免疫吸附特异性清除循环肿瘤坏死因子-α对内毒素休克时一氧化氮的影响

目的观察免疫吸附特异性清除循环肿瘤坏死因子－α（ＴＮＦ－α）对内毒素休克时一氧化氮（ＮＯ）的生成及其作用的影响。方法利用新西兰白兔内毒素休克模型，观察经抗ＴＮＦ－α单克隆抗体亲和免疫吸附柱血液灌流对血压、血浆ＴＮＦ－α活性、ＮＯ－２含量、脏器ＮＯ合酶（ＮＯＳ）活性及肝、肾功能等的影响。结果免疫吸附治疗后，血浆ＴＮＦ－α水平迅速下降，２小时即为４４±１０Ｕ／ｍｌ；低血压状态明显改善，ＮＯ的生成与释放显著减少，２小时为８．７±２．１μｍｏｌ／Ｌ。脏器ＮＯＳ活性降低，肝肾功能损害显著减轻，实验动物存活率明显提高。结论免疫吸附特异性清除循环ＴＮＦ－α，其效果实际上相当于一种选择性抑制诱导型ＮＯＳ的方法，可能是治疗内毒素休克的一条新的有效途径。     

1,6—二磷酸果糖抗失血性休克实验研究

本实验观察了ＦＤＰ抗失血性休克作用。３组失血性休克大鼠分别接受５％ＦＤＰ溶液（Ａ组）、５％葡萄糖溶液（Ｂ组）和生理盐水（Ｃ组）静注。给药６０ｍｉｎ后，Ａ组ＭＡＰ为１０．４±２．１ｋＰａ，与Ｂ、Ｃ组７．９±２．４和７．７±２．６ｋＰａ间均有差异（Ｐ＜０．０１）；Ａ组动物存活率７５％，而Ｂ、Ｃ组分别为２５％和１５％（Ｐ＜０．０１）；Ａ组动脉血ｐＨ和ＰａＯ２分别为７．２４±０．１４和１３．４６±１．２２ｋＰａ，与Ｂ、Ｃ组７．１４±０．１４和１０．２９±３．８４ｋＰａ与７．０２±０．１０和７．２５±２．１２ｋＰａ间有显著差异（Ｐ＜０．０１）；Ａ组回输血液再灌流后血浆ＳＯＤ和ＭＤＡ分别为１２００±１２６Ｕｍｌ－１和０．４７±０．２５ｎｍｏｌｍｌ－１，同Ｂ、Ｃ组１０８１±１１９Ｕｍｌ－１和０．９１±０．２９ｎｍｏｌ－１与８３５±９Ｕｍｌ－１和１．１３±０．１６ｎｍｏｌ－１间均有显著差异（Ｐ＜０．０１）。结果表明ＦＤＰ保护组织损伤而产生抗休克作用。     

清除循环肿瘤坏死因子对急性肺损伤的影响

目的研究亲和免疫吸附清除循环肿瘤坏死因子（ＴＮＦ）对内毒素性急性动物的保护作用。方法以６１只新西兰白兔为实验动物，建立内毒素性急性肺损伤模型。随机分为三组：（１）免疫吸附组（２７只），颈静脉注射自制脂多糖（ＬＰＳ）１００×１０８ＣＦＵ／ｋｇ后１小时开始血液灌流，通过含重组肿瘤坏死因子ａ（ｒＨｕＴＮＦ－ａ）单克隆抗体的吸附柱，灌流时间２小时；（２）致伤组（２７只），颈静脉注射ＬＰＳ，无吸附柱，仅有相同血量的体外循环；（３）对照组（７只），颈静脉注射生理盐水２ｍｌ，无吸附柱，仅有体外循环。通过亲和免疫吸附清除循环ＴＮＦ，观察了肺系数、肺通透指数、肺泡灌洗液（ＢＡＬＦ）中ＴＮＦ和白细胞介素８（ＩＬ－８）水平、白细胞数的变化以及对存活率的影响。结果免疫吸附组能有效清除循环ＴＮＦ、ＢＡＬＦ中ＴＮＦ及ＩＬ－８水平较致伤组显著降低（Ｐ＜０．０１）。肺毛细血管通透性等指标明显清除循环ＴＮＦ、ＢＡＬＦ中ＴＮＦ及ＩＬ－８水平较致伤组显著降低（ｐ＜０．０１）。结论免疫吸附清除循环ＴＮＦ，能有效地保护内毒素所致的急性肺损伤。     

大鼠实验性肝硬变腹水形成及其与肿瘤坏死因子α关系的研究

目的：研究大鼠实验性肝硬变晚期腹水形成与肿瘤坏死因子α（ＴＮＦα）及肠源性内毒素血症的关系，探讨肝硬变腹水形成的机理。方法：以大鼠为实验对象，分为正常对照组（ｎ＝８）、肝硬变对照组（ｎ＝１２）和肝硬变伴腹水组（ｎ＝１８）。实验组采用复合因子复制肝硬变动物模型。各组均测定腹主动脉血中ＴＮＦα和内毒素水平，肝硬变组还测定了腹水量。结果：随着肝硬变形成，大鼠血中ＴＮＦα水平增高，各组含量分别为９０８３±１０７１ｎｇ／ｍｌ和９５７７±１２７６ｎｇ／ｍｌ（肝硬变组和肝硬变伴腹水组）。相关分析表明，肝硬变组腹水量与血中ＴＮＦα成正相关（ｒ＝０８６，Ｐ＜００５），内毒素水平增高，并与ＴＮＦα的浓度成正相关（ｒ＝０７５，Ｐ＜００５）。结论：肝硬变腹水形成与血中ＴＮＦα升高有关，而ＴＮＦα的升高则源于肠源性内毒素血症的形成。     

免疫吸附特异性清除循环肿瘤坏死因子—α对内毒素休克时一氧化氮？…

目的 观察免疫吸附特异性清除循环肿瘤坏死因子α（ＴＮＦ－α）对内毒素休克时一氧化氮（ＮＯ）的生成及其作用的影响。方法 利用新西兰白兔内毒素休克模型,观察经抗ＴＮＦα－单克隆抗体亲和免疫吸附血液灌注重对血压、血浆ＮＴＦ－α活性、ＮＯ２含量、脏器ＮＯ合酶（ＮＯＳ）活性及肝、肾功能等的影响,结果 免疫吸附治疗后,血浆ＴＮＦ－α水平迅速下降,２小时即为４４±１０Ｕ／ｍｌ,低血压状态明显改善,ＮＯ的生成与释     

乙型病毒性肝炎患者血清IFN-Υ和TNF-α的检测及意义

目的：探讨ＩＦＮ－和ＴＮＦ－α在乙型病毒性肝炎发病机制中的作用。方法：采用双抗体夹心ＥＬＩＳＡ法对９６例乙型肝炎患者和３０例健康献血员血清中ＩＦＮ－和ＴＮＦ－α进行检测，用ｔ检验进行统计学分析和相关性分析。结果：各型乙型肝炎患者血清ＩＦＮ－和ＴＮＦ－α水平明显高于对照组（Ｐ＜０．０５）；重型肝炎组（ｘＩＦＮ＝２３４．７±１６．５；ｘＴＮＦ＝３５９．０±１７．２ｐｇ／ｍｌ）与急性肝炎组（ｘＩＦＮ＝１７４．９±１２．０；ｘＴＮＦ＝２２０．６±８．９ｐｇ／ｍｌ）比较，前者均明显高于后者，差异显著（Ｐ＜０．０５）；各型乙型肝炎患者ＩＦＮ－和ＴＮＦ－α呈正相关（ｒ＝０．２４，Ｐ＜０．０５）。结论：ＩＦＮ－和ＴＮＦ－α异常增高可能与肝损伤发生有关。     

实验性急性胰腺炎大鼠肺内肿瘤坏死因子αmRNA的表达及其意义

为了解急性胰腺炎（ＡＰ）时,肺组织中肿瘤坏死因子（ＴＮＦ）转录水平上调在肺损伤机制中的意义,作者以半定量逆转录聚合酶链反应（ＲＴ－ＰＣＲ）技术,检测了急性水肿性胰腺炎（ＡＥＰ）与急性坏死性胰腺炎（ＡＮＰ）两种模型的大鼠肺组织内ＴＮＦ－αｍ ＲＮＡ 表达的状况,同时观察了它与内毒素（ＥＴ）血症及肺损伤的关系。结果表明,ＡＮＰ组血ＴＮＦ－α水平（１０７．４±４９．７ｐｇ／ｍ ｌ）显著高于ＡＥＰ组（５５．８±１０．３ ｐｇ／ｍ ｌ）,后者又高于对照组（４６．７±４．２ｐｇ／ｍ ｌ）（Ｐ＜ ０．０５）;诱导ＡＰ后１ 小时,肺组织内即出现了ＴＮＦ－αｍ ＲＮＡ的明显表达,在早期（３ 小时内）两组大鼠的表达水平接近,但随后ＡＮＰ组ＴＮＦ－α转录水平明显较ＡＥＰ组高（Ｐ＜ ０．０５）;ＡＮＰ组血ＥＴ水平（２０４．４±９５．４ＥＵ／Ｌ）也显著高于ＡＥＰ组（１２７．８±１９．４ＥＵ／Ｌ）,且当ＥＴ含量明显增多时（６ 小时）,肺内ＴＮＦ－αｍ ＲＮＡ表达强烈,同时肺部出现明确的病理损害。经分析,ＡＮＰ组大鼠血ＥＴ水平和肺内ＴＮＦ－αｍ ＲＮＡ表达水平均与其肺损伤评分呈正相关（γ＝ ０．９０,Ｐ＜ ０．０５ 及γ＝ ０．８７,Ｐ＜ ０．０５）,因此     

补阳还五汤治疗早期脑梗塞血清肿瘤坏死因子的变化

为探讨补阳还五汤治疗早期脑梗塞机理，将６０例患者分为补阳还五汤治疗组和对比治疗组（用７０６代血桨、复方丹参注射液、肠溶阿斯匹林治疗），动态观察发病第４ｄ、７ｄ、１４ｄ血清肿瘤坏死因子（ＴＮＦ）水平，并观察了治疗效果。结果：发病４ｄ两组ＴＮＦ分别为（２．９０３±０．４１０）ｎｇ／ｍｌ、（２．８９６±０．３９８）ｎｇ／ｍｌ，７ｄ时为（１．９０５±０．３５０）ｎｇ／ｍｌ、（２．００１±０．３８６）ｎｇ／ｍｌ，１４ｄ时为（１．３０１±０．２２３）ｎｇ／ｍｌ、（２．５０５±０．４０１）ｎｇ／ｍｌ（Ｐ＜０．０１），补阳还五汤组显效１６例，对比治疗组显效８例（Ｐ＜０．０５）。结论：补阳还五汤能改善早期脑梗塞患者ＴＮＦ代谢失衡状态，从而减轻ＴＮＦ介导的神经损伤而获效。显效率优于对比治疗组     

特异性清除循环肿瘤坏死因子—α对内毒素休克时氧自由基代谢的影响

为观察免疫吸附特异性清除循环肿瘤坏死因子－α（ＴＮＦ－α）对内毒素休克时氧自由基代谢的影响，给新西兰白兔一次性静注内毒素８．０×１０９ｃｆｕ／ｋｇ，免疫吸附组和空灌流组分别于１ｈ后经抗ＴＮＦ－α单克隆抗体亲和免疫吸附柱或未偶联抗体的空灌流柱进行血液灌流２ｈ，对照组不予血液灌流，观察血压、血浆ＴＮＦ－α活性和ＭＤＡ含量、全血ＧＳＨ－Ｐｘ活力的变化。结果发现免疫吸附治疗后，血浆ＴＮＦ－α水平迅速下降，低血压状态明显改善，血浆ＭＤＡ含量明显降低，全血ＧＳＨ－Ｐｘ活力显著增高。提示免疫吸附特异性清除循环ＴＮＦ－α能显著减少氧自由基的生成，抑制脂质过氧化作用。     

兔失血性休克及缺血──再灌流后血浆TXA_2与PGI_2含量的变化

复制失血性休克模型，采集休克前后及缺血──再灌流后颈动脉血液样本，利用放射免疫方法，测定血浆ＴＸＢ２和６—ｋｅｔｏ—ＰＧＦ１α含量变化。结果显示休克以及再灌后血浆ＴＸＢ２和６—ｋｅｔｏ—ＰＧＦ（１α）明显高于休克前水平（Ｐ＜０．０１或Ｐ＜０．０５），但再灌期与休克期相比，无显著性差异（Ｐ＞０．０５），ＴＸＢ２／６—ｋｅｔｏ—ＰＧＦ（１α）比值于休克及再灌后下降（Ｐ＜０．０５），但再灌期与休克期相比无显著性差异（Ｐ＞０．０５）。将休克前后、休克与再灌后血浆ＴＸＢ２和６—ｋｅｔｏ—ＰＧＦ１α的变化进行分析，两者无相关性（分别为ｒ＝０．１６６６和ｒ＝—０．４４０９）。本研究表明，单纯的输血输液不能明显地改善休克状态。至于休克及再灌后ＰＧＩ２变化的机理及其在休克中的作用，值得重新认识和深入探讨。     

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.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

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.