充血性心力衰竭跨室壁复极不均一性的改变

目的研究充血性心力衰竭模型左心室三层心肌之间单相动作电位的改变。以探讨充血性心力衰竭易发心室颤动的基础电生理机制。方法用阿霉素制作充血性心力衰竭家兔模型，测定其室颤阈值（VFT）以及心外膜、中层心肌和心内膜心肌细胞的单相动作电位复极90％时程（APD90）、跨室壁复极离散度（TDR）。结果充血性心力衰竭VFT明显降低，三层心肌细胞APD90均明显延长，但中层心肌细胞较心外膜、心内膜下心肌细胞延长更为显著；充血性心力衰竭跨室壁TDR增加。结论中层心肌细胞APD90明显延长、跨室壁TDR增加可能是充血性心力衰竭容易发生心室颤动的重要原因。     

参松养心胶囊对兔跨室壁复极离散度的影响

目的观察参松养心胶囊对兔跨壁复极离散度(TDR)的影响,为阐述参松养心胶囊抗心律失常机制以及药物安全性提供实验依据。方法 20只兔随机分为2组,参松养心组(予参松养心胶囊1g/kg,n=10)和健康对照组(予等量生理盐水,n=10),2周后均建立冠脉灌注左室楔形心肌组织块模型,在不同基础刺激周长(BCL)下,记录2组兔TDR的变化。结果 (1)与健康对照组比较,参松养心组兔内、外膜心肌细胞的动作电位时程(APD)延长,当BCL分别为500 ms、1000 ms、2000 ms、4000 ms时,心内、外膜APD均有不同程度延长,参松养心组同健康对照组相比,差异均有统计学意义(P<0.01)。(2)与健康对照组比较,参松养心组TDR显著缩短,差异有统计学意义(P<0.01)。结论参松养心胶囊可延长心肌内、外膜细胞APD,有效减小TDR,从而发挥抗心律失常作用。     

灯盏花素对家兔肥厚心肌室性心律失常的影响

目的观察口服灯盏花素对家兔肥厚心肌室性心律失常的影响,探讨灯盏花素抗心律失常的作用机制。方法 30只家兔随机分为假手术组、心肌肥厚组和灯盏花素组,每组10只。假手术组开腹但不行腹主动脉缩窄术;心肌肥厚组和灯盏花素组采用腹主动脉缩窄术制备家兔心肌肥厚模型;灯盏花素组自手术后第2天开始喂服灯盏花素,每只每日1片,喂养8周。制备兔左心室楔形心肌块,利用浮置玻璃微电极法同步记录楔形心肌块内、外膜心肌细胞跨膜动作电位和跨壁心电图;测心脏质量(HW)、体质量(BW)和左心室游离壁厚度(LVT)。观察各组QT间期和内、外膜心肌细胞跨膜动作电位以及跨室壁复极离散度(TDR),程序电刺激诱发室性心律失常,记录跨膜动作电位复极90%的时程(APD90),早期后除极(EAD)和尖端扭转性室性心动过速(Tdp)的发生率。结果心肌肥厚组与灯盏花素组HW、HW/BW及LVT值与假手术组相比均明显升高(P<0.05);灯盏花素组HW、HW/BW及LVT值与心肌肥厚组相比均明显减小(P<0.05)。心肌肥厚组与灯盏花素组QT间期及内、外膜心肌APD90较假手术组明显延长(P<0.05);灯盏花素组QT间期及内、外膜心肌APD90与心肌肥厚组相比明显缩短(P<0.05)。假手术组、心肌肥厚组和灯盏花素组TDR分别为(55±17)、(99±12)和(68±11)ms,3组间比较差别有统计学意义(P<0.05)。灯盏花素组EAD和Tdp的发生率明显低于心肌肥厚组(P<0.05)。结论肥厚心肌TDR增大,心律失常的发生率显著升高。灯盏花素可减少TDR,明显降低EAD和Tdp的发生率。     

普伐他汀对兔急性心肌缺血室性心律失常的影响

目的观察普伐他汀对兔急性心肌缺血室性心律失常的影响并探讨其作用机制。方法将36只家兔随机分为对照组、缺血再灌组和普伐他汀组，每组各12只。制备冠脉灌流的兔左心室楔形心肌块的灌注模型，采用浮置玻璃微电极法同步记录楔形心肌块心内膜、心外膜心肌细胞跨膜动作电位和跨室壁心电图。观察各组缺血30 min和再灌注15 min时的QT间期和内、外膜心肌细胞跨膜动作电位时程以及跨室壁复极离散度（TDR），同时记录各组缺血和再灌注时室性心律失常的诱发率。结果①缺血状态下缺血再灌组较对照组TDR和心律失常的诱发率显著增加（均P〈0.01），普伐他汀组和缺血再灌组与对照组相比，TDR和心律失常的诱发率显著减少（均P〈0.05），对照组、缺血再灌组和普伐他汀组室性心律失常的诱发率分别为0/12、9/12、2/12。②再灌注状态下缺血再灌组和普伐他汀组TDR和室性心律失常的发生率差异均无显著性意义（均P〉0.05）。结论普伐他汀可显著降低兔急性缺血心肌跨室壁复极离散度和室性心律失常发生率，并能够改善缺血心肌的各项异常电生理指标。     

银杏叶提取物对家兔心室肌细胞瞬时外向钾电流和动作电位的影响

目的:探讨银杏叶提取物(Egb761)对家兔心室肌细胞瞬时外向钾电流(Ito)和动作电位的作用,揭示其抗心肌缺血及缺血引起的心律失常的离子机制。方法:酶解法分离家兔的心室肌细胞。全细胞膜片钳技术记录心肌细胞的Ito和动作电位及其被Egb761作用后的变化。结果:①在电压钳制方式下,60μg/L Egb761作用心室肌细胞5 min后,各个钳制电位下的Ito均明显增大,在钳制电位为+50 mV时,Egb761使Ito的电流密度由对照组的(7.59±0.19)pA/pF增加到(11.18±0.89)pA/pF(P<0.01,n=8),Egb761还使Ito的I-V曲线比对照组Ito的I-V明显抬高,但I-V曲线方向没有发生改变,表明Egb761引起了心肌细胞Ito的明显外流。②在电流钳制下,对照组心室肌细胞动作电位都具有从0期到4期的动作电位形态,60μg/L Egb761使心肌细胞动作电位形态呈三角形尖锥锋形,动作电位时程(APD)明显缩短,其复极化50%时程(APD50)和复极化90%时程(APD90)分别由(83.6±4.3)ms缩短为(51.3±3.2)ms和由(168.7±4.1)ms缩短为(93.8±4.4)ms(分别与对照组相比,P<0.01,n=8),尽管Egb761使动作电位幅度(APA)和静息电位(RP)降低,但与对照组相比,没有显著性差异(P>0.05)。结论:Egb761可使心室肌细胞Ito显著增加和APD明显缩短,从而减轻心肌缺血时细胞内阳离子超载对心肌造成的损伤和心肌缺血引起的心律失常的发生,以及增加心脏泵血功能。     

贝那普利对扩张型心肌病中层心肌细胞动作电位时程的影响

目的探讨贝那普利对扩张型心肌病（DCM）中层心肌细胞动作电位时程的影响及其抑制莹性心律失常。方法制作DCM家兔模型，并给予贝那普利干预，然后测定其室颤阈值（VFT）以及心外膜、中层心肌和心内膜心肌细胞的单相动作电位复极90％时程（APD90）、跨室壁复极离散度（TDR）。结果DCM治疗组（DCM＋贝那普利）与DCM对照组相比，治疗组VFT阈值升高，三层心肌APD90均缩短，以中层心肌APD90缩短更为明显，TDR减小。结论贝那普利能抑制DCM室性心律失常的发生，间接地减小三层心肌跨室壁复极不均一性是重要机制。     

药物致尖端扭转型室性心动过速的发生机制

目的探讨药物致尖端扭转型室性心动过速(Tdp)的发生机制。方法建立冠状动脉灌注的犬左室心肌楔形组织块模型,同步记录左心室内膜、中层、外膜心肌细胞的动作电位及跨壁心电图,观察不同浓度D-Sotalol对动作电位时间(APD)、QT间期、跨壁复极离散度(TDR)、早期后除极(EAD)及Tdp发生的影响。结果浓度为0～100μmol/L的D-Sotalol呈剂量依赖性地延长各层细胞APD,尤以中层细胞最为显著(P<0.05),因而增加TDR;D-Sotalol在中层细胞可诱发EAD,触发室性早博并形成跨壁折返导致Tdp。结论 D-Sotalol在中层细胞诱发EAD、R on T室性早博是其致Tdp的始动因子,在TDR增加的基础上形成跨室壁折返是Tdp得以维持的关键。     

稳心颗粒对缺血大鼠心室肌电生理特性的影响

目的观察不同浓度稳心颗粒对大鼠缺血左心室肌跨膜动作电位及有效不应期等电生理特性的影响。方法将40只SD大鼠随机分为缺血对照组,含有1、5、10 g/L稳心颗粒给药组,每组10只。脱臼法处死大鼠后迅速分离左心室楔形心室肌组织块。利用标准玻璃微电极技术,记录缺血前、灌注单纯缺血液或灌注含不同浓度稳心颗粒缺血液时不同刺激周长下大鼠左室心内膜跨膜动作电位（TAP）及有效不应期（ERP）。结果①与正常对照组比较,缺血对照组左心室肌动作电位幅值（APA）降低,动作电位时程（APD）缩短,0期最大去极速度（Vmax）减小,有效不应期（ERP）缩短（P〈0.05）;与缺血对照组比较,各稳心颗粒给药组APA、APD、Vmax增大（P〈0.05）,5、10 g/L稳心颗粒给药组ERP明显延长（P〈0.05）。②缺血液灌流使心肌组织的频率依赖性减弱,随着稳心颗粒给药浓度的增加和给药时间的延长,心肌组织的频率依赖性特点逐渐恢复。结论稳心颗粒可减轻缺血引起的心室肌电生理改变,这可能是其抗心律失常的机制之一。     

伊布利特与胺碘酮联合应用对兔心肌电生理的影响

【目的】观察伊布利特与胺碘酮联合使用后对兔跨室壁复极离散度的影响,为临床上合理使用伊布利特,提高药物安全性提供理论依据。【方法】新西兰大白兔40只,随机分为正常组、伊布利特组、胺碘酮组、伊布利特+胺碘酮组,每组10只。采用冠脉灌注左室楔形心肌组织块模型,在不同灌注溶液条件下,记录各组兔心室肌内膜及外膜动作电位时程(action potential duration,APD)及跨室壁复极离散(transmural dispersion of repolarization,TDR)。【结果】伊布利特组与对照组相比,心肌内膜、外膜细胞APD均延长,TDR也显著增大(P<0.05)。胺碘酮组与对照组相比,心肌内膜、外膜细胞APD延长(P<0.05),而TDR减小(P<0.05)。伊布利特+胺碘酮组与对照组、胺碘酮组、伊布利特组相比,心肌内膜、细胞APD均有延长(P<0.05)。伊布利特与胺碘酮合用后,TDR虽较胺碘酮组有所增大,但较伊布利特组减小,且与对照组无明显差异(P>0.05)。【结论】胺碘酮与伊布利特联合使用,有效减少单独使用伊布利特所引起的TDR增大,从而提高伊布利特临床使用的安全性。     

心肌缺血时复极和传导交替是T波电交替的电生理机制

目的:探讨缺血性T波电交替(TWA)的电生理学机制.方法:在体实验组家兔10只,开胸后结扎左冠状动脉前降支(LAD),造成心肌缺血模型,在结扎LAD前、结扎后60 min重复观测缺血区域心室壁内膜下层、中层和外膜下层的单相动作电位时程(MAPD)、有效不应期(ERP),快速心室刺激诱发TWA.离体实验组家兔10只,快速开胸取出心脏后作Langendorff灌流,先用正常Tyrode's液灌流30 min再用模拟缺血液灌流.在Tyrode's液灌流20 min后、模拟缺血液灌流60 min后重复观测模拟肢体导联心电图,以及左心室前壁、侧壁、右心室和心尖部心外膜的MAPD、ERP,快速心室刺激诱发TWA.结果:缺血后各位点MAPD的频率适应性降低,MAPD90和ERP缩短.与生理状态相比,心肌细胞复极梯度发生了明显重排.20个在体和离体心脏在缺血后全部可用快速心室刺激诱发TWA,诱发TWA的心动周期(CL)窗口在130-170ms之间,CL=140,150 ms时可稳定地诱发TWA.TWA时伴有单相动作电位复极和传导的交替.离体心外膜增频刺激时,CL=170 ms开始出现TWA,随后的减频刺激至CL=200 ms时TWA消失,即TWA的滞后现象.结论:心肌细胞复极不均一可能是引起心电图T波的原因之一.心肌缺血使心脏正常的复极梯度发生改变,在快速心室刺激时易于发生动作电位复极和传导的交替,在体表心电图上表现为TWA.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.