重症急性胰腺炎时肠屏障破坏的机制及防治

众多因素参与了重症急性胰腺炎时肠屏障破坏的发生、发展,随之而来的菌群移位及内毒素血症又加重了肠屏障破坏,导致严重不良预后。本文综合了肠屏障受损的可能原因,同时针对发病原因提出了相应防治对策。     

Identification of a recurrent t(4;6) chromosomal translocation in prostate cancer

PURPOSE: We developed and describe a practical method by which primary prostate cancer specimens can be screened for recurrent chromosomal translocations, which is a potential source of fusion genes, as well as a process by which identified translocations can be mapped to define the genes involved. MATERIALS AND METHODS: A series of 7 prostate cancer cell lines and 25 transiently established primary cell cultures, which were sourced from tissue harvested at 16 radical prostatectomies and 9 channel transurethral prostate resections, were screened for chromosomal translocations using multiplex-fluorescence in situ hybridization technology. A series of fluorescence in situ hybridization based breakpoint mapping experiments were performed to identify candidate genes involved in regions associated with recurrent translocation. RESULTS: Our analysis identified the repetition of 2 translocations in prostate cancer lines, that is t(1;15) and t(4;6), at a frequency of 28% and 57%, respectively. More significantly 4 of the 25 subsequently established primary cultures (16%) also revealed a t(4;6) translocation. Using the LNCaP cell line the breakpoints involved were mapped to the t(4;6)(q22;q15) region and a number of candidate genes were identified. CONCLUSIONS: We found that the t(4;6) translocation is also a repeat event in primary cell cultures from malignant prostate cancer. Breakpoint mapping showed that the gene UNC5C loses its promoter and first exon as a direct result of the translocation in the 4q22 region. As such, we identified it as a possible contributor to a putative fusion gene in prostate cancer.     

早期肠内营养对犬重症急性胰腺炎自然病程和肠道屏障功能的影响

目的　观察早期肠内营养对犬重症急性胰腺炎 (SAP)自然病程和肠道屏障功能的影响。方法　在SAP动物模型基础上将 15只犬随机分为肠外营养组 (PN组 )和早期肠内营养组 (EEN组 )。EEN组在术后 2 4h实施经空肠营养 ,共 7d。两组的供热、氮及液体量基本相等。两组动物分别于SAP模型制作前及制作后 3 0min及营养支持后 1d、4d及 7d测定外周血血糖、血钙、淀粉酶、溶酶体酶及内毒素含量 ;第 7d实验结束前 4h ,经静脉注入12 5I 白蛋白以测定胰腺通透性 ;实验结束后处死动物取门静脉血、肺组织、胰腺组织及肺门淋巴结和肠系膜淋巴结检测其中的细菌量 ,同时观察胰腺组织的病理学改变 ,结果作病理评分。测定小肠和结肠蛋白质和DNA含量以及粘膜形态学变化。结果　SAP动物模型制成后 ,血糖浓度升高 ,EEN组血糖浓度较PN组易于控制 ;两组动物的血钙、血淀粉酶和溶酶体酶水平在模型制作前后变化差异无显著性意义 ;胰腺 /血液及胰腺 /肌肉的12 5I 白蛋白标记指数比值两组间差异无显著性意义 ;EEN组外周血内毒素含量及门静脉血、胰腺及远隔脏器细菌数均明显低于PN组 (P<0 .0 5 )。胰腺病理评分两组间差异无显著性意义。EEN组肠壁蛋白质和DNA含量明显高于PN组 (P<0 .0 5 )。在绒毛高度、肠粘膜及全层厚度等指标EEN组也明显     

Behavior and quality of life measures after anesthesia for tonsillectomy or ear tube insertion in children

Background: Past research examining the psychosocial impact of general anesthesia and day case surgery on children has been hampered by a lack of valid and reliable assessment tools. Aim: The purpose of the current study was to assess the feasibility of using a well‐validated scale (i.e. the Pediatric Quality of Life Inventory Generic Core Scales Version 4.0, PedsQL) in the perioperative setting and to establish changes seen in a sample of children having day case surgery when using this scale. Method: Eighty‐nine children (aged 3–12 years) scheduled for general anesthesia for day case tonsillectomy or ear tube insertions were recruited into a prospective study in Melbourne, Australia. Parents completed the PedsQL and the Post Hospitalization Behavioral Questionnaire (PHBQ), and children completed the PedsQL (child self‐report) at baseline (preanesthesia), 7 days following anesthesia and 30 days following anesthesia. Results: The response rate at day 7 and day 30 was modest but when returned the PedsQL and PHBQ had minimal missing data. On the PedsQL, parents rated children’s physical functioning as worse at day 7 than at baseline but psychosocial functioning did not differ significantly from baseline. At 30 days, both physical and psychosocial functioning was rated by parents to be better than baseline levels. From children’s perspective, there was little evidence of a change in their physical or psychosocial functioning on the self‐report PedsQL at day 7, but by day 30 both physical and psychosocial functioning was above baseline levels. A similar pattern was observed on the PHBQ, with little difference in ratings of behavioral problems between baseline and day 7, but less behavioral problems reported at day 30 compared with baseline. Conclusions: The PedsQL is feasible for use in the perioperative setting. Future studies should take into account the possibility that deterioration of psychosocial functioning is uncommon at 1 ‐month postsurgery compared to the preoperative baseline.     

表皮生长因子改善移植小肠黏膜屏障功能的实验研究

目的了解表皮生长因子(epidermalgrowthfactor,EGF)对移植小肠通透性及细菌易位的作用。方法以Wistar大鼠为供体,SD大鼠为受体行异位全小肠移植,并以环孢素A(CsA,6mg.kg-1.d-1,im)抑制排斥反应。表皮生长因子组(EGF组)用微量输液泵持续均匀输入EGF200μg.kg-1.d-1;对照组输入等量生理盐水。第7天以乳果糖及甘露醇行移植肠灌注并收集尿液行高效液相色谱仪分析乳果糖及甘露醇含量,第8天采集移植肠系膜淋巴结及门静脉血行细菌培养。结果对照组尿液中乳果糖含量[(0.093±0.008)vs(0.015±0.002),P=0.0001]及乳果糖/甘露醇比值[(0.132±0.021)vs(0.020±0.005),P=0.0001]明显高于基准,EGF组乳果糖含量[(0.043±0.008)vs(0.015±0.002),P=0.0054]及乳果糖/甘露醇比值[(0.060±0.017)vs(0.020±0.005),P=0.0029]也较基准增加,EGF组乳果糖含量[(0.043±0.008)vs(0.093±0.008),P=0.0067)及乳果糖/甘露醇比值[(0.060±0.017)vs(0.132±0.021),P=0.0116]显著低于对照组。EGF组移植肠系膜淋巴结细菌阳性率为10%,对照组阳性率为60%,明显高于EGF组(P=0.028)。EGF组与对照组门静脉血培养阳性率比较差异无统计学意义(P>0.05)。结论本研究提示EGF能够降低同种移植小肠的通透性及细菌易位率,改善肠黏膜屏障功能。     

参附注射液对实验性急性坏死性胰腺炎肠道细菌移位的影响

目的：研究参附注射液对实验性急性坏死性胰腺炎（ANP）时肠道细菌移位的影响。方法：ANP大鼠制模方法采用胰腺被膜下注射牛磺胆酸钠。假手术组、对照组经皮下注射生理盐水，实验组同法给予等量参附注射液。取标本（下腔静脉血、腹水、肠系膜淋巴结及大肠内容物）进行细菌培养，计数菌落数及鉴定细菌种类。结果：标本中生长的细菌与大肠内容物培养细菌种类相同，实验组标本的菌落数少于对照组（P〈0.01）。结论：实验性ANP大鼠合并感染的细菌来源于肠道，参附注射液可以减少肠道细菌移位。     

EZH2和Bmi-1基因在膀胱移行细胞癌组织中的表达及其意义

目的 观察EZH2和Bmi-1基因在膀胱正常组织和癌组织中的表达及在膀胱肿瘤发生和发展中的作用.方法 应用逆转录-聚合酶链反应(RT-PCR)和实时定量PCR的方法 ,检测EZH2和Bmi-1基因在膀胱正常黏膜(共15例)和膀胱癌中(共70例)的相对表达量,以膀胱癌T24细胞株作为阳性对照.结果 在膀胱正常黏膜中,EZH2和Bmi-1基因的mRNA不表达或低表达.而在膀胱癌组织中,两者的表达量明显高于对照组,差异有统计学意义(P＜0.01).EZH2基因在低度恶性倾向尿路上皮乳头状肿瘤(PUNLMP)组、低分级组和高分级组的表达量分别为:0.1082±0.1880、0.0740±0.0984、0.1885±0.2144,与对照组(0.0158±0.0208)比较,P值分别为＞0.05、＜0.01和＜0.01;在浸润性膀胱癌的表达(0.2069±0.2241)高于表浅性膀胱癌(0.0868±0.1233),其差异有统计学意义(P＜0.01).Bmi-1基因在PUNLMP组、低分级组和高分级组的表达量分别为:0.6654±0.7668、0.4955±0.4553、0.7986±0.9259与对照组(0.1745±0.0973)比较,P值分别为＞0.05、＞0.05和＜0.01;在浸润性膀胱癌组(0.8368±1.0041)的表达高于表浅性膀胱癌组(0.5505±0.4992),但差异无统计学意义(P＞0.05).结论 EZH2和Bmi-1基因在膀胱癌的发生中起重要作用,并且EZH2与膀胱癌的发生、进展相关.     

Gut bacterial translocation contributes to microinflammationin experimental uremia

ObjectiveTo investigate whether gut microbiome dysbiosis and translocation occurred in experimental uremia, and whether they consequently contribute to microinflammation.MethodsHealth male SD rats were randomly divided into uremic group and sham group. Uremic group were operated for 5/6 nephrectomy to establish uremic models, while sham group were only operated for nephrocapsulotomy. Postoperative blood, livers, spleens, and mesenteric lymph nodes (MLNs) were subjected to bacterial 16S ribosomal DNA amplification to determine if bacteria were present. Bacterial genomic DNA samples from the MLNs and colon were amplified with specific primers designed by the 16SrRNA sequence of the species obtained from blood, livers and spleens. Pyrosequencing was used to analyze the ileum and colonic microbiome of each subject. Intestinal permeability to 99mTc-DTPA, plasma hs-CRP, and IL-6 were measured. ResultsBacterial DNA in extraintestinal sites and altered colonic microbiomes at the phylum, family, and genus levels were detected in some rats in the uremic group. Bacterial genomic DNA in MLNs and colon were obtained by primers specific for bacterial species observed from blood, livers, and spleens of identical individuals. Intestinal permeability, plasma hs-CRP, and IL-6 levels were statistically higher in the uremic group compared with that in sham group(all P＜0.05). ConclusionGut microbiome dysbiosis occurs and presumably bacteria translocate to the systemic and lymph circulation, thereby contributing to microinflammation in experimental uremia.