Objective To investigate the protective effects of antitumor necrosis factor-α antibody （TNF-αAb） on lung injury after cardiopulmonary bypass （CPB） and their mechanisms. Methods Forty healthy New Zealand white rabbits，weighting 2.0-2.5 kg，male or female，were randomly divided into 4 groups with 10 rabbits in each group. In groupⅠ，the rabbits received CPB and pulmonary arterial perfusion. In group Ⅱ，the rabbits received CPB and pulmonary arterial perfusion with TNF-αAb. In group Ⅲ，the rabbits received CPB only. In group Ⅳ，the rabbits only received sham surgery. Neutrophils count，TNF-α and malondialdehyde （MDA） concentrations of the blood samples from the left and right atrium as well as oxygenation index were examined before and after CPB in the 4 groups. Pathological and ultrastructural changes of the lung tissues were observed under light and electron microscopes. Lung water content，TNF-α mRNA and apoptoticindex of the lung tissues were measured at different time points. Results Compared with group Ⅳ，after CPB，the rabbitsin group Ⅰ to group Ⅲ showed significantly higher blood levels of neutrophils count，TNF-α and MDA（P＜0.05），higherTNF-α mRNA expression，apoptosis index and water content of the lung tissues （P＜0.05），and significantly lower oxyg-enation index （P＜0.05） as well as considerable pathomorphological changes in the lung tissues. Compared with group Ⅱ，after CPB，the rabbits in groups Ⅰ and Ⅲ had significantly higher blood concentrations of TNF-α （5 minutes after aortic declamping，220.43±16.44 pg/ml vs.185.27±11.78 pg/ml，P＜0.05；249.99±14.09 pg/ml vs.185.27±11.78 pg/ml，P＜0.05），significantly higher apoptosis index （at the time of CPB termination，60.7‰±13.09‰ vs. 37.9‰±7.78‰，P＜0.05；59.6‰±7.74‰ vs. 37.9‰±7.78‰，P＜0.05），significantly higher blood levels of neutrophils count and MDA （P＜0.05），significantly higher TNF-α mRNA expression and water content of the lung tissues （P＜0.05），and significantly loweroxygenation index （P＜0.05） as well as considerable pathomorphological changes in the lung tissues. Compared with groupⅠ，rabbits in group Ⅲ had significantly higher above parameters （P＜0.05） but lower oxygenation index （P＜0.05） only at 30 minutes after the start of CPB. Conclusion Pulmonary artery perfusion with TNF-αAb can significantly attenuate inflammatory lung injury and apoptosis of the lung tissues during CPB.
Objective To investigate the significance and surgical skill for lymphadenectomy around common hepatic artery in gastric cancer. Methods Two hundred and fifty-seven cases with undergoing lymphadenectomy around common hepatic artery in gastric cancer between January 2001 and December 2006 were retrospectively reviewed. Experiences and understanding of dealing with this procedure in curative gastrectomy for gastric cancer were concluded. Results The number of dissected No.8 lymph node was 2.2±1.7, and the positive rate of No.8 lymph node was 30.35%. There were no lymphadenectomy related complications, such as anastomotic leakage, lymphatic fistula and postoperative hemorrhage in this series. Dissection around common hepatic artery lymph nodes along artery intrathecal space, division and ligation of left gastric vein at its root, and sufficient exposure of anatomic structures were important to dissection lymph nodes around the common hepatic artery. The exposure of anatomic structures included liberation of common hepatic artery by traction with the band, and the exposure of posterior side of pancreas by Kocher incision.Conclusion Being familiar with the anatomy around common hepatic artery, careful dissection, and attention to the surgical skill of lymphadenectomy are very important to improve the effectiveness of lymphadenectomy around common hepatic artery in gastric cancer.
Objective To observe the clinical manifestation and ophthalmoscopic image characteristics of uveal metastatic carcinoma. Methods Thirty-six uveal metastatic carcinoma patients (43 eyes) were enrolled in this study. The patients included 21 males and 15 females. The patientsprime; ages ranged from 28 to 71 years, with a mean age of (47.3plusmn;10.2) years. Seven patients had bilateral carcinoma and 29 patients had unilateral carcinoma. There were 30 patients with lung cancer, three patients with breast cancer, one patient with gastric cancer and two patients without primary tumors. There were 20 patients with known primary cancer, 16 patients visited the Department of Ophthalmology first. All the patients were examined documenting visual acuity, intraocular pressure, slit-lamp microscopy and mydriatic fundus examination. Meanwhile, 22 patients (26 eyes) were examined using B-type ultrasound and/or color Doppler flow imaging (CDFI). Twelve patients (12 eyes) were examined using fundus fluorescein angiography (FFA) and/or indocyanine green angiography (ICGA). Seventeen patients (22 eyes) were examined using MRI and/or CT. The clinical manifestation and ophthalmoscopic image characteristics of uveal metastatic carcinoma patients were observed. Results Among 43 eyes, four lesions were in the iris, three lesions in the ciliary body and 32 lesions were in the choroid. Fundus examination showed an isolated mass in 26 eyes and more than two masses in nine eyes. Metastatic tumors of the iris and ciliary body often showed irregular cauliflower-like mass with gray-white or meat-red color and abundant vessels. The choroidal metastasis usually demonstrated flat rounded or irregular intraocular masses with gray-yellow or gray-white color in the posterior pole. B-type ultrasound showed ill-defined, flat, and irregular-shaped masses with uneven internal reflectivity. CDFI showed rich blood flow within the tumor. FFA and (or) ICGA showed pinpoint and mottled leaks against hyperfluorescence background. MRI revealed low or middle signal using T1WI and low signal intensity using T2WI. Conclusions The uveal metastatic carcinoma usually occurs in one eye with an isolated mass. Most of them show a flat gray-yellow mass in posterior choroids and have the primary cancer sites of the lung. FFA and/or ICGA show pinpoint and mottled leaks against hyperfluorescence background. B-type ultrasound and (or) CDFI show ill-defined, flat, and irregular-shaped mass with rich blood flow within the tumor. MRI reveals low signal intensity on T2WI.
OBJECTIVE: To investigate the protective effect of tumor necrosis factor-alpha(TNF-alpha) on spinal motor neurons after peripheral nerve injury. METHODS: Twenty Wistar rats were divided into two groups, the right sciatic nerves of 20 Wistar rats were transected, the proximal stumps were inserted into a single blind silicone tube. 16 microliters of normal saline(NS) and TNF-alpha(30 U/ml) were injected into the silicone tubes. After 2 weeks, the 4th, 5th lumbar spinal cord were taken for examination. Enzyme histochemical technique and image analysis were used to show acetylcholinesterase(AChE) and nitric oxide synthase(NOS) activity of spinal motor neurons. RESULTS: The number of AChE and NOS staining neurons were 8.65 +/- 1.98 and 5.92 +/- 1.36 in the experimental group and 6.37 +/- 1.42 and 8.67 +/- 1.45 in the control group respectively, there were significant difference between the two groups(P lt; 0.01). CONCLUSION: It suggests that TNF-alpha has protective effect on motor neurons after peripheral nerve injury.
胆总管在穿过十二指肠壁时与胰管汇合，汇合后略膨大，称Vater壶腹（简称壶腹）。壶腹及其外周环绕的括约肌向十二指肠肠腔突出，使十二指肠粘膜隆起形成十二指肠乳头。在壶腹周围（包括壶腹），上述组织结构所发生的肿瘤统称为壶腹周围肿瘤，并以恶性居多。壶腹周围的恶性肿瘤包括来自壶腹、胆总管下端、十二指肠乳头和胰头的癌肿，临床上把前三者连同胰头癌统称为壶腹周围癌。目前，外科手术仍是治疗壶腹部肿瘤的主要手段，提高壶腹部肿瘤的外科治疗技术水平是患者获得治愈的唯一途径。壶腹部肿瘤因其组织来源不同其生物学行为亦表现出很大差异，应根据壶腹部肿瘤的不同组织来源、生物学行为及其发展阶段作出合理的外科治疗。
Objective To investigate the family-dependence status in patients with tumor, and analyze the related factors of family dependence. Methods The self-made family-dependence scale was distributed to 432 patients with tumor to asses their family dependence status. Results The mean score of family-dependence was 40±5.8. A total of 198 cases (45.8%) were family-dependent, including 52 mild cases, 98 moderate cases, and 48 severe cases. The logistic regression analyses showed that sex (OR=3.873, P=0.022), age (OR=2.378, P=0.035), and personality type (OR=1.079, P=0.028) were the related factors of family-dependence. Conclusion More attention should be paid to patients with tumor about their family-dependence. After being instructed, the family members should use proper emotional expression method to provide family support to the patients with tumor. The female patients, older patients, and patients with dependent personality should be encouraged to improve their self-care ability to avoid family-dependence as possible as they can.
To study the effects of human growth hormone on protein catabolic state of gastric and colonic cancer patients after surgical intervention and whether it can improve the postoperative host immune function and reduce the postoperative fatigue syndrome (POF) by using rhGH. Thirtyeight gastric and colonic cancer patients (21 cases of gastric cancer; 17 cases of colonic cancer) were diveided into control group (n＝18) and rhGHtreated group (n＝20). All the patients were performed resection and treated by early postoperative intraperitoneal thermochemotherapy (EPIC) and total parenteral nutrition (TPN). Subcutaneous injections of 8 U rhGH at 9∶30 am was administered to the rhGHtreated group (six days) at the same time. Results: In the control group, a significant decrease in serum levels of albumin, prealbumin, transferri, IgG, IgA, IgM and CD＋３, CD＋4, CD＋8 were observed after operation (Ｐ＜0.01). In the rhGHtreated group, CD＋３, CD＋4 and CD＋8 raised significantly and the other did not change significantly. The postoperative vigour state of the patient was better than that in the control group. In the control group, pronouced weight loss of 3-5 kg, was detected on the 10th pastoperative day, while the weight loss was 1-2 kg in the rhGHtreated group (Ｐ＜0.01). Conclusion: The treatment with rhGH together with TPN and EPIC not only overcomes the protein catabolism of the cancer patient after operation by increasing protein synthesis, but also improves postoperative host immune function, reduces POF, and can raise the killing effect of chemotherapy on cancer cells, enhances the tolerance to chemotherapy.