虾钳草、叶里含珠对·O_2^-和·OH清除率影响的实验研究

目的研究虾钳草、叶里含珠水提液对·O-2和·OH自由基清除率(%)的影响以及药理作用。方法用水提取中草药虾钳草、叶里含珠(干品),用AP-TEMED系统产生,用Fenton反应产生·OH自由基,分光光度法测定上述药物对·O-2和·OH清除率(%),并进行对比分析。结果虾钳草、叶里含珠水提液(浓度0.1g/ml生药)及维生素C(浓度为1mg/ml),对·O-2清除率分别为:(25.84±1.59)%、(78.19±5.14)%、(100.00±0.00)%,虾钳草与叶里含珠比较(P<0.01),有显著性差异,但均明显低于维生素C;1.0、0.5、0.25(mL)三种不同剂量的虾钳草水溶液对·O-2清除率分别为:25.84%、12.56%、6.53%,相关系数r=0.9993,有直线关系,三种不同剂量的叶里含珠水溶液对清除率分别为:89.66%、48.24%、25.88%,r=0.9996,维生素C作为标准对照,r=0.9967,均有直线关系。虾钳草对·OH自由基清除率为(66.29±1.28)%。结论虾钳草、叶里含珠水提液均有较高的·O-2和羟自由基清除率,可能与它们的药理作用有关。

梅花钻对衰老糖尿病小鼠模型生化指标的影响

用链佐霉素(STZ)和D-半乳糖及亚硝酸钠溶液联合给小鼠作腹腔注射,建立拟衰老糖尿病模型。分实验1组、实验2组、实验3组灌服,同时设立不灌药的模型组和正常组。测定造模前、后和灌药前、后各组小鼠血糖及其他生化指标,对结果作对比分析。结果血糖,造模前,各组比较,P>0.05,差异无统计学意义;造模后灌药前,正常组、实验1组、实验2组、实验3组、模型组血糖依次为5.89±0.86、16.22±4.50、14.84±3.79、16.95±5.62、14.04±4.53(mmol/L),各组与正常组比较,P<0.01,差异有统计学意义;灌药后依次为5.37±1.64、21.12±6.80、13.57±5.51、17.90±8.07,(mmol/L),各组与正常组比较,P<0.05,P<0.01,差异有统计学意义,实验2组灌药后比灌药前降低;甘油三酯(TG)依次为1.05±0.40、3.02±1.56、1.68±1.35、2.28±1.40、1.84±0.79:mmol/L,正常组较低,其次是实验2组;造模各组尿糖明显高于正常组,治疗后实验2组明显下降;血清总蛋白正常组明显高于其他各组;大脑超氧阴离子自由基(O·-2)清除率(%)依次为33.88±3.50、23.90±5.73、21.54±4.20、21.46±5.72、12.54±4.22(%),正常组明显高于其他各组(P<0.01),模型组明显低于其他各组(P<0.01);脑Ach E,各组比较,P>0.05,差异无统计学意义;尿素,与实验2组明显低于其他各组。结论实验2组(广西梅花钻提取液)有较好的降低衰老糖尿病模型小鼠血糖、尿糖、TG,其他中药效果不明显。

Radical Scavenging Ability of Soymilk Fermented with Compound Lactic Acid Bacteria towards DPPH Free Radical

The DPPH scavenging ability of soymilk fermented with lactic acid bacteria under different fermentation conditions were investigated in this paper. According to the result, the optimal combination of starter species was S. thermophilus, L. plantarum and L. helveticus at a ratio of 2∶1.5∶1.5. The optimal fermentation parameters were temperature of 37 ℃, solids content of 12% and fermentation time of 6 h.Under above conditions, the fermented soymilk showed the highest ability to scavenge DPPH free radicals（84.3%）. Besides, the radical scavenging ability of fermented soymilk was compared with that of Baiyu lactone soymilk and bean curd which were coagulated by chemical method. The result indicated that the scavenging rate of lactone bean curd of Baiyu lactone soymilk and bean curd was only32.1% and 23.2%. According to the comparison, the free radical scavenging ability of soymilk was significantly improved by lactic acid fermentation. This product which had no beany flavor would be beneficial to human health.

Extracorporeal shock wave lithotripsy for pancreatic and large common bile duct stones

Extraction of large pancreatic and common bile duct(CBD)calculi has always challenged the therapeutic endoscopist.Extracorporeal shockwave lithotripsy(ESWL)is an excellent tool for patients with large pancreatic and CBD calculi that are not amenable to routine endotherapy.Pancreatic calculi in the head and body are targeted by ESWL,with an aim to fragment them to<3 mm diameter so that they can be extracted by subsequent endoscopic retrograde cholangio-pancreatography(ERCP).In our experience,complete clearance of the pancreatic duct was achieved in 76% and partial clearance in 17%of 1006 patients.Short-term pain relief with reduction in the number of analgesics ingested was seen in 84%of these patients.For large CBD calculi,a nasobiliary tube is placed to help target the calculi,as well as bathe the calculi in salinea simple maneuver which helps to facilitate fragmenta-tion.The aim is to fragment calculi to<5 mm size and clear the same during ERCP.Complete clearance of the CBD was achieved in 84.4%of and partial clearance in 12.3%of 283 patients.More than 90%of the patients with pancreatic and biliary calculi needed three or fewer sessions of ESWL with 5000 shocks being de-livered at each session.The use of epidural anesthesia helped in reducing patient movement.This,together with the better focus achieved with newer third-gen-eration lithotripters,prevents collateral tissue damage and minimizes the complications.Complications in our experience with nearly 1300 patients were minimal,and no extension of hospital stay was required.Similar rates of clearance of pancreatic and biliary calculi with minimal adverse effects have been reported from the centers where ESWL is performed regularly.In view of its high efficiency,non-invasive nature and low complication rates,ESWL can be offered as the first-line therapy for selected patients with large pancreatic and CBD calculi.

Effect of Phenylephrine on Alveolar Fluid Clearance in Ventilator-induced Lung Injury

Objective To investigate the effect of phenylephrine （an α-adrenergic agonist） on alveolar fluid clearance （AFC） in ventilator-induced lung injury and the possible mechanism involved. Methods A total of 170 male Wistar rats were randomly allocated into 17 groups （n= 10） using ran- dom number tables. Short-term （40 minutes） mechanical ventilation with high tidal volume （HVT） was per- formed to induce lung injury, impair active Na＋ transport and lung liquid clearance in the rats. Unventilated rats served as controls. To demonstrate the effect of phenylephrine on AFC, phenylephrine at different con- centrations （1×10^-5, 1 ×10^-6, 1×10^-7, 1×10^-8, and 1×10^-9 mol/L） was injected into the alveolar space of the HVT ventilated rats. To identify the influence of adrenergic antagonists, Na＋ channel, and microtubular sys- tem on the effect of phenylephrine, phenylephrine at 1×10^-5mol/L combined with prazosin （an α1-adrener- gic antagonist, 1×10^-4 mol/L）, yohimbine （an α2-adrenergic antagonist, 1×10^-4 mol/L）, atenolol （a β1- adrenergic antagonist, 1×10^-5 mol/L）, ICI- 118551 （an β2-adrenergic antagonist, 1×10^-5 mol/L）, amiloride （a Na＋ channel blocker, 51×10^-4mol/L）, ouabain （a Na＋/K＋-ATPase blocker, 5~×10^-4mol/L）, colchicine （a mi- crotubular disrupting agent, 0.25 mg/100 g body weight）, or β-lumicolchicine （an isomer of colchicine, 0.25 mg/100 g body weight） were perfused into the alveolar space of the rats ventilated with HVT for 40 minutes. AFC and total lung water content were measured. Results Basal AFC in control rats was （17.47±2.56）%/hour, which decreased to （9.64± 1.32）%/hour in HVT ventilated rats （P=0.003）. The perfusion of phenylephrine at 1 ×10^-8, 1×10^-7, 1×10^-6, and 1×10^-5 mol/L significantly increased the AFC in HVT ventilated rats （all P〈0.05）. This effect of phenylephrine on AFC was suppressed by prazosin, atenolol, and ICI-118551 in HVT ventilated rats by 53%, 31%, and 37%, respectively （all P〈0.05）. The AFC-stimulating effect of phenylephrine was lowered by 33% and 42% with amiloride and ouabain, respectively （both P〈0.05）. Colchicine significantly inhibited the effect of phenylephrine （P=0.031）. Conclusion Phenylephrine could increase the AFC in HVT-ventilated rats and accelerate the ab- sorption of pulmonary edema.

Measurement of serum cystatin C,creatinine clearance and urea micro-albumin as renal function evaluation indicators in cancer patients during chemotherapy with platinum

Objective:Chemotherapy drugs such as platinum may cause damage to the renal function,creatinine clearance(Ccr),as a "golden standard" indicator in clinical evaluation of renal function,was limited in application due to complicated detection steps.By detecting the expression of serum Cystatin C(Cys C),Ccr and urinary micro-albumin(UMA),this study was designed to analyze and discuss their roles and status in renal function evaluation for cancer patients before and after chemotherapy with platinum.Methods:We retrospectively reviewed 110 patients who receiving platinum-containing protocols or non-platinum-containing ones,and got the expression of Cys C,Ccr(was calculated by Cockcroft-Gault equation) and UMA,then analyzed whether there were differences for Cys C,Ccr and UMA in those patients;for patients with mildly impaired renal function(Ccr between 50-75 mL/min),whether there were differences for Cys C and UMA before and after chemotherapy with platinum.Results:There was statistical significance for Ccr,Cys C and UMA in patients who receiving platinum-containing protocols(85.01 ± 28.40) vs(76.79 ± 26.63) mL/min,(1.49 ± 0.50) vs(1.80 ± 0.84) mg/L and(14.30 ± 9.15) vs(16.90 ± 10.95) mg/L,P = 0.00,0.00 and 0.01),and no statistical significance for those receiving non-platinum-containing ones(89.45 ± 29.69) vs(86.78 ± 27.96) mL/min,(1.51 ± 0.78) vs(1.63 ± 0.73)mg/L and(17.31 ± 10.46) vs(16.59 ± 8.33) mg/L,P = 0.45,0.07 and 0.57);and there were also significant differences for Cys C for patients with mildly impaired renal function before and after chemotherapy(1.68 ± 0.55) vs(2.04 ± 0.68) mg/L,P = 0.03),while no statistical significance for UMA for the same ones(21.11 ± 10.06) vs(21.22 ± 8.81) mg/L,P = 0.93).There were statistical significance both for Cys C and UMA before and after chemotherapy in platinum-containing group,but the AUC for Ccr and Cys C is greater than that for UMA(P < 0.02).Conclusion:Cys C and UMA can both access renal dysfunction early after chemotherapy,but Cys C is more sensitive than UMA in reflecting early renal dysfunction,so Cys C can replace Ccr and become a reliable indicator in the assessment of renal function for cancer patients before and after chemotherapy especially with platinum.

Factors influencing a low rate of hepatitis C viral RNA clearance in heroin users from Southern China

AIM: To study the virological and host factors influencing hepatitis C infection outcomes in heroin users in southern China. METHODS: HCV RNA and associated factors were analyzed among 347 heroin users from Guangxi Zhuang Autonomous Region, southern China who were hepatitis C virus (HCV) EIA positive for two or more consecutive visits. RESULTS: Using the COBAS AMPLICOR HCV TEST, a remarkably low HCV RNA negative rate of 8.6% was detected. After multivariate logistic regression analysis, HCV RNA clearance was significantly associated with the presence of HBsAg (OR = 8.436, P < 0.0001), the lack of HIV-1 infection (OR = 0.256, P = 0.038) and age younger than 25 (OR = 0.400, P = 0.029). CONCLUSION: Our study suggests HCV infection among Chinese heroin users results in high levels of viral persistence even amidst factors previously found to enhance viral clearance. Prospective studies of a possible genetic component within the Chinese population and the pathogenicity of non-genotype 1 HCV infections are needed.

What are the benefits of a minimally invasive approach in frail octogenarian patients undergoing aortic valve replacement？

A best evidence topic was devised in light of a structured protocol. What is the advantage of （minl＂mally invasive） approach in （frail patients） undergoing （aortic valve replacement）？ In cardiac outpatient clinic you review an 85-year old male with severe aortic valve stenosis, low left ventricular ejection fraction and creatinine clearance of less than 50 mL/min. Other comorbidities include treated pulmonary hypertension, mild cognitive impairment, marked limitation of ordinary physical activity and depression. You resolve to determine whether to recommend mim＇mally invasive or conventional aortic valve replacement （AVR） or transcathe- ter aortic valve implantation （TAVI）, however you are not sure of the differences of the impact of frailty on preopera- tive risk for each approach; hence you investigate the best evidence on the topic.

Tamsulosin as medical expulsive therapy for lower ureterolithiasis:A meta-analysis

Objective: To review the evidence for tamsulosin as medical expulsive therapy in enhancing the effectiveness of distal ureteral stone clearance rate. Methods: We searched Pubmed/Medline, Embase, CBM and the Cochrane Library up to October 2011. All randomized controlled trials in which tamsulosin was evaluated with distal ureterolithiasis were eligible for the analysis. Outcome measure assessed was stone clearance rate. Two authors independently assessed study quality and extracted data. All data were analyzed using RevMan 5.1. Results: Thirteen studies involving 1067 participants met the inclusion criteria. Study duration ranged from 7 to 42 d. The pooled analysis showed an improvement of 41% in stone clearance rate of tamsulosin as medical expulsive therapy for distal ureteral calculi (RR=1.41, 95% CI=1.18 to 1.70). According to stone size (6 mm<size<10 mm, 5 mm<size<6 mm, size <5 mm), the pooling effects of tamsulosin were analyzed, with a higher stone expulsion rate obtained than control (RR=1.52, 1.75, 1.05, 95% CI=1.30 to 1.77, 1.25 to 2.45, 0.95 to 1.16, respectively). Adverse effects of tamsulosin, mainly retrograde ejaculation, dizziness and hypotension, were reported in 7 included trials. Conclusion: Treatment with tamsulosin appears to be a safe and effective medical expulsion therapy for distal ureterolithiasis. To make a definite clinical recommendation to use tamsulosin as medical expulsive treatment for distal ureteral calculi, high quality multicentric, randomized, double blinded, controlled trials are necessary to prove its efficacy.

Estimating glomerular filtration rate preoperatively for patients undergoing hepatectomy

AIM:To compare creatinine clearance(Ccr) with estimated glomerular filtration rate(eGFR) in preoperative renal function tests in patients undergoing hepatectomy.METHODS:The records of 197 patients undergoing hepatectomy between August 2006 and August 2008 were studied,and preoperative Ccr,a three-variable equation for eGFR(eGFR3) and a five-variable equation for eGFR(eGFR5) were calculated.Abnormal values were defined as Ccr < 50 mL/min,eGFR3 and eGFR5 < 60 mL/min per 1.73 m2.The maximum increases in the postoperative serum creatinine(post Cr) level and postoperative rate of increase in the serum Cr level(post Cr rate) were compared.RESULTS:There were 37 patients(18.8%) with abnormal Ccr,31(15.7%) with abnormal eGFR3,and 40(20.3%) with abnormal eGFR5.Although there were no significant differences in the post Cr rate between patients with normal and abnormal Ccr,eGFR3 and eGFR5 values,the post Cr level was significantly higher in patients with eGFR3 and eGFR5 abnormality than in normal patients(P < 0.0001).Post Cr level tended to be higher in patients with Ccr abnormality(P = 0.0936 and P = 0.0875,respectively).CONCLUSION:eGFR5 and the simpler eGFR3,rather than Ccr,are recommended as a preoperative renal function test in patients undergoing hepatectomy.

Comparison of GFR by Creatinine Clearance with Estimated GFR by Various Prediction Equations in a Bangladeshi Population

Glomerular filtration rate （GFR） is considered as the best marker of kidney function. Evaluation of various prediction equations to estimate GFR is rare in our population. The aim of this study was to compare GFR estimated by various prediction equations with GFR by creatinine clearance （GFRer） in Bangladeshi population. Serum creatinine and 24 hours urinary creatinine concentrations were measured in 216 adult Bangladeshi subjects （100 males and 116 females）. Creatinine clearance rate was calculated and adjusted for body surface area to obtain GFRcr. GFR was also calculated by CKD-EPI, MDRD4, Cockcroft-Gault, Jelliffe, Mawer, Bjornsson, Gates, Apollo-Chennai and Mayo Clinic prediction equations and compared with GFRcr. Results were expressed as mean ＋ SD and compared by two-tailed paired t-test, precision （r2） and receiver-operating characteristic curve. Mean ± SD of age of the total subjects was 57.15 ±10.96 years. The mean GFILzr was 42.41 ± 22.95 mL/min/1.73m2. Estimated GFR （eGFR） by CKD-EPI, MDRD4, Cockcroft-Gault, Jelliffc 1, Jelliffe 2, Mawer, Bjornsson, Gates, Apollo-Chennai and Mayo Clinic prediction equations were 8.19 ± 13.80, 5.30 ±13.61, 11.54 ± 16.86, 8.66± 18.64, 17.25 ± 19.98, 10.86 ± 22.48, 14.60 ± 17.92, 12.18 ± 16.42, 39.86 ± 21.96 and 20.47 ± 20.49 mL/min/1.73m2 higher than GFR, （P 〈 0.001）. The precision （r2） of eGFRs were 0.7114, 0.6924, 0.6431, 0.4802, 0.5048, 0.5921, 0.6286, 0.6158, 0.1635, and 0.5586 for CKD-EPI, MDRD4, Cockcroft-Gault, Jelliffe 1, Jelliffe 2, Mawer, Bjornsson, Gates, Apollo-Chennai and Mayo Clinic prediction equations, respectively. The area under receiver-operating characteristic curve was the lowest for MDRD4 equation. This study revealed that GFR estimated by standardized MDRD4 variables equation is closer to creatinine clearance rate in the study population.

The role of visceral adipose tissue on improvement in insulin sensitivity following Roux-en-Y gastric bypass:a study in Chinese diabetic patients with mild and central obesity

Background:Most Chinese patients with type 2 diabetes mellitus(T2DM)have mild obesity and central obesity.Central obesity is combined with insulin resistance.The aim of this study was to assess the effect of abdominal adipose tissue on insulin-sensitivity improvement after Roux-en-Y gastric bypass(RYGB)in Chinese diabetic patients with mild and central obesity.Methods:Seventeen T2DM patients with a mean body mass index of 30.3 kg/m^(2) were scheduled for laparoscopic RYGB.A hyperinsulinemic-euglycemic clamp and dual-energy X-ray absorptiometry were performed prior to surgery and 3 months after RYGB.The primary end points were the correlations between insulin sensitivity and abdominal adipose tissue,including visceral adipose tissue(VAT)and subcutaneous adipose tissue(SAT),before and 3 months after RYGB.Results:Indices of peripheral insulin sensitivity,including glucose-disposal rate(M value)and glucose infusion rate,were significantly increased after RYGB.Body-fat mass,VAT and SAT were significantly reduced after RYGB.The pre-operative M value was significantly correlated with VAT mass(r=–0.57,P=0.02),but not correlated with SAT mass.M value changes after RYGB were highly correlated with changes in VAT mass(r=–0.59,P=0.01),percentage of VAT mass(r=–0.66,P<0.01),VAT area(r=–0.56,P=0.02)and percentage of VAT area(r=–0.57,P=0.02).Conclusions:A significant correlation was observed between increased peripheral insulin sensitivity and decreased VAT following RYGB in Chinese patients with mild and central obesity.VAT and SAT were significantly decreased with improved insulin sensitivity after RYGB.VAT mass may be considered as an indication for gastric bypass during patient selection.

COMPARISON OF TWO-STEP DILATION VERSUS STEP BY STEP DILATION IN MINIMAL PERCUTANEOUS NEPHROLITHOTOMY

Objective To investigate minimizing dilation times of percutaneous nephrolithotomy （PCNL） in treating large renal stones. Methods A total of 105 consecutive patients undergoing minimal PCNL by using the two-step dilation protocol （ Group I ） and step by step dilation protocol （ Group 1I ） were reviewed. Two groups were compared in terms of stone size, dilating time, operation time, and blood loss. Results In all patients, the dilating of channel was finished and the success rate was 100%. The stone-free rate was 88. 7% （47/53） in Group [ and84.6% （44/52） in Group O . There were significant differences in the time of dilating and the blood loss in dilating channel （P = O. 000）. But there was no significant difference in the operation time of PCNL. Conclusion PCNL of the urinary calculi is safe in Chinese patients. Two-step dilation in PCNL has advantages of shorter dilating time and lower blood loss in different types of calculi during dilating.