一氧化氮对大鼠在体心肌缺血预适应作用的研究

目的:实验以缺血预适应模型为基础,研究一氧化氮(NO)在心肌缺血预适应延迟相中的作用。方法:实验将Wistar大鼠随机分为5组:假手术组、仅行缺血预适应处理的对照组、于延迟相给药的S-甲基琉脲硫酸盐(SMT)组、硝普钠(SNP)组和SMT+SNP组。测算各组动物血清NO2-+NO3-含量及CK-MB定量,观察NO的释放对心肌损伤、梗死面积的影响。心肌细胞超微结构的变化。结果:限制内源性NO的释放可降低心肌损伤的程度,缩小心肌损伤、梗死面积。结论:在心肌缺血预适应延迟相过程中,内源性NO加重心肌损伤程度,而外源性NO可减轻心肌损伤程度。     

心肌缺血后处理与缺血预适应的相关性研究

目的 在体条件下,比较缺血后处理与缺血预适应对大鼠心肌缺血再灌注损伤的保护作用,并观察两种保护性处理是否有叠加效应.方法 建立大鼠在体缺血再灌注模型,将30只大鼠随机分为假手术组、缺血再灌注组、缺血后处理组、缺血预适应组、缺血预适应加缺血后处理组,于再灌注末测定心肌组织梗死面积,测定心肌酶.结果 与缺血再灌注组相比,缺血后处理组、缺血顸适应组、缺血后处理加缺血预适应组心肌梗死面积、血浆肌钙蛋白Ⅰ明显降低(P<0.05),但缺血后处理组、缺血预适应组、缺血后处理加缺血预适应组3组比较差异无统计学意义.结论 缺血后处理与缺血预适应均可减轻心肌缺血再灌注损伤,具有相似的心肌保护效应.这两种保护作用无叠加效应,提示缺血后处理与缺血预适应可能具有相同或相近的保护机制.     

心肌缺血预适应对缩小心肌梗塞范围的临床研究

近年动物试验证明心肌缺血预适应有一种保护作用。本组分析了近３年我院急性前壁心肌梗塞１１０例病人缺血预适应对心肌梗塞的影响。其中男７７例，女３３例。心肌梗塞前有预缺血者６９例（Ａ组），无预缺血者４１例（Ｂ组）。资料分析显示：Ｂ组心肌梗塞时心肌坏死范围、心肌酶峰值、心功能损害、室壁瘤形成及死亡率均高于Ａ组，两组差异有显著性。还就心肌缺血预适应发生时间及其对心肌保护作用之间的关系，缺血预适应的可能机制及临床意义进行了讨论。     

PTEN在心肌缺血预适应和后适应中的调控作用

目的探讨人第10号染色体缺失的磷酸酶及张力蛋白同源的基因(PTEN)/Akt信号通路在心肌缺血预适应和后适应中的作用。方法雄性SD大鼠60只,随机分为4组:假手术组(sham组)、缺血再灌注组(IR组)、缺血预适应组(Ipre组)及缺血后适应组(Ipost组)。建立动物模型,实验结束后,计算心肌梗死面积,测定血清肌酸激酶(CK)、乳酸脱氢酶(LDH)活性,检测缺血心肌PTEN m RNA和蛋白含量及p-Akt蛋白表达水平。结果与IR组比较,Ipre组和Ipost组的心肌梗死面积明显缩小,CK、LDH的活性降低,PTEN m RNA和蛋白的含量降低,p-Akt蛋白的水平升高(P0.05)。结论 PTEN/Akt信号通路在心肌缺血再灌注损伤中发挥重要作用,心肌缺血预适应和后适应通过调节PTEN/Akt信号通路的表达在缺血再灌注损伤中发挥保护心肌的作用。     

心肌缺血预适应对缩小心肌梗塞范围的临床研究

近年动物试验证明心肌缺血预适应有一种保护作用。本组分析了近３年我院急性前壁心肌梗塞１１０例病人缺血预适应对心肌梗塞的影响。其中男７７例，女３３例。心肌梗塞前有预缺血者６９例（Ａ组）．，无预缺血者４１例（Ｂ组）。资料分析显示：Ｂ组心肌梗塞时心肌坏死范围、心肌酶峰值、心功能损害、室壁瘤形成及死亡率均高于Ａ组，两组差异有显著性。还就心肌缺血预适应发生时间及其对心肌保护作用之间的关系，缺血预适应的可能机制及临床意义进行了讨论。     

缺血预适应减少心肌缺血损伤机制的研究

目的　通过对心肌缺血预适应的动物模型观察 ,探讨细胞凋亡在其中的作用 ,以及p5 3,bcl 2 ,Bax基因对其发生进行的调控。方法　采用TUNEL标记技术研究心肌缺血预适应心肌细胞中细胞凋亡现象 ,并采用免疫组化染色技术及原位分子杂交技术研究p5 3,bcl 2及Bax基因的蛋白及mRNA的表达。结果　缺血预适应组 (P)及非缺血预适应组 (NP)非缺血区均未见凋亡细胞 ,但在P组缺血区可见散在的凋亡细胞 ,而在NP组缺血区则多见。P组p5 3蛋白表达显著低于NP组 ,bcl 2蛋白表达在P组显著高于NP组 ,Bax蛋白表达在P组显著低于NP组 ,并且bcl 2 /Bax的比值P组与NP组相比显著升高。P组p5 3基因mRNA表达显著低于NP组 ,bcl 2基因mRNA表达在P组显著高于NP组。结论　心肌缺血预适应对心肌的保护可通过抑制细胞凋亡来实现 ,并且通过bcl 2表达增加 ,p5 3、Bax表达减少对其进行调控。     

细胞信号转导在心肌缺血预适应中的研究进展

心肌缺血预适应是指心脏短暂缺血后能耐受较长时间的缺血现象,是一种有效的心肌保护方法。心肌缺血预适应与细胞信号转导密切相关。细胞信号转导系统包括:受体、转导途径及作用效应并通过这三个方面介导心肌缺血预适应。     

心肌缺血预适应延迟相的研究进展

心肌缺血预适应(ischemicpreconditioning,IPC)现象的发现,为心肌缺血再灌注损伤的预防开拓了一个新的研究领域。IPC分为快速相和延迟相,快速相IPC对心脏具有显著的保护作用,但这种保护作用在IPC后1~2h即消失。延迟相IPC在IPC后24h出现,心脏保护持续时间长,保护范围广。现对IPC延迟相的机制进展作一简要综述。     

缺血预适应对心肌梗死的保护作用

心肌缺血预适应(ischemic precondition，IP)是指反复短暂的心肌缺血和再灌注可明显增强心肌对较长时间持续缺血和再灌注损伤的耐受能力。动物实验表明，心肌缺血预适应能够延迟缺血造成的致命性细胞损伤，缩小梗死面积，降低心律失常和心衰的发生率，从而降低病死率，对患者产生有益的保护作用。笔者对我院近年来收治的急性心肌梗死患者的临床资料进行了回顾性分析，进一步认识缺血预适应对急性心肌梗死患者产生的有益影响，现报告如下。     

心肌缺血预适应基础与临床研究进展

预先一次或反复短时间缺血可使心肌在其后长时间缺血中得到保护,使心肌细胞死亡延缓,这种现象称为缺血预适应现象。这种缺血预适应现象可以分为"早期保护"和"延迟保护"。除缺血外,化学损伤等也可引起机体普遍适应现象,一些药物也可以引发预适应现象。缺血预适应现象与再灌注后氧自由基生成增多、细胞内钙超载、细胞凋亡等有关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

Results of treatment of fistula-in-ano

To evaluate the application of Parks' classification in the management of patients with fistula-in-ano, a study was undertaken to assess the outcome of surgery, especially with respect to the recurrence rate and alteration of continence. A retrospective analysis of 160 consecutive patients who were classified at the time of operation was conducted. The distribution of fistulas was as follows: intersphincteric, 41.9 percent, transsphincteric, 52.1 percent, suprasphincteric, 1.3 percent, extrasphincteric, 0. A horseshoe extension occurred in 8.8 percent of the fistulas and 3.8 percent did not exactly conform to the classification as they were either complex or combinations of more than one type of fistula. The sole immediate postoperative complication was bleeding, which occurred one week postoperatively and ceased spontaneously (0.7 percent). Alteration in continence occurred in 6 percent of patients with 2.6 percent experiencing temporary incontinence to flatus, 1.3 percent to liquid stool, and 0.7 percent to solid stool. Permanent loss of control for flatus occurred in one patient (0.7 percent) and for liquid stool in one patient (0.7 percent). No patients suffered loss of control for solid stool. Recurrence developed in 6.3 percent of patients, all between five and 25 months postoperatively. Classifcation was found to be a useful guide in the operative management of patients with fistula-in-ano. Read at the joint meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.     

Intake of energy drinks in association with alcoholic beverages in a cohort of students of the School of Medicine of the University of Messina

BACKGROUND: Energy drinks (ED) are a widely used group of beverages known for their stimulant effects on central nervous system (CNS). The main components of ED are caffeine, taurine, carbohydrates, glucuronolactone, inositol, niacin, pantenol, and beta-complex vitamins. The studies evaluating the effects of ED describe improvements in attention and/or reaction times and indices of alertness. It has been also shown that combination of caffeine and glucose, fundamental constituents of ED, can ameliorate deficits in cognitive performance and subjective fatigue during extended periods of cognitive demand. Moreover, the associated ingestion of alcohol and ED has recently been observed to be becoming more and more widespread. METHODS: With the aim to know the habits and uses of students, we administered a questionnaire containing questions regarding ED drinking alone or in association with alcoholic beverages. Five hundred students of the School of Medicine of the University of Messina were interviewed, and 450 filled the questionnaire. RESULTS: A total of 56.9% of students declared using ED. A great part of users (48.4%) associate frequently ED and alcohol. In particular, 35.8% of ED + alcohol users have used ED + alcohol more than 3 times in the last month. Distinguishing the users into 2 groups (users of ED + alcohol and users of both ED and ED + alcohol), we observed in the second group a major use of cocktail containing a mix of ED and alcoholic beverages. This difference between the 2 groups is less represented about the ingestion of ED + alcohol in the night. CONCLUSIONS: Our data indicate that association of ED + alcohol is very popular among students. This behavior can be dangerous. In fact, the combination of ED + alcoholic drinks can reduce adversive symptoms of alcohol intoxication including the depressant effects. As consequence, users of ED + alcoholic beverages might not feel the signs of alcohol intoxication, thus increasing the probability of accidents and/or favoring the possibility of development of alcohol dependence.