An experimental model for the study of transient lower oesophageal sphincter relaxation and motor function of the proximal stomach in humans

A simple and reliable experimental model would be useful in human research on new drugs which target transient lower oesophageal sphincter (LOS) relaxation. The aim was to investigate the effect of repeated distensions on the rate of transient LOS relaxation, LOS pressure and motor function of the proximal stomach. Twelve healthy subjects were studied with a multilumen manometric assembly incorporating a sleeve sensor for the LOS and a bag positioned in the proximal stomach and connected to a barostat. Intrabag volume was set at 75% of the threshold for gastric discomfort and maintained for two 30-min distension periods separated by a 45-min washout with the bag deflated. The studies lasted 145 +/- 2 min. The rate of transient LOS relaxations was similar during the two distensions, 3.5;2-4 vs 3;2.5-4 (median;interquartile range) and so was LOS pressure. Baseline intrabag pressure, as a measure of gastric tone, and the number of pressure waves, as a measure of phasic contractions, were also similar, 11.3;9.3-12.3 mmHg vs 10.8;9.3-12.5 mmHg and 16;13-28 mmHg vs 19;15-29 mmHg, respectively. Our model allows to perform 1-day studies which can assess two experimental conditions on transient LOS relaxations and motor function of the proximal stomach within an acceptable time span.     

一氧化氮在高胆固醇血症家兔Oddi括约肌中的含量变化

目的探讨一氧化氮在高胆固醇血症家兔Oddi括约肌中的变化。方法将32只成年家兔随机分成正常对照组、高胆固醇血症4周组、6周组、10周组,每组8只,分别以高胆固醇饲料喂养,取其Oddi括约肌用硝酸还原酶法行一氧化氮含量检测。结果家兔喂养高胆固醇饲料后可形成高胆固醇血症,Oddi括约肌中一氧化氮的含量明显改变（P〈0.05）。结论高胆固醇血症家兔Oddi括约肌一氧化氮含量降低;高胆固醇血症通过影响NO的含量改变Oddi的舒张功能。     

一氧化氮对犬下食管括约肌压力的作用

目的 :应用苄基二甲基十四烷氯化铵 (benzyldim ethyltetradecyl amm onium chloride,BAC)建立犬下食管括约肌(L ES)无神经动物模型 ,研究一氧化氮 (NO)对 L ES压力的作用。方法 :将 BAC环周注入犬 L ES,对照组注入等量生理盐水 ,均于注射前及注射后 6周测定 L ES压力 ;并观察 L -精氨酸、D -精氨酸、硝普钠及一氧化氮合酶 (NOS)抑制剂 N-硝基 - L -精氨酸 (L - NNA)对 L ES压力的影响 ;此外还测定了两组犬 L ES中 NO含量和 NOS活性。结果 :BAC处理组 L ES压力 [(4 2 .43±4.19) m m Hg,1m m Hg=0 .133 k Pa]显著高于对照组 [(2 2 .71± 5 .19) mm Hg]。 L -精氨酸可使对照组 L ES压力降低 ;L - NNA使其增高 ,但对 BAC处理组 L ES压力均无影响。硝普钠可降低两组犬 L ES压力。对照组 L ES中 NO为 (6 .0 5 8± 2 .0 6 7)μm ol/g,NOS为 (1.45 8± 0 .146 ) U /mg;而 BAC处理组 NO为 (1.797± 0 .873)μmol/g,NOS为 (0 .46 3± 0 .0 39) U /m g,均较对照组显著降低 (P<0 .0 1)。 结论 :BAC可使犬 L ES压力增高 ,其机制可能与 L ES局部 NO减少有关。     

膝胸卧位红光照射联合肛提运动对产后痔急性发作的疗效

目的 探讨膝胸卧位红光照射联合肛提运动对产后痔急性发作的改善效果.方法 将68例经阴道分娩并发产后痔急性发作的产妇按入院时间分为对照组36例、观察组32例.两组产妇产后给予相同的产褥期知识宣教、母婴护理指导等常规护理措施,在此基础上,对照组采用屈膝侧卧位配合红光照射,观察组给予膝胸卧位红光照射联合肛提运动.观察两组产后24 h和产后5d痔疼痛程度、肛周水肿程度、治疗效果、治疗过程舒适度.结果 干预后两组疼痛评分、肛周水肿程度、治疗效果比较,差异有统计学意义(均P＜0.01);两组治疗过程舒适程度差异无统计学意义(P＞0.05).结论 产后痔急性发作的产妇应用膝胸卧位红光照射配合肛提运动能有效减轻产妇疼痛及肛周水肿程度,治疗效果较好.     

解剖性保留控尿肌群技术在腹腔镜根治性前列腺切除术中的临床应用价值

目的 探讨腹腔镜前列腺癌根治术（LRP）中解剖性保留控尿肌群技术对术后早期控尿功能恢复的影响,及其肿瘤学安全性。方法 回顾性队列研究。纳入2016年1月—2020年6月浙江大学医学院附属金华医院泌尿外科采用LRP治疗的前列腺癌患者共292例,将其中采用解剖性保留控尿肌群技术的83例纳入观察组;对另外209例接受经典前列腺癌根治术的患者与观察组患者进行1∶1倾向性评分匹配,选择其中83例纳入对照组。全组共166例,年龄45~75（64.0±7.3）岁,BMI 21~31（24.4±2.4）kg/m²。对比分析2组患者手术时间、术中出血量、术后病理TNM分期、Gleason评分、术后留置导尿时间、手术并发症和手术切缘阳性（PSM）率;采用Kaplan-Meier法评估患者3年、5年无生化复发（BCR）累积生存率;根据术后每天使用的尿垫数量进行控尿功能分级评估,分别于拔除导尿管后的当天（第1个24 h）、1周及1、3、6、12个月时,观察并对比2组患者控尿功能恢复情况。结果 2组患者年龄、临床分期、危险分级、膀胱颈和神经保留与否等临床基线特征比较,差异均无统计学意义（P值均>0.05）。全组166例均在腹腔镜下完成手术,术后恢复良好,无围手术期死亡病例。2组患者手术时间、术中出血量、术后病理TNM分期、术后Gleason评分、术后留置导尿时间和手术并发症比较,差异均无统计学意义（P值均>0.05）。观察组PSM率为10.84％（9/83）,低于对照组的13.25%（11/83）,但差异无统计学意义（χ²=0.23, P=0.633）。2组患者术后随访12~71个月,平均33.73个月。随访期间无死亡病例。观察组3年、5年无BCR累积生存率分别为90.2％和73.2%,对照组分别为91.4%和77.8%,2组差异无统计学意义（χ²=0.38, P=0.535）。在拔除导尿管后当天、1周及1、3、6个月,观察组完全控尿率分别为39.76%（33/83）、53.01%（44/83）、66.27%（55/83）、90.36%（75/83）和97.95%（81/83）,对照组为16.87%（14/83）、21.96%（18/83）、38.55%（32/83）、53.01%（44/83）和68.67%（57/83）;观察组控尿功能分级均优于对照组,差异均有统计学意义（Z=-4.24、-4.09、-3.78、-5.61、-4.99,P值均<0.001）;拔管后12个月,2组完全控尿率分别为98.80%（82/83）和93.98%（78/83）,控尿功能分级比较差异无统计学意义（Z=-1.67,P=0.094）。术后3个月,观察组控尿（完全+社交）率达100％（83/83）,高于对照组的73.49%（61/83）,差异有统计学意义（χ²=25.36, P<0.001）。结论 LRP中解剖性保留控尿肌群技术的应用有助于患者术后早期恢复控尿功能,且不影响手术的肿瘤学安全性。     

适形切除保肛术与经括约肌间切除术治疗低位直肠癌的临床疗效

目的探讨适形切除保肛术(CSPO)与经括约肌间切除术(ISR)治疗低位直肠癌的临床疗效。方法采用回顾性队列研究方法。收集2011年8月至2020年4月2家医学中心收治的183例(海军军医大学附属长海医院117例、复旦大学附属华山医院66例)低位直肠癌病人的临床病理资料;男110例,女73例;年龄为(57±11)岁。183例病人中,117例行CSPO设为CSPO组,66例行ISR设为ISR组。观察指标:(1)两组低位直肠癌病人手术情况。(2)两组低位直肠癌病人术后并发症情况。(3)随访情况。(4)影响低位直肠癌病人预后因素分析。(5)影响低位直肠癌病人肛门满意度因素分析。采用门诊、问卷和电话方式进行随访,了解病人肿瘤局部复发及远处转移、病人生存、造口还纳、肛门满意度评分情况。正态分布的计量资料以x±s表示,组间比较采用t检验;偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示,组间比较采用χ²检验。等级资料比较采用秩和检验。采用Kaplan-Meier法绘制生存曲线,采用寿命表法计算生存率,采用Log-rank检验进行生存情况分析。单因素分析采用线性回归,将单因素线性回归分析中P<0.10的变量纳入多因素分析。多因素分析采用COX逐步回归分析模型和线性回归分析。结果(1)两组低位直肠癌病人手术情况:CSPO组和ISR组病人腹腔镜手术例数、手术时间、术中出血量、肿瘤远切缘、术后化疗、术后住院时间分别为44例和55例、(165±54)min和(268±101)min、(142±101)mL和(91±85)mL、(0.6±0.4)cm和(1.9±0.6)cm、76例和9例、(6.6±2.5)d和(7.9±4.7)d,两组病人上述指标比较,差异均有统计学意义(χ²=35.531,t=8.995、-3.437、-3.088,χ²=44.681,t=2.267,P<0.05)。(2)两组低位直肠癌病人术后并发症情况:CSPO组术后19例病人发生并发症,其中Ⅰ级并发症6例,Ⅱ级并发症12例,Ⅲb级并发症1例。ISR组术后14例病人发生并发症,其中Ⅰ级并发症4例,Ⅱ级并发症7例,Ⅲa级并发症1例,Ⅲb级并发症2例。两组病人术后总体并发症发生情况比较,差异无统计学意义(χ²=0.706,P>0.05)。两组病人并发症经对症支持治疗后均好转。两组病人均无围术期(术后30 d内)死亡病例。(3)随访情况:183例病人均获得随访,CSPO组和ISR组随访时间分别为(41±27)个月和(37±19)个月,两组病人比较,差异无统计学意义(t=-1.104,P>0.05)。CSPO组和ISR组病人中,肿瘤局部复发分别为2例和3例、肿瘤远处转移分别为9例和4例,两组病人上述指标比较,差异均无统计学意义(χ²=1.277、0.170,P>0.05)。CSPO组和ISR组病人3年无病生存率分别为84.0%和88.6%,3年总体生存率分别为99.0%和92.8%,两组病人无病生存情况和总体生存情况比较,差异均无统计学意义(χ²=0.218、0.002,P>0.05)。CSPO组和ISR组分别有102例和66例病人随访至CSPO或ISR术后12个月,其造口还纳率分别为92.16%(94/102)和96.97%(64/66),两组病人比较,差异无统计学意义(χ²=1.658,P>0.05)。CSPO组8例造口未还纳病人中,2例因高龄、4例主观拒绝还纳、2例因放疗致瘢痕无法还纳。ISR组2例造口未还纳病人中,术后因肝转移和主观拒绝还纳各1例。CSPO组和ISR组分别有92例和61例病人随访至造口还纳术后12个月,其中CSPO组75例和ISR组38例完成肛门功能满意度调查。CSPO组和ISR组病人肛门功能满意度评分分别为(6.8±2.8)分、(5.4±3.0)分,两组病人比较,差异有统计学意义(t=-2.542,P<0.05)。CSPO组和ISR组病人肛门功能满意度评分>5分分别为54例和21例,两组病人比较,差异无统计学意义(χ²=3.165,P>0.05)。(4)影响低位直肠癌病人预后因素分析:COX逐步回归分析结果为性别、肿瘤pT分期是影响低位直肠癌病人无病生存率的独立影响因素(风险比=2.883,1.963,95%可信区间为1.090~7.622,1.129~3.413,P<0.05);性别、肿瘤pT分期是影响低位直肠癌病人总体生存率的独立影响因素(风险比=10.963,3.187,95%可信区间为1.292~93.063,1.240~8.188,P<0.05)。(5)影响低位直肠癌病人肛门满意度因素分析:单因素分析结果显示手术方式和肿瘤分化程度是影响低位直肠癌病人肛门满意度的影响因素(偏回归系数=1.464,-1.580,95%可信区间为0.323~2.605,-2.950~-0.209,P<0.05)。多因素分析结果显示:手术方式、肿瘤分化程度、术前放疗是影响低位直肠癌病人肛门满意度的独立影响因素(偏回归系数=1.637,-1.456,-1.668,95%可信区间为0.485~2.788,-2.796~-0.116,-2.888~-0.447,P<0.05)。结论与ISR比较,低位直肠癌施行CSPO同样可实现超低位保肛,不增加术后并发症发生率,保障肿瘤学安全性,改善肛门功能,提升病人术后肛门功能满意度。     

Effects of capsaicin,tachykinins, calcitonin gene-related peptide and bradykinin in the pig iris sphincter muscle

Summary Capsaicin-sensitive sensory neurons of the rabbit iris, by releasing tachykinins, exert a major role in the control of pupil motility in response to various noxious stimuli. However, the contribution of sensory innervation to the regulation of iris smooth muscle tone in other mammals species is not known. We have studied the effects produced by electrical field stimulation, capsaicin, substance P, neurokinin A, calcitonin gene-related peptide (CGRP), and bradykinin in the isolated iris sphincter muscle of the pig.Capsaicin (10 M): a) contracted the isolated sphincter muscle and; b) released immunoreactivity for substance P (SP-LI) and CGRP (CGRP-LI) from this preparation. These two effects were no longer observed at the second exposure to the drug. Electrical field stimulation (10 Hz, 60 V, 0.5 ms for 5 s) produced a biphasic contractile response. The rapid component was inhibited by atropine (1 M), while the delayed response was blocked by previous exposure to capsaicin (10 M).Substance P and neurokinin A consistently produced contraction of the pig iris sphincter muscle, substance P being more potent than neurokinin A. CGRP induced a contractile response in more than 50% of the preparations. The tachykinin antagonist [D-Argl, D-Trp^7,9, Leu¹¹-substance P (3 M) blocked: a) the effect of substance P (1 nM); b) the delayed response to electrical field stimulation and; c) reduced by more than 50% response to capsaicin. Bradykinin (10 M) failed to release either SP-LI or CGRP-LI. The contractile response evoked by bradykinin was unaffected by in vitro pretreatment with capsaicin (10 M).The existence in the pig iris of capsaicin-sensitive sensory fibres releasing neuropeptides and thus regulating sphincter muscle tone is proposed. Send offprint requests to Dr. P. Geppetti at the above address     

Muscarine receptor types mediating autoinhibition of acetylcholine release and sphincter contraction in the guinea-pig iris

Summary The potencies of several muscarine receptor antagonists in blocking either the autoinhibition of acetylcholine release or the muscarinic contraction of the sphincter muscle upon acetylcholine release were investigated in the guinea-pig iris. The agonist at pre- or postjunctional muscarine receptors was acetylcholine released upon field stimulation (5.5 Hz, 2 min) of the irides preloaded with ¹⁴C-choline. The stimulation-evoked ¹⁴C-overflow was doubled in the presence of atropine 0.1 mol/l but unaffected by the agonist (±)-methacholine (50 mol/l). Thus, under the present stimulation conditions, the autoinhibition of acetylcholine release on the guinea-pig iris cholinergic nerves was nearly maximally activated. Isotonic contractions of the irides upon field stimulation consisted of a rapid, atropine (0.1 mol/l). peak phase followed by a sustained contraction which involved a cholinergic and a non-cholinergic stimulation of the sphincter muscle. The M₂-selective antagonists methoctramine (10 mol/l) and gallamine (100 µmol/l). increased both the ¹⁴Goverflow and the peak contractions evoked by field stimulation. In contrast, the M₃-selective antagonist hexahydrosiladifenidol (0.1–10 mol/l) failed to affect the evoked ¹⁴C-release but concentration-dependently (1–10 mol/l) reduced the iris contractions. Pirenzepine (10 mol/l) enhanced the evoked ¹⁴C-overflow and inhibited the peak contractions (0.1–10 mol/l; maximal effect at 10 mol/l). The low potency of the antagonist at both receptor sites indicates that an M₁ muscarine receptor is not involved. The results are consistent with the idea of M₂ muscarine receptors mediating autoinhibition of acetylcholine release in the guinea-pig iris and M₃-like receptors inducing the contraction of the sphincter muscle. Send offprint requests to I. T. Bognar at the above address     

Role of Laryngeal Movement and Effect of Aging on Swallowing Pressure in the Pharynx and Upper Esophageal Sphincter

Objectives Describe contribution of laryngeal movement to pressure changes at the upper esophageal sphincter (UES) and the effect of aging on the swallowing function. Study Design Manofluorography on 56 nondysphagic adults divided into three age groups: the 21‐ to 31‐year‐old group (n = 32), the 61‐ to 74‐year‐old group (n = 12) and the 75‐ to 89‐year‐old group (n = 12). Analyses of the bolus transit time, the amplitudes and durations of pharyngeal pressures, the timing of a pressure fall at the UES and the laryngeal movements. Methods Intraluminal strain‐gauge sensors recorded pressure changes in the oropharynx, hypopharynx and the UES. Motion pictures of the videotapes were fed into a personal computer, and movements of the hyoid bone were measured in both the horizontal and vertical directions as an indication of laryngeal movement. Results In 26‐ and 70‐year‐old men with calcification of the thyroid cartilage, it was determined that the larynx and hyoid bone moved in consonance until the end of the rapid hyoid movements in both the superior and anterior directions. In the 21‐ to 31‐year‐old group, the magnitude of the pressure fall at the UES was maximal before or almost at the same time as the bolus arrival, in preparation for smooth passage of the bolus from the pharynx to the esophagus. The rapid superior movements of the hyoid bone started significantly early as compared with its anterior movements (P = .0001). The rapid anterior movements of the hyoid bone started simultaneously with the pressure fall at the UES. In the elderly, all segmental transit times were significantly increased. The timing of the pressure fall at the UES was significantly delayed and the UES pressure reached its minimum value after arrival of the bolus at the UES. The minimum pressure at the UES increased to a significantly positive value. The rapid anterior movements of the hyoid were significantly delayed, suggesting that this delay causes the delay in the pressure fall at the UES. Conclusions The rapid superior and anterior movements of the hyoid bone are considered to start at the same time as those of the larynx. In the young group, it is suggested that superior laryngeal movement protects the lower airway prior to the anterior laryngeal movement, causing the pressure fall at the UES to enable the passage of a bolus into the UES. In the elderly, smooth passage of the bolus from the pharynx to the esophagus is hindered and the system that prevents aspiration is rendered inefficient by changes in the swallowing pressures and laryngeal movements with aging.     

pH电极位置对反流性食管炎酸监测的影响

为探讨ｐＨ电极位置对反流性食管炎酸监测的影响,将６０例反流性食管炎随机分为对照（Ｃ）组和试验（Ｔ）组。 Ｃ组 ３０例用测压法将 ｐＨ电极置于下食管括约肌（ＬＥＳ）上缘 ５ ｃｍ处;Ｔ组 ３０例用 ｐＨ梯度法将电极放于胃食管连接处（ＧＥＪ）上方 ５ ｃｍ处。连续 ２４ ｈ ｐＨ监测。结果显示,Ｃ与Ｔ组前鼻孔至ＧＥＪ平均距离分别为（４６． ２±４．１） ｃｍ与（４６． ５±４． ５） ｃｍ,两者无明显差异（Ｐ＝０． ８）。两组前鼻孔至ＧＥＪ平均距离（４６． ３±４． ３） ｃｍ比 Ｃ组前鼻孔至ＬＥＳ上缘平均距离（４３． ３±３． １） ｃｍ低 ３． ０ ｃｍ（Ｐ＝０． ０００３）。食管酸监测的 ｐＨ＜４,总百分时间和总计分在Ｔ组（８．５和 ４５． ５）和Ｔ组中ＧＥＪ＞ＬＥＳ上缘＋３ ｃｍ和＜－３ｃｍ范围者（１０． ０和 ９９． ３）较Ｃ组（４． ８和 ２６． ３）均有明显增高, Ｐ均＜０． ０１）,而Ｔ组中ＧＥＪ≤ＬＥＳ上缘＋３ ｃｍ和≥－３ ｃｍ范围者（７． １和 ３９． ４）则无明显差异（ Ｐ均＞０． ０５）。研究结果表明,因 ＧＥＪ常比 ＬＥＳ上缘偏低,故以 ＧＥＪ安放电极（尤其是ＧＥＪ＞ＬＥＳ上缘 ＋ ３ｃｍ或＜－ ３ｃｍ范围者）对反流性食管炎行 ｐＨ监测时