丁苯酞对颈动脉狭窄大鼠认知功能及海马CA1区神经元凋亡的影响及相关机制研究

摘要 目的：探讨与研究丁苯酞对颈动脉狭窄大鼠认知功能及海马CA1区神经元凋亡的影响及相关机制。方法：将颈动脉狭窄大鼠大鼠（n=42）随机为三组-模型组、低剂量丁苯酞（20 mg/kg）组和高剂量丁苯酞（40 mg/kg）组,每组14只。低剂量丁苯酞组与高剂量丁苯酞组每天给予20 mg/kg、40 mg/kg丁苯酞灌胃治疗,对照组给予等剂量的生理盐水灌胃,持续21 d。结果：低剂量丁苯酞组与高剂量丁苯酞组治疗第7 d、第14 d、第21 d的BBT评分低于模型组（P<0.05）,高剂量丁苯酞组低于低剂量丁苯酞组（P<0.05）。低剂量丁苯酞组与高剂量丁苯酞组治疗第21 d、第28 d的海马CA1区神经元凋亡指数低于模型组,高剂量丁苯酞组低于低剂量丁苯酞组（P<0.05）。低剂量丁苯酞组与高剂量丁苯酞组治疗第21 d、第28 d的脑组织超氧化物歧化酶（Superoxide dismutase,SOD）活性高于模型组（P<0.05）,丙二醛（Malondialdehyde,MDA）活性低于模型组（P<0.05）,高剂量丁苯酞组与低剂量丁苯酞组对比差异都有统计学意义（P<0.05）。低剂量丁苯酞组与高剂量丁苯酞组治疗第21 d、第28 d的海马CA1区BCL2-Associated X（Bax）、B淋巴细胞瘤-2（B-cell lymphoma-2,bcl-2）蛋白相对表达水平高于模型组（P<0.05）,高剂量丁苯酞组高于低剂量丁苯酞组（P<0.05）。结论：丁苯酞在颈动脉狭窄大鼠的应用能提高海马CA1区Bax、Bcl-2蛋白的表达,抑制神经元的凋亡,改善氧化应激状态,从而提高大鼠的认知功能。     

食管癌患者术前营养风险评估及与术后吻合口瘘和住院时间的关系研究

摘要 目的：评估食管癌患者术前营养风险及其影响因素,并分析其与术后吻合口瘘和住院时间的关系。方法：回顾性分析2017年1月至2020年12月在合肥市第二人民医院胸外科行手术治疗的105例食管癌患者的临床资料,患者术前均完善营养风险筛查表-2002（NRS-2002）对其营养风险的评估,根据评估结果分为营养风险组（≥3分,43例）和无营养风险组（＜3分,62例）,采用单因素及多因素Logistic回归分析食管癌患者术前营养风险的影响因素,比较不同术前营养风险状态患者术后吻合口瘘发生率以及住院时间的差异。结果：食管癌患者的术前营养风险较高,营养风险发生率为40.95%（43/105）。单因素分析结果显示,营养风险组年龄≥65岁、入院体质量指数＜18.5 kg/m²、术前接受过新辅助放化疗、过去1周膳食摄入不足、术前白蛋白＜35 g/L的患者比例高于无营养风险组（P＜0.05）。多因素Logistic回归分析结果显示,术前接受过新辅助放化疗、过去1周膳食摄入不足、术前白蛋白＜35 g/L是食管癌患者术前存在营养风险的危险因素（P＜0.05）。营养风险组术后胸腔吻合口瘘、颈部吻合口瘘发生率高于无营养风险组（P＜0.05）,住院时间长于无营养风险组（P＜0.05）。结论：术前新辅助放化疗、过去1周膳食摄入情况、术前白蛋白水平是食管癌患者术前营养风险的影响因素,术前营养风险会增加患者术后吻合口瘘发生风险,延长患者住院时间。     

Effects of pretreatment with a xanthine oxidase inhibitor on free radical levels during carotid endarterectomy

Objective: Free radicals contribute to the tissue damage caused by ischaemia-reperfusion. The aim of the present study was to investigate whether preoperative antioxidant therapy (allopurinol) affects free radical levels in cerebral venous blood in connection with surgery for carotid artery stenosis.

Materials and methods: Twenty-five patients were randomised into the study. Thirteen were controls and 12 were pretreated with allopurinol the day before surgery. Before, during and after surgery, blood samples were drawn from the ipsilateral jugular vein. Radical levels were measured using the spin trap technique ex vivo using OXANOH as the spin trap. Multivariate statistics were used with Principal Component Analysis and Partial Least Square regression analysis.

Results: Radical levels increased with diabetes, high leukocyte count, high creatinine and a high degree of contralateral stenosis. Radical levels decreased with high age, blood pressure, collateral circulation as well as operation for left-side carotid artery stenosis. After pretreatment with allopurinol, several of the relationships noted in the control group were eliminated, i.e. leukocyte count, side of operation, Betapred pretreatment and collateral circulation.

Conclusions: Radical levels can be determined in connection with surgery for carotid artery stenosis using an ex vivo spin trap method. With preoperative antioxidant therapy the relationships between enhanced radical levels and clinical data, as seen in control subjects, disappeared. This might indicate a beneficial effect of preoperative pretreatment with antioxidants.     

Circulating oxidized low-density lipoprotein and common carotid artery intima-media thickness in a random sample of middle-aged men

Circulating oxidized low-density lipoprotein (oxLDL) has been suggested to play an important role in atherosclerosis development. According to previous observations, oxLDL correlates with clinically manifest coronary and carotid artery disease. We investigated the association between the oxLDL concentration measured directly in plasma and common carotid artery intima-media thickness (IMT) in a population-based, case-control study in middle-aged men from Southern Finland. oxLDL was determined in 214 men by a commercially available sandwich ELISA test (Mercodia). Carotid artery IMT was measured at 12 standardized segments by B-mode ultrasonography (at the near and far wall of the left and right common carotid arteries, bifurcations and internal carotid arteries), and the overall mean maximum IMT (MMaxIMT) was calculated. The MMaxIMT of the carotid arteries was significantly associated with circulating oxLDL (r_s=0.16, p=0.018). In a stepwise multiple regression model with MMaxIMT as dependent variable and systolic blood pressure, smoking, oxLDL, HDL cholesterol and apolipoprotein B as covariates, systolic blood pressure (=0.22, p<0.001), oxLDL (=0.15, p=0.022) and smoking (=0.17, p=0.014) showed an independent association with IMT (R²=0.10, p<0.001). Our results show that oxLDL measured directly from plasma is independently associated with subclinical carotid artery atherosclerosis in middle-aged men.     

A single nucleotide polymorphism in the promoter region of the human gene for osteoprotegerin is related to vascular morphology and function

Osteoprotegerin (OPG) is a secreted member of the tumor necrosis factor receptor family, and has previously been shown to regulate bone mass by inhibiting osteoclast differentiation and activation. Recent evidence indicates that OPG also plays a role in the vascular system, since ablation of the OPG gene in mice results in calcification of the aorta and renal arteries, and association has been found between serum levels of OPG and cardiovascular mortality. This study presents a novel single nucleotide polymorphism, a T/C transition located 129 bp upstream the TATA-box of the human OPG gene, detected by sequence analysis. The OPG genotype was determined by restriction fragment length polymorphism in a cohort consisting of 59 healthy subjects. The intima-media thickness (IMT) in the common carotid artery and maximal post-ischemic forearm blood flow (FBF) were investigated. Subjects with the CC genotype showed a significantly increased IMT (p<0.05) and a concommitantly reduced maximal FBF (p<0.01) as compared to those with the T allele. Thus, our results show that the polymorphism in the promoter region of OPG is associated with both vascular morphology and function in apparently healthy subjects.     

Determinants of Intestinal Detoxication of Lipid Hydroperoxides

It has long been recognized that hydroperoxides are agents of cytotoxicity. However, in recent years, it is increasingly apparent that lipid hydroperoxide may play an important role in mediating cellular and molecular events in degenerative pathophysiological processes that lead to intestinal disorders, such as cancer. Yet, surprisingly, little is known of the intestinal disposition of peroxidized lipids and of the metabolic factors that determine mucosal peroxide elimination. The present paper summarizes the evidence for the pivotal role of reductant (GSH and NADPH) availability in intestinal peroxide detoxication. This information will provide important insights into the relationship between luminal lipid hydroperoxides and intestinal GSH redox homeostasis, and is pertinent to understanding how dietary oxidants like lipid peroxides, can impact intestinal integrity with implications for genesis of gut pathology.     

泡沫敷料对结肠造瘘患者造瘘口周渗出液炎性物质的影响

目的:探讨泡沫敷料对结肠造瘘患者造瘘口周渗出液炎性物质的影响。方法:选取我院普外科收治的结肠造瘘术患者104例,采用随机数字表方法将所有患者平均分为两组,各52例,对照组常规清洁造瘘口,造瘘口及周围皮肤涂抹氧化锌软膏后安装肛门袋;治疗组在对照组治疗的基础上,平铺一层多爱肤有边辅料,安装肛门袋,两组患者均每日更换肛门袋一次,连续治疗2周。采用酶联免疫吸附法(ELISA)检测两组患者治疗前后造瘘口周渗出液炎性物质水平;记录两组患者治疗过程中和治疗后皮肤损伤及造瘘口并发症发生情况。结果:1治疗后,两组患者造瘘口渗出液炎性物质水平较治疗前明显降低,且治疗组下降程度高于对照组(P0.05);2治疗后,治疗组造瘘口皮肤完好率明显高于对照组,差异有统计学意义(P0.05);3对照组造瘘口并发症的发生率明显高于治疗组,差异有统计学意义(P0.05)。结论:泡沫敷料能够降低结肠造瘘患者造瘘口周炎性物质的分泌,减少造瘘口周围皮肤的损伤,降低造瘘口并发症的发生,对结肠造瘘口的护理具有重要临床意义。     

RECK基因在兔颈动脉壁损伤后再狭窄过程中的表达

目的:通过建立动物损伤模型,分析RECK基因在兔子颈动脉球囊损伤术后的表达与动脉内膜变化和官腔狭窄的相关性。方法:兔子手术损伤侧的动脉血管设置为实验组,未进行手术操作的一侧动脉作为对照组。建立动脉模型的四个时间点7、14、21、28 d,在麻醉状态下处死模型动物。取得所需长度的损伤动脉血管及对照组动脉血管。将取得的标本进行HE病理染色,通过计算机图像计算软件观察标本动脉内膜随时间的变化;同时通过western-blot方法测定RECK蛋白表达水平、real-time PCR测量RECK基因表达量。结果:血管手术损伤后,血管内膜面积在随着术后日期的增长呈逐渐增厚变化,血管内膜与中层比值逐渐增大,同对照实验组比较,有统计学意义(P0.05)。实验组及对照组的中膜无显著增生。结论:RECK基因在组织中表达变化影响MMPs基因表达。实验论证了在动脉损伤后RECK基因参与了血管再狭窄,为血管再狭窄研究寻得新的研究方向。     

一种动态检测小鼠微量血中T细胞受体重排删除环含量的方法

目的:通过检测比较外周血(颈动脉大量采血和微量隐静脉采血)、胸腺组织和脾脏组织等不同成分或组织中T细胞受体重排删除环(T cell receptor rearrangement excision circles,TREC)的含量,并建立一种通过微量外周血PCR预扩增的方法,评估胸腺输出功能。方法:采用C57BL/6小鼠作为实验对象,分成幼年组(5周龄,n=10)和成年组(15周龄,n=10)。经过隐静脉采血及颈动脉采血后处死小鼠,取小鼠胸腺器官和脾脏器官,提取基因组DNA(g DNA),隐静脉微量血g DNA通过PCR预扩增,提纯后再和颈动脉血、胸腺组织和脾脏组织g DNA一起进行实时定量PCR,分析各组织成分TREC的表达水平及差别。结果:幼年组胸腺组织及外周血中TREC的含量比成年组高,且二者趋势基本一致;而脾脏组织结果与其相反;幼年组小鼠胸腺组织中TREC的含量比脾脏组织中高,成年组小鼠结果与之相反;微量外周血经过预扩增后再进行实时定量PCR的结果与直接定量PCR结果一致,且更高效。结论:研究提供了一种新型高效的动态检测T细胞受体重排删除环和检测胸腺输出功能的方法。     

Cologastric fistula with a foreign body in a patient with Crohn's disease

Although the medical management of fistulizing Crohn's disease is improving, a subset of patients does not respond to maximal medical therapy and is referred for surgical consultation. We report a case of Crohn's colitis with an ingested foreign body resulting in a cologastric fistula. The patient underwent segmental colectomy and takedown of the cologastric fistula. At the time of laparotomy, the foreign body was found in the fistulous colonic segment. The presence of an ingested foreign body likely contributed to a rare fistula that was refractory to medical management.