (mtTFA) mRNA were detected by real-time quantitative polymerase chain reaction (RT-PCR). Apoptosis and expression of intercellular adhesion molecule-1 (ICAM-1) were detected by terminal dUT nick endlabeling (TUNEL) immuno-fluorescence and immunohistochemistry respectively. Results The contents of undamaged mtDNA in rats of DR1m, DR2m, DR3m were less than those of NR1m、NR2m、NR3m. The contents of undamaged mtDNA in diabetic rats decreased with the increase of disease courses. In addition, the mRNA levels of COX-1 and mtTFA were downregulated in diabetic rats. The positive cells of TUNEL and ICAM-1TUNEL and ICAM-1 in diabetic rats increased with the increase of disease courses. Conclusion With the increase of disease courses, mtDNA damage and apoptotic cells are increased, while the expression of mRNA encoded by mtDNA and ICAM-1 decreased in retinal capillary cells in diabetic rats.

Müller细胞反应性胶质化在视网膜病变中作用

Muuml;ller细胞是脊椎动物视网膜内最主要的神经胶质细胞。它贯穿整个视网膜，与视网膜神经细胞及视网膜血管发生多种功能的交互作用，在视网膜神经递质调节、钾离子调节和pH值调节中都具有重要作用。Muuml;ller细胞受到各种急性或慢性病理因素刺激时被激活而发生不同程度活化的反应性胶质化对多种视网膜病变或病理状态均有影响。研究Muuml;ller细胞对于理解视网膜功能以及视网膜疾病的发生发展过程具有重要意义。

Relationship between cyclin dependent kinase 5 and apoptosis in the pathogenesis of retinitis pigmentosa in Royal College of Surgeon rats

Objective To observe the expression of cyclin dependent kinase 5 (Cdk5) and p25 in the pathogenesis of retinitis pigmentosa (RP) in Royal College of Surgeon (RCS) rats and its relationships with apoptosis. To explore the mechanism of Cdk5 and p25 induced photoreceptor apoptosis in the pathogenesis of RP. Methods Retinas of RCS and RCS-rdy+ rats were obtained at the ages of postnatal day 17, 25, 35, 60. The retinal structure and thickness of outer nuclear layer were measured by optical microscopy. The expression of Cdk5, p25, cleave-caspase 3 in the retina was evaluated by immunohistochemistry. The protein expression of cleave-caspase 3 in the retina was determined by Western blot. The apoptosis of retinal cells was examined by terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL). The mean absorbance value of apoptotic cells was analyzed by SPSS 17.0 software. Results The retinal thickness of the RCS rats was significantly reduced in comparison to the RCS-rdy+ rats as the postnatal days progressed, particularly in the layer of rods and cones and the outer nuclear layer. The expression level of Cdk5, p25, cleave-caspase 3 of RCS rats increased from postnatal 17 days to postnatal 35 days, while decreased on postnatal 60 days; but there was no obvious change of above indexes in RCS-rdy+ rats. The protein expression of cleave-caspase 3 in the RCS rats was significantly increased with progression of postnatal days to postnatal 35; but there was no obvious similar change in RCS-rdy+ rats. The results of TUNEL showed that the apoptotic cells significantly increased in the outer nuclear layer of RCS rats from postnatal 17 days to postnatal 35 days, while decreased on postnatal 60 days; but there was no obvious change of above index in RCS-rdy+ rats. This study showed that there were significant correlations between the following variables: Cdk5 expression and p25 expression, Cdk5 expression and cleave-caspase 3 expression, Cdk5 expression and apoptotic cells, p25 expression and cleave-caspase 3 expression, p25 expression and apoptotic cells, cleave-caspase 3 expression and apoptotic cells. The partial correlation coefficients were 0.949, 0.808, 0.959, 0.887, 0.979, 0.852, respectively and the P value was 0.000. Conclusions The apoptotic cells significantly increases and the expression level of Cdk5, p25, cleave-caspase 3 of RCS rats increases from postnatal 17 days to postnatal 35 days. The tendency of apoptotic cells to increase is consistent with the change of Cdk5, p25, cleave-caspase 3 expression. The apoptosis of photoreceptor cells is related to increasing expression of Cdk5 and p25 in RCS rats. Cdk5 may be involved in the development of RP in RCS rats.