盐酸替罗非班治疗急性心肌梗死的临床疗效观察及相应机制

目的:观察盐酸替罗非班对急性心肌梗死的临床疗效及相应机制。方法:哈尔滨医科大学附属第四医院急诊急救中心入选急性ST段抬高型心肌梗死的患者(n=50),其中男性35例,女性15例,平均年龄58.4±10.3岁,给予内科药物治疗。患者随机分为常规药物组(n=23)和替罗非班组(常规药物+替罗非班,n=27)。通过观察临床症状和心电图ST段变化评价治疗效果,应用血小板聚集仪比浊法测定样本不同时间点(治疗前,给药过程中,给药结束后2小时)血小板聚集率变化以及应用酶联免疫吸附剂测定(ELISA)方法检测血清中血小板第四因子(PF4)的水平变化。并进一步做相关性分析。结果:与常规药物组比较,替罗非班组患者胸痛明显减轻,心电图ST回落指数增加(P<0.05),给药过程中血小板聚集率明显降低(P<0.001),同时血清中PF4的水平也显著降低(P<0.001),并且与血小板聚集率呈正相关性(r=0.86,P<0.001)。结论:盐酸替罗非班对于急性ST段抬高型急性心肌梗死有确切的治疗效果,可能是通过抑制血小板的聚集和减少PF4的释放而发挥作用的。     

替罗非班在急性脑卒中溶栓后再闭塞患者治疗中的价值与安全性分析

目的探讨替罗非班在急性脑卒中溶栓后再闭塞患者治疗中的价值与安全性。方法按照治疗方案不同将溶栓治疗后再闭塞的80例急性脑卒中患者分为观察组和对照组各40例,对照组给予依诺肝素治疗,观察组给予替罗非班治疗,比较两组患者的治疗效果及安全性。结果两组患者的治疗总有效率比较差异无明显统计学意义(P0.05),但观察组患者的基本治愈率显著高于对照组(P0.05);观察组溶栓后24 h及溶栓后1周的NIHSS评分均显著低于对照组,差异有统计学意义(均P0.05);两组患者溶栓后24 h的凝血功能指标水平以及不良事件发生率比较,差异无明显统计学意义(P0.05)。结论替罗非班治疗急性脑卒中溶栓后再闭塞的疗效显著,可明显改善患者神经功能,且不良事件发生率低,对凝血功能无影响,值得临床应用。     

冠状动脉内注射负荷量替罗非班对急性心肌梗死患者心肌灌注及心功能的影响

目的：探讨急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉注射负荷量盐酸替罗非班对心肌灌注及心功能的影响。方法：选择急性ST段抬高型心肌梗死患者270倒,随机分为实验组（n=133）和对照组（n=137）。所有入选患者均急诊进行经皮冠状动脉介入治疗（PCI）,术中实验组患者予冠脉内注射负荷量盐酸替罗非班,对照组不予注射,主要终点为观察PCI术后即刻造影结果,同时观察术后3天、30天、360天的左室射血分数（EF）,左室舒张末期内径（LVEDD）、左室收缩期末内径（LVESD）及术后360天主要心血管不良事件的发生率;次要终点为一般出血事件的发生率、血小板下降情况、血小板聚集率的变化。结果：实验组患者术后校正的TIMI帧数、术后2小时ST段回落程度、磷酸肌酸肌酶同工酶（CK-MB）峰值及峰值时间显著优于对照组（P〈0．05）．梗死相关血管无复流发生率及360天MACE的发生率显著低于对照组（P〈0．05）,与对照组相比,术后30天、360天的EF值明显增加,术后30天、360天的LVEDD、LVESD显著降低（P〈0．05）;实验组术后2天血小板聚集率明显低于对照组（P〈0．05）。结论：急诊PCI术中联合冠脉内注射负荷量替罗非班可以改善心肌灌注水平及心功能,且不增加出血事件的发生率,提高远期愈后。     

高负荷剂量氯吡格雷联合替罗非班在非ST段抬高型急性冠状动脉综合 征患者经皮冠状动脉介入中的应用

目的：探讨高负荷剂量氯吡格雷联合替罗非班在高危非ST 段抬高型急性冠状动脉综合征（acute coronary syndrome,ACS） 患者经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）中的作用及安全性。方法：入选208 例高危非ST 段抬高型 ACS患者,根据PCI术前氯吡格雷负荷量不同,随机分为观察组和对照组。对照组：112 例,以氯吡格雷300 mg+ 替罗非班(用法同 观察组)治疗,观察组：96例,以氯吡格雷600 mg +替罗非班0.4 滋g/(kg·min)在30 min 内静脉注射。继以0.1 g/(kg·min)由微量泵 静脉持续泵入至手术后36 h,分别测定两组最大血小板聚集率(MPAR)变化、PCI 术后TIMI心肌灌注分级(TMPG);随访住院期间 和30 d内不良心血管事件和出血事件。结果：两组临床情况、PCI前负荷剂量氯吡格雷给药时间、支架置入数目比较差异无统计 学意义(P>0.05);用药后2 h、6 h、术后24 h两组MPAR均较用药前明显降低(P<0.05);用药后6 h两组MPAR 均低于用药后2 h (P<0.05);用药后2 h时观察组MPAR 低于对照组(P<0.05)。PCI术后TMPG 3级获得率观察组高于对照组(P<0.05);30 d内复合心 血管事件发生率、出血并发症两组比较差异均无统计学意义(P>0.05)。结论：PCI术前负荷氯吡格雷600 mg可以更有效、更迅速地 抑制患者的MPAR,联合应用替罗非班时仍可改善心肌灌注,且安全可行。     

替罗非班对急性心梗患者急诊PCI中冠脉内血栓的影响

目的:探讨替罗非班对ST段抬高急性心肌梗死患者直接经皮冠状动脉内介入治疗(PCI)中冠状动脉内血栓的影响。方法:79例患者,随机分为试验组(替罗非班 PCI,34例)和对照组(直接PCI,45例)。观察住院期间主要心血管事件(MACE)发生率,冠状动脉内血栓和使用替罗非班的不良反应。结果:与对照组相比,试验组于术前应用替罗非班使PCI术前梗死相关血管(IRA)内血栓存在比例明显降低(P<0.05);试验组出血发生率较对照组有增多趋势(P>0.05)。结论:早期使用血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班,可以明显减少STEMI梗死相关血管内血栓的发生率。     

高负荷剂量氯吡格雷联合替罗非班在非ST段抬高型急性冠状动脉综合征患者经皮冠状动脉介入中的应用

目的：探讨高负荷剂量氯吡格雷联合替罗非班在高危非ST段抬高型急性冠状动脉综合征（acute coronarysyndrome,ACS）患者经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）中的作用及安全性。方法：入选208例高危非ST段抬高型ACS患者,根据PCI术前氯吡格雷负荷量不同,随机分为观察组和对照组。对照组：112例,以氯吡格雷300 mg＋替罗非班（用法同观察组）治疗,观察组：96例,以氯吡格雷600 mg＋替罗非班0.4μg/（kg·min）在30 min内静脉注射。继以0.1 g/（kg·min）由微量泵静脉持续泵入至手术后36 h,分别测定两组最大血小板聚集率（MPAR）变化、PCI术后TIMI心肌灌注分级（TMPG）;随访住院期间和30 d内不良心血管事件和出血事件。结果：两组临床情况、PCI前负荷剂量氯吡格雷给药时间、支架置入数目比较差异无统计学意义（P〉0.05）;用药后2 h、6 h、术后24 h两组MPAR均较用药前明显降低（P〈0.05）;用药后6 h两组MPAR均低于用药后2 h（P〈0.05）;用药后2 h时观察组MPAR低于对照组（P〈0.05）。PCI术后TMPG 3级获得率观察组高于对照组（P〈0.05）;30 d内复合心血管事件发生率、出血并发症两组比较差异均无统计学意义（P〉0.05）。结论：PCI术前负荷氯吡格雷600 mg可以更有效、更迅速地抑制患者的MPAR,联合应用替罗非班时仍可改善心肌灌注,且安全可行。     

替罗非班对老年急性冠脉综合征患者血清 sCD40L水平的影响

目的：观察替罗非班对老年急性冠脉综合征(ACS)患者血清可溶性CD40 配体(sCD40L)水平的影响。方法：将120 例老年 ACS患者,按照临床治疗方法分为非介入组(60 例)和介入组(60 例)。每组患者再随机分为两个亚组：对照组和替罗非班组。非介 入组中的对照组应用阿司匹林、氯吡格雷、低分子肝素等常规药物治疗;替罗非班组则在对照组常规治疗的基础上加用盐酸替罗 非班持续治疗72 h。介入组应用PCI,其中对照组在PCI 术前嚼服阿司匹林和氯吡格雷,低分子肝素皮下注射,术中鞘内注射肝 素;替罗非班组在常规治疗的同时,于PCI术前10 min 开始以10 滋g/kg 的替罗非班冠状动脉内注射。各组患者均在治疗前及治 疗后48 h采用酶联免疫吸附测定(ELISA)法测定血清sCD40L水平。结果：介入组和非介入组的替罗非班组患者治疗后48 h的血 清sCD40L浓度较治疗前明显降低,差异有统计学意义(P<0. 05)。结论：替罗非班可以降低ACS患者的血清sCD40L水平,从而发 挥除抗栓以外的抗炎作用。     

阿托伐他汀联合替罗非班对冠心病介入治疗患者血管内皮功能的影响

目的探讨阿托伐他汀联合替罗非班对冠心病介入治疗患者血管内皮功能的影响。方法选择2016年3月～2018年3月在我院接受介入治疗的冠心病患者128例,按随机对照原则分为两组各64例。对照组给予阿托伐他汀治疗,观察组在对照组基础上给予替罗非班治疗,观察比较两组的临床疗效、血管内皮功能指标及不良反应情况。结果观察组的治疗总有效率高于对照组(95.31%和79.69%),差异有统计学意义(P0.05)。治疗前,两组患者的血管内皮功能指标比较,差异无统计学意义(P0.05);治疗后,两组患者的血管内皮功能指标均优于治疗前,且观察组优于对照组,差异均有统计学意义(P0.05)。两组患者的不良心脏事件发生率比较(10.94%和25.00%),差异有统计学意义(P0.05)。结论阿托伐他汀联合替罗非班对冠心病介入治疗患者的临床疗效显著,能有效改善患者血管内皮功能,降低心脑血管意外事件发生率,值得临床推广应用。     

冠脉内注射替罗非班不同给药方式对急性心肌梗死介入治疗术中血流异常的影响

目的：比较急性心肌梗死介入治疗中冠脉内常规给予以及必要时给予血小板膜糖蛋白（GP）Ⅱb／Ⅲa受体拮抗剂替罗非班两种给药方式对冠脉血流异常的影响,寻找较好的替罗非班用药方式。方法：入选九四医院2005年1月至2008年10月急性心肌梗死直接PCI患者58例,随机分成常规给药组（血管开通前所有患者冠状动脉内均注射替罗非班,n=30）与必要时给药组（血管开通后即时造影显示TIMI血流≤2级者冠脉内注射替罗非班,TIMI血流3级者不给药,n=28）,观察支架植入后30分钟TIMI血流、30天内主要不良心血管事件（MACE）、出血以及血小板减少情况。结果：必要给药组冠脉内给药可显著改善冠脉血流（TIMI3级给药前46．4％,给药后75％,P〈0．05）,常规给药组支架植入后30分钟TIMI3级获得率高于必要给药组（96．7％比75％,P〈0．05）,MACE、出血和血小板减少事件两组之间差异无统计学意义。结论：冠脉内给予替罗非班可有效降低急性心肌梗死PCI术中血流异常情况,血管开通前冠脉内常规给药方式优于必要时给药方式。     

替罗非班对老年急性冠脉综合征患者血清sCD40L水平的影响

目的：观察替罗非班对老年急性冠脉综合征（Acs）患者血清可溶性CD40配体（sCD40L）水平的影响。方法：将120例老年ACS患者,按照临床治疗方法分为非介入组（60例）和介入组（60例）。每组患者再随机分为两个亚组：对照组和替罗非班组。非介入组中的对照组应用阿司匹林、氯吡格雷、低分子肝素等常规药物治疗;替罗非班组则在对照组常规治疗的基础上加用盐酸替罗非班持续治疗72h。介入组应用PCI,其中对照组在PCI术前嚼服阿司匹林和氯吡格雷,低分子肝素皮下注射,术中鞘内注射肝素;替罗非班组在常规治疗的同时,于PCI术前10min开始以10μg／kg的替罗非班冠状动脉内注射。各组患者均在治疗前及治疗后48h采用酶联免疫吸附测定（ELISA）法测定血清sCD40L水平。结果：介入组和非介入组的替罗非班组患者治疗后48h的血清sCD40L浓度较治疗前明显降低,差异有统计学意义（P〈0．05）。结论：替罗非班可以降低ACS患者的血清sCD40L水平,从而发挥除抗检以外的抗炎作用。     

Characteristics of the membranes of the pellicle of the ciliatePseudomicrothorax dubius

Summary The membranes of the pellicle of the ciliatePseudomicrothorax dubius are investigated using thin section electron microscopy and freeze-fracture replicas. The plasma membrane is covered by a surface coat and is connected to the outer alveolar membrane by short, sometimes branched, bridges. The inner alveolar membrane is coated on both sides. The epiplasm lies in intimate contact with the cytoplasmic surface of this membrane, and there is a corresponding deposit on the other surface. This deposit is regularly striated.The epiplasmic layer and the alveoli are interrupted at sites of cytotic activity,e.g., the attachment sites of trichocysts, the cytoproct, and the parasomal sacs. The striated deposit ends where the epiplasm ends, indicating a direct relationship between these two epimembranous layers.There is a deposit along the sides of the first part of the tip of the trichocysts, and in this region the trichocyst membrane is free of intramembranous particles.The membrane of the parasomal sacs has a coat on both surfaces. That on the extraplasmic surface is similar to the surface coat of the plasma membrane. The origin of the cytoplasmic coat is unknown. The cytotic activity of these sacs is indicated by their highly irregular profiles.     

The early development of the tail and the transformation of the shape of the nucleus of the spermatid of the domestic fowl,Gallus gallus

Summary The differentiation of the spermatid, especially in reference to the formation of the flagellum, and transformation of the shape of the nucleus was investigated in the domestic fowl.In the early stage of the spermatid, a prominent Golgi apparatus appears around the centrioles. The Golgi vesicles then surround the axial-filament complex which develops from the distal centriole. These vesicles fuse to form continuous membrane at the earliest stage of flagellar formation, and in the succeeding stage Golgi lamellae are attached to the plasma membrane of the developing flagellum. From these observations, it is assumed that Golgi apparatus may be a source of the membrane system of the flagellum.The microtubules distributed around the nucleus form the circular manchette. The anterior region of the nucleus with the manchette is cylindrical in shape and the posterior region without it remains irregular in shape. When the circular manchette has been completed, the whole nucleus acquires a slender cylindrical shape. The circular manchette then changes into the longitudinal manchette. The nuclei of spermatids without a longitudinal manchette are abnormal in shape. In view of these observations it is assumed that the nuclear shaping of the spermatid may be accomplished by circular manchette and the maintenance of shape of the elongated nucleus by longitudinal manchette.The authors wish to thank Mr. Takayuki Mori for his helpful suggestions and technical advices     

Characterization of the composition of the aqueous humor and the vitreous body of the eye of the frog Rana temporaria L

This study aimed to analyze the aqueous humor (AH) and the vitreous body (VB) of the eye of the adult frog Rana temporaria L. as a representative species of amphibians, which lead a semi-terrestrial life. The presence of collagen, albumin, uric acid and electron donors was shown in both media; however, there are slight differences in their concentrations. To determine collagen, a spectral-fluorescent probe, cyanine dye, was used. The presence of collagen in AH of the frog was found at the first time. The total content of electron donors (ascorbic and uric acids, tryptophan, and tyrosine) in VB and HA was roughly estimated at ~ 1.5 × 10^− 4 mol/L. Both VB and AH absorb light in similar UV regions. The total protein and albumin contents in AH were found to be somewhat higher than those in VB. The uric acid content was at an equally low level in both intraocular media. It is supposed that the similarity of VB and AH compositions shown in this work is due to some exchange between VB and AH contents in the course of accommodation. The role of intraocular fluids in physiological functions of the eye and in protecting the retina against UV light is discussed.