Prediction model of stress ulcer after laparoscopic surgery for colorectal cancer established by machine learning algorithm

BACKGROUND Patients with colorectal cancer(CRC)are prone to stress ulcer after laparoscopic surgery.The analysis of risk factors for stress ulcer(SU)in patients with CRC is important to reduce mortality and improve patient prognosis.AIM To identify risk factors for SU after laparoscopic surgery for CRC,and develop a nomogram model to predict the risk of SU in these patients.METHODS The clinical data of 135 patients with CRC who underwent laparoscopic surgery between November 2021 and June 2022 were reviewed retrospectively.They were divided into two categories depending on the presence of SUs:The SU group(n=23)and the non-SU group(n=112).Univariate analysis and multivariate logistic regression analysis were used to screen for factors associated with postoperative SU in patients undergoing laparoscopic surgery,and a risk factor-based nomogram model was built based on these risk factors.By plotting the model's receiver operating characteristic(ROC)curve and calibration curve,a Hosmer-Lemeshow goodness of fit test was performed.RESULTS Among the 135 patients with CRC,23 patients had postoperative SU,with an incidence of 17.04%.The SU group had higher levels of heat shock protein(HSP)70,HSP90,and gastrin(GAS)than the non-SU group.Age,lymph node metastasis,HSP70,HSP90,and GAS levels were statistically different between the two groups,but other indicators were not statistically different.Logistic regression analysis showed that age≥65 years,lymph node metastasis,and increased levels of HSP70,HSP90 and GAS were all risk factors for postoperative SU in patients with CRC(P<0.05).According to these five risk factors,the area under the ROC curve for the nomogram model was 0.988(95%CI:0.971-1.0);the calibration curve demonstrated excellent agreement between predicted and actual probabilities,and the Hosmer-Lemeshow goodness of fit test revealed that the difference was not statistically significant(χ2=0.753,P=0.999),suggesting that the nomogram model had good discrimination,calibration,and stability.CONCLUSION Patients with CRC aged≥65 years,with lymph node metastasis and elevated HSP70,HSP90,GAS levels,are prone to post-laparoscopic surgery SU.Our nomogram model shows good predictive value.

Xiaotan Tongfu granules contribute to the prevention of stress ulcers

AIM:To investigate the efficacy and potential mechanism of Xiaotan Tongfu granules(XTTF)in stress ulcers.METHODS:One hundred sixty rats were randomly divided into 4 groups(n=10)as follows:the model group(MP group),the control group(CP group),the ranitidine group(RP group)and the XTTF granule group(XP group).Rats in the MP group received no drugs,rats in the CP group received 0.2 mL of a 0.9%sodium chloride solution via oral gavage,and rats in the RP and XP groups received the same volume of ranitidine(50 mg/kg)or XTTF granule(4.9 g/kg).The cold-restraint stress model was applied to induce stress ulcers after 7 consecutive days of drug administration.Afterwards,rats were sacrificed at 0,3,6 and24 h.Gastric pH was measured by a precise pH meter;gastric emptying rate(GER)was measured by using a methylcellulose test meal;myeloperoxidase activity(MPO),macrophage migration inhibitory factor(MIF),proliferating cell nuclear antigen(PCNA),and heat shock protein 70(HSP70)were measured by immunohistochemical staining;and mucosal cell apoptosis was measured by transferase dUTP nick end labeling.RESULTS:In the cold-restraint stress model,the development of stress ulcers peaked at 3 h and basically regressed after 24 h.Gastric lesions were significantly different in the RP and XP groups at each time point.Interestingly,although this index was much lower in the RP group than in the XP group immediately following stress induction(7.00±1.10 vs 10.00±1.79,P<0.05.Concerning gastric pH,between the RP and XP groups,we detected a statistically significant difference immediately after stress induction(0 h:4.56±0.47 vs 3.34±0.28,P<0.05)but not at any of the subsequent time points.For GER,compared to the RP group,GER was remarkably elevated in the XP group because a statistically significant difference was detected(3 h:46.84±2.70 vs 61.16±5.12,P<0.05;6 h:60.96±6.71 vs 73.41±6.16,P<0.05;24 h:77.47±3.17 vs 91.31±4.34,P<0.05).With respect to MPO and MIF,comparisons between the RP and XP groups revealed statistically significant differences at 3 h(MPO:18.94±1.20 vs 13.51±0.89,P<0.05;MIF:150.67±9.85 vs 122.17±5.67,P<0.05)and 6 h(MPO:13.22±1.54 vs 8.83±0.65,P<0.05;MIF:135.50±9.46 vs 109.83±6.40,P<0.05).With regard to HSP70,HSP70 expression was significantly increased in the RP and XP groups at 3 and 6 h compared to the MP and CP groups.In addition,comparing the RP and XP groups also showed statistically significant differences at 3 and 6 h.The expression of PCNA was higher in the RP and XP groups 3 h after stress induction.Between these two groups,small but statistically significant differences were observed at all of the time points(3 h:69.50±21.52 vs 79.33±15.68,P<0.05;6 h:107.83±4.40 vs 121.33±5.71,P<0.05;24 h:125.33±5.65 vs 128.50±14.49,P<0.05)except 0 h.With regard to apoptosis,the apoptotic activity in the RP and XP groups was significantly different from that in the MP and CP groups.The XP group exhibited a higher inhibition of cell apoptosis than the RP group at3 h(232.58±24.51 vs 174.46±10.35,P<0.05)and6 h(164.74±18.31 vs 117.71±12.08,P<0.05).CONCLUSION:The Xiaotan Tongfu granule was demonstrated to be similar to ranitidine in preventing stress ulcers.It exhibited multiple underlying mechanisms and deserves further study.

Stress ulcer prophylaxis guidelines:Are they being implemented in Lebanese health care centers?

AIM:To evaluate the current practice of stress ulcer prophylaxis (SUP) in Lebanese Health care centers.METHODS:A multi-center prospective chart review study was conducted over 8 mo.A questionnaire was distributed to pharmacy students who collected data on demographics,SUP medications,dose,route,duration and associated risk factors.The appropriateness of SUP use was determined as per American Society of Health-System Pharmacists guidelines.Institutional review board approval was obtained from each hospital center.RESULTS:A total of 1004 patients were included.67% of the patients who received prophylaxis did not have an indication for SUP.The majority (71.6%) of the patients who were administered parenteral drugs can tolerate oral medications.Overall,the regimen of acid-suppressant drugs was suboptimal in 87.6% of the sample.This misuse was mainly observed in non-teaching hospitals.CONCLUSION:This study highlighted the need,in Lebanese hospitals,to establish clinical practice guidelines for the use of SUP;mainly in non-critical care settings.

Influence of astragaloside on gastric mucosa of stress ulcer rats

Objective To investigate the effect of astragaloside(AST)on the gastric mucosal injury of water immersion restraint stress ulcer rat.Methods The stress ulcer model was made by water immersion and restraint.The gastric mucosal injury index was observed.The SOD activity,the MDA contents and the gene expression of melatonin receptor 1 and 2 were detected in gastric mucosa.Results Compared with the normal group,the model group showed mucous edema,hyperemia and even ulcer damage.The injury index and the MDA content of gastric mucosa in model group were significantly increased(P<0.05),the SOD activity of gastric obviously depressed(P<0.01),and the melatonin receptor 1 and 2 mRNA expressions of damaged gastric mucosa were also lower.After administration of AST,the gastric mucosal ulcer index and MDA contents relieved obviously(P<0.01,P<0.05),the SOD activity and the expressions of melatonin receptor 1 and 2 mRNA raised up(P<0.01,P<0.05).Conclusions AST could prevent the gastric mucosal damage of rat in stress ulcer.And the mechanism of the gastric mucosal protection should be concerned with regulating the melatonin receptor and lessening the injury of oxygen free radical.

Gastrointestinal stress ulcer prophylaxis in the intensive care unit,where is the data?

Stress-induced gastrointestinal ulcers are common among patients admitted to the intensive care unit(ICU).These ulcers impose significant morbidity and mortality,therefore,stress ulcer prophylaxis(SUP) is a common clinical practice among healthcare providers dealing with these critically-ill patients.Several strategies for SUP have been suggested over the past four decades,with acid suppressive therapies being the most commonly used in the ICU.Whether SUP is effective and safe,or not,remains a topic of controversy.The data is still conflicting,and provision of a simple answer is not feasible at the present time.Recently,a large phase IV,multicenter,randomized clinical trial(SUP-ICU),negated the benefits(and harms) of proton pump inhibitors as SUP.This article reviews some of these controversies.

The therapeutic effect of high-dose esomeprazole on stress ulcer bleeding in trauma patients

Purpose： To compare the therapeutic effects of different doses of intravenous esomeprazole on treating trauma patients with stress ulcer bleeding. Methods： A total of 102 trauma patients with stress ulcer bleeding were randomly divided into 2 groups： 52 patients were assigned to the high-dose group who received 80 mg intravenous esomeprazole, and then 8 mg/h continuous infusion for 3 days; 50 patients were assigned to the conventional dose group who received 40 mg intravenous esomeprazole sodium once every 12 h for 72 h. Results： Compared with the conventional dose group, the total efficiency of the high-dose group and conventional dose group was 98.08% and 86.00%, respectively （p 〈 0.05）, the hemostatic time was 22.10 h ± 5.18 h and 28.27 h ± 5.96 h, respectively （p 〈 0.05）. Conclusion： Both doses of intravenous esomeprazole have good hemostatic effects on stress ulcer bleeding in trauma patients. The high-dose esomeprazole is better for hemostasis.

Effect and Mechanism of Moxibustion on Acupoints Zusanli （ST 36） and Liangmen （ST 21） in the Prevention and Treatment of Stress Ulcer

Objective： To observe the effect of moxibustion on acupoints Zusanli （ST 36） and Liangmen （ST 31） on cell proliferation and cell apoptosis of gastric mucosa in rats with stress ulcer, investigatethe mechanism of moxibustion in promoting the repair of gastric mucosal injury at cellular and molecular levels, Methods： Sixty healthy Sprague-Dawley rats were randomly divided into four groups： the restraint control group, model group, moxibustion on acupoints group and moxibustion on non-acupoints group. Water immersion and restraint stress （WRS） was used to copy the stress ulcer model of rats, radio-immunoassay was used to detect the content of transforming growth factor （TGF-α）, and S-P immunohistochemical assay was adopted to determine the HSP70 expression, the proliferating cell nuclear antigen （PCNA） and cell apoptosis index in gastric mucosa. Results： For the WRS-induced gastric ulcer model of rat, the gastric mucosal injury （gastric ulcer index, UI） was increased, the content of TGF-α was decreased, PCNA was also decreased, HSP70 expression and cell apoptosis index were all increased （P〈0.01）, Moxibustion on acupoints Zusanli （ST 36） and Liangmen （ST 31） could decrease UI, increase the content of TGF-α, promote the expression of PCNA and HSP70, decrease cell apoptosis index in gastric mucosa, with significant differences when compared with the model group and control group （P〈0.01）. Conclusions： Moxibustion on acupoints Zusanli （ST 36） and Liangmen （ST 31） had protective effect on the gastric mucosa of stress ulcer, its mechanism may be promoting the TGF-α synthesis, stimulating cell proliferation in gastric mucosa and inhibiting cell apoptosis in gastric mucosa, and this process is related to the moxibustion-induced HSP70 expression.

Experimental study on mechanism and protection of stress ulcer produced by explosive noise

AIM To establish an experimental model of stress ulcer produced by explosive noise, and to probe into its mechanism and protection. METHODS The country standard Wistar white rats were randomly divided into control group ( n =8), which were neither stimulated nor protected, and stimulating group (divided into subgroups A, B and C, including 8 rats each which were decapitated to draw blood for test immediately, 12 hours and 24 hours after stimulation) and prevention group (divided into subgroups A, B and C, having 8 rats each, subgroup A was given cimetidine, B anisodamine and C both drugs). Firing noises of submachine guns were used as inflicting factor. The rats were fasted for 24 hours and stimulated by firing noise for 12 hours. The change of ulcer index, gastric mucosal and related serum hormones were observed. RESULTS Stress ulcer was significant in the stimulating group, and its ulcer index (8 6±0 6) was remarkably higher than that in both the control group and prevention group (0 3±0 1, P <0 01). Its serum gastrin (Gas ng/L , 294±163 vs 63±40, P <0 01) and endothelin (ET ng/L , 181±57 vs 135±42, P <0 01) were apparently higher than those in the control group, and its serum nitric oxide (NO) level was conspicuously lower than that in the control group ( ng/L , 0 2±0 1 vs 0 8±0 5, P <0 05), while the serum gastrin level ( ng/L , 556±225) in prevention group was distinctly higher than that in both the control ( P <0 01) and stimulating group ( P <0 05). There were no significant differences in the changes of ET and NO between the control and the stimulating groups. CONCLUSION Stress ulcer model of rats can be successfully established by the stimulation of explosive noise. Gas, ET and NO are related to the formation of stress ulcer, and play an important role in its mechanism. Hepatic function affected by noise is observed in this experiment.

Sirtuin 1 alleviates endoplasmic reticulum stress-mediated apoptosis of intestinal epithelial cells in ulcerative colitis

BACKGROUND Sirtuin 1(SIRT1)is a nicotinamide adenine dinucleotide(NAD+)-dependent protein deacetylase that is involved in various diseases,including cancers,metabolic diseases,and inflammation-associated diseases.However,the role of SIRT1 in ulcerative colitis(UC)is still confusing.AIM To investigate the role of SIRT1 in intestinal epithelial cells(IECs)in UC and further explore the underlying mechanisms.METHODS We developed a coculture model using macrophages and Caco-2 cells.After treatment with the SIRT1 activator SRT1720 or inhibitor nicotinamide(NAM),the expression of occludin and zona occludens 1(ZO-1)was assessed by Western blot analysis.Annexin V-APC/7-AAD assays were performed to evaluate Caco-2 apoptosis.Dextran sodium sulfate(DSS)-induced colitis mice were exposed to SRT1720 or NAM for 7 d.Transferase-mediated dUTP nick-end labeling(TUNEL)assays were conducted to assess apoptosis in colon tissues.The expression levels of glucose-regulated protein 78(GRP78),CCAAT/enhancerbinding protein homologous protein(CHOP),caspase-12,caspase-9,and caspase-3 in Caco-2 cells and the colon tissues of treated mice were examined by quantitative real-time PCR and Western blot.RESULTS SRT1720 treatment increased the protein levels of occludin and ZO-1 and inhibited Caco-2 apoptosis,whereas NAM administration caused the opposite effects.DSS-induced colitis mice treated with SRT1720 had a lower disease activity index(P<0.01),histological score(P<0.001),inflammatory cytokine levels(P<0.01),and apoptotic cell rate(P<0.01),while exposure to NAM caused the opposite effects.Moreover,SIRT1 activation reduced the expression levels of GRP78,CHOP,cleaved caspase-12,cleaved caspase-9,and cleaved caspase-3 in Caco-2 cells and the colon tissues of treated mice.CONCLUSION SIRT1 activation reduces apoptosis of IECs via the suppression of endoplasmic reticulum stress-mediated apoptosis-associated molecules CHOP and caspase-12.SIRT1 activation may be a potential therapeutic strategy for UC.

Stress gastric ulcer after cardiac surgery: Pathogenesis risk factors and medical management

Stress ulcer lesions of upper gastrointestinal tract are well recognized in patients undergoing open cardiac surgery. Gastrointestinal bleeding following cardiac surgery is infrequent with significant morbidity and mortality. The pathogenesis of mucosal lesions and subsequent haemorrhage is complex and multifactorial. The diagnosis as well as the treatment of this complication remains a challenge for surgeons. Identifying the source of bleeding can be difficult. Despite of the successful control of haemorrhage using various combinations of endoscopic and pharmacological therapies, the mortality rate remains unchanged. Benefit of routine stress ulcer prophylaxis remains controversial.

Proteomics of the mediodorsal thalamic nucleus of rats with stress-induced gastric ulcer

BACKGROUND Stress-induced gastric ulcer(SGU) is one of the most common visceral complications after trauma. Restraint water-immersion stress(RWIS) can cause serious gastrointestinal dysfunction and has been widely used to study the pathogenesis of SGU to identify medications that can cure the disease. The mediodorsal thalamic nucleus(MD) is the centre integrating visceral and physical activity and contributes to SGU induced by RWIS. Hence, the role of the MD during RWIS needs to be studied.AIM To screen for differentially expressed proteins in the MD of the RWIS rats to further elucidate molecular mechanisms of SGU.METHODS Male Wistar rats were selected randomly and divided into two groups, namely, a control group and an RWIS group. Gastric mucosal lesions of the sacrificed rats were measured using the erosion index and the proteomic profiles of the MD were generated through isobaric tags for relative and absolute quantitation(iTRAQ) coupled with two-dimensional liquid chromatography and tandem mass spectrometry. Additionally, iTRAQ results were verified by Western blot analysis.RESULTS A total of 2853 proteins were identified, and these included 65 dysregulated(31 upregulated and 34 downregulated) proteins(fold change ratio ≥ 1.2). Gene Ontology(GO) analysis showed that most of the upregulated proteins are primarily related to cell division, whereas most of the downregulated proteins are related to neuron morphogenesis and neurotransmitter regulation. Ingenuity Pathway Analysis revealed that the dysregulated proteins are mainly involved in the neurological disease signalling pathways. Furthermore, our results indicated that glycogen synthase kinase-3 beta might be related to the central mechanismthrough which RWIS gives rise to SGU.CONCLUSION Quantitative proteomic analysis elucidated the molecular targets associated with the production of SGU and provides insights into the role of the MD. The underlying molecular mechanisms need to be further dissected.

Effects of endoplasmic reticulum stress on the expressionof inflammatory cytokines in patients with ulcerative colitis

AIM: To explore the changes of X-box binding protein 1splicing(XBP1s) and inflammatory cytokine expression in patients with ulcerative colitis(UC) in response to endoplasmic reticulum stress(ERS).METHODS: Reverse transcription polymerase chain reaction and quantitative polymerase chain reaction were performed to detect the forms of XBP1 s and the expression of interleukin(IL)-2, interferon(IFN)-γ, and IL-17α. Differences between patients with UC and normal subjects were then determined.RESULTS: Mononuclear cells of the peripheral blood of normal subjects and UC patients with were stimulated with no drugs(control), phytohemagglutinin(PHA), thapsigargin(TG), or both PHA and TG. XBP1 s in patients with UC exhibited splicing, which was greater with co-stimulation than single stimulation. Costimulation increased the expression level of IL-2, IFN-γ, and IL-17α.CONCLUSION: The T lymphocytes of both normal subjects and patients with UC responded to ERS by activating the XBP1s-mediated signalling pathway, upregulating the expression of inflammatory cytokines, and increasing the occurrence of inflammation. The mononuclear cells in the peripheral blood of patients with UC were more sensitive to ERS than those in the peripheral blood of normal subjects.

Oral administration of hyperoxygenated solution for the prophylaxis of gastric ulceration induced by stress or Helicobacter pylori

Oxygen was first discovered by Sweden chemist Scheele in 1773 and convinced as an essential factor for living by French scientists in 1777.To tackle with different hypoxic emergencies,corresponding medical approaches,e.g.mask or nasal catheter oxygen inhalation,breathing machine,hyperbaric oxygen therapy etc.,have been contrived in succession.However,one mortal trouble exists in all these conventional ways,i.e.they must rely on the ventilation and gas exchange via lungs,thus not being able to promptly render oxygen to specific hypoxia tissues.Hyperoxygenated solution(HOS),a new kind of medical liquid which can be orally taken or intravenously administrated,has been widely applied as an auxiliary method of offering oxygen in China.A large number of experiments have proved its validity in the treatment of myocardial and cerebral ischemia/reperfusion injury,nerve lesions,shock,respiratory diseases,neonatal hypoxia and so forth.These findings suggest that HOS might not only play a role of increasing oxygen pressure in local region,but also conspicuously contribute to improving the pathologic process of hypoxia,which coincidently is the vital link in stress-induced lesions in the gastrointestinal tract.Additionally,Helicobacter pylori(H.pylori),a kind of microaerophilic(anaerobic)bacterium which can hardly survive in an aerobic atmosphere,has also been identified as an independent risk factor for the occurrence and development of ulceration.Considering the etiology of peptic ulceration and the features of HOS,we hypothesize that drinking HOS might prevent gastric ulceration caused by stress or anaerobic H.pylori.

外科手术患者围术期使用质子泵抑制剂预防应激性溃疡的合理性分析

目的:分析外科手术患者围术期使用质子泵抑制剂预防应激性溃疡的合理性。方法:回顾性分析2019年9月—2022年8月于南京医科大学第二附属医院外科行手术并于围术期应用质子泵抑制剂的1 640例患者的临床资料,统计各科室患者围术期质子泵抑制剂预防应激性溃疡的不合理用药情况。结果:1 640例患者中,质子泵抑制剂预防应激性溃疡的不合理用药发生率为76.65%(1 257/1 640),用药指征不合理例数最多,占85.28%(1 027/1 257)。结论:该院外科手术患者围术期使用质子泵抑制剂预防应激性溃疡存在不合理情况,以用药指征不合理为主,相关部门需制定相关干预措施,规范外科围术期质子泵抑制剂的使用。

足三里-中脘合募配穴针刺对运动应激性胃溃疡大鼠胃黏膜功能、氧化应激及炎症反应的影响

【目的】观察足三里-中脘合募配穴针刺对运动应激性胃溃疡大鼠的治疗作用及机制。【方法】将40只雄性SD大鼠随机分为空白组、模型组、针刺组、奥美拉唑组,每组10只。除空白组外,其余各组大鼠均采用每日力竭游泳法构建运动应激性胃溃疡模型。成功造模后,针刺组选用足三里穴和中脘穴针刺干预,每日1次,每次10 min;奥美拉唑组大鼠每日游泳2 h前给予奥美拉唑肠溶片蒸馏水混悬液灌胃。连续干预7 d后,观察大鼠整体状态与行为学,Guth法计算胃黏膜损伤指数,苏木素-伊红(HE)染色法观察胃黏膜病理形态,采用WST-1法、比色法和TBA法分别对应测定血清超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)和丙二醛(MDA)含量,酶联免疫吸附分析(ELISA)检测血清中胃泌素(GAS)、生长抑素(SS),肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)、白细胞介素6(IL-6)和白细胞介素10(IL-10)的含量,实时荧光定量聚合酶链反应(qPCR)法检测胃黏膜组织表皮生长因子受体(EGFR)、基质金属肽酶3(MMP3)、核因子红细胞系相关因子2(NRF2)、血红素加氧酶1(HO-1)和线粒体超氧化物歧化酶2(SOD2)、TNF-α、IL-1β、IL-6和IL-10 mRNA表达水平。【结果】与空白组比较,模型组大鼠体质量增长缓慢,旷场试验中活动路程缩短、活跃度降低,胃黏膜溃疡指数显著升高,胃黏膜功能指标血清GAS水平升高、血清SS水平降低、胃黏膜组织中EGFR mRNA表达水平降低及胃黏膜组织MMP3 mRNA表达水平升高,血清中抗氧化物质SOD、GSH-PX水平显著降低,氧化产物MDA水平显著升高,胃黏膜组织中抗氧化基因NRF2、HO-1、SOD2 mRNA表达水平显著降低,炎症因子TNF-α、IL-1β、IL-6的血清含量与胃黏膜组织mRNA水平显著升高,IL-10的血清含量与胃黏膜组织mRNA水平显著降低(P<0.05或P<0.01或P<0.001),HE染色可见明显胃黏膜损伤;与模型组比较,针刺组、奥美拉唑组上述各指标均得到明显改善(P<0.05或P<0.01或P<0.001),HE染色可见胃黏膜损伤明显减轻。【结论】足三里-中脘合募配穴针刺可减轻运动应激性胃溃疡大鼠局部的氧化应激和炎症反应,减少胃黏膜损伤,改善大鼠情绪状态,维持大鼠整体活力。

运动应激性胃溃疡发生机制探讨

运动应激性胃溃疡是运动引起的应激性溃疡(stress ulcer,SU),是一种以黏膜糜烂、溃疡及出血为特征的急性胃黏膜病变,临床调查显示,应激性溃疡除了会导致胃肠道黏膜的急性糜烂、溃疡,通常还会伴随胃肠道出血增多,发展至后期预后不良。自胃溃疡被发现并命名以来,研究人员一直在探讨溃疡的发生机制,由于运动应激性胃溃疡的发病范围广、频率高,其发生机制复杂,本文主要从运动引起的氧化应激产生过多的自由基会损伤胃肠黏膜细胞损坏黏膜的屏障功能、运动系统损伤会加重机体的炎症反应、运动时胃肠道血流量减少易出现缺血损伤、过度运动影响细胞代谢能量供给4个方面对运动应激性胃溃疡发生的机制进行分析总结,旨在为运动应激性胃溃疡的防治提供更多的借鉴与参考。

重症脑卒中并发消化道应激性溃疡出血的高危因素分析

目的探讨重症脑卒中并发消化道应激性溃疡出血的发病率及相关因素,可为临床预防提供借鉴。方法选择2017年5月至2022年5月收治的487例重症脑卒中患者作为研究对象,采用单因素和多因素logistic回归分析影响重症脑卒中合并消化道应激性溃疡出血发生的独立危险因素。结果487例重症脑卒中共发生消化道应激性溃疡出血35例(观察组),其余患者452例(对照组),发生率为7.2%。经单因素分析结果表明,2组性别、文化程度、吸烟史、饮酒史比较差异无统计学意义(P>0.05);2组年龄、BMI、糖尿病、高脂血症、动脉硬化、高血压、白蛋白水平和hs-CRP比较差异有统计学意义(P<0.05)。将上述单因素分析具有统计学差异的纳入多因素logistic回归分析,年龄、BMI、糖尿病、高脂血症、动脉硬化、高血压、白蛋白水平和hs-CRP为影响重症脑卒中并发消化道应激性溃疡出血的独立危险因素(P<0.05)。结论重症脑卒中并发消化道应激性溃疡出血发病率较高,其中年龄、BMI、糖尿病、高脂血症、动脉硬化、高血压、白蛋白水平和hs-CRP为独立危险因素,临床上应加强重点预防。

Association of high expression in rat gastric mucosal heat shock protein 70 induced by moxibustion pretreatment with protection against stress injury

AIM:To study the effect of moxibustion on Zusanli or Liangmeng point on gastric mucosa injury in stress-induced ulcer rats and its correlation with the expression of heat shock protein 70 (HSP70). METHODS:Sixty healthy SD rats (30 males,30 females) were divided into control group,injury model group,Zushanli point group,Liangmeng point group. Stress gastric ulcer model was induced by binding cold stress method. Gastric mucosa ulcer injury (UI) index was calculated by Guth method. Gastric mucosa blood flow (GMBF) was recorded with a biological signal analyzer. Protein content and gene expression in gastric mucosal HSP70 were detected by immunohistochemistry (IHC) and reverse transcription polymerase chain reaction (RT-PCR). Thiobarbital method was used to determine malondialdehyde (MDA) content. Gastric mucosal endothelin (ET) and prostaglandin E2 (PGE2) were analyzed by radioimmunoassay. RESULTS:High gastric mucosal UI index,high HSP70 expression,low GMBF and PGF2,elevated MDA and ET were observed in gastric mucosa of rats subjected to cold stress. Moxibustion on Zusanli or Liangmeng point decreased rat gastric mucosal UI index,MDA and ET. Conversely,the expression of HSP70,GMBF,and PGE2 was elevated in gastric mucosa after pretreatment with moxibustion on Zusanli or Liangmeng point. The observed parameters were significantly different between Zusanli and Liangmeng points. CONCLUSION:Pretreatment with moxibustion on Zusanli or Liangmeng point protects gastric mucosa against stress injury. This protection is associated with the higher expression of HSP70 mRNA and protein,leading to release of PGE2 and inhibition of MDA and ET,impairment of gastric mucosal index.

Dynamic functional and ultrastructural changes of gastric parietal cells induced by water immersion-restraint stress in rats

AIM： To investigate the dynamic functional and ultrastructural changes of gastric parietal cells induced by water immersion-restraint stress （WRS） in rats.METHODS： WRS model of Sprague-Dawley （SD） rats was established. Fifty-six male SD rats were randomly divided into control group, stress group and post-stress group. The stress group was divided into 1, 2 and 4 h stress subgroups. The post-stress group was divided into 24, 48 and 72 h subgroups. The pH value of gastric juice, ulcer index （UI） of gastric mucosa and H^＋, K^＋- ATPase activity of gastric parietal cells were measured. Ultrastructural change of parietal cells was observed under transmission electron microscope （TEM）.RESULTS： The pH value of gastric juice decreased time-dependently in stress group and increased in post-stress group. The H^＋, K^＋-ATPase activity of gastric parietal cells and the UI of gastric mucosa increased time-dependently in stress group and decreased in poststress group. Compared to control group, the pH value decreased remarkably （P = 0.0001）, the UI and H^＋, K^＋- ATPase activity increased significantly （P = 0.0001, P = 0.0174） in 4 h stress subgroup. UI was positively related with stress time （r = 0.9876, P 〈 0.01） but negatively with pH value （r = -0.8724, P 〈 0.05）. The parietal cells became active in stress group, especially in 4 h stress subgroup, in which plenty of intracellular canalicular and mitochondria were observed under TEM. In post-stress group, the parietal cells recovered to resting state.CONCOUSION： The acid secretion of parietal cells is consistent with their ultrastructural changes during the development and healing of stress ulcer induced by WRS and the degree of gastric mucosal lesions, suggesting gastric acid play an important role in the development of stress ulcer and is closely related with the recovery of gastric mucosal lesions induced by WRS.

补中益气汤对高原应激性胃溃疡小鼠的作用效果及其机制的代谢组学分析

[目的]分析补中益气汤对高原应激性胃溃疡小鼠胃黏膜损伤的作用,并基于代谢组学探究补中益气汤预防小鼠高原应激性胃溃疡的机制.[方法]使用低压氧舱构建小鼠高原应激性胃溃疡的模型,60只KM小鼠随机分为模型组、正常组、补中益气汤低剂量组、补中益气汤高剂量组、阳性药物组;通过比较各组小鼠的体质量变化、胃黏膜表观形态及胃黏膜苏木精-伊红染色,分析补中益气汤对高原应激性胃溃疡胃黏膜损伤的影响;通过蛋白免疫印迹法检测各组葡萄糖-6-磷酸脱氢酶(G6PDH)、转录因子YY1蛋白的表达情况,分析补中益气汤对低氧相关的G6PDH和YY1蛋白表达的调控作用;基于液相色谱-质谱联用技术对小鼠胃组织样本进行代谢组学分析,统计分析差异代谢物,进行代谢通路富集分析.[结果]与正常组相比,模型组的胃黏膜表观出现红肿,有大量出血点,出现腺体细胞脱落、细胞坏死、炎细胞浸润等现象,经过补中益气汤的预防,胃溃疡现象有较好的改善;模型组中G6PDH和YY1蛋白表达量增加,而补中益气汤处理后表达量明显减少;小鼠胃组织样本代谢组学检测结果表明差异代谢物参与花生四烯酸代谢、5-羟色胺能突触以及环磷酸腺苷信号等通路.[结论]补中益气汤通过调节5-羟色胺能突触、组氨酸代谢、环磷酸腺苷信号、花生四烯酸代谢等通路以及G6PDH和YY1蛋白的表达缓解高原应激性胃溃疡的发生.