美托洛尔对大鼠缺血心肌血管新生及血管内皮生长因子表达的影响

目的: 观察美托洛尔对大鼠缺血心肌血管新生和缺血心肌血管内皮生长因子(VEGF)表达的影响.方法: 运用大鼠心肌缺血模型,随机分为给药组和模型组,并记录心率.用免疫组织化学方法检测缺血心肌中内皮细胞数、毛细血管密度、VEGF蛋白质的表达,用RT-PCR方法检测VEGF mRNA的表达.结果: (1)与模型组比较,给药组大鼠缺血心肌毛细血管密度和内皮细胞数均明显增加(P＜0.01),其心率明显降低(P＜0.01);(2)与模型组比较,给药组大鼠缺血心肌VEGF蛋白质及mRNA的表达均明显增加(P＜0.01).结论: (1)美托洛尔能促进大鼠缺血心肌的血管新生;(2)美托洛尔减慢心肌缺血大鼠的心率和上调VEGF的表达可能是其促大鼠缺血心肌血管新生的机制之一.     

瓜蒌皮注射液对急性心肌梗死大鼠缺血心肌损伤的保护作用

目的探讨瓜蒌皮注射液对急性心肌梗死大鼠缺血心肌的保护作用及其对血管内皮生长因子（VEGF）表达的影响。方法 60只SD大鼠随机分成正常对照组、单纯手术组、低剂量给药组、高剂量给药组、假手术组各12只。采用开胸结扎冠状动脉左前降支的方法建立心肌梗死模型,4周后处死动物。测定血清肌酸磷酸激酶同工酶MB（CK-MB）、一氧化氮（NO）,取梗死边缘区心肌组织行病理分析及分级。免疫组化技术及Western blot技术检测各组缺血心肌VEGF蛋白质水平表达变化;逆转录多聚酶链反应（RT-PCR）法检测缺血心肌VEGF mRNA表达变化。结果给药组心肌坏死病理积分较组单纯手术明显降低,手术组和给药组大鼠血清CK-MB明显高于对照组及假手术组,给药组血清CK-MB均较单纯手术组降低（P〈0.01）,且高剂量组低于低剂量组（P〈0.01）;单纯手术组大鼠血清NO明显低于给药组和对照组,给药组高于单纯手术组。单纯手术组VEGF及其mRNA表达较正常对照组和假手术组增加,给药组缺血心肌VEGF及其mRNA表达较单纯手术组增加（P〈0.01）,高剂量组缺血心肌VEGF及其mRNA表达高于低剂量给药组（P〈0.01）。结论瓜蒌皮注射液能够减轻心梗大鼠缺血心肌损伤,其作用机制可能增加心肌损伤大鼠心肌VEGF表达,与血清NO的含量有关,且作用与剂量相关。     

靶向超声介导VEGF165 cDNA联合抗细胞间黏附分子1单克隆抗体治疗大鼠心肌缺血

目的:探讨靶向超声介导VEGF165基因联合抗细胞间黏附分子-1(ICAM-1)单克隆抗体治疗大鼠心肌缺血的有效性.方法:60只雄性SD大鼠经冠状动脉左前降支阻断法制备急性心肌缺血模型后,随机分为3组,每组各20只.超声介导治疗组采用超声破坏微泡造影剂的方法,经大鼠尾静脉输入含VEGF165 cDNA及抗ICAM-1单克隆抗体的造影剂1 ml;单纯联合治疗组仅输注等量的VEGF165 cDNA及抗ICAM-1单克隆抗体混合物;对照组注射生理盐水1 ml.每组分别于24 h和14 d后处死动物,分别行坏死区中性粒细胞计数、梗死心肌质量百分比测定,免疫组织化学法检测坏死区心肌VEGF蛋白表达,毛细血管染色法对坏死心肌进行新生血管计数.结果:心肌缺血24 h后,坏死边缘区中性粒细胞计数超声介导治疗组＜单纯联合治疗组＜对照组(P＜0.01);心肌缺血24 h和14 d后,超声介导治疗组梗死心肌质量百分比均低于单纯联合治疗和对照组(P＜0.05);心肌缺血14 d后,超声介导治疗组中可见大量VEGF阳性反应的棕褐色颗粒,而单纯联合治疗组相对减少,对照组心肌中仅有极少量.心肌缺血14 d后,超声介导治疗组毛细血管密度＞单纯联合治疗组＞对照组(P＜0.05).结论:靶向超声介导VEGF165 cDNA联合抗ICAM-1单克隆抗体可明显提高缺血心肌局部药物浓度,促进心肌功能恢复.     

自体骨骼肌卫星细胞移植对心肌梗死大鼠心功能的影响

目的 了解自体骨骼肌卫星细胞(satellite cell,SC)移植至心肌对心肌梗死(myocardial infarction,MI)大鼠心功能的影响及其可能机制.方法 45只Wistar大鼠采用随机抽签法分为假手术组、对照组及移植组,对照组及移植组大鼠经结扎冠状动脉前降支建立MI模型.将体外培养2周的大鼠自体SC以注射的方式移植到移植组大鼠梗死区周围,4周后测定各组大鼠血流动力学、心功能、血清血管内皮生长因子(vascular endothelial growth factor,VEGF)浓度及缺血心肌毛细血管密度的变化,同时观察移植细胞在梗死区的生长、增殖情况并探讨它们相互的关系.结果 SC在梗死区中可增殖分化为横纹肌纤维;与假手术组比较,尽管对照组及移植组大鼠之收缩压、舒张压、平均动脉压、左室收缩压及左室压力最大上升/下降速率均明显降低(P＜0.05,P＜0.01),左室舒张末压均明显增高(P＜0.01),但移植组左室压力最大上升速率、左室压力最大下降速率及左室舒张末压较之对照组则有明显改善(P＜0.05,P＜0.01);SC移植4周后,对照组大鼠毛细血管密度较之假手术组明显增高(P＜0.05);移植组大鼠缺血心肌中毛细血管密度及血清VEGF浓度较之假手术组、对照组亦明显升高(P＜0.05,P＜0.01).结论 SC在心肌梗死区中能增殖分化为横纹肌样细胞,并可分泌VEGF促使缺血心肌毛细血管增生,从而共同参与改善心功能.     

自体骨骼肌卫星细胞心肌移植对心肌梗死大鼠心肌纤维化的影响

目的了解自体骨骼肌卫星细胞(satellite cell,SC)心肌移植对心肌梗死(myocardial infarction,MI)大鼠心肌纤维化的影响及可能机制。方法45只Wistar大鼠随机分为假手术组(n=15)、对照组(n=15)及移植组(n=15),对照组及移植组大鼠经结扎冠状动脉前降支建立MI模型;假手术组除不结扎左前降支外,其余操作同对照组和移植组。将体外培养2周的大鼠自体SC以注射的方式移植到移植组大鼠梗死区周围,4周后测定各组大鼠缺血心肌VEGFmRNA的表达、VEGF蛋白质的表达、缺血心肌毛细血管密度的变化及缺血心肌的纤维化程度,同时观察移植细胞在梗死区的生长、增殖情况并探讨它们相互的关系。结果SC在梗死区中可增殖分化为横纹肌纤维;SC移植4周后,与假手术组比较,对照组大鼠缺血心肌中毛细血管密度明显增高,差异有统计学意义(P<0.05),而移植组大鼠缺血心肌中毛细血管密度及VEGFmRNA、VEGF蛋白质的表达较之假手术组、对照组亦明显升高,差异有统计学意义(P<0.05或0.01或0.001)。移植组心肌梗死区域的纤维化被有效抑制,而对照组则呈现出明显的纤维化特征。结论SC在心肌梗死区中可增殖分化为具有弹性和收缩功能的横纹肌样细胞,并通过自分泌和旁分泌的形式分泌VEGF促使缺血心肌毛细血管增生,从而有效地抑制了缺血心肌的纤维化进程。     

尼莫地平对大鼠急性心肌缺血的保护作用及其对心肌细胞凋亡的影响

目的:探讨尼莫地平对大鼠急性心肌缺血的保护作用和机制,以及对心肌细胞凋亡的影响.方法:Wistar大鼠40只随机分为正常对照组、单纯缺血组及尼莫地平高、低剂量组,每组10只,采用BL-410生物信号采集系统测定左室内压上升/下降最大速率(±dp/dtmax);用原位末端脱氧核苷酸转移酶标记法(TUNEL法)检测各组心肌细胞凋亡情况.结果:(1)与正常对照组比较单纯缺血组±dp/dtmax显著降低(P＜0.01),尼莫地平低、高剂量组明显高于单纯缺血组(P＜0.01);(2)结扎左冠状动脉前降支后心肌缺血心电图ST段抬高明显,尼莫地平低、高剂量组ST段均降低,与单纯缺血组相比,差异均有统计学意义(P＜0.01);(3)与正常对照组比较,单纯缺血组细胞凋亡数明显增多.尼莫地平低、高剂量组凋亡细胞显著减少,随剂量增加呈递减趋势(P＜0.01).结论:尼莫地平能升高缺血引起的左室内压变化率,抑制缺血损伤引起的细胞凋亡,从而保护缺血对心肌的损伤.     

25 Hz电刺激对缺血心肌VEGF和NF-кB表达的影响

目的:探讨25 Hz频率的阈下电刺激对大鼠缺血心肌中血管内皮生长因子(VEGF)和核因子-кB(NF-кB)表达的影响. 方法:将18只心肌缺血模型大鼠随机分为25 Hz频率阈下电刺激组(A组)、25 Hz频率阈下电刺激加NF-κB抑制剂N-乙酰基-L-半胱氨酸(NAC)干预组(B组)和非刺激对照组(C组),分别用免疫组织化学法和RT-PCR方法测定3组缺血心肌中的内皮细胞数、毛细血管密度、VEGF mRNA和蛋白的表达以及NF-κB的蛋白表达.结果:(1)与C组比较,A、B组大鼠缺血心肌中内皮细胞数目、毛细血管密度以及缺血心肌中VEGF mRNA及蛋白表达均显著增加(P＜0.01);(2)与A组比较,B组大鼠缺血心肌中内皮细胞数目、毛细血管密度以及缺血心肌中VEGF mRNA及蛋白表达均无显著差异;(3)3组大鼠的缺血心肌中NF-κB 蛋白的表达差异均无显著性.结论:促进大鼠缺血心肌中血管新生的25 Hz频率阈下电刺激能显著上调缺血心肌中VEGF的表达;25 Hz频率阈下电刺激对大鼠缺血心肌中NF-κB蛋白表达无显著影响.     

丙泊酚后处理对离体大鼠缺血再灌注心肌的保护作用及机制

目的研究丙泊酚后处理对离体大鼠缺血再灌注心肌细胞的保护作用以及对PI3K/Akt信号通路的影响。方法选用SD大鼠28只,按照随机数字表法分为缺血再灌注组(I/R组)、丙泊酚后处理组(PPC组)、丙泊酚后处理+Wortmannin后处理组(PPC+W组)、Wortmannin组(W组)。4组均建立Langendorff离体心肌缺血再灌注模型。各组心肌做相应分组处理后,观察缺血前及再灌注120 min时左室心功能变化情况,免疫组化检测Bcl-2蛋白的表达,Tunel法检测各组心肌细胞凋亡情况,Western blot测定p-Akt(Ser473)蛋白表达。结果与I/R组相比,PPC组LVEDP降低[(43.31±4.70)vs(29.93±3.72),P<0.05],+dp/dtmax和-dp/dtmax均明显升高[(1 140±138)vs(1 622±160),(749±99)vs(1 008±178),P<0.05],心肌组织Bcl-2蛋白和p-Akt的表达均增加[(0.171 9±0.012 1)vs(0.199 1±0.014 4),(0.241 4±0.053 9)vs(0.436 3±0.081 7),P<0.05],心肌细胞凋亡明显减少[(33.87±1.72)vs(29.84±1.83),P<0.05]。Wortmannin能阻断丙泊酚后处理的心肌保护效应(P<0.05)。结论丙泊酚后处理能减少离体大鼠缺血再灌注心肌细胞凋亡,发挥心肌保护作用,其保护机制与激活PI3K/Akt信号通路及上调Bcl-2蛋白的表达有关。     

延迟缺血预处理介导的心肌保护与血管再生的关系

目的:探讨延迟缺血预处理对急性心梗大鼠远期的心肌保护及其促进血管再生的作用.方法:分别制作4组大鼠模型.处理组:缺血预处理(IPC)后24h结扎冠脉建立急性心梗大鼠模型;对照组:开胸后只穿线未进行IPC,24h后结扎冠脉建立急性心梗大鼠模型;IPC组:只进行IPC不结扎冠脉;假手术组:既不进行IPC操作也不结扎冠脉.对前2组模型建立3d、7d和14d后免疫组化法检测梗死边缘区毛细血管新生、动脉再生.14d后评价心功能,测量心梗面积:对IPC组和假手术组采用免疫组化法检测缺血区心肌血管内皮生长因子(VEGF)表达.结果:处理组IPC后24h缺血区心肌可见到毛细血管新生,梗死3d、7d和14d后梗死边缘区心肌毛细血管密度和小动脉密度较对照组显著增加.处理组大鼠短轴缩短率较对照组显著升高,心梗面积减少.IPC组缺血区心肌VEGF表达较假手术组显著升高.结论:延迟缺血预处理改善心梗后远期心功能,减少心梗面积,增加梗死边缘区毛细血管新生和小动脉再生,至少部分与IPC后VEGF表达增加有关.     

巨噬细胞移植对大鼠心肌梗死后细胞外基质修复的影响

目的探讨移植巨噬细胞对大鼠缺血再灌注引起的心肌梗死后细胞外基质修复和心室重塑的影响。方法贴壁法培养Wistar大鼠腹腔巨噬细胞,建立Wistar大鼠心肌缺血-再灌注模型,随机分为对照组(AMI组,n=23),巨噬细胞移植组(MΦ组,n=20),假手术组(n=12)。术后第7天和第28天,取大鼠左室心肌组织进行组织病理学分析,分别测定膨展指数、梗死面积、非梗死区心肌细胞横截面积(CSA)、梗死区及非梗死区胶原容积分数(CVF)、梗死区胶原成熟程度。结果与AMI组比较,MΦ组术后第7天膨展指数[(0.27±0.13)vs(0.41±0.19),P<0.05]、非梗死区CSA[(330.65±57.30)μm2vs(408.00±99.98)μm2,P<0.01]均显著减少,MΦ组术后第28天膨展指数[(0.30±0.11)vs(0.48±0.12,P<0.01]、非梗死区CSA[(335.80±92.52)μm2 vs(515.41±93.13)μm2,P<0.01]也均显著减少;术后第7天和第28天MΦ组梗死区CVF显著大于AMI组[(53.51±5.82)%vs(45.05±3.66)%,(79.17±5.58)%vs(73.17±5.94)%,P<0.01],非梗死区CVF显著小于AMI组[(2.37±0.65)%vs(4.84±1.81)%,(2.64±0.63)%vs(6.01±1.34)%,P<0.01],梗死区胶原成熟程度显著大于AMI组[(0.566±0.009)vs(0.509±0.011),(2.162±0.047)vs(1.454±0.020),P<0.01]。结论巨噬细胞心肌内移植促进梗死区胶原沉积和成熟度增加,减少梗死范围,减轻非梗死区纤维化程度和心肌肥厚程度,从而改善心肌梗死后左室重塑。     

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.