养心通脉有效部位方对心肌缺血大鼠心血管内皮细胞血管生成的影响

目的：探讨养心通脉有效成分部位方（YTⅡ）促血管生成的作用靶点及其机理。方法：设YTⅡ组和各对照组[养心通脉原方（YTⅠ）组、麝香保心丸（SBW）组、重组牛碱性成纤维细胞生长因子（bFGF）组、空白血清组、生理盐水（NS）组]．并进行心肌缺血模型大鼠心脏血管内皮细胞的培养;观察比较在血管生成的过程中YTⅡ组及各对照组含药血清对心脏血管内皮细胞“增殖”、“迁移”和“管腔结构形成”不同环节的干预作用。结果：各组药物干预后,心肌缺血大鼠冠状血管内皮细胞的增殖率、迁移率、成管率3类指标均呈现出bFGF组〉YTⅡ组〉YTI组〉SBW组〉NS组〉空白血清组的递减趋势。YTⅡ和bFGF对血管生成的不同环节均有明显的促进作用,且显著优于其他各组（P均〈0．01）,但YTⅡ组和bFGF组无显著差异（P〉0．05）。结论：养心通脉有效部位方益气活血,能刺激血管内皮细胞“增殖”、“迁移”和“管腔结构形成”不同环节,促进缺血心肌的血管生成。     

养心通脉方对心肌缺血再灌注损伤血瘀证大鼠心肌损伤的治疗作用及其机制

目的 探讨养心通脉方（YTF）对心肌缺血再灌注损伤（MIRI）血瘀证大鼠心肌损伤的治疗作用并分析其相关机制。方法 Wistar大鼠分为正常对照组、模型对照组、阴性对照组、阳性对照组、YTF低剂量组、YTF中剂量组、YTF高剂量组,每组10只。除正常对照组外均建立大鼠MIRI血瘀证模型,YTF低剂量组、YTF中剂量组、YTF高剂量组分别给予4.725、9.450、18.900 g/kg YTF灌胃,阳性对照组给予10.710 g/kg冠心苏合丸混悬液灌胃,阴性对照组给予等体积生理盐水灌胃,每日2次,连续给药14 d;正常对照组常规饲养不灌胃。透射电镜观察各组心肌组织及线粒体超微结构,TUNEL荧光染色观察各组心肌细胞凋亡情况,酶标仪检测各组心肌细胞线粒体膜肿胀度（OD540）及线粒体超氧阴离子含量。结果 透射电镜观察结果显示,正常对照组心肌肌丝排列整齐,肌节规则,结构清晰,线粒体外膜完整,嵴结构正常,排列致密;模型对照组、阴性对照组心肌肌节断裂,核周间隙增宽,线粒体排列紊乱,部分外膜模糊甚至破裂变形,线粒体嵴结构部分缺失,出现少量自噬体包裹线粒体及细胞质,有少量溶酶体出现;阳性对照组及Y...     

养心通脉Ⅱ方治疗慢性心力衰竭60例

目的观察养心通脉Ⅱ方治疗慢性心力衰竭的临床疗效。方法将120例心功能Ⅱ级～Ⅳ级患者随机分为治疗组和对照组各60例,对照组采取西医规范化治疗,治疗组在规范化治疗基础上加用养心通脉Ⅱ方,观察患者治疗前后心功能、中医证候变化,应用彩色超声心动图测定治疗前后左心室舒张末期内径(LVDD)、左心室射血分数(LVEF)变化。结果治疗组在改善心功能、中医证候积分及LVDD、LVEF值方面与对照组比较,差异有统计学意义(P0.05)。结论养心通脉Ⅱ方治疗慢性心力衰竭疗效确切。     

养心通脉饮方治疗心绞痛46例临床观察

目的 观察养心通脉饮方治疗心绞痛的疗效.方法 治疗组:服用心通脉饮方;对照组:服用异舒吉.两组疗程均为8周.结果 两组在治疗前后,临床症状、心电图、血脂分析等的对比,证实该方对治疗心绞痛有显著疗效.结论 用养心通脉饮方治疗心绞痛疗效显著.     

养心通脉液对心肌缺血再灌注损伤大鼠冠状微循环的影响

目的探讨养心通脉液对心肌缺血再灌注损伤(CIRI)冠状微循环的影响及其作用机制.方法对养心通脉注射液治疗组、复方丹参注射液治疗组、CIRI模型组和假手术组4组的心肌毛细血管墨汁灌流数、大鼠冠状微循环荧光变化时间及心肌组织MDA、NO、Na -K ATPase、Ca2 -ATPase、血清CK活性、血浆TXB2和6-K-PGF1α含量进行检测和相关分析.结果与CIRI模型组比较,养心通脉组大鼠显示:①原缺血部位心肌毛细血管墨汁灌流数有明显增加,其荧光饱和时间(ST)和荧光出现时间(AT)均明显缩短(P＜0.05或P＜0.01);②心肌组织MDA含量下降,Na K -ATPase、Ca2 -ATPase活性均提高,血清CK水平下降,心肌组织NO的含量升高,血浆6-K-PGI2/TXA2平衡亦得到改善(P＜0.05或＜0.01);③养心通脉组在改善CIRI大鼠冠状微循环及生化指标上优于复方丹参组(P＜0.05或＜0.01).结论养心通脉注射液能有效地改善CIRI冠状微循环障碍.     

从钙超载角度探讨通脉养心丸心肌保护作用的机制

目的从抑制钙超载的角度探讨通脉养心丸抗细胞凋亡保护心肌的作用机制。方法采用大鼠心肌细胞原代培养方法获得正常心肌细胞并建立缺氧损伤细胞模型,采用FLIPR Calcium 4试剂盒检测药物对胞浆内钙离子浓度变化的影响;Annexin V/PI双染法检测心肌细胞总凋亡率。结果缺氧损伤组心肌细胞胞浆内钙离子浓度显著升高(P<0.01),通脉养心丸各剂量组变化不显著;再次加药后,通脉养心丸各剂量组胞浆内钙离子浓度均显著低于缺氧损伤组(P<0.01)。缺氧损伤组心肌细胞凋亡率显著升高(P<0.01),通脉养心丸4 g/kg、8 g/kg剂量组可显著降低心肌细胞凋亡率(P<0.01)。结论抑制心肌细胞钙超载是通脉养心丸抗心肌细胞凋亡保护心肌的作用机制之一。     

温阳通脉方预处理对心肌缺血再灌注大鼠MDA及SOD的影响

目的 观察温阳通脉方预处理对大鼠心肌缺血再灌注损伤（IR）模型丙二醛（MDA）、超氧化物歧化酶（SOD）含量的影响，探讨温阳通脉方对大鼠再灌注心肌的保护机制。方法 采用结扎大鼠冠状动脉左前降支，缺血30min，再灌注120min的方法建立心肌缺血再灌注损伤模型；缺血5min，再灌注5min，反复3次后缺血30min，再灌注120min建立心肌缺血预适应（IP）模型。检测大鼠灌胃14d后温阳通脉方组、心肌缺血预适应组（IP组）、再灌注损伤纽（IR组）、假性处理组血清MDA、SOD含量。结果 温阳通脉方组、IP组MDA含量低于IR组，SOD高于IR组，差异有统计学意义（P〈0．05）。结论 温阳通脉方预处理后，能降低大鼠心肌缺血再灌注损伤模型MDA含量，升高SOD含量，减轻大鼠急性心肌缺血所致心肌损伤，其机制可能是通过模拟心肌缺血预适应参与心肌保护作用。     

通脉养心丸治疗不同性别老年冠心病患者的分子机制研究

背景 冠心病是临床常见的心血管疾病,且心血管疾病风险存在性别差异.通脉养心丸已被广泛用于治疗冠心病,但其具体的作用机制仍不清楚.目的 采用生物信息学方法分析通脉养心丸治疗不同性别老年冠心病患者的分子机制.方法 2021年6—10月,从基因表达综合数据库(GEO)获取GSE142008数据集,将治疗前3例女性患者、3例男...     

养心通脉片对IRS大鼠血液流变学及胰岛素敏感性的实验研究

目的：观察养心通脉片对IRS大鼠血液流变学及IS的影响及其作用机制。方法：对IRS大鼠养心通脉片治疗组、二甲双胍片治疗组、病理模型组和健康对照组的全血黏度、血浆黏度、红细胞比容、血小板黏附率、ISI进行检测和相关分析。结果：与健康对照组比较，病理模型组血液流变学及IS指标严重异常，养心通脉片在降低血糖、高胰岛素血症方面与二甲双胍片相似，但在改善血波流变学及IS指标方面明显优于二甲双胍片。结论：养心通脉片在改善IRS大鼠血液流变学及IS方面明显优于二甲双胍片。     

养心通脉方含药血清预处理内皮祖细胞对急性心肌梗死兔心肌bFGF、VEGF水平的影响

目的观察养心通脉方含药血清预处理内皮祖细胞(EPCs)对急性心肌梗死(AMI)兔心肌血管内皮生长因子(VEGF)和碱性成纤维细胞生长因子(bFGF)水平的影响。方法从35只雄性SPF级兔中随机选取25只建立急性心肌梗死兔模型,随机分为模型组、中药EPCs心肌注射组、中药EPCs耳缘静脉注射组、EPCs心肌注射组、EPCs耳缘静脉注射组,每组5只,另设正常组和假手术组,各5只,通过移植干预后14 d取梗死心肌区及缺血心肌区组织,荧光定量聚合酶链式反应(PCR)检测bFGF、VEGF的mRNA表达,蛋白质印迹法(Western Blot)检测bFGF、VEGF蛋白表达。结果在梗死心肌区及缺血心肌区,中药EPCs心肌注射组和中药EPCs耳缘静脉注射组bFGF、VEGF的mRNA及蛋白表达明显高于假手术组、模型组、EPCs心肌注射组、EPCs耳缘静脉注射组,差异均有统计学意义(P<0.05),但中药EPCs心肌注射组bFGF、VEGF的mRNA及蛋白表达与中药EPCs耳缘静脉注射组比较差异均无统计学意义(P>0.05),EPCs心肌注射组bFGF、VEGF的mRNA及蛋白表达与EPCs耳缘静脉注射组比较差异均无统计学意义(P>0.05)。结论养心通脉方含药血清预处理EPCs,能够明显增加损伤心肌bFGF、VEGF表达,但耳缘静脉注射与心肌注射疗效相当。     

Components of Comprehensive and Effective Transitional Care

Transitional care (TC) has received widespread attention from researchers, health system leaders, clinicians, and policy makers as they attempt to improve health outcomes and reduce preventable hospital readmissions, yet little is known about the critical elements of effective TC and how they relate to patients’ and caregivers’ needs and experiences. To address this gap, the Patient‐Centered Outcomes Research Institute (PCORI) funded a national study, A chieving patient‐centered C are and optimized H ealth I n care transitions by E valuating the V alue of E vidence (Project ACHIEVE). A primary aim of the study is the identification of TC components that yield desired patient and caregiver outcomes. Project ACHIEVE established a multistakeholder workgroup to recommend essential TC components for vulnerable Medicare beneficiaries. Guided by a review of published evidence, the workgroup identified and defined a preliminary set of components and then analyzed how well the set aligned with real‐world patients' and caregivers' experiences. Through this process, the workgroup identified eight TC components: patient engagement, caregiver engagement, complexity and medication management, patient education, caregiver education, patients' and caregivers' well‐being, care continuity, and accountability. Although the degree of attention given to each component will vary based on the specific needs of patients and caregivers, workgroup members agree that health systems need to address all components to ensure optimal TC for all Medicare beneficiaries.     

脑缺血过程中自噬作用的研究进展

缺血性脑卒中是致死致残率极高的一类难治性疾病。越来越多的证据表明,适度的自噬可以清除受损细胞器,从而保护细胞抵御各种伤害;然而,长期过度自噬,使得细胞内容物降解过多引发细胞死亡,导致组织器官严重损伤。在多个不同的缺血性脑损伤动物模型中观察到,缺血性脑损伤过程中自噬被激活并参与其神经元死亡的调节。本文就缺血性脑损伤过程中自噬的相关作用的研究进展做一概述。     

养心通脉片对动脉粥样硬化白兔VEGF的表达和新生血管数的影响

目的观察养心通脉片对动脉粥样硬化（AS）白兔血管内皮生长因子（VEGF）的表达和新生血管数的影响和机制.方法利用高脂饲料喂养白兔造模,正常组和模型组用双蒸水灌胃,养心通脉片组用养心通脉液灌胃.1个月后,取出白兔主动脉,运用免疫组化法来观察VEGF和新生血管数.结果模型组和养心通脉片组主动脉斑块都可见棕黄色阳性表达,模型组表达较为强烈,两者比较有统计学意义（P〈0.05）.两组主动脉斑块都可见大于10 μm的颗粒,养心通脉片组颗粒较少,与模型组比较有统计学意义（P〈0.01）.结论养心通脉片在动脉粥样斑块形成后,通过影响VEGF和新生血管的表达来有效地逆转或消退AS斑块.     

脑缺血的神经保护治疗研究现状

目前,在时间窗内进行溶栓治疗是FDA推荐的唯一有效的脑缺血急性期治疗方案,但溶栓时间窗限制了其临床应用,而神经保护则具有更为广泛的适应证,成为脑缺血治疗的研究热点之一.文章综述了目前国内外尚处于实验阶段和已应用于临床的神经保护治疗方法.     

Flexural Toughness Test and Inversion Research on a Thermal Conductivity Formula on Steel Fiber-Reinforced Concrete Components Post-Fire

Steel fibers are widely used because they can effectively improve the tensile, compressive and flexural properties of concrete structures. The selection of steel fiber dosage and aspect ratio at high temperature has an important impact on the flexural toughness of concrete components post-fire. In this paper, discussions are made on the simulated fire test in compliance with the ISO 834 standard to study the steel fiber-reinforced concrete (SFRC) components post-fire. The research reveals the influence of two commonly used steel fiber aspect ratios (50, 70) and steel fiber dosages (30 kg/m³, 40 kg/m³, 45 kg/m³) on the changes of the internal temperature field, the initial crack flexural strength and the flexural toughness of the SFRC components under a single-side fire. Moreover, combined with the four-point flexural test of the SFRC components post fire, the research also describes the damage of high temperatures to the flexural toughness of SFRC components, and suggests a calculation formula for SFRC thermal conductivity by way of the numerical inversion method. The results of this study have verified that the incorporation of steel fiber into concrete helps to reduce its internal thermal stress difference and improve the crack resistance and fire resistance of the concrete. Moreover, under high temperature conditions, the concrete component added with the steel fiber in an aspect ratio of 70 and a dosage of 45 kg/m³ increased their initial crack flexural strength by 56.8%, higher than that of plain concrete components, and the loss of equivalent flexural strength and flexural toughness of SFRC post fire was only 45.2% and 13.6%, respectively. The proposed calculation formula of thermal conductivity can provide a reference for a numerical simulation study of the temperature field of SFRC components in a high temperature environment.     

Identifying Key Components for an Effective Case Report Poster: An Observational Study

BACKGROUND  Residents demonstrate scholarly activity by presenting posters at academic meetings. Although recommendations from national organizations are available, evidence identifying which components are most important is not. OBJECTIVE  To develop and test an evaluation tool to measure the quality of case report posters and identify the specific components most in need of improvement. DESIGN  Faculty evaluators reviewed case report posters and provided on-site feedback to presenters at poster sessions of four annual academic general internal medicine meetings. A newly developed ten-item evaluation form measured poster quality for specific components of content, discussion, and format (5-point Likert scale, 1 = lowest, 5 = highest). Main outcome measure(s): Evaluation tool performance, including Cronbach alpha and inter-rater reliability, overall poster scores, differences across meetings and evaluators and specific components of the posters most in need of improvement. RESULTS  Forty-five evaluators from 20 medical institutions reviewed 347 posters. Cronbach’s alpha of the evaluation form was 0.84 and inter-rater reliability, Spearman’s rho 0.49 (p < 0.001). The median score was 4.1 (Q1 -Q3, 3.7-4.6)(Q1 = 25th, Q3 = 75th percentile). The national meeting median score was higher than the regional meetings (4.4 vs, 4.0, P < 0.001). We found no difference in faculty scores. The following areas were identified as most needing improvement: clearly state learning objectives, tie conclusions to learning objectives, and use appropriate amount of words. CONCLUSIONS  Our evaluation tool provides empirical data to guide trainees as they prepare posters for presentation which may improve poster quality and enhance their scholarly productivity. Presented in part at the 2008 Society of General Internal Medicine Southern Regional Meeting, February 22, 2008, New Orleans, Louisiana.     

干细胞治疗缺血性心力衰竭研究进展

干细胞移植已经被用于治疗如急性心肌梗死、心力衰竭等心脏疾病,其可以提高心功能、促进新生血管的形成和对心脏生理间接影响。被研究的干细胞包括胚胎干细胞、胎儿心肌细胞、骨骼肌肌原细胞、骨髓干细胞、外周血CD34 细胞、内皮祖细胞、心肌祖细胞和成纤维细胞。虽然干细胞治疗心力衰竭是一项革命性进展,但还有许多问题期待解决,比如说何种人群适合做干细胞治疗、移植细胞种类、移植方式、移植细胞数目和疗效的评估等都还没有明确。现从干细胞类型,移植后的效果及移植的方法等方面做一综述。