随着人口的老龄化，越来越多的有症状或无症状的冠心病患者需接受非心脏外科手术。接受非心脏外科手术而死亡的患者大约有50%是由于心脏并发症所致［1］。围手术期发生的心脏并发症大约5%～10%为心肌梗死，主要发生于术后头3天，其病死率很高，可达32%～69%［2，3］。术后发生心肌梗死或不稳定型心绞痛的患者发生心血管问题的几率增加20倍［4］。因此，如何评估非心脏外科手术患者的心脏危险性，如何预防围手术期心脏并发症的发生，已成为外科医生十分关注的一个问题。
Abstract： Pulmonary metastasectomy is an option for patients with metastatic tumor of lung. Numerous retrospectivestudies have demonstrated that complete control of primary tumor and complete resection of metastases limited to thelungs may be associated with prolonged survival. Speci?c issues require consideration when planning pulmonary metastasectomy. Regardless of histological type of primary tumor, complete resection is the most important prognostic factor. The other two important prognostic factors are long disease interval and limited number of metastatic tumor of lung. Hand-assisted thoracoscopic surgery for bilateral lung metastasectomy through sternocostal triangle access is recommended. Pulmonary hilar and mediastinal lymph node metastases are some relative contraindications for this surgery. Nowdays preoperative imaging examinations still have limitations in detecting all the lung metastases. Some data emphasize the importance of considering patients for extended resection in metastatic tumor of lung. Repeat resection after previous metastasectomies can be of benefit under certain circumstances so we should remove as little healthy lung tissue as possible. In this review, we discuss about some disputed issues in order to establish a useful criterion for consideration of pulmonary metastasectomy.
OBJECTIVE: To investigate the selection and identification of human keratinocyte stem cells(KSC) in vitro. METHODS: According to the characteristics of KSC which can adhere to extracellular matrix very fast, we selected 3 groups of different time(5 minutes, 20 minutes and 60 minutes) and unselected as control group. And the cells were identified by monoclone antibody of beta 1-integrin and cytokeratin 19 (Ck19), then the image analysis was done. Furthermore we analyzed the cultured cells with flow cytometer(FCM) and observed the ultrastructure of the cell by transmission electron microscope(TEM). RESULTS: The cell clones formed in all groups after 10 to 14 days, while the cells of 5 minute group grew more slowly than those of the other groups, however, the clones of this group were bigger. The expression of beta 1-integrin and Ck19 were found in all groups. The positive rate of beta 1-integrin was significant difference between 5 minute group and the other groups (P lt; 0.05). And the expression of Ck19 was no significant difference between 5 minute group and 20 minute group(P gt; 0.05), and between 60 minute group and control group. But significant difference was observed between the former and the later groups(P lt; 0.05). The result of FCM showed that most cells of the 5 minute group lied in G1 period of cell cycle, which was different from those of the other groups. At the same time, the cells of 5 minute group were smaller and contained fewer organelles than those of the other groups. CONCLUSION: The above results demonstrate that the cells of 5 minute group have a slow cell cycle, characteristics of immaturity, and behaving like clonogenic cells in vitro. The cells have the general anticipated properties for KSC. So the KSC can be selected by rapid attachment to extracellular matrix and identified by monoclone antibody of beta 1-integrin and Ck19.
The pGenesil-1-Beclin1 eukaryotic expression vectors were constructed to establish an SH-SY5Y cell line stably expressing shRNA-Beclin1. The shRNA was connected to pGenesil-1 to construct the recombinant plasmid pGenesil-1-Beclin1, which was transformed into JM109 E.coli. Positive clones were identified by digestion with restriction endonuclease and DNA sequencing. SH-SY5Y cells were cultured by the conventional method. The pGenesil-1-Beclin1 and pGenesil-1 plasmids were transfected into SH-SY5Ycells, and the cells were screened by G418 until the stable G418-resistant monoclonal cells were acquired. Beclin1 mRNA and Beclin1 protein were detected by RT-PCR and Western blot analysis respectively. The results of restriction endonuclease analysis and DNA sequencing confirmed the correct construction of the eukaryotic expression vector pGenesil-1-Beclin1. Two SH-SY5Y transfected cell lines were successfully selected. Compared with the control group, RT-PCR and Western blot showed that the expression of Beclin1 mRNA and protein were down regulated 71.28%±1.45%(P<0.05)and 75.50%±2.63%(P<0.05), respectively. The results indicated that the eukaryotic expression vector pGenesil-1-Beclin1 was successfully constructed and the SH-SY5Y cell lines with inhibited Beclin1 expression were established. It provides a useful cell model for studying the biological function of Beclin1.
Objective To developapatient-reported outcomes scale of chronic obstructive pulmonary disease used for Chinese, thus offering tools for clinical efficacy assessment. Methods According to the development standard of International Patient-Reported Outcomes, the item pool was established and the preliminary scale was prepared. Then, 100 patients with chronic obstructive pulmonary disease and 50 healthy subjects were face-to-face interviewed with preliminary scale by well-trained investigators.Those copies were collected, surveys were analyzed and items were selected with 5 methods including measure of discrete tendency method, factor analysis, correlation coefficient method, Cronbach’s alpha coefficient method and item response Theory. Finally, the final scale was gained. Results The eventual scale contains 4 areas(physiological dimain, psychological dimension, social dimension, treatment), 11 dimensions(specific symptoms, general symptoms, individual, anxiety, depression, disease cognization, disease influence on social pctivity, social support, compliance, drug adverse reaction, satisfactory), and 52 items. Conclusion The ultimate scale coincides with the theoretical framework and reflects the connotation of the quality of life of patients with chronic obstructive pulmonary disease.
ObjectiveTo systematically review the effectiveness of traditional morphological embryo screening method and other screening methods. MethodsWe electronically searched PubMed, EMbase, Web of Knowledge, CBM, WanFang Data and CNKI, for studies about the effectiveness of traditional morphological embryo screening method and other screening methods from inception to July 1st, 2013. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using the software RevMan 5.1. ResultsA total of 4 studies involving 951 patients were included. The results of meta-analysis showed that, for the traditional morphological embryo screening method, when compared with the NIR method and CCS method, there were no significant differences in clinical pregnancy rate (OR=0.94, 95%CI 0.57 to 1.53, P=0.80) and live birth rate (OR=0.90, 95%CI 0.60 to 1.37, P=0.63). However, significant difference was found for the embryos fragment rate (OR=0.40, 95%CI 0.27 to 0.59, P < 0.000 01). ConclusionThe current evidence shows that, compared with other methods, the traditional morphological embryo screening method could significantly reduce the embryos fragments rate. The results are needed to be further validate by more high-quality and large-scale studies.
This study aimed to comprehensively evaluate the biological activity in different passage populations of mesenchymal stem cells (BMSCs) derived from bone marrow in ovariectomy osteoporotic rats (named OVX-rBMSCs), providing experimental basis for new osteoporotic drug development and research. OVX-rBMSCs were isolated and cultured in vitro by the whole bone marrow adherent screening method. The morphological observation, cell surface markers (CD29, CD45, CD90) detection, cell proliferation, induced differentiation experimental detection were performed to evaluate the biological activity of Passage 1, 2, 3, 4 populations (P1, P2, P3, P4) OVX-rBMSCs. The results showed that whole bone marrow adherent culture method isolated and differentially subcultured OVX-The morphology of P4 OVX-rBMSCs was identical fibroblast-like and had the characteristics of ultrastructure of stem cells. The CD29 positive cells rate, CD90 positive cells rate, cell proliferation index, and the osteogenic, adipogenic, chondrogenic differentiation capacities of P4 OVX-rBMSCs were significantly better than those of other populations (P < 0.05). OVX-rBMSCs purity and biological activity were gradually optimized with the passaged, and among them P4 cells were superior to all the other populations. Based on these results, we report that the P4 OVX-rBMSCs model developed in this study can be used to develop a new and effective medical method for osteoporotic drug screening.
ObjectiveTo explore the selection problem of independent variables and stepwise regression method for multiple logistic regression analysis. MethodsAccording to the data of the case-control investigation for coronary heart disease, age (X1), hypertension history (X2), hypertension family history (X3), smoking (X4), hyperlipidemia history (X5), animal fat intake (X6), weight index (X7), type A personality (X8), and coronary heart disease (CHD, Y) were analyzed by SPSS 18.0 software. The multiple logistic regression analysis was done and the differences of risk factors were compared among 6 kinds stepwise regression variable selection method. ResultsThe univariate analysis showed that no difference was found between CHD group and non-CHD group in age distribution (P=0.116). But the multivariate logistic regression analysis showed that, comparing to population over 65 years old, age was a protective factor on the low age groups (OR< 45=0.100, 0.000 to 0.484, P=0.020; OR45-54=0.051, 0.003 to 0.975, P=0.048). If the age was defined as categorical variable, the risk factors for coronary heart disease were animal fat intake (X6), type A personality (X8), hypertension history (X5) and age (X1), respectively (P < 0.05). If the age was defined as a continuous variable, the effect of age (X1) was not statistically significant (P=0.053). The common risk factors were intake of animal fat (X6) and type a personality (X8) by six kinds method of stepwise variable selection. In addition, the risk factor also included hyperlipidemia history (X5) (forward-condition, forward-LR, forward-wald), hypertension family history (X3), age (X1) (backward-condition, backward-LR) and hypertension history (X2) (backward-wald). ConclusionStepwise regression method should be used to analyze all the variables, including no statistically significant independent variables in univariate analysis. If the categorical variable is regarded as continuous variables, some information may be lost, and even the risk factors may be missed. When the risk factors are not the same by several stepwise regression variable selection method, it should be combined with clinical and epidemiological significance, as well as biological mechanisms and other professional knowledge.