曲安奈德对鼻息肉中T细胞激活分泌调节因子及嗜酸性粒细胞的影响

目的 观察鼻息肉组织中T细胞激活分泌调节因子及嗜酸性粒细胞表达的变化,探讨糖皮质激素治疗鼻息肉的可能机制.方法 对60例鼻息肉患者分别采用曲安奈德1 mg鼻腔雾化治疗,并以30例生理盐水治疗作为对照,通过免疫组化方法测定鼻息肉治疗前后的T细胞激活分泌调节因子表达及嗜酸性粒细胞数量的变化.结果 经曲安奈德治疗后鼻息肉中T细胞激活分泌调节因子的表达较治疗前显著降低(P<0.05),且嗜酸性粒细胞也随之下降,二者有相关性;而对照组治疗前后差异无统计学意义(P>0.05).结论 T细胞激活分泌调节因子是诱导嗜酸性粒细胞在鼻息肉中浸润的重要趋化因子,曲安奈德可能通过下调T细胞激活分泌调节因子的表达,发挥抗EOS炎症的作用.     

TGF-α在鼻息肉中的表达及其与浸润嗜酸性粒细胞的关系

目的研究转化生长因子-α(TGF-α)对鼻息肉组织上皮细胞的增殖作用,二者相互关系及其与浸润嗜酸性粒细胞的关系,以进一步了解鼻息肉的发病机制。方法32例鼻息肉患者被分为A、B两组,A组为Ⅲ型鼻息肉患者(11例),B组为Ⅰ型及Ⅱ型鼻息肉患者(21例),并以C组8例正常下鼻甲粘膜作为对照,采用免疫组化SP法对鼻息肉组织中TGF-α、增殖细胞核抗原(PCNA)的表达进行了检测比较。结果①TGF-α、PCNA在鼻息肉[(A B)组]上皮细胞、腺上皮细胞中呈现中、高度表达,正常对照下鼻甲组(C组)均呈阴性,且上皮细胞、腺上皮细胞中TGF-α的表达与PCNA的表达显著相关(r1=0.77,P1<0.01,r2=0.84,P2<0.01);②(A B)组间质中TGF-α阳性表达程度与浸润嗜酸性粒细胞显著相关(r=0.55,P<0.05);③A组浸润嗜酸性粒细胞程度及TGF-α阳性表达程度均显著高于B组(P<0.05)。结论①TGF-α可能直接参与鼻息肉的病理变化,在鼻息肉的形成和发展中起一定作用;②嗜酸性粒细胞可能为TGF-α的主要来源;③鼻息肉组织中浸润嗜酸性粒细胞程度及TGF-α阳性表达程度与鼻息肉临床分型密切相关,提示二者在复发性鼻息肉的发病过程中发挥一定的作用。     

嗜酸性粒细胞凋亡在鼻息肉发病机制中的作用

鼻息肉(nasal polyps,NP)是耳鼻咽喉科常见病,成人发病率为1%~2%,术后或保守治疗后复发率高。组织学特点为上皮增生、间质水肿、腺体水肿增生等改变,同时伴有炎性细胞浸润,以嗜酸性粒细胞浸润为主,尚可见淋巴细胞、浆细胞、中性粒细胞及巨噬细胞等。嗜酸粒细胞浸润增多是鼻息肉发病的关键,近年来有研究表明,鼻息肉组织中嗜酸性粒细胞凋亡抑制是导致组织中嗜酸性粒细胞浸润增多的机制之一。本文对其研究进展综述如下。1息肉中的嗜酸性粒细胞与细胞凋亡细胞凋亡(apoptosis)又称程序性细胞死亡(programmed celldeath,PCD),是由基因调控的细胞自主的有序性死亡。嗜酸粒细胞凋亡调节基因主要有Bcl家族蛋白和Fas/FasL系统。研究表明,鼻息肉组织中嗜酸性粒细胞凋亡受到抑制是引起嗜酸性粒细胞浸润增多的原因之一[1]。鼻息肉的发生与嗜酸性粒细胞的凋亡是复杂的多因素、多基因共同作用的结果,嗜酸性粒细胞在凋亡抑制或诱导的过程中,相关的凋亡调控基因表达可能会发生变化。1.1Bcl家族在鼻息肉中嗜酸性粒细胞的表达B细胞淋巴瘤/白血病(B-celllymphoma/leukemia,Bcl)家族蛋白是目前已...     

白细胞介素17C在50例鼻息肉组织中的表达及其意义

[目的]观察白细胞介素17C(IL-17C)在鼻息肉组织中的表达情况,探讨其在慢性鼻-鼻窦炎伴鼻息肉发病过程中的作用机制.[方法]收集2016年1月—2016年6月间行鼻内窥镜下鼻窦手术的慢性鼻-鼻窦炎伴鼻息肉(CRSwNPs)患者的鼻息肉标本50例(鼻息肉组),同时收集同期住院行鼻中隔成形术的鼻中隔偏曲患者的中鼻甲黏膜标本10例(对照组).根据HE染色结果再将鼻息肉分为嗜酸性粒细胞型和非嗜酸性粒细胞型.应用免疫组织化学染色法检测IL-17C在鼻息肉组及对照组标本中的表达水平.[结果]鼻息肉组50例中嗜酸性粒细胞型24例(48.0%),非嗜酸性粒细胞型26例(52.0%);IL-17C主要在鼻息肉组织的上皮细胞中表达.鼻息肉组IL-17C的表达水平明显高于对照组(P<0.01),嗜酸性粒细胞型鼻息肉组中的IL-17C阳性表达率为87.5%,非嗜酸性粒细胞型鼻息肉组为73.1%,对照组为20.0%,嗜酸性粒细胞型鼻息肉组及非嗜酸性粒细胞型鼻息肉组与对照组比较差异均有统计学意义(P<0.01);IL-17C在嗜酸性粒细胞型鼻息肉的上皮细胞中的表达强度评分明显高于非嗜酸性粒细胞型(P<0.05).[结论] IL-17C是参与CRSwNPs发病的重要细胞因子.     

IL-12、TGF-β1在CRSwNP组织中的表达水平及其临床意义

目的 研究白介素-12 (IL-12)、转化生长因子β₁(TGF-β₁)在慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)组织中的表达水平及其临床意义。方法 将2020年1月至2020年12月于陕西中医药大学附属医院就诊的58例CRSwNP患者纳入观察组,另选择同期于本院就诊的55例慢性鼻-鼻窦炎不伴鼻息肉(CRSsNP)患者纳入对照组。比较观察组息肉组织及对照组鼻黏膜组织中IL-12、TGF-β₁表达水平的差异,根据Lund-Mackay内镜评分结果将观察组患者分为轻度组和重度组,根据炎性细胞浸润比例不同将观察组患者分为嗜酸性粒细胞组和非嗜酸性粒细胞组,根据疾病复发情况将观察组患者分为复发组和未复发组,比较不同组患者的IL-12、TGF-β₁表达水平,采用Spearman等级相关分析IL-12、TGF-β₁表达与嗜酸性粒细胞浸润百分比的相关性。结果 观察组患者的IL-12、TGF-β₁表达水平分别为(42.93±10.52) pg/mL、(529.89±147.6...     

白细胞介素17A,17C在24例鼻息肉组织中的表达及其意义

[目的]探讨白细胞介素(IL)-17A与IL-17C在鼻息肉组织中的表达及其意义.[方法]选择自2017年3月至2018年3月间行鼻内窥镜下鼻窦手术治疗的24例慢性鼻-鼻窦炎伴鼻息肉(CRSwNPs)患者的鼻息肉标本做为鼻息肉组,同时选择同期行鼻内窥镜下鼻中隔成形术治疗的鼻中隔偏曲患者的中鼻甲黏膜标本12例做为对照组,通过HE染色方法再将鼻息肉组分为嗜酸性粒细胞型和非嗜酸性粒细胞型,应用PCR方法测定IL-17A及IL-17C在对照组和鼻息肉组中的表达情况.[结果]鼻息肉组IL-17A表达水平明显高于对照组(P<0.05),嗜酸性粒细胞型鼻息肉组和非嗜酸性粒细胞型鼻息肉组IL-17A表达水平间差异无统计学意义(P>0.05);鼻息肉组IL-17C表达水平明显高于对照组(P<0.05),嗜酸性粒细胞型鼻息肉组IL-17C表达水平明显高于非嗜酸性粒细胞型鼻息肉组(P<0.01).[结论] IL-17A及IL-17C在CRSwNPs发病过程中起到促进炎症发生发展的作用.     

蛋白激酶C在鼻息肉中的表达及意义

目的探讨蛋白激酶C在鼻息肉组织中的表达及其与嗜酸粒细胞凋亡的相关性。方法13例鼻息肉患者给予丙酸氟替卡松喷鼻治疗,采用流式细胞术检测激素治疗前后鼻息肉组织中蛋白激酶C表达及凋亡的嗜酸粒细胞,并与7例健康正常人下鼻甲黏膜进行比较。结果蛋白激酶C主要表达在嗜酸粒细胞,其次在血管内皮细胞、腺体周围的平滑肌细胞;13例鼻息肉组织中嗜酸粒细胞表面均有蛋白激酶C表达(100%),而7例健康下鼻甲黏膜中3例(42.86%)有蛋白激酶C表达,差异有显著意义(P<0.05)。糖皮质激素治疗后的鼻息肉组织中有蛋白激酶C表达的嗜酸粒细胞减少,与激素治疗前相比,差异有显著意义(P<0.05)。结论蛋白激酶C在鼻息肉组织中呈高表达,糖皮质激素可以有效抑制鼻息肉中蛋白激酶C的表达,减少嗜酸粒细胞的浸润。     

布地奈德对咳嗽变异性哮喘患儿血清IgE水平的影响

目的:探讨咳嗽变异性哮喘患儿吸入布地奈德治疗前后血清总IgE及外周血嗜酸性粒细胞计数的变化及意义。方法:选择2007年l月-2010年1月本院门诊咳嗽变异性哮喘患儿147例,随机分为对照组(56例),布地奈德治疗组(91例)。对照组与治疗组分别于治疗前和治疗2个月后测定血清IgE、外周血嗜酸性粒细胞计数。结果:对照组治疗前及治疗2个月IgE水平分别为(226.16±21.09)ng/L、(240.39±19.56)ng/L(P>0.05);治疗组治疗前后IgE分别为(255.48±23.67)ng/L、(169.00±15.72)ng/L,治疗前后比较差异有统计学意义(P<0.01),对照组治疗前后外周血嗜酸性粒细胞计数为(1.22±0.60)×109个/L、(0.98±0.41)×109个/L,治疗组治疗前后血嗜酸性粒细胞计数为(1.35±0.73)×109个/L、(0.41±0.20)×109个/L,治疗前后比较差异有统计学意义(P<0.01)。结论:布地奈德可降低咳嗽变异性哮喘儿童血清IgE水平,观察血清IgE水平和外周血嗜酸性粒细胞计数对咳嗽变异性哮喘的诊断和治疗效应的判断具有重要意义。     

川芎嗪对哮喘大鼠气道壁嗜酸细胞浸润和转化生长因子-β1表达的影响

目的:观察川芎嗪对哮喘大鼠模型气道壁嗜酸性粒细胞(EOS)浸润、转化生长因子-β1(TGF-β1)含量的影响。方法:32只SD大鼠随机分成正常对照组、哮喘模型组和大、小剂量川芎嗪干预组,以卵蛋白致敏,并长期吸入激发诱喘制备大鼠哮喘模型,干预组每次雾化吸入前腹腔注射川芎嗪(分别为80mg/kg和40mg/kg),模型组以生理盐水代替。肺组织石蜡切片行TGF-β1免疫组化染色,并经计算机图像分析测定其含量,同时HE染色计数气道壁嗜酸性粒细胞(EOS)数。结果:模型组气道壁EOS计数及TGF-β1含量均高于正常对照组(P均<0.001);两种剂量川芎嗪干预组EOS计数均低于模型组(P<0.01,P<0.05),但大小剂量组间无差别(P>0.05);干预组TGF-β1含量均显著低于模型组(P均<0.001),大、小剂量组间差异有显著性(P<0.01);TGF-β1的表达与EOS计数呈显著正相关(rs=0.7180,P<0.01)。结论:川芎嗪可以减少气道壁EOS浸润和TGF-β1的表达,其降低TGF-β1表达的作用可能部分通过抑制EOS浸润而实现。     

阿奇霉素联合布地奈德喷鼻治疗慢性鼻窦炎伴鼻息肉术后疗效及对嗜酸性粒细胞的影响

目的 观察阿奇霉素联合布地奈德喷鼻治疗慢性鼻窦炎鼻息肉术后疗效,并探讨其对嗜酸性粒细胞的影响.方法 60例慢性鼻窦炎伴鼻息肉并行鼻内镜手术治疗的患者为研究对象.对照组(30例)术后给予常规治疗,包括使用布地条德喷鼻和广谱抗生素治疗,术后生理盐水鼻腔冲洗.治疗组(30例)在常规治疗基础上加服阿奇霉素.两组随访3个月评价临床疗效,观察上皮化时间和复发情况,测定嗜酸性粒细胞个数.结果 治疗组临床疗效总有效率显著高于对照组(96.7%vs 70.0%,P<0.05);治疗组患者均上皮化,随访期无复发,对照组22例上皮化,3例复发,治疗组上皮化时间和复发率与对照组比较有显著性差异(P<0.05);治疗后两组嗜酸性粒细胞个数与手术时比较均显著下降(P<0.05),且治疗组与对照组比较下降明显(P<0.05).结论 阿奇霉索联合布地奈德喷鼻可以提高慢性鼻窦炎鼻息肉术后临床疗效,并且对嗜酸性粒细胞有抑制作用.     

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.