脑钠肽对猪冠状动脉的舒张作用及机制研究

目的观察脑钠肽(BNP)对猪冠状动脉舒张作用,探讨其扩血管机制。方法采用猪冠状动脉环张力测定法,观察脑钠肽对猪冠状动脉的舒张作用及C型利钠肽受体(NPR-C)拮抗剂cANF4-28、鸟苷酸环化酶抑制剂1H-(1,2,4)恶二唑(4,3-α)喹喔啉-1-酮(ODQ)和各种钾离子通道阻滞剂对其舒血管效应的影响。结果 10-6 mol/L的BNP对血管的最大舒张率为(68.5±11.5)%,ODQ、四乙胺或格列苯脲均能明显抑制脑肽钠的舒血管作用(P<0.05),cANF4-28对BNP的舒张血管作用无明显影响(P>0.05)。结论 BNP可通过激活BKCa和KATP对猪冠状动脉产生舒张作用。     

钩藤碱对猪冠状动脉平滑肌舒缩作用的影响及其机制

目的观察钩藤碱对离体猪冠状动脉血管的作用,并探讨其作用机制。方法采用血管环张力测定技术及全细胞穿孔膜片钳技术分别观察钩藤碱对离体猪冠状动脉血管环张力的影响以及对大电导钙激活钾通道(BKCa)的作用。结果血管环张力实验显示钩藤碱能够明显舒张[(89.94±1.18)%,n=7]高钾(40mmol/L)去极化所致的冠状动脉血管收缩,而K+通道阻断剂四乙基胺(TEA)不能抑制钩藤碱的舒血管作用,提示K+通道几乎不参与钩藤碱对猪冠状动脉血管的舒张。在全细胞穿孔膜片钳模式下,钩藤碱(100μmol/L)可显著抑制猪冠状动脉平滑肌细胞的BKCa通道[(48.22±4.24)%,n=6],BKCa通道介导的自发性瞬时外向电流(STOCs)的幅度和频率也分别下降了(45.74±6.26)%和(87.98±6.39)%(n=5)。结论钩藤碱可明显舒张猪冠状动脉血管,而对全细胞BKCa通道具有明显的抑制作用,K+通道的激活在钩藤碱的舒血管机制中所起的作用不大。     

在体评价犬和猪冠状动脉内皮细胞的功能

[目的]在体观察缺血再灌注对犬冠状动脉内皮细胞功能的影响以及猪冠状动脉对血管活性药物的反应性.[方法]动脉麻醉后开胸、心包吊床,之后分离冠状动脉左前降支.犬作第一对角支插管,猪作冠状动脉左回旋支插管.犬冠状动脉左前降支缺血30 min后再灌注60 min,猪不作缺血再灌注.分别向冠状动脉内注射乙酰胆碱和硝酸甘油,以注药后平均冠状动脉血流量变化的百分率来评价冠状动脉内皮细胞依赖性和非依赖性的舒张功能.[结果]注乙酰胆碱后,基线状态下犬平均冠状动脉血流量从(17±4)mL/min升至(41±12)mL/min(P＜0.05);但缺血再灌注后舒血管反应幅度降低,其中再灌注15 min时间点平均冠状动脉血流量增幅水平明显低于基线增幅水平(142%±54%vs 87%±57%,P＜0.05).注乙酰胆碱后,基线状态下猪平均冠状动脉血流量在(11±3)s内从(21±11)mL/min迅速降至(12±8)mL/min,在(42±10)s内又回升至(23±13)mL/min.硝酸甘油使基线状态下犬平均冠状动脉血流量从(18±5)mL/min升至(40±22)mL/min(P＜0.05),猪的冠状动脉也呈类似反应.[结论]乙酰胆碱引起犬冠状动脉呈舒血管反应,缺血再灌注使犬冠状动脉内皮细胞功能明显受损.猪冠状动脉对乙酰胆碱呈先收缩后舒张的"双向反应".硝酸甘油则引起犬或猪的冠状动脉均呈舒张反应.     

C型利钠肽扩张猪冠状动脉的作用及机制的研究

目的本研究通过离体灌流方法观察C型利钠肽(CNP)对离体猪冠状动脉血管张力的影响,探讨C型利钠肽的扩血管能力及其机制。方法本实验分为三组:C型利钠肽组(CNP组)、硝酸甘油组(GTN组)、利钠肽受体C(NPR-C)激动剂组(c ANF4-23组)。1上述各组中分别加入去甲肾上腺素(NE),然后分别加入GTN、CNP和c ANF4-23,比较CNP和硝酸甘油对冠状动脉的扩张能力,并了解c ANF4-23是否有扩血管作用。2在CNP组预先加入NPR-C受体抑制剂(c ANF4-28),比较加药前后的扩血管作用变化。380m M高钾溶液预收缩血管,然后分别加入CNP、c ANF4-23,观察高钾对CNP和c ANF4-23扩血管作用的影响。结果 1CNP、NPR-C受体激动剂(c ANF4-23)及硝酸甘油均有明显的舒血管作用。CNP组舒血管作用与c ANF4-23组类似,低于GTN组,差异有统计学意义(P<0.05)。2预先加入NPR-C受体抑制剂(c ANF4-28),CNP组最大舒张率明显下降,差异有统计学意义(P<0.01)。3高钾溶液中加入CNP、c ANF4-23,血管舒张作用明显抑制,与对照组相比差异有统计学意义(P<0.05),但血管舒张作用未被完全抑制。结论本研究阐明CNP对冠状动脉具有良好的舒张作用;CNP主要通过NPR-C受体介导发挥舒血管效应;CNP/NPR-C路径所致的血管舒张主要与钾通道有关。     

低温停搏液灌注压力对猪冠状动脉内皮及平滑肌功能的影响

目的 探讨心脏停搏液灌注压力高低对猪冠状动脉血管平滑肌功能及内皮依赖性舒张反应的影响.方法 用改良的St. Thomas' hospital液分别在40、60、80 mmHg的灌注压下灌注猪冠状动脉后,取2 cm长的猪冠状动脉前降支(left anterior descending branch, LAD)远端血管,外径1.0～1.5 mm,截成1 mm长的血管环.将所取血管环直接置入器官浴槽内测定内皮及平滑肌功能.通过蓄积方式加入浓度增递的P物质测定血管内皮依赖性舒张(endothelium dependent relaxation, EDR)功能.结果 在本实验灌注压力下,冠状动脉平滑肌的舒缩功能均不受影响(P＞0.05).与新鲜对照组血管[(98.0±1.2)%]相比,40 mmHg和60 mmHg组冠状动脉的最大EDR值无显著下降[分别为(96.7±1.5)%、(96.6±1.9)%、(P＞0.05)],80 mmHg组血管的最大EDR值则显著降低[(90.8±2.2)%, (P＜0.01)].在血管内皮对P物质的敏感性(用50%最大舒张时的浓度值表示,pEC50)方面, 与新鲜对照组对比, 40 mmHg组血管环pEC50值无显著降低(P＞0.05),60 mmHg组和80 mmHg组血管环的pEC50值则显著降低(P＜0.05)、(P＜0.01).结论 用改良的St. Thomas' hospital 溶液灌注猪心时,60 mmHg的压力即可以造成冠状动脉内皮功能的损害,而且灌注压力越高,损伤越重.     

C型利钠肽舒张兔主动脉作用机制的探讨

目的 探讨C型利钠肽(CNP)舒张血管的受体和通道机制.方法 采用兔胸主动脉环张力测定法,观察CNP和C型利钠肽受体(NPR-C)激动剂cANF4-23对肾上腺素(NE)10 μmol/L或氯化钾(KCI)60 mmol/L预收缩血管的舒张作用,及多种钾通道阻断剂对两者舒血管效应的影响.结果 1 μmol/L CNP和cANF4-23对血管的最大舒张率分别为(33.5±5.9)%、(38.4±10.6)%,两组舒血管作用比较差异无统计学意义(P>0.05);NPR-C受体阻断剂能减弱CNP的舒血管作用[(19.8±8.3)%];高钾预收缩后CNP、cANF4-23对血管舒张作用明显降低(P<0.01);优降糖或氯化钡能明显抑制CNP的血管舒张作用(P<0.05);氯化钡使cANF4-23的血管舒张作用明显降低(P<0.05).结论 NPR-C/内向整流钾通道(KIR)、NPR-C/钙通道和B型利钠肽受体(NPR-B)/ATP敏感钾通道(KATP)参与了CNP对兔主动脉的舒张作用.     

甘草次酸对溶血性磷脂酰胆碱损伤兔胸主动脉内皮依赖性舒张功能的保护作用

目的　为观察甘草次酸对溶血性磷脂酰胆碱损伤离体兔胸主动脉血管内皮依赖性舒张功能的保护作用及机制。方法　采用离体血管环张力实验法 ,用溶血性磷脂酰胆碱 (LPC)损伤血管内皮 ,比较使用甘草次酸前后血管环对乙酰胆碱 (Ach)的舒张比值。结果　发现甘草次酸自身对血管的舒缩功能无直接的作用 ,对LPC损伤的血管环舒张功能具有保护作用 ,舒张比从 0 .4 3± 0 .15上升到 0 .60± 0 .16(P <0 .0 2 )。结论　环加氧酶抑制剂吲哚美辛、一氧化氮合成酶抑制剂Nω-硝基 -L -精氨酸及鸟苷酸环化酶抑制剂美蓝均可阻断甘草次酸的舒张保护作用 ;甘草次酸对LPC损伤血管内皮依赖性舒张功能的保护作用可能与促进内皮细胞释放或合成一氧化氮 (NO)和前列环素 (PGI2 )有关     

一种评价猪冠状动脉内皮细胞完整性的新方法

血管内皮细胞通过释放内皮细胞源性收缩和舒张因子调节血管平滑肌细胞的舒缩活动,经典上在离体血管实验中常采用乙酰胆碱作为检验血管内皮细胞完整性的工具药。最近我们在离体猪冠状动脉环上观察到不论内皮是否完整,乙酰胆碱均呈剂量依赖性收缩反应,但三磷酸腺苷则可诱发内皮依赖性松弛反应,在此基础上我们建立了以三磷酸腺苷为工具药评价猪冠状动脉内皮细胞完整性的新方法。     

不同剂量瑞舒伐他汀对冠状动脉粥样硬化斑块及血管内皮细胞功能的影响

目的:探讨不同剂量瑞舒伐他汀对冠状动脉粥样硬化斑块及血管内皮细胞功能的作用.方法:选取冠状动脉粥样硬化病人86例,随机分为观察组和对照组,各43例.对照组采用小剂量瑞舒伐他汀(10 mg)治疗;观察组采用大剂量瑞舒伐他汀(20 mg)治疗,持续治疗3个月.比较2组病人血管体积、管腔体积、斑块体积及肱动脉血流介导的舒张功...     

低温HP100XD保存液对离体猪冠状动脉内皮依赖性舒张反应的影响

目的:评价新型保存液HP100XD对猪离体冠状动脉内皮的保护作用.方法:健康瑞典家猪7头,取出冠状动脉前降支远端血管,外径1.0～1.5 mm,并截成1 mm长的血管环.将所取的血管环随机分配到以下3组,每组7段.新鲜对照组,将血管环直接置入器官浴槽内行内皮依赖性舒张反应(EDR)测定;24 h保存组和48 h保存组,分别将血管环保存于4℃的HP100XD溶液中24 h和48 h,再行EDR测定.血栓烷A2受体激动剂U-46619和罂粟碱分别用来诱导平滑肌的收缩和舒张.通过蓄积方式在器官浴槽内加入浓度递增的P物质(10-15～10-7mol/L)测定血管EDR.结果:与新鲜对照组最大舒张反应值(97.6±0.3)%比较,24 h保存组血管环的(95.6±0.7)%无变化(P＞0.05),48 h保存组则下降为(87.2±3.8)%(P＜0.05).与新鲜对照组的50%最大舒张时P物质的浓度对数(pEC5o)(9.93±0.17)比较,24 h保存组的pEC5o(9.64±0.05)无变化(P＞0.05),48 h保存组则下降为(9.54±0.04)(P＜0.05).结论:在4℃条件下,HP100 XD溶液可以有效地保存离体猪冠状动脉内皮功能达24 h,是一种较好的心脏保存溶液.     

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.     

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.     

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…     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.