目的:揭示miR-424-5P及NAcht富含亮氨酸重复蛋白1(NLRP1)在非小细胞肺癌细胞系增殖迁移和侵袭过程的作用机制.方法:利用qRT-PCR检测来自医院的15名非小细胞肺癌患者肿瘤组织和癌旁组织中NLRP1的mRNA水平;通过qRT-PCR检测2种非小细胞肺癌细胞HCC827、A549和正常肺上皮细胞BEAS-2B中NLRP1的mRNA水平;利用CCK-8检测下调表达NLRP1对A549细胞增殖能力的影响,Transwell检测下调表达NLRP1对A549细胞迁移和侵袭的影响;通过Targetscan软件预测,miR-424-5p是NLRP1的调控miRNA之一,将检测细胞分为miR-NC组、miR-424-5p mimics组及miR-424-5p inhibitor组,利用qRT-PCR检测3组细胞中miR-424-5p及NLRP1的mRNA水平,Western印迹检测NLRP1蛋白表达水平,双萤光素酶报告基因实验检测miR-424-5p与NLRP1之间靶向调控关系;将肺癌细胞A549分为miR-NC组、miR-424-5p inhibitor组及miR-424-5p inhibitor+si-NLRP1组,利用CCK-8法检测3组细胞的增殖能力,Transwell检测3组细胞的迁移和侵袭能力.结果:非小细胞肺癌患者肿瘤组织中NLRP1表达量明显高于癌旁组织;A549细胞中NLRP1表达量最高(P<0.01),而BEAS-2B中NLRP1表达量最低(P=0.157);下调表达NLRP1抑制A549细胞增殖迁移和侵袭能力;过表达miR-424-5p的A549细胞中NLRP1蛋白表达量降低(P<0.01),而敲低miR-424-5p增加NLRP1的蛋白表达(P<0.01);双萤光素酶报告基因实验验证miR-424-5p能与NLRP1的3'非翻译区结合抑制其表达(P<0.01);敲低miR-424-5p能够促进A549细胞的增殖迁移和侵袭能力(P<0.01),同时敲低miR-424-5p和NLRP1的表达量则可以使A549细胞的增殖迁移和侵袭能力降低到miR-NC的水平.结论:miR-424-5p能够靶向NLRP1抑制非小细胞肺癌A549细胞增殖迁移和侵袭能力.

Objective To study the applicability of the video-assisted thoracoscopic gastric tube in esophagectomy with a small incision.Methods Clinical data about 95 esophageal patients who had undergone esophagectomy with a small incision and gastric tubes between July 2012 and December 2015 were retrospectively analyzed.The applicability of this approach was assessed according to the duration of operation,intraoperative blood loss,postoperative complications and pulmonary function.Results The incision was (7.5 ± 2.2) cm long,the duration of operation (210 ± 26) min,the intraoperative blood loss (285.0 ± 106.5) ml.hospital stay (9.2 ± 1.5)d,and the incidence of postoperative complications was 27.4％.The incidence of digestive complications was the highest,accouting for 15.8 ％ of the total.The forced vital capacity was (2.75 ± 0.80) L and forced expiratory volume 1 second was (1.95 ± 0.34) L.Three months after operation,the quality of life of these patients was better than one month after operation (P ＜ 0.05).Conclusions Radical esophagectomy with video-assisted thoracoscopic small incision and gastric tubes is characterized by user-friendliness,less trauma,fewer complications,lower expenses,and better quality of life compared with traditional surgical approaches and other approaches.

食管化学烧伤合并胃严重烧伤的情况,不能单独做食管重建,可利用剩余部分好的胃底与空肠复合重建食管.该术式操作简单,成功率高,远期效果好.

1临床资料<br>　　1．1一般资料患者男性，46岁，主因“发现左上肺占位10 d”于2014-06-16入院，拟行“肺叶切除伴淋巴结清扫术”。既往血压波动于（140～150）／（90～100） mmHg，未规范治疗。完善术前相关检查：肺部CT检查提示左上肺占位性病变，无胸腔及纵隔淋巴结浸润；肺功能检测：肺活量（VC）2．99 L，潮气量（VT）0．88 L，用力肺活量（FVC）3．47 L，第一秒用力呼气容积（ FEV1）3．05L，一秒率（ FEV1％）87．85％，最大通气量（MVV）121．82 L／M，通气功能正常；颈部彩超提示双侧颈部及锁骨上窝未见肿大淋巴结；心脏彩超提示心内结构及心功能未见明显异常；血尿便常规、腹部B超、心电图均未见异常；血液生化检查：谷丙转氨酶（ ALT）38 U／L，谷草转氨酶（AST）26．6 U／L，碱性磷酸酶（ALP）109．0 U／L，总胆红素（T-Bil）33．0μmol／L，直接胆红素（D-Bil）9．3μmol／L，间接胆红素（I-Bil）23．7μmol／L，血脂肪酶（LPS）50．5 U／L。初步诊断：左上肺占位。

Objective To study the clinical outcome of radical gastroesophagetomy with small incision in patients with tubular gastroesophageal cancer. Methods Clinical data about 150 gastrogastroesophageal cancer patients who underwent radical gastroesophagetomy with a small incision in our hospital from October 2009 to March 2012 were retrospectively analyzed. The procedure was assessed according to the operation time, intraoperative blood loss, postoperative complications and pulmonary function. Results The radical resection rate of gastroesophageal cancer was 100%. The incision was(13.4±2.8) cm long. The operation time was(213±28) min. The intraoperative blood loss was(340±207.2) ml. The incidence of postoperative complications was 10.5%. The incidence of pulmonary complication was the highest, accounting for 4%. The forced vital capacity and expiratory volume were(2.73±0.85) L and(1.91±0.32) L, respectively, 1 month and 1 second after operation, which were not significantly lower than those before operation(P >0.05). Conclusion Radical gastroesophagectomy with a small incision is characterized by less traumas, less complications and easy to perform as compared with traditional surgery, but its indications should be strictly taken into consideration.

晚期胃底贲门癌常侵犯胰腺及周围组织,行贲门癌根治、联合胰体尾脾切除,手术复杂,难度较大,术中及术后并发症较多,甚至失去手术机会;先行腹腔干动脉化疗并栓塞胃左动脉,使肿瘤局限萎缩,降低了手术风险,减少术中出血,增加了手术安全性.我院2003-05至2008-10对5例实施了该手术,患者均康复出院,生存期内生活质量比较满意.笔者认为,晚期胃底贲门癌如果侵犯胰腺及周围组织,介入治疗后联合胰体尾脾切除手术具有积极的临床意义.

目的探讨烧伤后早期强化胰岛素治疗对脓毒症合并高血糖患者体内过度炎性反应、脓毒症的发生、发展、并发症的出现及其预后的影响。方法依据治疗方法的不同将40例患者分成常规组和强化组。脓毒症并发高血糖期间胰岛素持续泵入,其中常规组血糖(BS)维持在10.1～11.1 mmol/L,强化组为4.4～6.1 mmol/L,同时监测两组患者血清中TNF-α、IL-6、IL-18和CRP等炎性介质及前白蛋白(PA)、尿素氮(BUN)的水平,并对脓毒症引起的并发症及死亡率进行分析。结果强化组于治疗后10、14、21 d,血清中TNF-α、IL-6、IL-18、CRP和BUN水平明显低于常规组(P<0.05),而PA明显高于常规组(P<0.05)。强化组脓毒症的预后明显优于常规组。结论烧伤后早期强化胰岛素治疗减缓了脓毒症的进一步发生、发展,从而减少并发症的发生,降低了死亡率。

我院于1995年1月～2005年10月,对385例食管癌、贲门癌患者施行手术治疗,切除362例,手术切除率94%,术后未发生吻合口瘘、脓胸及住院死亡,所有患者均康复出院.

Objective To investigate the changes of gene expression and protein contents of matrix metalloproteinase-2,9 and its inhibitor(TIMP-2) in normal skin versus hyperplastic scars and appraise their biological significance.Methods Morphological characteristics of hperplastic scar and normal skin were studied by pathological techniques.After the total RNA of hyperplastic scars at different periods after wounding and normal skin was isolated and purified to mRNA,gene expression levels and protein contents of MMP-2,9 and TIMP-2 were examined by reverse transcription-polymerase chain reaction(RT-PCR) and Western blotting.Results In the skin,the genes of MMP-2,9 and TIMP-2 were weakly expressed,and protein contents were low.In proliferative scar,the contents of gene transcripts and proteins of these 2 MMPs and TIMP-2 significantly increased(P0.05).In mature scar,although mRNA levels of MMP-2,9 were restored to the levels of normal skin,the protein contents of these 2 MMPs were significantly higher than those of normal skin(P0.05).At the same time,the mRNA and protein contents of TIMP-2 decreased to the levels of normal skin.Conclusions Enhancement of MMP-2,9 and TIMP-2 expression might be related to formation of hyperplastic scar,while high protein levels of these 2 MMPs and low content of TIMP-2 protein might be associated with hyperplastic scar reaching the mature stage.

近年来,随着胸外科手术技术的不断发展,电视胸腔镜手术(VATS)的广泛应用,手术伤口美观和微创越来越受到重视.笔者自2007年5月～2008年6月采用腋下小切口行胸部手术83例,达到微创和手术目的,效果良好.

病人 女,21岁.活动后心悸、憋气伴胸痛1月余.5年前右小腿行神经纤维瘤切除术.查体:全身可见多发牛奶咖啡斑,以胸腹部明显,最大约20 cm×10 cm,右腰部肿物高出皮肤约1 cm,分别为10 cm×3 cm、5 cm×4 cm大小,质地软,无压痛.全身浅表淋巴结无肿大.右上肺叩诊稍浊,呼吸音粗,未闻及明显干、湿罗音.左手掌可见与腰部相同肿物,约5 cm×5 cm×1 cm,延伸将第3、4指完全包囊,两手指屈指、并指功能明显受限.X线胸片、胸部CT示右胸壁占位.

自1976年Radovan[1]首先应用皮肤软组织扩张器以来,扩张器在整形外科已得到广泛应用,尤其在修复瘢痕性秃发方面更具有其它传统方法所无法比拟的优越性.但对于颈部瘢痕的治疗仍有许多商榷的地方.我院近8年来共埋置扩张器106个,修复颈部瘢痕45例,获得了比较满意的效果.

临床营养支持的合理应用对于提高机体免疫功能,促进康复,降低术后并发症,感染等都有非常重要的作用.我院自2000年～2004年共实施食管癌手术86例,现就术后的营养支持治疗探讨总结如下.

Objective To investigate the effect of oral lactulose on interleukin-18 mRNA expression in severe burned rats.Methods The rats were subjected to full-thickness thermal injury on 30% of total body surface area. They were randomly divided into two groups:scald controls (Group C) and lactulose group (Group L). The level of IL-18 mRNA in tissues of intestine was determined by reverse transcription polymerase chain reaction.Diamine oxidase (DAO) activity of small intestine was assayed by chromatography. The tissues of mesenteric lymph nodes (MLN) in ileocecum and whole blood were cultured at 2,8,16 and 24 hours after burn.Results The IL-18 mRNA expression in group C was significantly higher than that in group L after burn injury (P 0.05). DAO activity in group L was significantly higher than that in group C at 8,16 and 24 hours after burn, while the positive rate of blood bacterial culture and bacterial count in MLN after burn injury were lower in group L than in group C (P0.05).Conclusion IL-18mRNA over expression in intestine results in the damage of intestinal barrier and the high incidence of bacterial/lipopolysaccharide(LPS) translocation to MLN and whole blood in early stage of burn.The lactulose therapy protects intestinal barrier from high incidence of bacterial/LPS translocation.

1临床资料 患者女,57岁,"颈部肿物半年余,近日明显增大,憋气"入院.入院后出现夜间憋气3次,查体:体温36.4℃,脉搏90次/分,呼吸20次/分,血压14.6/10kpa,颜面部青紫肿胀,双眼睑水肿,结膜无充血,双眼球活动可,未见明显突出.

胃肠道是早期重度烧伤患者主要的细菌及其毒素的移位场所.烧伤后肠道细菌导致的内毒素血症、脓血症,进而发展成多脏器不全综合症(MODS),是烧伤患者死亡的主要原因之一.既往研究证明,烧伤早期减少肠道内G-杆菌的含量能有效地降低循环内毒素血症的水平,控制脓毒症的发生与发展[1].为此,有关研究不少,但如何降低循环内毒素水平,缺乏有效可行的方法.本研究旨在进一步探讨烧伤后口服乳果糖是否可以减轻内毒素血症,减少肠道细菌及其毒素移位.