紫杉醇预防心肌细胞线粒体缺血再灌注损伤的机制研究

目的 探讨紫杉醇能否预防心肌细胞线粒体缺血再灌注损伤,并对其机制进行初步探讨。方法 将离体大鼠心脏分为对照组、缺血组、缺血+0.1μmol/L紫杉醇组、缺血+0.3μmol/L紫杉醇组和缺血+1μmol/L紫杉醇组(n=15)。每组先给予15 min平衡后,对照组继续给予150 min常氧灌注;缺血组给予30 min缺血处理(Langendorff灌流,结扎左前降支30 min)+120 min常氧再灌注;缺血+0.1μmol/L(或0.3μmol/L、1μmol/L)紫杉醇组给予30 min缺血处理+120 min常氧再灌注,整个过程中均给予0.1μmol/L(或0.3μmol/L、1μmol/L)紫杉醇灌流。灌流结束后,左心室心肌进行冰冻切片。采用免疫组织化学方法观察微管;DCFH-DA试剂盒用来检测活性氧物种的数量,同时通过荧光光度计和分光光度计检测氧化酶活性。结果 10.1μmol/L紫杉醇灌流能明显降低微管断裂评分。20.1μmol/L,0.3μmol/L和1μmol/L紫杉醇减少氧自由基水平分别为33%、46%和51%(P<0.05)。30.3μmol/L和1μmol/L紫杉醇增加线粒体电子传递链复合体Ⅰ的活性,而0.1μmol/L,0.3μmol/L和1μmol/L紫杉醇均增加线粒体电子传递链复合物Ⅲ的活性。结论 紫杉醇能预防心肌细胞线粒体缺血再灌注损伤。减少氧自由基生成、增加线粒体电子传递链复合体Ⅰ、Ⅲ的活性或许是其作用机制之一。     

氟哌啶醇季铵盐衍生物(F2)对缺血再灌注心律失常的拮抗作用

目的:研究氟哌啶醇季铵盐衍生物(F2)对心肌缺血再灌注引发的心律失常的拮抗作用。方法:采用大鼠Langendorff灌流心脏模型,通过结扎冠状动脉左前降支缺血20 min,解除结扎再灌注,可引出长时间(至少5 min)室性心动过速,在灌流液中加入不同浓度F2,观察其对室性心动过速的拮抗作用。结果:F2可浓度依赖地翻转缺血再灌注引发的室性心动过速,半最大效应浓度为0.46μmol/L。结论:F2对大鼠心脏缺血再灌注心律失常具有拮抗作用。     

U50,488H对大鼠离体心脏的抗心律失常作用

目的:研究к阿片受体选择性激动剂(U50,488H)和肾上腺素受体激动剂(去甲肾上腺素 NE)对大鼠离体心脏缺血再灌注(ischemia and reperfusion, I-R)室性心律失常的影响.方法:将35只SD大鼠完全随机设计分为五组(每组7只):假手术组;单纯缺血-再灌注(I/R)组;I/R NE组;I/R U50组;I/R U50 NE组. 分离正常大鼠心脏,采用Langendorff离体心脏灌流方法,结扎冠脉前降支20 min,再灌20 min造成I-R. 在此期间分别应用U50,488H(5×10-6 mol/L)和NE(1×10-7 mol/L)进行干预. 并测定心脏功能的相关指标. 结果:①心脏缺血后,心脏各项生理功能指标明显下降,心率上升,再灌注后情况有所恢复. 与I-R组相比较,给予U50,488H后,心脏各项生理功能指标变化不明显,心率明显下降(P<0.05). ②假手术对照组偶发早搏,I-R组心律失常发生频率明显增加,与I-R组相比较,I-R NE组心律失常评分明显增高(P<0.01);如果提前给予U50,488H,发现不仅可以明显降低I-R组缺血和再灌注期间室速和室颤的发生率(P<0.01),和降低I-R组心律失常的评分,而且明显降低I-R NE组心律失常的评分(P<0.01). 结论:κ阿片受体激动剂U50,488H对于NE诱导的缺血再灌注时心律失常有拮抗作用.     

(口山)酮对外源性自由基发生系统加重离体大鼠心肌缺血再灌注损伤的保护作用

目的:研究从穿心草中提取的三种酮:1.8-dihydroxy-3,5-dimethoxyxanthone(Xan-I);1-hydroxy-3,5-dimethoxy-xanthone(Xan-Ⅱ);1-hydroxy-3,7,8-trimethoxyxanthone(Xan-Ⅲ)对外源性自由基发生系统加重缺血再灌注损伤的保护作用.方法:在Langendorff心脏模型上于缺血前10min给离体大鼠心脏灌流FeSO4(0.1μmo1/L)/抗坏血酸(1 μmol/L)自由基发生系统,测定室颤发生率和相关生化指标.结果:灌流自由基发生系统后加重大鼠离体心脏再灌注损伤;缺血前给予3种酮,能显著减少自由基发生系统所致再灌注室颤发生率,同时使心肌超氧化物歧化酶活力升高,丙二醛含量降低,灌脉流出液中乳酸脱氢酶含量减少.结论:3种Xan对外源性自由基发生系统加重缺血再灌注损伤有不同程度的保护作用.     

左西孟旦对离体鼠心再灌注性心律失常及心功能影响的对比研究

目的 观察比较新型强心药钙增敏剂左西孟旦与传统强心药多巴酚丁胺对大鼠离体心脏缺血/再灌注后心律失常及心功能的影响.方法 雄性SD大鼠32只,随机分为4组(n＝8):对照组(CON组)、左西孟旦组(LS组)、多巴酚丁胺组(DB组)和无水乙醇溶剂组(SOL组).建立离体心脏缺血/再灌注损伤Langendorff灌注模型,平衡灌注20 min、缺血25 min、复灌120 min.复灌期分别灌注K-H液,含左西孟旦0.3 μmol/L、多巴酚丁胺0.1 μmol/L及无水乙醇0.6 mmol/L的K-H液120 min.观察比较各组心脏功能学指标;记录全程心电图,对各组心律失常发生情况进行评分,统计各组室性心动过速(VT)和心室纤颤(VF)发生率及其持续时间.结果 在再灌注20～120 min,LS组和其他各组相比,左心室舒张末压(LVEDP)显著降低,左心室发展压(LVDP)和左心室内压变化最大速率(±dp/dtmax)显著增加(P<0.05或P<0.01).再灌期LS组心律失常评分显著小于DB组(P<0.01),和CON组差异无显著性(P>0.05).DB组7例发生VT,3例发生VF,持续时间分别为VT(16.8±2.3) s及VF(9.6±1.9) s,而LS组无VT及VF发生.结论 与传统强心剂多巴酚丁胺相比,左西孟旦显著改善大鼠缺血/再灌注后心功能,不加重再灌注性心律失常.     

MG53预处理改善离体大鼠心脏缺血再灌注心律失常

目的 利用Langendorff离体灌注模型研究MG53蛋白预处理对缺血再灌注心律失常的影响.方法 SD大鼠40只(8～10周龄,体质量200～ 240 g)Langendorff离体心脏灌注后,采取平衡20 min,缺血30 min,再灌注30 min的方法建立冠状动脉左前降支缺血再灌注心律失常模型.预处理组平衡10 min后,予含MG53蛋白的K-H液继续平衡10 min.分为5组(n =8):Sham组,缺血再灌注(I/R)组,MG53低(0.35 μg/mL)、中(0.7μg/mL)、高(1.4 μg/mL)浓度+I/R组.记录各组的心电图,观察再灌注期间心律失常的变化.结果 与I/R组比较,MG53蛋白预处理中、高浓度组能显著减少再灌注期室速(50％、37.5％ vs 75％,P＜0.05)和室颤(均为0vs 37.5％,P＜0.05)发生率;缩短室速[(3.7±5.0)、(2.2±3.6) vs (118.0±208.3)s,P＜0.05]和室颤[均为0vs (310.9 ±604.1)s,P＜0.05]持续时间;并降低再灌注心律失常评分(1.4±0.7、1.1 ±0.8 vs 3.4 ±2.4,P＜0.05,P＜0.01).结论 MG53蛋白预处理能改善离体大鼠心脏的缺血再灌注心律失常.     

基于Cx43/mito-KATP信号轴观察右美托咪定预处理对大鼠离体缺血再灌注心脏的保护机制

目的探讨右美托咪定预处理对大鼠离体缺血再灌注(myocardial ischemia-reperfusion injury,MIRI心脏的保护作用以及对缝隙连接蛋白43(connexin43,Cx43)/线粒体ATP敏感性钾通道(mitochondrial ATPsensitive potassium channel,mito-KATP)信号轴的调控机制。方法构建离体心脏Langendorff灌注模型。采用随机数字表法将50个离体心脏分为5组(n=10):空白组(Blank组)、缺血再灌注组(I/R组)、缺血再灌注+右美托咪定预处理组(I/R+Dex组)、缺血再灌注+右美托咪定预处理+mito-KATP通道阻断剂5-HD组(I/R+Dex+5-HD组)、缺血再灌注+mito-KATP通道阻断剂组(I/R+5-HD组)。采用停灌30 min,再灌注120 min的方法制备大鼠离体心脏心肌缺血再灌注损伤模型。Blank组以K-H溶液持续灌流180 min;模型组以K-H溶液灌流30 min,停止30 min,再以K-H溶液灌流120 min,造成MIRI损伤; I/R+Dex组以含10 mg/L的右美托咪定的K-H溶液灌流30 min,停止30min,再以K-H溶液灌流120 min; I/R+Dex+5-HD组先以含10 mg/L的mito-KATP通道阻断剂5-羟葵酸(5-HD)的K-H溶液灌流15 min,含10 mg/L的右美托咪定的K-H溶液灌流15 min,停止30 min,再以K-H溶液灌流120 min;I/R+5-HD组先以含10 mg/L的5-HD的K-H溶液灌流30 min,停止30 min,再以K-H溶液灌流120 min。TTC染色检测各组心脏心梗死面积比例。免疫组化检测各组心脏中Cx43的表达。Western blot检测各组心脏中p-Cx43的表达水平。结果与Blank组相比,I/R组、I/R+Dex组、I/R+Dex+5-HD组、I/R+5-HD组心脏的心肌梗死面积明显升高,Cx43、p-Cx43的表达明显降低;与I/R组相比,I/R+Dex组、I/R+Dex+5-HD组心脏的心肌梗死面积明显降低,Cx43、p-Cx43的表达升高,I/R+5-HD组心脏的心肌梗死面积明显升高,Cx43、p-Cx43的表达明显降低;与I/R+Dex组相比,I/R+Dex+5-HD组、I/R+5-HD组心脏的心肌梗死面积明显升高,Cx43、p-Cx43的表达明显降低,差异均具有统计学意义(P0.05)。结论右美托咪定预处理能够促进Cx43的表达及磷酸化,促进mito-KATP通道的开放,减轻离体心脏的缺血再灌注损伤。     

KATP通道激动剂吡那地尔对哇巴因诱发大鼠离体心脏心律失常的影响

目的 应用哇巴因在大鼠离体心脏建立稳定的心律失常模型,观察KATP通道激动剂吡那地尔(pinacidil)对哇巴因诱发心律失常的影响. 方法 采用健康成年SD大鼠建立离体心脏Langendorff主动脉逆行灌流系统.实验分5组:正常对照组,哇巴因模型组和吡那地尔1,3,10 μmol/L干预组.每组8只动物.应用5 μmol/L哇巴因和低K+台式液([K+]o=2.7 mmol/L)灌流心脏诱发室性心律失常,分别观察1,3,10 μmol/L吡那地尔对药物性心律失常的影响,全程记录心电图的变化. 结果在正常台式液中加入5 μmol/L哇巴因灌流大鼠离体心脏仅引起一过性心律失常,而降低台式液中KCl浓度(2.7 mmol/L),则相同浓度哇巴因可诱发出稳定的室性心律失常,包括室性早搏、室速和室颤.给药30 min内,期前收缩(PVB)达到(386±49)个,室速(VT)和室颤(VF)发生率分别为100%(8/8)和87.5%(7/8)(n=8,P<0.01).待哇巴因诱发出心律失常后立即应用吡那地尔可浓度依赖性抑制哇巴因诱发的期前收缩,降低室速和室颤的发生率(n=8,P<0.01). 结论作为KATP通道激动剂,1-10 μmol/L吡那地尔可拮抗哇巴因所致心律失常,其电生理机制可能为增大心肌外向离子流,缩短动作电位时程并使心肌细胞膜超极化.     

瑞芬太尼后处理对大鼠离体缺血再灌注心肌凋亡的影响-P38MAPK信号转导系统的意义

目的观察阿片μ受体激动剂-瑞芬太尼后处理对离体大鼠心肌缺血再灌注损伤的保护作用,探讨其抗缺血再灌注损伤过程中,p38MAPK分子信号通路及其介导的心肌凋亡效应的可能机制。方法 40只SD雄性大鼠体重220～250g,随机分为5组(n=8),即:缺血再灌注组(C)、100μg/L瑞芬太尼后处理组(R)、100μg/L瑞芬太尼后处理+1μmol/L纳洛酮组(R+N)、100μg/L瑞芬太尼后处理+10μmol/L纳曲吲哚组(R+NTI)、100μg/L瑞芬太尼后处理+5μmol/L SB203580组(R+SB)。建立Langendorff大鼠离体心脏灌注模型。Krebs-Henseleit缓冲液(KHS)平衡灌注自主跳动的离体心脏20min,继之30min实验性缺血,再灌注相应灌流液60min。C组灌注空白KBS60min,其余四组分别灌注含相应试剂的KHS 60min。分别测定缺血前5min,再灌注30min,再灌注60min的心室力学指标HR和LVDP。取再灌注60min后左室心肌组织用Tune1法检测心肌细胞凋亡情况。结果与C组比较,R组再灌注30min、60min心室力学指标HR和LVDP以及心肌细胞凋亡率明显降低(P<0.05),其余各组间差异无显著性(P>0.05)。结论瑞芬太尼后处理可明显减轻缺血再灌注对心功能的影响,抑制离体大鼠心肌缺血再灌注造成的细胞凋亡,δ阿片受体拮抗剂纳曲吲哚可部分屏蔽瑞芬太尼后处理的心肌保护作用,表明该保护作用部分与瑞芬太尼激动δ阿片受体有关。p38MAPK分子信号机制参与了阿片受体介导的心肌保护作用,是减少缺血再灌注心肌细胞凋亡重要的信号转导通路。     

卡维地洛与比索洛尔对豚鼠缺血再灌注心室颤动的影响

目的:比较2种β-受体阻滞剂卡维地洛和比索洛尔对豚鼠缺血再灌注心肌去甲肾上腺素(NE)释放和心室颤动(VF)的影响.方法:将66只雄性豚鼠随机分成8组:空白对照组12只;卡维地洛和比索洛尔0.1 μmol/L、1.0 μmol/L和10.0 μmol/L浓度组,每组8只;卡维地洛助溶剂对照组6只.按经典的Langendorff方法进行离体心脏缺血再灌注,观察各组心肌NE释放量及再灌注VF的发生情况.结果:NE释放量与再灌注VF持续时间呈直线正相关(Y=0.11X-1.12,r=0.89,P＜0.001).卡维地洛1.0 μmol/L和10.0 μmol/L组心肌NE释放量及再灌注VF发生率和持续时间均少于对照组及相同剂量的比索洛尔组(P＜0.05).结论:缺血再灌注时心肌释放大量NE,是触发再灌注心律失常发生的重要原因.抑制NE释放的程度可能是卡维地洛抗再灌注VF效果优于比索洛尔的原因之一.     

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…