PPARα／PGC—lα信号通路对大鼠肥大心肌细胞能量代谢的影响

目的：探讨过氧化物酶体增殖物活化受体仪（PPARα）／过氧化物酶体增殖物激活受体,辅激活子la（PGC一1仅）信号通路对血管紧张素Ⅱ（AngⅡ）诱导大鼠肥大心肌细胞能量代谢的影响。方法：将原代培养的新生大鼠心肌细胞分为对照组（C组）、Ang刺激组（AngⅡ组）、PPARa激活剂及非诺贝特预处理组,即（AngII＋F）组,C组予生理盐水处理,AngII组加入AngⅡ（终浓度10mmol／L）刺激24h建立肥厚心肌细胞模型,（AngⅡ＋F）组心肌细胞在AnglI刺激前24h加非诺贝特（10Ixmol／L）预处理;HE染色后采用软件检测细胞表面积,用Western-blot检测心肌细胞中PPARa、PGC-1仅和腺苷酸转运体（ANT）蛋白表达水平,用高效液相层析法（HPLC）测量线粒体内腺苷酸含量,氚标iE--磷酸腺苷（3H-ADP）掺入法检测线粒体膜ANT转运活性。结果：与AngII组相比,非诺贝特可使PGC·la、ANT表达上调（P〈0．05）,细胞内线粒体内高能磷酸盐含量则未发现有显著变化（P〉O．05）,但显著逆转了AnglI诱导的心肌细胞肥大,改善了AnglI引起的ANT转运活性下降（P〈0．05）。结论：PPARa／PGC-la信号通路激活能有效预防心肌细胞肥大,可改善心肌能量代谢,对缺血后心肌有保护作用。     

CaMKⅡ信号通路在神经肽Y诱导心肌细胞肥大中的作用

目的：探讨钙离子／钙调蛋白（Ca^2＋／CaM）依赖的蛋白激酶Ⅱ（CaMKⅡ）信号通路在神经肽Y（NPY）诱导下心肌细胞肥大的作用。方法：原代培养SD乳鼠心肌细胞，将细胞分为5组，NPY组：培养液中加入终浓度为100nmol／L的NPY：KN-931组、KN-935组和KN-9310组除加入100nmol／L的NPY外，分别加入CaMKⅡ特异性抑制剂KN-93，终浓度为1μmol／L、5μmol／L和10μmol／L；对照组：培养液中不加任何刺激药品。加药24h后采用 ^3H-亮氨酸（Leu）掺入法测定各组心肌细胞蛋白质合成速率，Western blotting测定对照组与NPY组心肌细胞的CaMKⅡδ蛋白表达。结果：经100nmol／L NPY刺激24h后，可明显增加心肌细胞^3H-Leu掺入量（p〈0．05），KN-93（1-10μmol／L）可以抑制NPY刺激的心肌细胞^3H-Leu掺入量的增加，并呈剂量依赖性（P均〈0．05）；100nmol／L NPY明显增加心肌细胞内CaMKⅡδ蛋白的表达（P〈（0．05）。结论：Ca^2＋／CaM依赖的蛋白激酶Ⅱ（CaMKⅡ）信号途径参与NPY诱导的大鼠心肌细胞肥大反应。     

非对称二甲基精氨酸诱导大鼠心肌细胞肥大的作用

目的：探讨非对称二甲基精氨酸（ADMA）诱导心肌细胞肥大的作用机制。方法：原代取材新生SD大鼠的心肌细胞进行细胞培养。原代培养的第4天，用不同浓度的ADMA（4～16μmol／L）和L-精氨酸（L-arg）（0．8～3．2mmol/L）处理心肌细胞，24h后测定细胞上清液中一氧化氮（NO）的含量、一氧化氮合酶（NOS）的活性，细胞内氧活性物质（ROS）的水平、RNA含量、总蛋白量以及心肌细胞表面积。结果：①4μmol／L，8μmol／L，16μmol／L的ADMA分别能剂量依赖性使细胞内NO的含量减少，NOS的活性降低（P〈0．05）；②16μmol／L的ADMA能使心肌细胞内ROS的水平升高、细胞内RNA含量和总蛋白含量增加以及心肌细胞表面积增加（P〈0．05）；⑧0．8mmol／L，1．6mmol／L，3．2mmol/L的L-arg对ADMA诱导的心肌细胞内ROS水平的升高、细胞内RNA含量和总蛋白含量的增加以及心肌细胞表面积的增加产生剂量依赖性的抑制作用（P〈0．05）。结论：ADMA能够诱导心肌细胞肥大，NO的前体L-arg能够剂量依赖性地抑制ADMA诱导的心肌细胞肥大。     

HOE642对缺氧/复氧心肌细胞的保护机制

目的 观察Na^＋/H^＋交换抑制剂HOE642对心肌细胞缺氧／复氧（A／R）损伤的保护作用，方法 原代培养的心肌细胞分为对照组、A／R组、A／R＋HOE642组、A／R＋尼卡地平（Nic）组、A／R＋蛋白激酶（PKC）阻滞剂（H7）组和A／R＋丝裂元活化蛋白激酶（MAPK）阻滞剂（PD98059）组。检测各组心肌细胞内游离钙浓度（[Ca^2＋]i）、细胞活力、ATP含量及孵育液中乳酸脱氢酶（LDH）含量、MAPK和PKC活性。免疫印迹法检测心肌细胞钙蛋白酶（u-calpain和m-calpain）。结果 A／R＋Nic、A／R＋HOE642使心肌细胞[Ca^2＋]i降低，且m-calpain蛋白表达亦降低。A／R＋Nic、A／R＋HOE642组心肌细胞孵育液中心肌激酶（LDH、CK）均低于A／R组（P〈0．01）；细胞活力、ATP含量、PKC和MAPK活性高于A／R组（P〈0．05或P〈0．01）。PKC抑制剂H7及MAPK抑制剂PD98059组心肌细胞孵育液中心肌激酶（LDH、CK）均高于A／R组（P〈0．05），细胞活力、ATP含量明显低于A／R组（P〈0．05）。结论 HOE642与钙通道阻滞剂一样，可抑制心肌细胞内游离钙超载引起的心肌细胞A／R损伤，阻断PKC和MAPK，使A／R的心肌细胞损伤加剧。     

芬太尼配伍小剂量吗啡用于硬膜外术后镇痛效果的观察

目的探讨芬太尼配伍小剂量吗啡用于成人硬膜外术后镇痛的效果。方法将33例择期手术患者随机分3组，组Ⅰ：o．125％盐酸罗哌卡因＋0．004％芬太尼。组Ⅱ：0.125％盐酸罗哌卡因＋0．006％芬太尼。组Ⅲ：0．125％盐酸罗哌卡因＋0．004％芬太尼＋0．03％吗啡。术后定时进行镇痛、镇静评分及不良反应的观察。结果镇痛评分组Ⅱ、组Ⅲ明显低于组Ⅰ（P〈0．05），镇静评分组Ⅰ明显低于组Ⅱ、组Ⅲ，不良反应率组Ⅰ、组Ⅲ明显低于组Ⅱ（P〈0．05）。结论芬太尼配伍小剂量吗啡用于成人硬膜外术后镇痛能取得较满意的效果。     

内皮素-1和Ki-67在膀胱癌中的表达及意义

目的探讨内皮素-1（ET-1）在膀胱癌中的表达及其与肿瘤细胞增殖的关系。方法应用免疫组化方法对63例膀胱癌中ET-1和Ki-67的表达进行检测。结果63例膀胱癌中ET-1的阳性表达率为30．16％（19／63），明显高于正常组（P〈0．05）。ET-1的表达随着肿瘤的分级增高而增强，各级各期之间ET-1的表达差异均有显著性（P〈0．05）。膀胱癌中Ki-67的表达阳性率为33．33％（21／63），肿瘤分级愈高Ki-67的表达愈强，各组间差异有显著性（P〈0．05），未发现分期间Ki-67的表达差异（P〉0．05）。膀胱癌细胞中ET-1表达和Ki-67表达呈正相关（r=0．623，P〈0．01）。结论ET-1的表达随肿瘤恶性程度的增加而增强，且与Ki-67有明显相关性，提示ET-1的高表达在膀胱癌的发生或发展方面可能起重要作用。     

重组腺病毒转染心衰大鼠心肌细胞cAMP水平变化

目的测定重组腺病毒Ad5-ADRbeta2-EGFP转染体外培养心衰大鼠心肌细胞48h后环磷酸腺苷（cAMP）的水平变化。方法重组腺病毒Ad5-ADRbeta2-EGFP转染心衰大鼠心肌细胞,培养48h后,检测心肌细胞β2-AR蛋白表达和cAMP的水平。结果①心肌细胞β2-AR蛋白表达测定：心衰组与对照组（假手术组）相比没有明显差异（P〉0．05）,心衰＋β2组与心衰组、对照组相比均明显升高（P〈0．05）。②心肌细胞cAMP水平：心衰组与对照组（假手术组）相比明显减少（P〈0．01）,心衰＋β2组与心衰组相比明显升高（P〈0．01）,心衰＋ISO组与心衰组相比明显升高（P〈0．01）,心衰＋ISO＋β2组与心衰组相比明显升高（P〈0．01）,心衰＋ISO＋β2组与心衰＋β2组、心衰＋ISO组相比没有明显差异（P〉0．05）。结论重组腺病毒Ad5-ADRbeta2-EGFP转染体外培养心衰大鼠心肌细胞后,β2-AR蛋白表达上调,同时伴有基础cAMP逆转恢复正常水平,其可能与β2-AR活性的内在活化有关。     

降脂冲剂抗动脉粥样硬化的临床观察

目的：观察降脂冲剂抗动脉粥样硬化的临床效果。方法：135例高血脂症患者随机分为降脂冲剂治疗组（简称T组）95例，肠溶阿司匹林对照组（C组）40例，同时观察降脂冲剂开放组（O组）58例，治疗8周，T组观察颈动脉血管内膜-中膜厚度（IMT）者治疗6月。治疗前后按中、西医证候计分，并检查心电图、血脂、血糖、血尿素氮、肌酐、血尿酸、血尿常规，P选择素、NO、ET-1、OX-LDL和颈动脉IMT。结果：T组综合疗效显效率48．5％、总有效率81．2％，优于C组7．7％及21．5％（P〈0．01）。T组头晕耳鸣、腰酸口干、手足心热、舌质红、脉细速等证候积分治疗后均有下降，优于c组下降（P均〈0．01）。T组与C组TC、TG、LDL-C、OX-LDL、ET-1治疗后的下降均有显著性（P均〈0．05）。T组治疗后NO、HDL-C分别上升＋13．6％、＋43．1％，C组分别是-4．2％、＋4．3％（P〈0．01）。T组P选择素治疗后降低25．1％，治疗前后P〈0．0l，与C组比较，P〉0．05。T组颈动脉IMT检出率下降明显（P〈0．05）。结论：降脂冲剂治疗高血脂症，安全、有效，且有调脂及抗动脉粥样硬化作用。     

美托洛尔联合拉西地平片治疗高血压60例

目的观察美托洛尔联合拉西地平与两药单用对高血压病的降压效果及安全性。方法将1、2级原发性高血压患者120例随机分成联合治疗组60例,关托洛尔组30例,拉西地平组30例三组。联合治疗组60例服用拉西地平片2mg,每天2次,美托洛尔12．5哗,每天2次;关托洛尔组30例,单用美托洛尔12．5～50mg,每天2次;拉西地平组30例,单用拉西地平片2—4mg,每天2次,均治疗6周,观察三组降压效果,对心率的影响及不良反应发生率。结果联合治疗组降压有效率及不良反应发生率分别为95．0％、10．0％,与美托洛组的80％、30％相比差异有统计学意义（P〈0．05、P〈0．01）;与拉西地平组的80％、40％相比差异有统计学意义（P〈0．05、P〈0．05）。治疗6周后联合治疗组心率无明显改变（P〈0．05）;关托洛尔纽心率明显减慢（P〈0．05）;拉西地平组则心率明显增快（P〈0．05）。结论美托洛尔联合拉西地平片有协同降压作用,减少了不良反应,并克服了两药对心率的影响。     

川芎嗪关节腔内注射对膝骨关节炎的治疗作用

目的：探讨川芎嗪关节腔内注射对膝骨关节炎的治疗作用。方法：7l例膝骨关节炎患者随机分为两组，分别予盐酸川芎嗪注射液或透明质酸钠注射液膝关节腔内注射，每周1次，连续5周。随访3月。参照Lequesne骨关节炎严重性和活动性评估法制定观察表，分别对两组患者治疗前后Lequesne评分及疗效进行比较。结果：透明质酸钠组在治疗1周后Lequesne评分较治疗前有明显降低（P〈0．01），川芎嗪组在治疗3周后Lequesne评分明显降低（P〈0．01）。治疗5周后，川芎嗪组总有效率为82．1％，透明质酸钠组总有效率为87．2％，两组疗效差异无统计学意义（P〉0．05）。两组在治疗过程中均未见明显的不良反应。结论：川芎嗪关节腔内注射对膝骨关节炎具有治疗作用，且无明显不良反应，但起效较慢。     

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…     

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.     

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.     

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.     

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.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…