Spontaneous rupture of splenic vein in a pregnant woman during a religious ritual

The treatment of retroperitoneal hemorrhage can be by surgical or a conservative approach but the main problems about these cases are difficulty in diagnosis due to negative results after abdominal lavage and the difficulties in accessing the retroperitoneal area surgically. Retroperitoneal hemorrhage during pregnancy, occurring as a result of spontaneous rupture, is very rare event. Such cases require urgent operation and if not, result in high mortality. A twenty-eight year old pregnant woman was admitted to the hospital dead after collapsing at home during a religious ritual. No systemic or gynecological pathology had been diagnosed. No traumatic injury on her body was found at early postmortem examination. The pathologic findings found at the autopsy are; approximately 2.5 L of coagulated blood in the retroperitoneal region and 10-12 cm of haematoma at the hilum of spleen; dissection revealed a tear of 0.5 cm on lienal vein at a point 3 cm from the hilum. Surgical approach is the most important procedure for diagnosis and therapy of the bleeding. Autopsy may be only diagnostic technique in the case of retroperitoneal hemorrhage death when the death is so rapid that there is no time to intervene surgically.     

Reconstruction of distal forefoot burn defect with retrograde medial plantar flap

Burn reconstruction of forefoot remains as a difficult challenge, because the local flap alternatives are limited. We evaluated the efficiency of distally based medial plantar fasciocutaneous island flap in the coverage of forefoot defects resulting from release of toe contracture and burn debridement. Four patients with toe contractures and two patients with third degree burn in forefoot were treated between June 2004 and February 2006. The mean follow-up period was 10.4 months. The flaps were elevated as with a fasciocutaneous base on the distal medial plantar artery. The dimensions of the flaps ranged from 4cmx3cm to 5cmx4cm. The skin over the pedicle was included as a part of flap in three cases. Concomitant vein of the pedicle was anastomosed with the first plantar digital vein in four cases. In the early postoperative period, one flap used to cover third degree burn due to high-voltage electric injury was lost completely. We concluded that this flap was an appropriate alternative reconstructive option for the forefoot defect. Including skin and subcutaneous tissue over the pedicle to flap protects the pedicle against kinking and compression. Venous supercharging of the flap improves venous drainage.     

灯盏细辛联合依帕司他对糖尿病肾病模型大鼠的治疗作用及机制

目的:探讨基于多元醇通路(PP)中醛糖还原酶(AR)灯盏细辛联合依帕司他(EPST)对糖尿病肾病(DN)大鼠氧化应激以及肾功能的干预机制。方法:将50只SD大鼠,随机平均分为正常对照组以及各干预组(模型组、EPST组、灯盏细辛组和EPST+灯盏细辛组)。各干预组采用单次注射链脲佐菌素(STZ)55 mg/kg合并喂养高脂高糖饲料的方法制备大鼠DN模型。持续灌胃给药6周后,观察大鼠一般形态学变化; HE染色观察大鼠肾组织形态变化; 血糖仪检测空腹血糖(FBG)水平; 动物体重天平检测体重水平; 全自动生化仪检测血肌酐(Scr)和尿素氮(BUN)水平; 试剂盒检测肾组织中超氧化物歧化酶(SOD)、丙二醛(MDA)、还原型谷胱甘肽(GSH)水平; ELISA检测24 h尿微量白蛋白(24 h UmAlb)和肾组织AR水平。结果:与正常对照组比较,模型组大鼠出现“三多一少”糖尿病典型症状,肾小球肥大,肾小管呈空泡样变性,FBG水平升高(P<0.01),体重水平降低(P<0.01),24 h UmAlb、Scr和BUN水平升高(P<0.01),SOD和GSH水平降低(P<0.01),MDA水平升高(P<0.01),AR活性升高(P<0.01)。与模型组比较,各给药组整体状态好转,肾组织病理结构损害显著降低,FBG水平降低(P<0.01),体重水平升高(P<0.01),24 h UmAlb、Scr和BUN水平降低(P<0.01),SOD和GSH水平升高(P<0.01),MDA水平降低(P<0.01),AR活性降低(P<0.01),而EPST+灯盏细辛组的作用显著优于EPST或灯盏细辛组(P<0.05)。结论:灯盏细辛与EPST联合给药能改善DN大鼠肾功能以及提高其抗氧化能力,且治疗效果优于单独给药组,其作用机制可能与通过下调肾组织AR活性来抑制PP的激活,并协同减轻肾组织氧化应激有关。     

Favourable effects of whey protein on acetic acid-induced ulcerative colitis in a rat model

IntroductionIn the present study, we aimed to examine the effects of the administration of whey protein through rectal enema to rats with acetic acid-induced ulcerative colitis on the pathways of nuclear-related factor-2 (Nrf-2), haem oxygenase-1 (HO-1), nuclear factor κB (NF-κB), active protein kinase-1 (AP-1), tumour necrotising factor-α (TNF-α), and cyclooxygenase-2 (COX-2), IL-6, IL-10.Material and methodsTwenty-eight rats were employed for the trial. Ulcerative colitis was induced through the use of acetic acid. The therapeutic doses of whey protein were administered rectally. Ulcerative colitis was subjected to histopathological examination and protein levels in colon tissue were measured with the Western blot method.ResultsThe significant increases observed in the levels of AP-1, COX-2, IL-6, IL-10, NF-κB, and TNF-α as markers of inflammation following the development of ulcerative colitis showed remarkable decreases along with the administration of whey protein (p < 0.05). On the other hand, we identified a decrease in the Nrf2-ARE signal pathway and HO-1 protein having protective roles in the colon inflammatory response along with the development of ulcerative colitis and activation of the Nrf2-HO-1 pathway by the whey protein.ConclusionsWhey protein modulates Nrf2/HO-1 and NF-kB pathways, thereby creating a therapeutic effect against colonic inflammation induced by acetic acid (AA) due to its anti-inflammatory effects.     

Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!

Background/aimThe objective of the study was to evaluate the response, relapse, reproductive results and demographic features of the patients with endometrioid adenocancer (EAC) and endometrial intraepithelial neoplasia (EIN) who were treated with conservative treatment. This is the largest study when we consider the single center studies in this field.Materials and methodsIn the current retrospective study, 38 patients (6 EAC, 31 EIN, 1 synchronous tumors of ovary and endometrium) were recruited. They were treated with progesterone products for their fertility desire and comorbidity. Reproductive results, response rates, and recurrence rates were calculated and survival analyses were performed. ResultsMean duration of the medical treatment was 10 months (range 2–60). Among the 32 patients with EIN, 28 (87.5%) had a response, 8 (25%) had a relapse and 4 (12.5%) had persistence. Among the 32 patients who expecting fertility, seven patients got pregnant (21.8%) with a total of five live births. The median follow-up was 40.5 months (range 3–180), and recurrence-free interval was 28.7 months (range 2–180).ConclusionFertility-sparing treatment of EAC and EIN is a feasible approach, and the eligible patients should be given a chance to get pregnant.     

基于“凡动皆属火”辨治恶性肿瘤

《格致余论》“火内阴而外阳，主乎动者也，故凡动皆属火”。“凡动者皆属火”是对火邪作用特点的高度概括，也与恶性肿瘤其善变动，易侵袭，伤津耗气等特性相符。现基于“凡动皆属火”理论，从火邪角度对癌瘤发生发展以及转归中的本质与病机特点进行阐述，并基于癌瘤之火邪病机结合现代医学研究成果提出治疗思路，以期对肿瘤的中医临证辨治提供新启发。     

基于数据挖掘的吕仁和教授治疗2型糖尿病用药规律研究

目的:总结吕仁和教授治疗糖尿病的用药规律,阐发吕仁和教授治疗糖尿病的学术思想与临床经验.方法:选取吕仁和教授2012年1月至2021年6月治疗糖尿病的处方,基于PageRank算法,采用FangNet平台,多维度分析处方药物的四气五味、药物剂量、核心处方及药物群组.结果:研究纳入患者214例,涉及214诊次,处方涉及中...     

基于网络药理学探讨补阳还五汤治疗高脂血症的作用机制＊

目的 本研究探讨补阳还五汤治疗高脂血症的物质基础与作用机制。方法 运用TCMSP数据库和STICH数据库收集补阳还五汤化学成分和靶点信息，通过HPO数据库筛选疾病的靶点，然后利用Cytoscape 3.6.1软件对成分靶点和疾病靶点进行网络拓扑学分析，获取补阳还五汤治疗高脂血症的作用靶点，再运用DAVID在线分析工具对作用靶点进行KEGG通路富集及分析，最后构建“补阳还五汤-化学成分-核心靶点-关键通路”的多层次网络关联图。结果 共得到补阳还五汤潜在活性成分107个，药物靶点487个，疾病靶点95个，拓扑分析共得核心靶点113个，主要KEGG通路20条。本研究结果表明，补阳还五汤治疗高脂血症的作用机制可能与CREBBP、TP53和PPARA等靶点及脂肪细胞因子、FoxO、TNF、HIF-1和PI3K-Akt信号通路有关。结论 本研究筛选了补阳还五汤治疗高脂血症的关键靶点和通路，为补阳还五汤用于临床治疗提供了科学依据。