脂肪固有免疫细胞与胰岛素抵抗

胰岛素抵抗是指外周组织对胰岛素敏感性及反应性降低,肥胖是胰岛素抵抗的主要原因.近年来研究显示,脂肪组织内的炎性反应状态与胰岛素抵抗及2型糖尿病等代谢疾病之间存在密切关系,而脂肪组织中的巨噬细胞、肥大细胞、中性粒细胞、树突状细胞、嗜酸性粒细胞以及自然杀伤T细胞等多种固有免疫细胞通过活化和释放炎性反应介质,参与炎性反应,从而促进机体胰岛素抵抗的形成.进一步深入阐明固有免疫细胞在脂肪组织炎性反应和胰岛素抵抗方面的作用,可以为糖尿病基础研究和治疗提供新的方向和思路.     

2型糖尿病的抗炎治疗

胰岛素抵抗与胰岛β细胞功能障碍是2型糖尿病发病的主要病理生理基础,而炎性反应因子介导的慢性非特异性低度炎性反应状态与胰岛素抵抗及β细胞功能障碍密切相关.传统意义上的降糖药物如二甲双胍、噻唑烷二酮类药物、胰岛素、胰高血糖素样肽-1以及他汀类降脂药都具有抗炎效应.新型的抗炎药物如白细胞介素1受体拮抗剂、白藜芦醇、姜黄素等可以通过多种途径改善炎性反应状态而降低血糖.因此,针对炎性反应因子的抗炎治疗有望成为一种崭新的糖尿病治疗u方法.     

Chemerin与动脉粥样硬化的关系

新发现的脂肪细胞因子chemerin不仅是传统意义上的趋化蛋白,还通过多种途径参与动脉粥样硬化的发展.其可能机制是参与胰岛素抵抗,糖、脂代谢异常及代谢综合征的发生,进而促进动脉粥样硬化的发展;直接影响血管内皮细胞的炎性反应状态,促进单核巨噬细胞黏附、迁移以及泡沫细胞的形成;促进新生血管形成,使斑块不稳定性增加,参与斑块破裂、血栓形成.深入研究chemerin与动脉粥样硬化的关系将为动脉粥样硬化的防治提供新靶点.     

糖尿病足溃疡局部炎性反应状态与伤口愈合的关系

糖尿病伤口局部的炎性反应状态表现为炎性反应起始晚、持续时间长、消退障碍,与巨噬细胞对凋亡中性粒细胞的吞噬减少和促炎消退脂类介质分泌减少有关.而炎性反应过程中中性粒细胞数量和功能的异常、不同表型巨噬细胞比例异常、促炎/抗炎因子失平衡、晚期糖基化终末产物(AGEs)/细胞外新发现的AGEs受体结合蛋白(EN-RAGEs)和AGEs受体相互作用干扰了参与伤口愈合的多种细胞和细胞外基质的功能,导致糖尿病伤口愈合障碍.     

Chemerin研究进展

Chemerin是一种免疫调节因子,在炎性反应相关的一系列蛋白酶作用下可对白细胞产生趋化作用,并参与炎性反应.同时chemerin也是一种调节脂肪细胞生成、代谢及葡萄糖稳态的脂肪因子,其参与了肥胖及代谢综合征的发生、发展.近年来研究发现chemerin对糖尿病及代谢综合征具有一定的诊断意义,且其有可能成为治疗相关疾病的新靶点.     

肿瘤坏死因子在感染性休克心脏损伤机制中的作用

感染性休克是各种感染性病原体引起的全身炎性反应综合征(SIRS)并发组织灌注不足及多器官功能障碍综合征(MODS)[1],主要特征是体内重要器官的低灌流状态,使机体细胞无法维持正常的营养代谢和功能,临床上表现为低血压、血管损伤、弥漫性血管内凝血(DIC),最终导致多脏器功能衰竭,     

炎性标记物与动脉硬化不稳定斑块的研究

动脉硬化发生、发展是复杂的,并受多种因素影响的慢性过程。脂质代谢异常、慢性炎性反应均参与其中。病人病情稳定与否不仅与动脉硬化管腔狭窄程度有关,更与斑块是否活跃密切相关。有学者在急性冠脉综合征（ACS）患者尸检中发现,冠状动脉斑块中存在泡沫细胞、巨噬细胞、淋巴细胞和肥大细胞,其中巨噬细胞和淋巴细胞是破裂斑块中细胞的主要成分。     

调节性T细胞亚群在肥胖发病中的作用

CD4+CD25+Foxp3+调节性T细胞(Treg细胞)与效应性T细胞数量和(或)功能状态的失衡触发炎性反应.在健康小鼠及人体内脏脂肪组织中Treg细胞丰富存在,而在肥胖小鼠及人体脂肪中Treg细胞的数量及功能状态存在异常.Treg细胞亚群的异常将直接造成脂肪组织的慢性低度炎性反应状态.由于慢性低度炎性反应状态在肥胖及肥胖相关的胰岛素抵抗的发生、发展中扮演重要角色,Treg细胞将成为其未来研究的一个新热点.     

炎性反应——肥胖和胰岛素抵抗的重要特征

肥胖和胰岛素抵抗呈现一种慢性炎性反应状态,表现为白细胞介素-6、白细胞介素-1β、巨噬细胞趋化因子等炎性反应因子水平升高.其原因在于能量代谢不平衡导致脂肪细胞肥大、增生、内质网应激和线粒体功能障碍,c-Jun氨基末端激酶(JNK)/激活蛋白(AP)-1和核因子(NF)-KB抑制蛋白激酶(IKK)β/NF-κKB两条信号通路活化,脂肪因子、游离脂肪酸和其他炎性反应介质表达增高,进而影响了全身各器官如肝脏、胰岛β细胞和骨骼肌.单核细胞和巨噬细胞是炎性反应因子另一个重要的来源.肥胖导致的JNK活化通过胰岛素受体底物-1的丝氨酸磷酸化影响胰岛素信号转导.饮食、运动、降低体重和药物可以改变炎性反应因子的水平.炎性反应理论为代谢性疾病的临床干预提供了重要的方向.     

肝X受体与代谢综合征

肝X受体（LXR）是与代谢综合征相关的核受体之一，对脂代谢的转录调控起重要作用。LXR是多种细胞内胆固醇含量的感受器，被激活后，诱导一系列与胆固醇吸收、转运和分泌相关的基因表达，并促进脂肪酸和甘油三酯的合成。LXR激动剂减少肝糖异生，降低血浆葡萄糖水平，增加胰岛素抵抗动物模型的胰岛素敏感性。LXR是胰岛素信号通路的组成部分，与能量平衡和肥胖相关，并参与调节炎性反应和氧化应激反应。作为代谢通路与炎性反应信号通路的结合点，LXR可能成为代谢性疾病治疗的新靶点。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.