电针对局灶性脑缺血急性期大鼠脑组织中自由基水平影响和神经功能相关性的实验研究

目的 探讨电针对局灶性脑缺血急性期大鼠脑组织中自由基水平影响和神经功能缺损程度的相关性。方法 48只健康的雄性Wister大鼠，随机分为针灸组、正常组、模型组。采用光化学法复制局灶性脑缺血急性期动物模型。术后3h、24h检测脑组织中丙二醛（MDA）、超氧化物歧化酶（SOD）的含量同时进行神经行为学评分。结果 模型组脑缺血后3h时MDA含量明显增高；针灸组与模型组比较，24hMDA含量相对降低（P〈0．05），24hSOD的活性明显增高（P〈0．05）。神经行为学障碍量化评定显示电针治疗后24h针灸组的神经缺损程度明显低于模型组，其程度与脑组织MDA含量呈负相关，与SOD活性呈正相关。结论 早期的针灸对光化学诱导大鼠局灶性缺血脑组织有保护作用并可相应的减轻脑缺血后神经功能的缺损程度。     

四逆汤对局部脑缺血大鼠的保护作用及其神经酰胺机制

目的：研究四逆汤对大鼠局部脑缺血后脑组织神经酰胺含量的影响。方法：采用大鼠大脑中动脉局部阻塞模型（MCAO），观察四逆汤对脑缺血大鼠丙二醛（MDA）和神经酰胺含量、以及超氧化物歧化酶（SOD）活性的影响。结果：与正常组比较，缺血模型组MDA含量和脑组织神经酰胺含量均显著升高；与缺血模型组比较，四逆汤组能提高SOD的活性，减少MDA的产生（P〈0．05），降低神经酰胺含量（P〈0．001）。结论：四逆汤能对局部脑缺血大鼠产生保护作用，其可能机制是减轻氧化损伤，减少神经酰胺的生成量。     

肢体反复短暂缺血预处理在大鼠脑缺血再灌注损伤中的保护作用

目的 探讨肢体反复短暂缺血预处理(LIP)在大鼠脑缺血再灌注损伤中可能的脑保护机制.方法 随机将42只成年健康雄性Wistar大鼠分为7组,假手术组、脑缺血组、脑缺血再灌注组、预处理0 h组、预处理6 h组、预处理12 h组、预处理24 h组.采用线栓法制备大脑中动脉缺血及缺血再灌注模型,重复夹闭大鼠双侧股动脉4 次(每次10 min,间隔10 min) 作为LIP,采用生化方法测定各组脑组织中丙二醛(MDA)、超氧化物歧化酶(SOD)、三磷酸腺苷(ATP)酶的含量;HE染色观察大鼠脑组织的病理改变.结果 肢体反复短暂缺血预处理组可明显减少MDA的含量,升高SOD活性,增加ATP含量,尤以预处理0 h和6 h组为著,同其余预处理组及对照组相比差异有统计学意义(P<0.05).结论 肢体缺血预处理可提高脑缺血大鼠的SOD活性、降低MDA含量、促进ATP的生成,推知反复短暂的肢体缺血预处理对大鼠脑缺血再灌注损伤有保护作用,它可通过提高脑组织抗氧化酶活性、提高线粒体能量,抑制氧自由基产生及脂质过氧化反应来发挥作用.     

西维来司钠对大鼠脑缺血再灌注损伤的保护作用

目的 探讨西维来司钠(ONO-5046)对大鼠全脑缺血再灌注(I/R)损伤的保护作用及其机制.方法 SD大鼠随机分为假手术组、I/R组和I/R+ONO-5046组,I/R组和I/R+ONO-5046组根据再灌注时间的不同分为6、12、24、48 h四个亚组.采用四血管阻断法制备I/R模型,缺血15 min,I/R+ONO-5046组于再灌注时经股静脉持续给予 ONO-5046 2 mg·kg-1·h-1,假手术组和I/R组给予生理盐水.观察大鼠脑组织病理学变化,并检测中性粒细胞弹性蛋白酶(NE)、丙二醛 (MDA)含量及超氧化物歧化酶(SOD)、肿瘤坏死因子-α(TNF-α)活性.结果 I/R后,NE含量随再灌注时间延长而不断增强(P＜0.05或P＜0.01),TNF-α表达量也增加并于再灌注12 h达最高峰(P＜0.01).ONO-5046组显著降低缺血再灌注后脑组织NE、MDA含量,升高SOD活性以及减少TNF-α表达,明显改善脑组织病理形态.结论 ONO-5046对脑缺血-再灌注损伤有明显的保护作用,其机制可能与降低NE、MDA含量,升高SOD活性及下调TNF-α阳性表达细胞有关.     

党参对大鼠脑缺血再灌注损伤的保护作用

目的 研究党参(Codonopsis pilosula．)对大鼠脑缺血再灌注损伤的保护作用，并从改善能量代谢角度探讨其作用机制。方法 Wistar大鼠随机分为假手术组，缺血再灌注 生理盐水组，缺血再灌注 党参组，缺血再灌注 CoQ10组。其中缺血再灌注 生理盐水组、缺血再灌注 党参组、缺血再灌注 CoQ10组分别连续5d灌胃口服生理盐水、党参浸提液、CoQ10混悬液。采用阻断大鼠双侧颈总动脉和尾部放血，并重复缺血再灌注的脑缺血模型，分别于缺血后3，6，12h断头取脑，采用高效液相法测定脑组织中ATP含量、比色法测定Na^ ，K^ —ATPase活性。结果 生理盐水对照组中大鼠脑组织ATP含量、Na^ ，K^ —ATPase活性明显低于假手术组(P＜0．05)，党参组、CoQ10组中大鼠脑组织ATP含量、Na^ ，K^ —ATPase活性明显高于生理盐水对照组(P＜0．05)，且二者间无显著性差异。结论 党参可改善缺血再灌注脑细胞能量代谢，具有脑保护作用，作用效果与CoQ10相近。     

黄体酮对局灶性脑缺血再灌注大鼠脑组织SOD及MDA水平的影响

目的探讨黄体酮对局灶性脑缺血大鼠脑组织匀浆超氧化物歧化酶(SOD)活性和丙二醛(MDA)含量的影响。方法采用线栓法制作左侧大脑局灶性脑缺血模型(MCAO模型),将SD大鼠随机分为假手术组、手术组、溶剂治疗组、黄体酮组,术后3、6、12、24 h断头取脑,制备脑匀浆,用生化方法检测MDA含量及SOD活性。结果与假手术组比较,缺血2 h再灌注3 h后,手术组和溶剂治疗组脑组织SOD活性开始下降,再灌注24 h达到最低,与手术组比较,再灌注6、12、24 h时黄体酮组脑组织的SOD活性显著升高(P<0.05)。与假手术组比较,缺血2 h再灌注3 h后,手术组和溶剂治疗组脑组织MDA含量开始升高,再灌注12 h时达到高峰,24 h时仍高,与手术组比较,黄体酮组脑组织的MDA含量在6、12、24 h均显著降低(P<0.05,P<0.05,P<0.01)。结论黄体酮可通过一定的抗氧化作用,对脑缺血再灌注大鼠脑组织产生保护作用。     

兴奋性氨基酸在尿毒症大鼠脑缺血再灌注损伤中的变化及相关因素

目的 动态观察尿毒症(CRF)大鼠脑缺血再灌注(I/R)早期兴奋性氨基酸(EAA)的变化.方法 清洁级健康雄性Wistar大鼠120只,随机分为正常对照组12只、CRF组12只、单纯I/R组(I/R组)48只、CRF+I/R组48只.按再灌注后不同时间点(0、2、12、24 h)I/R组、CRF+I/R组又分为4个亚组,每个亚组取6只.化学比色法测脑组织匀浆中谷氨酸(Glu)含量,离子指示剂法测定细胞内游离钙浓度.结果 与正常对照组相比,CRF组大鼠脑组织中Glu含量、细胞内游离钙浓度均升高,但无显著差异(P﹥0.05),与I/R组各时间点比较,CRF组大鼠脑组织中Glu、游离钙浓度均降低(P﹤0.05).发生再灌注损伤的两组大鼠Glu含量在2 h时间点均明显升高,随着再灌注时间的延长,两组Glu含量均呈下降趋势,I/R组至24 h降至正常;CRF+I/R组各时间点Glu含量均较其余三组升高(P﹤0.05).与正常对照组、I/R组和CRF组相比,CRF+I/R组各时间点游离钙浓度均明显升高(P﹤0.05).结论 CRF大鼠合并I/R后脑组织中Glu含量显著增加,并引起细胞内钙超载明显增多,加重了组织损伤,提示CRF可能是I/R损伤的独立危险因素.     

疏血通注射液对局灶脑缺血自由基损伤的脑保护作用

目的探讨疏血通注射液对大鼠局灶脑缺血神经细胞损伤的保护作用。方法用自体血栓法建立大鼠大脑中动脉阻塞的局灶脑缺血（MCAO）模型。120只SD大鼠随机分为3组：假手术组、对照组、治疗组各40只,制造大脑中动脉闭塞模型,治疗组于造模成功后给予尾静脉注射疏血通注射液,0．25ml/kg,1次/d;对照组、假手术组给予注射等量0．9%氯化钠溶液。观察3组大鼠脑组织丙二醛（MDA）含量、超氧化物歧化酶（SOD）、一氧化氮合酶（NOS）、诱导型一氧化氮合酶（inducible NOS,iNOS）活性的变化。结果对照组与假手术组在各时间点脑组织MDA、SOD、NOS、iNOS含量间差异均有显著性意义（P＜0．05）,且治疗组与对照组在2d、3d、5d各时间点脑组织MDA含量间差异均有显著性意义（P＜0．05）,治疗组与对照组脑组织SOD、NOS、iNOS的活性各时间点间差异亦均有显著性意义（P＜0．05）。结论疏血通注射液对大鼠局灶性脑缺血具有明显的保护作用。     

高脂血症对脑缺血大鼠血清超氧化物歧化酶、丙二醛和脑组织细胞间黏附分子-1、新生血管的影响

目的探讨高脂血症对脑缺血大鼠血清超氧化物歧化酶(SOD)、丙二醛(MDA)和脑组织细胞间黏附分子(ICAM)-1及新生血管影响。方法构建高脂血症复合大脑动脉缺血模型,酶联免疫法(ELISA)检测血清SOD和MDA的含量和免疫组化法测定脑组织中ICAM-1和CD34的表达。结果复合脑缺血组与单纯脑缺血组相比较,血清MDA在缺血3、7 d含量均下降(P0.05);复合脑缺血组与单纯脑缺血组比较,脑组织梗死边缘区ICAM-1和CD34在缺血3、7 d表达增高(P0.05)。结论高脂血症对脑缺血在不同时期相关因素具有特异性的表达有影响,这可能在脑缺血恢复期有助于脑组织损伤的修复。     

山楂叶与三七叶有效部位组合物对兔全脑缺血再灌注损伤的保护作用

目的观察山楂叶与三七叶有效部位(SS)组合物对兔全脑缺血再灌注损伤的保护作用。方法采用六动脉结扎加股动脉放血法制备家兔全脑缺血再灌注损伤模型,缺血30 min,再灌注2 h。40只家兔随机分为假手术组、模型组、血塞通21. 0 mg/kg组、SS组合物高、低剂量组(6. 370、3. 185 mg/kg)。于再灌2 h后使用南京建成生物工程研究所测定试剂盒检测脑组织中超氧化物歧化酶(SOD)活性、丙二醛(MDA)、谷氨酸含量及血清中谷胱甘肽过氧化物酶(GSH-PX)活力,并进行病理学检查。结果 SS组合物高、低剂量组均能明显增加脑组织SOD活性(P<0. 01; P<0. 05),降低脑组织中MDA含量(P<0. 01)及脑组织中谷氨酸含量(P<0. 01; P<0. 05),同时还可明显增加血清GSH-PX活力(P<0. 05),病理检查结果显示,SS组合物能减少家兔全脑缺血再灌注损伤的脑组织范围,并能保护神经细胞。结论 SS组合物对兔脑缺血再灌注损伤有一定的保护及改善作用,其机制可能与其抗氧化和抑制兴奋性氨基酸释放或拮抗兴奋氨基酸毒性有关。     

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.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。