他克莫司对大鼠肝脏组织蛋白磷酸酶2A和P-AKT表达的影响

目的 通过观察他克莫司对大鼠血糖、胰岛素水平、肝脏组织蛋白磷酸酶2A和磷酸化AKT表达的影响,进一步探究他克莫司导致血糖升高的机制。方法 将60只雄性SD大鼠（89.83?.44g）随机均分为他克莫司组和对照组,他克莫司组（n=40）,每日空腹（禁食水8小时）灌胃给药,剂量为4mg/kg?d;对照组（n=20）,每日空腹灌胃给予等量生理盐水,每月测量大鼠体重、空腹血糖, 5个月后处死大鼠,心脏穿刺取血,;取胰腺组织和肝脏组织,测大鼠血清胰岛素水平,行胰腺组织病理组织学观察,并对肝脏行组织处理和免疫组织化学技术检测肝细胞浆质中蛋白磷酸酶2A和磷酸化AKT的表达。结果 用药2个月后,他克莫司组大鼠的血糖水平明显高于对照组（P＜0.05）,他克莫司组大鼠的胰岛素分泌指数、胰岛素敏感指数和均明显低于对照组（P＜0.05）;胰岛素抵抗指数明显增高（P＜0.05）。他克莫司组大鼠与对照组相比,其肝细胞浆质内PP2A表达明显增加,磷酸化的AKT表达明显减少。结论 他克莫司导致胰岛细胞坏死,胰岛细胞数量减少,胰岛素的分泌降低、胰岛素敏感性下降、胰岛素抵抗增加,从而导致大鼠血糖升高。他克莫司增加大鼠肝脏组织PP2A的表达,减少肝脏组织磷酸化的AKT的表达,可能通过PI3K/AKT信号转导途径参与胰岛细胞凋亡和胰岛素抵抗,引起血糖的升高。     

Triterpenoids with antioxidant activities from Myricaria squamosa

A new triterpenoid, namely myricarin C (compound 1), together with three known compounds myricarin A (compound 2) and myricarin B (compound 3), 3α-hydroxy-D-friedoolean-14-en-28-oic acid (compound 4), was isolated from the overground part of Myricaria squamosa. Compound 2 and compound 3 existed in the solution by the form of cis-trans isomers. Their structures were elucidated by means of extensive spectroscopic methods, including 1D-NMR, 2D-NMR, and HR-ESI-MS. The antioxidant properties of all compounds were calculated based on the DPPH radical scavenging activities. Results showed that myricarin A and myricarin C had general antioxidant activities with EC₅₀ values of 40.90 μg/ml, 42.22 μg/ml, respectively, compared to the control, rutin (5.17 μg/ml). The EC₅₀ values of myricarin B was 195.81 μg/ml. Compound 4 had no antioxidant activities.     

Chemical radiculitis

The theory of chemical radiculitis had been put forward about 30 years ago, but as yet it has not been proved by clinical studies. The aim of the current studies was to determine whether the annular tear of a painful disc proved by discography is the cause of radiating leg pain (radiculopathy) in patients with discogenic low back pain. Forty-two patients with discogenic low back pain at single disc level with concomitant radiating leg pain were studied in order to analyse the relationship between site of annular tear and side of radiating leg pain. Electromyogram and motor nerve conduction velocity were monitored to examine nerve root injury. The current studies found that there was a significant positive correlation between the site of annular tear and the side of radiation pain. Abnormalities of electromyogram and reduction of motor nerve conduction velocity were found on the side of radiating leg pain. The studies indicated that leakage of chemical mediators or inflammatory cytokines, which are produced in the painful disc, into epidural space through annular tear could lead to injury to adjacent nerve roots, and it might constitute the primary pathophysiologic mechanism of radiating leg pain in patients with discogenic low back pain but with no disc herniation.     

抗骨髓炎片对家兔骨髓炎的改善作用研究

目的 探讨抗骨髓炎片对家兔慢性骨髓炎的作用。方法 采用右胫骨骨髓腔内注射金黄色葡萄球菌的方法建立家兔慢性骨髓炎模型,随机分为4组：抗骨髓炎片高、低剂量（480、240 mg/kg）组,庆大霉素（60 mg/kg）组,模型组（等体积0.5% CMC-Na）;另取家兔向骨髓腔内注入生理盐水,作为假手术组（等体积0.5% CMC-Na）,术后当天开始ig给药,每天1次,连续6周。术后第6周对右胫骨行X-线检查并做Laurence评分;术后第2、4、6周采血,血细胞分析仪进行白细胞计数,ELISA法测定血清溶菌酶、肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）含量。结果 模型组家兔均有典型骨髓炎表现,抗骨髓炎片高、低剂量对骨髓炎症状有显著缓解,Laurence评分与模型组比较显著降低（P<0.01）;与模型组比较,抗骨髓炎片高、低剂量组的白细胞计数、血清TNF-α和IL-6含量在术后2、4、6周均明显降低（P<0.01）,高剂量组血清溶菌酶含量在术后2、4、6周均明显升高（P<0.01）,低剂量组血清溶菌酶含量在第4、6周亦明显升高（P<0.05）。结论 抗骨髓炎片对家兔慢性骨髓炎发挥显著改善作用,可能与抑制致病菌、提高机体免疫力、下调炎性因子等途径有关。     

急性腹泻患者对口服补液盐认知水平调查及护理干预研究

目的了解急性腹泻患者对口服补液盐（ORS）的认知水平、选择意愿及使用情况，探讨护理干预措施。方法自行设计调查问卷对137例急性腹泻病住院患者进行调查，评估患者对ORS的认知水平、选择意愿；给予护理干预措施后．再次调查，比较护理干预前后患者对ORS认知水平的异同。结果本组患者对ORS的认知水平、选择意愿及正确服用率普遍较低；文化程度、患腹泻病次数、曾接触过ORS信息宣教等因素与ORS认知水平和选择意愿呈正相关。护理干预后，患者对ORS的认知情况明显改善，平均得分由（7．28±5．02）上升到（11．15±4．08）（t=7．00，P=0．000）；对ORS的选用率由原来的13．86％上升到72．26％（x^2=95．26，P=0．000）；ORS正确服用率由原来的7．29％升高到68．61％（x^2=109．35．P=0．000）。结论护理干预措施能提高腹泻患者对ORS的认知水平、选择意愿和正确使用率。     

Literature review of peripheral vascular trauma:Is the era of intervention coming?

Traumatic peripheral vascular injury is a significant cause of disability and death either in civilian environments or on the battlefield.Penetrating trauma and blunt trauma are the most common forms of vascular injuries.Besides,iatrogenic arterial injury(IAI)is another pattern of vascular trauma.The management of peripheral vascular injuries has been improved in different environments and wars.There are different types of vascular injuries,such as vasospasm,contusion,intimal flaps,intimal disruption or hematoma,external compression,laceration,transection and focal wall defects,etc.The main clinical manifestations of vascular injuries are shock following massive hemorrhage and limb necrosis due to tissue and organ ischemia.Ultrasound,computed tomography angiography(CTA)and magnetic resonance angiography(MRA)are most valuable for assessment of peripheral vascular injuries.Angiography remains the gold standard for diagnosing vascular trauma.Immediate hemorrhage control and rapid restoration of blood flow are the primary goals of vascular trauma treatment.There are many operative treatment methods for vascular injuries,such as vascular suture or ligation,vascular wall repair and vascular reconstruction with blood vessel prostheses or vascular grafts.Embolization,balloon dilation and covered stent implantation are the main endovascular techniques.Surgical operation is still the primary treatment for vascular injuries.Endovascular treatment is a promising alternative,proved to be safe and effective,and preferred selection for patients.In summary,rapid diagnosis and timely surgical intervention remain the mainstays of the treatment.However,many issues need to be resolved by further studies.     

特发性门静脉高压症13例临床诊治分析

目的 通过对特发性门静脉高压症（idiopathic portal hypertension,IPH）患者的临床症状、影像学检查、手术治疗方式及预后情况描述,探讨特发性门静脉高压症的诊断、治疗及预后状况。方法 回顾性分析解放军总医院第五医学中心自2010年1月至2019年12月外科手术治疗的13例特发性门静脉高压症患者的临床资料,患者行胃镜检查发现食管胃底静脉曲张,5例出现上消化道出血,均无肝硬化。结果 13例均行脾切除+断流术+肝组织活检术,肝组织活检病理均可排除其他类型门静脉高压症,可提示特发性门静脉高压症。术后随访,患者食管胃底静脉曲张减轻,近期内出血风险明显降低,生活质量改善。1例在术后第4年出现黑便状况。结论 特发性门静脉高压症确诊主要依靠肝组织活检病理的排除性诊断,多普勒超声对特发性门静脉高压症具有一定的诊断价值。相对于内科药物治疗,外科脾切除加断流术能够更有效治疗IPH,且治疗效果要好于肝硬化型门静脉高压症。     

Characterization of the geometric properties of the sclero-conjunctival structure: a review

AIM: To investigate the variation of IGSF3 gene in three families with congenital absence of lacrimal puncta and canaliculi, and to lay a foundation for further research on the pathogenic gene of congenital lacrimal duct agenesis. METHOD: The members of the three families were recruited. The ophthalmologic examinations in details, including slit-lamp biomicroscope, intraocular pressure and fundus examination, etc were carried out. All patients were checked with paracentesis of puncta membrane and lacrimal duct probing, as well as the CT-DCG (computed tomography-dacryocystography). Peripheral blood of 13 participants (3 normal) from three families were collected, 4 mL each, for genomic DNA extraction, and 11 exon fragments of IGSF3 gene were amplified and sequenced by polymerase chain reaction (PCR) to determine whether there were IGSF3 genetic variation. RESULTS: A total of 13 members from three families were screened for 4 synonymous variants: c.930C>T (p.Pro366=), c.1359T>C (p.Ser709=), c.1797G>A (p.Ser855=), c.1539G>A (p.Ser769=), and 6 missense variants: c.1507G>A (p.Gly759Ser), c.1783T>C (p.Trp851Arg), c.1952G>T (p.Ser 907Ile), c.3120C>G (p.Asp1040Glu), c.3123C>G (p.Asp1041Glu), c.3139_3140insGAC (p.Asp1046_Pro1047insAsp), and the latter three were only found in two patients with absence of lacrimal puncta and canaliculi combined with congenital osseous nasolacrimal canal obstruction from the first family. CONCLUSION: The same IGSF3 gene mutation c.3139_3140insGAC is found in the patients with congenital absence of lacrimal puncta and canaliculi combine with osseous nasolacrimal canal obstruction.