兔脑缺血再灌注后细胞凋亡与TIMP-1表达的特点

目的 探讨兔脑缺血再灌注后细胞凋亡和基质金属蛋白酶抑制因子-1（TIMP-1）表达的特点.方法 成年健康新西兰兔103只,应用线栓法建立大脑中动脉闭塞（MCAO）动物模型,将成功的60只兔MCAO模型随机分为永久性缺血组和缺血再灌注组,各30只.原位末端标记法检测两组脑组织细胞凋亡的情况,免疫组织化学方法检测脑组织TIMP-1表达的情况.结果 脑缺血后脑组织细胞凋亡数逐渐增多,缺血12 h达高峰,以后逐渐减少（F=14.48,q=4.79～9.39,P〈0.01）.缺血1 h时脑组织TIMP-1阳性细胞数逐渐增多,48 h达高峰（F=52.05,q=4.98～19.43,P〈0.01）.动物缺血1 h再灌注后,各时间点凋亡细胞数和TIMP-1表达都低于永久性缺血组,再灌注23 h阳性细胞数最多,再灌注47 h下降（F=8.34、53.34,q=3.10～18.70,P〈0.01）.结论 急性脑缺血再灌注后,细胞凋亡与TIMP-1表达一致.     

生地预处理对全脑缺血再灌注大鼠血清TNF与NSE表达的影响

目的：观察比较中药生地预处理与缺血预处理减轻全脑缺血再灌注大鼠肿瘤坏死因子（TNF）与特异性神经元 烯醇化酶（NSE）表达变化。方法：实验选用25只雄性SD大鼠，体质量180—220g,随机将25只大鼠分为5组（假手术组、缺血预处理组、生地预处理组、阿司匹林预处理组、脑缺血再灌注组），采用热凝椎动脉，钳夹双侧颈总动脉建立全脑缺血模型，缺血预处理组预缺血3min,3d后给予缺血10min,再灌注24h后处死。假手术组暴露双侧颈总动脉不夹闭，缺血再灌注组，夹闭双侧大脑颈总动脉10min，再灌注24h后处死。采用ELISA检测血清中TNF与NSE含量。结果：脑缺血再灌注后血清中TNF与NSE含量增加（P<0.05），生地预处理组与缺血预处理组血清中TNF与NSE含量降低，生地预处理组TNF与NSE含量与缺血预处理组比较P＞0.05，两者与缺血再灌注组比较P＜0.05。结论：生地预处理对随后的脑梗死有明显的保护作用，能诱导缺血耐受的产生。其机制可能是调节TNF与NSE的病理性表达。     

脑缺血再灌注后神经元特异性烯醇化酶和S-100β蛋白变化与神经功能等级评定的关系

背景：脑脊液和血浆中神经元特异性烯醇化酶(NSE)和神经组织蛋白S-100β含量在脑缺血性损伤时升高的程度能反映脑损伤的程度和预后。目的：观察大鼠脑缺血再灌注损伤脑组织NSE和S-100β的变化规律及其意义。设计：随机对照的研究。地点及对象：本实验在青岛大学医学院脑血管病研究所和山东省脑血管病防治重点实验室完成。成年健康雌性SD大鼠36只，体质量230-270g，清洁级，由中国科学院上海实验动物中心提供。方法：实验由作者完成。方法：用线栓法建立大鼠大脑中动脉缺血再灌注模型，应用神经等级评分观察脑缺血再灌注后行为功能的恢复，免疫组织化学法检测脑组织中NSE和S-100β的动态变化。主要观察指标：各组大鼠皮质区、纹状体NSE，S-100β含量及神经功能评分。结果：皮质区、纹状体区的NSE和S-100β免疫阳性反应均于缺血再灌注后12h明显增强，并随时间变化而逐渐下降，至14d降至正常水平。神经功能评分再灌注2h—1d时为3．00分，再灌注3，7，14d恢复至1．50分(t=2．60．4．48，P&;lt;0．05)。结论：脑缺血再灌注损伤后脑组织NSE和S-100β蛋白表达增加，并与神经功能恢复有相关性。     

高压氧对缺血再灌注小鼠脑组织细胞因子IL-10及血脑屏障通透性的影响

目的：探讨高压氧（HBO）对缺血再灌注小鼠脑组织中细胞因子IL-10含量、mRNA的表达、血脑屏障（BBB）通透性的影响。方法：复制清醒小鼠脑缺血再灌注模型，并于再灌注期间行0．25MPa（CBFATA）HBO治疗5次，在处死动物前1h经尾静脉注射2％伊文思兰（Evansblue，EB），采用比色法、ABC—ELISA、RT—PCR分别检测脑组织中细胞因子IL-10含量、mRNA的表达及EB的含量的变化。结果：脑组织EB的渗出于缺血再灌注后第4h为最多，于再灌注后第11h、23h、48h、72h逐渐下降；HBO＋脑缺血再灌注组脑组织EB的渗出与相应时间的脑缺血再灌注组相比明显降低（P〈0．01）。HBO组脑组织EB的渗出与相应时间的假手术组相比变化不明显（P〉0．05）。脑缺血再灌注组细胞因子IL-10含量于再灌注11h开始增加并于再灌注23h达到高峰，再灌注48h、72h逐渐下降。脑缺血再灌注组细胞因子IL-10含量与相应时间的假手术组相比于再灌注后11h、23h、48h、72h都明显增高（P〈0．01）。HBO＋脑缺血再灌注组细胞因子IL-10含量于再灌注后11h、23h、48h、72h与相应时间的脑缺血再灌注组相比变化不明显（P〉0．05）；而IL-10mRNA的表达明显增加（P〈0．01）。HBO组与相应时间的假手术组相比IL一10含量和mRNA的表达变化都不明显（P〉0．05）。结论：HBO从基因水平可明显增加脑缺血再灌注72h细胞因子IL-10mRNA的表达，从而具有保护血脑屏障的作用；HBO对正常脑组织中IL-10含量、mRNA的表达作用不明显。     

电针对大鼠早期局灶性脑缺血再灌注损伤细胞凋亡机制的研究

摘要 目的：探讨电针刺激对大鼠早期局灶性脑缺血再灌注损伤细胞凋亡的机制。 方法：选用96只雄性SD大鼠,随机分为假手术组、模型组、电针组各32只。采用改良Longa线栓法制作缺血再灌注大脑中动脉闭塞（MCAO）大鼠模型,电针组于脑缺血再灌注2h后开始电针患侧“曲池”、“足三里”穴。各组于术后24h行神经行为学评分,TUNEL法检测脑组织细胞凋亡,免疫印迹法及逆转录PCR法检测脑组织细胞凋亡相关蛋白Bcl-2,Bax的表达,ELISA检测血清BDNF的变化。 结果：脑缺血再灌注24h后,电针组大鼠神经行为学评分较模型组差异有显著性,且脑组织中TUNEL阳性细胞数明显降低（P＜0.05）;与模型组相比,电针组Bcl-2表达增高,Bax表达下降;模型组与电针组血清脑源性神经营养因子（BDNF）水平较假手术组相比均明显下降,但电针组较模型组有进一步的升高,差异有显著性意义（P＜0.05）。 结论：电针刺激可抑制脑组织中Bax的表达,提高Bcl-2,BDNF的作用,对抗脑缺血再灌注损伤所致的细胞凋亡,达到加速神经功能恢复的目的。     

电针对MCAO大鼠脑皮质EPO表达和脑血流量的影响

目的：观察电针疗法对局灶性脑缺血大鼠脑皮层EPO表达和缺血局部组织血流量的影响,探讨其作用机制.方法：SD大鼠80只,随机分为正常组和假手术组各10只、模型组和电针组各30只;模型组和电针组又各按缺血再灌注24h、48h和72h分别分为3个亚组,每组10只.假手术组仅分离血管而不插线栓,模型组和电针组制备大脑中动脉缺血再灌注模型（MCAO）,电针组采用电针治疗.采用免疫组化组法及免疫印迹法检测大鼠脑皮质中促红细胞生成素（EPO）蛋白的表达,用激光多谱勒血流仪检测大鼠脑组织血流量（rCBF）的变化.结果：EPO免疫组化及Western结果比较,模型组及电针组EPO阳性细胞及蛋白表达均在脑缺血再灌注24h开始增加,48h达到峰值,72h开始下降,且电针组在3个时间点均高于同时间点模型组（P＜0.05,0.01）.rCBF比较,模型组和电针组随着24、48、72h 3个时间点呈明显增加趋势,且电针组各时间点rCBF均较模型组明显升高（P＜0.05,0.01）.结论：电针能使脑缺血再灌注脑组织中EPO表达增加,明显提高局部脑组织血流量,有助于减轻脑缺血再灌注后脑组织损伤.     

阿托伐他汀钙对大鼠脑缺血再灌注后NF-κB、表达及神经细胞凋亡的影响

目的：探讨阿托伐他汀钙对大鼠脑缺血再灌注后脑组织中NF-κBp65表达水平及神经细胞凋亡的影响。方法：Wistar大鼠105只，分为假手术组、再灌注组及干预组各35只。干预组阿托伐他汀灌胃20d后，与再灌注组采用大脑中动脉线栓法制备局灶性脑缺血再灌注模型，参考Longa的5分制法在大鼠麻醉清醒后进行评分，应用免疫组化、TUNEL法检测阿托伐他汀钙对大鼠脑缺血再灌注后NF-κBp65表达及对神经细胞凋亡的影响。结果：与假手术组比较，再灌注组及干预组大鼠脑缺血再灌注后缺血脑组织中NF-κBp65表达明显增加（P〈0．01），缺血再灌注24h达高峰；干预组给予阿托伐他汀钙干预后与再灌注组比较能减少缺血脑组织中NF-κBp65表达（P〈0．01），减少神经元凋亡（P〈0．01），降低神经功能缺损评分（P〈0．01）。结论：阿托伐他汀钙能抑制大鼠脑缺血再灌注后脑组织中NF-κBp65表达，并能减少神经元凋亡，减轻缺血再灌注损伤。     

肌苷对脑缺血再灌流损伤神经功能恢复和S-100β表达的影响

目的：观察大鼠脑缺血再灌流损伤脑组织S-100β蛋白的变化规律；探讨肌苷对缺血性脑损伤的保护机制。方法：成年SD大鼠建立大脑中动脉缺血(MCAO)再灌流模型，腹腔注射肌苷注射液，应用神经功能等级评分观察脑缺血再灌流后行为功能的恢复，免疫组化法检测脑缺血再灌流各时间点脑组织中S-100β的动态变化。结果：对照组脑缺血再灌流后3d、7d、14d功能恢复、等级评分减低；缺血侧S-100β的免疫阳性反应于脑缺血再灌流后12h明显增强，随时间推移逐渐增强，3d达高峰，7d时有昕下降，14d降至假手术组水平。治疗组治疗后神经功能评分在7-14d明显低于对照组，同时脑组织中S-100β蛋白表达水平较对照组显著升高。结论：肌苷对缺血性脑损伤的功能恢复有一定的促进作用，其机制可能与增加脑组织中S-100β的表达有关。     

左卡尼汀对脑缺血再灌注损伤的抗氧化作用及其机制研究

目的：观察左卡尼汀对脑缺血再灌注损伤的保护作用，探讨其作用机制。方法：健康雄性Wistar大鼠40只，随机分成4组：假手术组、生理盐水对照组、左卡尼汀100mg／kg治疗组及左卡尼汀200mg／kg治疗组，每组10只。采用线栓法制备大脑中动脉缺血再灌注模型，缺血2h，再灌注24h，观察左卡尼汀对脑组织丙二醛（MDA）、超氧化物歧化酶（SOD）含量的影响，HE染色观察大鼠脑组织的病理改变。结果：左卡尼汀可明显减少MDA的含量，升高SOD活性，同生理盐水对照组相比，P〈0．01。结论：左卡尼汀对脑缺血再灌注损伤有保护作用，与提高脑组织中抗氧化酶活性、抑制氧自由基产生及脂质过氧化反应有关。     

活血通脉汤对脑缺血再灌注大鼠TNF-α、ICAM-1表达的影响

目的：探讨活血通脉汤对脑缺血再灌注大鼠脑组织TNF-α、ICAM-1的影响。方法：制作脑缺血再灌注模型，70只大鼠随机平均分为活血通脉汤组、阿司匹林组、手术组和假手术对照组，应用免疫组织化学方法分别测定缺血再灌注24h、48h脑组织TNF-α、ICAM-1表达的改变情况。结果：手术组大鼠脑缺血再灌注24h、48h脑皮质TNF-α、ICAM-1表达显著高于假手术对照组（P〈0．01），缺血再灌注48h ICAM-1表达低于24h（P〈0．05）。使用活血通脉汤治疗能降低TNF-α、ICAM-1表达水平，减轻缺血脑组织神经元坏死的程度。结论：活血通脉汤对脑缺血再灌注具有保护作用，其机制与其降低TNF-α、ICAM-1的表达，从而减少神经元坏死有关。     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿，主要表现为肺炎支原体感染为临床特点进行分析，并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中，以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征；②外周血：85％（47／55）的病例外周血变化不大，WBC（4—10）×10 9／L之间，嗜酸性粒细胞增多；③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性，83．64％（46／55）PeR技术检测肺炎支原体特异性DNA；④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一，对儿童慢性咳嗽，特别是顽固性咳嗽的诊治中应更加重视。     

Trust and distrust between patient and doctor

To trust someone is to have expectations of their behaviour; distrust often involves disappointed expectations. But healthy trust and distrust require a good understanding of which expectations are reasonable, and which are not. In this paper, I discuss the limits of trustworthiness by drawing on recent studies of trust in the context of defensive medicine, biobanking and cardiopulmonary resuscitation decisions.     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.