质子泵抑制剂对双氯芬酸诱导小肠黏膜损伤保护机制研究

目的 探讨不同质子泵抑制剂(PPI)对大鼠非甾体类抗炎药(NSAID)所致小肠损伤是否具有保护作用及可能的保护机制.方法 将72只SD大鼠均分为空白对照组、模型对照组和奥美拉唑治疗组、埃索美拉唑治疗组、雷贝拉唑治疗组、兰索拉唑治疗组.除空白对照组外其余各组予双氯芬酸7.5mg· kg-1 ·d-1灌胃,1次／d,制备NSAID相关性小肠损伤大鼠模型.各治疗组分别予奥美拉唑30mgmg·kg-1 ·d-1、埃索美拉唑30mg· kg-1·d-1、兰索拉唑45mg·kg-1·d-1、雷贝拉唑15mg· kg1·d1,1次／d灌胃.连续给药5d,处死后取小肠组织,观察其大体和病理学损伤变化,应用Western印迹检测、实时PCR分析小肠组织转录因子红细胞系-2p45相关因子-2(Nrf2)蛋白及mRNA表达,免疫组织化学染色行小肠组织Nrf2的定性及定位分析,黄嘌呤氧化酶法和硫代巴比妥法检测小肠组织超氧化物歧化酶(SOD)和丙二醛(MDA)活性.结果 实验造模成功率100％.空白组对照组大鼠存活率为12/12;模型对照组存活率为9/12;奥美拉唑治疗组存活率为10/12;埃索美拉唑治疗组存活率为11/12;雷贝拉唑治疗组存活率为11/12;兰索拉唑治疗组存活率为10/12.雷贝拉唑、埃索美拉唑、兰索拉唑治疗组大体和病理损伤积分均明显低于模型对照组(P＜0.05).小肠组织SOD活性雷贝拉唑治疗组明显高于模型对照组(P＜0.05),而MDA活性雷贝拉唑、埃索美拉唑治疗组明显低于模型对照组(P＜0.05).Western印迹检测显示雷贝拉唑治疗组小肠组织Nrf2蛋白表达量较模型对照组升高(P＜0.05).实时PCR结果雷贝拉唑治疗组小肠组织Nrf2 mRNA表达较空白对照组和模型对照组明显升高(P值分别＜0.01和0.05).结论 不同PPI对NSAID小肠损伤的保护作用不同,但奥美拉唑的保护作用不明显.其中雷贝拉唑防止NSAID小肠损伤的机制可能通过上调转录因子Nrf2的表达及促进其活化来实现.     

食管内照射支架治疗晚期食管癌六年回顾性分析

目的 观察食管置入内照射支架的疗效及安全性.方法 回顾分析32例晚期食管癌患者置入食管内照射支架后支架置入的时间和置入成功率、即时疗效、近中期疗效、生存期、并发症、体重、血象、免疫指标、平均住院时间和住院费用.结果 支架置入术操作时间平均(18±5) min,置入成功率100%,释放过程中无放射粒子脱落,吞咽困难缓解率...     

非甾体抗炎药肠损伤大鼠模型小肠组织中蛋白酶激活受体2的表达与肥大细胞分布

Objective To identify the expression and significance of protease-activated receptor-2 (PAR-2) and mast cell ( MC) in the rat model of small intestinal mucosal damage by a short-term administration of diclofenac. Methods Twenty-four SD-rats were divided into 2 groups ( control group and model group, 12 rats each) by random digit table. The rats in the control group were treated with 1 ml distilled water per 250 g, once a day while those in the model group diclofenac 7. 5 mg/kg per day. Their terminal ileum was harvested at Day 5 after an intraperitoneal injection. Toluidine blue dyeing was employed to determine the distribution of MC and its count in intestinal mucous membrane. Immunohistochemistry,Western blot and real-time PCR (polymerase chain reaction) were employed analyze the location, expression and change of PAR-2 mRNA in intestinal mucous membrane. Results The count of MC was obviously higher in the model group than that in the control group( 10. 3 ±2. 2 vs 4. 2 ± 1. 2, P ＜0.05 ). PAR-2 was expressed on the mucous surface, recesses epidermis and lamina propria inflammatory cells. And positive dyes were located within cytoplasm. As compared with the control group, the expression of PAR-2 mRNA was higher(2. 63 ±0. 26 vs 1, P ＜0. 05)and its protein expression higher in the model group(24. 3 ±2.4 vs 17. 5 ±3. 5, P＜0. 05). Conclusion Both PAR-2 and mast cell are involved in the pathogenesis of small intestinal mucosa injury induced by diclofenac in rats. PAR-2 may be activated by tryptase released from mast cells and participate in the pathogenesis of small intestinal injury as induced by non-steroidal antiinflammatory drugs.     

白芍总苷联合甲氨蝶呤治疗类风湿关节炎的疗效评价

目的:探讨白芍总苷联合甲氨蝶呤治疗类风湿关节炎疗效。方法:2018年2月至10月,广州中医药大学第二附属医院动物实验中心建立类风湿关节炎大鼠模型,建模成功后随机分为观察组和对照组,给予对照组大鼠甲氨蝶呤治疗,给予观察组大鼠白芍总苷联合甲氨蝶呤治疗,4周后比较两组治疗总有效率,然后处死两组大鼠,截取足部跖趾关节组织,采用免疫组化法检测磷酸酶基因(PTEN)、胞浆信号转导蛋白(AKT)、血管内皮生长因子(VEGF)、缺氧诱导因子1α(HIF–1α)表达情况,并采集尾动脉血,进行VEGF、HIF–1α检测。结果:观察组大鼠治疗总有效率较对照组高,差异具有统计学意义(P 0.05),观察组大鼠关节组织的PTEN阳性率较对照组低,AKT、VEGF、HIF–1α阳性率及尾动脉血VEGF、HIF–1α水平均较对照组高,差异具有统计学意义(P 0.05)。结论:白芍总苷联合甲氨蝶呤治疗类风湿关节炎,疗效良好。     

阿萨伊油、醇提及水提物对虚热及虚寒小鼠温度趋向性及代谢水平的影响

通过考察阿萨伊油、醇提物和水提物等拆分组分对虚热及虚寒证小鼠的温度趋向性动物行为学表征,环核苷酸及代谢水平等内在生化指标的影响,探讨阿萨伊各拆分组分的寒热药性特点以及寒凉的物质基础。将昆明种雄性小鼠随机分为空白组、虚热模型组、虚热+阿萨伊冻干原粉组、虚热+阿萨伊油组、虚热+阿萨伊醇提物组、虚热+阿萨伊水提物组、虚寒模型组、虚寒+肉桂组、虚寒+阿萨伊冻干原粉组、虚寒+阿萨伊油组、虚寒+阿萨伊醇提物组、虚寒+阿萨伊水提物组共12个组。虚热组小鼠每天下午灌胃给予甲状腺片溶液160 mg·kg-1,虚寒组小鼠给予氢化可的松溶液25 mg·kg-1,连续14 d,各给药组灌胃相关药物,实验结束后测定动物温度趋向性、环核苷酸及代谢水平等相关指标。阿萨伊醇提物同阿萨伊原粉一致,表现出对虚热模型小鼠的调整作用;阿萨伊油及其水提物同肉桂一致,表现出对虚寒模型小鼠的调整作用。该研究基于中药性味可拆分理论,采用同类比较异类反证的方法证明了阿萨伊醇提物性偏凉,油及其水提物性偏温的特征,并明确了醇提物为阿萨伊性凉的物质基础。     

葛琳仪教授治疗慢性泄泻的临床经验撷菁

分析总结葛琳仪教授治疗慢性泄泻的临床经验,倡导“三位合一”中医思辨模式,融辨证、辨病、辨体(质)为一体,强调辨体论治,根据不同的体质选方用药;谨守病机,“正本清源”为要,主张攻补兼施,以祛邪健脾为主,疏肝补肾为要,标本兼治;巧施对药,遣方用药以简练、轻重有度为特点,不同时期用药轻重不同。现将经验总结如下。     

非甾体抗炎药肠损伤大鼠模型小肠组织中蛋白酶激活受体2的表达与肥大细胞分布

Objective To identify the expression and significance of protease-activated receptor-2 (PAR-2) and mast cell ( MC) in the rat model of small intestinal mucosal damage by a short-term administration of diclofenac. Methods Twenty-four SD-rats were divided into 2 groups ( control group and model group, 12 rats each) by random digit table. The rats in the control group were treated with 1 ml distilled water per 250 g, once a day while those in the model group diclofenac 7. 5 mg/kg per day. Their terminal ileum was harvested at Day 5 after an intraperitoneal injection. Toluidine blue dyeing was employed to determine the distribution of MC and its count in intestinal mucous membrane. Immunohistochemistry,Western blot and real-time PCR (polymerase chain reaction) were employed analyze the location, expression and change of PAR-2 mRNA in intestinal mucous membrane. Results The count of MC was obviously higher in the model group than that in the control group( 10. 3 ±2. 2 vs 4. 2 ± 1. 2, P ＜0.05 ). PAR-2 was expressed on the mucous surface, recesses epidermis and lamina propria inflammatory cells. And positive dyes were located within cytoplasm. As compared with the control group, the expression of PAR-2 mRNA was higher(2. 63 ±0. 26 vs 1, P ＜0. 05)and its protein expression higher in the model group(24. 3 ±2.4 vs 17. 5 ±3. 5, P＜0. 05). Conclusion Both PAR-2 and mast cell are involved in the pathogenesis of small intestinal mucosa injury induced by diclofenac in rats. PAR-2 may be activated by tryptase released from mast cells and participate in the pathogenesis of small intestinal injury as induced by non-steroidal antiinflammatory drugs.     

基层医院新生儿病房的感染控制与管理

新生儿免疫功能不全,抵抗力低,细菌很容易从皮肤黏膜、脐带残端、呼吸道、消化道进入新生儿体内而致感染.因此,降低新生儿医院感染的发生是科室工作的重要内容.现将我院新生儿病房医院感染控制管理总结如下. 1 建立健全各种制度 制定新生儿病室物品清洁消毒制度;手、空气、物体表面环境卫生学监测制度;新生儿病室医院感染监控和报告制度;医务人员在诊疗过程中实施标准预防,并严格执行手卫生规范和无菌操作技术;新生儿病室医疗废弃物管理按照《医疗废物管理条例》及有关规定进行分类、处理.     

国医大师葛琳仪治疗胃食管反流病临床经验

葛琳仪教授是第三届国医大师、第二批全国老中医药专家学术经验继承工作指导老师。葛琳仪教授治学严谨,悬壶55载,学验俱丰,尤善治脾胃病、肺病、老年病、疑难病。其基本学术思想是“三位合一,多元思辨”、“谨守病机,正本清源”、“用药简练,衷中参西”。胃食管反流病是指胃或十二指肠内容物反流至食管而引起的以烧心、反酸等为主要症状的一类消化道疾病,属于中医“吐酸”、“食管瘅”范畴[1],其病因病机为胃失和降、胃气上逆,病位在胃、食管,与肝脾息息相关。葛教授在治疗脾胃病时以疏理中焦气机、健脾和胃为大法,在治疗胃食管反流病时佐以“清”法。现将其治疗胃食管反流病的经验总结如下。     

中医学专业学生西医临床实践技能的现状和需求分析

为了解中医学专业学生西医临床实践技能的现状和需求情况,采用问卷调查法对我校05-07级168名中医学专业本科及硕士生进行抽样调查。83.0%的学生认为有必要进行西医临床实践技能的专业培训;非常期望能加强临床诊断思维,体格检查,常见急症的处理,医患关系处理,X线、心电图诊断等技能。因此中医学专业学生提高西医临床实践技能较迫切,应在后期教学和实习中有针对性的加强。