缝隙连接蛋白α7促进骨髓间充质干细胞转化为心脏起搏样细胞的实验研究

目的 探讨缝隙连接蛋白α7(GJA7)基因转染大鼠骨髓间充质干细胞(rat mesenchymal stem cells,rMSCs),经与乳鼠心肌细胞(neonatal rat ventricular myocytes,NRVMs)共培养,诱导心脏起搏样细胞相关基因表达的变化.方法 构建携带GJA7基因的慢病毒载体,转染rMSCs,经嘌呤霉素加压筛选纯化后,与NRVMs共培养.分为RFP(red fluorescent protein,红色荧光蛋白)-rMSCs组(A组)、GJA7-RFP-rMSCs组(B组)、RFP-rMSCs+ NRVMs组(C组)、GJA7-RFP-rMSCs+NRVMs组(D组)4组.荧光定量PCR法检测心脏起搏细胞相关基因(HCN4、GJA7、Tbx3、Tbxl8)及工作心肌细胞相关基因(Cx43、Nkx2.5)的表达.全细胞膜片钳检测各组细胞起搏电流(If).结果 携带GJA7基因的慢病毒载体成功转染rMSCs,经嘌呤霉素加压筛选,转染效率高达95％以上.RT-qPCR结果显示,D组HCN4、GJA7、Tbx3、Tbxl8表达较其他各组明显增高(P＜0.05);C组Nkx2.5、Cx43则较其他组表达明显升高(P＜0.05).全细胞膜片钳检测结果显示,仅D组记录到超极化激活的内向电流,该电流具有明显时间电压依赖性,且可被Cscl(4 mmol/L)阻断,符合If电流特性.结论 经GJA7基因修饰并通过与心肌细胞共培养,使rMSCs在体外诱导出具有If电流的心脏起搏样细胞.     

ISL-1诱导脂肪干细胞向起搏样细胞分化

目的 探讨过表达胰岛素基因增强子结合蛋白1(insulin gene enhancer binding protein 1,ISL-1)的慢病毒在体外转染脂肪干细胞(adipose-derived stem cells,ADSCs),能否诱导ADSCs向起搏样细胞分化。方法 取第3~5代ADSCs,随机分成Bank.mCherry和胰岛素基因增强子结合蛋白1(insulin gene enhancer binding protein 1,ISL-1)3组,按分组分别转染病毒,经荧光强度和流式分析确定最适感染复数,与乳鼠心室肌细胞(neonatal rat cardiomyocytes,NRVMs)共培养7天后进行实时荧光定量聚合酶式反应(quantitative real time polymerase chain reaction,qRT-PCR).蛋白质印迹.免疫荧光检测分析,期间观察细胞形态和搏动频率变化,并用膜片钳技术记录细胞内电流活动。结果 分离贴壁后的ADSCs呈长梭形,慢病毒转染ADSCs的最适感染复数为50。ISL-1组ADSCs形态呈多样化,窦房结特异性基因HCN4.Cx45和Tbx3的mRNA表达水平上调,而工作心肌特异性基因Nkx2.5下调,组间比较差异有统计学意义(P＜0.05)。ISL-1组大多数细胞可检测到HCN4表达并且可记录到超极化内向电流。结论 经ISL-1基因修饰的ADSCs通过体外心肌微环境诱导,产生了一定的高表达窦房结标志性基因并具有细胞内典型超极化电活动的起搏样细胞。     

窦房结细胞起搏基因HCN4的研究进展

HCN即超级化激活的环核苷酸门控阳离子通道,其激活后产生的If/Ih离子流是窦房结起搏细胞动作电位正常形成的分子基础。随着对窦房结细胞起搏机制和HCN基因家族研究的不断深入,人们对HCN亚型HCN4的结构、分布、特性已有了较深入的了解。近年来有较多研究表明,人窦房结起搏基因HCN4突变与病态窦房结综合征密切相关。现就窦房结细胞起搏基因HCN4的特性及其与窦房结功能之间的关系作进一步研究和探讨。     

大鼠骨髓间充质干细胞体外诱导分化为心肌样细胞的研究

目的观察体外不同诱导条件下大鼠骨髓间充质干细胞(BMSCs)在不同时间段分化为心肌样细胞的能力及表达心肌细胞特异性标志物的差别。方法分离培养SD大鼠BMSCs和SD乳鼠心肌细胞并鉴定,取第3代BMSCs分别进行5-氮胞苷(5-Aza)诱导、与心肌细胞共培养及单独培养,分别于第2、4、6、8、10周使用倒置显微镜观察细胞生长情况和形态变化,反转录-聚合酶链反应检测每组细胞心肌特异性基因肌钙蛋白I(cTnI)、缝隙连接蛋白43(Cx43)和心肌特异性转录因子4(GATA-4)的表达。结果对照组未见有搏动细胞,cTnI、Cx43和GATA-4基因表达阴性;5-氮胞苷诱导组于第2周时细胞呈梭形且排列方向趋于一致,未见有搏动细胞,cTnI、Cx43基因表达第8周达到高峰,GATA-4基因表达第4周达高峰;共培养组细胞多为梭形,呈肌性排列,可见搏动频率不一致的搏动细胞,cTnI、Cx43基因表达于第2⁸周表达逐渐增加,GATA-4基因表达第6周达高峰;相同时段内,共培养组的cTnI、Cx43和GATA-4基因表达高于5-氮胞苷诱导组(P<0.05)。结论 BMSCs经5-氮胞苷诱导或与心肌细胞共培养可转化为心肌样细胞并表达基因cTnI、Cx43和GATA-4,且共培养组BMSCs分化为心肌样细胞的能力比5-氮胞苷诱导组强,推测心肌微环境可促进BMSCs定向分化为心肌样细胞。     

HCN4基因修饰大鼠MSCs体外诱导获得的心脏起搏样细胞动作电位检测

目的 探讨超极化激活及环化核苷酸调控的阳离子通道亚型4(hyperpolarization-activated cyclic nucleotidegated cation channel 4,HCN4)基因修饰大鼠MSCs体外诱导分化的心脏起搏样细胞的动作电位特性.方法 以HCN4基因修饰大鼠MSCs体外诱导获得的具有自发搏动的心脏起搏样细胞为实验组,同期培养的原代乳鼠窦房结细胞为对照组,采用全细胞膜片钳技术对两组细胞的动作电位进行检测.结果 心脏起搏样细胞及原代培养乳鼠窦房结细胞均可记录到具有舒张期自动去极化的动作电位,心脏起搏样细胞的动作电位特性与原代培养的乳鼠窦房结细胞相比,其静息电位、动作电位幅度及动作电位周期均无显著性差异(P＞0.05),但阈电位较原代培养的乳窦鼠房结细胞显著降低(P＜0.01).结论 从电生理角度证实,心脏起搏样细胞的特性与原代培养的乳鼠窦房结细胞相似.     

甲状旁腺素增加心率的机制研究

目的研究甲状旁腺素(PTH)增加心率的机制。方法运用微电极、膜片箝技术,记录PTH对家兔自律性动作电位和兔起搏离子流的影响。结果2×10-7mol/Lnifedipine使窦房结细胞动作电位的幅值减小及自律性减慢(P<0.05)。PTH20nmol/L增加窦房结动作电位的自律性及动作电位幅值的作用可被nifedipine减弱(P<0.05)。PTH10nmol/L使酶解游离窦房结细胞起搏离子流(If)明显增加。结论甲状旁腺素通过增强窦房结细胞起搏离子流If及钙内流来增加窦房结的自律活动。     

心脏营养素-1对骨髓间充质干细胞分化为心肌样细胞的作用

目的 观察心脏营养素-1(CT-1)是否能促进经诱导分化剂5-氮杂胞苷(5-aza)诱导的骨髓间充质于细胞(BMMSCs)分化为心肌样细胞,并研究其相关机制.方法 自成年大鼠骨髓中分离BMMSCs,分别以普通培养基(A 组)、加入含CT-1的培养基(B组)培养、经5-aza诱导后加入普通培养基(C组)及5-aza加入含CT-1的培养基(D组)培养.观察细胞形态的改变,并通过免疫组化分析分化后细胞表达心脏特异性肌钙蛋白T(cTnT)的情况.电镜观察分化后细胞的超微结构及实时荧光定量检测a-actin、β-myosin heavy chain(ffMHC)、Nkx2.5、GATA4基因表达.结果 C、D组的BMMSCs在培养4周后均形成心肌样细胞形态,并且均表达eTnT D组BMMSCs分化的心肌样细胞形成了肌管样结构;D组α-actin、β-MHC、Nkx2.5、GATA4基因表达明显高于C组.结论 CT-1可能通过对GATA4、Nkx2.5基因表达的调控而促进5-aza诱导的BMMSCs分化为心肌样细胞.     

甲状旁腺素增加心率的机制研究

目的研究甲状旁腺素(PTH)增加心率的机制.方法运用微电极、膜片箝技术,记录PTH对家兔自律性动作电位和兔起搏离子流的影响.结果2×10-7 mol/L nifedipine使窦房结细胞动作电位的幅值减小及自律性减慢(P＜0.05).PTH 20 nmol/L增加窦房结动作电位的自律性及动作电位幅值的作用可被nifedipine减弱(P＜0.05).PTH 10 nmol/L使酶解游离窦房结细胞起搏离子流(If)明显增加.结论甲状旁腺素通过增强窦房结细胞起搏离子流If及钙内流来增加窦房结的自律活动.     

转录因子Tbx18、Tbx3、Shox2在生物起搏方面的研究进展

近年来,一些转录因子在生物起搏方面的作用受到了极大关注,无论是离体的细胞实验还是在体直接注射,都产生了令人瞩目的成果。文章就转录因子Tbx18、Tbx3、Shox2在生物起搏方面的研究进展做一综述,希望为其今后在临床上的应用提供依据。     

超极化激活环核苷酸门控阳离子通道的研究进展

1976年Noma首次报道在家兔心脏窦房结组织记录到一种超极化激活的内向电流，称为拼。随后在感光细胞和海马CA1区的锥体细胞也记录到这种超极化激活的内向电流，称为Iq。在神经系统，这种超极化激活电流称为Ih。1997年发现介导Ih的离子通道HCN，此后2年间陆续克隆出多种编吗HCN通道的基因。If表示出与超级化激活的阳离子电流的分子组成关联，在包括心脏和大脑起搏活性的生理功能上起着至关重要的作用，它决定了静息膜电位、树突样整合和突触传导。[第一段]     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.