共查询到20条相似文献,搜索用时 255 毫秒
1.
���Է����Գ����������̽�� 总被引:13,自引:0,他引:13
目的 探讨慢性放射性肠炎的手术适应证及手术方式。方法 回顾性分析1995~2002年南京医科大学第一附属医院经手术治疗的5例慢性放射性肠炎的临床资料。结果 5例慢性放射性肠炎因狭窄伴穿孔、肠梗阻、直肠阴道瘘、出血分别行肠切除吻合、旁路手术、结肠造口及Miles手术。5例手术均获成功。随访6个月至2年,效果满意。结论 慢性放射性肠炎出现肠梗阻、肠瘘、出血、肠穿孔等并发症宜行手术治疗,肠切除吻合是较理想的术式。 相似文献
2.
目的探讨乌司他丁联合谷氨酰胺在治疗重症急性胰腺炎(severe acute pancreatitis,SAP)时对急性胰腺炎相关性肺损伤(acute pancreatitis associated lung injury,APALI)的预防和治疗作用。方法我院收治的60例SAP患者随机分为两组,对照组30例行常规+乌司他丁治疗;研究组30例在对照组基础上加用谷氨酰胺治疗。分别于治疗后第0,3,7,10天分析患者动脉血气,以血Pa O_2与吸氧浓度比值(Pa O_2/Fi O_2)、呼吸频率和肺部X线检查等为观察指标,同时抽取静脉血以检测患者血清TNF-α、IL-8及DAO水平的变化,观察研究组和对照组之间肺损伤发生率和对肺损伤疗效的差异。结果研究组APALI的发生率为33.3%,对照组为57.1%,两者差异有统计学意义(P0.05);治疗7 d后,研究组肺损伤程度较对照组显著减轻,且血清中TNF-α、IL-8及DAO的数值较对照组明显下降(P0.05)。结论乌司他丁联合谷氨酰胺在治疗SAP时具有协同作用,对急性胰腺炎相关性肺损伤有显著预防和治疗作用。 相似文献
3.
Prevention of mucosal atrophy: Role of glutamine and caspases in apoptosis in intestinal epithelial cells 总被引:6,自引:0,他引:6
Harry T. Papaconstantinou M.D. Dai H. Chung M.D. Weiping Zhang M.D. Naseem H. Ansari Ph.D. Mark R. Hellmich Ph.D. Courtney M. Townsend Jr. M.D. Tien C. Ko M.D. 《Journal of gastrointestinal surgery》2000,4(4):416-423
Glutamine starvation induces apoptosis in enterocytes; therefore glutamine is important in the maintenance of gut mucosal
homeostasis. However, the molecular mechanisms are unknown. The caspase family of proteases constitutes the molecular machinery
that drives apoptosis. Caspases are selectively activated in a stimulus-specific and tissue-specific fashion. The aims of
this study were to (1) identify specific caspases activated by glutamine starvation and (2) determine whether a general caspase
inhibitor blocks glutamine starvation-induced apoptosis in intestinal epithelial cells. Rat intestinal epithelial (RIE-I)
cells were deprived of glutamine. Specific caspase activation was measured using fluorogenic substrate assay. Apoptosis was
quantified by DNA fragmentation and Hoechst nuclear staining. Glutamine starvation of RIE-1 cells resulted in the time-dependent
activation of caspases 3 (10 hours) and 2 (18 hours), and the induction of DNA fragmentation (12 hours). Caspases 1 and 8
remained inactive. ZVAD-fluoromethyl ketone, a general caspase inhibitor, completely blocked glutamine starvation-induced
caspase activation, DNA fragmentation, and nuclear condensation. These results indicate that glutamine starvation selectively
activates specific caspases, which leads to the induction of apoptosis in PIE-1 cells. Furthermore, inhibition of caspase
activity blocked the induction of apoptosis, suggesting that caspases are potential molecular targets to attenuate apoptotic
responses in the gut.
Supported by National Institutes of Health grants F32 DK09867, KO8 CA64191, PO1 DK35608, and EY 08547; the American Cancer
Society, Texas Division, Inc.; the Lions Eye Bank Fotmdation; and the Walls Medical Research Foundation. Dr. Papaconstantinou
is a Visiting Scientist from the University of Cincinnati Medical Center, Cincinnati, Ohio, and is the recipient of a Clinical
Oncology Fellowship from the American Cancer Society, Texas Division, Inc.
Presented at the Fortieth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Fla., May 16–19, 1999,
and published as an abstract in Gastroenterology 116:A1325, 1999. 相似文献
4.
Prevention of chronic radiation enteritis 总被引:3,自引:0,他引:3
Waddell BE Rodriguez-Bigas MA Lee RJ Weber TK Petrelli NJ 《Journal of the American College of Surgeons》1999,189(6):e42-624
5.
6.
Giriş M Erbil Y Oztezcan S Olgaç V Barbaros U Deveci U Kirgiz B Uysal M Toker GA 《American journal of surgery》2006,191(4):503-509
BACKGROUND: Radiation enteritis is a significant clinical problem in patients receiving ionizing radiation directed at the abdomen or pelvis. The small intestine is the most radiosensitive gastrointestinal organ. Myeloperoxidase (MPO) activity and malondialdehyde (MDA) levels of the small intestine were measured to determine the oxidative damage caused by radiation. In addition, caspase-3 activity of the small intestine was measured to define the degree of apoptosis. The present study was undertaken to investigate the effect of glutamine administration on heme oxygenase-1 (HO-1) expression of the radiation enteritis model. METHODS: Rats received 1 g/kg/d glutamine (HO-1-inducer) for 7 days before irradiation and continued for 3 days after irradiation. Zn-prothoporphyin (Zn-PP) 40 micromol/kg was delivered subcutaneously for 1 day before irradiation. Intestinal MPO activities and MDA levels are indicators of oxidative damage, whereas caspase-3 activities show the degree of apoptosis of the small intestine. At histopathologic examination, terminal ileum tissue was analyzed for morphologic changes. Also, the nuclear factor-kappa (NF-kappa) expression level of the terminal ileum was determined with immunohistochemistry methods to show the mucosal inflammatory process. RESULTS: Irradiation significantly increased the intestinal MPO and caspase-3 activities, MDA levels, and HO-1 expression in comparison with the sham group. Glutamine treatment was associated with increased HO-1 expression, decreased MPO activity, caspase-3 activity, and MDA levels. Inhibition of HO-1 activity by Zn-PP completely eliminated the protective effects of glutamine. Histopathologic examination showed that the intestinal mucosal structure was preserved in the glutamine-treated group. In the irradiation group, NF-kappaB overexpression was detected. NF-kappaB positivity was strongest in the intestine of animals in the radiation alone group and the Zn-PP-treated irradiation group. CONCLUSIONS: Glutamine appears to have protective effects against radiation-induced intestinal damage. This protective effect is mediated in part by the induction of HO-1 activity because inhibition of Zn-PP resulted in the complete abolishment of the protective effect of glutamine. 相似文献
7.
目的探讨术前营养支持对放射性肠炎合并肠梗阻患者手术治疗效果的影响。方法回顾性分析因放射性肠炎合并肠梗阻而进行病变肠管切除手术的158例患者的临床资料。130例(82.3%)患者接受术前营养支持,其中行全胃肠外营养60例,完全肠内营养28例,肠内与肠外联合营养支持42例。分析术前营养支持对患者营养指标、手术方式、术后并发症及术后住院时间的影响。结果接受术前营养支持的130例患者血清白蛋白、前白蛋白和转铁蛋白等营养指标明显改善(均P〈0.05),但体质量指数和血红蛋白变化不明显(均P〉O.05)。与未接受营养支持者相比,术前行营养支持者肠造口率明显降低[31.5%(41/130)比53.6%(15/28),P=O.027]。术后感染并发症发生率明显降低[13.8%(18/130)比32.1%(9/28),P=O.019],术后住院时间显著缩短[(14.10±7.3)d比(18.8±15.8)d,P=-O.013]。在接受术前营养支持的130例患者中,能耐受或部分耐受肠内营养者,其肠造口率和感染性并发症发生率分别为28.6%(20/70)和7.1%(5/70)。术后住院时间为(15.5±9.6)d,明显优于全胃肠外营养者[48.3%(29/60),P=O.020;21.7%(13/60),P=O.017;(21.7±19.0)d,P=O.025]。结论术前营养支持可有效降低放射性肠炎合并梗阻的手术治疗患者的肠造口率和术后感染性并发症发生率,缩短术后住院时间。如果可以耐受,应尽量选择肠内营养进行营养支持。 相似文献
8.
目的 评价O-GlcNAc修饰在谷氨酰胺减轻脓毒症大鼠脑损伤中的作用.方法 健康清洁级4周龄SD雄性大鼠60只,体重180-240 g,采用随机数字表法,将其随机分为4组:假手术组(S组,n=12)、脓毒症组(CLP组,n=16)、谷氨酰胺组(G组,n=16)及谷氨酰胺+四氧嘧啶组(G+A组,n=1 6).采用盲肠结扎穿孔术(CLP)建立大鼠脓毒症模型,G组术毕静脉注射谷氨酰胺0.75 g/kg,G+A组术毕静脉注射谷氨酰胺0.75 g/kg及腹腔注射四氧嘧啶90 mg/kg,CLP组和S组注射等容量生理盐水.术后24h时记录神经反射评分,断颈处死,测定脑组织含水量,采用Western-blot法测定脑组 织O-GlcNAc表达水平,观察脑组织病理学结果.结果 与S组比较,CLP组、G组及G+A组大鼠脑组织含水量、神经反射评分升高(P<0.05);与CLP组比较,G组和G+A组大鼠脑组织含水量、神经反射评分降低,G组大鼠脑组织蛋白质O-GlcNAc表达上调(P<0.05);与G组比较,G+A组大鼠脑组织含水量、神经反射评分升高,脑组织蛋白质O-GlcNAc表达下调(P<0.05);S组、CLP组及G+A组大鼠间脑组织蛋白质O-GlcNAc表达差异无统计学意义(P>0.05).G组病理学损伤较CLP组及G+A组轻.结论 O-GlcNAc修饰参与了谷氨酰胺减轻脓毒症大鼠脑损伤的过程. 相似文献
9.
Epidermal growth factor activation of intestinal glutamine transport is mediated by mitogen-activated protein kinases 总被引:5,自引:0,他引:5
Christopher L. Wolfgang M.D. Ph.D. Cheng Mao Lin Ph.D. Qing He Meng M.D. Anne M. Karinch Ph.D. Thomas C. Vary Ph.D. Ming Pan M.D. Ph.D. 《Journal of gastrointestinal surgery》2003,7(1):149-156
Glutamine is an essential nutrient for gut functions, but the regulation of its uptake by intestinal mucosal cells is poorly
understood. Given the pivotal role of epidermal growth factor (EGF) in regulating gut metabolism, growth, and differentiation,
this in vitro study was designed to investigate the intracellular signaling pathways involved in the regulation of EGF-mediated
intestinal glutamine transport in intestinal epithelia. Continuous incubation with EGF (>30 hours, 100 ng/ml) stimulated glutamine
transport activity across intestinal epithelial Caco-2 cell apical membrane. Exposure to EGF for 48 hours resulted in an increase
in transport activity (50%) and glutamine transport system B gene ATB0 mRNA levels (ninefold). EGF stimulated glutamine transport activity by increasing the glutamine transporter maximal velocity
(Vmax) without altering the transporter apparent affinity (Km). Furthermore, EGF stimulated both intracellular protein kinase C
and mitogen-activated protein kinase MEK1/2 activities. The EGF-stimulated glutamine transport activity was attenuated individually
by the specific protein kinase C inhibitor chelerythrine chloride and the mitogen-activated protein kinase MEK1 inhibitor
PD 98059. These data suggest that EGF activates glutamine transport activity across intestinal epithelial membrane via a signaling
mechanism that involves activation of protein kinase C and the mitogen-activated protein kinase MEK1/2 cascade. EGF activates
glutamine transport via alterations in transporter mRNA levels and the number of functional copies of transporter units.
Presented at the Forty-Third Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, California,
May 19–22, 2002 (poster presentation). 相似文献
10.
11.
封闭负压引流技术对人慢性创面中胶原酶活性的影响 总被引:10,自引:0,他引:10
目的研究人慢性创面经封闭负压引流(vacuum—assisted closure,VAC)治疗前后,创面渗出液中胶原酶活性的变化,以部分阐明VAC促进慢性创面愈合的机理。方法取4例急性创面在术后1、2、3d的创面引流液(乳癌术后),同时收集6例慢性创面(4例静脉性溃疡,2例压力性溃疡)在VAC治疗前以及治疗后2、4、6d的创面渗出液,利用酶谱分析的方法,观察各时间点的渗出液对可溶性Ⅲ型胶原的降解情况,同时应用强力霉素抑制实验来分析渗出液中胶原酶的类型。结果急性创面引流液可以部分降解Ⅲ型胶原,随时间推移变化较小,慢性创面渗出液中的胶原酶活性较高,VAC治疗前基本将Ⅲ型胶原全部降解,随时间推移、降解减少,胶原酶活性下降,强力霉素抑制实验证明在100μmol/L浓度时无抑制,在600μmol/L浓度时出现部分抑制。结论在慢性创面渗出液中胶原酶活性增高,VAC的应用可以降低胶原酶的活性,阻止胶原蛋白大量降解,利于创面愈合,在慢性创面渗出液中胶原酶应主要是MMP-1型(成纤维细胞型)。 相似文献
12.
BackgroundThis study aimed to compare the clinical outcomes and toxicity between small hepatocellular carcinoma (HCC) patients treated with stereotactic body radiation therapy (SBRT) and those treated with radiofrequency ablation (RFA).MethodsWe searched databases for relevant clinical studies. The primary outcomes of interest were overall survival (OS) at 1 and 2 years, freedom from local progression (FFLP) rate at 2 years, and complications.ResultsFive cohorts from 5 retrospective studies and 4,814 patients with HCC were included. Pooled OS at 2 years was significantly lower for SBRT than for RFA [odds ratio (OR): 0.63; 95% confidence interval (CI): 0.51–0.79; P<0.0001], but the pooled FFLP rate at 2 years was higher for SBRT than for RFA (OR: 1.66; 95% CI: 1.05–2.61; P=0.03). In addition, there was no significant difference in the local and liver toxicities of the two treatments. The contradictory conclusion between the OS and FFLP outcome may be attributed to the difference in radiological dose and location, but there were no uniform criteria to illustrate the radiological dose and location in the included studies.ConclusionsSBRT had a higher local control ratio but poorer prognosis than RFA in patients with small HCC. The local toxicity was comparable in both treatments. Further trials should be designed with uniform standards for SBRT and RFA treatments. 相似文献
13.
Bone morphogenic protein-7 (BMP7) is a morphogen that is important for kidney development and which is also an integral part of the kidney's physiological response to repair of acute kidney injury. Several studies demonstrate that preexisting renal BMP7 pathways can be utilized by administering recombinant BMP7 to protect the kidney in experimental models of chronic kidney disease (CKD). Effectiveness of recombinant BMP7 in animal studies raises the possibility that the BMP7 pathway could be equally utilized to treat patients with CKD and interstitial fibrosis. However, regulation of BMP7 activity in the kidney is complex. BMP7 activity in the kidney is not only determined by availability of BMP7 itself, but also by a balance of agonists, such as Kielin/chordin-like protein (KCP) or BMP receptors, and antagonists including gremlin, noggin, or uterine sensitization-associated gene-1 (USAG-1). Presence of BMP7 agonists and antagonists has to be considered when recombinant BMP7 is supplemented to treat injured kidneys. Here we summarize recent insights into the role of BMP7 in acute and chronic kidney injury and discuss the implications for future directions of antifibrotic therapies. 相似文献
14.
G A Coles J H Meadows C Bright K Tomlinson 《Nephrology, dialysis, transplantation》1989,4(10):877-882
Forty-five adult clinic patients with chronic renal failure each supplied a 4-day weighed dietary record, a 24-h urine collection, and a nocturnal spot urine sample. Total nitrogen (N) losses derived from the urines were corrected for proteinuria and non-urea nitrogen excretion. Individual estimates of N intake were compared by correlation and assessing the level of agreement. Daily urea N excretion derived from the spot sample correlated well with the 24-h collection P less than 0.001, but the degree of agreement was poor, mean difference being +1.62 g with 95% limits of +5.7 to -2.47 g. The correlation between the spot-sample-derived N loss and dietary N intake was poor, r = 0.42; P less than 0.05. For 12 patients taking a low-protein diet, N intake correlated well with 24-h urine derived N losses, P less than 0.001, mean difference being +0.59 g, 95% limits +2.39 to -1.21 g. The correlation and agreement was less satisfactory for the subjects who had not received dietary instruction, due largely to individual variation in day-to-day protein intake. Use of spot urine samples is too inaccurate for routine clinical practice. Single 24-h urine derived estimates of N intake are only of value for assessing patients previously prescribed a low-protein intake. 相似文献
15.
16.
Theresa R. Grover Beverly S. Brozanski James Barry Isabella Zaniletti Jeanette M. Asselin David J. Durand Billie L. Short Eugenia K. Pallotto Francine Dykes Kristina M. Reber Michael A. Padula Jacquelyn R. Evans Karna Murthy 《Journal of pediatric surgery》2014
Background/purpose
Infants with severe chronic lung disease (sCLD) may require surgical procedures to manage their medical problems; however, the scope of these interventions is undefined. The purpose of this study was to characterize the frequency, type, and timing of operative interventions performed in hospitalized infants with sCLD.Methods
The Children's Hospital Neonatal Database was used to identify infants with sCLD from 24 children’s hospital’s NICUs hospitalized over a recent 16-month period.Results
556 infants were diagnosed with sCLD; less than 3% of infants had operations prior to referral and 30% were referred for surgical evaluation. In contrast, 71% of all sCLD infants received ≥ 1 surgical procedure during the CHND NICU hospitalization, with a mean of 3 operations performed per infant. Gastrostomy insertion (24%), fundoplication (11%), herniorrhaphy (13%), and tracheostomy placement (12%) were the most commonly performed operations. The timing of gastrostomy (PMA 48 ± 10 wk) and tracheostomy (PMA 47 ± 7 wk) insertions varied, and for infants who received both devices, only 33% were inserted concurrently (13/40 infants).Conclusions
A striking majority of infants with sCLD received multiple surgical procedures during hospitalizations at participating NICUs. Further work regarding the timing, coordination, perioperative complications, and clinical outcomes for these infants is warranted. 相似文献17.
18.
Ito M Ejiri S Jinnai H Kono J Ikeda S Nishida A Uesugi K Yagi N Tanaka M Hayashi K 《Journal of bone and mineral metabolism》2003,21(5):287-293
We investigated the ability of synchrotron radiation computed tomography (SR-CT) to demonstrate trabecular microstructure, detail of trabecular surfaces, and mineralization of bones. Eight rat vertebrae, six rat tibiae, and eight minipig vertebrae were scanned using SR-CT at the synchrotron radiation facility Super Photon ring-8GeV (SPring-8). Images obtained using conventional micro-CT, scanning electron microscopy (SEM), and contact microradiography (CMR) were compared with the SR-CT images. SR-CT showed high image quality without visible partial volume effect. Three-dimensional SR-CT revealed shallow concavities in the bone surface, which were considered to correspond to osteoclastic resorption areas, as well as the connectivity, anisotropy, and shape (rod- or platelike) of trabeculae. Two-dimensional SR-CT showed different density along the surface of the trabecular bone, indicating the degree of bone mineralization. In conclusion, SR-CT seems to be a useful tool for delineating trabecular surfaces, evaluating bone mineralization, and revealing precise trabecular structure. 相似文献
19.
Tokashiki K Tozawa M Iseki C Kohagura K Kinjo K Takishita S Iseki K 《Clinical and experimental nephrology》2009,13(1):55-60
BACKGROUND: Obesity and metabolic syndrome are risk factors for the development of chronic kidney disease (CKD). Few studies have examined the effect of change in body mass index (DeltaBMI) on CKD incidence in a general screening setting. METHODS: Subjects of this study were screenees that participated in the screening program of the Okinawa General Health Maintenance Association in 1993 and 2003 in Okinawa, Japan. Using identification number, birth date, sex, and other recorded identifiers, we identified 33,389 subjects among the 1993 screening participants (N = 143,948) who also participated in the 2003 screening. CKD was defined as estimated glomerular filtration rate <60 ml/min/1.73 m(2), according to the modification of diet in renal disease study equation. Obesity was defined as BMI > or = 25 kg/m(2). RESULTS: CKD prevalence was 13.8% in 1993 and 22.4% in 2003. The incidence of developing CKD in 10 years was 15.5%. The effect of DeltaBMI on CKD incidence was evaluated after considering other confounding factors such as age, sex, blood pressure, BMI, fasting plasma glucose, and proteinuria. Median DeltaBMI was 1.0%. The adjusted odds ratio (95% CI) for the effect of DeltaBMI on CKD incidence was 1.111 (1.026-1.204, P < 0.01; entire study population), 1.271 (1.116-1.448, P = 0.0030; men), and 1.030 (0.931-1.139, NS; women), when DeltaBMI > or = 1% was taken as a reference. DeltaBMI was an independent predictor of CKD incidence. CONCLUSIONS: The present results suggest that there was an inverse relationship between DeltaBMI and CKD incidence among screened subjects. The reasons for this observation are not clear, but careful follow-up for DeltaBMI is necessary, particularly in obese men with proteinuria. 相似文献
20.
慢性阻塞性腮腺炎导管内镜探查与扩张灌注治疗 总被引:2,自引:0,他引:2
目的探讨内镜下慢性阻塞性腮腺炎的表现和导管扩张、药物灌注治疗疗效. 方法应用乳管镜对12例慢性阻塞性腮腺炎患者的导管进行观察,1周后做导管扩张及用庆大霉素灌注.结果导管炎11例[其中伴狭窄7例(狭窄伴炎性增生4例、狭窄伴粘液栓2例),单纯导管炎4例],单纯导管狭窄1例.术后4周随访,优4例,良7例,差1例.结论内镜检查结合扩张和灌注治疗对慢性阻塞性腮腺炎有一定近期疗效. 相似文献