术中恶心、呕吐及返流的原因分析与预防

成人下端食管括约肌长约2～5 cm,随膈肌运动上下伸展移动,维持其张力高于胃内压.食管肌肉通常分为三层,中层环状肌延自食管体部,对肾上腺能,胆碱能拮抗剂极为敏感.括约肌的神经支配来自自主神经系统交感神经丛,此外,食管括约肌部位存在着许多复合受体,这些受体可以接受乙酰胆碱、去甲肾上腺素、组织胺、5-羟色胺、前列腺素以及肠管激素刺激,其张力受神经、激素以及许多药物影响,正常情况下括约肌对胃内压的增加有一定适压能力,若胃内压过高(超过80～100 mm Hg)或括约肌张力过低(低于100 mmg)则可能引起呕吐与返流发生[1].     

多潘立酮易致泌乳反应

多潘立酮(吗丁啉)是一种合成的苯丙咪唑类衍生物,是一种具有抗呕吐作用的多巴胺受体拮抗剂,能直接作用于胃肠壁,可增加胃肠道蠕动和张力,促进胃排空,增加胃窦和十二指肠的运动,同时也增加食道的蠕动和食道下端括约肌张力,抑制恶心、呕吐。临床主要用于功能性消化不良、糖尿病性胃轻瘫(胃病)、胃食管反流病(GERD)、帕金森病等疾病的辅助治疗。     

针灸配合中药治疗贲门失弛缓症8例报告

<正>贲门失弛缓症是一种病因尚未明确累及食管平滑肌和下食管括约肌(LES)的动力障碍性疾病。以吞咽时食管体部蠕动消失、LES松弛障碍为特征,临床表现为吞咽困难和胸痛等,可根据临床表现结合内镜、食管钡餐造影和食管动力     

血管活性肠肽和食管腹内段长度在胃食管反流性疾病中的临床研究

<正>胃食管反流性疾病(gastroesophageal reflux disease,GERD)是常见的临床症状,被认为是运动障碍性疾病[1],其发病与食管下括约肌(lower esophageal sphincter,LES)功能降低、食管廓清作用减弱及攻击因子增强密切相关,与食管下括约肌长度也有一定关系,因为维持一定长度是保证括约肌功能完整的     

食管胃交界部收缩指数(EGJ-CI)对胃食管反流病患者抗反流屏障功能的判断价值

目的:探讨食管胃交界部收缩指数(EGJ-CI)对胃食管反流病患者抗反流屏障功能的判断价值。方法:纳入某院2017年4月～2021年4月收治的58例患者,29例为胃食管反流病,29例为功能性烧心,分别检测两组患者的EFJ-CI、EGJ-CIT、EGJ部静息压力、IRP4s,同时完成食管高分辨压力测定,分析对比两组之间相关参数的差异以及与反流参数的关系。结果:两组患者年龄、性别无显著差异(P0.05),胃食管反流病组Gerd-Q、DeMeester积分低于功能性烧心组;胃食管反流病组pH4时间、pH4时间比例、酸反流次数、弱酸反流次数、非酸反流次数高于功能性烧心组(P0.05);胃食管反流病组EFJ-CI、EGJ-CIT、EGJ部静息压力均低于功能性烧心组(P0.05),两组IRP4s无显著差异(P0.05);EFJ-CI与食管胃酸暴露以及酸反流事件呈现负相关(P0.05);EGJ-CIT、EGJ部静息压力、IRP4s与食管胃酸暴露以及酸反流事件呈现微弱负相关。结论:EGJ-CI能够有效的反映胃食管反流病患者抗反流屏障功能组的变化,且在胃食管反流病与功能性烧心两种疾病中存在显著差异,在鉴别胃食管反流病与功能性烧心两种疾病具有一定的临床价值。     

胃食管反流病的药物治疗

减少食道下端括约肌瞬间松弛频率；增加食管收缩幅度和频率，减少胃酸暴露时间；加速胃排空，减少胃酸反流。①甲氯普胺（胃复安）是最早使用的一种促动力药物，是一种多巴胺受体拮抗剂，对食管及胃的平滑肌有显著促动力作用，增加食管蠕动，增加食管下端括约肌收缩幅度。用法：10mg，3次／d，连续8周。有的患者可出现锥体外系不良反应；     

九成胃食管反流病患者用药不正确

胃食管反流病是一种由胃内容物反流引起的疾病，发病原因主要是由于下食管括约肌松弛，导致胃内容物（主要是胃酸）反流入食管，而引起的食管黏膜炎症。其典型症状是烧心和泛酸，严重时可导致食管溃疡、出血和狭窄，甚至引发食管癌。胃食管反流可使患者的生活质量明显下降，包括睡眠障碍、饮食受限、社交活动受影响等。     

小剂量红霉素与西咪替丁治疗胃食管反流的疗效观察

胃食管反流(GER)是指由于各种原因引起下段食管括约肌(LES)功能不全、胃动力紊乱、排空延迟而致胃或十二指肠内容物反流入食管的一种疾病,是小婴儿、尤其是新生儿常见的消化道疾病。临床上常表现为频繁呕吐,常引起体重不增、食管炎、肺部疾病、呼吸暂停及婴儿猝死等并发症[1]。     

食管胃结合部腺癌：是独立的实体肿瘤吗？

食管胃结合部（esophagogastric junction，EGJ）癌是指侵及EGJ，距离EGJ近端或远端5 cm以内的恶性肿瘤。随着对幽门螺杆菌的重视及生活习惯的改变，目前胃癌及食管癌的发病率有所下降，而EGJ癌的发病率在世界各地呈逐年上升的趋势。由于此病跨域食管和胃，对于其属于食管还是胃，或者是否属于独立的实体肿瘤成为近年热点。本文献将通过其定义、病因、危险因素、内镜特征等，探讨此病不同部位的特点，以帮助临床及科研人员深入了解，并提高肿瘤的治愈率。     

毒蕈碱受体亚型对人食管下括约肌的调节作用

目的探讨毒蕈碱受体亚型对人食管下括约肌套索纤维和钩状纤维胆碱能收缩的调节作用。方法选取高位食管中段癌行食管大部切除术患者32例,取食管、胃接合部标本分离套索纤维和钩状纤维,做M1~M4受体选择性拮抗剂哌仑西平、美索曲明、4-DAMP、托品酰胺的Schild曲线,并由此计算pA2。结果①M1~M4受体选择性拮抗剂均使ACh诱导套索纤维和钩状纤维的浓度—效应曲线发生右移,每条拮抗曲线形状类似。②4-DAMP在两肌纤维的pA2分别是8.18±0.76和8.05±1.11,较其它3种拮抗剂大(F=47.4,P=0.00),而同一拮抗剂在两肌纤维的pA2无差异(F=1.36,P=0.24)。结论ACh诱导两种肌纤维的收缩主要由M3受体介导;2种肌纤维间没有毒蕈碱受体亚型功能的差异。     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.     

Biochemical and molecular characterisation of cubozoan protein toxins

Class Cubozoa includes several species of box jellyfish that are harmful to humans. The venoms of box jellyfish are stored and discharged by nematocysts and contain a variety of bioactive proteins that are cytolytic, cytotoxic, inflammatory or lethal. Although cubozoan venoms generally share similar biological activities, the diverse range and severity of effects caused by different species indicate that their venoms vary in protein composition, activity and potency. To date, few individual venom proteins have been thoroughly characterised, however, accumulating evidence suggests that cubozoan jellyfish produce at least one group of homologous bioactive proteins that are labile, basic, haemolytic and similar in molecular mass (42-46 kDa). The novel box jellyfish toxins are also potentially lethal and the cause of cutaneous pain, inflammation and necrosis, similar to that observed in envenomed humans. Secondary structure analysis and remote protein homology predictions suggest that the box jellyfish toxins may act as α-pore-forming toxins. However, more research is required to elucidate their structures and investigate their mechanism(s) of action. The biological, biochemical and molecular characteristics of cubozoan venoms and their bioactive protein components are reviewed, with particular focus on cubozoan cytolysins and the newly emerging family of box jellyfish toxins.     

Dose tolerability of chronically inhaled voriconazole solution in rodents

Invasive pulmonary aspergillosis (IPA) is a fungal disease of the lung associated with high mortality rates in immunosuppressed patients despite treatment. Targeted drug delivery of aqueous voriconazole solutions has been shown in previous studies to produce high tissue and plasma drug concentrations as well as improved survival in a murine model of IPA. In the present study, rats were exposed to 20 min nebulizations of normal saline (control group) or aerosolized aqueous solutions of voriconazole at 15.625 mg (low dose group) or 31.25 mg (high dose group). Peak voriconazole concentrations in rat lung tissue and plasma after 3 days of twice daily dosing in the high dose group were 0.85 ± 0.63 μg/g wet lung weight and 0.58 ± 0.30 μg/mL, with low dose group lung and plasma concentrations of 0.38 ± 0.01 μg/g wet lung weight and 0.09 ± 0.06 μg/mL, respectively. Trough plasma concentrations were low but demonstrated some drug accumulation over 21 days of inhaled voriconazole administered twice daily. Following multiple inhaled doses, statistically significant but clinically irrelevant abnormalities in laboratory values were observed. Histopathology also revealed an increase in the number of alveolar macrophages but without inflammation or ulceration of the airway, interstitial changes, or edema. Inhaled voriconazole was well tolerated in a rat model of drug inhalation.