烧伤后回肠组织二胺氧化酶活性变化的动态观察

采用大鼠烫伤模型对烧伤后回肠组织二胺氧化酶 (DAO)活性和肠道内容物IgA水平的变化进行动态观察。探讨烧伤后肠道机械屏障与肠道免疫屏障变化及相互间的关系。结果表明 ,烧伤后回肠DAO活性和肠道内IgA含量均明显降低 ,但二者变化趋势有所不同。提示烧伤后肠道屏障损伤与肠源性脓毒症关系密切 ,而且肠道机械屏障损伤较重 ,持续时间较长。

加减大柴胡汤对胆囊胆固醇结石湿热证模型小鼠回肠组织病理及肠道菌群的影响

目的探讨加减大柴胡汤对胆囊胆固醇结石湿热证模型小鼠的干预作用及可能作用机制。方法将48只小鼠随机分为空白组、模型组、加减大柴胡汤组和熊去氧胆酸组,每组12只。除空白组外,其余各组小鼠采用“内湿+外湿+高胆固醇致石饲料”建立胆囊胆固醇结石湿热证小鼠模型。造模成功后,加减大柴胡汤组小鼠给予浓度为1.17 g/ml的加减大柴胡汤药液0.02 ml/g灌胃,熊去氧胆酸组小鼠给予浓度为2.5 mg/ml的熊去氧胆酸溶液0.02 ml/g灌胃,同时空白组和模型组给予0.02 ml/g生理盐水灌胃,每日1次,共干预4周。自造模起每周观察记录各组小鼠体质量、饮食量、皮毛、二便等一般情况变化,造模前后及给药干预后均进行旷场实验(包括水平穿越格子数、直立次数和静止时间)评价小鼠活跃情况;干预结束后检测胆汁中总胆固醇(TC)、总胆汁酸(TBA)含量;HE染色法观察回肠组织病理学变化;16S rDNA扩增测序法检测各组小鼠肠道菌群生物多样性。结果干预后与空白组比较,模型组小鼠水平穿越格子数和直立次数均减少、静止时间均延长,胆汁内TC含量升高、TBA含量降低(P<0.01)。与模型组和熊去氧胆酸组比较,加减大柴胡汤组小鼠水平穿越格子数和直立次数增多、静止时间缩短,胆汁内TC含量均降低、TBA含量均升高(P<0.05或P<0.01)。HE染色显示,模型组小鼠回肠结构完整性被破坏,肠绒毛疏松、杂乱、断裂,固有层明显增厚;加减大柴胡汤组和熊去氧胆酸组小鼠较模型组肠绒毛密度有所增加,肠绒毛断裂等状况有所好转,其中加减大柴胡汤组小鼠回肠组织病理形态改善状况更佳。肠道菌群Alpha多样性分析结果示,与空白组比较,模型组小鼠肠道Chao1、Observed species、Pielou_e、Shannon、Simpson指数均降低(P<0.01);加减大柴胡汤组小鼠肠道Shannon、Pielou_e指数明显高于模型组和熊去氧胆酸组(P<0.05或P<0.01)。Beta多样性分析发现,除模型组与熊去氧胆酸组之间的组间差异小于组内差异、组间差异不明显(P>0.05)外,其余各组组间差异均大于组内差异、组间差异显著(P<0.01)。各组之间在界、门、纲、目、科、属分类学水平总共有66个显著差异菌,其中属水平有25个。与模型组和熊去氧胆酸组比较,异杆菌属、乳杆菌属和苏黎世杆菌属为加减大柴胡汤组显著差异菌属。结论加减大柴胡汤可改善胆囊胆固醇结石湿热证模型小鼠活跃程度及湿热证候,调节脂质代谢,从而达到利胆消石功效,其机制可能与改善肠道菌群紊乱及回肠组织病理损伤有关。

白头翁汤对湿热泄泻大鼠回肠黏膜屏障功能的影响

为探究白头翁汤(Pulsatilla Decoction,PD)对湿热泄泻(Damp-heat Diarrhea,DHD)大鼠回肠黏膜屏障功能的影响,选用48只雄性SD大鼠随机分为空白组(NC)、模型组(Model)、自愈组(SH)、白头翁汤高剂量组(PD-H)、白头翁汤中剂量组(PD-M)、白头翁汤低剂量组(PD-L).以“高糖高脂+高热高湿+肠毒性大肠杆菌”复杂因素诱导大鼠DHD模型,模型建立成功后,PD组大鼠分别以0.752 g/mL(PD-H),0.376 g/mL(PD-M),0.188 g/mL(PD-L)进行灌胃治疗,SH组和NC组大鼠等量生理盐水灌胃,每日1次,连续5 d.试验期间,记录大鼠体质量及采食量变化,试验结束后,采集血液进行血常规指标检测并测定血浆炎症细胞因子;采集心、肝、脾、肺、肾称质量并计算脏器指数;采集回肠组织进行病理组织学观察并检测炎症反应、黏膜屏障及色氨酸通路相关基因mRNA表达水平.结果显示,与NC组比较,Model组大鼠采食量、体质量变化率降低,心、肝、脾、肺、肾脏器指数均显著上升(p<0.05),淋巴细胞数(Lymph)、单核细胞数(Mon)、平均红细胞体积(MCV)显著降低(p<0.05),中性粒细胞绝对值(Gran)、淋巴细胞百分比(Lymph%)、红细胞数(RBC)、血小板数(PLT)显著升高(p<0.05),血浆IL-1β,IL-6水平显著上升(p<0.05),回肠绒毛排列杂乱、固有层明显增厚、部分隐窝结构有消失、杯状细胞数量减少、微绒毛形成的纹状缘弥漫性缺失、乳糜管内有红细胞浸润、肠绒毛高度/隐窝深度(V/C)显著降低(p<0.05),回肠IL-1β,IL-6和IFN-γ,TNF-α,IL-17 mRNA水平显著升高(p<0.05),IL-4,ZO-1 mRNA水平显著降低(p<0.05),TPH1,KMO,IDO-1,MUC1,MUC2 mRNA水平显著升高(p<0.05);与Model组比较,PD-H组大鼠Lymph,MCV显著升高(p<0.05)、 PD-M组大鼠Lymph,Mon,PLT均显著降低(p<0.05),PD-L组大鼠HGB显著降低(p<0.05)、 MCV显著升高(p<0.05),PD-M大鼠肝脏指数显著降低(p<0.05),PD-H组、 PD-M组、 PD-L组大鼠脾脏指数均显著降低(p<0.05),PD-H组、 PD-L组大鼠肺脏、肾脏指数显著降低(p<0.05),PD-H组、 PD-M组肠绒毛形状完整、排列整齐、固有层厚薄不一、隐窝结构明显、杯状细胞有增多或排列整齐、纹状缘完整、乳糜管增宽内有红细胞浸润,PD-H肠绒毛高度/隐窝深度显著上升(p<0.05),PD-H组血浆IL-1β,IL-6含量显著降低(p<0.05),PD-H组、 PD-M组、 PD-L组回肠TPH1,KMO mRNA表达水平显著降低(p<0.05),PD-H组、 PD-M组MUC1 mRNA表达水平显著降低(p<0.05),PD-H组、 PD-M组、 PD-L组MUC2的mRNA表达水平极显著降低(p<0.01),PD-H组、 PD-M组ZO-1 mRNA表达水平极显著升高(p<0.01).表明白头翁汤可以通过改善炎症反应,调控色氨酸代谢,减轻黏膜屏障损伤,维持回肠正常功能.

大鼠肠缺血后回肠组织内一氧化氮代谢的变化

目的 :研究缺血及缺血再灌注后肠组织内NO代谢产物的变化。方法 :建立大白鼠肠系膜上动脉阻断模型 ,采用荧光法测定回肠组织内NO-2 含量。结果 :缺血后 3 0min ,肠组织NO-2 上升 ,2h达高峰。缺血再灌注组 ,在复灌 3 0min、60min、12 0min、180min时NO-2 含量均明显高于单纯缺血组。缺血前腹腔给予iNOS抑制剂氨基胍 (AG)可明显降低缺血及缺血再灌时肠组织NO-2 含量。结论 :肠缺血及缺血再灌注后肠组织内NO-2 含量发生明显改变 ,iNOS抑制剂AG对缺血及缺血再灌所致iNOS活性增高有明显抑制作用。NO参与了肠缺血再灌注的损伤过程。

硫化氢对缺血-再灌注损伤大鼠回肠Toll样受体4、核因子-κB表达的影响

硫化氢（H2S）由胱硫醚-γ-裂解酶（CSE）等催化L-半胱氨酸合成，对缺血-再灌注损伤大鼠小肠黏膜屏障功能障碍、肝脏功能障碍起保护作用。本实验旨在观察H2S对缺血-再灌注损伤大鼠回肠组织Toll样受体4（TLR4）、核转录因子-κB（NF—κB）表达的影响。

临床应用回肠血管弓解剖45例报告

目的观察回肠血供，验证相应的手术对策，解决回肠造袋-肛管吻合术后肠道张力过高问题。方法解剖和观察45例回肠血管弓，从解剖学角度了解回肠血供机理及“延长”小肠的方法。结果血管弓2列者2例（4％），血管弓3列者35例（78％），四列者5例（11％），五列者3例（7％）。结论在右结肠动脉平面下，离断肠系膜上动静脉，松解了小肠长度50-60cm，尚有2。5列血管弓提供血液，可以避免回肠袋一肛管吻合术后肠管张力高和回肠缺血。

Small intestine contrast ultrasonography vs computed tomography enteroclysis for assessing ileal Crohn's disease

AIM:To compare computed tomography enteroclysis(CTE) vs small intestine contrast ultrasonography(SICUS) for assessing small bowel lesions in Crohn's disease(CD),when using surgical pathology as gold standard.METHODS:From January 2007 to July 2008,15 eligible patients undergoing elective resection of the distal ileum and coecum(or right colon) were prospectively enrolled.All patients were under follow-up.The study population included 6 males and 9 females,with a median age of 44 years(range:18-80 years).Inclusion criteria:(1) certain diagnosis of small bowel requiring elective ileo-colonic resection;(2) age between 18-80 years;(3) elective surgery in our Surgical Unit;and(4) written informed consent.SICUS and CTE were performed ≤ 3 mo before surgery,followed by surgical pathology.The following small bowel lesions were blindly reported by one sonologist,radiologist,surgeon and histolopathologist:disease site,extent,strictures,abscesses,fistulae,small bowel dilation.Comparison between findings at SICUS,CTE,surgical specimens and histological examination was made by assessing the specificity,sensitivity and accuracy of each technique,when using surgical findings as gold standard.RESULTS:Among the 15 patients enrolled,CTE was not feasible in 2 patients,due to urgent surgery in one patients and to low compliance in the second patient,refusing to perform CTE due to the discomfort related to the naso-jejunal tube.The analysis for comparing CTE vs SICUS findings was therefore performed in 13 out of the 15 CD patients enrolled.Differently from CTE,SICUS was feasible in all the 15 patients enrolled.No complications were observed when using SICUS or CTE.Surgical pathology findings in the tested population included:small bowel stricture in 13 patients,small bowel dilation above ileal stricture in 10 patients,abdominal abscesses in 2 patients,enteric fistulae in 5 patients,lymphnodes enlargement(> 1 cm) in 7 patients and mesenteric enlargement in 9 patients.In order to compare findings by using SICUS,CTE,histology and surgery,characteristics of the small bowel lesions observed in CD each patient were blindly reported in the same form by one gastroenterologistsonologist,radiologist,surgeon and anatomopathologist.At surgery,lesions related to CD were detected in the distal ileum in all 13 patients,also visualized by both SICUS and CTE in all 13 patients.Ileal lesions > 10 cm length were detected at surgery in all the 13 CD patients,confirmed by SICUS and CTE in the same 12 out of the 13 patients.When using surgical findings as a gold standard,SICUS and CTE showed the exactly same sensitivity,specificity and accuracy for detecting the presence of small bowel fistulae(accuracy 77% for both) and abscesses(accuracy 85% for both).In the tested CD population,SICUS and CTE were also quite comparable in terms of accuracy for detecting the presence of small bowel strictures(92% vs 100%),small bowel fistulae(77% for both) and small bowel dilation(85% vs 82%).CONCLUSION:In our study population,CTE and the non-invasive and radiation-free SICUS showed a comparable high accuracy for assessing small bowel lesions in CD.

Ileal lesions in patients with ulcerative colitis after ileo-rectal anastomosis:Relationship with colonic metaplasia

AIM:To assess whether in ulcerative colitis (UC) patients with ileo-rectal anastomosis (IRA), ileal lesions may develop in the neo-terminal-ileum and their possible relation with phenotypic changes towards colonic epithelium. METHODS: A total of 19 patients with IRA under regular follow up were enrolled, including 11 UC and 8 controls (6 Crohn’s disease, CD; 1 familial adenomatous polyposis, FAP; 1 colon cancer, colon K). Ileal lesions were identifi ed by ileoscopy with biopsies taken from the ileum (involved and uninvolved) and from the rectal stump. Staining included HE and immunohistochemistry using monoclonal antibodies against colonic epithelial protein CEP (Das-1) and human tropomyosin isoform 5, hTM5 (CG3). Possible relation between development of colonic metaplasia and ileal lesions was investigated.RESULTS: Stenosing adenocarcinoma of the rectal stump was detected in 1 UC patient. The neo-terminal ileum was therefore investigated in 10/11 UC patients. Ileal ulcers were detected in 7/10 UC, associated with colonic metaplasia in 4/7 (57.1%) and Das-1 and CG3 reactivity in 3/4 UC. In controls, recurrence occurred in 4/6 CD, associated with colonic metaplasia in 3/4 and reactivity with Das-1 and CG3 in 2/3. CONCLUSION: Present fi ndings suggest that in UC, ileal lesions associated with changes towards colonic epithelium may develop also after IRA. Changes of the ileal content after colectomy may contribute to the development of colonic metaplasia, leading to ileal lesions both in the pouch and in the neo-terminal ileum after IRA.

Primary colonic type adenocarcinoma of the cecal appendix presented as obstructive acute abdominal syndrome

We reported a case with an obstructive acute abdomen,and emergency exploratory laparotomy was performed.Ap-pendiceal neoplasm was observed adhered to the ileum,and an ileohemicolectomy was performed.From the histopathological point of view the neoplasm was an infiltrating colonic type adenocarcinoma of the appendix,with extension to the periapendicular adipose tissue and fixation of an adjacent ileal loop secondary to infiltration of the intestinal wall.The tumor produced a moderate luminal stenosis of the intestine,this explained the clinical manifestations of the patient.Post-operative evolution was satisfac-tory and there had been no signs of recurrence in the 5 years since the operation.Based upon the comparison of clinical char-acteristics,pathological behavior(in relation to the growth and dissemination),and therapeutic considerations,possibly colonic type adenocarcinoma of the appendix is a neoplasm similar to the carcinomas of ascending colon.

Postoperative excessive gain in visceral adipose tissue as well as body mass index are associated with adverse outcomes of an ileal pouch

Background:There are no published studies on the impact of visceral adipose tissue(VAT)change on outcomes of restorative proctocolectomy and ileal pouch-anal anastomosis(IPAA).The aim of this historic cohort study was to evaluate the impact of excessive VAT gain on the outcomes of inflammatory bowel disease(IBD)patients with IPAA.Methods:We evaluated all eligible patients with at least two sequential CT scans after pouch construction from our prospectively maintained Pouchitis Registry between 2002 and 2014.The visceral fat area(VFA)was measured on CT images.The study group comprised patients with a significant VAT gain(>15%),and the control group was those without.The adverse outcomes of the pouch were defined as the new development of chronic pouch inflammation(chronic pouchitis,chronic cuffitis or Crohn’s disease of the pouch),anastomotic sinus and the combination of above(the composite adverse outcome)or pouch failure,after the inception CT.Results:Of 1564 patients in the Registry,59(3.8%)with at least 2 CT scans after pouch surgery were included.Twenty-nine patients(49.2%)were in the study group,and 30(50.8%)were in the control group.The median duration from the inception to the latest CT was 552(range:31–2598)days for the entire cohort.We compared the frequency of new chronic pouch inflammation(13.8%vs 3.3%,P=0.195),new pouch sinus(10.3%vs 0%,P=0.112),composite adverse pouch outcome(24.1%vs 3.3%,P=0.026)or pouch failure(10.3%vs 6.7%,P=0.671)between the two groups.Kaplan-Meier plot for time-to-pouch failure between the pouch patients with or without excessive body mass index(BMI)gain(>10%)showed statistical difference(P=0.011).Limited stepwise multivariate analysis showed that excessive VAT gain(odds ratio=12.608,95%confidence interval:1.190–133.538,P=0.035)was an independent risk factor for the adverse pouch comes.Conclusions:In this cohort of ileal pouch patients,excessive VAT gain as well as gain in BMI after pouch construction was found to be associated with poor long-term outcomes.