一氧化碳高压干燥环境对离体兔心的保护效果

目的观察一氧化碳（CO）高压干燥环境对离体兔心的保护效果,与传统HTK液低温浸泡保存比较,为心脏移植提供一种
新的保存方式。方法将85只新西兰兔随机分为3组,分别为空白对照组（n=5）,CO组（n=40）和HTK组（n=40）。空白对照组在
取下心脏后直接进行酶学检测,而两个保存组中,每组兔心在不同保存方式下（高压罐中干燥保存及HTK液中浸泡保存）分别
保存2、4、6、8、10、14、18和24 h,每个时间点各5只。通过建立改良Langendorff离体兔心灌注模型,监测模型保存前后心肌舒缩
功能变化情况,心律失常评分,检测CK、CK-MB等酶学指标,观察心肌超微结构改变。结果恢复灌注后30 min,（1）CO干燥组
的心肌舒缩功能、心功酶和心律失常评分改变在短期保存（2~4 h）内与HTK浸泡组无明显差别,而在中长期保存（6~24 h）上,
CO干燥组各项指标均优于HTK浸泡组;（2）保存24 h后2组心肌超微结构均存在明显改变,但CO干燥组心肌细胞内结构损伤
较HTK浸泡组轻。结论CO高压干燥环境确实对离体兔心具有保护作用,而且在长时间保存方面,CO高压干燥保存比HTK
浸泡保存更有优势。
     

含二氮嗪的Celsior液和HTK液对移植鼠心脏超时低温保存效果的分析

目的评价含二氮嗪的Celsior液和HTK液对移植鼠心长时间低温保存的效果。方法将32只同种系雄性SD大鼠随机分为Celsior液组和HTK液组，每组8对。采用改良Heron法大鼠颈部异位心脏移植术建立模型。供体麻醉抗凝后，4℃ stanford停搏液灌注心脏停跳，制备离体鼠心，保存于4℃两种不同保存液中10h。之后移植于受体，成功复跳后观察1h，留取标本并测定心率（HR）、心肌含水量（MWC）、心肌肌钙蛋白Ⅰ（cTnⅠ）、心肌酶谱[乳酸脱氢酶（LDH）、磷酸肌酸激酶（CK）]，并观察心肌超微结构。结果两组大鼠心脏复跳后均跳动有力、心律齐，与Celsior液组比较，HTK液组大鼠HR明显较慢（P〈005），cTnⅠ、LDH及CK含量明显较高（P〈005），但MWC并无明显变化（P〉0．05）。心肌超微结构显示，Celsior液组大鼠心肌结构清楚，肌纤维排列较整齐，肌节清晰，偶见肌丝溶解；线粒体肿胀不明显，嵴结构相对清楚。HTK液组大鼠心肌结构尚清楚，肌纤维疏松，个别区域肌丝肌节溶解，线粒体轻度肿胀，嵴排列尚整齐，偶有空泡变性。结论含二氮嗪的Celsior液和HTK液低温长时间（10h）保存离体心脏均具有良好的心肌保护效作用，而且相对于HTK液，Celsior液的保存效果更好，可作为临床上心脏移植手术中心脏保存的一种有效的方法。     

低温高压一氧化碳(CO)干燥法对离体兔心的保护作用及机制

目的 探讨低温(4 ℃)高压CO(CO=0.8ATA,O₂=3.2ATA,ATA:1个标准大气压)干燥法对离体兔心的保护作用及其机制。方法 取72只新西兰兔作为实验对象,采用数字表法随机分为5组,空白对照组(8只),即刻移植组(16只),普通干燥组(16只),低温高压CO干燥保存组(16只),低温HTK浸泡保存组(16只);分别将后3组离体兔心用单纯干燥、低温高压CO干燥及低温HTK液浸泡等方法进行保存18 h,并将保存后的离体兔心进行兔子腹腔异位移植,测定移植兔心复跳率、心肌酶(CK:肌酸激酶;CK-MB:肌酸激酶同工酶;AST:血清门冬氨酸氨基转移酶;LDH:血清乳酸脱氢酶)、炎性反应因子(TNF-α:肿瘤坏死因子-α;IL-1:白细胞介素-1;IL-17:白细胞介素-17;ICAM-1:细胞间黏附因子-1)及行心肌组织苏木精-伊红染色(HE染色)检查。对各项试验指标进行统计分析,进一步探讨低温高压CO干燥对离体兔心的保护效果及其在抗炎性反应方面的作用及其机制。结果 低温高压CO干燥保存法较低温HTK液浸泡保存法而言能有效的降低心肌酶(CK-MB、LDH、CK)的量(P值均<0.05),有效抑制炎性反应因子(IL-1、IL-17、TNF-α)的释放(P值均<0.05),减轻心肌细胞损伤。结论 低温高压CO干燥保存法对离体兔心的保存效果优于传统的低温HTK液浸泡法。     

不同心脏保存液对离体鼠心低温保存效果的对比研究

目的通过研究康斯特保护液（HTK液）和阜外改良液（FWM液）两种心脏保存液在低温条件下保存离体鼠心不同时间的效果,为临床应用提供依据,并探讨心脏移植手术过程中供心的临界保存时间。方法将36只雄性SD大鼠随机分成2组（HTK组和FWM组）,每组18只。采用Langendoff装置进行心脏保存前后的灌注,各实验组分别使用不同保存液灌停心脏并在低温条件下保存鼠心8 h,于灌停前及复灌后留取冠脉流出液测定心肌酶（CKMB,LDH）漏出量。灌注结束后,取心肌组织测定含水量并制作光镜标本观察心肌组织结构变化。结果与FWM组比较,HTK组心肌酶漏出量较少,但仅有少数时间点存在显著性差异（P〈0.05）,心肌含水量稍低,但无显著性差异（P〉0.05）,心肌结构变化较轻。结论相同保存时间的条件下,HTK液及FW液的心肌保存效果相近,理论上应都可作为心脏移植术中供心的保存液,但与FWM液相比,HTK液仍具有一定优势。     

离体鼠心低温器官保存液保存后超微结构的分析

目的评价阜外改良心肌保存液(fuwai mod ified solution,FWM),HTK液(h istid ine-tryptophan-ketogluratesolution)和UW液(un iversity of w isconsin solution)对离体鼠心的保存效果。方法20只雄性W istar大鼠随机分为四组(Control组、FWM组、HTK组和UW组),每组5只。Control组切取鼠心后立即移至Langendorff装置灌注1h,其它三组分别用不同的保存液4℃下保存6 h,然后将离体鼠心移至Langendorff装置复灌1 h,测定复灌1h后的心肌含水量变化,并用透射电镜观察复灌1 h后心肌超微结构的改变。结果UW组心肌含水量高于Control、FWM和HTK组,而Control,FWM和HTK三组相比无显著统计学差异(P>0.05)。电镜结果显示,Control组和FWM组心肌超微结构基本正常,HTK组出现心肌超微结构改变,而UW组心肌超微结构改变严重。结论FWM液的心肌保存效果优于HTK和UW液。     

腺苷、卡托普利联合用药对心肌缺血再灌注的保护作用

目的：观察腺苷、卡托普利联合用药对缺血再灌注心肌的保护作用。方法：40只SD雄性大鼠,随机分成4组：空白组（I组）,腺苷组（Ⅱ组）,卡托普利组（Ⅲ组）,联合用药组（Ⅳ组）,制成Langendorff离体心脏模型。测定冠脉回流液中LDH,CPK活性,心肌组织匀浆中MDA含量,SOD活性,心肌组织超微结构变化。结果：（1）各组心脏冠脉回流液中LDH,CPK活性随时相变化逐渐上升,复灌20,30min时用药组明显低于对照组,Ⅳ组上升趋势最慢。Ⅱ,Ⅲ,Ⅳ组心肌MDA含量明显降低。SOD活性增加。（2）心肌组织超微结构观察示用药组心肌损伤轻于对照线,Ⅳ组损伤最轻。（3）Ⅱ,Ⅳ组出现心脏复跳延迟及心律失常。结论：（1）腺苷,卡托普利联合用药对心肌缺血再灌注的保护作用优于单一用药。（2）腺苷有延缓心脏复跳作用。     

钠/氢离子交换抑制剂预处理对犬心脏移植供心的保护作用

目的 研究HOE-642（Cariporide，Na^＋／H^＋交换抑制剂）预处理对供体心肌的保护作用。方法 10对杂种犬随机分为2组：对照组（C组）：在没有热缺血的情况下取下供心，用4℃的UW液保存4小时；实验组（E组）：在没有热缺血的情况下取下供心，也用4℃的UW液保存4小时，实验组供体在取下心脏前10分钟和受体再灌注前10分钟分别静脉给以HOE-642（2mg／kg）预处理。应用心输出量（CO）、心肌含水率、ATP含量和心脏超微结构作为评价心肌保护效果的观察指标。结果 心脏复跳情况E组好于C组，心输出量E组〉C组（P〈0．05）；心肌含水量C组〉E组（P〈0．05）；ATP含量E组〉C组（P〈0．05）；心脏超微结构E组明显好于C组。结论 HOE-642预处理能明显改善心肌保护液对供体心肌的保护。     

阜外极化停搏液大鼠离体心肌保护效果研究

目的研究阜外极化停搏（FWP）液对大鼠离体心肌保护的效果。方法SD大鼠24只,随机分为四组,对照组,STH-2液（St.ThomasⅡ）组,HTK液（histidine-trptophan-ketoglurate）组和FWP液（fuwai polarizing）组。除对照组,其他各组心脏均在4℃心肌保护液中保护1 h。观察左心室功能恢复情况、冠状动脉流量（CF）、冠状静脉引流液中肌酸激酶同工酶（CKMB）、乳酸脱氢酶（LDH）、肌钙蛋白I（cTnI）含量以及心肌细胞的超微结构等。结果各实验组心功能指标均有不同程度下降。FWP组和HTK组LVDP,CF和-dp/dtmax显著高于STH-2组（P〈0.01）;FWP组dp/dtmax显著高于HTK组和STH-2组（P〈0.01）;FWP组和HTK组心肌酶CKMB、LDH和cTnI含量显著低于STH-2组。心肌超微结构显示FWP组和HTK组超微结构保存较好,损伤比对照组小。结论FWP液组对心肌保护效果明显优于STH-2液组,与HTK液相似。     

尼可地尔改善心脏停搏液对心脏的保护作用

目的　观察在HTK液和UW液中加入尼可地尔 (Nicorandil)对心肌保存液保存效果的影响。方法　实验分为 4组 :UW液 (U)组 ;HTK液 (H)组 ;UW液组 +Nicorandil(U +N)组 ;HTK液 +Nicorandil(H +N)组 ;每组 8只大白鼠。麻醉和抗凝后 ,快速取下鼠心并悬挂在Langendorff灌注模型上灌注 ,测定血流动力学基础值。分别用四组保存液灌停离体鼠心并低温 (4℃ )浸泡保存 6h。复温、复灌后再次测定血流动力学值 ,留取标本分别测定心肌水含量、心肌酶漏出量、心肌细胞ATP和CP含量和心肌细胞超微结构变化。结果　心肌血流动力学恢复率 :H +N组>U +N组 >H组 >U组。心肌水含量 :4组间差异无显著意义。灌脉流出液中心肌酶漏出量 :H +N组 U +N组 >H组 >U组。心肌细胞超微结构变化 :H +N组心肌损害最轻 ,H组轻于U +N组 ,U组心肌损害最严重。结论　HTK液和UW液都是比较合适的心肌保存液 ,HTK液对心肌的保护作用优于UW液 ,钾离子通道开放剂Nicorandil能够善器官保存液HTK液和UW液对心肌的保存效果。     

HTK液与Verapamil配伍对供心保存效果的实验研究

目的 通过建立Langendorff离体鼠心灌流模型,研究HTK液与Verapamil配伍对供心的保护效果.方法 30只SD大鼠(200～400g/只),随机分为实验组与对照组,实验组予以HTK液与Verapamil(5mg/L)配伍、对照组予以单纯HTK液作为停搏液,建立标准的Langendorff离体心脏灌注模型,4℃低温下保存大鼠心脏6h,予以37℃ K-H液复灌,心脏复跳,生理仪记录缺血前、复灌20min、40min、60min、80min时血流动力学标值,检测心脏复灌45min时冠脉流出液中心肌酶学指标,实验结束后各组留取样本以行常规病理切片及电镜切片观察微观结构变化.结果 实验组LVSP平均恢复率高于对照组,对照组LVEDP持续上升,实验组LVEDP相对稳定;对照组心肌酶均明显高于实验组(P＜0.05);病理切片显示对照组损伤较实验组明显.结论 HTK液联合Verapamil较单独使用HTK液作为心肌保护液,对心肌具有更明显的保护作用.     

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.