核因子-κB在脓毒症大鼠肾细胞凋亡中的作用

目的研究脓毒症时核因子-κB(NF-κB)在肾细胞凋亡信号转导中的作用,探讨脓毒症时肾功能降低的机制。方法将30只大鼠随机分为5组,其中6只作为对照组,另外24只采用盲肠结扎穿孔术(CLP)复制脓毒症模型,以术后2 h、3 h、4 h、5 h时限分为4组作为实验组。各组均测定肾脏组织NF-κB蛋白及肾细胞凋亡的情况,同时测定肾功能的变化。结果CLP术后肾组织NF-κB蛋白表达升高,与对照组相比差异有统计学意义(P<0.01);4 h组NF-κB的含量达高峰,3 h组相对较弱。CLP术后肾细胞凋亡数目与肾组织NF-κB蛋白表达相反。CLP术后血清尿素氮及肌酐增加,与对照组相比差异有统计学意义(P<0.01)。结论CLP所致的脓毒症过程中,NF-κB蛋白表达升高,其活性增强可抑制肾细胞凋亡。     

脓毒血症过程肝脏结构和功能关系的研究

目的：研究脓毒血症时肝吐功能降低的机制及糖皮质激素的作用机制。方法：将24只雄性Wistar大鼠随机分为4组，其中6只作为对照组，另外18只采用盲肠结扎穿孔术（CLP）致脓毒血症模型，其中12只于术后60、180min时限又分为2组作实验组，另6只于术后即给予糖皮质激素地塞米松（5mg／kg）作为干预组。各组均测定肝组织TNF—α和Bcl-2蛋白表达及肝细胞凋亡的情况，同时测定肝脏功能的变化。结果：CLP术后肝组织中TNF—α水平持续升高，与对照组相比有统计学差异（P〈0．01）。血清TNF—α含量变化与肝组织TNF—α的表达具有一致性。CLP术后肝细胞凋亡数目与对照组相比有统计学差异，并呈进行性增加（P〈0．01）。肝细胞的凋亡数目与肝组织TNF—α的表达也呈现一致性。CLP术后肝组织Bcl-2蛋白与TNF—α蛋白相比表达较弱，但与对照组仍有统计学差异（P〈0．01）。血浆中ALT／AST呈异常改变，同时术后肝脏组织结构紊乱。结论：由CLP所致的脓毒血症过程中，肝脏组织TNF-α蛋白的表达和血浆中TNF—α蛋白的含量进行性增加，通过激活促细胞凋亡的程序，相对抑制抗凋亡蛋白Bcl-2的表达而诱导肝细胞凋亡。与肝脏结构受损、功能下降是一致的。早期应用地塞米松处理脓毒血症对肝脏有一定的保护作用，其机制可能是抑制了脓毒血症早期细胞因子TNF-α的释放，以及由此导致的细胞凋亡的发生。     

脓毒症大鼠Fas-L、Caspase-3和NF-κB的表达与肝细胞凋亡的关系

目的　探讨脓毒症时Fas L、Caspase 3、NF κB在肝细胞凋亡信号转导中的作用。方法　Wistar大鼠 3 0只随机分为观察组和对照组 ,观察组 2 4只采用盲肠结扎穿孔术 (CLP)致脓毒症模型 ,以术后 2h、3h、4h、5h时限分为 4组 ,对照组 6只 ,不行CLP术。各组均测定肝脏组织Fas L、Caspase 3、NF κB蛋白表达及肝细胞凋亡的情况 ,同时测定肝脏功能的变化。结果　CLP术后肝组织Fas L、Caspase 3、NF κB蛋白表达升高与对照组相比有显著差异 ;3h组的Fas L、Caspase 3的含量达高峰 ,4h组的NF κB的含量达高峰 ;血浆中丙氨酸转氨酶 (ALT)、乳酸脱氢酶 (LDH)呈异常改变 ,CLP术后血浆中ALT、LDH增加 ,与对照组相比有显著差异 (P <0 .0 1) ,ALT呈进行性增加 ,LDH以 4h组最显著。肝组织细胞凋亡指数呈进行性增加。结论　由CLP所致的脓毒症过程中 ,肝组织Fas L、Caspase 3蛋白表达升高 ,激活促细胞凋亡的程序 ;NF κB蛋白表达亦升高 ,NF κB活性增强 ,抑制细胞凋亡     

氯胺酮对脓毒症大鼠及血清TNF-α、IL-6和NO水平及生存率的影响

目的探讨氯胺酮在盲肠结扎穿孔术（CLP）脓毒症中的作用及可能的作用机制．方法120只雄性sD大鼠随机分为正常对照组、对照组、氯胺酮组；每组各分为Ⅰ、Ⅱ、Ⅲ、Ⅳ4个亚组．对照组和氯胺酮组建立CLP脓毒症模型．术毕半小时开始给药，氯胺酮组肌肉注射氯胺酮50mg／kg，q12h，正常对照组与对照组给予等容积生理盐水，直至大鼠死亡或5d观察期结束．每组的Ⅰ亚组大鼠观察5d的生存情况；Ⅱ、Ⅲ、Ⅳ亚组的大鼠于术前0h、术后4h，及以对照组的Ⅳ亚组各只大鼠的临终时刻为观察时相点，分别处死每组中一个亚组的大鼠测定血中TNF-α、IL-6及NO的水平．结果与正常对照组比，对照组血清TNF-α、IL-6在CLP术后4h及临终时点均明显升高（P〈0．01）；且TNF-α在CLP术后4h较临终时点高；IL-6在临终时点较CLP术后4h高；而NO在CLP术后的临终时点才明显升高（P〈0．01）．与对照组比，氯胺酮组血清TNF-α和IL-6在CLP术后4h及临终时点均明显降低（P〈0．01）；NO仅在CLP术后的临终时点明显降低（P〈0．01）．正常对照组5d生存率100％，对照组5d生存率0，氯胺酮组5d生存率60％；与对照组相比，氯胺酮组的5d生存率明显升高（P〈0．01）．结论氯胺酮能够抑制CLP脓毒症大鼠血清TNF-α、IL-6和NO的水平，从而提高大鼠的生存率．     

糖皮质激素对脓毒症大鼠肾细胞凋亡的影响

目的探讨糖皮质激素对脓毒症大鼠肾细胞凋亡的影响。方法将30只大鼠随机分为对照组、脓毒症组和地塞米松组,每组10只。其中脓毒症组和地塞米松组采用盲肠结扎穿孔术(CLP)致脓毒症模型,地塞米松组行盲肠结扎穿孔术后即给予地塞米松,测定各组大鼠肾功能及肾细胞凋亡的情况。结果与对照组相比,CLP术后血清尿素氮、肌酐水平及肾脏细胞凋亡指数明显升高(P<0.01);地塞米松组与脓毒症组比较血清尿素氮、肌酐水平以及肾脏细胞凋亡指数均降低(P<0.01)。结论在CLP所致的脓毒症早期,应用地塞米松对肾脏有一定的保护作用,其作用机制可能与其抑制肾细胞凋亡的发生有关。     

白藜芦醇对脓毒症小鼠急性肾损伤的保护作用和机制研究

目的探讨白藜芦醇对脓毒症小鼠急性肾损伤的保护作用及作用机制。方法将45只C57BL/6雄性健康小鼠随机分成3组：假手术组（Sham组）、脓毒症模型组[盲肠结扎穿孔（CLP）组]和白藜芦醇实验组（CLP+白藜芦醇组）,每组15只,采用CLP术构建脓毒症小鼠模型,术后72h每组选取存活的5只小鼠处死并取材,检测血肌酐、尿素氮、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肾损伤标志物-1（KIM-1）、沉默信息调节相关酶1（SIRT1）表达情况;观察小鼠肾脏结构、肾细胞凋亡情况,计算生存率,检测肾脏组织Caspase-3的表达。结果与Sham组相比,CLP组小鼠肾小球毛细胞血管扩张、充血,肾小管上皮细胞水肿、颗粒性变样,管腔缩小,大量炎症细胞浸润,血肌酐、尿素氮水平均升高（均P＜0.05）,血清NGAL、KIM-1水平均升高（均P＜0.05）;可见大量肾小管上皮细胞凋亡,SIRT1mRNA、蛋白表达水平均升高（均P＜0.05）,Caspase3蛋白表达上调（P＜0.05）;小鼠7d成活率为0%。与CLP组相比,CLP+白藜芦醇组小鼠肾小球毛细血管扩张不明显,炎症细胞浸润有所减轻,血肌酐、尿素氮水平均降低（均P＜0.05）,血清NGAL、KIM-1水平均降低（均P＜0.05）;且肾小管上皮细胞凋亡明显减少,SIRT1mRNA、蛋白表达水平均升高（均P＜0.05）,Caspase3蛋白表达下调（P＜0.05）,小鼠7d成活率为30%（P＜0.05）。结论白藜芦醇可能通过激活SIRT1信号抑制凋亡通路抑制肾小管上皮细胞凋亡,减轻脓毒症相关性急性肾损伤程度。     

核因子-κB对感染性休克大鼠肾功能的影响

目的观察核因子-κB(NF-κB)对感染性休克大鼠肾功能的影响,探讨感染性休克时肾功能降低的机制。方法将20只大鼠随机分为2组,每组10只。实验组采用盲肠结扎穿孔术(CLP)制作感染性休克模型,对照组不进行CLP术,其余操作同实验组。各组均测定肾脏组织NF-κB蛋白表达及肾功能情况。结果实验组CLP术后12 h肾组织NF-κB蛋白表达升高,与对照组比较有显著差异(P<0.01);实验组CLP术后12 h血清尿素氮及肌酐增加,与对照组比较有显著差异(P<0.01)。结论CLP所致大鼠感染性休克过程中,肾组织NF-κB蛋白表达升高,可能是导致肾功能减退的重要因素。     

重组β-防御素2多肽对脓毒症大鼠肺组织细胞凋亡的影响

目的：观察重组β-防御素2多肽预处理对脓毒症大鼠肺组织细胞凋亡的影响。方法：SPF级SD大鼠48只随机分成对照组和防御素组，采用盲肠结扎穿孔术（CLP）复制脓毒症模型，防御素组在CLP前48h经气管插管气道滴注10^7PFU重组腺病毒（含有β-防御素2编码基因），而对照组则同法给予对照腺病毒（不合β-防御素2编码基因）。分别于CLP后0、12、36和72h处死大鼠，取肺组织，采用透射电镜，末端脱氧核苷酸转移酶介导的dUTP缺口末端标记法（TUNEL）检测细胞凋亡，采用电镜、苏木精-伊红（HE）染色观察肺组织病理变化。结果：TUNEL检测显示，对照组大鼠CLP后12、36和72h肺组织细胞凋亡指数显著增加（P〈0．01）；与对照组相比，防御素组CLP后相应时间点肺组织细胞凋亡指数显著降低（P〈0．05）。HE染色可见，两组大鼠CLP后12、36和72h肺泡及肺泡间质充血、水肿，炎症细胞渗出，肺泡腔不同程度狭窄。与对照组相比较，防御素组相应时间点肺组织内炎症细胞渗出减少，间质水肿减轻。结论：重组β-防御素2多肽预处理能抑制脓毒症肺组织的细胞凋亡，对急性肺损伤（ALI）具有保护作用。     

氯胺酮对脓毒症大鼠肾脏保护作用的研究

目的探讨氯胺酮对脓毒症大鼠肾脏的保护作用及其机制。方法选健康雄性Wistar大鼠54只,随机分为三组：假手术组（SHAM）组、盲肠结扎加穿孔组（CLP）组及氯胺酮组（KT）组。SHAM组开腹后不做任何处理,其余各组行盲肠结扎穿孔术（CLP）。KT组于CLP前20min腹腔给药40mg/kg。各组在3h、6h和12h分别经心脏采血,检测尿素氮和肌酐的含量,并取肾脏行HE染色观察其病理组织学变化,用免疫组化方法检测热休克蛋白70（HSP70）的表达。结果与SHAM组比较,CLP组大鼠血清BUN含量在术后6h和12h显著升高（P〈0.01）,血清Cr在术后12h显著升高（P〈0.01）;与CLP组比较,KT组大鼠血清BUN较CLP组含量在6、12h时相点明显降低（P〈0.05）。血清Cr在12h明显降低（P〈0.05）。三组肾组织中HSP70均有表达,CLP组及KT组均明显高于SHAM组（P〈0.01）,而KT组明显高于CLP组（P〈0.05）。结论氯胺酮能抑制脓毒症大鼠血清BUN和Cr的增高,减轻肾组织损害,对脓毒症大鼠肾脏具有一定的保护,此作用可能与诱导HSP70表达增强有关。     

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.