高度房室传导阻滞患者主动导线在右心室流出道间隔部起搏的研究

目的观察高度房室传导阻滞患者行右心室流出道间隔部（RVOT）主动导线起搏和右心室心尖部（RVA）被动导线起搏方式对远期心脏功能的影响。方法回顾分析2007年1月～2010年1月于我院植入DDD起搏器的66例高度房室传导阻滞患者。其中RVA被动导线起搏组33例,RVOT主动固定导线起搏组33例。比较两组术中手术时间、X线曝光时间、QRS波宽度。术后随访观察的时间为植入后第1、3、6、12个月及以后每半年1次,随访内容为心脏彩超、体表心电图及患者NYHA心功能分级并与安装起搏器之前进行比较。结果两组均顺利完成手术,未出现严重并发症。术后随访19～42个月。主动导线组手术时间较被动导线组长[（73.45±11.21）min vs（68.34±11.43）min,t=2.12,P〈0.05）];X线曝光时间较被动导线组长[（9.13±3.04）min vs（7.11±2.21）min,t=3.58,P〈0.01）]。主动导线组QRS波宽度明显窄于被动导线组[（0.11±0.03）s vs（0.20±0.04）s,P〈0.05]。植入起搏器后第12个月患者NYHA心功能分级,被动导线组为（2.02±0.13）级,较术前无明显变化;主动导线组为（2.68±0.19）级,两组差异有统计学意义（P〈0.01）。结论右室间隔部主动导线起搏对患者远期心功能影响较小。     

Colorectal cancer-derived Foxp3(+) IL-17(+) T cells suppress tumour-specific CD8+ T cells

The pathogenesis of cancer is remained to be further understood. This study aims to investigate the role of tumour-derived Foxhead box P3 (Foxp3)(+) interleukin (IL)-17(+) T cells on suppressing tumour-specific CD8(+) T cells. Colorectal cancer (CRC) tissue was collected from surgically removed cancer tissue of 22 patients with CRC. Foxp3(+) IL-17(+) T cells in cancer tissue were examined by flow cytometry. A set of cell markers and cytokines expressed by Foxp3(+) IL-17(+) T cells were determined by immune staining. By coculture with isolated peripheral CD8(+) T cells, the immune regulatory capacity of Foxp3(+) IL-17(+) T cells was examined. The results showed that a number of Foxp3(+) IL-17(+) T cells were found in CRC tissue (22.8 ± 2.6 cells/mm(2) tissue) that was significantly more than in non-cancer colonic mucosa (5.6 ± 1.04 cells/mm(2) tissue). The Foxp3(+) IL-17(+) cells also CD4(+), CCR6(+), transforming growth factor (TGF)-beta(+) and IL-6(+) . The CD8(+) T cells proliferated markedly after exposure to tumour protein in culture that was suppressed in the presence of CRC-derived Foxp3(+) IL-17(+) T cells; the suppression was attenuated by pretreatment with anti-IL-17 antibody. We conclude that CRC-derived Foxp3(+) IL-17(+) T cells have the ability to suppress tumour-specific CD8(+) T cells. This subset of T cells may be a novel therapeutic target in the treatment of CRC.     

精氨酸对梗阻性黄疸大鼠肝损伤的保护作用及其对肝细胞凋亡的影响

目的 探讨梗阻性黄疸时精氨酸是否对肝脏具有保护作用及其对肝细胞凋亡的影响.方法 Wistar大鼠42只随机分为3组:A组为假手术组、B组为梗阻性黄疸组、C组为精氨酸治疗组;B组和C组采取双重结扎大鼠胆总管制作梗阻性黄疸模型,C组术后第1天开始每天腹腔注射精氨酸500 mg/(kg·d),分别于术后第7天和第14天取材,采集鼠血清检测TBIL、DBIL、ALT、AST;大鼠肝脏组织进行HE染色切片观察组织形态,电镜观察胞内形态并对组织切片应用Bax、Bcl-2试剂盒行免疫组化染色.结果 与A组大鼠相比,B组大鼠血清胆红素和转氨酶明显增高.肝细胞损伤不断加重并出现显著凋亡改变,随着胆总管结扎时间的延长而更加明显.应用精氨酸治疗的C组大鼠,其肝功能和肝脏组织病理学改变较B组轻.B组和C组大鼠肝组织中Bax、Bcl-2蛋白表达均随时间而增多,但B组Bax表达增多较明显,而C组Bcl-2蛋白表达增多较明显.结论 精氨酸对梗阻性黄疸大鼠肝脏有保护作用,可能是通过上调肝脏组织Bcl-2蛋白表达,下调肝脏组织Bax蛋白的表达减少细胞凋亡来实现的.     

灯盏细辛与单硝酸异山梨酯治疗不稳定型心绞痛的对比研究

目的对比观察灯盏细辛与单硝酸异山梨酯治疗不稳定型心绞痛的临床疗效及其对血液动力学、超敏C-反应蛋白的影响。方法将120例确诊为不稳定型心绞痛的住院患者随机分为两组,每组60例。两组治疗前年龄、性别、血脂、血糖、吸烟史、心功能级别、病程、心绞痛发作次数、持续时间、程度、常规心电图及药物治疗等一般情况,无显著性差异。灯盏组给予灯盏细辛注射液40 mL加入5%的葡萄糖注射液250 mL中静脉点滴;单硝酸异山梨酯组给予单硝酸异山梨酯注射液40 mg加入5%葡萄糖注射液250 mL中静脉点滴,疗程为14 d。观察两组治疗前后的临床疗效、心电图改善情况及血液动力学和超敏C-反应蛋白的变化。结果灯盏组患者心绞痛缓解和心电图改善的总有效率分别是88.3%和80.0%;而单硝酸异山梨酯组患者心绞痛缓解和心电图改善的总有效率分别是95.0%和93.3%,两者相比差异有显著性,达到统计学标准(P<0.05);但灯盏组患者血液动力学指标与治疗前相比明显减少(P<0.05),单硝酸异山梨酯组则无明显变化;两组患者治疗前后血浆C反应蛋白的含量均较治疗前有明显下降,但灯盏细辛治疗组下降更明显,且与单硝酸异山梨酯组比较有显著差异(P<0.05)。另外,灯盏组患者平均收缩压与平均心率的乘积治疗前后明显降低,同时单硝酸异山梨酯组这一积值无明显变化,两者相比有显著差异(P<0.05)。结论灯盏细辛注射液治疗不稳定型心绞痛的疗效及心电图改善方面虽不如硝酸酯类药物,但它在减少心肌耗氧、降低血液黏滞度、减轻斑块炎症方面优于硝酸酯药物,有利于缓解心绞痛发作时的供氧/需氧失衡;有利于钝化稳定已经被激活的粥样斑块;有利于预防继发性血栓的形成,在不稳定心型绞痛患者临床症状缓解、安全渡过急性期及改善预后方面,起重要的辅助治疗作用。     

Hypoxia and HIF-1α expression in the epiphyseal cartilage following ischemic injury to the immature femoral head

HIF-1α has been shown to be a central mediator of cellular response to hypoxia. The role it plays after ischemic injury to the immature femoral head is unknown. The purpose of this study was to determine the region of the femoral head affected by hypoxia following ischemic injury to the immature femoral head and to determine the site of HIF-1α activation and revascularization. We hypothesize that the epiphyseal cartilage, rather than the bony epiphysis, is the site of HIF-1α activation following ischemic osteonecrosis and that the epiphyseal cartilage plays an important role in the revascularization process.Materials and methodsFemoral head osteonecrosis was surgically induced in 56 immature pigs. Hypoxyprobe staining, cell viability assay, HIF-1α western blot, RT-qPCR of HIF-1α, VEGF, VEGFR2, and PECAM, and micro-CT assessments of microfil-infused femoral heads were performed.ResultsSevere hypoxia was present in the bony epiphysis and the lower part of the epiphyseal cartilage following ischemia. In the bony epiphysis, extensive cell death and tissue necrosis was observed with degradation of proteins and RNAs which precluded further analysis. In the epiphyseal cartilage, the loss of cell viability was limited to its deep layer with the remainder of the cartilage remaining viable. Furthermore, the cartilage from the ischemic side showed a significant increase in HIF-1α protein level and HIF-1α expression. VEGF expression in the cartilage was dramatically and significantly increased at 24 h, 2 and 4 weeks (p < 0.05 for all) with 5 to 10 fold increase being observed on the ischemic side compared to the normal side. PECAM and VEGFR2 expressions in the cartilage were both significantly decreased at 24 h but returned to the normal levels by 2 and 4 weeks, respectively. Micro-CT showed revascularization of the cartilage on the ischemic side with the vessel volume/total volume equaling the normal side by 4 weeks.ConclusionsAcute ischemic injury to the immature femoral head induced severe hypoxia and cell death in the bony epiphysis and the deep layer of the epiphyseal cartilage. Viable chondrocytes in the superficial layer of the epiphyseal cartilage showed HIF-1α activation and VEGF upregulation with subsequent revascularization occurring in the cartilage.     

超声造影在肾透明细胞癌检出和诊断中的应用

Background Renal clear cell carcinoma （RCCC） is the most common malignant renal tumor. It is highly malignant, does not cause clinical symptoms in its early stages, and cannot be diagnosed using conventional ultrasound. This study was aimed to investigate the contrast-enhanced ultrasound （CEUS） mode and characteristics of the time-intensity curve for RCCC and its pathological basis.
Methods Forty-two patients with pathologically diagnosed RCCC underwent CEUS examination before surgery. The patients＇ kidneys were visualized after injection of contrast agents using the Technos MPX DU8. We analyzed the CEUS mode, time-intensity curve, and pathological findings.
Results The detection rate of RCCC with conventional ultrasound was about 71%, while the rate using CEUS was 100%. Larger tumors （33 cases） showed non-uniform enhancement with defective filling. CEUS modes were divided into 4 types： type Ⅰ, ＂quick in and out＂ （26.19%, 11/42）; type Ⅱ, ＂quick in and slow out＂ （40.48%, 17/42）; type Ⅲ, ＂Simultaneous in and out＂ （16.67%, 7/42）; and type Ⅳ ＂slow in and out＂ （16.67%, 7/42）. All types had a close correlation to the pathological basis. Time-intensity curve of CEUS consisted of 3 phases, the perfusion phase, regression phase, and lag phase. Cases of types Ⅰ and Ⅲ only had a perfusion and regression phase, those of type Ⅱ and Ⅳ had a perfusion phase, regression phase, and lag phase. Quantitative analysis of the time-intensity curve showed that the time-to-peak （FTP） of the lesions was shorter than that of normal renal parenchyma （P 〈0.0001）, the mean value of the up slope rate of the absolute value of lesions was higher than that of the ipsilateral normal renal parenchyma （P 〈0.0001）, and that the mean value of descent slope rate of the absolute value of lesions was lower than that of the ipsilateral normal renal parenchyma （P 〈0.0001）.
Conclusions CEUS is useful in detecting small vessels in tumors. Although there are several different CEUS modes, type Ⅰ ＂quick in and out＂ and type Ⅱ ＂quick in and slow out＂ accounted for the most cases that had a close correlation to pathologic angiogenesis. Time-intensity curves also showed some special characteristics. These data could provide valuable information for the clinical diagnosis of RCCC.     

Changes of autologous neural stem cells in the hippocampi of aging mice

Although there is possibility of cognitive disturbance in aging people, many of them live for long life and enjoy well-functioning brain during the whole life-span. The biological basis of longevity is unknown. In this study, we investigated the influence of aging on hippocampal neural stem cells (NSCs), and the correlations between hippocampal neurogenesis and cognitive function. The result showed that the protein production and mRNA expression of nestin, and the number of BrdU⁺ cells in dentate gyrus (DG) of the aged non-dementia mice were clearly higher than that in the aged dementia mice and the young adult mice. We also found that the number of NeuN⁺ (neuron-specific nuclear antigen) cells in DG and CA1, choline O-acetyltransferase (ChAT, EC 2.3.1.6) production and mRNA expression in hippocampi of the aged-dementia mice were significantly reduced as compared to that of the young adult mice and the aged non-dementia mice, whereas the number of NeuN⁺ cells, ChAT production and mRNA expression of the aged non-dementia mice has no difference with that of the young adult mice. Glial fibrillary acidic protein (GFAP) expression in the hippocampi of aged dementia mice significantly higher than that of the young adult mice and the aged non-dementia mice. Our results suggest that aging sometimes does not cause changing of the number of neurons and the hippocampal neurogenesis. Increment of DNA replication and neuron replacement, promotion of differentiation of neural stem cells, enhancement of neuronal proliferation, facilitation of synaptic plasticity of neurons may all benefit to the maintenance of the normal cognitive ability in the aged mice.     

胎盘组织液-同种异体冻干骨与同种异体冻干骨修复颌骨缺损的对照

背景：研究证实,冻干和辐照灭菌的同种异体骨是理想的骨移植材料,不仅具有良好的生物相容性、生物力学特性,而且还保留骨基质中的骨形态发生蛋白和构成形态发生蛋白所必须的一些酶类,具有一定的骨诱导能力。 目的：观察胎盘组织液-同种异体冻干骨修复犬的人工颌骨缺损效果,以同种异体冻干骨为对照。 设计、时间及地点：对比观察性实验,于2007-12/2008-09在哈尔滨医科大学动物实验中心完成。 材料：健康杂种成年犬8只;同种异体冻干骨由湖北联结生物材料有限公司提供;胎盘组织液为广东珠海丽珠制药厂产品,2 mL/支。同种异体冻干骨∶胎盘组织液=(4.0~5.0)∶1。 方法：在犬上、下中切牙、尖牙、第一磨牙根尖相对应的颌骨处分别建立直径1.0 cm类半球型上下颌骨缺损模型共96个实验区,实验组选择大小合适的同种异体冻干骨及骨颗粒按比例浸泡在胎盘组织液呈饱和状,阳性对照组亦将大小合适的同种异体冻干骨及骨颗粒浸泡在生理盐水液呈饱和状,分别放入颌骨缺损处并添满,阴性对照组不植入任何材料。每只犬的实验区均由4个实验组材料、4个阳性对照组材料、4个阴性对照组材料组成。 主要观察指标：术后2,4,8,12周取材进行放射线学和组织学观察。 结果：实验组早期以软骨内化骨为主,晚期以膜内化骨为主,有明显的新骨形成,并与周围骨组织连接良好;阳性对照组可见新生骨,与周围骨组织连接欠佳;阴性对照组骨缺损区中央尚未被骨小梁充满。经组织学测定,术后2,4,8,12周实验组成骨量均高于其他两个对照组,差异有显著性意义(P < 0.05,P < 0.01)。 结论：胎盘组织液-同种异体冻干骨复合材料能够积极地促进颌骨缺损的修复并有效缩短修复时间。     

胎鼠神经干细胞局部注射移植大鼠高位脊髓损伤缺损处：体感及运动诱发电位与后肢运动功能评价

背景：如何促进脊髓损伤后的神经再生和功能恢复始终是医学界一大难题,胚胎神经干细胞有利于神经元的存活,并能促进轴突再生。 目的：观察胚胎鼠神经干细胞局部注射移植治疗高位脊髓损伤大鼠的可行性,以神经电生理及后肢运动功能评分评价其效果。 设计、时间及地点：细胞学体内实验,于2007-06/2008-06在哈尔滨医科大学动物实验中心完成。 材料：健康成年雌性SD大鼠40只,随机分为生理盐水组、细胞移植组,20只/组。另取孕14 d的SD大鼠5只用于制备胚胎神经干细胞。 方法：生理盐水组、细胞移植组大鼠均建立高位脊髓损伤模型,取双侧第8~10对肋间神经各2 cm,交叉植入脊髓缺损处(近端白质与远端灰质、远端白质与近端灰质),细胞移植组局部注射鼠胚胎神经干细胞2×106个,生理盐水组局部注射等量无菌生理盐水。 主要观察指标：通过体感诱发电位和运动诱发电位的检测,观察神经电生理恢复情况;通过BDA顺行神经示踪,观察运动传导束恢复情况;BBB后肢运动功能评分结果。 结果：细胞移植组大鼠体感诱发电位及运动诱发电位的潜伏期、波幅明显优于生理盐水组(P < 0.01);细胞移植组大鼠在损伤区有较多BDA标记阳性神经纤维通过,而生理盐水组未见BDA标记阳性神经纤维;细胞移植组大鼠BBB后肢运动功能评分较生理盐水组明显提高(P < 0.01)。 结论：胎鼠神经干细胞局部注射可以较好地恢复高位脊髓损伤后的神经电生理及后肢运动功能。