整合素连接激酶在梗阻性肾病肾小管上皮细胞转分化中的作用及尿激酶对其表达调节的研究

目的 研究整合素连接激酶(ILK)在单侧输尿管梗阻(UUO)小鼠肾小管上皮细胞转分化中的作用及尿激酶对其的影响.方法 将雄性CD-1小鼠随机分为假手术对照组(Sham,n=20)、UUO组(UUO,n=28)和尿激酶治疗组(uPA,n=28),分别于术后1、3、7和14 d处死小鼠.Masson染色观察肾间质纤维化.免疫荧光和Western印迹检测小鼠肾组织ILK的分布及表达.免疫组化检测肾组织上皮细胞钙粘蛋白(E-cadherin)的表达.RT-PCR检测ILK、E-cadherin和α-平滑肌肌动蛋白(α-SMA)mRNA表达.结果 与Sham组相比,UUO组术后1dILKmRNA及蛋白表达均增高,7d达到高峰:E-cadherin mRNA及蛋白表达明显减少,α-SMA mRNA表达显著上调.与UUO组同时间点相比,uPA治疗组ILK、α-SMA表达均被显著抑制(P<0.05);E-cadherin表达则增高(P<0.05).结论 ILK通过介导肾小管上皮细胞转分化而参与肾间质纤维化的发生发展.uPA能减轻肾小管间质纤维化,这可能与其抑制肾小管细胞ILK表达有关.     

根皮素通过抑制FAK改善肾小管间质纤维化

目的 探究根皮素能否通过抑制黏着斑激酶(FAK)改善肾小管间质纤维化。方法 肾小管上皮细胞NRK-52E经TGF-β1(10 ng/mL)诱导建立肾纤维化细胞模型,并构建单侧输尿管梗阻(UUO)肾间质纤维化小鼠模型。通过免疫荧光及Western blot法检测细胞及小鼠肾脏组织中α-SMA、FN的蛋白表达水平,明确根皮素体内外抗肾纤维化作用;检测实验小鼠血清中肌酐(Cr)和尿素氮(BUN)水平,分析根皮素的肾保护作用;以苏木精-伊红(HE)染色和Masson染色观察根皮素对UUO小鼠肾脏病理学改变和胶原纤维沉积的影响;Western blot检测TGF-β1诱导的NRK-52E细胞和UUO小鼠肾组织中FAK、p-FAK的蛋白表达水平;通过分子对接预测根皮素与FAK蛋白的潜在结合模式和结合能力;使用FAK抑制剂PND-1186,探究根皮素改善肾间质纤维化的作用机制。结果 根皮素可逆转TGF-β1所致的肾小管上皮细胞及UUO小鼠肾组织中α-SMA、FN的蛋白表达水平升高,且显著降低UUO小鼠血清中Cr、BUN水平,改善UUO小鼠肾小管扩张、炎性细胞浸润及间质胶原沉积;根皮素可以显著抑制UU...     

KIF3A在单侧输尿管梗阻小鼠肾脏中的表达及意义

目的 通过研究KIF3A在单侧输尿管梗阻（UUO）小鼠和TGF-β1诱导的NRK-52E细胞中的表达情况,探讨KIF3A在肾间质纤维化中的作用。方法 将36只C57BL/6J小鼠随机分为假手术组（Sham, n=18）和单侧输尿管梗阻组（UUO, n=18）,分别于术后7、14、21 d 处死小鼠。苏木素-伊红（HE）染色、马松（Masson）三色法染色和天狼星红（Sirius Red）染色观察小鼠肾间质纤维化程度,RT-PCR、免疫组织化学（IHC）和免疫印迹（Western blot）检测小鼠肾组织KIF3A的表达和分布。免疫印迹检测小鼠肾组织KIF3A、E-cadherin 和α-SMA 蛋白的表达。TGF-β1诱导NRK-52E细胞转分化后,免疫印迹检测KIF3A、E-cadherin 、α-SMA、Wnt4和β-catenin 蛋白的表达。结果 与Sham组相比,UUO小鼠肾间质纤维化程度随着梗阻时间延长而增加,表明造模成功。同时,KIF3A mRNA和蛋白表达均增高,于21 d达到高峰,α-SMA蛋白表达显著上调,E-cadherin蛋白表达明显降低。NRK-52E细胞发生转分化时,KIF3A蛋白的表达增多（P<0.001）,同时wnt/β-catenin信号通路中Wnt4和β-catenin蛋白表达增加（P<0.05,P<0.0001）。结论 KIF3A可能通过wnt/β-catenin信号通路介导的上皮细胞-间充质转化参与肾纤维化的发生发展过程。     

迷迭香酸对单侧输尿管梗阻小鼠肾脏的抗氧化保护作用

目的:探讨迷迭香酸对小鼠单侧输尿管梗阻(UUO)模型肾间质纤维化的抗氧化保护作用.方法:将雄性C57BL/6J小鼠随机分成3组:假手术对照组(Sham组,n=8)、UUO模型组(结扎左侧输尿管制作UUO模型,n=24)、UUO迷迭香酸干预组(UUO+RA组,n=24).除Sham组外,其余2组根据不同的观察时间细分为3、7、14天亚组n=8).术后第3、7、14天分别处死各组小鼠.组织病理学方法观察肾小管间质损伤情况;Western blotting方法检测肾组织中波形蛋白(Vimentin)和E-5黏蛋白(E-cadherin)表达;比色法测定小鼠左肾皮质匀浆中脂质过氧化标志物MDA以及抗氧化酶SOD的含量.结果:UUO模型组与假手术组比较:随着模型损伤时间的延长,肾间质损伤程度逐渐加重,Vimentin和MDA含量明显增高,E-cadherin和SOD含量明显降低.迷迭香酸干预组与UUO模型组比较:3大时肾脏病理、Vimentin、E-cadherin以及MDA、SOD含量无明显改变;7天时肾间质纤维化减轻,Vimentin、MDA含量降低,E-cadherin、SOD含量增高;14天时肾间质纤维化明显减轻,Vimentin、MDA含量明显降低.E-cadherin、SOD含量明显增高.结论:迷迭香酸可能通过减少单侧输尿管梗阻侧肾皮质脂质过氧化物的产生、增加抗氧化酶的含量.从而改善小鼠氧化应激所致的肾问质纤维化.     

MMP-9与TIMP-1在肾小管上皮细胞转分化中的作用

目的研究结扎大鼠单侧输尿管(UUO)制备的实验性肾纤维化模型梗阻肾基质金属蛋白酶9(MMP-9)和组织金属蛋白酶抑制剂1(TIMP-1)表达的动态变化,探讨MMP-9和TIMP-1在肾小管上皮细胞转分化中的作用。方法将64只雄性大鼠随机分为假手术组和UUO组(n=32),UUO组结扎单侧输尿管,术后3d、7d、14d、21d每组各处死8只大鼠,用免疫组化法检测大鼠梗阻肾组织MMP-9、TIMP-1、α-平滑肌肌动蛋白(α-SAM)及纤维连接蛋白(FN)的表达。结果UUO术后3d,PAS染色见少量肾小管基底膜(TBM)局灶性断裂。术后7d,TBM断裂程度加重,基底膜断裂的肾小管数增多。术后14d直至术后21d,可见部分TBM增厚、扭曲,基底膜断裂程度和基底膜断裂的肾小管数较7d时略减轻和减少。与假手术组相较,UUO组随着梗阻时间的延长,肾间质中α-SMA、FN、TIMP-1蛋白表达逐渐增多。UUO组术后3d可见MMP-9在肾小管间质有强阳性表达,术后7d达高峰,14～21d呈下降趋势。α-SMA、MMP-9、TIMP-1主要表达于肾小管上皮和肾间质。MMP-9阳性染色面积与α-SMA阳性染色面积、TBM的断裂程度、基底膜断裂的肾小管个数均呈正相关(r分别为0.894,0.854,0.821,P均<0.05)。结论肾小管间质MMP-9和TIMP-1蛋白表达的动态变化影响TBM完整性与ECM堆积。MMP-9与TIMP-1相互拮抗调节肾小管基底膜代谢,参与肾小管上皮细胞转分化,影响肾纤维化进展。     

整合素连接激酶在梗阻性肾病合并肾小管酸中毒中的表达

目的：观察整合素连接激酶（ILK）在梗阻性肾病合并肾小管酸中毒中的表达,探讨肾小管酸中毒在致肾间质纤维化中的作用。方法实验大鼠75只,其中假手术组大鼠25只,单侧输尿管梗阻（UUO）大鼠50只。UUO大鼠于术后第7天分为肾小管酸中毒大鼠（UUO1组,n＝31）和非肾小管酸中毒大鼠（UUO2组,n＝19）,同时做肾功能与组织学检测,于手术后7、14、21、28 d时分批处死大鼠,免疫组织化学与 Western blot法测定肾组织中 ILK的表达。结果与 UUO2组比较,UUO1组光镜下炎症细胞浸润和间质纤维化程度更严重;假手术组仅有少量的 ILK蛋白表达,几乎无纤粘连（FN）蛋白的沉积,UUO2组 ILK蛋白表达及 FN蛋白的沉积增多,而 UUO1组较 UUO2组增多。结论在梗阻性肾病中,肾小管酸中毒可上调 ILK蛋白的表达与FN的沉积,加速肾小管间质纤维化。     

黄芪当归合剂对梗阻性肾病大鼠肾间质纤维化的防治作用

目的 :研究黄芪当归合剂 (A&A)对梗阻性肾病大鼠肾小管间质纤维化的防治作用 ,探讨其抗纤维化作用的可能机制。方法 :采用单侧输尿管梗阻 (UUO)诱导肾间质纤维化的动物模型 ,以目前公认具有肾脏保护作用的血管紧张素转换酶抑制剂 (ACEI)作为阳性对照 ,将大鼠随机分为假手术组 (Sham)、模型组 (UUO)、黄芪当归合剂组 (A&A)、依那普利组 (ACEI) ,术后第 1 0天处死大鼠 ,收集血清测定肌酐、尿素氮水平 ,肾组织用Masson染色后进行图像分析评定各组肾小管间质损害程度 ,免疫组化半定量检测各组肾间质的α 平滑肌肌动蛋白 (α SMA)、转化生长因子 β1 (TGF β1 )、纤维连接蛋白 (FN)和层粘连蛋白 (LN)的表达。结果 :UUO组的肾小管间质损伤指数及α SMA、TGF β1 、FN和LN的表达明显高于Sham组 ,肾小管间质损伤指数与肾间质的α SMA、TGF β1 、FN和LN的表达均呈正相关关系。A&A组、ACEI组的肾小管间质损伤指数及α SMA、TGF β1 、FN和LN的表达均明显低于UUO组 ;两治疗组间比较 ,A&A对TGF β1 表达的抑制作用弱于依那普利的作用 ,而其余各指标差异无显著性。结论 :在单侧输尿管梗阻诱导的肾间质纤维化大鼠模型中 ,中药复方A&A的防治作用与ACEI相似 ,可能是通过减少肾间质肌成纤维细胞的数量、抑制TGF β1 表达     

肾炎康复片对大鼠肾间质纤维化的保护作用

目的:研究肾炎康复片对单侧输尿管梗阻(UUO)大鼠肾间质纤维化的保护作用。方法:21只SD大鼠随机分为假手术组(Sham组)、肾间质纤维化组(UUO组)及肾炎康复片组(SKT组),观察大鼠UUO术后14d梗阻侧肾脏的组织学变化、纤维连接蛋白(FN)及基质金属蛋白酶抑制物-1(TIMP-l)的表达情况。结果:与Sham组相比,UUO组大鼠肾间质纤维化面积显著增加(P<0.01),FN及TIMP-1表达均有显著增高(P<0.01);与UUO组相比,SKT组大鼠肾间质纤维组织面积减少,FN及TIMP-1表达减弱(P<0.01);UUO组和SKT组大鼠FN及TIMP-1与肾间质纤维化面积成正相关(P<0.01)。结果:肾炎康复片可下调FN和TIMP-1在UUO大鼠肾间质中的表达,从而延缓肾间质纤维化的进展。     

输尿管结扎对小鼠肾皮质骨架蛋白与炎症因子表达的影响

目的 通过对UUO小鼠肾组织俚一平滑肌肌动蛋白（α-smooth muscle actin,α-SMA）、波形蛋白（vimentin）、炎症介质细胞间粘附分子（intercellular adhesion molecule 1,ICAM-1）、单核细胞趋化因子（monocyte chemoattractant protein1,MCP-1）表达的研究,探讨肾间质纤维化机制。方法实验取单侧输尿管结扎（UUO）21天小鼠结扎侧肾组织,肾组织α-SMA、Vimentin表达采用免疫组化技术;ICAM-1蛋白质表达采用Western-blotting方法检测;MCP-1基因表达采用反转录-聚合酶链式反应（RT-PCR）方法。结果 UUO模型组小鼠肾小管间质α-SMA、Vimentin的表达较假手术组显著增高,肾组织中ICAM-1蛋白表达、MCP-1基因表达亦较假手术组显著增高。结论 输尿管结扎21天可诱导肾小管间质肌成纤维细胞的大量积聚,可能与肾组织炎症因子的高度表达相关。     

尿毒清颗粒抑制大鼠肾脏间质纤维化作用靶点研究

目的：研究尿毒清抑制大鼠肾脏间质纤维化的作用。方法采用单侧输尿管结扎术制备肾间质纤维化大鼠模型,将10周龄SPF级雄性大鼠60只,随机分3组：假手术(Sham,n=20)、模型组(UUO,n=20)和尿毒清治疗组（UNQ,n=20）;UNQ组于于术前1天给予尿毒清2 g/（kg·d）灌胃,假手术组及模型组每天灌胃等量生理盐水,各组分别于术后第3、7、14天处死5只大鼠,取梗阻侧肾脏进行组织学检查,对肾间质细胞浸润、肾小管萎缩和肾间质纤维化情况进行半定量评分;采用免疫组化、ELISA和Western Blot分别分析肾组织中转化生长因子β1(TGF-β1)、纤粘连蛋白(FN)表达。结果与Sham相比,UUO大鼠各时间点的病理损害进行性加重,肾小管间质中TGF-β1、FN 表达均增高(P<0.05)。与UUO相比,尿毒清治疗后3 d,可观察到大鼠的肾间质炎性细胞浸润、肾小管萎缩及肾间质纤维化(P<0.05)明显减轻,同时肾组织中TGF-β1表达减少(P<0.05);治疗后7 d,上述治疗作用持续存在,同时进一步使UUO大鼠肾间质的FN 表达下降(P<0.05);治疗14 d后,肾间质细胞浸润情况评分（CIS）和慢性病变(包括肾小管萎缩和间质纤维化)评分（AFS）较 UUO 组分别下降22.2%和19.1%(P<0.05),TGF-β1、FN的表达则较UUO 组分别减轻30.8%和30%(P<0.05)。结论尿毒清的保护作用表现在肾损伤的开始就通过减少TGF-β1表达从而使肾间质炎症细胞浸润受到抑制,同时还能减少病变肾组织细胞外基质的积聚,从而减轻肾间质纤维化。     

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.