Analysis of the mechanisms of rabbit's brainstem hemorrhage complicated with irritable changes in the alvine mucous membrane

AIM: To explore the dynamic changes in the pressure of the lateral ventricle during acute brainstem hemorrhage and the changes of neural discharge of vagus nerve under the load of intracranial hypertension, so as to analyze their effects on the congestive degree of intestinal mucous membrane and the morphologic changes of intestinal mucous membrane.METHODS: An operation was made to open the skull to obtain an acute brainstem hemorrhage animal model.Microcirculatory microscope photography device and video recording system were used to determine the changes continuously in the caliber of jejunal mesenteric artery during brainstem hemorrhage and the changes with time in the congestion of jejunal mucosal villi. We used HE stain morphology to analyze the changes of duodenal mucosal villi. A recording electrode was used to calculate and measure the electric discharge activities of cervical vagus nerve.RESULTS: (1) We observed that the pressure of lateral cerebral ventricle increased transiently during acute brainstem hemorrhage; (2) The caliber of the jejunal mesenteric artery increased during brainstem hemorrhage.Analysis of red color coordinate values indicated transient increase in the congestion of jejunal mucous membrane during acute brainstem hemorrhage; (3) Through the analysis of the pathologic slice, we found enlarged blood vessels, stagnant blood, and transudatory red blood cells in the duodenal submucous layer; (4) Electric discharge of vagus nerve increased and sporadic hemorrhage spots occurred in duodenal mucous and submucous layer, when the lateral ventricle was under pressure.CONCLUSION: Brainstem hemorrhage could causeintracranial hypertension, which would increase the neural discharge of vagus nerve and cause the transient congestion of jejunal mucous membrane. It could cause hyperemia and diffused hemorrhage in the duodenal submucous layer 48 h after brainstem hemorrhage.

Ocular cicatricial pemphigoid:diagnosis and systemic management

Ocular cicatricial pemphigoid(OCP)is a subcategory of mucous membrane pemphigoid(MMP)where the conjunctiva is the main site of inflammation.It is a chronic and autoimmune disease characterized by acute and chronic conjunctivitis that can progress to severe conjunctival cicatrization,corneal opacification,ocular surface keratinization,and eyelid abnormalities.OCP can lead to structural damage that can result in visual impairment,visual loss,and blindness,and can have a significant impact in a patient’s quality of life.Patients may manifest with varying symptoms,degrees of severity and may have different rates of progression.Early diagnosis and appropriate systemic immunosuppression are of utmost importance for prompt and adequate disease control.Various systemic immunomodulatory therapies(IMTs),including anti-metabolites,alkylating,and biologic agents have been utilized to achieve inflammation control and remission.Careful monitoring of disease progression is important to assess response and to modify and escalate therapy if needed.Treatment to alleviate symptoms of dry eye disease and address trichiasis and other eyelid abnormalities is recommended as well.A multidisciplinary approach to optimize clinical care is recommended in the management of patients with OCP.This review will address the immunopathogenesis,clinical features,keys to diagnosis and staging of patients with OCP.It will highlight the current immunomodulators utilized for disease management and proposed stepladder strategies.This review will discuss the updated roles of combination therapy,novel use of biologics as well as the recent use of adrenocorticotropic hormone(ACTH)analog in severe recalcitrant cases.

Analysis on Pathogenesis of 50 Cases of Bladder Proliferative Lesions

In order to study the pathogenesis, clinical and pathological characteristics of proliferative lesions of the bladder, 50 cases of proliferative lesions of the bladder from 150 patients with complaints of frequency, urgency, hematuria and dysuria were subjected to cystoscopic biopsy of the suspicious foci in the bladder In combination with the symptoms, urine routine and urodynamics, the relationship of proliferative lesions of the bladder to the inflammation and obstruction of the lower urinary tract was analyzed Of the 50 cases of proliferative bladder lesions, 44 cases (88%) had lower urinary tract infection and 29 (58%) lower urinary tract obstruction The patients with lower urinary tract obstruction were all complicated with infection Three cases were associated with transitional cell carcinoma Malignant cells were detected in 1 case by urinary cytologic examination Proliferative lesions of the bladder, especially those without other obvious mucosa changes under cystoscopy, are common histological variants of urothelium in the patients with chronic inflammation and obstruction of the lower urinary tract Chronic inflammation and obstruction of the lower urinary tract might be the causes for proliferative lesions of the bladder It is suggested that different treatments should be applied according to the scope and histological type of the proliferative lesions

Protective Effect of Wheat Peptides Against Small Intestinal Damage Induced by Non-Steroidal Anti-Inflammatory Drugs in Rats

Non-steroidal anti-inflammatory drugs（NSAIDs） were able to produce tissue damage and oxidative stress in animal models of small intestinal damage. In this study, the putative protective effect of wheat peptides was evaluated in a NSAID-induced small intestinal damage model in rats, different doses of wheat peptides or distilled water were administered daily by intragastric administration for 30 d until small intestinal damage was caused. Before sacrificing, NSAIDs（aspirin and indomethacin） or physiological saline were infused into the digestive tract twice. Wheat peptides administration reduced edema and small intestinal damage, and significantly decreased the level of tumor necrosis factor（TNF）-α in mucous membrane of small intestine. Oxidative stress was significantly increased after NSAID infusion and was reduced by wheat peptides. Wheat peptides increased glutathione peroxidase（GSH-Px） activity in mucous membrane of small intestine. μ-Opioid receptor mRNA expression decreased more significantly in wheat peptides treated rats than in the model control group. Overall, the results suggest that non-steroidal anti-inflammatory drugs induced small intestinal damage in rats and wheat peptides administration may be an effective tool for protecting small intestinal tissue against NSAID-induced small intestinal damage and oxidative stress.

Histologyassessmentofbipolarcoagulationandargonplasmacoagulationon digestivetract

AIM: To analyze the effect of bipolar electrocoagula-tion and argon plasma coagulation on fresh specimens of gastrointestinal tract. METHODS: An experimental evaluation was performed at Hospital das Clinicas of the University of So Paulo, on 31 fresh surgical specimens using argon plasma coagulation and bipolar electrocoagulation at different time intervals. The depth of tissue damage was his-topathologically analyzed by single senior pathologist unaware of the coagulation method and power setting applied. To analyze the results, the mucosa was divided in superficial mucosa (epithelial layer of the esophagus and superficial portion of the glandular layer of the stomach and colon) intermediate mucosa (until thelamina propria of the esophagus and until the bottom of the glandular layer of the stomach and colon) and muscularis mucosa. Necrosis involvement of the layers was compared in several combinations of power and time interval. RESULTS: Involvement of the intermediate mucosa of the stomach and of the muscularis mucosa of the three organs was more frequent when higher amounts of en-ergy were used with argon plasma. In the esophagus and in the colon, injury of the intermediate mucosa was frequent, even when small amounts of energy were used. The use of bipolar electrocoagulation resulted in more frequent involvement of the intermediate mucosa and of the muscularis mucosa of the esophagus and of the colon when higher amounts of energy were used. In the stomach, these involvements were rare. The risk of injury of the muscularis propria was significant only in the colon when argon plasma coagulation was em-ployed.CONCLUSION: Tissue damage after argon plasma coagulation is deeper than bipolar electrocoagulation. Both of them depend on the amount of energy used.

Detection of nanobacteria in serum, bile and gallbladder mucosa of patients with cholecystolithiasis

In 1990, nanobacterium was found and named by Kajander.~1 With distinct mineralizing ability, nanobacteria are thought to play a role in extraskeletal calcifying diseases. It have been found in many human tissues, but whether they exist in the bile or gallbladder mucosa remains unclear. The present study was undertaken to investigate by ELISA, bacterial culturing, immunohistochemical staining and transmission electron microscopy (TEM), whether nanobacteria exist in serum, bile or gallbladder mucosa of healthy people and patients with cholecystolithiasis.

Chitosan-DNA microparticles as mucosal delivery system: synthesis, characterization and release in vitro

Background Mucosal immunity is important to defense against dental caries. To enhance mucosal immunity, a DNA vaccine mucosal delivery system was prepared by encapsulating anticaries DNA vaccine (plasmid pGJA-P/VAX) in chitosan under optimal conditions and the characteristics of the microparticles was investigated. Furthermore, the release properties and protective action of microparticles for plasmid were studied in vitro.Methods Plasmid loaded chitosan microparticles were prepared by complex coacervation. Three factors, concentration of DNA, sodium sulfate, and the chitosan/DNA ratios in complexes [better expressed as N/P ratio: the number of poly nitrogen (N) per DNA phosphate (P)] influencing preparation were optimized by orthogonal test. The characteristics of microparticles were evaluated by scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). DNA release rate of microparticles in similar gastro fluid (SGF) or similar intestinal fluid (SIF) at 37℃ was determined by ultraviolet spectrophotometry.Results High encapsulation efficiency (96.8%) was obtained with chitosan microparticles made under optimal conditions of 50 mmol/L Na2SO4, 200 μg/ml DNA and N/P ratio of 4. The size of particles was about 4 to 6 μm. The encapsulation process did not destroy the integrity of DNA. When incubated with SIL, after a release of about 10% in the first 60 minutes, no further DNA was released during the following 180 minutes. When incubated with SGL, the microparticles released a small burst (about 11%) in the first 60 minutes, and then slowly released at a constant, but different rate.Conclusions These chitosan microparticles showed suitable characteristics in vitro for mucosal vaccination and are therefore a promising carrier system for DNA vaccine mucosal delivery.

Healing of the nasal septal mucosa in an experimental rabbit model of mucosal injury

Objective:The aim of this study was to investigate the regeneration process of the nasal mucosa after a surgically created mucosal defect in the rabbit nasal septum,and to evaluate the effects of different interventions.Methods:A 7 mm-diameter circular mucosal defect was made in the septum of forty New Zealand white rabbits.The rabbits were divided into four groups (ten rabbits in each group) according to the type of intervention;no treatment (control),silastic sheet (SS),hyaluronic acid (HA),and silastic sheet and hyaluronic acid (SS + HA) group.The diameter of the defect,mucosal thickness,epithelial thickness,and ciliated cell count were evaluated every week for five weeks.Results:The average diameter of the defect in the control group were 5.1,3.65,1.2,0.75,and 0.05 mm at postoperative 1,2,3,4,and 5 weeks.In the SS group,the diameter decreased to 4.35,2.1,0.35,0.15,and 0 mm at postoperative 1,2,3,4,and 5 weeks,respectively,in which the mean diameter of the postoperative week 2 was significantly smaller compared to control (3.65 mm vs.2.1 mm,P =0.039).For the HA group and SS + HA group,the diameter of the defect did not show a significant difference from the control group during the five weeks.The mucosal thickness,epithelial thickness,and ciliated cell count of the regenerated mucosa were not significantly different among the groups.Conclusion:The regeneration process of the nasal septal mucosa was identified using a novel rabbit model.Mucosal regeneration can be accelerated by applying silastic sheets.

Nivolumab-induced severe bullous pemphigoid in a patient with renal cancer:a case report and literature review

With the widespread use of immunotherapy in numerous solid tumours,immunotherapy-related adverse events(irAEs)have started to emerge and bring new challenges for clinicians to manage.Among established irAEs,dermatologic toxicity is one of the most common toxicities;it is often mild but can be severe and potentially life-threatening,such as bullous pemphigoid.Here,we report a case of nivolumab-mediated severe,extensive,refractory bullous pemphigoid involving both skin and oral mucosa in a patient with metastatic renal cancer.We also summarise a list of selected case reports of immunotherapy-induced bullous pemphigoid by literature review.We highlight various presentations,investigations and managements of this type of skin irAEs.Meantime,we would like to discuss the correlation of skin irAEs incidence rate with immunotherapy drug benefit and resistance.