大鼠小肠移植后LFA-1的表达和FK506的抑制作用

目的　探讨大鼠移植小肠组织内淋巴细胞相关抗原- 1(L FA- 1)的异常表达与急性排斥反应之间的关系 ,及FK5 0 6对其的抑制作用 .方法　选用近交系封闭群 SD和Wistar/ A大鼠进行全小肠异位移植 .实验分 4组 :非手术对照组 (Wistar/ A) ;同基因移植组 (Wistar/ A→ Wistar/ A) ;异基因移植组 (SD→Wistar/ A) ;异基因移植加用 FK5 0 6治疗组[SD→ Wistar/ A+FK5 0 6 (2 mg· Kg- 1 · d- 1 ,im) ],每组 18个样本 .分别于术后 3,5 ,7d采集移植小肠标本进行组织病理学和免疫组织化学检查 .结果　异基因移植组肠组织中L FA- 1表达增高 ,与相应对照组比较差异显著 (P<0 .0 5 ) ;检测 L FA- 1可以比组织病理切片 HE染色早 2～ 3d发现排斥反应 ;经 FK5 0 6治疗组中 L FA- 1表达最弱 .结论　 L FA- 1的表达水平和排斥反应的发生、发展有关 ;FK5 0 6可以明显地抑制 L FA- 1的表达     

异基因大鼠小肠移植选择素的表达与急性排斥反应的相关性

目的: 建立大鼠异位全小肠移植的急性排斥反应动物模型,分析急性排斥反应过程中选择素的表达变化及其在排斥反应中的意义.方法: 选用近交系Wistar/A和F344/N大鼠建立全小肠移植模型.实验共分4组,每组供受体各18只:第1组非手术对照组(F344/N);第2组同基因移植组 (F344/N→F344/N);第3组异基因移植组(F344/N→Wistar/A);第4组异基因移植治疗组(F344/N→Wistar/A FK506).每组分别于术后第3,5,7日处死,在无菌条件下取移植肠行常规HE染色,观察组织学变化;免疫组织化学染色测组织中选择素的表达,同时检测移植肠中选择素mRNA表达的变化.结果: 异基因大鼠异位全小肠移植术后3,5,7 d可出现典型的轻、中、重度排斥反应,而同基因组及异基因移植治疗组中未出现排斥反应. P-选择素在异基因移植术后早期显著升高,但随着排斥反应的加重,持续升高不明显,而E、L-选择素随着排斥反应的加重而持续升高,而同基因移植及治疗组选择素的升高不明显,且治疗组略低于同基因移植组.结论: 早期肠黏膜中P-选择素的表达对急性排斥反应的早期诊断及治疗有一定意义.     

普乐可复对大鼠小肠移植排斥反应的免疫抑制作用

目的　观察大鼠小肠移植术后应用普乐可复(FK5 0 6 )对小肠移植排斥反应的免疫抑制作用 .方法　选用近交系大鼠 F34 4/ N(RT 1 )和 Wistar大鼠进行全小肠异位移植 ,实验分 4组 .第 1组 ,异基因移植组 F34 4/ N- Wistar;第2组 ,小剂量普乐可复治疗组 F34 4/ N- Wistar+FK5 0 6 (0 .2mg· kg- 1 · d- 1 ,0～ 14d,im ) ;第 3组 ,普乐可复治疗组F34 4/ N- Wistar+FK5 0 6 (0 .5 m g· kg- 1· d- 1 ,0～ 14d,im ) ;第 4组 ,同基因移植组 (F34 4/ N- F34 4/ N ) .观察大鼠的一般状况及存活时间并于术后第 3,5 ,7日取移植小肠标本进行病理学检查和比较 .结果　第 1组大鼠存活时间与其他3组有显著差异 (P<0 .0 1) ,第 1组大鼠在术后第 3,5 ,7日病理学检查移植肠出现排斥反应 ,而第 2 ,3,4组无明显排斥 ,可长期存活 .结论　普乐可复能明显抑制小肠移植急性排斥反应的产生 ,显著地延长移植物存活时间     

大鼠肝肠联合移植IL-2、IL-4及IFN-γ基因表达的研究

目的:检测细胞因子白细胞介素2(IL-2)、IL-4和干扰素γ(IFN-γ)在大鼠肝/小肠移植中的变化规律,从细胞因子角度探讨大鼠肝肠联合移植免疫耐受机理。方法:建立大鼠肝肠联合移植(LSBTx组)和单独小肠移植(SBTx组)模型,每组取6只受鼠观察生存期,每组另取6只大鼠于移植后5 d、7 d收集小肠移植物,术后14 d单独收集LSBTx组小肠移植物,分别进行组织病理学检查,同时采用RT-PCR方法检测移植物中IL-2、IFN-γ和IL-4等细胞因子的mRNA表达。结果:LSBTx组大鼠均获得长期存活(>28 d),SBTx组大鼠中位生存期12.7 d。组织学提示SBTx组大鼠死于严重排斥反应,而LSBTx组至术后14 d移植肠排斥反应已明显缓解,SBTx组术后5 d、7 d移植肠排斥反应评分高于LSBTx组,存在显著性差异(P<0.05)。两组间不同时段IL-2基因表达水平未见显著性差异(P>0.05),SBTx组术后5 d IL-4基因表达高于LSBTx组(P<0.05),SBTx组术后5 d、7 d IFN-γ基因表达也高于同时段的LSBTx组(P<0.05)。结论:移植物中IL-2基因转录水平并不能反映术后移植排斥反应强度;术后早期IL-4水平的下调与免疫耐受有关;持续低水平的IFN-γ表达是肝脏诱导小肠耐受的重要原因之一。     

肝移植大鼠肝内一氧化氮合酶的表达

目的 :探讨移植肝一氧化氮合酶的表达与急性排斥反应间关系及其细胞定位。方法 :应用近交系 BN至 Lew大鼠原位肝移植急性排斥反应及同基因 ( Lew- Lew)肝移植动物模型 ,用免疫组化法检测移植肝组织中诱导型一氧化氮合酶 ( i NOS)的表达。同时观察 i NOS抑制剂氨基胍和免疫抑制剂 FK5 0 6对肝移植术后急性排斥反应的影响。结果 :在急性排斥组 i NOS表达强阳性 ,与氨基胍组、FK5 0 6组及同基因对照组比较差异显著。结论 :在大鼠原位肝移植发生急性排斥反应时 i N-OS增高程度与排斥反应的强度有明显关系。氨基胍、FK5 0 6可以抑制 i NOS的表达。抑制 i NOS的表达可明显减轻移植肝组织的急性排斥反应     

小剂量FK506预处理对大鼠小肠移植缺血再灌注损伤中细胞凋亡的影响

目的 :研究小剂量FK5 0 6预处理对大鼠小肠移植缺血再灌注 (ischemia/reperfusion ,I/R)损伤中细胞凋亡的影响 .方法 :建立大鼠小肠移植I/R损伤模型 ,FK5 0 6预处理方式为大鼠浅麻醉后按 0 .3mg·kg-1 剂量通过尾静脉注射 ,自然环境恢复 6h后行异位节段性小肠移植术 ;免疫荧光细胞化学方法检测移植肠凋亡细胞 ;免疫组化方法测定移植肠中热休克蛋白 70 (HSP70 )表达 .结果 :小肠移植I/R损伤造成小肠粘膜细胞凋亡增加 ,小剂量FK5 0 6预处理可有效减少I/R损伤引起的细胞凋亡 ,荧光强度定量分析表明 ,同虚假手术组相比 ,I/R组各时相点荧光强度明显增强 (0 .5 ,6 .0 ,2 4 .0h ,P<0 .0 1 ) ;FK5 0 6预处理组各时相点荧光强度与I/R组相比明显减少 (0 .5h ,P <0 .0 5 ;6 .0h ,P <0 .0 5 ;2 4 .0h ,P <0 .0 1 ) ;虚假手术组无HSP70表达 ,I/R组再灌注后 0 .5和 6 .0h未见HSP70表达 ,2 4 .0h可见有少量HSP70表达 ,FK5 0 6预处理组再灌注后 0 .5h即可见有少量HSP70表达 ,6 .0h时表达增多 ,再灌注后 2 4 .0h ,HSP70表达至高峰 .结论 :小剂量FK5 0 6预处理可有效减少I/R引起的细胞凋亡 ,减轻大鼠移植肠的缺血再灌注损害 ;这种保护作用与热休克蛋白的合成有关     

大鼠肾移植急性排斥反应中诱导型一氧化氮合酶的表达及其抑制剂的作用

目的:探讨大鼠移植肾组织中诱导型一氧化氮合酶(iNOS)的表达及iNOS抑制药氨基胍(Aminoguanidine,AG)和免疫抑制药他克莫司(FK506)对移植术后急性排斥反应的影响。方法:实验分为同基因移植组(5只,供、受鼠均为SD大鼠)和异基因移植组,后者又分为急性排斥组、AG治疗组和他克莫司治疗组(各组大鼠均为5只,供鼠为SD大鼠,受鼠为Wistar大鼠)。术后第7 d取移植物进行病理检查,观察排斥反应发生情况,并运用RT-PCR、免疫组化法检测各组移植肾组织中iNOS的表达水平。结果:急性排斥组iNOS表达呈强阳性,与AG治疗组、他克莫司治疗组、同基因移植组比较,差异有显著性意义(P<0.01)。AG治疗组、他克莫司治疗组、同基因移植组之间比较,差异无显著性意义。结论:在大鼠原位肾移植发生急性排斥反应时,iNOS表达明显增高,增高程度与排斥反应的强度移植物损伤有明显关系。应用AG和他克莫司可抑制iNOS的表达,从而减轻移植肾组织的急性排斥反应。     

Th17细胞相关细胞因子在大鼠小肠移植急性排斥反应中的作用

目的 通过对大鼠小肠移植FK506预处理模型研究,探讨Th17细胞相关细胞因子在大鼠小肠移植急性排斥反应中的表达。根据病理表现及相关细胞因子表达,进一步探究Th17细胞相关因子在大鼠小肠移植急性排斥的作用机理,试图为预防小肠移植急性排斥损伤提出新思路。方法 雄性健康F344大鼠5对及Lewis大鼠10对,6~8周龄,采用数字表法随机分为对照1组(F344 5只、Lewis 5只)、对照2组(Lewis大鼠5对)和实验组(F344 5只、Lewis 5只)。采用供体肠系膜上动脉-受体腹主动脉端侧、供体门静脉-受体下腔静脉端侧吻合法,供体肠管近端旷置远端回肠-回肠端侧吻合的异体全段性小肠移植术式。实验组:FK506按2 mg/Kg的剂量实验前3日每日肌肉注射,手术当日及术后7 d,按0.3 mg·kg^-1·d^-1肌肉注射。术后7 d处死受体大鼠或濒死大鼠,取供体肠管行HE染色及免疫组织化学染色观察病理变化,右心室穿刺取血用ELISA方法检测血清中IL-17、IL-23、IL-6、TGF-β、IFN-γ的含量。结果 在大鼠小肠移植急性排斥反应模型中,移植肠管的黏膜发生明显的病理形态学改变。对照1组小肠黏膜的病理形态学改变最明显,实验组病理学改变相对较轻,对照2组大鼠小肠黏膜改变最轻。免疫组织化学染色提示巨噬细胞浸润以对照1组最明显,其次为实验组,对照2组浸润最轻。实验组和对照组的大鼠静脉血血清中的IL-6、IL-17、IL-23、TGF-β平均浓度大体趋势相同,各种细胞因子以对照1组最高,实验组次之,对照2组最低。结论 在大鼠小肠移植模型中,FK506预处理能减轻小肠移植急性排斥反应造成的黏膜损伤,有利于移植受体的存活。其机理与减少移植肠管巨噬细胞的浸润有关。对照1组和实验组大鼠血液中IL-17、IL-23等细胞因子水平均值都高于对照2组,提示Th17相关因子参与急性排斥反应过程。阻断Th17相关因子产生可能会减轻小肠移植急性排斥反应损伤。     

大鼠原位肝移植急性排斥反应中一氧化氮变化的意义

目的:探讨一氧化氮在大鼠肝移植急性排斥反应中的变化规律.方法:大鼠施行原位肝移植术:异基因移植未治疗组(Brown Norway-to-Lewis),异基因移植FK506(Tacrolimus)治疗组,异基因移植氨基胍治疗组,同基因移植对照组(Lewis-to-Lewis).结果:大鼠肝移植发生急性排斥反应时,血清亚硝酸盐和硝酸盐(Nitric and Nitrat,NO2- and NO3-)水平显著升高;给予氨基胍治疗后,血清NO2-和NO3-水平降至正常,移植肝的损害程度也明显减轻.结论:一氧化氮是大鼠肝移植急性排斥反应中的一种标志性物质,抑制一氧化氮的合成可减轻移植肝的损害程度.     

TLR4mRNA在大鼠肾移植急性排斥反应中的表达及意义

目的探讨大鼠肾移植术后急性排斥反应时TLR4 mRNA的表达及意义。方法建立大鼠肾移植模型,将大鼠分为健康对照组(6例),同基因移植组(30例),异基因移植组(C组,30例),采用实时荧光定量聚合酶链反应(PCR)技术分别于术后1、2、3、5及7 d检测受体大鼠血液及移植肾TLR4 mRNA的表达,同时检测其外周血肌酐,并在光镜下观察肾脏组织病理变化。结果异基因移植组TLR4mRNA的表达和血肌酐明显高于健康对照组和同基因移植组,且TLR4 mRNA表达在造模后第1天即明显升高,组织病理学也观察到排斥现象。结论 TLR4mRNA有助于早期诊断肾移植急性排斥反应的发生,可能作为一种新的监测标志物。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.