Direct intestinal cholesterol secretion contributes significantly to total fecal neutral sterol excretion in mice

BACKGROUND & AIMS: Hepatobiliary secretion is generally believed to be an integral step in the pathway of cholesterol excretion from the body. Here we have investigated the validity of this paradigm in mice. METHODS: Cholesterol balance was assessed by measuring intake, excretion, and biliary output in different mouse models. Direct secretion of cholesterol from the luminal side of enterocytes was studied by perfusion of isolated segments of the small intestine in mice. RESULTS: Cholesterol input and output measurements in different mouse models revealed that fecal neutral sterol excretion was higher than the sum of dietary cholesterol intake and biliary cholesterol secretion indicating the existence of an alternative pathway. Here we show that substantial amounts of cholesterol can be secreted directly by enterocytes. Transintestinal cholesterol secretion is a specific process observed throughout the small intestine (proximal > medial > distal). Secretion depended on the presence of a cholesterol acceptor and was strongly stimulated by bile salts and phospholipids. The capacity of the pathway was sufficient to account for the missing cholesterol in the balance studies. The contribution of this pathway to cholesterol excretion in mice is approximately twice that of the biliary pathway. CONCLUSIONS: In mice, the intestine plays a significant role in removal of cholesterol from the body.     

肝硬化患者血清TPO水平与APN和HA水平相关性探讨

目的：探讨肝硬化患者血清血小板生成素（TPO）水平与脂联素（APN）和HA的相关性。方法：应用放射免疫分析和酶联法对63例肝硬化患者进行血清TPO、APN和HA检测,并与35名正常健康人作比较。结果：肝硬化患者血清TPO、APN水平均非常显著地低于正常人组（P〈0.01）,而HA水平则显著地高于正常人组（P〈0.01）,血清TPO水平与APN水平呈正相关（r=0.6284,P〈0.01）,与HA水平呈负相关（r=-0.4982,P〈0.01）。结论：肝硬化患者血清TPO、APN和HA水平与疾病的发生、发展密切相关,有重要的临床价值。     

APN排班在新生儿监护病房护士层级管理中的应用

目的探讨在新生儿监护病房（NICU）通过APN排班实现护士层级管理的效果。方法在NICU通过实施APN排班,划分护士层级,确定层级护士岗位、能力标准和工作内容,从而实现护士的全层级管理。选择2011年5—7月实施APN排班与护士层级管理前397名患儿家属作为对照组,2011年8—11月实施APN排班与护士层级管理后382患儿家属作为观察组。比较分层管理前、后患儿家属满意度和护士满意度。结果观察组患儿家属对护理工作满意度在质量及安全（4．574-0．32）分、服务可及性（4．13±0．27）分、健康教育（4．52±0．33）分、人文关怀评价（4．67±0．45）分4个方面均高于对照组的（4．47±0．62）,（3．92±0．5）,（4．12±0．48）,（4．56±0．48）分,两组比较,差异有统计学意义（t分别为2．830,7．033,13．5,3．29;P〈0．05）;实施APN排班实现护士层级管理后,护士对选择自己工作方式的自由度（2．83±0．39）分、护士的收入（2．664-0．49）分、发挥自己能力的机会（3．67±0．49）分、承担职责（4．10±0．71）分方面的满意度较实施前（2．35±0．87）,（2．25±0．86）,（3．25±0．43）,（3．63±0．66）分显著提高,前后比较,差异有统计学意义（t分别为3．7237,3．2086,4．9903,2．7556;P〈0．05）。结论在NICU通过实施APN排班来实现护士的层级管理,既有利于提高患儿家属和护士的满意度,又有利于护理质量的提高。     

APN排班模式在优质护理服务示范病房中的应用

目的探讨实行APN连续排班模式对院内开展优质护理服务的影响。方法选取2010年4—10月的排班模式为对照组,2010年10月至2011年4月排班模式为观察组,对照组采用传统护理排班模式,观察组采用APN排班模式,比较两组每月护理工作质量、患者满意度、护士身心健康状况。结果实验组患者满意度为95．0％,高于对照组的75．0％,两组比较差异有统计学意义（Х^2=37．77,P〈0．05）;每月护理工作质量两组比较差异有统计学意义（P〈0．05）,APN连续排班模式下的护士身心健康状况均高于传统排班模式,两组比较差异有统计学意义（P〈0．05）。结论采用APN排班模式能明显提高医院护理工作质量、患者满意度、护士身心健康状况,有利于优质护理服务示范工程的开展。     

The Retinohypothalamic tract: Comparison of axonal projection patterns from four major targets

The retinohypothalamic tract is one component of the optic nerve that transmits information about environmental luminance levels through medial and lateral branches to four major terminal fields in the hypothalamus. The spatial distribution and organization of axonal projections from each of these four terminal fields were analyzed and compared systematically with the anterograde pathway tracer PHAL in rats where the terminal fields had been labeled with intravitreal injections of a different anterograde pathway tracer, CTb. First, the well-known projections of two medial retinohypothalamic tract targets (the ventrolateral suprachiasmatic nucleus and perisuprachiasmatic region) were confirmed and extended. They share qualitatively similar projections to a well-known set of brain regions thought to control circadian rhythms. Second, the projections of a third medial tract target, the ventromedial part of the anterior hypothalamic nucleus, were analyzed for the first time and shown to resemble qualitatively those from the suprachiasmatic nucleus and perisuprachiasmatic region. And third, projections from the major lateral retinohypothalamic tract target were analyzed for the first time and shown to be quite different from those associated with medial tract targets. This target is a distinct core part of the ventral zone of the anterior group of the lateral hypothalamic area that lies just dorsal to the caudal two-thirds of the supraoptic nucleus. Its axonal projections are to neural networks that control a range of specific goal-oriented behaviors (especially drinking, reproductive, and defensive) along with adaptively appropriate and complementary visceral responses and adjustments to behavioral state.     

Extrarenal manifestations of severe acute pyelonephritis: CT findings in 21 cases

The aim of this study is to report the extrarenal computerized tomography (CT) findings in patients with acute pyelonephritis (APN). Twenty-one CT examinations of 20 patients [19 women and one man, with ages ranging from 18 to 57 years (mean —35.2 years)], presenting either with a clinical diagnosis of APN (n=17) or with a suspected acute appendicitis, fever of unknown origin, and adult respiratory distress syndrome, one in each, were retrospectively reviewed. None had a known preexisting systemic disease. Results showed that renal abnormalities were seen on CT in all patients. In addition, ascites was detected in all women patients associated with subcutaneous edema in five of them. A thickened gallbladder wall was found in 19 cases, all were women, and periportal tracking and a dilated inferior vena cava in 17 CTs. Pleural effusion and thickened interlobular septa were present in 16 and 15 studies, respectively. Relevant laboratory findings included hypoalbuminemia in 14, elevated liver enzymes in 11, hypocholesterolemia in nine, and elevated LDH levels in six cases. In conclusion, radiologists should be familiar with the extrarenal imaging features of APN that may be seen on CT, and on ultrasonography as well, and should look for renal abnormalities to diagnose a clinically unsuspected APN. Alternatively, APN should be included in the differential diagnosis of systemic diseases that cause gallbladder wall thickening to avoid misdiagnosing it as acute cholecystitis.     

多囊卵巢综合征患者脂联素、C反应蛋白水平的变化及其意义

目的:探讨脂联素(APN)、C反应蛋白(CRP)的变化对多囊卵巢综合征(PCOS)发病的意义。方法:按体重指数(BMI≥25kg/m2或<25kg/m2)分别将PCOS患者52例、对照组47例分为PCOS肥胖组(25例)、非肥胖组(27例)和对照肥胖组(23例)、对照非肥胖组(24例)4组。用ELISA法测定4组的APN水平、散射比浊法测CRP水平,葡萄糖氧化酶法测定空腹血糖(FPG)、化学发光法测空腹胰岛素(FIN)水平,并计算胰岛素抵抗指数(HOMA-IR)。结果:①PCOS组APN水平低于对照组(P<0.05),且同组肥胖者低于非肥胖者。②PCOS组CRP水平高于对照组(P<0.05),且肥胖者高于非肥胖者。③APN水平与BMI、HOMA-IR水平呈明显负相关(P<0.05)。结论:PCOS组APN水平降低,CRP水平升高,且以肥胖者明显。APN水平降低、CRP水平升高与PCOS患者胰岛素抵抗密切相关。     

基层医院实施APN连续性排班模式初探

目的：探讨基层医院实施APN连续性排班的效果。方法：选择3个病区实施排班模式改革,实行APN连续性排班,比较两种排班模式的交接班次数、交班所占用的时间、拖班现象及患者满意度等。结果：APN连续性排班模式比传统的排班模式每天交班次数少、交接班所占时间少、护士拖班现象减少、患者对护士满意度提高（P〈0.05）。结论：APN连续性排班模式符合医院院情,符合患者的需要,提高了服务质量,达到保证患者安全的目的。     

中药足浴治疗糖尿病合并冠心病患者的疗效及对 APN、MBP、IGF-1 的影响

目的 分析中药足浴治疗糖尿病合并冠心病患者的疗效及对APN、MBP、IGF-1 的影响。方法 选2018 年2 月至2020 年2 月间我院内分泌科收治的82 例糖尿病合并冠心病患者作为研究对象，均分为两组（随机信封法），对照组41 例选用常规治疗，观察组41 例在对照组基础上选用中药足浴治疗，统计两组临床总有效率、临床指标、临床症状积分。结果 观察组临床总有效率（92.68%）高于对照组（75.61%），差异有统计学意义（χ2=4.479，P＜0.05）。观察组APN（8.91±1.82）mg/mL、IGF-1（4.94±0.91）pg/mL 高于对照组APN（7.52±1.24）mg/mL、IGF-1（4.02±0.52）pg/mL，MBP（8.31±1.62）μg/mL、FPG（5.84±0.42）mmol/L 低于对照组MBP（10.62±1.81）μg/mL、FPG（7.52±0.92）mmol/L，差异有统计学意义（P＜0.05）。观察组临床症状积分低于对照组，差异有统计学意义（P＜0.05）。结论 将中药足浴应用在糖尿病合并冠心病患者治疗中，可降低临床症状积分，改善临床指标，促进糖脂代谢，值得借鉴。