CH10P7 Blood, vessels and heart

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思普瑞肠道清洁剂说明书

Medication Guide®SUPREP (Soo-prěp) Bowel Prep Kit(sodium sulfate, potassium sulfate and magnesium sulfate)Oral SolutionRead this Medication Guide before you start taking SUPREP Bowel Prep Kit. This information does not take the place of talking with your healthcare provider about your medical condition or your treatment.What is the most important information I should know about SUPREP Bowel Prep Kit?SUPREP Bowel Prep Kit and other osmotic bowel preparations can cause serious side effects, including:Serious loss of body fluid (dehydration) and changes in blood salts (electrolytes) in your blood.These changes can cause:•abnormal heartbeats that can cause death•seizures. This can happen even if you have never had a seizure.•kidney problemsYour chance of having fluid loss and changes in body salts withSUPREP Bowel Prep Kit is higher if you:•have heart problems•have kidney problems•take water pills or non-steroidal anti-inflammatory drugs (NSAIDS)Tell your healthcare provider right away if you have any of these symptoms of a loss of too much body fluid (dehydration) while taking SUPREP Bowel Prep Kit:•vomiting that prevents you from keeping down the additional prescribed amount of water listed in the Instructions for Use in the Patient Instructions for Use Booklet•dizziness•urinating less often than normal•headacheSee Section “What are the possible side effects of SUPREP Bowel Prep Kit?” for more information about side effects.What is SUPREP Bowel Prep Kit?SUPREP Bowel Prep Kit is a prescription medicine used by adults to clean the colon before a colonoscopy. SUPREP Bowel Prep Kit cleans your colon by causing you to have diarrhea. Cleaning your colon helps your healthcare provider see the inside of your colon more clearly during your colonoscopy.It is not known if SUPREP Bowel Prep Kit is safe and effective in children.Who should not take SUPREP Bowel Prep Kit?Do not take SUPREP Bowel Prep Kit if your heathcare provider has told you that you have:• a blockage in your bowel (obstruction)• an opening in the wall of your stomach or intestine (bowel perforation)• problems with food and fluid emptying from your stomach (gastric retention)• a very dilated intestine (bowel)• an allergy to any of the ingredients in SUPREP Bowel Prep Kit. See the end of this leaflet for a complete list of ingredients in SUPREP Bowel PrepKit.What should I tell my healthcare provider before taking SUPREP Bowel Prep Kit?Before you take SUPREP Bowel Prep Kit, tell your healthcare provider if you:• have heart problems• have stomach or bowel problems• have ulcerative colitis• have problems with swallowing or gastric reflux• have gout• have a history of seizures• are withdrawing from drinking alcohol• have a low blood salt (sodium) level• have kidney problems• any other medical conditions• are pregnant. It is not known if SUPREP Bowel Prep Kit will harm your unborn baby. Talk to your doctor if you are pregnant or plan to becomepregnant.• are breastfeeding or plan to breastfeed. It is not known if SUPREP Bowel Prep Kit passes into your breast milk. You and your healthcare providershould decide if you will take SUPREP Bowel Prep Kit while breastfeeding. Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. SUPREP Bowel Prep Kit may affect how other medicines work. Medicines taken by mouth may not be absorbed properly when taken within 1 hour before the start of each dose of SUPREP Bowel Prep Kit.Especially tell your healthcare provider if you take:• medicines for blood pressure or heart problems• medicines for kidney problems• medicines for seizures• water pills (diuretics)• non-steroidal anti-inflammatory medicines (NSAID) pain medicines• laxativesAsk your healthcare provider or pharmacist for a list of these medicines if you are not sure if you are taking any of the medicines listed above.Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.How should I take SUPREP Bowel Prep Kit?See the Instructions for Use in the Patient Instructions for Use Booklet for dosing instructions. You must read, understand, and follow these instructions to take SUPREP Bowel Prep Kit the right way.• Take SUPREP Bowel Prep Kit exactly as your healthcare provider tells you to take it.• Do not drink SUPREP Bowel Prep Kit solution that has not been mixed with water (diluted), it may increase your risk of nausea,vomiting and fluid loss (dehydration).• Each bottle of SUPREP Bowel Prep Kit must be mixed with water (diluted) before drinking.• It is important for you to drink the additional prescribed amount of water listed in the Instructions for Use to prevent fluid loss (dehydration).• Do not take other laxatives while taking SUPREP Bowel Prep Kit.• Do not eat solid foods while taking SUPREP Bowel Prep Kit. Only clear liquids are allowed while taking SUPREP Bowel Prep Kit.What are the possible side effects of SUPREP Bowel Prep Kit?SUPREP Bowel Prep Kit can cause serious side effects, including:• See Section “What is the most important information I should know about SUPREP Bowel Prep Kit?”• changes in certain blood tests. Your healthcare provider may do blood tests after you take SUPREP Bowel Prep Kit to check your blood forchanges. Tell your healthcare provider if you have any symptoms of toomuch fluid loss, including:• vomiting• nausea• bloating• dizziness• stomach (abdominal) cramping• headache• urinate less than usual• trouble drinking clear liquid• heart problems. SUPREP Bowel Prep Kit may cause irregular heartbeats.• seizures• ulcers of the bowel or bowel problems• worsening goutThe most common side effects of SUPREP Bowel Prep Kit include:• discomfort• bloating• stomach (abdominal) cramping• nausea• vomitingTell your healthcare provider if you have any side effect that bothers you or that does not go away.These are not all the possible side effects of SUPREP Bowel Prep Kit. For more information, ask your healthcare provider or pharmacist.Call your doctor for medical advice about side effects. You may report sideeffects to FDA at 1-800-FDA-1088.How should I store SUPREP Bowel Prep Kit?•Store SUPREP Bowel Prep Kit at room temperature, between 59ºF to 86°F (15ºC to 30°C).Keep SUPREP Bowel Prep Kit and all medicines out of the reach ofchildren.General information about the safe and effective use of SUPREP Bowel Prep Kit.Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use SUPREP Bowel Prep Kit for a condition for which it was not prescribed. Do not give SUPREP Bowel Prep Kit to other people, even if they are going to have the same procedure you are. It may harm them.This Medication Guide summarizes important information about SUPREP Bowel Prep Kit. If you would like more information, talk with your healthcare provider. You can ask your pharmacist or healthcare provider for information that is written for healthcare professionals.For more information, go to or call 1-800-874-6756.What are the ingredients in SUPREP Bowel Prep Kit?Active ingredients: sodium sulfate, potassium sulfate and magnesium sulfate Inactive ingredients: sodium benzoate, sucralose, malic acid, citric acid, flavoring ingredients, purified waterBraintree Laboratories, Inc.Braintree, MA 02185, USAThis Medication Guide has been approved by the U.S. Food and Drug Administration.Revised Month/Year。

内皮细胞在缺血性心脏病及心力衰竭中的作用

㊃综㊀述㊃内皮细胞在缺血性心脏病及心力衰竭中的作用牛宇,张丽晖∗,王静,秦俊楠(山西医科大学附属白求恩医院综合医疗科,太原030000)ʌ摘㊀要ɔ㊀内皮细胞是上皮细胞的一种,广泛分布于心㊁血管和淋巴管腔面,在人体生理稳态中参与止血㊁血管调节㊁血管生成等重要过程㊂近年来有研究发现,内皮细胞除上述作用外,还促进了缺血性心脏病等多种疾病的病理进展,并且表现出独特的多向分化能力,其中内皮间质转分化能力与心肌纤维化及心力衰竭关系密切㊂本文主要探讨血管内皮细胞生理特点及在缺血性心脏病㊁心力衰竭治疗中的研究进展,为相关疾病治疗提供新思路㊂ʌ关键词ɔ㊀内皮细胞;内皮间质转分化;缺血性心脏病;心力衰竭ʌ中图分类号ɔ㊀R541㊀㊀㊀㊀㊀ʌ文献标志码ɔ㊀A㊀㊀㊀㊀ʌDOI ɔ㊀10.11915/j.issn.1671-5403.2021.03.051收稿日期:2020-02-20;接受日期:2020-04-03基金项目:山西省自然科学基金面上项目(201801D121202)通信作者:张丽晖,E-mail:134****5229@Role of endothelial cells in ischemic heart disease and heart failureNIU Yu,ZHANG Li-Hui ∗,WANG Jing,QIN Jun-Nan(Department of General Medicine,Bethune Hospital of Shanxi Medical University,Taiyuan 030000,China)ʌAbstract ɔ㊀Endothelial cells are one kind of the epithelial cells that widely adhere to the lumen of the heart,blood vessels,andlymphatic vessels.They are involved in important processes such as hemostasis,regulation of blood vessels,and angiogenesis in humanphysiological homeostasis.In addition,recent studies have found that endothelial cells contribute to the pathological progress of variouscardiovascular diseases and also have unique capability of multi-directional differentiation.Endothelial-mesenchymal transition is closely related to myocardial fibrosis.This article focuses on vascular endothelial cells,mainly exploring their physiological characteristics and their role in ischemic heart disease and heart failure with a view to providing new ideas for the treatment of cardiovascular disease.ʌKey words ɔ㊀endothelial cells;endothelial mesenchymal transition;ischemic heart disease;heart failureThis work was supported by the General Project of Natural Science Foundation of Shanxi Province (201801D121202).Corresponding author :ZHANG Li-Hui ,E-mail :134****5229@㊀㊀心血管疾病的发病率和死亡率逐年攀升,我国每年约有300万人死于此类疾病㊂缺血性心脏病和心力衰竭是其中重要的组成部分,了解疾病的病理机制有助于早期实施医疗干预,改善预后㊂内皮细胞在人体心血管系统中广泛分布,在维持生理稳态中起重要作用㊂近年来研究发现,病理状态下内皮细胞可以促进缺血性心脏病和心力衰竭的病情进展㊂关注并探究内皮细胞在心血管疾病中的作用机制及靶点,有望为此类疾病提供新的诊疗思路㊂本文就内皮细胞在缺血性心脏病和心力衰竭中的作用进行阐述㊂1㊀内皮细胞1.1㊀内皮细胞生理特点㊀㊀内皮细胞为鹅卵石状单层扁平上皮细胞,衬贴在心㊁血管和淋巴管腔面,在不同组织中表现出相应的器官适应性,即具备特异的形态及功能㊂例如,内皮细胞在中枢神经系统中形成血脑屏障,在子宫中表达雌激素受体,在血管系统则具备不同程度的出芽能力[1]㊂㊀㊀心脏中主要为心内膜内皮细胞和血管内皮细胞㊂前者位于心腔内侧,而后者位于心肌致密层㊂二者分别表达不同的特异性标志物,其中,apelin㊁细胞质1等为心内膜内皮细胞标志物,酸性结合蛋白4为血管内皮细胞标志物[2-5]㊂内皮细胞是人体血管系统的核心部分,在人体生理稳态中起到保障运输㊁控制血管通透性和调节血管张力的重要作用[1],其损伤㊁过度活化和功能障碍是许多心血管疾病的病因之一㊂1.2㊀内皮细胞对心血管系统的作用㊀㊀内皮细胞对血流量非常敏感,生理状态下可以适应不同的血流量条件并对其进行反应性调节,这一功能逐步丧失往往意味着内皮细胞功能障碍,并且与心血管疾病的不良预后相关[6]㊂内皮细胞可以分泌内皮素,在心肌梗死区域观察到的大量中性粒细胞浸润现象可能与内皮素的促炎症作用相关㊂同时,内皮素也能以旁分泌的方式作用于血管平滑肌细胞,促使后者收缩,而这一作用在一定程度上可以限制局部炎症反应㊂内皮细胞还可以分泌内皮型一氧化氮合酶(endothelial nitric oxide synthase, eNOS),从而升高NO水平,抑制内皮素1,并且起到抑制动脉粥样硬化的作用[7]㊂此外,内皮细胞还可以分泌前列环素㊁血栓素A2等多种活性物质参与血管生理的调节㊂2㊀内皮细胞与缺血性心脏病2.1㊀内皮细胞的影响因素㊀㊀内皮细胞对缺氧的耐受性较好,但是对缺血再灌注损伤敏感,坏死的心肌细胞和缺氧都可以激活内皮细胞,使其被白细胞识别并攻击[8]㊂内皮细胞还容易受到氧自由基(reactive oxygen species,ROS)的损害,研究表明,适度的ROS刺激对细胞生命活动有利,但长期线粒体ROS负荷可以促使冠状动脉内皮细胞凋亡[9]㊂脉动层流利于内皮细胞分泌eNOS㊁维持血清中NO水平,从而抑制内皮素1,而湍流及高剪切应力可以促进内皮细胞重塑,打破NO和内皮素1的平衡,进而促进不稳定动脉粥样硬化斑块形成㊂高血糖也是激活内皮细胞的重要因素,通过TLR2和TLR4/MyD88/NF-kB/AP1等信号通路导致内皮细胞糖萼脱落,促进白细胞黏附和增加ROS负荷,使糖尿病患者更易发生心血管损害㊂2.2㊀内皮细胞对缺血性心脏病的影响㊀㊀内皮细胞参与了缺血性心脏病病理机制的多个环节,并对病情进展起到重要作用㊂心肌梗死区域微血管灌注不足是决定不良心血管事件的关键因素,而这一过程与内皮细胞功能障碍密切相关㊂由于梗死区域的局部炎症作用,内皮细胞屏障功能丧失㊁糖萼损耗,加之离子泵丧失引起的电解质浓度变化,导致血管通透性增加㊁水肿形成,而局部压迫作用又进一步减少了微血管灌注[10]㊂此外,在梗死区域,内皮素作用更占优势,血管活动往往表现为过度收缩,进一步导致血管重塑㊁微循环障碍㊂当冠状动脉粥样硬化病灶出现斑块脱落㊁或接受介入治疗后产生微量血栓栓塞时,这些栓子均可能因黏附分子表达增加而形成细胞聚集体,从而进一步减少微血管灌注[11]㊂㊀㊀在缺血性心脏病中,内皮细胞既是受损靶点,也是促进疾病进展的始动因素㊂病理状态下,内皮细胞促血管生成作用激活导致屏障功能丧失,水肿形成,促炎症作用激活增加了黏附分子表达,并引起白细胞大量浸润㊂过多的免疫细胞浸润进一步对已受损组织造成二次打击㊂内皮细胞合成NO的能力下降进一步加重了心脏的血管闭塞㊂此外,内皮细胞活化有利于血栓形成㊂㊀㊀综上所述,大多数血管病变始于经典内皮功能破坏,加之内皮细胞在免疫应答中的核心作用,加剧了损伤㊂因此,有必要在心血管疾病的传统治疗方案中加入靶向性内皮细胞治疗㊂有学者建议,在足够的侧支循环存活的情况下,可以采取心脏保护性干预措施来增加危险区域的微血管灌注[12]㊂目前,已有临床试验显示内皮祖细胞移植疗法在急性脑梗死患者中取得显著成效[13]㊂远端缺血预处理也在动物模型中体现出了心脏保护作用,并且涉及内皮细胞的相关分子机制研究已取得初步进展,这使得内皮细胞成为治疗缺血性疾病新的潜在靶标㊂3㊀内皮细胞与心力衰竭3.1㊀内皮间质转分化作用㊀㊀内皮间质转分化是指内皮细胞失去原有的细胞形态及紧密连接和特异性标志物,迁移到周围组织并获得间质细胞特征形态,表达间质细胞产物的分化过程㊂间质细胞呈星形或纺锤形,因缺乏细胞间黏附与紧密连接,可以自由迁移并通过细胞外基质,形成结缔组织并起到器官支持的作用[14],具有多向分化能力,也称为间充质干细胞㊂近年来在多种纤维化疾病中均发现间质细胞具有促进成纤维细胞生成的作用[15]㊂内皮细胞发生间质转分化后特异性标志物表达发生改变:内皮细胞标志物(如VE-钙粘蛋白㊁CD31)丢失,间质细胞标志物(如波形蛋白㊁前胶原I㊁成纤维细胞特异性蛋白1)表达上调[16]㊂㊀㊀在心脏发育过程中,心内膜的内皮细胞也发生了内皮间质转分化,并进一步形成房室垫㊁瓣膜原发层及隔膜的基质㊂研究表明,这一过程也为成熟心脏瓣膜提供了多向分化的祖细胞储备,特定条件下可以转化为多种细胞群㊂内皮间质转分化可能会在整个生命活动过程中参与内皮细胞的修复和补充[17]㊂3.2㊀内皮间质转分化与心力衰竭㊀㊀近年来,由于人口年龄结构和生活模式的改变,以及急性心肌梗死存活率显著升高等因素,全球心力衰竭的发病率逐年攀升㊂心力衰竭始于心肌损伤,导致病理性重塑,最终多种神经-体液机制激活诱发直接细胞毒性,引起心肌纤维化,导致心力衰竭㊂成纤维细胞通过促进心室重构,加速心肌梗死后心肌细胞功能丧失,在心肌纤维化及心力衰竭中起到重要作用㊂而内皮细胞可以通过内皮间质转分化参与成纤维细胞的形成,从而促进心室重构和心肌纤维化[18]㊂这一作用可能与内皮细胞多向分化能力㊁间质的相互作用以及复杂的内分泌因子调节作用相关[19]㊂心肌纤维化的主要介导细胞为成纤维细胞㊂除了常驻间质成纤维细胞外,还可以由骨髓细胞或上皮细胞分化而来㊂Zeisberg等[20]利用谱系分析和免疫荧光双染技术确定了内皮细胞通过内皮间质转分化作用成为心脏成纤维细胞的来源之一,约占总数的1/3㊂并且这一过程在体内外均可发生㊂随着相关研究进一步深入,目前可以确定成纤维细胞是异质群体,在纤维化疾病中具有多种来源㊂此外,内皮间质转分化不仅参与心肌纤维化,也可能参与狭窄血管中新内膜的形成㊂㊀㊀心肌纤维化过程会显著损害心脏功能,不仅可以直接导致心室壁弹性及收缩力下降,还会导致心脏电传导异常㊂不论何种原因导致的心肌纤维化,均与间质中成纤维细胞过度聚集以及细胞外基质蛋白过量分泌有关㊂这些间质中的成纤维细胞,有很大一部分是通过转化生长因子β(transforming growth factorβ,TGF-β)依赖性过程由内皮细胞经过内皮间质转分化转化而来[21]㊂除涉及多种相关信号通路外,研究者还观察到,内皮间质转分化与表观遗传学关系密切,DNA甲基化㊁组蛋白修饰及一些调控因子有望成为阻断内皮间质转分化过程的潜在靶标[22]㊂也有研究表明,慢性肾脏病患者心脏内源性Klotho丢失促进了TGF-β1信号转导增强,从而上调Wnt信号转导,促进心肌纤维化[23],也为阻断内皮间质转分化提供了有效途径㊂此外,目前已经观察到参与胚胎时期心内膜内皮间质转分化过程的多种信号通路与心血管疾病中涉及的信号通路一致,且在多种心血管疾病(包括心脏瓣膜疾病㊁心肌梗死㊁心力衰竭㊁心内膜弹力纤维增生症㊁动脉粥样硬化和肺动脉高压)中发现有内皮间质转分化参与,例如在动脉粥样硬化中,巨噬细胞可以促进内皮间质转分化,而这种改变可以影响动脉粥样硬化斑块的形成[24]㊂3.3㊀内皮间质转分化抑制因子㊀㊀内皮细胞可以经过内皮间质转分化成为成纤维细胞,但生理状态下这一过程在体内受到不同程度的抑制㊂研究人员观察到,在缺血性二尖瓣反流中二尖瓣小叶增厚,内皮细胞发生内皮间质转分化,同时二尖瓣内皮细胞和间质细胞分泌可溶性因子,分别抑制间质细胞激活以及TGF-β诱导的内皮间质转分化㊂骨髓来源的间充质干细胞也能够抑制TGF-β诱导的瓣膜内皮细胞间质转分化,研究者观察到这种细胞与间质细胞具有相同的特异性标志物㊂TGF-β以外的许多因素,例如不稳定剪切应力和振荡剪切应力㊁TNF-α和白细胞介素-6 (interleukin-6,IL-6)㊁高糖等均可诱导内皮间质转分化,但尚未明确间质细胞分泌的这种可溶性因子是否能够预防由上述刺激因素所诱导的内皮间质转分化[25]㊂有人推测间质细胞产生的可溶性因子可能作用于生长因子的下游,通过刺激成纤维细胞生长因子(fibroblast growth factor,FGF)受体或下游信号分子来降低内皮细胞对TGF-β的反应能力㊂目前,该分泌因子的性质和特性以及它们阻止内皮间质转分化的机制尚未明确㊂㊀㊀内皮间质转分化在其他纤维化疾病(如肺纤维化和肾脏纤维化)以及癌症进展期,均表现出诱导成纤维细胞形成的作用[26]㊂明确内皮间质转分化抑制因子的生化性质及作用机制可能为多种纤维化疾病的治疗提供新思路㊂4㊀结论与展望㊀㊀综上所述,内皮细胞在生理及病理状态下,都不仅仅表现为静态的机械保护,而是动态的参与其中并发挥重要作用㊂在缺血性心脏病中,内皮细胞不仅是受害者,也是疾病的促发因素,其免疫作用和促血管生成作用的激活成为疾病进展的核心环节,并导致恶性循环㊂内皮细胞独特的内皮间质转分化作用不仅在心脏发育和瓣膜修复中扮演重要角色,更参与了心力衰竭及其他多种纤维化性疾病的形成和进展,并且已发现体内存在内皮间质转分化抑制因子㊂在未来的研究当中应进一步探讨干预内皮细胞功能的有效靶点,这有望为缺血性心脏病及心力衰竭等纤维化性疾病提供新的治疗思路㊂ʌ参考文献ɔ[1]㊀Sattler S,Kennedy-Lydon T.The Immunology of CardiovascularHomeostasis and Pathology[M].Lydon:Springer International Pub-lishing,2017:17-118.[2]㊀Zhang H,Pu W,Liu Q,et al.Endocardium contributes to cardiacfat[J].Circ Res,2016,118(2):254-265.DOI:10.1161/CIRCRESAHA.115.307202.[3]㊀Zhang H,Pu W,Li G,et al.Endocardium minimally contributesto coronary endothelium in the embryonic ventricular free walls[J].Circ Res,2016,118(12):1880-1893.DOI:10.1161/CIR-CRESAHA.116.308749.[4]㊀He LJ,Tian XY,Zhang H,et al.BAF200is required for heartmorphogenesis and 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[21]Evangelia P,Gonzalo SD,Maria GP,et al.TGF-β-inducedendothelial-mesenchymal transition in fibrotic diseases[J].Int J Mol Sci,2017,18(10):1810-2157.DOI:10.3390/ijms18102157.[22]Melanie SH,Xingbo X,Guido K,et al.Epigenetic regulation ofendothelial-to-mesenchymal transition in chronic heart disease[J].Arterioscl Throm Vas,2018,38(9):1986-1996.DOI:10.1161/ATVBAHA.118.311276.[23]Qinghua L,Langjing Z,Ana Maria WG,et al.The axis of localcardiac endogenous Klotho-TGF-β1-Wnt signaling mediates cardiac fibrosis in human[J].J Mol Cell Cardiol,2019,136(1): 113-124.DOI:10.1016/j.yjmcc.2019.09.004. 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《人工心脏》ppt课件PPT23页

▪ Carmat TAH由法国杰出的心脏外科医生卡彭铁尔（Alain Carpentier）发明，电动驱动，双心室完成射血，其形态和生理学对自然心脏的模拟度更高。使用牛心包等生物材料，降低了血栓栓塞并发症和排斥反应风险；内置诸多传感器以感受心室压力变化，根据患者运动或安静状态调整相应心输出量。该器械预期使用寿命为5年，大小与自然心脏相当，但重量超过900g
JARVIK-7/CARDOWEST全人工心脏
▪ 1970年，美国Utah大学的Kolff博士及其团队研制了Jarvik-7TAH。该装置是一个气动的、双心室搏动泵，血泵用人工合成的材料连接到自体心房，每个泵中都有柔韧度很好的合成材料膜将空气和血分开。机械瓣膜保证血流向单一方向流动。泵的频率，压力和收缩时间都可以进行控制。Jarvik-7TAH的射血量为70mL，心输出量为6～8L/min （最大为15L/mim）。
▪ 在Ⅰ期临床试验中，14例患者植入 AbioCorTAH作为永久支持治疗，其中有两例患者出现泵的功能障碍，试验发现血栓栓塞是其最主要的并发症，最长的支持时间为512 天。AbioCorTAH体积大，只能应用于胸腔体积较大的患者。应用较少，还没有通过美国 FDA认证。
2013年更新型TAH
▪ 2013年12月，被称为“全球第一颗永久性生物合成人工心脏”的法国Carmat公司 TAH被首次置入人体，Carmat心脏临床可行性研究纳入的第一例患者在术后75天死亡，第二例患者于2014年9月8日接受置入。
▪ 2004年，美国FDA批准CardioWest 全人工心脏作为移植前的辅助治疗措施在使用，它也是唯一一个经美国 FDA以及欧洲CE认证可进行临床应用的全人工心脏。
▪ 到目前为止，全世界共有1250例 CardioWest全人工心脏的临床应用，其中2013年植入为161例，最长的辅助时间为1374天（将近4年）。目前该全人工心脏也在进行永久性人工心脏移植的临床试验。

机械通气临床应用指南(中华重症医学分会2024)

机械通气临床应用指南中华医学会重症医学分会（2024年）引言重症医学是探讨危重病发生发展的规律，对危重病进行预防和治疗的临床学科。

器官功能支持是重症医学临床实践的重要内容之一。

机械通气从仅作为肺脏通气功能的支持治疗起先，经过多年来医学理论的发展及呼吸机技术的进步，已经成为涉及气体交换、呼吸做功、肺损伤、胸腔内器官压力及容积环境、循环功能等，可产生多方面影响的重要干预措施，并主要通过提高氧输送、肺脏爱护、改善内环境等途径成为治疗多器官功能不全综合征的重要治疗手段。

机械通气不仅可以依据是否建立人工气道分为“有创”或“无创”，因为呼吸机具有的不同呼吸模式而使通气有众多的选择，不同的疾病对机械通气提出了具有特异性的要求，医学理论的发展及循证医学数据的增加使对呼吸机的临床应用更加趋于有明确的针对性和规范性。

在这种条件下，不难看出，对危重病人的机械通气制定规范有明确的必要性。

同时，多年临床工作的积累和多中心临床探讨证据为机械通气指南的制定供应了越来越充分的条件。

中华医学会重症医学分会以循证医学的证据为基础，采纳国际通用的方法，经过广泛征求看法和建议，反复仔细探讨，达成关于机械通气临床应用方面的共识，以期对危重病人的机械通气的临床应用进行规范。

重症医学分会今后还将依据医学证据的发展及新的共识对机械通气临床应用指南进行更新。

指南中的举荐看法依据2024年ISF提出的Delphi分级标准(表1)。

指南涉及的文献依据探讨方法和结果分成5个层次，举荐看法的举荐级别依据Delphi分级分为A E级，其中A 级为最高。

表1 Delphi分级标准举荐级别A 至少有2项I级探讨结果支持B 仅有1项I级探讨结果支持C 仅有II级探讨结果支持D 至少有1项III级探讨结果支持E 仅有IV级或V探讨结果支持探讨课题分级I 大样本，随机探讨，结果清楚，假阳性或假阴性的错误很低II 小样本，随机探讨，结果不确定，假阳性和/或假阴性的错误较高III 非随机，同期比照探讨IV 非随机，历史比照和专家看法V 病例报道，非比照探讨和专家看法危重症患者人工气道的选择人工气道是为了保证气道通畅而在生理气道与其他气源之间建立的连接，分为上人工气道和下人工气道，是呼吸系统危重症患者常见的抢救措施之一。

CRRT的几个基本概念

Return Pressure Positive +50 to +150 mmHg
Effluent Pressure Negative or Positive >+50 to -150 mmHg
高通量旳滤器面积 1.6-2.2平方米
HVHF
总之，对重症脓毒血症或合并休克患者， CRRT极难设定上限计量，尚需研究，超滤
率至少应≥35ml/kg/h。
Access Pressure Negative -50 to -150 mmHg
Filter Pressure Positive +100 to +250 mmHg
凝措施）局部肝素抗凝法局部枸橼酸盐抗凝法低分子肝素抗凝法无肝素抗凝法前列腺素抗凝法
前列腺素抗凝法
原理：阻断血小板粘附功能和汇集功能有人以为比肝素安全，半衰期极短（2min) 缺陷：停用后抗血小板活性时间长（24H）无中和制剂调整需依赖血小板汇集试验药物剂量依赖性低血压发生率高应用
技术构成三
滤器聚砜膜（AV400及AV600）滤器聚丙烯腈膜（AN69）滤器
AN 69
AV600
血液滤过器旳构造
血液入口
透析液和滤出液出口
横断面
空心纤维膜
透析液入口
血液出口
空心纤维外面（滤出液）空心纤维里面（血液）
血滤器
种类
聚砜膜
聚丙烯晴膜
聚酰胺
膜通透性
低通量滤器 <10000D
治疗中旳经典压力
治疗中旳经典压力
动脉压Access Pressure
测量当血液离开病人血液通路(例如双腔导管)时旳压力(体外旳)

美国导管相关血流感染预防与控制技术指南的分析

• Rupp, et al. Ann Intern Med, 2005 (CHG/SS vs Control CVC)
– 393例CVC导管定植的发生率：锁骨下为5%，颈内为19%，股静脉为39%
• Raad, et al. Ann Intern Med, 1997
– 266例CVC导管定植的让步比：锁骨下VS 颈内为 0.39(p=0.02);锁骨下VS股静脉为0.28(p=0.002)
3. 手卫生和无菌操作
1.在触摸插管部位前、后，以及插入、重置、触碰、维护导管及更换敷料前、后时，均应严格执行手卫生程序，可以是传统的皂液和水，或者用酒精擦手液。在对插管部位进行消毒处理后，不应再触摸该部位，除非采用无菌操作。（ⅠB）
2.在进行插管和维护操作时须无菌操作。（ⅠB） 3.进行周围静脉置管时，若对插管部位进行皮肤消毒后不
教育项目的效果
• 外科ICU • 为ICU护士制定的10页
自学模块材料 • 总体的BSI发生率
– 教育前：10.8/1000 导管日
– 教育后：3.7/1000导管日
Coopersmith CM, et al. Critical Care Med, 2002
病人/护士比率和人员水平
• 在SICU内，中心静脉导管相关BSI 爆发与病人数与护士数比例有关
病学上的研究或理论依据 • 未解决的问题.代表一个尚未解决的争议性措施，因为
没有充分的实证或目前无法判断其实施的效果性
推荐程度总结
• Total 103 recommendations 所有103项推荐
– 21 IA – 37 IB – 3 IC – 31 II – 11项为未解决的问题
1.教育、培训与人员配备

中国血液透析用血管通路专家共识(第2版)解读(医学知识)

量4倍、无法达到充分性透析。 • 原因：纤维蛋白鞘和/或血栓形成
医药医学
30
导管功能不良的预防
定期采用尿激酶封管可以降低导管的血栓发生率
尿激酶浓度差别较大(10000～50000IU/ml)，目前尚无统一认识
经常发生导管血栓或流量不佳的高凝患者，可考虑服用血小板抑制剂或抗凝剂，但需定期监测凝血功能。
医药医学
3
一、血管通路的临床目标
首选AVF(autogenous arteriovenous fistula) 次选AVG(arteriovenous graft) 最后TCC(tunnel-cuffed catheter)
医药医学
4
一、血管通路的临床目标
血管通路的比例：AVF＞80%、TCC＜10%
初始建立AVG的失败率：前臂直型 AVG＜15%、前臂袢型 AVG＜10%、上臂AVG＜5%
AVF并发症和通畅性：①血栓形成＜0.25次/患者年、②感染＜1%、③使用寿命≥3年
AVG 并发症及通畅性：①血栓＜0.5 次/患者年、②感染 ≤10%、③使用寿命≥2 年、④PTA术后使用寿命：≥4个月
首次透析的血管通路类型选择：内瘘第一
股静脉临时导管原则上不超过1周，长期卧床者可以视情况酌情延长至2～4周
医药医学
26
导管长度的选择
导管长度
临时、NCC (导管体内长
度)
半永久、TCC (导管全长)
右颈内静脉（CM）
12～15
36～40
左颈内静脉（CM）
股静脉（CM）
15～19
>19
40～45
>45
医药医学
27
儿童患者
• 不能配合置管操作的儿童患者施行颈内静脉或锁骨下静脉置管时建议采用基础麻醉

(IE工业工程)IEC60479-1_1994-汉译文

健康和安全执行局
采暖、通风与空气调节设备制造商协会
内政部
独立工程保险委员会
电气工程师学会
执行工程师联合协会
工厂设备工程师学会
照明协会
照明工业联邦协会
英国国家电气安装监察委员会
本出版文件是在电工行业委员会的指导下制定的，经标准委员会许可出版并于1995年4月15日生效。
© BSI 08-1999版权所有
在接触电压出现瞬间，限制电流峰值的电阻。
1.3.2在15Hz至100Hz范围内的正弦交流电流的效应
1.3.2.1感知阈
通过人体能引起任何感觉的电流的最小值
1.3.2.2反应阈
引起肌肉不自觉人手握电极能自行摆脱电极时接触电流的最大值
1.3.2.4心室纤维性颤动阈
通过人体能引起心室纤维性颤动的电流最小值
本报告适用于主要由电流引起死亡的心室纤维性颤动域。根据最近对心脏生理学和纤维性颤动域研究工作成果的分析，有可能更好地理解主要物理参数的影响，尤其是电流持续时间的影响。
最近，还进行了关于其他次要物理参数，尤其是电流的波形和频率以及人体阻抗的研究工作。因此，对IEC479的这一修订被认为是必要的，并且应被看作是第2版的合乎逻辑的发展和演变的结果。
当接触电压达到大约直流50 V，即使是同一个人，皮肤阻抗的值也会随着条件的不同而发生很大的变化，如接触的表面积、温度、出汗以及快速呼吸等。
当接触电压较高，大约超过50 V时，皮肤阻抗会大幅下降；而当皮肤被击穿时，皮肤阻抗就可以忽略不计了。
至于频率的影响，则是频率增加时皮肤阻抗降低。
2.3人体总阻抗（ZT）
1.3定义
本技术报告应用以下定义。
1.3.1人体电阻抗
1.3.1.1人体的内阻抗（Zi）

neural stem cell culture protocol

Author(s): Laura Pacey KK, Shelley Stead, Jacqueline Gleave A, Kasia Tomczyk and Laurie Doering CLab/Group: Department of Pathology and Molecular Medicine, McMaster UniversityDOI: 10.1038/nprot.2006.215Neural Stem Cell Culture: Neurosphere generation, microscopical analysis and cryopreservationLaura Pacey KK, paceylk@mcmaster.ca, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada, L8N 3Z5Shelley Stead , steads@mcmaster.ca, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada, L8N 3Z5Jacqueline Gleave A, gleaveja@mcmaster.ca, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada, L8N 3Z5Kasia Tomczyk , tomczyk@mcmaster.ca, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada, L8N 3Z5Laurie Doering C, doering@mcmaster.ca, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada, L8N 3Z5IntroductionStem cells and their progeny, from all ages of the CNS, can be stimulated to proliferate when they are exposed to growth factors in tissue culture1. When appropriate plating densities are established in culture, continued cell division generates non-adherent spherical clusters of cells, commonly referred to as neurospheres2,3. The neurosphere assay has proven to be an excellent technique to isolate neural stem cells and progenitor cells to investigate the differentiation and potential of cell lineages. These spheres can be dissociated, expanded and pooled in sufficient quantity for subsequent scientific inquiry. With many potential therapeutic applications for neural stem cells4, qualitative and quantitative insight into the precise cellular makeup of the neurosphere is required.Many factors contribute to the cellular composition of the neurosphere. Key variables including the age of the animal, plating density and passage number will all influence the homogeneity or heterogeneity of the neurosphere5,6. While the neurosphere assay is a valuable procedure from many biological perspectives, the user should be aware that there are particular relationships between the definitive neural stem cell and the production of neurospheres in culture that the can lead to shortcomings7.We describe the steps in detail to isolate and expand neural stem cells in the form of neurospheres from tissue dissections of the post-natal mouse brain. Procedures for the long term passage of neurospheres and the cryopreservation of neurospheres are also provided. In addition to the guidelines and tips for generating neurosphere cultures, we describe the method to prepare neurospheres for analysis by light microscopy. The ability to section neurospheres for histology or immunocytochemistry provides the researcher with the additional dimension to study specific molecular and cellular aspects of the neurosphere. Many of the commercial kits designed to assess aspects of the cell cycle, programmed cell death, and cell signaling can be readily applied to the outlined protocols.MaterialsReagentsReagent setup:Distilled H2O (dH2O) sterilized with a 0.22 µm pore size filter.See Table 1 for the recipes to make the Tissue Dissection Solution and the Enzyme Mix. Refer to Table 2 for the components added to the Serum Free Medium (SFM).The SFM is DMEM/F12 (1:1) + L glutamine & 15mM HEPES (Invitrogen cat. no. 11330-032). SFM is filtered with a 0.22µm pore size filter after the addition of the components, with the exception of the growth factors (EGF, FGF), B-27 and ITSS which are added to the sterile SFM.Additional components added to the SFM:Putrescine (100x stock) (1,4-Diaminobutane dihydro-chloride) (Sigma cat. no. P5780) –dissolve 0.096g in 100ml dH2O and filter with a 0.22µm pore size filter (store at 4°C). Progesterone (1000x stock) (Sigma cat. no. P-8783) – dissolve 0.00629g in 100ml of dH2O and filter with a 0.22 µm pore size filter (store at 4°C).1.0M Hepes Buffer (Sigma cat. no. H0887)B-27 Supplement (Invitrogen cat. no. 17504-044)TIP: In the past few years this supplement has often been on back order. Check in advance for availability.Insulin-Transferrin-Sodium Selenite Supplement (ITSS) (Roche cat. no. 1074547) –dissolved in 5.0 ml sterile dH2O (1000x stock) and make 100µl aliquots (store at -20°C). One aliquot is added to the SFM.Heparin (Sigma cat. no. H3149) – dissolve 0.05g in 2.0 ml of filtered dH2O (store at 4°C) Trypsin inhibitor – 1.0 mg/ml in SFM (Roche cat no. 10109878001). Make fresh each time. TrypLE TM express (Invitrogen cat. no. 12604-021)Growth factors:Fibroblast growth factor-basic (FGF) (Sigma cat. no. F0291) – 25 µg dissolved in 1.0 ml of 5mM Tris (pH 7.6) and sterilized with a 0.22µm pore size filter. Make 20 µl aliquots (stored at -20°C) and add 1 aliquot to 100 mls of SFM.Epidermal growth factor (EGF) (Sigma cat. no. E4127)-0.1 mg dissolved in 1.0 ml of phosphate buffered saline containing 0.1% bovine serum albumin (Sigma cat. no. A7511). Make 20 µl aliquots (stored at -20°C) and add 1 aliquot to 100 mls of SFM.Critical:The biological activity of the growth factors in the SFM decreases with time. For optimal results, use SFM with the growth factors on the day of preparation. We keep our medium for up to 7 days for passage of the neurospheres.EquipmentCO2 desiccation chamberDissecting microscopeWater bath (shaking) set at 37°CMicro-dissecting instrumentsScapel blades (No. 10 curved)Betadine antiseptic solution (10% povidone-iodine)Cidex antiseptic (ortho-Phthaladehyde solution) (Johnson and Johnson cat. no. 20394)Table top centrifuge60 × 15 mm style polystyrene tissue culture dishes (Falcon cat. no. 353002)24 well (multi-well) tissue culture plates (Falcon cat. no. 353047)5 ml polypropylene round bottom tubes (Falcon cat. no. 352063)15 ml polystyrene conical tubes (Falcon cat. no. 352095)50 ml polypropylene conical tubes (Falcon cat. no. 352070)Tissue culture equipmentIncubator at 37°C with 95% air and 5% CO2Laminar flow hood or biological safety cabinetTime TakenWith all the reagents prepared in advance, the dissection and cell plating procedure will require 2-3 hours (depending on experience).ProcedurePre-surgery:1. Set the water bath to 37°C.2. Bubble the tissue dissection solution with 95%O2 and 5%CO2 for 10 minutes.3. Disinfect the dissection area with 95% ethanol.4. Sterilize the dissection instruments in an antiseptic solution (Cidex, followed by a complete sterile water rinse and then immerse in 95% ethanol).5. Fill three 60 × 15 mm style tissue culture dishes with 3.0 ml of the tissue dissection solution.TIP: In addition to sterile micro-dissecting instruments, three sets of sterile instruments should be used. A separate set for the skin, skull and removal of the brain will reduce the chances of contamination as you proceed through the tissue layers. The sterile instruments can be dipped into sterile tissue dissection solution to avoid ethanol contact with the tissues. Removal and dissection of the brain:6. Euthanize the mouse in the CO2 chamber. Animals less than 3 weeks old should initially be decapitated.7. Shave the top of the head.8. Swab the head with gauze soaked in Betadine to sterilize and remove any loose hairs from the skin.9. Swab the head with gauze soaked in 95% ethanol.10. Make a midline incision in the skin with a scalpel blade over the entire length of the skull.11. Reveal the surface of the skull by reflecting the skin.12. Make additional cuts in the skin to expose the sides of the skull just below the ears.13. Cut the skull on both sides with small scissors. (you want to remove the upper portion of the skull cap without cutting the brain)14. Break off the skull with forceps.CautionMake sure the dissecting instruments are free of ethanol before touching the brain. The ethanol will fix the tissue!15. Slide curved forceps under the base of the brain to cut the spinal cord, blood vessels and cranial nerves that are connected to the base of the brain.TIP: Apply slight downward pressure with the curved forceps on the floor of the skull under the brain. Slide the forceps back and forth to loosen the brain.16. Transfer the brain with the same curved forceps to a 60 mm tissue culture dish with the dissection solution.17. Strip any remaining meninges from the surface of the brain, rinse thoroughly and place the brain into a second 60 mm tissue culture dish with dissection fluid.TIP: The meninges are most readily stripped from the surface of the brain when viewed under the dissection microscope.18. Under the dissecting scope, cut the brain along the midline and isolate the desired region of the brain with fine forceps.TIP: While all regions of the brain will generate neurospheres, specific zones and regions will yield higher numbers of neurospheres. Dissections that concentrate on the cell layers that form the ventricles (mainly subventricular zone8, the hippocampus9 and the rostral migratory stream10) are areas that will yield the most neurospheres. A working knowledge of the mouse brain in combination with an atlas of the developing and postnatal mouse brain11 is an asset.19. Transfer the dissected tissue into a third 60 mm tissue culture dish containing tissue dissection solution.20. Cut the tissue into small squares (approximately 1.0 mm3) with No. 10 curved scalpel blades.TIP: The efficiency of cutting the tissue into small pieces is improved with experience and the aid of the dissecting microscope. Smaller pieces of tissue will dissociate better and yield a higher number of neurospheres.Dissociation of the brain tissue:21. Transfer the dish with the dissected tissue (small squares) to the tissue culture hood and use a Pasteur pipette to load the tissue pieces into a 5 ml polypropylene round bottom tube.22. Centrifuge for 1 minute at 250g.23. Remove the supernatant and add the enzyme mix (1.0 ml).TIP: If a specific brain region is not required, the entire brain from a mouse pup (less than 1 week old) can be used to generate the maximum number of neurospheres. In this situation, the entire brain is divided into 2 tubes, with each tube containing 1.0 ml of the enzyme mix. Younger animals will generate more neurospheres.24. Place the tube in the water bath for at least 40 minutes (newborn to one week old) or for approximately 1.5 hours (young adult less than 2 months old) and triturate the samples briefly with a Pasteur pipette every 20 minutes.TIP: Check the status of the tissue dissociation regularly. The exact amount of time required depends on the age of the animal. Animals several months old may require 2-3 hours of digestion. Cell viability is correspondingly reduced with prolonged digestion.CautionNewborn brain tissue is digested rapidly by the enzyme mix. Excessive digestion will significantly reduce cell viability.25. Centrifuge for 5 minutes at 250g and remove the supernatant.26. Add 4.0 ml of the trypsin inhibitor.27. Triturate (10 times) with a Pasteur pipette to break up the pellet and take care to minimize the introduction of air bubbles.28. Place the tube in the water bath for 10 minutes.29. Centrifuge for 5 minutes at 500g and remove the supernatant.30. Re-suspend the cells in 0.5 ml of SFM and triturate sufficiently to produce a single cell suspension.TIP: A small bore fire polished Pasteur pipette is recommended for dissociating the suspension into single cells.Plating the cells:31. Calculate and adjust the viable cell concentration with a hemacytometer. Viable cells are determined by Trypan Blue dye exclusion.TIP: A plating density of 10-15 cells/µl will favor the establishment of neurospheres from single cells12. If you do not require a clonal assay and desire a higher (bulk) production of neurospheres, plate the cells at a higher density (eg. 50-100 cells/µl). Plating the cells at a higher density will also generate the neurospheres more rapidly with a shorter interval between the initial passages.Examples of internet sites that detail the use of a hemacytometer and the vital dye Trypan Blue are:/content/sfs/appendix/Cell_Culture/Viable%20Cell%20Counts% 20Using%20Trypan%20Blue.pdf/protocolstools/protocol.jhtml?id=p2151/pdfdocs/Cell%20Documents/hemat.pdf32. Add 0.5 ml of SFM containing the cells to each well of a 24 multi-well plate.33. Incubate at 37°C with 95% air and 5% CO2.Passage of neurospheres:TIP: Check each well for contamination before pooling the contents of the entire plate, especially for the first passage. A heavily contaminated well will lower the pH with an obvious change in color (yellow) of the culture medium. It is not unusual to have a well(s) slightly contaminated. A low level of contamination will not be detected by a color change in the medium, but only detected by observation with a phase contrast microscope. If you miss a contaminated well, all the wells of the next passage will be contaminated!1. Transfer the neurospheres and medium from all wells to a 15 ml conical tube.2. Centrifuge for 5 minutes at 200g.3. Remove the supernatant and add 2.0 ml of TrypLE TM to the tube.4. Use a Pasteur pipette to mix the neurospheres with the TrypLE TM.5. Place the tube in the water bath for 20 minutes at 37°C.6. Centrifuge for 5 minutes at 500g.7. Remove the supernatant and re-suspend the cells in 0.5 ml of SFM.8. Triturate with a Pasteur pipette (60-70 times)TIP: Avoid the formation of air bubbles. Excessive air bubbles will lower the cell viability and enhance the possibility of contamination.9. Determine the cell concentration by Trypan Blue dye exclusion and plate the desired concentration of cells to a new 24 multi-well plate. Incubate at 37°C with 95% air and 5% CO2.TIP: The best time to pass the neurospheres is often determined on an individual basis dictated by the experimental requirements and timetable. Passage of the neurospheresrenews the SFM and expands the number of neurospheres. Plates containing an average of at least 25 neurospheres per well can be passed into 2 plates. With densities in excess of 50 neurospheres per well, 3 plates can easily be established from the initial 24 multi-well plate.A stage micrometer can be used to calibrate the crossed (focusing) lines on the ocular(s) of the phase contrast microscope and allow you to quickly determine the size of the neurospheres. See Figure 1b.Cryopreservation and re-establishment of neurospheres:1. Pool the culture medium with the neurospheres from a 24 multi-well plate into a 15 ml conical tube.2. Centrifuge for 5 minutes at 200g.3. Remove the supernatant and re-suspend the cells in 10.0 ml SFM (without EGF and FGF) containing 15.0% dimethyl-sulfoxide (DMSO).4. Gently mix the neurospheres in the SFM with a Pasteur pipette. Aliquot 1.5 ml of the mixture into polypropylene cryovials (Nunc Cryo Tubes cat. no. 357418).5. Transfer the tubes to a -80°C freezer overnight.6. The following morning, transfer the vials to a liquid nitrogen cryofreezer.TIP: If you do not have access to a liquid nitrogen freezer, the neurospheres can be kept for several weeks at -80°C. The number of viable neurospheres obtained in culture will decrease with prolonged storage at -80°C.7. To re-establish the neurospheres in tissue culture, remove the cryovial from the freezer and let the vial warm up to room temperature on the bench.8. Add the contents of the cryovial slowly to a 15 ml conical tube containing 10 ml of SFM.9. Centrifuge for 5 minutes at 200g and remove the supernatant.10. Gently mix the neurospheres with 4.0 ml of the SFM with a Pasteur pipette.11. Fill 8 wells of a 24 multi-well plate with 0.5 ml of the mixture and incubate at 37°C with 95% air and 5% CO2.TIP: Smaller neurospheres will survive the freezing process better than larger neurospheres (in excess of 100µm in diameter). The viability of neurospheres following the freezing process in this tissue culture medium is low (< 20%). It is recommended that the individual wells contain at least 50-100 neurospheres. You want to freeze a high concentration of neurospheres to enhance neurosphere re-establishment after freezing. Neurosphere viability can also be enhanced by the addition of 20% fetal bovine serum (FBS) to the freezing medium. However, keep in mind that FBS will induce differentiation.Preparation of neurospheres for cryostat sectioning and immunocytochemistry: Procedures have been developed to section intact neurospheres.1. Transfer the culture medium with neurospheres to a 50 ml polypropylene conical tube.2. Allow the neurospheres to settle by gravity (approximately 30 minutes. The time for the neurospheres to settle is dependent on the size of the neurospheres.CautionCentrifugation of the viable neurospheres will alter the shape of the neurospheres.3. Remove the supernatant, add and mix gently with 2.0 ml of4.0% phosphate buffered paraformaldehyde (fixative).4. Allow the neurospheres to settle in the tube.5. Remove the fixative supernatant with a Pasteur pipette and rinse with 5.0 ml of phosphatebuffered saline (PBS).6. Allow the neurospheres to settle for at least 30 minutes before removal of the PBS.7. Repeat the rinsing procedure at least 3 times.Immunocytochemistry may be performed on intact neurospheres at this stage.TIP: Observing the removal of the supernatant at any step under the dissecting scope ensures maximum withdrawal of the fluid without disturbing the cell pellet.8. Remove the final PBS rinse and add 5.0 ml of 30% sucrose (dissolved in 0.1M PBS).9. Transfer the tube to the fridge and allow the neurospheres to settle overnight.10. Remove the 30% sucrose and add embedding medium for frozen tissue specimens for 1 hour (Sakura Tissue-Tek O.C.T. compound, cat. no. 4583)11. Prepare the cryostat chuck with a layer of O.C.T.12. Transfer the neurosphere pellet to the O.C.T. layer on the cryostat chuck.CautionYou can lose the neurosphere pellet quickly during the transfer of the pellet from the tube to the cryostat chuck. With a Pasteur pipette or an 1000 µl Eppendorf pipettor (using the blue tips) pre-load a small amount of O.C.T. into the tip and then withdraw the neurosphere pellet into the tip, continuous with the pre-loaded O.C.T. Try not to induce any air bubbles into the O.C.T.13. Cut sections at desired thickness and collect on APTEX (3-Aminopropyl) triethoxy-silane) (Sigma cat. no. A3648) coated glass microscope slides.14. Continue with the desired immunocytochemical procedure (non-specific blocking, application of primary antibody etc.).TroubleshootingNeurosphere generation:Many of the problems that may arise are associated with standard tissue culture protocols. Contamination of the cultures is often a result of non-sterile techniques during the tissue dissection or contamination of an ingredient added to the tissue culture medium. If the cultures are initiated with a very high cell density, the dead and dying cells can lower the tissue culture pH and prevent the progression of neurosphere development. Cryopreservation and re-establishment of neurospheres:If low numbers of neurospheres are obtained after the freezing process, cut back on the number of wells seeded (4 or even 2 wells for the initial seeding step). Alternatively, you may wish to dissociate the neurospheres into single cells for freezing.Critical StepsRemoval and dissection of the brain:Step 4Step 17 - the meninges (especially the piamater) and associated blood vessels are a source of contaminating cells (blood cells, endothelial cells and fibroblasts)Step 20Dissociation of the brain tissue:Step 27Cryopreservation and re-establishment of neurospheres:Step 8 – add the contents of the cryovial slowly to the conical tube with the SFMStep 9 – make sure all the freezing medium is removed from the pellet. The DMSO in tissue culture will kill the cells.Anticipated ResultsEarly post-natal and especially newborn brain tissue will yield the highest numbers of neurospheres per well. Figure 1a and 1b illustrate the appearance of neurospheres in culture. With increasing age of the donor tissue, the wells will contain numerous dead cells and cell debris. It will require 1 or 2 neurosphere passages to eliminate the majority of the cell debris from the tissue culture medium. The steps for immunocytochemical processing will maintain the integrity of the neurosphere morphology (Figure 1c and 1d).Size and density of neurospheres:The initial plating density will influence the number of neurospheres that develop in the wells. As the neurospheres increase in size, they become more difficult to dissociate, especially when they exceed 200 µm in diameter. Neurospheres are easily dissociated into single cells when less than 100 µm in diameter.References1. Vescovi, A.L., Reynolds, B.A., Fraser, D.D. & Weiss, S. bFGF regulates the proliferative fate of unipotent (neuronal) and bipotent (neuronal/astroglial) EGF-generated CNS progenitor cells. Neuron, 11, 951-966 (1993).2. Reynolds, B.A. & Weiss, S. Generation of neurons and astrocytes from isolated cells of the adult mammalian central nervous system. Science, 255, 1707-1710 (1992).3. Bez, A., Corsini, E., Curti, D., Biggiogera, M., Colombo, A., Nicosia, R.F., Pagano, S.F. & Parati, E.A. Neurosphere and neurosphere-forming cells: morphological and ultrastructural characterization. Brain Res. 993, 18-29 (2003).4. Goldman, S. Stem and progenitor cell-based therapy of the human central nervous system. Nature Biotechnol. 23, 862-870 (2005).5. Suslov, O.N., Kukekov, V.G., Ignatova, T.N. & Steindler, D.A. Neural stem cell heterogeneity demonstrated by molecular phenotyping of clonal neurospheres. Proc. Natl. Acad. A, 99,14506-14511 (2002).6. Maslov, A.Y., Barone, T.A., Plunkett, R.J. & Pruitt, S.C. Neural stem cell detection, characterization, and age-related changes in the subventricular zone of mice. J. Neurosci. 24, 1726-1733 (2004).7. Reynolds, B.A. & Rietze R.L. Neural stem cells and neurospheres – re-evaluating the relationship. Nature Meth. 2, 333-336 (2005).8. Lois, C. & Alvarez-Buylla, A. Proliferating subventricular zone cells in the adult mammalian forebrain can differentiate into neurons and glia. Proc. Natl. Acad. Sci. USA, 90, 2074-2077 (1993).9. Kempermann, G., Gast, D., Kronenberg, G., Yamaguchi, M. & Gage F.H. Early determination and long-term persistence of adult-generated new neurons in the hippocampus of mice. Development, 130, 391-399 (2003).10. Gritti, A., Bonfanti, L., Doetsch, F., Caille, I., Alvarez-Buylla, A., Lim, D.A., Galli, R., Veerdugo, J.M., Herrera, D.G. & Alvarez-Buylla, A. Multipotent neural stem cells reside into the rostral extension and olfactory bulb of adult rodents. J. Neurosci. 22, 437-445 (2002).11. Franklin, K.B.J. & Paxinos, G. (Eds.) The Mouse Brain in Stereotaxic Coordinates, Academic Press, San Diego (1977).12. Morshead, C.M., Garcia, A.D., Sofroniew, M.V. & van der Kooy, D. The ablation of glial fibrillary acidic protein-positive cells from the adult central nervous system results in loss of forebrain neural stem cells but not retinal stem cells. Eur. J. Neurosci. 18, 76-84 (2003). AcknowledgementsWe thank all the previous undergraduate and graduate students who have completed a project or a thesis in the laboratory and helped to build the foundations of these protocols. This research is supported by the Natural Sciences and Engineering Research Council of Canada (NSERC).Keywordsmouse, brain dissection, tissue culture, stem cell, neurosphere, cryopreservation, immunocytochemistryFigure 1Appearance of neurospheres in tissue culture and when processed for immunocytochemistry.a) Early phase of neurosphere formation. Individual cells forming small clusters can be identified. Phase contrast microscopy. b) High density neurosphere culture. Phase contrast microscopy.c) Immunocytochemical localization of the epidermal growth factor (EGF) receptor (FITC secondary antibody - green) and the intermediate filament nestin protein (rhodamine secondary antibody - red) on an intact neurosphere. Indirect immunofluorescence microscopy.d) Frozen section (15 µm thick) of a neurosphere processed for the detection of cell mitosis by the incorporation of 5-bromo-2’-deoxyuridine (BrdU) (FITC secondary antibody - green) and counterstained with DAPI (blue) to identify nuclei. Indirect immunofluorescence microscopy.Table 1Formulations for the Tissue Dissection Solution and the Enzyme MixTable 2Components added to the Serum Free Medium (SFM)CommentsVery good paper!thank you very much!Posted by: xuekai zhang | May 20, 2007 09:51 AMHelp! neural stem cells culture - no neurosphere after P1 !!??I am starting culturing neural stem cell from new-born rat pups' cortex, but I find it is much more difficult than what I expected. The problem is I cannot obtain neurospheres after the first passage. I strictly followed this protocol except using 25cm2 flask but not 24-well plate.I am totally lost now. I am glad if you can give me some real suggestions to see me through. Thank you.Posted by: Ming Shi | February 1, 2010 04:54 PMThank you for this excellent article. It helped me to clarify some doubts I had growing my NSC´s. Your protocol is written in a great detail and that is why it is so useful.Thanks a lot.Posted by: Sylvia Amini | May 20, 2010 11:30 AM。

英语国际会议PPT课件

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Materials and Methods
Patients
Materials and Methods
Cytokine assessment by ELISA
Western blot
Cell isolation and culture
Statistical analysis
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Methods
IFN-c-induced protein of 10-kDa (IP-10)/CXCL10
we studied the effects of α-toxin on Th1- and Th2related chemokines in macrophages from patients with AD and psoriasis where the intrinsic abnormal and different chemokines production profile is well defined.
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Figure 3 Punch biopsies (3 mm) from healthy individuals were left either unstimulated (A) or stimulated with a-toxin (100 ng/ ml) (B) or IFN-c (100 ng/ml) (C) for 24 h at 37C. 5-lm parafﬁn sections were stained for CXCL10 along with appropriate isotype as well as CD68.
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Low effect of a-toxin on CXCL10 induction (Th1-related chemokine) in macrophages from patients with AD

GE Healthcare Discovery IGS 7 移动血管造影系统说明书

Discovery® IGS 7for Interventional Radiology 2 IGS 740 configurationFree yourself from the railsFree yourself from the constraints of fixed ceiling-mounted systems’ rails with the Discover IGS 7 mobileangiography system.The untethered Discover IGS 7 offers amazing siting and room design flexibility. Practice with exceptionalcomfort and control with Discovery’s rail-free design and flexible C-arm positioning. Plus, its ample detectorcovers large anatomies in both 2D and 3D.IGS 740 configuration 34 IGS 740 configurationPut yourself at the center of your proceduresGet full head to toe coverage without moving the patientWith nothing in your way, you can image the anatomy of interest easily, position your monitors freely, and access your patients completely from the left or right side on the Discovery IGS 7.Discovery IGS 7 flexibility with extended lateral panning motion allows to cover head to toe without moving the patient during interventions.IGS 740 configuration 56 IGS 740 configurationDedicated arm imaging positionsPerform procedures such as left arm fistulogramscomfortably with the Discovery IGS 7’s dedicatedarm imaging positions.Liberating rail-free designThe Discover IGS 7’s swiveling wheeled gantrymoves freely on the floor, not on the ceiling,eliminating overhead rails. So, you can placeyour monitors exactly where you need themfor comfortable viewing without straining.IGS 740 configuration 7A wide-bore C-armThe combination of the Discovery IGS 7 wide borewith the large 41 x 41 cm detector enablesto image patient in 3D at any point ofthe anatomy without collision even for largepatients with BMI up to 40.18 IGS 740 configurationIGS 740 configuration 9Cover large anatomies such as the liver or both legs simultaneously, with fewer runs than smaller detectors, for efficient use of contrast and dose.Appreciate the high quality of contrast uptaketo see fine details comfortably with a41 x 41cm (16.1 in.) field of view.Capture large anatomies in a single image with the large 41 x 41cm (16.1 in. )detector and the ability to perform off-centeracquisitions.See large anatomies in one view10 IGS 740 configurationImage the entire liver in a single 3D acquisition with the Discovery IGS 7. Identify right after your procedure the ablatedarea with high quality CT-like imaging.IGS 740 configuration 1112 IGS 740 configurationAn exceptionally large detectorWith its broad 41 x 41 cm (16.1 in) digital detector,the Discovery IGS 7 system boasts one of the largestfields of view for interventional imaging. Moreover,the GE-proprietary digital detector delivers oneof the industry’s highest levels of DQE, the acceptedmeasure of X-ray detector dose efficiency.Extended coverage in 2DWith InnovaBreeze TM 2, take full advantageof the Discovery IGS 7’s very large field-of-viewand follow the contrast bolus in both legs in real timeusing variable panning speed control.Large organs in 3DCombine the wide-bore C-arm and the 41 x 41 cm(16.1 in) digital detector, and see large organs likethe liver in 3D. Then use Liver ASSIST V.I.3 to help youidentify tumor-feeding vessels in a few clicksand be selective during your liver embolization.IGS 740 configuration 134PelvisLung LiverAortaWhen breathing gets in your way, clear it up with Motion FreezeAccess the full potential of CBCT with Motion Freeze5, the first solution6 commercialized that helps compensate artifacts caused by involuntary respiratory motion during the CBCT acquisition.Motion Freeze can help salvage CBCT acquisitions by refining and increasing small contrasted structuresin CBCT images that would have otherwise been discarded due to involuntary respiratory motion artifacts. Motion Freeze helps to recover small details visibility, may enable reduction of repetitive acquisitions,and facilitates access to advanced solutions.7CBCT reconstruction affected by involuntary respiratory motions artifacts CBCT reconstruction with Motion FreezeLiver ASSIST V.I. without Motion Freeze Liver ASSIST V.I. with Motion FreezeBEFORE AFTERWITHOUT WITHIGS 740 configuration 158abc and helps reach a high selectivity during liver embolizationAssessPerform procedure assessment by comparing preand post 3DCT HD on Volume Viewer.Liver ASSIST V.I. has demonstrated ~68% complete tumor response rate (vs. 36% with DSA alone).10GuideOnce ready, you can proceed with a single-click fusion imaging betweenthe live fluoroscopic image and the vessels highlighted for 3D fusion guidance 9to guide catheters across tortuous vessels and bifurcations, helping you perform the embolization with confidence.This facilitates catheter selection in complex vascular anatomies for a higher selectivity in liver embolization procedures.IGS 740 configuration 17PlanWith Needle ASSIST,11 plan the procedure using outstanding 3D information and determine the optimal skin entry points and needle paths directlyon oblique CBCT cross-sections.AssessAll at table side, reconstruct a needle in 3D with 2 fluoroscopic images with accuracyneedle on the 3D anatomy.GuideWith Needle ASSIST, thanks to 3D fusionneedle along the virtual trajectory that willmis-registrations in both translation and rotation, so you can correct for even small patient motion from tableside.IGS 740 configuration 19121314IGS 740 configuration 2122 IGS 740 configurationDesign your room with amazing flexibilityBy eliminating the rails of ceiling-mounted system, the Discovery IGS 7 frees up your ceiling entirely for more flexibility in designing your room.Drawing the ideal room With no rails on the ceiling obstructingthe positioning of ceiling-mounted ancillaries, the Discovery IGS 7 gives you flexibility to draw the location of your monitors, lights and radshields where you need them to be.And with two customizable parking positions, the Discovery IGS 7 adapts to suit your room size and shape.Siting in precious space Whether you’re building a new room, repurposing an existing room, or re-configuring a small room, the Discovery IGS 7 lets you use precious space efficiently. Fit the Discovery IGS 7 in rooms as small as just 35 square meters (377 square feet) for a wider choice of siting options in situations where space is ata premium.No reinforced ceilingstructure neededWith the mobile Discovery IGS 7 system,there’s no need for long and complexinfrastructure improvements to reinforceyour room’s ceiling structure.IGS 740 configuration 23GE Healthcare, Europe Headquarters Buc, France +33 800 90 87 19GE Healthcare, Middle East and Africa Istanbul, Turkey + 90 212 36 62 900GE Healthcare, North America Milwaukee, USA + 1 866 281 7545GE Healthcare, Latin America Sao Paulo, Brazil + 55 800 122 345GE Healthcare, Asia Pacific Tokyo, Japan + 81 42 585 5111GE Healthcare, ASEAN Singapore +65 6291 8528GE Healthcare, China Beijing, China+ 86 800 810 8188GE Healthcare, India Bangalore, India +91 800 209 9003GE Healthcare GE Healthcare GE Healthcare@GEHealthcare About GE HealthcareGE Healthcare provides transformational medicaltechnologies and services to meet the demand for increased access, enhanced quality and more affordable healthcare around the world. GE (NYSE: GE) works on things that matter - great people and technologies taking on tough challenges. From medical imaging, software & IT, patient monitoring and diagnostics to drug discovery, biopharmaceuticalmanufacturing technologies and performance improvement solutions, GE Healthcare helps medical professionals deliver great healthcare to their patients.GE Healthcare Chalfont St.Giles,Buckinghamshire,UKData subject to change.Marketing Communications GE Medical SystemsSociété en Commandite Simple au capital de 65.146.245 Euros283 rue de la Minière – 78533 Buc Cedex France RCS Versailles B 315 013 359A General Electric company, doing business as GE HealthcareGE, GE Monogram, Discovery IGS 7 and Innova Breeze are trademarks of General Electric Company.Discovery I GS 7 and products mentioned in this material cannot be marketed in countries where market authorization is required and not yet obtained. Refer to your sales representative.1. T ested on a patient model based on published anthropometric data : C. Bordier, R. Klausz and L. Desponds, Patient Dose Map I ndications on I nterventional X-Ray Systems and Validation with Gafchromic XR-RV3 Film, Radiation Protection Dosimetry (2014), pp. 1–13, doi:10.1093/rpd/ncu1812. O ption that requires an AW workstation.3.L iver ASS ST V.I. solution includes Hepatic VCAR and FlightPlan For Liver that can be used independently. It also requires an AW workstation with Volume Viewer and Volume Viewer Innova. These applications are sold separately. May not be available for sales in all markets.4. 3DCT HD is an option sold separately. Includes 3DXR. Requires AW workstation and Volume Viewer.5.M otion Freeze is a feature of 3DXR ((part of GE vascular systems I nnova I GS 5, I nnova I GS 6, Discovery IGS 7 and Discovery IGS 7 OR). 3DXR may not be available in all markets. Refer to your sales representative.6. Based on competitive research, among major players in interventional imaging.7. T he improvement related to Motion Freeze depends on the acquisition conditions, table position, patient, type of motion, anatomical location and clinical practice, it has been assessed visually on a physical phantom. Motion Freeze is not intended for free breathing and does not prevent to ask the patient to hold his breath.8. T he above Liver ASSIST V.I. performance aspects reflect the results of three published journal articles that used a previous version of FlightPlan for Liver software (b,c) or its prototype (a). The results of these published studies do not necessarily represent individual performance of FlightPlan for Liver a) C omputed Analysis of Three-Dimensional Cone-Beam Computed Tomography Angiography for Determination of Tumor-Feeding Vessels During Chemoembolization of Liver Tumor: A Pilot Study – Deschamps et al. Cardiovasc Intervent Radiol. 2010. b)T racking Navigation I maging of Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma Using Three-Dimensional Cone-Beam CT Angiography – Minami et al. Liver Cancer. 2014. c) C linical utility and limitations of tumor-feeder detection software for liver cancer embolization. Iwazawa et al. European Journal of Radiology. 2013.9.T o guide, Liver ASSIST V.I. solution, requires Vessel ASSIST solution which includes Vision 2, VesselIQ Xpress, Autobone Xpress. Liver ASSIST V.I. and Vessel ASSIST are sold separately10. L iver ASSIST V.I, through a previous version of FlightPlan for Liver, has demonstrated ~68% complete tumor response rate (vs. 36% with DSA alone). Hepatic Arterial Embolization Using Cone Beam CT with Tumor Feeding Vessel Detection Software: Impact on Hepatocellular Carcinoma Response. Cornelis et al. Cardiovasc. Intervent. Radiol. 2017.11. N eedle ASSIST solution includes TrackVision 2, stereo 3D and requires AW workstation with Volume Viewer, Volume Viewer Innova. These applications are sold separately.12. I NTERACT Active Tracker is an optional feature of 3DXR (part of GE interventional X-ray systems Innova IGS 5, Innova IGS 6 and Discovery IGS 7 or Discovery IGS 7OR). This feature supports only one ‘Active Tracker’ type: OmniTRAX TM Active Patient Tracker (sold separately by CIVCO). Requires availability of a LOGIQ E9 XDclear 2.0 or LOGIQ S8 XDclear 2.0 or LOGIQ E10 system into the GE angio suite.13.R equires I ntegrated registration which requires an AW workstation with volume Viewer and Volume Viewer Innova. These applications are sold separately.14. R esults may vary depending on the institution, the patient characteristics, and the experience of the operator.。

新知

每月健康扫描家庭医药 2019.084新知胎盘干细胞可救心梗患者美国西奈山医院心血管病的研究人员在最新一期《美国科学院院刊》上发表文章称，他们在小鼠身上发现了一种胚胎干细胞，能够让患有心肌梗死的成年小鼠再生出心肌细胞。

研究人员在小鼠实验中发现，怀孕的母鼠若出现心率衰竭，一种来自胎盘的混合细胞会自动迁移到母鼠心脏受损部位，并向心脏细胞分化。

研究人员把这类被称为Cdx2的细胞分离出来，在实验室中进行培养，意外地分离出血管细胞和心肌细胞。

为了验证这类细胞的再生能力，研究人员设计了一个实验：把患心肌梗死的小鼠分成3组，分别注射含Cdx2细胞的胎盘干细胞，不含有Cdx2的胎盘干细胞和生理盐水。

3个月后，注射了含有Cdx2胎盘干细胞的小鼠，心脏长出了新的健康组织，而且这些接受了异体来源干细胞的小鼠都未发生免疫排斥反应。

研究人员称，Cdx2胎盘干细胞可以逃过免疫系统的监视，有利于进行异体细胞治疗。

目前，这项研究还只限于动物实验，不过它为心脏修复和其他器官的再生提出了潜在方法。

如果该治疗原理可以在人类身上应用，大量被废弃的胎盘将有用武之地，不仅可以挽救更多心肌梗死患者，还可给予数千万需要器官再生的患者以希望。

戴上眼镜看起来更聪明？英国研究发现确实如此日常生活中，人们总认为戴眼镜的人看起来更聪明博学，但你知道吗，这种看似以貌取人的现象是有科学依据的！据英国爱丁堡大学的一项研究结果称，认知能力与视力之间具有一定关联，智商高的人戴眼镜的可能性比一般人要高。

英国爱丁堡大学的研究人员分析了30多万人的认知和遗传数据后发现，记忆、语言、推理能力以及注意力等遗传的因素都会影响人的认知功能，而拥有较高认知功能的人往往都戴眼镜，因为认知能力与视力之间具有一定关联，智商高的人戴眼镜的可能性比一般人高28%。

研究人员强调，这一结果并不意味着所有具有视力问题的人就一定拥有高智商。

该研究报告指出，通常来说近视人群比其他戴眼镜的人智商更高，而相反远视人群在测试中得分较低。

寻常型银屑病三大基本中医证型皮损的皮肤镜特征观察

•临床研究•寻常型银屑病三大基本中医证型皮损的皮肤镜特征观察纪云清1周冬梅2【摘要】目的观察寻常型银屑病中医各证型皮损的皮肤镜表现特征,为更客观准确的判断银屑病中医证型提供依据。

方法收集2016年1月一203年3月期间于北京中医医院皮肤科确诊的且经中医辨证分别属血热证、血燥证及血瘀证的寻常型银屑病患者54例。

使用皮肤镜观察记录各中医证型皮损的背景颜色、鳞屑特征、血管特征，并进行统计分析。

结果血热证患者皮肤镜下图像背景颜色亮红甚至鲜红、点状血管密集颜色亮红甚至紫红、鳞屑较少呈细碎状，与血燥证、血瘀证患者镜下皮损特征差异有统计学意义(P<0.05)；血燥证患者皮肤镜下图像背景颜色淡红，点状血管较为稀疏颜色淡红、鳞屑较多密集且单片鳞屑面积较大，与血热证、血瘀证镜下皮损特征差异有统计学意义(P<0.05)；血瘀证患者皮肤镜下图像背景暗红可见色素沉着，点状血管较少见颜色略深于肤色，鳞屑少见，与血热证、血燥证镜下皮损特征差异有统计学意义(P<0.05)。

结论银屑病各证型皮损具有典型的皮肤镜影像表现，可用于临床辅助诊断。

【关键词】寻常型银屑病；中医证型;皮肤镜【中图分类号】R758.28【文献标识码】AExploration of Dermoscopic Images Characteristic of Patieets with Psoriasis Vulgarisin Three Different Traditional Chinese Medicine SyndramesJ Yum-qiny1,ZHOU Dony-mei7(1.Be/iny University of Chinese Medicine,Beijiny120029;2.De/adment of Dermatology,Be/iny Hospital of TradikonaiCPinese Medicine,Capital Medical University,Be/iny120012)[Abstract i Objective Tv compare the diXerences of dermoscopic images of patients with psoriasis vopa/s ix different Wadikonai chines”medicine(TCM)syncOomes,and pro v ide the clinical evidence of UermaOscope for the skid syndrome diXerenPation of psoriasis vopa/s.Methods From January243to December243,54patients with psoriasis v/Pga/s who were diagnosed ix the De/adment of Dermatology of Be/iny Hospital of Tradikonai Chinese Medicine and were diagnosed with blood-heat syndrome,blood d/ness syndrome and blood stasis syndrome were cohecOd.Dermoscopy wasused to odserve and record the bachg/nnU color,scaly chapcte/stics,and vvscular chamcte/sPcs of the skid lesions of vv-/ons TCM syndromes, and pePorm s/tistical analysis.Reselts The bachgronud colvr of the UermaOscopic images of pa-Pents with blood一heat syndrome is b/ght red or even b/ght red,with dense puuc/O blood vessels；b/ght red or even pupp/sh red, and less scaly,which is slightly di/erent from those of patients with blood dryness syndrome and blood stasis syndrome.S/tisPcal significance(P<0.45)；the bachoround colvr of the UermaOscope image of paPents with blood d/ness islight red,the puuc/O blood vessels arc sparse,the color is light red,the scales arc more dense,and the sinylo scale area islarger/which is related to blood heat syndrome and blood stasis The differences ix the chamcte/sPcs of the skid lesions uu-Uer the syndrome were s/PsPcaUy significant(P<0.05)；the bachoround of the UermaOscopic images of paPents withblood stasis syndrome was darb red and pigmen/Pon was seen,and the punc/te blood vessels were less common.The colorwas slightly darber than the skid color.There were s/tisPcaUy significant diXerences ix the chamcte/s/cs of skid lesionsunder microscope and blood d/ness syndrome(P<0.45).Concluhon Patients with psoriasis vopa/s ix di/erent t/Oi-Ponai Chinese medicine syndromes have/yicai dermoscopic imaginy manifes/tions,which can be used for c/nicai auxika-/diagnosis.【Keywords]Psoriasis vopa/s；TCM syndrome/pe；Dermoscopy银屑病中医学称之为“白秓”，是一种常见的慢DO)：12.13935//enki.sjzx.412343基金项目：燕京赵氏皮科流派传承工作室(LPGZ2014-23)作者单位：1・北京中医药大学，匕京140220；4.首都医科大学附属北京中医医院皮肤科6匕京100216通信作者：周冬梅,Emaii：32174837@ 性复发性炎症性皮肤病,本病病程长,常反复发作,缠绵难愈,严重时皮损泛发全身,大量脱屑，瘙痒难耐，给患者的身心健康带来严重影响，是皮肤科重点的研究疾病之一。

课程简介模板.doc

1．课程简介课程名称：生理学课程时间：第2学期课程安排: 总课时数 116科目授课学时数理论课 80实验 36总课时 116课程简介：生理学作为天津市留学生英语教学品牌课程和双语示范课程，目标是培养掌握基础知识与基础理论、具有基本实验技能、具有分析与解决问题能力和创新精神的高素质医学留学生。

生理学是研究机体各种生命现象及其活动规律的一门科学，是医学生完成正常人体形态学课程后首次接触的功能学科，内容涉及人体各系统、各重要器官的重要生理功能及其功能活动调节的原理。

通过对各章节重要的生理学概念、各器官的主要生理功能的学习理解，使学生全面整体地认识人体各种结构与功能之间的联系；通过生理实验训练学生的基本技能，培养学生的医学逻辑思维、分析综合能力和创新意识。

人体生理学作为医学专业的主干基础课程，是药理学、病理生理学及临床各学科的重要功能科学基础，对后续学科的学习起到至关重要的作用。

COURSE INTRODUCTIONName of Course: PhysiologyTime of Course: The 2nd semesterCurriculum arrangement: Total teaching hours 116Subject Teaching hoursLecture 80Experiment 36Total 116COURSE DESCRIPTION:As the Municipal Brand Course of Tianjin for International Students in English and the Excellent Bilingual Model Course, the aim of our Physiology Course is to cultivate high quality medical students with abilities of mastering the basic medical knowledges and theories, the basic experiment skills, the competence in analyzing and solving problems and the creative spirit. Physiology is a science of studying various kinds of life phenomena and their law of activities, and is a subject about body function that students first contact after they complete the nomal Human Morphology courses. The contents include the important physiological functions of every human body system, organs, as well as the principle of regulation on their activities.Through the learning and comprehending of important physiological concepts and the main physiological functions of different organs in each chapter, students are enabled to fully understand the relationship between the structure and function of human body. Physiological experiments are used to train students' basic skills, cultivate the students' ability of medical logic thinking, analyze the comprehensive competence and innovation consciousness. The Human Physiology as the main basic course of medical science is an important foundation of Pharmacology, Pathophysiology and related Clinical Sciences. It plays a crucial role in the study of the following subjects in the medical education for overseas students.2. 教学大纲Syllabus of PhysiologyDepartment of Physiology2016.4Syllabus of Pathophysiology(For International Students)PREFACEThis syllabus is based on the outline of Physiology teaching for international medical students. The overall objective of this curriculum is to provide the basic principles of Physiology.THEORYChapter 1 IntroductionPurpose and Requirement:1. To master the concepts of physiology.2. To understand the fundamental characteristics of life phenomena3. To study the regulation of body function.4. To master feedback control systemTeaching Contents:1. Physiology is a science that studies the vital regularity in living organisms.2. Basic characteristics of life phenomena: metabolism, excitability and reproduction.3. The concept of internal environment and homeostasis.4. Regulation of body function and homeostasis: nervous regulation, hormonal regulation and autoregulation.5. The concept of feedback regulation: negative feedback and positive feedback.6. Two ways and 3 levels for study of physiology.Part 1. Research contents and methods of Physiology1. The development of modern physiologyKnowing the important events in the history of Physiology and understanding the research object and task of physiology.2. Different levels of physiological researchAble to know the significance of studying body function from the overall level, the organ and system levels as well as cell and molecular levels.3. Research methods of PhysiologyPart 2. Basic characteristics of life1. Metabolism: Can explain the related physiological phenomena with the theory of metabolism.2. Excitability: The concept and significance of excitability.3. Reproduction: Can explain the important meaning of reproduction.4. Adaptability：Be able to explain the phenomenon of adaptation。

关于扶正护脑胶囊对脑出血大鼠蓝斑和心肌组织去甲肾上腺素含量的影响

关于扶正护脑胶囊对脑出血大鼠蓝斑和心肌组织去甲肾上腺素含量的影响【摘要】：目的观察扶正护脑胶囊对脑出血大鼠蓝斑和心肌组织去甲肾上腺素含量的影响。

方法动物随机分为假手术组、模型组、扶正护脑组和安宫牛黄组，分别于术后6、24、72 h 3个时相点取材，采用高效液相色谱-电化学检测法测定蓝斑和心肌组织去甲肾上腺素的含量。

结果术后各时间点蓝斑和心肌组织去甲肾上腺素的含量均显著升高，扶正护脑组和安宫牛黄组均能降低其含量。

结论扶正护脑胶囊通过抑制蓝斑-去甲肾上腺素系统的激活，减轻脑出血后心肌的损伤。

【关键词】扶正护脑胶囊去甲肾上腺素蓝斑-去甲肾上腺素系统大鼠Abstract：Objective To observe the effect of Fuzhenghunao capsule on NE of the locus ceruleus and myocardial tissues in rats with intracerebral hemorrhage. Methods 72 rats were randomly pided into 4 groups：sham， model， Fuzhenghunao and Angongniuhuang. The content of NE were tested by the high performance liquid phase-electrochemical method at 6 h， 24 h and 72 h of post-operation. Result NE was obviously increased in sham group， and decreased in two treatment groups. Conclusion Fuzhenghunao capsule could be used to inhibit the activation of locus ceruleus noradrenalin system and protect myocardial tissues by regulating NE content.Key words：Fuzhenghunao capsule；noradrenaline；locus ceruleus noradrenalin system；rat去甲肾上腺素(noradrenaline，NE)是与心血管活动密切相关的重要的神经递质，蓝斑核是重要的植物神经调节中枢之一，主要由含去甲肾上腺素能的神经元组成，是NE合成的主要部位，具有重要的心血管调节作用。