七氟醚迟发性预处理对大鼠局灶性脑缺血 损伤后NF-κB表达的影响

［摘要］目的：比较不同浓度七氟醚诱导的迟发性脑保护效应以及对大鼠局灶性脑缺血再灌注损伤后不同时间点NF-κB蛋白表达的影响。方法：健康SD雄性大鼠60只,体质量220～300 g,随机分为缺血再灌注组（I/R组）、2.5%七氟醚组（Sevo 1组）和4.0%七氟醚组（Sevo 2组）。采用大鼠大脑中动脉闭塞(middle cerebral artery occlusion, MCAO) 制备局灶性脑缺血再灌注模型。I/R组于脑缺血前24 h吸入纯氧,而Sevo 1组及Sevo 2组分别于脑缺血前24 h 吸入2.5% 或4.0%七氟醚+氧气混合气体60 min。缺血2 h,再灌注24和72 h后取脑组织,运用2,3,5-氯化三苯四唑（2, 3, 5-triphenyltetrazolium chloride,TTC）染色测算脑梗死体积百分比,免疫组化染色检测NF-κB蛋白表达。结果：与I/R组相比,Sevo 1组和Sevo 2组再灌注24和72 h脑梗死体积显著减少（P＜0.05）。I/R组脑组织顶叶皮层缺血半影区NF-κB表达明显增加,七氟醚能显著抑制脑缺血再灌注后24和72 h缺血半影区NF-κB表达的增加（P＜0.05）。结论：七氟醚对大鼠局灶性脑缺血再灌注损伤具有迟发性保护作用,其机制可能与降低NF-κB蛋白表达有关。     

吸入麻醉对大鼠急性肾缺血再灌注损伤的保护

目的探讨吸入麻醉剂对急性肾缺血-再灌注损伤的保护作用及其机制。方法SD大鼠36只,随机分为对照(S)组、缺血-再灌注(IR)组、异氟醚(SIO)组和七氟醚(Sevo)组,每组12只。建立大鼠急性肾缺血-再灌注损伤模型,缺血-再灌注后3h分别检测血清尿素氮(BUN)、肌酐(Cr)、超氧化物歧化酶(SOD)、丙二醛(MDA)及观察肾组织的病理学变化。结果与S组比较,IR组血清BUN、Cr水平显著增加(P<0.05),ISO组和Sevo组BUN、Cr低于IR组(P<0.05);与IR组比较,ISO组和Sevo组SOD显著升高,MDA显著降低(P<0.05);IR组和ISO组和Sevo组血清IL-6、TNF-α显著大于S组(P<0.05),但与IR组比较,ISO组和Sevo组均低于低于IR组(P<0.05);ISO组和Sevo组肾组织病理损伤分级明显低于IR组;ISO组和Sevo组比较各项指标均无显著性差异(P>0.05)。结论吸入麻醉药对大鼠急性肾缺血-再灌注损伤具有保护作用,抑制氧自由基反应和降低IL-6、TNF-α等细胞因子水平可能是其重要机制。     

七氟烷预处理对老年大鼠心肌线粒体敏感性钾通道的影响

目的:研究七氟烷预处理对老年大鼠心脏功能和线粒体形态结构的影响及其机制。方法:选取清洁级健康雄性SD大鼠60只,首先建立稳定的离体心脏灌注模型,经KH平衡液平衡15 min后随机将其分为假手术组、缺血再灌注(I/R)组、七氟烷预处理Ⅰ(SevoⅠ)组(0.5 Mac七氟烷)、七氟烷预处理Ⅱ(SevoⅡ)组(1.0 Mac七氟烷)、SevoⅠ+5-HD组、SevoⅡ+5-HD组,每组10只。比较平衡后,缺血前,再灌注5、15、30 min时的冠脉血流量(coronary flow,CF)、心率(heart rate,HR)、左室发展压(left ventricular developed pressure,LVDP)和左室舒张末压(left ventricular end diastolic pressure,LVEDP)。观察灌注末胞浆膜下线粒体(subsarcolemmal mitochondria,SSM)、心肌纤维间线粒体(intermyocardial fiber mitochondria,IFM)的形态学变化。结果:再灌注5、15、30 min,SevoⅠ组与SevoⅡ组CF、HR、LVDP均高于I/R组(P0.01),LVEDP均低于I/R组(P0.01);SevoⅠ+5-HD组CF、HR、LVDP均低于SevoⅠ组(P0.01),LVEDP均高于SevoⅠ组(P0.01);SevoⅡ+5-HD组CF、HR、LVDP均低于SevoⅡ组(P0.01),LVEDP均高于SevoⅡ组(P0.01)。电镜结果显示,SevoⅠ组、SevoⅡ组心肌线粒体形态保存较好,但联合应用K通道抑制剂5-HD后(SevoⅠ+5-HD组、SevoⅡ+5-HD组),其保护效应消失。结论:七氟烷预处理可增加老年大鼠缺血心脏的CF,减轻缺血再灌注对心肌细胞线粒体的损伤,而K通道抑制剂5-HD可以取消七氟烷预处理对老年大鼠缺血心肌的保护作用。     

七氟醚预处理对大鼠肝脏缺血再灌注损伤后TNF-α、IL-1β的影响

目的:探讨七氟醚预处理对大鼠肝脏缺血再灌注损伤后肿瘤坏死因子(TNF-α)和白细胞介素1β(IL-1β)表达水平的影响.方法:将40只SD雄性大鼠随机分为两组,每组20只,即肝脏缺血再灌注损伤(IR)组,七氟醚预处理(Sev)组.分别于肝脏缺血前(T1)、肝脏再灌注后30 min(T2)、120 min(T3)各时点,经股动脉采血2 mL,血液离心取血清,测定大鼠血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、乳酸脱氢酶(LDH)作为肝损害的标志,光镜检查组织病理学改变,检测大鼠血清TNF-α、IL-1β水平.结果:Sev组血清ALT、AST、LDH水平明显低于IR组(P<0.05),光镜下显示Sev组肝脏损伤程度小于IR组.Sev组IL-1β表达低于IR组(P<0.05),Sev组TNF-α的表达低于IR组,但差异无统计学意义(P>0.05).结论:七氟醚预处理可能通过抑制炎症细胞因子途径产生对肝脏缺血再灌注损伤起保护作用.     

苯妥英对局灶性脑缺血-再灌注后脑组织炎性细胞因子水平的影响

目的观察大鼠局灶性脑缺血-再灌注后脑组织炎性细胞因子水平的变化以及苯妥英（PHT）对其影响，以进一步探讨局灶性脑缺血-再灌注损伤机制及PHT对缺血-再灌注损伤后保护作用的机制。方法将雄性成年wistar大鼠随机分为4组：即假手术组、缺血-再灌注组、PHT低剂量治疗组和PHT高剂量治疗组。每组均观察手术后6、12和24h3个时间点的改变。采用线栓法制成大脑中动脉闭塞模型。测定手术后不同时点缺血脑组织白细胞介素-1β（IL-1β）和肿瘤坏死因子-α（TNF-α）的水平。结果缺血-再灌注组各时点IL-1β和TNF-α水平与假手术组相应时点比较明显升高，差异具有显著性（P〈0．05），PHT低剂量治疗组和高剂量治疗组IL-1β和TNF-α水平明显低于缺血-再灌注组各相应时间点（P〈0．05），PHT高剂量治疗组各时点IL-1β、TNF-α水平与PHT低剂量治疗组各相应时间点比较明显降低（P〈0．05）。结论脑缺血-再灌注后，缺血大鼠脑组织内的IL-1β和TNF-α的水平升高，说明炎性细胞因子参与了脑缺血-再灌注损伤的病理生理过程；PHT可降低IL-1β和TNF-α的水平，从而对脑缺血-再灌注损伤具有保护作用。     

大鼠局灶性脑缺血再灌注后纹状体内肿瘤坏死因子-α及白细胞介素-1β的动态变化

目的观测大鼠局灶性脑缺血再灌注早期不同时间缺血侧纹状体内肿瘤坏死因子-α(TNF-α)及白细胞介素-1β(IL-1β)的动态变化。方法对60只雄性Sprague-Dawley(SD)大鼠采用大脑中动脉线栓法建立局灶性脑缺血模型,并随机将大鼠分为对照组、缺血再灌注组,每组30只。缺血再灌注组在大鼠脑缺血1 h后进行再灌注。在再灌注1、3、6、122、4 h,应用ELISA方法检测缺血侧纹状体TNF-α及IL-1β的动态变化。结果与对照组相比,脑缺血大鼠再灌注1 h缺血侧纹状体TNF-α含量开始明显增高[(9.91±1.57)μg.(g Pro)-1],而IL-1β在再灌注3 h后才有明显升高[(8.75±1.59)μg.(g Pro)-1],TNF-α及IL-1β均于再灌注6 h升高最为明显[(12.62±1.64,12.24±1.23)μg.(g Pro)-1],然后逐渐下降,且至再灌注24 h二者仍维持在较高水平[(9.81±1.53,8.52±1.49)μg.(g Pro)-1](均P<0.05)。结论局灶性脑缺血再灌注后早期TNF-α及IL-1β的含量增高可能在缺血再灌注性脑损伤的病理过程中起重要作用。     

七氟醚对脂多糖诱导的大鼠急性肺损伤的保护效应

目的:评估七氟醚后处理对脂多糖(LPS)致急性肺损伤(ALI)大鼠肺的影响.方法:随机将30只大鼠分为5组(n=6):生理盐水组、脂多糖组:气管内滴注生理盐水1 ml/kg或脂多糖 5 mg/kg;七氟醚30 min组、七氟醚1 h组、七氟醚2 h组:气管内滴注脂多糖后4 h,分别吸入2.4%七氟醚0.5,1,2 h.各组于滴注生理盐水或脂多糖后6 h放血处死.检测各组肺组织病理切片和肺泡灌洗液(BALF)中TNF-α,IL-1β和IL-10的浓度.结果:与生理盐水组比较,脂多糖组病理切片示肺泡正常结构破坏严重,灌洗液中TNF-α,IL-1β和IL-10浓度显著升高(P<0.01).与脂多糖组比较,七氟醚组病理切片示肺泡结构破坏较轻,灌洗液中TNF-α,IL-1β和IL-10浓度降低(P<0.05);且1,2 h组七氟醚改善病理形态和抑制TNF-α,IL-1β的效果更佳.结论:七氟醚后处理能减轻脂多糖致急性肺损伤大鼠肺部炎症反应,且吸入时间长有更佳的效果.     

七氟烷后处理对海马HO-1表达的影响及其抗炎作用

目的 探讨七氟烷后处理对大鼠脑缺血再灌注损伤的保护作用及血红素氧合酶-1(HO-1)的抗炎作用.方法 清洁级雄性SD大鼠40只,体重230～270g,随机分为5组,假手术组(C组)、缺血再灌注组(IR组)、七氟烷组(S组)、抑制剂组(S+Z组)和溶剂对照组(S+D组).采用双侧颈总动脉夹闭合并低血压方法 制备脑缺血再灌注损伤模型.将所有大鼠再灌注24h后处死,取海马.光镜下观察各组海马病理学变化,检测海马肿瘤坏死因子α(TNFα)、白细胞介素1β(IL-1β)和HO-1表达.结果 七氟烷组HO-1(0.466±0.041)较缺血再灌注组(0.338±0.023)显著升高(P<0.05),TNF-α和IL-1β较缺血再灌注组显著降低(P<0.05);抑制剂组HO-1较七氟烷组显著降低(P<0.05),TNF-α和IL-1β较缺血再灌注组显著升高(P<0.05);七氟烷组海马病理学损伤较缺血再灌注组和抑制剂组减轻.结论 七氟烷后处理对大鼠脑缺血再灌注损伤有保护作用,其作用机制可能与七氟烷上调脑组织中HO-1表达,从而抑制炎症反应有关.     

大黄素甲醚对大鼠脑缺血预处理后缺血再灌注损伤作用的探讨

目的探讨脑缺血预处理联合大黄素甲醚(Phy)治疗对大鼠脑缺血再灌注损伤的保护作用及其机制。方法SD大鼠随机分为四组,分别为假手术组、脑缺血再灌注组、脑缺血预处理组和Ply治疗组。各组采用Zea-longa等的大脑中动脉线栓法并加以改进,制备缺血预处理及缺血再灌注损伤实验动物模型。比较各组神经功能缺失评分、脑梗死体积、血清神经元烯醇化酯(NSE)含量及脑组织白细胞介素-1β(IL-1β)和肿瘤坏死因子-α(TNF-α)含量。结果脑缺血预处理联合Phy可使神经功能缺损减轻、脑梗死体积缩小、血清NSE含量降低,均较缺血预处理组更为明显。脑组织IL-1β和TNF-α含量降低亦更为明显。结论Phy可增强缺血预处理诱导的脑缺血耐受作用,下调脑组织再灌注损伤时IL-1β和TNF-α的表达,二者具有叠加作用。     

不同脑缺血预处理时相对再次缺血损伤大鼠脑组织中IL-1β、TNF-α、IL-10含量的影响

目的观察脑缺血预处理(CIP)后24、72、120、168h4个不同的时间点再次缺血损伤大鼠脑组织中白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)含量的变化趋势,探讨IL-1β、TNF-α、IL-10在脑缺血耐受中的作用。方法将大鼠随机分为6组:假手术组,缺血再灌注损伤组,CIP后24、72、120、168h再次损伤组。CIP各组先短暂阻断双侧颈总动脉10min作为缺血预处理,分别于缺血预处理后24、72、120、168h线栓法阻断大脑中动脉2h作为再次缺血损伤;缺血再灌注损伤组只阻断大脑中动脉2h;采用酶联免疫吸附试验(ELISA)测定各组大鼠脑组织匀浆中IL-1β、TNF-α、IL-10含量。结果与假手术组比较,缺血再灌注损伤组大鼠脑组织中IL-1β、TNF-α和IL-10含量均明显升高(P0.05);与缺血再灌注损伤组比较,CIP后24、72h再次缺血损伤组IL-1β含量明显升高(P0.05),120、168h再次缺血损伤组IL-1β含量逐渐降低;CIP后24、120h再次缺血损伤组TNF-α含量明显升高(P0.05),72、168h再次缺血损伤组TNF-α含量呈降低趋势;CIP后24、72h再次缺血损伤组IL-10含量明显升高(P0.01,P0.05),120h再次缺血损伤组IL-10呈降低趋势,168h再次缺血损伤组IL-10又明显升高(P0.05)。结论在CIP后24h脑组织中细胞因子IL-1β、TNF-α、IL-10水平明显升高能持续到72h(TNF-α除外),表明细胞因子作为触发物质,启动较早,刺激机体产生内源性的保护作用,对抗下次缺血带来的损伤,提高脑缺血耐受。     

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…