胶原酶对腰椎间盘髓核组织中蛋白多糖的影响

 【目的】探讨胶原酶在作用时间内是否会引起腰椎间盘髓核组织中蛋白多糖的水解。【方法】经皮腰椎间盘切除术中获得髓核组织标本,-70℃保存。胶原酶15u作用于1mL(0.1g/mL)髓核组织匀浆,测定不同时间段的溶解效应。在胶原酶对髓核组织饱和溶解时间条件下,选择不同剂量的胶原酶作用于1mL(0.1g/mL)髓核组织匀浆,通过测定糖胺多糖的含量变化,推测蛋白多糖的含量变化情况。【结果】本实验的胶原酶对髓核组织饱和溶解时间为12h。胶原酶作用后髓核组织中糖胺多糖在9u胶原酶以内的各组呈独立散在分布,组间差异有统计学意义(P<0.05)。9u胶原酶以后组间差异没有统计学意义(P>0.05)。9u胶原酶时吸光度达到最大值,经与总量对照组比较,糖胺多糖最大水解程度为57.14%～64.76%。【结论】本实验初步证实胶原酶可以在短期内引起腰椎间盘髓核组织中蛋白多糖含量的降低,这可能与胶原酶溶解术后椎间盘退变的加重有关。     

经皮髓核摘除加胶原酶溶解术治疗腰椎间盘突出症

目的探讨经皮髓核摘除后再注入胶原酶溶解残余髓核组织治疗腰椎间盘突出症的疗效。方法C臂X线机监视下,采用电动旋切式椎间盘摘除器经皮穿刺摘除部分髓核组织,在原通道内注入400~600 u胶原酶溶解残余髓核。结果345例腰椎间盘突出症患者行髓核摘除加溶解术,术后随访3~18个月,患者平均随访10.5个月,疗效评价:有效率94.2%,优良率72.5%,明显高于单纯摘除术组有效率88.08%和优良率59.3%(P<0.05)。结论经皮髓核摘除加胶原酶溶解术可提高介入治疗腰椎间盘突出症疗效,近期效果较佳,远期效果也较好。     

胶原酶及臭氧联合治疗腰椎间盘突出的临床应用

胶原酶溶核及臭氧联合治疗腰椎间盘突出症,是近几年来发展起来的一项新技术,其作用原理是利用胶原酶溶解髓核中的胶原蛋白,利用臭氧氧化髓核内蛋白多糖,减轻或解除突出椎间盘对神经根的压迫,也减轻了突出物对神经根所引起的炎症,解除疼痛症状,达到治疗目的。本文对75例胶原酶及臭氧联合治疗腰椎间盘突出症进行了研究,目的在于探讨胶原酶及臭氧联合治疗腰椎间盘突出症的临床应用价值,寻找治疗腰椎间盘突出症的有效方法。     

原子力显微镜观察腰椎间盘突出胶原蛋白多糖纳米生物学形态…

对３例腰椎间盘突出症患者手术取出变性髓核，应用原子力显微镜（ＡＦＭ）观察髓核组织三维图像结构。结果显示，髓核中的胶原束、胶原纤维有不同排列。原胶原纤维组织及多糖的颗粒分子形态结构与正常人腰椎间盘髓核对比，胶原纤维形成的原胶原纤维，其网眼吸附蛋白分子及蛋白多糖、胶原组织均呈退行性改变，胶原纤维化合并钙化，原胶原纤维纵横纹６ｎｍ。同时可见，胶原纤维有断裂损伤。     

胶原酶单独注射和与髓核切吸术合用治疗腰椎间盘突出症疗效比较

目的：比较胶原酶单独注射和与髓核切吸术合用治疗腰椎间盘突出症疗效。方法：将腰椎间盘突出症病人分为4组分别按腰椎间盘出、外注射胶原酶法及分别将腰椎间盘出、外注射胶原酶与髓核切吸术合用进行治疗。结果：椎间盘内、外注射胶原酶法与髓核切吸术合用两组有效率分别为94％及93％,高于单独椎间盘内、外注射胶原酶两组（有效率分别为90％及88％）。结论：胶原酶溶解髓核与切吸髓核合用治疗腰椎间盘突出症能更快速、有效地降低椎间盘内压力,疗效更高。     

慢性疼痛治疗问答(续)

8．溶盘术是怎么回事?胶原酶能溶解椎间盘的什么组织?是否也会把正常组织一起溶解掉?答:胶原酶治疗椎间盘突出症的作用是通过酶对髓核、纤维环组织中胶原蛋白的特异降解,破坏髓核胶原网状结构支架,于是蛋白多糖不能结合于髓核组织而逸出,髓核胶原渗透压及吸水能力显著减弱,直至整个椎间盘退行性变、纤维化、萎缩,从而减轻对神经根的压迫,达到治疗目的。     

白细胞介素-1β诱导人椎间盘髓核细胞凋亡

目的：探讨人正常椎间盘髓核细胞的培养方法以及白细胞介素-1β（IL-1β）对人椎间盘髓核细胞凋亡的作用。方法：取特发性脊柱侧弯患者腰椎间盘髓核组织,用胰酶、胶原酶序贯消化法消化细胞,并用甲苯胺蓝、番红-O染色和Ⅱ型胶原免疫组化分别检测糖胺多糖、蛋白多糖和Ⅱ型胶原表达,分别用20μg/L和200μg/L重组人IL-1β刺激髓核细胞24 h,检测其凋亡率。结果：用酶消化法可成功分离培养人椎间盘髓核细胞,检测所培养细胞可表达糖胺多糖、蛋白多糖和Ⅱ型胶原,IL-1β20μg/L组中细胞凋亡率（8.46%）和IL-1β200μg/L组（19.00%）分别为空白对照组（2.86%）的2.95倍和6.63倍（P〈0.05）,IL-1β200μg/L组是IL-1β20μg/L组的2.24倍（P〈0.05）。结论：用酶消化法可成功培养人椎间盘髓核细胞,IL-1β可以诱导椎间盘髓核细胞凋亡,并且随着浓度升高凋亡率增加,提示炎症因子IL-1β在退变椎间盘细胞凋亡中起了重要的作用。     

CTGF和TIMP1双基因体外联合转染恒河猴腰椎间盘细胞对II型胶原和蛋白多糖的影响

目的 建立恒河猴腰椎间盘细胞体外培养模型,研究腺相关病毒（adeno-associated virus,AAV）介导的结缔组织生长因子（connective tissue growth factor,CTGF）和基质金属蛋白酶组织抑制因子1(tissue inhibitor of metalloproteinases 1,TIMP1) 双基因体外联合转染恒河猴椎间盘细胞较单基因对II型胶原和蛋白多糖合成的影响的变化,以探讨体外延缓椎间盘细胞退变的方法。方法 应用酶消化法培养恒河猴腰椎间盘髓核细胞,以感染复数（MOI） 为106的rAAV2-CTGF-IRES-TIMP1及rAAV2-CTGF、rAAV2-TIMP1分别感染髓核细胞,应用Western blot鉴定和RT-PCR检测II型胶原及蛋白多糖mRNA的表达,35S整合法性行蛋白多糖合成率的测定,SP-ABC免疫组化法检测Ⅱ型胶原含量。结果 rAAV2-CTGF-IRES-TIMP1双基因及rAAV-CTGF、rAAV-TIMP1单基因能够转染恒河猴椎间盘髓核细胞并在其内表达细胞因子。与对照组相比,CTGF可以促进II型胶原及蛋白多糖的合成,TIMP1可以促进蛋白多糖的合成,对II型胶原的合成未见到明显作用;双基因联合感染可以显著促进髓核细胞蛋白多糖和II型胶原的合成。结论 CTGF和TIMP1 单基因转染均可以促进蛋白多糖的合成,CTGF 对 II型胶原的合成亦有促进作用;双基因联合感染可以明显促进蛋白多糖和II型胶原的合成,其效果优于单基因,为多基因治疗椎间盘退变奠定了良好的基础。     

新生儿椎间盘中蛋白多糖的研究

本实验对6例新生儿椎间盘的髓核和纤维环中的生化成分进行了研究.结果表明髓核中糖醛酸、半乳糖胺、总己糖胺的含量明显高于纤维环中的含量.葡萄糖胺的含量在髓核与纤维环无显著差异.蛋白质的含量在髓核较纤维环中低.髓核中的糖醛酸与蛋白质之比及硫酸软骨素与硫酸角质素之比均高于纤维环中.提示椎间盘的髓核与纤维环中蛋白多糖的组成和含量均存在着明显差异.     

联合介入治疗腰椎间盘突出症的疗效分析

目的观察经皮穿刺激光椎间盘减压术（Percutaneous laser disc decompression,PLDD）联合臭氧腰椎间盘髓核消融术、胶原酶化学溶解术治疗腰椎间盘突出症的疗效。方法将213例腰椎间盘突出、膨出的患者进行分类治疗。对96例采用PLDD联合臭氧消融术及胶原酶化学溶解术治疗。结果PLDD联合胶原酶化学溶解术治疗组术后4个月～2年优良率95．7％;PLDD联合臭氧消融术及胶原酶溶解术治疗组为97．4％。结论联合介入治疗以往视为相对禁忌的腰椎间盘突出症,也能达到令人满意的中远期效果。应重新认识腰椎间盘突出症介入治疗的适应证。     

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.     

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…     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.