肠三叶因子对新生鼠坏死性小肠结肠炎模型iNOS及TNF-α、NO的影响及意义

目的探讨肠三叶因子(intestinaltrefoilfactor,ITF)对坏死性小肠结肠炎(necrotizingenterocolitis,NEC)新生大鼠的肠黏膜组织中iNOS、TNF-α、NO的含量的影响,及ITF对NEC是否具有保护作用。方法建立NEC模型,对新生1日龄Wistar大鼠予100%二氧化碳,5min后再予以100%氧气,5min后放回母鼠身边喂养,第4天处死,取肠组织待检。新生鼠40只随机分为五组,每组8只,A组为NEC模型后予以腹腔注射ITF0.5mg;B组为NEC模型后予以皮下注射ITF0.2mg;C、D组为NEC模型后予以腹腔注射生理盐水分别为0.5ml和0.2ml;E组为正常对照组。取近回盲部1~2cm肠道组织固定包埋、切片、HE染色做病理学检查及免疫组化观察iNOS的表达,其他肠道组织制备组织匀浆取上清液检测TNF-α、NO的含量。结果A、B及E组iNOS呈弱阳性表达,C、D组iNOS呈强阳性表达;A、B组组织匀浆中TNF-α的含量各为[(30.515±2.731)和(32.229±4.978)pg/mg·pro]均较C、D组[(39.957±8.283)、(39.960±8.374)pg/mg·pro]明显下降(P<0.01),与E组[(33.523±6.752)pg/mg·pro]差异无统计学意义(P>0.05);A、B组组织匀浆中NO的含量各为[(0.37±0.07)和(0.54±0.08)μmol/mgtissue]较C、D组[(0.76±0.01)和(0.82±0.04)μmol/mgtissue]明显下降(P<0.01),与E组[(0.41±0.02)μmol/mgtissue]差异无统计学意义(P>0.05);A、B组间及C、D组间TNF-α、NO含量差异无统计学意义(P>0.05);病理切片显示C、D组HE染色切片见肠壁损伤轻重不一,可见全肠黏膜绒毛坏死,病理评分的中位积分为3分;A、B组肠上皮细胞少量脱落,顶端绒毛坏死,病理评分的中位积分为1分。结论通过腹腔和皮下注射ITF可以减轻NEC后的肠道炎症反应,ITF有可能为治疗NEC提供新的方法。     

极低出生体质量儿输注悬浮红细胞后粪便钙卫蛋白的变化研究

目的　分析极低出生体质量儿在输注悬浮红细胞72 h内粪便钙卫蛋白的变化。方法　选取2016年1月—2017年1月云南省第一人民医院新生儿重症监护病房出生体质量<1 500 g的极低出生体质量儿27例为研究对象。将患儿符合输血指征、输注过悬浮红细胞为输血组（19例）,未接受输血患儿为未输血组（8例）。两组患儿均查血常规中的红细胞比容;未输血组患儿每24 h采集1次粪便,共采集4次;输血组患儿采集输血前最后1次粪便和输血后24、48、72 h粪便,测定患儿粪便中的钙卫蛋白。结果　输血组的红细胞比容低于未输血组（t=-5.114,P<0.001）。输血后24、48、72 h粪便钙卫蛋白高于输血前,输血后24 h粪便钙卫蛋白低于输血后48、72 h,输血后48 h粪便钙卫蛋白低于输血后72 h（P<0.05）。输血组粪便钙卫蛋白随时间的变化趋势的曲线拟合分析显示,粪便钙卫蛋白随时间的变化呈线性上升趋势（F=33.390,P<0.001）。未控制初始粪便钙卫蛋白水平时,红细胞比容与粪便钙卫蛋白变化幅度呈负相关（r=-0.696,P=0.001）。控制初始粪便钙卫蛋白水平后,红细胞比容与粪便钙卫蛋白变化幅度也呈负相关（r=-0.653,P=0.003）。结论　输血后,极低出生体质量儿肠道内的钙卫蛋白随时间的变化明显上升,而钙卫蛋白对肠道炎性应答的发生有很强的预警作用,所以在输注悬浮红细胞后,尤其贫血程度重的极低出生体质量儿可能会诱发肠道内炎性反应,从而增加发生坏死性小肠结肠炎的风险。     

先天性巨结肠症根治术后肠结肠炎的分度及治疗

１９８５￣１９９６年我院为９１例先天性巨结肠患儿施行根治手术，其中ｓｏａｖｅ法４０例，Ｄｕｈａｍｅｌ－Ｇｒｏｂ法１４例，Ｉｋｅｄａ法３１例和Ｒｅｈｂｅｉｎ法６例。为了准确评价肠结肠炎的严重程度，我们将先天性巨结肠症根治术后肠结肠炎分为三度。要后早期１１例（１２％）发生肠结肠炎，其中ｓｏａｖｅ法９例（２２．５％），Ｄｕｈａｍｅｌ－Ｇｒｏｂ法２例（１４．２％）。肠结肠炎分度：Ｉ度８例，Ⅱ度２例，Ⅲ度１     

Ecografía de la patología infecciosa y tumoral del intestino y el peritoneo

Ultrasonography is not the most cited imaging technique for the evaluation of infectious and neoplastic diseases of the gastrointestinal tract and the peritoneum, but it is often the initial technique used in the initial workup for nonspecific clinical syndromes. Despite its limitations, ultrasonography's strengths enable it to provide meaningful diagnostic information.To discuss the most important ultrasonographic, clinical, and epidemiological findings for infectious disease, we follow a topographical approach: stomach (Anisakis), proximal small bowel (Giardia lamblia, Strongyloides stercoralis, Mycobacterium avium-intracellulare complex, and Cryptosporidium), distal small bowel (Yersinia, Salmonella, and Campylobacter), terminal ileum and cecum (tuberculosis), right colon (Entamoeba histolytica), left colon (Shigella), sigmoid colon and rectum, pancolitis (Clostridium difficile, Cytomegalovirus, and Escherichia coli), and peritoneum.To discuss the ultrasonographic and clinical findings of the most common neoplastic diseases, we follow a nosological approach: polyploid lesions as precursors of tumors, carcinomas, neuroendocrine tumors, hematological tumors, mesenchymal tumors, and metastases. We briefly discuss tumors of the peritoneum and the use of ultrasonography to guide percutaneous biopsy procedures.     

老年难辨梭菌性结肠炎患者八例临床分析

目的　探讨老年患者使用广谱抗生素诱发难辨梭菌性结肠炎的临床特点、内镜下改变及防治措施。　方法　分析８例老年难辨梭菌性结肠炎患者的临床资料,对难辨梭菌分离、鉴定,并行细胞毒素测定。　结果　所用抗生素的种类繁多,在使用抗生素后３ 天至２周内发生腹泻,重者伴腹膜炎,４ 例行纤维结肠镜检查均见有小片至大斑片伪膜附着;治疗措施为停用原抗菌药物,应用万古霉素和（或）甲硝唑及加强支持疗法。８ 例中７例治愈,１例死亡。　结论　老年人特别是术后使用广谱抗生素者易诱发难辨梭菌性结肠炎     

Are the long-term results of the transanal pull-through equal to those of the transabdominal pull-through? A comparison of the 2 approaches for Hirschsprung disease

Purpose

The transanal endorectal pull-through (TERPT) is becoming the most popular procedure in the treatment of Hirschsprung disease (HD), but overstretching of the anal sphincters remains a critical issue that may impact the continence. This study examined the long-term outcome of TERPT versus conventional transabdominal (ABD) pull-through for HD.

Methods

Records of 41 patients more than 3 years old who underwent a pull-through for HD (TERPT, n = 20; ABD, n = 21) were reviewed, and their families were thoroughly interviewed and scored via a 15-item post-pull-through long-term outcome questionnaire. Patients were operated on between the years 1995 and 2003. During this time, our group transitioned from the ABD to the TERPT technique. Total scoring ranged from 0 to 40: 0 to 10, excellent; 11 to 20 good; 21 to 30 fair; 31 to 40 poor. A 2-tailed Student t test, analysis of covariance, as well as logistic and linear regression were used to analyze the collected data with confidence interval higher than 95%.

Results

Overall scores were similar. However, continence score was significantly better in the ABD group, and the stool pattern score was better in the TERPT group. A significant difference in age at interview between the 2 groups was noted; we therefore reanalyzed the data controlling for age, and this showed that age did not significantly affect the long-term scoring outcome between groups.

Conclusion

Our long-term study showed significantly better (2-fold) results regarding the continence score for the abdominal approach compared with the transanal pull-through. The stool pattern and enterocolitis scores were somewhat better for the TERPT group. These findings raise an important issue about the current surgical management of HD; however, more cases will need to be studied before a definitive conclusion can be drawn.     

Mutational spectrum of PTS gene and in silico pathological assessment of a novel variant in Mexico

Background

Tetrahydrobiopterin (BH4) is the cofactor for 6-pyruvoyl-tetrahydropterin synthase (PTPS); it is involved in BH4 biosynthesis and is encoded by PTS gene. Its deficiency (PTPSD) is characterized by hyperphenylalaninemia (HPA) and deficit in central monoamine neurotransmitters. We describe the clinical and mutational spectrum of five patients with PTPSD, from four unrelated Mexican families. All patients had symptomatic diagnosis and presented severe early neurological manifestations and HPA.

隐源性多灶性溃疡狭窄性小肠炎临床特征分析

目的　分析隐源性多灶性溃疡狭窄性小肠炎（CMUSE）临床特征,为临床诊治提供参考。方法　结合首都医科大学附属北京世纪坛医院2012年2月收治的1例CMUSE病例,检索中英文数据库,收集确诊或疑诊为CMUSE的个案报道,并对病例的一般资料、临床表现、实验室检查、影像学检查、内镜检查、病理检查、治疗方法与转归进行总结分析。结果　共收集22例患者,确诊18例,疑诊4例;男10例,女12例;中位年龄为32岁,自发病至确诊的中位时间为3年。常见的临床表现有腹痛（20例）,腹胀（10例）,恶心、呕吐（8例）,便血、黑便（7例）等;实验室检查低清蛋白血症12例,便隐血试验阳性11例;11例行小肠镜检查,9例行胶囊内镜检查,8例行小肠气钡双重对比造影,均可见阳性改变;12例行手术治疗,7例术后复发;12例行糖皮质激素治疗,8例病情缓解,4例无效;1例英夫利昔单抗治疗有效。结论　CMUSE是一种罕见的、病因不明的疾病,小肠多发浅表溃疡和肠腔狭窄是其典型表现。胶囊内镜、双气囊小肠镜对该疾病的诊断有重要意义,激素为其一线治疗,内镜下球囊扩张术开始用于治疗,其他治疗有营养支持、外科手术等。     

肠三叶因子对新生鼠NEC模型PI3K和caspase-3/9的影响

目的 利用PI3K的特异性抑制剂Wortmannin阻断PI3K/Akt细胞信号转导通路,观察ITF对新生鼠NEC模型caspase-3及caspase-9水平的影响,探讨ITF对NEC的保护作用机制.方法 建立NEC模型,对新生一日龄Wistar大鼠予100%氮气,1 min后放4℃冷环境中持续10min,每日2次,随后放回自制的保温箱内人工喂养,第四天处死,取肠组织待检.新生鼠50只随机分为5组,每组10只,A组为NEC模型后予以腹腔注射生理盐水0.2 ml;B组NEC模型后予以腹腔注射ITF0.2 mg;C组为NEC模型后腹腔内注射wortmannin(0.1 mg/kg);D组为NEC模型后腹腔内注射ITF+wortmannin;E组为正常对照组.取近回盲部1～2 cm肠道组织固定包埋、切片、HE染色做病理学检查,其他肠道组织制备组织匀浆取上清液应用ELISA试剂盒检测PI3K的含量及用分光光度法检测caspase-3/9的活性.结果 病理切片显示A组HE染色见肠壁损伤轻重不一,可见全肠黏膜绒毛坏死,病理评分中位积分3分;B组病变明显减轻,肠上皮细胞少量脱落,顶端绒毛坏死,病理评分中位积分1分;C、D组病理评分中位积分3分.A组组织匀浆中PI3K的含量(pg/ml)较E组略升高(P<0.05),与D组差异无统计学意义(P>0.05);B组PI3K表达水平较其他组显著升高(P<0.01);C组与E组比较显著降低,差异有统计学意义(P<0.01).Caspase-3及caspase-9活性在A组较B、E组明显升高,差异有统计学意义(P<0.01),C组更加明显升高(P<0.01),A、D组及B、E组之间,差异无统计学意义(P>0.05).结论 通过腹腔注射ITF可以减轻NEC后的肠道炎症反应,ITF有可能为治疗NEC提供新的方法 ;PI3K/Akt细胞信号转导通路参与了NEC发病过程,并起着信号转导作用.而ITF可能是通过激活PI3K/Akt信号转导途径来下调caspase-3/9的水平,从而保护新生Wistar大鼠NEC模型肠道损伤.