大鼠蛛网膜下腔出血后早期 ADAM TS-4的表达与血脑屏障通透性的相关性研究

目的通过建立大鼠蛛网膜下腔出血(subarachnoid hemorrhage,SAH)的动物模型,对ADAMTS-4在SAH后早期脑损伤中的作用进行初步研究。方法成年雄性SD大鼠72只,分对照组和SAH组,通过检测大鼠海马ADAMTS-4的表达及脑内伊文氏蓝(Evans Blue,EB)的浓度,并通过股静脉注射ADAMTS-4抑制剂-α2巨球蛋白进行干预等,探讨ADAMTS-4的表达与BBB通透性的相关性。结果 SAH后24hADAMTS-4mRNA及蛋白表达明显升高,脑内EB浓度于出血后12h明显升高,ADAMTS-4蛋白表达与脑内EB浓度成正相关(r=0.917,P<0.05)。经α2巨球蛋白干预后,SAH后48hADAMTS-4蛋白表达较非干预组明显降低(P<0.05),且干预组脑内EB浓度较非干预组亦有显著减少(P<0.05)。结论 ADAMTS-4可能参与了SAH后早期脑损伤的病理过程。     

高压氧对蛛网膜下腔出血大鼠脑内基质金属蛋白酶-9表达的影响

目的:探讨高压氧(HBO)对基质金属蛋白酶-9(MMP-9)在蛛网膜下腔出血(SAH)后的表达的影响及其对血脑屏障(BBB)的保护作用。方法:采用自体股动脉血枕大池单次注血法建立大鼠实验性SAH模型。造模成功后分不同时间点对HBO组给予高压氧暴露。并分不同时间点测脑含水量、BBB通透性及MMP-9的表达情况。结果:SAH后各组脑含水量、BBB通透性、MMP-9表达较Sham组显著升高(P<0.05),但在同一时间点HBO组较SAH组脑含水量、BBB通透性、MMP-9表达显著减少(P<0.05)。结论:HBO可能通过抑制MMP-9的表达,减轻了BBB的破坏,从而减轻脑水肿,对大鼠SAH后BBB具有保护作用。     

大鼠蛛网膜下腔出血后皮质中VDAC1的表达与神经元凋亡的关系

目的观察大鼠蛛网膜下腔出血(subarachnoid hemorrhage,SAH)后大脑皮质中VDAC1表达和皮质神经元凋亡,以及两者之间的关系,探讨电压依赖性阴离子通道蛋白1(voltage-dependent anion channel1,VDAC1)参与SAH后早期脑损伤的发生机制。方法将SD大鼠108只按随机数字表法分为假手术组(n=18只)和SAH组(n=90,下设SAH后6、12、36、48、72 h 5个时相点,每个时相点18只)。采用视交叉前池注血法建立SAH模型,应用RT-PCR、免疫组化和Western blot分别检测大鼠SAH后不同时相点VDAC1在mRNA水平、蛋白质水平的表达变化。凋亡原位末端标记法(Tunel)观察SAH后不同时相点大脑皮质神经元凋亡。结果大脑皮质中VDAC1表达,无论在mRNA水平,还是在蛋白质水平,在SAH后12 h均明显增加[mRNA(2.40±0.19),蛋白(1.14±0.08)],于36 h时表达达最高峰[mRNA(3.40±0.65),蛋白(1.72±0.22)],于48 h开始下降[mRNA(1.94±0.30),蛋白(0.97±0.07)],至72 h时基本恢复正常(P>0.05)。TUNEL法检测显示大鼠SAH后12 h,大脑皮质中神经元凋亡细胞数开始增加,36 h达到高峰,之后逐渐降低(P<0.05),72 h时降至正常(P>0.05)。结论 SAH后不同时间点VDAC1表达水平的动态变化与神经元凋亡发生、发展的时相性是一致的,提示VDAC1可能通过细胞凋亡途径参与SAH后早期脑损伤的病理过程。     

大鼠蛛网膜下腔出血后大脑皮质中神经元凋亡的研究

目的:研究大鼠蛛网膜下腔出血(SAH)后大脑皮质神经元凋亡与Caspase-3和Fas表达情况及其相互关系。方法:选用健康SD大鼠60只,随机分成正常对照组(n=6)、假手术组(n=6)和SAH组(n=48),SAH组在2、4、8、16h及1、3、5d和7d时相点各6只。采用枕大池二次注血法制备SAH模型,HE染色,光学显微镜观察大脑皮质神经元形态学改变,应用免疫组化法检测Caspase-3和Fas的表达。结果:大鼠SAH后2h大脑皮质中神经元凋亡细胞开始增加,3~7d呈典型凋亡细胞形态改变,随SAH时间延长Caspase-3和Fas在大脑皮质中的表达呈上升趋势,3d时达最高,7d时仍显著高于正常对照组(P<0.01)。结论:Caspase-3和Fas参与了大脑皮质神经元凋亡的过程,Caspase-3是大脑皮质神经元凋亡进程中的重要物质之一。     

液态氟碳纳米粒在大鼠蛛网膜下腔出血中对低氧诱导因子1α的抑制作用

目的 初步探讨液态氟碳(perfluorooctyl-bromide,PFOB)纳米粒对蛛网膜下腔出血后早期脑损的保护作用及其与低氧诱导因子1 α(HIF-1α)的关系.方法 健康雄性SD大鼠100只分为5个组:假手术组(Sham)、蛛血组(SAH)、蛛血+安慰剂组(SAH+vehicle)、蛛血+5g/kg PFOB组(SAH+5 g/kg PFOB)和蛛血+10 g/kg PFOB组(SAH+10 g/kg PFOB),每组20只.采用颈内动脉穿刺法制作SAH模型.造模后24 h对每组大鼠进行神经行为功能缺损评分,检测脑含水量和血脑屏障(BBB)通透性,末端脱氧核苷酸介导的X-dUTP缺口末端标记法(TUNEL)检测神经元凋亡,免疫组化和Western blot检测HIF-1α蛋白表达情况.结果 PFOB纳米粒能够显著降低早期脑损伤,包括改善神经功能缺失、减轻脑水肿、降低血脑屏障通透性和减少神经元凋亡,且SAH+10 g/kg PFOB组降低效果明显高于SAH+5g/kg PFOB组(P＜0.05).PFOB在降低早期脑损伤的同时能够显著抑制HIF-1 α蛋白表达,且SAH+ 10 g/kg PFOB组抑制效果明显高于SAH+5 g/kg PFOB组(P＜0.05).结论 液态氟碳纳米粒对蛛网膜下腔出血后早期脑损伤的保护作用可能与抑制HIF-1α蛋白表达有关.     

塞来昔布对大鼠蛛网膜下腔出血后迟发性脑血管痉挛的防治

目的探讨塞来昔布(Celecoxib)对迟发性脑血管痉挛的防治。方法36只SD大鼠随机分为对照组,蛛网膜下腔出血组,塞来昔布治疗组,每组12只。应用枕大池二次注血法建立大鼠SAH模型,治疗组第1次注血30min后给予塞来昔布灌胃,利用HE染色和透射电镜分别观察各组处理后第7天基底动脉形态学和超微结构改变。结果(1)经塞来昔布治疗后,治疗组管径显著大于蛛网膜下腔出血组,管壁厚度显著小于蛛网膜下腔出血组(P0.05),与对照组比较无显著性差异(P0.05)。(2)塞来昔布治疗后痉挛血管的形态学和超微结构得到改善。结论塞来昔布对蛛网膜下腔出血后迟发性脑血管痉挛有防治作用。     

肿瘤坏死因子α诱发脑水肿的机制

目的:研究肿瘤坏死因子α(Tumor necrosis fctor-alpha,TNF-α)对水通道蛋白4(Aquaporin4,AQP4)和血脑屏障(Blood-brain barrier,BBB)通透性的影响,探讨TNF-α诱发脑水肿的机制.方法:90只成年SD大鼠,其中45只用于脑含水量和脑组织AQP4 mRNA表达的测定,将其随机分为空白对照组(A组,n=5)、生理盐水组(NS组,n=20)、TNF-α组(TNF-α组,n=20),NS组和TNF-α组按注射后处死的时间再分为1h组、6h组、24h组、72h组,每组各为5只;其余45只用于BBB通透性的观察,分组方法同前.采用干湿重法计算脑含水量,采用RT-PCR法观察脑组织AQP4 mRNA表达的变化,采用伊文思兰法监测BBB通透性.结果:大鼠脑内注射TNF-α仅后脑含水量和脑组织AQP4 mRNA表达在1h均未见明显变化(P0.05),均于6h达到高峰,之后逐渐降低,72h脑含水量降到正常水平,但AQP4 mRNA表达仍高于正常(P<0.05);脑组织EB含量1h开始升高,6h迅速达到高峰,之后逐渐降低,72h仍高于正常(P<0.05);BBB通透性与AQP4 mRNA表达呈显著正相关(R=0.839,P<0.01),与脑水肿变化趋势一致.结论:TNF-α通过上调APQ4表达,增加BBB通透性,参与脑水肿形成和发展.     

大鼠脑出血后HIF-1α表达与血脑屏障通透性相关分析

目的 探讨血肿周边脑组织中HIF-1α蛋白的表达变化与血脑屏障(BBB)通透性之间的关系.方法 SD大鼠56只随机分假手术对照组(sham组)和脑出血组(ICH组).ICH组又分为6h组、24h组、3d组、7d组和14d组,每组8只.采用自体血脑内注射法建立脑出血动物模型,测定血肿周边脑组织中伊文思蓝(EB)外渗量,以EB外渗量反映BBB通透性的变化,以免疫组化方法检测脑出血后不同时间血肿周边脑组织中HIF-1α蛋白表达情况,并应用干湿比重法测定脑组织含水量.结果 脑出血后3d内,BBB通透性和脑组织含水量均呈进行性增加,并于出血后第3d达到高峰,此后逐渐下降,对照组与出血组脑组织含水量及BBB通透性比较差异均有统计学意义(P<0.05);脑出血组HIF-1 α蛋白阳性表达率60.42%(29/48),对照组HIF-1 α蛋白阳性表达牢为0％,二者相比差异有统计学意义(P<0.05);脑出血后,HIF-1 α蛋白表达于出血后3d达到高峰并维持到第7d,脑出血后不同时间阳性率比较差异有统计学意义(P<0.05).HIF-1α的表达变化与BBB通透性和脑组织含水量均呈正相关(P<0.05).结论 HIF-1 α在血肿周边脑组织中的表达与BBB通透性改变及脑水肿的形成和发展密切相关.     

实验性大鼠蛛网膜下腔出血后病理观察

在既往研究大鼠蛛网膜下腔出血（SAH）后局部脑血流量（rCBF）变化的基础之上，进一步观察SAH后颅底血管痉挛状态和结构变化、血脑屏障（BBB）开放及脑水肿过程．发现SAH后颅底动脉出现间期为72h的痉挛过程，rCBF变化与之有显著的相关性（r＝0．93，P＜0.01）；SAH后早期血管壁呈现强烈的收缩，无血管壁结构变化，晚期在血管壁扩张过程中有部分内皮细胞脱落，弹力膜断裂和平滑肌细胞退性变；SAH后早中期出现轻度BBB通透性增加和脑水肿，二者之间有显著的相关性（r＝0．92，P＜0．01）；BBB通透性改变与血管痉挛有显著的负相关关系（r＝－0．84，p＜005）．这些结果提示：SAH后rCBF变化是反映脑血管痉挛（CVS）状态的较好功能指标；SAH后CVS主要是由脑血管收缩功能改变所致而非血管壁结构改变所致；SAH后出现轻度的BBB开放和血管源性脑水肿，主要是由于CVS引起，但也可能间接部分地影响CVS过程。     

经鼻给予粒细胞集落刺激因子对蛛网膜下腔出血后抗自由基脑保护作用的实验研究

目的:建立蛛网膜下腔出血(Subarachnoid hemorrhage,SAH)模型,研究重组人粒细胞集落刺激因子(Recombinant human granulocyte colony stimulating factor,rhGCSF)经鼻腔给药对SAH后的抗自由基脑保护作用.方法:采用枕大池二次注血法复制大鼠SAH模型,将动物随机分为正常对照组,SAH组,SAH术后经鼻给NS组,SAH术后经鼻给rhGCSF组.二次注血后24 h观察皮层和海马CA1区形态学变化,测定脑组织匀浆SOD活力和MDA含量.结果:①与正常对照组相比,SAH组和SAH+NS组皮层和海马CA1区神经元数目显著减少、排列紊乱且形态异常.rhGCSF治疗组皮层及海马损伤明显减轻.②与正常对照组相比,各组SOD活力显著降低、MDA含量显著升高.SAH组和SAH+NS组相比,差异无统计学意义;而与SAH组和SAH+NS组相比,术后经鼻给rhGCSF组MDA含量降低(P＜0.05),SOD活力显著升高(P＜0.01).结论:经鼻靶向中枢给予rhGCSF通过增强脑组织SOD活力,降低MDA含量,减轻氧自由基介导的脑损伤,对SAH早期脑损伤有明显保护作用.     

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.