几种中药的灵活应用

中医药文化博大精深,就中药来说,每味都有它特殊的功效主治,同一味药物由于产地不同,炮制不同,往往作用也有差异.下面简单的举四味中药以便说明.     

Aktl在颞叶癫痫大鼠海马中的表达变化

目的研究颞叶癫痼模型海马区神经元Aktl表达变化,探讨其在癫痫发生发展中的作用。方法采用氯化锂．匹罗卡品方法制备颞叶癫痴大鼠模型,Westernblotting检测海马区总蛋白、Quantitvone软件行灰度值分析;免疫组织化学染色观察海马各区Aktl蛋白表达变化,计数不同处理组阳性神经元数目。结果Westernblotting检测结果显示,与正常对照组相比,癫痫模型组大鼠于癫痫持续状态发作即刻海马区Aktl蛋白表达升高（t=2．445,P=0．034）,并于第30天时达峰值水平（}=1．214,P=0．002）,发作后24h表达水平迅速降低,并低于正常值范围（t=4．294,P=0．000）,其余各测量时间点表达无明显改变;与氯化锂组相比,癫痼模型组大鼠于癫痫持续状态后1h海马区Aktl蛋白表达开始降低,24h降至最低水平（t：4．134,P=0．000）,至发作48h后开始逐渐升高（t=2．481,P=0．002）,并于发作第7天时升至氯化锂组水平。免疫组织化学染色显示,癫痫持续状态发作后海马CA3区Aktl蛋白表达阳性神经元数目立即增加,12h达高峰（t=16．586,P：0．000）,48h减少并降至正常值水平（t=0．357,P=0．089）,发作后第10天再次增加（t=3．123,P=0．000）,于第30天时阳性神经元数目再次达峰值水平（t=18．339,P=0．000）,第50天开始恢复至正常值水平（t=3．219,P=0．000）;氯化锂组仅海马CA3区Aktl蛋白表达于实验初始（0h）升高并高于正常对照组（P〈0．05）,海马CA1和CA2区Aktl蛋白表达变化组间差异均无统计学意义（P〉O．05）。结论海马及海马CA3区Aktl蛋白表达均呈现癫疝持续状态后升高、降低、再升高的动态过程,提示可能存在神经元保护作用,对抗细胞凋亡、促进细胞存活。     

乳腺钼靶摄影成像对乳腺癌的诊断价值

目的探讨乳腺钼靶摄影成像对乳腺癌的诊断价值。方法回顾性分析经手术病理证实并行乳腺钼靶摄影的乳腺癌60例,其X线征象对乳腺癌的诊断价值。结果浸润性导管癌48例,浸润性小叶癌5例,浸润性黏液腺癌3例,导管内癌4例。腋窝淋巴结转移29例。其中结节9例,边界欠清6例,边界清楚3例。肿块48例,其中毛刺征9例、分叶征17例,透亮环征2例,边缘模糊30例、边界清晰2例,合并钙化30例,其中成簇泥沙样钙化9例、小杆状钙化3例、小叉状钙化1例,沿导管分布线性钙化1例,混合型钙化16例。单纯成簇泥沙样钙化1例。结构扭曲紊乱伴钙化1例。片状致密影1例。结论乳腺钼靶摄影成像对乳腺癌的早期发现、早期诊断具有重要价值。     

维生素D受体基因多态性与2型糖尿病及血清1,25-二羟基维生素D3的相关性研究

目的探讨维生素D受体(vitamin D receptor,VDR)基因ApaI酶切位点多态性与2型糖尿病及血清1,25-二羟基维生素D3[1,25(OH)2D3]的相关性。方法采用聚合酶链反应限制性片段长度多态性(PCR-RFLP)技术,检测105例2型糖尿病患者和105例正常者的VDR基因型,用酶联免疫吸附(Elisa)法测定血清1,25(OH)2D3水平,并检测相关临床及生化指标,比较VDR基因型和等位基因频率的分布差异及不同基因型血清1,25(OH)2D3等相关指标的差异。结果维生素D受体基因ApaⅠ位点基因型和等位基因频率在两组中的分布差异明显(P<0.01)。糖尿病组等位基因a和基因型aa频率明显高于对照组。基因型AA组及Aa组血清1,25(OH)2D3高于基因型aa组,而收缩压、舒张压及空腹血糖低于基因型aa组,且差别有显著性意义(P<0.05或0.01)。结论 Apa I位点的VDR基因多态性与2型糖尿病存在相关性。血清1,25(OH)2D3水平、空腹血糖及血压与VDR基因多态性密切相关。     

ACE基因多态性与ADPKD的关系

目的 探讨血管紧张素-Ⅰ转换酶基因(ACE基因)插入／缺失(I/D)多态性与常染色体显性遗传性多囊肾病(ADPKD)之间的关系。方法 应用聚合酶链式反应(PCR)方法对62例ADPKD患者和96例健康对照者ACE基因多态性进行了分析。结果 ADPKD患者与健康对照组之间ACE基因型频率差异不明显;ADPKD肾功能不全组与健康对照组之间DD型及D等位基因频率差异有显著性。结论 ACE基因多态性与中国人ADPKD的发病无明显相关性。DD型基因是ADPKD发生肾功能不全的易感因素。     

Investigational glucagon-like peptide-1 agonists for the treatment of obesity

Introduction: Obesity is a worldwide problem predisposing to type 2 diabetes mellitus (T2DM), hypertension, cardiovascular disease, cancer and other comorbidities. Lifestyle modification is the first line intervention but adjunctive pharmacotherapy is often required. The GLP-1 receptor agonists (GLP-1RAs) were developed primarily for T2DM and they also reduce body weight. Liraglutide was approved for the treatment of obesity and other GLP-1RAs are likely to be suitable for this indication.

Areas covered: This review describes the GLP-1RAs that have been approved for the treatment of T2DM as potential candidates for the treatment of obesity and the new agents currently under development which may have advantages in patient adherence.

Expert opinion: The GLP-1RAs offer a welcome addition to obesity pharmacotherapy. They appear to be free of serious adverse effects although uncertainty remains about possible risks of pancreatitis and neoplasms. However, they have frequent gastrointestinal side effects, particularly nausea, which limits their tolerability. Cardiovascular outcome studies in T2DM support their use and this is likely to increase in both T2DM and obesity. Other GLP-1RAs which can be given by subcutaneous injection once weekly or less frequently or by oral administration would have advantages especially if nausea is less frequent than with liraglutide.     

化湿通窍方雾化术腔对鼻窦炎鼻内窥镜手术患者康复的疗效分析

目的:探讨化湿通窍方雾化术腔治疗鼻窦炎的疗效,促进患者早日康复。方法:将我院收治的进行鼻内窥镜手术及常规术后治疗的患者92例,用随机数字表法随机分为2组,每组46例,研究组在对照组治疗基础上加予化湿通窍方雾化术腔,持续雾化1个月,观察治疗效果及术腔康复情况。结果:2组治疗后头痛、流涕积分比较差异无统计学意义(P0.05),实验组鼻塞、嗅觉减退、鼻甲肿胀积分低于对照组(P0.05);2组术腔清洁时间比较差异无统计学意义(P0.05),实验组黏膜转归竞争、上皮化时间均短于对照组(P0.05);术后2个月实验组鼻黏液纤毛传输速度快于对照组(P0.05)。结论:对于实施鼻内窥镜手术治疗的慢性鼻-鼻窦炎患者,术后给予化湿通窍方雾化术腔可缩短黏膜上皮化时间,促进鼻黏膜纤毛功能恢复,临床应推广应用。     

Endoscopic stent for palliating malignant and benign biliary obstruction

Objective: To study the techniques of placement of memory alloy plating gold biliary stent and plastic stent for palliation of malignant and benign biliary obstruction, and to assess its clinical effectiveness. Methods: The patients in plastic stent group included papliila of duodenum inflamational strictures (n=24), common bile duct inflammational inferior segment strictures (n=4),choledocholithiasis (n=5), bile leak (n=11), bile duct surgery injurey (n=7) and pancreatic carcinoma (n=1).The patients in plating gold stent group included common bile duct carcinoma (n=5) and pancreatic carcinoma (n=6). Under fluoroscopic guidance the stent was inserted into biliary obstruction sites from oral cavity in all cases. Complications, liver function and blood serum amylase were investigated during the study period. Results: Successful stent placement was achieved in all cases. After operation of 7 days, in gold biliary stent groups, the rates of decrease of blood serum total bilirubin, glutamic-pyruvic transaminase, r-glutamyl transpeptidase and alkaline phosphatase were 67.16%,58.37%, 40.63% and 41.54% respectively. In plastic stent group, the rates of decrease of STB, ALT, r-GT and AKP were 53.24%, 55.03%, 37.15%, 34.12% respectively.Early complication included post-ERCP panereatitis and eholangititis. Occlusion of stent was the major late complication. Conclusion: Memory alloy plating gold biliary stent and plastic stent were safe and efficacious methods for malignant and benign biliary obstruction, and could improve patient‘s living quality. Plastic stent was an efficient complement for therapy of bile leak and bile duct injury.     

血小板胶原受体糖蛋白Ⅵ体外表达及功能研究

为了深入研究血小板胶原受体糖蛋白Ⅵ(glycoproteinⅥ，GPⅥ)功能及筛选特异性抑制剂，利用基因重组技术体外表达GPⅥ胞外区片段。采用PCR方法扩增GPⅥ胞外区片段eDNA，构建表达载体pET-20b( )-GPⅥ，转化大肠杆菌BL21(DE3)pLysS，经IPTG诱导表达。表达产物经Ni—NTA Resin纯化、复性：使用Western blot方法鉴定重组蛋白性质；采用胶原结合试验测定重组蛋白的胶原结合能力。结果表明，经测序证明PCR扩增产物与GPⅥ胞外区eDNA序列完全一致；酶切分析证明成功构建了表达载体pET-20b( )-GPⅥ；原核细胞经诱导表达后出现新的相对分子量32kD蛋白条带，诱导产物以包涵体形式存在；Western blot分析表明重组蛋白可与抗Penta—His抗体和抗GPⅥ多抗特异性结合；胶原结合试验表明重组蛋白拥有较好的生物学功能。结论：正确构建了GPⅥ表达载体并成功表达重组蛋白，纯化、复性后的重组蛋白具有良好的抗原性和生物学活性。     

肩关节镜下行Bankart术治疗复发性肩关节前脱位

目的 探讨肩关节镜下Bankart术治疗复发性肩关节前脱位的适应症、手术要点和疗效。方法 对我科2007年1月至2009年7月,15例复发性肩关节前脱位的临床资料进行回顾性分析。15例均为肩关节单方向不稳定,左侧4例,右侧11例,术前脱位次数为2-30次,平均为11.7次。所有患者均采用锚钉进行关节镜下Bankart术,术后采用Constant-Murley法进行评分。结果 术后随访10-24个月,平均12.5个月,所有患者均未出现切口感染及关节腔积血等并发症。终末随访时平均Constant-Murley评分较术前明显改善（术前79.3±4.0对术后95.0±2.2,p<0.01）。终末随访时所有病例均未发生再脱位,术后无残存恐惧试验阳性。结论 关节镜下Bankart术是治疗复发性肩关节前脱位的有效方法之一。