早期短程大剂量生长激素对鼠短肠综合征肠道增生作用

目的观察早期短程使用大剂量生长激素(GH)对短肠综合征(SBS)鼠残存肠道增生反应的影响.方法20只SD雄鼠,切除85%小肠,制成SBS模型,分为大剂量GH治疗组(10只)和对照组(10只).GH治疗组术后1～5 d,予GH 5.70 mg@kg-1@d-1分2次皮下注射;对照组注射等量注射用水.结果两组摄食量、体重减少差异无显著性,两组回肠黏膜厚度、绒毛高度、隐窝深度和升结肠黏膜厚度差异无显著性(P＞0.05).结论早期短程大剂量GH治疗SBS并不能促进残存肠道黏膜代偿性增生.     

大黄素对急性放射性肠炎的疗效及抗自由基损伤的实验研究

目的 探讨大黄素对急性放射性肠炎的疗效及作用机制。方法 选用SD大鼠53只,随机分为正常组、模型组、白头翁汤组和大黄素组。采用6MV高能X射线建立急性放射性肠炎大鼠模型,连续灌胃给药7d,光学显微镜下观察及图像分析仪测定其相关的形态学指标,并测定小肠组织匀浆NO含量、SOD活性及MDA含量。结果 大黄素组大鼠肠组织绒毛高度、隐窝深度、黏膜及全层壁厚度均显著高于模型组(P＜0.05),与白头翁汤组比较无明显差异(P＞0.05);大黄素组肠组织匀浆NO含量及MDA含量与模型组比较均显著降低(P＜0.05),SOD活性则显著升高(P＜0.05);与白头翁汤组比较,NO含量显著降低(P＜0.05),SOD活性及MDA含量无明显差异(P＞0.05)。结论 大黄素可明显升高小肠组织绒毛高度、隐窝深度、黏膜及全层壁厚度,减少组织NO生成,减轻炎症反应及组织过氧化损伤。     

表皮生长因子对全胃肠外营养大部小肠切除大鼠肠适应的实验研究

目的：观察应用表皮生长因子(EGF)对全胃肠外营养(TPN)大部小肠切除大鼠残存小肠黏膜的代偿作用。方法：30只大鼠切除80％小肠后分为对照组、常规TPN组、TPN EGF组，观测体重、小肠黏膜形态学改变，流式细胞仪分析肠黏膜细胞增殖活性。结果：术后3组大鼠体重逐渐降低，1周后渐增加。3组间差异无显著性。TPN组小肠肠壁各层均变薄，黏膜萎缩。TPN EGF组肠黏膜厚度、绒毛高度、隐窝深度较TPN组均增加，S期细胞比率系数、增殖指数TPN EGF组较TPN组高，而TPN捐与对照绸差异无昂著件。结论：TPN联合EGF可晟著地增讲肠黏膜的适应性代偿。     

肠内及肠外营养对梗阻性黄疸大鼠肠屏障功能的影响

目的：比较肠内营养（EN）及肠外营养(PN)对阻塞性黄疸(OJ)大鼠肠黏膜屏障功能的影响。方法：结扎胆总管建立OJ大鼠模型。60只SD大鼠随机分为A组：假手术组（SHAM）,B组：梗黄组（CBDL），C组：梗黄肠外营养组(CBDL+PN)，D组：梗黄肠内营养组(CBDL+EN)，E组：梗黄抗生素自由饮水组，每组12只，饲养1周后采腔静脉血分离血清待测内毒素；取肠系膜淋巴结、肝脾少量培养后观察记录细菌生长情况。取小肠制作切片光镜观察小肠黏膜形态学变化及绒毛高度、厚度和隐窝深浅等。结果：与A组比较，B组及D组空肠黏膜隐窝深度变浅(P<0.05),C组及E组大鼠空肠黏膜亦有不同程度变薄、萎缩、绒毛变短、隐窝变浅等；A组无肠系膜淋巴结细菌移位，B、C、D和E组肠系膜淋巴结细菌移位率高于A组（P<0.05或P<0.01）；B、C、D和E组血内毒素含量高于A组（P<0.05或P<0.01）,E组低于B、C和D组（P<0.05）。结论：①OJ时肠道屏障功能受损，发生细菌移位及内毒素血症；②肠内及标准肠外营养都不能维持OJ大鼠肠黏膜屏障及阻止肠道细菌移位，但肠内营养组好于肠外营养组；③肠道抗生素可降低内毒素血症的发生率及有利于阻止细菌移位。     

肠内免疫营养和生态营养对创伤后大鼠肠屏障功能及免疫功能的影响

目的探讨肠内免疫营养和生态营养对创伤后大鼠肠黏膜屏障和免疫屏障的影响。方法将40只Wistar大鼠随机分为4组:对照组、普通肠内营养组、肠内免疫营养组和生态营养组。通过胃造瘘术建立大鼠创伤模型,分别给予不同成分的肠内营养7d,观察各组大鼠小肠黏膜形态,免疫组化检测肠黏膜CD3 、CD4 、CD8 和IgA 细胞。结果肠内营养组、免疫营养组和生态营养组的小肠黏膜绒毛高度、肠腺隐窝深度、黏膜厚度及绒毛表面积均明显高于对照组(P<0.05),而肠内免疫营养组与生态营养组之间差异无显著性(P>0.05)。对照组和普通肠内营养组的小肠CD3 、CD4 、CD8 和IgA 细胞数明显低于肠内免疫营养组和生态营养组(P<0.01,P<0.05)。结论肠内营养,尤其是肠内免疫营养和生态营养能较好地改善创伤后大鼠的小肠机械屏障和免疫屏障功能,促进肠黏膜屏障功能的恢复。肠内免疫营养和生态营养在保护肠屏障功能方面具有相同的作用。     

黑灵芝多糖联合rhGH对患者受损小肠黏膜中PCNA、Musashi-1表达的影响

目的:分析黑灵芝多糖联合rhGH对患者受损小肠黏膜中PCNA、Musashi-1表达的影响。方法:选取2019年9月－2020年9月于浙江省台州医院、浙江大学医学院附属第一医院就诊的117例因服用阿司匹林导致小肠黏膜损伤患者,按照随机数字表法分为rhGH组(n=58)、联合组(n=59)。对比两组肠黏膜指标及炎症因子、PCNA、Musashi-1表达。结果:治疗后,联合组小肠黏膜绒毛高度、PCNA、Musashi-1表达高于rhGH组,陷窝深度、DAO、BT水平低于rhGH组(均P<0.05)。联合组治疗有效率高于rhGH组(P<0.05)。结论:黑灵芝多糖联合rhGH能调控小肠黏膜损伤患者的PCNA、Musashi-1表达,抑制炎症反应,减轻肠黏膜损伤,维持肠黏膜机械屏障稳定性,促进疾病转归。     

添加丙氨酰谷氨酰胺胃肠外营养对烫伤大鼠空肠黏膜及蛋白质代谢的作用

目的:探讨添加丙氨酰谷氨酰胺(Ala-Gln)全胃肠外营养(TPN)对烫伤大鼠空肠黏膜及蛋白质代谢的影响。方法:将33只SD大鼠随机分为非烫伤正常参照组(正常组)、传统TPN组(传统组)和添加二肽TPN组(二肽组)3组,每组11只。正常组自由饮食,另两组大鼠在颈外静脉插管后行30%体表面积Ⅲ度烫伤,并接受等热量(780kJ·kg-1·d-1)等氮量(氮量1.8g·kg-1·d-1,二肽组48%的氮量由Ala-Gln提供)TPN7d,留取24h尿测每日氮平衡和累积氮平衡;7d后取血测定总蛋白(TP)、白蛋白(ALB)、前白蛋白(PAB)、转铁蛋白(TRF),高效液相色谱法检测肌肉中谷氨酰胺(Gln)的含量;取一段空肠作黏膜形态学观察。结果:血清PAB、TRF及肌肉中Gln含量二肽组明显高于传统组(P<0.01);空肠黏膜绒毛高度、隐窝深度、黏膜厚度、绒毛表面积二肽组明显高于传统组(P<0.01)。结论:烫伤大鼠应用添加Ala-Gln的TPN能改善机体氮平衡,促进机体蛋白质合成,减缓肌肉中Gln含量的下降,减轻空肠黏膜的萎缩。     

芪黄煎剂对缺血-再灌注损伤肠黏膜上皮形态的影响

目的：观察健脾通里中药芪黄煎剂对缺血再灌注损伤大鼠肠上皮形态的影响。方法：将40只Wistar大鼠,随机分为正常组、缺血再灌注组（ischemia reperfusion,IR）、谷氨酰胺组、芪黄煎剂组,采用无创血管夹夹闭肠系膜上动脉45min,再灌注1h复制IR模型,谷氨酰胺组和芪黄煎剂组大鼠分别管饲谷氨酰胺和芪黄煎剂3d。取距回盲部2cm以上的小肠组织约5cm,经100ml／L甲醛固定,标本4μm切片后行苏木精伊红染色。分别对各组大鼠肠黏膜完整性予以Chiu氏评分;测定并比较各组肠绒毛高度、绒毛隐窝深度、肠黏膜厚度、绒毛面积。结果：①Chiu氏评分：正常组最低（0分）,IR组最高,芪黄煎剂组与谷氨酰胺组Chiu氏评分稍低,与I／R组比较,差异有显著性（P〈0．05）,芪黄煎剂组和谷氨酰胺比较,差异无统计学意义（P〉0．05）。②正常组肠绒毛高度、隐窝深度和面积及肠黏膜厚度最大;与正常组比较,IR组上述指标显著减少;与IR组比较,芪黄煎剂组肠绒毛高度、隐窝深度和面积显著增加（P〈0．05）。结论：健脾通里中药芪黄煎剂对肠黏膜上皮IR损伤具有保护作用。     

肠道去污剂经不同途径给药对肝硬化患者肠黏膜通透性及血清内毒素水平的影响

目的比较肠道去污剂口服和保留灌肠两种途径给药对肝硬化患者肠黏膜通透性和血清内毒素水平的影响,为肝硬化的治疗提供临床依据。方法选择78例肝硬化患者,按照给药途径分为口服组和保留灌肠组。两组在常规治疗的基础上,口服组将1人1 d的肠道去污剂剂量用0.9%氯化钠注射液制成悬浊液服用,保留灌肠组经肛门插入导管注射去污剂,均治疗14 d。比较治疗前后两组患者的Child-Pugh评分,行肠黏膜通透性[以尿液乳果糖/甘露醇排出比(L/M)表示]及血清内毒素水平检测,并对肠黏膜通透性和血清内毒素水平的相关性进行分析。结果治疗前两组肝硬化患者的尿液L/M值、内毒素水平及Child-Pugh评分比较,差异无统计学意义(P>0.05)。治疗后,保留灌肠组患者尿液L/M值、血清内毒素水平及Child-Pugh评分均显著低于口服组,差异有统计学意义(P<0.05)。肠黏膜通透性(尿液L/M值)与血清内毒素水平呈正相关(r=0.8287,P<0.05)。结论肠道去污剂保留灌肠给药较口服给药可以更好地保护和改善肝硬化患者肠道屏障功能,降低内毒素的水平,对肝硬化患者肝功能的恢复有一定的辅助作用。     

谷氨酰胺对肝硬化患者肠道粘膜保护作用研究

目的:探讨谷氨酰胺(Gln)对肝硬化患者肠道粘膜保护效果及可能机制。方法:将38例肝硬化患者随机分为两组,每组19例。对照组常规保肝、对症、支持治疗;试验组在此基础上加用L-谷氨酰胺呱仑酸钠颗粒(麦滋林,0.67g/包)3次/d,1包/次,治疗时间8w。对比两组患者治疗前后小肠粘膜通透性变化、血常规、肝功、IgM、IgG、IgA水平及患者自发性腹膜炎(SBP)发病率。结果:试验组用Gln治疗后小肠粘膜通透性明显降低,且和对照组比较有显著性差异。试验组SBP发病率较对照组低10.2%,但两者比较无显著性差异。其余各项生化指标两组比较无显著性差异。结论:谷氨酰胺能有效降低肝硬化患者肠道粘膜的通透性,从而减少细菌易位,降低SBP的发生率。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…