异丙酚对大鼠脊髓缺血再灌注早期自由基和超氧化物歧化酶的影响

目的 研究异丙酚对大鼠脊髓缺血再灌注早期脊髓组织丙二醛（MDA）含量及超氧化物歧化酶（SOD）活性变化的影响,以探讨异丙酚在抗脊髓氧化损伤中的作用。方法 45只成年雄性SD大鼠采用腹主动脉肾下夹闭法造成脊髓缺血再灌注模型,观察缺血前（假手术组）、再灌注后8b（再灌注组）脊髓组织内MDA含量和SOD活性变化,并与不同荆量异丙酚组比较。结果 脊髓缺血再灌注后脊髓组织MDA含量上升,SOD活性显著下降。异丙酚能抑制脊髓组织缺血再灌注后MDA上升,增强SOD活性。结论 异丙酚能减轻脊髓缺血再灌注损伤。     

脊髓缺血再灌注损伤中δ阿片受体的表达变化

目的通过建立兔脊髓缺血再灌注损伤(SCIRI)模型,研究SCIRI中脊髓组织δ阿片受体(DOR)m RNA表达的变化。方法 24只健康新西兰大耳白兔随机分成4组(每组6只),动物麻醉进腹后均钳夹腹主动脉,S组(假手术组)仅分离腹主动脉,不阻断血流;E-l组仅钳夹腹主动脉45 min;E-2组钳夹腹主动脉45 min后松钳再灌注30 min;E-3组钳夹腹主动脉45min后松钳再灌注60 min。在各时间点,采血检测血清神经特异性烯醇化酶(NSE)浓度后处死动物,取脊髓组织利用实时荧光定量PCR检测DOR m RNA表达情况。结果缺血45 min、再灌注30 min和60 min时血清NSE浓度均高于假手术组(P0.01),脊髓组织DOR m RNA表达均低于假手术组(P0.01)。结论脊髓缺血再灌注损伤后脊髓组织DOR m RNA的表达明显下降,提示DOR可能参与脊髓缺血再灌注损伤。     

异丙酚对脊髓缺血再灌注大鼠脊髓自由基和超氧化物歧化酶的影响

目的 研究异丙酚预处理对脊髓缺血再灌注早期脊髓组织丙二醛(MDA)含量及超氧化物歧化酶(SOD)活性变化的影响,以探讨异丙酚在抗脊髓继发性损伤中的作用.方法 54只成年雄性SD大鼠随机分为3组:假手术组(S)、再灌注组(m)和异丙酚组(P),再灌注组和异丙酚组又各分1h、4h、8h、16h四个观察相点组(各组n=6).除假手术组外,所有动物均采用腹主动脉肾下夹闭法造成脊髓缺血再灌注模型,观察各组脊髓组织内MDA含量和SOD活性.结果 脊髓缺血再灌注后脊髓组织MDA立即上升,8h达最高峰,此后随之下降,但至16h仍高于正常对照组;而SOD活性显著下降,8h达最低,随后逐渐回升,至16h仍低于缺血前.与再灌注组比较,异丙酚组各相点MDA含量降低,SOD活性增强.结论 异丙酚预处理对脊髓缺血再灌注损伤具有保护作用.     

氯胺酮对兔脊髓缺血性损伤过氧化反应的影响

目的观察氯胺酮对兔脊髓缺血再灌注损伤过氧化反应的影响.方法24只日本大白兔随机均分为假手术组(A组)、缺血再灌注组(B组)和氯胺酮组(C组).A组不阻断主动脉血流,B组左肾下阻断主动脉血流45min,C组左肾下阻断主动脉45 min前10min及开放后即刻分别静推氯胺酮30 mg/kg.测定首次给药前、松开前及松开后60min血中丙二醛(MDA)含量及超氧化物歧化酶(SOD)活性.术后进行后肢神经功能评分和脊髓形态学改变的观察.结果C组动物松开后60min血中MDA含量明显低于B组(P＜0.05),其松开前的SOD活力明显高于B组(P＜0.05).B组分别同A和C组相比,神经功能和病理学评分均显著性偏低(P＜0.01).结论氯胺酮对免脊髓缺血再灌注损伤具有一定的保护作用,其保护机制可能与抗过氧化反应作用有关.     

丙泊酚后处理及缺血后处理对兔脊髓缺血再灌注损伤的影响

目的探讨丙泊酚后处理及缺血后处理对脊髓缺血再灌注损伤的影响。方法健康新西兰白兔32只,体重2.0～3.0 kg,随机分为4组,每组8只。假手术组仅行手术操作不阻断腹主动脉;模型(IR)组行单纯缺血再灌注;丙泊酚后处理(PA)组阻断腹主动脉30 min,再灌注即刻经肾下腹主动脉泵注丙泊酚;丙泊酚后处理联合缺血后处理(PB)组阻断腹主动脉30 min,再灌注30 s,再阻断30 s,反复3次全面恢复灌注,同时泵注丙泊酚。再灌注48 h比较各组脊髓组织中丙二醛(MDA)和超氧化合物歧化酶(SOD)含量;采用tartor评分法对后肢神经功能评分。结果 PA组和PB组后肢神经功能明显优于IR组(P<0.05);与IR组比较,PA组和PB组中MDA含量明显降低,SOD含量显著上升。结论丙泊酚后处理及缺血后处理抑制在灌注后氧自由基生成、增强抗氧化酶活性发挥对脊髓损伤的保护作用。     

低温异丙酚对脊髓缺血再灌注损伤保护作用的实验研究

目的 探讨低温异丙酚经腹主动脉灌注对兔脊髓缺血再灌注损伤的保护作用.方法 健康成年新西兰大白兔60只.随机分为6组,每组10只,分别为SN组(生理盐水组)、IPN组(10%常温脂肪乳组)、PN组(50 mg/kg常温异丙酚组)、SH组(4 ℃生理盐水组)、PH组(4 ℃ 50 mg/kg异丙酚组)、IPH组(4 ℃ 10%脂肪乳组).每组的灌注容积均为5 mL/kg,灌注速度为10 mL/(kg·h).采用左肾下腹主动脉阻断法建立脊髓缺血再灌注模型,阻断开始时即泵入灌注液,30 min后停止灌注并开放腹主动脉.记录术中兔生命体征及再灌注后6 h、24 h、48 h神经行为学评分,于再灌注后48 h取L4-6节段脊髓观察组织形态学改变;取T8节段脊髓组织作为正常对照(N组),测定L4-6脊髓组织中兴奋性氨基酸(EAA)及丙二醛(MDA)、超氧化物歧化酶(SOD)的含量.结果 ①与对照组(SN、IPN组)比较,常温异丙酚组(PN组)和低温灌注组(SH、PH、IPH组)动物神经行为学评分均明显升高,脊髓组织中EAA含量明显降低,其中以低温异丙酚组(PH组)最显著(P＜0.05),SN、IPN组间差异无统计学意义.②与正常对照组(N组)比较,各实验组(SN～IPH组)L4-6脊髓组织中EAA及MDA含量明显升高,而SOD含量明显降低(P＜0.05).③与SN、IPN、SH、IPH组比较,常温和低温异丙酚组(PN、PH组)脊髓组织中SOD含量明显升高,MDA含量降低(P＜0.05).但PN、PH两组间差异无统计学意义.结论 异丙酚及低温液体均能减轻脊髓缺血再灌注损伤,具有脊髓保护作用,其中低温异丙酚的保护作用更显著.     

缺血预处理对兔脊髓缺血保护效应的实验研究

目的　探讨缺血预处理对兔脊髓缺血性损伤的作用。方法　夹闭腹主动脉肾下段 ,建立脊髓缺血模型。2 1只新西兰兔随机分为 3组 :假手术组 5只 ,缺血预处理组 8只 ,缺血组 8只。假手术组只进行麻醉和手术操作 ,不阻断腹主动脉 ;缺血预处理组先阻断腹主动脉 5min ,开放 15min ,再阻断 4 0min后开放灌注 ;缺血组阻断腹主动脉 4 0min后开放灌注。 3组术后均进行神经功能评分 ,再灌注 7d后处死动物 ,取L3～ 5段脊髓行病理学观察。结果　缺血预处理组神经功能评分在各时间点明显高于缺血组 (P <0 .0 1) ,脊髓前角正常神经元数量较缺血组明显增多 (P <0 .0 1)。结论　缺血预处理对主动脉阻断所致的兔脊髓缺血性损伤具有保护作用。     

曲美他嗪对大鼠心肌缺血再灌注损伤的保护作用

目的：探讨曲美他嗪（trimetazidine,TMZ)对心肌缺血再灌注损伤（RI）的保护作用及其机制。方法：50只SD雄性大鼠随机分为假手术组、生理盐水组和药物组（TMZ5或10mg/kg)，共4组，假手术组只开胸，不结扎冠脉。余3组制作RI模型，缺血前分别静脉注射TMZ（5或10mg/kg)及等量生理盐水，在缺血30min及再灌注40min时分别测定血清肌酸磷酸激酶（CK），再灌注40min时测定RI区心肌丙二醛（MDA）、超氧化物歧化酶（SOD）、谷胱甘肽（GSH）及谷胱甘肽过氧化物酶（GSH－Px)等变化。结果：药物组在缺血30min时及再灌注40min时的血清CK较生理盐水组显著降低。与假手术组相比，生理盐水组及药物组的MDA显著增高，SOD、GSH及GSH－Px显著降低；与生理盐水相比较，药物组的MDA显著降低，SOD、GSH及GSH－Px显著增高。结论：TMZ能抑制心肌细胞缺血及再灌注时心肌酶的漏出，对心肌缺血及缺血再灌注损伤具有一定的保护作用。其机制可能是通过提高体内自由基清除剂GSH的含量及SOD、GSH－Px的活力，减轻脂质过氧化及其有害代谢产物对心肌细胞膜的损害。     

经腹主动脉灌注低温异丙酚对兔脊髓缺血再灌注损伤的保护作用

目的研究低温异丙酚对脊髓缺血再灌注损伤的保护作用。方法40只新西兰白兔,随机分为4组,每组10只。采用阻断兔左肾下腹主动脉30min建立的脊髓缺血模型,经左股动脉灌注液体,A组(对照组)为常温生理盐水组;实验组:B组为低温生理盐水组;C组为低温脂肪乳组;D组为低温异丙酚组(50mg/kg)。4组灌注液体量均为5ml/kg。观察每组兔术中生命体征、再灌注后6,24,48h的神经行为学(Tarlov)评分、再灌注48h后的脊髓组织病理改变和测定脊髓组织中兴奋性氨基酸(谷氨酸和天门冬氨酸)的含量。结果实验组体温均于阻断15min开始下降,组间无差异(P>0.05):除D组阻断15min后平均动脉压开始下降外(P<0.05),A、B、C组均无明显变化;4组动物心率相对平稳;实验组Tarlov评分、脊髓病理学改变及兴奋性氨基酸含量均显著优于A组,其中以D组最佳(P<0.05)。结论经腹主动脉灌注低温液体对脊髓缺血再灌注损伤有保护作用,其中以低温异丙酚的保护作用为明显。     

异丙酚对大鼠肺缺血再灌注损伤保护作用的实验研究

目的:通过大鼠肺缺血再灌注模型,观察异丙酚( Propofol)对大鼠缺血再灌注损伤(ischemia reperfusion,IR)肺的保护作用,并探讨其作用机制.方法:随机将30只SPF级雄性SD大鼠分为3组:假手术组(n=10,左侧开胸后不阻断肺门)、肺缺血再灌注组(n=10,开胸后左侧肺门阻断45 min再灌注120 min)和异丙酚组(n=10,开胸后左肺门钳闭前30 min时股静脉注射异丙酚5mg·kg-1,继用微量泵以50 mg·kg-1·h-1的速度持续静脉输注,左侧肺门阻断45 min再灌注120 min).3组在开胸前均给予气管插管、机械通气.再灌注结束时抽取左心室血检测动脉血氧分压( PaO2);获取左肺组织,光镜下观察左肺组织和细胞损伤情况,计算左肺湿干重比,评价肺水肿程度;制作肺组织匀浆并用酶联免疫吸附( ELISA)法检测其中丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)含量和超氧化物歧化酶(SOD)活性.结果:与假手术组比较,肺缺血再灌注组及异丙酚组大鼠肺W/D值、肺组织中的MDA、TNF-α、IL-6含量明显增高(均P＜0.05);PaO2明显下降,SOD活性减弱明显降低(均P＜0.05).异丙酚组与缺血再灌注组比较,大鼠的PaO2升高(P＜0.05),肺组织中的MDA、TNF-α、IL-6含量及肺W/D值下降(P＜0.05),SOD活性增强(P＜0.05).肺组织病理切片显示假手术组损伤轻微,肺缺血再灌注组损伤严重,异丙酚组损伤重于假手术组但轻于肺缺血再灌注组.结论:异丙酚对缺血再灌注损伤SD大鼠的肺组织有一定的保护作用,其保护作用可能与异丙酚能清除氧自由基,抑制炎症因子产生有关.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.     

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.