改良三袖套吻合法建立大鼠左肺原位移植模型及其鉴定

目的对三袖套吻合法建立的大鼠肺移植模型进行改进,建立操作简便和稳定有效的大鼠左肺原位移植模型。方法在预实验的基础上,对三袖套吻合法建立的大鼠肺移植模型进行以下改进:供体采用胸骨正中切口,经肺动脉圆锥处进行低压肺灌注;制作"袖套"时用无损伤血管夹固定套管尾部;套入"袖套"时用无创显微心耳钳钳夹住左肺门,在不离断"病肺"的情况下完成吻合;完善呼吸道管理流程。以手术成功率、手术时间、移植肺功能、肺组织病理学改变等对模型进行评估。结果完成大鼠左肺原位移植10例,手术成功率80%。供肺灌洗到获取时间为(12±2)min,体外套管时间为(18±3)min,吻合时间为(31±3)min。移植肺再灌注15 min的氧合指数显著高于单肺通气30 min(P<0.05)。移植肺再灌注2 h后的病理学改变符合典型的缺血-再灌注损伤特征。结论成功改进了大鼠左肺原位移植模型,该模型稳定有效且操作简便。     

改良三袖套吻合法建立大鼠左肺原位移植模型及其鉴定

目的对三袖套吻合法建立的大鼠肺移植模型进行改进,建立操作简便和稳定有效的大鼠左肺原位移植模型。方法在预实验的基础上,对三袖套吻合法建立的大鼠肺移植模型进行以下改进:供体采用胸骨正中切口,经肺动脉圆锥处进行低压肺灌注;制作袖套时用无损伤血管夹固定套管尾部;套入袖套时用无创显微心耳钳钳夹住左肺门,在不离断病肺的情况下完成吻合;完善呼吸道管理流程。以手术成功率、手术时间、移植肺功能、肺组织病理学改变等对模型进行评估。结果完成大鼠左肺原位移植10例,手术成功率80%。供肺灌洗到获取时间为(12±2)min,体外套管时间为(18±3)min,吻合时间为(31±3)min。移植肺再灌注15 min的氧合指数显著高于单肺通气30 min(P<0.05)。移植肺再灌注2 h后的病理学改变符合典型的缺血-再灌注损伤特征。结论成功改进了大鼠左肺原位移植模型,该模型稳定有效且操作简便。     

大鼠单肺原位移植模型的建立及改良

目的:改进大鼠原位单肺移植模型建立的方法,建立稳定的动物模型?方法:将46只健康SD雄性大鼠随机配对,采用三袖套法进行肺动?静脉及支气管的吻合,建立大鼠肺移植模型?结果:手术成功20例,失败3例,其中肺静脉撕裂1例,吻合肺动脉失败1例,术后出血失败1例?供肺获取时间为(11.6±2.1)min,供肺套管时间为(13.6±2.4)min,动静脉和支气管套管吻合时间为(17.7±3.5)min?血气?胸片及病理检查证实成功建立大鼠单肺原位移植模型?结论:改良的建立大鼠单肺原位移植模型的方法能够更好的满足肺移植研究的需要?     

非套管法大鼠异体原位单肺移植动物模型的建立

 目的 建立稳定的大鼠非套管法异体原位左肺移植模型。方法 使用250~350 g Sprague Dawley（SD）大鼠进行实验,采用显微外科技术,分别连续缝合支气管和肺动、静脉,建立大鼠异体原位左肺移植模型。观察大鼠存活时间,移植肺脏血管、支气管吻合口通畅性。结果 10只接受左肺移植的受体大鼠均成功脱离呼吸机,供肺冷缺血时间约40 min,热缺血时间约40 min,总手术时间约130 min。解剖后检查示各吻合口均通畅。结论 非套管法大鼠原位左肺移植模型具有稳定、可靠、接近临床肺移植的优点。     

大鼠左肺原位移植模型手术技术改进

目的 探讨建立更简便有效的大鼠左肺原位移植模型.方法 将40只雄性SD大鼠随机分成供、受体2组,采用手术技术改进的三套管法建立大鼠左肺原位移植模型.结果 2例手术死亡,18例手术获得成功,受体手术时间平均(35±4)min,术后均存活30 d以上,阻断大鼠的右肺门前后行动脉血气分析,结果无明显差异(P＞0.05).结论 该方法具有操作简单,成功率高,手术时间短的特点,可用于建立大鼠左肺原位移植模型.     

大鼠原位肝移植及术后肝细胞超微结构观察

用５１只Ｗｉｓｔａｒ大鼠建立了新的大鼠原位肝移植手术模型,手术成功率为９２．１％,周存活率为８６．２７％。手术要点是术前供肝冷灌注;受体肝只建立门静脉血供,静脉吻合分别采用“双袖套”式吻合和“８”字外翻缝合;胆管重建采用单管支架总胆管对端吻合法。移植术后肝细胞超微结构动态观察表明：术后２周是控制免疫排斥反应的关键时期,术后８周实验鼠产生免疫耐受性,移植肝脏成活。     

SD大鼠左肺移植模型的建立与改进

目的改进大鼠原位左肺移植技术,建立快速、安全、可重复性强的大鼠肺移植动物模型的方法。方法SPF级健康雄性SD大鼠90只,体质量300~350g。其中60只作为供、受体,受体略大于供体,供、受体间体质量差不超过20g,运用三袖套法吻合左肺动、静脉及支气管以建立大鼠左肺移植模型,移植成功后的受体在48h后取肺静脉血进行血气分析(PO2、PCO2);30只为对照组,肺静脉取血进行血气分析。观察记录大鼠肺移植供肺获取、套管及受体移植时间;移植肺血液循环及膨胀情况;移植肺与对照组血气分析结果比较。结果完成大鼠肺移植手术30例,成功27例,失败3例(肺静脉撕裂1例,脱机失败1例,肺动脉扭转1例)。大鼠供肺获取时间为(13.5±2.0)min,供肺套管时间为(15.5±2.5)min;游离大鼠受体左侧肺门部动、静脉及支气管并套线、结扎时间为(19.2±2.0)min;吻合时间为(18.5±4.0)min。在先开放肺动脉血流,接着开放肺静脉血流后,移植的左侧肺叶颜色均匀一致的红润,左肺血流得到充分的灌注,静脉充盈良好,回流畅通;恢复机械通气后,27例移植肺膨胀良好。左肺移植成功48h后,肺移植大鼠右侧肺门夹闭5min后PO2为(7.88±0.84)kPa,PCO2为(6.67±1.09)kPa;对照组大鼠夹闭右侧肺门5min后肺静脉PO2为(8.55±0.97)kPa,PCO2为(6.20±0.88)kPa。2组PO2比较差异有统计学意义(P<0.05),PCO2比较差异无统计学意义(P>0.05)。结论改进后的肺移植技术可为大鼠肺移植的相关研究提供稳定、可靠及可重复的动物模型。     

改良三袖套法建立大鼠原位全小肠移植模型

目的简化大鼠原位全小肠移植术式,建立符合生理条件、稳定的动物模型。方法取32只封闭群雄性SD大鼠为供、受体,进行同种同基因原位无造瘘全小肠移植,腹主动脉、门静脉的吻合改良为三袖套法。结果手术成功率为87.5%(28/32),供肠热缺血时间0 min,冷缺血时间(32±5)min。术后7 d受体存活率100%。结论改良的大鼠原位全小肠移植三袖套血管吻合法缩短供肠冷缺血时间,吻合口无出血,提高了手术成功率。此方法操作简单,为研究小肠移植后急、慢性排斥反应,移植物抗宿主反应以及肠道功能的良好模型。     

改良三袖套法建立大鼠原位全小肠移植模型

目的 简化大鼠原位全小肠移植术式,建立符合生理条件、稳定的动物模型.方法 取32只封闭群雄性SD大鼠为供、受体,进行同种同基因原位无造瘘全小肠移植,腹主动脉、门静脉的吻合改良为三袖套法.结果 手术成功率为87.5%(28/32),供肠热缺血时间0min,冷缺血时间(32±5)min.术后7d受体存活率100%.结论 改良的大鼠原位全小肠移植三袖套血管吻合法缩短供肠冷缺血时间,吻合口无出血,提高了手术成功率.此方法操作简单,为研究小肠移植后急、慢性排斥反应,移植物抗宿主反应以及肠道功能的良好模型.     

重建肝动脉的大鼠肝移植模型改良的实验研究

目的:探讨稳定、高效地建立肝动脉重建的大鼠原位肝移植模型的手术方法.方法:参照"双袖套"法,在供肝的灌注、切取、肝上下腔静脉吻合等方面进行改良,供、受体肝总动脉间用改良的支架法吻合重建肝动脉血供.结果:共完成大鼠原位肝移植80例,供体手术时间:(40±3)min,受体手术时间:(50±5)min,无肝期时间:(16±2)min,肝上下腔静脉吻合时间:(6～9)min,肝动脉吻合时间:(2～3)min.术中无受体死亡,48 h存活率为96.3%,1周存活率为93.7%,1月存活率为:87.5%.结论:该方法成活率高,稳定性好,是建立肝动脉重建的大鼠原位肝移植模型的理想方法.     

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.