犬自体肋软骨膜构建的气管假体行气管移植重建

目的：探讨犬自体肋软骨膜构建的气管假体进行气管移植重建的可行性。方法：实验犬10条,以其自体肋软骨膜包绕特制的硅胶棒制成管状物,埋植到气管旁肌肉组织内,建立血运,4周后,除去硅胶棒制成气管假体进行气管移植重建。通过观察实验犬移植术后的存活情况,移植后8周的大体标本检查以及病理学检查,评价假体置换的效果。结果：8条存活的实验犬移植术后呼吸道通畅,饮食活动与正常犬无差别;构建的气管假体与气管旁肌肉组织紧密愈合,血运丰富,吻合口处愈合良好,无肉芽组织及瘢痕形成;管腔内表面光滑,表面有一层白色的黏膜覆盖。在普通光学显微镜下,可见气管假体的吻合口两端及吻合口处有气管黏膜生长,其内表面被覆无明显纤毛存在的假复层柱状上皮;其外层为成纤维细胞和纤维组织,其间散在少量炎性细胞;在纤维膜下可见新生软骨细胞,数量较少,软骨细胞的胞浆着色较淡,表明软骨细胞为新生的;其外层可见横纹肌细胞,其间有大量的新生的直径不等的微血管和毛细血管,软骨细胞与肌细胞之间连接紧密。结论:应用犬自体肋软骨膜构建的气管假体进行犬气管的移植重建具有可行性。     

气流动力学影响的小鼠气管移植模型的建立

目的建立并改进同种异体小鼠气管原位移植模型,用于研究气流动力学对供体气管的影响。方法C57BL/6小鼠气管为供体,移植于BALB/c小鼠。取两个供者气管各7个软骨环,两端的膜部分别予以侧侧缝合作并行连接,新建的气管段以原位移植的方式,移植于受体BALB/c小鼠。上述一供体气管用作小鼠的通气气管段,另一以4号线结封堵以阻断气流通过。28 d后获取标本,HE染色评价气道上皮的完整性、分化程度、黏膜下炎症细胞浸润和纤维组织增生情况。结果建立小鼠气管原位通气移植模型30例,从标本采集至移植完毕平均用时(100±14)m in。全组受体动物术后生存率90%,无感染。手术后28 d移植气管病理检查提示,存在通气的供体气管管腔通畅,假复层柱状纤毛上皮较连续并完整,黏膜下轻度炎细胞浸润和纤维组织增生。而阻断了气流通过的供体气管表现为扁平上皮分布,纤毛上皮减少,黏膜下纤维组织增生、淋巴细胞浸润明显。结论新建的小鼠气管移植模型可用于研究移植后的气流动力学影响,同时可用于观察受体气道上皮移行的动力学参数。     

游离空肠移植术重建下咽及颈部食管动物实验研究

目的:探讨游离空肠移植术重建下咽及颈部食管的临床应用。方法:选用10条比格犬(Beagle)行游离空肠移植下咽颈部食管重建术,术中以空肠血管与甲状腺前动脉及颈外静脉行端-侧、端-端吻合,空肠移植颈部食管重建。结果:6条实验犬手术成功,存活4周以上并能够正常饮食,术后移植空肠血供良好。结论:游离空肠移植技术可以重建颈部组织缺损,且并发症少,符合正常生理要求,比格犬的特殊的实验价值在游离空肠移植术中有重要的临床意义。     

组织胚胎学练习参考答案

一、问答题 1.被覆上皮分几类?根据什么分的? 被覆上皮根据细胞形态和细胞的排列层次,分为单层和复层两大类。单层上皮根据细胞形态又分为:①单层扁平上皮;②单层立方上皮;③单层柱状上皮;④假复层柱状上皮。(单层扁平上皮,分布在胸,腹膜和心包膜上的,称为间皮;分布在心血管和淋巴管内面的,称为内皮。假复层柱状上皮,分布在呼吸道上的,其游离面长有纤毛,故称之为假复层柱状纤毛上皮)复层上皮分为:复层扁平上皮和变移上皮。 2.各种被覆上皮公分布于何处? 单层扁平上皮分布于胸,腹膜,心脏和血管、淋巴管的内表面。单层立方上皮主要分布于甲状腺滤泡和肾小管上。(如甲状腺滤泡壁和肾集合管壁以及远曲小管的     

游离空肠移植术重建颈部食管、下咽并发症分析

目的探讨游离空肠移植下咽及颈部食管重建术中常见并发症及其防治措施。方法选用10条比格犬(Beagle)行游离空肠移植下咽及颈部食管重建术,术中以空肠血管与甲状腺前动脉及颈外静脉行端-侧、端-端吻合,空肠移植颈部下咽、食管重建,观察并发症发生情况。结果术后6条实验犬手术成功,存活4w以上并能够正常饮食,术后移植空肠血供良好;4条犬出现并发症而死亡。结论游离空肠移植技术可以重建颈部组织缺损的修复,术前准备充足、术中操作细腻、术后观察及护理及时可以减少并发症,提高手术成功率,是颈部缺损修复最为理想的方法。     

大鼠气管发生的形态学观察

本实验对胚胎第15天至出生后30天的大鼠气管上皮的发生过程进行了观察。证实胚胎第15天的气管上皮为假复层上皮,细胞表面有少量微绒毛;胚胎第17天,气管上皮出现典型的杯状细胞;胚胎第19天出现纤毛细胞;出生5天以后,上皮细胞增殖、聚集并内陷,形成气管腺。杯状细胞的粘液颗粒主要是中性粘多糖,气管腺的粘液颗粒为酸性粘多糖和中性粘多糖。实验结果表明:在胚胎期和生后早期,粘液纤毛运送系主要由纤毛细胞和杯状细胞等组成,出生5天以后,粘液纤毛运送系统主要由纤毛细胞和气管腺组成。     

游离自体心包补片修复气管膜部缺损的实验研究

目的 研究游离自体心包补片修复气管膜部缺损的可行性.方法 选8条成年实验犬为研究对象.右后外侧切口进胸取实验犬心包壁作为补片移植物.暴露实验犬颈部气管,切除环状软骨下方第四气管环水平部分膜部形成约2 cm×2 cm大小全层缺损,并使用心包补片移植物修补受损气管膜部缺损.术后使用纤维支气管镜检查气管通畅度.实验犬存活至术后6个月实施安乐死,取气管标本计算收缩率,并进行组织学检查.结果 所有实验犬均未出现手术并发症,支气管镜检查未发现吸气或者呼气时气管塌陷.气管断面最狭窄部位与补片下第三软骨环部位之比平均为1.07±0.03.组织学检查显示所有补片移植物表面新生纤毛柱状上皮.结论 心包补片移植物修补气管膜部缺损安全且有效.     

小儿内脏器官的形态学研究(七)——新生儿气管和肺的组织学观察

新生儿呼吸器官—气管和肺的结构已基本发育完全。气管上皮为假复层纤毛柱状上皮。软骨内同源群细胞很少见。肺泡上皮以立方形细胞较多。肺泡隔较厚,毛细血管丰富。     

气管干细胞分化过程中Shh信号通路的动态观察

目的:探讨大鼠气管上皮损伤后,气管干细胞增殖分化过程中Shh信号通路的动态变化.方法:应用5-氟尿嘧啶(5-FU)诱发气管上皮损伤,通过RT-PCR检测气管上皮Shh的表达.结果:5-FU作用30 min后大鼠气管上皮细胞绝大部分脱落,仅残留少量裸核样G0期细胞位于基底膜上.之后细胞数目逐渐增多,经过扁平、立方形态,向纤毛细胞、黏液细胞、基底细胞等分化,去除5-FU后48 h接近恢复假复层纤毛柱状上皮;正常气管上皮及5-FU作用30 min气管上皮Shh无表达,去除5-FU恢复3 h后Shh轻度表达,6 h后表达增强,12 h达高峰,之后表达减弱,48 h已极微弱.结论:Shh参与了气管干细胞的增殖分化过程.     

电动鼻窦切割钻切除部分下鼻甲对鼻黏膜纤毛清除系统的影响

目的:探讨电动鼻窦切割钻切除部分下鼻甲对鼻黏膜纤毛清除系统的影响。方法:用糖精法测定30例慢性肥厚性鼻炎患者术前、术后3个月及术后6个月和10例无鼻腔疾病志愿者作为对照组的鼻黏膜纤毛输送率。取30例病例组其中10例和10例对照组其中2例下鼻甲黏膜行光镜、扫描电镜观察。结果:糖精试验:慢性肥厚性鼻炎患者术前的鼻黏膜纤毛输送率(3.63±0.57)mm/min与健康对照(6.20±0.68)mm/min比较差异有显著性(P<0.01),患者术后6个月的鼻黏膜纤毛输送率(6.09±1.19)mm/min与术前、术后3个月(3.76±0.43)mm/min比较差异有显著性(P<0.01)。光镜及电镜观察:电动鼻窦切割钻切除部分下鼻甲术后鼻黏膜上皮再生为假复层纤毛柱状上皮,杯状细胞与术前相比明显减少,纤毛密集、粗细长短均匀、方向一致,基本和正常黏膜纤毛系统表现一致。结论:电动鼻窦切割钻切除部分下鼻甲术后黏膜再生较好,鼻黏膜纤毛清除系统基本恢复正常结构及生理功能。     

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.