含聚合血红蛋白的St.Thomas液对低温保存离体大鼠心脏的保护作用

目的 研究含聚合血红蛋白(polymerized hemoglobin,PolyHb)的心脏停搏保存液(St.Thomas液)对离体大鼠心脏低温保存8 h复灌后缺血再灌注损伤的保护作用.方法 将60只成年SD大鼠随机分成3组(n=20):假手术组(sham组)、对照组(St.Thomas solution组,STS组)和实验组(PolyHb组).利用Langendorff离体心脏灌流法,观察心脏在4 ℃含或不含PolyHb的St.Thomas液中保存8 h复灌120 min心脏功能的变化情况,比较冠脉流出液中肌酸激酶(CK)和乳酸脱氢酶(LDH)的释放量和心肌梗死面积.结果 与STS组比较,含PolyHb的St.Thomas液可增强再灌注时左室发展压(P<0.001)和左室压力变化率(P<0.001),减少冠脉流出液中CK和LDH的含量(P<0.001),减少心肌梗死面积百分比(P<0.001).结论 含PolyHb的St.Thomas液对低温保存8 h后离体鼠心的缺血再灌注损伤有明显的保护作用.     

附加N-乙酰半胱氨酸心停搏液对低温缺血-再灌注大鼠心脏的保护作用

目的探讨附加N-乙酰半胱氨酸(NAC)心停搏液对低温缺血再灌注大鼠心脏的保护作用.方法:采用离体左心做功模型,观察附加NAC液和St. Thomas液灌注对大鼠全心低温缺血180 min再灌注60 min的作用,比较两组心脏功能和心肌能量代谢的恢复状况.结果:附加NAC组再灌注后心脏功能和高能磷酸腺苷酸代谢的恢复状况明显优于St. Thomas液灌注组.结论:附加NAC可显著改善St.Thomas液心肌保护作用,NAC可能是有价值的心脏停搏液添加剂.     

HOE642对未成熟心肌保护作用的实验研究

目的：研究Na^ /H^ 交换抑制剂HOE642（cariporide)对未成熟心肌缺血／再灌注损伤的保护作用。方法：取健康新西兰幼兔（2－3周龄＿心脏24枚,随机均分为2组。对照组St.ThomasⅡ液作为保护液。实验组HOE642（10μmol/L）加St.ThomasⅡ液作为保护液。使用Langendorff离体心灌注实验模型,药受常温缺血60min,期间每隔20min灌注一次心肌保护液, 恢复再灌注后,观察血流动力学变化,并测定心功能指标。结果：HOE642实验组,平均动脉压（MAP）,主动脉流量（AF）,冠脉流量（CAF）,左室收缩／舒张压（LVSP／LVDP）及左室压力微分（dp/dt）恢复率明显优于单纯St.ThomasⅡ的对照组（P＜0．01）,左房压（LAP）,HO3642组明显低于对照组（P＜0．05）。 恢复灌注后,HOE642实验组室颤发生率明显低于对照组（P＜0．01）。肌酸激酶（CK）、乳酸脱氢酶（LDH）漏出量（U／L）,HOE642组明显少于单用St.Thomas Ⅱ液组（P＜0．01）。结论：HO3642（cariporide)对未成熟心肌缺血／再灌注损伤有明显的保护作用。     

超极化停搏对离体兔心肌补体C3a表达的抑制作用

目的观察离体兔心脏超极化停搏对心肌组织补体C3a蛋白质表达的影响情况.方法日本大耳白兔32只,随机分为3组,每组均为8只.剩余8只在心率平衡10min后取标本作为缺血前对照.空白对照组(K组);St.ThomasⅡ组(S组);Pinacidial组(P组).离体兔心Langendorff模型灌注充氧K-H液,心率稳定10min后,K组以4℃的K-H液灌注心脏,S组灌注4℃ St.ThomasⅡ(K 16mmol·L-1)停跳液,P组灌注含Pinacidial(50μmol ·L-1)的4℃ St.ThomasⅡ(K 5mmol·L-1)停跳液.全心缺血40min,复灌60min.采用免疫荧光法对比观察缺血/再灌注前、后心肌组织补体C3a蛋白质表达的变化.结果与平衡10min比较,再灌注后60min各组心肌细胞胞浆荧光着色均增强,但P组明显低于K组与s组(P《0.01).结论超极化停搏可抑制离体兔心肌组织缺血/再灌后补体蛋白质的表达.     

缺血预处理联合St.ThomasⅡ心麻痹液对兔未成熟心脏功能和病理学影响

目的：研究缺血预处理（IPC）对兔未成熟心肌缺血再灌注损伤的影响，并探讨其可能机制。方法：利用Langendorff模型灌注幼兔（14－21天）离体心脏。18只幼兔心随机分为2组，每组9只，IPC组经历5min缺血、10min再灌的IPC处理后，使用St.ThomasⅡ心麻痹液（STH）使心脏停跳；对照组只用STH停跳心脏。两组兔心均在生理体温(39℃）下接受45min缺血、40min灌注。观察复灌后的心肌酶释放、心肌能量、心脏功能及病理学变化。结果：与对照组相比，IPC组肌酸磷酸激酶同工酶（CK－MB）漏出量明显减少（P＜0．01），心肌ATP含量以保存（P＜0．05），再灌注末心脏左室发展压（LVDP）显著改善（P＜0．05）；光、电镜显示经过缺血预处理的心肌细胞损伤轻。结论：缺血预处理能明显减轻兔未成熟心肌缺血再灌注损伤，改善再灌注后心脏功能的恢复，其机制可能与保存再灌注后心肌细胞中ATP含量有关。     

黄芪注射液抗体外兔心脏缺血再灌注损伤作用研究

目的:研究黄芪注射液对体外兔心脏再灌注损伤的保护作用。方法:采用体外兔心共生支持系统模型。16只心脏随机分为黄芪组和对照组各8只,缺血期停跳液分别采用黄芪注射液加St.Thomas’液和St.Thomas’液进行心肌保护。常温缺血45 min,再灌注60 min,比较两组再灌注后5 min,30 min和60 min的冠脉回流液中心肌酶含量,组织标本采用HE染色和酸性复红光绿染色评价缺血区面积。结果:再灌注后黄芪组冠脉回流液中心肌酶含量低于对照组,缺血区面积小于对照组,有显著性差异(P<0.05)。结论:缺血过程中停跳液中加入黄芪注射液可以减轻体外心脏再灌注损伤。     

不同浓度二氮嗪对离体兔心缺血/再灌注损伤的保护作用

目的 观察二氮嗪预处理对高钾停跳离体兔心缺血/再灌注损伤的保护作用.方法 采用离体兔心Langendorff灌注实验模型,离体兔心40只随机等分成5组（n=8）.离体兔心4℃标准St.Thomas停搏液（K^＋ 16 mmol/L）至心脏停跳,45 min后再灌注20 min,药物于心脏停跳前灌注15 min,观察在不同二氮嗪浓度下对再灌注后心功能及冠脉血流的影响以及再灌注末心肌超微结构、蛋白含量、脂质过氧化物丙二醛、超氧化物歧化酶、心肌酶以及腺苷酸含量的变化.结果 再灌注后各浓度二氮嗪预处理的离体兔心心功能的恢复率均明显高于对照组,心肌丙二醛的含量、蛋白的漏出量明显低于对照组（P〈0.05或0.01）,超微结构观察结构损伤较轻.结论 二氮嗪预处理和超极化停跳对离体兔心缺血/再灌注心肌具有较好的保护效果.     

硝酸甘油预处理的心肌保护作用及对Caveolin-3表达的影响

目的探讨小剂量[2μg/(kg.min)]硝酸甘油预处理对大鼠缺血再灌注心肌的保护作用及对caveolin-3表达的影响。方法 24只SD大鼠,完全随机分为3组(n=8):缺血再灌注(I/R)组、小剂量硝酸甘油预处理(PC)组和预处理干预(M)组。采用Langendorff离体心脏灌流方法,制备大鼠离体心脏缺血再灌注模型,离体心脏灌注液为K-H液:I/R组大鼠离体心脏全心停跳30 min,再灌注90 min;PC组在心肌缺血前静脉持续1 h泵入小剂量硝酸甘油[2μg/(kg.min),总量120μg/kg];M组灌注液为含甲基-β环糊精(脂筏清除剂)0.2 mmol/L的K-H液,余处理同PC组。分别观察各组缺血前及再灌注30 min时左室心功能变化情况,并于再灌注末取心肌组织标本,通过ELISA检测心肌组织中cTnI,硝酸还原酶法检测NO变化情况,TUNEL法检测各组心肌细胞凋亡情况、免疫组化方法及PCR方法检测Caveolin-3在各组心肌细胞中的表达变化情况。结果与I/R组比较,PC组左室LVSP、+dp/dtm ax、-dp/dtm ax及心肌组中NO明显升高,cTnI明显降低(P<0.05),心肌细...     

人重组促红细胞生成素预处理对缺血再灌注心肌血流动力学、心肌酶谱和超微结构的影响

目的研究人重组促红细胞生成素(rHuEPO)对离体缺血再灌注心脏的血流动力学、心肌酶谱和超微结构的影响.方法利用Langendorff离体心灌注模型平衡30 min,给予停搏液使心脏停跳90 min,再灌注60 min.16只Wistar大鼠(雌雄不拘)随机分为两组:对照组、rHuEPO预处理组.预处理组大鼠实验前24 h于腹腔给予rHuEPO 5 000 U/kg.观察两组再灌注后血流动力学指标、冠脉流出量、心肌酶谱(CK、LDH),电镜观察心肌超微结构.结果预处理组大鼠血流动力学、冠脉流出量及心肌酶谱改善情况显著优于对照组(P＜0.01);电镜示:预处理组大鼠心肌肿胀轻,线粒体及肌丝等超微结构损伤小.结论 rHuEPO预处理对离体心肌缺血再灌注损伤有良好保护作用,可望成为心外科极具应用前景的促进造血、心肌保护和脑保护的药物.     

选择性钠/氢离子交换抑制剂预处理对未成熟心肌的保护作用

目的　研究选择性Na+ /H+ 交换抑制剂HOE6 4 2 (Cariporide)预处理对未成熟心肌缺血 /再灌注损伤的保护作用及机制。方法　 2 0只健康新西兰幼兔 (3～ 4周龄 ) ,利用Langendorff左室做功模型灌注其离体心脏 ,建立全心缺血 /再灌注模型。KH液自主动脉逆行灌注心脏 ,向球囊缓慢注入生理盐水 ,调整至左室舒张末压 (LVEDP)为 10mmHg ,做功 2 0min ,随机分为两组 ,组Ⅰ :对照组 ,继续灌注 15min ;组Ⅱ :HOE6 4 2预处理组 ,用加入HOE6 4 2的KH液 (浓度为 5 μmol/L)继续灌注 15min。然后两组心脏均以St.Thomas停搏液诱导停跳 ,常温(37℃ )缺血 4 5min(保湿保温 ) ,再灌注 6 0min。记录冠脉流量 (CAF) ,多导生理记录仪记录左心功能指标 ,原子吸收分光光度计测定心肌细胞内钙 (Ca)含量 ,自动生化分析仪测量冠脉流出液中磷酸肌酸激酶 (CK)、磷酸肌酸激酶同工酶 (CK -MB)、乳酸脱氢酶 (LDH)漏出量含量 ,计算心肌含水量 ,透射电镜观察心肌超微结构改变。结果　CAF、左室发展压 (LVDP)、左室压力微分 (±dp/dtmax)恢复率 ,心肌组织内Ca及心肌含水量 ,心肌超微结构变化 ,HOE6 4 2预处理组明显优于对照组 (P <0 .0 5 )。结论　HOE6 4 2预处理通过减少细胞内钙超载 ,模拟缺血预处理的心肌保护效果 ,对未成熟心肌缺血 /     

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.