柴芍承气汤对急性坏死性胰腺炎合并肺损伤大鼠血PAF、TNF-α、IL-8的影响

近来研究证明,胰腺微循环障碍和炎性细胞因子在重症急性胰腺炎(SAP)病理生理中起重要作用.目前,中药治疗胰腺炎成为研究热点.本实验观察柴芍承气汤对急性坏死性胰腺炎(ANP)大鼠血中血小板活化因子(platelet activating factor,PAF)、肿瘤坏死因子-α(TNF-α)和IL-8水平的影响,探讨柴芍承气汤的作用机制.     

中西医结合治疗急性重症胰腺炎28例

目的:观察对照组(传统治疗组)与治疗组(中西医结合治疗组)对急性重症胰腺炎(severe acute pancreatits,SAP)的临床疗效.方法:48例随机分为对照组和治疗组,治疗组在西医常规治疗的基础上,以柴芍承气汤加减,汤药鼻管注入和直肠滴入,在胰腺体表投影部位芒硝碾碎成粉末与蜂蜜搅拌调制成膏状外敷、配合针灸、穴位注射新斯的明等中医药技术;分别对两组患者住院时间,腹痛腹胀缓解时间,肠鸣音恢复时间,血淀粉酶恢复时间及并发症及死亡发生率进行统计分析.结果:治疗组在住院天数(24±3.6d vs 32.5±2.5 d),腹痛(13.2±4.8h vs 25.6±5.1h),腹胀缓解时间(7.62±4.30h vs 12.5±5.1h),肠鸣音恢复时间(3.8±2.5h vs 8.2±2.25h),血淀粉酶恢复时间(6.5±1.0d vs 11_3±2.3d),并发症(25% vs 80%)及死亡率(7.14% vs 15%)明显短于或低于对照组.结论:中西医结合治疗SAP的疗效确切,值得推广应用.     

柴芍承气汤联合芒硝治疗重症急性胰腺炎的临床观察

目的 探讨柴芍承气汤联合芒硝治疗重症急性胰腺炎(SAP)的治疗作用.方法 将62例SAP患者按完全随机法分成柴芍组32例,对照组30例.对照组给予常规治疗,柴芍组在常规治疗的基础上加用柴芍承气汤联合芒硝治疗.观察两组患者腹痛持续时间、第1次排便时间、胃肠减压时间、平均住院日、高淀粉酶血症持续时间、并发症发生率及病死率.结果 柴芍组患者腹痛持续时间、第1次排便时间、胃肠减压时间、平均住院日及并发症发生率分别为(5.8±2.5)d、(1.84±0.67)d、(8.2±2.2)d、(21.2±12.5)d和15.6%,均较对照组显著降低(P<0.05);高淀粉酶血症持续时间为(10.2±3.2)、病死率为3.12%,较对照组降低,但无统计学意义(P>0.05).结论 SAP患者在进行常规治疗的同时应用柴芍承气汤联合芒硝可改善肠道功能,缩短病程,减少并发症发生率,改善患者的预后.     

丙酮酸乙酯对急性坏死性胰腺炎大鼠肺损伤的保护作用

目的:观察丙酮酸乙酯(EP)对急性坏死性胰腺炎(ANP)肺损伤大鼠血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)和肺组织高迁移率族蛋白B1(HMGB1)mRNA表达的影响,探讨丙酮酸乙酯治疗急性坏死性胰腺炎肺损伤的机制.方法:逆行性胰胆管注射50 g/L牛磺胆酸钠制作ANP模型.随机分成3组,对照组、ANP组和EP治疗组(40 mg/kg,每隔6h静脉注射一次).ELISA法检测血清TNF-α和IL-1β水平;半定量逆转录聚合酶链反应(RT-PCR)法检测肺组织HMGB1 mRNA表达,并观察血氧变化及肺组织的病理变化.结果:ANP组血清TNF-α和IL-1β水平在建模后6h达高峰,12h下降,在此两时点治疗组血清TNF-α和IL-1β水平明显低于ANP组(TNF-α:131.6±29.6 ng/L vs 196.3±16.3 ng/L,65.0±16.6 ng/L vs 90.2±20.1 ng/L,P<0.05;IL-1β:194.9±26.8 ng/L vs 223.0±34.8 ng/L,105.2±24.0 ng/L vs 130.4±23.0 ng/L,P<0.05).ANP组大鼠肺组织HMGB1 mRNA表达水平在ANP后12h明显升高,至24h仍维持在高水平.治疗组肺组织HMGB1 mRNA表达水平在各时间点均明显低于ANP组(0.68±0.11 vs 0.88±0.11,0.81±0.11 vs 1.04±0.10,1.08±0.08 vs 1.33±0.15,P<0.05),且同期肺损伤比ANP组轻.治疗组PaO_2均明显高于ANP组.结论:丙酮酸乙酯能显著抑制TNF-α、IL-1β和HMGB1等早晚期炎症因子,改善低氧血症,对ANP肺损伤有明显保护作用.     

丙氨酰-谷氨酰胺联合柴芍承气汤治疗重症急性胰腺炎72例

目的:探讨丙氨酰-谷氨酰胺联合柴芍承气汤对重症急性胰腺炎的治疗效果.方法:72例重症急性胰腺炎患者,随机分为对照组和治疗组,各36例.对照组采用常规治疗,治疗组在常规治疗的基础上加用谷氨酰胺和柴芍承气汤,治疗结束后检测两组均检测各项生化指标,治疗结束后进行对比并做统计学分析.结果:治疗组的D-二聚体(4.6±1.9vs8.1±2.5)、白细胞(9.5±3.2vs16.3±4.9)、血淀粉酶恢复正常时间(4.1±1.9vs8.6±2.7)以及腹痛缓解(2.8±0.7vs4.7±0.8)、腹水消失时间(8.2±1.5vs15.3±2.4)、住院时间(21±7.4vs34±12.6)均少于对照组,且两组有显著性差异(P<0.05);并发症和死亡率与对照组无统计学差异(P>0.05).结论:对于重症急性胰腺炎患者在常规治疗的基础上,使用丙氨酰-谷氨酰胺与柴芍承气汤有较好疗效.     

早期空肠内营养联合中药肠内滴注对重症急性胰腺炎患者肠麻痹的改善作用

目的:评价早期空肠内营养联合中药加味大承气颗粒肠内滴注治疗对改善重症急性胰腺炎患者肠麻痹的作用,探索重症急性胰腺炎的中西医结合治疗的新途径.方法:39例重症急性胰腺炎患者在常规治疗基础上,随机分成3组分别进行全胃肠外营养(PN组)、早期肠内营养(EN组)、肠内营养+中药大承气颗粒(EN+中药组)肠内滴注,观察患者腹痛腹胀缓解时间、胃肠道功能恢复(肠鸣音出现、肛门排气及排便)时间,并动态监测血淀粉酶、高敏C反应蛋白(CRP)、血浆肿瘤坏死因子-α(TNF-α).结果:EN组、EN+中药组患者经治疗后腹痛腹胀症状均缓解或消失,胃肠道功能恢复正常.PN组12例中,有2例腹胀、肠麻痹持续加重,其中1例出现腹腔隔室综合征并发多脏器功能衰竭.EN组、EN+中药组在腹胀(d)、腹痛缓解时间(d)以及胃肠道功能恢复时间(d)均优于PN组(4.22±0.94,3.02±0.75vs5.72±1.55;4.66±1.14,3.14±0.62vs6.81±1.81;3.42±0.82,3.21±0.88vs6.04±1.67,均P<0.05),其中EN+中药组腹胀(d)、腹痛缓解时间(d)优于EN组(3.02±0.75vs4.22...     

塞来昔布对大鼠重症急性胰腺炎的治疗作用

目的:探讨塞来昔布对大鼠重症急性胰腺炎(severe acute pancreatitis,SAP)治疗效果及机制.方法:SD大鼠共135只,其中75只随机平均分为SAP组,低剂量及高剂量塞来昔布组,观察其生存率;60只SD大鼠随机平均分为对照组(假手术组),SAP组,低剂量及高剂量塞来昔布组.胆胰管内注射牛磺胆酸钠溶液造模,ELISA法检测大鼠血清TNF-α、IL-1β及IL-6的表达;RT-PCR检测胰腺组织COX-2 mRNA的表达;HE染色、胰腺组织半定量积分评价胰腺病理学改变.结果:塞来昔布可降低大鼠SAP的病理损害积分,高剂量组在造模后的24 h可显著减低组织水肿(2.28±0.30 vs 2.73±0.22,P<0.05);在12和24 h均可显著降低腺泡坏死(2.03±0.15vs 2.48±0.24,2.09±0.10 vs 2.65±0.25,均p<0.05)及炎性细胞浸润(1.80±0.22 vs 2.51±0.17,1.57±0.26 vs 2.20±0.22,均p<0.05).造模后COX-2 mRNA表达及TNF-α、IL-1β及IL-6产生增加.塞来昔布治疗组上述检测指标明显低于SAP组(均P<0.05),且随塞来昔布剂量的增加其抑制作用逐渐增强.塞来昔布高剂量治疗组可显著提高大鼠SAP的生存率(16%vs 52%,P<0.05).结论:塞来昔布可能通过抑制TNF-α、IL-1β及IL-6的表达,改善胰腺局部病理改变及预后.     

乌司他丁联合丙氨酰谷氨酰胺对重症急性胰腺炎患者细胞因子的影响

目的:观察蛋白酶抑制剂乌司他丁联合丙氨酰谷氨酰胺对重症急性胰腺炎(SAP)患者血清细胞因子的影响.方法:64例SAP患者随机分为治疗组(乌司他丁联合丙氨酰谷氨酰胺治疗)及对照组(乌司他丁治疗)各32例,对照组加用乌司他丁1×105U溶于50g/L葡萄糖溶液250mL中静滴,8h1次,治疗组在对照组治疗的基础上每天加用丙氨酰谷氨酰胺0.4g/kg.结果:治疗组第7、10天TNF-α(ng/L)、和内毒素(ng/L)水平明显低于对照组(7d:38.83±14.71vs51.92±18.29;0.46±0.13vs0.71±0.19;10d:31.49±12.65vs48.36±15.43;0.22±0.07vs0.43±0.15;均P<0.05),IL-6在第7天时明显低于对照组(117.68±14.87vs163.43±19.76,P<0.05),IL-18两组各时间点差异无统计学意义.结论:蛋白酶抑制剂乌司他丁联合生长抑素能抑制SAP患者TNF-α、IL-6的表达和合成,减少肠道内毒素易位,有利于提高SAP患者的救治成功率.     

大鼠重症急性胰腺炎内毒素血症、细胞因子和一氧化氮的变化及善宁的治疗作用

目的:探讨内毒素血症、细胞因子和一氧化氮在重症急性胰腺炎(severe acuce pancreatitis, SAP)发展中的作用及善宁的治疗作用．方法:经胰管逆行注射15 g/L去氧胆酸钠建立SAP模型,给予善宁治疗,观察造模后各时间点血中内毒素(ET)、过氧化脂质(LPO), TNF-α,IL-6,一氧化氮(NO)的变化,并进行相关分析;于24 h后取胰腺组织,测定胰腺组织中LPO,TNF-α,IL-6和NO水平,同时进行相关分析及胰腺组织病理学检查．结果:与对照组比较,SAP组各时间点血浆 ET,LPO,TNF-α,IL-6,NO的水平明显升高 (P<0．01),其中ET,LPO,TNF-α和NO 6 h尤为显著(898±114 EU/L,24．58±1．23 μmol/L, 246．3±16．5 ng／L,162．8±10．9 mmol／L,P< 0．05 vs 12,24 h)．胰腺组织LPO,TNF-α,IL-6, NO的水平SAP组明显高于对照组(3．31±0．85 μmol/g vs 0．33±0．04 μmol/g,P<0．01:2．57± 0．14 ng/g vs 0．16±0．04 ng/g,P<0．01;85．6± 24．6 ng/g vs 32．5±5．7 ng/g,P<0．01;15．3± 1．2 mmol／g vs 6．6±1．4 mmol/g,P<0．01),光镜下胰腺组织病理损害明显．相关分析显示 SAP组血浆LPO,TNF-α,IL-6,NO水平分别与ET水平呈显著正相关(r=0．858,P<0．01:r =0．958,P<0．01;r=0．918,P<0．01;r=0．875, P<0．01)．善宁治疗后上述各指标均较SAP组明显改善(P<0．01)．结论:ET血症、细胞因子、NO等相互激发、相互促进,在SAP的发展中起着重要的协同作用．善宁能阻断这些损伤因子的连锁反应．     

大鼠重症急性胰腺炎三磷酸肌醇变化与钙代谢的关系

目的:观察重症急性胰腺炎(SAP)时三磷酸肌醇(IP3)变化及其与钙代谢的关系, 以探讨SAP的发病机制.方法:20只SD大鼠随机分为2组:重症急性胰腺炎模型组(SAP组)和对照组(C组), 每组10只. SAP组以30 g/L牛磺胆酸钠逆行胰胆管注射建立SAP模型, C组为假手术并注射生理盐水(NS). 两组术后立即、6 h行阴茎背静脉注射NS. 术后18 h处死动物. 观察各组胰腺细胞内IP3和钙(Ca2+)、血清肿瘤坏死因子α(TNF-α)、血清钙(血钙)和淀粉酶(AMY)及胰腺的病理改变.结果:SAP组胰腺细胞内IP3、Ca2+和TNF-α显著高于C组(252.99±35.72 μg/L vs 57.28±48.66 μg/L, 10.63±2.38 vs 2.50±1.04,281.66±106.83 ng/L vs 42.27±16.75 ng/L, 均P<0.05), 而SAP组的血钙明显低于C组(2.51±0.11 mmol/L vs 3.04±0.15 mmol/L, P<0.05).胰腺细胞内IP3与Ca2+和TNF-α间呈明显正相关( r = 0.987, 0.937, P<0.05), 上述三者与血钙呈明显负相关( r = -0.997, -0.980, -0.915, 均P<0.05). SAP组AMY和胰腺病理评分分别显著高于C组(5336.1±1937.83 U/L vs 783.5±200.07 U/L, 11.1±0.88 vs 6.4±1.07, 均P<0.05).结论:SAP存在胰腺细胞内IP3明显升高, IP3是引起细胞内外钙和TNF-α变化的重要原因之一.     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.