Objective To investigate the effects of adenosine preconditioning on the expression of myocardial tumor necrosis factor-alpha (TNF-α) mRNA and intercellular adhesion molecule-1 (ICAM-1) mRNA in patients undergoing off-pump coronary artery bypass graft (OPCABG).Methods Forty patients, aged 44-68 yr, with more than three coronary artery obstructions and the ejection fraction≥40%,undergoing elective OPCABG, were randomly divided into 2 groups (n=20 each): control group and adenosine group. Adenosine group received adenosine preconditioning, with the initial infusion rate of 50 μg. kg-1.min-1, then increasing to 100μg.kg-1.min-1after 1 min, finally increasing to 150 μg. kg-1 . min-1 after 2 min and maintaining for 7 min. Vascular anastomosis was started at 5 min after preconditioning. While the control group received normal saline instead of adenosine. Tissue samples of the right auricle were taken before preconditioning (baseline) and at 15 min after blood current retum to measure the expression of myocardial TNF-α mRNA and ICAM-1 mRNA. The myocardial ultrastructure was observed and hemodynamic parameters were monitored.Results The myocardial damage was milder in the adenosine group than in the control group. The expression of myocardial TNF-α mRNA and ICAM-1 mRNA was significantly lower in the adenosine group than in the control group ( P＜0.05).Conclusion Adenosine preconditioning can attenuate myocardial ischemia-reperfusion injury in patients undergoing OPCABG through down-regulating the expression of myocardial TNF- mRNA and ICAM-1 mRNA.

Objective: To determine the optimal manipulation parameters in Liu's back tuina therapy for remission-stage cough variant asthma (CVA) in kids. Methods: A 5-factor 3-level L18(37) orthogonal design was adopted. The experimental factors and levels were selected: A, the number of times of Rou-kneading Feishu (BL 13); B, the frequency of Rou-kneading Feishu (BL 13); C, the number of times of Tui-pushing in a '介'-like pattern; D, the frequency of Tui-pushing in a '介'-like pattern; E, the intensity of red color after Ca-scrubbing Feishu (BL 13) with salt. A1, A2 and A3 stood for 10 times, 20 times and 30 times, respectively; B1, B2 and B3 stood for 200 times/min, 240 times/min and 280 times/min, respectively; C1, C2 and C3 stood for 50 times, 75 times and 100 times, respectively; D1, D2 and D3 stood for 150 times/min, 175 times/min and 200 times/min, respectively; E1, E2 and E3 stood for pinkish, bright red and dark red, respectively. A total of 108 kids with CVA in remission stage were divided into 18 groups using the random number table method, with 6 cases in each group. Changes in the cough score and fractional exhaled nitric oxide (FENO) level were observed after 15-day treatment. Results: The cough score and FENO level changed significantly in every group after treatment (all P<0.01). By the effect in improving cough score, the factors were listed as D, B, A, C and E in descending order; the most optimal manipulation parameter combination was group 17 (A3B2C1D3E1); the second optimal parameter combinations were group 7 (A3B1C2D1E3), group 13 (A2B1C2D3E1) and group 14 (A2B2C3D1E2). Regarding the effect in down-regulating the level of FENO, the factors were listed as C, A, E, B and D in descending order; the most optimal manipulation parameter combination was group 13 (A2B1C2D3E1); the second optimal parameter combinations were group 18 (A3B3C2D1E2), group 16 (A3B1C3D2E3) and group 14 (A2B2C3D1E2).Conclusion: Two most effective manipulation parameter combinations were selected out of 18 different parameter combinations in Liu's back tuina therapy for remission-stage CVA in kids. Doctors can choose an appropriate manipulation based on the symptom features of the disease.

Objective: To observe the therapeutic efficacy of warm needling moxibustion plus intra-articular injection of sodium hyaluronate in treating chondromalacia patellae and its effect on inflammatory factors in knee joint fluid. Methods: Sixty-eight patients with chondromalacia patellae were randomized into a control group and an observation group, with 34 cases in each group. The control group was treated with intra-articular injection of sodium hyaluronate, while the observation group was given additional warm needling moxibustion treatment. Before and after treatment, the two groups were scored using Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and visual analog scale (VAS), examined by magnetic resonance imaging (MRI) and determined for the levels of nuclear factor-κB (NF-κB), tumor necrosis factor (TNF)-α and interleukin (IL)-1β in knee joint fluid. Clinical efficacy was estimated after treatment. Results: The effective rate was higher in the observation group than in the control group (P<0.05). After treatment, the scores of pain, stiffness and daily activities, as well as the general score of WOMAC declined significantly in both groups (all P<0.05), and were lower in the observation group than in the control group (all P<0.05); the time cost for climbing up and down one staircase and VAS score decreased markedly in both groups (all P<0.05), and were shorter or lower in the observation group than in the control group (both P<0.05); the MRI grading showed no significant change in the control group after intervention (P>0.05), while the grading in the observation group showed notable improvement (P<0.05), and was better than that in the control group (P<0.05); the levels of NF-κB and IL-1β in knee joint fluid dropped significantly in the control group after treatment (both P<0.05), while the levels of NF-κB, TNF-α and IL-1β in knee joint fluid all decreased significantly in the observation group (all P<0.05) and were lower than those in the control group (all P<0.05). Conclusion: Warm needling moxibustion plus intra-articular injection of sodium hyaluronate can produce definite efficacy in treating chondromalacia patellae; it can mitigate the clinical symptoms, improve the lesion extent of chondromalacia and down-regulate the levels of NF-κB, TNF-α and IL-1β in knee joint fluid.

During the reform of scientific research system the financial and the material resources were centralized and the central laboratory was constructed in cardiovascular Institute & Fu Wai Hospital.The biosafety was implemented thoroughly in this construction process.The brand-new concept war established and the strict rules were formulated through comprehensively study and repeatedly practice.In the meantime,the advanced management and the operation mode were established.A new biosafety lab was constructed under these conditions.

Examination reform was explored in Introduction to clinical medicine, and a new evaluation system was constructed which included the combination of formative assessment and sum-mative assessment as well as content system, operation system and monitoring system. The feedback mechanism of formative assessment was put into a full use to improve the teaching effect in this new evaluation system. At the same time, the method of summative assessment was substituted from the traditional closed-book exam to literature translation and presentation carried out by groups. The com-bination of summative assessment and formative assessment could evaluate the teaching efficiency of introduction to clinical medicine more comprehensively and objectively. In addition, it played an ac-tive role in improving students' comprehensive ability and their learning enthusiasm.

Objective: To observe the clinical efficacy of sinew-bone balancing manipulation in treating lumbar disc herniation (LDH) and offer clinical evidence to support the concept of paying equal attention to sinew and bone. Methods: Sixty LDH patients were randomized into an observation group and a control group, with 30 cases in each group. The observation group was treated with the sinew-bone balancing manipulation, and the control group received conventional Tuina (Chinese therapeutic massage) manipulation. The clinical efficacy and posterior muscle chain tone effect were compared between the two groups by observing the visual analog scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and posture-associated indicators. Results: The total effective rate was 86.7％ in the observation group, higher than 76.7％ in the control group, but the between-group difference in efficacy was statistically insignificant (P>0.05). After treatment, the VAS and JOA scores, angle-dependent muscle tone indicator of the posterior muscle chain, and lumbar posture symmetry showed significant changes in both groups (P<0.05). The VAS and JOA scores, angle-dependent muscle tone indicator of the posterior muscle chain, and lumbar posture symmetry in the observation group were significantly different from those in the control group after treatment (P<0.05), but the between-group difference in the general posture symmetry was statistically insignificant (P>0.05). Conclusion: Both the sinew-bone balancing and conventional Tuina manipulations can reduce pain in LDH patients, improve lumbar function, and adjust the angle-dependent muscle tone coefficient of the posterior muscle chain and lumbar posture symmetry; except for the general posture symmetry of the posterior muscle chain, the sinew-bone balancing manipulation wins out over the conventional Tuina manipulation.

Objective:To observe the clinical efficacy of combining contralateral needling and tendon-bone balancing Tuina(Chinese therapeutic massage)in treating scapulohumeral periarthritis(SP). Methods:Sixty-eight eligible participants were chosen and randomized into an acupuncture group and an acupuncture plus Tuina group,with 34 cases in each group.The acupuncture group received treatment with contralateral needling,and the acupuncture plus Tuina group was treated with contralateral needling combined with tendon-bone balancing Tuina.The post-treatment changes in the Constant-Murley score for comprehensive shoulder function,visual analog scale(VAS)score for pain,and shoulder range of motion(ROM)score were compared after 2 treatment courses to estimate the clinical efficacy in the two groups. Results:After treatment,the total effective rate was 96.7%in the acupuncture plus Tuina group versus 83.9%in the acupuncture group,showing a significant difference between the two groups(P<0.05).The Constant-Murley shoulder function score increased in the acupuncture plus Tuina group after the intervention;a decreased VAS pain score and an increased shoulder ROM score were found in both groups.After 1 and 2 treatment courses,the between-group comparisons of the Constant-Murley and shoulder ROM scores showed statistical significance(P<0.05).Regarding the VAS score,the acupuncture plus Tuina group was lower than the acupuncture group after the first treatment course(P<0.05),but there was no significant difference between the two groups after 2 treatment courses(P>0.05). Conclusion:Contralateral needling plus tendon-bone balancing Tuina can produce more significant clinical efficacy and relieve pain faster than contralateral needling alone in treating SP.

OBJECTIVETo investigate the effect of kappa-Opioid receptors in the cardioprotection elicited by ischemic postconditioning and the underlying mechanism.

METHODSThe isolated perfused hearts of male Sprague-Dawley rats were subjected to 30 min of global ischemia followed by 120 min of reperfusion. formazan content of myocardium was measured spectrophotometrically, and the level of lactate dehydrogenase (LDH) in the coronary effluent was also measured. In isolated ventricular myocytes hypoxia postconditioning was achieved by 3 cycles of 5 min reoxygenation/5 min hypoxia starting at the beginning of reoxygenation, and cell viability was measured.

RESULTIn the Langendorff perfused rat heart model, ischemic postconditioning (6 cycles of 10 s reperfusion/10 s global ischemia starting at the beginning of reperfusion) increased formazan content, reduced LDH release, improved the recovery of the left ventricular developed pressure, maximal rise/fall rate of left ventricular pressure, left ventricular end-diastolic pressure and rate pressure product (left ventricular developed pressure multiplied by heart rate), attenuated the decrease of coronary flow during reperfusion and increased the isolated cell viability. Pretreatment with nor-BNI, an antagonist of kappa-Opioid receptors and mitoK(ATP) blocker 5-HD attenuated the effect of ischemic/hypoxic postconditioning.

CONCLUSIONPostconditioning may protect myocardium against ischemia/reperfusion injury via activating kappa-Opioid receptors and mitoK(KATP).

Animals ; In Vitro Techniques ; Ischemic Preconditioning, Myocardial ; methods ; L-Lactate Dehydrogenase ; metabolism ; Male ; Myocardial Reperfusion Injury ; metabolism ; physiopathology ; prevention & control ; Myocardium ; metabolism ; pathology ; Potassium Channels ; metabolism ; physiology ; Rats ; Rats, Sprague-Dawley ; Receptors, Opioid, kappa ; metabolism ; physiology

OBJECTIVETo explore the cardioprotection effect of co-treatment with ischemic postconditioning and preconditioning in ischemia/reperfusion (I/R) injury and the related mechanism.

METHODSMale Sprague-Dawley rats were used for Langendorff isolated heart perfusion. The hearts were subjected to global ischemia for 60 min followed by 120 min of reperfusion. The cardiomyocyte viability was measured by MTT-formazan method, and the cardiac injury was evaluated by the levels of lactate dehydrogenase (LDH) in the coronary effluent. Ventricular hemodynamic parameters were also measured.

RESULTIn 60 min of ischemia and 120 min of reperfusion group, ischemic postconditioning increased formazan content, reduced LDH release, but hemodynamic parameters did not improved. Co-treatment with ischemic postconditioning and preconditioning during the prolonged ischemia further improved the hemodynamic parameters. The calcium activated potassium channel antagonist paxilline attenuated the effect of co-treatment with ischemic postconditioning and preconditioning.

CONCLUSIONIschemic postconditioning and preconditioning may synergically protect myocardium from severe ischemia injury, which may be related to calcium-activated potassium channel.

Animals ; Cell Survival ; In Vitro Techniques ; Ischemic Preconditioning, Myocardial ; methods ; L-Lactate Dehydrogenase ; metabolism ; Male ; Myocardial Ischemia ; pathology ; physiopathology ; Myocardial Reperfusion Injury ; metabolism ; physiopathology ; prevention & control ; Myocardium ; metabolism ; pathology ; Potassium Channels, Calcium-Activated ; metabolism ; Rats ; Rats, Sprague-Dawley

AIM: To assess the degree of oxidative damage during acute myocardial infarction and reperfusion, and to clarify the protective effect of Tongxinluo in mini-swine model. METHODS: Thirty mini-swines were randomized into 5 study groups: sham group, model group, low dose (0.05 g·kg~(-1)·d~(-1)), medium dose (0.2 g·kg~(-1)·d~(-1)) and high dose (0.5 g·kg~(-1)·d~(-1)) of Tongxinluo groups (pretreated with Tongxinluo for 3 d). Animals except in sham group were subjected to 3 h of coronary occlusion followed by 1 h of reperfusion. Concentrations of total antioxidative capability (T-AOC), total superoxide dismutase (T-SOD), reduced glutathione (GSH) and malondialdehyde (MDA) in blood sample and the myocardium were measured. RESULTS: (1) T-AOC, T-SOD and GSH in serum significantly decreased (all P<0.05), while MDA significantly increased (P<0.01) at 3 h after AMI in comparison with those at baseline. Compared to those at 3 h after AMI, the contents of T-AOC, T-SOD and GSH at 1 h after reperfusion significantly decreased (all P<0.01), accompanied by increase of MDA (P<0.01). (2) Compared to those in normal area, levels of T-AOC, T-SOD and GSH in reperfusion myocardium decreased significantly (all P<0.01) and MDA increased significantly (P<0.01). T-AOC, T-SOD and GSH in no-reflow myocardium further decreased (all P<0.01) and MDA increased (P<0.01) as compared to those in reperfusion myocardium. (3) Compared to model group, medium dose of Tongxinluo increased the contents of T-AOC and T-SOD and reduced MDA production in serum at 3 h after AMI (all P<0.05), while medium dose of Tongxinluo increased T-SOD level at 1 h after reperfusion (P<0.05). High dose of Tongxinluo increased the levels of T-AOC and T-SOD and decreased MDA content in serum at 3 h after AMI and 1 h after reperfusion (all P<0.05). (4) The medium dose of Tongxinluo increased T-AOC content (P<0.05) and reduced MDA (P<0.05) in reperfusion myocardium, while high dose of Tongxinluo increased T-AOC, T-SOD and GSH (all P<0.05), reduced MDA (P<0.01) in reperfusion myocardium, and also increased T-AOC, T-SOD (all P<0.05), reduced MDA (P<0.01) in no-reflow area as compared to those in model group. CONCLUSION: Impairment of antioxidant defense system in vivo and imbalance of redox homeostasis in myocardium region might play an important role in the pathogenesis of no-reflow after myocardial acute infarction following reperfusion. Tongxinluo protects myocardium from reperfusion injury by improving antioxidant defense and attenuating oxidative damage.