培哚普利抑制慢性缺氧高二氧化碳大鼠肺动脉高压的形成

研究慢性低氧高二氧化碳性肺动脉高压大鼠模型的血浆血管紧张素Ⅱ（ＡｎｇⅡ）的变化与平均肺动脉压（ｍＰＡＰ）的关系，并观察血管紧张素转换酶抑制剂（ＡＣＥＩ）—培哚普利的干预作用。实验分五组。结果：①缺氧四周组（Ｆ１）与八周组（Ｅ１）ＡｎｇⅡ浓度和ｍＰＡＰ都比正常对照组（Ｃ）明显升高（Ｐ＜０．０１），且两者成正相关（ｒ＝０．８１１，Ｐ＜０．０１）。②相对应的用培哚普利四周组（Ｆ２）与八周组（Ｅ２），其ＡｎｇⅡ与ｍＰＡＰ分别比Ｆ１组、Ｅ１组低（Ｐ＜０．０５，Ｐ＜０．０１），与Ｃ组相比无升高（Ｐ＞０．０５）。提示：慢性缺氧高二氧化碳大鼠肺动脉压升高与ＡｎｇⅡ有关，培哚普利有阻抑肺动脉高压形成的作用。     

实验性肺动脉高压犬肺血流动力学特征

目的 探讨肺动脉高压（ＰＨ）形成的过程中,肺血流动力学变化特点。方法 实验幼犬１５只分２组,组１为分流组（ｎ＝１２）,应用成年犬左锁骨下动脉行降主动脉－左下肺动脉分流术,组２为正常对照组（ｎ＝３）,两组在一定时间内进行血流动力泞主病理学检查。结果 组１在分流前后血流动力学出现明显改变,表现为：左下肺动脉压（ＰＬＬＰＡ）上升、肺血流量（Ａｐ）增加,左下肺动脉血氧饱和度（Ｓｌａｏ２）增加以及体动脉压（     

慢性低氧大鼠肺动脉内皮素mRNA的表达及定位

目的；探讨慢性低氧大鼠肺动脉内皮素－１基因表达及分布。方法；采用生物素标记ｃＤＮＡ探针，对Ｗｉｓｔａｒ大鼠肺动脉进行原位杂交。结果：低氧１周组及２周组大鼠大部分肺动脉内皮细胞ＥＴ－１ｍＲＮＡ表达呈阳性信号，面对照组大鼠仅极少数性信号（Ｐ〈０．０１）；低氧１周组大鼠部分显示强阳性信号。低氧１周组及低氧２周组大鼠部分肺产滑肌细胞呈现ＥＴ－１ｍＲＮＡ表达阳性信号，而对照组大鼠则无阳性信号表达（Ｐ〈０．０     

肺动脉狭窄手术指征的实验研究及临床应用

杂种犬１８只，随机分为４组，开胸手术建立肺动脉狭窄的动物模型，Ａ组：肺动脉缩窄３５％（ｎ＝５）；Ｂ组：肺动脉缩窄５０％（ｎ＝５）；Ｃ组：肺动脉缩窄６５％（ｎ＝５）Ｄ组：肺动脉无缩率（ｎ＝３）。观察肺动脉缩窄前及缩窄后１６８ｈ的右心室压力，心肌组织学及动脉血气，血清心肌酶学的变化。结果发现Ｂ、Ｃ组变化尤其显著（Ｐ〈０．０１）。结论：（１）肺动脉缩窄达正常外径５０％以上时，心肌病理变化显著；（２）肺动     

三磷酸腺苷——硫酸镁对肺心病肺动脉高压患者的肺血管选择性舒张作用

笔者应用三磷酸腺苷（ＡＴＰ）－硫酸镁（下称Ｍｇ＾２＋）治疗肺心病肺动脉高压（ＰＡＨ）者２１例，观察其肺血管选择性舒张作用并设对照组。结果表明，对照组的肺动脉平均压（ＭＰＡＰ）及肺血管顺应性（Ｃｐａ）在用药１分钟后及用药后最低水平与用药前相比，有显著性差异（Ｐ均〈０．０１以下），但多数作用时间仅维持５￣１０分钟，除１例作用时间维持３４分钟外，１５分钟后均恢复原水平。耐肺心病组的ＭＰＡＰ及Ｃｐａ用药１     

血小板激活因子在慢性肺动脉高压中的作用

对大鼠采用血小板激活因子（ＰＡＦ）以每日３次每次每公斤体重３μｇ作腹腔内注射处理４周，研究其在慢性肺动脉高压形成过程中的作用。结果发现：ＰＡＦ处理组大鼠与对照组相比，其肺动脉平均压升高１．１７ｋＰａ，肺血管阻力升高２４０９．３ｋＰａ·ｓ／Ｌ，心输出量降低９．１ｍｌ／ｍｉｎ，右心室／（左心室＋室间隔）比值升高０．１；大鼠肺小动脉管壁增厚，反映管壁增厚的两个指标，管壁厚度占外径的百分比和管壁面积占血管总面积的百分比均显著升高（Ｐ＜０．０５），说明ＰＡＦ可引起肺动脉压升高和肺小动脉结构重建，提示ＰＡＦ在慢性肺动脉高压发病过程中发挥重要的作用     

西拉普利对大鼠缺氧性肺动脉高压治疗作用的实验研究

目的：观察西拉普利对大鼠缺氧性肺动脉高压的治疗作用。方法：应用血液动力学变化指标、循环内皮细胞（ＣＥＣ）、一氧化氮（ＮＯ）、组织丙二醛（ＭＤＡ）、血管紧张素转换酶（ＡＣＥ）测定和电子显微镜病理学观察。结果：西拉普利治疗后，肺动脉平均压（２．８５±０．２２ｋＰａ）较安慰剂组（３．５８±０．２０ｋＰａ）显著下降，ＮＯ（２４．００±４．２１ｎｍｏｌ／Ｌ）较安慰剂组（１９．８６±１．８０ｎｍｏｌ／Ｌ）显著升高（Ｐ＜０．０１），肺组织ＡＣＥ（３８．７０±４．６２Ｕ）较安慰剂组ＡＣＥ（４５．１７±４．５６Ｕ）下降显著（Ｐ＜０．０１），组织ＭＤＡ（２６．２９±４．８１ｎｍｏｌ／ｍｇ）较安慰剂组（３１．４６±３．４８ｎｍｏｌ／ｍｇ）显著下降（Ｐ＜０．０１），肺组织的病理学损伤减轻。结论：西拉普利可降低肺动脉高压，促进ＮＯ释放，减轻肺动脉内皮的病理损伤     

多普勒超声心动图无创性估测肺动脉压

选择拟诊为肺动脉高压（ＰＡＨ）患者２５例。采用三尖瓣返流压差法和肺动脉血流频谱分析法定量估测肺动脉压。其中７例同时行右心导管检查。结果显示：①随着肺动脉压力的增高，肺动脉血流频谱有其特征性的变化；②根据三尖瓣返流压差估测的肺动脉收缩压（ＰＡＳＰ）与右心导管实测值相近，两值高度相关（ｒ＝０．８５，Ｐ＜０．０１）；③多普勒参数右室射血前期（ＲＶＰＥＰ）、加速时间（ＡｃＴ）、ＲＶＰＥＰ／ＡｃＴ与肺动脉压相关性较好（ｒ＝０．７７、－０．８３、０．７９）；④根据ＲＶＰＥＰ／ＡｃＴ估测的肺动脉平均压（ＰＡＭＰ）与右心导管实测值相关性较好（ｒ＝０．６８）。结果表明，多普勒超声心动图可用于肺动脉高压的定性和定量诊断     

L精氨酸对大鼠低氧性肺动脉高压的防治作用

观察Ｌ－精氨酸对大鼠常压低氧性肺动脉高压的预防和治疗作用。结果表明，Ｌ－精氨酸（２００ｍｇ／ｋｇ·ｄ）可明显预防低氧所致的肺动脉高压和右心室肥厚，Ｌ－精氨酸预防组平均肺动脉压（ｍＰＡＰ）（２．６１±０．０９ｋＰａ）明显低于低氧处理组（３．５８±０．０６ｋＰａ），两组间差异有显著性（Ｐ〈０．０５）；右心室／（左心室＋室间隔）重量比值（０．２６±０．０１）明显低于低氧组（０．３４±０．０１），两组间差     

肺血管磁共振成像的对比研究

用１．０Ｔｅｓｌａ超导ＭＲ仪,体外圈技术,对４６例志愿者进行２ＤｔｕｒｂｏＦＬＡＳＨ和／或３ＤＦＩＳＰ肺释ＭＲＡ成像共１１３次,分４组进行分析统计。结果显示：Ｇｄ－ＤＴＰＡ增强后的２Ｄ和３Ｄ－ＴＯＦ ＭＲＡ信噪比明显高于未使用Ｃｄ－ＤＴ－ＰＡ的ＭＲＡ信噪比（Ｐ〈０．０１）;２Ｄ－ＴＯＦ ＭＲＡ增强后所显示的左、右肺动脉分支数量（险左叶舌段）明显多于增强前（Ｐ〈０．０５）;３Ｄ－ＴＯＰ ＭＲＡ增强后     

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.