肠黏膜屏障功能检测的研究现状

肠黏膜屏障是指肠道能防止肠腔内有害物质如毒素或细菌穿过肠黏膜进入体内其他组织器官和血液循环的结构和功能总和。近年来随着基础医学研究的深入，人们逐渐认识到肠黏膜不仅仅有消化和吸收功能，而且具有重要的防御性屏障功能，发现肠道屏障功能障碍、肠内细菌及内毒素移位是导致SIRS、MODS，甚至MSOF的一个重要因素。肠道屏障功能已成为判断危重病人预后的一个重要指标，[第一段]     

细胞焦亡在肠黏膜屏障损伤机制中的作用

肠上皮细胞、免疫系统及微生物的相互联系维持肠黏膜屏障完整性和自我更新。肠黏膜屏障损伤易导致难以预测的严重疾病发生。细胞焦亡是一种由活化的半胱天冬酶切割Gasdermin家族蛋白介导的炎症细胞死亡形式,在急慢性疾病控制中发挥重要作用。病理生理状态下,细胞焦亡参与肠黏膜屏障损伤及异常免疫调节,最终导致多种肠道疾病发生。本文综述细胞焦亡在肠道感染、肠缺血再灌注、坏死性小肠结肠炎及炎症性肠病中的最新调控机制,针对此类肠道疾病提供新的有效治疗策略。     

MicroRNAs在肠屏障功能障碍的调控作用及其机制的研究进展

肠屏障主要由机械屏障、化学屏障、免疫屏障和生物屏障构成.肠黏膜缺血及再灌注损伤、肠黏膜应激性损伤、蛋白质缺乏、肠道菌群失调等因素均可引起肠屏障功能障碍,从而可引起全身炎症反应综合征和细菌易位,以及多脏器功能衰竭等严重后果.因此,关于肠屏障功能障碍及其调控的研究及防治具有重要意义.MicroRNAs(miRNAs)是近年来的研究热点,但其在肠屏障相关方面研究甚少.最近研究表明[1],miRNAs在肠上皮细胞(intestinal epithelial cell,IEC)的分化、结构和屏障功能中发挥重要作用,对肠道机械屏障、免疫屏障、化学屏障等均具有重要的影响.     

肠道微生态与肠黏膜屏障研究进展

人类肠道内含有大量微生物群,这一复杂而重要的生态系统构成影响人体的生理功能。肠道黏膜是机体的重要屏障,正常的肠道微生态和肠黏膜屏障相互作用,共同维持机体的内稳态。一旦肠道微生态被破坏,肠道菌群失衡,并通过各种途径导致肠黏膜屏障受损,进而有害病原菌入侵。     

肠道杯状细胞在肠道免疫调控中作用的研究进展

杯状细胞(GC)是人和哺乳动物的一种单细胞腺,分布于人体呼吸道、消化道、生殖道等部位的上皮中。肠道内的黏蛋白2(MUC2)主要由GC分泌,黏蛋白和水、无机盐等在肠道黏膜上皮表面形成黏液屏障,在抵御外源细菌和肠道固有微生物侵袭、维持肠黏膜动态平衡、调控微生物-宿主免疫应答中起重要作用。更重要的是GC及其分泌黏蛋白的缺陷与肠道多种疾病密切相关。我们总结了GC的结构和功能及其在肠道免疫调控中的研究进展。     

慢性脑低灌注对大鼠回肠黏膜Occludin及Claudin-2表达的影响

文题释义：慢性脑低灌注模型：通过永久结扎双侧颈总动脉构建的全脑慢性缺血模型，模拟慢性脑缺血损伤患者的病理生理状态，主要用于阐明神经变性疾病以及认知功能障碍的病理生理机制。 肠黏膜屏障：是一个复杂的半透屏障，吸收营养物质，感测免疫，同时限制有害抗原和微生物的运输，这种看似相互冲突的任务调节是通过结构成分和肠黏膜细胞之间的相互作用实现的，它们以动态方式运作以维持肠道完整性和免疫稳态。肠黏膜屏障主要由机械屏障、化学屏障、免疫屏障与生物屏障共同构成，机械屏障由肠道上皮细胞和它们之间的紧密连接构成，是维持肠黏膜屏障功能的主要因素，闭合蛋白occludin 及claudin是其中的重要组成部分，对维持上皮细胞极性及调节肠屏障的通透性发挥着重要的作用，维持肠上皮结构和功能的健全对于保护肠道屏障功能、防止细菌内毒素及毒性物质进入体内具有重要意义。背景：前期研究发现，慢性脑低灌注可致大鼠肠道黏膜屏障发生改变，而闭合蛋白occludin 及claudin是构成肠道黏膜屏障的重要组成部分。 目的：探讨慢性脑低灌注对大鼠回肠黏膜屏障的影响。 方法：20只健康雄性Sprague-Dawley大鼠随机分为假手术和慢性脑低灌注组。慢性脑低灌注组通过永久结扎双侧颈总动脉建立大鼠慢性脑低灌注模型；假手术组双侧颈总动脉只分离而不结扎和剪断。术后4周通过苏木精-伊红染色观察大鼠回肠组织形态学变化并评分，TUNEL荧光染色检测回肠细胞凋亡情况，Western blot检测回肠紧密连接蛋白Claudin-2，Occludin的表达水平，免疫组织化学检测Occludin表达变化。实验方案经西部战区总医院动物实验伦理委员会批准。结果与结论：①苏木精-伊红染色形态学观察显示，与假手术组相比，慢性脑低灌注组大鼠回肠组织形态结构出现损伤不明显，病理评分无显著升高(P > 0.05)；②Western blot结果显示，与假手术组相比，慢性脑低灌注组大鼠回肠组织claudin-2表达升高，而Occludin表达降低(P < 0.05)；③TUNEL荧光染色显示，与假手术组相比，慢性脑低灌注组的细胞凋亡比例显著升高(P < 0.05)；④免疫组织化学结果显示，慢性脑低灌注组大鼠回肠组织Occludin表达降低(P < 0.05)；⑤结果说明，慢性脑低灌注会导致回肠黏膜屏障紧密连接蛋白Occludin表达降低及Claudin-2升高，可能存在一定肠道黏膜屏障功能损伤。 ORCID: 0000-0003-1961-1808(李思宇) 中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程     

失血性休克大鼠早期肠黏膜缺血/再灌注损伤的形态学研究

目的:观察动物缺血/再灌注损伤(I/R)早期肠黏膜屏障的形态学变化.方法:在建立大鼠失血性休克模型的基础上,通过放血和输入生理盐水的方法,输注所放出血液2倍以上的生理盐水供动物休克后复苏,复苏后0h、1h、3h、6h、12h、24h观察其肠黏膜标本在显微镜下病理改变及肠黏膜上皮损伤指数等指标.结果:①I/R过程可造成肠黏膜屏障损伤,表现在复苏0h可见回肠绒毛水肿,片状坏死、脱落及黏膜萎缩,黏膜损伤以1h和3h明显,其损伤指数分别为2.8和2.6,损伤的黏膜6h后开始重建,24h重建基本完成;②结肠黏膜上皮水肿、脱落,伴有中性粒细胞浸润及杯状细胞脱颗粒,但其损伤指数明显小于回肠.结论:失血性休克早期的肠I/R后可造成肠黏膜屏障损害,但肠黏膜具有强大的重建潜能;早期的重建只是肠黏膜上皮细胞间连续性建立,其黏膜仍进行性萎缩;结肠较回肠更耐受I/R打击.     

分析患儿肠道内微生物的变化与轻度胃肠炎伴良性婴幼儿惊厥之间的关系

目的 分析轻度胃肠炎伴良性婴幼儿惊厥(BICE)和患儿肠道内微生物的变化间的相关性.方法 回顾分析2017年1月至2018年12月在我院诊治的BICE患儿40例,作为研究组,将2019年1月至12月我院诊治的40例单纯轻度胃肠炎患儿作为对照组,两组均行粪便轮状病毒抗原检测、相关病菌检测及肠黏膜屏障功能检测,记录试验数据,并进行比对分析.结果 研究组及对照组轮状病毒感染率分别为47.5％、15.0％;粪便内大肠杆菌、肠球菌、乳酸杆菌、双歧杆菌数量及DAO、D-乳酸、NO水平,研究组均高于对照组(P＜0.05)差异有统计学意义.结论 肠道微生物改变可影响BICE发生及发展,轮状病毒及肠内益生菌减少可促使BICE病情发展,损坏肠黏膜屏障功能.     

组胺对肠道感染大鼠肠黏膜屏障保护作用的研究

肠道感染时,肠黏膜屏障可受到损伤,引起肠道细菌易位,组胺受体阻断剂可降低肠黏膜屏障的保护作用,增加肠道细菌易位及肠源性脓毒血症的发生率.本研究通过小剂量、低浓度组胺肠道内灌注,对肠道感染大鼠肠道细菌易位的影响和肠黏膜上皮细胞病理变化进行探讨,了解组胺对肠黏膜屏障的保护作用,为保护肠黏膜提供实验依据.     

肠道菌群和"肠-肺"轴在脓毒症中的作用

肠道菌群是寄生在人体肠道内数量庞杂的微生物群。"肠-肺"轴是连接肠道和肺部的双向轴。肠道菌群和"肠-肺"轴参与了脓毒症的发生与发展。脓毒症发生时,肠黏膜屏障受损,肠道菌群失调,细菌移位,肺为最先发生损伤的器官,肺部感染也会导致肠道功能紊乱。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

Hypo- und Hypermagnesämie aus kardiologischer Sicht

Zusammenfassung Eine Reihe pathologischer Zustände bedingen Magnesiummangel. Zustände mit Hypermagnesämie sind ebenfalls bekannt, doch wesentlich seltener. Für den Kardiologen beachtenswert ist, daß unter Therapie mit bestimmten Diuretica bei Herzinsuffizienz, bei Herzinfarkt, Kardiomyopathie, Digitalisintoxikation und bestimmten Herzrhythmusstörungen Hypomagnesämie beobachtet wurde. Leider kann in der klinischen Routine nur ein extracelluläres Magnesiumdefizit durch Serumbestimmungen gemessen werden; über Magnesiummangel einzelner Organe kann nichts ausgesagt werden. Hinweise für Magnesiummangel geben aber neben der Messung des Serumspiegels Anamnese, klinischer Befund, bestimmte EKG-Veränderungen wie auch evtl. Hypokalämie, ein Zustand, bei dem sich oft — besonders bei Aldosteronismus — parallele Veränderungen zeigten.Tierexperimente deuten darauf hin, daß infarktähnliche Läsionen unter Magnesiummangel entstehen, doch ob Herzinfarkt beim Menschen durch Magnesiummangel ausgelöst werden kann, ist noch ungeklärt. In Leichenherzen zeigte sich im Infarktgebiet neben Calciumakkumulation signifikanter Magnesiumverlust, wobei unklar blieb, ob sich Ursache oder Folge des Infarktes widerspiegelten. Falls ein ursächlicher Zusammenhang besteht, ist er im Myokardstoffwechsel selbst zu suchen, wie bei der Alkoholkardiomyopathie, wo myokardialer Magnesiummangel zumindest als pathogenetischer Teilfaktor anerkannt wird. Andererseits versucht man aber auch Beziehungen zwischen Atherosklerose, Blutgerinnung und Hypomagnesämie herzustellen, in der Meinung, daß Magnesiummangel auch über den coronaren Pathomechanismus des Herzinfarktes wirken könnte. Sicher scheint, daß gewisse EKG-Veränderungen und Herzrhythmusstörungen durch einen irritierten Magnesiumhaushalt bedingt sein können, da sie bei Gabe bzw. Entzug von Magnesium verschwinden. Daß Magnesiummangel die Glykosidtoleranz verringert, wird tierexperimentell bestätigt. Unter Hypomagnesämie bewirkt Acetylstrophanthidin eher und länger Rhythmusstörungen als ohne, außerdem lassen diese sich durch Magnesiumgaben eliminieren. Da in gewissen Fällen spontane und digitalisinduzierte Herzrythmusstörungen durch Magnesiuminjektionen beseitigt wurden, scheint Magnesium als Therapeuticum angebracht. Einsatz verschiedener Magnesiumsalze bei Angina pectoris, degenerativen Herzerkrankungen und Herzinsuffizienz ohne geprüften und offensichtlich gestörten Magnesiumhaushalt ist fragwürdig, weil keine eindeutigen klinischen Erfolgsbeweise vorliegen. Immerhin mag es aber larvierte, durch Serumbestimmungen nicht erfaßbare Mangelzustände geben. Allgemein erscheint es aus kardiologischer Sicht ratsam, den Magnesiumhaushalt zu überwachen und in entsprechenden Fällen auszugleichen, um möglichen Myokardläsionen oder fatalen Herzrhythmusstörungen entgegenzuwirken.     

Environmental risk factors and their role in the management of atopic dermatitis

Introduction: The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors.

Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on AD.

Expert commentary: The increased global prevalence of AD cannot be attributed to genetics alone, suggesting that evolving environmental exposures may trigger and/or flare disease in predisposed individuals. There is a complex interplay between different environmental factors, including individual use of personal care products and exposure to climate, pollution, food and other exogenous factors. Understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions. Moreover, patients require counseling on optimal regimens for minimization of exposure to irritants and pruritogens and other harmful exposures.     

Class II HLA in Georgia Caucasus Tbilisi Georgians and their Mediterranean ancestry: The Usko Mediterranean languages

Georgia (or Sakartvelo in its own language) is a South Caucasus Mts. country with its easternmost part is enigmatically named Iberia, like the Iberian Peninsula, which may refer to rivers “Kura” and “Ebro” or their valleys respectively. Most of their inhabitants speak Georgian which is included within Dene-Caucasian group and Usko-Mediterranean subgroup of languages. The latter includes Basque, Berber, ancient Iberian-Tartessian, Etruscan, Hittite, Minoan Lineal A and others. In the present paper, HLA class II -DRB1 and -DQB1 alleles has been studied and extended haplotypes calculated. Most frequent haplotypes are also of Mediterranean origin (i. e.: (A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*51)-DRB1*13:01-DQB1*06:03, or (A*24-B*35)-DRB1*01:01-DQB1*05:01) and DA genetic distances show that closest world populations to Georgians are Mediterraneans. Georgians also show common extended haplotypes ((A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*13)-DRB1*07:01-DQB1*02:01 and (A*03-B*35)-DRB1*11:01-DQB1*03:01) with Svan people, a secluded population in North Georgia mountains. We can conclude that Georgians belong to a very old Mediterranean substratum according to both linguistics (Usko Mediterranean languages) and HLA genetics.     

HLA genes in Amerindians from Mexico San Vicente Tancuayalab Teenek/Huastecos

Huastecos or Teenek Amerindians are presently living at North East Mexico (San Luis Potosi State). They have probably one of the most ancient culture of Mexico and Central America together with Mayas and Olmec groups with which also show close relationships. Proximity to Atlantic Ocean/Mexican Gulf originated that Spaniards had very early contact with them at about 1519 CE or before. In the present paper we have aimed to study HLA gene profile which may be useful for HLA and disease epidemiology and transplant programs in Teeneks. HLA-DRB1*04:07, -DRB1*14:06 and -DRB1*04:11 have been found in high frequency like in other Amerindian groups. High frequency typical Amerindians HLA extended haplotypes have been found, such as A*02-B*35-DRB1*04:07-DQB1*03:02; A*68-B*39-DRB1*04:07-DQB1*03:02 and A*02-B*39-DRB1*04:07-DQB1*03:02; also new haplotypes have been described, like A*02-B*52-DRB1*04:11-DQB1*03:02, A*68-B*35-DRB1*14:02-DQB1*03:01 and A*68-B*40-DRB1*16:02-DQB1*03:01. Genetic proximity is observed not only to linguistically close Mayans, but also to Mazatecans, Mixtecans and Zapotecans, who speak an altogether different languages; it shows once more that genes and languages do not correlate. This population was greatly diminished after European contact between 1500 and 1600 years CE; in fact, North and South America First Inhabitants population was brought from 80 down to 8 million people because of diseases (i.e.: measles, smallpox or influenza), slavery and war.     

État de l’art : nouveaux anticoagulants et transfusion

Direct oral anticoagulants (DOAC) are indicated for stroke prevention in atrial fibrillation and for the prevention and treatment of venous thromboembolism. As any anticoagulant, they are associated with a bleeding risk. Management of DOAC-induced bleeding is challenging. Idarucizumab, antidote for dabigatran, is currently available and is part of the therapeutic strategy, whereas antidotes for anti-Xa agents are under development. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain. We propose an update on DOAC-associated bleeding management, integrating the availability of idarucizumab and the critical place of DOAC concentration measurements.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.