心脏营养素-1治疗失神经骨骼肌萎缩过程中对正常肌肉组织的影响

目的 探讨应用心脏营养素-1(cardiotrophin-1,CT-1)治疗失神经骨骼肌萎缩的有效剂量和安全剂量,观察不同剂量的CT-1对正常骨骼肌、心肌和血管平滑肌的副作用.方法 取Swiss小鼠80只,随机分成8组,每组分别于胫神经切断术后连续腹腔注射重组小鼠CT-1(rmCT-1)40、60、80、100、120、140、160μg·kg-1·d-1,剩余1组腹腔注射等体积CT-1溶媒,28d后称量失神经侧腓肠肌、正常侧腓肠肌和心脏的湿重;测量胸主动脉平滑肌厚度;检测正常腓肠肌中α-actin和MHC Ⅱa以及心肌中β-MHC的表达、胸主动脉血管平滑肌细胞中α-actin的含量.结果 采用腹腔注射给药,当CT-1用量达到60μg·kg-1·d-1时,开始对失神经骨骼肌产生营养作用,并呈剂量依赖性增强,当给药剂量超过100 μg·kg-1·d-1后,出现对正常骨骼肌、心肌和血管平滑肌的影响.给药剂量达到120μg·kg-1·d-1时,开始促进心肌β-MHCmRNA的表达,增加正常心脏的湿重.当给药剂量达到140μg·kg-1·d-1时,开始促进正常骨骼肌α-actin和MHC Ⅱ amRNA的表达,以及骨骼肌湿重的增加,同时提高了主动脉血管平滑肌α-actin的含量,增加了血管平滑肌的厚度.结论 腹腔注射CT-1防治失神经骨骼肌萎缩的有效剂量为60 μg·kg-1·d-1,最高安全剂量为100 μg·kg-1·d-1.当给药剂量达到120 μg·kg-1·d-1时,开始出现心肌肥厚,当给药剂量达到140 μg·kg-1·d-1时,可导致正常骨骼肌的肥大和血管平滑肌的增厚.     

通心络胶囊对实验性偏头痛大鼠CGRP及α-CGRP基因表达的影响

目的研究通心络胶囊对硝酸甘油性偏头痛大鼠模型血浆降钙素基因相关肽(CGRP)、脑干及三叉神经节αCGRP基因mRNA表达的影响,以探讨通心络治疗偏头痛的可能机制。方法50只SD大鼠随机分为空白对照组、生理盐水组、模型组、苯噻啶防治组、通心络防治组。模型组和药物干预组用硝酸甘油10mg/kg皮下注射造模,每周1次,连续4周,第2次造模后每天分别灌服通心络1.5g/kg/d(通心络组)或苯噻啶0.5mg/kg/d(苯噻啶组)进行干预。第4次造模后用放射免疫法测定血浆CGRP、RTPCR技术测定脑干及三叉神经节区αCGRP基因mRNA的表达。结果与空白对照组比较,反复硝酸甘油造模后,通心络组血浆CGRP水平明显升高(55.63±9.01ng/Lvs45.23±1.79ng/L,P<0.05);苯噻啶组和通心络组αCGRP基因mRNA表达分别为0.67±0.12和0.64±0.12,与空白对照组的0.88±0.09比较,明显下调(P<0.05)。结论通心络胶囊下调了脑干及三叉神经节αCGRP基因mRNA的表达,增加了血浆CGRP含量,提示通心络胶囊不是通过下调血浆CGRP含量而起到预防偏头痛的作用。     

慢加急性肝衰竭病因及其病理生理机制研究进展

慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)是国内最常见的肝衰竭类型,其临床表现复杂,病死率极高.ACLF的病理生理学改变目前尚不明确,深入了解ACLF的病理生理学改变有助于临床治疗工作的改善.近年来ACLF的病理生理学研究取得了一定的成就.本文就ACLF的概念、病因及其病理生理学改变作一综述.     

舒芬太尼复合丙泊酚靶控输注对心脏瓣膜置换患者气管插管和转流前血流动力学的影响

目的 评价不同效应室浓度(C=e)的舒芬太尼复合相同Ce的丙泊酚靶控输注(TCI)对心脏瓣膜置换患者气管插管和心肺转流(CPB)前血流动力学的影响.方法 择期在CPB下行心脏瓣膜置换术的风湿性心脏病患者48例,根据舒芬太尼Ce,随机均分为四组.麻醉诱导:咪达唑仑0.05mg/kg,丙泊酚Ce 1.8μg/ml TCI,罗库溴铵0.9mg/kg,舒芬太尼靶控浓度分别为0.6 ng/ml(Ⅰ组)、0.8ng/ml(Ⅱ组)、1.0 ng/ml(Ⅲ组)、1.2 ng/ml(Ⅳ组).记录麻醉诱导前(T<,0>)、麻醉诱导后(T<,1>)、气管插管后1 min(T<,2>)、3min(T<,3>)、5 min(T<,4>)、切皮前(T<,5>0、切皮时(T<,6>)、劈胸时(T<,7>)及(CPB 前 5 min(T<,8>)的HR、MAP、中心静脉压(CVP)及脑电双频指数(BIS),并统计气管插管和CPB前血管活性药物的使用情况.结果 与Ⅰ组比较,T<,1>时Ⅲ组、T<,1>～T<,3>时Ⅳ组的HR明显减慢(P<0.05);T<,1>、T<,2>时Ⅳ组的MAP明显降低(P<0.05).在血管活性药物的使用上,Ⅲ组使用去氧肾上腺素、尼卡地平、艾司洛尔的病例少于Ⅰ组(P<0.05),Ⅳ组使用尼卡地平、艾司洛尔病例少于Ⅰ组(P<0.05).结论 不同Ce的舒芬太尼复合Ce为1.8 μg/ml的丙泊酚TCI均能抑制心脏瓣膜置换术患者气管插管和CPB前的血流动力学应激反应,其中1.0 ng/ml的舒芬太尼复合1.8 μg/ml的丙泊酚TCI能更有效维护心脏瓣膜置换术患者气管插管和CPB前的血流动力学稳定.     

俯卧位背侧人路后腹腔镜肾囊肿去顶术的临床分析（附12例报告）

目的：探讨俯卧位经背侧人路后腹腔镜肾囊肿去顶术的方法和疗效。方法：回顾性分析俯卧位经背侧入路后腹腔镜肾囊肿去顶术治疗12例单纯性肾囊肿患者的临床资料。其中男7例,女5例,年龄为31～67岁,平均42．6岁。术前均行泌尿系B超、静脉尿路造影（IVu）和肾脏CT平扫及增强检查明确囊肿大小、数量及位置,证实与肾盂集合系统不相通。囊肿直径4．5～12．0cm,平均7．6cm。结果：12例患者均在后腹腔镜下顺利完成手术。手术时间30～105min,平均48．5min;术中出血量5～25ml,平均14．2ml;术后住院时间3～6天,平均4．8天。围手术期未出现并发症。随访12~20个月,平均15．3个月,未见囊肿复发。结论：俯卧位背侧入路后腹腔镜肾囊肿去顶术治疗单纯性肾囊肿安全可行。经背侧入路后腹腔镜手术的成功实施为临床手术路径的研究提供一种新的思路。     

体外循环下小儿肌部室间隔缺损的镶嵌治疗

目的 探讨镶嵌模式(hybrid procedure)治疗小儿肌部室间隔缺损(Mvsd)的手术方法及临床应用.方法 2006年1月至2010年6月,在体外循环心内直视手术下采用手术及封堵相结合的镶嵌技术矫治小儿Mvsd 45例,其中男20例,女25例;年龄52天～12岁;体重3～32 kg.7例为单个Mvsd,38例为多发性VSD.同时合并大血管错位(D-TGA)1例、法洛四联症(TOF)2例、肺动脉狭窄(PS)3例、动脉导管未闭(PDA)6例、房间隔缺损(ASD)6例、主动脉缩窄1例.均在心脏停跳后直视下将导引钢丝经三尖瓣孔自心脏右室面穿过VSD至左室面,直视下置入导引器,然后送入封堵器,完成Mvsd封堵.多发性VSD 38例,予自体心包片修补膜周部等较大的VSD,心内其他畸形同期完成矫治.结果 42例置入单枚封堵器(直径4～10 mm)、3例置入双枚封堵器(直径4～7 mm).手术经过顺利,术前左室射血分数(EF)均在正常范围,术后1天小于8月龄组EF均值低于正常,大于8月龄组EF正常,两者差异有统计学意义.术后常规每天给予5 mg/kg肠溶阿司匹林3～6个月.术后随访超声检查示封堵器位置无偏移,无残余分流,无二尖瓣、主动脉瓣反流、Ⅲ度传导阻滞及新发心律失常等.术后因重症感染放弃治疗1例,无远期死亡病例.结论 体外循环下镶嵌技术治疗小儿 Mvsd明显降低了围手术期并发症及病死率,简化了手术过程,降低了手术风险,是一种安全、有效的方法.

Abstract：

Objective To summarize the technique and clinical experience of hybrid procedure under cardiopulmonary bypass (CPB) in children with muscular ventricular septal defect (mVSD). Methods From January 2006 to June 2010, 45 cases of mVSD underwent hybrid procedure with CPB. mVSDs were closed with devices under direct vision in 45 cases. Of them, there were 20 males and 25 females. They ranged from 52 days to 12 years [mean (2.05 ±2.48) year] in age and from 3 to 30 kg [(11.93 ±7.70)kg] in body weight. Preoperatively, most of children were highly susceptible to respiratory tract infections. The hybrid approach was used in all patients with CPB under the guidance of transesophageal echocardiography (TEE). The diameter of mVSDs ranged from 2 to 7 mm under TEE. Of 45 cases, 40 patients had increased rates of pulmonary blood flow. 29 patients had left axis deviation and 12 cases had sinus arrhythmia on electrocardiography (ECG). 19 had other congenital heart lesions, including transposition of great arteries in 1 case, tetralogy of Fallot in 2, pulmonary artery stenosis in 3, patent ductus arteriosus in 6, atrial septal defects in 6) and aorta coactation in 1. The quantity of VSDs were from 1 to 7 (single, in 7; two, in 24 case; three, in 8 case; four, in 5 case and seven, in lease. 37 patients were combined with pulmonary hypertension in our cohort. 38 patients with another large VSD and 19 with other congenital heart lesions were required surgical repair at sometime. Results The hybrid procedures were undertaken in all 45 cases of this cohort. All cases were successful and no deaths occurred during operation. A total of 48 devices were implanted in 45 patients, including single devices in 42 cases (device size ranged from 4 to 10 mm) and two devices in 3 cases (device size ranged from 4 -7 mm). The average time on CPB was (58.28 ±20.70) min , while aortic crossclamp time was(34. 94 ± 14.75) min. In addition, the time on mechanical ventilation postoperatively ranged from 2 hours to 6 days. Compared to the older children, 20 infante aged less than 8 monhad a significant difference in cardiac function in the early postoperative period. One infant was given up treatment because of serious infection. Anather cases recovered with the use of supportive treatment, such as using vasoactive agents, digoxin, inhaling nitric oxide, diuresis, and so on. The enteric-coated aspirin was given at dose of 5 mg ? kg -1. day -1 for a period of 3 to 6 months as usual postoperatively. All patients attended follow-up at 1 week, 1 month, 3 months, 6 months, 1 year and 2 years post-procedure. No major complications were encountered during this period. All cases were no instance of migration of any of the devices, residual shunt, aortic regurgitation, atrioventricular valve dysfunction, Ⅲo atrial-ventricular conduction block, new arrhythmia, and so on. There are no death in long-term follow-up. Conclusion Hybrid procedure is safe and effective for the closure of congenital heart defects in children.     

北京市通州区女性乳腺疾病流行状况及危险因素分析

目的 通过对北京市通州区女性乳腺疾病流行病学调查,了解该地区女性乳腺疾病的发病状况,并进一步研究引起女性乳腺疾病的危险因素,为制定乳腺疾病预防措施提供客观依据.方法 采用整群分层随机抽样方法对北京市通州区1 575例18～ 60岁妇女进行流行病学问卷调查,并由专科医师对每位妇女进行乳腺检查,采用乳腺临床体检配合近红外线...     

曲尼司特对环孢素A诱导的人肾小管上皮细胞向间充质转变的抑制作用

目的 研究曲尼司特(Tran)对环孢素A(CsA)诱导的人肾小管上皮细胞(HK-2)向间充质转变的影响,并探讨该药抗纤维化的机制.方法 所有用于实验的HK-2细胞株均为8～12代细胞,分为4组:(1)空白对照组,收获细胞,不做任何处理;(2)CsA组,加入4.2μmol/LCsA;(3)CsA+Tran组,预先加入100μmol/L Tran,作用2 h后再加入4.2 μmol/L CsA;(4)Tran组,仅加入100μmol/L Tran.72 h后于共聚焦显微镜下观察各组细胞形态学变化;用免疫荧光法以及免疫印迹法检测各组钙黏蛋白(E-cadherin)、平滑肌肌动蛋白α(α-SMA)和骨桥蛋白(OPN)的表达.结果 HK-2细胞在正常情况下表现为典型的"鹅卵石"样形态,细胞圆钝,且与邻近的细胞连接较为紧密;空白对照组和Tran组细胞表现为典型的HK-2细胞形态;CsA组细胞变狭长,甚至向周边伸出"伪足"样改变,细胞间连接较为稀疏;CsA+Tran组的细胞形态学改变有明显改善.CsA组细胞E-cadherin荧光表达强度明显弱于对照组,α-SMA、OPN荧光表达强于对照组;CsA+Tran组细胞E-cadherin荧光表达强于CsA组,α-SMA、OPN荧光表达弱于CsA组.免疫印迹检查中,CsA组细胞E-cadherin 的表达明显低于对照组,而α-SMA、OPN的表达明显高于对照组,CsA+Tran组细胞E-cadherin的表达高于CsA组,而α-SMA、OPN的表达低于CsA组.结论 曲尼司特能抑制CsA诱导的HK-2细胞由肾小管上皮向间充质细胞转化的过程,其机制可能与抑制OPN的表达有关.

Abstract：

Objective To study the effect of tranilast on cyclosporine A (CsA)-induced epithelial-to-mesenchymal transition in human renal tubular epithelial cells, and investigate the mechanism of its antifibrotic effect. Methods Cultured HK-2 cells were divided into four groups: (1)In the control group, cells were treated without any medicine; (2) The cell were treated with CsA (4. 2μmol/L) for 72 h; (3) The cells were treated with a combination of CsA (4. 2 μmol/L) and tranilast (100μmol/L); (4) The cells were treated with tranilast (100 μmol/L) alone for 72 h.Morphological changes of the cells were assessed by phase-contrast microscopy. The immunofluorescence and Western blotting were adopted to detect the expression of E-cadherin, α-SMA and OPN mRNA and proteins respectively. Results Tranilast could markedly ameliorate the morphological changes of HK-2 cells stimulated by CsA. The irmmunofluorescence staining revealed the expression of E-cadherin was markedly decreased in HK-2 cells stimulated with CsA for 72 as compared with the control group, while the expression of α-SMA and OPN was significantly higher in CsA group than the control group. The expression of E-cadherin in the CsA + Tranilast group was higher than the CsA group, while the expression of α-SMA and OPN in the CsA + Tranilast group was lower than the CsA group. Western blotting showed that protein expression level of E-cadherin in CsA group was dramatically lower than that in the control group (P＜0. 05), while that of α-SMA and OPN in CsA group was significantly higher than in the control group (P＜0.05). The protein expression level of E-cadherin in HK-2 cells in the CsA + Tranilast group was markedly higher than in the CsA group (P＜0.05), and that of α-SMA and OPN in CsA + Tranilast group was significantly lower than in the CsA group (P＜0. 05). Conclusion Tranilast can block the CsA-induced epithelialto-mesenchymal transition in HK-2 cells probably by suppressing the expression of OPN.     

精液分析的外部质量控制研究

目的在严格遵循WHO第5版精液分析标准化方法培训的基础上,率先在国内男科学实验室尝试开展外部质量控制,探索精液分析外部质量控制的方法和模式,为在全国范围内开展精液分析的外部质量控制打下基础。方法本实验室根据《世界卫生组织人类精液检查与处理实验室手册》第5版（WH05）推荐的标准化精液分析方法,对来自全国23个实验室的技术人员进行理论与实际操作培训。各实验室技术人员带回质控样本,包括冷冻的混合精液、伊红一苯胺黑染色并封片的玻片、未经染色固定的形态学涂片,分别作为精子浓度、精子存活率和精子形态学评估的质控品。各实验室按要求采用血球计数板方法评估精子浓度;×100倍油镜评估精子存活率;巴氏染色法染色质控片并用×100倍油镜评估精子正常形态率;在规定日期内反馈结果。用WH05推荐方法对外部质控结果进行评估。结果于截止日期前21个实验室反馈了结果。对2个质控品进行精子浓度评估,各实验室间的变异系数（CV）分别为28．54％和27．11％。Youden图分析,15％实验室的2个质控品的检测结果均在95％可信区间内。对2个质控品进行精子存活率评估,各实验室问的CV分别为7．90％和9．59％。Youden图分析,42％的实验室2个质控品检测结果均在95％可信区间内。对2个质控品进行精子正常形态率评估,各实验室间的CV为52．96％和48．66％。Youden图分析,14％的实验室2个质控品检测结果均在95％可信区间内。结论结果表明,严格遵循WH05精液分析标准化方法培训后,除精子存活率评估各实验室间的CV较低、在控的实验室较多外,精子浓度评估和形态学分析CV、均较高、失控的实验室较多。精液分析的质量亟需提高、标准化培训亟待普及和推广,质量控制迫在眉睫。     

激光损伤致猪视网膜色素上皮细胞中游离钙变化的实验研究

目的探讨激光照射后视网膜色素上皮（ＲＰＥ）细胞中游离钙的变化规律。方法用不同输出功率的氩离子激光照射培养的猪ＲＰＥ细胞（光斑直径２００μｍ,照射时间０２ｓ）,用激光扫描共聚焦显微镜测量光凝斑周围ＲＰＥ细胞中游离钙的浓度。结果用０．９、１．８及２．７Ｗ的激光照射后,ＲＰＥ细胞中游离钙浓度（ｎｍｏｌ／Ｌ）分别为４１５±１４８、５２５±２４７、９９４±２０３,而空白对照组为２２２±６４,各组之间差异均有非常显著意义（均为Ｐ＜００１）。结论激光损伤可使ＲＰＥ细胞中游离钙浓度明显升高,升高程度与激光能量的大小呈正相关。