大鼠左右大脑中动脉缺血再灌注模型比较

目的探讨大鼠左右大脑中动脉缺血再灌注模型的差异。方法选择右利雄性Wistar大鼠48只,按照随机数字表分为左侧大脑中动脉缺血再灌注组(左侧优势组)、右侧大脑中动脉缺血再灌注组(右侧非优势组),每组24只,每组使用各自侧别的假手术对照。血管内线栓法阻塞大脑中动脉2h,然后再灌注。测试神经功能,取脑分别进行常规TTC染色和HE染色,测量脑梗死体积,光镜下观察脑组织病理变化。结果左侧优势组再灌注24、48和72h神经功能缺损评分明显低于右侧非优势组(P<0.05)。左侧优势组缺血程度较右侧非优势组重。左侧优势组神经元数量严重缺失,海马细胞排列紊乱,脑梗死体积明显大于右侧非优势组[(102.1±8.8)mm3 vs(97.0±11.2)mm3,P<0.05]。结论大鼠优势半球大脑中动脉阻塞后,神经功能缺损程度较非优势侧严重,脑梗死体积更大。大鼠优势半球局灶性脑缺血模型重复性好,而且可靠。     

托吡酯对脑缺血再灌注后脑保护作用的研究

目的 探讨托吡酯对大鼠高血压急性脑缺血再灌注后的脑保护作用。 方法 将25只大鼠制成高血压模型,喂养2个月。随机分为3组:即托吡酯治疗组(9只)、缺血再灌注组(9只)和假手术组(7只)。将大鼠用线栓法制成大脑中动脉闭塞模型,缺血时间为2 h,将线栓拔除即形成缺血-再灌注模型。假手术组末置入线栓。再灌注后6 h,将大鼠快速断头取脑,经TTC染色,用计算机病理图像分析仪测量鼠脑梗死体积及鼠脑总体积,并将两者的比值作为脑梗死体积比。结果 托吡酯治疗组的脑梗死体积比为0.1087±0.0426,明显小于缺血-再灌注组脑梗死体积比0.286 3±0.064 7(P<0.05)。假手术组未见梗死灶。结论 托吡酯使大鼠高血压脑缺血-再灌注后的脑梗死体积减小,对脑缺血-再灌注损伤的脑组织有保护作用。     

大鼠局灶性脑缺血模型制备方法的比较

目的比较线栓法、电凝大脑中动脉同时结扎单侧颈总动脉（简称电凝单侧结扎）和电凝大脑中动脉同时结扎双侧颈总动脉（简称电凝双侧结扎）3种方法制作局灶性大鼠脑缺血模型的优劣。方法按照动物模型制备方法的不同,将20只大鼠随机分为线栓组（6只）、电凝单侧结扎组（7只）和电凝双侧结扎组（7只）。采用三种方法制备大鼠局灶性脑缺血模型,用激光多普勒血流仪测得梗死前后的脑血流量的相对值,24h后对模型进行神经功能缺损评分,行2,3,5-氯化三苯基四氮唑染色,计算脑梗死体积。结果①线栓组（9．6±0．6）和电凝双侧结扎组（9．8±0．6）大鼠的神经功能缺损评分高于电凝单侧结扎组（5．7±0．7）,差异有统计学意义,P〈0．01;②线栓组（132±16）mm3和电凝双侧结扎组（142±20）mm3大鼠的梗死体积高于电凝单侧结扎组（40±11）mm3,差异有统计学意义,P〈0．01;③电凝双侧结扎组的脑血流量相对值低于电凝单侧结扎组,差异有统计学意义,P〈0．05;再灌注后,线栓组的脑血流量相对值高于电凝双侧结扎组,差异有统计学意义,P〈0．05。结论三种方法建立大鼠局灶性脑缺血模型,各有优缺点,应根据研究目的采用不同的模型。     

阻断缝隙连接通讯对局灶性脑缺血后海马迟发性神经元死亡及脑梗死体积的影响

目的:探讨阻断缝隙连接通讯对大鼠局灶性脑缺血后海马迟发性神经元死亡及脑梗死体积的影响.方法:大鼠左侧脑室注射缝隙连接阻断剂甘珀酸,对照组左侧脑室注射生理盐水,2h后颈内动脉插线法制备大脑中动脉缺血再灌注模型,采用DNA原位末端标记TUNEL技术及红四氮唑(TTC)染色,观察阻断缝隙连接通讯对大鼠局灶性脑缺血3d后海马迟发性神经元死亡及脑梗死体积的影响.结果:不给予缝隙连接阻断剂,大脑中动脉缺血模型大鼠有45%在术后3 d出现海马迟发性神经元死亡;用甘珀酸阻断缝隙连接后30%的大鼠出现海马迟发性神经元死亡,几率明显减小(P＜0.01);与对照组相比,干预组的脑梗死体积明显减少(P＜0.01).结论:阻断缝隙连接通讯,局灶性脑缺血后海马迟发性神经元死亡的发生率降低,脑梗死体积减小.     

脑心通对实验性脑缺血大鼠梗死体积和神经巢蛋白的影响

目的观察缺血再灌注损伤(IRI)后大鼠不同时间点梗死体积、5-溴脱氧尿嘧啶核苷(BrdU)标记的阳性细胞和神经巢蛋白(Nestin)的表达,探讨脑心通对其影响。方法制作大鼠大脑中动脉缺血(MCAO)模型,2,3,5-氯化三苯基四氮唑(TTC)染色测定大鼠脑缺血再灌注(IR)后梗死体积;免疫组化法测定第3、7、14天和21天缺血侧BrdU标记的阳性细胞和Nestin的平均荧光强度值。结果 TTC染色发现IR后第7天大鼠脑梗死体积最大,不同剂量的脑心通实验组与模型组间差异显著(P<0.01);IR第3天,模型组、不同剂量脑心通组海马齿状回颗粒下层(SGZ)及室管膜下区(SVZ)已出现BrdU阳性细胞和Nestin表达,第7天时其平均荧光强度值最高,各组内不同时间点BrdU阳性细胞和Nestin平均荧光强度值差异显著(P<0.01);而组间比较无差异(P>0.05)。结论脑心通胶囊对减轻IR损伤后实验鼠梗死体积有一定的促进作用;但未发现脑心通胶囊对SVZ、SGZ区域BrdU阳性细胞和Nestin表达有促进作用。     

多发性脑梗死性痴呆模型的形态学研究

目的建立一种有机微血栓所导致的多发性脑梗死性痴呆动物模型，评价其可靠性和实用性。方法将Wistar成年大鼠随机分为正常对照组（不给予任何处置）、模型组（于左侧颈外动脉逆行插管至左侧颈总动脉分叉处，注入有机微血栓0．5ml，造成多发性脑梗死动物模型）、假手术组（于左侧颈外动脉逆行插管至左侧颈总动脉分叉处，向颈内动脉内注入生理盐水0．5m1）。应用光镜观察多发性脑梗死性痴呆大鼠海马的形态学改变。结果造模后脑内存在广泛而多发的梗死灶，以海马区梗死发生率为最高。结论建立的模型与临床上多发性脑梗死性痴呆病人相似，是进行多发性脑梗死性痴呆基础研究和临床研究的理想动物模型。     

性别因素对局灶脑缺血再灌注损伤大鼠脑梗死体积及脑血流的影响

目的探讨性别因素对局灶脑缺血再灌注损伤大鼠脑梗死体积及脑血流的影响。方法健康SD大鼠24只,随机分为雌性组和雄性组各12只。采用线栓法制作大脑中动脉单侧栓塞模型,再灌注24 h断头取脑行TTC染色并测量各组脑梗死体积。手术过程采用激光多普勒血流仪检测两组梗死前、栓塞后即时、再灌注24 h大脑中动脉供血区脑血流值。结果再灌注24 h时,雌性组与雄性组脑梗死体积分别为(28.4±3.3)%、(42.0±2.9)%,P<0.05。梗死前雌性组与雄性组脑血流基础值分别为(153±19)、(211±23)pu,P<0.05;栓塞后即时雌性组与雄性组脑血流值分别为(47±2)、(77±20)pu,P<0.05,与梗死前比较,雌性组与雄性组血流值分别减少(67±3)%、(62±11)%,P>0.05;再灌注24 h雌性组与雄性组脑血流值分别为(158±4)、(103±10)pu,P<0.05,分别恢复为基础值的(103±10)%、(90±13)%,P>0.05。结论雌性脑缺血再灌注损伤大鼠脑梗死体积较小,其机制可能与雌性大鼠基础脑血流值较低有关。     

二氯化钴预处理对大鼠脑梗死体积及SDF-1α/CXCR4表达水平的影响

目的观察二氯化钴预处理对大鼠脑梗死体积百分比、基质细胞衍生因子1α(SDF-1α)/趋化因子受体4(CXCR4)表达的影响;探讨缺氧缺血环境中SDF-1α/CXCR4生物轴对脑的保护作用。方法将168只成年雄性SD大鼠随机分为缺氧预处理组(n=84)、模型组(n=84)。按缺血后再灌注时间不同分为再灌注6 h、24 h、3天、5天、7天、14天6个亚组。采用改良Longa方法制备局灶性脑缺血模型。观察缺氧缺血后脑组织病理学改变,通过氯化三苯基四氮唑(TTC)染色法观察脑缺血后再灌注两组大鼠脑梗死体积百分比的变化;免疫组织化学法检测大鼠脑组织皮层区各个时间点SDF-1α及CXCR4的表达变化。结果 TTC染色显示,缺氧预处理组及模型组大鼠6 h时即可见明显梗死灶,24 h脑梗死体积趋于稳定。两组大鼠24 h、3天、5天、7天、14天5个时间点脑梗死体积百分比比较,差异无统计学意义(P0.05);缺氧预处理组各时间点脑梗死体积百分比均明显小于模型组(P0.05)。免疫组织化学法结果显示,两组于脑缺血再灌注6 h皮层区SDF-1α、CXCR4表达明显增加,7天表达至高峰,随后表达逐渐减少,14天仍有表达。缺氧预处理组各时间点皮层区SDF-1α、CXCR4的阳性细胞数均显著多于模型组(P0.05)。结论二氯化钴预处理能缩小脑梗死体积,其可能通过上调SDF-1α、CXCR4的表达水平,诱导脑缺氧耐受,促进间充质干细胞向缺血组织迁移,发挥脑保护作用。     

老龄大鼠线栓和自体血栓性大脑中动脉闭塞模型的比较研究

目的　探索一种适合于老龄大鼠脑梗死研究的大脑中动脉闭塞 (MCAO)模型。方法　用神经功能缺损评分、墨汁或 TTC染色、病理学观察以及脑组织含水量测定等方法比较研究老龄大鼠线栓与改良自体血栓 MCAO模型的稳定性。结果　血栓组与线栓组成功率分别为 95.83%和 1 5% ,前者神经功能缺损较后者重 (评分为 8.59± 3.52与 1 4 .0 6± 4.0 4 ,P=0 .0 0 1 ) ,前者梗死体积亦高于后者 (2 60 .67± 1 4 .65mm3与 1 51 .0 0±98.1 4 mm3 ,P<0 .0 5) ;脑组织含水量血栓组明显高于线栓组 (P=0 .0 0 1 )。后者蛛网膜下腔出血的发生率为 2 %。结论　自体血栓性 MCAO模型成功率高、梗死范围恒定、可重复性好 ,较线栓更适合于老龄大鼠局灶性脑缺血的研究。     

大鼠脑局灶性低灌注模型的建立

目的探讨应用激光多普勒血流仪监测和改良栓线法建立大鼠可逆性局灶性脑低灌注模型的方法。方法将48只SD雄性大鼠,随机分为假手术组、脑梗死组、低灌注组和低灌注再灌注组,每组12只。在激光多普勒血流仪的监测下,采用直径0.195mm的尼龙线制造大鼠局灶性脑梗死模型,采用直径0.175mm的尼龙线制造局灶性低灌注模型。造模后予以神经功能评分及病理学检查。结果脑梗死组大鼠的神经行为评分高于其他组(P<0.01),TTC染色均有梗死灶,HE染色及透射电子显微镜检查结果表明,神经细胞、星形胶质细胞和微血管损伤严重;低灌注组和低灌注再灌注组TTC染色均未见明显的梗死区,HE染色及透射电子显微镜检查可发现神经细胞、星形胶质细胞出现可逆性损伤,两组改变差异无显著性。结论在激光多普勒监测脑血流量的情况下,采用不同直径的栓线,可以建立较好的可逆性局灶性脑低灌注及再灌注脑梗死模型。     

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.     

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。     

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。     

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。     

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.     

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。     

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.