细胞衰老与血管老化的关系及其研究进展

人类进入老年期后,随增龄与衰老相关的各种血管性疾病的发生率也随之上升.同时,各种血管性疾病如动脉粥样硬化(AS)、冠心病和中风的发生,也促进了衰老的提前出现[1,2]然而,这些随衰老进程不断增加的血管性疾病的细胞和分子机制仍不完全清楚.

Peripheral vascular disease embraces a variety of conditions such as thromboangiitis obliterans, Raynaud's disease, thrombophlebitis, aorto-arteritis, obliterate atherosclerosis, varix or phlebothrombosis of the lower limb. Although the affected blood vessel may be arterial or venous one and caused either by inflammation or degenerate changes, they share common symptoms and signs, such as blood stasis, ischemia, thrombosis, ecchymosis, swelling, constriction or obliteration of blood vessels due to circulatory impairment. Since they share common characteristics, the treating principles and methods will be discussed as follows.

营养支持对多器官功能不全综合征的治疗作用

目的为了观察营养支持对多器官功能不全综合征(MODS)治疗的临床作用.方法对4例多器官功能不全综合征病人进行肠内与肠外营养治疗,其中男性2例,女性2例.4个重要脏器受损2例,3个器官受损2例.原发病因中2例为腹腔内严重感染,2例为重症坏死性胰腺炎.在治疗原发病及必要器械支持的同时给予病人肠内与肠外营养,早期以肠外营养支持为主,其中非蛋白热卡30Kcal·hg-1·d-1,脂肪占40%～50%,氮量0.25g·k8-1.d-1,如伴肾功能衰竭则氮热比降至1g:400Kcal,氮源主要给予必需氨基酸.所有病人均辅以少量肠内营养(口服谷氨酰胺Gln),并视肠功能情况逐渐向肠内营养过渡.结果3例病人痊愈出院,1例死亡.营养支持时间长47天,短23天.除死亡病例外,其余3例病人随营养支持全身情况和营养指标改善,治愈出院.讨论①要正确理解和接受MODS这一新的命名,它能更准确地反应此综合征进行性和可逆性的特点,从而指导早期诊断和治疗.②MODS病情凶险,机体处于严重应激,蛋白质分解,机体器官功能和免疫力下降,营养支持能为病人提供足够而合理的营养代谢底物,纠正机体负氮平衡,为MODS的抢救成功奠定基础.③严重应激时肠屏障功能受损,细菌和内毒素移位必将加重MODS,补充Gln和早期少量进食是预防和阻断加重MODS的重要环节,同时早期少量进食还能改善危重病人内脏微循环障碍,加速病人恢复.④保持内环境稳定对MODS的治疗很重要,对呼衰病人要限制糖量,提高脂肪乳比例.氮量的补充除肾衰外应提高支链氨基酸含量,肾衰则给予小量必需氨基酸.结论合理的营养支持能使MODS渡过危险而漫长的病理过程,改善预后.

肠外营养支持临床应用七年回顾

目的分析7年来肠外营养支持在我院临床应用的疗效.方法据不完全统计,从1992年中旬到1999年11月,对2768例病人进行了以肠外营养为主的营养支持.凡严重感染、创伤可能引起之营养不良,不能进食,胃肠道无功能或胃肠道需要休息,以及各种原因引起或即将引起营养不良者均为肠外营养适应症.2768例病人分布于我院普外科,SICU、烧伤、胸外、骨科、干疗科,神经内科,肾内,血液等17个科室,其中外科系统占71.8%,内科仅占28.2%.结果和结论1.肠外营养是治疗危重病人的重要手段,它使重症胰腺炎,肠瘘,严重感染,严重创伤等病人获得了治愈机会.2.危重病人处于严重应激和代谢紊乱,治疗中应遵循代谢支持原则,减少糖量,增加氮量.3.治疗中应注意保护胃肠粘膜屏障,少量早期进食和口服谷氨酰胺是保护胃肠粘膜屏障简单有效的方法.4.对于严重创伤病人,尽管提供了足够而合理的营养底物,但病人的分解代谢并不因此而减轻,给予代谢调理剂(如生长激素)是有益的.5.肿瘤病人的营养支持应配合化疗或用于围手术期,肝功能差的病人则应提高支链氨基酸含量,肾衰病人应降低氮量,主要提供必需氨基酸.6.一旦肠道能利用就要尽可能利用,肠内营养能保护肠屏障功能,还能改善内脏血液循环障碍,加速重症病人的康复.7.肠外营养的并发症时有发生,要特别注意.

PPARγ激动剂噻唑烷二酮类药物对心血管保护及安全性现状

过氧化物酶体增殖物激活受体(peroxisome proliferators activated receptor,PPAR)是一类由配体激活的核转录受体,分为PPARα、PPARβ和PPARγ.噻唑烷二酮类药物(thiazolidinediones,TZDs)是PPARγ的合成配基,可以激活PPARγ,改善胰岛素抵抗,增加脂肪酸氧化[1].

Astrocytes are intimately involved in the formation and development of retinal vessels. Astrocyte dysfunction is a major cause of blood-retinal barrier injury and other retinal vascular diseases. In this study, the development of the retinal vascular system and the formation of the blood-ret-inal barrier in mice were investigated using immunolfuorescence staining, gelatin-ink perfusion, and transmission electron microscopy. The results showed that the retinal vascular system of mice develops from the optic disc after birth, and radiates out gradually to cover the entire retina, taking the papilla optica as the center. First, the superifcial vasculature is formed on the inner retinal layer;then, the vasculature extends into the inner and outer edges of the retinal inner nuclear layer, forming the deep vasculature that is parallel to the superifcial vasculature. The blood-retinal barrier is mainly composed of endothelium, basal lamina and the end-feet of astrocytes, which become mature during mouse development. Initially, the naive endothelial cells were immature with few organelles and many microvilli. The basal lamina was uniform in thickness, and the glial end-feet surrounded the outer basal lamina incompletely. In the end, the blood-retinal barrier matures with smooth endothelia connected through tight junctions, rela-tively thin and even basal lamina, and relatively thin glial cell end-feet. These ifndings indicate that the development of the vasculature in the retina follows the rules of“center to periphery”and“superifcial layer to deep layers”. Its development and maturation are spatially and tempo-rally consistent with the functional performance of retinal neurons and photosensitivity. The blood-retinal barrier gradually becomes mature via the process of interactions between astro-cytes and blood vessel cells.

Arsenic in drinking water is a worldwide health problem that is associated with cardiovascular disease, but the cause is currently unknown. In order to examine whether arsenic affects vasomotor tone in blood vessels, we investigated the effect of arsenic on agonist-induced vasorelaxation and vasoconstriction using the isolated rat aortic rings in in vitro organ bath system.

Objective. To observe the regulating effects of vascular endothelial growth factor (VEGF) and angiotensinⅡ (ANG II) on the frog's pericardium, lymphatic stomata and angiogenesis so as to reveal their effects and mechanism on the mesothelial permeability, lymphatic stoma regulation and myocardial hypertrophy. Methods. VEGF and ANGⅡ were injected into the frog's peritoneal cavity so as to examine the changes of the pericardial stromata by using transmission electron microscopy, scanning electron microscopy and computerized imaging analysis. Results. Scattered distributed pericardial stomata were found on the parietal pericardium of the frog with a few sinusoid mesothelial cells, whose blood supply was directly from the cardiac chambers flowing into the trabecular spaces of the myocardium (because there are no blood vessels in the myocardium of the frog). The average diameters of the pericardial stomata in VEGF and ANGⅡ groups were 1.50 μ m and 1.79 μ m respectively, which were much larger than those in the control group (0.72 μ m, P< 0.01); the average distribution densities of the stomata were 8.25/0.1 mm2 and 12.80/0.1 mm2 in VEGF and ANGⅡ groups, which were also much higher than those in the control group (3.57/0.1 mm2, P< 0.01); the sinusoid areas in VEGF and ANGⅡ groups were 2442.95 μ m2/0.1 mm2 and 2121.79 μ m2/0.1 mm2, which were larger than that in the control group (995.08 μ m2 /0.1 mm2 , P< 0.01); no angiogenesis was found in the frogs of the experimental groups. Conclusions. VEGF and ANGⅡ could strongly regulate the pericardial stomata by increasing their numbers and openings with larger diameters and higher distribution density. They could also increase the sinusoid areas with the result of the higher permeability of the pericardium, which clearly indicated that VEGF and ANGⅡ could speed up the material transfer of the pericardial cavity and play an important role in preventing myocardial interstitial edema. Yet there was no strong evidence to show the angiogenesis in the myocardium.

血管内皮细胞生长因子的血管新生、神经新生及神经保护作用

血管内皮细胞生长因子(VEGF)又称血管通透因子(VPF),于1989年被正式克隆确认,是体内一种强效促血管生成因子,能直接作用于血管内皮细胞促进血管内皮细胞的增殖,直接或间接参与血管生成,增强血管通透性[1].目前认为,血管内皮细胞生长因子还直接作用于神经元,促进神经突触延伸,具有神经保护和神经新生作用[2].现将血管内皮细胞生长因子在神经系统方面作用的研究进展综述如下.

超声对2型糖尿病合并缺血性脑血管病患者的颈动脉内中膜厚度及斑块评价的应用价值

目的：探讨超声测量颈动脉内-中膜厚度(IMT)及斑块在2型糖尿病合并缺血性脑血管病中的应用价值。方法使用彩色多普勒超声仪对糖尿病与缺血性脑血管病组60例及正常对照组60例进行颈部血管彩超检查，并对I M T及斑块情况进行检测，分析相互之间的关系。结果糖尿病与与缺血性脑血管病组颈动脉平均IMT厚度明显高于对照组。糖尿病与与缺血性脑血管病组颈动脉斑块阳性率及血管狭窄率明显高于对照组。结论超声不仅可以检测2型糖尿病患者IMT及斑块，并可以确定斑块的性质，为临床预测缺血性脑血管病组的发生提供参考依据。

1例吻合血管的小肌肉游离移植动态修复晚期面瘫的围术期护理

面瘫是由多种原因造成的面神经损害,是以面部表情功能丧失和组织营养障碍为主要表现的综合证候群.面瘫的主要症状是面部表情肌功能不全或丧失,导致口角歪斜、眼睑闭合不全,给病人生活、工作和社交带来极大困难[1].吻合血管的肌肉游离移植治疗面瘫在国内外有很多的报道,但近几年尚未见关于运用完整的小肌肉游离移植治疗面瘫的报道.2008年 1月我科收治了1例晚期面瘫病人,通过应用吻合血管去神经的拇趾短伸肌游离移植手术治疗,经过20 d的精心护理,病人痊愈出院,动态功能恢复较理想.现报道如下.

多排CT在全身血管成像中的应用现状

自1972年Hunsfield发明的CT首次应用于人体检查以来,CT设备在30余年时间里经历了翻天覆地的变化.1988年单排螺旋CT成功应用于临床;1998年同时能进行4层图像采集的多层CT机问世;2001-2002年推出了16层采集的CT机,薄采集层厚达0.5 mm,每圈扫描采集时间为0.5s;2003年又推出了64层多排采集的CT机,每圈扫描采集时间可达0.33 s;紧接着又产生了128排、320排CT机,每圈扫描采集时间仅为0.27～0.3 s.可以说,多层螺旋CT代表着今后相当长一段时间内CT发展的方向.

对老年缺血性脑血管疾病脑血流及功能分析

BACKGROUND: The ischemic cerebrovascular disease ofsenile patients has the features of high recurrence rate, bad prognosisand many influence factors. The coming out of CT makes diagnosis ofcerebrovascular disease getting reliable foundation. But the diagnosisof CT can not determine the location of specific blood vessels ofresion, especially the ischemic changes caused by spasm and nar-rowness of blood vessels in early period. In addition, examination ofcerebral angiography can cause trauma, so patients with severecerebrovascular disease can not endure it.

前列地尔对突发性耳聋听力恢复的效果分析

BACKGROUND: Sudden deafness means sudden unknownneural deafness, which exact cause has not been found. And theroutine treatment adopts low molecular dextran and power mixtureand usually has a long course of treatment. Alprostadil useslipo-microball as carrier and does not easily lose activity and has theproper of distributing to injured blood vessehs, so brings into fullplay in dilating blood vessels and inhibiting gathering of bloodplatelet, which is used for curing sudden deafness.

脑超声扫描仪及生物电反馈对颅脑损伤后持续性植物状态的康复作用

BACKGROUND: Persistent vegetable state(PVS) means a special vegetable state. Brain ultrasonic wave scaning apparatus can improve the activity of enzyme, strenthen the permeability of cellular membrane and stimulate peripheral nerve to expand cerebral blood vessels. It also can add brain emtabolism, increase cerebral blood quantity and benefit the building of collateral circulation.

丹奥对脑梗死神经功能恢复的近期疗效观察

Backgroud:The cerebral infarction is one of the major reasons which cause deathes or disabilities in the aged.The initiaion factors of cerebral infarction were increased aggregation of the platelets and released thromboxane synthase(TXA2).Tehenzyme caused the aggregation of the platelets and the constration of blood vessels and so caused the formation of thrombus.Dan'ao(Ozagren sodium)may inhibit the synthesis of thrombus synthase,inhibit synthesis of platease and facilitate production of Prostaglandin synthase.

BACKGROUND:Corneal lymphangiogenesis is beneficial to the transport of corneal antigenic materials, and accelerates the process of antigen presentation, thereby playing an important role in corneal immunity. However, due to the paral el outgrowth of corneal blood and lymphatic vessels in transplanted corneas, it is often difficult to accurately evaluate the role of corneal lymphatic vessels in allograft rejection. OBJECTIVE:To explore the development of corneal lymphangiogenesis and angiogenesis in transplanted rat corneas after the blockade of vascular endothelial growth factor C (VEGF-C). METHODS:130 rats used to establish corneal al ogenic transplantation models were equally randomized into two groups:the anti-VEGF-C group and the control group. VEGF-C was blocked in the anti-VEGF-C group by intraperitoneal injection of neutralizing monoclonal anti-VEGF-C antibody every other day for 2 consecutive weeks. Meanwhile, rats in control groups received intraperitoneal injections of saline. Corneal angiogenesis and lymphangiogenesis were characterized using whole mount immunofluorescence, and the immune rejection of the grafts was evaluated by scoring the rejection index (RI). In addition, the expression of VEGF-C was examined by real-time PCR. The relationship of corneal lymphangiogenesis and angiogenesis to RI in transplanted corneas was also characterized. RESULTS AND CONCLUSION:VEGF-C expression was markedly downregulated after VEGF-C blockade. Corneal lymphangiogenesis developed in parallel with corneal angiogenesis in the control group. While there was a mild reduction in blood vessel area (BVA) and a significant decrease in lymphatic vessel area (LVA) in the anti-VEGF-C group (P<0.05). In addition, RI was positively correlated with BVA (P<0.05) and LVA (P<0.05) in the control group. However, although RI was significantly correlated with BVA (P<0.05) in the anti-VEGF-C group, the correlation between RI and LVA was not statistically significant (P>0.05). the graft survival time in the anti-VEGF-C group was significantly increased compared with that in the control group (P<0.05). Our results show that the outgrowth of lymphatic vessels is separated from that of blood vessels in transplanted corneas by blocking VEGF-C. The blockade of VEGF-C has a significant role in preventing corneal lymphangiogenesis in corneal beds, which results in higher al ograft survival rates.

Abducent paralysis is a kind of the pathological change of the cranial nerve, manifested mainly by the clinical symptoms of inward strabismus, limited abduction of the eyeball and double vision. It is believed in modern medicine that this disease can be caused by pathological change of the pons, basicranial metastatic carcinoma, elevated intracranial pressure, and also by inflammation in the head and face, rupture of local small blood vessels or traumatic injury. Now, Prof. WU Lian-zhong's experience in the treatment of abducent paralysis is reported in the following.

The Femoral Hernia-a rare hernia and its treatment

IntroductionHernias age protrusions through weak areas of our abdominal wall.The most common hernia is Inguinal Hernia in men.A rather rare hernia is the Femoral Hernia,a protrusion into the femotal canal next to the blood vessels in our groin (Picl).

Objective:The present study was designed to test the hypothesis that inflammation is involved in the end-organ damage(EOD) induced by sinoaortic denervation(SAD) in rats.Method:SAD was performed in male Sprague-Dawley rats at the age of 10 weeks.Under anaesthesia,aortic nerves were cut and the sinus region of the carotid artery was stripped and painted with 10% phenol.Pathological evaluation of EOD and the determination of plasma or tissue levels of the factors related to inflammation,including thromboxane B2(TXB2) interleukin-1(IL-1),tumour necrosis factor α(TNF-α) and reactive oxygen species(ROS) were performed at 16 weeks after SAD.Pathological evaluation of EOD included heart weigh ratio,myocardial and blood vessel hydroxyproline and collagen volume fraction,glomerular injury score and number of infiltrating inflammatory cells.Indomethacin(20 mg/kg per day,orally) or vitamin E(100 mg/kg per day,orally) was administered for 12 weeks,beginning from4 weeks after SAD,to observe their effects on SAD-induced EOD.Results:There were significant fibrosis and inflammatory infiltration in the myocardium and blood vessels,represented by higher hydroxyproline and collagen volume fraction,and a large amount of inflammatory cells in the tissues of SAD rats.Heart weight and kidney glomerular injury score were significantly higher in ed significantly after SAD.Indomethacin and vitamin E significantly decreased the contents of some factors related to inflammation in SAD rats.Both drugs also alleviated myocardial and vessel fibrosis,inflammatory infiltration and kidney damage.Conclusion:Inflammation is involved in the organ damage induced by SAD in rats.