葡萄籽原花青素对小鼠脂肪肝模型缺血再灌注造成的急性肝损伤的保护作用

目的 探讨葡萄籽原花青素对脂肪肝缺血再灌注(IR)损伤小鼠模型的保护作用。方法 将30只C57BL/6小鼠随机分为3组。喂食蛋氨酸胆碱缺乏高脂饲料3周后进行非酒精性脂肪肝造模,实验分3组:假手术组、对照组(肝脏缺血再灌注前灌服蒸馏水)、花青素缺血再灌注组(肝脏缺血再灌注前灌服原花青素)。再灌注6 h后处死小鼠,检测血清中丙氨酸转氨酶(AST)和天冬氨酸转氨酶(ALT)含量,观察肝脏组织形态学变化,分析肝脏组织损伤程度,巨噬细胞浸润程度,炎性因子TNF-α、IL-6、iNOS、INFγmRNA表达水平和肝脏组织内p38蛋白表达水平。结果 与对照组相比较,花青素组血清ALT和AST水平较低(P<0.05),巨噬细胞浸润和凋亡细胞明显减少,炎性因子mRNA的表达明显降低。蛋白水平p38基本无变化,磷酸化的p38表达显著升高。结论 花青素能够减轻脂肪肝小鼠肝脏IR损伤,其机制可能与抑制肝脏再灌注后氧化应激反应和炎症反应,促进p-p38的表达升高有关。     

PPARγ激动剂15d-PGJ2对大鼠肝缺血再灌注损伤中细胞凋亡的影响

目的 探讨过氧化物酶体增殖物激活受体γ(PPARγ)激动剂15d-PGJ2对大鼠肝脏缺血再灌注损伤中细胞凋亡的作用及可能的机制.方法 建立70%的大鼠肝脏缺血再灌注损伤模型,40只SD大鼠随机均分为4组:假手术组(SO组)、缺血再灌注损伤组(IK组)、15-脱氧前列腺素J2预处理组(15 d-PGJ2组),15d-PGJ2+GW9662预处理组(15 d-PGJ2+GW9662组).再灌注后,取静脉血栓测肝血清酶(ALT、AST)水平,取肝脏组织TUNEL法检测缺血肝脏细胞凋亡指数(apoptotic index,AI),免疫组化检测Bcl-2、Bax、Caspase-3表达.结果 与SO组相比,其他3组血清ALT和AST水平、肝脏细胞AI、Bax、Bcl-2及Caspase-3均升高(P＜0.05).与IR组相比,15d-PGJ2组血清ALT和AST水平、肝脏细胞AI、Bax及Caspase-3表达降低,Bcl-2表达升高(P＜0.05);而15d-PGJ2+GW9662组与缺血再灌注组相比差异无显著性(P＞0.05).与15d-PGJ2组相比,15d-PGJ2+GW9662组血清ALT和AST水平、肝脏细胞AI、Bax及Caspase-3表达增加,Bcl-2表达减少(P＜0.05).结论 PPARγ激动剂15d-PGJ2对肝脏缺血再灌注损伤有保护作用,其机制可能是通过PPAR γ激活上调Bcl-2、下调Bax的表达和抑制Caspase-3活性实现的.     

活化蛋白C对大鼠脂肪肝缺血再灌注损伤的影响

目的 探讨大鼠脂肪肝缺血再灌注损伤过程中炎症变化情况以及活化蛋白C (APC)对大鼠脂肪肝缺血再灌注损伤的影响.方法 清洁级健康雄性Wistar大鼠60只,制备成脂肪肝模型后,随机分为假手术组、对照组和APC组.APC组和对照组行部分肝缺血50 min,各组于再灌注6 h和24 h两个时间点,分别对10只大鼠取材,观察各组ALT、AST、TNF-α、肝组织MPO含量、肝组织ICAM-1免疫组化染色和肝脏组织病理学改变等指标.结果 APC组与对照组的ALT、AST、TNF-α、MPO和ICAM-1表达在各个时间点上均明显高于假手术组.再灌注6 h后与对照组比较,APC组ALT、AST、TNF-α水平和MPO含量明显降低,ICAM-1的表达明显减弱.光镜下观察肝形态学变化,对照组损伤甚为明显,APC组和假手术组损伤程度较对照组轻,假手术组更轻.再灌注24 h后,与对照组比较,APC组TNF-α水平明显降低,APC组与对照组其余各项指标间差异无统计学意义.结论 APC通过抗炎和减少内皮细胞损伤,对大鼠脂肪肝缺血再灌注损伤起保护作用.     

肌醇依赖酶1内切酶活性抑制剂STF⁃083010对肝脏缺血再灌注损伤的保护作用

目的：探讨STF-083010在小鼠肝脏缺血再灌注损伤中的保护作用及其可能机制。方法：选取健康清洁级雄性C57BL/6 小鼠30只,随机分成假手术组(sham组)、肝缺血再灌注组(IR+NS组)和STF-083010预处理+肝缺血再灌注组(IR+STF-083010组)三组,每组10只。缺血再灌注 6h后处死小鼠,收取静脉血及肝组织标本。通过酶联免疫吸附试验（ELISA法）检测小鼠血清谷丙转氨酶( ALT) 和谷草转氨酶（AST）水平;用苏木素-伊红（HE）染色及TUNEL染色检测肝脏组织损伤情况及肝细胞的凋亡情况;用实时定量PCR法检测白介素-6（IL-6）、肿瘤坏死因子α(TNF-α),白细胞介素1β( IL-1β)水平;免疫组织化学法检测sXBP1蛋白表达水平,蛋白印迹法检测肝脏组织中sXBP1、CHOP蛋白表达水平。结果: 与IR+NS组相比,IR+STF-083010组小鼠血清ALT,AST水平明显降低（P＜0.01）;组织学上,损伤情况得到明显改善（P＜0.01）;肝组织中IL-6、TNF-α、IL-1βmRNA水平及sXBP1、CHOP蛋白水平明显降低（P＜0.01）。结论: STF-083010预处理可通过抑制sXBP1/CHOP通路减轻肝脏缺血再灌注损伤。     

异氟烷对大鼠肝脏缺血再灌注损伤时细胞间黏附分子-1表达的影响

目的研究异氟烷对大鼠肝脏缺血再灌注损伤后细胞间黏附分子-1（ICAM-1）的影响，探讨异氟烷肝脏缺血再灌注保护作用的机制。方法将32只SD成年雌性大鼠分为假手术组、缺血再灌注组、异氟烷组、异氟烷．缺血再灌注组。假手术组、异氟烷组作为对照；缺血再灌注组和异氟烷-缺血再灌注组阻断支配大鼠肝脏左叶和中叶的门静脉分支，建立肝脏70％缺血再灌注模型，缺血60min再灌注3h后取材，测定大鼠血清ALT、AST；免疫组织化学方法检测ICAM-1蛋白的表达，HE染色进行病理学检查。结果肝脏缺血60min再灌注3h后肝组织ICAM-1蛋白表达水平增高；血清酶ALT和AST升高；肝组织损害严重。异氟烷抑制ICAM-1表达，降低ALT、AST水平，减轻肝细胞损伤。结论肝脏缺血再灌注损伤程度与肝组织内ICAM-1水平有密切的关系，异氟烷可抑制肝脏缺血再灌注期间肝组织ICAM-1的表达，同时减轻伤肝脏损伤。     

肝脏缺血激活PI3K/p⁃Akt2信号通路并促进库普弗细胞向M1型巨噬细胞转化

目的：研究肝脏库普弗细胞（Kupffer cells,KCs）在肝脏缺血及再灌注过程中的转化转归及其在肝脏缺血再灌注损伤中的作用。方法：制作小鼠肝脏不同缺血时间的模型,用流式细胞术分析缺血后KCs数量,体外培养中用实时荧光定量PCR（qPCR）技术分析炎性细胞因子的表达及巨噬细胞表面标记物的表达水平,免疫印迹（Western blot）技术分析磷脂酰肌醇3?激酶/磷酸化蛋白激酶B?2（PI3K/p?Akt2）信号通路的表达情况。使用qPCR技术分析Akt2抑制剂对KCs炎性细胞因子的表达及其表面标记物表达的影响,另外小鼠肝脏缺血后再灌注6 h,通过肝脏切片HE染色及血清丙氨酸氨基转移酶（alanine aminotransferase,ALT）水平等指标分析肝脏损伤情况。结果：肝脏缺血后KCs数量减少,而存活细胞在体外培养中,脂多糖（lipopolysaccharide,LPS）刺激后促炎性细胞因子的表达明显高于对照组（P < 0.05）,且M1型巨噬细胞的表面标记物诱导型一氧化氮合酶（iNOS）表达水平也高于对照组（P < 0.05）,其细胞内的PI3K/p?Akt2通路被激活,促进KCs向M1型巨噬细胞转化,而Akt2抑制剂可阻断细胞转化过程,减轻肝脏缺血再灌注损伤。结论：小鼠肝脏缺血能激活KCs内PI3K/p?Akt2信号通路,从而在炎性刺激下促进其向M1型巨噬细胞转化,并加重肝脏缺血再灌注损伤。     

缺血后处理对大鼠肝脏一氧化氮合酶表达的影响及意义

目的:探讨缺血后处理(ischemic postconditioning,IPO)对大鼠肝脏一氧化氮合酶(nitric oxide sythase,NOS)表达的影响及意义。方法:建立70%大鼠肝脏缺血再灌注模型,将32只雄性SD大鼠随机分为3组:假手术组(SO组,n=8)、缺血再灌注组(IR组,n=12)、缺血后处理组(IPO组,n=12),IPO组于再灌注恢复血流前,给予多次短暂复灌复停处理。再灌注3h后,比较各组血清谷丙转氨酶(ALT)、谷草转氨酶(AST)变化,硝酸还原酶法测定一氧化氮(NO)含量,逆转录-聚合酶链反应法(RT-PCR)检测肝脏组织内皮型NOS(eNOS)mRNA、诱导型NOS(iNOS)mRNA表达,蛋白免疫印迹法(Western blot)检测肝脏组织eNOS、iNOS蛋白表达,光镜观察组织病理学改变。结果:与SO组相比,其余两组血清ALT、AST、NO含量均明显升高(P<0.01),组织eNOS、iNOS表达均明显增强。与IR组相比,IPO组ALT、AST明显降低(P<0.01),NO明显升高(P<0.01),eNOS、iNOS表达增强。光镜下,IR组、IPO组呈现典型缺血再灌注...     

PPARγ激动剂罗格列酮在大鼠肝缺血再灌注损伤中的作用及机制探讨

目的:探讨过氧化物酶体增殖物激活受体γ(PPARγ)激动剂罗格列酮在大鼠肝脏缺血再灌注损伤中的作用及机制.方法:建立70%的大鼠肝脏缺血再灌注损伤模型,SD大鼠随机分为6组,对照组(control,C),假手术组(sham,S),缺血再灌注损伤(ischemia-reperfusion,IR)组,罗格列酮(rosiglitazone,Ros)预处理组,GW9662预处理组,以及Ros GW9662预处理组.再灌注后,取静脉血检测肝血清酶(ALT、AST)水平,取肝脏组织TUNEL法检测缺血肝脏细胞凋亡指数(apoptotic index,AI),免疫组化检测Bcl-2,Bax,Caspase-3表达.结果:IR组和Ros组与假手术组相比肝脏细胞凋亡指数、Bax、Bcl-2及Caspase-3均升高.Ros处理组与IR组相比肝脏细胞凋亡指数、Bax及Caspase-3表达降低,Bcl-2表达升高,GW9662能阻断Ros的保护作用.单独应用GW9662时肝脏细胞凋亡指数、Caspase-3以及Bax表达比IR组升高,而Bcl-2降低.结论:PPARγ激动剂罗格列酮对肝脏缺血再灌注损伤有保护作用,它可能是通过上调Bcl-2表达,下调Bax和Caspase-3表达,抑制肝脏细胞凋亡而起作用的.     

大鼠脂肪肝热缺血再灌注损伤的实验研究

目的:通过大鼠脂肪肝热缺血再灌注过程中血清ALT(丙氨酸氨基转移酶)、AST(天门冬氨酸氨基转移酶)、肝组织中ICAM-1(细胞间粘附分子-1)等细胞因子表达的变化来探讨脂肪肝热缺血再灌注损伤的机制。方法:用高脂饮食加酒精灌胃制备大鼠脂肪肝模型,采用大鼠部分肝缺血模型,缺血1 h后,开放血管夹,于不同的再灌注时间采血及肝脏组织。结果:脂肪肝组织中ICAM-1含量及血清ALT、AST高于对照组。结论:由于微循环障碍及ICAM-1等细胞因子的表达增高,脂肪肝更易受到热缺血再灌注损伤。     

丹参酮ⅡA减轻肝脏缺血再灌注损伤的作用及分子机制研究

目的:研究丹参酮ⅡA(TanshinoneⅡA,TanⅡA)对肝脏缺血再灌注损伤的保护作用及其体内机制。方法:将C57BL/6小鼠随机分为假手术组(A组)、缺血再灌注组(B组)、药物溶媒对照组(C组)及口服TanⅡA不同剂量组(D、E组),治疗组于术前3 d开始TanⅡA灌胃。采用小鼠部分肝叶缺血90min/再灌注模型,再灌注6 h后收集各组小鼠血液及肝脏标本,检测血清中ALT、AST水平,评估肝脏病理损害,Real-time PCR及Western-blot分析肝脏组织HO-1、TLR4的表达及其信号蛋白磷酸化和炎性细胞因子产生的影响。结果:A组小鼠经假手术处理后血清转氨酶(AST和ALT)、IL-6等炎症因子的表达较低,并显示正常的肝脏组织结构;B组小鼠缺血再灌注后,血清转氨酶、IL-6等炎症因子的表达与A组小鼠比较明显升高(P<0.01),肝脏细胞病理损害严重,但与C组小鼠比较,差异无统计学意义。经TanⅡA治疗3 d的D组、E组小鼠血清转氨酶水平较B组、C组明显降低,肝脏的病理损害较轻;肝脏细胞TNF-α、IL-6、IL-1β和MCP-1的表达明显降低;并抑制肝脏细胞TLR4表达以及JNK,p65的磷酸化,促进HO-1的表达,E组的作用较D组更强。结论:TanⅡA预处理能够有效抑制肝脏表达TLR4,并诱导HO-1表达,从而抑制炎症信号的活化,减轻缺血再灌注损伤。     

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.