梗死前心绞痛对急性心肌梗死溶栓-再灌注的影响

目的 :探讨梗死前心绞痛与急性心肌梗死溶栓 再灌注的关系。方法 :对 2 7例梗死前 1周内有不稳定性心绞痛和 2 5例梗死前无心绞痛的患者进行比较。 2组基础临床情况相匹配。梗死范围大小根据血清酶和∑R、NQ来估计 ,冠脉再通时间以抬高最明显的ST段迅速下降达 5 0 %为准。结果 :溶栓后 30min内梗死前心绞痛组 33%冠脉再通 ,而梗死前无心绞痛组没有 1例再通 (P <0 0 0 5 ) ;6 0min内再通率分别为 5 9%和 36 % (P <0 0 0 5 ) ;再通时间分别为 (49± 16 )min和 (6 9± 19)min(P <0 0 5 )。在梗死前心绞痛组 ,反映梗死范围大小的血清酶均明显低 ,而∑R相对较高 ,NQ数目相对较少 (均P <0 0 5 )。结论 :梗死前心绞痛组溶栓效果较好 ,梗死范围较小 ,梗死前反复心绞痛可作为对溶栓治疗敏感的预测指标。     

急性肺水肿不同湿化剂吸氧疗效的实验研究

目的通过对急性肺水肿不同湿化剂吸氧疗效的动物实验,筛选一种合适的湿化剂.方法复制急性肺水肿的动物模型,给予蒸馏水及不同浓度的乙醇、丁醇湿化吸氧,观察吸氧前后PaO2变化及支气管肺泡灌注液(BALF)中SOD及血浆NO变化情况.结果各组PaO2在吸氧后明显增高,尤以15%、25%乙醇组增高显著(P均<0.01),肺系数显著低于未吸氧组(P<0.01);15%乙醇组BALF中SOD显著高于其它各组(P<0.05),血浆NO在吸氧后亦明显升高,但与其它各组无显著性差异.结论①低浓度乙醇(15%～25%)为最佳湿化剂浓度,丁醇不适合作湿化剂;②不同湿化剂对肺水肿吸氧疗效的影响除与其消泡作用有关外,尚与水肿液成份及其它因素有关.     

家兔肌皮神经躯体神经元的定位研究

目的 :用HRP逆行追踪技术显示家兔肌皮神经躯体神经元的定位。方法 :将 6只家兔分别切断左侧肌皮肌神经 ,并在近侧断端涂抹HRP ,对躯体运动和躯体感觉神经元的节段性分布进行研究。结果 :HRP标记细胞见于脊髓C7节段前角外侧部 ,同侧C7脊神经节内也出现大量的HRP标记细胞。结论 :对比感觉和运动神经元的定位 ,可见两者间呈对应性关系的节段性分布。     

慢性肾功能衰竭与心率变异性时域分析的相关性研究

目的 :评价慢性肾功能衰竭患者自主神经损伤及其相关因素。方法 :选择肾内科住院患者及健康体检人员共 40例 ,按肾功能水平分为正常对照组、肾功能正常组、氮质血症组和尿毒症组 ,分别检测患者心率变异性 (HRV )时域指标并同步监测患者动态血压 ,进行显著性差异检验。 结果 :(1)尿毒症组 HRV时域指标中主要观察指标显著低于其余各组 (P<0 .0 1或P<0 .0 5 ) ,而其余各组间 HRV时域指标均无显著性差异 ;(2 )尿毒症肾性高血压患者 HRV时域指标显著低于尿毒症正常血压患者 (P<0 .0 5 )。 结论 :(1)随着慢性肾功能衰竭病程进展 ,患者逐步出现心脏自主神经系统损害及功能失调 ;(2 )慢性肾功能衰竭患者心脏自主神经系统损害与肾功能水平呈正相关 ;尿毒症本身即为心脏自主神经系统损害的独立因素。 (3)尿毒症肾性高血压将加重患者心脏自主神经系统损害     

脉冲多普勒超声定量检测狭窄管流中流动指标的方法学探讨

目的　探讨狭窄管流中一系列流动指标的定量检测方法 ,包括 Reynolds数、相对频带展宽度(RSB)、层流剪应力、法向雷诺应力 (RNS)等。方法　采用临床使用的脉冲多普勒血流仪在狭窄前后多个位点进行多时点检测 ,得出流场特征 ,再分别评价各项指标。结果　定性评价见狭窄下游呈现鲜亮的“烛焰形”花色镶嵌湍流流型 ,狭窄后 1.0 cm处得到较大的 RSB、RNS等 ,1/ 2 R取样容积处湍流指标大于相应的轴心处。结论　狭窄后1.0 cm1/ 2 R取样容积处存在最大的湍流度 ;狭窄后各位点的数据离散度大于狭窄前。该研究为进一步在不同流场中开展生物力学的在体研究奠定了前期工作基础     

氟伐他丁对血管损伤后内皮素、血栓素A2和前列环素的作用

目的探讨兔髂动脉急性损伤后,血清中内皮素(ET)、血栓素A2(TXA2)和前列环素(PGI2)水平的变化及氟伐他丁的作用. 方法 12只新西兰大耳白兔行右髂动脉球囊导管内膜剥脱术.6只予氟伐他丁8 mg·kg-1·d-1灌胃治疗,余6只作对照,术前、术后3 h及3天放射免疫法测定血清中ET、TXA2和PGI2浓度. 结果兔髂动脉损伤后血清ET即明显增加,氟伐他丁治疗显著抑制血管损伤后ET水平的升高;血管急性损伤后,血清中TXA2浓度明显增加,PGI2水平则显著下降,氟伐他丁治疗在明显提高血清PGI2水平的同时,抑制了TXA2的升高. 结论氟伐他丁抑制血清ET和TXA2的升高、促进PGI2的生成,可能减轻血管损伤后血栓形成和内膜肥厚.     

Effect of Wuzi Yanzong Pills on Sertoli cells and blood–testis barrier in heat-stressed rats based on Akt signalling pathway

The blood–testis barrier (BTB) of Sertoli cells (SCs) is an important biological barrier that maintains spermatogenesis and provides a favourable microenvironment for spermatogenesis. However, heat stress can directly damage the BTB structural proteins of testicular SCs, leading to dyszoospermia. Wuzi Yanzong Pills (WYP) is a traditional Chinese medicine formula used to treat male reproductive diseases. However, whether WYP could ameliorate heat stress injury in primary SCs extracted from rat testes and BTB proteins remains unknown. Here, treatment with WYP (low, medium and high dose) increased the SC viability and the proliferation of cell antigen Ki67 significantly. Additionally, it promoted SC maturation, which presented in the form of increased androgen receptors (ARs) and decreased cytokeratin 18 (CK-18) in three WYP dose groups. WYP upregulated BTB proteins such as zonula occludens 1 (ZO-1) and occludin across all WYP groups and decreased phosphorylated Akt (p-Akt) in the middle and high-dose groups; however, ZO-1 and occludin recovery were reduced with the presence of Akt inhibitor in WYP groups. WYP improved SC viability and proliferation, and ameliorated dedifferentiation and BTB-proteins damaged by heat stress via Akt signalling. The findings present theoretical support for the effects of WYP in the management of dyszoospermia and male infertility.     

Pyriform sinus fistula in children: A comparison of endoscopic-assisted surgery and endoscopic radiofrequency ablation

BackgroundPyriform sinus fistula (PSF) is a rare congenital anomaly, and the preferred definitive treatment is yet to be verified. In this study, we investigated the treatment outcomes of PSF specifically comparing endoscopic-assisted surgery and endoscopic radiofrequency ablation (RA).MethodsThe medical records of patients treated for PSF at the Shanghai Children's Hospital between October 2016 and September 2019 were retrospectively evaluated.ResultsThere were 93 girls and 98 boys. The median age at onset and operation was 3 years and 5 years, respectively. Endoscopic-assisted surgery was performed in 143 patients. During the same period, RA was performed in 48 patients, and 10 of them concurrently underwent incision and drainage of neck abscesses. Longer hospital stay was found in the endoscopic-assisted surgery group than in the RA group (10.50 ± 3.93 vs. 5.02 ± 3.30 days, P < 0.001). Postoperative complications were not significantly different between the two groups, except for neck infection (0 vs. 8.3%, P = 0.004). After a median follow-up period of 21 months, no significant difference was found between the two groups in terms of recurrence (1.4% vs. 0, P = 0.560).ConclusionPatients treated with RA had a significantly shorter hospital stay than those treated with endoscopic-assisted surgery. Outcomes of endoscopic-assisted surgery and RA were not significantly different for the management of PSF and treatment method should be tailored to the patient.Level of evidenceIV.     

Mechanism of Graft Damage Caused by NTPDase1-activated Macrophages in Acute Antibody-Mediated Rejection

ObjectivesTo investigate the effect and mechanism of macrophage activation and graft damage caused by nucleoside triphosphate diphosphohydrolase 1 (NTPDase1) in acute antibody-mediated rejection (AMR).MethodsAcute AMR was induced in different skin-grafted nude mouse models with wild-type NTPDase1 expression, transgene-enhanced NTPDase1 expression, or NTPDase1 gene knockout. Several methods (eg, real-time fluorescence quantitative polymerase chain reaction, high-performance liquid chromatography [HPLC], immunofluorescence, flow cytometry, and luciferin/luciferase assays) were used to study (at the histologic and molecular levels) the extracellular adenosine diphosphate (ADP) concentration, macrophage proliferation, major histocompatibility complex (MHC) class II antigen expression on the surface of macrophages, B-cell activating factor (BAFF) expression in the peripheral blood serum, and the total number of SmIg-positive B cells during acute AMR. The relative activity of NTPDase1 in B cells and epithelial cells, pathologic changes, and the incidence of positive C4d deposition around the capillaries of skin grafts on the different nude mice were studied.ResultsMacrophages proliferated significantly when acute AMR occurred. The higher the NTPDase1 expression level, the lower the extracellular ADP concentration, the expression of MHC class II antigens on the surface of macrophages, the expression of BAFF in the peripheral blood serum, and the total number of SmIg-positive B cells, indicating negative correlations. The relative activity of NTPDase1 in B cells and epithelial cells of the skin graft was different among the different mice. The higher the NTPDase1 expression level, the lower the degree of pathologic damage to the skin graft.ConclusionsImbalance in extracellular ADP degradation by NTPDase1 may promote macrophage activation, and activated macrophages may be an important cause of graft damage.     

中医药在糖尿病胃轻瘫治疗中的应用及思考

糖尿病胃轻瘫（DGP）发病率较高,药物治疗存在一定的局限性,部分患者可能出现一定的不良反应,这影响糖尿病的治疗。中药治疗DGP可以有效缓解患者症状,降低现有药物不良反应,辅助控制血糖。现代医家多利用辨证分型组方、经方验方及中成药进行辨病辨证治疗相结合,运用单味药、药对、中药提取物进行个体化治疗。现通过概述中药的多种组方思路,总结其优势,并对中药治疗DGP的现状进行思考与总结,以期中医药治疗DGP得到更好的发挥。