电针预处理对心肌缺血再灌注模型大鼠心肌组织FXR基因及心肌细胞线粒体功能的影响

目的探讨电针预处理改善心肌缺血再灌注损伤的可能作用机制。方法40只Wistar大鼠随机分为假手术组、缺血再灌注组、FXR抑制剂组及电针预处理组,每组10只。各组大鼠均予捆绑固定7天后,除假手组外其余各组均进行心肌缺血再灌注造模处理。FXR抑制剂组第8天尾静脉注射法尼酯X受体(FXR)抑制剂z-Guggulsterone 0.4μl/g后再造模,电针预处理组从第1天开始取"内关""足三里""关元"电针7天,第8天再造模。造模后测定大鼠血清白细胞介素8(IL-8)浓度及心肌细胞线粒体呼吸链酶活性及Na^+-K^+-ATP酶、Ca^2+-Mg^2+-ATP酶活性,检测心肌组织FXR基因表达水平。结果与假手术组相比,缺血再灌注组IL-8浓度升高,呼吸链酶Ⅰ、Ⅱ、Ⅲ、Ⅳ及Na^+-K^+-ATP酶、Ca^2+-Mg^2+-ATP酶活性均降低,FXR基因表达水平上调(P<0.01)。与缺血再灌注组相比,FXR抑制剂组与电针预处理组IL-8浓度均降低,呼吸链酶Ⅰ、Ⅱ、Ⅲ、Ⅳ及Na^+-K^+-ATP酶、Ca^2+-Mg^2+-ATP酶活性升高,FXR基因表达水平降低(P<0.01)。与FXR抑制剂组比较,电针预处理组IL-8浓度、FXR基因表达水平升高,Na^+-K^+-ATP酶、Ca^2+-Mg^2+-ATP酶活性及呼吸链酶Ⅲ、Ⅳ均降低(P<0.05)。结论电针预处理可能通过降低血清IL-8浓度,提高心肌细胞线粒体呼吸链复合酶、ATP酶活性,下调FXR基因表达,从而改善心肌缺血再灌注损伤。     

电针预处理对心肌缺血再灌注大鼠线粒体能量代谢的影响

ObjectiveTo explore the effects of electroacupuncture pretreatment on mitochondrial energy metabolism in the rats with myocardial ischemia reperfusion injury (MIRI).MethodsA total of 60 SPF Wistar rats were randomly divided into a sham-operation group (sham group), a myocardial ischemia reperfusion injury group (MIRI group) and an electroacupuncture pretreatment group (EA group), 20 rats in each one. The rats in the sham group and the MIRI group were binded for 7 days, once a day, 20 min each time. On the 8^th day, the sample was collected after the heart exposed for 50 min in thoractomy in the sham group and the sample was collected after ischemia for 20 min and reperfusion for 30 min in thoractomy in the MIRI group. In the EA group, the pretreatment intervention with electroacupuncture was applied at "Nèiguān (内关PC6)", "Guānyuán (关元CV4)" and "Zúsānlĭ (足三里ST36)" in the rats for 7 days, once a day, 20 min each time. On the 8^th day, after ischemia for 20 min and reperfusion for 30 min in thoractomy, the sample was collected in the EA group. The changes in ST_Ⅱ segment of electroacardiogram (ECG) were observed and measured. Using enzyme-linked immunosorbent assay (ELISA), the concentrations of cardiac troponin T (cTnT) and cardiac troponin I (cTnI)were detected. Using nitro blue tetrazolium chloride monohydrate (NBT) staining, the myocardial infarction weight percentage was measured. Using ELISA, the concentrations of mitochondrial adenosine monophosphate (AMP), adenosine diphosphate (ADP)and adenosine triphosphate (ATP)were detected.Results(1) ST_Ⅱ changes: in 20 min of ligation, compared with the sham group, the ST_Ⅱ segment of electrocardiograph (ECG) was elevated significantly in the MIRI group and EA group (both P < 0.01), but the elevation range in the EA group was lower than that of the MIRI group (P < 0.01). After reperfusion for 30 min, the ST_Ⅱ segment was fallen by over 50% in the MIRI group and the EA group. Simultaneously, the ST_Ⅱ segment in the EA group was lower than that of the MIRI group (P < 0.01). (2) Regarding myocardial infarction weight percentage, compared with the sham group, the infarction weight was larger in the MIRI group and the EA group (both P < 0.05) and the infarction weight in the EA group was lower than that of the MIRI group (P < 0.05). (3) Regarding the levels of serum cTnt and cTnI, compared with the sham group, the levels of serum cTnT and cTnI were higher in the MIRI group and the EA group (all P < 0.01) and the levels of cTnT and cTnI in the EA group were lower than that of the MIRI group (both P < 0.01). (4) Regarding the concentrations of AMP, ADP and ATP, compared with the sham group, ATP concentration was lower in the MIRI group and the EA group (both P < 0.01) and the concentrations of AMP and ADP were higher (P < 0.05, P < 0.01). Compared with the MIRI group, ATP concentration was higher in the EA group (P < 0.05) and the concentrations of AMP and ADP were lower (both P < 0.01).ConclusionsElectroacupuncture pretreatment reduces the elevation of ECG ST_Ⅱ segment, decreases the concentrations of myocardial injury markers, cTnT and cTnI and regulates the transfer among AMP, ATP and ADP. The protective effect of electroacupuncture pretreatment may result from the regulation of mitochondrial energy metabolism.     

神经外科住院病人便秘管理的循证护理实践

目的:将神经外科住院病人便秘预防和管理的最佳证据应用于临床实践,为病人提供有效的护理支持。方法:采用澳大利亚乔安娜布里格斯研究所(JBI)循证卫生保健中心的证据应用模式,将病人便秘预防管理证据转化为7条审查指标应用于神经外科住院病人,并比较证据应用前后审查指标的执行情况。结果:证据应用后,7条审查指标的执行率均明显提高(P<0.01);护士的便秘知识得分从(6.06±1.37)分提高到(11.50±0.70)分(P<0.01)。病人及家属的便秘知识得分从(3.68±1.47)分提高至(4.52±1.52)分(P<0.05)。结论:基于循证的质量改进项目能够提高护士对各项审查指标的依从性,有利于改善神经外科住院病人便秘评估和管理的临床护理实践。     

《黄帝内经》中气机升降的探讨

古代唯物主义认为"气"是最原始的物质,是构成宇宙万物最小的单位,并把自然界万物的变化归结于气机升降变化的影响。因此,在中医学中气机升降在生理、病理、辩证、治疗、选方用药上均有着不可忽视的重要意义。《黄帝内经》奠定了气机升降的最初理论基础,是后代理论发展延伸的源头,其理论内容有着重要意义值得我们学习与探讨。     

电针预处理对心肌缺血再灌注损伤大鼠线粒体介导的细胞凋亡的影响

目的:探讨电针预处理对心肌缺血再灌注损伤大鼠的线粒体膜电位(△Ψm)及其介导的细胞凋亡的影响。方法:将60只SPF级雄性Wistar大鼠随机分为假手术组(Sham)、缺血再灌注组(MIRI)和电针预处理组(EA),每组20只。Sham组、MIRI组均采用自制鼠衣捆绑,固定于自制鼠台7天,1次/天,20min/次,第8天,Sham组开胸暴露心脏50min后、MIRI组开胸缺血20min再灌注30min后取材。EA组,电针预处理"内关"(双侧)、"足三里"(双侧)、"关元"7天,1次/天,20min/次,第8天开胸缺血20min,再灌注30min后取材。采用TTC染色法测定缺血再灌注损伤后心肌梗死的面积和重量,采用JC-1染色法检测△Ψm的水平,采用实时荧光定量PCR法检测第二个线粒体衍生的半胱氨酸蛋白酶激活剂(Smac/Diablo)、天冬氨酸特异性半胱氨酸蛋白酶-7(Caspase-7)、天冬氨酸特异性半胱氨酸蛋白酶-9(Caspase-9)基因表达水平。结果:(1)心肌梗死面积和重量:与Sham组相比,MIRI组和EA组的梗死面积和重量均增加(均P0.05),且EA组的梗死面积和重量低于MIRI组(均P0.01)。(2)线粒体膜电位:与Sham组相比,MIRI组和EA组的红/绿荧光比值均明显下降(均P0.01);与MIRI组比较,EA组红/绿荧光比值明显升高(P0.01)。(3)Smac/Diablo基因表达水平:与Sham组相比,MIRI组和EA组的Smac/Diablo、Caspase-7、Caspase-9的基因表达水平显著升高(均P0.01);与MIRI组相比,EA组的Smac/Diablo、Caspase-7、Caspase-9基因表达明显下降(均P0.01)。结论:电针预处理可有效缩小心肌梗死范围,提高线粒体膜电位水平,下调促凋亡基因Smac/Diablo、Caspase-7、Caspase-9的表达,电针预处理的保护作用可能是基于改善线粒体膜电位水平、抑制Smac/Diablo介导的线粒体Caspase凋亡通路产生的。