Modified Goligher’s highly selective vagotomy (HSV) for 217 cases of duodenal ulcers is reported. In this series they were: duodenal ulcer (100 cases), combined gastric and duodenal ulcers (79 cases) and complicated perforating, bleeding or stenosed ulcers (38 cases). In the complicated duodenal ulcer, HSV was usually carried out with suturing bleeding point, perforated ulcer or with pyloroplasty. With a follow-up of 3~20 years, the recurrence rate werelt;2% and 85.7% of cases had excellent or good results as Visick classification. Considerations relevant to the HSV technic are deemed worthy of emphasis; complete resection of gastric branches of anterior and posterior vagal trunks and preservation of the first limb of the "Crow’s foot", extended dissection of the distal 5-7cm of the esophagus and division of the distal 8-10cm of the bundle of the gastroepiploic vessels in order to deprive the whole parietal cell mass of its vagal supply. In 4 patients, recurrence were easily controlled with remedies or operation for gastric retention by rational type. The authors suggest that the modified HSV plus mucusdeprived antrectomy be the rational surgical choice for duodenal ulcer.
Objective To investigate the effects of extracts of Pinellia ( EP) on a rat model of airway mucus hypersecretion induced by LPS. Methods Thirty Wisatr rats were randomly divided into 5 groups, ie. a blank group, a model group, and three EP groups treated with different doses of EP. There were 6 rats in each group. Airway mucus hypersecretion model was established by intratracheally instillation of LPS in the model group and three EP groups. The rats in three EP groups were orally administered with EP at dosages of 10 g/kg, 30 g/kg and 60 g/kg respectively for 4 days. The expression of Mucin 5AC ( MUC5AC) protein in airway was assayed by immunohistochemistry. The mRNA expressions of MUC5AC and Aquaporin-5( AQP-5) in lung tissue were detected by RT-PCR. ELISA technique was performed to detect TNF-αin bronchoalveolar lavage fluid( BALF) . Results LPS significantly stimulated the mRNA and protein expression of MUC5AC in lung and TNF-αlevel in BALF, and inhibited the expression of AQP-5 mRNA in lung. The EP at dosages of 10 g / kg and 30 g/ kg had little effect on mucus hypersecretion. While 60 g/kg of EP could significantly inhibited the expression of MUC5AC, and decreased the release of TNF-α in BALF. The AQP-5 mRNA was also up-regulated by 60 g /kg of EP. The expression of MUC5AC mRNA was positively correlated with level of TNF-α( r = 0. 948, P lt;0. 05) ; AQP-5 mRNA was negatively correlated with MUC5AC mRNA and TNF-α( r = - 0. 955, P lt; 0. 05; r = - 0. 909, P lt; 0. 05) . Conclusion EP ( 60 g/ kg) can significantly attenuated airway mucus hypersecretion in rats.
Objective To explore the role of sulforaphane (SFN) on the regulation of airway mucin 5AC mucin expression in the airway epithelial cell line (A549), and the underlying mechanism. Methods The experiments were performed in culture of PMA and H2O2 induced A549 in vitro. A549 cells divided into three groups: the control group, the model group (PMA and H2O2) and the intervention groups (SFN+PMA; SFN+H2O2). The intervention group's cells were pretreated with SFN for 30 mins before exposure to stimuli (PMA or H2O2). The MUC5AC, Nrf2 and the antioxidant gene HO-1, NQO1, GCLC mRNA levels were analyzed by real time-PCR, and protein production was assayed by western blot. Results Compared with the control group, expression of MUC5AC mucin was increased after being stimulated by PMA or H2O2 (P<0.05), but it was significantly inhibited by SFN (P<0.05). SFN induced the expression of Nrf2 gene and the antioxidant gene HO-1 (compared with the control and model groups,P<0.05). Conclusion Sulforaphane involves the airway mucous hypersecretion induced by PMA and H2O2, and Nrf2/HO-1 signaling pathway may play an important role in mucin MUC5AC regulation.
Objective To explore the effect of leukotriene receptor antagonist montelukast on physicochemical property of sputum and airway mucus hypersecretion in patients with acute exacerbation of bronchiectasis. Methods Eighty-four inpatients with acute exacerbation of bronchiectasis were randomly divided into a control group and an experiment group, with 42 cases in each group. The control group received conventional therapy and the experiment group took orally montelukast 10 mg before sleep every day based on conventional therapy for two weeks. At admission and 15 days after admission, the amount in 24 hours, dry/wet weight ratio and viscosity of sputum were observed while the levels of neutrophil elastase (NE) and mucin MUC5ac in sputum were determined by ELISA. The pulmonary ventilation function, airway resistance and blood gas analysis were also measured. Results The sputum amount in 24 hours, dry/wet weight ratio and viscosity of sputum, NE and MUC5ac of sputum, pulmonary ventilation function, blood gas analysis and airway resistance were declined or improved remarkably after treatment compared with before treatment in two groups (P<0.05). Meanwhile, the sputum amount in 24 hours [(5.62±1.83) g vs. (7.53±2.32) g], NE [(3.85±0.97) μg/ml vs. (4.54±1.03) μg/ml], MUC5ac [(0.65±0.21) μg/ml vs. (0.82± 0.29) μg/ml] and the airway resistance [(119.16±11.76)% vs. (128.37±12.08)%] were declined remarkably in the experiment group compare with the control group after treatment (all P<0.05). The viscosity of sputum between the two groups after treatment showed no significant difference. Conclusion In patients with acute exacerbation of bronchiectasis, montelukast can reduce amount of sputum and airway resistance, reduce expression of mucin MUC5ac through down-regulation of NE, thus inhibit airway mucus hypersecretion.
ObjectiveTo investigate the expression and pathological significance of neutrophil elastase (NE) and mucin 5AC (MUC5AC) in chronic obstructive pulmonary disease (COPD) rats. MethodsA total of 60 male specific pathogens free Sprague-Dawley rats were randomly divided into model group and blank group, each with 30 rats. The number of goblet cells and the positive expression of NE and MUC5AC were compared between the two groups by hematoxylin-eosin staining, alcianblue-periodic acid Schiff staining and immunohistochemical staining. ResultsNo rats died accidentally during the experiment. The number of goblet cells was 57.93±7.79 in the model group and 6.80±3.19 in the blank group, and the difference between the two groups was statistically significant (t=−44.267, P<0.05). The median (lower quartile, upper quartile) of the positive expression score of NE was 0 (0, 0) in the blank group and 2 (2, 3) in the model group, the median (lower quartile, upper quartile) of the positive expression score of MUC5AC was 0 (0, 1) in the blank group and 2 (2, 2) in the model group, and the differences between the two groups were statistically significant (P<0.05).ConclusionsThe positive expression of NE, goblet cells, MUC5AC and mucus secretion in COPD model rats increases significantly. Perhaps NE and MUC5AC can be used as target interventions to inhibit mucus hypersecretion.