【摘要】 目的 探讨急性肾缺氧复氧损伤过程中氧化侵袭与肾细胞凋亡在肾损伤发生机制中的作用。 方法 20只雄性新西兰大白兔随机分成两组，每组10只。正常对照组（A组）：吸入空气6 h。单纯缺氧复氧组（B组）:经自制面罩吸入8% O2 3 h，缺氧结束后吸入空气复氧3 h，制成全身缺氧复氧模型。复氧结束后立即处死动物，取出肾脏组织，一份行HE染色，观察组织病理学改变，一份供半胱氨酸蛋白酶3（caspase-3）检测，一份供检测丙二醛（MDA）、超氧化物歧化酶（SOD）。 结果 病理学检查结果显示，A组肾脏组织结构基本正常，未见病理性改变，肾脏组织中极少的caspase-3阳性细胞表达。B组:肾小管上皮细胞肿胀，空泡变性；可见少量坏死，管腔明显扩张；caspase阳性蛋白表达指数（29.3±5.7）%。B组和A组MDA分别为（28.05±1.92）、（7.88±1.69）nmol/g；SOD分别为（218±18.41）、（372±13.14）U/g，两组比较，均有统计学意义（Plt;0.05）。 结论 兔肾脏缺氧复氧损伤与氧化侵袭与细胞凋亡密切相关。【Abstract】 Objective To investigate the effect of oxidative invasion and cellular apoptosis on the mechanism of kidney injury during the process of acute renal hypoxic-reoxygenation injury. Methods Twenty male white New Zealand rabbits were selected and randomly divided into two groups with 10 rabbits in each. The rabbits in normal control group inhaled air for 6 hours while the ones in hypoxic/reoxygenation (H/R) group breathing in air for 3 hours inhaled 8% O2 for 3 hours after. After the H/R mode was set up, the rabbits were executed, and the kidney tissues were removed in which the caspase-3 protein expression was assessed by immunohistochemical method. Superoxide dismutase (SOD) activity and malonical aldehyde (MDA) were also detected. Results The results of pathological examination showed that the structure of renal tissues was normal with little expression of caspase-3; while swelling of renal tubular epithelial cells, vacuolar degeneration, little necrosis, dilated vascular lacuna were found in H/R group. The positive expression of caspase-3 was (29.3±5.7)% in H/R group. The contents of MDA were (28.05±1.92) and (7.88±1.69) nmol/g and SOD were (218±18.41) and (372±13.14) U/g in H/R and control group, respectively; the differences between the two groups were significant (Plt;0.05). Conclusion The acute renal hypoxic/reoxygenation injury has a correlation with oxidative invasion and cellular apoptosis.
Objective To investigate the survivability of ret inal ganglion cells (RGC) after optic nerve crush with intraocular injection of schwann cells(SC) derived neurotrophic (SCNA) in vivo． Methods Schwann cells of 3～5 day newborn mice were cultured,conditioned media without serum was collected,ultraspeed centrifugalized,and frozen-dry.SD rats were divided into normal contrl,crush control,medium treatment and SCNA treatment groups,and 20 eyes in every group.RGC of adult rats were labelled with flu orogold.Seven days later,the optic nerve was intraorbitally crushed and SCNA was injected into the vitreous on the 5th,7th,21th and 28th day after crush,the number of RGC were counted respectively. Results The densities of RGC began to decrease on the 7th day after injury,the number of RGC was 70.2% and 40.5% of normal controls on the 14th and 28th day,respectively .In the group with SCNA injection,RGC densities decreased on the 7th day,but RGC densities were much higher then that of controls on the 14th,21th,and 28th day after injury (Plt;0.01). Conclusions SCNA administered intraocularly at the time of crush of optic nerve can protect RGC from injury and death of the cells. (Chin J Ocul Fundus Dis，2000，16：1-70)
Objective To observe whether apoptosis was involved in cells of aspiration fluid from vitrectomy for proliferative vitreoretinopathy(PVR),and whether there was an association with expression of Fas antigen(Fas )and Fas ligand (FasL). Methods Cytocentrifuge slides of 11 fresh vitreous specimenｓ of PVR were prepared to be stained by TUNEL met hod for detection of apoptosis and by immunohistochemical technique for detection of Fas,FasL，and cytokeratin (CK),a cell-type specific antigen. Results Fas and FasL were expressed in normal human retina.Fas,FasL,CK，and apoptosis were found in all preparations.TUNEL-positive cells were 20.53% in total cells.70.35%,51.58%，and 82.97% of cells highly expressed Fas,FasL，and CK,respectively.The linear correlation coefficient of Fas and apoptosis was 0.99(Plt;0．001). Conclusion Vitrectomy specimens of PVR showed expression of Fas，FasL，and apoptosis.Prominent Fas and FasL expressions may be associated with apoptosis of proliferating retinal pigment epithelial cells in the vitreous of PVR. (Chin J Ocul Fundus Dis,1999,15:78-80)
Objective To investigate the preventive effect of rapid preoxygenation technique on hypoxia caused by respiratory depression during outpatient obstetrics-gynecology operations. Methods According to a computer-generated random sequence, a total of 120 ASA I-II patients undergoing outpatient obstetrics-gynecology operations were randomly allocated into the trial group or the control group, 60 in each group. Patients in the control group received preoxygenation with tidal volume breathing. Patients in the trial group received preoxygenation with eight deep breaths (DB) in 1 min before anesthesia. All patients were induced with midazolam 1 mg, fentanyl 1μg /kg and propofol 2 mg/kg, and were maintained with propofol when needed. The following parameters were observed, including the incidences of respiratory depression and apnea, the onset time of anesthesia, the total doses of propofol as well as the changes in PetCO2 and SpO2. Results No significant differences were observed in demographic characteristics, the onset time of anesthesia, the total doses of propofol, and the incidences of respiratory depression and apnea between the two groups (P gt;0.05). However, the SpO2 in the control group was decreased significantly with a higher incidence of hypoxia (Plt;0.05). Conclusions Rapid preoxygenation technique may increase the oxygen reserves and improve the tolerance to hypoxia. It is effective in avoiding hypoxia caused by respiratory depression and apnea during outpatient obstetrics-gynecology operations.
Objective To evaluate the evidence-based prevention and treatment of post-dural puncture headache (PDPH) for parturient women. Methods We searched The Cochrane Library (Issue 3, 2006), Medline (Jan. 1980 to Oct. 2006) and CBM-disc (Jan. 1980 to Oct. 2006) to identify current best evidence on the prevention and treatment of PDPH for parturient women. The quality of available evidence was critically appraised.Results We identified 2 Cochrane systematic reviews, 2 meta-analyses and 9 randomized controlled trials. Evidence indicated that posture, fluid, and pharmacological managements had no significant effect on PDPH except epidural blood patch. The selection of appropriate spinal needle and the technique of needle insertion may reduce the incidence of PDPH, whereas the effect of intrathecal saline infusion and catheter insertion need further clinical validation. Conclusions Epidural blood patch has definite therapeutic effect on PDPH. Appropriate spinal needle and insertion technique may effectively prevent PDPH for parturient women.
Objective To evaluate the current situation of the design of the randomized controlled trials (RCTs) in Clinical Anesthesiology, Chinese Journal of Anesthesiology and Chinese Journal of Pain Medicine from 1999 to September in 2003. Method The clinical therapeutic studies in the three journals from 1999 to September of 2003 were hand searched over page by page to identify strictly the randomized controlled trials according to Chinese Cochrane Center hand search guideline. Results 412, 378 and 142 papers of the three journals were published, among which, there were 237, 221 and 68 papers of RCT. Conclusions Although the quality of RCT in the three journals has been increased significantly year by year, but there still exist some problems. The quality of RCT papers needs more improvement to guarantee RCT to be more precise as it demands.