Bloodletting Puncture at Hand Twelve Jing-Well Points Relieves Brain Edema after Severe Traumatic Brain Injury in Rats via Inhibiting MAPK Signaling Pathway

Objective:To investigate whether blood-brain barrier(BBB)served a key role in the edema-relief effect of bloodletting puncture at hand twelve Jing-well points(HTWP)in traumatic brain injury(TBI)and the potential molecular signaling pathways.Methods:Adult male Sprague-Dawley rats were assigned to the shamoperated(sham),TBI,and bloodletting puncture(bloodletting)groups(n=24 per group)using a randomized number table.The TBI model rats were induced by cortical contusion and then bloodletting puncture were performed at HTWP twice a day for 2 days.The neurological function and cerebral edema were evaluated by modified neurological severity score(mNSS),cerebral water content,magnetic resonance imaging and hematoxylin and eosin staining.Cerebral blood flow was measured by laser speckles.The protein levels of aquaporin 4(AQP4),matrix metalloproteinases 9(MMP9)and mitogen-activated protein kinase pathway(MAPK)signaling were detected by immunofluorescence staining and Western blot.Results:Compared with TBI group,bloodletting puncture improved neurological function at 24 and 48 h,alleviated cerebral edema at 48 h,and reduced the permeability of BBB induced by TBI(all P<0.05).The AQP4 and MMP9 which would disrupt the integrity of BBB were downregulated by bloodletting puncture(P<0.05 or P<0.01).In addition,the extracellular signal-regulated kinase(ERK)and p38 signaling pathways were inhibited by bloodletting puncture(P<0.05).Conclusions:Bloodletting puncture at HTWP might play a significant role in protecting BBB through regulating the expressions of MMP9 and AQP4 as well as corresponding regulatory upstream ERK and p38 signaling pathways.Therefore,bloodletting puncture at HTWP may be a promising therapeutic strategy for TBI-induced cerebral edema.     

如何学好药理学

药理学是研究药物与机体相互作用、作用机制及规律的科学,是连接基础医学与临床医学、医学与药学的一门重要课程.许多学生在初次学习药理学时,认为药理学不好学,内容复杂、抽象,药物种类较多,抓不住重点,难以记忆,不知道怎样学习药理学,现就这些问题谈谈学习药理学的方法.     

昆虫抗冻蛋白及其在医学领域中的应用

抗冻蛋白(antifreeze protein,AFP)是一类结构多样的蛋白质,具有热滞效应(thermal hysteresis,TH,降低冰点而不改变熔点)和重结晶抑制效应(recrystalization inhabition,RI).通过非共价吸附抑制机制吸附到冰核表面,限制冰晶生长和抑制冰晶重结晶,从而保护有机体免受结冰引起的伤害.由于抗冻蛋白具有阻止冰晶生长而不破坏细胞的特点,因而利用抗冻蛋白在低温中长期保存各种细胞、组织和器官,特别在器官移植中可能具有很好的应用前景.     

Sternal Reconstruction of Deep Sternal Wound Infections Following Median Sternotomy by Single-stage Muscle Flaps Transposition

Objective To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection （DSWI） following median sternotomy. Methods Between January 2009 and December 2013, 19 patients with DSWI after median sternotomy for cardiac surgery were admitted to our hospital, including 14 males （73.7%） and 5 females （26.3%）, aged 55±13 （18-78） years. According to the Pairolero classification of infected median sternotomies, 3 （15.8%） patients were type II, and the other 16 （84.2%） were type III. Surgical procedure consisted of adequate debridement of infected sternum, costal cartilage, granulation, steel wires, suture residues and other foreign substances. Sternal reconstruction used the bilateral pectoralis major or plus rectus abdominis muscle flaps to obliterate dead space. The drainage tubes were placed and connected to a negative pressure generator for adequate drainage. Results There were no intraoperative deaths. In 15 patients （78.9%）, bilateral pectoral muscle flaps were mobilized sufficiently to cover and stabilize the defect created by wound debridement. 4 patients （21.0%） needed bilateral pectoral muscle flaps plus rectus abdominis muscle flaps because their pectoralis major muscle flaps could not reach the lowest portion of the wound. 2 patients （10.5%） presented with subcutaneous infection, and 3 patients （15.8%） had hematoma. They recovered following local debridement and medication. 17 patients （89.5%） were examined at follow-up 12 months later, all healed and having stable sternum. No patients showed infection recurrence during the follow-up period over 12 months. Conclusion DSWI following median sternotomy may be effectively managed with adequate debridement of infected tissues and reconstruction with bilateral pectoralis major muscle or plus rectus abdominis muscle flap transposition.     

植皮区域局限性皮肤松弛症1例

病人,女,81岁.40年前在工作时双上肢不慎被火烧伤,当年在大连化工厂医院烧伤科给予取自体腹部皮肤行前臂植皮术,术后植皮区域皮肤成活修复良好.4年前无明显诱因双侧前臂植皮区域肤色逐渐变深,无意中发现皮肤明显松弛,无不适感.近3个月自觉植皮区域疼痛不适,局部无红肿等,轻微牵拉皮肤时疼痛明显.自发病起4年皮损未见扩大.患者既往体健,否认家族有类似病患者.     

对症喝汤好处多

夏季多喝汤不仅能调节口味,补充体液,增强食欲,而且能防病抗病,对健康有益. 日常人们常喝的汤有荤、素两大类.荤汤有鸡汤、肉汤、骨头汤、鱼汤、蛋花汤等,素汤有海带汤、豆腐汤、紫菜汤、番茄汤、冬瓜汤和米汤等.无论是荤汤还是素汤,都应根据各人的喜好与口味来选料烹制,加之"对症喝汤",就可达到抗衰治病、清热解毒的"汤疗"效果.     

第16届欧洲呼吸学会年会会议纪要

第16届欧洲呼吸学会年会(The European Respiratory Society 16th Annual Congress)于2006年9月1日～6日在德国慕尼黑市国际会议中心(ICM)召开,来自100多个国家和地区的16 888名代表参加了会议,大会共收到论文5277篇,接收论文4221篇,其中来自中国(包括香港、澳门和台湾)84篇(图1).现将会议内容扼要介绍如下.     

POCT的信息管理

POCT是在医疗条件下,由非实验室的卫生保健人员,在实验室的质控指导下,于病人身边进行的检验。它广泛适用于医院(如外科,儿科)、监护病房、急救单位、保险公司、社区医疗、家庭保健网络等领域。当今,POCT在全球方兴未艾,据调查,现今已有10%的诊断实验是在POCT仪器上完成的,究其原因,无非是POCT兼具医学上的有效性及经济两个方面的优势。当然,随着POCT设备的投放不断增加,使用范围不断拓展,POCT的管理问题也日益凸现,本文将对POCT实施中的信息管理的若干问题进行初步探讨。     

维生素B1和维生素B12肌注致过敏性休克1例报告

1 临床资料 患者,男,23岁,因左下肢疼痛20 d来医院就诊.询问病史:患者2 d前在上级医院诊断为坐骨神经痛.既往健康,无药物过敏史.门诊当日给予维生素B1 100 mg,维生素B12 250靏肌注,用药约5 min时患者感到头晕、胸闷、呼吸困难、寒战,面色苍白,脉搏105次·min-1,血压80/50 mmHg,考虑为药物所致过敏性休克,立即给予平卧,氧气吸入,肾上腺素1 mg肌注,地塞米松10 mg静注,5 min后患者恢复正常.     

Translating Mendelian and complex inheritance of Alzheimer's disease genes for predicting unique personal genome variants

Objective

Although trait-associated genes identified as complex versus single-gene inheritance differ substantially in odds ratio, the authors nonetheless posit that their mechanistic concordance can reveal fundamental properties of the genetic architecture, allowing the automated interpretation of unique polymorphisms within a personal genome.

Materials and methods

An analytical method, SPADE-gen, spanning three biological scales was developed to demonstrate the mechanistic concordance between Mendelian and complex inheritance of Alzheimer''s disease (AD) genes: biological functions (BP), protein interaction modeling, and protein domain implicated in the disease-associated polymorphism.

Results

Among Gene Ontology (GO) biological processes (BP) enriched at a false detection rate <5% in 15 AD genes of Mendelian inheritance (Online Mendelian Inheritance in Man) and independently in those of complex inheritance (25 host genes of intragenic AD single-nucleotide polymorphisms confirmed in genome-wide association studies), 16 overlapped (empirical p=0.007) and 45 were similar (empirical p<0.009; information theory). SPAN network modeling extended the canonical pathway of AD (KEGG) with 26 new protein interactions (empirical p<0.0001).

Discussion

The study prioritized new AD-associated biological mechanisms and focused the analysis on previously unreported interactions associated with the biological processes of polymorphisms that affect specific protein domains within characterized AD genes and their direct interactors using (1) concordant GO-BP and (2) domain interactions within STRING protein–protein interactions corresponding to the genomic location of the AD polymorphism (eg, EPHA1, APOE, and CD2AP).

Conclusion

These results are in line with unique-event polymorphism theory, indicating how disease-associated polymorphisms of Mendelian or complex inheritance relate genetically to those observed as ‘unique personal variants’. They also provide insight for identifying novel targets, for repositioning drugs, and for personal therapeutics.     

The Univariate and Bivariate Impact of HIV/AIDS on the Quality of Life： A Cross Sectional Study in the Hubei Province-Central China

This study is aimed to evaluate the quality of life （QOL） for individuals living with human immunodeficiency virus （HIV）/acquired immunodeficiency syndrome （AIDS） in Hubei province-central China by using WHOQOL-BREF instrument （Chinese version）. One hundred and thirty six respondents （HIV/AIDS individuals） attending out-patient department of Chinese Center for Disease Control and Prevention （Chinese CDC） were administered a structured questionnaire developed by investigators. QOL was evaluated by using WHOQOL-BREF instrument （Chinese version）. The results showed that the mean score of overall QOL on a scale of 0-100 was 25.8. The mean scores in 4 domains of QOL on a scale of 0-100 were 82.9 （social domain）, 27.5 （psychological domain）, 17.7 （physical domain） and 11.65 （environmental domain）. The significant difference of QOL was noted in the score of physical domain between asymptomatic （14.6） and early symptomatic individuals （12） （P=0.014）, and between patients with early symptoms （12） and those with AIDS （10.43） （P〈0.001）. QOL in psychological domain was significantly lower in early symptomatic （12.1） （P〈0.05） and AIDS patients （12.4） （P〈0.006） than in asymptomatic individuals （14.2）. The difference in QOL scores in the psychological domain was significant with respect to the income of patients （P〈0.048） and educational status （P〈0.037）. Significantly better QOL scores in the physical domain （P〈0.040） and environmental domain （P〈0.017） were noted with respect to the occupation of the patients. Patients with family support had better QOL scores in environmental domain. In our research, QOL for HIV/AIDS individuals was associated with education, occupation, income, family support and clinical categories of the patients. It was concluded that WHOQOL-BREF Chinese version was successfully used in the evaluation of QOL of HIV/AIDS individuals in Chinese population and proved to be a reliable and useful tool.     

β-蜕皮甾酮对激素性骨质疏松大鼠血清骨代谢指标及骨密度的影响

目的：观察β-蜕皮甾酮（β-Ecd）对糖皮质激素性骨质疏松大鼠血清骨代谢指标及骨密度（BMD）的影响。方法：30只雄性Wistar大鼠随机分为5组：对照组、泼尼松龙（Pred）组、Pred+β-Ecd（5 mg/kg）组、Pred+β-Ecd（10 mg/kg）组、Pred+阿仑膦酸（ALN）（3 mg/kg）组,每组6只。采用全自动生化分析仪检测各组大鼠血清钙、磷浓度、抗酒石酸磷酸酶（TRAP）和碱性磷酸酶（ALP）活性。应用Micro-CT测定各组大鼠第5 腰椎骨结构和BMD。结果：血清骨代谢指标检测结果显示,与对照组比较Pred组血清钙、磷水平显著升高,血清ALP活性和TRAP活性升高。与Pred组比,Pred+ALN组和Pred+β-Ecd（10 mg/kg）组血清钙、磷水平降低,血清ALP活性和TRAP活性降低。而Pred+β-Ecd（5 mg/kg）组血清ALP活性和TRAP水平降低,而对钙、磷水平无明显影响。骨结构和BMD Micro-CT检测结果显示,在所有Pred处理的大鼠中均观察到不同程度的骨丢失。在Pred组中第5腰椎的BMD值明显低于对照组。Micro-CT评估显示Pred组骨表面积和组织体积的比值（BS/TV）较对照组降低。三维模型分析显示,Pred组骨小梁数量（Tb.N）、骨体积分数（BV/TV）均明显低于对照组,并且骨小梁分离度（Tb.Sp）明显增加,但骨小梁厚度（Tb.Th）和结构模型指数（SMI）未表现出显著差异。与Pred组比,Pred+ALN组和Pred+β-Ecd（10 mg/kg）组BMD、BS/TV、BV/TV和Tb.N水平显著增加,而Tb.Sp和SMI降低。与Pred组相比,Pred+β-Ecd（5 mg/kg）组中BMD、BS/TV、BV/TV和Tb.N水平显著增高,而Tb.Th和Tb.Sp水平降低。结论：β-Ecd可能通过抑制骨丢失、改善骨代谢的作用机制,治疗糖皮质激素性骨质疏松症。     

具有抗细菌黏附和杀菌双重功能的(HA/CHI-Van)5涂层的制备

目的：研究开发一种涂覆(HA/CHI-Van)5多层膜结构的骨科内植入物以用于预防骨内植入物感染。方法：将透明质酸（HA）和壳聚糖-万古霉素（CHI-Van）溶液进行层层自组装,制备得到(HA/CHI-Van)5多层膜结构;通过zeta电位检测组装过程,通过活细菌染色实验评价多层膜的抗细菌黏附效果,通过越狱实验和FE-SEM实验检测体外抗菌效果。SD大鼠随机分为空白组、(HA/CHI-Van)5组和假手术组,并以X线、Micro-CT、骨组织切片等方法检测该材料的体内动物实验效果。结果：每次组装不同的单层,zeta电位交替变化,证明多层膜组装成功。活细菌染色实验显示多层膜结构中的CHI具有一定的抗细菌黏附作用。越狱实验和FE-SEM实验证明(HA/CHI-Van)5多层膜结构在体外具有良好的抗菌作用。在体外实验中,(HA/CHI-Van)5组的X线评分为0.7,而空白组的评分为12.3,(HA/CHI-Van)5组在骨密度、骨小梁数量、骨体积分数、骨组织切片方面均优于空白组（均P＜0.05）,且非常接近假手术组（均P＞0.05）。结论：通过在骨科内植入物表面涂覆(HA/CHI-Van)5多层膜结构能够获得一定的抗细菌黏附功能和良好的抗菌作用,可以预防骨内植入物感染。     

卡维地洛对兔心肌梗死后转化生长因子β_1表达和心室重构的影响

目的探讨卡维地洛对兔心肌梗死后转化生长因子β1(TGF-β1)的表达和心室重构的影响。方法采用结扎冠状动脉左室支建立心肌梗死(MI)模型(假手术组开胸后在相应部位挂线不结扎)。术后24h将存活兔分为3组:假手术组、MI组、MI+卡维地洛组。各组饲养4周后行血流动力学检查;测量体质     

Evaluation of antihepatotoxic potential of Solanum xanthocarpum fruit extract against antitubercular drugs induced hepatopathy in experimental rodents

Objective

To assess the hepatoprotective effect of Solanum xanthocarpum (S. xanthocarpum) fruit extract against antitubercular drug-induced liver toxicity in experimental animals.

Methods

Ethanolic (50%) fruit extract of S. xanthocarpum (100, 200 and 400 mg/kg bw) was administered daily for 35 days in experimental animals. Liver toxicity was induced by combination of three antitubercular drugs [isoniazid (I) 7.5 mg/kg, rifampicin (R) 10 mg/kg and pyrazinamide (P) 35 mg/kg] given orally as suspension for 35 days in rats. The hepatoprotective activity was assessed using various biochemical parameters like aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatise (ALP), total bilirubin (TBL), albumin (ALB), total protein (TP), lactate dehydroginase (LDH), and serum cholesterol (CHL). Meanwhile, in vivo antioxidant activities as lipid peroxidation (LPO), reduced glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT) were measured in rat liver homogenate. The biochemical observations were supplemented by histopathological examination.

Results

The results demonstrated that treatment with S. xanthocarpum significantly (P<0.05-P<0.001) and dose-dependently prevented drug induced increase in serum levels of hepatic enzymes. Furthermore, S. xanthocarpum significantly (up to P<0.001) reduced the LPO in the liver tissue and restored activities of defence antioxidant enzymes GSH, SOD and CAT towards normal levels. Histopathology of the liver tissue showed that S. xanthocarpum attenuated the hepatocellular necrosis and led to reduction in inflammatory cells infiltration.

Conclusions

The results of this study strongly indicate the protective effect of S. xanthocarpum against liver injury which may be attributed to its hepatoprotective activity, and thereby scientifically support its traditional use.     

乙型肝炎病毒e抗原对Bewo细胞RIG-I和MAVS表达的作用

目的探讨乙型肝炎病毒e抗原(hepatitis B e antigen,HBeAg)对Bewo细胞维甲酸诱导基因-I(retinoic acid-inducible-I,RIG-I)和线粒体抗病毒信号蛋白(mitochondrial antiviral signaling protein,MAVS)表达的作用。方法首先以终浓度2 μg/mL的RIG-I配体poly(dAT∶dAT)处理Bewo细胞24 h,观察RIG-I、MAVS mRNA的表达。然后将5 μg HBeAg重组质粒pcDNA3.1(+)-HBe转染Bewo细胞,转染48 h后,以2 μg/mL的poly(dAT∶dAT)刺激24 h。采用实时荧光定量反转录PCR和酶联免疫吸附测定分别检测细胞RIG-I、MAVS mRNA表达及上清干扰素-β(interferon-β,IFN-β)水平。并采用免疫荧光染色法观察HBeAg对细胞核因子-κB（nuclear factor-κB,NF-κB）p65入核的影响。结果poly(dAT∶dAT)可诱导Bewo细胞RIG-I、MAVS mRNA表达(27.86±9.49,21.75±8.04),高于对照组(14.51±6.27,11.59±4.73)(P<0.01)。转染5 μg HBeAg重组质粒组poly(dAT∶dAT)可诱导Bewo细胞RIG-I、MAVS mRNA表达(13.33±4.23,10.48±3.17)及IFN-β产生 [(14.20±5.01)pg/mL],低于对照组[27.86±9.49,21.75±8.04;(47.69±14.3)pg/mL](P<0.01),但与pcDNA3.1-HBe-5组[11.82±3.58,9.39±3.22;(10.82±3.75)pg/mL]比较,差异无统计学意义(P>0.05)。且HBeAg可干扰poly(dAT∶dAT)诱导Bewo细胞NF-κB p65入核,抑制NF-κB的激活。结论HBeAg可下调Bewo细胞RIG-I、MAVS mRNA的表达,并抑制NF-κB入核及IFN-β产生,这可能是乙型肝炎病毒(hepatitis B virus,HBV)逃避宿主免疫应答的一种重要策略。     

哮喘患儿血清IL-12、IL-4与IgE水平变化的研究

目的　研究哮喘患儿白细胞介素 12 (IL 12 )、白细胞介素 4 (IL 4 )与免疫球蛋白E(IgE)水平的变化。 方法哮喘患儿 30例 ,随机分为 :发作组 15例 ;缓解组 :15例。健康对照组 :2 0例。分别检测血清IL 12、IL 4 (ELISA法 )与IgE(MEIA法 )水平。结果　发作组血清IL 12水平明显低于     

家兔急性房颤模型的建立

目的探讨经快速肺静脉起搏方法制作家兔急性心房颤动(房颤)动物模型的可行性。方法64只家兔随机分为实验组(n=32)及对照组(n=32),对照组为假手术组通过开胸植入食道调搏电极但不起搏,实验组通过开胸植入食道调搏电极(程序刺激与Burst刺激相结合)刺激肺静脉建立家兔急性房颤模型     

膝外翻全膝关节置换外侧髌旁入路的手术方法探讨

目的探讨外侧入路行膝外翻全膝关节置换手术技术。方法采用膝关节外侧入路对中重度固定膝外翻患者行膝关节置换术。术中行膝关节正中偏外侧皮肤切口,行髂胫束苹果派样延长,自髌骨外侧“Z”字成形切开关节囊。以松解髂胫束止点、股骨侧及胫骨侧外侧副韧带及后外侧关节囊为主进行软组织平衡。股骨远端内外翻截骨定为5。外翻,股骨远端旋转角度截骨采用Whiteside线结合内外上髁轴线定位,全部病例均行髌骨置换。屈曲位缝合关节囊,将关节囊外侧袖套结构（深层）与内侧支持带边缘（浅层）缝合。结果8例10个膝外翻骨性关节炎患者采用外侧入路行全膝关节置换术。其中男1例1膝,女7例9膝。平均年龄68．2岁（58～79岁）。KrackowⅠ型外翻7例9膝,Ⅱ型1例1膝。临床分型均大于15°,属重度外翻。其中双膝关节同时置换2例4膝,单膝关节置换6例6膝。7例9膝采国产后稳定骨水泥型假体（TC—Dynamic,PLUS）,1例1膝采用进口旋转铰链式假体（RT—PLUS^TM Solution,PLUS）。全部患者术后外翻畸形均得到完全矫正,出院时均能独立或习步架辅助行走距离平均超过100m。关节活动度由术前平均95．6°（85°～110°）提高到术后平均117．1°（100°-125°）。被动内外翻活动度由术前平均12．6°（9°-15°）提高到术后0°。平均FTA角由术前的27．6°（20°～40°）提高到术后的6．8°（5°～9°）。KSS评分及功能评分由术前22．7分（9～48分）及26．5分（12—55分）分别提高到术后的86．4分（85～95分）及89．1分（80～95分）。术后平均随访时间19．6个月（1个月-51个月）,随访期间股胫角无明显变化,关节稳定性良好。结论采用外侧入路,关节囊“Z”字成形切开方法能够直接松解外侧韧带及软组织结构,并有效地缓解了腓总神经压力,解决了外侧软组织覆盖问题。