三七皂苷对缺血大鼠脑组织神经元型一氧化合酶的调节作用

目的:研究三七皂苷保护缺血脑组织中神经元的机制。方法:应用免疫细胞化学SP法和计算机图象分析系统观察三七皂苷(7mg.kg-1,i.m) 对不同缺血时间(4,12和24h)老龄大鼠大脑皮质、海马与尾壳核内神经元型一氧化氮合酶(nNOS)表达丰度和病理组织学变化的影响。结果:单侧结扎颈总动脉可使大脑皮层、海马与尾壳核内nNOS的表达丰度显著下降,部分神经元出现空泡样变性。预先注射三七皂苷可有效阻止大脑皮质、海马与尾壳核内nNOS表达丰度的下降,并减少这些区域的病理学改变。结论:三七皂苷可促进缺血早期脑组织表达nNOS,并由此对神经元发挥保护作用。

Planned second-look laparoscopy in the management of acute mesenteric ischemia

AIM： To investigate the role of second-look laparoscopy in patients with acute mesenteric ischemia （AMI）. METHODS： Between January 2000 and November 2005, 71 patients were operated for the treatment of AMI. The indications for a second-look were low flow state, bowel resection and anastomosis or mesenteric thromboembolectomy performed during the first operation. Regardless of the clinical course of patients, the second-look laparoscopic examination was performed 72 h post-operatively at the bed side in the ICU or operating room. RESULTS： The average time of admission to the hospital after the initation of syrnptoms was 3 d （range, 5 h-9 d）. In 14 patients, laparotomy was performed. In 11 patients, small and/or large bowel necrosis was detected and initial resection and anastomosis were conducted. A low flow state was observed in two patients and superior mesenteric artery thromboembolectomy with small bowel resection was performed in one patient. In 13 patients, a second-look laparoscopic examination revealed normal bowel viability, but in one patient, intestinal necrosis was detected. In two of the patients, a third operation was necessary to correct anastomotic leakage. The overall complication rate was 42.8%, and in-hospital mortality rate was 57.1% （n = 6）. CONCLUSION： Second-look laparoscopy is a minimally invasive, technically simple procedure that is performed for diagnostic as well as therapeutic purposes. The simplicity and ease of this method may encourage wider application to benefit more patients. However, the timing of a second-look procedure is unclear particularly in a patient with anastomosis.

Hepcidin modulation in human diseases: From research to clinic

By modulating hepcidin production, an organism controls intestinal iron absorption, iron uptake and mobilization from stores to meet body iron need. In recent years there has been important advancement in our knowledge of hepcidin regulation that also has implications for understanding the physiopathology of some human disorders. Since the discovery of hepcidin and the demonstration of its pivotal role in iron homeostasis, there has been a substantial interest in developing a reliable assay of the hormone in biological fluids. Measurement of hepcidin in biological fluids can improve our understanding of iron diseases and be a useful tool for diagnosis and clinical management of these disorders. We reviewed the literature and our own research on hepcidin to give an updated status of the situation in this rapidly evolving field.

Resveratrol attenuates oxidative stress and histological alterations induced by liver ischemia/reperfusion in rats

AIM： To investigate the effects of resveratrol on liver ischemia/reperfusion （I/R） injury in rats. METHODS： A total of 40 male Sprague-Dawley rats weighing 240-290 g were randomized into four groups of ten： （1） controls： data from unmanipulated animals; （2） sham group： rats subjected to the surgical procedure, except for liver I/R, and given saline; （3） I/R group： rats underwent liver ischemia for 45 rain followed by reperfusion for 45 rain; （4） I-R/Resveratrol group： rats pretreated with resveratrol （10 umol/L, iv）. Liver tissues were obtained to determine antioxidant enzyme levels and for biochemical and histological evaluation. RESULTS： Plasma aminotransferase activities were higher in the I/R group than in the I-R/Resveratrol group. Malondialdehyde levels and the hepatic injury score decreased, while superoxide dismutase, catalase, and glutathione peroxidase levels increased in group 4 compared to group 3. In group 4, histopathological changes were significantly attenuated in resveratroltreated livers. CONCLUSION： These results suggest that resveratrol has protective effects against hepatic I/R injury, and is a potential therapeutic drug for ischemia reperfusionrelated liver injury.

β-FIBRINOGEN PROMOTER -455 G/A(HaeIII)POLYMORPHISM PREDICTION OF PLASMA FIBRINOGEN BUT NOT OF ISCHEMIC CEREBROVASCULAR DISEASE

Objective The -455 G/A(HaeIII)polymorphism of β-fibrinogen gene influences levels of plasma fibrinogen. We further investigated whether it influences the risk of ischemic cerebrovascular disease. Methods We accumulated 134 acute ischemic cerebrovascular disease(ICVD)cases and compared their -455 G/A status with a control group(n = 166). The β-fibrinogen gene -455 G/A polymorphism was analyzed for all subjects by PCR-RFLP with the restrictive enzyme HaeIII. Results Plasma fibrinogen was higher in AA homozygous participants(341 mg/dL)than in partici-pants carrying the G allele: GA(290 mg/dL), GG(298 mg/dL)in the control group. Plasma fibrinogen was also higher in AA homozygous patients(353 mg/dL)than in cases carrying the G allele: GA(287 mg/dL), GG(302 mg/dL)in the ICVD group. However, there was no significant association between β-fibrinogen gene -455 G/A polymorphism and ICVD group. Conclusions Although a small effect cannot be excluded, β-fibrinogen gene -455 G/A polymor-phism is an independent predictor of plasma fibrinogen, but not of ischemic cerebrovascular disease.

Recent advances in cellular and molecular aspects of mammalian retinal ischemia

Retinal ischemia is a common clinical entity and, due to relatively ineffective treatment, remains a common cause of visual impairment and blindness. Generally, ischemic syndromes are initially characterized by low homeostatic responses which, with time, induce injury to the tissue due to cell loss by apoptosis. In this re-spect, retinal ischemia is a primary cause of neuronal death. It can be considered as a sort of fnal common pathway in retinal diseases and results in irreversible morphological and functional changes. This review summarizes the recent knowledge on the effects of ischemia in retinal tissue and points out experimental strategies/models performed to gain better compre-hension of retinal ischemia diseases. In particular, the nature of the mechanisms leading to neuronal damage （i.e., excess of glutamate release, oxidative stress and infammation） will be outlined as well as the potential and most intriguing retinoprotective approaches and the possible therapeutic use of naturally occurring molecules such as neuropeptides. There is a general agreement that a better understanding of the funda-mental pathophysiology of retinal ischemia will lead tobetter management and improved clinical outcome. In this respect, to contrast this pathological state, spe-cifc pharmacological strategies need to be developed aimed at the many putative cascades generated during ischemia.

Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis

AIM： To determine survival parameters as well as char-acteristics of patients with this syndrome. METHODS： The investigation was conducted over a period of eight years, as a prospective, non-random-ized, clinical study which included 204 patients, treated by chronic hemodialysis. Most patients received hemo-dialysis 12 h per week. As vascular access for hemodi-alysis all subjects had an arteriovenous fstulae. Based on surveys the respondents were divided into groups of patients with and without digital hypoperfusion isch-emic syndrome. Gender, demographic and anthropo-metric characteristics, together with comorbidity and certain habits, were recorded. During this period 34.8% patients died.RESULTS： Patients with digital hypoperfusion ischemic syndrome were older than those without ischemia （P = 0.01）. Hemodialysis treatment lasted signifcantly lon-ger in the patients with digital hypoperfusion ischemic syndrome （P = 0.02）. The incidence of cardiovascular disease （P 〈 0.001） and diabetes mellitus （P = 0.01）, as well as blood fow through the arteriovenous fstula （ P = 0.036）, were higher in patients with digital hypoper-fusion ischemic syndrome. Statistically significant dif-ferences also existed in relation to oxygen saturation （P = 0.04）. Predictive parameters of survival for patients with digital hypoperfusion ischemic syndrome were： adequacy of hemodialysis （B = -3.604, P 〈 0.001）, hypertension （B = -0.920, P = 0.018）, smoking （B = -0.901, P = 0.049）, diabetes mellitus （B = 1.227, P = 0.005）, erythropoietin therapy （B = 1.274, P = 0.002） and hemodiafltration （B = -1.242, P = 0.033）. Kaplan-Meier survival analysis indicated that subjects with and without digital hypoperfusion ischemic syndrome dif-fered regarding the length of survival （P 〈 0.001）, i.e. , patients with confrmed digital hypoperfusion ischemic syndrome died earlier.CONCLUSION： Survival was signifcantly longer in the patients without digital hypoperfusion ischemic syn-drome.

Clinical investigation of 41 patients with ischemic colitis accompanied by ulcer

AIM: To investigate the relationship among the presence of ulcer lesions, underlying disease, and clinical course in patients with ischemic colitis. METHODS: The subjects were 41 patients (10 male and 31 female; mean age 70 years) with ischemic colitis who were admitted to and received treatment in our hospital from 2000 to 2006. We compared their characteristics and analyzed the mean lengths of admission and fast- ing for 9 patients with ulcer lesions (ulcer group) and 32 without (non-ulcer group). RESULTS: The groups with presence and absence of ulcer differed significantly only in white blood cell (WBC) count. Lengths of fasting and admission were 7.9 d and 17.9 d for the ulcer group and 4.4 d and 10.7 d for the non-ulcer group, respectively, and significantly longer in the ulcer group (P = 0.0057 and 0.0001). There was no correlation between presence of ulcer and presence of underlying diseases. CONCLUSION: Lengths of fasting and admission were significantly longer in patients with ischemic colitis with ulcer than for those without ulcer.

Pretreatment of cromolyn sodium prior to reperfusion attenuates early reperfusion injury after the small intestine ischemia in rats

AIM: To investigate the effects of Cromolyn Sodium (CS) pretreated prior to reperfusion on the activity of intestinal mucosal mast cells (IMMC) and mucous membrane of the small intestine in ischemia-reperfusion (IR) injury of rats. METHODS: Thirty-two Sprague-Dawley (SD) rats were randomly divided into four groups: sham group (group S), model group (group M), high and low dosage of CS groups, (treated with CS 50 mg/kg or 25 mg/kg, group C1 and C2). Intestinal IR damage was induced by clamping the superior mesenteric artery for 45 min followed by reperfusion for 60 min. CS was intravenouly administrated 15 min before reperfusion. Ultrastructure and counts of IMMC, intestinal structure, the expression of tryptase, levels of malondisldehyde (MDA), TNF-α, histamine and superoxide dismutase (SOD) activity of the small intestine were detected at the end of experiment. RESULTS: The degranulation of IMMC was seen in group M and was attenuated by CS treatment. Chiu’s score of group M was higher than the other groups. CS could attenuate the up-regulation of the Chiu’s score, the levels of MDA, TNF-α, and expression of tryptase and the down-regulation of SOD activity and histamine concentration. The Chiu’s score and MDA content were negatively correlated, while SOD activity was positively correlated to the histamine concentration respectively in the IR groups. CONCLUSION: Pretreated of CS prior to reperfusion protects the small intestine mucous from ischemia- reperfusion damage, the mechanism is inhibited IMMC from degranulation.

Dual protective role of HO-1 in transplanted liver grafts:A review of experimental and clinical studies

Liver transplantation is considered as the most effective treatment for end-stage liver disease.However,serious complications still exist,particularly in two aspects:ischemia and subsequent reperfusion of the liver,causing postoperative hepatic dysfunction and even failure;and acute and chronic graft rejections,affecting the allograft survival.Heme oxygenase(HO),a stressresponse protein,is believed to exert a protective function on both the development of ischemia-reperfusion injury(IRI) and graft rejection.In this review of current researches on allograft protection,we focused on the HO-1.We conjecture that HO-1 may link these two main factors affecting the prognosis of liver transplantations.In this review,the following aspects were emphasized:the basic biological functions of HO-1,itsroles in IRI and allograft rejection,as well as methods to induce HO-1 and the prospects of a therapeutic application of HO-1 in liver transplantation.

Multiple small bowel ruptures due to ischemic enteritis: A case report

A rare case of multiple small bowel ruptures due to ischemic enteritis （ISE） is reported. The patient was admitted to the hospital with acute abdominal pain followed by bloody diarrhoeas. Preoperative colonoscopic findings were similar to those presented in Crohn＇s disease. Intraoperatively, ischemic lesions and multiple ruptures were localized at the jejunum and the proximal ileum. Histopathological examination of the resected bowel segment established the diagnosis of ISE. Although ISE is not common, concurred multiple ruptures of the small bowel is a rare but actual complication.

Vasospastic angina with J waves formation in patients with sudden loss of consciousness

Vasospastic angina is caused by sudden occlusive vasoconstriction of a segment of an epicardial artery, which can present with a wide spectrum of clinical scenario. We report the cases of two patients diagnosed with vasospastic angina, with one of which presenting with sudden cardiac arrest, while the other presenting with a relatively benign syncope. But both of them have J waves formation on ECG during active ischemia. The diagnosis and management of vasospastic angina, as well as the proposed clinical significance of J waves during coro- nary soasm are discussed.

Effects of Kaiqiao Huazhuo prescription on the content of Matrix metallopro teinases-9 in brain of focal cerebral ischemia rats

OBJECTIVE:To observe the effect of Kaiqiao Huazhuo prescription on the content of Matrix metallopro teinases-9(MMP-9)in brain of focal cerebral ischemia rats.METHODS:The model of focal cerebral ischemia was established by inserting nylon thread,the effect of Kaiqiao Huazhuo prescription on brain edema and the content of MMP-9 in brain of focal cerebral ischemia rats were observed 6 h,12 h,24 h and 48 h after cerebral ischemia respectively and was compared with effect of Buchangnaoxintong.RESULTS:6 h after cerebral ischemia,compared with sham operation group,the content of MMP-9 in brain increased,and it reached peak value in 24 h(P<0.01);the change of brain edema is similar to that of MMP-9.Compared with model group,the content of MMP-9 in brain and the brain edema of each treatment groups were decreased(P<0.05 or P<0.01).CONCLUSIONS:Through decreasing the content of MMP-9 in brain of focal cerebral ischemia rats,Kaiqiao Huazhuo prescription could protect blood brain barrier and reduce brain edema.

Randomized,double-blind,parallel-controlled clinical trial on correspondence of prescriptions and Traditional Chinese Medicine syndrome of ischemic stroke

OBJECTIVE:To investigate the effect of correspondence of prescriptions and the traditional Chinese medicine(TCM) syndrome of ischemic stroke.METHODS:Based on standard syndrome diagnosis and a series of effective formulas,a randomized,double-blind,parallel-controlled clinical trial on correspondence of prescriptions and the TCM syndrome of ischemic stroke was conducted.The formulas were dynamically changed according to the patient's TCM syndrome.RESULTS:The treatment was composed of a series of formulas changed daily according to the TCM syndrome.Treatments which were composed of a series of formulas had similar short-term(1 month after onset) effects in improving mild and moderate neurological deficits compared with treatments composed of only one formula.However,patients treated with a series of formulas showed improved subjective symptoms in the short-term and a decreased risk of stroke recurrence within three months after onset.CONCLUSION:Complete(series of formulas) and incomplete(only one formula) correspondence of prescriptions and TCM syndrome have similar effects on the central clinical manifestation of ischemic stroke,such as neurological deficit and activities in daily living.However,they have significant differences regarding individual dysfunctions,such as subjective symptoms.