他莫昔芬对单侧输尿管梗阻大鼠肾间质纤维化的保护作用

目的:探讨他莫昔芬对肾组织纤维化的影响及作用机制.方法:雌性SD大鼠,建立单侧输尿管梗阻模型(UUO),设:①模型组(n=6),行左侧输尿管结扎术,0.3 ml无菌生理盐水灌胃,每天2次;②治疗组(n=6),他莫昔芬5 rmg/kg(0.3 ml无菌生理盐水配置)灌胃,每天2次;③假手术组(n=6).术后第9天处死各组大鼠.采用光镜和免疫组化观察肾组织纤维化和α平滑肌肌动蛋白(α-SMA)表达的变化.结果:①治疗组大鼠肾间质纤维化程度较模型组明显减轻.②UUO模型第9天时大鼠肾组织α-SMA表达明显增强,采用他莫昔芬治疗后,肾组织α-SMA表达的异常增强能得到有效抑制.结论:昔芬类药物具有减轻肾组织纤维化的作用,而这一作用与其能有效阻抑肾组织上皮细胞-间充质细胞转分化(EMT)有关.     

维甲酸对单侧输尿管梗阻大鼠肾间质纤维化的作用

目的 探讨维甲酸（at-RA）对单侧输尿管梗阻大鼠（UUO）肾间质纤维化的影响.方法将26只大鼠随机分为假手术组、模型组、给药组,结扎单侧输尿管造成梗阻性肾病模型.术后9天处死大鼠,取梗阻侧肾做组织学检查,HE染色,用免疫组化方法检测肾组织中结缔组织生长因子（CTGF）、α-平滑肌肌动蛋白（α-SMA）.结果维甲酸显著减轻肾小管间质损害,治疗组肾间质炎细胞浸润和肾间质CTGF、α-SMA表达显著低于对照组.结论维甲酸减轻UUO模型大鼠肾小管间质损害和炎细胞浸润,降低CTGF表达,抑制α-SMA表达,从而减轻肾间质纤维化.     

UUO模型大鼠肾间质纤维化动态进展及α-SMA、TGF-β1和VDR表达变化

目的 观察单侧输尿管梗阻（UUO）模型大鼠肾小管间质纤维化动态进展,研究该病理过程中肾脏纤维化相关蛋白表达的变化.方法 32只清洁级SD大鼠随机分为假手术组（n=16）和UUO模型组（模型组,n=16）.两组大鼠分别于术后（模型组建模后）第2、5、9、14天分批（n=4）处死,留取手术侧（模型组梗阻侧）肾脏组织.分别采用HE和Masson染色、免疫组织化学染色及Western blotting等方法,评价肾小管间质纤维化损伤程度并检测肾脏组织α平滑肌肌动蛋白（α-SMA）、纤维连接蛋白（FN）、维生素D受体（VDR）及转化生长因子β1（TGF-β1）等相关蛋白的表达.结果 肾脏组织形态学观察显示,随着输尿管梗阻时间的延长,肾小管间质纤维化程度逐步加重.免疫组织化学染色显示,模型组大鼠建模后各时间点肾间质α-SMA和FN阳性面积百分比均显著高于假手术组（P＜0.05）,且随着梗阻时间的延长逐渐升高,至建模后第14天时达到高峰.Western blotting分析表明,模型组大鼠建模后各时间点α-SMA和TGF-β1相对表达量均显著高于假手术组（P＜0.05）,而VDR相对表达量显著低于假手术组（P＜0.05）;建模后第2天,模型组大鼠肾脏组织α-SMA相对表达量已显著增加;建模后第14天,模型组α-SMA和TGF-β1相对表达量分别增高至假手术组的12.7倍和8.8倍,而VDR相对表达量下降至假手术组的3%.结论 UUO模型大鼠建模后第14天可出现显著的肾间质纤维化;建模早期肾间质中α-SMA表达增加提示肾间质成纤维细胞的活化;VDR表达的进行性减少提示其与肾间质纤维化有关.     

活性维生素D3抑制UUO模型大鼠肾间质纤维化作用的研究及其对TGF-β1，α—SMA表达的影响

目的：探讨活性维生素D3对单侧输尿管梗阻模型（UUO）大鼠肾小管间质纤维化的抑制作用,研究该病理过程中转化生长因子β1（TGF—β1）,α-平滑肌肌动蛋白（α—SMA）的表达变化。方法：36只雄性Wistar大鼠,随机分为三组,活性维生素D。组、假手术组、模型组,每组12只。造模后活性维生素D。组给予罗盖全（骨化三醇）灌胃（3ng／100g）,假手术组及UUO模型组给予等量生理盐水灌胃。三组大鼠于给药后第14天,28d分批（n=6）处死,留取造模侧肾脏。用HE染色及Masson染色法观察肾小管间质纤维化程度,用免疫组化法测定TGF-β1,α-SMA在各组大鼠造模侧肾脏的表达情况。结果：免疫组织化学显示：UUO模型组大鼠的肾脏组织中TGF—β1及α—SMA的表达显著高于假手术组（P〈0．05）,而在活性维生素D3治疗组中,TGF—β1及的n—SMA表达低于UUO模型组（P〈0．05）,肾脏组织形态学显示：模型组肾间质纤维化程度明显高于假手术组,活性维生素D3组肾间质纤维化程度明显小于模型组（P〈0．05）。结论：活性维生素D3能有效抑制UUo大鼠肾间质中TGF—β1及Ⅱ-SMA的表达,从而减轻UU0大鼠肾间质纤维化程度。     

辛伐他汀对单侧输尿管梗阻大鼠肾间质纤维化的影响

目的 研究羟甲基戊二酰辅酶A（HMG-COA）还原酶抑制剂（职I）辛伐他汀（simvastatin）对输尿管梗阻大鼠（UUO）肾间质纤维化的影响及可能机制。方法 通过结扎单侧输尿管造成大鼠肾间质纤维化，随机分为假手术组、模型组和给药组，术后9天处死各组大鼠，取梗阻侧肾做组织学检查，HE染色，并用免疫组化方法检测肾组织中结缔组织生长因子（CTGF）、α-平滑肌肌动蛋白（α-SMA）、胶原-Ⅳ（COL-Ⅳ）的水平。结果 模型组出现了明显的间质纤维化，给药组肾间质纤维化与模型组相比有所减轻，CTGF、α-SMA、COL-Ⅳ的水平也明显减低。结论 辛伐他汀可以影响细胞因子、抑制细胞增殖、减轻细胞外基质的积聚，从而减轻间质纤维化，发挥肾保护作用。     

α-平滑肌肌动蛋白在单侧输尿管梗阻大鼠肾组织中的表达

目的观察α-平滑肌肌动蛋白（α-SMA）在单侧输尿管梗阻大鼠中的表达情况,探讨其与肾间质纤维化的关系。方法采用单侧输尿管结扎术制备肾间质纤维化模型,将60只SD大鼠随机分为假手术组,模型组,每组分别于术后7、14、21d各处死10只大鼠,取梗阻侧肾组织行HE、Masson染色观察肾间质纤维化程度,行免疫组化方法检测两组大鼠不同时间段α-平滑肌肌动蛋白（α-SMA）表达水平。结果假手术组中,肾小球、肾小管和间质细胞均无α-SMA,与假手术相比,模型组手术后7d,肾间质中α-SMA阳性细胞数增多,呈进行性升高趋势,其与肾间质纤维化程度呈正相关。结论α-平滑肌肌动蛋白在肾间质纤维化的进展过程中发挥重要作用。     

地灵丹汤对单侧输尿管梗阻大鼠模型肾间质纤维化的防治作用

目的：研究中药复方地灵丹汤对单侧输尿管梗阻（unilateral ureteral obstruction，UUO）致肾间质纤维化模型大鼠肾间质纤维化的防治作用及其可能机制。 方法：将60只SD大鼠随机分为假手术组、模型组、依那普利组及地灵丹组。采用UUO法建立肾间质纤维化大鼠模型，观察血尿素氮、血清肌酐和24h尿蛋白定量及肾组织病理改变，并采用免疫组织化学法检测转化生长因子β1（transforming growth factor-β1，TGF-β1）、α-平滑肌肌动蛋白（α-smooth muscle actin，α-SMA）、纤维连接蛋白（fibronectin，FN）及层黏连蛋白（laminin，LN）的表达。 结果：第7天模型组肾间质大量炎症细胞浸润及胶原表达，TGF-β1、FN和LN表达面积百分率较假手术组明显增加（P＜0．05）；地灵丹组间质纤维化面积较模型组减少（P＜0．05）。第14天地灵丹组和依那普利组肾间质TGF-β1、α-SMA、FN和LN表达面积百分率较模型组减少（P＜0．05），BUN、SCr和24h尿蛋白无明显差异。第21天地灵丹组SCr、肾间质纤维化和TGF-β1表达面积百分率较依那普利组和模型组下降（P＜0．05）。 结论：地灵丹能减轻单侧输尿管梗阻模型大鼠的蛋白尿和肾间质纤维化，抑制TGF-β1、α-SMA、FN和LN的表达。在较长时间应用后，地灵丹对模型大鼠的肾功能保护作用优于依那普利。     

银杏叶对肾间质纤维化防治作用的实验研究

目的观察银杏叶对肾间质纤维化的防治作用及其效果。方法45只雄性SD大鼠随机分为3组,假手术组、模型组和治疗组,每组15只动物。治疗组在单侧输尿管结扎(unilated ureteral obstruction,UUO)基础上给予银杏叶(300 mg/kg.d-1)灌胃治疗,1次/d;模型组在UUO基础上给予生理盐水灌胃;对照组除不结扎输尿管外,其余同模型组。分别于实验第3、7、14 d分批处死大鼠,每次处死5只。对大鼠结扎侧肾组织进行形态学和免疫组织化学观察。采用HE、Masson两种染色观察梗阻侧肾组织病理学的改变,采用免疫组织化学的方法检测肾组织中转移生长因子-β1(transforming growth factor,βTGF-β1)、核因子kappa B(nuclear factor-kappa B,NF-κB)、α-平滑肌肌动蛋白(-αsmooth muscle actin,-αSMA)的表达,采用氯胺T法测定肾组织中羟脯胺酸的含量。结果大鼠UUO术后3d,肾间质水肿,单核细胞浸润。14 d后肾小管萎缩,间质增宽,肾组织中TGF-β1、NF-κB、α-SMA的表达及肾组织中胶原蛋白含量明显增加,且随着梗阻时间延长,其阳性表达率也增加。银杏叶治疗组肾组织中TGF-β1的表达及胶原蛋白的含量较模型组明显降低,单核细胞浸润减轻,肾脏病理学明显改善。结论银杏叶能够抑制UUO大鼠肾间质炎性细胞浸润,减少肾间质胶原蛋白的含量,有防治UUO大鼠肾间质纤维化的作用。     

UUO模型大鼠肾间质纤维化动态进展及α-SMA、TGF-β1和VDR表达变化

目的 观察单侧输尿管梗阻(UUO)模型大鼠肾小管间质纤维化动态进展,研究该病理过程中肾脏纤维化相关蛋白表达的变化.方法 32只清洁级SD大鼠随机分为假手术组(n=16)和UUO模型组(模型组,n=16).两组大鼠分别于术后(模型组建模后)第2、5、9、14天分批(n=4)处死,留取手术侧(模型组梗阻侧)肾脏组织.分别采用HE和Masson染色、免疫组织化学染色及Western blotting等方法,评价肾小管间质纤维化损伤程度并检测肾脏组织α平滑肌肌动蛋白(α-SMA)、纤维连接蛋白(FN)、维生素D受体(VDR)及转化生长因子β1(TGF-β1)等相关蛋白的表达.结果 肾脏组织形态学观察显示,随着输尿管梗阻时间的延长,肾小管间质纤维化程度逐步加重.免疫组织化学染色显示,模型组大鼠建模后各时间点肾间质α-SMA和FN阳性面积百分比均显著高于假手术组(P＜0.05),且随着梗阻时间的延长逐渐升高,至建模后第14天时达到高峰.Western blotting分析表明,模型组大鼠建模后各时间点α-SMA和TGF-β1相对表达量均显著高于假手术组(P＜0.05),而VDR相对表达量显著低于假手术组(P＜0.05);建模后第2天,模型组大鼠肾脏组织α-SMA相对表达量已显著增加;建模后第14天,模型组α-SMA和TGF-β1相对表达量分别增高至假手术组的12.7倍和8.8倍,而VDR相对表达量下降至假手术组的3%.结论 UUO模型大鼠建模后第14天可出现显著的肾间质纤维化;建模早期肾间质中α-SMA表达增加提示肾间质成纤维细胞的活化;VDR表达的进行性减少提示其与肾间质纤维化有关.     

口服氯化汞对大鼠肾间质纤维化的作用

目的口服氯化汞(HgCl2)造成大鼠的肾间质纤维化模型并探讨相关机制。方法用不同剂量HgCl2[(A组为5mg/(kg·bw)、B组为10mg/(kg·bw)、C组为20mg/(kg·bw)]给大鼠灌胃1周,观察大鼠一般状况、肾功能和肾组织病理变化,免疫组化法观察肾组织纤维连接蛋白(FN)和α-平滑肌肌动蛋白(α-SMA)表达。结果模型大鼠体重下降,肾体比增加,肾功能损害和肾组织Hyp含量呈剂量依赖性升高,肾间质炎性细胞浸润,肾间质胶原沉积增加,肾间质FN和α-SMA表达增强,以C组病变最重。结论20mg/(kg·bw)剂量HgCl2灌胃1周可造成大鼠的肾间质纤维化病变,其部分机制在于HgCl2促使肾间质肌成纤维细胞活化和细胞外基质的生成沉积。     

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.