胆红素代谢

胆红素由血红蛋白分解而来,是血红素的代谢产物,即血红素的卟啉环裂解后放出铁,成为直线型4吡咯的结构。血红素Ⅸ→胆绿素Ⅸ_a→胆红素Ⅸ_a 除了血红蛋白外,胆红素也可以从肌红蛋白、细胞色素、过氧化氢酶、过氧化物酶、色氨酸吡咯酶等裂解而来,正常人每天产生350～400毫克胆红素,其中2/3(65％)来自血红蛋白,1/3来自其它方面,特别来自肝脏,人体所有细胞,包括肝、脑、脾、成纤维细胞均可合成与裂解血红素,产生胆红素。肝、脾的细胞含裂解血红素的酶最多,产生的胆红素也较其它脏器为多。     

不同检测指标在预测高胆红素血症新生儿胆红素脑损伤的比较

目的:观察并比较患高胆红素血症新生儿在伴脑损伤情况下,血清神经元特异性烯醇化酶(NSE)、总胆红素(TSB)水平及总胆红素与白蛋白比值(B/A)的差异,分析上述检测指标在预测高胆红素血症新生儿发生胆红素脑损伤中的优劣。方法:选择日龄1~7 d内的足月高胆红素血症新生儿47例进行脑干听觉诱发电位(BAEP)检测,并依据检测结果分为BAEP正常组和BAEP异常组。酶联免疫吸附法检测患儿血清NSE水平,重氮法检测TSB(B),溴甲酚绿法检测白蛋白(A)并计算B/A值;受试者工作曲线(ROCC)。比较TSB、NSE、B/A值等检测指标与BAEP法的相关性。结果:(1)BAEP异常组的TSB、NSE、B/A值分别为(303.07±51.77)μmol/L、(124.28±33.06)μg/L、(6.65±2.53)×10-3,BAEP正常组分别为(296.20±46.87)μmol/L、(65.41±20.96)μg/L、(4.20±1.99)×10-3;两组TSB值比较差异无统计学意义(P0.05),但NSE、B/A值的比较差异均有统计学意义(P0.01);(2)以BAEP法为金标准,TSB、NSE、B/A值的敏感性分别为84.33%、75.10%、45.31%,特异性分别为65.18%、76.23%、49.06%;NSE、B/A值的敏感性与特异性均显著高于TSB,差异均有统计学意义(P=0.005);NSE检测的敏感性最高,而B/A值的特异性最高。(3)NSE、B/A值预测胆红素血症新生儿听力损害的临界点分别为100.56μg/L、6.06×10-3。结论:测定血清中NSE及B/A值的敏感性及特异性均高于TSB,可作为预判新生儿高胆红素血症发生脑损伤的指标。     

高效液相色谱仪测定未结合胆红素光异构体校正因子及临床意义

目的分析不稳定、无法提纯的未结合胆红素(4Z,15Z-胆红素Ⅸα,简称ZZ)光异构体的校正因子,以便临床对它们进行定量分析研究.方法采用高效液相色谱对光照前后ZZ光异构体峰面积进行测定,然后通过公式计算校正因子.结果两种主要的光异构体的校正因子分别是4Z,15E-胆红素Ⅸα为1.33±0.01,光红素为1.85±0.02.结论校正因子为临床定量分析ZZ光异构体提供客观依据.     

毛细管电泳法检查盐酸左西替利嗪片中右旋异构体杂质

目的：建立毛细管电泳法检查盐酸左西替利嗪片中右旋异构体杂质。方法：用磺酸化-β-环糊精（S-β-CD）作为手性选择剂,考察了S-β-CD浓度、pH值和缓冲盐浓度对分离的影响。结果：在30 mmol/L磷酸盐运行缓冲液(含20 g/L S-β-CD,pH 7.0)中,西替利嗪对映体在分离电压为15 kV的条件下得到良好分离,并满足对盐酸左西替利嗪片检查右旋异构体杂质所需要的条件。结论：本实验建立的方法灵敏、可靠,可用于左旋西替利嗪中右旋异构体杂质的检查。     

盐酸贝那普利多晶型的制备和表征

目的:获得制备盐酸贝那普利两种晶型——A晶型和B晶型的制备工艺,研究不同晶型的盐酸贝那普利在红外光谱、热稳定性和晶体结构上的差异,探讨两种晶型的转晶条件及稳定性关系.方法:用傅里叶红外光谱(IR)、热重(TG)、差示扫描量热法(DSC)、X射线粉末衍射(PXRD)、X射线单晶衍射(SCXRD)等分析手段,对盐酸贝那普利A晶型和B晶型分别进行表征研究.结果:获得了A晶型和B晶型的制备工艺、晶体结构及晶体稳定性.晶体结构分析表明,A晶型属单斜晶系,空间群P21,晶胞参数a=7.8655(4)(A),b=11.7700(6)(A),c=13.5560(7)(A),β=102.9470(10)°,晶胞体积V=1223.07(11)(A)3,晶胞内分子数Z=2.B晶型属正交晶系,空间群P212121,晶胞参数a=7.9353(8)(A),b=11.6654(11)(A),c=26.6453(16)(A),晶胞体积V=2466.5(4)(A)3,晶胞内分子数Z=4.从DSC和XRD结果表明B晶型热处理后会转变成A晶型.结论:盐酸贝那普利A晶型和B晶型都是无水晶型,是分子构型不同产生的多晶型,A晶型的高温稳定性优于B晶型.     

牵引配合针刺治疗神经根型颈椎病52例

目的研究神威归－胶囊的最佳提取工艺;方法应用正交试验法,选用提取次数(A)、提取时间(B)及含醇量(C)3个因素,每个因素设计3个水平;结果因素A对指标成分含量有显著性意义;结论最佳提取工艺为A3B3C1,即提取3次,每次90min,含醇量50％。     

148例新生儿高胆素血症的血清胆红素值及B/A比值的结果分析

目的了解新生儿高胆红素血症的血清胆红素含量及间接胆红素/白蛋白(B/A)比值水平.方法测定新生儿高胆素血症患儿的血清总胆红素、间接胆红素、白蛋白,计算B/A比值.将患儿分为胆红素脑病组和无胆红素脑病组,并将其测定结果作比较.无胆红素脑病组又按病因分为溶血、感染、母乳、围产因素组.结果高胆红素血症发生率男性为68.9%、女性为31.1%,男性高于女性(P＜0.01);胆红素脑病组与无胆红素脑病组比较中,血清胆红素值和B/A比值差异均有显著性(P＜0.01);无胆红素脑病的各组结果显示高胆红素血症发生率最高的为溶血组(40.9%),血清胆红素值最高的为溶血组[(291.1±120.6)μmol/L].结论检测血清胆红素、B/A,可为早期诊断和合理防治新生儿胆红素血症,降低胆红素脑病的发生率提供数据信息.     

药物诱导SD大鼠大肠癌模型血清PpⅨ动力学实验研究

目的 探讨药物诱导SD大鼠大肠癌模型血清PpⅨ含量动力学变化规律.方法 45只成功诱导大肠癌的SD大鼠分3组A组ALA尾静脉注射;B组DFO腹腔注射半小时后ALA尾静脉注射;C组等量生理盐水尾静脉注射.各组用药后分别在1、2、4、6和12 h经股动脉抽血,取其血清用高效液像色谱-荧光检测法测定PpⅨ含量.结果 A、B两组大鼠血清内PpⅨ含量明显高于对照(C)组,B组PpⅨ含量明显高于A组(P＜0.01);在0～2 h内血清PpⅨ的积聚率B组明显高于A组(P＜0.05),在4～6 h血清PpⅨ的清除率B组明显高于A组(P＜0.05).结论 DFO与ALA联合诱导,可使大肠癌SD大鼠体内PpⅨ迅速大量积聚并快速清除.     

宁泌泰胶囊联合盐酸坦洛新缓释胶囊治疗慢性前列腺炎的效果及对炎症因子的影响

目的 研究对慢性前列腺炎(CP)采用宁泌泰胶囊联合盐酸坦洛新缓释胶囊治疗的效果及对炎症因子的影响.方法 随机数表法将本院2018年3月至2019年12月诊治的90例CP患者分为观察组(A组)与对照组(B组),各45例,B组给予盐酸坦洛新缓释胶囊治疗,A组治疗方法是在B组基础上加用宁泌泰胶囊.观察两组患者的总有效率和不良...     

正交法优选桃花精油的提取工艺

目的优选桃花精油的最佳提取工艺。方法以提取桃花精油的得率为指标,设计L9(34)正交试验,对桃花浸泡时间(A)、提取时间(B)、料液质量比(C)、桃花形态的完整性(D)进行优选研究。结果在各设计方案中,向捣烂状态的桃花(D3)中加6倍的水(C3)浸泡3 h(A2)、蒸馏提取3 h(B2)时,桃花精油的得率最高。结论优选所得最佳提取工艺A2B2C3D3稳定可行。     

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.