奥曲肽联合白蛋白对重症急性胰腺炎患者肠黏膜屏障功能的影响

目的分析奥曲肽联合白蛋白治疗重症急性胰腺炎患者的临床效果。方法选取2017年4月至2018年6月本院收治80例重症急性胰腺炎患者作为研究对象,采用随机数字表法分为观察组和对照组,每组40例。对照组患者采用常规治疗+奥曲肽,观察组采用常规治疗+奥曲肽+白蛋白。比较两组患者治疗后肠黏膜屏障功能[二胺氧化酶(DAO)、D-乳酸、内毒素]指标变化,同时比较临床相关指标改善情况。结果治疗前,两组患者DAO、D-乳酸、内毒素水平比较差异无统计学意义;治疗后,观察组患者DAO、D-乳酸、内毒素水平均低于对照组,差异有统计学意义(t=7.011、14.091、6.034,P均=0.000);观察组患者腹痛消失时间、退热时间、血淀粉酶恢复时间、住院时间均短于对照组,差异有统计学意义(t=2.952、4.314、3.380、3.932,P=0.004、0.000、0.001、0.000)。结论奥曲肽联合白蛋白治疗重症急性胰腺炎患者临床效果显著,可有效改善患者临床症状,缩短住院时间,促进肠黏膜屏障功能恢复。     

Contact lens-related corneal infection: Intrinsic resistance and its compromise

Contact lenses represent a widely utilized form of vision correction with more than 140 million wearers worldwide. Although generally well-tolerated, contact lenses can cause corneal infection (microbial keratitis), with an approximate annualized incidence ranging from ~2 to ~20 cases per 10,000 wearers, and sometimes resulting in permanent vision loss. Research suggests that the pathogenesis of contact lens-associated microbial keratitis is complex and multifactorial, likely requiring multiple conspiring factors that compromise the intrinsic resistance of a healthy cornea to infection. Here, we outline our perspective of the mechanisms by which contact lens wear sometimes renders the cornea susceptible to infection, focusing primarily on our own research efforts during the past three decades. This has included studies of host factors underlying the constitutive barrier function of the healthy cornea, its response to bacterial challenge when intrinsic resistance is not compromised, pathogen virulence mechanisms, and the effects of contact lens wear that alter the outcome of host-microbe interactions. For almost all of this work, we have utilized the bacterium Pseudomonas aeruginosa because it is the leading cause of lens-related microbial keratitis. While not yet common among corneal isolates, clinical isolates of P. aeruginosa have emerged that are resistant to virtually all currently available antibiotics, leading the United States CDC (Centers for Disease Control) to add P. aeruginosa to its list of most serious threats. Compounding this concern, the development of advanced contact lenses for biosensing and augmented reality, together with the escalating incidence of myopia, could portent an epidemic of vision-threatening corneal infections in the future. Thankfully, technological advances in genomics, proteomics, metabolomics and imaging combined with emerging models of contact lens-associated P. aeruginosa infection hold promise for solving the problem - and possibly life-threatening infections impacting other tissues.     

Acrylamide exposure impairs blood-cerebrospinal fluid barrier function

Previous studies show that chronic acrylamide exposure leads to central and peripheral neu- ropathy. However, the underlying mechanisms remained unclear. In this study, we examined the permeability of the blood-cerebrospinal fluid barrier, and its ability to secrete transthyretin and transport leptin of rats exposed to acrylamide for 7, 14, 21 or 28 days. Transthyretin levels in cerebrospinal fluid began to decline on day 7 after acrylamide exposure. The sodium fluorescein level in cerebrospinal fluid was increased on day 14 after exposure. Evans blue concentration in cerebrospinal fluid was increased and the cerebrospinal fluid/serum leptin ratio was decreased on days 21 and 28 after exposure. In comparison, the cerebrospinal fluid/serum albumin ratio was increased on day 28 after exposure. Our findings show that acrylamide exposure damages the blood-cerebrospinal fluid barrier and impairs secretory and transport functions. These changes may underlie acrylamide-induced neurotoxicity.     

腹腔镜胃癌根治术对肠道屏障功能损伤的研究分析

目的:对比腹腔镜与传统开腹胃癌根治术对胃癌患者肠道屏障功能的损伤及手术效果,为临床术式选择提供依据。方法:选择2008年10月至2012年10月113例胃癌患者,其中57例为观察组,行腹腔镜胃癌D2根治术;56例为对照组,行开腹胃癌D2根治术。观察两组患者手术时间、失血量、切口长度、肠道功能恢复时间、清除淋巴结数量、住院时间及术后第1天、第3天、第5天、第7天血浆D-乳酸浓度、血浆二胺氧化酶浓度、C-反应蛋白值等。结果:两组淋巴结清除数量差异无统计学意义(P>0.05);手术时间观察组长于对照组,但在出血量、切口长度、肠道功能恢复时间及住院时间方面观察组明显优于对照组,差异有统计学意义(P<0.01)。两组患者术后第1天、第3天血浆D-乳酸浓度、二胺氧化酶浓度及C-反应蛋白值差异有统计学意义(P<0.05);术后第5天、第7天血浆D-乳酸浓度、二胺氧化酶浓度及C-反应蛋白值差异有统计学意义(P<0.01)。结论:腹腔镜胃癌根治术是安全、有效的微创手术,与传统开腹胃癌根治术相比,对肠道屏障功能的损伤更小,更利于患者术后快速恢复,值得临床推广。     

Blood-testis barrier and spermatogenesis： lessons From genetically-modified mice

The blood-testis barrier （BTB） is found between adjacent Sertoli cells in the testis where it creates a unique microenvironment for the development and maturation of meiotic and postmeiotic germ cells in seminiferous tubes. It is a compound proteinous structure, composed of several types of cell junctions including tight junctions （TJs）, adhesion junctions and gap junctions （GJs）. Some of the junctional proteins function as structural proteins of BTB and some have regulatory roles. The deletion or functional silencing of genes encoding these proteins may disrupt the BTB, which may cause immunological or other damages to meiotic and postmeiotic cells and ultimately lead to spermatogenic arrest and infertility. In this review, we will summarize the findings on the BTB structure and function from genetically-modified mouse models and discuss the future perspectives.     

健脾类中药修复肠黏膜屏障损伤的研究进展

肠黏膜屏障作为肠道内环境与外界接触的第一道防线,是肠道防御机制最重要的环节,能够维持机体内的稳定环境。肠黏膜屏障损伤,会使肠道通透性改变,导致细菌移位、内毒素入血,从而诱发一系列由炎症反应引起的相关组织损伤,加重原发疾病的发生。脾为后天之本,能维持人体的内外平衡,抵御外邪,其生理功能与肠黏膜屏障的功能具有相似之处。脾气亏虚,易导致肠黏膜屏障功能下降。因此益气健脾、恢复脾胃之气的防御和运化功能是防治肠黏膜屏障损伤的基础及关键所在。近年来研究表明,健脾类中药可通过促进肠上皮细胞紧密连接蛋白表达、调节肠道免疫功能、菌群及其代谢产物和补充肠道营养等作用修复肠黏膜的损伤,逐渐成为研究热点。现结合国内外研究,阐述常见中医证型及脾虚时肠黏膜屏障的变化、健脾类中药对肠黏膜屏障损伤的修复作用机制,以期为健脾类中药治疗肠黏膜屏障功能紊乱相关疾病的研究提供一定线索。     

迷迭香酸干预PI3K/Akt信号通路保护缺氧/复氧损伤血脑屏障功能的影响

[目的] 考察迷迭香酸对缺氧/复氧损伤血脑屏障功能的影响并探讨作用机制。[方法] 通过单层血脑屏障体外模型,考察药物对细胞活力、乳酸脱氢酶漏出率、跨细胞间电阻值、异硫氰酸荧光素-葡聚糖透过率的变化,同时分析相应关键信号分子的变化。[结果] 与正常对照组比较,缺氧/复氧损伤可导致细胞活力降低,乳酸脱氢酶漏出增加,跨细胞间电阻值降低,异硫氰酸荧光素-葡聚糖透过率增加,罗丹明123（Rh123）蓄积增多,提示缺氧/复氧损伤条件下内皮屏障功能受损。给予迷迭香酸后血脑屏障功能明显改善,分子信号显著上调。[结论] 迷迭香酸可通过激活PI3K/Akt信号通路发挥保护缺氧/复氧损伤的血脑屏障功能的作用。     

从“脾为之卫”浅析腹泻型肠易激综合征肠黏膜机械屏障损伤机制

肠黏膜机械屏障受损是腹泻型肠易激综合征(IBS-D)的重要病理生理基础,是目前的研究热点及新方向。“脾为之卫”是指脾具有抗御外邪、保护机体的作用,主要依托于“脾主运化”“脾主升清”而产生,“正气存内,邪不可干”是“脾为之卫”的主要内涵。从现代医学角度阐述,“脾为之卫”理论与肠黏膜机械屏障相通,是对于人体抵御外界有害物质侵袭功能的描述。脾气亏虚,正气不足,抗邪无力,湿邪内侵而致泄泻。脾气虚弱,肠黏膜机械屏障受损,有害物质通过肠黏膜直接作用于肠道而致腹痛、腹泻。现以“脾为之卫”为切入点,探讨脾虚型腹泻型肠易激综合征(IBS-D)肠黏膜机械屏障的损伤机制,为健脾益气法治疗IBS-D夯实理论基础,且为从“肠黏膜屏障”的角度治疗IBS-D提供理论依据。     

中风康对局灶性脑缺血大鼠脑组织超微结构的影响

目的:探讨中药中风康对局灶性脑缺血大鼠脑组织超微结构的影响.方法:采用线栓法复制局灶性脑缺血大鼠模型.以步长脑心通为对照,于脑缺血48 h观察中风康(主要成分:枸杞子、怀牛膝、川芎、水蛭、地龙、橘络、胆南星、石菖蒲、冰片等)对局灶性脑缺血大鼠脑组织含水量和超微结构的影响.结果:与假手术组比较,模型组出现明显的血-脑屏障和神经元超微结构损害,脑组织含水量增加(P<0.01);与模型组比较,各治疗组脑组织超微结构损害均有不同程度减轻,脑组织含水量均下降(P均<0.01).结论:中风康可减轻缺血时脑组织超微结构的损害,维护血-脑屏障的完整性,有效减轻脑水肿和神经元的缺血坏死.     

急性脑梗死动脉溶栓术后脑出血与"脑染色"的鉴别诊断

目的研究急性脑梗死早期(6 h之内)动脉溶栓治疗后即刻脑CT征象及脑出血危险因素.方法对82例急性脑梗死早期溶栓治疗后的患者进行头颅CT检查,观察即刻、4～6 h、24 h脑CT表现.结果即刻CT扫描出现27例高密度区,包括脑组织染色8例,其中神经核团染色5例,脑灰质染色3例;溶栓后脑出血15例;亚急性脑梗死区脑组织染色4例.CT早期缺血改变及较低的ESS评分是脑动脉溶栓术后脑出血的主要危险因素,它们的相对危险度分别为8.33和11.35.结论急性脑梗死动脉溶栓后即刻脑CT显示的脑组织染色是由于闭塞的脑血管部分或全部再通,引起缺血-再灌流损伤,进一步损伤血管内皮,使血管通透性增加,局部血脑屏障受损,含对比剂的血液内液体成分渗到脑组织间隙所致,使血管再通区受损伤的灰质或神经核团的脑组织染色,白质不染色.随着对比剂在体内的减少,染色在几小时后逐渐变淡,此种表现是闭塞的脑血管再通前局部脑组织已出现缺血性脑梗死的征象,勿误认为脑出血征象.