博莱霉素静脉注射制备小鼠肺间质纤维化模型

目的经尾静脉一次性注射博莱霉素(BLM)复制小鼠肺间质纤维化动物模型,并观察模型的肺组织病理学变化。方法8周龄雌性C57BL/6小鼠66只,随机分为BLM80组18只、BLM150组19只、BLM300组19只和对照组10只,分别经尾静脉一次性注射BLM80、150、300 mg/kg和生理盐水。结果①BLM80组和BLM150组小鼠最低体重分别为BLM注射前的84%和65%。②BLM80组、BLM150组、BLM300组和对照组小鼠的生存率分别为:100%、43%、0和100%。③BLM150组BLM注射后14 d、28 d,右肺羟脯氨酸含量分别为738±46 nmol、886±83 nmol,与对照组(360±75 nmol)比较差异均有显著性意义(P<0.01)。④BLM150组小鼠BLM注射28 d,在胸膜下及血管周围形成广泛、稳定、明显的纤维化改变。BLM150组与BLM80和对照组比较,肺纤维化病理评分分别呈明显增高(P值均小于0.001)。结论C57BL/6小鼠经尾静脉一次性注射BLM150mg/kg可以制备肺间质纤维化动物模型。     

核因子κB反义寡核苷酸对博莱霉素致小鼠肺间质纤维化形成及白细胞介素4表达的影响

目的探讨核因子-κB（NF-κB）在博莱霉素（BLM）致肺间质纤维化小鼠支气管肺泡灌洗细胞中的表达和对白细胞介素4（IL-4）的影响,及其反义寡核苷酸（ASON）对肺间质纤维化的干预作用。方法将C5781／6小鼠随机均分为4组,对照组和BLM组经尾静脉注射生理盐水,ASON组注射p65ASON,SON组注射p65顺义寡核苷酸（SON）,6h后,BLM组、ASON组、SON组气管内注射博莱霉素-A5（BLM-A5）,对照组注射生理盐水。对照组在气管注射后0．5、1、14d,其余各组在0．5、1、3、7、14、28d处死小鼠,行支气管肺泡灌洗,灌洗液测IL4,灌洗细胞行P65和IL-4免疫组织化学染色。每组另取5只小鼠,在气管注射后28d处死,左肺行HE及Masson三色病理染色,右肺测羟脯氨酸。结果（1）BLM组和SON组肺病理可见大片实变及胶原沉积。而ASON组无实变,肺间质可见少量胶原纤维。（2）BLM组和SON组肺组织羟脯氨酸含量较对照组明显增高,ASON组明显低于BLM组和SON组。（3）BLM组和SON组支气管肺泡灌洗细胞的胞核p65表达明显高于对照组,亦明显高于ASON组。（4）BLM组和SON组支气管肺泡灌洗细胞IL-4的表达明显高于对照组,亦明显高于ASON组。（5）BLM组和SON组支气管肺泡灌洗液IL-4含量明显高于对照组,亦明显高于ASON组。（6）BLM组和ASON组小鼠支气管肺泡灌洗细胞表达的p65与IL-4均呈正相关（r=0．890,P〈0．05;r=0．909,P〈0．05）。结论BLM致肺间质纤维化的病理过程中,支气管肺泡灌洗细胞NF-κB的表达明显增强,并可能通过IL-4途径形成肺间质纤维化。NF-κBASON可明显抑制NF-κB的活化和IL-4的表达,并进而抑制BLM所致的肺间质纤维化。     

NF-κB反义寡核苷酸对博莱霉素致小鼠急性肺损伤的保护作用

目的研究转录因子NF-κB在博莱霉素(BLM)致小鼠急性肺损伤病理过程中的重要作用,及其反义寡核苷酸对肺损伤的防治作用。方法小鼠随机分为5组,于0d经小鼠尾静脉分别注射150mg/kg或300mg/kgBLM,在注射前6h和注射后第5d,150组和300组分别注射生理盐水(NS);anti150组和anti300组分别注射p65的硫甙反义寡核苷酸(900μg/只);同时设立正常对照组,分别在3个时间点(注射前6h、0d、第5d),经尾静脉注射NS,观察各组小鼠体质量变化、死亡情况和肺组织病理改变。结果(1)150组和anti150组死亡率分别为53%和0%(P<0.05);而300组和anti300组死亡率分别为100%和60%(P<0.05)。p65反义寡核苷酸抑制了BLM所致小鼠死亡;(2)150组和anti150组小鼠的最低体质量分别减轻至原来的(65.5±7.8)%和(82.1±3.4)%(P<0.01)。p65反义寡核苷酸改善了BLM所致小鼠体质量减轻;(3)肺组织HE染色显示,BLM致死的150组小鼠,可见肺组织血管结构丧失,出血性水肿,肺泡腔内大量炎性渗出;非BLM致死小鼠注射BLM后14d,可见肺组织大片实变,肺泡结构丧失。而anti150组14d明显减轻了BLM导致的肺组织损伤。结论NF-κB可能在BLM致小鼠急性肺损伤过程中具有重要作用。NF-κB反义寡核苷酸对BLM所致小鼠急性肺损伤具有保护作用。     

博莱霉素制备新生SD大鼠慢性肺部疾病模型

目的探索合适剂量的博莱霉素(BLM)腹腔注射导致新生SD大鼠肺发育不良,肺间质纤维化,建立一种新的慢性肺部疾病(CLD)动物模型。方法 30只2日龄新生SD大鼠随机分为3组,每组10只,分别予BLM 5.0、7.5 mg/(kg.d)及等体积生理盐水连续5 d腹腔注射,分别于第14、30天各处死5只。观察新生大鼠的存活状况,肺组织病理改变、Masson染色和羟脯氨酸(HYP)含量的变化。结果给予5.0 mg/kg BLM后大鼠可存活4周以上,肺组织病理主要为小肺泡数量减少,肺间隔增厚,Masson染色可见肺间隔有较多蓝色胶原沉积,HYP增加等肺发育不良、肺纤维化的表现;7.5 mg/kg BLM注射后大鼠陆续死亡,肺组织病理为肺泡出血,肺结构紊乱;等体积生理盐水注射大鼠存活状况良好,肺组织未见有病理改变。结论新生SD大鼠用BLM 5.0 mg/kg连续5d腹腔注射,可成功制备CLD模型。     

帕夫林通过抑制NLRP3形成减轻博莱霉素诱导的小鼠肺纤维化

目的：探讨帕夫林（paeoniflorin,PA）对博莱霉素（bleomycin,BLM）诱导的小鼠肺纤维化的影响及其作用机制。方法：将60只SPF级雄性C57BL/6小鼠随机分为4组：对照组（sham operation,SH）、对照组+帕夫林组（SH+PA）、模型组（BLM）、模型组+帕夫林（BLM+PA）;气管内滴注博莱霉素（2 mg/kg）建立小鼠肺纤维化模型,对照组气管内滴注生理盐水,从造模当天开始,SH+PA、BLM+PA组小鼠每日给予50 mg/kg帕夫林灌胃,SH、BLM组小鼠每日给予等量生理盐水灌胃;在造模第14天处死小鼠,留取小鼠肺组织。记录各组小鼠体重变化;统计各组小鼠生存率;HE染色法观察小鼠肺组织纤维化程度;肺组织匀浆羟脯氨酸定量评估肺组织胶原蛋白含量;ELISA法测定肺组织匀浆中白介素（interleukin,IL）-18、IL-1β含量;Western blot法检测肺组织匀浆中NLRP3、转化生长因子β1（transforming growth factor-β1,TGF-β1）表达水平。结果：与对照组相比,帕夫林可显著提高小鼠生存率;经帕夫林治疗14 d后,小鼠肺组织纤维化病变较模型组减轻;小鼠肺组织胶原蛋白含量显著降低（P＜0.05）;小鼠外周血及肺组织中IL-18、IL-1β含量较模型组相比明显减少（P＜0.05）;与模型组相比,NLRP3蛋白水平以及TGF-β1蛋白表达水平显著下调（P＜0.05）。结论：帕夫林可减轻博莱霉素诱导的小鼠肺纤维化程度,其作用可能是通过抑制NLRP3炎症小体的形成发挥的。     

核因子кB在博莱霉素致小鼠肺纤维化病理过程中的动态表达

目的:探讨在博莱霉素(BLM)致小鼠肺间质纤维化(IPF)病理过程中,核因子κB(NF-κB)在肺组织中表达的动态变化及其分布。方法:实验组小鼠35只气管内注射BLM,对照组20只注射生理盐水。对照组小鼠于12h,1,14d,实验组于12h,1,3,7,14,28d处死,右肺行支气管肺泡灌洗(BAL)3次,灌洗细胞行p65免疫组化染色,图像分析,左肺病理切片亦行p65免疫组化染色。另分别取两组小鼠各5只,3d后处死,取肺组织原代培养细胞行p65免疫组化染色,图像分析。结果:在BLM诱导的IPF病理过程中,NF-κB在肺间质细胞、肺泡上皮细胞、肺泡内及肺间质内免疫细胞中广泛表达,病程早期较强,随着病程的进展表达强度减弱。实验组BAL细胞核p65表达较对照组明显增强;气管内灌入BLM后1d,p65表达强度明显高于12h、3,7,14,28d;实验组肺组织培养细胞p65平均积分光密度(aiOD)值为462.04±152.25,对照组为1.03±0.37(P<0.05)。结论:NF-κB在IPF病理的早期阶段,可能具有更重要的作用。NF-κB不仅在BAL细胞中,而且在肺间质细胞中的表达明显增强,可能在IPF的病理过程中具有重要作用。     

C型钠尿肽对博莱霉素介导的小鼠肺纤维化的保护作用

目的 观察C型钠尿肽对博莱霉素诱导的小鼠肺纤维化的抑制作用.方法 经气管注射博莱霉素制作肺纤维化小鼠模型,将实验动物分为三组,包括空白对照组、博莱霉素处理组(BLM组)和C型钠尿肽干预组(CNP组),于第1、3、7、14天进行肺泡灌洗,回收各组肺泡灌洗液并检测炎性细胞和IL-1β量;记录药物处理后小鼠死亡率;第14天处死小鼠,取肺组织制备病理切片后评价各组模型肺组织形态学变化,测定肺组织匀浆中羟脯氨酸含量.结果 BLM组的肺纤维化和炎症反应较明显,死亡率高;CNP组与BLM组相比,肺纤维化程度减轻,炎性细胞较少,组织羟脯氨酸含量减低,死亡率下降.结论 C型钠尿肽能减轻博莱霉素诱导的小鼠肺纤维化,与干预炎症因子的产生及纤维化过程有关.     

抗Ⅳ型胶原酶单链抗体对博莱霉素诱导小鼠肺纤维化的防治作用

目的 研究抗Ⅳ型胶原酶单链抗体scFv(3G11)对博莱霉素(BLM)诱导的小鼠肺纤维化的防治作用.方法 C57BL/6小鼠分为空白对照组、盐水对照组、BLM组和低、中、高剂量scFv(3G11)组.BLM组气管内注射BLM 400 ng/g;低、中、高剂量scFv(3G11)组注射BLM当天记为0 d,第1～7天每天腹腔注射scFv(3G11) 15、30、45 μg/g.第21天处死盐水对照组、BLM组和中剂量scFv(3G11)组小鼠各6只,取左肺行组织病理学观察,并测定肺泡隔面积比和有核细胞计数;另处死空白对照组、盐水对照组、BLM组和低、中、高剂量scFv(3G11)组小鼠各6只,取肺组织测定羟脯氨酸含量以衡量肺胶原沉积状况.取小鼠腹腔巨噬细胞进行原代培养,采用明胶酶谱法观察不同浓度scFv(3G11)(0、15、30、45、60 μmol/L)对巨噬细胞分泌基质金属蛋白酶2(MMP-2)和MMP-9的影响.结果 组织病理学观察显示scFv(3G11)组小鼠肺纤维化程度明显轻于BLM组,肺泡隔面积比(45.3%± 3.2%)和有核细胞计数(451 ± 47)均明显低于BLM组(59.0% ± 3.0%,599 ± 42,均P<0.01).中、高剂量scFv(3G11)组小鼠肺组织羟脯氨酸含量[分别为(0.82±0.05)和(0.80±0.03)μg/mg]明显低于BLM组[(0.92±0.07)μg/mg,P<0.05,P<0.01].明胶酶谱分析显示,scFv(3G11)浓度为15 μmol/L时即可抑制巨噬细胞分泌的MMP-2和MMP-9的活性.结论 抗Ⅳ型胶原酶单链抗体scFv(3G11)能抑制BLM诱导的小鼠肺纤维化.     

川芎嗪对博莱霉素所致大鼠肺纤维化的保护作用

目的：观察川芎嗪对肺间质纤维化的保护作用.方法：将SD大鼠随机分为3组,即正常对照组、博莱霉素（BLM）组和川芎嗪＋BLM组.采用气管内注入BLM方法制作肺间质纤维化动物模型.分别于给药后7d、14d、28d光镜下观察肺组织.结果：7d时BLM组大鼠肺泡间隔有所增宽,视野中可见炎性细胞浸润增多,肺泡间质中成纤维细胞和胶原细胞增多,肺泡腔内分泌物多,而7d时川芎嗪＋BLM组较之明显减轻;14d、28d时BLM组大鼠肺泡炎症逐步减轻,炎性细胞减少,肺间质细胞增多,胶原纤维增多,间隔仍增宽,肉芽组织渐向瘢痕组织过渡,可见明显纤维化病变,而川芎嗪＋BLM组纤维化病变减轻.结论：川芎嗪在治疗肺纤维化中起重要作用.     

小剂量多次尾静脉注射与气管内滴注博来霉素致小鼠肺纤维化模型的比较研究

目的：与单剂量气管内滴药模型比较,研究小剂量多次尾静脉注射博莱霉素（bleomycin,BLM）致小鼠肺纤维化的特点与差异。方法：40只雄性ICR（Iastitute for Cancer Research）小鼠随机分为模型组I、模型组II和两个对照组,每组10只。模型组I尾静脉注射10mg／kgBLM均持续14d;模型组II于实验第一天气管内注入5mg／kg BLM,两对照组分别给与等量生理盐水,28aM处死并收集肺泡灌洗液（bronchoalveolar lavage fluid,BALF）。检测BALF细胞总数及蛋白含量、肺系数、羟脯氨酸（hydroxyproline,HYP）,观察肺组织病理改变。结果：1）两种给药方法均能使肺组织发生明显的炎性和纤维化反应,两模型组BALF细胞总数及蛋白含量、肺系数、HYP含量、肺间质损伤指数较两对照组均显著增加（P〈0．01）;2）模型组I病灶主要分布在胸膜下及血管周围,模型组II则主要分布在支气管和细支气管周围;3）模型组II病死率高于模型组I;4）模型组IIBALF蛋白含量高于模型组I（P〈0．05）;BALF细胞总数、肺系数、HYP含量、肺间质损伤指数两组间差异无统计学意义（p〉0．05）。结论：小剂量多次尾静脉注射与气管内滴入BLM都能成功制备肺间质纤维化动物模型,但两者纤维化形成的部位存在着一定的差异,小剂量多次尾静脉给药肺间质纤维化模型更接近特发性肺间质纤维化。     

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.