血小板活化因子和一氧化氮合酶在高原支气管哮喘发生中的作用

目的 探讨血小板数、血小板活化因子(platelet-activating factor,PAF)和一氧化氮合酶(nitric oxide synthase,NOS)对高原低氧环境中支气管哮喘(简称哮喘)发病的影响.方法 采用酶联免疫吸附法测定平原对照组、高原对照组、高原哮喘组和平原哮喘组血清PAF活性、总一氧化氮合酶(TNOS)、诱导型一氧化氮合酶(iNOS)和原生型一氧化氮合酶(cNOS)的活性,并进行血小板计数.计量资料用(-x)±s表示,组间均数差异的显著性分析采用单因素方差分析.相关性分析用Pearson直线相关分析法.结果 (1)高原对照组和高原哮喘组血小板数分别为(140±47)和(166±46)×109/L,低于平原对照组的(237±98)×109/L和平原哮喘组的(232±71)×109/L(均P＜0.01).(2)哮喘组血清PAF浓度均高于对照组,平原哮喘组PAF浓度(877±297)pg/L不仅高于平原对照组(290±132)pg/L和高原对照组(223±82)pg/L,而且高于高原哮喘组(429±254)pg/L,各组总体间差异有统计学意义(F=66.08,P＜0.01).血小板数和血清PAF活性间存在正相关(r=0.283,P＜0.01).(3)不同海拔高度对照组TNOS、iNOS和cNOS活性比较差异无统计学意义;平原哮喘组TNOS、iNOS和cNOS水平[分别为(36.2±23.0)、(20.3±14.7)和(15.9±8.4)U/ml]明显高于高原对照组[(11.9±1.3)、(9.4±1.5)和(4.9±0.5)U/ml]和高原哮喘组[(21.0±2.3)、(15.4±2.5)和(5.3±0.8)U/ml],均P＜0.01,主要以iNOS增高为主.4组TNOS、iNOS和cNOS水平总体差异有统计学意义(F值分别为17.197、8.258和34.250,均P＜0.01).结论 PAF和NOS活性降低可能是高原地区哮喘患病率低的原因之一.     

补肾活血法联合优思明预防人工流产后宫腔粘连临床研究

目的：探讨补肾活血法联合优思明对于人工流产术后宫腔粘连的预防效果。方法随机选择100例在我院人流的自愿患者（纳入标准）,随机分为两组：试验组和对照组,两组孕周、孕次、年龄等方面都无明显差异性,对照组在人工流产后第1d开始给予优思明口服,每天1次,每次1片,共21d。月经来潮后,月经第5d开始继续服用,持续服用3个月,如果无月经来潮,则停药第7d开始下一个疗程,也持续服用3个月.试验组在对照组基础上加上补肾活血方。随访观察两组患者人流术后各项指标：首次月经复潮的时间、有无周期性的腹痛、有无经量减少、有无宫腔积血（通过B超检查）、有无宫腔粘连及其宫腔粘连的程度（宫腔镜检查）。结果试验组人流术后首次月经复潮的时间为（27±2）d,周期性腹痛0例,经量减少2例,无宫腔积血患者出现,轻度宫腔粘连患者2例,中度宫腔粘连患者2例,重度宫腔粘连患者0例,对照组人流术后月经复潮时间（28±3）d,周期性腹痛2例,经量减少4例,宫腔积血患者2例,轻度宫腔粘连患者3例,中度宫腔粘连患者4例,重度宫腔粘连患者1例。试验组与对照组比较：人流术后月经首次复潮时间无明显的差异性,P>0.05;月经量减少有明显的差异性, P<0.05;宫腔积血的发生率有明显差异性,P<0.05;轻、中、重度宫腔粘连发生率有明显的差异性,P<0.05,宫腔粘连的总发生率有明显的差异性,P<0.05,结论补肾活血法联合优思明应用于人工流产术后对于宫腔粘连的预防疗效好,预防范围广,安全性强,值得在临床中推广应用。     

Salvianolic acid B protects human endothelial progenitor cells against oxidative stress-mediated dysfunction by modulating Akt/mTOR/4EBP1, p38 MAPK/ATF2, and ERK1/2 signaling pathways

The vascular endothelium is specifically sensitive to oxidative stress, and this is one of the mechanisms that causes widespread endothelial dysfunction in most cardiovascular diseases and disorders. Protection against reactive oxygen species (ROS)-mediated oxidative damage via antioxidant mechanisms is essential for tissue maintenance and shows therapeutic potential for patients suffering from cardiovascular and metabolic disorders. Salvianolic acid B (SalB), a natural bioactive component known from Traditional Chinese Medicine, has been reported to exert cellular protection in various types of cells. However, the underlying mechanisms involved are not fully understood. Here, we showed that SalB significantly promoted the migratory and tube formation abilities of human bone marrow derived-endothelial progenitor cells (BM-EPCs) in vitro, and substantially abrogated hydrogen peroxide (H₂O₂)-induced cell damage. SalB down-regulated Nox4 and eNOS, as well as nicotinamide adenine dinucleotide phosphate (NADPH)-oxidase expression upon H₂O₂ induction that in turn prevents oxidative-induced endothelial dysfunction. Moreover, SalB suppressed the Bax/Bcl-xL ratio and caspase-3 activation after H₂O₂ induction. Furthermore, our results provide mechanistic evidence that activation of the mTOR/p70S6K/4EBP1 pathways is required for both SalB-mediated angiogenic and protective effects against oxidative stress-induced cell injury in BM-EPCs. Suppression of MKK3/6-p38 MAPK-ATF2 and ERK1/2 signaling pathways by SalB significantly protected BM-EPCs against cell injury caused by oxidative stress via reduction of intracellular ROS levels and apoptosis. Taken together, by providing a mechanistic insight into the modulation of redox states in BM-EPCs by SalB, we suggest that SalB has a strong potential of being a new proangiogenic and cytoprotective therapeutic agent with applications in the field of endothelial injury-mediated vascular diseases.     

补肾活血中药结合关节镜治疗膝骨关节炎的临床研究

目的：探讨补肾活血中药结合关节镜治疗膝关节炎的临床效果。方法：选取本院膝骨关节炎患者80例分为两组各40例,两组均进行关节镜下等离子软骨修复手术,对照组服用西乐葆胶囊,观察组患者在对照组的基础上,同时服用补肾活血中药胶囊。对比两组WOMAC评分,关节液IL-6和TGF-β1浓度,以及临床疗效和不良反应。结果：观察组治疗后1个月、6个月疼痛、关节僵硬、生理功能程度以及总分均低于对照组（P〈0.05）。治疗后6个月,观察组IL-6和TGF-β1浓度分别为（25.42±3.15）pg/mL、（374.85±133.64）pg/mL,而对照组分别为（74.44±3.49）pg/mL、（535.47±164.53）pg/mL,观察组浓度低于对照组（P〈0.05）。两组患者治疗后,观察组显效32例,占80.00%,而对照组为16例,占40.00%,观察组治疗显效率高于对照组,比较差异有统计学意义（P〈0.05）。结论：关节镜下等离子软骨修复手术结合补肾活血中药治疗膝骨性关节炎能显著改善临床症状及炎症指标,疗效显著,可在临床上推广应用。     

Wiskott–Aldrich Syndrome protein deficiency perturbs the homeostasis of B-cell compartment in humans

Wiskott–Aldrich Syndrome protein (WASp) regulates the cytoskeleton in hematopoietic cells and mutations in its gene cause the Wiskott–Aldrich Syndrome (WAS), a primary immunodeficiency with microthrombocytopenia, eczema and a higher susceptibility to develop tumors. Autoimmune manifestations, frequently observed in WAS patients, are associated with an increased risk of mortality and still represent an unsolved aspect of the disease. B cells play a crucial role both in immune competence and self-tolerance and defects in their development and function result in immunodeficiency and/or autoimmunity. We performed a phenotypical and molecular analysis of central and peripheral B-cell compartments in WAS pediatric patients. We found a decreased proportion of immature B cells in the bone marrow correlating with an increased presence of transitional B cells in the periphery. These results could be explained by the defective migratory response of WAS B cells to SDF-1α, essential for the retention of immature B cells in the BM. In the periphery, we observed an unusual expansion of CD21^low B-cell population and increased plasma BAFF levels that may contribute to the high susceptibility to develop autoimmune manifestations in WAS patients. WAS memory B cells were characterized by a reduced in vivo proliferation, decreased somatic hypermutation and preferential usage of IGHV4-34, an immunoglobulin gene commonly found in autoreactive B cells.In conclusion, our findings demonstrate that WASp-deficiency perturbs B-cell homeostasis thus adding a new layer of immune dysregulation concurring to the increased susceptibility to develop autoimmunity in WAS patients.     

X连锁凋亡抑制蛋白和线粒体第二激活因子在锰诱导大鼠生精细胞凋亡蛋白酶表达中的调节作用

目的:研究氯化锰导致的大鼠生精细胞半胱氨酸天冬氨酸蛋白酶-9(caspase-9)及凋亡蛋白酶活化因子-1(Apaf-1)表达中X连锁凋亡抑制蛋白(XIAP)和线粒体第二激活因子(Smac)的调节机制,探讨锰导致的雄性不育机制。方法:雄性SD大鼠随机分为对照组、低剂量(15 mg/kg MnCl_2)和高剂量(30 mg/kg MnCl_2)组,腹腔注射MnCl_2 4周和6周,免疫组织化学检测生精细胞caspase-9、Apaf-1、XIAP和Smac表达。结果:与对照组相比较,各组生精细胞caspase-9、Apaf-1和Smac表达均显著升高,XIAP表达降低。同时间的高剂量组与低剂量组比较,同剂量的6周组与4周组比较,生精细胞caspase-9、Apaf-1和Smac表达均显著升高,XIAP表达降低。各组caspase-9与Apaf-1表达呈正相关,XIAP与Smac表达呈负相关。结论:锰可促进生精细胞caspase-9、Apaf-1和Smac表达,抑制XIAP表达,导致细胞凋亡,产生雄性生殖毒性效应。     

益气活血解毒方对晚期卵巢癌患者无复发生存时间及生活质量的影响

目的 观察益气活血解毒方对晚期卵巢癌患者无复发生存时间及生活质量的影响.方法 选取2009-2013年中国中医科学院广安门医院125例晚期卵巢癌一线治疗病灶完全消失后复发的患者,根据是否采用中药干预分为中药组（50例）及对照组（75例）.中药组给予手术治疗及化疗后服用益气活血解毒方,对照组给予西医手术治疗及化疗.采集2组患者基本情况及无复发生存时间,并采用卵巢癌治疗功能评价系统的健康状态评分、卡氏评分和中医症状积分评估2组患者的生活质量.结果 中药组无复发生存时间为18.5个月,对照组无复发生存时间16.0个月,Kaplan-Meier曲线显示中药维持治疗可延长中位无复发生存期（log rank：P=0.006）.中药组复发时生活质量卵巢癌治疗功能评价系统积分、卡氏评分及症状积分与对照组比较,差异均有统计学意义[（20.1±2.6）分比（24.8 ±4.0）分,（79±9）分比（72±9）分,（12.7±2.4）分比（16.6±3.2）分,均P＜0.05].结论 益气活血解毒方能延长晚期卵巢癌患者的无复发生存期,提高其生活质量.     

陈浩波从肾虚血瘀论治高龄不孕症经验

正不孕症是指有正常性生活的育龄期女性,未避孕1年及以上未孕,属中医"全不产""断续"等范畴。研究发现,随着女性年龄增大,尤其超过35岁后,卵巢储备功能明显下降,不孕发生率、妊娠失败率均呈上升趋势~([1])。随着社会发展,晚婚女性增多,以及国家生育政策调整,高龄(≥35岁)女性不孕症患者占比升高,且多为继发性不孕~([2])。而体外受精-胚胎移植技术在高龄不孕症上仍有极大局限性,获卵数及优质胚胎数少,胚胎移植周期取消率高达9.3%~([3])。     

裘昌林教授从肝论治紧张型头痛经验探析

[目的]在中医治未病理论的指导下,探讨补肾活血中药联合耳穴压豆对肾虚血瘀型胚胎移植不孕症患者子宫动脉血流动力学和子宫内膜的干预作用。[方法]选择2018年1月至2019年1月的胚胎移植不孕症患者,经辨证分型后选取肾虚血瘀型病例90例,随机分成A组(补肾活血中药联合耳穴压豆治疗组)、B组(补肾活血中药组)及C组(耳穴压豆组)共3组,每组30例。3组患者均使用长方案超促排卵,治疗从月经周期第3天开始,至胚胎移植后第5周结束。同时,A组另予补肾活血中药、耳穴压豆治疗,B组另予单纯补肾活血中药治疗,C组予耳穴压豆治疗。观察并比较各组子宫内膜厚度、子宫动脉血流搏动指数(pulsatility index,PI)、双侧收缩期峰值流速/舒张末期流速(systolic/diastolic ratio value,S/D)、生化妊娠率、临床妊娠率等指标。[结果]与C组比较,A组和B组生化妊娠率、临床妊娠率方面均优于C组,差异均有统计学意义(P0.05)。与C组比较,A组和B组内膜厚度显著增加,子宫动脉血流PI、双侧S/D显著降低,差异均有统计学意义(P0.05);与B组比较,A组子宫动脉血流PI显著降低,而生化妊娠率、临床妊娠率方面均优于B组,差异均有统计学意义(P0.05)。[结论]补肾活血中药联合耳穴压豆治疗可以改善肾虚血瘀型胚胎移植患者的子宫内膜厚度、子宫动脉血流阻力,提高临床妊娠率,且较单纯使用中药或耳穴压豆效果更佳。