“和血生络法”对PI3K/Akt信号转导通路的影响

目的通过研究"和血生络方"对心肌梗死模型大鼠左室心肌组织AKT mRNA表达的影响,从信号转导通路角度探讨"和血生络法"促血管新生的作用机制。方法选雄性Wistar大鼠,制作心肌梗死大鼠模型,随机分为消心痛组,和血生络高、低剂量组及模型组,同时建立假手术组,每组6只。药物治疗组分别给予和血生络水溶液(9.9,19.8 g.kg-1.d-1)及消心痛水溶液(2.7 mg.kg-1.d-1)每天灌胃1次,其他组给予等量蒸馏水,连续用药3 w后处死大鼠,取心脏组织检测AKT mRNA的表达。结果模型组较假手术组大鼠显著增高(P<0.05)。和血生络高、低剂量组及消心痛组明显高于模型组(P<0.05)。和血生络高剂量组与消心痛组明显优于和血生络高低剂量组(P<0.05)。和血生络高剂量组明显优于消心痛组(P<0.05)。结论 PI3K/Akt信号通路在"和血生络法"促血管新生中起着重要作用。     

和血生络法对心肌梗死大鼠血清中中性粒细胞集落刺激因子与碱性成纤维细胞生长因子的影响

目的通过观察和血生络方对心肌梗死大鼠血清中中性粒细胞集落刺激因子(G-CSF)、碱性成纤维细胞生长因子(bFGF)等的影响。方法以雄性Wistar大鼠制作心肌梗死大鼠模型,随机分为硝酸异山梨酯(消心痛)组、和血生络高、低剂量组及模型组,同时建立假手术组,每组8只。药物治疗组分别给予和血生络水溶液(9.9,19.8 g.kg-1.d-1)及消心痛水溶液(2.7 mg.kg-1.d-1)每天灌胃1次,其他组给予等量蒸馏水,连续用药3 w后处死大鼠,取血清检测G-CSF与bFGF的含量。结果和血生络高剂量组、消心痛组血清中G-CSF与bFGF含量较模型组显著增高(P<0.05),和血生络高剂量组血清中G-CSF较消心痛组显著增高(P<0.05)。结论和血生络法的作用机制可能与两个方面有关,一方面促进内皮细胞增殖和迁移以利于血管的新生,另一方面动员骨髓中的内皮祖细胞迁移到梗死局部并分化成为内皮细胞促进新血管形成。     

心肝胃同治方对心肌梗死大鼠血清中血管内皮生长因子的影响

目的观察心肝胃同治方对血管内皮生长因子的影响,探讨"心肝胃同治法"的作用机制。方法以Wistar大鼠制作心肌梗死模型,随机分为消心痛组、心肝胃同治高、低剂量组及模型组,同时建立假手术组,每组8只。药物治疗组分别给予心肝胃同治水溶液及消心痛水溶液,每天1次灌胃,其他组给予等量蒸馏水,连续用药2 w后处死大鼠,检测血清中血管内皮生长因子(VEGF)的含量。结果心肝胃同治高、低剂量组及消心痛组血清中VEGF含量明显高于模型组(P<0.05),和血生络高剂量组优于其他处理组(P<0.05)。结论心肝胃同治法的治疗机制与促血管新生有关。     

祛风生脉颗粒对实验性心肌缺血大鼠心脏促血管生成作用的研究

目的探讨祛风生脉颗粒对心肌梗死模型大鼠心脏的促血管生成作用及其机制.方法选择结扎法制作心肌梗死模型大鼠,运用冠状动脉造影、免疫组化技术等,观察大鼠缺血心肌侧支血管的新生情况,检测内皮细胞数(EC)、毛细血管密度(CD)、血管内皮细胞生长因子(VEGF)和碱性成纤维细胞生长因子(bFGF)的变化.结果祛风生脉颗粒高、低剂量组大鼠心脏造影剂聚集明显,结扎后的前降支显影度与模型组比较有统计学意义;祛风生脉颗粒治疗后Ⅷ因子免疫组化标记的毛细血管管腔增粗、密度增加,与重组bFGF蛋白心肌内注射诱导的血管新生数目相当;同时,祛风生脉颗粒高剂量组缺血心肌中VEGF表达上调,高于模型组和低剂量组(P<0.01).结论祛风生脉颗粒能够促进缺血心肌侧支循环的建立和毛细血管的新生,发挥"自身血管搭桥"的作用.其机制可能与缺血心肌中VEGF表达上调有关.     

辛伐他汀对心肌梗死后血管新生及血管生成素-1的影响

目的:观察辛伐他汀对大鼠急性心肌梗死(AMI)后血管新生的影响,以及血管生成素-1(Ang-1)在这一过程中的表达变化.方法:SD大鼠60只,随机分为假手术组、对照组、小剂量辛伐他汀(1 mg·kg-1·d-1)组、中剂量辛伐他汀(10 mg·kg-1·d-1)组、大剂量辛伐他汀(40 mg·kg-1·d-1)组.结扎大鼠冠状动脉左前降支建立AMI动物模型.术后次日起分别灌胃给予相应剂量辛伐他汀4周.检测缺血区心肌新生血管密度、左室重量指数(LVMI)、及Ang-1蛋白及mRNA表达.结果:小剂量及中剂量辛伐他汀组缺血区心肌新生血管密度较对照组显著增加(P<0.05);各剂量辛伐他汀组Ang-1蛋白及mRNA表达较对照组均显著增强(P<0.05);小、中剂量辛伐他汀组LVMI较对照组显著减小(P<0.05),大剂量组LVMI则进一步减小(P<0.01).结论:小、中剂量辛伐他汀可促进AMI后心肌血管新生;辛伐他汀这一作用可能与其上调Ang-1的表达有关.     

灯盏花素对缺血再灌注大鼠心肌Caspase-9蛋白及mRNA表达的影响

目的观察灯盏花素(Bre)对缺血再灌注(IR)大鼠心肌Caspase-9蛋白及mRNA表达的影响。方法 40只SD大鼠随机分为假手术组、模型组、BreⅠ组(25 mg.kg-1.d-1腹腔注射,7 d)和BreⅡ组(50 mg.kg-1.d-1腹腔注射,连续7 d)。采用结扎大鼠左冠状动脉前降支方法制备心肌IR模型。应用TTC染色的方法检测各组大鼠心肌梗死面积,western印迹技术检测大鼠心肌组织Caspase-9蛋白表达的变化,RT-PCR技术检测大鼠心肌组织Caspase-9 mRNA表达的变化。结果与假手术组比较,模型组大鼠心肌梗死面积明显增加(P<0.01),Bre明显改善了IR大鼠心肌梗死面积,BreⅡ组比BreⅠ组心肌梗死面积小(P<0.05);模型组大鼠的Caspase-9蛋白及mRNA表达水平较假手术组明显增加(P<0.01),Bre组大鼠心肌的Caspase-9蛋白及mRNA表达水平较模型组明显减少(P<0.01)且BreⅡ组大鼠心肌的Caspase-9蛋白及mRNA表达水平比BreⅠ组减少(P<0.05)。结论 Bre可以减轻IR大鼠心肌梗死面积,其机制可能与减少大鼠心肌的Caspase-9蛋白及mRNA表达有关。Bre对IR损伤心肌的保护作用呈剂量依赖性。     

白藜三醇对兔心肌梗死后血管新生的诱导作用

目的:探讨白藜三醇对兔心肌梗死后血管新生的诱导作用及可能机制.方法:32只新西兰白兔随机分为假手术组、手术对照组、白藜三醇组、消心痛组,每组8只.除假手术组,其余兔建立心肌梗死模型.术后予溶剂、白藜三醇或消心痛不同药物喂养.两周后,检测各组心肌梗死面积及梗死边缘区微血管密度(microvessel density,MVD)、血管内皮生长因子-A(VEGF-A)、胰岛素样生长因子-1(IGF-1)和碱性成纤维细胞生长因子(bFGF)的表达水平.结果:白藜三醇组、消心痛组较假手术组、手术对照组能明显增加梗死边缘区微血管密度及VEGF-A、IGF-1、bFGF的表达(P<0.05),白藜三醇组、消心痛组梗死面积小于手术对照组(P<0.05).手术对照组较假手术组VEGF-A、IGF-1表达增加(P<0.05),但bFGF表达两组之间无明显变化(P>0.05);白藜三醇组IGF-1的表达水平较消心痛组明显增加(P<0.05),VEGF-A、bFGF两组之间无统计学差异(P>0.05).结论:在缺血缺氧环境下,机体可启动心肌梗死边缘区的血管生成,但作用强度有限;白藜三醇与消心痛均可促进心肌梗死后边缘区血管生成,有利于冠状动脉侧支循环的建立,减小心肌梗死面积;白藜三醇诱导血管发生与多种血管生长因子表达增多相关,主要与介导IGF-1高表达相关.     

阿托伐他汀早期干预对急性心肌梗死心肌细胞凋亡的影响

目的探讨不同剂量阿托伐他汀提早干预治疗,对兔急性心肌梗死(AMI)细胞凋亡的影响。方法24只新西兰兔随机分为3组:①对照组:不予药物干预;②低剂量组:0.5mg·kg-1·d-1阿托伐他汀;③高剂量组:5mg·kg-1·d-1阿托伐他汀。在药物干预3d后制作AMI模型,检测心肌梗死及其边缘区细胞凋亡率并观察心肌Bax和Bcl-2表达。结果①高剂量组心肌细胞凋亡率明显低于对照组和低剂量组(P<0.05,P<0.01)。②高剂量组Bcl-2表达高于对照组及低剂量组(P<0.01,P<0.05),对照组与低剂量组差异无统计学意义;三组Bax表达均较高,但组间比较,差异无统计学意义。③Pearson线性相关分析显示梗死及其边缘区心肌细胞凋亡率与相应区域Bcl-2表达呈负相关,与心肌组织Bax表达无明显相关关系。结论高剂量阿托伐他汀降低梗死区及其边缘区心肌细胞凋亡率,与低剂量相比显示出更好保护作用。     

芎归六君子汤对心肌梗死大鼠G-CSF含量和VEGF、bFGF表达的影响

目的探讨芎归六君子汤对心肌梗死大鼠粒细胞集落刺激因子(G-CSF)含量、血管内皮生长因子(VEGF)和碱性成纤维细胞生长因子(bFGF)表达的影响。方法将大鼠随机分为假手术组、模型组、消心痛组、复方丹参滴丸组和芎归六君子汤组。采用左冠状动脉前降支结扎法复制心肌梗死模型,假手术组只穿线不结扎。造模结束后,分别给予生理盐水及对应药物灌胃,1次/d,连续28 d。下腔静脉取血,检测外周血G-CSF含量;取梗死边缘心肌,测定VEGF和bFGF蛋白和基因表达。结果各给药组血清G-CSF含量升高,心肌梗死边缘VEGF、bFGF蛋白和基因表达增强,与模型组相比差异显著,且芎归六君子汤组上述指标优于复方丹参滴丸和消心痛组(P0.01)。结论芎归六君子汤能够通过提高G-CSF含量、改善VEGF和bFGF表达,促进梗死心肌微血管再生,提示从脾胃论治心肌梗死具有重要应用价值。     

硝酸异山梨酯对大鼠缺血心肌血管新生的影响

目的观察硝酸异山梨酯对急性心肌梗死(AMI)大鼠缺血心肌组织形态、梗死面积及毛细血管新生的影响。方法Wistar大鼠90只建立AMI模型后,随机分为5组,分别为正常组,假手术组,模型组,硝酸异山梨酯低剂量组(IDL组)和硝酸异山梨酯高剂量组(IDH组),每组18只。大鼠饲养7、14天后各随机处死9只,截取心肌组织,进行光镜、电镜观察,利用NBT染色法测定心肌梗死面积,应用免疫组织化学法测定Ⅷ因子,进而计算缺血心肌微血管密度(MVD),通过RT-PCR技术检测血管内皮生长因子(VEGF)及碱性成纤维细胞生长因子(bFGF)基因表达情况。结果光镜下观察,缺血区可见炎细胞浸润、心肌肿胀、梗死区纤维化。与模型组比较,IDL组和IDH组7、14天心肌梗死面积明显缩小,MVD明显增加(P<0.05);正常组、假手术组VEGF mRNA、bFGF mRNA表达有所减少,而IDH组则有所增加。结论硝酸异山梨酯可明显缩小AMI大鼠梗死面积,促进缺血心肌的毛细血管新生,对心肌缺血损伤具有保护作用。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。