基于“分子胶”的新型两亲性嵌段共聚物 β-CD-PLA的合成及其胶束化

以二重氢键为引导,二硫键连接疏水性聚乳酸（PLA）和亲水性β-环糊精（β-CD）合成了嵌段共聚物β-CD-PLA。采用¹H-NMR和GPC对嵌段共聚物β-CD-PLA的结构进行了表征,以芘作为荧光分子探针对嵌段共聚物β-CD-PLA自组装胶束的性质进行了表征,采用动态光散射纳米粒度仪（DLS）对自组装胶束的粒径进行了测试。结果表明：在二重氢键的引导作用力和碘的氧化作用下,中间体脱去保护基形成双二硫键,形成目标嵌段共聚物β-CD-PLA, 该嵌段共聚物能够在水中自组装形成纳米胶束,临界胶束浓度（CMC）为0.089 mg/mL,在稀溶液中具有良好的稳定性,自组装形成空白胶束的粒径为31 nm,阿霉素盐酸盐（DOX）载药胶束的粒径为42 nm。     

mPEG-PLA共聚物胶束对DHA的增溶及光保护作用

以聚乙二醇单甲醚（mPEG）和外消旋丙交酯（D,L-LA）为原料,采用开环聚合法合成聚乙二醇单甲醚-聚乳酸（mPEG-PLA）共聚物,并用溶剂挥发法制备包载双氢青蒿素（DHA）的共聚物胶束（DHA/mPEG-PLA）。利用红外光谱（FT-IR）、核磁共振氢谱（¹H-NMR）和接触角测量仪研究了共聚物的结构和性质;利用激光粒度分析仪和扫描电镜（SEM）研究了胶束的粒径和形貌。结果表明mPEG-PLA共聚物的临界胶束浓度（CMC）为7.71 mg/L。DHA/mPEG-PLA共聚物胶束呈球形,平均粒径（118.1±1.9） nm,载药量和包封率分别为（2.7±0.1）%和（77.1±0.3）%。胶束对DHA的水相表观溶解度增大约1.5倍。紫外光光照39 h,纯DHA在混悬液中降解率达37%且持续增长,胶束中DHA降解率达到10%后基本保持不变。     

Angiopep-2修饰的脑靶向多肽胶束的制备及体外评价

目的 构建angiopep-2修饰的硫辛酸-聚精氨酸组氨酸（LHRss）多肽纳米胶束并包载抗肿瘤药物多柔比星（DOX）的脑胶质瘤靶向纳米给药系统（LHRss-An/DOX）。方法 采用超声乳化法制备包载化疗药物DOX的多肽胶束LHRss-An/DOX,检测复合物的粒径、zeta电位和外观形态;测定载药量和包封率,并对其体外释放特性进行考察;通过体外血脑屏障（BBB）模型考察载药胶束的跨膜转运效率,使用激光扫描共聚焦显微镜观察DOX胞内的分布情况及对脑胶质瘤的靶向性。结果 胶束LHRss-An/DOX呈球形,平均粒径为（100.9±8.7） nm,聚合物分散性指数为0.232,电位为（28.8±3.3） mV,最佳药载比为40%,载药量为15.8%,包封率为55.3%,在pH 7.4、pH 5.5和pH 5.5+10 mmol/L DL-二硫苏糖醇（DTT）环境下72 h内的累积释放率分别为（60.3±2.6）%、（84.1±3.9）%和（96.6±2.7）%;LHRss-An/DOX的跨BBB效率分别是LHRss/DOX和游离DOX的2.04和4.27倍,差异有统计学意义（P<0.05）;脑胶质瘤细胞U251摄取LHRss-An/DOX的荧光强度强于LHRss/DOX和游离DOX的荧光强度。结论 经过angiopep-2修饰的载药纳米胶束的跨BBB能力及脑胶质瘤的靶向性显著增强,是一种潜在高效的靶向胶质瘤给药系统。     

多嵌段共聚物/纳米粒子杂化多级结构的光学性能

结合耗散粒子动力学模拟和时域有限差分方法,研究了A（BC）_n多嵌段共聚物和纳米粒子共混体系的自组装行为及其光学性能,分析了纳米粒子体积分数和嵌段间相互作用强度对自组装形貌及其光学性能的影响。结果表明,A（BC）_n多嵌段共聚物/纳米粒子共混体系可形成有机/无机杂化的多级结构,改变纳米粒子的体积分数和嵌段间相互作用强度可以调控纳米粒子的分布及其相应的多级结构。不同尺度的结构对不同频率光的反射作用有明显区别,而纳米粒子的加入显著增大了反射峰的强度和宽度。改变纳米粒子的分布可调控反射峰的强度和宽度。     

黄芩素PLGA纳米粒的制备及制剂学性质研究

[目的] 优化影响黄芩素聚乳酸/羟基乙酸共聚物（PLGA）纳米粒成型工艺参数,并评价优化工艺后所制纳米粒的制剂学性质。[方法] 采用乳化-溶剂挥发法制备黄芩素PLGA纳米粒,以粒径、包封率为评价指标,单因素实验考察了聚乙烯醇（PVA）浓度、PLGA型号、PLGA分子量、PLGA浓度、水相与有机相体积比、丙酮与无水乙醇体积比、药物与PLGA的比例共7个参数对纳米粒成型工艺的作用规律。[结果] 优化处方工艺制备的纳米粒包封率为（95.03±1.33）%、平均粒径为（126.80±4.50） nm、Zeta电位（-21.30±0.23） mV.[结论] 乳化-溶剂挥发法制备的黄芩素PLGA纳米粒圆整,粒径均一。     

姜黄素磷脂复合物在大鼠体内的药代动力学评价

目的 通过对大鼠口服灌胃给药,评价姜黄素磷脂复合物在SD大鼠体内的药物代谢动力学性质。 方法 制备姜黄素磷脂复合物,以姜黄素作为对照,检测两者在水中的溶解度和体外累计溶出率;取SD大鼠12只,经口服灌胃给予姜黄素磷脂复合物或姜黄素混悬液后,不同时间点于大鼠眼底静脉丛取血,采用高效液相色谱法（HPLC）测定血浆中姜黄素的浓度。 结果 姜黄素磷脂复合物的溶解度、累计溶出率分别为0.150 g/L、68.04%,较姜黄素（0.057 g/L、50.68%）均有所增加。姜黄素磷脂复合物和姜黄素的药代动力学参数分别如下：C_max为（74.34±5.57） μg/L和（61.64±4.29） μg/L,T_max为（0.17±0） h和（0.25±0） h,AUC_0-t为（637.38±30.04） μg·h·L^-1和（172.41±31.66） μg·h·L^-1,AUC_0-∞为（857.80±223.69） μg·h·L^-1和（191.08±43.27） μg·h·L^-1。日内及日间精密度、回收率符合测定要求。 结论 姜黄素磷脂复合物混悬液与姜黄素相比吸收速度快,消除速率慢。     

18F-FDG PET-CT与乳腺癌新辅助化疗疗效中的关联性分析

目的 本研究旨在探讨¹⁸F-FDG PET-CT与乳腺癌新辅助化疗疗效的关联性。方法 2014年1月~2015年12月,收集笔者医院收治的行新辅助化疗的乳腺癌患者98例。前瞻性分析¹⁸F-FDG PET-CT与乳腺癌新辅助化疗疗效的关联性。结果 与病理无效组相比,病理有效组患者SUV_max0显著增加（9.54±3.11 vs 6.12±3.21,P=0.015）;SUV_max1变化率显著增加（53%±17% vs 29%±11%,P=0.000）;SUV_max2变化率显著增加（61%±21% vs 34%±12%,P=0.000）。与未pCR组相比,pCR组患者SUV_max0显著增加（10.54±4.11 vs 5.87±2.21,P=0.000）;SUV_max1变化率显著增加（57%±17% vs 28%±10%,P=0.000）;SUV_max2变化率显著增加（64%±23% vs 33%±11%,P=0.000）。结论 ¹⁸F-FDG PET-CT可作为评价乳腺癌新辅助化疗效果的一种影像学方式,值得临床进一步推广。     

两性霉素B的聚乙二醇-聚乳酸胶束的制备及其体外释放动力学

目的 制备两性霉素B的聚乙二醇-聚乳酸嵌段共聚物胶束,对其物理化学性质和体外释药特性进行评价.方法 采用阴离子聚合法合成了一系列聚乙二醇-聚乳酸嵌段共聚物;用透析法制备了聚合物胶束;用透射电镜观察了聚合物胶束的形态;用激光散射法测定了聚合物胶束的粒径及其分布;采取荧光探针法测定了聚合物的临界缔合浓度;用透析法考察了载药聚合物胶束的体外释放动力学.结果 聚合物胶束大小均匀,具有球形核-壳结构,平均粒径范围为28～49 nm,并随着疏水链段的增长,胶束粒径逐渐增大;3种聚合物的临界缔合浓度均较低,分别为1.87 &#215;10-7,1.45 &#215;10-7,9.61&#215;10-8 mol&#183;L-1;两性霉素B聚合物胶束的体外释放缓慢,符合一级动力学特征.结论 聚乙二醇-聚乳酸嵌段共聚物胶束可作为疏水性药物的纳米级长循环载体,具有很好的应用前景.     

PET-CT在三维适形放射治疗胰腺癌靶区勾画中的应用

目的 探讨PET-CT在局部晚期胰腺癌（local advanced pancreatic carcinoma,LAPC）三维适形放射治疗（three dimensional conformal radiotherapy, 3D-CRT）靶区勾画中的价值,为基于PET-CT的精确放疗方案制定奠定基础。 方法 13例局部晚期胰腺癌确诊患者,分别采用PET-CT融合图像及同机CT图像勾画靶区体积,对比分析肿瘤靶区（GTV）、临床靶区（CTV）、计划靶区（PTV）、周围正常组织受量等指标。 结果 PET-CT改变GTV、PTV：13例患者靶体积均有改变,GTV_CT、GTV_PET-CT分别为（57.3±22.9）、（68.4±31.7） cm³,CTV_CT、CTV_PET-CT分别为（119.9±38.7）、（132.7±47.5） cm³,PTV_CT、PTV_PET-CT分别为（288.6±52.1）、（312.4±79.4） cm³,差异均有统计学意义（P<0.05）;其中6例患者GTV体积增大明显（超过20%）,平均增大36.5%。PET-CT改变放疗计划参数：给予相同的靶区剂量60 Gy/30次,基于PET-CT制定的放疗计划与基于CT制定的放疗计划相比,周围正常组织受量均发生相应变化,但差异无统计意义。 结论 应用PET-CT融合图像,可在保证正常组织受量符合临床要求的前提下,较精确地确定胰腺癌放射治疗靶区,利于制定合理的三维适形放疗计划,但相关结论仍有待进一步大样本研究证实。     

高压氧治疗在重型新型冠状病毒肺炎患者救治中的疗效分析

目的 分析重型新型冠状病毒肺炎（COVID-19）患者高压氧治疗（HBOT）的疗效及潜在机制。方法 选择长江航运总医院收治的5例重型COVID-19患者,年龄为24～69岁,因常规治疗不能控制病情且存在进行性低氧血症而接受HBOT。HBOT方法：每天1次,15 min匀速加压至2.0 ATA（表压0.1 MPa,患者1）或1.6 ATA（表压0.06 MPa,患者2～5）,持续停留90 min（首次治疗）或60 min（随后治疗）,然后20 min减压至常压;HBOT全程无间歇面罩吸氧;病房脉搏血氧饱和度（SpO₂）日均值连续2 d超过95%结束HBOT。收集患者症状、呼吸频率、SpO₂、动脉血气分析结果、血常规、凝血功能、高敏C-反应蛋白（hs-CRP）和胸部CT检查结果等资料。采用配对t检验比较治疗前后各指标的差异。结果 首次HBOT治疗后所有患者症状、体征均开始好转。开始HBOT 4次后平卧位呼吸急促消失,5次后消化道症状完全消失,仅残存轻微胸痛、静息和活动状态下呼吸急促症状。结束HBOT疗程后,患者呼吸频率较HBOT前下降［（20.80±2.28）min^-1 vs （27.20±5.40）min^-1,P<0.05］。病房监测SpO₂均在引入HBOT后逐日回升,5例患者日平均SpO₂分别在第1、2、3、3、6次HBOT后恢复至95%以上。首次HBOT减压后SpO₂为（93.60±0.07）%,高于加压前的（73.20±6.42）%（P<0.05）,第2、3次HBOT加压前SpO₂与首次加压前相比均升高（P均<0.05）,第3次HBOT前后即刻相比差异无统计学意义（P>0.05）。HBOT前,患者的动脉血二氧化碳分压（PaCO₂）为（31.48±3.40）mmHg（1 mmHg=0.133 kPa）,低于正常参考值（35～ 45 mmHg）。HBOT疗程结束后动脉血氧分压［（130.20±18.58）mmHg］、动脉血氧饱和度［（98.40±0.55）%］、淋巴细胞比例［（0.207 8±0.074 2）］和淋巴细胞绝对值［（1.09±0.24）×10⁹/L］均较HBOT前［（61.60±15.24）mmHg、（73.20±6.43）%、0.094 6±0.062 1、（0.61±0.35）×10⁹/L］升高,纤维蛋白原水平［（2.97±0.27）g/L］和hs-CRP水平［（7.76±6.95）mg/L］均较HBOT前［（4.45±0.94）g/L、（30.36±1.27）mg/L］降低,差异均有统计学意义（P均<0.05）;血乳酸和D-二聚体水平均回降［（1.13±0.10）mmol/L vs （2.17±1.71）mmol/L、（0.42±0.13）mg/L vs（1.84±1.29）mg/L］,但差异均无统计学意义（P均>0.05）。患者HBOT前均有重型COVID-19典型肺部CT影像学改变,HBOT后均有所改善。结论 持续性低氧血症诱发的全身性系统性缺氧或许是重型COVID-19患者病情恶化的主要原因。COVID-19患者呼吸功能障碍以肺泡换气功能障碍为主,HBOT可能是纠治重型COVID-19患者常压给氧无法控制的进行性低氧血症的最佳手段。HBOT为处于持续缺氧的机体组织提供了充足氧供的有氧代谢间歇,有利于机体免疫功能、循环功能、应激水平的恢复,从而促进病情好转。     

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.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.