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1.
目的 研究氨氯地平对氧化低密度脂蛋白(ox - LDL)诱导健康人单核巨噬细胞基质金属蛋白酶-9(MMP -9)mRNA及蛋白表达影响.方法 采用体外密度离心法分离健康人单核细胞培养并传至4代后,以佛波酯(40 ng/mL)诱导为巨噬细胞,培养48 h后用于实验.根据实验要求分为空白对照组、ox- LDL组、不同剂量(0.1 μmol/L,1 μmol/L,10 μmol/L)氨氯地平组.RT- PCR检测各组MMP-9 mRNA的表达情况.Elisa检测各组MMP -9蛋白的表达.结果 单核巨噬细胞经100 ug/mL ox - LDL诱导后,与空白对照组比较MMP-9 mRNA和蛋白表达显著增加;经ox- LDL诱导后禾同剂量氨氯地平组与ox - LDL组比较MMP -9mRNA和蛋白表达显著降低,并呈浓度效应依赖关系,差异具有统计学意义(P<0.05).结论 ox- LDL可使人单核巨噬细胞MMP -9的表达增加,氨氯地平可呈浓度效应依赖性地减少ox- LDL诱导人单核巨噬细胞MMP -9的表达,从而在稳定斑块,减少急性冠脉事件发生中起作用.  相似文献   

2.
氧化修饰低密度脂蛋白(Ox—LDL)在动脉粥样硬化发生发展中的作用越来越引起人们的重视。本文通过比较Ox—LDL和脂质过氧化降解产物丙二醛(MDA)修饰的低密度脂蛋白(MDA—LDL)在致泡沫细胞形成方面的差异,探讨了脂质过氧化对巨噬细胞的损伤在泡沫细胞形成中的作用。结果显示:Ox—LDL和MDA—LDL都可被巨噬细胞清道夫受体所识别,引起大量吞噬,造成细胞内胆固醇的聚集,但由MDA—LDL造成的细胞内胆固醇酯聚集可被高密度脂蛋白(HDL_3)所清除,而Ox—LDL造成的胆固醇酯聚集则不能。进一步的研究表明Ox—LDL和MDA—LDL对巨噬细胞HDL_3结合量及细胞内脂质过氧化物(LPO)含量的影响不同。虽然MDA—LDL和Ox—LDL处理巨噬细胞,都可使其HDL_3结合量有不同程度的下降,细胞内LPO含量有不同程度的升高,但当处理因素消除后,细胞继续培养时,由MDA—LDL处理的细胞其降低的HDL_3结合量又有一定的恢复,细胞LPO含量不再上升;而由Ox—LDL处理的细胞,其HDL_3结合量则继续下降,细胞LPO含量则继续升高。由Ox—LDL导致的巨噬细胞HDL_3结合量下降与细胞LPO含量升高之间呈负相关(r=-0.81,P<0.01)。用叔丁基脂氢过氧化物(tbooh)(1×10~(?)mol/L)对巨噬细胞损伤24小时,然后用两种修饰的LDL处理,则两种修饰LDL造成的胆固醇酯聚集都不能被HDL_3清除。本文结果提示Ox—LDL对巨噬细胞的脂质过氧化损伤可能在巨噬细胞向泡沫细胞转变过程中起着重要作用。  相似文献   

3.
氧化修饰低密度脂蛋白(Ox—LDL)在动脉粥样硬化发生发展中的作用越来越引起人们的重视。本文通过比较Ox—LDL和脂质过氧化降解产物丙二醛(MDA)修饰的低密度脂蛋白(MDA—LDL)在致泡沫细胞形成方面的差异,探讨了脂质过氧化对巨噬细胞的损伤在泡沫细胞形成中的作用。结果显示:Ox—LDL和MDA—LDL都可被巨噬细胞清道夫受体所识别,引起大量吞噬,造成细胞内胆固醇的聚集,但由MDA—LDL造成的细胞内胆固醇酯聚集可被高密度脂蛋白(HDL3)所清除,而Ox—LDL造成的胆固醇酯聚集则不能。进一步的研究表明Ox—LDL和MDA—LDL对巨噬细胞HDL3结合量及细胞内脂质过氧化物(LPO)含量的影响不同。虽然MDA—LDL和Ox—LDL处理巨噬细胞,都可使其HDL3结合量有不同程度的下降,细胞内LPO含量有不同程度的升高,但当处理因素消除后,细胞继续培养时,由MDA—LDL处理的细胞其降低的HDL3结合量又有一定的恢复,细胞LPO含量不再上升;而由Ox—LDL处理的细胞,其HDL3结合量则继续下降,细胞LPO含量则继续升高。由Ox—LDL导致的巨噬细胞HDL3结合量下降与细胞LPO含量升高之间呈负相关(r=-0.81,p<0.01)。用叔丁基脂氢过氧化物(tbooh)(1×10~(?)mol/L)对巨噬细胞损伤24小时,然后用两种修饰的LDL处理,则两种修饰LDL造成的胆固醇酯聚集都不能被HDL3清除。本文结果提示Ox—LDL对巨噬细胞的脂质过氧化损伤可能在巨噬细胞向泡沫细胞转变过程中起着重要作用。  相似文献   

4.
目的 探讨载脂蛋白A-I(APOA-I)对泡沫细胞内胆固醇含量的影响.方法 ①一次性密度梯度超速离心法分离人血清脂蛋白,获取LDL;用Cu'2+>(15 μmol/L)氧化法获得氧化型低密度脂蛋白(ox-LDL)鉴定.160 nmol/L的佛波脂(PAM)诱导THP-1细胞成巨噬细胞,巨噬细胞与ox-LDL孵育成泡沫细胞,建立泡沫细胞模型.②不同浓度(0、5、10、15、20 mg/L)的APOA-I蛋白刺激泡沫细胞24 h;15 mg/LAPOA-I蛋白以不同时间(0、6、12、18、24、36 h)刺激泡沫细胞.测定各组泡沫细胞内胆固醇含量.结果 各浓度APOA-I蛋白刺激泡沫细胞24 h后,细胞内胆固醇含量减少,且呈浓度依赖性;15 mg/L APOA-I蛋白在不同时间刺激泡沫细胞后,细胞内胆固醇含量减少,以前24 h明显.结论 ApoA-I蛋白能减轻泡沫细胞内胆固醇负荷,这可能是ApoA-I蛋白防治动脉粥样硬化的机制之一.  相似文献   

5.
mm—LDL与M—CSF对动脉壁细胞胆固醇酯蓄积的协同作用   总被引:7,自引:1,他引:7  
本研究发现当鼠腹腔巨噬细胞或牛主动脉平滑肌细胞经单核细胞集落刺激因子(M—CSF)预孵育后再加入轻度修饰LDL(mm—LDlL)可显著增加两种细胞内胆固醇酯蓄积程度。这说明在致细胞内脂质蓄积方面mm—LDL与M—CSF具有协同作用。还发现M—CSF有加强巨噬细胞氧化修饰正常LDL的作用,这可能是其作用机制之一。  相似文献   

6.
目的 观察小檗碱对THP-1巨噬细胞源性泡沫细胞ATP结合盒转运体A1(ABCA1)表达及其细胞内胆固醇流出的影响,并探讨肝x受体α(LXR-α)去乙酰化在此过程中的作用.方法 用不同浓度的小檗碱(0、5、10、20 μmol/L)处理THP-1巨噬细胞源性泡沫细胞24 h,或以20 μmol/L小檗碱处理THP-1巨噬细胞源性泡沫细胞不同的时间(0、6、12、24 h).采用Western Blot检测ABCA1、LXR-α和乙酰化LXR-α的蛋白表达,液体闪烁计数法观察细胞内胆固醇的流出,高效液相色谱法测定细胞内胆固醇浓度.结果 与对照组比较,小檗碱呈浓度(0~20 μmol/L)和时间依赖性(0~24 h)上调巨噬细胞源性泡沫细胞ABCA1的表达和下调乙酰化LXR-α的表达,增加THP-1巨噬细胞源性泡沫细胞内胆固醇的流出,减少细胞内胆固醇的含量.上述效应在20 μmol/L小檗碱处理THP-1巨噬细胞24 h后达到最大值.结论 小檗碱能上调THP-1巨噬细胞源性泡沫细胞ABCA1的表达,并促进细胞内胆固醇流出,这种效应与调节LXR-α乙酰化有关.  相似文献   

7.
目的 观察氨氯地平预处理对氧化型低密度脂蛋白诱导的平滑肌细胞泡沫化过程中亲环素A表达的影响及其对胆固醇蓄积的作用,从新的角度探讨氨氯地平的抗动脉粥样硬化作用.方法 实验分为6组:对照组、氧化型低密度脂蛋白组、氨氯地平(0.1、1.0和10.0 μmol/L)处理细胞1 h后加入80 mg/L氧化型低密度脂蛋白共同孵育72 h组及10.0 μmol/L氨氯地平单独处理组,Western-blot和RT-PCR分别检测亲环素A mRNA和蛋白质的表达改变;油红O染色观察细胞内脂滴的形成情况,高效液相色谱法检测细胞内胆固醇含量变化.结果 氧化型低密度脂蛋白处理组的细胞内亲环素A的表达明显减少;经氨氯地平处理后,随着氨氯地平浓度的增加,细胞内亲环素A的表达逐渐增加,10.0μmoL/L氨氯地平预处理细胞组效果最明显,较氧化型低密度脂蛋白组差异有显著性(P<0.05).油红O染色显示,氧化型低密度脂蛋白组细胞内大量脂滴形成,细胞内胆固醇酯/总胆固醇的比值为57.9%,符合泡沫细胞特征;预先予氨氯地平处理后,随着药物浓度的增加,细胞内脂滴逐渐减少,细胞内胆固醇酯/总胆固醇的比值逐渐降低,10.0μmol/L氨氯地平预处理细胞组效果最明显,为37.8%;结论 氨氯地平预处理,可上调氧化型低密度脂蛋白诱导的平滑肌细胞泡沫化过程中亲环素A的表达,减轻细胞内的胆固醇蓄积.  相似文献   

8.
抗氧化低密度脂蛋白抗体与冠心病的关系   总被引:5,自引:0,他引:5  
目的 :探讨氧化修饰低密度脂蛋白 (ox LDL)引发的免疫反应在动脉粥样硬化 (AS)发生发展中的作用 ,揭示ox LDL致AS的免疫学机制。方法 :90例冠心病 (CHD)患者 (分为 3组 :稳定型心绞痛组、不稳定型心绞痛组、急性心肌梗死组 ) ,采用ELISA法检测其血液中ox LDL、ox LDL Ab及ox LDL IC水平。并入选 4 0例健康人群作为对照组。结果 :CHD各组血液中ox LDL、ox LDL Ab及ox LDL IC水平明显高于对照组 ,以急性心肌梗死组为最高。 3项指标的阳性率以ox LDL IC为最高。ox LDL Ab与血清脂蛋白无关 ,与ox LDL呈负相关 ,与ox LDL IC正相关。结论 :ox LDL的免疫反应参与AS的发生发展 ,这是细胞和分子的一系列复杂的免疫炎症反应过程  相似文献   

9.
张秀丽  刘映峰  吴鹏  陈允钦  梁东辉  缪绯 《心脏杂志》2008,20(4):373-375,380
目的探讨体外氧化修饰后的高密度脂蛋白(ox-HDL)对人外周血单核细胞源性泡沫细胞内胆固醇流出的影响。方法采用一次性密度梯度超速离心法从血浆中分离低密度脂蛋白(LDL)及高密度脂蛋白(HDL),分别以Cu2+诱导法将其氧化修饰成ox-LDL及ox-HDL。采用密度梯度离心法和塑料吸附法从人外周血中分离出单核细胞,以50nmol/L佛波酯(PMA)刺激48h使之转化为巨噬细胞。细胞分为对照组(ox-LDL组)、阳性对照组(HDL组)及实验组(ox-HDL组),对照组仅加入终浓度为80mg/L的ox-LDL;HDL组和ox-HDL组分别先加入终浓度均为50mg/L的HDL和ox-HDL共孵育1h后,再分别加入终浓度为80mg/L的ox-LDL,并于实验的0、6、12及24h测定细胞内总胆固醇(TC)、游离胆固醇(FC)及蛋白(Pro)含量。观察不同时间点各组细胞内TC/Pro比值的变化,并比较ox-HDL与HDL对细胞内TC/Pro比值影响的时效关系。结果成功地由体外氧化修饰了LDL及HDL并制备出理想的泡沫细胞模型。在实验的6、12及24h,ox-HDL组细胞内TC/Pro比值均较HDL组细胞高,差异具有统计学意义(P<0.05)。结论体外氧化修饰后的HDL导致其胆固醇逆向转运(RCT)功能与效率的降低。  相似文献   

10.
目的 :观察冠心病不同类型患者中巨噬细胞集落刺激因子 (MCSF)水平的变化及其与氧化低密度脂蛋白 (ox LDL)之间的关系 ,进一步探讨急性冠状动脉综合征预测的炎症指标。  方法 :采用酶联免疫法检测急性冠状动脉综合征组 (n =46)、稳定性心绞痛组 (n =45)和正常对照组 (n =40 )血浆MCSF及ox LDL水平。  结果 :3组血清MCSF、ox LDL的水平。血清MCSF和ox LDL水平在急性冠状动脉综合征组均显著高于稳定性心绞痛组和正常对照组 (P均 <0 0 0 1) ;稳定性心绞痛组血清MCSF和ox LDL水平均显著高于正常对照组 (P <0 0 5和 <0 0 0 1)。急性冠状动脉综合征组MCSF水平与ox LDL呈显著正相关 (r=0 571,P <0 0 0 1)。  结论 :急性冠状动脉综合征患者血清MCSF和ox LDL水平均明显升高 ,且两者呈显著正相关。从临床角度提示MCSF和ox LDL可能相互作用 ,促进了急性冠状动脉综合征的发生。  相似文献   

11.
目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤,因其临床表现多样,导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用,拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点,以期有助于提高影像学的诊断准确率和降低漏诊率,尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料,检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例,通过查阅病例的方法,提取出胰岛素瘤的大小和解剖分布等数据,进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例,其中,男45例、女71例,年龄13~76岁,平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布:头颈部46例(39.7%),单发45例、多发1例;体尾部68例(58.6%),单发65例、多发3例;全胰腺多发2例(1.7%)。病变大小特点:最大径0.4~3.4 cm,平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例,≤3 cm 15例,>3 cm 3例。年龄与肿瘤的大小相关,≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm,P<0.05。头颈部的肿瘤大于体尾部的肿瘤,头颈部肿瘤平均大小(1.66±0.63)cm,体尾部(1.42±0.52)cm,P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发;绝大多数单发,但可以全胰腺多发;多数小于1.5 cm,肿瘤的大小与患者年龄和肿瘤的解剖分布相关。  相似文献   

12.
Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.  相似文献   

13.
Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.  相似文献   

14.
BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.  相似文献   

15.
血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。  相似文献   

16.
目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。  相似文献   

17.
氯硝柳胺悬浮剂的毒性评价   总被引:2,自引:2,他引:2  
目的评价氯硝柳胺悬浮剂的毒性,为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg,经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3,该药经口、经皮肤、经呼吸道毒性均属微毒类药物;兔眼用药后,观察期内无不良反应,对眼无刺激性;皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比,氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物,对鱼的毒性低于其乙醇胺盐可湿性粉剂,适合于现场应用。  相似文献   

18.
The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002  相似文献   

19.

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl−1•min−1 (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl−1•min−1 (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.  相似文献   

20.
The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H2-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.  相似文献   

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