基因bcl-2及bax在风湿性心脏病心肌组织中的表达及意义

目的 :研究凋亡基因bcl 2及bax在风湿性心脏患者心肌组织中的表达、定位及意义 .方法 :采用鼠抗人bcl 2mAb ,兔抗人bax多克隆抗体进行免疫组织化学SABC法 ,心肌胶原纤维染色及超声波检查评价患者心功能 .结果 :5 1例风湿性心脏病心肌组织中bcl 2 ,bax基因表达阳性率分别为 (6 8.6± 5 .3) %、(74 .5± 6 .5 ) % ,用于对照 10例正常心肌组织阳性率分别为 (10 .0± 1.2 ) %、(2 0 .0± 3.1) % ,两者差异显著 (P <0 .0 1) .风湿性心脏病心肌纤维化百分比平均为(2 4 .1± 2 .8) % ,与正常对照组心肌间质 (3.6± 0 .3) %比较差异显著 (P <0 .0 1) ,Bcl 2 ,Bax蛋白阳性程度和心肌纤维化程度 ,术后心功能改善程度比较有显著差异 (P <0 .0 1) .结论 :凋亡基因bcl 2 ,bax在风湿性心脏病心肌组织中过表达与心肌病变程度有关 ,随心肌病变程度加重 ,凋亡基因bcl 2表达减弱 ,而凋亡基因bax表达增强 .     

细胞凋亡在小鼠病毒性心肌炎中的作用

目的 :探讨柯萨奇病毒 B3(CVB3)所致小鼠病毒性心肌炎 (VM)心肌细胞损伤的变化 ,观察细胞凋亡在心肌损伤中的作用。方法 :采用 CVB3制备小鼠病毒性心肌炎动物模型 ,分别于腹腔接种 CVB3后第 5、7、10、14、2 1、2 8d,取心肌组织切片 HE染色了解心肌损伤 (坏死 )情况 ;电镜和流式细胞仪检测 ,观察心肌中的细胞凋亡。结果 :心肌坏死方面 :光镜观察见对照组小鼠心肌组织无异常改变 ,实验组病鼠可见心肌细胞坏死和单核、淋巴细胞浸润 ,后期可见纤维化 ;心肌细胞凋亡方面 :电镜观察对照组心肌中未检出凋亡细胞 ,而病鼠心肌凋亡细胞检出率较高 5 8.33% (7/12例 ) ,且细胞凋亡多存在于炎症病灶周围的心肌细胞及病灶处炎性浸润细胞 ;各期病鼠心肌组织中的细胞凋亡比率较对照组明显增加 ,流式细胞仪检测平均心肌细胞凋亡百分率为 2 6 .74± 15 .2 2 % ,感染后第 7～ 14 d心肌细胞凋亡百分率明显高于其余时间 (P<0 .0 0 1)。结论 :小鼠病毒性心肌炎中心肌损伤坏死与凋亡共存 ,其中异常的心肌细胞凋亡与病毒性心肌炎的发病过程有关     

病毒性心脏病小鼠心肌细胞凋亡的动态变化

目的探讨急、慢性病毒性心肌炎和感染性扩张型心肌病小鼠心肌细胞凋亡的动态变化。方法以柯萨奇病毒B3感染Balb/c小鼠建立急、慢性心肌炎和扩张型心肌病的系列动物模型,同期设正常对照;经组织病理学方法和超声心动图验证模型后,以缺口末端标记法(TUNEL)检测各组小鼠心肌细胞凋亡。结果各期感染小鼠心肌细胞凋亡率较同期对照组明显增高,心肌细胞凋亡率依次分别为(8.2±1.4)%vs(1.3±0.5)%,(15.3±1.1)%vs(2.7±0.7)%,(13.9±2.1)%vs(3.1±0.6)%,(均P<0.01)。结论心肌细胞凋亡贯穿病毒性心脏病全程,可能对其病程和预后产生深远影响。     

二维超声心动图测定左室心肌质量和容量/质量比值的临床研究

本文用二维超声心动图测定左心室心肌质量和容量/质量比值.报告125例正常人,高血压病45例,风心病46例,冠心病34例,扩张型心肌病33例检测结果:心肌质量正常组男性154±31.4g,女性117±21.5g;高血压病组男性258.6±19.4g,女性176.4±13.3g;风心病联合瓣膜损害组男性226.7±19.1g,女性182.1±13.5g;冠心病组男性175.5±12.4g,女性138.4±10.7g;扩张型心肌病组男性245.3±18.9g,女性208.8±10.2g,表明各患者组心肌质量均较正常组显著增加(P<0.01),容量/质量比值正常组男性0.68±0.1,女性0.69±0.2。高血压病组男性0.48±0.1,女性0.50±0.1,均显著低于正常组(P<0.001),提示向心性肥厚;扩张型心肌病组男性0.82±0.4,女性0.80±0.4,均显著高于正常组(P<0.001),提示心肌肥厚伴心腔扩张。     

细胞凋亡在宫颈癌发生发展中的变化

目的:探讨细胞凋亡在宫颈癌发生发展中的变化.方法:采用脱氧核苷酸转移酶介导的生物素末端缺口标记法(TdT mediated dUTP-biotin nick end labeling,TUNEL)检测15例正常宫颈上皮,22例宫颈上皮内瘤变(CIN)Ⅰ/Ⅱ,16例CIN Ⅲ及52例浸润性宫颈鳞癌(ISCC)组织中的细胞凋亡标记指数(A-LI),并用免疫组化ABC法检测这些组织中增殖细胞核抗原PCNA的表达.结果:在正常宫颈上皮,CIN Ⅰ/Ⅱ,CIN Ⅲ及 ISCC中 A-LI分别为0.00±0.00,0.33±0.09,0.69±0.14和0.07±0.01;PCNA标记指数(P-LI)分别为:9.87±1.32,22.57±2.05,31.01±2.04和65.92±3.01.结论:细胞凋亡在宫颈癌恶变前的发生发展中以抑制细胞过度增殖而发挥负调控作用,在ISCC阶段其调控作用可能已经紊乱.     

阿霉素致扩张型心肌病心肌损伤中各项相关指标变化

目的:探讨阿霉素致扩张型心肌病中心肌损伤中相关指标的变化。方法:通过腹腔注射阿霉素诱导SD大鼠扩张型心肌病模型;通过ELISA方法检测血浆脑利钠肽(BNP)水平,超声心动图测定左室射血分数(LVEF)及观察心脏大体形态以及光学显微镜下病理形态来评估是否造模成功;通过Western blot技术检测造模前后SD大鼠心肌组织凋亡指标P53蛋白表达量。结果:扩张型心肌病造模后SD大鼠较造模前BNP明显升高,LVEF明显下降,P53蛋白表达增多。结论:阿霉素致扩张型心肌病过程中,大鼠心功能明显下降,p53表达增多对阿霉素致心肌损伤有重要作用。     

地方性甲状腺肿组织中细胞凋亡的检测

目的 :探讨地方性甲状腺肿病变中细胞凋亡发生的意义。方法 :利用DNA末端标记法 (TUNEL法 )检测2 5例地方性甲状腺肿、43例甲状腺癌、15例甲状腺腺瘤、11例癌旁甲状腺组织中的凋亡细胞 ,计算其凋亡率。结果 :地方性甲状腺肿、甲状腺癌、甲状腺腺瘤、癌旁甲状腺组织的细胞凋亡率分别为 :(9.81± 4.36 ) %、(17.73± 6 .6 2 ) %、(12 .43± 3.6 9) %、(11.37± 6 .6 9) % ,其中地方性甲状腺肿的细胞凋亡率低于甲状腺癌 (P <0 .0 1) ,地方性甲状腺肿、甲状腺腺瘤、癌旁甲状腺组织各组间凋亡率无显著差异 (P >0 .0 5 )。结论 :细胞凋亡与增殖的平衡在地方性甲状腺肿病变的发生发展中起着重要作用     

经冠脉自体骨髓单个核细胞移植治疗扩张型心肌病的随机对照研究

目的采用随机、对照、前瞻性的临床试验,旨在评价经冠脉自体骨髓单个核细胞(BMMNCs)移植治疗扩张型心肌病的有效性和安全性。方法连续入选26例扩张型心肌病患者,细胞移植组(14例)行经冠脉自体BMMNCs移植联合标准药物治疗;对照组(12例)接受标准药物治疗。结果3个月后,细胞移植组的左室射血分数(LVEF)由(29.21±4.41)%提高至(31.08±4.54)%(P=0.004),与对照组比较,无统计学差异(P=0.216);PET/CT示心肌13N-NH3灌注和18F-FDG代谢显像显著改善;氮末端脑钠素前体(NT-proBNP)、6min步行试验和明尼苏达生活质量评分的改变均具有统计学意义。结论经冠脉自体BMMNCs移植治疗扩张型心肌病安全而有效,可能是通过BMMNCs转分化为心肌细胞和血管内皮细胞而改善心功能。     

扩张型心肌病心肌组织中肠道病毒感染与趋化因子Mrna表达的关系

目的探讨病毒感染与趋化因子表达的改变在扩张型心肌病发病中的作用.方法利用RT-PCR方法检测12例原位异体心脏移植的扩张型心肌病受体心肌组织以及5例正常对照心肌组织中Evs-RNA的存在以及趋化因子RANTES、MCP-1、FKN及其受体US28的表达水平.结果在病理学证实的12例扩张型心肌病心肌组织中有7例Evs-RNA阳性.25%(3/12)心肌组织中MCP-1mRNA的表达明显增高,经DNA同源序列分析,与人JE MCP-1同源性为97%.而正常对照心肌组织中病毒基因及趋化因子检测均阴性.结论肠道病毒感染可能会改变趋化因子的表达水平,而趋化因子的异常表达在扩张型心肌病发生发展中可能起重要作用.     

过继转输扩张型心肌病小鼠淋巴细胞诱导心肌损害

目的探讨扩张型心肌病(DCM)小鼠的自身免疫学机制。方法用人线粒体ADP/ATP载体肽免疫小鼠建立扩张型心肌病模型(DCM组),分别将其以伴刀豆凝集素A(ConA)刺激和未刺激的脾淋巴细胞过继转移给同源近交系小鼠(DCM-T-A组和DCM-T组),以用不含肽的对照液体免疫的小鼠为对照组;观察各组小鼠心肌组织病理学变化,以酶联免疫吸附法检测其血清抗ADP/ATP载体自身抗体水平、实时荧光定量聚合酶链反应检测其心肌细胞因子基因表达。结果在免疫或过继后的第1和第6个月末,DCM组和以ConA刺激的DCM-T-A组小鼠血清抗ADP/ATP载体自身抗体均为阳性;心脏在前期分别出现心肌炎性细胞浸润和轻度心肌纤维化,在后期均出现心脏增大、心肌细胞溶解断裂和弥漫性纤维化;心肌中细胞因子表达均增高,其中干扰素(IFN)-γ(DCM组30d:1486.0±243.0,180d:192.0±38.0;DCM-T-A组30d:357.0±38.6,180d:186.0±19.27)和白细胞介素(IL)-2(DCM组30d:197.0±11.0,180d:103.0±19.0;DCIN-T-A组30d:166.0±13.8,180d:96.0±4.47)表达增高在前期明显,IL-4、IL-6和肿瘤坏死因子(TNF)-α表达增高在后期更为显著。未用ConA刺激的DCM-T组与对照组均无上述改变。结论过继转输DCM小鼠脾淋巴细胞可诱导同源近交系小鼠产生抗ADP/ATP载体自身抗体和T细胞介导的免疫应答,发生过继免疫性心肌损害,且此损害与供体小鼠体内改变相似。     

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.