缺血性脑血管病急性期氧化应激反应的机制研究

缺血性脑血管病的发病率逐年升高,其机制涉及众多。其中氧化应激损伤在脑缺血后神经细胞损伤中起了关键作用。氧化应激导致活性氧产生,直接损伤神经细胞,引发凋亡,激活一系列的损伤级联反应,涉及线粒体、Bcl家族、caspase以及钙蛋白酶等,并激活小神经胶质细胞的吞噬作用。对以上各种途径的深入研究,将为有效地防治缺血性脑血管病提供帮助。     

缺血性脑损伤神经干细胞与突触可塑性研究进展

脑血管疾病是目前人类三大死因之一,也是致残的主要原因,存活者中50%～70%严重致残,其中缺血性脑血管疾病约占80%[1].虽然超早期溶栓和急性期神经细胞保护取得了重要进展,但对于大多数脑缺血患者而言,神经细胞死亡不可避免,如何积极有效地促进脑缺血损伤后神经细胞的恢复仍然是目前研究的重点.     

抗血小板药物研究概述

随着人口老龄化的加剧,脑血管病,尤其是缺血性脑血管病越来越成为威胁人类健康的主要疾病之一。缺血性脑血管病的主要发病过程之一是动脉血栓形成,即脑血栓,而血小板对血栓形成意义重大。多种证据表明[1],脑缺血后血小板被激活。激活后的血小板可发生粘附、聚集、释放等一系列反应,进一步加重缺血性脑损伤。抗血小板治疗是通过阻止血小板的粘附、聚集、释放,防止血栓形成,从而防治中风、心梗等缺血性脑血管病,因而运用抗血小板药物治疗缺血性脑血管病受到诸多研究者的关注与重视。本文主要从机制入手对抗血小板药物的研究现状作一综述。1抑…     

缺血性脑损伤机制的研究进展

缺血性脑损伤即缺血性脑血管病,是指局部脑组织包括神经细胞、胶质细胞及联系纤维由于供血障碍发生的变性、坏死或一过性的功能丧失[1,2].它占脑血管病的80%左右,是临床常见病、多发病,死亡率与致残率均高.     

亚低温抗脑缺血后神经细胞凋亡的信号传导途径

脑缺血后神经元坏死和凋亡并存,神经细胞坏死多发生在伤后即刻及之后数分钟至1 d内发生于损伤灶的中心部位.脑缺血所致的神经细胞凋亡则主要出现在伤灶四周的缺血、缺氧区及半影区内迟发型神经细胞死亡和对缺血缺氧敏感的海马、齿状回和大脑皮质的神经细胞[1].     

论中医毒邪的特性

20世纪90年代,以王永炎院士为首的老一辈专家将具有清热解毒、化痰通络、醒神开窍作用的清开灵注射液应用于缺血性中风病急危重症的救治,一定程度上提高了临床疗效。现代研究发现,脑缺血发生后出现的兴奋性氨基酸的神经毒、毒性氧自由基、酸中毒、花生四烯酸等一系列级联反应,最终导致神经细胞的凋亡,而清开灵注射液在不同环节、不同程度上阻抑了上述具有“毒”性效应的级联反应因子,这就促使我们对中风病病因病理深入思考。1997年王永炎在“关于提高脑血管疾病疗效难点的思考”一文[1]中,明确提出了毒邪的概念:“毒,何谓也,我们认为主要是…     

局灶性脑缺血动物模型的建立和评价

脑血管疾病是常见病、多发病.临床上脑动脉系统疾病分为缺血性脑血管病和出血性脑血管病,其中以缺血性脑血管病多见.脑梗死占全部脑血管病的59.2%～85%[1].因此用动物制作最接近人类脑缺血的模型来模拟人类缺血性脑血管疾病并对之进行研究是十分重要的.本文就常用动物制作脑缺血模型作一综述.     

白质保护在脑卒中药物治疗中的重要作用

随着脑缺血引起的神经化学级联反应的机制被逐渐阐明,神经保护作用作为一个新的概念而产生。大量治疗卒中的药物临床试验失败,使得脑血管病发生中的白质损伤受到日益重视。虽然当前的神经保护剂在脑缺血级联反应中的单个和多个位点都证明有效,但不能保护白质,特别是轴突和少突胶质细胞的缺血性损伤。本文总结了卒中治疗药物的研究情况、白质损伤的相关机制,其中N-甲基-D-天冬氨酸受体可能为新的卒中治疗药物的设计提供靶点。     

信息动态

溶栓是缺血性脑血管病发生后能够治疗成功的关键,溶栓后易造成脑水肿及脑缺血再灌注性损伤.如何降低脑缺血再灌注对脑组织的损伤成为国内外学者的研究焦点[1].脑微血管紧密连接为血脑屏障的主要结构基础,可有效阻止细菌入侵脑组织,从而保护脑组织[2].但血脑屏障的保护作用大大降低了药物对脑组织损伤的治疗.临床研究显示,全麻药异丙酚可以降低缺血性脑损伤后血脑屏障通透性、脑血管事件的发生率,但对其脑保护的作用机制尚不清楚.研究发现组织紧密连接蛋白MMP-2、MMP-9在脑缺血性损伤后表达显著升高,参与血脑屏障的破坏,加剧缺血后的脑损伤[2].本实验观察异丙酚对SD大鼠脑微血管内皮细胞紧密连接蛋白MMP-2、MMP-9表达的影响,探讨异丙酚对脑组织的保护机制.     

缺血预适应和缺血后适应在脑缺血耐受中的作用

急性缺血性脑血管病是中老年人死亡与致残的主要病因之一,至今尚未发现有令人满意的治疗方法使神经细胞损伤得到有效的保护或者相应的神经功能改善。所以脑缺血耐受（brainis-chemictolerance,BIT）成为内源性神经保护的研究热点,而缺血预适应和缺血后适应则是诱导脑缺血耐受的重要手段。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.