弯曲变形对牛心包瓣损坏的影响

病理学检查显示,牛心包瓣原发性损坏的主要形式表现为钙化和撕裂。经戊二醛处理的牛心包片弯曲试验表明,急剧弯曲变形处呈严重压缩挤压。此种弯曲变形也会出现在瓣叶与瓣架交接处。由于瓣叶周期性弯曲而造成的胶原纤维损伤会诱发瓣叶撕裂和钙化,直至瓣膜失功。     

生物瓣膜原发性组织衰坏——放射、光镜和电镜观察

1983年3月－1990年6月，61个生物瓣因原发性组织衰坏而行再换瓣术，对取出的瓣膜作大体、放射、光镜和电镜观察。发现猪主动脉瓣以钙化为主，牛心包瓣以撕裂为主，钙化主要发生在交界，撕裂以Ⅰ型为主。光镜和电镜下表现为：（1）胶原纤维变性、断裂；（2）钙化；（3）血细胞浸润；（4）上皮细胞层消失，瓣环口结缔组织增生；（5）微血栓、电镜还发现血浆蛋白和脂肪浸润、未植入的猪主动脉瓣保存1年时，组织细胞结构既有改变。     

猪瓣替换二尖瓣功能失调初步分析与防治对策

目的：为适应临床需要研制一种比较理想的生理瓣。方法：对15只失功瓣膜进行病理研究，分析其失功原因并提出改进措施，结果：15只功瓣膜基本病损为钙化，撕裂及穿孔，钙化是造成生物瓣功能失调的首要因素，钙化部位主要在右窦及三瓣叶交界处。结论：任何延缓生物瓣钙化的方法都可使生物瓣生命提高，而更趋势理想化，所以我们采用环氧氯丙烷改性戊二醛处理生物瓣，取掉生物瓣右窦以另一瓣膜的无冠瓣与之匹配等方法，明显减轻钙化，应用临床效果良好。     

猪瓣替换二尖瓣功能失调初步分析与防治对策

目的:为适应临床需要研制一种比较理想的生理瓣。方法:对15只失功瓣膜进行病理研究,分析其失功原因并提出改进措施。结果:15只失功瓣膜基本病损为钙化,撕裂及穿孔,钙化是造成生物瓣功能失调的首要因素。钙化部位主要在右窦及三瓣叶交界处。结论:任何延缓生物瓣钙化的方法都可使生物瓣生命提高,而更趋理想化。所以我们采用环氧氯丙烷改性戊二醛处理生物瓣,取掉生物瓣右窦以另一瓣膜的无冠瓣与之匹配等方法,明显减轻钙化,应用临床效果良好。     

无支架心包组织工程二尖瓣的研制与临床应用

我国心脏瓣膜疾病发病人数达200万，瓣膜病变严重者须行人工心脏瓣膜替换。生物瓣具有血流动力学性能优秀，不需终生抗凝，没有机械噪音的烦扰及生活质量较高等优点，但其耐久性尚不如机械瓣。戊二醛鞣制的传统有支架生物瓣因瓣膜钙化或胶原纤维劳损断裂致瓣衰坏失功，是再次手术的常见原因。本研究目的为改进生物瓣鞣制方法，仿生设计降低瓣叶应力，生物材料脱细胞，宿主成纤维细胞及内皮细胞组织工程重建，实现体外人工内皮化，以延长生物瓣的使用寿命。     

戊二醛固定的牛颈静脉带瓣管道的钙化实验研究

目的检测戊二醛固定的牛颈静脉带瓣管道的在体钙化程度,评价用戊二醛固定牛颈静脉带瓣管道的可行性,为寻找最佳的固定方法提供基础资料.方法将戊二醛处理后的牛颈静脉管壁及瓣叶组织用肝素进行处理,植入脱乳的SD大鼠背部皮下,60 d后取出,进行自身对照,采用原子吸收分光光度法检测组织钙含量,HE染色、Von-Kossa染色进行形态学检测,透射电镜观察超微结构变化.结果包埋前的牛颈静脉瓣膜、管壁试片平均钙含量分别为(1.84±0.75)、(0.53±0.22)μg/mg干重,包埋后的牛颈静脉瓣膜、管壁试片平均钙含量分别为(16.23±8.32)、(151.00± 23.78)μg/mg干重,两组相比有显著差别(P＜0.001).光镜及电境下显示包埋前的牛颈静脉瓣膜、管壁内皮保存完整,组织结构紧凑,胶原纤维结构保持良好;包埋后的牛颈静脉瓣膜、管壁则内皮残缺,结构疏松,胶原纤维破坏严重.结论戊二醛交联的牛颈静脉带瓣管道,可见明显钙化.瓣膜钙化较轻,管壁钙化严重.     

改良方法处理的生物瓣膜组织宿主内皮化的实验研究

目的：探讨L－谷氨酸（L－G）改良方法处理的异种生物瓣膜组织寄主内皮化的可行性。方法：将戊二醛或戊二醛和L－谷氨酸处理的2组牛心包进行体外内皮细胞种植培养,并同时将此2组牛心包植入猪的右心房,观察心包片宿主内皮细胞生长的形态学特征。结果：组织学及扫描电镜分析显示,改良L－谷氨酸组牛心包体外内皮细胞种植培养及动物心脏内移植后,心包组织无钙化,心包表面内皮细胞生长良好,而戊二醛组牛心包钙化及胶原纤维断裂明显,未见内皮细胞生长,结论：采用改良L－谷氨酸处理方法可有效地抑制常规戊二醛处理生物瓣膜组织所残留的细胞毒性,有助于宿主内皮细胞在生物瓣膜上的生长,优化生物瓣膜的生化处理,减少生物瓣膜的钙化,衰坏并改善其生物相容性。     

无支架心包组织工程二尖瓣的研制与临床应用

我国心脏瓣膜疾病发病人数达200万,瓣膜病变严重者须行人工心脏瓣膜替换。生物瓣具有血流动力学性能优秀,不需终生抗凝,没有机械噪音的烦扰及生活质量较高等优点,但其耐久性尚不如机械瓣。戊二醛鞣制的传统有支架生物瓣因瓣膜钙化或胶原纤维劳损断裂致瓣衰坏失功,是再次手术的常见原因。本研究目的为改进生物瓣鞣制方法,仿生设计降低瓣叶应力,生物材料脱细胞,宿主成纤维细胞及内皮细胞组织工程重建,实现体外人工内皮化,以延长生物瓣     

戊二醛与猪主动脉瓣瓣叶胶原的交联反应

本实验研究戊二醛处理猪主动脉瓣(猪瓣)的交联反应,希有助于改进生物瓣膜的化学处理。将猪瓣浸泡在pH7.4、0.65％戊二醛溶液中12h,瓣叶胶原固相氨基含量、瓣叶胶原氨基酸组成、浸泡液中戊二醛浓度和瓣叶收缩温度等变化趋于平稳,表明交联反应已经完成,并且交联比较稳定。并平行观察4％甲醛处理猪瓣的交联反应,浸泡1h,瓣叶胶原固相氨基含量和瓣叶胶原氨基酸组成已趋平稳,表明交联反应已经完成,但是瓣叶收缩温度变化不稳定,提示这种交联不稳定。对实验结果及其实用价值作了探讨。     

再次二尖瓣替换术10例报告

生物瓣膜替换术后的严重合并症为瓣膜损毁。作者在1981年11月～1985年3月期间,共作二尖瓣再次替换术10例(男、女各5例,其中9例为牛心包瓣叶撕裂及破裂,1例以瓣膜钙化为主,伴小撕裂)。再次手术均使用人工机械瓣膜。两次瓣膜替换术时间间隔22～81个月,平均50个月。术后早期死亡3例,存活7例,     

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.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

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.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.