电针足三里穴促胃动力机制研究

目的 探讨电针足三里穴促胃动力作用机制.方法 采用电生理学方法同步观察电针不同穴位后胃电的变化;采用免疫组化荧光双重标记胃电起搏区Cajal间质细胞(interstitial cells of cajal, ICCs)与缝隙连接蛋白43(CX43)、ICCs 与ERK的方法,观察针刺足三里穴引起胃电起搏区ICCs的变化、与ICCs信息传递相关的CX43的变化、丝裂原活化蛋白激酶(MAPK)家族中的ERK的变化情况.结果 电针足三里穴对胃电有明显影响.电针足三里穴可使胃电频率及波幅增高;电针足三里穴可显著激活胃ICCs表达及与ICCs信息传递密切相关的CX43的表达;电针足三里穴能促进胃ICCs调节胃运动的细胞信号转导的MAPK途径中ERK的表达.结论 电针足三里穴对大鼠胃电具有明显的促进作用;电针足三里穴促进胃运动的机制可能通过激活ICCs而产生显著电生理活动,通过ICCs及SMC之间的缝隙连接蛋白传递达到平滑肌进而调节胃运动.这一作用的完成,可能是通过ICCs信号转导MAPK途径中ERK通路实现的.     

电针抗应激性胃溃疡大鼠脑组织和胃粘膜中一氧化氮合酶的变化

观察应激性胃溃疡大鼠脑组织和胃粘膜中一氧化氮合酶（NOS）活性的变化．并对电外足三里穴和阳陵泉穴NOS的变化及与胃粘膜损伤的关系作了比较。结果发现,应激性胃溃疡大鼠脑组织和胃粘膜NOS均增高，尤其是胃粘膜NOS增高非常显著（P＜0.01）；电针足三里使脑和胃NOS回降，应激前先电针更为明显，使胃溃疡损伤指数显著下降（P＜0.01）；而电针阳陵泉．与应激组相比虽也下降，但无统计学意义。提示NOS参与了电针对应激所致胃粘膜损伤的保护．这种保护作用可能与中枢和肠神经系统对胃功能的双重调节有关，同时NOS的变化与电针胃经足三里穴位特异性有一定的联系。     

电针对糖尿病胃轻瘫大鼠胃电活动与延髓神经元和星状胶质细胞可塑性的影响

[目的]观察电针对糖尿病胃轻瘫（DGP）大鼠胃电活动与延髓迷走孤束复合体（VSC）内神经元和星状胶质细胞可塑性变化的影响。[方法]实验大鼠分为空白对照（空白）组、DGP模型（模型）组、模型加电针足三里穴（足三里）组和模型加电针三阴交穴（三阴交）组。模型制备采用腹腔注射5％四氧嘧啶和熟地灌胃诱导的方法。实验3周后记录大鼠的胃电活动,取延髓进行抗Fos蛋白和抗胶质原纤维酸性蛋白（GFAP）的免疫组化染色。[结果]与空白组比较,模型组的胃电平均频率和振幅明显降低。而足三里组和三阴交组的平均频率和振幅较模型组明显升高（P〈O．01,〈0．05）;以足三里组升高更明显,与三阴交组比较差异有统计学意义（P〈0．05）。除空白组外,Fos阳性神经元、GFAP阳性星状胶质细胞集中表达于VSC。以模型组的Fos和GFAP表达最高,而足三里组与三阴交组的表达较模型组明显减少,且它们之间差异有统计学意义（P〈0．01）。[结论]针刺可改善糖尿病胃运动功能障碍,延髓VSC内免疫阳性神经元和胶质细胞可能参与了此调节作用。     

针刺足阳明经穴对大鼠胃运动及脑肠肽的影响

目的：探讨针刺足阳明经穴对胃运动的调整作用与脑肠肽的关系。方法：以乙醇灌胃造成大鼠胃粘膜损伤模型,气囊法测量胃运动频率和波幅的变化率,采用放免分析法（RIA）检测大鼠胃窦及延髓内P物质（SP）、胃动素（MTL）及胃泌素（GAS）含量。结果：模型组胃运动频率和波幅呈抑制状态,针刺四白、天枢、足三里穴可促进胃运动恢复,与此同时胃窦、延髓内SP、MTL、GAS含量出现相应变化。三穴比较：四白主要影响胃窦MTL含量,天枢主要影响胃窦SP及延髓GAS含量,足三里穴对SP、MTL及GAS均有影响。结论：推测针刺足阳明经对胃运动的调整作用有脑肠肽参与,但上述三穴对胃运动的影响所涉及的脑肠肽不完全一致。     

辣椒素对电针调控胃运动的影响作用及意义

目的探讨辣椒素毁损感觉神经生长的情况下,对电针调控胃运动的影响作用及意义。方法电针刺激经辣椒素干预大鼠足三里穴,采用免疫组织化学方法及电生理的方法,检测原癌基因c fos在中枢延髓的孤束核(NTS)及迷走神经背运动核(DMV)中的表达以及中枢延髓的孤束核及迷走神经背运动核中神经元细胞放电频率的变化情况,同时采用浆膜法观察胃电的变化情况。结果辣椒素针刺组胃电的波幅和频率与生理盐水针刺组存在显著性差异(P <0 .0 1) ,生理盐水针刺组胃电的波幅和频率与单纯生理盐水组胃电的波幅和频率存在显著性差异(P <0 .0 1)。原癌基因c fos在孤束核及迷走神经背运动核中的表达,辣椒素针刺组阳性率与生理盐水针刺组存在显著性差异(P <0 .0 1) ,生理盐水针刺组阳性率与单纯生理盐水组存在显著性差异(P <0 .0 1)。辣椒素针刺组NTS与DMV内神经元细胞放电频率的变化与生理盐水针刺组存在显著性差异(P <0 .0 1)。而与辣椒素非针刺组及单纯生理盐水组未见有明显差异(P >0 .0 5 ) ;同时,生理盐水针刺组NTS与DMV内神经元细胞放电频率与单纯生理盐水组存在显著性差异(P <0 .0 1)。结论电针对胃运动具有调控作用,且电针对穴位的作用性质可能是一种伤害性刺激。     

不同频率电针足三里对运动大鼠下丘脑单胺类神经递质的影响

目的 研究不同频率电针对运动大鼠下丘脑单胺类神经递质的影响,筛选出电针消除运动性疲劳的最佳频率.方法　选用SD大鼠,采用Bedford渐增负荷跑台跑运动模型,用韩氏电针仪对运动性疲劳大鼠双侧足三里穴进行2/15 Hz 、2/100 Hz两种不同频率的刺激,用高效液相电化学法检测各组下丘脑单胺类神经递质的含量.结果 (1)运动组大鼠下丘脑内5-羟色胺(5-HT)升高,而多巴胺(DA)水平则显著降低(P＜0.05,P＜0.01).(2)运动+电针(2/15 Hz)、运动+电针(2/100 Hz)两组下丘脑内 5-HT、DA含量与运动后60 min组比较,差异显著(P＜0.05).(3)运动+电针(2/15 Hz)组下丘脑DA含量与运动+电针(2/100 Hz)组比较,差异显著(P＜0.05).结论 (1)急性运动后可显著增加下丘脑内5-HT和NA含量,降低下丘脑DA含量.(2)不同频率电针均可降低急性运动后大鼠下丘脑5-HT含量,增加DA含量.(3)2/15 Hz可能是要筛选的电针消除运动性疲劳的最佳频率.     

眼针对腹泻型肠易激综合征模型大鼠结肠AQP8调节机制的研究

[目的]研究眼针对腹泻型肠易激综合征（D-IBS）模型大鼠结肠组织水通道蛋白8（AQP8）的表达的影响,探讨眼针对D-IBS模型大鼠结肠组织水液代谢的调控及其机制.[方法]32只雄性Wistar大鼠随机分成对照组、D-IBS模型组、眼针组、眼针＋VIP受体拮抗组（针抗组）,采用慢性应激与束缚相结合的方法建立D-IBS模型,免疫组织化学SABC法检测大鼠结肠组织AQP8的蛋白表达.[结果]与正常组相比,模型组AQP8的蛋白表达明显降低（P＜0.01）;与模型组相比,眼针组AQP8的蛋白表达显著升高（P＜0.01）;与眼针组相比,针抗组AQP8的蛋白表达显著下降（P＜0.01）.[结论]眼针治疗D-IBS的机制之一可能是通过上调结肠组织AQP8的蛋白表达,进而调控了结肠的水液代谢,其中AQP8的调控可能是通过VIP通路实现的.     

不同频率电针足三里对运动大鼠腓肠肌核因子-κB、血清肿瘤坏死因子-α和白细胞介素-1β的影响

目的研究不同频率电针对运动大鼠腓肠肌核因子(NF)-κB、血清肿瘤坏死因子(TNF)-α和白细胞介素(IL)-1β的影响。方法采用Bedford渐增负荷跑台跑运动模型,用韩式电针仪对运动性疲劳大鼠双侧足三里穴进行2/15 Hz、2/100 Hz两种不同频率的刺激,观察血清睾酮/皮质酮比值、腓肠肌NF-κB含量、血清TNF-α和IL-1β含量的变化。结果 1与安静对照组比较,运动组大鼠血清睾酮/皮质酮比值显著降低(P0.05,P0.01);2运动组大鼠腓肠肌NF-κB、血清TNF-α和IL-1β显著升高(P0.05,P0.01);3运动+2/15 Hz电针组和运动+2/100 Hz电针组两组大鼠腓肠肌NF-κB、血清TNF-α和IL-1β与运动后60 min组比较差异显著(P0.05,P0.01);4运动+2/15 Hz电针组大鼠腓肠肌NF-κB、血清TNF-α和IL-1β与运动+2/100 Hz电针组比较,差异显著(P0.05,P0.01)。结论 1急性运动后可显著增加大鼠腓肠肌NF-κB、血清TNF-α和IL-1β含量;2不同频率电针均可降低急性运动后大鼠腓肠肌NF-κB、血清TNF-α和IL-1β的含量;32/15 Hz可能是要筛选的电针消除运动性疲劳的最佳频率。     

急性应激诱导肠功能紊乱后大鼠肠道协同刺激分子的表达

目的应用冷-束缚应激方法 ,诱导建立大鼠肠功能紊乱动物模型,了解与应激有关的肠功能紊乱时,肠道协同刺激分子CD80、CD86以及炎症因子VIP、IL-1β的表达,探讨大鼠肠道免疫耐受的变化。方法将60只Wistar大鼠随机分为实验组和对照组,建立冷-束缚应激动物模型。应用Bristol分型进行评分、于应激第6天利用直结肠扩张实验测定内脏敏感性,第7天行肠道黏膜病理检查。免疫组化法检测肠道CD80、CD86以及VIP、IL-1β表达。结果实验组大鼠在应激后第6天大便性状发生改变,肠道感觉阈值比对照组明显下降(P0.05),组织病理学检查无异常改变。免疫组化显示:在回肠末端,与正常对照组比较,实验组大鼠CD80和CD86的表达差异无统计学意义(P0.05);实验组大鼠VIP、IL-1β表达均较对照组明显增加,差异有统计学意义(P0.05),并且VIP的表达与IL-1β呈正相关(r=0.78,P0.01)。在远端结肠,实验组大鼠CD80、CD86以及VIP的表达均较对照组明显增高,差异有统计学意义(P0.05);而IL-1β表达较对照组差异无统计学意义(P0.05);并且CD80的表达与VIP呈正相关性(r=0.70,P0.01),CD86的表达与VIP的表达呈正相关性(r=0.34,P0.05)。结论冷-束缚应激后肠功能紊乱大鼠中,末端回肠和远端结肠黏膜存在轻度的炎症反应,CD80和CD86分子在远端结肠的免疫调节过程中发挥了重要作用。     

银杏叶提取物对大鼠不同状态胃动力的影响及其机制

目的 探讨银杏叶提取物(Egb)对正常状态和冷束缚应激引起的胃肠功能紊乱的情况下大鼠胃动力的影响及可能机制.方法 采用冷束缚应激的方法建立胃肠功能紊乱模型,应用葡聚糖蓝2000(DB-2000)作为染料观察Egb在正常及应激状态对胃排空速率的影响;并利用比色法观察大鼠胃组织和血浆中一氧化氮(nitricoxide,NO)含量的变化.结果 在正常状态下,Egb对胃排空速率无显著性影响.冷束缚应激可导致大鼠胃排空减慢(P<0.05).Egb干预可明显拮抗应激引起的胃排空减慢(P<0.05).Egb对正常大鼠胃组织和血浆中NO含量没有影响;冷束缚应激可导致胃内NO含量降低(P<0.01),而血浆中NO升高(P<0.01).Egb可降低应激引起的血浆NO含量的升高(P<0.01).结论 Egb在不同状态下对大鼠胃动力的影响有所不同,具有正相调节作用.NO可能参与了Egb对大鼠胃动力的调节作用.     

胰岛素瘤的解剖分布特点分析

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。     

Pathogenesis of carcinoma of the papilla of Vater

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.     

Demonstration of the mechanism of action of biguanides

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.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

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.     

血吸虫童虫生长发育及其机制的研究进展

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。     

氯硝柳胺悬浮剂的毒性评价

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。     

124例耐多药结核分枝杆菌基因突变特征分析

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。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

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     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

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.     

Study of constancy of hydrogen-consuming flora of human colon

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.