目的 观察右美托咪定(DEX)对慢性神经病理性疼痛模型小鼠细胞因子信号抑制因子3(SOCS3)和白细胞介素6(IL-6)表达的影响,探讨DEX减轻神经病理性疼痛的作用机制.方法 将6～8周龄雄性C57小鼠72只随机分为假手术(Sham)组、坐骨神经慢性压迫模型(CCI)组和DEX组,每组24只.分别于术前1 d和术后3、7、10 d测定各组小鼠的机械痛和热痛阈值,采用免疫组化方法观察中枢神经系统小胶质细胞的形态学和数量变化,采用实时荧光定量PCR(qRT-PCR)检测脊髓组织中SOCS3和IL-6 mRNA的表达.结果 与CCI组比较,DEX组小鼠术后的热缩足反射潜伏期和机械性缩足阈值显著升高(F=19.612～839.607,P<0.05).DEX组小鼠脊髓组织中的小胶质细胞活化程度较CCI组轻.与CCI组比较,术后3、7、10 d时DEX组小鼠L4～6脊髓中IL-6 mRNA的表达显著降低(F=5.265～26.022,P<0.05),术后7、10 d时DEX组小鼠L4～6脊髓中SOCS3 mRNA的表达显著升高(F=7.221、114.542,P<0.05).结论 DEX腹腔注射可提高CCI小鼠的热痛阈和机械痛阈,其作用机制可能与促进SOCS3表达从而负反馈抑制IL-6等炎性因子有关.

This article reports a case of sinus node dysfunction induced by thalidomide in ulcerative colitis in the Affiliated Hospital of Qingdao University and discusses the drug-induced arrhythmias induced by thalidomide.

Intestinal microbe is very important to human health, and the change of intestinal microbe is closely related to the occurrence and development of many systemic diseases. As the lifestyle and eating habits changing, intestinal microbes are changing, the human disease is also a major change, a growing number of studies to clarify the intestinal microbial effects on human health and disease, among them, the intestinal microbes-immune axis is put forward on the happening of the disease development we have a more profound understanding. This review summarizes how intestinal microorganisms affect the occurrence and development of some systemic diseases by regulating the immune system of the body. By understanding the interaction between intestinal microorganisms and the immune system of the body, it will provide new ideas for the diagnosis and treatment of some diseases.

目的 探讨叙事护理对维持性血液透析患者焦虑抑郁情绪及疾病应对方式的影响.方法 采用便利抽样法选取在青岛市某三级甲等医院血液净化中心治疗的且符合纳入、排除标准的86例维持性血液透析患者为研究对象,运用软件生成随机数字表进行分组,将其分为对照组和观察组.对照组实施常规血透专科护理,观察组在对照组的基础上实施叙事护理.比较两组患者干预前后的焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分和医学应对方式问卷(MCMQ)评分.结果 干预后,观察组的SAS评分、SDS评分、MCMQ中的屈服评分及回避评分均低于对照组(P<0.05),MCMQ中的面对评分高于对照组(P<0.05).结论 实施叙事护理可以缓解维持性血液透析患者的焦虑、抑郁情绪,改善其疾病应对方式,值得临床推广应用.

目的 比较行腹腔镜胆囊切除术中应用舒芬太尼复合丙泊酚或七氟烷麻醉对减轻老年患者应激反应及改善苏醒质量的作用.方法 抽取我院2015年1月~2017年4月行腹腔镜胆囊切除术治疗的老年患者66例为研究对象,以术中所用麻醉方式分组:对照组33例行舒芬太尼+七氟烷麻醉,研究组33例行舒芬太尼+丙泊酚麻醉,对两组术中应激反应进行观察,评估两组苏醒质量.结果 研究组术后各应激激素水平、术后恢复时间显著低于对照组(P<0.05).结论 在行腹腔镜胆囊切除术时应用舒芬太尼+丙泊酚复合麻醉,可减轻老年患者应激反应,改善苏醒质量,值得借鉴.

患者女，75岁，因“突发呕血、黑便、上腹疼痛3 d”入院。患者既往有高血压病史，发病后在当地医院治疗，效果欠佳，转入我院后仍间断呕吐少量鲜红色血液，伴胸骨后隐痛。入院体检：血压144／56 mmHg（1 mmHg＝0?13 kPa），神志清，精神差，睑结膜苍白，心率90次／min，腹软，无压痛及反跳痛，肝脾肋下未触及，肠鸣音活跃，其余无异常。血常规：血红蛋白76 g／L，红细胞压积22?8％，红细胞2?82×1012／L，白细胞7?76×109／L，血小板125×109／L。肝炎全套、肿瘤标记物阴性，血凝常规、肝肾功能正常。因患者年龄较大、贫血症状明显，输注红细胞2 U，复查血红蛋白78 g／L，行急诊胃镜检查。镜下见食管入口至贲门全程有巨大紫红色隆起，周边可见较多条长条紫红色隆起（图1A），全部病变占食管管腔1／2～2／3；部分长条隆起表面破溃，呈窦道样改变（图1B），部分完全破溃，形成溃疡样改变，有新鲜血迹；齿状线以下黏膜光滑。胸部增强CT提示：食管全程扩张，腔内有不规则隆起，强化后黏膜强化均匀，其内可见多个腔隙（图2）。综合上述检查结果，诊断考虑食管内多发血肿，其中部分血肿破裂出血。给予禁饮食，埃索美拉唑抑酸，生长抑素减少内脏血流量，静脉高营养治疗，之后患者未再出现呕血。治疗9d后复查胃镜：见黏膜下血肿完全吸收，食管全程可见较多窦道样假腔改变及多处较大表浅溃疡形成（图3）。继续给予抑酸、营养支持治疗，予出院。随访1年，未再出现上述临床症状。

AIM:To investigate the impact of endoscopy nurse involvement during colonoscopy on the polyp detection rate (PDR) and adenoma detection rate (ADR).METHODS:This was a single-center,prospective study.Patients involved were prospectively randomized to a routine colonoscopy group or an endoscopy nurse involvement group.The association of nurse involvement with PDR and ADR was evaluated.RESULTS:A total of 1192 patients were included in the study.The PDR was significantly higher (33.19％ vs 27.81％,P =0.000) among colonoscopies that included an endoscopy nurse compared with those performed by only a physician,as was the left-sided and the right-sided adenomas detected (P =0.017).There was no difference in ADR between the two groups (20.88％ vs 20.55％,P =0.889).Nurse participation was associated with a higher detection rate of small (＜5 mm) polyps (P =0.006).CONCLUSION:Endoscopy nurse involvement in colonoscopies significantly improves the overall PDR.Involvement of a well-trained nurse in screening colonoscopies may be an effective strategy to increase access.

Background:CT portography(CTP)permits comprehensive evaluation of portal vein and its collateral pathways. It is widely used for assessment of portal hypertension in clinical practice. Aims:To assess the value of CTP in esophagogastric varices in cirrhotic patients. Methods:A retrospective cohort study was performed in 143 cirrhotic patients admitted from Jan. 2013 to Sep. 2015 at the Affiliated Hospital of Qingdao University. All patients fulfilled the inclusion criteria and underwent CTP and gastroscopy within 7 days after admission. According to the occurrence of gastrointestinal bleeding at admission,patients were allocated into two groups:bleeding group( n = 70 ) and non-bleeding group( n = 73 ). Consistency of the results of CTP and gastroscopy was analyzed by kappa coefficient;the accuracy of CTP parameters, including diameters of main portal vein(MPV),splenic vein(SPV)and left gastric vein(LGV)for prediction of variceal bleeding was evaluated by ROC curve. Results:CTP and gastroscopy had a good consistency in typing and grading of esophagogastric varices,with the kappa value of 0. 793 and 0. 775,respectively. The diameters of MPV,SPV and LGV were significantly higher in bleeding group than in non-bleeding group(P < 0. 01),and their area under the ROC curve (AUC)in predicting variceal bleeding was 0. 741,0. 627 and 0. 816,respectively. The accuracy of diameter of LGV was superior to that of MPV and SPV. With the cutoff value of 6. 1 mm,the sensitivity and specificity of diameter of LGV were 65. 71% and 84. 93% ,respectively. With the cutoff value of 16. 3 mm,the sensitivity of diameter of MPV was 75. 71% , which was higher than that of LGV and SPV. Conclusions:CTP can be used in clinical diagnosis of esophagogastric varices in cirrhotic patients,and two CTP parameters,the diameters of LGV and MPV,might be helpful for prediction of variceal bleeding.

胃、结肠多发癌在临床上比较少见,通过对1例胃、结肠多发癌的病例分析,报道胃、结肠多发癌的诊治体会.

Objective To evaluate the role of mitochondrial fission in hypoxia-reoxygenation (H/ R) injury to hippocampal neurons of rats.Methods Primarily cultured hippocampal neurons obtained from newborn Wistar rats were randomly divided into 5 groups (n =60 each) using a random number table: normal group (N group), vehicle group (V group), H/R group, H/R + vehicle group (H/R + V group),and mitochondrial division inhibitor group (group M).The cells were cultured in normal culture medium in group N.Dimethyl sulfoxide (DMSO) was added to the culture medium with the final concentration ＜ 0.1％, and the cells were incubated for 40 min in group V.The cells were subjected to 6 h hypoxia, followed by 20 h reoxygenation in H/R, H/R+V and M groups.DMSO was added to the culture medium with the final concentration ＜0.1％ at 40 min before hypoxia in group H/R+V.In group M, mitochondrial division inhibitor Mdivi-1 50 mmol/L (dissolved in DMSO, DMSO concentration ＜0.1％) was added to the culture medium at 40 min prior to hypoxia.Mito Tracker staining was used to examine mitochondrial morphology.Western blot was used to measure the expression of mitochondrial dynamin-related protein 1 (Drp1), mitofusin 2 (Mfn2) , peroxisome proliferator activated receptor γ coactivator 1α (PGC-1α), nuclear respiratory factor-1 (NRF-1), and mitochondrial transcription factor A (TFAM).Multifunctional microplate reader and fluorescent microscope were used to detect the mitochondrial reactive oxygen species (ROS) level.The flow cytometer was used to detect the apoptosis in hippocampal neurons.Apoptosis rate was calculated.Results Compared with group N, the expression of Drp1, PGC-1α, NRF-1 and TFAM was significantly up-regulated, the ROS content and apoptosis rate were increased, and the expression of Mfn2 was down-regulated in group H/R (P＜0.05).Compared with group H/R, the expression of Drp1 was significantly down-regulated, the ROS content and apoptosis rate were decreased, and the expression of Mfn2, PGC-1α, NRF-1 and TFAM was up-regulated in group M (P＜0.05).Conclusion Mitochondrial fission is involved in H/R injury to hippocampal neurons of rats.

Objective To investigate the bacterial species of the intestinal flora in mice with experimental colitis and study its relationship with experimental colitis. Methods The composition of the common cultured intestinal microflora in mucosal samples was investigated by classical bacterial culture. Single strand conformation polymorphism( SSCP) analysis was used to determine microbial diversity in mucosal samples. Results Stable and repeatable intestinal flora finger-prints were obtained by PCR-SSCP. Diversity of the normal controls was significantly higher compared with the model group. Considering not only number of bands but also their intensity,analysis of the most obviously different bands indicated that the main difference between the two groups was the uncultured bacteria. Baterial culture indicated that Staphylococcus aureus and the total count of aerobian were increased significantly in acute experimental colitis mice compared with controls. Conclusion Diversity of the microflora was reduced in experimental colitis. Disproportionality existed in intestinal bacteria,intestinal microflora imbalance may be invdved in the production process or exacerbation of colitis.

A 45-year-old man received rabeprazole sodium enteric-coated tablets 10 mg once daily for acid regurgitation.Three week later,the symptom worsened,so he self-medicated double dosage.He developed generalized weakness,inappetence,dark yellow urine after 3 days.Rabeprazole sodium entericcoated tablets was stopped.Laboratory tests showed the following values;alanine aminotransferase 401 U/mL, aspartate aminotransferase 314 U/mL,alkaline phosphatase 143 U/mL,γ-glutamyl transferase 359 U/mL, total bilirubin 22.7 μmol/L.He was given liver protective drugs.One week later,the levels of alanine aminotransferase and aspartate aminotransferase were 40 U/L and 15 U/L,respectively.

Objective To investigate whether mitochondrial calcium uniporte (MCU) can regulate the mitochondrial permeability transition pore(mPTP) in primary hippocampal neurons. Methods The primary hippocampal hippocampal neurons were randomly divided into seven groups according to the random number table:control group (n=6):without any prior administration,Spermine(Sper) group(n=6):gave 30 μmol/L Sper before the test,Ru360 group(n=6):gave 10 μmol/L Ru360 30 min before the test,Ciclosporin A(CsA) group(n=6):gave 0.2 μmol/L CsA 30 min before the test,Atractyloside(Atr) group(n=6):gave 400 μmol/L Atr before the test,Ru360+Atr group(n=6):gave 10 μmol/L Ru360 30 min before the test and then gave 400 μmol/L Atr before the test,CsA+Sper group (n=6):gave 0.2 μmol/L CsA 30 min before the test and then gave 30 μmol/L Sper before the test.200 μmol/L CaCl2 were added to each group at the time of the test to establish the model of calcium overload.Then monitored the mitochondrial calcein AM fluorescence intensity continuously over time for 6 min under the laser confocal microscope. Results The mitochondrial calcein AM fluorescence intensity of the control group reduced rapidly (0.073±0.011),compared with the control group,the mitochondrial calcein AM fluorescence intensity of the Ru360 group (0.779±0.015) and CsA group (0.923±0.011) reduced slowly (P＜0.05).Compared with the Sper group (0.023±0.006),the mitochondrial calcein AM fluorescence intensity of the CsA+Sper group (0.713±0.032) reduced slowly (P＜0.05).The mitochondrial calcein AM fluorescence intensity of the Ru360+Atr group (0.643±0.087) was slower than the Atr group (0.047±0.015) (P＜0.05),the mitochondrial calcein AM fluorescence intensity of the Ru360 group (0.779±0.015) reduced slower than the Sper group (0.023±0.006) (P＜0.05). Conclusions Mitochondrial calcium uniporter could regulate the mPTP in hippocampal neurons in vitro.

Objective To investigate the effects of ATP-sensitive potassium channel openers (Cromakalim) on the expression of aquaporin-4 and permeability of blood-brain barrer (BBB) after cerebral ischemic/repeffusion. Methods Thirty healthy male Wistar rats were randomized into three groups for different conditioning, the sham-operated group(A,n=10), the cerebral I/R group(B,n=10),and the cerebral I/R+Cromakalim group (C,n=10). Intraluminal suture methods were applied to establish the middle cerebral artery occlusion(MCAO) model with occlusion 2 h and reperfusion 24 h. The neurobehavioral function was evaluated with Bederson's test, and the pathological changes were observed with hematoxylin-eosin(HE) staining. The water content of brain was evaluated by wet-dry weight method, and the expressions of IgG and AQP-4 in brain were observed by immunohistochemistry staining. Results In comparison with group A's water content(78.2±1.3 )% and expressions of IgG and AQP-4 (0.0±0.0,13.6±1.5) ,the expressions of IgG and AQP-4(2.4±0.4,19.8±1.9) and the water content (81.3±1.2)% in group B both were significantly higher (P<0.05). However,in group C,the water content (79.5±0.6)%was similar to group A( 78.2± 1.3 )%. Interestingly, the expressions of IgG and AQP-4( 1.1 ±0.2, 15.7± 1.2 ) of group C were higher than that of group A' s (P<0.05); compared with group B, The neurobehavioral deficit scores were obviously reduced, the expressions of IgG and AQP-4 (1.1 ±0.2,15.7±1.2) and the water content (79.5 ±0.6)% were significantly lower in group C (P<0.05).Conclusion Cromakalim maybe can alleviate cerebral edema via reducing permeability of blood-brain barrier and inhibit the expression of AQP-4 in cerebral ischemia/reperfusion mice.