细胞凋亡在实验性急性胰腺炎大鼠肠粘膜屏障功能障碍中的作用

目的 :探讨细胞凋亡在大鼠急性重症胰腺炎 (ASP)肠道粘膜屏障功能障碍中的作用。方法 :用胰胆管内注射 5 %牛磺胆酸溶液复制大鼠ASP模型。分别对ASP大鼠假手术 (shumoperation ;SO)组和正常组 (normal;N)大鼠 (SO)于术后 3、6、12、2 4h取末端回肠粘膜进行光镜、电镜观察 ,并用分子生物学标记 (TUNEL)方法研究肠粘膜上皮细胞的凋亡。结果 :ASP组大鼠除制模 2 4h光镜下可见肠粘膜上皮细胞脱落外 ,其它时相点肠粘膜均保持完整 ,电镜观察制膜各相点均可见典型凋亡细胞 ,TUNEL法显示制膜 3、6、12、2 4hASP组肠粘膜上皮细胞凋亡指数较假手术组显著增加P均 <0 .0 1,且于术后 6h达峰值 ,凋亡细胞主要分布于肠粘膜隐窝部。结论 :ASP大鼠早期肠粘膜上皮细胞凋亡明显增加 ,上皮细胞凋亡增加可能也参与了ASP时肠道粘膜屏障功能障碍的病理生理过程     

体外循环早期小肠粘膜细胞凋亡的实验研究

目的探讨体外循环(cardiopulmonarybypass,CPB)早期大鼠小肠粘膜上皮细胞凋亡规律及其意义。方法建立大鼠CPB模型。分别对CPB组、假手术组(shamoperation,SH)和正常组(normal,N)大鼠于术后3h、6h、12h和24h取回肠末端粘膜进行光镜、电镜观察,并用TUNEL方法研究肠上皮细胞凋亡。结果HE染色CPB组见较多的凋亡细胞分布于小肠黏膜上皮层;CPB后24h有少数的肠粘膜断裂;所有切片未见明显的炎症及坏死现象。电镜显示凋亡小体形成。TUNEL法见大量呈棕褐色的阳性细胞核,分布位置同HE染色。CPB后3h粘膜上皮细胞凋亡数较对照组明显增高(P<0.01),CPB后6h达到峰值。结论CPB早期大鼠肠粘膜上皮细胞出现大量凋亡,这些变化可能是CPB后肠道细菌及内毒素易位的细胞学基础。     

暴发性肝衰竭小鼠肠黏膜上皮细胞凋亡的研究

目的:研究暴发性肝衰竭小鼠肠上皮细胞凋亡情况,探讨重症肝炎并发自发性腹膜炎发病机制.方法:腹腔注射脂多糖(LPS)及D-氨基半乳糖(D-GalN)制造暴发性肝衰竭小鼠模型;生化法检测血清丙氨酸转氨酶(ALT);各组动物各时点取大、小肠组织进行光、电镜观察;缺口末端标记(TUNEL)检测肠组织凋亡.结果:实验各组动物各时点光镜下肠黏膜上皮细胞均保持完整,电镜观察实验组可见典型的凋亡细胞;肝衰竭组在9 h和12 h肠上皮凋亡细胞明显增加.结论:肠黏膜上皮细胞凋亡可能参与了暴发性肝衰竭时肠道黏膜屏障功能障碍的病理生理过程.     

柴芍承气汤对大鼠重症胰腺炎肠道屏障功能的影响

目的研究中药柴芍承气汤对大鼠重症急性胰腺炎(SAP)早期肠道屏障功能的影响。方法54只大鼠分为3组,健康对照组(C组)、SAP模型组(S组)和中药治疗组(T组)各18只,S组和T组应用胰胆管内注射5%牛磺胆酸溶液复制大鼠SAP模型,其中T组给予柴芍承气汤治疗直至处死。应用图像分析仪结合计算机图像分析系统检测肠绒毛高度及黏膜厚度;应用TUNEL法检测大鼠肠黏膜上皮细胞凋亡的情况。结果(1)与S组比较,T组大鼠胰腺和肠道组织的病理改变均明显减轻。(2)T组的肠绒毛高度及黏膜厚度较S组明显增加(P<0.01)。(3)各组大鼠肠黏膜上皮细胞凋亡均可见,但C组凋亡细胞极少,S组凋亡细胞明显增多,T组凋亡细胞较少。各组细胞凋亡指数比较情况:S组和C组相比,差异有统计学意义(P<0.01);T组和S组相比,差异亦有统计学意义(P<0.01)。结论柴芍承气汤能减轻SAP大鼠胰腺和肠道组织的病理损害,并能抑制SAP早期大鼠肠黏膜上皮细胞的凋亡,增加肠绒毛高度及黏膜厚度,早期使用可起到肠黏膜屏障保护作用。     

白藜芦醇对重症急性胰腺炎大鼠肠黏膜屏障的保护作用

目的 探讨白藜芦醇对重症急性胰腺炎(SAP)大鼠肠黏膜屏障功能的保护作用. 方法 24只成年雄性SD大鼠随机分为假手术组(SO组)、重症急性胰腺炎组(SAP组)、白黎芦醇治疗组(RES组).各组大鼠均于制模后6 h采集标本.动态浊度法检测血清内毒素含量,TUNEL法检测肠黏膜上皮细胞凋亡率,RT-PCR检测凋亡调控基因Bax、Bcl-2 mRNA表达,激光共聚焦显微镜检测肠黏膜细胞线粒体膜电位变化.结果 RES组血清内毒素水平和肠黏膜细胞凋亡指数均低于SAP组(P<0.01).RES组Bax mRNA表达低于SAP组(P<0.01),Bcl-2 mRNA表达高于SAP组(P<0.01).RES组线粒体膜电位高于SAP组(P<0.01).结论 白藜芦醇可通过抑制肠黏膜上皮细胞凋亡,维持肠黏膜屏障的完整性,从而防止SAP时细菌和内毒素的移居.     

急性坏死性胰腺炎肠道超微结构改变和褪黑素的保护作用

目的 观察急性坏死性胰腺炎(ANP)大鼠肠道超微结构及其通透性的变化,探讨褪黑素(MT)对肠道屏障功能(IBF)的影响.方法 将72只SD大鼠随机分成ANP组、MT组、假手术组(SO组),各24只.ANP组和MT组大鼠采用胰胆管末端穿刺逆行注入5%牛磺胆酸钠制备ANP模型.MT组于制模前腹腔注射MT溶液.术后4、12、24、48 h处死动物,用ELISA法测血清肠脂肪酸结合蛋白(IFABP),光镜下观察末端回肠病理改变,电镜下观察回肠组织超微结构变化,TUNEL法观察肠上皮细胞凋亡情况.结果 SO组大鼠胰腺及回肠黏膜未见明显病理改变,回肠组织超微结构无明显变化,TUNEL法检查未见明显细胞凋亡;ANP组大鼠光镜下可见回肠柱状上皮细胞坏死、绒毛脱落,回肠超微结构异常最明显,上皮细胞微绒毛排列紊乱且短矮,TUNEL法提示回肠上皮凋亡细胞较多,以绒毛顶端为主;MT组大鼠病理改变、超微结构异常均较ANP组减轻,上皮凋亡细胞较ANP组减少.ANP组大鼠各时点血清IFABP水平较SO组显著升高,差异有统计学意义(P均＜0.05);而MT组大鼠各时点血清IFABP水平较ANP组显著下降,差异亦有统计学意义(P均＜0.05).结论 ANP可导致IBF障碍,肠上皮细胞有不同程度的坏死和凋亡.提示ANP发病早期肠道上皮细胞凋亡和增生之间失去平衡是IBF障碍的病理机制之一.予以MT干预,可以改善ANP发病后的肠道病理改变和肠道超微结构异常,其作用途径可能是通过抗氧化作用及抑制炎症反应,有待进一步的研究证实.     

白藜芦醇对大鼠重症急性胰腺炎肠黏膜细胞的保护作用及其机制

目的 探讨白藜芦醇对实验性重症急性胰腺炎(SAP)大鼠肠黏膜细胞的保护作用及其可能的作用机制.方法 24只成年雄性SD大鼠随机分为假手术(SO)组、重症急性胰腺炎(SAP)组、白黎芦醇治疗(RES)组.SO组于开腹翻动十二指肠后关腹,SAP组大鼠以40g/L牛磺胆酸钠1 ml/kg经胰胆管逆行注射复制胰腺炎模型.RES组于胰腺炎模型复制成功后立即经阴茎背经脉注射白藜芦醇(10mg/kg).各组大鼠均于制模后6h采集标本.动态浊度法检测血清内毒素含量,TUNEL法检测肠黏膜上皮细胞凋亡率,RT-PCR检测凋亡调控基因Bax、bcl-2mRNA表达,激光共聚焦显微镜检测肠黏膜细胞线粒体膜电位变化.结果 RES组血清内毒素水平和肠黏膜细胞凋亡指数均低于SAP组(P＜0.01).RES组BaxmRNA表达低于SAP组(P＜0.01),bcl-2mRNA表达高于SAP组(P＜0.01).RES组线粒体膜电位高于SAP组(P＜0.01).结论 白藜芦醇可通过抑制肠黏膜上皮细胞的凋亡,维持肠黏膜屏障的完整性,从而防止SAP时细菌和内毒素的移位.     

生长抑素对大鼠不同肠段粘膜机械屏障损伤的保护作用

目的比较重症急性胰腺炎（severe acute pancreatitis，SAP）大鼠末段回肠及右半结肠起始段粘膜上皮细胞凋亡及凋亡相关基因bcl-2、bax蛋白表达的差异和生长抑素对肠粘膜机械屏障的保护作用。方法Spraque-Daw-ley大鼠90只，随机分为3组，对照组、SAP组、治疗组。术后6、12、24h分批处死大鼠，取末段回肠及右半结肠起始段，用原位末端标记技术、免疫组化技术，检测肠粘膜上皮细胞凋亡及凋亡相关基因bcl-2、bax蛋白的表达。结果（1）SAP组与对照组比较，肠粘膜上皮细胞bax蛋白表达上调，细胞凋亡增加；治疗组和SAP组比较，肠粘膜上皮细胞bax蛋白表达下调，细胞凋亡减弱；差异均有显著性。（2）SAP组中各时相点，结肠粘膜上皮细胞bax蛋白表达及细胞凋亡较回肠更强，差异有显著性。（3）各组各时相点bcl-2蛋白表达受抑制。结论SAP大鼠结肠粘膜机械屏障损伤较回肠更大；肠粘膜上皮细胞bax蛋白表达的上调是其细胞凋亡增加的重要原因；早期用生长抑素能有效保护SAP大鼠肠粘膜机械屏障。     

肝大部切除大鼠肠黏膜屏障的动态变化

目的探讨肝大部切除(PH)大鼠肠黏膜屏障的动态变化。方法102只健康雄性成年Wistar大鼠随机分为正常对照(NC)组(0h组,n=6)、假手术(SO)组(n=48)和PH组(n=48),在SO与PH术后不同时间点(6h,12h,24h,36h,48h,72h,120h,168h,各时点n=6)检测循环血中二胺氧化酶(DAO)的动态变化,观察光、电镜下肠黏膜结构通透性的动态变化。结果血清DAO水平PH术后12h为(1856±302)U/L、24h为(1446±125)U/L,分别与NC组及SO组各对应时间点比较差异有统计学意义(P<0.01)。SO组术后各时间点血清DAO水平与NC组比较无显著性差异。光学显微镜检查显示PH组大鼠术后6-24h肠黏膜中性粒细胞浸润,绒毛损害伴表浅坏死。透射电镜检查显示PH组大鼠术后6-48h肠黏膜细胞间隙普遍明显增宽和镧颗粒沉积。SO组术后仅在6h时间点光、电镜下所见肠黏膜有轻度损伤表现,其余各时间点与NC组比较无显著性差异。结论大鼠PH后6-48h期间出现肠黏膜屏障损伤,48h后损伤的肠黏膜屏障自行修复。     

白藜芦醇对梗阻性黄疸大鼠肠黏膜氧化应激损伤的影响

目的 探讨白藜芦醇(resveratrol,Res)对试验性梗阻性黄疸(obstructive jaundice,OJ)大鼠肠黏膜氧化应激损伤的影响.方法 健康雄性Wistar大鼠随机分为5组:假手术组、模型组、溶剂组、Res 10 mg组和Res 20mg组各12只.模型组、溶剂组、Res 10 mg组和Res 20 mg组均结扎胆总管建立梗阻性黄疸大鼠模型,假手术组不结扎胆总管.采用鲎试剂终点显色法检测血浆内毒素含量,HE和透射电镜观察小肠黏膜组织形态学改变,应用比色法检测肠组织丙二醛(malondialdehyde,MDA)含量和超氧化物歧化酶(superoxide dismutase,SOD)活性,TUNEL法检测肠黏膜上皮细胞凋亡.结果 实验处理2周后,模型组血浆内毒素浓度较假手术组明显升高(P＜0.05).HE染色观察模型组大鼠腺体排列紊乱,绒毛变钝、短缩,伴有较多淋巴细胞、炎性细胞浸润.透射电镜示肠黏膜微绒毛明显稀疏,排列紊乱,细胞连接模糊、间隙增宽.肠黏膜组织MDA含量明显高于假手术组,SOD活性明显低于假手术组(P＜0.05).TUNEL法检测示模型组肠黏膜上皮细胞凋亡指数较假手术组明显升高.不同浓度Res干预后上述病理改变得到纠正,大鼠肠黏膜脂质过氧化产物MDA含量较模型组和溶剂组明显降低(P＜0.05),且SOD增加(P＜0.05);大鼠肠黏膜上皮细胞凋亡指数降低(P＜0.05),Res 20 mg组较Res 10 mg组凋亡指数进一步降低(P＜0.05).结论 OJ大鼠存在肠黏膜氧化应激损伤,Res明显改善OJ大鼠高肠源性内毒素血症,提高肠黏膜的抗氧化作用,抑制肠上皮细胞凋亡,具有保护肠黏膜屏障作用.     

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.