自发高血压大鼠心肌肥厚与心室颤动阈值的关系

 【目的】探讨自发高血压大鼠心肌肥厚与心室颤动阈值的关系。【方法】20只雄性自发高血压大鼠，随机分成10周龄组（n=10）和18周龄组（n=10）；10只10周龄雄性Wistar大鼠为对照组。分别测定3组大鼠的动脉收缩压、心脏质量指数、心室有效不应期和心室颤动阈值。【结果】①自发高血压大鼠的动脉收缩压和心脏质量指数明显高于Wistar大鼠（P〈0．001），心室颤动阈值明显低于Wistar大鼠（P〈0．001）；②自发高血压大鼠中，18周龄自发高血压大鼠的动脉收缩压和心脏质量指数明显大于10周龄自发高血压大鼠（P〈0．001），心室颤动阈值明显低于10周龄自发高血压大鼠（P〈0．001）；③不同周龄自发高血压大鼠和Wistar大鼠之间，心室有效不应期没有明显差异（P〉0．05）；④Wistar大鼠中心脏质量指数与动脉收缩压及心室颤动阈值均无明显相关关系，不同周龄自发高血压大鼠中，心脏质量指数与动脉收缩压及心室颤动阈值均呈明显相关关系；动脉收缩压和心脏质量指数与心室颤动阈值呈负相关（P〈0．001）；⑤心脏质量指数、动物周龄和种类是影响心室颤动阈值的主要因素（P〈0．001）。【结论】肥厚心肌的心室颤动阈值降低；动脉收缩压愈高，心肌肥厚程度愈明显，心室颤动阈值愈低。     

氯通道阻滞剂DIDS对自发高血压大鼠左心室有效不应期及心室颤动阈值的影响

【目的】分析不同剂量氯通道阻滞剂DIDS对自发高血压大鼠左心室有效不应期及心室颤动阈值的影响。【方法】32只10周龄雄性自发高血压大鼠随机分成非DIDS处理组及3个DIDS不同剂量（0．05、0．5、5．0μmol／kg）处理组,每组8只,取8只雄性Wistar大鼠作为对照组,分别测定各组大鼠心率、动脉收缩压、心室有效不应期及心室颤动阈值左室质量指数。【结果】①自发高血压大鼠左室质量指数明显大于Wistar大鼠（P〈0．01）;②DIDS非处理组的心室颤动阈值明显小于对照组[（15．0±1．2）mA vs（26．4±1．5）mA,P〈0．01）];③DIDS呈浓度依赖地延长左室肥厚心肌的心室有效不应期和提高左室肥厚心肌的心室颤动阈值（P〈0．05）;④心室有效不应期与心室颤动阈值正相关,DIDS的3个不同处理剂量与心室有效不应期或心室颤动阈值正相关。【结论】DIDS可以延长左室肥厚心肌的心室有效不应期,提高左室肥厚心肌的心室颤动阈值。     

氯通道阻滞剂DIDS对自发高血压大鼠左心室有效不应期及心室颤动阈值的影响

 [目的]分析不同剂量氯通道阻滞剂DIDS对自发高血压大鼠左心室有效不应期及心室颤动阈值的影响。[方法]32只10周龄雄性自发高血压大鼠随机分成非DIDS处理组及3个DIDS不同剂量(0.05, 0.5, 5.0 umol/Kg. iv)处理组，每组8只，取8只雄性Wistar大鼠作为对照组，分别测定各组大鼠心率、动脉收缩压、心室有效不应期及心室颤动阈值左室质量指数。[结果]①自发高血压大鼠左室质量指数明显大于Wistar大鼠(P<0.01)；②DIDS非处理组的心室颤动阈值明显小于对照组(15.0±1.2 mA vs 26.4±1.5 mA, P<0.01)；③DIDS呈浓度依赖地延长左室肥厚心肌的心室有效不应期和提高左室肥厚心肌的心室颤动阈值(P<0.05)，④心室有效不应期与心室颤动阈值正相关，DIDS的3个不同处理剂量与心室有效不应期或心室颤动阈值正相关。[结论] DIDS可以延长左室肥厚心肌的心室有效不应期，提高左室肥厚心肌的心室颤动阈值。     

自发性高血压大鼠TGFβ1／Smad7通路与心室纤维化的关系

【目的】探讨自发性高血压大鼠心室纤维化过程中TGFβ1和其下游分子Smad7蛋白的表达规律。【方法】雄性自发性高血压大鼠（SHR）14只随机分为2组，SHR22周龄组和SHR14周龄组，另14只WKY大鼠也分为WKY大鼠22周龄组和WKY大鼠14周龄组。在实验动物14周龄和22周龄时，分别测定血压、心室质量指数：以氯胺T法测定心肌羟脯氨酸的含量．免疫组化测定I型和Ⅲ型胶原在心肌组织中的表达水平；RT—PCR和Westem-blot测定心肌中TGFB。和其下游分子Smad7的表达。【结果】自发性高血压大鼠在14周龄和22周龄时收缩压都显著高于同龄的WKY大鼠（P〈0．001），同时22周龄SHR的收缩压也比14周龄明显升高（P〈0．001）。与SHR14周龄组相比，SHR22周龄组的心室质量指数、心肌羟脯氨酸的含量、I型和Ⅲ型胶原均明显增加（P〈0．01）；在mRNA水平或蛋白水平，心肌中的TGFβ1的表达上调，Smad7的表达下调。【结论】在一定的时间窗内，自发性高血压大鼠血压的升高及心肌纤维化随着病程的进展而发展，同时伴随着TGFβ1的表达上调．Smad7的表达下调。     

压力过载型心肌肥厚大鼠模型的制备及评价

目的制备压力过载型心肌肥厚大鼠模型，并对其进行评价。方法选用240～260g雄性SD大鼠，采用内径0．6mm银夹对其腹主动脉进行缩窄手术，制备压力过载型心肌肥厚模型（LVH，n=15），同时设置假手术组（SHAM，n=15）作对照。术后第24周检测大鼠血流动力学指标、全心质量指数（heart mass index，HMI）及左室质量指数（left ventricular mass index，LVMI），并观察心肌组织形态学变化。结果与假手术组相比，模型大鼠动脉收缩压（systolic arterial pressure，SAP），舒张压（diastolic arterial pressure，DAP）及平均动脉压（mean arterial pressure，MAP）均显著上升（P〈0．001），左室收缩压（left ventricular systolic pressure，LVSP）及左室舒张末压（left ventficular end diastolic pressure，LVEDP）均显著升高（P〈0．01，P〈0．001）；全心质量指数及左室质量指数显著增加（P〈0．001）；模型大鼠心肌组织出现明显肥厚病理学改变。结论腹主动脉缩窄24周使大鼠产生明显的血流动力学及形态学异常，可成功制备压力过载型心肌肥厚动物模型。     

罗格列酮对压力超负荷大鼠血流动力学及心肌肥厚的影响

 【目的】探讨过氧化物酶体增殖物激活受体γ（PPAR-γ）配体罗格列酮对压力超负荷大鼠血流动力学及心肌肥厚的影响。【方法】30只SD大鼠随机分为假手术组（n=9）和压力超负荷模型组（n=21），应用腹主动脉缩窄的方法制作压力超负荷模型，将制作模型后24h仍存活的16只大鼠随机分为压力超负荷（PO）组（n=7）和罗格列酮（PO＋Ros）组（n=9）。罗格列酮组给予罗格列酮3mg／（kg·d）共8周。8周后测定血流动力学；称量心脏质量；放射免疫分析方法测量血浆肾素活性、血管紧张素Ⅱ和醛固酮。【结果】与PO组相比，PO＋Ros组动脉血压降低（P〈0．05）；＋dp/dtmax升高（P〈0．05）；心脏质量指数和左室质量指数降低（P〈0．05）；血浆肾素活性、血管紧张素Ⅱ、醛固酮和胰岛素及血糖水平无明显差异（P〉0．05）。【结论】PPAR-γ配体改善压力超负荷性心肌肥厚和左室舒缩功能，降低动脉血压，其效应与血浆肾素血管紧张素系统无明显关系。     

小檗碱对L-甲状腺素诱发大鼠心肌肥厚的保护作用

【目的】研究小檗碱对皮下注射L-甲状腺素所致心肌肥厚模型大鼠心血管功能的影响。【方法】SD大鼠皮下注射L-甲状腺素制备心肌肥厚模型，小檗碱分别按5、10、20mg／kg灌胃给药，连续2周。期间监测动物血压；给药6周后，经左心室插管测量心功能；取心肌组织和血清测定NO含量。【结果】小檗碱5、10、20mg／kg均可显著降低L-甲状腺素模型大鼠的血压；小檗碱10mg／kg可减慢心率（HR），降低左心室最大收缩压（LVSP），升高左心室舒张末期压力（LVEDP），降低最大收缩速率（＋dp／dtmax）；降低组织胶原含量（P〈0．05）；增加NO含量（P〈0．001）；抑制乙酰胆碱酯酶活力（P〈0．01）。【结论】小檗碱对L-甲状腺素诱导的心肌肥厚模型大鼠的血压升高及心功能障碍有保护作用。     

伊贝沙坦对糖尿病大鼠心脏的保护作用及抗氧化反应的机制探讨

【目的】探讨血管紧张素Ⅱ受体拮抗剂伊贝沙坦对糖尿病大鼠心脏的保护作用及其相关机制。【方法】将30只Wistar大鼠随机分为正常对照组、糖尿病组和伊贝沙坦组3组，每组10只。造模后12周终止实验处死大鼠，取血、尿和心脏标本，测定尿量、体质量、心脏质量，体质量、血糖、糖化血红蛋白（HbAlc）；测定血液和心脏组织的丙二醛（MDA）和超氧化物歧化酶（SOD）的活性；通过电镜观察心肌超微结构的变化。【结果】12周终止实验时糖尿病各组大鼠的尿量、心脏质量，体质量、血糖、HbAlc、血清和心脏组织的MDA水平均明显高于正常组，而体质量、红细胞和心脏组织的SOD活性明显低于正常组（P〈0．05）；伊贝沙坦组大鼠的血清和心脏组织的MDA水平明显低于糖尿病组，而SOD的活性高于糖尿病组（P〈0．05）。糖尿病组大鼠的心肌细胞超微结构明显损伤，伊贝沙坦组大鼠的心脏组织超微结构损伤较轻。【结论】伊贝沙坦能减轻糖尿病大鼠心脏损害的进展，其机制可能与伊贝沙坦抑制糖尿病大鼠脂质过氧化反应和提高抗氧化能力有关。     

螺内酯、厄贝沙坦单用及其联用对肾血管性高血压大鼠心室肥厚的影响

目的：观察螺内酯、厄贝沙坦单用及其联用对肾血管性高血压大鼠（RHR）心室肥厚的影响。方法：采用两肾一夹（2K1C）法在SD大鼠中建立肾血管性高血压大鼠模型。随机分为5组：假手术组（Sham组）、肾性高血压组（RHR组）、螺内酯组（Spi组）、厄贝沙坦组（Irb组）及联合用药组（Com组）,每两周测定大鼠尾动脉收缩压。连续给药8周后检测心脏指数和心室总蛋白含量等心肌肥厚指标。放免法检测血浆及心肌中AngⅡ、醛固酮水平。结果：RHR血压显著升高,大鼠心脏指数及心室总蛋白含量明显增加,药物治疗8周后Spi组收缩压稍降低（P〉0.05）、Irb组与Com组收缩压显著降低（P〈0.01）;各治疗组均可降低心脏指数、心肌总蛋白含量和心肌细胞大小,其中Com组效果优于单用组（P〈0.01或P〈0.05）。结论：螺内酯和厄贝沙坦联合应用对改善肾血管性高血压大鼠心室肥厚明显优于单用。     

动态脉压与原发性高血压患者左室肥厚的关系及预测价值

【摘要】目的 探讨动态脉压与原发性高血压患者左室肥厚的关系，为预防高血压患者心脏损害提供有用线索。方法 采用回顾性队列研究设计，共纳入2017年1月~2019年3月在我科住院的672名进行了动态血压监测及心脏超声检查的原发性高血压患者。采用多重线性回归分析动态脉压与左室肥厚的关系，受试者特征工作曲线分析动态脉压对左室肥厚的预测价值。结果 672名原发性高血压患者中，258（3839%）例患者检出左室肥厚。多重线性回归分析显示，24小时动态脉压与左室质量指数显著相关（P＜0002）。受试者工作特征曲线分析显示，24小时动态脉压预测左室肥厚的AUC为064，24小时收缩压预测左室肥厚的AUC为058；在经过AUC比较后，24小时动态脉压比24小时收缩压更好地预测左室肥厚（P＜0001）。结论 24小时动态脉压与原发性高血压患者左室肥厚密切相关，其是发生左室肥厚的独立危险因素；动态脉压对左室肥厚有一定的预测价值，且其预测价值优于24小时收缩压。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.