模拟睡眠呼吸暂停缺氧/再氧合对小鼠心肾超微结构的影响

目的模拟睡眠呼吸暂停慢性缺氧/再氧合探索其对心脏、肾脏超微结构影响。方法自制慢性缺氧/再氧合小鼠模型:通过控制程序调控箱内氧浓度,使得每一间断性缺氧循环时间为2min,氧浓度循环于(21.72±0.545)%与(6.84±0.467)%之间。ICR小鼠分对照组、模拟对照组、实验组,每组各10只。将实验组小鼠置于间断性缺氧箱中,每天8h,连续30d后进行取心尖部及肾皮质部行透射电镜检查。结果①心脏超微结构改变:对照组及空气对照组心肌细胞结构无异常所见。实验组10例均存在不同程度、不同形式的超微结构的改变:有8/10可见不同程度的心肌间质增宽、胶原增生,其中6例同时见毛细血管内皮细胞凋亡;6/10小鼠心脏可见心肌细胞核凋亡改变;6/10小鼠心肌细胞线粒体肿胀,嵴分离,电子密度明显下降,部分嵴破坏。3/10例小鼠心肌细胞内水肿,肌原纤维溶解;1/10例表现心肌细胞肌浆网扩张。②肾脏超微结构改变:对照组均未见异常改变。实验组所有10例均有不同程度的肾小球上皮细胞足突融合、电子致密物质增加;而对照组也有2例可见类似改变。8/10例的实验组可见不同程度的系膜区增宽、5/10例有系膜细胞及基质增生;这种改变也见于3/10例的对照组。8/10例实验组小鼠发现肾小管上皮水肿,呈细胞电子密度下降改变。同时9/10例实验组小鼠见肾小管上皮细胞次级溶酶体明显增多。结论研究发现慢性缺氧/再氧合可引起心肌细胞凋亡、心肌间质增生及胶原化等损害;可引起肾小球上皮细胞足突融合、肾小管上皮次级溶酶体增多等改变。     

川芎嗪对兔肾缺血再灌注损伤超微结构改变的干预作用

目的:观察兔肾缺血再灌注损伤超微结构改变,探讨川芎嗪注射液的干预作用.方法:复制家兔肾缺血再灌注损伤模型,日本大耳白兔30只,随机均分为三组:假手术组(S),缺血再灌注组(IR)和缺血再灌注 川芎嗪注射液组(LZ).使用透射电子显微镜观察各组肾组织标本超微结构的变化,作对比分析.结果:IR组主要异常改变有:①肾小球毛细血管腔狭窄,中性粒细胞附壁,大部分内皮细胞核固缩、染色体边集,细胞质内空泡形成,线粒体空泡变性.②多数脏层上皮细胞轻度核固缩,个别线粒体空泡变性,足突相互黏连,可见局灶性融合现象和微绒毛化现象.③近曲小管上皮细胞核固缩,胞质内出现较多空泡,溶酶体和致密颗粒沉积增多,线粒体数量减少,部分线粒体嵴断裂、空泡化,腔面微绒毛稀疏并有轻度肿胀现象.LZ组大部分标本的上述部位存在不同程度损伤性改变,但比IR组均明显减轻,其中近曲小管上皮细胞超微结构的改善较显著.结论:川芎嗪注射液可减轻肾缺血再灌注损伤所致的肾小球和肾小管超微结构的异常变化.     

新生大鼠窒息后肾组织c-fos和cyclinD1的表达及意义

目的：研究c-fos和cyclinD1在新生大鼠窒息后肾组织的表达及意义。方法：45只新生大白鼠随机分成4组，即对照组(13只)，窒息30min后复氧2h组(10只)，窒息30min后复氧24h组(11只)，窒息30min后复氧48h组(10只)。制成常压窒息模型。用免疫组化ABC法检测窒息后复氧不同时间点肾组织中c-fos，cyclinD1的表达。结果：窒息后复氧2h肾组织c-fos和cyclinD1的阳性细胞数开始增加，在24—48h达高峰。同时c-fos和cyclinD1的表达主要集中在肾小球，远曲小管，集合管等处的细胞核中，而近曲小管的表达弱。结论：c-fos和cyclinD1可能参与了窒息后肾损伤的修复和防护。     

米非司酮对妊娠中期胎儿肾脏超微结构的影响

目的：观察米非司酮对妊娠中期胎儿肾脏超微结构的影响。方法：将25例中期引产孕妇（孕龄16～28周）随机分为2组：对照组(水囊组n=10）;实验组(米非司酮+水囊组,n=15）。实验组按孕龄分为实验Ⅰ组（n=10,孕周16～22周）, 实验Ⅱ组（n=5,孕周23～28周）,实验组口服米非司酮100 mg•d^-1,连服3 d,行水囊引产,对照组只行水囊引产。胎儿娩出后取肾脏组织,电镜下观察肾脏组织的超微结构。结果：实验Ⅰ组肾小球毛细血管内皮细胞肿胀、空化;系膜细胞核不规则,胞质内线粒体肿胀,系膜基质正常。滤过膜内皮细胞质厚,无孔,基底膜薄,多数足细胞核基质空化,足细胞轻度微绒毛化,次级突起可见较多微丝,突起呈融合状。近曲小管上皮细胞核空化,胞质内可见空泡结构及较多溶酶体。远曲小管大部分细胞核及胞质空化。实验Ⅱ组肾小球毛细血管可见内皮细胞孔,局部轻度增生呈连拱状,系膜细胞少量核不规则或轻度固缩状,胞质内线粒体轻度肿胀,部分嵴断裂。滤过膜内皮细胞胞质轻度肿胀,足突细胞结构基本正常,可见初级和次级突起,局部融合,轻度微绒毛化。近曲及远曲小管结构基本正常。结论：米非司酮可以引发胎儿肾脏的缺血缺氧性改变,孕龄越小者胎儿肾脏超微结构改变越明显。     

联麦氧钒对自发性高血压大鼠肾脏形态学的影响

目的：探讨联麦氧钒对自发性高血压大鼠肾脏结构的影响及机理。方法：36只自发性高血压大鼠,随机分成空白组、硝苯地平组和联麦氧钒组,采用光镜和 电镜观察联麦氧钒对自发性高血压大鼠肾脏形态学的影响。结果：空白组大鼠肾小球系膜基质增生,周围毛细血管塌陷,系膜细胞增生,基底膜增厚,部分足突融合;经联麦氧钒治疗后大鼠无肾小球系膜增生及毛细血管塌陷现象,系膜细胞无增多,基底膜未见明显增厚,足突无明显融合。结论：联麦氧钒对自发性高血压大鼠肾脏具有一定的保护作用。     

庆大霉素所致家兔肾小球损伤的超微结构改变

为了探讨庆大霉素（ＧＭ）是否能引起肾小球的损伤，我们观察了家兔注射单剂ＧＭ（１００ｍｇ／ｋｇ）或每天注射一剂等量ＧＭ，边疆注射三天后肾皮质的超微结构改变，对照组家兔注射等容积生理盐水。发现家兔注射单剂ＧＭ后１ｈ，近端肾小管上皮细胞内即出现髓样小体，注射后２４ｈ，肾小球毛细血管内皮细胞、足细胞，和近端肾小管上皮细胞显著肿胀、变性，细胞器有显著病变；注射三剂ＧＭ后２４ｈ，足细胞足突融合，肾小球滤过膜增     

鱼精蛋白对大鼠肾小球多阴离子及超微结构的影响

作者用多阳离子化合物鱼精蛋白灌注大鼠肾脏,引起极似人类微小病变型肾病综合征病理改变.结合电镜观察,用图像分析仪及体视学原理分别对该模型肾组织胶体铁染色切片和电镜照片上足突平均厚度及足突占毛细血管的体积分数进行形态计量学研究.结果表明:用药组肾小球多阴离子明显减少;足突肿胀、融合、滤过裂隙变窄甚至消失。鱼精蛋白与多阴离子结合形成的电子致密颗粒,见于足突表面及基底膜内、外疏层,并以基底膜外疏层为著。显示肾小球多阴离子的分布特点.提示肾小球超微结构的改变可能系多阴离子被鱼精蛋白中和所致.     

诺迪康对糖尿病大鼠肾小球基底膜的影响

目的研究诺迪康对糖尿病大鼠肾小球基底膜超微结构的影响。方法SD雄性大鼠30只肾切除后随机分为对照组10只(NC组),模型组20只,后者按55 mg/kg体重单次腹腔注射1%链脲佐菌素(STZ)制作糖尿病模型。造模成功后随机分为糖尿病对照组(DC组)、糖尿病给药组(DK组)[诺迪康0.168 g/(kg.d)]各10只。12周后观察各组大鼠肾脏超微结构的改变以及24 h内肌酉千清除率(Ccr)的变化。结果12周后DK组大鼠的Ccr明显高于DC组大鼠,电镜显示DK组肾小球毛细血管基底膜增厚轻于DC组,无胶原纤维的增生,内皮细胞孔距不及正常组均匀,但较糖尿病对照组均匀,足细胞突起排列尚整齐。结论诺迪康能改善糖尿病大鼠肾脏超微结构,防止基底膜增厚,保护肾小球滤过屏障,改善肾功能。     

2型糖尿病db/db小鼠肾脏动态病理特点

目的：探讨2型糖尿病db/db小鼠肾脏动态病理特点,阐明其糖尿病肾病的发生发展机制,为糖尿病肾脏并发症的研究提供实验依据。方法：选取SPF级7~8周龄雄性db/db小鼠（模型组）和同龄雄性db/m小鼠（正常组）各16只,分别于8、16和32周龄时检测2组小鼠体质量和空腹血糖（FBG）水平,每组各处死小鼠8只,取肾组织行HE和Masson染色观察其病理形态表现,电镜下观察其超微结构。结果：与正常组比较,模型组小鼠8、16和32周龄时体质量增大（P<0.01）,FBG水平明显升高（P<0.01）,双肾指数明显降低（P<0.01）;32周时模型组小鼠双肾指数明显低于16周时（P<0.05）。HE和Masson染色,16周龄时模型组小鼠肾组织可见明显病理改变,主要是肾小球体积增大和肾小管上皮细胞明显水肿;32周龄时病变明显加重,肾组织中可见大量蓝染胶原物质。电镜观察,16周龄时模型组小鼠肾组织以肾小球基底增厚、足突融合、肾小管上皮细胞线粒体数目减少及形态肿胀为主;32周龄时病变明显加重,可见大量胶原纤维。结论：16周龄糖尿病db/db小鼠肾脏有明显病理改变,主要是肾小球基底增厚、足突融合,32周龄时小鼠肾组织呈明显纤维化。     

坎地沙坦对糖尿病肾病大鼠足细胞保护作用的研究

目的 探讨糖尿病肾病(diabetic nephropathy,DN)大鼠足细胞超微结构及其相关分子nephrin表达的变化,以及坎地沙坦对其干预的影响,为DN的防治提供理论依据.方法 选择健康雄性SD大鼠36只,按随机数字表法分为A组(正常对照组)、B组(DN组)和C组(DN+坎地沙坦组),每组12只.B、C组尾静脉注射链脲佐菌素(30 mg·kg-1)制备DN大鼠模型,于DN模型成模1周后将3组大鼠分别在代谢笼中喂养,C组给予坎地沙坦5 mg·kg-1·d-1灌胃,A组及B组给予等量生理盐水灌胃.用药后第4周和第7周检测各组大鼠的血糖、体质量、24 h尿蛋白和内生肌酐清除率(Ccr),于第7周取肾组织行光学显微镜及电子显微镜观察肾脏病理改变、RTPCR法检测nephrin-mRNA表达.结果 与A组比较:B组24 h尿蛋白排泄增多(P＜0.05),Ccr在7周时下降(P＜0.05);肾组织内nephrin-mRNA表达下调(P＜0.05);肾组织足细胞足突宽度增加并出现融合,肾小球基底膜增厚.与B组比较:C组24 h尿蛋白排泄量降低(P＜0.05),Ccr升高(P＜0.05);肾组织内nephrin-mRNA表达增加(P＜0.05),足细胞足突宽度及肾小球基底膜厚度变小.结论 DN时存在足细胞分子nephrin表达异常和超微结构改变,坎地沙坦对肾脏的保护作用机制可能是通过增加nephrin表达、改善足细胞超微结构而实现.     

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.