小肠粘膜下层的制备及细胞相容性的实验研究

目的了解猪小肠粘膜下层(SIS)的细胞相容性,探讨用SIS为生长载体复合骨髓基质干细胞(BMSCs)构筑组织工程骨的可能性。方法用物理和化学方法处理猪小肠粘膜下层,将兔骨髓基质干细胞与SIS进行体外复合培养,分别进行组织学、相差显微镜和扫描电镜观察。结果经物理和化学处理的SIS纯度高,孔隙多,胶原纤维未受损;BMSCs在SIS材料上生长、粘附、增殖,并能长入材料的孔隙内,分泌大量的细胞外基质成分。结论SIS的细胞相容性良好,不影响BMSCs的形态,对细胞生长和功能表达无抑制作用,可以用作骨组织工程的支架材料。     

Fecal stream is essential for adaptive induction of glucose-coupled sodium transport in the remnant ileum after total proctocolectomy

Our previous studies demonstrated that sodium glucose cotransporter 1 (SGLT-1) was induced in the remnant ileum of total colectomized rats via the action of factors other than hyperaldosteronism. The aim of the present study was to clarify whether fecal stream is required for the enhancement of SGLT-1-mediated sodium transport. Twenty-seven pairs of ileal tissues were obtained from the proximal and distal side, respectively, of loop ileostomy after total proctocolectomy. Mucosae were mounted in an Ussing chamber to evaluate glucose-coupled sodium transport. Levels of SGLT-1 mRNA in proximal and distal mucosae were compared by Northern blotting. Villous height and crypt depth were measured to test for correlations between mucosal structure and SGLT-1-mediated sodium transport or mRNA expression levels. Both glucose-coupled sodium transport and expression of SGLT-1 mRNA were significantly lower in distal mucosae relative to proximal mucosae. In distal mucosae, villous height, but not crypt depth, was significantly lower than in proximal mucosae, demonstrating a positive correlation between villous height and SGLT-1 function and expression. Comparative studies of proximal and distal mucosae demonstrated that in addition to hormonal changes, fecal stream is required for full induction of the sodium transport system (which includes SGLT-1-mediated transport) in the remnant ileum following total proctocolectomy. Presented in part at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–19, 2005 (poster presentation). This work was supported by Grants-in-Aid for Scientific Research 10557118 and 14657295 from the Ministry of Education, Science and Culture of Japan to K. Fukushima, and by Kanae Foundation to K. Fukushima.     

No difference in symptoms of irritable bowel syndrome between healthy subjects and patients with recurrent depression in remission

There is bidirectional comorbidity between anxiety/depression and irritable bowel syndrome (IBS). To investigate the prevalence of IBS symptoms, and factors associated with gastrointestinal symptoms in patients with recurrent depressive disorder. Patients (n = 95) with recurrent type of major depression according to DSM-IV criteria and sex- and age-matched controls (n = 190) were sent questionnaires investigating symptoms of IBS [Gastrointestinal Symptom Rating Scale (GSRS)-IBS] and symptoms of anxiety and depression [Hospital Anxiety and Depression Scale (HADS)]. Medical records were checked over a 10-year period for chronic somatic symptoms or diseases. Seventy-three patients with unipolar disorder (mean age 63.6 years SD 13.8; range 23-86 years) and 156 controls (mean age 59.2 years SD 11.6, range 21-85 years) responded. Patients with recurrent depression had higher GSRS-IBS scores and showed a strong correlation between symptoms of IBS and anxiety-depression (r(s) = 0.54; P < 0.001). IBS symptoms were also associated with multiple pain symptoms, higher health-seeking behaviour and selective-serotonin-reuptake inhibitor intake. However, patients with recurrent depression (n = 46) in remission (HADS-Depression score <8) did not have more symptoms of IBS than controls (GSRS-IBS median score 6.0 vs 6.5; P = 0.46). There is a strong association between symptoms of IBS and symptoms of anxiety and depression, whereas depressive patients in remission do not have more IBS symptoms than controls.     

儿童肠旋转不良的诊断与治疗（附18例分析）

目的 儿童肠旋转不良在临床上诊断困难，易漏诊而延误治疗，本文拟通过回顾性分析总结诊断与治疗本病的要点。方法 对18例4-15岁的先天性肠旋转不良患儿进行回顾分析。结果 发现儿童肠旋转不良其临床表现有症状较轻且不典型的特点，具体表现为：（1）复发性呕吐，且可以是非胆汁性呕吐；（2）间歇性腹痛；（3）便秘或顽固性腹泻。结论 出现反复性呕吐（包括非胆汁性呕吐）、腹痛、腹泻久治不愈者，应常规行钡灌肠检查，如证实为肠旋转不良，Ladd’s手术是安全可靠的治疗方法。     

胃肠道肿瘤术后复发与肠粘连引起的肠梗阻临床分析

目的：探讨胃肠道肿瘤复发和粘连性肠梗阻的临床区别和治疗特点。方法：回顾性复习了经手术治疗的86例胃肠道肿瘤术后出现肠梗阻的临床资料，并分析其在临床上区别和治疗特点。结果：86例中粘连性肠梗阻39例，肿瘤复发47例，在复发组胃癌术后复发最为多见(P＜0．05)，原发性肿瘤分化差的其复发引起肠道梗阻明显高于分化好引起的粘连性肠梗阻(P＜0．01)。症状上肿瘤复发组出现的恶心、呕吐及肛门停止排便排气低于粘连性肠梗阻(P＜0．01)。肿瘤复发的肠梗阻表现为不全性梗阻，口服泛影葡胺治疗多能缓解，但大部分患者部分症状仍存在，粘连性肠梗阻多为完全性肠梗阻(P＜0．005)，多需要手术。结论：低分化原发肿瘤、不全性肠梗阻、低发生率的恶心和呕吐及肛门停止排便排气的肠梗阻，多提示为肿瘤的复发，泛影葡胺治疗后梗阻缓解但仍有症状存在应首先考虑是肿瘤复发。     

肠道T细胞淋巴瘤临床分析

本文总结报告了3例肠道T细胞淋巴瘤(intestinal T-cell lymphoma，ITCL)的诊治资料，并结合文献复习，发现IT—CL多见于中年男性，以腹痛、血便、发热、体质量下降为主要症状，治疗效果差，预后不良。病理改变以肠道溃疡形成为特点，溃疡形态呈多形性、多灶性、不规则，镜下瘤细胞明显异型、弥漫性浸润，中至大细胞多见。肿瘤细胞呈T细胞表型。ITCL临床少见，缺乏特异性临床表现，极易误诊。故临床医师应重视对ITCL临床病理特征、免疫表型和基因型的研究，注意识别，促其早期诊治。     

复合吸收促进剂对葛根素肠吸收及毒性的影响

目的 考察吸收促进剂配伍对葛根素肠吸收的影响,并进一步观察复合吸收促进剂对肠黏膜的毒性.方法 运用外翻肠囊法,采用L9(3)4正交设计试验考察各吸收促进剂的协同作用,确定较理想复合吸收促进剂;运用显微形态学观察复合吸收促进剂对肠黏膜的毒性.结果 复合吸收促进剂:1%壳聚糖、0.02%白芷挥发油、0.06%冰片配伍具有协同作用,可显著提高葛根素的肠吸收;复合吸收促进剂无肠黏膜毒性.结论 1%壳聚糖、0.02%白芷挥发油、0.06%冰片配伍可安全有效地促进葛根素的肠吸收.     

胆囊结石与胆囊收缩素受体(CCK-A)和血管活性肠肽(VIP)的关系研究

目的探讨胆囊动力学异常在胆囊结石形成中的作用.方法随意选择胆囊结石患者35例,胆囊息肉样病变患者25例,正常对照30例.B超测空腹胆囊容积.放射免疫法测定血浆中血管活性肠肽(VIP)的浓度,逆转录-聚合酶链反应(rt-PCR)法测胆囊黏膜中胆囊收缩素(CCK-A)受体表达数目.结果①胆囊结石组胆囊空腹体积明显大于其它两组(F=3.45,P=0.039);②胆囊结石组胆囊收缩率明显低于其它两组 (F=5.747,P=0.005);③三组之间餐后VIP升高量无明显差异 (F=0.768,P=0.47);④胆囊结石组胆囊收缩素(CCK-A)受体表达明显低于胆囊息肉样病变组(t′=4.390,P=0.022),差异具有显著性.结论①胆囊结石组空腹胆囊体积增大与其胆囊结石形成有关; ②胆囊结石组胆囊收缩功能下降导致结石形成;③胆囊收缩素(CCK-A)受体表达低,使胆囊收缩功能减弱,促进胆囊结石的形成;④血管活性肠肽(VIP)与胆囊结石的形成无明显关系.     

盐炙对补骨脂吸收特性的影响

 目的通过考察炮制前、后补骨脂中主要成分补骨脂素和异补骨脂素胃肠道吸收参数的变化,研究炮制对补骨脂吸收特性的影响。方法以SD大鼠为模型动物,进行大鼠在体肠灌注实验。并分别考察高、中、低3个浓度下的药动学参数,以确定浓度对吸收的影响。采用t检验法考察生品和盐炙品中补骨脂素和异补骨脂素的药动学参数之间的差异。结果生品中补骨脂素在高、中、低3个浓度下的吸收速率常数为0.203,0.165,0.203 h^-1,异补骨脂素的吸收速率常数则分别为0.178、0.168,0.204 h^-1;而盐炙品中补骨脂素在高、中、低3个浓度下的吸收速率常数为0.326,0.377,0.369 h^-1,异补骨脂素的吸收速率常数则分别为0.373,0.371,0.329 h^-1。盐炙品的吸收速率明显高于生品,而不同浓度下的吸收速率常数没有明显变化。结论补骨脂生品和盐炙品在小肠中的吸收机制是简单的被动扩散,吸收呈现一级动力学过程;炮制可以增加补骨脂的吸收。