黄芪、当归对血管内皮剥脱后内膜增生的影响及作用机制

目的 研究黄芪和当归防治血管内皮剥脱后再狭窄与血管平滑肌细胞(VSMC)表型转化之问的关系。方法 建立大鼠主动脉内皮剥脱模型，分别采用形态学和Northern印迹分析技术，观察大鼠血管内皮剥脱后内膜增生情况及VSMC表型标志基因SM α—肌动蛋白、平滑肌胚胎型肌聋蛋白重链(SMemb)表达活性。结果 术后7d模型组内膜明显增生，14～21d内膜呈进行性弥漫性增厚，与模型组相比，两种中药治疗组的内膜增生程度均明显藏轻1分化标志SM α—肌动蛋白基因表达增高，去分化标志SMemb表达降低。结论 黄芪和当归通过抑制VSMC表型转化而减缓血管内膜增生。     

高脂血症对内皮剥脱术后血管炎症反应的影响

目的探讨高脂血症对内皮剥脱术后血管炎症反应的影响。方法建立大鼠主动脉内皮剥脱后内膜增生模型,利用免疫组化及Western blot方法检测血管壁NF-κB和iNOS的表达变化,并结合形态学分析研究高脂血症大鼠内皮剥脱后血管炎症反应及新生内膜增生情况。结果主动脉内皮剥脱后内膜呈弥漫性增厚,管腔变小,增厚的内膜以VSMC为主,中膜VSMC排列紊乱。高脂血症明显促进了增生的内膜中NF-κB和iNOS的表达。结论高脂血症通过促进NF-κB表达进而诱导iNOS的表达,加剧了内皮剥脱后的血管炎症反应。     

全反式维甲酸对球囊剥脱大鼠胸主动脉内皮后平滑肌细胞增殖和P21表达的影响

目的：探讨全反式维甲酸（ATRA）对球囊损伤大鼠胸主动脉后管腔狭窄、血管平滑肌细胞（VSMC）增殖及细胞周期依赖性激酶抑制蛋白P21表达规律的影响。方法：54只SD大鼠随机分为三组。对照组不进行球囊损伤，术后28天处死；手术组和ATRA治疗组行球囊剥脱胸主动脉内皮术，分别于术后2d、7d、14d、28d处死。取胸主动脉应用HE染色、免疫组化和计算机图像分析法进行形态学、PCNA和P21表达水平检测。结果：①正常动脉壁不表达PCNA及P21。②手术组中膜VSMC术后2d PCNA表达达高峰，后迅速下降；而新生内膜在术后7d现并高表达PCNA，14d、28d内膜迅速增厚，其中PCNA表达逐渐下降。P21在术后14d新生内膜中可见少量表达，28d表达增多。③ATRA治疗组术后7d新生内膜中已有P21表达，14d、28d大量表达，而PCNA的表达明显低于手术组，显著抑制VSMC的迁移和增殖、内膜增生和管腔狭窄（P〈0．01）。④P21表达与PCNA表达呈负相关（P〈0．001）。结论：ATRA可通过诱导P21蛋白表达，抑制VSMC迁移和增殖，从而抑制球囊剥脱大鼠胸主动脉内皮后新生内膜过度增生和管腔狭窄。     

大鼠颈动脉球囊损伤后血管平滑肌细胞E1A激活基因阻遏子的表达变化

目的探讨血管再狭窄发生的病理生理机制及E1A激活基因细胞阻遏子(CREG)在新生内膜增殖中的调控作用, 为研究CREG防治增生性血管疾病的作用奠定基础.方法采用大鼠颈动脉球囊损伤后血管再狭窄的动物模型, 以免疫组织化学染色、逆转录-聚合酶链反应(RT-PCR)方法, 检测新生内膜中增殖细胞核抗原(PCNA)和平滑肌α肌动蛋白(SM α-actin)的表达变化及血管壁中CREG mRNA水平、蛋白表达的动态变化.结果大鼠颈动脉球囊损伤后1 d血管壁 CREG mRNA水平开始下降, 至损伤后5 d达最低, 损伤后7 d CREG mRNA表达回升, 至28 d时仍未回到正常对照组的水平.血管损伤后3 d血管内表面可见增殖的血管平滑肌细胞(VSMC), PCNA染色阳性, 其胞浆内SM α-actin和CREG染色均为阴性; 损伤后5 d新生内膜形成并增厚, PCNA阳性细胞数达到高峰, 部分VSMC胞浆内SM α-actin和CREG染色均呈阳性; 损伤后28 d管腔严重狭窄, 新生内膜中PCNA表达已较低, SM α-actin和CREG表达均明显增加, 新生内膜SM α-actin表达程度仍弱于中膜, CREG表达程度接近中膜.损伤后不同时间点VSMC增殖程度与血管壁中CREG mRNA水平的变化呈负相关(r=-0.80, P<0.05), CREG mRNA的表达为先降低, 后回升, 而细胞增殖指数为先升高, 后回降.结论 VSMC的表型转化、增殖、迁移和分泌细胞外基质导致新生内膜过度增生和管腔狭窄, CREG参与VSMC增殖的调控.     

旋覆花素抑制内皮剥脱诱导血管炎症反应的研究

目的探讨旋覆花素抑制血管内膜增生的药理学机制。方法SD大鼠灌胃服用旋覆花素溶液,3d后行球囊内皮剥脱术,术后继续给药,于不同时间处死大鼠后检测各指标变化。结果和对照组相比,旋覆花素能显著抑制内皮剥脱术后血管新生内膜的增生,降低内皮剥脱术引起的血清C-反应蛋白（CRP）、前列腺素E2（PGE2）、丙二醛（MDA）水平的升高（P〈0.05）,同时增加总抗氧化能力（TAOC）（P〈0.05）。结论旋覆花素通过发挥抗氧化与抗炎作用,减缓了内皮剥脱后血管新生内膜的增厚。     

大鼠胸主动脉内皮损伤后内膜增生及PDGF-BB、PCNA、P16表达的变化

目的研究大鼠血管内皮损伤后内膜增生情况及血小板衍生生长因子-BB(PDGF-BB)、增殖细胞核抗原(PCNA)和抑癌基因P16的表达变化过程。方法选用雄性SD大鼠24只,球囊剥脱大鼠胸主动脉内皮,并随机将大鼠分为术后2 d、7 d、14 d、28 d处死4个组,每组6只。摘除胸主动脉,通过组织学检查和免疫组化技术检测内膜增生情况、PDGF-BB、PCNA、P16表达的变化。结果内皮损伤后2 d无血管内膜增厚,7 d内膜开始增生,28 d血管平滑肌细胞(VSMC)的增殖减弱,但细胞外基质增加,内膜继续增生;PDGF-BB、PCNA的表达均于术后2 d开始升高,PCNA的表达在术后7 d达高峰,而PDGF-BB在术后14 d达到高峰,P16在术后各时间点的表达变化不显著。结论 PDGF-BB、PCNA和P16的表达变化规律为寻找有效控制再狭窄的药物提供了理论依据。     

冠状动脉损伤修复中Ⅲ型胶原的表达及其与血管平滑肌细胞增生的关系

目的探讨血管损伤修复中Ⅲ型胶原的表达规律及其与血管平滑肌细胞(VSMC)增生的关系.方法26只犬冠状动脉内置入过大钽丝支架建立再狭窄模型,分别于术后7d、14d和28d处死动物,用透射电镜及免疫组化染色技术观察新生内膜中Ⅲ型胶原表达和VSMC特征,并用图象处理技术对Ⅲ型胶原的染色密度作定量分析.结果支架置入后7d以VSMC移行增生为主,14d时VSMC增生达高峰并有较多胶原表达,28d时VSMC由合成型逐渐转变为收缩型并表达大量胶原,Ⅲ型胶原在不同时间阶段的表达量具有显著差异(P<0.05).结论Ⅲ型胶原可能在再狭窄形成的后期内膜增生中起重要作用.     

葛根素对球囊损伤血管内皮后血小板活化及血管紧张素Ⅱ1型受体mRNA变化的影响

目的　研究球囊损伤后血管内膜增生的过程、血小板活化水平、血管紧张素II 1型受体(AngⅡAT1受体 )mRNA的变化及中药葛根素对它们的影响。方法　球囊剥脱大鼠主动脉内皮 ,并随机分为对照组、手术组和葛根素治疗组。分别在术后 3、7、14和 2 8d ,取主动脉 ,通过组织学检查、放射免疫法和逆转录聚合酶链反应技术检测内膜增生的情况、血小板表面GMP 14 0的数目、血管AT1受体mRNA的水平及葛根素 (5 0mg·kg-1·d-1)腹腔注射对它们的影响。结果　 (1)AT1受体mRNA于术后 3d已明显增高 ,并持续至术后 14d。 (2 )GMP 14 0于术后 3d明显升高 ,术后 7d开始下降。 (3)内皮损伤后 3d已有血管平滑肌细胞 (VSMC)的移行、增殖 ,7d内膜开始增生 ,2 8dVSMC的增殖减弱 ,但细胞外基质增加 ,内膜继续增生。 (4)使用葛根素后血小板表面GMP 14 0的数目和VSMC的移行减弱 ,但AT1受体mRNA及内膜增生程度无明显改变。结论　血管内皮损伤后内膜增生的过程中AT1受体mRNA的表达增加 ,葛根素能抑制血小板的活化及VSMC的移行 ,但对AT1受体mRNA的表达及内膜增生的程度无明显影响。     

舒心益脉煎对气滞血瘀型大鼠动脉内膜损伤后细胞凋亡及基因蛋白产物的影响

探讨气滞血瘀型大鼠胸主动脉内膜剥脱后内膜增生中，舒心益脉煎对血管平滑肌细胞凋亡及相关基因Fas抗原和Fas配体的影响。将58只大鼠随机分为假且10只，舒心益脉煎组和对照组各24只。后两组大鼠行胸主动脉内膜剥脱术，舒心益脉煎组动物于术前7d至术后14d每日接受舒心益脉煎治疗。术后14d处死动物，用免疫组织化学法测定Fas抗原与Fas配体在血管中的表达，原位末端标记法测定凋亡细胞。术后14d血管新生内膜中有平滑肌细胞凋亡；舒心益脉煎显著增加新生内膜中Fas抗原与Fas配体的表达，增加血管平滑肌细胞凋亡，减少新生内膜面积。说明舒心益脉煎可能通过Fas系统调节动脉血管内皮损伤修复过程中血管平滑肌细胞凋亡，从而抑制新生内膜形成。     

辛伐他汀对支架置入后兔腹主动脉内膜增生的影响

目的 观察辛伐他汀对兔腹主动脉支架置入后内膜增殖的影响.方法 30只新西兰大白兔随机分为对照组和辛伐他汀治疗组.采用含1.5%胆固醇的高脂饮食加腹主动脉内皮剥脱术制作兔腹主动脉粥样硬化模型.内皮剥脱术后第12周实验组和对照组服用阿司匹林25 mg/d,氯吡格雷12.5 mg/d, 3 d后,分别行支架置入术.术后实验组继续服用辛伐他汀5 mg/d,服药至第30天处死动物,取腹主动脉含支架段血管,进行血管壁组织形态学变化观察和检测细胞周期抑制蛋白P27kip1、增殖细胞核抗原(PCNA)在各组的表达量的变化.结果 血管超声发现内皮剥脱术后第10周实验组和对照组腹主动脉均可见有不同程度的粥样硬化斑块和血管内狭窄.组织形态学观察发现服用辛伐他汀的实验组兔腹主动脉支架段内的血管内膜厚度(0.107±0.072 mm,与对照组0.133±0.047 mm比,P=0.006)、新生内膜面积(0.975±0.084 mm2,与对照组1.350±0.043 mm2比,P=0.001)均明显降低,且血管的狭窄程度较轻(20.460%±2.325%,与对照组31.020%±1.904%比,P=0.002).实验组兔腹主动脉支架段内的血管新生内膜中的血管平滑肌细胞(VSMC)的胞核P27kipl蛋白表达量明显升高(7.149±0.305,与对照组2.997±0.310比,t=9.551,P＜0.05),而血管新生内膜中VSMC的胞核PCNA表达量明显降低(着色强度IS为3.003±0.192, 与对照组着色强度IS 5.268±0.475比,t=4.423,P＜0.05).结论 辛伐他汀能明显抑制支架置入术后血管内膜增生.其机制可能为通过上调P27kip1蛋白表达量,使增殖标志物PCNA表达量降低,而对VSMC增殖周期起负调控作用,达到抑制VSMC增殖和新生内膜的增生.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.