Vagal nerve and the gastric mucosal defense

An essential role for an intact vagal nerve has been proven in the development of gastric mucosal cyto- and general protection. On the other hand, chemically-induced (ethanol, HCl, indomethacin) gastric mucosal damage is enhanced after acute surgical vagotomy. The aims of this paper were to study the possible mechanisms of the vagal nerve in the development of gastric mucosal defense. The following questions were addressed: 1) effect of surgical vagotomy on the development of ethanol- (ETOH), HCl-, and indomethacin (IND)-induced gastric mucosal damage; 2) changes in the gastric mucosal defense by scavengers, prostacyclin and other compounds (small doses of atropine and cimetidine: 3) changes in the gastric mucosal vascular permeability due to chemicals; 4) effect of indomethacin in the ETOH and HCl models with and without surgical vagotomy; 5) changes in the gastric mucosal content of prostacyclin and PGE₂ in the ETOH and HCl models after surgical vagotomy; and 6) changes in the role of SH-groups in gastric mucosal defense after surgical vagotomy. It was found that: 1) the gastric mucosal damage produced by chemicals (ETOH, HCl, and indomethacin) was enhanced after surgical vagotomy; 2) the cyto- and general gastric protective effects of β-carotene, prostacyclin, and small doses of atropine and cimetidine disappeared after surgical vagotomy; 3) the vascular permeability due to chemicals (ETOH, HCl, indomethacin) significantly increased after surgical vagotomy in association with an increase in both number and severity of gastric mucosal lesions; 4) IND alone (in animals with an intact vagus) did not produce gastric mucosal lesions (in 1-h experiments), but it aggravated ETOH-induced gastric mucosal damage (both its number and severity); 5) the gastric mucosal levels of prostacyclin and PGE₂ decreased after surgical vagotomy; 6) IND application (after surgical vagotomy) decreased further the tissue levels of prostacyclin and PGE₂ in association with an increase of gastric mucosal damage; and 7) the gastric mucosal protective effects of SH-groups were abolished by surgical vagotomy.     

水罐疗法联合白头翁汤灌肠对溃疡性结肠炎患者Th1/Th2免疫平衡及肠黏膜屏障功能的影响

摘要 目的：探讨水罐疗法联合白头翁汤灌肠对溃疡性结肠炎（UC）患者Th1/Th2免疫平衡及肠黏膜屏障功能的影响。方法：选取2020年2月~2022年5月期间湖南中医药大学第一附属医院收治的UC患者100例。根据随机数字表法分为对照组（n=50）和研究组（n=50）。对照组患者接受白头翁汤灌肠,研究组在此基础上接受水罐疗法。对比两组疗效、中医证候评分、Th1/Th2免疫平衡及肠黏膜屏障功能变化情况。结果：研究组的总有效率明显高于对照组（P<0.05）。治疗后,两组里急后重、身热不扬、腹泻黏液脓血便、小便短赤、肛门灼热、腹痛、口干口苦等症状评分均降低,且研究组低于对照组同期（P<0.05）。治疗后,两组Th1/Th2相关指标白介素（IL）-2、γ-干扰素（IFN-γ）均降低,且研究组较对照组低;IL-4、IL-10均升高,且研究组较对照组高（P<0.05）。治疗后,两组肠黏膜屏障功能指标二胺氧化酶（DAO）、D-乳酸（D-LA）均降低,且研究组低于对照组同期（P<0.05）。结论：水罐疗法联合白头翁汤灌肠治疗UC患者,总有效率高,可缓解中医证候,疗效显著,对调节患者的Th1/Th2免疫平衡及肠黏膜屏障功能具有重要作用。     

经皮椎间孔镜手术不同入路治疗单节段腰椎间盘突出症疗效对比的回顾性研究

摘要 目的：对比经皮椎间孔镜手术不同入路治疗单节段腰椎间盘突出症（LDH）的疗效。方法：回顾性分析2018年5月至2020年5月我院收治的80例单节段LDH患者的临床资料。患者均接受经皮椎间孔镜手术,根据手术入路的不同,分为经椎间孔入路（PETD）组和经椎板间入路（PEID）组,每组均40例。比较两组的手术相关指标、术后恢复指标、手术前后的Oswestry功能障碍指数（ODI）和视觉模拟评分法（VAS）评分,以及术后并发症情况。结果：PEID组的手术时间短于PETD组,X线透视次数少于PETD组,差异均有统计学意义（P<0.05）。两组的术中出血量相比,差异无统计学意义（P>0.05）。PETD组的术后卧床时间短于PEID组,差异有统计学意义（P<0.05）。两组的术后1 d直腿抬高试验角度、住院时间、复发率相比,差异无统计学意义（P>0.05）。两组患者术后1 d、术后3个月、术后12个月的ODI评分、VAS评分均低于术前,且呈降低趋势（P<0.05）;同一时间点两组间ODI评分、VAS评分比较,差异无统计学意义（P>0.05）。两组的并发症发生率相比,差异无统计学意义（P>0.05）。结论：PETD和PEID经皮椎间孔镜手术治疗单节段LDH总体疗效和安全性接近,PETD可缩短术后卧床时间,PEID的操作难度更低、可减少手术时间和X线透视次数。临床中应视患者实际情况选择合适的入路。     

Correlation of endoscopic cytology and histology in oesophageal cancer: results in Porto Alegre,RS—Brazil

A retrospective study of oesophageal cytopathology at the Hospital de Clínicas de Porto Alegre (HCPA), RS, Brazil, from 1989 to 1992 was made to assess the sensitivity, specificity, predictive values and accuracy of endoscopic cytology and biopsy; and study the correlation between cytopathological and histopathological diagnosis. Specimens from 94 patients were available for review. The final diagnosis was based on surgical pathology and follow up. The 81 patients with cancer of the oesophagus had the following sex distribution: 64 males and 17 females (a 3.7–1 ratio). No tumour was found in 13 patients. The following conclusions were made: (i) there is excellent correlation between cytology and histology in oesophageal lesions sampled by endoscopy; (ii) a correct positive cytologic report was obtained in 77 (95%) of the 81 proven oesophageal cancers; a false-negative or unsatisfactory result was given in four patients. A false-positive diagnosis of cancer was not made. There were 13 true-negative reports. These findings result in a sensitivity of 95% with 95% confidence intervals (CI) of 90.26–99.74%; a specificity of 100% (CI of 98.5–100%); a positive predictive value of 100% (CI of 99.3–100%); a negative predictive value of 76% (CI of 55.7–96.3%); (iii) a correct positive histological report was obtained in 67 (83%) of the 81 proven oesophageal cancers; a false-negative or unsatisfactory result was given in 14 patients. A false-positive diagnosis of cancer was not made. There were 13 true-negative reports. These findings result in a sensitivity of 83% with 95% CI of 74.82–91.18%; a specificity of 100% (CI of 98.5–100%); a positive predictive value of 100% (CI of 99.25–100%); a negative predictive value of 48% (CI of 29.16–64.84%); (iv) of 81 patients with proven cancer, in 79 (98%) at least one of the methods was positive. In only two patients with cancer were both methods negative. These findings result in a combined sensitivity of 98% (CI of 94.92–100%); a specificity of 100% (CI of 98.5–100%); a positive predictive value of 100% (CI of 99.31–100%); and a negative predictive value of 87% (CI of 70–100%). Our series confirms the value of the combined use of cytology and biopsy for the investigation of oesophageal lesions. However, it should be remembered that even with the combined use of cytology and biopsy there are some tumours that will be negative by both procedures: we had only two such cases, confirming the rarity of such an event.     

Absorption and imagery locate immune responses in the body

Imagery instructions specifying mucosal immunity should alter mucosal immunoglobulin A (m-IgA) levels in high absorbers, whose intent concentration evokes intense physiological responses. After screening for health status, 121 high or low absorbers were randomly assigned to either Relaxation Alone (R), Relaxation with Mucosal Immune Imagery (RI), or Vigilance Task control (VT). Before and after one 60-min intervention, subjects reported theory-relevant psychological variables and provided 5ml whole saliva, which was immediately frozen and assayed lateren masse with enzyme-linked immunoabsorbence (ELISA). MANOVA analysis of psychological variables replicated past research. ANOVA on residualized m-IgA found Time × Absorption interaction and Condition main effects. High more than low absorbers responded to relaxation with mucosal immune imagery by producing higher m-IgA. High absorbers appear able to locate where their immune systems will respond. Individual differences like absorption level need to be emphasized in diagnosis and treatment responsiveness.National Institutes of HealthM. Banks (Jasnoski) Gregerson, Department of Psychology, The George Washington University, changed to The Family Therapy Institute; Ingram M. Roberts, The George Washington University Medical Center, changed to Department of Medicine, Bridgeport Hospital; and Michael M. Amiri, The George Washington University Medical Center, changed to the Department of Neuroscience, NINDS Branch, National Institutes of Health. This research supported by an intra-mural BioMedical Research Grant from The George Washington University, was presented at the 1992 Annual Meeting of the Eastern Psychological Association, Boston, Massachusetts. Special thanks are extended to the following students who assisted instrumentally at various stages: undergraduates Lina Alathari, S. Theodor King, Beth Lieberman, Parisa Lotfi, Anita McClenon, and Karen Siscoe, and graduate student Mariken Hasert.     

Crystal structure of a non-toxic mutant of heat-labile enterotoxin, which is a potent mucosal adjuvant.

Two closely related bacterial toxins, heat-labile enterotoxin (LT-I) and cholera toxin (CT), not only invoke a toxic activity that affects many victims worldwide but also contain a beneficial mucosal adjuvant activity that significantly enhances the potency of vaccines in general. For the purpose of vaccine design it is most interesting that the undesirable toxic activity of these toxins can be eliminated by the single-site mutation Ser63Lys in the A subunit while the mucosal adjuvant activity is still present. The crystal structure of the Ser63Lys mutant of LT-I is determined at 2.0 A resolution. Its structure appears to be essentially the same as the wild-type LT-I structure. The substitution Ser63Lys was designed, based on the wild-type LT-I crystal structure, to decrease toxicity by interfering with NAD binding and/or catalysis. In the mutant crystal structure, the newly introduced lysine side chain is indeed positioned such that it could potentially obstruct the productive binding mode of the substrate NAD while at the same time its positive charge could possibly interfere with the critical function of nearby charged groups in the active site of LT-I. The fact that the Ser63Lys mutant of LT-I does not disrupt the wild-type LT-I structure makes the non-toxic mutant potentially suitable, from a structural point of view, to be used as a vaccine to prevent enterotoxigenic E. coli infections. The structural similarity of mutant and wild-type toxin might also be the reason why the inactive Ser63Lys variant retains its adjuvant activity.     

Feedback inhibition of sodium uptake in K+-depolarized toad urinary bladders

Ouabain-blocked toad urinary bladders were maintained in Na⁺-free mucosal solutions, and a depolarizing solution of high K⁺ activity containing only 5 mM Na⁺ on the serosal side. Exposure to mucosal sodium (20 mM activity) evoked a transient amiloride-blockable inward current, which decayed to near zero within one hour. The apical sodium conductance increased in the initial phase of the current decay and decreased in the second phase. The conductance decrease required Ca²⁺ to be present on the serosal side and was more rapid when the mucosal Na⁺ activity was higher. At 20 mM mucosal Na⁺ and 3 mM serosal Ca²⁺ the initial (maximal) rate of inhibition amounted to 20% in 10 min. The conductance decrease could be accelerated by raising the serosal Ca²⁺ activity to 10 mM. The inhibition reversed on lowering the serosal Ca²⁺ to 3 μM and, in addition, the mucosal Na⁺ to zero. Exposure of the mucosal surface to the ionophore nystatin abolished the Ca²⁺ sensitivity of the transcellular conductance, showing that the Ca²⁺-sensitive conductance resides in the apical membrane. The data imply that in the K⁺-depolarized epithelia, cellular Ca²⁺, taken up from the serosal medium by means of a Na⁺-Ca²⁺ antiport, cause feedback inhibition by blockage of apical Na⁺ channels. However, the rate of inhibition is small, such that this regulatory mechanism will have little effect at 1 mM serosal Ca²⁺ and less than 20 mM cellular Na⁺.     

Stimulation of mucosal uptake of selenium from selenite by some thiols at various sites of rat intestine

The influence of several thiols (conc. 1 mmol/L) on mucosal uptake of⁷⁵Se from⁷⁵Se-labeled selenite (conc. 10 μmol/L) across the brush border of rat jejunum and cecum was investigated in vitro using a short-term uptake technique.l-Cysteine (l-Cys) stimulated⁷⁵Se uptake in the mid- and distal jejunum and cecum, but not in the proximal jejunum. The effect was maximal in the distal jejunum.d-Cys was less effective in the jejunum and similarly effective in the cecum.l-Leucine (l-Leu) andl-glutamic acid significantly reduced the stimulatory effect ofl-Cys on Se uptake in the distal jejunum, whereas the respective effect ofd-Cys was not diminished byl-Leu. Cysteamine stimulated mucosal⁷⁵Se uptake at all intestinal sites tested, whereas the effect of mercaptopyruvate was restricted to the distal jejunum. Thioglycolate also enhanced⁷⁵Se uptake in the distal jejunum. The stimulatory effects ofl-Cys, mercaptopyruvate, and thiologlycolate were Na⁺-dependent, whereas the effect of cysteamine also occurred in the absence of Na⁺. Mercaptosuccinate,d-penicillamine, ergothioneine, and thiosulfate did not enhance mucosa⁷⁵Se uptake. It is concluded from these findings that the reaction of some thiols with selenite results in Se compounds that are rapidly absorbed by the intestinal epithelium through various Na⁺-dependent and Na⁺-independent, mechanisms. The high bioavailability of Se from selenite found by others might thus be the result of the presence of thiols in the gastrointestinal tract.     

Molecular pathogenesis of malignant melanoma: a different perspective from the studies of melanocytic nevus and acral melanoma

The Clark model for melanoma progression emphasizes a series of histopathological changes beginning from benign melanocytic nevus to melanoma via dysplastic nevus. Several models of the genetic basis of melanoma development and progression are based on this Clark’s multi-step model, and predict that the acquisition of a BRAF mutation can be a founder event in melanocytic neoplasia. However, our recent investigations have challenged this view, showing the polyclonality of BRAF mutations in melanocytic nevi. Furthermore, it is suggested that many melanomas, including acral and mucosal melanomas, arise de novo, not from melanocytic nevus. While mutations of the BRAF gene are frequent in melanomas on non-chronic sun damaged skin which are prevalent in Caucasians, acral and mucosal melanomas harbor mutations of the KIT gene as well as the amplifications of cyclin D1 or cyclin-dependent kinase 4 gene. Amplifications of the cyclin D1 gene are detected in normal-looking ‘field melanocytes’, which represent a latent progression phase of acral melanoma that precedes the stage of atypical melanocyte proliferation in the epidermis. Based on these observations, we propose an alternative genetic progression model for melanoma.