病毒性肝炎、肝癌与肝移植

原位肝移植已走过42年历程。目前肝移植1年存活率已攀升到88%,手术死亡率已降至0。不伴有肝硬化和能切除的肝细胞癌患者应首选肝切除术;有肝硬化者需行肝移植;晚期肝癌不宜肝移植。手术前、后联合应用乙型肝炎免疫球蛋和拉米夫定,可使患乙型肝炎者接受肝移植的长期疗效与其他肝病受者相媲美。没有肝移植条件的医院不提倡开展肝移植。     

ROLE OF PERIPHERAL LYMPHOCYTES SIALYL LEWIS（X） （CD15s） ANTIGEN BEFORE AND AFTER KIDNEY TRANSPLANTATION

Objective To investigate the role of peripheral lymphocytes Sialyl Lewis（x） （CD15s） antigen before and after kidney transplantation. Methods Flow cytometry technique was applied to examine the expression of peripheral lymphoid cell surface CD15s antigen after renal transplantation, and to evaluate various therapeutic regimen. Results The statistic analysis results of peripheral lymphoid cell surface CD15s antigen expression level showed that there was significant difference among the patients with acute rejection, long-term dialysis and with normal renal function post-transplant; significant difference of CD15s expression level between group of rejection and infection; no significant difference of CD15s expression among the different groups treated by various therapeutic regimens. Conclusion The different therapeutic regimen has no influence to CD15s expression; Detection of peripheral lymphoid cell surface CD15s antigen expression periodically, intelligently make convenience to understand suitable status of immunosuppression.     

骨髓移植患者和献血员巨细胞病毒特异性抗体的检测及其意义

用酶联免疫吸附法检测了5例骨髓移植病人,204名献血员巨细胞病毒特异性抗体IgM和IgA,结果5名接受骨髓移植的病人全部阴性,204名献血员中总抗体检出率29.91％,表明西安地区部分献血员中巨细胞病毒感染率较高,且为近期或活动性感染。这将对骨髓移植构成极大的危险。因此在骨髓移植中应筛选巨细胞病毒抗体阴性的献血员。     

Perceptions of Diving Impacts and Implications for Reef Conservation

SCUBA diving can contribute to both coral reef degradation and conservation. Divers’ perceptions of these possible impacts were studied in Phuket, Thailand. The most endorsed impact of diving was a positive one: the educational impact on the divers. Impact perceptions changed after the dive. Perceptions of anchor damage and garbage disposal as negative impacts fell markedly. Following the trip liveaboard divers were more likely than day divers to see the impact of diving as positive. Almost 30% of divers witnessed perceived negative impacts on the reef by their dive group. Divers who saw damage were more likely to feel that diving has a negative impact on the reef than divers who did not see impacts. They were also more likely to take part in a reef conservation project. The results reinforce the potential for diving to be a positive force for reef conservation but indicate the need for greater investment in diver education.     

Impacts of the 2004 Tsunami on Surin Marine National Park,Thailand

The impacts of the tsunami in 2004 on the reefs in Surin Marine National Park, Thailand, varied with the location and exposure of the reefs. Channel areas between islands were severely damaged. Areas with steep reef slopes were damaged by sand slides or coral collapse more than areas with low slopes. Massive, sub-massive, and encrusting corals were more resistant and resilient to the direct impact of the tsunami than branching, tabulate, and foliose life forms whereas the latter were more tolerant of temporary coverage by sand. Sub-massive corals were the most tolerant overall and survived sand coverage, breakage, and overturning. Live coral cover measured three months after the tsunami was significantly greater than immediately post-tsunami as broken, moved, or sand-covered corals, recorded as impacted in the initial survey, had survived and were regenerating. Low turbidity, lack of pollution, and mild currents possibly contributed to rapid recovery and limited long-term effects of the tsunami. Impact assessment shortly after a major disturbance may give an initial measure of damage but subsequent surveys must be undertaken to identify long-term effects. Understanding patterns of reef damage can help to formulate reef zoning and protection strategies in response to catastrophic events, but also in advance of such events to improve likely resilience of the marine park to disturbance.     

SCUBA Diver Specialization and Behavior Norms at Coral Reefs

SCUBA diving is an increasingly popular activity that provides a number of benefits to coastal communities. However, the sustainability of recreational diving on coral reefs is largely dependent on the health of reef ecosystems. Divers can minimize their impacts to coral reefs through responsible diving behaviors, which are in part guided by social norms. The behavioral obligation and sanction components of twelve diving behaviors were determined for Florida Keys divers throughout the course of a year. Recognizing that recreationists are not homogenous, these norms were compared according to diver specialization level. Specialized divers felt a stronger obligation not to touch corals and to pick up garbage from the sea floor than did less specialized divers. Specialized divers also reported they would feel greater embarrassment for losing buoyancy control, touching corals, taking pieces of dead corals, or touching marine mammals. The findings point to a connection between specialization level and social norms, and a relationship to ensuring continued reef health.     

Impact of coastal construction on coral reefs in the U.S.‐affiliated pacific Islands

Abstract

During the past century, traditional ownership, control, and use of coral reef habitats in the U.S.‐affiliated islands in the Pacific have declined, exposing them to increased construction for plantation, transportation, military, urban, aquaculture, fisheries, mineral, and resort development. Dredging, filling, and other construction in coral reef and related ecosystems are expected to continue at high levels. Collectively, these activities have resulted in major adverse ecological impacts, many of which can be avoided or reduced to minor levels. Improvements in the design, siting, and construction of coastal projects can be accomplished by early integration of environmental objectives. Ecological baseline surveys; environmental impact assessments; regulatory conditions; guidelines and standards during construction; monitoring of construction; post‐construction evaluation; and long‐range research, planning, and management are among the most useful of the environmental tools to describe reefs and to identify measures to reduce or avoid adverse impacts on coral reefs.     

Successful Transplantation of a Fragmenting Coral,Montipora digitata,for Reef Rehabilitation

The scleractinian coral Montipora digitata (Acroporidae) is a common reef flat species that thrives under high levels of light and water turbulence, and propagates successfully by natural fragmentation. It was used for transplantation experiments in an attempt to restore a degraded lagoon environment in the northwestern Philippines. Branches about 5 cm high from a natural population in the lagoon were transplanted to dead coral outcrops or knolls in two locations (Binlab and Malilnep-Ac) with different environmental characteristics. Growth and survival were significantly better at Malilnep Ac, which resembled the natural habitat of the species more closely. Environmental conditions at this site also favored the establishment of a greater diversity of species around the coral transplants. There was no difference in performance between transplants on vertical and horizontal surfaces, and the transplants showed limited differences due to density within the experimental range. Significant survival of detached, transplanted colonies or fragments thereof around the bases of the experimental bommies at the more successful site was an additional positive outcome. Water motion showed significant effects on survival and growth, possibly enhancing the suitability of the more successful site for transplantation. These results demonstrate the potential of coral transplantation to initiate the establishment of natural communities in degraded reef areas, a concern for coastal managers in developing countries.     

山莨菪碱在非转流经典原位肝移植中的应用

目的观察山莨菪碱对非转流经典原位肝移植术血流动力学、氧代谢和肾功能的影响。方法选择行非转流经典原位肝移植患者30例,ASA分级Ⅲ-Ⅳ,随机分为山莨菪碱组和对照组,每组15例。山莨菪碱组术中使用1 g/L山莨菪碱10 mg/h,对照组使用相同容量的生理盐水。分别于术前、无肝期前、无肝期30 min、新肝期60 min和术毕测定血流动力学、组织氧代谢和肾功能指标。结果与无肝期前相比,两组无肝期30 min中心静脉压(CVP)明显降低,新肝期60 min CVP明显升高(P<0.05);两组间各时点的心率(HR)、平均动脉压(MAP)和CVP均无显著性差异(P>0.05);两组手术时间、无肝期时间、出血量、总入量均无显著性差异(P>0.05);与对照组相比,山莨菪碱组尿量显著增多(P<0.05),而速尿的用量显著减少(P<0.05);两组肌酐(Cr)和β2-微球蛋白(β2-MG)术中各时点与术前相比及两组之间相比差异均无统计学意义(P>0.05)。与术前比较,两组无肝期30 min乳酸盐(LAC)水平明显增高,持续至术毕(P<0.01);与对照组相比,山莨菪碱组在无肝期30 min后各时点LAC明显降低(P<0.05)。结论肝移植术中使用山莨菪碱能改善组织微循环,增加术中尿量,对改善肾功能有一定意义。     

肝动脉缺血对肝细胞凋亡的影响及其机制初探

目的　探讨肝动脉缺血 (HAI)过程中氧自由基对肝细胞凋亡的影响及其机制。方法　将家兔按再灌注后有无HAI分为HAI组和对照组。在兔肝自体原位移植模型基础上 ,应用原位末端标记 (TUNEL)技术、免疫组化法和比色法 ,检测肝细胞凋亡指数 (AI)、bc1 2蛋白表达和肝组织中MDA生成水平。结果　随着HAI时间的出现和延长 ,肝细胞凋亡指数增大。当HAI 3h时 ,HAI组凋亡指数增高为 12 .5 %± 1.38% ,与同组HAI 30min、HAI 2h和对照组的AI值比较均有显著性升高 (P <0 .0 5 )。bc1 2蛋白表达阳性细胞于再灌注后增多 ,但HAI组与对照组比较 ,各时点均无明显差异。同时 ,肝组织内MDA含量逐渐增多 ,HAI组HAI 3h达到最高 ,同组HAI各时点的MDA含量比较均有显著性差异 (P <0 .0 5 )。结论　HAI损伤可通过进一步促进缺血再灌注后氧自由基的生成而加重肝细胞凋亡的发生 ,阻碍供肝功能的恢复 ,是肝移植后供肝功能不全和并发症发生的关键因素之一。