Possible role of autoantibodies against nephrin in an experimental model of chronic graft-versus-host disease

Nephrin, a product of the NPHS1 gene, is a component of the slit diaphragms that are found between glomerular foot processes and is a crucial element for glomerular filtration barrier. Recently, nephrin has been focused in a number of studies of proteinuria development including various types of acquired glomerular diseases including minimal change nephrotic syndrome and membranous nephropathy. However, the precise role of nephrin in such acquired glomerular diseases is still unknown. To analyse the role of nephrin further, two kinds of anti-nephrin antibodies were raised in the rabbits and applied to an experimental mouse model of chronic graft-versus-host disease, in which (C57BL/10 x DBA/2) F1 mice developed clinically apparent severe proteinuria with significant glomerular lesions 7 weeks after parental DBA/2 cell transfer. Antibody-sandwich ELISA detected anti-nephrin antibodies during week 2 to week 6, with the peak at week 2 or week 4. Colocalization of nephrin and IgG on week 4, week 6, and week 8 was revealed by confocal microscopic analysis, suggesting that in situ immune complex formation with nephrin in glomerular lesion. Taken together, it seems to be suggested nephrin and its autoantibody have a certain role in the development of glomerular lesion in our model mice.     

Effects of endurance training on myosin heavy-chain isoforms and enzyme activity in the rat diaphragm

We investigated the effects of endurance training (20 m/min, 60 min/day, 5 days/week) on myosin heavy-chain (MHC) isoforms and succinic dehydrogenase (SDH) activity in rat crural and costal diaphragms, and plantaris muscles. Although the 4-week endurance training produced significant (P<0.05) increases, both in SDH activity and the percentage of isoform HCIIa in the plantaris of the trained rat compared with the sedentary control rat, these alterations did not occur in either the crural or costal diaphragms. After 10 weeks of endurance training, trained animals had significantly (P<0.05) higher SDH activity in the costal diaphragm and the plantaris. Moreover, a significant (P<0.05) decrease occurred in the percentage of HCIIb in the costal diaphragm, and a significant (P<0.01) decrease in the percentage of HCIIb concomitant with a significant (P<0.05) increase of HCIIa resulted in the plantaris. However, the crural diaphragm did not show any significant changes after 10 weeks of endurance training. These results indicate that endurance training induces an alteration in the expression of an MHC phenotype, in addition to causing an increase in oxidative enzyme activity. However, the alterations in response to endurance training are apparently not uniform, varying between regions and/or kinds of muscles.     

Suppression of spontaneous breathing during high-frequency jet ventilation

Conditions which suppress spontaneous breathing activity during high-frequency jet ventilation (HFJV) were analysed in Yorkshire piglets under pentobarbital anesthesia. The highest P_aCO₂ at which the animals did not breathe against the ventilator (apnea point) was established during different patterns of ventilation, either by changing the minute volume or by adding CO₂ to the inspiratory gas. Arterial oxygen tension was maintained throughout the study above 80 mm Hg. An elevation of ventilatory rate increased the apnea point, suggesting a progressive suppression of spontaneous breathing. This suppression did not depend on the amount of lung stretch during insufflation, because at higher rates lower tidal volumes were used. Suppression also appeared to be independent of insufflatory flow, i.e. the velocity of lung stretch. At higher frequencies end-expiratory airway pressure (P_EE) increased and there appeared to be a positive relationship between the apnea point and P_EE. In a separate series this positive relationship between the apnea point and P_EE was confirmed. A hysteresis effect in this relationship, however, suggests that other than jet frequency, lung volume rather than positive end-expiratory pressure (PEEP) is a major determinant of suppression of spontaneous breathing activity during HFJV.     

膈肌起搏器在慢性阻塞性肺疾病呼吸机依赖患者脱机中的应用临床疗效观察

目的:探讨慢性阻塞性肺疾病(COPD)呼吸机依赖患者膈肌起搏器的应用及疗效。方法:把2018年6月~2019年6月本院呼吸内科收治的COPD使用呼吸机并发生依赖的清醒患者60例作为研究对象,男27例,女33例;患者年龄60~75岁,平均(66.3±1.2)岁,随机分为观察组(运用常规治疗及护理并增加使用膈肌起搏器)和对照组(运用常规治疗及护理),每组30例,对两组脱机成功率和脱机时间进行比较。结果:观察组患者脱机情况明显优于对照组,观察组与对照组2周脱机成功率分别为83.3%和46.7%,脱机时间分别为(7.56±1.45),(9.42±1.28)d,差异均有统计学意义(P<0.05)。结论:COPD呼吸机依赖患者准备脱机前,给予膈肌起搏器治疗,可明显提高脱机成功率及缩短呼吸机使用时间。     

Laparoscopic resection for a large gastrointestinal stromal tumor (GIST) with diaphragm invasion following preoperative imatinib treatment: A case report

IntroductionNeoadjuvant imatinib for large GISTs may prevent tumor rupture and the need for extended surgery by reducing tumor size. In this study, we present a case of large gastric GIST with diaphragm invasion, due to the patient receiving laparoscopic resection following preoperative imatinib treatment.Presentation of caseA 72-year-old woman was hospitalized with left hypochondriac pain for a month. Examinations revealed a large heterogeneous gastric mass measuring 80 mm in size, arising from the greater curvature of the corpus. The mass invaded the left thoracic diaphragm. Treatment with imatinib at an initial dosage of 400 mg/day was initiated. After a further two months of follow-up, the lesion had sustained reduction to 50 mm in size, however, the invasion to the diaphragm remained. The patient eventually underwent laparoscopic partial gastrectomy and partial resection of the diaphragm with curative intent. Adjuvant chemotherapy was initiated at one month after the surgery, however, was discontinued due to nausea. After one-year follow-up, no recurrence was noted.DiscussionNeoadjuvant imatinib may shrink tumor size remarkably and prevent tumor rupture during surgery, and thus lead to increased rates of complete resection. To date, several publications have directly compared the oncologic results between laparoscopic and open resection for GISTs. In the present case, the tumor was movable, and moderately fixed on diaphragm. It was favorable condition for laparoscopic surgery.ConclusionsThis is the first report of a large gastric GIST invading the diaphragm that was successfully treated by laparoscopic resection after tumor reduction by neoadjuvant imatinib.     

大鼠膈腹膜间皮通透性的电镜观察

腹膜腔内注射兔血液和中墨汁后，用电镜观察了大鼠膈腹膜间皮对示踪剂血细胞和碳颗粒的通透笥。在膈膜隐窝区，示踪剂经三种途径通过膈腹膜间皮。（１）间皮孔的吸收作用。示踪剂由腹膜腔经间皮孔直接进入膈毛细淋巴管，或被成纤维细胞的突起包绕。（２）间皮细胞的吞噬作用。（３）示踪剂通过间皮细胞间裂隙或细胞间连接。     

人膈肌内神经分支分布

目的：探讨人膈的神经支配和肌内神经分支分布特点。方法：改良Sihler’s肌内神经分支染色法。结果：(1)一侧膈神经入肌后一般分为3—4支(3支型4例,4支型2例),1支(前支)向前内侧走行,支配胸部,1～2支(前外侧支)向外侧走行,支配肋部,最后1支(后支)最粗大,向后下走行,分为后外侧支和后脚支,分别支配膈中心腱外侧叶后外侧的肋部和腰部,各级神经的分支在肌束中部密集排列成神经丛。(2)6例标本均未发现左侧或右侧膈神经越过中线至对侧。(3)2例带肋间肌的标本肉眼未见有肋间神经分支进入膈。结论：(1)左、右膈神经分布于膈,未见左右侧膈神经重叠支配和优势支配。(2)膈神经的终末分支在肌束中部密集排列形成似“肾形”的神经丛带。     

基于体表生理信号的呼吸功能监测仪研制

目的：研制一款基于体表心电、膈肌电和胸阻抗信号的呼吸功能监测仪原理样机,可在家庭、医疗急救等场合实现对呼吸功能的持续监测。方法：以STM32F411VET6单片机开发系统为平台,用一对Ag/AgCl电极作为高频激励信号的输出和心电、胸阻抗信号的检测电极,另一对Ag/AgCl电极作为膈肌电信号检测电极,两对电极同时检测心电、膈肌电和胸阻抗信号。系统硬件主要包括心电信号检测电路、胸阻抗信号检测电路、膈肌电信号检测电路、恒流源激励电路以及微控制器。系统采用12 V可充电锂电池供电,模拟信号通过单片机A/D转换成数字信号,通过SDIO接口存储于SD卡。在完成样机制作和性能测试之后,采集13例因呼吸功能障碍实施机械通气患者和13例健康成年人的信号,计算15个与呼吸功能相关的参数,比较机械通气患者与健康对照组参数之间的差异,验证了呼吸功能监测仪的可靠性。结果：样机采集信号的信噪比>10 dB、共模抑制比>80 dB,样机漏电流<30μA。机械通气患者的吸气时间、呼气时间、潮气量、胸阻抗峰峰值、胸阻抗1 s变化量、膈肌电低频功率、膈肌电高频功率、高频比低频、膈肌放电面积、膈肌放电时...     

Motility Disorders after Roux-en-Y Gastrojejunostomy

About 30% of patients who have a Roux-en-Y gastrojejunostomy after gastrectomy suffer from abdominal pain, nausea, vomiting of food and bloating made worse by eating. This syndrome, called the Roux stasis syndrome, is caused, in part, by a motility disorder of the Roux limb. Transection of the jejunum during the construction of the limb separates the limb from the natural small intestinal pacemaker located in the duodenum. Ectopic pacemakers then appear in the limb and trigger retrograde contractions in its proximal portion. These contractions slow transit through the limb and result in Roux stasis. Current nonsurgical treatment of the syndrome includes the use of prokinetic agents and intestinal pacing, neither of which has demonstrated long-term benefits. A near-total gastrectomy may speed upper gastrointestinal transit somewhat, but stasis in the Roux limb often persists. Our current approach aims at preventing the syndrome by the use of an ‘uncut’ Roux limb, an operation which preserves myoneural continuity between the duodenal pacemaker and the Roux limb and so prevents the appearance of ectopic pacemakers and stasis in the limb.     

Effets de l’halothane sur la ventilation et les gaz du sang artériel chez le rat avec ou sans paralysie diaphragmatique

Certains patients atteints de paralysie diaphragmatique ou de dysfonctionnement diaphragmatique maintiennent leur ventilation par la mise en jeu d’autres muscles que le diaphragme. L’anesthésie, modifiant le fonctionnement de ces muscles, représente un risque potentiel chez ces patients. Afin d’évaluer ce risque, nous avons étudié les effets de l’halothane sur la ventilation et sur les gaz du sang artériel sur un modèle de paralysie diaphragmatique bilatérale, le rat phrénicectomisé. L’étude a été réalisée sur 43 rats. L’efficacité de la phrénicectomie a été contrôlée par l’observation directe, après laparotomie. La laparotomie n’entraine pas de modification des gaz du sang. Chez 23 rats, une laparotomie a été effectuée et une artère carotide a été cathétérisée. Chez 11 rats témoins, les nerfs phréniques ont été abordés, sans être sectionnés. Chez 12 rats, les phréniques ont été sectionnés. La ventilation a été mesurée par une technique pléthysmographique, chez les rats éveillés, avant et après l’opération, puis chez les mêmes rats anesthésiés avec 1,1%, d’halothane inspiré. Les gaz du sang ont été mesurés après l’opération chez les rats éveillés, puis anesthésiés. Chez les 23 rats opérés on observe, après l’opération, une diminution du poids et de la température centrale, plus importante chez les phrénicectomisés que chez les témoins. Chez les 11 rats témoins, après l’opération, la ventilation augmente, sans modification des gaz du sang. Chez ces rats, l’halothane provoque une diminution de la ventilation minute et de la PaO₂ et une augmentation de la PaCO₂. La phrénicectomie entraine chez les 12 rats, éveillés, une augmentation de la ventilation minute, une hypoxémie et une hypercapnie. Chez ces rats, l’halothane entraine le décès dans trois cas, une diminution de la ventilation minute et une hypercapnie et une hypoxémie importantes chez les neuf autres rats. Les modifications des gaz du sang sont plus importantes que chez les témoins anesthésiés. Chez le rat intact, l’halothane provoque des modifications des gaz du sang comparables à celles observées chez d’autres espèces et chez l’homme. La présente étude confirme les effets de l’halothane sur les muscles respiratoires autres que le diaphragme. Elle met en évidence le risque respiratoire majeur que l’anesthésie peut fair courir aux patients dont la ventilation est maintenue par d’autres muscles que le diaphragme.