内源性一氧化氮抗兔肺缺血再灌注损伤作用及其机制探讨

目的　探讨内源性一氧化氮在兔肺缺血再灌注过程中有无抗肺损伤作用及可能的机制。方法　制备兔缺血再灌注损伤模型 ,32只新西兰大白兔随机分为对照组即假手术组 (Sh O)、肺缺血再灌注组 (L IR)、L IR 左旋精氨酸 (L- Arg)组 (静脉注入 NO合成的底物 L- Arg2 0 0 mg/ kg)、L IR 左旋硝基精氨酸 (L- NNA)组 (静脉注入NO合成抑制剂 L- NNA10 0 mg/ kg)。大白兔在肺动脉再灌注 6 0 m in后立即取肺组织观察各组病理改变、肺湿重 /干重比值 (W/ D) ,检测各组肺组织内髓过氧化物酶 (MPO)活性、丙二醛 (MDA)含量及硝酸盐 /亚硝酸盐 (N/ N)比值。结果　与 Sh O组比较 ,L IR组肺水肿明显 ,W/ D比值上升、MPO活性及 MDA含量增高 ,而 N/ N下降 (P<0 .0 1) ;与 L IR组比较 ,L IR L - Arg组肺水肿减轻 ,MPO活性及 MDA含量下降 ,N/ N量增加 (P<0 .0 1) ;与 L IR或 L IR L - Arg组比较 ,L IR L - NNA组肺水肿更加严重 ,MPO活性及 MDA含量增高更明显 (P<0 .0 1)。结论内源性 NO的释放可减轻肺缺血 -再灌注损伤 ,其作用机制与抑制中性粒细胞在肺内的聚集 ,降低血管通透性 ,对抗氧自由基造成的肺损伤有关。     

左旋精氨酸及还原型谷胱甘肽对大鼠肝脏热缺血再灌注损伤早期的作用

目的:探讨左旋精氨酸(L-arg)及还原型谷胱甘肽对大鼠肝脏热缺血再灌注损伤(IRI)的作用。方法:将32只SD大鼠随机分为假手术组(SO组=8)、缺血再灌注组(IR组=8)、精氨酸组(LA组=8)、还原型谷胱甘肽组(RG组=8)。制备大鼠肝IR损伤模型,观察损伤后血中谷丙转氨酶(ALT)、超氧化物歧化酶(SOD)活力变化,血及肝脏组织中一氧化氮(NO)、丙二醛(MDA)含量变化及肝组织病理变化。结果:与SO组比较,IR组血中ALT含量明显升高、SOD活性明显下降,血及肝组织中MDA明显升高、NO升高;与IR组比较,LA组及GS组:ALT、MDA明显下降;SOD活性升高,血及肝组织中NO明显升高,肝组织的病理损伤也较对照组轻;GS组的MDA含量较LA组明显低。结论:左旋精氨酸及还原型谷胱甘肽均具有减轻肝I/R引起的肝功能损害和脂质过氧化损害,具有保护作用;还原型谷胱甘肽清除自由基的能力较左旋精氨酸强。     

左旋精氨酸对兔肺缺血再灌注损伤的保护作用

目的 :观察左旋精氨酸对在体兔肺缺血再灌注损伤的影响。方法 :复制在体兔肺缺血再灌注损伤模型。 30只日本雄性大耳兔 ,随机分为三组 :假手术组 ,缺血再灌注组 (IR组 )和左旋精氨酸 +缺血再灌注组(Larg组 )。对比观察各组血浆SOD活力 ,NO、MDA含量 ,肺组织湿干重比 (W /D) ,肺损伤组织学定量评价指标 (IQA)及光镜和电镜下的组织形态学改变。结果 :缺血再灌注后Larg组血浆NO含量和SOD活力较S组、IR组明显升高 (P <0 .0 1) ,MDA、W/D、IQA较IR组明显降低 (P <0 .0 5 ,P <0 .0 5 ,P <0 .0 1) ;IR组镜下见有肺组织水肿 ,肺泡损伤严重 ,内皮细胞线粒体水肿或空泡化 ,毛细血管内炎性细胞浸润 ;而Larg组肺组织上述改变明显减轻。结论 :在体兔肺缺血前预先用L Arg处理 ,可减轻随后的缺血再灌注损伤 ;其机制之一可能与L Arg抗氧自由基作用有关     

肺缺血再灌注损伤时一氧化碳的变化及葛根素对其影响

目的:观察兔肺缺血再灌注损伤时一氧化碳的变化及葛根素对其的影响.方法:30只健康日本大耳白兔随机分成假手术对照组(C组)、肺缺血再灌注组(IR组)和葛根素组(Pur组).复制兔单侧肺缺血再灌注损伤模型,各组在缺血前、缺血1 h、再灌注1 h、3 h和5 h分别抽血,检测一氧化碳血红蛋白(COHb)浓度、环磷酸鸟苷(cGMP)含量.实验结束时取肺组织检测cGMP含量,电镜观察肺组织超微结构的改变.结果:血浆COHb浓度、cGMP含量和肺组织cGMP含量IR组、Pur组明显高于C组,以Pur组为著(P＜0.01).电镜显示IR组有明显的肺超微结构损伤,而Pur组损伤较轻.结论:葛根素可通过提高内源性C0水平,对缺血再灌注损伤肺组织发挥保护作用.     

地塞米松对大鼠肺缺血再灌注损伤保护的研究

目的:通过观察地塞米松对大鼠肺缺血再灌注后病理形态变化的影响,探讨其对肺缺血再灌注损伤的保护机制。方法:健康的SD大鼠40只,雌雄不拘,随机分为5组:假手术组(S)、单纯缺血组(I)、缺血再灌注组(IR)、小剂量地塞米松干预组(D1)及大剂量地塞米松干预组(D2),每组8只。根据Eppinger模型制作SD大鼠单侧肺缺血再灌注动物模型,用Western印迹法分析各实验组中一氧化氮合酶蛋白表达的变化,HE染色观察肺组织病理形态学改变结果:与其它组比较,缺血再灌注组肺组织中蛋白一氧化氮合酶表达明显增高(P<0.01),在地塞米松干预后,一氧化氮合酶蛋白下降,以D2组明显,病理切片显示IR组肺结构损害分级显著重于其它组,在地塞米松干预后,肺结构损害分级下降,以D2组明显。结论:正常肺脏一氧化氮合酶蛋白的表达微弱,缺血再灌注可使一氧化氮合酶蛋白表达增加,肺组织损伤加重,地塞米松可使一氧化氮合酶蛋白表达下降,肺组织损伤减轻,这种效应以大剂量时明显。     

一氧化氮与大鼠肠缺血再灌注损伤关系的研究

目的了解一氧化氮(NO)与大鼠肠缺血再灌注损伤之间存在的关系。方法制作肠缺血再灌注损伤的动物模型,设立对照组、缺血组、再灌注45min和90min组,检测不同时点血浆NO浓度、肠组织一氧化氮合酶(iNOS)免疫组化染色光密度及肠管病理损伤程度。结果伴随肠缺血再灌注进程,各组大鼠Chiu病理评分及iNOS免疫组化染色光密度值依次升高,且组间均有显著性差异。F值分别为287.13,62.484,P均小于0.01。而血浆NO含量则是在再灌注后才呈现渐增趋势,F=38.667,P<0.01。结论肠组织中iNOS表达在缺血期即被激活,由iNOS催化合成的NO在大鼠肠缺血再灌注过程中基本以致损作用为主。     

山莨菪碱预处理对兔肺缺血再灌注损伤的实验研究

目的 探讨山莨菪碱预处理对兔肺缺血再灌注损伤的保护作用及其作用机制.方法 建立兔肺缺血再灌注动物模型,健康家兔24只,随机分为3组,每组8只.假手术组不行缺血再灌注处理,对照组进行左肺缺血再灌注处理,山莨菪碱组静脉给予山莨菪碱预处理后行左肺缺血再灌注处理.各组不同时间点采血,测血浆丙二醛(MDA)和一氧化氮(NO)含量;术后取左肺组织进行形态学观察和还原型谷胱甘肽过氧化物酶(GSHpx)含量测定;最后通过静脉注射伊文思兰的方法比较3组肺血管通透性差异.结果 缺血再灌注处理后,对照组血浆MDA和NO含量明显高于假手术组(P均<0.01),GSHpx含量明显低于假手术组(P<0.01),组织病理损伤严重,肺血管通透性高,山莨菪碱组上述指标水平改善(P均<0.05),组织损伤减轻,肺血管通透性低.结论 应用山莨菪碱预处理可以显著减轻肺缺血再灌注损伤的程度.     

肢体缺血再灌注损伤时血管组织一氧化氮产生途径及其机制

目的 探讨肢体缺血再灌注(I／R)损伤时．血管组织一氧化氮(NO)产生的途径和机制。方法 采用Rosenthal方法复制大鼠肢体I／R损伤模型,实验动物分为对照组和I／R组。分别测定血浆中、主动脉孵育液中NO2ˉ含量和主动脉组织中cGMP含量及一氧化氮合酶(NOS)活性,观察主动脉组织^3H-L-精氨酸(^H-L-Arg)的含量。结果(1)I／R组大鼠血浆和主动脉条孵育液中NO2ˉ明显增加,主动脉cGMP含量也增高;(2)I／R组大鼠血管总NOS(tNOS)活性增高,其中主要是诱导型NOS(iNOS)活性增加;(3)I／R时血管组织中^3H-L-Arg的含量增多。结论 肢体I／R后．血管组织L-Arg跨膜转运加强,iNOS活性增加．导致非内皮源性NO生成增多。     

氯胺酮抗兔肺缺血-再灌注损伤的实验研究

目的:观察氯胺酮对兔肺缺血-再灌注损伤的保护作用.方法:实验兔50只随机均分为对照组(C组)、缺血-再灌注组(IR组)和缺血-再灌注 氯胺酮预注组(Ket组).测量血浆中肿瘤坏死因子-α(TNF-α)、一氧化氮(NO)、丙二醛(MDA)含量,分析每组肺湿干重比(W/D)、肺泡损伤数(IQA)及肺组织形态改变情况.结果:IR组与C组相比,NO含量显著降低(P＜0.01),TNF-α、MDA、W/D、IQA明显升高(P＜0.01).Ket组与IR组相比,NO含量明显升高(P＜0.05),TNF-α、MDA、W/D、IQA有不同程度降低(P＜0.01或P＜0.05).光镜下C组肺泡较完整,未见炎症细胞浸润;IR组肺不张,肺间质水肿,炎症细胞浸润,而Ket组肺损伤明显减轻,炎症细胞浸润少.结论:氯胺酮可抑制炎性因子的释放和过氧化反应,增加一氧化氮含量,减轻肺血管内皮细胞损伤,从而对缺血再灌注损伤的肺组织起到保护作用.     

脑血管内皮细胞损伤对大鼠脑缺血再灌注神经元凋亡的影响

目的:探讨脑缺血再灌注脑血管内皮细胞损伤、内皮素(ET-1)、一氧化氮(NO)与神经元凋亡的关系。方法:采用4血管夹闭法制作大鼠脑缺血再灌注模型,观察缺血再灌注不同时间内皮素、一氧化氮及脑血管内皮细胞超微结构变化对神经元凋亡的影响。结果:脑缺血再灌注组缺血10m in血浆ET-1含量显著升高,再灌注24h有所下降,于72h又开始升高,血浆NO于再灌注24h有所下降,48h时间点又恢复到缺血时水平。全脑缺血10m in内皮细胞部分缺损,凋亡神经元数量较少,缺血再灌注24h内皮损伤加重,凋亡神经元数量明显增加,至48h达到高峰,再灌注72h,凋亡神经元数量明显减少。结论:脑缺血再灌注ET-1含量升高,NO水平下降,内皮损伤加重可导致神经元进一步损害。     

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.