Radioactive Enteritis and Gut Microecology / 中国医学科学院学报

Radioactive enteritis(RE)is one of the most serious and common complications of intestinal tract caused by radiotherapy for malignant tumors in abdominal cavity,pelvic cavity,or retroperitoneum.Involved intestinal diseases are widespread,complex,and persistent,which make treatment difficult and ineffective.Short bowel syndrome can develop in some serious cases.Gut flora is the largest and most complex micro-ecosystem in human body and has a wide range of functions.Studies have shown that intestinal flora plays an important role in radiation-induced RE.This article summarizes recent research advances in the relationship between RE and gut flora.

Comparative study on the preservation quality of intestinal grafts from donors of donation after cardiac ;death and cadaveric donors / 器官移植

Objective To compare the preservation quality of intestinal grafts from donors of donation after cardiac death (DCD)and cadaveric donors.Methods Quality of intestinal grafts from 7 cadaveric donors (group N)and 7 DCD donors (group DCD)in Beijing from 201 3 to 201 4 was evaluated.The grafts were preserved after perfusion and resection,and then intestinal tissue was collected 30 min and 6 h later.Meanwhile,histopathological examination and intestinal graft injury score (Chiu's integral method)were performed.The content of malondialdehyde (MDA)in intestinal tissue was detected by thiobarbituric acid assay,and the apoptosis of intestinal mucosa cells was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL)method.Results Intestinal graft injury scores for group N and DCD were (1 .46 ±0.81 )and (1 .76 ±0.21 )respectively at 30 min after preservation,and (3.86 ± 0.42)and(4.1 7 ±0.71 ),respectively at 6 h after preservation(both in P >0.05).Compared with the preservation of 30 min,intestinal graft injury scores increased significantly in both groups at 6 h after preservation (both in P <0.05).The contents of MDA in intestinal tissue of the small intestinal graft in group N and DCD were (1 00 ±1 0)pmol/mg and (1 1 0 ±1 3)pmol/mg,respectively at 30 min after preservation (P >0.05),and (1 70 ±1 8)pmol/mg and (31 0 ±29) pmol /mg,respectively at 6 h after preservation,of which the difference was statistically significant between the two groups at the same time (P <0.05).Compared with the preservation of 30 min,the contents of MDA increased significantly in both groups at 6 h after preservation (both in P <0.05 ).The number of apoptotic intestinal mucosal cells in small intestinal grafts for group N and DCD was (9.78 ±2.56)and (1 5.78 ±2.84),respectively at 30 min after preservation (P >0.05),and (31 .32 ±1 .38)and (53.42 ±1 .95),respectively at 6 h after preservation,of which the difference was statistically significant between the two groups (P <0.05).Compared with the preservation of 30 min,the number of apoptotic intestinal mucosal cells in small intestinal grafts increased significantly in both groups at 6 h after preservation (P <0.05).Conclusions Preservation quality of small intestinal grafts in DCD donors is roughly equivalent to that in traditional cadaveric donors,which suggests that small intestinal grafts in DCD donors may be used in clinical intestinal transplantation.

Improved synthesis process of diethyl N-[4-[(2,4-diaminopyrido[3,2-d] pyrimidin-6-yl) methylamino] benzoyl]-L-glutamate / 北京大学学报(医学版)

Objective:To establish a new approach to synthesis of diethyl N-[4-[(2,4-diaminopyrido [3,2-d]pyrimidin-6-yl)methylamino]benzoyl]-L-glutamate.Methods:Target compound (5) was syn-thesized by the use of (2,4-dioxo-tetrahydropyridopyrimidin-6-yl) methyl acetate (1) as starting material via hydrolysis, chlorination, condensation with diethyl (p-aminobenzoyl)glutamate and aminolysis.Re-sults:A new approach to synthesis of diethyl N-[4-[(2,4-diaminopyrido[3,2-d]pyrimidin-6-yl)methyl-amino]benzoyl]-L-glutamatewas established .This synthetic route has hydrolysis reaction , chlorination, diethyl N-( p-aminobenzoyl )-L-glutamate condensation reaction and ammonolysis reaction .The total yield is 36.7%.The structures of those compounds have identified by 1 H nuclear magnetic resonance , 13 C nu-clear magnetic resonance and mass spectrometry .This synthetic route avoid the unstable brominated re-action product and improves the harsh condition of ammonolysis reaction .Conclusion:The new synthetic route has improved the reaction condition and the stability of the intermediate , and increased the extent of the derivative compounds , which has great significance to anti-folic acid of anti-tumor inhibitor synthesis .

Surgical management of bowel obstruction caused by Crohn's disease / 中华消化外科杂志

Treatment for Crohn's disease usually involves medication,however,with chronic intestinal inflammation,damaged intestine become fibrotic and finally resulted in bowel obstruction,which need surgical management.In recent years,the basic research,diagnosis and treatment of Crohn's disease have made tremendous progress.Under the new treatment strategies and technical conditions,surgical technologies and concepts for bowel obstruction caused by Crohn's disease have been markedly changed.Surgeons should cooperate with clinicians from the departments of gastroenterology,endoscopy,imaging examination and pathology,and the indications and timing for surgical treatment should be strictly controlled.Damage control surgery,fast track surgery and laparoscopic surgical techniques have also been commonly used,which are effective for improving the efficacy of surgical treatment of bowel obstruction caused by Crohn's disease.

Morphologic evaluation of biopsy specimens on patients with small bowel allotransplantation: singlecenter experience / 中华器官移植杂志

ObjectiveTo investigate the continuous pathological features of biopsy specimens from five cases of small bowel allotransplantation (SBT) in order to provide more reliable information for the diagnosis and treatment of acute rejection (AR) in SBT.Methods324 biopsy specimens of intestinal mucosa after SBT from 5 patients were collected and studied by histology,histochemistry and electron microscopy.ResultsIn the early stage after operation (0～3 months),AR IND-1 grade was diagnosed for four times on 3 of 5 patients.During 3-6 months,AR IND-1 grade for three times was diagnosed in 2 cases,and AR 2 grade for two times during 7 ～ 12 months. All the patients suffered ischemia reperfusion injury, lymphatic vessel reconstruction and AR.Conclusion The pathological examination of biopsy specimens of intestinal mucosa is still the most reliable detecting method to diagnose AR,and continuous observation may play an important role to monitor the occurrence,development,and treatment response of AR. The final diagnosis of AR depends on structure of intestinal mucosa,crypt epithelium injury and inflammatory cells infiltration. The communication among the pathologist and surgeon is the best way to reduce misdiagnoses.Ultrastructural examination is used to verify the pathogenic microorganism.

Cytomegalovirus infection after small bowel transplantation / 中华器官移植杂志

Objective Cytomegalovirus (CMV) has remained the most significant pathogen that threatens the outcome of small bowel transplantation (SBTx). This paper To outline preliminary experience of prophylaxis and treatment of cytomegalovirus (CMV) in 15 cases subject to small bowel transplantation (SBTx) and also review current progress of diagnosis and treatment of CMV.Methods Fifteen cases of SBTx were divided into 3 eras: era Ⅰ (1994-1995)-3 SBTx treated with cyclosporine-based immunosuppression; era Ⅱ (2003-2006)-7 SBTx treated with tacrolimus-based immunosuppression; and era Ⅲ (2007-present)-5 SBTx treated with Alemtuzumab induction therapy and maintenance tacrolimus monotherapy. No antiviral prophylaxis after SBTx was applied during era Ⅰ; in era Ⅱ, ileoscopic and pathological diagnosis of CMV graft enteritis was defined, and plasma diagnosis tools including CMV-IgM, CMV pp65 and CMV DNA with PCR were introduced. 2-3 weeks intravenous ganciclovir prophylaxis of CMV was underway, followed by 3 months oral acyclovir; In era Ⅲ, more precise real-time PCR technique was used to detect CMV DNA copies, and the schedule of the CMV surveillance was set up, antiviral prophylaxis therapy was modified to 2-3 weeks intravenous ganciclovir and 3 months oral ganciclovir, and preemptive therapy to halt the progression of asymptomatic infection to clinical disease was also introduced.Results Two of 15 SBTx recipients suffered from CMV with the occurrence rate of 13.3%. One recipient in era Ⅱ suffered from CMV graft enteritis on postoperative day 45, and CMV pneumonia on postoperative day 64, he received intravenous ganciclovir and thymus peptide, paused tacrolimus maintenance, and finally he died from severe acute cellular rejection. 94 100 copies/ml of CMV DNA in periphery blood of a recipient in era Ⅲ was detected with real-time PCR at 3rd month after SBTx, and a preemptive therapy successfully halted the CMV infection.Conclusion Antiviral prophylaxis therapy and close surveillance of CMV infection after SBTx should be performed, and preemptive therapy can also halt the CMV infection. When CMV disease occurs, the recipient should receive effective antiviral therapy, and acute cellular rejection also should be closely monitored at same time.

Follow-up and surveillance of immunosuppressive treatment in intestinal transplantation / 中华器官移植杂志

Objective To evaluate the efficiency of monitoring parameters and methods of immunosuppresive treatment in intestinal transplantation and to provide scientific evidence for establishment of Intestinal Transplant Registry.Methods The data of 15 patients receiving intestinal transplantation between 1994 and 2009 were analyzed retrospectively for one year. The patients were fallen into 3 eras (1994-1995, 2003-2006, 2007-2009) according to different immunosuppresive strategies. The perioperative status and one-year survival rate were followed up. The monitoring frequency of implications of intestinal transplantation, such as rejection, infection, toxic and side-effects, was evaluated. The monitoring parameters were examined in the proportion of lymphocytes, concentration of tacrolimus, and function of the liver and kidney during a follow-up period of one year.Results During 1994-1995 and 2003-2006, the survival time of grafts was under one year. During 2007-2009, the 6-month and one-year survival rate in 5 patients (grafts) was 100% and 83.33% respectively; The increased frequency of rejection occurred during 7 to 12 months after operation; The closure of abdominal stoma was postponed from postoperative six months to one year; Asymptomatic mild rejection after operation was examined (10/13, 76.92%).Conclusion During one year postoperation, monitoring methods, parameters and frequency for immunosuppressive treatment in intestinal transplantation are rational, and may monitor the disease conditions of the patients.

Clinicopathological study of subclinical cellular rejection after isolated small bowel transplantation / 中华器官移植杂志

Objective To investigate the clinical presentation, endoscopy and pathological features of subclinical cellular rejection (SCR) of small bowel allotransplantation. Methods Three times of SCR in a patient after isolated small bowel transplantation were studied by endoscopy and microscopy, and the clinical data and literature were reviewed. Results SCR was an unusual type of acute rejection after small bowel transplantation. SCR showed low-grade morphological changes of acute rejection, and may be relived after low-dose steroid or bolus steroid was given. Conclusion The causes of SCR are not clear now. SCR may be the early stage of clinical acute rejections, and may be correlated with unexpected high grade acute rejection, and chronic loss function of graft. The biopsy through ileoscopy is a "golden standard" of diagnosis of SCR in small bowel transplantation.However, the vessel lesions of graft, ileus, and inflammation should be excluded before diagnosis.

Invasive fungal infection after small bowel transplantation / 中华器官移植杂志

Objective Invasive fungal infection (IFI) after small bowel transplantation (SBTx) is aggressive and associated with high mortality rates. This paper reviewed preliminary experience of treatment of IFI in 15 cases after SBTx. Methods Fifteen cases of SBTx were divided into 3 groups according to the eras. era Ⅰ (1994-1995)-3 cases of SBTx treated with cyclosporine-based immunosuppression, era Ⅱ (2003-2006)-7 cases of SBTx treated with tacrolimus-based immunosuppression, and era Ⅲ (2007-present)-5 cases of SBTx treated with Alemtuzumab induction therapy and maintenance tacrolimus monotherapy. During era Ⅰ and era Ⅱ, Fluconazole Ⅳ was used as prophylaxis and treatment protocol. If the IFI was aggressive, Amphotericin B or Amphotericin B Liposome were also given with initial dose of 1-5 mg/d (or 0.02-0.10 mg·kg~(-1)·d~(-1). During era Ⅲ, 2-weeks Arnphotericin B Liposome was used as prophylaxis therapy after SBTx, and the dose of 6 mg· kg~(-1)·d~(-1) of Amphotericin B Liposome was given to treat IFI after SBTx. The administration manner of Amphotericin B Liposome was also improved during era Ⅲ, and the initial dose achieved 6 mg without gradually increasing process. Closely surveillance of vital sign, liver and renal function, and electrolyte was also carried out, and the doses of Amphotericin B Liposome were titrated according liver and renal function. Results Four of 15 SBTx recipients suffered from IFI with the occurrence rate of 26.7%, 1, 2 and 1 recipient(s) suffered from IFI during different 3 eras, respectively. Three recipients died of severe IFI after SBTx during era Ⅰ and era Ⅱ. One SBTx recipient with IFI during the era Ⅲ totally recovered after 44-days treatment of Amphotericin B Liposome with the totally dose of 9100 mg, and the renal dysfunction was observed and.ameliorated after ceasing of Amphotericin B Liposome. The mortality of these 4 IFI after SBTx was 75%. Conclusion IFI after SBTx is associated with high mortality rate. Amphotericin B Liposome can effectively control IFI after SBTx. With closely surveillance of recipient renal function, high dose of Amphotericin B Liposome can be safely used.

Timing and diagnostic value of endoscopic biopsy of intestinal graft after small bowel transplantation / 中华器官移植杂志

Objective To summarize the timing and diagnostic value of endoscopic biopsy of intestinal graft after small bowel transplantation (SBTx).Methods Fifteen cases of SBTx were divided into 3 eras:era Ⅰ (1994-1995)-3 cases of SBTx treated with cyclosporine-based immunosuppression; era Ⅱ (2003-2006)-7 cases of SBTx treated with tacrolimus-based immunosuppression,and era Ⅲ (2007-present) than CVC group 5 cases of SBTx treated with Atemtuzumab induction therapy and maintenance tacrolimus monotherapy.The scheme of endoscopic surveillance was initially used in era Ⅲ, the first endoscopic biopsy was performed on postoperative day 3,2 times weekly during the first month, followed once weekly during months 2-3, once every other week during months 4-6 and once monthly thereafter.When clinical signs and symptoms of rejection were present, and during rejection episodes, the additional endoscopic biopsies were also performed.Results A total of 276 biopsies of these 15 SBTx recipients were obtained.Fifty-one biopsies (18.5%) were diagnosed as acute cellular rejection (ACR), which included IND to mild (n = 32,11.6 %), moderate (n = 9,3.3 %), and severe (n = 1 0, 3.6 %), two biopsies (0.7 %) were diagnosed as cytomegalovirus (CMV) enteritis and other 2 biopsies (0.7 %) bacteria enteritis.The ACR episodes verified by biopsy pathology and undergoing anti-rejection treatment were 20 (11 IND to mild,5 moderate,and 4 severe) ,and 1 episode of CMV enteritis and 1 episode of bacteria enteritis were observed.Conclusion Endoscopic surveillance and biopsy pathology is crucial diagnostic tool for ACR and sepsis.ACR surveillance after SBTx and early diagnosis of ACR could be made with scheming endoscopic biopsies.Endoscopic biopsy can be used to make differential diagnosis when clinical signs and symptoms were present, and to guide the treatment during anti-rejection episode.

Study on dissolution in vitro of Zhike Pingchuan sustained-release tablets / 中国中药杂志

<p><b>OBJECTIVE</b>To establish a method to evaluate the in vitro release of Zhike Pingchuan sustained-release tablets.</p><p><b>METHOD</b>The ephedrine, pseudoephedrine, scopolamine were chosen as marker components components, and the chromatographic conditions were chosen according to the separation of baseline and theoretical plate number for determining the marker in vitro release of Zhike Pingchuan sustained-release tablets; through the dissolution curves of the three active components, the release behavior was judged as well-balanced release or not.</p><p><b>RESULT</b>Compared with conventional tablets, the Zhike Pingchuan sustained-release tablets had a well-balanced behavior in 10 h.</p><p><b>CONCLUSION</b>The maker components of Zhike Pingchuan sustained-release tablets and two chromatographic conditions, which were used to determine the dissolution of the sustained-release tablets, could be chosen as evaluation methods for the in vitro release of Zhike Pingchuan sustained-release tablets.</p>

Studies on Fingerprints of Pogostemon cablin (Blanco) Benth. from Different Places of Origin by Thin-layer Chromatography / 广州中医药大学学报

[Objective] To compare the difference of fingerprints of Pogostemon cablin (Blanco) Benth. from different places of origin. [Methods] The chemical components of Pogostemon cablin (Blanco) Benth. from 6 places of origin were detected by thin-layer chromatography. [ Results ] The thin-layer chromatogram of volatile components of Pogostemon cablin (Blanco) Benth. from different places of origin was similar. The contents of methanol-extract and petroleum-ether-extract from Pogostemon cablin (Blanco) Benth. planted in Gaoyao, Guangdong differed greatly from those in other places of origin, which can be used to identify the herb of Pogostemon cablin ( Blanco) Benth. from Gaoyao, Guangdong. [Conclusion] Thin-layer chromatographic fingerprints can be used as the parameter to differentiate Pogostemon cablin (Blanco) Benth. from different places of origin.

Selection and evaluation of the methods of tissue processing on mucosa tissue from small intestine transplantation / 肠外与肠内营养

Objective: To improve the limitation and stability of tissue processing on mucosa from small intestine transplantation and to provide better evidence of pathological diagnosis for the acute rejection on small intestine transplantation. Method:92 samples of mucosa from small intestine transplantation were reviewed.There were three methods of tissue processing (ultrasonic wave and microwave as well as routine) were adopted.The results were analyzed with statistical methods. Results: Among 18 samples processed by the method of ultrasonic wave,4 samples were A grade (22.22%). Among 50 samples processed by the method of microwave,30 samples were A grade (60.00%). Among 24 samples processed by the method of routine,13 samples were A grade (54.17%).The Chi Square Test suggested that there was statistic difference among three processing methods. Conclusions: Microwave is the best method of tissue processing on mucosa of small intestine transplantation and for the diagnosis acute rejection.

Immune tolerance induced by bone marrow infusion combined with costimulatory blockade / 医学研究生学报

Organ transplantation is the optimal treatment for patients with an end-stage organ disease.The induction of donor-specific tolerance is necessitatd because of severe side-effects of immunosuppression and chronic rejection of the transplanted organ that defy management.Bone marrow infusion and costimulatory blockade are considered to be the most effective strategies to induce immune tolerance.This review briefly discusses the mechanism and clinical application of immune tolerance induced by bone marrow infusion combined with costimulatory blockade.

Percutaneous transhepatic gallbladder drainage under color Doppler ultrasound in critically ill patients / 医学研究生学报

Objective:To study percutaneous transhepatic gallbladder drainage(PTGD) under color Doppler ultrasound in critically ill patients with acute calculus cholecystitis.Methods:A paracentetic needl was stuck into the cholecyst after going straight through 1.5-2.5 cm hepar under color Doppler ultrasound.The operator took out the bullet core,put in a guide wire,extracted the needl,inserted a central venous catheter along the guide wire,and then drew out the bile and clusised the cholecyst with metronidazole until the extracted fluid was clear and bright.Results:PTGD immediately relieved the pain in the of upper right quadrant in all the patients.Body temperature and WBC descended obviously 24 hours and returned to normal 5 days after the operation. Conclusion:Color Doppler ultrasound guided PTGD,easy to perform and with few complications and high suness rate,is an returned effective and reliable procedure for critically ill patients who are intolerant of cholecystectomy or for whom the operation is difficult to perform.

Influence of recombinant growth hormone on protein metabolism in chronic abdominal infection / 肠外与肠内营养

Objectives: To study the ameliorated effect of recombinant growth hormone on protein metabolism in chronic abdominal infection. 　Methods: 20 patients were divided randomly into two groups. Patients in the control group received TPN only for 10 days, while patients in the GH groups received both rGH(13.5u/d) and TPN for 10 days. Sepsis Score grade and detection of serum Growth Hormone (GH), Insulin like growth factor-1 (IGF-1), and Insulin like growth factor binding protein- 3(IGFBP-3) were carried out on day 0 and day 11, Serum albumin, prealbumin, transferring, fibronectin and C-reaction protein were detected on day 0, day 3, day 7 and day 11, Nitrogen balance and 24-hour urine creatinine secretion were assayed daily. 　Results: GH, IGF-1 and IGFBP-3 in the GH group on day 11 were significantly higher than those in the GH group on day 0 and those in the control group on day 11, Serum albumin, prealbumin, transferring and fibronectin increased, while C-reaction protein decreased when patients were undertaken GH treatment, Nitrogen balance ameliorated and accumulative total nitrogen balance in the GH group was significantly higher than that in the control group, while 24-hour urine creatinine secretion decreased. 　Conclusions: Recombinant growth hormone can ameliorate protein metabolism in chronic abdominal infection. IGF-1 plays important role in the ameliorated effect of recombinant growth hormone on protein metabolism in chronic abdominal infection.

Insulin stimulates translocation of GLUT4 and glucose uptake in ischemic myocar dium in dog / 第二军医大学学报

Objective: To investigate whether insulin stimulates the translocation of glucose transporter-4 (GLUT4) and glucose uptak e in ischemic myocardium. Methods: Plasma concentration of gluc ose, lactate, free fatty acid and insulin were determined by autoanalyser, and G LUT4 was studied by Western blotting analysis. Results: Insulin increased GLUT4 significantly in sarcolemma of ischemic myocardium ［(25±4)% vs (40±6)%］, and GLUT4 content in intracellular membrane decreased proporti onally. The glucose uptake increased significantly in insulin-ischemic myocardi um. The uptake of insulin-ischemic myocardium was almost 2 times that of ischem ic myocardium. Conclusion: Insulin stimulation results in GLUT4 translocation and increases glucose uptake in ischemic myocardium. When myocardi al ischemia occurs, insulin is helpful in increasing myocardial glucose uptake a nd utilization.

Studies on Preparation Technology for Maodongqing Drop Pill / 广州中医药大学学报

[Objective] To optimize the preparation technology of Maodongqing Drop Pill (MDP). [Methods] Orthogonal design was used to observe the influence of preparation conditions such as dry extract content, dry extract gram size, gel forming matrix and cooling agents on the quality of MDP. [Results] MDP made under the optimized conditions was good in shape, and color and luster, and not adhesive, indicating the good quality of the product. [Conclusion] This optimized preparation technology of MDP is simple with satisfied technique parameters and is suitable for mass production in the enterprises.

Influence of Different Dosage Form on the Release Rate of Sustained-released Danshen Extract Preparations / 中药新药与临床药理

Objective To study the influence of different dosage forms on the release rate of total salvianolic acid of sus- tained-released Danshen extract preparations.Methods With salvianolic acid B as the standard,uhraviolet spec- trophotometry and the release test were applied to determine the accumulated release rate of total salvianolic acid of sus- tained-released Danshen extract preparations(R1～R9)of 9 different dosage forms and to evaluate the release behav- ior of sustained-released Danshen extract preparations in vitro.Results The accumulated release rate of total sal- vianolic acid in R7 was the best,and the in vitro release behavior was consistent with Higuchi equation:M_1/M_∞= 0.363 4t~(1/2)-0.1656,r= 0.996 2.Conclusion R7 is the first choice dosage form for the preparation of the sus- tained-released Danshen extraction preparations.

Nutritional support and metabolic intervention after combined liver and intestinal transplantation / 肠外与肠内营养

Objective: To observe the effect of nutritional support and metabolic intervention in a patient receiving combined liver and intestinal transplantation. Methods: Glycyl glutamine(Gly Gln)and arginine supplemented total parenteral nutrition(TPN) was administered since postoperative day(POD)1. Glutamine(Gln) and arginine supplemented enteral nutrition(EN) was applied since POD 4. Growth hormone(GH) was delivered intermittently since POD 4.With adaptation and tolerance, enteral feeding was progressively increased while parenteral nutrition reciprocally decreased. Results: Transplanted organs functioned well. Conclusions: Rehabilitation of the allograft function can profit from the application of nutritional support and metabolic intervention.