电针对脑缺血再灌注大鼠学习记忆行为及海马区α7烟碱型乙酰胆碱受体的影响

目的:探讨电针对脑缺血再灌注大鼠学习记忆行为及海马区α7烟碱型乙酰胆碱受体(alpha7 nicotinic acetylcholine receptor,α7n ACh R)的影响。方法:将45只雄性SD大鼠按随机数字表法分为假手术组、模型组和电针组,每组均15只。模型组和电针组均参照Longa改良线栓法制备大鼠局灶性脑缺血再灌注模型。电针组电针神庭、百会穴,共7d,每次30min。采用Morris水迷宫实验观察大鼠的学习记忆功能;HE染色法观察大鼠海马神经元细胞结构变化;免疫组织化学染色法观测大鼠海马区α7n Ach R免疫阳性细胞的表达;Western blot法检测大鼠海马区α7n ACh R蛋白的表达。结果:各组大鼠游泳速度未见显著性差异(P0.05);模型组与假手术组相比大鼠逃避潜伏期明显延长(P0.01),跨越平台次数明显减少(P0.01);电针组与模型组相比大鼠逃避潜伏期明显缩短(P0.01),跨越平台次数明显增加(P0.01)。与假手术组相比,模型组海马区CA1区α7n ACh R免疫阳性细胞表达及整个海马区α7n ACh R蛋白的表达降低(P0.01),海马神经元细胞损伤加重;与模型组相比,电针上调海马区CA1区α7n ACh R免疫阳性细胞表达及整个海马区α7n ACh R蛋白的表达(P0.01),同时降低海马神经元细胞的损伤。结论:电针能改善脑缺血再灌注损伤大鼠的学习记忆能力,保护神经元细胞,其机制可能与上调海马区α7n ACh R表达有关。     

电针神庭、百会对脑缺血再灌注大鼠学习记忆能力和海马CA1区环磷酸腺苷效应元件结合蛋白及其磷酸化水平的影响

目的探讨电针神庭、百会治疗脑卒中后认知功能障碍的机制。方法 45只Sprague-Dawley大鼠随机分为假手术组、模型组和电针组,每组15只。后两组线栓法复制大鼠大脑中动脉缺血2 h再灌注模型。电针组于造模后24 h开始电针神庭和百会,共7 d。每天电针后行Morris水迷宫测试。治疗后,取大鼠脑组织TTC染色测量脑梗死体积,免疫组化检测海马CA1区环磷酸腺苷效应元件结合蛋白(CREB)及其磷酸化水平(p-CREB)的表达。结果从第4天开始,与模型组相比,电针组大鼠逃避潜伏期及游泳路程缩短(P0.05);穿越平台次数增多(P0.05)。电针组大鼠脑梗死体积小于模型组(P0.05);海马CA1区CREB、p-CREB表达量较模型组增加(P0.05)。结论电针神庭、百会后,脑缺血再灌注大鼠海马CA1区CREB、p-CREB表达量增加,从而保护神经元,改善学习记忆功能。     

电针神庭、百会对脑缺血再灌注大鼠学习记忆能力和LIM激酶1磷酸化的影响

目的探讨电针神庭、百会穴对脑缺血再灌注大鼠海马突触可塑性和学习记忆能力的影响,及其可能的机制。方法雄性Sprague-Dawley大鼠32只,随机分为假手术组、模型组、电针组、非穴组,每组8只。模型组、电针组、非穴组采用线栓法制备大鼠脑缺血120 min再灌注模型。电针组电针神庭、百会14 d,非穴组电针大鼠双侧胁下非经非穴14 d。采用Morris水迷宫检测学习记忆能力;电镜观察海马区突触形态;Western blotting检测海马LIM激酶1及其磷酸化水平。结果与假手术组比较,模型组大鼠逃避潜伏期明显增加(t6.789,P0.01),穿越平台次数显著减少(t=8.695,P0.001),突触数减少,LIM激酶1总蛋白(t=7.568,P0.01)及磷酸化水平下降(t=8.874,P0.001);与模型组比较,电针组大鼠平均逃避潜伏期明显减少(t4.938,P0.01),穿越平台次数显著增多(t=-7.891,P0.001),突触数量增多,LIM激酶1总蛋白(t=-6.473,P0.01)及磷酸化水平上升(t=-6.579,P0.01)。非穴组各项指标与模型组比较无显著性差异(P0.05)。结论电针神庭、百会穴可以改善脑缺血再灌注大鼠学习记忆能力,可能与LIM激酶1磷酸化水平升高进而改善突触可塑性有关。     

电针百会、神庭对脑缺血再灌注损伤大鼠学习记忆能力及突触可塑性的影响

目的:探讨电针百会、神庭穴对脑缺血再灌注损伤大鼠学习记忆能力及突触可塑性的影响。方法:将36只清洁级雄性SD大鼠随机分为假手术组、模型组和电针组,其中12只仅分离血管作为假手术组,其余24只运用线栓法制备左侧大脑中动脉局灶性脑缺血再灌注大鼠模型,缺血时间为2 h。造模成功后采用随机数字表法分为模型组和电针组各12只。电针组大鼠给予电针百会、神庭穴,1次/d,持续7 d;其余2组同等条件抓取,不予干预。各组大鼠在造模成功后第3天开始采用Morris水迷宫检测大鼠学习记忆能力,水迷宫试验共持续5 d;采用透射电镜观察海马区突触超微结构的变化;免疫组化法检测突触后致密蛋白95(PSD-95)和突触囊泡膜蛋白-突触素(SYN)的表达。结果:水迷宫测试中,模型组与假手术组相比逃避潜伏期明显增加(P0.001),穿越平台次数减少(P0.01);电针组与模型组比较逃避潜伏期缩短(P0.01),穿越平台次数增加(P0.05),第5天的穿越平台轨迹较集中于平台附近,而模型组则较分散和不规则。通过透射电镜观察,模型组与假手术组相比突触数量显著减少(P0.001);电针组比模型组海马CA1区突触的结构更加清晰和完整,数量显著增加(P0.01)。免疫组化发现假手术组比模型组海马区PSD-95及SYN表达显著增高(P0.001);与模型组相比,电针组海马区的PSD-95表达明显增高(P0.001),SYN表达也显著增高(P0.01)。结论:电针百会、神庭穴可以改善脑缺血再灌注损伤大鼠学习记忆能力,其机制可能与增强突触可塑性,包括促进突触结构的完整,增加PSD-95和SYN的表达有关。     

电针对脑缺血再灌注大鼠学习记忆能力及RhoA蛋白表达的影响

目的探讨电针神庭、百会穴对脑缺血再灌注模型大鼠学习记忆能力的影响及其可能机制。方法 45只雄性Sprague-Dawley大鼠随机分为假手术组(n=15)、模型组(n=15)和电针组(n=15)。模型组和电针组均采用左侧大脑中动脉缺血(MCAO)再灌注模型。电针组电针神庭、百会穴共7 d。采用Morris水迷宫测试观察大鼠学习记忆能力;尼氏染色观察大鼠海马神经元形态结构变化;Western blotting法检测大鼠左侧海马Rho A蛋白的表达。结果与模型组相比,电针组学习记忆能力改善(P0.05),海马神经元损伤减少(P0.05),海马组织中Rho A蛋白表达降低(P0.05)。结论电针能够改善脑缺血再灌注大鼠学习记忆能力,其机制可能与抑制Rho A蛋白表达有关。     

电针百会、神庭穴对脑缺血再灌注大鼠学习记忆影响的小动物磁共振波谱研究

目的:观察脑缺血再灌注损伤大鼠海马区神经细胞代谢,探讨电针改善脑缺血再灌注损伤大鼠学习记忆能力的机制。方法:将SD大鼠按照随机数字表分为假手术组、模型组、电针组;利用Koizumi线栓法制备左侧大脑中动脉缺血再灌注大鼠模型,电针百会、神庭穴,每天1次,每次30 min,持续7 d;采用Morris水迷宫评估大鼠学习记忆能力,小动物核磁共振T2WI成像观察大鼠脑梗死,小动物磁共振波谱(MRS)观察大鼠海马区神经细胞代谢。结果:电针干预7 d后,大鼠在Morris水迷宫中穿越平台的次数显著增加(P0.01);大鼠脑梗死体积减少(P0.01),大鼠海马区N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)左侧/右侧含量的比值均升高(P0.05)。结论:电针刺激百会、神庭穴可改善脑缺血再灌注损伤大鼠海马区NAA和Cho的代谢,起到神经保护作用,从而改善学习记忆能力。     

电针百会、神庭穴对缺血再灌注损伤大鼠学习记忆能力及海马CA1区嘌呤受体P2X7表达的影响

目的观察电针百会、神庭穴对缺血再灌注损伤大鼠学习记忆功能的影响,并探究其可能机制。方法雄性Sprague-Dawley大鼠42只随机分为假手术组(n=12)和手术组(n=30)。手术组线栓法制备左侧大脑中动脉栓塞90 min再灌注模型,符合纳入标准的24只分为模型组(n=12)和电针组(n=12)。电针组电针百会、神庭共7 d。造模后2 h和干预后1 d、3 d、7 d,采用Longa神经行为学评分进行评定;干预后3 d起行Barnes迷宫实验检测,共5 d;干预7 d后,免疫荧光标记法检测缺血侧海马CA1区嘌呤受体P2X7的表达,酶联免疫吸附法检测海马CA1区白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)。结果干预后7 d,与模型组相比,电针组Longa评分降低(P0.05);与假手术组相比,模型组Barnes迷宫逃避潜伏期显著延长(P0.001),进入错误洞口次数显著增多(P0.001);与模型组相比,电针组逃避潜伏期显著缩短(P0.001),进入错误洞口次数显著减少(P0.001);与假手术组比较,模型组P2X7受体平均光密度,IL-1β、TNF-α水平均显著提高(P0.001);与模型组相比,电针组P2X7受体表达,IL-1β、TNF-α水平减少(P0.05)。结论电针百会、神庭穴能有效改善缺血再灌注损伤大鼠的学习记忆能力,可能与抑制海马CA1区嘌呤受体P2X7表达,改善缺血再灌注损伤大鼠海马CA1区神经炎症反应有关。     

电针百会、神庭穴对脑缺血再灌注大鼠学习记忆能力及海马CA1区突触超微结构的影响

目的观察电针百会、神庭穴对脑缺血再灌注大鼠学习记忆能力及损伤大鼠海马CA1区突触超微结构的影响。方法雄性Sprague-Dawley大鼠25只随机分为假手术组(n=6)和手术组(n=19)。手术组线栓法建立左侧大脑中动脉栓塞90 min后再灌注模型,筛选符合纳入标准的12只大鼠随机分为模型组和电针组各6只。电针组电针百会、神庭穴7 d。采用Longa评分检测大鼠神经功能;小动物磁共振成像分析系统T2加权成像观察脑梗死体积;Barnes迷宫测试检测大鼠学习记忆能力;透射电镜观察海马CA1区突触超微结构。结果与模型组相比,电针组Longa评分降低(P0.05),脑梗死体积明显减少(P0.01);Barnes迷宫测试逃避潜伏期明显缩短(P0.01),平均进入错误洞口次数显著减少(P0.001)。透射电镜显示,模型组突触结构溶解,数量减少,囊泡稀疏、破坏;与模型组相比,电针组突触结构较清晰,突触数量较多,突触囊泡较多。结论电针百会、神庭能有效改善脑缺血再灌注大鼠的学习记忆能力,其机制可能与改善海马CA1区突触的超微结构,提高突触可塑性有关。     

电针对VD大鼠海马神经细胞PKC mRNA、mGluRs和AMPAR表达的影响

目的 观察电针对血管性痴呆(VD)大鼠海马神经细胞PKC mRNA、mGluRs、AMPAR表达的影响,探讨电针的治疗作用机制.方法 将SD大鼠随机分为假手术组、模型组和电针组,每组10只.模型组和电针组采用重复脑缺血再灌注方法建立VD大鼠模型.将电针组大鼠放入大鼠固定器中,暴露大鼠头部和背部,将电针浅刺入大鼠“百会”、“大椎”穴,每天电针1次,留针20 min,连续治疗10 d.3组大鼠均于造模10d后采用逆转录聚合酶链式反应(RT-PCR)检测海马神经细胞PKC mRNA,免疫组织化学染色技术观察脑组织海马神经细胞mGluRs、AMPAR染色结果.结果 模型组海马PKC mRNA表达较假手术组降低,而与模型组比较,电针组海马PKC mRNA表达显著增加,差异有统计学意义(P＜0.05).海马mGluRs免疫阳性细胞积分光密度在假手术组、模型组和电针组分别为(58.6±3.6)、(36.3±2.5)和(51.5±4.8),与假手术组比较,模型组海马mGluRs免疫阳性细胞积分光密度显著降低,差异有统计学意义(P＜0.01);而与模型组比较,电针组海马mGluRs免疫阳性细胞积分光密度显著增加,差异有统计学意义(P＜0.05);海马AMPAR免疫阳性细胞积分光密度在假手术组、模型组和电针组分别为(66.5±2.8)、(40.1±5.1)和(58.3±4.6),与假手术组比较,模型组海马AMPAR免疫阳性细胞积分光密度显著降低,差异有统计学意义(P＜0.01),而与模型组比较,电针组海马AMPAR免疫阳性细胞积分光密度显著增加,差异有统计学意义(P＜0.05).结论 电针可增加VD大鼠海马PKC mRNA、mGluRs和AMPAR表达.电针大鼠“百会”、“大椎”穴改善大鼠学习记忆能力的机制可能与提高海马mGluRs、AMPAR和PKC mRNA表达有关.     

电针神庭、百会穴对脑缺血再灌注后认知障碍大鼠学习记忆能力及自噬相关基因和蛋白表达的影响

目的:观察电针神庭、百会穴对脑缺血再灌注大鼠学习记忆能力及海马部位自噬相关基因和蛋白表达的影响,探讨脑卒中后认知障碍康复的机制。方法:清洁级健康SD雄性大鼠48只,按照随机数字表分为电针组18只、模型组18只和假手术组12只;电针组和模型组采用改良Zea Longa线栓法建立大鼠脑缺血再灌注损伤模型。造模后第2天电针其神庭、百会穴,每次30 min,每天1次,造模后第10天处死动物。电针干预后第4~8天,采用Morris水迷宫实验观察大鼠学习记忆能力,TTC染色观察大鼠脑梗死面积,荧光定量PCR和Western Blot分别检测大鼠海马部位自噬相关基因和蛋白表达。结果:(1)Morris水迷宫实验:与模型组比较电针组大鼠的逃避潜伏期明显缩短,穿越平台期的次数增多,路程缩短(P0.05);(2)神经缺损评分:与模型组比较,电针组治疗后脑缺血再灌注损伤大鼠的神经缺损评分降低(P0.05);(3)TTC染色结果:电针组和模型组中大鼠梗死面积明显高于假手术组;与模型组比较,电针组大鼠梗死体积明显减小,差异有统计学意义(P0.05);(4)基因及蛋白表达:与模型组比较,电针组左侧海马部位的Beclin-1、LC3Ⅰ/Ⅱ、PI3K的基因及蛋白表达水平升高,差异有统计学意义(P0.05)。结论:电针神庭、百会穴可减少脑梗死体积,改善动物行为学,对神经细胞具有保护作用。对自噬的调控可能是电针能改善脑卒中后认知障碍的生物学机制之一。     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

妊娠合并血小板减少症与心、肝、肾脏器损伤

目的探讨妊娠合并血小板减少症伴随重要脏器的损伤情况。方法前瞻性研究我院及北华大学附属医院2004年10月至2005年5月妊娠合并血小板减少症的临床资料，对41例妊娠合并血小板减少症者尿素氮（BUN）、肌酐（CREA）、谷丙转氨酶（ALT）、乳酸脱氢酶（LDH）的测定及妊娠期高血压疾病与血小板计数（PLT），血小板平均体积（MPV）和血小板体积分布宽度（PDW）参数的测定进行对比分析。结果妊娠合并血小板减少症患者心、肝、肾等重要脏器均有不同程度的改变，且随着血小板计数降低，损害程度加剧，差异具有显著性（P〈0．01）。妊娠期高血压疾病，随着疾病程度的加重，血小板计数较正常孕妇明显减少，MPV、PDW明显升高，有显著性差异（P〈0．01）。结论血小板参数是判断疾病的重要参考指标，肝、肾、心脏器损伤程度与血小板计数具有相关性。