血管内皮生长因子在实验性胆汁性肝硬化形成过程中的作用

目的探讨血管内皮生长因子(vascular endothelial growth factor,VEGF)在实验性胆汁性肝硬化形成中的作用.方法将雄性SD(Sprague-Dawley)大鼠40只随机分为肝硬化(CIR)组30只和假手术(SO)组10只,采用胆总管结扎复制大鼠胆汁性肝硬化模型,假手术组仅游离胆总管而不结扎;于术后4周处死大鼠,抽取下腔静脉血,测定肝功能;留取肝组织分别作HE染色、VG染色及VEGF免疫组化染色,并作图像半定量分析.结果CIR组肝组织学检查显示胆汁性肝硬化的典型特征,SO组无此改变;免疫组化结果表明:CIR组VEGF呈强阳性表达,主要位于肝细胞、肝窦内皮细胞、肝内血管内皮细胞;而SO组VEGF呈弱阳性表达,主要位于肝细胞、肝窦内皮细胞;CIR组VEGF平均积分光密度值(0.108±0.036)以及胶原纤维面密度值(0.304±0.131)与SO组相比(0.031±0.015,0.060±0.038)差异均具显著性(P＜0.001).结论血管内皮生长因子可能在肝硬化进程中起着一定的保护作用.     

血管内皮生长因子在门静脉高压大鼠腹水形成中的作用

目的 探讨血管内皮生长因子(VEGF)在门静脉高压大鼠腹水形成中的作用.方法 将雄性SD大鼠随机分为3组:门静脉结扎(PVL)组32只,假手术(SO)组16只,门静脉结扎联合沙利度安治疗(PVL-T)组8只.为诱导腹水形成,于手术后第1、3、5、7天分批给予每只大鼠腹腔注射33.33%葡萄糖溶液1 mL,30 min后收集腹水标本并测总量,同时采用ELISA检测腹水中VEGF含量;留取肠系膜组织作VEGF免疫组化染色和实时 RT-PCR检测.结果 术后第1、3天PVL组大鼠腹水总量和VEGF含量明显大于SO组(P<0.05),术后第5、7天PVL组大鼠腹水总量和VEGF含量与SO组比较,差异无统计学意义(P>0.05),术后第3天PVL-T组腹水总量明显低于PVL组[分别为(3.4±0.27) mL、(4.92±1.53)mL,P<0.05)].组织学检查PVL组肠系膜可见较多扩张血管.PVL组VEGF呈强阳性表达,而SO组VEGF则呈弱阳性表达,且表达部位多为血管内皮细胞胞浆;PVL-T组肠系膜VEGF mRNA表达明显降低(P<0.05).结论 门静脉高压可增加由于渗透性改变所致大鼠腹水形成,VEGF高表达可能与大鼠腹水形成有关.     

肝硬化大鼠睾丸一氧化氮合酶免疫组化研究

探讨肝硬化睾丸功能障碍的发生机制.将清洁级雄性SD大鼠分为假手术组(SO,n=10)、肝硬化组(CIR,n=10).采用胆管结扎(BDL)复制肝硬化模型,假手术组则仅分离出胆总管而不予结扎.应用免疫组织化学法对SO组和CIR组大鼠睾丸组织内皮型一氧化氮合酶(eNOS)和诱导型一氧化氮合酶(iNOS)的表达进行比较性研究.结果术后4周,组织学检查显示胆汁性肝硬化特征性表现.CIR组和SO组大鼠睾丸组织eNOS表达均在间质细胞胞浆,二者平均吸光度和面密度相比较均无显著性差异(P＞0.05).而iNOS表达则存在较大差异,SO组仅在睾丸组织间质细胞胞浆表达;CIR组不仅在间质细胞胞浆,还在支持细胞、生精细胞以及脱落的生精上皮细胞胞浆表达,二者平均吸光度及面密度相比均存在非常显著性差异(P＜0.01).表明CIR组大鼠睾丸组织iNOS活性增高,参与了支持细胞、生精过程的调节,从而进一步证明了肝硬化睾丸功能障碍的发生机制中存在NO途径.     

门静脉高压大鼠腹膜血管内皮生长因子的表达及意义

目的探讨门静脉高压大鼠腹膜血管内皮生长因子(VEGF)的表达及意义。方法雄性SD大鼠随机分为3组:门静脉结扎(PVL)组32只,假手术(SO)组16只,门静脉结扎联合沙利度安治疗(PVL-T)组8只。为诱导腹水形成,于手术后第1,3,5,7天分批给予每只大鼠腹腔注射33.33%葡萄糖溶液1mL,30min后收集腹水标本并测总量,同时采用ELISA测定腹水中VEGF含量;留取腹膜组织做VEGF免疫组化染色和实时RT-PCR。结果术后第1、3天PVL组大鼠腹水总量和VEGF含量显著大于SO组(P<0.05),术后第5、7天大鼠腹水总量和VEGF含量在PVL组和SO组之间无显著性差异(P>0.05),术后第3天PVL-T组腹水总量显著低于PVL组(3.4±0.27mLvs4.92±1.53mL,P<0.05)。免疫组化结果显示PVL组VEGF呈强阳性表达,而SO组VEGF则呈弱阳性表达,且表达部位多在腹膜间皮细胞、巨噬细胞胞浆;实时RT-PCR结果表明PVL组腹膜VEGFmRNA表达显著高于SO组(P<0.05)。结论门静脉高压可增加由于渗透性改变所致大鼠腹水形成,腹膜VEGF高表达可能与大鼠腹水形成有关,抑制VEGF活性可能是治疗门静脉高压所致腹水的一种新的治疗策略。     

肝内血管病变及血管内皮生长因子与乙型肝炎关系的病理学研究

目的研究肝内血管病变及血管内皮生长因子(VEGF)与乙型肝炎(乙肝)的关系.方法选取300例乙肝患者(急性乙肝、慢性乙肝G1～G4及肝硬变患者各50例)肝活检组织及52只SD大鼠(CCl4诱导模型组40只及正常对照组12只)不同时间(2、5、8、12周)肝组织,采用:①动物实验;②肝活检随访观察及体视学分析技术;③组织化学(组化)染色:对肝组织中胶原、网状及弹力纤维进行染色;④免疫组织化学(免疫组化)染色:用纤维连接蛋白(FN)、层连蛋白(LN)、Ⅳ-型胶原(Ⅳ-Co)、平滑肌肌动蛋白(α-SMA)及VEGF等单克隆抗体对肝组织进行染色;⑤酶联免疫吸附法(ELISA)定量检测:定量检测75例乙肝患者血清中VEGF含量.结果①CCl4大鼠实验中,在实验不同时间内,其肝组织肝内血管病变、肝组织病变及VEGF的表达各不相同.早、中期(2～5周),肝组织炎症反应显著,中央静脉周围肝细胞脂肪变,VEGF阳性肝细胞主要分布在脂肪变区域;晚期(8～12周)则肝组织炎症反应轻微,但肝细胞病变显著,血管破坏、血管及成肌纤维细胞增生更趋明显,并见有局部纤维瘢痕形成,假小叶内肝组织肝窦扩张或毛细血管化,其VEGF示阳性.②乙肝肝细胞的变性坏死等与肝内血管病变导致的肝血供障碍密切相关,肝内血管病变主要有血管炎症、血管阻塞、血管破坏、血管增生及肝窦狭窄、阻塞、扩张和肝窦毛细血管化.其贯穿于乙肝的整个病程中并发挥着非常重要的作用.③乙肝肝组织中VEGF的表达及血清中VEGF含量变化与其肝炎分级(G)、分期(S)及血管病变关系密切.在急性乙肝,VEGF呈弥漫性强阳性表达,血清VEGF含量显著升高(P<0.001).在慢性乙肝及肝硬变(LC),其血清VEGF含量并无升高,到LC反而下降(P<0.01),肝组织中VEGF散在表达,以扩张肝窦的内皮细胞及周围肝细胞较显著,其表达在血管形成前期最明显,而在肝血管生成期则逐渐降低.结论肝内血管病变在乙肝的整个病程中发挥着非常重要的作用;VEGF与乙肝肝细胞的再生及肝病变的程度有关,在肝内血管增生及改建中担当一最重要的角色,其在肝组织内增强表达发生于乙肝病变的始发阶段.     

门脉高压性胃病大鼠VEGF及其受体FLT-1和FLK-1的表达

目的:探讨门脉高压性胃病(portal hypertensive gastropathy,PHG)模型大鼠胃组织血管内皮生长因子(VEGF)及其受体FLT-1和FLK-1的表达情况?方法:Wistar大鼠60只随机分为PHG组及假手术(SO)组,一期缩窄门静脉主干法制作PHG大鼠模型,术后2周用生理测压仪测定门静脉压力,免疫组化法测定大鼠胃组织VEGF及其受体的表达,并利用RT-PCR法测定VEGF及其受体mRNA的表达?结果:PHG组大鼠门静脉压力显著高于SO组(P < 0.05),免疫组化结果显示,PHG组大鼠胃组织细胞胞浆中VEGF及其受体的阳性表达率明显高于SO组(P < 0.05);RT-PCR结果显示,PHG组VEGF及其受体mRNA的表达显著高于SO组(P < 0.05)?结论:VEGF及其受体FLT-1和FLK-1可能参与PHG的形成?     

血管内皮生长因子在大鼠门脉高压性胃病发病机制中的作用

目的　探讨血管内皮生长因子在大鼠门脉高压性胃病发病机制中的作用。方法　 SD大鼠随机分为门静脉高压 (portal hypertensive,PHT)组和假手术 (sham- operated,SO)组。采用门静脉主干部分结扎复制门脉高压模型 ,于术后第 14 d,测量门静脉压力、胃底及胃窦黏膜血流量 ;采用免疫组织化学 SABC法检测胃组织血管内皮生长因子 (vas-cular endothelial growth factor,VEGF)表达情况。结果　 PHT组大鼠门静脉压力 [(19.89± 2 .2 9) mm Hg]和胃底黏膜血流量 [(116 .2 1± 13.4 0 ) BPU]显著高于 SO组 [(8.5 3± 0 .84 ) mm Hg,(79.0 1± 11.6 6 ) BPU](P<0 .0 1,P<0 .0 5 )。而胃窦黏膜血流量在 PHT组和 SO组之间无显著性差异 (P>0 .0 5 )。免疫组化发现血管内皮生长因子在 PHT组大鼠胃黏膜组织中呈强阳性表达 ,在 SO组则呈弱阳性表达。结论　 VEGF可能参与了门脉高压性胃病 (portal hyper-tensive gastropathy,PHG)的发病机制 ,门脉高压性胃病所致的上消化道出血可能与 VEGF有关     

外源性血管内皮生长因子对肝硬化大鼠门静脉压力的影响

 目的研究外源性血管内皮生长因子对肝硬化大鼠门静脉压力的影响,以探索一种新的门静脉高压治疗方法。方法25
只肝硬化门静脉高压造模成功SD 雄性大鼠,体质量180~220 g,随机分为肝硬化门静脉高压对照组（B组, n=10）和肝硬化门静
脉高压实验组（C 组, n=15）,C 组应用Alzet 微渗泵从大鼠门静脉泵入血管内皮生长因子165（30 ng/d）持续2 周,正常对照组（A
组, n=10）和B 组开腹后关腹作对照,2 周后对各组大鼠进行门静脉压力测定,光镜和电镜下观察肝组织病理学改变。结果C
组门静脉压力明显低于B 组（ P<0.01）。光镜下观察C 组肝细胞水肿及肝窦病变较B 组减轻,电镜下观察B 组肝窦内皮细胞形
态不规则,窗孔缺失,基底膜形成,C 组病变减轻。结论血管内皮生长因子能够降低肝硬化门静脉高压大鼠的门静脉压力。     

胆汁淤积性肝硬化大鼠模型的改良

目的构建肝纤维化大鼠模型,并对经典结扎胆总管(BDL)复制模型方法进行适当改进。方法 80只SD雄性成熟大鼠,按随机数字表法分为A组40只、B组40只,分别运用胆总管结扎法和肝门部肝总管缝扎法先后两次造模,各取其中10只为假手术组进行对照,术后1周眼眶取血采用酶联免疫吸附法检测血清谷草转氨酶(AST)、谷丙转氨酶(ALT)、碱性磷酸酶(ALP)、总胆红素(TBIL)、直接胆红素(DBIL)、γ-谷氨酰转肽酶(GGT)、白蛋白/球蛋白(A/G),术后4周HE染色观察大鼠肝组织病理学变化,采用免疫组化染色分析肝脏组织α-SMA和CK-19表达水平。结果两种方法均表现出明显肝功能损害;标本胆小管增生明显,肝脏假小叶形成,达到早期肝硬化,肝脏α-SMA和CK-19表达水平明显升高,胆总管结扎组死亡率为66.7%,肝门部肝总管缝扎组死亡率为26.7%。结论肝门缝扎法可成功建立胆汁淤积性肝硬化大鼠模型,能够明显降低模型动物死亡率,提高模型质量及实验效率。     

胆汁淤积性肝硬化大鼠模型改良的研究

目的：构建肝纤维化大鼠模型,并对经典结扎胆总管(BDL)复制模型方法进行适当改进。方法：80只SD雄性成熟大鼠,按随机数字表法分为A组40只、B组40只,分别运用胆总管结扎法和肝门部肝总管缝扎法先后两次造模,各取其中10只为假手术组进行对照,术后1周眼眶取血采用酶联免疫吸附法检测血清肝功能(AST、ALT、ALP、TBIL、DBIL、GGT、A/G)检测,术后4周HE染色观察大鼠肝组织病理学变化,采用免疫组化染色分析肝脏组织α-SMA和CK-19表达水平。结果：两种方法均可均明显肝功能损害表现;部分标本胆小管增生明显,肝脏假小叶形成,达到早期肝硬化,肝脏α-SMA和CK-19表达水平明显升高,胆总管结扎组死亡率为66.7%,肝门部肝总管缝扎组死亡率为26.7%。结论：肝门缝扎法可成功建立胆汁淤积性肝硬化大鼠模型,能够明显降低模型动物死亡率,提高模型质量及实验效率。     

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.     

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…     

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.     

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.