核因子 κB抑制剂PDTC在肺动脉高压中的作用

目的探讨核因子 κB (NF κB)及其抑制剂吡咯烷二硫代氨基甲酸盐（PDTC）在野百合碱（MCT）所致肺动脉高压中的作用及其机制。方法大鼠腹腔注射MCT建立肺动脉高压模型,将58只Wistar大鼠随机分为MCT0组、MCT1W组、MCT2W组、MCT3W 组、对照/盐水组、MCT/盐水组和MCT/PDTC组。采用右心导管法测定血流动力学指标,用免疫组化法检测细胞间粘附分子 1(ICAM 1)表达及巨噬细胞浸润情况,用电泳迁移率变动分析法（EMSA法）检测NF κB 活化情况。结果MCT注射后1周开始,大鼠肺组织ICAM 1的表达和巨噬细胞浸润明显增加（P＜0.01),2周开始,平均右心室压力升高,右心肥厚指数增加（P＜0.01)。与对照/盐水组相比,MCT/盐水组平均右心室压力、右心肥厚指数明显增加,NF κB活化、ICAM 1表达及巨噬细胞浸润明显增多（P均＜0.01)。与MCT/盐水组相比,MCT/PDTC组平均右心室压力、右心肥厚指数明显降低,NF κB活化、ICAM 1表达及巨噬细胞浸润明显减少（P均＜0.01)。结论NF κB/ICAM 1介导的炎症级联反应参与了MCT诱导的肺动脉高压的发展,PDTC可抑制这一炎症反应,减轻肺动脉高压。     

川芎嗪对左室肥厚大鼠血流动力学的影响

目的观察川芎嗪（ugustrazine）对压力超负荷所致左室肥厚大鼠血流动力学指标的影响。方法采用腹主动脉缩窄（abdominal aorti ccoarctation，AAC）法建立大鼠心肌肥厚模型，观察各组大鼠心肌肥厚参数及血流动力学指标改变。结果制模后大鼠平均体重增长明显减慢；左室肥厚参数明显增高（P〈0．05），川芎嗪（100，50me/kg）可明显增加左室肥厚大鼠平均体重增长值，而降低左室肥厚参数（P〈0．05），造模各组间血压及左室内压无显著差异，但均高于假手术组，但与模型组比较，川芎嗪可显著降低左心室舒张期末压。结论川芎嗪对AAC术导致的左心室心肌肥厚有明显保护作用，且显著改善肥厚心肌的血流动力学指标。     

吸入CDDO⁃NO对野百合碱诱导的大鼠肺动脉高压的作用

目的：研究吸入新型一氧化氮供体型甲基巴多索隆(bardoxolone methyl,CDDO-Me)衍生物CDDO-NO对野百合碱 (monocrotaline,MCT)诱导大鼠肺动脉高压(pulmonary arterial hypertension,PAH)的作用。方法：SD雄性大鼠随机分为6组,对照组(Con 组)、MCT 组、MCT+10 μg/kg CDDO-NO 组(MCT+10NO 组)、MCT+30 μg/kg CDDO-NO 组(MCT+30NO 组),以及 MCT+7 μg/kg CDDO-Me组(MCT+7Me组)和MCT+21 μg/kg CDDO-Me组(MCT+21Me组)。MCT组及各治疗组均给予60 mg/kg MCT腹腔注射造模,CDDO-NO及CDDO-Me治疗组在MCT注射1 h后通过口鼻暴露式雾化吸入装置给药。连续雾化吸入给药 28 d后,右心导管测量大鼠右心室收缩压(right ventricular systolic pressure,RVSP),计算右心室肥厚指数(right ventricular hyper- trophy index,RVHI)和大鼠右室/体重比(RV-to-body weight ratio,RV/BW)。苏木素伊红(hematoxylin-eosin,HE)染色检测肺小动脉中膜层厚度(pulmonary artery medial thickness,PAMT)及右心室心肌细胞横截面积(cross-sectional area,CSA),马松三色染色(masson trichrome staining,MTS)评估肺小动脉周围纤维化程度,α-平滑肌肌动蛋白(α-smooth muscle actin,α-SMA)免疫组化染色检测肺小动脉肌化程度。结果：血流动力学及右室重构指标显示,吸入CDDO-NO或CDDO-Me均可降低MCT诱导PAH大鼠的RVSP、RVHI和RV/BW升高,其中30 μg/kg CDDO-NO降低RVHI和RV/BW的效应优于等量母体化合物CDDO-Me(21 μg/kg)。 此外,病理学研究显示,吸入30 μg/kg CDDO-NO改善MCT诱导的PAH模型大鼠右室心肌细胞肥大和肺血管中膜层肥厚、降低完全肌化型血管比例及肺血管外膜胶原沉积的效果较等量母体化合物CDDO-Me(21 μg/kg)更佳。结论：吸入CDDO-NO可通过抑制肺血管重构减轻MCT诱导的大鼠PAH,效果优于母体化合物CDDO-Me,是一种治疗PAH的潜在化合物。     

丹参川芎嗪对野百合碱诱导的肺动脉高压大鼠ET-1、NO和RVHI的影响

目的 观察丹参川芎嗪对野百合碱（MCT）诱导的肺动脉高压大鼠血浆中内皮素-1（ET-1）、一氧化氮（NO）含量、大鼠的平均肺动脉压（mPAP）、右心室肥厚指数（RVHI）的影响.方法 SD大鼠90只,随机分为对照组、模型组、丹参川芎嗪组.采用MCT进行一次性皮下注射（60 mg/kg）造模,28天后测定血浆中ET-1、NO的含量及mPAP、RVHI.结果 模型组及丹参川芎嗪组mPAP、ET-1、RVHI高于对照组（P＜0.05）,模型组及丹参川芎嗪组NO含量低于对照组（P＜0.05）.结论 丹参川芎嗪可能通过抑制血管壁的炎症、调节血管扩张和收缩失衡、减轻右心室肥厚,从而降低mPAP.     

EPS对肺动脉高压大鼠右心室重构的影响及机制

探讨依帕司他(EPS)对肺动脉高压大鼠右心室重构的影响及机制。采用野百合碱(MCT)诱导的方法建立肺动脉高压大鼠模型。分别给予为50 mg/kg和100 mg/kg EPS连续干预4周,观察大鼠血流动力学指标、右心室重构及其心肌形态和心肌Cx43表达。结果显示,EPS能够降低右心室收缩压(RVSP)、平均肺动脉压(mPAP)、肺动脉收缩压(PASP)、右心室肥厚指数(RVHI),右心室质量指数(RVMI)及增加心肌Cx43表达,并呈剂量依赖效应。结果说明,EPS能改善MCT诱导的肺动脉高压大鼠右心室重构,机制可能与其增加心肌Cx43表达有关。     

豨莶草对压力超负荷型大鼠心肌重构的影响

目的：观察稀莶草提取物对压力超负荷型大鼠心肌重构的影响。方法：采用腹主动脉结扎的方法造成压力超负荷型心肌重构大鼠模型,将模型大鼠分为5组,分别为假手术组、模型组、阳性药物卡托普45mg／kg组、豨莶草高剂量9．6g生药／kg组、豨莶草低剂量4．8g生药／kg组,灌胃给药,观察药物对大鼠心肌重构模型血流动力学指标、左心室重／体重（LVW／BW）、右心室重／体重（RVW／BW）及病理组织学改变的影响。结果：与模型组相比,卡托普利组收缩压明显下降（P〈0．05）,左心室重和IVW／Bw明显减小（P〈0．01）,病理组织学改变明显减轻;豨莶草高剂量组的收缩压、舒张压、LVEDP、LVSP、＋dp／dtmax等均有降低趋势,LVW／BW明显降低（P〈0．05）,病理组织学改变明显减轻。结论：高剂量的豨莶草提取物对压力超负荷型心肌重构具有一定的保护作用。     

γ氨基丁酸对肺动脉高压大鼠肺组织VEGF、MMP-9表达的影响

目的：研究γ氨基丁酸（GABA）对野百合碱（MCT ）诱导肺动脉高压大鼠的治疗作用,并检测血管内皮生长因子（VEGF）、基质金属蛋白酶-9（MMP-9）表达水平的变化。方法应用随机数字表法将30只雄性SD大鼠随机分3组,分别为正常对照组（对照组）、MCT模型组（模型组）、γ氨基丁酸干预组（干预组）,每组10只。观测平均右心室压（mRVP）,计算右心室肥厚指数（RVHI）,测定肺小动脉管壁厚度与动脉外直径的百分比（WT％）及管壁面积与血管总面积的百分比（WA％）,免疫组织化学染色法观察MMP-9、实时荧光定量PCR（FQ-PCR）检测VEGF mRNA在肺组织中的表达。结果干预组mRVP、RVHI、WT％、WA％、MMP-9蛋白和VEGF mRNA的表达水平明显高于对照组（P＜0．05）;而低于模型组（P＜0．05）。结论 GABA可抑制野百合碱诱导的肺动脉高压模型大鼠肺组织VEGF mRNA和MMP-9蛋白的表达,对肺动脉高压有治疗作用。     

腺苷A1受体激动剂拮抗大鼠慢性低氧所致右心室肥厚的实验研究

目的通过外周途径持续给予腺苷A1受体激动剂2-氯环戊腺苷（CPA）,观察其拮抗低氧致右心室肥厚的作用和机制。方法将24只SD大鼠随机分为3组：A组（常氧组）、B组（慢性低氧组）、C组（慢性低氧＋CPA治疗组）。B、C组于缺氧箱中喂养。于实验第8天予皮下埋泵给予CPA。于第21天处死大鼠,检测右心室/（左心室＋室间隔）[RV/（LV＋S）]、右心室/体重（RV/BW）比值;采用RT-PCR及Western-blot法检测RGS4基因及蛋白表达。结果慢性缺氧组与常氧组相比,RV/（LV＋S）、RV/BW比值明显增高（分别P〈0.01,P〈0.05）,而RGS4的mRNA及蛋白表达水平明显下降（均P〈0.01）;CPA处理后RV/（LV＋S）、RV/BW比值明显低于缺氧组（分别P〈0.01,P〈0.05）,而RGS4的mRNA及蛋白表达水平明显增高（P均〈0.01）。结论外周途径应用CPA能拮抗慢性缺氧所致右心肥厚,其机制可能是通过上调RGS4表达从而抑制G蛋白介导的信号通路。     

西地那非对野百合碱所致大鼠肺动脉高压的影响

目的：探讨西地那非对野百合碱（MCT）所致大鼠肺动脉高压的影响。方法：Wistar大鼠30只随机分为对照组（C组）、模型组（H组）和干预组（S组）。H组及S组一次注射MCT60mg／b制作肺动脉高压模型,4周后,S组大鼠灌喂西地那非25mg／kg·d^-12周。测定平均肺动脉压（mPAP）、体循环平均动脉压（mPA）、右心室肥厚、肺小动脉管壁增厚指标和血浆中cGMP浓度。结果：S组mPAP明显低于H组（P〈0．01）,3组循环平均动脉压比较,差异无统计学意义（P〉O．05）。右心室游离壁（RV）与左心室＋室间隔（LV＋s）的重量比和肺小动脉平均血管壁面积与血管总面积的百分比（WA）（％）,S组均明显低于H组（P〈0．01）,而血管腔面积与血管总面积的百分比（VA）（％）高于H组（P〈0．01）。S组肺小动脉管壁及管腔狭窄较H组显著减轻,心肌细胞的显微结构比H组好转。S组cGMP浓度显著高于H组（P〈0．01）。结论：西地那非扩张肺血管和逆转肺血管重构,降低肺动脉高压,改善右心室重构,但西地那非不影响体循环动脉压,可能与血浆中cGMP浓度增加有关。     

两种低氧性肺动脉高压小鼠模型的建立与比较

目的 比较单纯低氧与低氧联合SU5416建模方法的异同,探索低氧联合SU5416能否建立更显著的肺动脉高压小鼠模型。方法 15只雄性C57BL/6小鼠采用数字表法随机分为3组（每组5只）：常氧组、单纯低氧组和低氧联合SU5416组,4周后,检测各组小鼠体质量（body weight,BW）、右心室收缩压（right ventricular systolic pressure,RVSP）、右心室肥厚指数（the index of right ventricular hypertrophy,RVHI）、右心室/体质量比值（right ventricle/body weight,RV/BW）,并检测其肺小动脉的形态学改变以及血管中膜厚度占血管外径百分比（medial thickness,MT%）。结果 4周后,常氧组小鼠的体质量明显高于单纯低氧组和低氧联合SU5416组,单纯低氧组、低氧联合SU5416组小鼠的RVSP、RVHI、RV/BW、MT%均高于常氧组,且低氧联合SU5416组小鼠的RVSP、RVHI、MT%三项指标较单纯低氧组更高,而低氧联合SU5416组小鼠的RV/BW与单纯低氧组差异无统计学意义。结论 低氧联合SU5416能建立比单纯低氧更显著的肺动脉高压小鼠模型。     

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…     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.