高胆红素血症新生大鼠听力损伤与脑组织Na+-K+-ATP酶活力的研究

目的研究胆红素神经毒性的作用环节,探讨高胆红素血症时听力损伤的机制.方法 50只新生SD大鼠,随机分为对照组(C组)和实验组(M组),M组又根据腹腔注射胆红素的量分为M1、M2、M3、M4组,测试各组动物脑干听觉诱发电位(ABR),检测各组血清胆红素浓度和脑组织胆红素含量,定磷法测定脑组织中的Na+-K+-ATP酶的活力.结果实验组随着腹腔注射胆红素量的增加,ABR测试Ⅰ、Ⅲ、Ⅴ波潜伏期及Ⅰ～Ⅲ、Ⅲ～Ⅴ波间期延长,反应阈增高,给药后4 h和8 h的血清总胆红素浓度、脑组织内胆红素含量均逐渐增加,Na+-K+-ATP酶活力则逐渐降低,除M1组外其余各组与对照组差异均有显著性(P＜0.05).各实验组血清总胆红素浓度4 h、8 h之间差异无显著性(P＞0.05).但脑组织内胆红素含量、Na+-K+-ATP酶活力除M1组外其余各组4 h、8 h之间差异有显著性(P＜0.05).血清总胆红素浓度与脑组织内胆红素含量无相关性(r＝0.28,P＞0.05),脑组织内胆红素含量与Na+-K+-ATP酶活力呈负相关(r＝-0.86,P＜0.01).结论高胆红素血症时,脑组织内胆红素抑制Na+-K+-ATP酶活力,影响听觉信号传导,导致听力损伤.     

光疗对新生儿黄疸脑干听觉诱发电位的影响

对血清胆红素值大于３４０μｍｏｌ／Ｌ的新生儿高胆红素血症患儿光疗前后进行脑干听觉诱发电位测定，结果显示：光疗后随着血清胆红素值的下降，可使延长的脑干听觉诱发电位Ｖ波潜伏期，Ⅴ－Ⅲ波间期明显缩短，经光疗后血清胆红素低于２０５μｍｏｌ／Ｌ者，其脑干听觉诱发电位各波潜伏期恢复正常，揭示光疗能使胆红素的致的耳神经毒性损害逆转。     

溶血致新生大鼠高胆红素血症动物模型的建立及评价

目的 探讨建立操作简便可行、成功率高、具有良好模拟性的新生大鼠高胆红素血症动物型，为开展高胆红素血症致核黄疸及相关神经损伤机制研究提供实验基础模型。方法 随机选取7日龄SD大鼠，分别采用25、50、75mg/kg三个梯度腹腔内注射盐酸苯肼，建立溶血致高胆红素血症动物模型，同时设立对照组，分别在实验处理48小时后，测定血、脑组织胆红素、同时进行脑组织NSE分析对模型进行评价。结果 三组实验组分别与对照组相比,血、脑组织胆红素、脑组织NSE均大于对照组，差异具有显著性（P<0.05），而血红蛋白含量小于对照组，差异具有显著性（P<0.05）；50mg和75mg剂量组血、脑组织胆红素、脑组织NSE均大于25 mg剂量组,而血红蛋白含量小于25 mg剂量组，差异具有显著性（P<0.05）；50mg和75mg剂量组间相比各项指标差异无显著性（P>0.05）。结论 腹腔注射盐酸苯肼能够制作出符合临床特征的高胆红素动物模型，50mg/kg为最佳浓度，是建立新生儿高胆红素血症动物模型的理想方法。     

外源性激活素A对高胆红素血症新生大鼠脑细胞凋亡的保护作用

目的探讨外源性激活素A（ACT A）对高胆红素血症（简称高胆）新生大鼠脑细胞凋亡的保护作用。方法将96只新生7日龄Wistar大鼠随机分为正常对照组、高胆对照组、ACT A治疗Ⅰ、Ⅱ组,每组24只。采用腹腔注射胆红素溶液的方法建立高胆标准动物模型,ACT A治疗Ⅰ、Ⅱ组于造模后分别给予高（0.025?mg/L）、低（0.001?mg/L）剂量ACT A灌胃。采用重氮反应法检测各组血清和脑组织中胆红素含量,电镜下观察脑组织超微结构,采用流式细胞仪进行脑组织细胞凋亡分析。结果治疗Ⅰ、Ⅱ组神经行为异常较高胆对照组明显减轻;高胆对照组、治疗Ⅰ、Ⅱ组血清、脑组织胆红素含量均高于正常对照组（P均＜0. 01）;治疗Ⅰ、Ⅱ组血清、脑组织胆红素含量均低于高胆对照组（P均＜0.05）;治疗I组血清、脑组织胆红素含量均低于治疗Ⅱ组（P均＜0.01）。镜下观察可见,高胆对照组神经元损伤明显,各治疗组均有不同程度的修复;流式细胞术结果表明,在造模后12?h,高胆对照组、治疗Ⅰ、Ⅱ组脑组织凋亡细胞数均值高于正常对照组（P均＜0.001）,治疗Ⅰ、Ⅱ组脑组织凋亡细胞数均值低于高胆对照组（P均＜0.05）,治疗Ⅰ组脑组织凋亡细胞数低于治疗Ⅱ组（P＜0.001）。结论外源性ACT A可明显减少高胆模型鼠体内胆红素的蓄积,有效抑制高胆模型鼠脑细胞凋亡,对高胆所致脑损伤具有保护作用。     

胆红素对新生豚鼠蜗核损伤的动态研究

目的　探讨听性脑干反应 (ABR)在胆红素所致听力损伤中的监测价值。方法　 2 0只新生 5日豚鼠随机分为胆红素组和对照组 ,胆红素组腹腔注射胆红素 (2 0 0 μg/ g) ,对照组腹腔注射相应体积的生理盐水 (0 1ml/g) ,于腹腔注射前和后 4h、 8h分别记录ABR并观察神经行为状况 ,每组各取 5只于腹腔注射后 4h、 8h分别行蜗核形态学观察。结果　注射胆红素后 ,ABR波潜伏期、波间期呈逐渐延长趋势 ,振幅呈逐渐下降趋势 ,其中波Ⅱ改变出现最早且最明显。用药后 4h ,无明显神经系统症状和形态学改变时 ,Ⅰ -Ⅱ波间期延长及波Ⅱ振幅下降与对照组及用药前比较差异有显著性 (P <0 0 1) ;用药后 8hABR改变更明显 ,同时伴有神经症状和镜下形态学改变 ,蜗核体积及大椭圆细胞截面积显著性减小 (P <0 0 1)。结论　ABR是监测胆红素所致听力损害早期的敏感指标 ,优于耳蜗电图和耳声发射等主要反映周围听觉系统功能状态的电生理技术 ,加强高胆红素血症新生儿的ABR动态监测有非常重要的临床意义     

生姜提取物6-姜酚对对乙酰氨基酚致小鼠肝脏毒性的保护作用

目的：研究生姜提取物6-姜酚对对乙酰氨基酚致小鼠肝脏毒性的保护作用。方法：实验组小鼠在腹腔注射对乙酰氨基酚（900mg／kg）30min后,分别给予6-姜酚（30mg／kg）或标准对照药水飞蓟素（25mg／kg）。注射对乙酰氨基酚4h后处死小鼠,检测血清中天冬氨酸氨基转移酶、丙氨酸氨基转移酶、碱性磷酸酶活性,总胆红素的含量及肝匀浆中脂质过氧化及抗氧化情况,如超氧化物歧化酶、过氧化氢酶、谷胱甘肽过氧化物酶、谷胱甘肽还原酶、谷胱甘肽转移酶活性及还原型谷胱甘肽含量。结果：与对照组相比,6-姜酚及水飞蓟素均能显著降低对乙酰氨基酚引起的小鼠血清天冬氨酸氨基转移酶、丙氨酸氨基转移酶、碱性磷酸酶活性及总胆红素含量的升高（P〈0．05）。此外,6-姜酚及水飞蓟素有效控制了肝脏内丙二醛的形成及各种抗氧化酶的降低（P〈0．05）。结论：本研究的结果证实了6-姜酚具有与水飞蓟素相当的保肝作用。     

视神经切开减压术对大鼠视神经不完全损伤的疗效观察

目的：评价视神经切开减压对大鼠视神经不完全损伤的疗效。方法：用压力恒定的反向镊夹持大鼠双眼视神经建立不完全损伤模型，在伤后15min、3h、6h、24h、48h，对左眼夹伤处行视神经切开减压术(ONID)，应用闪光视觉诱发电位(F—VEP)，观察视神经损伤后潜伏期和振幅的变化及评价视神经切开减压后的效果。结果：F—VEP表明，视神经切开减压后，中度损伤组的减压眼较未减压眼潜伏期提前，振幅增大；越早减压效果越好，48h后减压基本无效。相反，视神经切开使轻、重损伤组潜伏期延迟，振幅减小。结论：视神经切开减压对轻、重度损伤后F—VEP的转归不理想，对中度视神经损伤后F—VEP的变化有一定改善作用，但需尽早(48h内)进行。     

大鼠中脑导水管周围灰质内注射抗甲—脑啡肽血清对神经降压？…

目的 探讨大鼠中脑导水管周围灰质内内源性的脑啡肽对神经降压素镇痛作用的影响。方法 采用钾离子透入法以引起大鼠甩尾反应的电流强度为痛反应指标，观察中脑导水管周围灰质内注射神经降压 、抗甲－脑啡肽血甭对大鼠痛阈的影响。结果 中脑导水管周围灰质内注射神经降压素后，大鼠闯阈明显增加；注射抗离啡肽知清后再注射神经降压素，大鼠痛阈较注射正常兔血清后再注射神经降压明显降低，但仍高于注射抗甲－脑啡肽血清组。结论     

大鼠高胆红素血症与海马神经细胞凋亡关系的实验研究

目的探讨高胆红素血症新生大鼠海马区Fas蛋白、N-甲基-D-天冬氨酸(NMDA)受体的表达、神经细胞凋亡率及其相关性，以进一步阐明胆红素的神经毒性机制。方法通过制作高胆红素血症动物模型，采用免疫组化法、TUNEL法及流式细胞术检测大鼠海马区Fas蛋白、NMDA受体的表达率及神经细胞的凋亡率，并探讨其问相关性。结果高胆红素血症时，海马区神经组织，Fas蛋白、NMDA受体表达率及神经细胞凋亡率明显增高，且与脑组织胆红素浓度呈正相关。结论高胆红素血症时，胆红索可通过NMDA受体过度活化和Fas系统的参与，传递凋亡信号，介导胆红素神经毒性的发生，导致神经细胞凋亡。     

新生豚鼠高胆红素血症时P50抑制变化的研究

目的:评价新生豚鼠高胆红素血症时P50抑制值[即T/C值(T为实验,C为对照)]的动态变化对神经系统的毒性作用.方法:出生5～7天的新生豚鼠30只,随机分成5组,每组6只.其中,第一组为正常对照组(C),其余4组为实验组(T).5组新生豚鼠均在硫喷妥钠麻醉下行颅骨电极包埋术,待手术麻醉清醒后,分别测各组新生豚鼠的T/C值.检测完毕,分别向其中2组实验组动物腹腔注入胆红素溶液100 μg/g,4 h、8 h后观察;另2组实验组动物腹腔注入胆红素溶液200 μg/g,4 h、8 h后观察.正常对照组动物均向腹腔注入生理盐水0.5 ml.各组动物在观察完行为学变化和T/C值检测后,再迅速处死动物,取脑组织,在光镜、电镜下观察脑组织结构的变化.结果:实验豚鼠在注入胆红素溶液后,除Tlb组变化不明显外(P＞0.05),其余各组豚鼠T/C值的变化差异均有统计学意义(P＜0.01).不同实验组与正常对照组的T/C值的变化差异也均有统计学意义(P＜0.01).结论:P50抑制(T/C)在高胆红素血症不同时段均有明显变化,可以较早期地(在胆红素聚集阶段)预测胆红素对神经系统的毒性作用,为临床预防和评价高胆红素血症对新生儿神经系统损伤提供一种新的方法.     

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…