胰腺中乙醇有氧和无氧代谢的关联及乙醇无氧代谢产物对胰腺腺泡细胞的毒性

酗酒是器官损伤的主要原因 ,特别是在胰腺和肝脏 ,但是乙醇靠什么机制发挥毒性作用 ,是直接还是间接通过代谢产物 ,仍然未完全被理解。乙醇或通过有氧途径代谢成乙醛 ,或通过无氧代谢途径生成脂肪酸乙基酯 (FAEE)或磷脂酰乙醇。然而在胰腺中 ,乙醇的氧化发生在相对低的速度 ,使得乙醛是酒精引起的胰腺损伤的唯一介质不太可能。现在在体内和体外有令人信服的实验证据说明在酒精引起的器官损伤中 FAEE是毒性介质。当前研究的目的是想确定 :(1)在伴和不伴胰腺炎的大鼠中 ,是否抑制乙醇有氧代谢途径导致无氧代谢的增加 ,随之发生肝脏和胰腺…     

谷氨酰胺产生菌NS611的代谢流分析

建立并完善了谷氨酸棒杆菌NS611生产谷氨酰胺的中心碳代谢网络.研究了菌体生长和生产阶段的代谢流分布,结果说明该菌葡萄糖的代谢以糖酵解途径为主,在产酸阶段丙酮酸羧化反应的代谢流量较大。NADPH不是谷氨酸棒杆菌NS611代谢的限制性因素.研究了氮饥饿处理对代谢流分布的影响,提出要提高谷氨酰胺的产量必须适当保留α-酮戊二酸的向下氧化的功能,以保证能量供给.     

新型蛋白聚糖类生物絮凝剂REA-11的合成途径

谷氨酸棒杆菌CCTCC M201005能合成一种以半乳糖醛酸为主要结构单元的蛋白聚糖类生物絮凝剂(命名为REA-11).为了研究该聚合物的生物合成途径,首先构建了谷氨酸棒杆菌生物合成REA-11的假设途径,然后从(1)中间代谢产物的添加及相关途径关键酶活性的检测和(2)胞内中间代谢产物的检测两个方面来验证该代谢途径的合理性.研究表明,在培养基中添加代谢途径的中间产物UDP-葡萄糖,可显著提高REA-11的絮凝活性,并且UDP-半乳糖差向酶和UDP-半乳糖脱氢酶的比酶活也分别提高了200%和50%;以不同底物为碳源,UDP-葡萄糖焦磷酸化酶、UDP-半乳糖差向酶和UDP-半乳糖脱氢酶的比酶活与REA-11产量的相关系数可分别达到0.75,0.89,0.97. 此外,利用HPLC检测出REA-11合成途径中3种关键中间产物UDP-葡萄糖、UDP-半乳糖和UDP-葡萄糖醛酸.由此证明,所构建的REA-11生物合成途径基本合理.     

尿酸代谢途径的研究进展

目的尿酸是嘌呤代谢的产物,导致尿酸升高的原因主要是尿酸生成过多和尿酸排泄减少。尿酸主要代谢途径在肾脏,其次在肠道,尿酸的排泄主要依赖于尿酸转运蛋白。目前大量文献报道的尿酸代谢途径在肾脏,肠道方面报道较少。因此,本文将尿酸代谢途径的国内外最新研究从肾脏和肠道两个方面进行综述,为降尿酸治疗提供新思路。     

代谢调节理论指导下的核黄素发酵条件

发表了从葡萄糖到核黄素的整条生物合成途径。根据这条代谢途径和Ｔ３０突变株的发酵条件试验结果，对阿舒假囊酵母合成核黄素的过程中碳基质流量在ＥＭＰ和ＨＭＰ途径中的分配，油和骨胶在核黄素合成中的不同作用，以及丙酮酸的氧化能力等与核黄素过量合成的关系进行了初步的讨论。     

葡萄糖代谢对卵母细胞成熟和植入前胚胎发育的影响

葡萄糖主要通过糖酵解途径、磷酸戊糖途径、己糖胺生物合成途径和多元醇途径进行代谢,在卵母细胞发育成熟及植入前胚胎发育过程中起重要作用。葡萄糖代谢异常,可导致卵母细胞成熟障碍和胚胎发育异常。本文对上述四条葡萄糖代谢途径在卵母细胞和植入前胚胎发育过程中的作用进行综述。进一步研究卵母细胞成熟和植入前胚胎发育过程中葡萄糖代谢途径的调控机制,有利于改善卵母细胞体外成熟和胚胎的培养条件,提高体外培养的卵母细胞和胚胎的发育能力。     

L-色氨酸产生菌TQ2223的途径分析

应用途径分析方法分析了在稳态时谷氨酸棒杆菌TQ2223菌株由葡萄糖发酵生产L 色氨酸的途径,确定了L 色氨酸合成的最佳途径及其代谢流分布和最大理论产率.通过刺激所选途径的酶活来提高L 色氨酸产率,结果表明,经NH4+调节后,代谢途径流量发生显著变化,可以使色氨酸的代谢流从6提高到8.8.     

胆道梗阻对大鼠肝脏葡萄糖和酮体代谢的影响

目的观察明道梗阻对大鼠肝脏葡萄糖和酶体代谢的影响。方法大鼠胆道结扎后48小时，胶原酶灌流后分离肝细胞，用分光光度计按标准酶学方法检测葡萄糖、乙酸乙酸和三羟基丁酸。结果胆道结扎48小时后，肝细胞总数低于对照组1／3。在基础或最大刺激条件下，结扎组和假手术组的葡萄糖、酮体异生差异无显著性（P＞0．05）。结论明道结扎48小时后，对大鼠肝细胞的糖异生和酮体生成无损害。     

肝脏对损伤和脓毒症的代谢反应

实验报告提示脓毒症时肝脏氧化和合成代谢受到抑制,但有关感染引起肝功能不良的机制尚不清楚,有的还存在着争论。鉴于脓毒症病人具有最高的葡萄糖排出,提示加速葡萄糖生成是肝脏需氧的主要决定因子,这里氧化代谢不一定受损,因此比较了18名正常志愿者、10例损伤病人和18例脓毒症病人的内脏代谢、血流动力学和内分泌反应。志愿者均无急性疾患或肝、肾、内分泌病变,入院后静脉注射5％葡萄糖和0.45％生理盐水共18小时,该时间内不给口服饮食以模拟住院情况,随后仅生理     

肠促胰素与骨代谢

机体内不断进行着骨代谢转换。凡是能增加骨吸收、减少骨生成的因素均能使骨密度(BMD)下降,进而发生骨质疏松症(OP)。最新研究发现,人体胃肠道内分泌的肠促胰素,不仅能促进胰岛素释放、调节血糖代谢,对骨代谢转换过程也具有良好的调节作用。这类肠促胰素包括葡萄糖依赖性胰岛素释放肽(GIP)、胰高血糖素样肽-1(GLP-1)和胰高血糖素样肽-2(GLP-2)。它们对骨代谢的作用主要通过相应的受体来完成,达到调节钙平衡、影响破骨细胞和成骨细胞的增生与凋亡、影响其他骨代谢生化指标等目的。其中,GIP、GLP-1均有减少骨吸收和增加骨生成的双相调节作用,而GLP-2仅能抑制骨的吸收,而不影响骨的生成。肠促胰素的这些特性,将为骨质疏松现有的治疗模式发展出新的方向。     

Liposuction sepsis �C be alert

Postoperative infection in liposuction patients may be exceedingly difficult to clinically appreciate because of the skin edema, colour changes and even blistering that can occur. The authors outline such a case with practical advice about establishing an accurate and precise diagnosis of an early septic process.     

Quality in paediatric anaesthesia: a pilot study of interdepartmental peer review

A pilot to assess a process of interdepartmental peer review of paediatric anaesthetic departments in the United Kingdom was undertaken. Departments were assessed in relation to the standards which should characterise anaesthetic departments throughout the country. Examples of good practice and areas for further development were identified. Peer review visits were conducted by teams which included medical and non-medical members. The importance of the inclusion of lay people in such visits is being increasingly recognised. All of those who participated in the process felt their time had been usefully spent, and they were enthusiastic for the process to continue.     

The effect of lumbar epidural analgesia on the neurobehavioural responses of newborn infants

The effects of maternal lumbar epidural analgesia (Th10-L5) on the neonatal neurobehavioural response were studied at the ages of 3 h, 1 day, 2 days and 4-5 days. The subjects were healthy, full-term neonates, born vaginally to 15 mothers with lumbar epidural block and 19 mothers without analgesia. Those delivered with epidural analgesia scored significantly better on alertness at the age of 3 h, 2 days and 4-5 days than the control group. No other statistically significant differences were found between the groups. The formation of the two groups according to the mothers' desire for epidural analgesia may have contributed to differences in the process of labour, but with this reservation it may be suggested that lumbar epidural analgesia may enhance the infant's recovery from the stress of labour and vaginal delivery.     

The influence of 10 mg and 20 mg of bambuterol on the duration of succinylcholine-induced neuromuscular blockade

Bambuterol is an inactive prodrug which is enzymatically cleaved by plasma cholinesterase to yield the active compound, terbutaline. This catalytic process is accompanied by a selective inhibition of plasma-cholinesterase, the enzyme also necessary for the break-down of succinylcholine. We therefore studied the possible effect of bambuterol on succinylcholine-induced neuromuscular blockade in a double-blind fashion in patients undergoing surgery under general anaesthesia. Of the 39 patients studied, 13 patients had 10 mg of bambuterol, 12 had 20 mg and 14 were given placebo 10-16 h prior to anaesthesia. Succinylcholine 1 mg.kg-1 bw was administered after induction of anaesthesia. Following supramaximal train-of-four stimulation of the ulnar nerve, the tension developed in the adductor pollicis muscle was measured. Onset time and the durations of action (times to 10%, 25%, 75% and 90% recovery of the first twitch of the train-of four response) were recorded. The mean recovery times were prolonged 30-50% in patients who had received 10 or 20 mg of bambuterol as compared with placebo. It is concluded that a prolonged duration of action of succinylcholine can be expected in patients being treated with bambuterol.     

The use of inpatient goal planning in a regional burns centre: A thematic analysis of staff and patient experiences

BackgroundRehabilitation from a burn or related injury can be a lengthy and painful process.ObjectivesThe present study explored the experiences of staff and patients of inpatient goal planning used on a rehabilitation ward within a regional burns centre.DesignA qualitative study using semi-structured interviews.SettingPatients and staff were recruited from The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, South Wales, UK.ParticipantsTwelve participants were recruited and interviewed in two phases. Phase one included six staff members who had been involved in delivering goal planning sessions and phase two included six former inpatients who had participated in goal planning during their rehabilitation in hospital.ResultsThree main themes were identified for staff: benefits for patients and families, process and structure and challenges of the process. For patients, the three main themes identified were: role of goal planning in rehabilitation, tailoring the programme around the patient and encountering challenges.ConclusionsFindings from the narratives of staff and patients suggest the use of goal planning in inpatient recovery and rehabilitation in a burns centre is very beneficial. Although challenges were reported, this investigation yields potential for goal planning to be a successful rehabilitation strategy.     

Specific requirements for preoperative and postoperative photos used in publication

In this paper, eight variables in clinical photography are discussed. It is important that the photographs taken before and after a procedure be as similar as possible in order to accurately reflect the results. The variables that can have a big impact on photographs are: the room in which the photographs are taken, the camera used, the type of film used, the distance of the photographer from the patient, the photographer him or herself, the light source and location, the film development process, and when the postoperative photographs are taken.     

The development and application of a remediation process in an osteopathic curriculum

BackgroundRemedial education is crucial to help struggling students meet the complex requirements of a health sciences curriculum. For this reason, a remediation process was developed by the Centre Ostéopathique du Québec (COQ) for students enrolled in its osteopathic training program. This remedial process focuses on four axes that represent the foundations of effective clinical practice.AimsA study was conducted to describe the motives, interventions and outcomes of COQ's remediation process. Four aspects were assessed: 1) information about students who have benefited from the remediation process; 2) main reasons leading to remedial education and types of intervention used; 3) students' academic outcomes after experiencing the remediation process; and 4) students' perceived effects and satisfaction levels of the remedial program.MethodData was gathered by self-administered survey and students’ educational files were reviewed.ResultsRemedial education was mainly initiated in response to students' request or following students' poor outcomes to theoretical, and/or practical, and/or clinical reasoning exams. Different types of intervention were used such as solving clinical cases, knowledge organization activities, supervised clinics, palpation workshops, and broadening learning strategies. This program yielded positive outcomes both in terms of students’ academics results and learning processes.ConclusionDespite globally positive results, best-practice pedagogy needs to be further defined.     

Fentanyl supplementation of sevoflurane induction of anaesthesia

Sevoflurane induction of anasthesia has been examined extensively, but little is known about the usefulness of other drugs as adjuncts to hasten and smooth the process. Sixty patients, undergoing surgery of a type suitable for a spontaneous respiration, laryngeal mask airway anasthetic technique, were randomly allocated to receive 1.0 microgram.kg-1 intravenous fentanyl or the equivalent volume of normal saline, 30 s prior to triple-breath induction with sevoflurane. The study was double-blind. There were no differences between the groups for the times to loss of eyelash reflex, jaw relaxation, insertion of the laryngeal mask airway or regular settled breathing. However, there was a difference in the incidence of adverse airway events (breath-holding, coughing and laryngospasm) between the two groups (16.5% in the fentanyl group and 40% in the placebo group); this did not reach statistical significance. Both groups were haemodynamically stable throughout induction, although the fentanyl group had a statistically significant decrease in systolic blood pressure at 4 min compared with the placebo group, which was not considered clinically relevant. We conclude that fentanyl has no significant influence over the speed and quality of sevoflurane induction.     

Evolution of left-sided thoracoscopic approach for long gap esophageal atresia repair

BackgroundLeft-sided repair for long gap esophageal atresia (LGEA) has been described for patients with a large leftward upper pouch, no thoracic tracheoesophageal fistula (TEF) nor tracheobronchomalacia (TBM), or as salvage plan after prior failed right-sided repair. We describe our experience with left-sided MIS traction induced growth process.MethodsWe retrospectively reviewed patients who underwent Foker process for LGEA at two institutions between December 2016 and November 2021. Patient characteristics, surgical techniques, and outcomes were reviewed.Results71 patients underwent Foker process. Of 34 MIS cases, 28 patients (82%) underwent left-sided repair (median gap length 5 cm) at median age 4 months with median 3 (range 2–8) operations and median 13.5 (IQR 11–21) days on traction until esophageal anastomosis. 9 patients (32%) underwent completely MIS approach, whereas 5 patients (18%) converted to open at first operation and 14 patients (50%) converted to open later in the traction process. Traction was internal in 68%, external in 11%, and combination in 21%. Median follow-up was 15.4 (IQR 7.5–31.7) months after anastomosis. 14% had anastomotic leak managed with antibiotics and/or esophageal vacuum therapy. Median number of esophageal dilations was 3.5 (range 0–13). 18% required stricture resection. 39% underwent Nissen fundoplication. None have needed esophageal replacement.ConclusionsFor multiple reasons including the tendency of both esophageal pouches to have a leftward bias, less tracheal compression by upper pouch, and clean field of surgery for reoperative cases, we now more commonly use left-sided approach for MIS LGEA repair compared to right side, regardless of left aortic arch.Level of evidenceLevel IV Treatment Study.     

Validation of the electronic version of the BREAST-Q in the army of women study

Women undergoing surgery for primary breast cancer can choose between breast conserving therapy and mastectomy (with or without breast reconstruction). Patients often turn to outcomes data to help guide the decision-making process. The BREAST-Q is a validated breast surgery–specific patient-reported outcome measure that evaluates satisfaction, quality of life, and patient experience. It was originally developed for paper-and-pencil administration. However, the BREAST-Q has increasingly been administered electronically. Therefore, the aim of this study was to evaluate the psychometric properties of an electronic version of the BREAST-Q in a large online survey. Women with a history of breast cancer surgery recruited from the Love/AVON Army of Women program completed an electronic version of the BREAST-Q in addition to the Impact of Cancer Survey and PTSD Checklist. Traditional psychometric analyses were performed on the collected data. BREAST-Q data were collected from 6748 women (3497 Breast Conserving Therapy module, 1295 Mastectomy module, 1956 Breast Reconstruction module). Acceptability was supported by a high response rate (82%), low frequency of missing data (<5%), and maximum endorsement frequencies (<80%) in all but 17 items. Scale reliability was supported by high Cronbach's α coefficients (≥0.78) and item-total correlations (range of means, 0.65–0.91). Validity was supported by interscale correlations, convergent and divergent hypotheses as well as clinical hypotheses. The electronically administered BREAST-Q yields highly reliable, clinically meaningful data for use in clinical outcomes research. The BREAST-Q can be used in the clinical setting, whether administered electronically or using paper-and-pencil, at the choice of the patient and surgeon.