间充质干细胞外泌体作用机制的研究进展

间充质干细胞（MSC）来源于中胚层,具有修复组织损伤的作用。外泌体是细胞分泌的囊泡样物质,与来源细胞功能相似。近年来,间充质干细胞来源外泌体（MSC-exo）受到广泛关注,其生物学特性及作用机制成为研究热点。本文就外泌体特性及间充质干细胞来源外泌体在治疗疾病中作用机制作一综述。     

间充质干细胞及其衍生外泌体治疗ARDS进展

间充质干细胞（mesenchymal stem cells, MSC）及其衍生的外泌体因其强大的免疫调节和组织再生等特性引起广泛关注,本文对MSC及其衍生外泌体的特性,以及MSC及其衍生外泌体通过抗微生物、免疫调节、组织再生、血管生成、抗纤维化、抗氧化应激和抗凋亡作用抑制急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS）发病机制多个环节及临床研究进展予以概述。     

间充质干细胞来源外泌体治疗心肌梗死的研究进展

大量研究表明间充质干细胞（mesenchymal stem cell,MSC）主要通过旁分泌作用抑制细胞凋亡、抑制心肌纤维化、促进血管生成、抑制免疫反应来修复心肌损伤,外泌体在其中起主要作用。外泌体是细胞分泌的天然的纳米载体,内含细胞特异性蛋白、核酸和脂质。与脂质体载体相比,还具有低免疫原性、无细胞毒性及能够穿透生物屏障等优点。目前已有多种靶向心脏的工程外泌体在动物心肌梗死模型中取得很好的疗效。本文就MSC及MSC来源外泌体促进心肌梗死后受损心肌修复的机制及研究进展作一综述。     

间充质干细胞来源外泌体在组织修复中的研究进展

<正>组织修复是临床治疗中极为重要的环节，伴随着组织细胞的再生、增殖、分化和迁移，炎症水平调节，活性氧（ROS）含量的回归稳态，伤面消肿愈合等过程。目前有关组织修复方面的临床治疗方法很多，但效果不尽人意。通过对外泌体的研究，我们发现其在促进组织修复方面有着重要的作用。本文拟对间充质干细胞（MSC）来源外泌体促进组织修复方面的研究进展进行综述，现报道如下。1 MSC的旁分泌机制MSC是一种来源于中胚层，具有自我更新和多方向分化能力的多能干细胞，     

肺动脉高压诊治现状

肺动脉高压（pulmonary hypertension, PH）是一类恶性肺血管疾病，其主要病理生理学特征为肺血管持续收缩及重构，导致肺血管阻力进行性增高，同时合并不同程度右心功能衰竭。超声心动图是疑诊PH首选无创筛查方法，右心导管检查是确诊PH的“金标准”。近10年，三大针对PH靶向治疗经典途径的药物： 内皮素受体拮抗剂、磷酸二酯酶5抑制剂、前列环素类药物陆续上市，联合治疗策略也被临床医师认可，PH患者预后明显改善。此外，第四大类慢性血栓栓塞性PH患者通过肺动脉内膜剥脱术或经皮肺动脉球囊扩张术，部分患者甚至获得“治愈”。随着PH研究机制的进展，不同作用途径的靶向药物陆续上市，越来越多不同专业的医生投入到肺血管疾病的诊治及研究工作中，推动PH领域的快速发展。     

间充质干细胞来源的外泌体调节缺血性脑卒中后炎症反应的研究进展

缺血性脑卒中发病急、致死率高,而抑制神经炎症是治疗缺血性脑卒中的关键。间充质干细胞（MSC）来源的外泌体因其来源广、直径小、有效成分多而被广泛关注。近期研究表明,MSC来源的外泌体可抑制小胶质细胞、星形胶质细胞的促炎反应活性,刺激其神经保护活性;也可通过调节免疫细胞和炎症介质抑制神经炎症。本文阐述了MSC来源的外泌体在缺血性脑卒中后神经炎症中的作用及其潜在机制,希望为其在缺血性脑卒中疾病的治疗提供思路和借鉴。     

内质网应激在肺动脉高压病理生理过程中的作用

内质网腔内蛋白折叠平衡在维持细胞功能中发挥重要作用。多种刺激可破坏内质网腔内蛋白折叠平衡,引发内质网应激。内质网应激与肺动脉高压(PH)发生发展关系密切。PH的主要病因是肺血管重构引起肺动脉腔隙狭窄,肺血管重构过程涉及肺动脉平滑肌细胞、肺动脉内皮细胞、炎症细胞、循环免疫细胞等多种细胞的病理改变。本文主要阐述内质网应激对PH肺血管重构时血管细胞功能的影响,为理解PH肺血管重构机制及寻找新的PH治疗药物提供参考。     

肺动脉高压动物模型及参与肺血管重构生长因子的研究进展

肺血管重构在肺动脉高压(PH)的发病机制中具有重要作用,随着分子生物学技术的进展,生长因子在肺血管重构中的作用逐渐引起了研究者的广泛关注。由于PH动物模型造模方式多样,且效果各不相同。结合3种经典的PH动物模型,及最近研究的野百合碱联合单侧肺叶切除模型,对有关生长因子与肺血管重构关系的研究进行综述,以期能为PH发病机制的相关研究提供一定的参考。     

外泌体在体外对胃癌耐药信息传递作用的研究

目的探讨外泌体(EXOs)在胃癌细胞间耐药信息传递的作用。方法选用胃癌敏感细胞株(SGC-7901)及其阿霉素耐药株(SGC-7901/VCR)为模型,用CCK-8绘制细胞生长曲线,计算细胞倍增时间;用超速离心法提取SGC-7901/VCR外泌体(VCR/EXO);用透射电子显微镜观察鉴定细胞外泌体形态;运用CCK-8法检测VCR/EXO与SGC-7901细胞共培养后对长春新碱(VCR)的IC50的影响。结果 SGC-7901、SGC-7901/VCR和SGC-7901/VCR/EXO细胞倍增时间分别是(31.54±1.37)h、(47.21±1.65)h和(42.89±1.73)h;透射电子显微镜下,外泌体呈现典型的圆形或椭圆形杯口状结构,直径为40~100 nm;与VCR/EXO共培养后敏感细胞株SGC-7901对长春新碱的IC50耐药性升高2.29倍,差异有统计学意义(P0.05)。结论胃癌外泌体可能具有传递耐药信息的作用,耐药细胞外泌体能够使敏感细胞获得一定的耐药性。虽然外泌体通过细胞间通讯的具体机制仍不清楚,但抑制外泌体的形成和释放,可能会为胃癌的治疗提供新的策略。     

外泌体miRNA在心血管重构中的研究进展

作为一种纳米级囊泡结构,外泌体由多种细胞分泌且在细胞间的信息交流过程中发挥着关键作用,因此受到医学领域研究者的广泛关注。外泌体miRNA在血管重塑、心肌缺血、心肌肥厚等病理性心室重构过程中发挥重要作用。本文对外泌体的来源和功能以及其中的miRNA在病理性心血管重构形成过程中的作用作一综述,以探究外泌体在疾病发生发展中的具体机制,并为其在临床治疗中的应用提供理论基础。     

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.