中药胰必清对急性出血坏死性胰腺炎急性肺损伤大鼠肺泡巨噬细胞的作用

目的 观察TLR4、核转录因子(NF)-κB在急性出血坏死性胰腺炎(AHNP)大鼠肺泡巨嗜细胞的表达及应用胰必清(YBQ)治疗前后的变化.方法 72只SD大鼠平均随机分为3组:A组(假手术对照组)、B组(AHNP)及C组(AHNP+YBQ),开腹胰胆管注入5%牛磺胆酸钠法建立大鼠AHNP模型,分别于术后3、6、12、24 h处死大鼠,逆转录·聚合酶链反应(RT-PCR)法、免疫荧光共聚焦法分别检测支气管灌洗液肺泡巨噬细胞中TLR4 mRNA、NF-KB表达水平的变化,肺组织病理检查行病理学评分.结果 C组肺泡巨噬细胞3、6、12、24 h TLR4 mRNA表达水平结果为0.54、0.65、0.65、0.54,NF.KB免疫荧光检测结果为49.54、68.67、74.27、59.23,与肺组织的病理学评分相一致,随时间的延长而逐渐升高,6～12 h左右达高峰,与时间明显相关,与B组比较明显降低,差异有统计学意义(P《0.05).结论 中药胰必清能通过调节肺泡巨噬细胞中TLR4的基因表达,进一步调节NF-KB的活化来改善AHNP-ALI.     

大承气汤对急性出血坏死性胰腺炎急性肺损伤大鼠肺泡巨噬细胞的影响

目的观察大承气汤对急性出血坏死性胰腺炎（AHNP）并发急性肺损伤（ALI）大鼠肺泡巨噬细胞的影响。方法SD大鼠经胆胰管逆行注射5％牛磺胆酸钠（1ml／kg,0．1ml／min）诱发AHNP,AHNP＋DT组在造模后30min用大承气汤（10ml／kg）灌胃;AHNP＋DEX组在造模后30min经尾静脉地塞米松（O．5ms／100g）注射;AHNP＋DT＋DEX组则于造模后30min同时给予大承气汤（10ml／kg）灌胃和地塞米松（0．5mg／100g）尾静脉注射,比较3、6、12、24h各个时间段不同治疗方法支气管灌洗液肺泡巨噬细胞数量、吞噬功能和肺干湿比变化。结果AHNP＋DT组和AHNP＋DT＋DEX组两组肺泡巨噬细胞的数量明显减少、吞噬功能减弱,与模型组和AHNP＋DEX组比较,P〈0．05,差异有显著性。结论大承气汤能抑制肺泡巨噬细胞的吞噬活性、改善急性肺损伤。     

急性出血坏死性胰腺炎肝损伤Toll样受体2/4mRNA的表达变化

目的研究急性出血坏死性胰腺炎（AHNP）肝损伤Toll样受体（TLR）2／4 mRNA表达的变化规律。方法采用逆行胰胆管牛磺胆酸钠（TAC）注射制造AHNP肝损伤动物模型。动物分为假手术组（S组）、胰腺炎组（P组）。RT—PCR方法检测不同时间点肝组织TLR2和TLR4 mRNA表达变化。结果P组大鼠3h肝组织TLR2和TLR4 mRNA表达开始增高,伤后6～12h肝组织TLR2和TLR4 mRNA表达迅速达到峰值（P〈0.05或P〈0．01）,肝损伤加重（P〈0.05或P〈0.01）。S组变化不明显。结论AHNP肝组织内TLR2和TLR4的基因表达上调。肝组织内TLR2和TLR4的基因表达增高可能在AHNP肝脏损伤的发生、发展中起作用。     

Toll-样受体2，4mRNA在急性出血坏死性胰腺炎肺损伤中的表达变化

目的研究急性出血坏死性胰腺炎（AHNP）肺损伤中Toll-样受体（TLR）2/4mRNA表达的变化规律.方法建立AHNP肺损伤动物模型.动物分为假手术组（S组）、胰腺炎组（P组）.计算各组肺组织学评分和肺损伤指数以评价肺损伤的程度;RT-PCR方法检测不同时间点肺组织TLR2和TLR4mRNA表达的变化.结果肺组织TLR2和TLR4mRNA在S组仅有低表达,在P组3h表达开始增高,伤后6～12h该两指标表达达到峰值（P＜0.05或P＜0.01）,而S组变化不明显.结论AHNP时,肺组织内该两种基因的表达上调;肺组织内TLR2和TLR4的基因表达增高可能在AHNP肺损伤的发生、发展中起作用.     

生长抑素对急性出血坏死性胰腺炎肝损伤的作用机制

目的探讨生长抑素对大鼠急性出血坏死性胰腺炎（AHNP）时肝损伤的治疗作用及其机制。方法逆行胰胆管注射牛磺胆酸钠（TAC）制备AHNP模型。动物分为假手术组（SO组），AHNP生理盐水处理组（AHNP组）和AHNP奥曲肽治疗组。各组动物术后3，6，12h剖杀，检测肝组织中Toll一样受体（TLR）2，4mRNA和细胞核转录因子（NF—KB）的表达情况。结果与SO组比较，胰腺炎组大鼠TLR2，4mRNA于3h开始升高，于12h达高峰（均P〈0．01）；肝组织中NF—KB于3h开始表达增强，6h达高峰。奥曲肽组肝组织中的TLR2，4mRNA及NF—KB各时点表达均较AHNP组降低（P〈0．05）。结论生长抑素对AHNP有显著的保护作用。其机制可能是通过抑制胰弹性蛋白酶的分泌与激活，抑制Toll受体和NF-κB表达，降低炎症反应，从而减轻肝损伤。     

急性出血坏死性胰腺炎肝损伤中TLR2/4mRNA的表达及氯喹的干预效应

目的： 研究急性出血坏死性胰腺炎（AHNP）肝损伤中Toll-样受体(TLR)2/4mRNA表达的变化及氯喹的干预效应。 方法：采用逆行胰胆管牛磺胆酸钠（TAC）注射造成大鼠AHNP肝损伤动物模型。动物分为假手术组（S组）、胰腺炎组和氯喹（CQ）治疗组。后2组于术后3，6，12 h分批剖杀，S组于术后6 h剖杀。观察血清淀粉酶、ALT和AST及肝组织NO和TNF-α的变化，RT-PCR方法检测各组不同时点肝组织TLR2和TLR4mRNA的表达。 结果：相对于S组，胰腺炎组大鼠3 h肝组织TLR2和TLR4mRNA表达开始增高，术后6～12 h肝组织TLR2和TLR4mRNA表达迅速达到峰值（P<0.05），肝损伤加重，血清淀粉酶升高，肝组织TNF-α浓度升高，NO浓度逐渐降低（P<0.05）；相对胰腺炎组，CQ治疗组TLR2/4mRNA表达降低（P<0.05），肝损伤程度减轻，血清淀粉酶降低，肝组织TNF-α浓度降低，NO浓度显著升高（P<0.05）。 结论：AHNP大鼠肝组织内TLR2和TLR4的基因表达上调；其表达增高可能在AHNP肝损伤的发生、发展中起重要作用。氯喹对大鼠AHNP过程中肝损伤可能有保护作用。     

骨髓间充质干细胞对急性出血坏死性胰腺炎大鼠肺组织Toll样受体2/4mRNA表达的影响及意义

目的 研究骨髓间充质干细胞(BMSCs)对急性出血坏死性胰腺炎(AHNP)大鼠肺组织T0ll样受体(TLR)2/4表达的影响并初步探讨其机制.方法 采用逆行胰胆管牛磺胆酸钠注射制造AHNP大鼠模型,动物分为假手术组、胰腺炎组和BMSCs治疗组;流式细胞仪检测BMSCs表面标记阳性细胞率;RT-PCR方法检测肺组织TLR2/4mRNA表达变化;同时观察肺组织形态学改变,进行肺湿/干重比(W/D)测定.结果 与假手术组比较,胰腺炎组大鼠从3h时肺组织TLR2/4mRNA表达开始增高,在12 h时肺组织TLR2/4mRNA表达达到峰值;同时肺损伤加重,肺组织TNF-α浓度升高(P＜0.05).给予BMSCs治疗后,TLR2/4mRNA表达降低,肺损伤程度减轻,肺组织TNF-α浓度降低(P＜0.05).结论 急性出血坏死性胰腺炎时,组织内TLR2和TLR4mRNA表达上调,肺组织损伤加重.BMSCs可以明显抑制AHNP肺组织TLR2/4mRNA的表达,降低肺组织TNF-α浓度,从而减轻肺损伤.

Abstract：

Objective To investigate the effect of bone mesenchymal stem cells on Toll-like receptors (TLR) 2/4 expression in the lungs of rats with acute hemorrhagic necrotizing pancreatitis (AHNP). Methods Seventy SD male rats were randomly divided into sham-operation group (n=10), AHNP group(n=30) and MSCs-treated group(n=30). Masc rate of BMSCs with surface mark were measured by flow cytometer. TLR2/4mRNA expression in the the lung were measured by RT-PCR, and The ratio of Wet/dry and lung histological changs were observed. Results TLR2/4 mRNA could be detected in the lungs with low values in sham-operation group, markedly increased in 3 h, and peaked in 12 h in AHNP group (P＜0.05). Lung injuries were aggravated and the levels of TNF-α in the lung were increased (P＜0. 05) . Treatment with MSCs could effectively inhibit TLR2/4 mRNA expression and relieve lung injuries. The levels of TNF-α in the lung were decreased (P＜0.05). Conclusions The expression of TLR2/4 mRNA is increased in the lungs in AHNP and the lung injuries are aggravated. MSCs could markedly inhibit TLR2/4 mRNA expression in the lungs in AHNP, which would lead to relief of lung injury.     

清胰颗粒减轻急性出血坏死性胰腺炎大鼠早期肺损伤

目的：探讨复方中药提取物清胰颗粒对急性出血坏死性胰腺炎（AHNP）大鼠早期肺损伤的影响和可能作用机制。方法：72只健康雄性Wistar大鼠随机分为假手术组、AHNP组、清胰颗粒组。采用胆胰管逆行注射3.5%牛磺胆酸钠建立AHNP动物模型。清胰颗粒组于制模前2 h给予清胰颗粒水溶液灌胃,以后每12 h灌胃1次。各组大鼠分别于制模后6 h、12 h和24 h取肺组织观察病理改变并进行病理评分,检测髓过氧化物酶（MPO）活性,并用荧光定量PCR检测Toll样受体4（TRL-4）和p38MAPK mRNA表达。结果：与同时点AHNP组比较,清胰颗粒组于造模后12 h和24 h肺组织病理评分、MPO活性降低（P〈0.05）,于造模后6 h、12 h和24 h TRL-4和p38MAPK mRNA表达显著降低（P〈0.05）。结论：清胰颗粒能够减轻AHNP大鼠病理损伤和炎症反应,其作用机制可能与抑制p38MAPK信号通路有关。     

清胰汤对急性出血坏死性胰腺炎肠道细菌及内毒素移位的影响

目的探讨清胰汤对急性出血坏死性胰腺炎(AHNP)大鼠肠道细菌、内毒素移位的影响。方法SD大鼠随机分成AHNP组,AHNP+清胰汤治疗(QYT)组,假手术(SO)组。AHNP组与QYT组大鼠建立AHNP模型,SO组大鼠仅开腹翻动胰腺。QYT组造模后进行清胰汤胃灌注,另两组生理盐水灌胃,24 h后检测门静脉血内毒素(ET)浓度和大肠杆菌DNA含量(Ct值)。结果QYT组ET浓度、大肠杆菌DNA含量均低于AHNP组。结论清胰汤可降低实验性AHNP大鼠门静脉血中细菌DNA表达和内毒素浓度,减少肠道的细菌、内毒素移位。     

急性出血坏死性胰腺炎大鼠肺脏TNF-αmRNA表达的实验研究

实验观察大鼠急性出血坏死性胰腺炎(AHNP)模型中肺脏TNF-αmRNA表达情况及善得定(SS-op)对其表达的影响,为探讨AHNP时急性肺损伤的发生机制及治疗方法提供线索.     

Erroneous diagnosis of acute appendicitis in acute gynecological diseases

On the basis of an analysis of 84 observations the authors describe special features of the clinical course and diagnosis of gynecological diseases simulating acute appendicitis (rupture of the ovary, extrauterine pregnancy, torsion or rupture of the ovarian cyst, adnexitis).     

Severe acute respiratory syndrome mimicking acute abdomen

Severe acute respiratory syndrome (SARS) is a novel epidemic disease. The clinical presentation can sometimes be very non-specific. The present study reports a case of SARS, which presented as acute abdomen, warranting laparotomy. The atypical presentation in the present case reminded us of the importance of strict infection control measures in all surgery-related specialist workplaces.     

Risk factors of acute kidney injury after acute myocardial infarction

Objectives: To study the risk factors for acute kidney injury (AKI) in-patients with acute myocardial infarction (AMI).

Methods: A total of 1371 cases of adult in-patients with AMI in the First People's Hospital of Changzhou from January 2008 to December 2012 were retrospectively analyzed. Based on the occurrence of AKI diagnosed according to the 2012 KDIGO AKI criteria, they were divided into AKI group and non-AKI group and further into conservative treatment groups, coronary angiography (CAG) groups, and coronary artery bypass grafting (CABG) groups based on the timing of AKI occurrence, respectively. Related risk factors of AKI were analyzed by univariate and multivariate logistic regressions.

Results: 410 (29.9%) developed AKI. Patients with AKI had significantly increased in-hospital mortality than patients without AKI. Multivariate logistic regression analysis showed that decreased baseline eGFR, increased fasting plasma glucose (FPG), use of diuretics and Killip grade IV were independent risk factors of AKI, while increased DBP on admission was a protective factor for patients in conservative treatment group. Decreased baseline eGFR, increased FPG, use of diuretics, intraoperative hypotension and acute infection were independent risk factors of AKI for patients in the CAG group. Decreased baseline eGFR, increased FPG, use of diuretics and low cardiac output syndrome after operation were independent risk factors of AKI for patients in the CABG group.

Conclusions: AKI is a common complication and associated with increased mortality after AMI. Decreased baseline renal function, increased FPG and use of diuretics were common independent risk factors of AKI after AMI.     

The CT findings of acute thyroiditis and acute suppurative thyroiditis

Although acute thyroiditis often has a distinctive clinical presentation, this relatively uncommon entity can occasionally be confused with other inflammatory processes. In general, the earlier the diagnosis of acute thyroiditis is established, the lower is the frequency and severity of its attendant complications. Computed tomography (CT) is an extremely useful modality in establishing the diagnosis early because it can evaluate iodine content of the thyroid gland and provides more accurate mapping than ultrasound and nuclear medicine techniques. Three patients with acute thyroiditis--two with suppuration--are presented and the CT findings and clinical aspects of this disease are reviewed.     

暴发性胰腺炎急性反应期治疗经验

目的探讨暴发性胰腺炎（FAP）急性反应期治疗的对策。方法将64例FAP患者分为死亡组（27例）和治愈组（37例）。分析急性反应期内休克时间、肠道功能恢复时间和液体复苏参数;机械通气前24h氧合指数（PaO2／FiO2）及肺泡动脉氧差（AaDO2）、持续血液滤过（CVVH）应用率、腹腔间隔室综合征（ACS）发生率和疾病严重度。其次,分析外科干预方式及时间对预后的影响。结果死亡组休克持续时间、肠道功能恢复时间较治愈组显著延长（P〈0．05）;入院至入院后72h的晶体量两组无显著差异,而治愈组输注的胶体总量和胶晶比值显著高于死亡组,且第三间隙液体潴留量显著低于死亡组（P〈0．05）;人院日治愈组的液体输注速率显著高于死亡组（P〈0．05）。机械通气前24h死亡组PaO2／FiO2和AaDO2较治愈组呈负性变化（P〈0．05）。发病72h内,治愈组CVVH应用率显著高于死亡组（P〈0．05）;入院72小时内死亡组ACS发生率高于治愈组（P〈0．05）;入院后3d内,死亡组的APACHEⅡ评分显著高于治愈组（P〈0．05）。7—14d内接受手术患者的治愈率显著高于7d内和14d后接受手术的治愈率（P〈0．05）;手术组第1次手术时间较穿刺引流组显著提前（P〈0．01）,且治愈率明显低于穿刺引流组（P〈0．05）。结论缩短缺氧时间、控制持续全身炎症反应综合征（SIRS）及合理的外科干预是FAP急性反应期治疗的关键。     

���Է����ˡ����Ժ��������ۺ��������ƽ�չ

急性肺损伤(acute lung injury，ALI)、急性呼吸窘迫综合征(acute respiratory distress syndrome，ARDS)是指由非静水压原因所导致的肺部一系列病理生理改变继而引起急性、进行性缺氧性呼吸衰竭。ALI和ARDS不是孤立、相互分割的疾病，它们是严重损伤引起机体全身免疫炎征反应失控过程中的不同阶段。从损伤→全身炎症反应综合征