间歇性缺氧通过内质网途径诱导滋养层细胞凋亡

目的 分析间歇性缺氧对人绒毛膜滋养层细胞(HTR8/SVneo)内质网应激及凋亡的影响,并探讨其可能的机制。方法 选用人绒毛膜滋养层细胞(HTR8/SVneo),间歇性缺氧-24 h组和间歇性缺氧-48 h组分别进行24 h和48 h的间歇性缺氧处理,空白对照组始终置于常氧中培养。观察间歇性缺氧对细胞凋亡与增殖,以及内质网应激相关分子、细胞凋亡相关蛋白、细胞周期相关蛋白和缺氧诱导因子-1α(HIF-1α)表达的影响。结果 与空白对照组比较,间歇性缺氧组CCAAT/增强子结合蛋白同源蛋白(CHOP)、葡萄糖调节蛋白78(GRP78)、激活转录因子6(ATF6)、X-盒结合蛋白1(XBP-1)mRNA和蛋白表达水平显著增加,早期凋亡率显著增加,Caspase-3蛋白、多聚ADP-核糖聚合酶(PARP)mRNA和蛋白表达水平显著增加,HIF-1αmRNA和蛋白表达水平显著增加,并随缺氧时间延长而增加(P<0.05);与空白对照组比较,间歇性缺氧可显著抑制HTR8/SVneo细胞增殖,并随缺氧时间延长而细胞活力降低(P<0.05);与空白对照组比较,间歇性缺氧组细胞周期蛋白D1(CyclinD1)、CyclinD3 mRNA和蛋白表达水平显著降低,并随缺氧时间延长而降低(P<0.05)。结论 间歇性缺氧可能通过调控HIF-1α,激活内质网应激途径,进而抑制滋养层细胞增殖,诱导其凋亡。     

慢性间歇性低氧激活内质网应激介导大鼠肾脏损伤

目的探讨慢性间歇性低氧在普通饮食及高脂饮食引起肾脏损伤中的作用机制。方法将SPF级健康雄性Wistar大鼠24只,随机分为4组(每组6只),分别为A组(常氧并普通饮食)、B组(常氧并高脂饮食)、C组(慢性间歇性低氧并普通饮食)和D组(慢性间歇性低氧并高脂饮食)。6周后检测血清中肾脏早期损伤指标半胱氨酸蛋白酶抑制剂C(Cys-C),行肾脏CHOP蛋白免疫组化,并在电镜下观察肾小球及肾小管超微结构变化。结果 B组、C组、D组中肾早损指标Cys-C水平较A组显著升高,且在D组中值最高(均P0.05);B组、C组、D组中内质网应激标志性蛋白CHOP平均光密度值与A组比较显著升高,且在D组中值最高(均P0.05)。电镜下观察,A组肾小球及肾小管未见明显异常;B组、C组近曲肾小管上皮细胞局灶性核固缩,刷状缘稀疏并脱落;D组中有大片肾小管上皮细胞核固缩,刷状缘稀疏并脱落。结论慢性间歇性低氧、高脂饮食可通过激活内质网应激介导近曲肾小管上皮的凋亡,使肾脏的超微结构发生改变,进而导致肾脏功能损伤。     

抑制HDAC6可增强自噬减轻肾脏缺血再灌注损伤

目的 探讨HDAC6在小鼠肾脏缺血再灌注损伤中对α-微管蛋白和自噬相关基因表达的影响。方法 通过夹闭肾动脉建立小鼠肾缺血再灌注损伤模型,检测小鼠血清肌酐、尿素氮,用HE染色观测肾脏形态学,用Western blot法和qPCR法检测HDAC6在缺血再灌注损伤过程中蛋白和基因表达的变化。建立小鼠肾小管上皮缺氧复氧模型,用Western blot法检测α-微管蛋白和自噬相关蛋白表达,用CCK-8检测细胞活力,用凋亡试剂盒检测细胞凋亡。结果 在小鼠肾脏缺血再灌注损伤后,小鼠肾脏组织中HDAC6含量增加(P<0.05)。在细胞缺氧复氧加HDAC6选择性抑制剂tubastatin A (TA)组,细胞活力增强,细胞凋亡减少(P<0.05)。肾小管细胞缺氧复氧后, α-微管蛋白乙酰化水平降低,肾小管细胞缺氧复氧加TA组,α-微管蛋白乙酰化水平升高。肾小管细胞缺氧复氧后,自噬相关基因 LC3、ATG7、Beclin-1表达增加,自噬激活,加TA组LC-3、ATG7、Beclin-1表达较单纯缺氧复氧组增多,自噬增强(P<0.05)。结论 HDAC6抑制剂可通过激活自噬减轻肾脏缺血再灌注损伤。     

白藜芦醇对脓毒症小鼠急性肾损伤的保护作用和机制研究

目的探讨白藜芦醇对脓毒症小鼠急性肾损伤的保护作用及作用机制。方法将45只C57BL/6雄性健康小鼠随机分成3组：假手术组（Sham组）、脓毒症模型组[盲肠结扎穿孔（CLP）组]和白藜芦醇实验组（CLP+白藜芦醇组）,每组15只,采用CLP术构建脓毒症小鼠模型,术后72h每组选取存活的5只小鼠处死并取材,检测血肌酐、尿素氮、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肾损伤标志物-1（KIM-1）、沉默信息调节相关酶1（SIRT1）表达情况;观察小鼠肾脏结构、肾细胞凋亡情况,计算生存率,检测肾脏组织Caspase-3的表达。结果与Sham组相比,CLP组小鼠肾小球毛细胞血管扩张、充血,肾小管上皮细胞水肿、颗粒性变样,管腔缩小,大量炎症细胞浸润,血肌酐、尿素氮水平均升高（均P＜0.05）,血清NGAL、KIM-1水平均升高（均P＜0.05）;可见大量肾小管上皮细胞凋亡,SIRT1mRNA、蛋白表达水平均升高（均P＜0.05）,Caspase3蛋白表达上调（P＜0.05）;小鼠7d成活率为0%。与CLP组相比,CLP+白藜芦醇组小鼠肾小球毛细血管扩张不明显,炎症细胞浸润有所减轻,血肌酐、尿素氮水平均降低（均P＜0.05）,血清NGAL、KIM-1水平均降低（均P＜0.05）;且肾小管上皮细胞凋亡明显减少,SIRT1mRNA、蛋白表达水平均升高（均P＜0.05）,Caspase3蛋白表达下调（P＜0.05）,小鼠7d成活率为30%（P＜0.05）。结论白藜芦醇可能通过激活SIRT1信号抑制凋亡通路抑制肾小管上皮细胞凋亡,减轻脓毒症相关性急性肾损伤程度。     

肌红蛋白诱导的内质网应激及细胞凋亡在挤压综合征中的机制初探

目的 建立挤压综合征急性肾损伤(AKI)小鼠模型,探究肌红蛋白诱导的肾小管上皮细胞内质网应激及细胞凋亡在挤压综合征中的致病机制。方法 体内实验:将C56BL/6小鼠随机分为对照组、模型组8 h及模型组24 h,每组6只,模型组于小鼠大腿外侧肌注50%甘油生理盐水溶液（8 μL/g）建立挤压综合征模型,对照组注入等量生理盐水。分别于注射后8、24 h麻醉处死动物,检测血清肌酐（sCr）,获取完整肾脏标本进行电镜及TUNEL染色观察凋亡,采用免疫组化、实时荧光定量PCR等检测凋亡及内质网应激相关蛋白表达。体外实验:将人近端肾小管上皮细胞随机分为对照组、干预组6 h及干预组12 h,对照组加入标准细胞培养液,干预组加入等量含马肌红蛋白的细胞培养液,分别于6、12 h后收取细胞进行流式分析检测细胞凋亡。结果 注射甘油8 h后sCr明显升高,挤压综合征模型建立成功。电镜示与对照组相比,模型组肾小管上皮细胞内质网、线粒体等细胞器肿胀较明显。TUNEL染色提示模型组肾组织凋亡细胞百分比高于对照（P<0.05)。免疫组化染色和实时荧光定量PCR示模型组肾组织凋亡标志蛋白半胱氨酸天冬氨酸蛋白酶（caspase）3及内质网应激标志蛋白CCAAT增强子结合蛋白同源蛋白（CHOP）、caspase12表达高于对照组（P<0.05）。细胞流式分析提示马肌红蛋白干预组细胞凋亡比例较对照组升高（P<0.05）。结论 内质网应激及凋亡参与了挤压综合征导致AKI的发病机制,肌红蛋白可能是诱导细胞凋亡的重要因素。     

内质网应激预处理对大鼠急性缺血性肾损伤的保护作用

目的 研究内质网应激预处理对大鼠急性缺血性肾损伤的保护作用. 方法 24只雄性SD大鼠均分为对照组、衣霉素(tunicamycin,TM)处理组、缺血再灌注(ischemia reperfusion,I/R)组,衣霉素+缺血再灌注(TM+I/R)组.采用自动生化分析仪检测大鼠血肌酐、尿素氮水平, PAS染色检测肾小管损伤情况,免疫组化和Western blot检测肾组织内质网应激标志物GRP78蛋白表达. 结果 ①与对照组(0.2±0.03)比较,I/R组肾组织GRP78表达(2.4±0.17)增加(P<0.05),与对照组血肌酐、尿素氮[(47.42±6.02)μmol/L、(4.75±1.77)mmol/L]比较,I/R组血肌酐[(186.83±20.21)μmol/L]、尿素氮[(21.73±2.33)mmol/L]水平升高(P<0.05),肾小管损伤评分升高. ②TM组大鼠肾组织GRP78表达升高,但未见明显肾小管损伤,与对照组比较,血肌肝、尿素氮水平无明显变化. ③与I/R组比较,TM+I/R组大鼠GRP78表达(3.2±0.24)升高;肾小管损伤评分降低(P<0.05),血肌酐[(98.72±14.55) μmol/L]、尿素氮[(13.22±2.45)mmol/L]水平降低(P<0.05). 结论 内质网应激预处理对急性缺血性肾损伤有保护作用,其机制可能为通过激活适宜的内质网应激,上调肾组织GRP78表达,从而抑制I/R导致的过度内质网应激,提高肾组织对缺血的耐受性,减轻细胞和组织损伤,实现其对大鼠急性缺血性肾损伤的保护作用.     

G蛋白偶联受体激酶4调控小鼠肾脏急性缺血再灌注损伤的机制探讨

目的 探讨G蛋白偶联受体激酶4(G protein-coupled receptor kinase 4,GRK4)对小鼠肾脏急性缺血再灌注损伤的影响及其作用机制.方法 取SPF级健康野生型[8周龄、体质量(21.34±0.42)g]和GRK4转基因型[8周龄、体质量(21.87 ±0.68)g] C57BL/6小鼠,各12只.各型分别按随机数字表法分为4组(n=6):野生型假手术对照组、野生型肾脏缺血再灌注损伤组、GRK4转基因型假手术对照组、GRK4转基因型肾脏缺血再灌注损伤组.假手术对照组均采用开腹后不阻断肾动脉血流;缺血再灌注损伤组均采用夹闭肾动脉缺血45 min再灌注24 h,建立小鼠肾脏I/R模型.各组处死小鼠后,取血标本进行肾功能检测(血肌酐、血尿素氮);HE染色观察肾脏病理形态改变,并行肾小管损伤半定量评分;测定肾脏组织中过氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdehyde,MDA)等氧化应激水平改变;TUNEL染色检测肾脏组织中细胞凋亡情况;蛋白质免疫印记方法检测各组小鼠肾脏组织中GRK4和AT1受体的蛋白表达变化.结果 野生型小鼠肾脏I/R模型后肾功能受损,血肌酐、血尿素氮升高,肾脏小管上皮细胞脱落、死亡(P＜0.05);肾脏组织中GRK4蛋白表达含量增加,差异有统计学意义(P＜0.05).在GRK4过表达小鼠上研究结果发现,过表达GRK4的肾脏在缺血再灌注损伤后,肾功能损害进一步加重;肾脏病理损伤评分明显增加(P＜0.05).肾脏氧化应激水平明显上升,总SOD下降和MDA升高(P＜0.05);肾脏凋亡细胞数目显著增多(P＜0.05).肾脏组织中AT1受体表达量增加(P＜0.05),AT1受体含量的升高可以加重小管细胞氧化应激和凋亡的发生.结论 GRK4可以通过上调肾脏AT1受体表达,增加肾脏氧化应激水平和肾小管细胞凋亡,加重肾脏缺血再灌注损伤.     

慢性肾病患者肾小管上皮细胞内质网应激与细胞凋亡的关系

目的 探讨慢性肾病(chronic kidney disease,CKD)患者蛋白尿诱导肾小管上皮细胞内质网应激与细胞凋亡的关系.方法 应用免疫组织化学技术检测CKD患者肾小管上皮细胞中内质网应激标志蛋白氧调节蛋白150(cells-oxygen-regulated protein150, ORP150)和糖调节蛋白78(glucose-regulated protein 78, GRP78)的表达;TUNEL法检测细胞凋亡.对各指标与CKD患者24 h尿蛋白量进行相关性分析.结果 CKD患者肾小管上皮细胞细胞质中ORP150、GRP78的表达较正常对照组显著增强(P＜0.01),且轻、中、重度蛋白尿3组各组间亦均有显著性差异(P＜0.01),并与尿蛋白水平呈正相关(r=0.695,r=0.76,P＜0.01);各组小管上皮细胞凋亡系数(apoptosis index,AI)均亦有显著性差异(P＜0.01),并与尿蛋白水平呈正相关性(r=0.835,P＜0.01).结论 CKD患者肾小管上皮细胞有内质网应激与凋亡的发生,并且其强度与蛋白尿水平呈正相关关系.内质网应激可能是大量蛋白尿引起小管上皮细胞凋亡的重要环节.     

信号传导和转录激活因子3及其蛋白抑制剂在狼疮小鼠肾组织中的表达

目的探讨信号传导和转录激活因子3(STAT3)及其蛋白抑制剂(PIAS3)在MRL/lpr狼疮小鼠肾组织中的表达。方法以18周龄雌性MRL/lpr小鼠作为狼疮肾炎组,相同周龄的BALB/C小鼠作为正常对照组。分别取两组小鼠肾组织,应用荧光定量RT-PCR法检测STAT3和PIAS3 mRNA的表达,采用Western blot和免疫组织化学方法检测磷酸化STAT3(p-STAT3)和STAT3的蛋白表达,同时检测小鼠实验室指标以及肾脏组织病理的表现。结果 MRL/lpr小鼠尿蛋白、血尿素氮、血肌酐均高于BALB/C小鼠(P<0.05)。MRL/lpr小鼠肾脏组织病理主要表现为肾小球系膜细胞增生,肾小管间质炎症细胞浸润,而BALB/C小鼠肾小球、肾小管无异常。MRL/lpr小鼠肾组织STAT3 mRNA和p-STAT3蛋白的表达均较BALB/C小鼠升高(P<0.05),其PIAS3mRNA表达则较BALB/C小鼠明显降低(P<0.01),而两组小鼠STAT3总蛋白的表达无明显差别。结论 MRL/lpr小鼠肾组织STAT3 mRNA和p-STAT3蛋白的表达均高于对照组,而其PIAS3 mRNA表达低于对照组。     

糖肾宁对KK-Ay小鼠肾脏病理及足细胞凋亡的影响

目的观察糖肾宁对KK-Ay小鼠肾脏病理及足细胞凋亡的影响。方法利用KK-Ay小鼠建立糖尿病肾病模型,将造模成功的KK-Ay小鼠随机分为模型组、糖肾宁组及缬沙坦组。另外选取相同数量的C57BL/6J小鼠作为正常对照组。糖肾宁组小鼠予20 g·kg-1·d-1的糖肾宁灌胃,缬沙坦组小鼠予10 mg·kg-1·d-1的缬沙坦灌胃,正常对照组及模型组予等剂量蒸馏水灌胃。灌胃时长为12周。分别在灌胃0、4、8、12周时检测24 h尿蛋白,灌胃12周后心尖取血检测血肌酐及尿素氮水平。HE、Masson、PAS染色观察各组小鼠肾脏病理改变,免疫组化及RT-PCR检测各组小鼠足细胞Caspase-3蛋白表达,TUNEL染色观察各组小鼠足细胞凋亡情况。结果①与正常对照组比较,模型组小鼠24 h尿蛋白、血清肌酐、尿素氮水平明显升高(P<0.05)。与模型组比较,糖肾宁组及缬沙坦组小鼠24 h尿蛋白、血清肌酐、尿素氮水平明显降低(P<0.05)。②与正常对照组比较,模型组小鼠肾小球系膜细胞增多,细胞外基质增生;与模型组比较,糖肾宁组及缬沙坦组小鼠肾小球系膜细胞减少,细胞外基质增生减轻。③与正常对照组比较,模型组小鼠足细胞Caspase-3蛋白及mRNA表达明显上调(P<0.05);与模型组比较,糖肾宁组及缬沙坦组小鼠足细胞Caspase-3蛋白及mRNA表达明显下调(P<0.05)。④与正常对照组比较,模型组小鼠足细胞凋亡数目明显升高(P<0.05);与模型组比较,糖肾宁组及缬沙坦组小鼠足细胞凋亡数目明显降低(P<0.05)。结论糖肾宁能够降低糖尿病肾病蛋白尿,改善肾功能,其机制可能与其改善肾脏病理及减轻足细胞凋亡有关。     

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.