从胰岛微循环探索“脾气散精”环节对血糖稳态的调节机制

减少血糖波动是目前干预糖尿病和预防并发症的重点,也是中医药在糖尿病治疗中的优势所在。越来越多的研究表明,胰岛微循环障碍是胰岛功能下降进而引发血糖波动的关键病理环节,而胰岛微循环局部肾素-血管紧张素系统(renin-angiotensin system,RAS)的过度激活作为胰岛功能失代偿的使动环节,与胰岛内分泌细胞功能密切相关,是研究胰岛功能的关键靶点。中医学认为糖尿病血糖波动与"脾气散精"障碍密切相关,脾不散"精"(血糖),精滞为浊,浊邪壅塞,是血糖稳态失衡的使动环节,亦为糖尿病全病程的关键病机。通过补益"脾"气以促进"胰"中精微物质的布散能够恢复糖调节激素间的平衡,从而减少血糖波动。目前,"脾气散精"对血糖波动的调节机制尚不明确。作者基于以往的临床和科研工作基础,提出"脾气散精"环节通过促进机体胰岛微循环从而发挥其改善胰岛功能、调节血糖稳态的作用,其机制可能与抑制胰岛微循环局部RAS的激活状态相关。RAS系统在胰岛微循环中各信号通路的相互拮抗关系,与中医理论中脾气散精与固精作用的对立制约关系相类似。因此"脾气散精"环节对血糖波动的调节机制有必要从胰岛微循环RAS整体调控的角度进行深入探索,以此揭示中医药调节机体内环境稳态,减少糖尿病患者血糖波动的科学内涵。     

Ginsenoside Rb3 ameliorates myocardial ischemia-reperfusion injury in rats

Context: Panax ginseng C. A. Mey (Araliaceae) has been widely used in clinic for treatment of cardiovascular diseases in China. Ginsenoside Rb3 is the main chemical component of Panax ginseng.

Objective: The aim of this study was to evaluate the effect of ginsenoside Rb3 on myocardial ischemia-reperfusion injury in rats.

Methods: Sprague–Dawley rats were orally treated with Rb3 (5, 10 or 20?mg/kg) daily for 3 days followed by subjecting to left anterior descending coronary artery ligation for 30?min and reperfusion for 24?h.

Results: This study showed that ginsenoside Rb3 treatment resulted in a reduction in myocardial infarct size. Ginsenoside Rb3 significantly attenuated the changes of creatine kinase activity and lactate dehydrogenase activity. The cardioprotective effect of ginsenoside Rb3 was further confirmed by histopathological examination. Ginsenoside Rb3 alleviated the increase of malondialdehyde content and the decrease of superoxide dismutase activity in left ventricle. Treatment with ginsenoside Rb3 also decreased plasma endothelin and angiotensin II levels.

Conclusion: These findings suggested that ginsenoside Rb3 possesses the effect against myocardial IR injury and the underlying mechanism is related to its antioxidant activity and microcirculatory improvement.     

Changes in nerve microcirculation following peripheral nerve compression

Following peripheral nerve compression, peripheral nerve microcirculation plays important roles in regulating the nerve microenvironment and neurotrophic substances, supplying blood and oxygen and maintaining neural conduction and axonal transport. This paper has retrospectively analyzed the articles published in the past 10 years that addressed the relationship between peripheral nerve compression and changes in intraneural microcirculation. In addition, we describe changes in different peripheral nerves, with the aim of providing help for further studies in peripheral nerve microcirculation and understanding its protective mechanism, and exploring new clinical methods for treating peripheral nerve compression from the perspective of neural microcirculation.     

替罗非班对急性心肌梗死急诊冠状动脉介入治疗冠状动脉微循环的影响

目的探讨并评价采用替罗非班对心肌梗死患者急诊实施冠状动脉介入治疗微循环产生的影响。方法将我院收治的ST段抬高性急性心肌梗死患者62例随机分成观察组32例与对照组30例,对比分析两组患者的临床状况、心电图ST段回落幅度、主要心脏不良事件及住院期间出血事件发生率等。结果观察组1.5 h心电图ST段回落幅度大于对照组,治疗前后比较差异具有统计学意义（P〈0.05）;观察组发生牙龈出血4例,对照组3例,两组均未见颅内出血与血小板减少症。术后观察组凝血因子TF与vWF均低于对照组,两组比较差异具有统计学意义（P〈0.05）,两组患者的PT与AFTT之间差异无统计学意义。结论采用替罗非班对心肌梗死患者急诊实施冠状动脉介入手术能够争取更多时间,以防止大量心肌细胞发生永久性坏死,有效解除心肌微循环障碍,明显降低无复流现象。     

Late Results After Surgical Closure of Ventricular Septal Defect in Children

Twenty-two children, who were operated on for ventricular septal defects (VSD) at 3-11 years of age, were studied 2-11 years postoperatively with respect to signs of residual shunt, cardiomegaly, physical capacity and pulmonary resistance at various rates of perfusion. There was evidence of residual shunt in one of the patients at follow-up. This was also the only patient who had persisting cardiomegaly in the group. Exercise tests were as a rule within normal limits. Total pulmonary resistance (TPR) decreased in all instances and was abnormally elevated in 6 patients at the follow-up. as compared to 12 at the pre-operative study. Total pulmonary resistance index (TRP¹) was abnormally elevated in 8 patients, as compared to 10 at the pre-operative study. Whereas TPR decreased from an average pre-operative level of 7.9 to 4.2, TPR¹ average remained virtually unchanged. The two most hyper-resistive patients were found to have identically high resistance indices at the follow-up investigation, indicating little effect on the obstructive vascular lesion. During provoked increase of pulmonary blood flow TPR fell further in nearly all patients. The presure/flow characteristics of the pulmonary circulation in patients with normal resting vascular resistance (PVR) followed closely the regression line of a normal material. Conversely the 5 patients with elevation of PVR at test demonstrated a uniformly steep pressure/flow relationship, indicating a rigid vascular basin in these patients. It is suggested that some of the discrepancies that exist in relation to the effect of surgical closure of VSD may be related to the fact that for the most part a growing population is under study. The “natural” history of pulmonary haemodynamics in the growing individual constitutes a potential error for the long-term evaluation of the effect of VSD closure on pulmonary vascular resistance. It is recommended that resistance figures based on body-size-related flow indices are used and that particularly when the postoperative investigation reveals a moderately hyperresistive patient or a “borderline” case, the resistive characteristics of the pulmonary circulation be studied at various flow rates. Our results support the opinion that the VSD patient should be operated on before a markedly obstructive vascular lesion has developed since there is little evidence to suggest a reversibility of the disease.