腹股沟疝嵌顿患者血清内毒素水平的临床监测分析

目的探讨血清内毒素与腹股沟疝嵌顿患者急诊行手法复位成功率及手法复位并发症发生率的关系。方法以腹股沟疝嵌顿患者急诊成功行手法复位的为A组（n=64）,未成功行手法复位的为B组（n=32）。B组中急诊手术治疗术中证实手法复位未出现并发症的为C组（n=26）,出现并发症的为D组（n=6）,由鲎三肽基质显色法测血清内毒素水平。结果A组腹股沟疝嵌顿患者血清内毒素水平（14．23±5．3）Eu／L较B组低（t=12．14,P〈0．05）,C组腹股沟疝嵌顿患者血清内毒素水平（27．5±8．2）Eu／L较D组低（t=10．46,P〈0．05）。结论血清内毒素水平与腹股沟疝嵌顿患者急诊手法复位成功率密切相关,与手法复位并发症发生率密切相关,可作为判断能否行手法复位有用指标。     

急性肺损伤大鼠多核白细胞与肺组织β受体变化的相关性研究

目的:观察急性肺损伤(ALI)大鼠循环血多核白细胞(PMN)和肺组织β肾上腺素能受体(β-AR)的变化,并探讨二者β-AR变化的相关性。方法:静注内毒素复制大鼠ALI模型,循环血PMN及肺组织β-AR用放射性配基结合分析法测定。结果:静注内毒素后1、4、6 h,大鼠循环血PMN及肺组织β-AR的最大结合容量(Bmax)均明显低于对照组(P＜0.01);静注内毒素后4 h, 6 h较1 h及6 h较4 h PMNβ-AR的Bmax均显著降低(P＜0.05),肺组织β-AR Bmax各内毒素组间差异不明显(P＞0.05);循环血PMN和肺组织β-AR变化在程度上无相关性(P＞0.05)。结论:ALI时循环血PMN及肺组织β-AR数目均明显减少,其在ALI发生发展中可能起一定的作用,但ALI时外周血PMN β-AR不能作为观察肺组织β-AR变化的相关指标。     

内毒素诱导原代肝细胞表达FasL及其细胞毒效应

目的 探讨内毒素直接与间接致肝细胞凋亡在内毒素血症肝脏损伤中的病理机制。方法 采用低浓度胶原酶原位循环灌流法分离,培养肝细胞,经不同浓度内毒素（１、５、１０μｇ／ｍｌ）作用２４、４８ｈ后免疫组织化学法检测肝细胞膜性ＦａｓＬ（ｍＦａｓＬ）表达及ＴＵＮＥＬ试验检测内毒素直接与间接致肝细胞凋亡情况。结果 内毒素作用２４ｈ后肝细胞ｍＦａｓＬ表达阳性程度为＋＋－＋＋＋,对照组为阴性,内毒素直接作用２４ｈ后肝     

肠源性内毒素血症在硫代乙酰胺所致肝损伤发病中的作用

目的探讨肠源性内毒素血症在硫代乙酰胺（thioacetamide,TAA）所致肝损伤模型发病机制中的地位和作用。方法选用雄性Wistar大鼠26只,随机分为4组,即正常组（N）及结肠切除（C）对照组;TAA损伤组（T）和结肠切除+TAA组（C+T）。采用生化检测法测定血浆内毒素含量和ALT活性。结果单纯给予TAA组,血浆内毒素水平和ALT活性显著高于其它三个组;而结肠切除+TAA组的血浆内毒素水平与结肠切除对照组和正常对照组相比无明显升高,ALT活性结肠切除组+TAA组和正常对照组比较明显升高,但比TAA组却明显减低。T组与C+T组血浆内毒素水平与ALT活性变化之间呈正相关关系（r＝0.985,P＜0.01）。结论TAA所导致的内毒素血症是肠源性内毒素血症;TAA本身有直接致肝细胞损伤的作用,但其所形成的肠源性内毒素血症造成的肝损伤更为严重。     

Changes in biologic markers of oxidative stress and plasma endotoxin levels in gynecologic cancer patients treated with pelvic radiotherapy: a pilot study

Objective

We conducted a pilot study to evaluate the effects of pelvic radiotherapy on biologic markers of oxidative stress and plasma endotoxin levels, and to assess the relationship between the changes of such factors and radiotherapy-related complications.

Methods

Twelve gynecologic cancer patients who were treated via pelvic radiotherapy with or without concurrent chemotherapy were enrolled in this study. Biologic markers of oxidative stress, such as glutathione (GSH) and oxidized glutathione (GSSG), as well as endotoxin levels, were measured weekly during treatment. Subjective symptoms were assessed using the Korean version of the EORTC QLQ-C30 at the baseline and on the 5th week of radiotherapy.

Results

No changes were noted in the level of GSH in whole blood, but the GSH/GSSG ratio was reduced dramatically after the initiation of radiotherapy. The mean plasma endotoxin for all patients tended to increase and persisted during radiotherapy, and the number of patients who evidenced clinically significant endotoxin levels (defined as >0.005 EU/mL) also increased. Nausea/vomiting and diarrhea were significantly changed (p=0.019 and p<0.001, respectively). A significant relationship was noted to exist between the changes in the endotoxin level and nausea/vomiting (p=0.001). However, such symptoms did not correlate with the changes of oxidative stress markers.

Conclusion

Pelvic radiotherapy oxidized the GSH redox system and increased plasma endotoxin. Further investigations containing interventional and longitudinal studies will be required to assess the effects of the changes in oxidative stress markers and endotoxin on radiotherapy-related adverse events.     

血管活性肠肽对肺损伤大鼠Toll样受体mRNA表达的影响

目的 探讨血管活性肠肽(vasoactive intestinal peptide,VIP)对内毒素(脂多糖,lipopolysaceberide,LPS)致休克大鼠肺损伤后Toll样受体(Toll-like receptor,TLR)2和TLR4 mRNA表达的影响.方法 40只SD大鼠,随机分为LPS组(16只)、LPS+VIP组(16只)和对照组(8只).LPS组尾静脉注射LPS(E.coli O_(55)B_5)10 mg/kg;LPS+VIP组尾静脉注射LPS 10 ms/kg后注射VIP 5 nmol/kg;对照组尾静脉注射等容量生理盐水.分别于注射后6 h和24 h处死,留取肺标本,RT-PCR检测肺TLR2/4 mRNA表达,并观察24 h时肺组织病理变化.结果 (1)肺组织病理改变:制模24 h时.光镜和透射电镜下,LPS组见肺泡间隔弥漫性增宽、炎性细胞浸润,隔内毛细血管不同程度充血,肺泡壁增厚,肺泡腔结构破坏、炎性细胞浸润、出血、间质水肿、细胞器破坏,LPS+VIP组病变较轻.(2)TLR2/4 mRNA表达:注射LPS后6 h、24 h,肺组织TLR2/4 mRNA表达升高(F=16.638,P=0.000;t=5.876,P=0.000);24 h时LPs+VIP组TLR2/4 mRNA表达低于LPS组(F=16.676,P=0.000;t=3.9,16,P<0.001).结论 LPS致休克大鼠肺损伤时,肺组织TLR2/4 mRNA表达增强.VIP可减轻LPS所致肺损伤,其机制可能与下调重要炎症基因TLR2/4 mRNA表达有关.     

肠内免疫微生态营养对重症急性胰腺炎全身炎性反应及预后的影响

目的 探讨肠内免疫微生态营养对重症急性胰腺炎(SAP)全身炎性反应及预后的影响.方法 57例SAP患者在人院48 h内采用随机数字表法被随机分为肠外营养组(PN组)28例和肠内免疫微生态营养组(EIN组)29例,分别进行相应的营养支持7d.入院时及营养后1、3、5、7 d分别检测外周血内毒素、TNF-α、IL-1β、IL-6、IL-10及单核细胞NF-κB活性,并统计两组治疗结果.结果 入院时EIN组内毒素、TNF-α、IL-1β、IL-6、IL-10及单核细胞NF-κB活性与PN组比较差异无统计学意义;营养后7 d,EIN组内毒素、TNF-α、IL-1β、IL-6、IL-10及单核细胞NF-κB活性分别为(2.70±O.13)ng/L、(30.13 4±8.12)ng,L、(20.17±8.04)ng,L、(36.43±8.24)ng,L、(86.45 ±14.54)ng/L、(70.4±3.2)%,均较PN组的(3.25±0.32)ndL、(313.42±144.35)ng/L、(155.29±32.78)ng/L、(324.15±31.47)ng/L、(472.72±48.55)ng/L、(88.4±5.3)%明显下降(P<0.05或<0.01).结论 早期肠内免疫微生态营养能有效减轻内毒素血症,减低NF-κB活性及细胞因子浓度,维持促抗炎反应平衡,改善患者病情及预后.     

Analyse des risques et validation du procédé de production du liquide de substitution de la technique d’hémodiafiltration en ligne

IntroductionOnline hemodiafiltration is a technique of dialysis with many advantages, but its use is limited because of the lack of control of microbiological risks. This work conducts a risk analysis of the process for producing substitution liquid for online hemodiafiltration and validates this process from a microbiological point of view.Material and methodThe risk analysis was carried out following the approach of analysing failure modes, their effects and their criticalities. It identified the “worst case” of the production process being studied. For the validation of this process, we used the limulus amoebocytes lysate assay for bacterial endotoxins and the membrane filtration test for sterility control.ResultsWe identified 17 failure modes, 13 of which were acceptable. Failure modes that exceeded the acceptability threshold were defined as “worst cases”. Sterility monitoring and endotoxin testing, conducted in the “worst case”, verified the microbiological quality of the liquid produced to the required standards and subsequently validated the process used.DiscussionThis approach has resulted in the identification of as many failure modes as possible. Validating in “worst case” is an extreme challenge to the process and its success provides a sufficient basis to conclude that the technique is safe and, therefore, to validate the process.ConclusionThis work has enabled us to validate our production process in extreme cases to promote safer use of the technique.     

强弱电针对内毒素致热兔散热过程影响的对比观察

目的　观察强、弱电针对兔内毒素性耳温变化的影响,确定针刺散热功效及其与躯体传入系统的关系。方法　使用热敏电阻温度计与计算机联机采样方法。结果　强电针对小剂量（２５ Ｅ Ｕ）及大剂量（２００ Ｅ Ｕ）内毒素引起的耳温变化均产生明显的抑制性影响,但弱电针无此效应。结论　提示针刺散热主要是通过躯体细纤维（Ⅲ、Ⅳ类）传入系统引起的,并验证了内毒素性耳温变化是可以作为针刺散热作用观察指标的     

内毒素、IL-1β对家兔下丘脑神经细胞内游离钙浓度的影响

目的:研究内毒素(ET)性发热家兔下丘脑神经细胞内游离钙([Ca²⁺]i)浓度变化及ET、白介素-1β(IL-1β)对正常家兔离体下丘脑神经细胞 [Ca²⁺]i浓度的影响。方法:采用荧光分光光度法,应用钙离子探针(Fura-2/AM),检测 i浓度。结果:(1)微量ET(2 ng/mL)使正常家兔下丘脑神经细胞内 [Ca²⁺]i浓度显著升高;ET性发热家兔下丘脑神经细胞 [Ca²⁺]i水平也显著高于对照组;(2) 3种剂量IL-1β(100、500、1 000 ng/mL)均未能明显影响下丘脑神经细胞 [Ca²⁺]i 浓度。结论:(1)低Ca²⁺参与ET性发热体温调节的作用部位,可能不是在下丘脑神经细胞内;(2)ET引起下丘脑神经细胞 [Ca²⁺]i 浓度变化,不是通过IL-1β直接引起。