2,5-MC抑制支架植入术后内膜增殖的实验研究

目的评估酪氨酸蛋白激酶抑制剂2,5-MC抑制支架植入术后内膜增殖的效果.方法将含2,5-MC的F-127凝胶包裹于新西兰兔支架植入段颈动脉腔外,对侧包裹空白F-127凝胶作对照.通过RT-PCR、免疫组化染色检测核内癌基因c-myc和细胞核抗原Ki67的表达;通过三色染色观察内膜增厚情况,检测2,5-MC抑制内膜增殖的效果.结果2,5-MC治疗组核内癌基因c-myc mRNA和Ki67抗原的表达均显著低于对照组(P＜0.05,P＜0.01).组织学检测显示治疗组内膜增生厚度明显低于对照组;植入术后3个月,治疗组内膜/中膜比为0.92±0.10,血管腔狭窄率(51.0±5.58)%;对照组内膜/中膜比为1.30±0.39,血管腔狭窄率(73.01±5.94)%,二组比较有显著差异(P＜0.05,P＜0.01).结论腔外包裹酪氨酸蛋白激酶抑制剂2,5-MC具有抑制支架植入术后内膜增殖的效果.     

人参皂苷Rg1对大鼠血管球囊损伤后原癌基因c-myc表达的影响

目的 观察人参皂苷Rg1( Rg1)对大鼠颈动脉球囊损伤后原癌基因c-myc表达的影响,补充说明Rg1对球囊损伤所致血管狭窄形成的防治机制.方法 建立大鼠颈总动脉球囊损伤模型,制模后随机分为假手术组、模型组、Rg1低剂量(4 mg/kg)组和Rg1高剂量(16 mg/kg)组.制模次日腹腔注射给药,模型组及假手术组给予等体积生理盐水,连续给药14d后取损伤侧颈总动脉,行H.E.染色并测量管腔面积(Lumen area,LA)以判定血管腔狭窄程度;采用实时荧光定量RT-PCR (real-time RT-PCR)法检测管壁c-myc mRNA的表达.结果 颈总动脉球囊损伤模型组大鼠血管腔面积较假手术组明显狭窄(P＜0.01).Rg1低剂量及高剂量均明显改善球囊损伤所致的颈动脉狭窄,使球囊损伤后狭窄的血管腔面积增大(P＜0.05);Rg1高剂量显著下调损伤血管壁的c-myc mRNA表达(P＜0.01).结论 Rg1能减轻球囊损伤所致大鼠颈动脉狭窄,可能与其下调c-myc基因的表达有关.     

1-磷酸鞘氨醇1型受体促进小鼠颈动脉损伤后血管内膜增生

目的 探究1-磷酸鞘氨醇1 型受体(sphingosine-1-phosphate type 1 receptor,S1PR1)对小鼠颈动脉损伤后血管内膜增生的作用及其机制.方法 40只C57BL/6小鼠按随机数字表法分为4组:假手术+AAV-LacZ组、假手术+AAV-S1PR1组、导丝损伤+AAV-LacZ组和导丝损伤+AAV-S1PR1组,每组10只.各组小鼠尾静脉分别注射对应AAV-LacZ病毒或AAV-S1PR1病毒,2周后,假手术组仅切开颈部皮肤,颈动脉未损伤;导丝损伤组行颈动脉导丝损伤.4周后取颈动脉,HE染色检测新生内膜增生程度,组织免疫荧光检测颈动脉α-平滑肌肌动蛋白(α-smooth muscle actin,α-SMA)表达水平,组织免疫组化检测颈动脉组织增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)和IL-6表达水平.分离并培养小鼠原代主动脉血管平滑肌细胞,腺病毒Ad-S1PR1或Ad-LacZ转染后,加入1 μmol/L 1-磷酸鞘氨醇(sphingosine-1-phosphate,S1P)干预,Western blot和细胞免疫荧光检测原代主动脉平滑肌细胞表型转化,EdU染色检测细胞增殖,划痕实验和Transwell实验检测细胞迁移,Western blot检测IL-6/STAT3通路激活情况.结果 小鼠颈动脉损伤4周后,与假手术+AAV-LacZ组相比,导丝损伤+AAV-LacZ组小鼠颈动脉可见显著的血管内膜增生、表型转化和细胞增殖(P＜0.05);同时,导丝损伤后颈动脉IL-6表达上调.与导丝损伤+AAV-LacZ组相比,导丝损伤+AAV-S1PR1组颈动脉组织S1PR1过表达(P＜0.05),上述病理生理学改变加重(P＜0.05).细胞实验结果显示:S1P诱导血管平滑肌细胞表型转化和增殖迁移,激活IL-6/STAT3通路(P＜0.05).腺病毒介导S1PR1过表达后,上述病理改变进一步加重(P＜0.05).结论 S1P/S1PR1促进血管平滑肌细胞表型转化和增殖迁移,加重血管损伤后内膜增生,可能与S1P/S1PR1激活血管平滑肌细胞IL-6/STAT3通路有关.     

内皮素抗血清抑制动脉损伤后内膜增生的实验研究

目的通过兔颈总动脉球囊损伤模型,观察内皮素(ET)抗血清对损伤动脉内膜增生的影响,以寻找预防动脉损伤后内膜增生的新途径.方法设立假手术组、对照组、ET抗血清组.ET抗血清 组术后按0.5ml/kg/d自耳缘静脉给予ET抗血清,假手术组及对照组给同等量的正常兔血清,观察术后2周各组血浆6-keto-PGF1α、TXB2水平、血管增殖指数及血管内膜厚度和管腔狭窄度.结果1.血浆6-keto-PGF1α水平ET抗血清组显著高于对照组(P＜0.01),2.血浆TXB2水平ET抗血清组显著低于对照组(P＜0.01).3.损伤侧血管增殖指数各组均显著高于假手术组(P＜0.01),ET抗血清组显著低于对照组(P＜0.01).4.对照组损伤侧血管内膜厚度、截面积、管腔狭窄度均显著高于假手术组(P＜0.01),而ET抗血清组上述指标均低于对照组(P＜0.01).结论ET抗血清抑制动脉内膜的增生.     

白杨素对动脉损伤后新生内膜增生的影响及机制

目的 利用小鼠颈动脉导丝损伤的动物模型和血小板衍生生长因子(PDGF)-BB刺激血管平滑肌细胞(VSMCs)增殖的细胞模型,研究白杨素对动脉损伤后新生内膜增生的抑制作用及相关机制。方法 建立小鼠颈动脉导丝损伤模型,随机分成模型对照组与白杨素组,分别喂以正常啮齿类动物饲料和含0.09%白杨素[w/w,相当于150mg/(kg·d)白杨素]的正常啮齿类动物饲料。取术后28天损伤侧颈动脉,检测指标。苏木素－伊红染色评价新生内膜增生,测算内膜面积和内膜中膜比值;免疫组化法测定损伤动脉内增殖细胞核抗原(PCNA)阳性细胞表达状态,评价白杨素对内膜增生的影响。同时体外培养VSMCs,给予20ng/ml PDGF-BB和(或) 12.5μmol/L白杨素处理,流式细胞仪检测细胞增殖,Western blot法测定c-Jun氨基末端激酶(JNK)和信号转导及转录激活因子(STAT)3的总蛋白和磷酸化蛋白水平。结果 白杨素显著抑制导丝损伤所致颈动脉内膜增生,降低内膜面积.内中膜比值以及损伤侧颈动脉新生内膜内PCNA阳性细胞表达数。PDGF-BB明显促进VSMCs增殖,并显著升高VSMCs中JNK和STAT3的磷酸化水平,白杨素导致PDGF-BB引起的VSMCs增殖停滞在G₀/G₁期,并显著减弱PDGF-BB诱导的JNK和STAT3磷酸化。结论 白杨素可能通过阻止JNK和STAT3通路活化降低VSMCs增殖,从而遏制动脉损伤后新生内膜增生。     

泛素蛋白连接酶1在大鼠颈动脉球囊损伤后新生内膜中的表达及意义

目的 研究胞质泛素蛋白连接酶1(KPC1)在大鼠颈动脉球囊损伤后的蛋白表达情况,探讨其在新生内膜形成过程中的生物学功能.方法 将成年雄性SD大鼠(450 ～ 500 g)随机分为假手术组和颈动脉球囊损伤模型组,建模后以左侧损伤动脉为实验组,同时以假手术组的左侧正常颈动脉为对照组.实验组大鼠于损伤后1d、3d、7d、14d、28d分别处死并取材,采用Western blot检测KPC1蛋白、内膜增殖细胞核抗原(PCNA)表达情况,以qRT-PCR检测KPC1的mRNA表达,苏木精-伊红(HE)染色后比较内膜增生程度;采用体外培养血管平滑肌细胞(VSMC)建立增殖模型,运用Western blot及qRT-PCR检测其KPC1蛋白、KPC1 mRNA表达特征.结果 Western blot结果显示,颈动脉球囊损伤后实验组KPC1蛋白表达水平明显低于正常对照组(P＜0.05),而PCNA蛋白表达量明显高于正常对照组(P＜0.05);qRT-PCR检测结果显示,实验组KPC1的mRNA水平明显低于对照组(P＜0.05);HE染色结果示颈动脉球囊损伤后1d、3d时光镜下血管内膜增生不明显;7d时光镜下可见新生内膜,增生的VSMC向内膜下迁移,管腔开始狭窄;14d时,可见明显新生内膜,VSMC排列紊乱,内弹力膜断裂,管腔明显狭窄,内膜厚度超过中膜;28d时,血管内膜继续不规则增生,血管腔狭窄程度继续加重,狭窄超过50％.体外培养并模拟VSMC增殖,提取细胞进行Western blot和qRT-PCR检测显示,KPC1蛋白、KPC1 mRNA表达在血小板源性生长因子-BB刺激增殖后开始逐渐减低.结论 抑制KPC1基因表达可促进损伤内膜增生,其作用机制可能与促进VSMC增殖有关.     

2,5-MC抑制支架植入术后内膜增殖的实验研究

目的评估酪氨酸蛋白激酶抑制剂2,5-MC抑制支架植入术后内膜增殖的效果。方法将含2,5-MC的F-127凝胶包裹于新西兰兔支架植入段颈动脉腔外,对侧包裹空白F-127凝胶作对照。通过RT-PCR、免疫组化染色检测核内癌基因c-myc和细胞核抗原Ki67的表达;通过三色染色观察内膜增厚情况,检测2,5-MC抑制内膜增殖的效果。结果2,5-MC治疗组核内癌基因c-mycmRNA和Ki67抗原的表达均显著低于对照组(P<0.05,P<0.01)。组织学检测显示治疗组内膜增生厚度明显低于对照组;植入术后3个月,治疗组内膜/中膜比为0.92±0.10,血管腔狭窄率(51.0±5.58)%;对照组内膜/中膜比为1.30±0.39,血管腔狭窄率(73.01±5.94)%,二组比较有显著差异(P<0.05,P<0.01)。结论腔外包裹酪氨酸蛋白激酶抑制剂2,5-MC具有抑制支架植入术后内膜增殖的效果。     

川芎嗪抑制大鼠颈动脉球囊损伤后再狭窄的在体研究

研究川芎嗪对大鼠颈动脉球囊损伤后再狭窄的影响及机制。方法建立SD大鼠颈动脉球囊损伤模型,分为假手术组、模型组和川芎嗪组。川芎嗪组为川芎嗪[10mg（kg·d）]尾静脉预给药1周,球囊成形术后继续同剂量川芎嗪尾静脉注射6周。于第6周末收集损伤段颈动脉,病理切片HE染色测量内中膜厚度比及Western blot检测相关蛋白表达水平。结果大鼠颈动脉球囊损伤后6周,损伤段血管内膜明显增厚,模型组和川芎嗪组与假手术组比较,内膜/中膜面积比显著增加（P＜0.05）;与模型组比较,川芎嗪组内膜/中膜面积比下降（P＜0.05）。模型组损伤段血管Wnt 4、Dvl-1、β- catenin、Cyclin- D1表达表达水平较假手术组显著增高,而川芎嗪组的表达明显减少（均P＜0.05）。结论川芎嗪可以抑制大鼠颈动脉球囊损伤后再狭窄,其机制与下调Wnt信号通路有关。     

全反式维甲酸对兔颈动脉粥样硬化病灶中PKCα和MAPK表达的影响

目的 探讨全反式维甲酸(ATRA)对兔颈动脉粥样硬化病灶中血管平滑肌细胞(VSMC)转型、迁移和增殖信号传导机制的影响.方法 新西兰雄性大白兔随机分为正常对照组(n＝12),手术组(n=12)及ARTA治疗组(n=12).三组均高脂饮食2周后,手术组用空气干燥法制作颈动脉内膜损伤模型.ARTA治疗组于术前3天开始给予全反式维甲酸灌胃,直至处死,其余操作同手术组.术后分别于14、28天随机处死.采取颈动脉标本,对血管粥样硬化病变进行大体形态学观察,用免疫组化方法检测血管粥样硬化病灶中PKCα、MAPK的表达水平.结果 ①正常动脉壁PKCα、MAPK呈阴性表达.②手术组在术后第一周时内膜开始增生;第四周增生明显.增生内膜中PKCα、MAPK表达水平较正常组显著增高.③治疗组PKCα、MAPK的表达明显低于手术组(P＜0.05).VSMCs的迁移、增殖、内膜增生和管腔狭窄显著减轻(P＜0.05).结论 ARTA能抑制兔颈动脉内膜损伤后新生内膜过度增殖,其机制可能为通过抑制蛋白激酶Cα(Protein Kinase Cα,PKCα)及丝裂原活化蛋白激酶(Mitogen Activated Protein Kinase,MAPK)的表达.     

6-姜烯酚通过下调TLR4/NF-κB通路抑制血管平滑肌细胞增殖

目的 探讨6-姜烯酚对血管平滑肌细胞(vascular smooth muscle cells,VSMCs)增殖的影响及其可能的分子机制.方法 组织贴块法培养野生型(wild type,WT)和Toll样受体4敲除(Toll-like receptor 4 knockout,TLR4-/-)小鼠原代VSMCs.应用血小板源性生长因子(platelet derived growth factor,PDGF)诱导VSMCs增殖.分别应用TLR4配体脂多糖(LPS)和TLR4抑制剂(Eritoran,E5564)激活和抑制TLR4,观察TLR4在VSMCs增殖中的作用.加入6-姜烯酚刺激,观察对VSMCs增殖以及对TLR4表达的影响.结果 6-姜烯酚呈浓度依赖性地抑制PDGF诱导的VSMCs增殖(P＜0.05);PDGF和LPS均可激活TLR4并促进野生VSMCs的增殖(P＜0.05),TLR4基因敲除抑制PDGF和LPS诱导的VSMCs增殖(P ＜0.05);6-姜烯酚下调VSMCs中TLR4表达(P＜0.05).6-姜烯酚下调VSMCs中TLR4下游蛋白NF-κB的表达(P＜0.05).结论 6-姜烯酚通过下调TLR4/NF-κB通路抑制血管平滑肌细胞增殖.     

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…