目的:观察银屑病样小鼠皮损紧密连接蛋白中水闸蛋白(claduin-1,claudin-7),闭锁蛋白(occludin)的表达,明确养血解毒方对银屑病表皮通透屏障的修复作用,为养血解毒方治疗银屑病提供科学依据.方法:将C57BL/6J小鼠随机分为空白组、模型组、甲氨喋呤组、养血解毒方组,制备甲氨喋呤溶液、养血解毒方水煎剂对应灌胃干预,同时小鼠背部剃毛后给予咪喹莫特涂抹诱导银屑病样皮损模型.每日拍照记录皮损形态并对严重程度指数(PASI)评分;水油测试笔检测皮损表皮含水量;苏木素-伊红(HE)染色观察其病理改变、测量表皮厚度;免疫荧光法检测增殖相关的核抗原(Ki67);免疫组化法检测表皮兜甲蛋白(loricrin),真皮中CD3+T淋巴细胞浸润和紧密连接蛋白claduin-1,claudin-7,occludin的表达;蛋白免疫印迹法(Western blot)检测皮损中claudin-7,occludin的表达.模拟银屑病皮损微环境,建立白细胞介素-17(IL-17,1 mg·L-1)刺激的角质形成细胞(Hacat)模型,制作养血组分、解毒组分、养血解毒方喷干粉进行干预.采用细胞增殖毒性检测试剂盒-8(CCK-8)法检测药物对Hacat细胞的毒性;细胞免疫荧光法检测药物对角质形成细胞claudin-1,claudin-7,occludin表达的干预作用.结果:与模型组比较,养血解毒方可显著减轻小鼠银屑病样皮损表现,降低PASI评分及皮损表皮厚度(P＜0.01),增加皮损区表皮水分含量(P＜0.01),减少表皮ki67,loricrin的异常表达和真皮CD3+T细胞浸润(P＜0.01),并增加紧密连接蛋白claudin-1,claudin-7,occludin的表达(P＜0.05),增加紧密连接结构的完整性;体外研究发现,与模型组比较,养血解毒方组和养血组分组明显升高紧密连接蛋白claudin-1,claudin-7,occludin的表达(P＜0.05);与模型组比较,解毒组分组蛋白表达水平无统计学差异.结论:养血解毒方通过调节角质形成细胞间紧密连接的表达抑制其异常的增殖分化过程,进一步恢复破坏的表皮通透屏障,可能是其治疗银屑病的作用机制之一.其中养血解毒方的养血组分对调节紧密连接的修复起主要作用.

To investigate the clinical diagnostic value of ultrasonographic superb micro‐vascular imaging ( SM I) for abdominal branch arteries′involvement in Stanford B aortic dissection ( AD ) . Methods A total of 34 AD patients underwent conventional ultrasound ,SMI and CTA . The characteristics of the ultrasonographic images of branch artery involvement including coeliac artery ,superior mesenteric artery ,left and right renal artery were analyzed . T he diagnostic performance of conventional ultrasound and SM I were compared and CT A was used as the reference standard . Results Among the 34 patients with AD ,according to the ultrasonographic images′characteristics ,136 branch arteries were categorized into four classes :Class Ⅰ (81/136) ,branch artery perfusion supplied from the aortic true lumen ; Class Ⅱ ( 27/136) , dissection extending into the branch ; Class Ⅲ ( 16/136 ) ,branch artery perfusion supplied from the aortic false lumen ; Class Ⅳ ( 12/136) ,branch artery perfusion supplied from the aortic true and false lumens . T he diagnostic accordance rate of the conventional ultrasound and SM I were 76 .5% ( 104/136 ) and 92 .6%( 126/136) and had significant differences ( P ＜0 .001) . Conclusions SMI can be used to evaluate branch artery involvement in AD patients w hich will guide the practice of pre‐operation and post‐operation .

目的 探讨养血活血解毒方治疗银屑病的可能作用机制.方法 将养血活血解毒方拆分为养血活血类药物和解毒类药物.80只Wistar大鼠随机分为空白组、全方组、养血活血方组、解毒方组,每组20只.全方组、养血活血方组、解毒方组分别给予相应药物10.18、6.17、4.01g/(kg·d)剂量灌胃,空白组予4 ml的蒸馏水灌胃,连续4天,制备含药血清.人真皮微血管内皮细胞(HDMEC)分为空白组、模型组、全方组、养血活血组、解毒组.除空白组外,其余各组采用佛波酯诱导细胞活化.同时加入相应药物的10％含药血清作用24h.检测各组内皮细胞增殖情况、迁移情况、管腔形成情况,以及血管内皮细胞生长因子(VEGF)、血管内皮细胞生长因子受体(VEGFR)、细胞外调节蛋白激酶1(ERK1)、细胞外调节蛋白激酶2 (ERK2) mRNA表达,检测VEGF/VEGFR通路及细胞外调节蛋白激酶/核因子κB (ERK/NF-κB)通路蛋白表达.结果 与空白组比较,模型组细胞增殖,迁移细胞数量,管腔形成数量,VEGF、VEGFR、ERK2 mRNA及VEGF/VEGFR通路、EKR/NF-κB通路相关蛋白表达升高(P＜0.01);与模型组比较,全方组和解毒组细胞增殖,迁移细胞数量,VEGF、VEGFR mRNA表达和p-ERK1、p-EKR2、p-NF-κB p65蛋白表达水平均降低,全方组VEGF、p-VEGFR蛋白表达降低,且全方组细胞增殖、ERK2mRNA表达低于解毒组(P＜0.05或P＜0.01). 结论 养血活血解毒方可通过干预ERK/NF-κB通路,调控促血管新生因子VEGF及其受体的表达,从而对银屑病血管新生的病理环节发挥治疗作用,且全方药效最佳,其养血活血组分未对内皮细胞增生环节有影响.

Objective To study the clinical value of intraoperative epicardial echocardiography ( IEE) in assessing graft-left anterior descending artery ( LAD ) of off-pump coronary artery bypass grafting ( OPCABG) . Methods IEE was used to detecte graft vessels anastomosis in 53 patients with OPCABG-LAD . Two-dimensional grey ultrasound and color Doppler ultrasound was used to show whether there was abnormal echo in proximal and distal lumen , measuring diameter and rate of stenosis . Pulse Doppler ultrasound was used to observe the blood flow spectrum . Intraoperative transient blood flow meter (TTFM) was employed to measure the pulsatility index and flow volume . Results Among the 53 patients with OPCABG-LAD ,38 cases were left internal mammary artery graft (LIMA) ,15 cases were saphenous vein graft (GSV) . Pulsatility index and flow volume showed normal by TTFM . The detection rates of graft vessels-LAD anastomosis in proximal and distal segment were 100％ using IEE , including 10 cases anastomotic plaques and 10 cases proximal plaques . Comparison of blood flow parameter of graft by IEE and TTFM in operation ,there was no significant difference in LIMA grafts ( P =0 .091) ,but the correlation was statistically significant ( r = 0 .809 , P < 0 .001 ) ;the difference in GSV grafts had no statistical significance ( P = 0 .821 ) ,but the correlation was statistically significant ( r = 0 .684 , P = 0 .005 ) . Conclusions IEE clearly displays the lumen of graft vessel and LAD ,and measures the hemodynamic indexes . It provides an intuitive ,accurate and convenient method for detecting the patency of the graft vessels during OPCABG .

Objective To explore the potential mechanism of Liangxue Jiedu Lishi Fang（凉血解毒利湿方,LJLF) in treating psoriasis.Methods Fifty BALB/c mice were randomized into control group,model group,methotrexate group as well as Chinese medicine high and low dose groups.Group except for the control group was coated with 5％ imiquimod cream for 6 days to establish a psoriasis model.Chinese medicine high and low dose groups were respectively given oral LJLF 42 and 21 g/(kg · d),methotrexate group was given methotrexate tablets 1 ng/(kg ·d) by gavage and the model group and the control group were given 0.4ml distilled water once a day for 6 days.On the 7th day,the changes of the skin lesions were observed;the morphological changes of the lesions were observed by HE staining and the thickness of the epidermis was measured under light microscope;immunofluorescence method was used to detect the number of proliferating cell nuclear antigen (PCNA) mitotic cell nucleus,mitotic cell ratio,and the expressions of cortical protein,peroxisome proliferator activated receptor α (PPAR-α),peroxisome proliferator activated receptor γ (PPAR-γ) and peroxisome proliferator-activated receptor β/δ (PPAR-β/δ) in skin lesions.The mRNA and protein expressions of PPAR-α,PPAR-γ and PPAR-β/δ in mouse skin were detected by real-time PCR and western blot respectively.Results The mice in the model group had squamous skin scales,deep erythema and thick infiltration.Compared with those of the model group,the lesions of each treatment group significantly improved.Compared with those in the control group,the epidermal cell layer in the model group was thicker,the number of mitotic nuclei and the mitotic cell ratio significantly increased.Compared with those in the model group,the expressions of PPAR-α and PPAR-γ protein increased in methotrexate group and Chinese medicine high and low dose groups,while the expression of PPAR-β/δ decreased,and the mRNA levels of PPAR-γ and PPAR-β/δ in methotrexate group significantly decreased,so as the PPAR-β/δ mRNA in high and low dose Chinese medicine groups (P ＜ 0.05 or P ＜0.01).Compared with the high dose Chinese medicine group,the expression of PPAR-β/δ mRNA in the low dose Chinese medicine group significantly decreased (P ＜ 0.01).Conclusion LJLF could regulate the expression of PPARs in the skin lesions of psoriatic mice and thus inhibits the excessive proliferation and differentiation of epidermal cells,which may be one of its mechanisms in the treatment of psoriasis.

Objective: To assess the values of conventional vascular ultrasound (US) and superb micro vascular imaging (SMI) for diagnosing carotid artery stenosis in relevant patients. Methods: A total of 37 patients of extra cranial carotid stenosis (with 70 blood vessels) treated in our hospital from 2014-08 to 2015-03 were retrospectively studied. Digital subtraction angiography (DAS) examination was used as golden standard, the diagnostic efifcacies for carotid artery stenosis by US and by SMI were compared. Results: The accuracy, sensitivity and specificity for diagnosing carotid stenosis by US were 81.42%, 83.33% and 80.95%; by SMI were 91.43%, 92.16% and 89.47% respectively. Conclusion: US and SMI showed good agreement for diagnosing carotid artery stenosis, while SMI was superior to US for accurately assess the degree of carotid stenosis, it might be used as a more reliable method for evaluating carotid plaque and stenosis in relevant patients.

Objective To assess the elasticity value of shear wave elastography (SWE)in quantitative evaluation the achilles tendons of familial hypercholesterolemia (FH).Methods Eleven patients with FH achilles tendons and 14 healthy volunteers were examined.Each achilles tendons were divided into the following 3 sections for grey scale ultrasound and SWE images evaluation,including proximal,middle and distal.The thickness and mean elasticity values obtained at different sections of achilles tendons were statistically analyzed.Results The thickness of proximal,middle and distal sections of achilles tendons in healthy volunteers were (4.5 1 ±0.63)mm,(4.5 1 ±0.63)mm and (4.32±0.39)mm,respectively.Grey scale feature was hypoecho with parallel linear hyperecho.The mean elasticity value of proximal,middle and distal sections in healthy volunteers achilles tendons were (404.94 ± 37.37 )kPa,(412.78 ± 36.65 )kPa and (400.53±35.1 7)kPa,respectively.The thickness of proximal,middle and distal sections of achilles tendons in FH were (5.45±1 .92)mm,(8.46±4.55)mm and (6.44± 1 .90)mm,respectively.Grey scale feature was thickened and hypoecho with irregular and haphazard linear hyperecho.Three of them had arc shaped calcifications. The mean elasticity value of proximal, middle and distal sections in familial hypercholesterolemia achilles tendons were (287.43±39.77)kPa,(280.75±59.78)kPa and (260.37±39.09) kPa,respectively.Statistically significant differences were found for the thickness measured at proximal, middle and distal sections between the healthy volunteers and FH (all P <0.05 ),and for mean elasticity value (all P <0.01).Conclusions The thickness,grey scale feature and elasticity value by SWE can reflect the stiffness of the achilles tendon,and provide more information for the quantitative assessment of FH's achilles tendon.

Objective To investigate the correlation between patent posterior communicating artery(PCoA) and proximal vertebral artery stenosis in patients with atherosclerotic carotid artery stenosis disease(≥70%).Methods Examine the intracranial artery and carotid artery by using color Doppler flow imaging(CDFI) in 160 patients with carotid arterial stenosis(≥70%) confirmed by angiography before and after surgical treatment(endarterectomy,carotid artery stent placement).The patients were divided into patients with PCoA flow group and patients without PCoA flow group,with occurrence rate of proximal vertebral artery stenosis compared between the two groups.Results(1) Flow velocity at proximal vertebral artery before operation(with PCoA flow) in patients with PCoA flow group was significantly improved compared to that after treatment(without PCoA flow).Peak systolic velocity(PSV) and end diastolic velocity(EDV) values of proximal vertebral artery with and without PCoA flow were 100.76±74.84cm/s,81.54±54.29cm/s(P=0.000).(2) Patients with PCoA flow accounted for 50%(80/160),including 45.6%(73/160) with stenosis of proximal vertebral artery;Patients without PCoA flow accounted for 50%(80/160),including 28.1%(45/160) with stenosis of proximal vertebral artery(P=0.002).Conclusion Proximal vertebral artery stenosis rate is significantly higher in patients with severe carotid artery stenosis disease with patent PCoA.