内热针联合云克疗法治疗膝关节骨性关节炎的疗效及其对患者IL-1和TNF-a水平的影响

目的:观察内热针联合云克疗法治疗膝关节骨性关节炎的临床疗效,以及检查其对患者白细胞介素-1(IL-1)和肿瘤坏死因子-a(TNF-a)水平的影响。方法:选取2012年6月至2013年3月武汉市普仁医院收治的膝关节骨性关节炎患者70例,随机分为观察组和对照组,每组35例,观察组患者给予内热针联合云克疗法治疗,对照组患者仅给予云克疗法治疗,疗程为6周。分别测定治疗前和治疗后不同时期2组患者的IL-1和TNF-a水平。并观察2组治疗前和治疗后不同时期膝关节HSS评分。结果:治疗后,2组患者各个时期的IL-1和TNF-a水平较治疗前明显下降(P0.05);且观察组的IL-1和TNF-a水平较对照组的显著下降,差异有统计学意义(P0.05);治疗后观察组各个时期的膝关节HSS评分明显高于对照组(P0.05)。结论:内热针联合云克疗法对治疗膝关节骨性关节炎有着明显的疗效,其机制可能是通过有效地降低抑制膝关节骨性关节炎患者的IL-1和TNF-a水平来减轻炎性反应,从而减缓膝关节的退化,值得临床作进一步推广。     

基于数据挖掘探讨吴寿善治疗慢性乙型病毒性肝炎用药规律

目的：基于中医医疗与临床科研信息共享系统,运用数据挖掘技术探讨湖北中医大师吴寿善教授 中医药治疗慢性乙型病毒性肝炎的用药规律。方法：应用结构化电子病历采集767例吴寿善接诊慢性乙型病 毒性肝炎门诊患者的临床资料,通过数据集成、汇交、整合后,利用数据分类、关联、聚类规则方法对临床资料进 行分析。结果：①确定259个处方中药物的使用频次前五位药物分别是茯苓、茵陈、陈皮、丹参、连翘;②药物配 伍方面,关联度最高的配对分别为茯苓-甘草-白术、茯苓-丹参-白术、茵陈-茯苓-甘草等;③挖掘核心处方时, 发现蒿芩清胆汤、大安丸、半夏白术天麻汤等经典方加减使用频次最高。结论：通过数据挖掘方法,我们发现吴 寿善教授以中医药治疗慢性乙型病毒性肝炎在治则治法上,主要从毒痰瘀虚进行辨证施治。     

心力衰竭蒙医寒证热证模型的建立及评价

目的：研究心力衰竭（简称心衰）蒙医寒证、热证模型的建立方法及其评价。方法：将68只（雌雄各半）Wistar大鼠随机分为正常对照组（CON）8只,阿霉素心衰模型组（ADR）12只,阿霉素+冰水心衰寒证模型组（ADR+IW）12只,阿霉素+阿魏、肉桂心衰热证模型组（ADR+MY）12只,冰水心衰寒证模型组（IW）12只,阿魏、肉桂心衰热证模型组（MY）12只等6组。ADR组给于腹腔注射盐酸阿霉素针剂;ADR+IW组给予腹腔注射盐酸阿霉素针剂同时,冰水（0℃）灌胃建立心衰寒证模型,ADR+MY组予腹腔注射盐酸阿霉素针剂同时,阿魏+肉桂灌胃建立心衰热证模型,IW组给予冰水（0℃）灌胃建立心衰寒证模型, MY组予阿魏+肉桂灌胃建立心衰热证模型,CON组给予等量生理盐水灌胃,干预6周后做心脏彩超、取材。将心肌组织做苏木精-伊红（HE）染色 、检测血清N末端B型利钠肽前体（NT-proBNP）及心肌酶变化,检测心肌组织钠、钾-三磷酸腺苷酶（Na+-K+-ATP）,钙-三磷酸腺苷酶（Ca2+-ATP）活性及琥珀酸脱氢酶（SDH）活性。结果：与CON组比较,5种模型组大鼠体重均显著下降（P<0.01）;与ADR+IW组比较,ADR和ADR+MY组大鼠体重均显著下降（P<0.05）、MY组大鼠体重下降,但无明显差异（P>0.05）;与ADR+MY比较,ADR+IW和IW组大鼠体重均显著增高（P<0.05,P<0.01）;与IW比较,ADR组大鼠体重显著下降（P<0.01）、MY组大鼠体重下降,但无显著差异（P>0.05）。与CON组比较,ADR+IW和IW组大鼠体温显著下降（P<0.01）;ADR+MY和MY组大鼠体温显著升高（P<0.01）;与ADR+IW比较,ADR、ADR+MY及MY组大鼠体温显著升高（P<0.01）,与ADR+MY比较,ADR、ADR+IW及IW组大鼠体温显著下降（P<0.01）;与IW比较,ADR和MY组大鼠体温显著升高（P<0.01）。与CON组比较,5个模型组血清NT-proBNP明显升高（P<0.05,P<0.01）;与CON组比较,5个模型组心肌酶各项指标出现不同程度升高;与CON组比较,5个模型组心脏彩超EF%、FS%显著降低（P<0.01）,而LVIDs值显著升高（P<0.01）,且ADR、ADR+IW及ADR+MY组各值降达到心衰水平。心肌组织HE染色结果示,各模型组大鼠心肌细胞出现不同程度病理变化,其中ADR+IW、ADR+MY大鼠组心肌细胞排列紊乱、丧失正常细胞结构、炎性细胞浸润,出现心肌纤维化,而病变程度依次为： ADR+IW>ADR>ADR+MY,IW和 MY组大鼠只出现心肌细胞排列紊乱。与CON组比较,ADR+MY和MY组大鼠心肌组织Ca2+-ATP和SDH等酶活性均显著升高（P<0.01）,而ADR+IW和IW组的显著下降（P<0.01）;与CON组比较,ADR+MY组大鼠心肌组织Na+-K+-ATP酶活性显著升高（P<0.01）,而ADR+IW和IW组的显著下降（P<0.01）、MY组的无显著差异（P>0.05）;与ADR+IW比较,ADR、ADR+MY和MY组心肌细胞Na+-K+-ATP、Ca2+-ATP及SDH等酶活性显著升高（P<0.01）;与ADR+MY比较,ADR 、ADR+IW及IW组大鼠心肌细胞Na+-K+-ATP、Ca2+-ATP及SDH等酶活性显著降低（P<0.01）,与IW组比较,MY组ATP和SDH酶活性明显降低（P<0.01）。结论：注射盐酸阿霉素的同时给予冰水和阿魏+肉桂能成功建立心衰寒证和热证模型,模型成功模拟心衰寒证、心衰热证的临床症状及病理组织学变化。采取该方法建立的心衰寒证和心衰热证动物模型可行,为本病症的研究提供了准确、客观、有效的动物模型的建立及评价方法。     

基于多重PCR技术检测蜡样芽胞杆菌3种毒素基因方法的建立及评价

目的 基于多重PCR技术,建立一种快速检测蜡样芽胞杆菌nhe、cytK和entFM 3种毒素基因的方法,并评价其效能。 方法 煮沸法提取蜡样芽胞杆菌DNA,以蜡样芽胞杆菌nhe、cytK和entFM特异性毒素基因作为靶基因,采用NCBI primer-BLAST 5.0软件设计特异性引物,优化反应体系。建立三重PCR检测体系,并检测其特异性、灵敏度和稳定性。 结果 煮沸法提取蜡样芽胞杆菌DNA,浓度为227 mg·L^－1,纯度为1.50~1.60。采用多重PCR体系同时检测蜡样芽胞杆菌3种毒素致病基因,于退火温度56 ℃时,蜡样芽胞杆菌基因引物nhe499的扩增片段为499 bp,基因引物cytK191的扩增片段为191 bp,基因引物entFM363的扩增片段为363 bp。PCR体系扩增蜡样芽胞杆菌3种毒素基因后条带清晰明亮,且无非特异性条带,与金黄色葡萄球菌、大肠埃希菌和铜绿假单胞菌均无扩增,表明蜡样芽胞杆菌基因引物nhe499、cytK191和entFM363特异性强;3种引物在同一反应体系中互不干扰。灵敏度检测,多重PCR体系最低检测限可同时达到10^－1 mg·L^－1;稳定性检测,多重PCR体系自制备起每6个月检测稳定性一致。 结论 建立的多重PCR检测体系对于蜡样芽胞杆菌nhe499、cytK191和entFM363 3种毒素基因灵敏度高、特异性强,检测结果准确稳定,检测体系具有良好稳定性,适用于快速检出蜡样芽胞杆菌的3种不同致病毒素基因。     

自拟通腑益肺汤联合喜炎平注射液对痰热壅肺型重症肺炎并Ⅱ型呼吸衰竭效果、肺功能及炎性因子研究

目的分析重症肺炎(痰热壅肺型)合并Ⅱ型呼吸衰竭应用喜炎平联合自拟通腑益肺汤治疗效果情况。方法选取本院2019年7月至2020年7月诊治的100例重症肺炎(痰热壅肺型)合并Ⅱ型呼吸衰竭患者资料,按随机数表分两组,对照组给予喜炎平,研究组给予喜炎平联合自拟通腑益肺汤,分析两组临床效果、肺功能及炎症因子指标情况。结果研究组总有效率(98.00%)比对照组(82.00%)高(P<0.01,χ;=7.1111),且研究组TLC[(5.15±0.75)L]、FEV;[(2.91±0.41)L]及MMV[(107.45±11.52)L]等肺功能高于对照组[(4.43±0.69)L、(2.31±0.43)L及(96.61±9.28)L;P<0.01,t=4.9957、5.1816];研究组患者IL-6[(25.38±5.18)ng/L]、PCT[(0.93±0.18)ng/L]与PAF[(9329.83±1136.28)U/L]等炎症因子低于对照组[(43.52±7.30)ng/L、(1.28±0.26)ng/L、(11851.96±1532.36)U/L;P<0.01,t=14.3300、8.0498、9.3486]。结论重症肺炎(痰热壅肺型)合并Ⅱ型呼吸衰竭应用喜炎平联合自拟通腑益肺汤治疗,可改善肺功能情况,降低机体炎症因子指标,临床用药效果显著。     

湿热交换过滤器的功能及其并发症研究进展

背景 湿热交换过滤器是一类用于代替上呼吸道和鼻功能的人工装置,具有一定程度的保温、保湿和滤过功能.目的 概述湿热交换过滤器及其并发症,为临床医师的合理选择和使用提供参考.内容 通过总结大量的临床和实验室研究文献,客观地讲述呼吸过滤器的三大功能及其影响因素,同时也详细地介绍了可能发生的并发症.趋向 随着临床和实验室研究的深入,湿热交换过滤器会得到进一步的改进和完善.     

HSP22在高脂致动脉粥样硬化病变中的作用及对他汀干预的影响

目的:研究热休克蛋白22(heat shock protein 22,HSP22)在高脂饮食诱导的小鼠动脉粥样硬化(atherosclerosis,AS)病变中的作用,及其对阿托伐他汀(atorvastatin,Ator)干预的影响。方法:8~9周龄Apo E~(-/-)和HSP22~(-/-)Apo E~(-/-)和HSP22+Apo E~(-/-)雄性小鼠各18只,每种小鼠分为2个亚组,分别为对照组与他汀干预组(Ator组),HSP22~(-/-)组(KO组)与HSP22~(-/-)他汀干预组(KO+Ator组)及HSP22~+组(Tg组)与HSP22~+他汀干预组(Tg+Ator组),各干预组从第5周开始给予Ator(10 mg·kg~(-1)·d~(-1))干预,各对照组给予等量生理盐水,共饲养13周。采用油红O及苏木精-伊红(hematoxylin-eosin,HE)染色法观察AS病变程度,免疫组化法、Western blot法和ELISA法检测主动脉和血清中HSP22、NF-κB、eNOS、ICAM-1及IL-6的表达。结果:油红O及HE染色示Tg组主动脉斑块相对面积低于KO组(P0.05)。KO组的血清和主动脉中HSP22的蛋白表达显著低于对照组和Tg组,对照组显著低于Tg组。Tg组及对照组的主动脉eNOS蛋白的表达显著高于KO组。对照组的主动脉NF-κB及ICAM-1蛋白表达较KO组显著降低,较Tg组显著升高。对照组、KO组及Tg组血清IL-6水平的差异无统计学显著性。结论:HSP22基因缺失可上调NF-κB和ICAM-1的表达,降低eNOS的表达,加速AS的进展;HSP22基因过表达可降低NF-κB和ICAM-1的表达,从而改善AS。HSP22基因缺失部分限制了他汀下调NF-κB和ICAM-1及上调eNOS表达的作用;其过表达可促进他汀下调ICAM-1表达,进一步改善AS。     

热激活蛋白70识别蛋白在脊髓缺血再灌注损伤后表达变化及其意义

目的:探讨热激活蛋白70识别蛋白(heat shock cognate protein 70,HSC70)在兔脊髓缺血再灌注损伤(spinal cord ischemia-reperfusion injury,SCIRI)后表达变化及其意义。方法:随机将36只新西兰白兔分成6组(每组6只),采用Zivin法建立兔SCIRI模型。A组只显露腹主动脉而不阻断血流,30min后关闭腹腔,取材(L3~L5段脊髓);B组阻断腹主动脉血流30min后关闭腹腔,取材;缺血再灌注组(C、D、E、F组)阻断腹主动脉血流30min后停止夹闭,再灌注6、12、24、48h时采用改良Tarlov评分分别进行运动功能评价后取材。应用差异蛋白质组学技术荧光差异双向凝胶电泳联合质谱分析筛选出应激相关蛋白HSC70,利用免疫印迹对质谱进行印证,结合免疫组化研究其在脊髓内的时空变化特点。结果:成功建立SCIRI兔模型,SCIRI后实验动物后肢功能逐渐好转,C~F组改良Tarlov评分分别为1.167±0.753、1.667±0.516、2.668±0.516和2.167±0.752分,再灌注24h达SCIRI早期最好水平,再灌注48h略有下降。应激相关蛋白HSC70在A组印迹清晰,B组印迹轻微加强,C组和D组印迹再次加强,E组印迹显著减弱至最低,F组印迹灰度回归至再灌注6~12h水平。A组灰质中部体积较小中间神经元胞浆见轻度免疫反应;B组灰质各部位神经元胞浆免疫反应程度与A组相当;C组胶质细胞核免疫反应加重;D组神经元免疫反应减轻,但胶质细胞及雪旺细胞核免疫反应较强烈;E组神经元免疫反应进一步减弱,低于A组水平;F组神经元胞浆免疫反应加重,胶质细胞及雪旺细胞核免疫反应仍强烈。结论:HSC70参与SCIRI发生和发展过程,可作为SCIRI预防、诊断和治疗的靶点。     

Influence of the heat irrigating effect of radiofrequency ablation on regional liver tissue in Bama miniature pigs

BACKGROUNDThe results of the heat irrigating effect of radiofrequency ablation (RFA) are uncertain, and the accurate impact of the heat irrigating effect on regional liver tissue is unknown due to a lack of control experiments.AIMThe aim of this study was to determine the influence of the heat irrigating effect of RFA on regional liver tissue in Bama miniature pigs. METHODSEight Bama miniature pigs were randomly divided into the observation group (group A) and the control group (group B), with 4 pigs/group. An RFA electrode needle was implanted near the hepatic segment vasculature (3-5 mm from the hepatic segment portal vein) under ultrasound guidance in group A. Similarly, an RFA electrode needle was implanted far from the hepatic segment vasculature (8-10 mm from the hepatic segment portal vein) in group B. The left internal lobe and right medial lobe were chosen as RFA sites in each pig. RFA was performed at the left internal lobe on day one in each pig, and at the right medial lobe 7 d later. Each RFA lasted 12 min. The general status of the pigs and serious complications were observed during the perioperative period. The pigs were sacrificed and the livers were removed immediately after RFA on the eighth day. The samples were roughly observed. Hematoxylin-eosin and Ki67 staining, as well as TUNEL detection, were performed on the tissue sections. RESULTSAll 8 animals successfully underwent ultrasound-guided RFA. No serious complications, such as massive hemorrhage, biliary fistula, severe pleural effusion, pneumothorax, peripheral organ failure, or renal failure occurred in any of the animals during the perioperative period. The RFA coagulative necrosis lesion was spherical and the surrounding liver tissue showed an inflammatory response. The difference in the Suzuki score of the liver tissue surrounding the ablated portal vein, and its distal area between groups A and B, was statistically significant (P < 0.05). More apoptotic cells were seen in liver tissue surrounding the ablated portal vein and its distal area in group A, while fewer apoptotic cells in the same area were seen in group B. The difference in the apoptotic index of the above area between group A and group B was statistically significant (P < 0.05). Cells staining positive for Ki67 were observed in liver tissue at the left internal lobe around the ablated portal vein and its distal area in group A. No Ki67 staining positive cells were observed in other tissue sections. The difference in the Ki67 staining positive index in the above area was statistically significant (P < 0.05) between group A and group B.CONCLUSIONChanges as a result of thermal damage occur in liver tissue around the ablated portal vein and its distal area due to the heat irrigating effect when the RFA electrode tip is close to (< 5 mm) the portal vein.     

HSP70 as a Diagnostic and Prognostic Marker in Egyptian Women With Breast Cancer

BackgroundHeat shock protein 70 (HSP70) is a significant cellular stress response protein that has intrinsic and extrinsic pathways to protect cells against apoptosis. It is one of the most induced proteins in cancer cells. The aim of the present study is to investigate the significant role of the HSP70 expression in Egyptian patients with breast cancer (BC) and its potential to be as a diagnostic and prognostic marker.Materials and MethodsHSP70 was examined in 155 cases in this prospective study; patients were subdivided into 3 groups: 60 patients with malignant metastatic disease, 60 patients with malignant non-metastatic disease, and 35 patients with benign lesions as control. HSP70 expression was detected using enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry (IHC).ResultsMost cases of breast cancer expressed HSP70 in both serum (98.3%) and tumor tissue (90%). A strong positive correlation was found between HSP70 IHC and ELISA (r = 0.811). The mean HSP70 levels, as detected in both patients’ serum by ELISA and tumor tissue by IHC, was significantly higher in patients with BC than in benign cases (P = .001). HSP70 was significantly higher in patients with metastatic BC than in those with non-metastatic BC (P = .001). HSP70 showed positive correlation with tumor size (pT stage) and number of lymph node metastases (P ≤ .001).ConclusionHSP70 is over-expressed in patients with metastatic and non-metastatic BC than in benign cases. A high level of HSP70 either in patient’s serum or in tumor tissue correlated significantly with advanced disease in patients with BC. This present study suggests that HSP70 can serve as a BC biomarker for early screening, diagnosis, and follow-up.