性别差异对脓毒症大鼠肝脏Toll样受体4和髓样分化蛋白-2基因表达的影响

目的探讨性别差异对脓毒症大鼠肝脏组织Toll样受体4(TLR4)和髓样分化蛋白- 2(MD-2)基因表达的影响。方法以脂多糖(LPS)按5 mg/kg体重由大鼠腹腔注射制作脓毒症动物模型,注射后2 h留取肝脏组织检测TLR4、MD-2和肿瘤坏死因子-α(TNF-α)基因表达,同时测定各组大鼠血浆中丙氨酸氨基转移酶(ALT)及雌二醇含量。结果正常雌雄性大鼠肝脏组织均可表达少量TLR4、MD-2、TNF-α基因,其中雌性组分别为0．175±0．034、0．211±0．044、0．201±0．068; 雄性组分别为0．205±0．061、0．243±0．049、0．243±0．063,两组数据差异无统计学意义(P> 0．05),但LPS刺激后雌性大鼠肝脏组织上述指标分别为0．615±0．089、0．708±0．181、0．730± 0．118,血浆中ALT含量为(81．07±10．72)U／L;雄性组分别为0．723±0．091、1．123±0．272、 0．881±0．156,ALT含量为(106．39±14．21)U／L,雌性组各项指标均明显低于雄性大鼠(P< 0．05)。相关分析表明雌性及雄性脓毒症大鼠肝脏组织TLR4及TNF-α基因表达与相应性别大鼠血浆中雌二醇含量呈显著负相关(P<0．05)。结论 LPS刺激后大鼠肝脏组织TLR4、MD-2及 TNF-α基因表达存在性别差异,内源性雌激素的作用可能导致雌性脓毒症大鼠肝脏组织损伤较雄性轻。     

重症急性胰腺炎大鼠脾脏巨噬细胞Toll样受体4的表达及分泌细胞因子水平的变化

目的 观察重症急性胰腺炎（SAP）大鼠脾脏巨噬细胞（sMΦ）T0u样受体4（TLR4）基因表达及分泌细胞因子水平的变化。方法 建立大鼠SAP模型，分别于6、12、24、72h分离sMΦ，观察sMΦ静息状态下和经1mg／L脂多糖（LPS）刺激后分泌肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6、白细胞介素（IL）-10水平的变化，逆转录-聚合酶链反应（RT-PCR）法检测sMΦ TLR4mRNA表达。结果 予LPS刺激后，对照组sM（I）分泌TNF-α、IL-6和IL-10水平显著升高，分别由（1．1844±0．3490）μg／L、（214．14±33．41）ng／L、（20．26±3．71）ng／L升至（9．3110±1．9962）μg／L、（519．01±52．64）ng／L和（55．43±6．28）ng／L，TLR4 mRNA表达亦由0．9091±0．2763明显升高至2．1944±0．6098；而模型各亚组分泌TNF-α和IL-6水平较刺激前无明显变化，同时TLR4 mRNA表达出现不同程度下调，且各指标均明显低于对照组。结论 SAP大鼠sMΦ对内毒素耐受的发生与TLR4 mRNA表达下调有关。     

蜕皮甾酮对急性肺损伤大鼠肺组织中Toll样受体4及肺表面活性蛋白A表达的影响

目的：观察蜕皮甾酮（EDS）对脂多糖（LPS）诱导急性肺损伤（ALI）大鼠肺组织中TNF-α、肺表面活性蛋白A（SP-A）、Toll样受体4（TLR4）表达的影响,并探讨其机制.方法：将40只雄性Wistar大鼠随机分成正常对照组、LPS组、EDS低（20 mg/kg）、中（30 mg/kg）、高（40 mg/kg）剂量治疗组（n=8）.腹腔注射LPS（10 mg/kg）诱导大鼠ALI模型,3个EDS治疗组于建模1 h后予不同剂量的EDS腹腔注射,其余两组注射等体积生理盐水.24 h后,取肺组织,用光学显微镜观察各组肺组织病理学改变;用Western blot测定肺表面活性蛋白A（SP-A）、Toll样受体4（TLR4）的表达;用ELISA测定各组肺组织中TNF-α含量,RT-PCR检测TNF-α mRNA表达水平.结果：肺组织病理学观察显示：LPS组可见肺间质充血、水肿,大量炎性细胞浸润,而EDS治疗组肺损伤明显改善,效果随EDS剂量的增加而增加.与正常对照组比较,LPS组肺组织的SP-A蛋白表达明显降低（P〈0.05）,而TNF-α含量、TNF-α mRNA表达、TLR4蛋白表达明显增加 （P〈0.05）.与LPS组相比较,不同剂量EDS治疗组肺组织SP-A蛋白表达均增加（P〈0.05）,而TNF-α含量、TNF-α mRNA表达、TLR4蛋白表达明显降低（P〈0.05）,其中EDS高剂量组比中、低剂量组效果明显 （P〈0.05）.结论：蜕皮甾酮对LPS诱导大鼠急性肺损伤有保护作用,其机制可能与抑制TLR4通路来降低肺组织中TNF-α炎性因子的表达,并促进抗炎物质SP-A释放有关.     

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。     

盐酸戊乙奎醚对内毒素性急性肺损伤大鼠肺组织Toll样受体4mRNA和Toll样受体2mRNA表达的影响

目的 探讨盐酸戊乙奎醚对内毒索性急性肺损伤大鼠肺组织Toll样受体4(TLR4)mRNA和Toll样受体2(TLR2)mRNA表达的影响.方法 健康SD大鼠60只,雌雄不拘,体重200～220g,采用随机数字表法,将大鼠随机分为5组(n=12),对照组(C组)、LPS组和低、中、高剂量盐酸戊乙奎醚组(P1组～P3组).C组腹腔注射生理盐水2ml;LPS组腹腔注射LPS 8mg/kg;P1组～P3组分别腹腔注射LPS 8 mg/kg和盐酸戊乙奎醚0.3、1.0和3.0 mg/kg.给药结束后6 h时开胸,心室取血,并取肺组织,采用ELISA法测定血清TNF-α和Ib-6的浓度,RT-PCR法测定肺组织TLR4 mRNA和TLR2 mRNA 的表达水平,并观察肺组织病理学结果.结果 与C组比较,LPS组、P1组～P3组血清TNF-α、IL-6浓度和肺组织TLR4 mRNA、TLR2 mRNA表达均升高(P<0.05);与LPS组比较,P2组和P3组血清TNF-α、IL-6浓度和肺组织TLR4 mRNA、TLR2 mRNA表达均降低(P<0.05),P1组上述指标差异无统计学意义(P>0.05);与P1组比较,P2组和P1组血清TNF-α、IL-6浓度和肺组织TLR4 mRNA、TLR2 mRNA表达均降低(P<0.05);P2组和P3组血清TNF-α、IL-6浓度和肺组织TLR4 mRNA、TLR2 mRNA表达比较差异无统计学意义(P>0.05).P2组和P3组肺组织病理学损伤程度明显轻于LPS组.结论 盐酸戊乙奎醚可通过下调肺组织TLR4 mRNA和耵JR2 mRNA的表达,降低炎性反应,从而减轻大鼠内毒素性急性肺损伤.

Abstract：

Objective To investigate the effect of penehyclidine (PHCD) on Toll-like receptor 4 (TLR4)mRNA and Toll-like receptor 2 (TLR2) mRNA expression in the lung tissue in rats with acute lung injury induced by lipopolysaccharide (LPS) .Methods Sixty healthy SD rats of both sexes weighing 200-220 g were randomly divided into 5 groups ( n = 12 each) :control group (group C) , LPS group and P1-3 groups. Acute lung injury was induced by intraperitoneal (IP) LPS 8 mg/kg in LPS and P1-3 groups. PHCD 0.3, 1.0 and 3.0 mg/kg were given IP after LPS administration in P1-3 groups. The animals were anesthetized at 6 h after IP LPS. Blood samples were collected for determination of serum TNF-α and IL-6 concentrations ( by ELISA) and then sacrificed, the lungs were immediately removed for determination of TLR4 mRNA and TLR2 mRNA expression (by RT-PCR), and microscopic examination. Results LPS significantly increased TLR4 mRNA and TLR2 mRNA expression in the lung tissue and serum TNF-α and IL-6 concentrations. PHCD 1.0 or 3.0 mg/kg significantly inhibited LPS-induced increase in TLR4 mRNA and TLR2 mRNA expression in the lung tissue and serum TNF-α and ILr6 concentrations.The lung histopathologic damage was significantly ameliorated in P2 and P3 groups as compared with group LPS.Conclusion PHCD can protect the lungs against LPS-induced acute lung injury through inhibiting TLR4 mRNA and TLR2 mRNA expression in the lung tissue and reducing the inflammatory response.     

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。     

兴奋胆碱能抗炎通路对内毒素致心肌损害的保护作用

目的：研究兴奋胆碱能抗炎通路对内毒素引起大鼠心肌损害的保护作用。方法：① 内毒素休克模型[静注内毒素（LPS）10mg/kg]：设手术对照组、单纯LPS组、迷走神经切断（VC）＋LPS组和VC＋LPS＋迷走神经电刺激（VS）组,观察电刺激迷走神经对心肌组织炎症介质和心肌酶指标的影响。②内毒素血症模型（静注LPS5mg/kg）：设LPS＋电针非经非穴组、LPS＋电针足三里穴组、VC后注射LPS组和VC＋LPS＋电针足三里穴组,观察电针副交感神经相关穴位足三里穴对内毒素血症引起的心肌组织损伤的保护作用。各组大鼠均于注射LPS后2h处死,检测血浆肌酸磷酸激酶同工酶（CK-MB）活性和组织病理学改变,内毒素休克各组测定心肌组织肿瘤坏死因子-α（TNF-α）含量。结果：刺激迷走神经可明显降低内毒素休克大鼠心肌组织TNF-α含量;刺激迷走神经或电针足三里穴能显著降低LPS注射后2h大鼠血浆CK-MB活性,减轻心肌组织病理损害;切断迷走神经能显著减轻或消除电针足三里穴的作用,进一步升高血浆CK-MB活性,加重心肌组织损害。结论：刺激副交感神经激活胆碱能抗炎通路对内毒素血症和内毒素休克大鼠心脏具有不同程度的保护作用。     

异丙酚对脂多糖诱导大鼠腹腔巨噬细胞Toll样受体-4 mRNA表达的影响

目的 观察异丙酚对脂多糖（LPS）诱导大鼠腹腔巨噬细胞Toll样受体-4（TLR-4）mRNA表达的影响，探讨异丙酚抑制LPS诱导白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF—α）产生的机制。方法 雄性Wistar大鼠32只，处死后分离腹腔巨噬细胞，随机分为4组（n=8）：A组（阴性对照组）；B组LPS（终浓度为1μg／ml）／加入巨噬细胞中；C组LPS（终浓度为1μg／ml）＋异丙酚（终浓度为1μg／ml）加入巨噬细胞中；D组LPS（终浓度为1μg／ml）＋异丙酚（终浓度为5μg／ml）加入巨噬细胞中。细胞培养12h后。用ELISA方法检测培养上清液中IL-6、TNF-α的浓度，用RT-PCR方法检测TLR-4mRNA的表达水平。结果 与A组相比，B组IL-6、TNF-α和TLR-4m RNA水平均增加，C组IL-6、TLR-4m RNA水平升高（P〈0．01）；与B组相比，C组、D组IL-6、TNF-α和TLR-4m RNA水平降低（P〈0．05或〈0．01）。结论 异丙酚通过下调TLR-4m RNA的表达水平，从而一定程度上抑制了LPS诱导大鼠腹腔巨噬细胞，TNF-α和IL-6的产生。     

氯沙坦对实验性糖尿病大鼠肾脏的炎症抑制作用

目的：观察氯沙坦对糖尿病大鼠肾脏的炎症抑制作用。方法：采用链脲佐菌素（streptomtoein，STZ）65mg／kg腹腔注射建立糖尿病大鼠模型。试验分正常对照组、模型组、治疗组，后一组于模型成功后1周给予氯沙坦20mg／kg灌胃，共12周。分别测定3组24h尿蛋白排泄量、血肌酐、肾重／体重、血浆C反应蛋白（CRP）及肿瘤坏死因子-α（TNF-α）水平；观察肾脏病理形态学变化；应用免疫组化法检测肾组织T011样受体4（TLR4）、核因子-κB（NF-κB）的蛋白表达；RT-PCR检测肾组织TLR4的核酸表达。结果：模型组与对照组相比：模型组大鼠24h尿蛋白、血肌酐、尿素氮、肾重／体重明显升高，肾小球肥大，细胞增生，PAS阳性物质沉积增多；血CRP、TNF-α含量及肾组织TLR4、NF-κB的表达明显增加。经氯沙坦治疗后大鼠血CRP、TNF-α含量下降，肾组织TLR4、NF-κB的表达亦减弱，治疗前后比较存在差异（P〈0．05）。结论：氯沙坦对糖尿病肾病具有保护作用，其作用机制还可能是通过下调NF-κB、TLR4的表达，降低血浆CRP、TNF-α含量，抑制炎症反应而减少糖尿病肾病损伤。     

缺血预处理对缺血再灌注损伤大鼠肾组织TLR2表达的影响

目的观察缺血预处理对缺血／再灌注损伤大鼠肾组织Toll样受体2（TLR2）表达的影响。方法将24只雄性SD大鼠随机分为3组：假手术对照组（SHAM组）、单纯缺血再灌注组（I／R组）和缺血预处理组（IPC组）,每组8只。于术后24h留取各组大鼠血标本和肾组织。检测各组大鼠血肌酐（SCr）和尿素氮（BUN）,肾组织切片行HE染色后观察其病理学改变,酶联免疫吸附法（ELISA）检测肾组织肿瘤坏死因子-α（TNF-α）含量,实时荧光定量多聚酶链反应检测肾组织TLR2mRNA表达,Westernblot检测肾组织TLR2蛋白表达。结果与SHAM组相比,I／R组大鼠SCr和BUN升高,肾组织TNF-α含量和TLR2蛋白表达升高,差异均有统计学意义（P〈0．01）;与I／R组相比,IPC组大鼠SCr和BUN降低,肾组织TNF-α含量和TLR2蛋白表达降低,差异均有统计学意义（P〈0．05）。结论缺血预处理可能通过抑制大鼠。肾组织TLR2表达及其信号通路,下调TNF-α的表达,发挥其肾脏保护作用。     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.     

MicroRNAs in hepatic pathophysiology in diabetes

MicroRNAs(miRNAs or miRs) are small approximately 22 nucleotide RNA species that are believed to regulate diverse metabolic and physiological processes.In the recent past,several reports have surfaced that demonstrate the role of miRNAs in various biological processes and numerous disease states.For a disease as complex as diabetes,the emergence of miRNAs as key regulators leading to the disease phenotype has added a novel dimension to the area of diabetes research.On the other hand,the liver,a metabolic hub,contributes in a major way towards maintaining normal glucose levels in the body as it can both stimulate and inhibit hepatic glucose output.This equilibrium is frequently disturbed in diabetes and hence,the liver assumes special significance considering the correlation between altered hepatic physiology and diabetes.While the understanding of the mechanisms behind this altered hepatic behavior is not yet completely understood,recent reports on the status and role of miRNAs in the diabetic liver have further added to the complexities of the knowledge of hepatic pathophysiology in diabetes.Here,we bring together the various miRNAs that play a role in the altered hepatic behavior during diabetes.     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.