Pretreatment with Tongxinluo protects porcine myocardium from ischaemia/reperfusion injury through a nitric oxide related mechanism

Background The traditional Chinese medicine Tongxinluo can protect myocardium against ischaemia/reperfusion injury, but the mechanism of its action is not well documented. We examined the involvement of nitric oxide in the protective role of Tongxinluo. Methods Miniswine were randomized to four groups of seven: sham, control, Tongxinluo and Tongxinluo coadministration with a nitric oxide synthase inhibitor Nω-nitro-L-arginine (L-NNA, 10 mg/kg i.v.). Three hours after administration of Tongxinluo, the animals were anaesthetised and the left anterior descending coronary artery ligated and maintained in situ for 90 minutes followed by 3 hours of reperfusion before death. Area of no reflow and necrosis and risk region were determined pathologically by planimetry. The degree of neutrophil accumulation in myocardium was obtained by measuring myeloperoxidase activity and histological analysis. Myocardial endothelial nitric oxide synthase activity and vascular endothelial cadherin content were measured by colorimetric method and immunoblotting analysis respectively.Results Tongxinluo significantly increased the local blood flow and limited the infarct and size of no reflow. Tongxinluo also attenuated myeloperoxidase activity and neutrophil accumulation in histological sections and maintained the level of vascular endothelial cadherin and endothelial nitric oxide synthase activity in the reflow region when compared with control group. The protection of Tongxinluo was counteracted by coadministration with L-NNA. Conclusions Tongxinluo may limit myocardial ischaemia and protect the heart against reperfusion injury. Tongxinluo regulates synthesis of nitric oxide by altering activity of endothelial nitric oxide synthase.     

“安全注射在行动研讨会”在京召开

2005年12月19日，中国安全注射联盟在北京召开了“安全注射在行动研讨会”（图1），会议得到了卫生部，国家食品药品监督管理局、联合国儿童基金会，世界卫生组织等政府部门的的支持，中国医疗器械行业协会作为此次会议的协办单位和90多位来自“联盟”成员的专家、教授、学会、协会、基金会领导和企业高层管理人员进行了积极的研讨。     

回收式自体输血对手术患者凝血及免疫功能的影响

目的探讨回收式自体输血（BS）对机体凝血状态和T淋巴细胞亚群、NK细胞功能的影响。方法选择骨科大手术患者40例，随机分为自体输血组（BS组）和异体输血组（异体组）各20例，术中分别采用BS及输异体血，分别于术前、输血后1h及输血后24h测定血常规、APTT、PT、FIB及ACT；流式细胞仪测定输血后第1天、第5天T淋巴细胞亚群CD3^＋、CD4^＋、CD8^＋、CD4^＋／CD8^＋值及NK细胞。结果输血后1h两组APTT、PT、ACT均延长，FIB和PLT计数均降低（P〈0．05），但尚在正常范围内，组间比较元显著性差异（P〉0．05）。异体输血组输血后第1天和第5天CD3^＋、CD4^＋、CD8^＋、NK变化显著低于BS组（P〈0．01）；BS前后上述指标元明显变化（P〉0．05）。结论．BS对凝血功能的影响与异体输血相似，大量回输时应注意补充凝血因子和血小板；BS对机体细胞免疫功能元明显抑制作用。     

胰岛素强化治疗对严重创伤患者炎性反应及预后的影响

Objective To investigate the effects of intensive insulin therapy on inflammatory re-sponse and prognosis of patients with severe trauma. Methods Eighty severely injured patients were di-vided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2 -4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6 -8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-α, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed. Results High fever appeared in 9 patients in IT group, and WBC exceeded 10.0×109 for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 pa-tients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5% ). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-α and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3 - 7 ( P<0.05 or P<0.01 ), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group ( P<0.05 or P<0.01 ). Plasma levels of TNF-α ( 1.3±0.6 μg/L) and CRP (55±16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0±0.8μg/L, 89±20 mg/L, respectively, P <0.01 ). Conclusions Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.     

Cav1.1基因26内含子67位点A/G多态性与甲状腺功能亢进性周期性瘫痪的相关性研究

目的探讨钙通道α1亚基（Cav1．1）基因26内含子-67A／G多态性与男性甲状腺功能亢进（简称甲亢）性周期性瘫痪（TPP）的相关性。方法采用多聚酶链反应-单链构象多态性（PCR-SSCP）方法检测46例男性TPP患者（TPP组）、68例男性甲亢患者（GD组）和72名男性健康对照者（CON组）Cav1．1基因26内含子-67A／G多态性。分析比较此多态位点基因型和等位基因在不同人群中分布的差异。结果（1）TPP组、GD组及CON组AG＋GG基因型频率分别为47．83％、14．71％、29．17％，G等位基因频率分别为44．57％、13．24％、27．78％。（2）TPP组AG＋GG基因型频率明显高于GD组和CON组（OR=5．32，P〈0．01；OR=2．23，P=0．04），TPP组G等位基因频率明显高于GD组和CON组（OR=5．27，P〈0．01；OR=2．09，P=0．008）。结论Cav1．1基因26内含子-67位点A／G多态性与男性TPP有相关性。     

胃癌全胃切除术后消化道重建方式的选择

目的：探讨全胃切除术后较理想的消化道重建方式。方法：对近6年来122例施行全胃切除术患者的临床资料进行回顾性分析。全胃切除后消化道重建分别采用全胃切除术后消化道重建Orr式Roux-en-Y食管空肠吻合术、P型空肠袢食管空肠Roux-en-Y吻合术和远端空肠反口贮袋的Roux-en-Y食管空肠吻合术。结果：3种术式在食后烧灼感、进食量、进食次数、体重下降、倾倒综合征、血红蛋白、白蛋白等指标的比较，无明显差异（均P>0.05）。P型空肠袢食管空肠Roux-en-Y吻合术组所用手术时间显著多于Orr组及反口组（P<0.05）。反口组的贮袋大小及半排空时间显著优于Orr组及P袢组（P<0.05）。结论：远端空肠反口贮袋的Roux-en-Y吻合术是一种值得推荐的新型全胃切除术后消化道重建方法。     

帕金森病的昨天、今天和明天

帕金森病（Parkinson disease，PD）日益成为公共卫生关注的焦点，在我国，它影响了近1．7％的65岁以上的老年人。回顾PD的历史，有几个里程碑需要铭记。1817年Parkinson首次详述了PD的典型临床表征。1895年Brissaud从病理上提出中脑可能是PD的解剖基础。1912年Lewy发现黑质内嗜伊红包涵体，即Lewy小体是PD的重要病理特征。1960年Ehringer和Homykiewicz发现纹状体多巴胺（dopamine，DA）神经递质水平下降是产生PD运动症状的主要因素。1961年Birkmayer和Hornykiewicz首次应用左旋多巴治疗PD，但最终将其成功推向临床的要归功于Cotzias。     

烧伤后早期应用中/长链甘油三酯对患者免疫功能的影响

目的　探讨烧伤后早期肠内喂养中链甘油三酯 (MCT) /长链甘油三酯 (LCT)对机体免疫功能的影响及其可能机制。　方法　选取 30例烧伤面积 >30 %TBSA的患者 ,随机分为两组 (每组 15例 )。F组 ,饲以含MCT/LCT的肠内营养制剂Fresubin 75 0MCT ;N组 ,饲以只含LCT的肠内营养制剂Nutrison。于伤后 2 4h内进行完全肠内营养支持 ,共持续 10d。于伤后 1、4、7、10d检测两组患者血浆白细胞介素 (IL) 2、IL 4、前列腺素 (PG)E2 及外周血T淋巴细胞转化率的改变。　结果　伤后各时相点F组患者血浆IL 2水平与N组相比 ,无明显差异 (P >0 .0 5 ) ;伤后 4dF组PGE2 水平较N组明显降低 (P <0 .0 1) ;伤后 4、7、10dF组IL 4水平及外周血T淋巴细胞转化率均明显高于N组 (P <0 .0 5～ 0 .0 1)。　结论　在改善烧伤后机体的免疫功能方面 ,含MCT/LCT的肠内营养制剂较单纯LCT制剂更具优势。     

碘和甲状腺球蛋白诱导大鼠自身免疫性甲状腺炎的研究

目的　研究碘与自身免疫性甲状腺炎 (EAT)的关系。方法　用碘和甲状腺球蛋白 (TG)诱导SD大鼠建立甲状腺炎模型 ,随机分为 5组 ,每组 10只。正常对照组 (NC组 ) ;少量碘组 (LI组 ) :饮 5 0 0 μg/L碘化钠水 ;大量碘组 (HI组 ) :饮 5 0 0mg/L碘化钠水 ;TG组 :于实验第 15天大鼠接受皮内多点注射完全福氏佐剂乳化的TG各 10 0 μg作为初次免疫 ,2周后以不完全福氏佐剂乳化的TG加强免疫 ,以后每周加强免疫 1次至第 6周末实验结束 ;TG HI组 :TG及HI给药方法同上。至第 6周末实验结束处死所有动物 ,用放免法检测血清TG抗体 (TGAb)及甲状腺过氧化物酶抗体 (TPOAb)效价 ,并于光镜下观察甲状腺组织淋巴细胞浸润程度。结果　TG HI组、HI组及TG组甲状腺滤泡破坏及淋巴细胞浸润均较明显 ,TG HI组及HI组与NC组比较 ,P<0 .0 5 ,TG组与NC组比较有增高趋势 ,但无统计学意义。 3组TGAb、TPOAb均明显高于NC组及LI组 (P<0 .0 1;仅HI组TPOAbP<0 .0 5 )。各组TGAb及TPOAb水平与甲状腺病理分级呈正相关关系 (r =0 .9,P<0 .0 5 )。结论　高碘可诱发SD鼠EAT发生 ,TG与高碘结合诱导SD大鼠EAT的作用更明显     

肾功能损伤分级系统在成人心脏术后的应用

Objective The aim of this study was to evaluate of adilty of two acute renal failure-specific scoring systenms (the classification by Bellome et al and the AKIN criteria) for predicting hospital mortality after cardiac surgery in adult patients. Methods Between October 1 st 2006 to Decemjber 31 st 2006, 509 adult patients who ungerwent coronary artery bypass grafting (CABG) and/ or valve operation were enrolled in this study. The medical data collection included gender, age, types of operation, perioperative he- modynamic parameters, urine output, biochemical parameters and outcome. Renal function was assessed daily according to the classi- ficatinn by Bellomo and the AKIN criteria, respectively. As references, Acure Physiology and Chronic Health Evaluation(APACHE) Ⅱ and Sepsis-related Organ Failure Assessment (SOFA) score were also calculated. Resuits Three hundred and forty-one patients were male (67.0%), and 168 were female (33.0%), mean age was (56.2±12.0) years old. Tnree hundred and nine patieats un- derwent CABG, 182 underwent valve operation and 18 underwent CABG plus valve operation, Mean duration of ventilation support was (20.4±17.7) houra, and the ICU stay was (1.4±1.0) days. Postoperative hospital stay was (13.8±9.1) days. According to the classification by Bellomo., the highest in-hospital mortality was 52.9% in ARFS group. Mahiplicatinn of in-hospital morality rate was abserved (X2 for trend, P<0.01) in 0.4% (non-ARF), 1.2% (stage 1), 12.0% (stal～ 2) and 32.4% (stage 3) of pa- tients based on the AKIN criteria. By applying the area under the receiver operating characteristic ourve, the classification by Bellomo and the AKIN criteria had good discriminative power. Furthering, multivariate logistic regression analysis verified that the Odds Ratio of the AKIN criteria was 5.478 (P =0.028, 95% Confidence Interval 1.027- 24.856), after adjusting for gender and age. Con- clusion Analytical data confinned good discriminative power of both the AKIN criteria and the classification by Bellomo for predicting hospital mortality of adult postoperative patient with ARF.