乙酰半胱氨酸对通气机所致大鼠肺损伤的保护作用

目的探讨乙酰半胱氨酸(NAC)对通气机所致大鼠肺损伤(VILI)的保护作用.方法将30只健康雄性SD大鼠随机分为3组,实施麻醉和气管切开术后,分别接受两种不同潮气量(VT)的通气,通气时间均为4 h.A组为对照组(VT=8 ml/kg);B组为致伤组,接受大潮气量通气(VT=40 ml/kg);C组(VT=40 ml/kg)为NAC处理组,分别在通气开始前30 min腹腔内注射和通气开始后1 h静脉内注射NAC150 mg/kg.对所有动物每小时行1次动脉血气分析.进行支气管肺泡灌洗液(BALF)中白细胞和中性粒细胞计数,分别测定右肺干湿比值(W/D),BALF中总蛋白含量,BALF和血中肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)水平以及肺组织和血中丙二醛(MDA)、超氧化物歧化酶(SOD)水平,并观察肺脏的组织病理学改变.结果机械通气4 h后,B组动脉血氧分压(PaO2)较A、C组显著下降(P＜0.01),BALF中有大量的白细胞和中性粒细胞浸润.B组BALF中总蛋白含量、右肺W/D值较A、C组显著升高(P＜0.01).B组BALF中TNF-α、IL-1β水平显著升高,分别为(0.53±0.09)μg/L、(0.092 0±0.012 4)μg/L,而C组较B组显著降低,分别为(0.25±0.04)μg/L、(0.046 5±0.007 5)μg/L(P＜0.01).C组肺内和血中MDA水平较B组显著下降,而SOD水平较B组显著升高(P＜0.01).组织病理学显示B组较A、C组肺脏内有明显的中性粒细胞浸润和肺泡壁结构破坏.结论一系列炎症和炎症前反应以及氧化和抗氧化反应的失衡参与了VILI的发生机制.NAC通过其抗炎和抗氧化作用对大鼠VILI模型具有较明显的保护作用.     

不同潮气量通气对大鼠呼吸机相关性肺损伤模型的影响

目的通过建立过度通气导致呼吸机相关性肺损伤（VILI）大鼠模型，评估不同潮气量对肺损伤的影响。方法清洁级SD大鼠随机分成对照组（A组）、正常通气组（B组）、过度通气小潮气量[潮气量（VT）=20ml／kg]组（C组）和过度通气大潮气量（VT=40ml／kg）组（D组）。机械通气组中每只大鼠采用经口气管插管。观察各组通气1、2和4h肺病理学改变、肺含水量、肺泡灌洗液（BALF）中自细胞总数（WBC）、总蛋白（Tp）、乳酸脱氢酶（LDH）含量的变化，以及两组过度通气组大鼠不同时程机械通气后3d内的死亡率。结果与A组和B组相比，两组过度通气组大鼠的肺组织湿／干比值及肺损伤评分均明显升高，BALF中的WBC计数、LDH、Tp含量显著性增加，且D组BALF中WBC计数、LDH、Tp含量较C组更高，并随着通气时间延长而增加。两组过度通气组大鼠生存率无明显差异。结论过度通气会导致严重的VILI。潮气量40ml／kg通气4h更能可靠复制VILI大鼠模型。     

高浓度氧加重大鼠通气机所致肺损伤的实验研究

目的研究高浓度氧（100％）对大鼠通气机所致肺损伤（VILI）的影响。方法将48只健康雄性SD大鼠随机分为4组，行机械通气，通气时间4h。A组实施空气常规潮气量（VT=8mL／kg）通气，B组实施高氧常规潮气量通气，C组实施空气大潮气量（VT=40mL／kg）通气，D组实施高氧大潮气量通气。每小时行1次动脉血气分析，计算氧合指数（PaO2／FiO2）。行支气管肺泡灌洗液（BALF）白细胞、中性粒细胞计数，测定左肺湿干重比值（W／D），BALF中肿瘤坏死因子α（TNF-α）、白细胞介素1β（IL-1β）、巨噬细胞炎症蛋白2（MIP-2）含量以及肺组织丙二醛（MDA）、超氧化物歧化酶（SOD）水平，并观察肺脏的组织病理学改变。结果组织病理学显示D组大鼠较C组肺脏内有更多的中性粒细胞浸润和肺泡壁结构的破坏。与C组比较，D组大鼠氧合指数显著下降，左肺W／D值显著升高，BALF中自细胞、中性粒细胞计数明显增加，BALF中TNF-α、IL-1β、MIP-2含量显著增高，肺组织MDA水平显著增加，SOD水平显著下降。B组与A组比较，除肺组织中MDA水平增加、SOD活性下降外，其余各项指标差异均无统计学意义。结论高浓度氧能明显加重大鼠大潮气量通气所致肺损伤，而对常规潮气量通气影响较小。     

乌司他丁对大鼠呼吸机相关性肺损伤的影晌

目的评价乌司他丁对大鼠呼吸机相关性肺损伤（vmi）的影响及机制。方法36只成年雄性sD大鼠,体重300--350g,随机分为三组（萨12）：对照组（c组）、机械通气组（V组）和乌司他丁组（U组）。采用大潮气量（Vr-40ml／kg）机械通气2．5h制备大鼠VILI模型。U组实验前30min腹腔注射乌司他丁10000U／100g,V组和C组给予等容量生理盐水。实验结束时抽取3ml动脉血离心取上清液,置于一80℃冰箱冻存待测。然后处死大鼠,取肺组织,测定肺组织湿／干重（W/D）比,光镜下观察肺组织病理学结果;收集支气管肺泡灌洗液（BALF）并测定其中的蛋白含量、白细胞计数以及采用双抗体夹心ELISA法测定血清和BALF中肿瘤坏死因子（TNF—a）、白细胞介素8（IL-8）的水平。计算肺的通透指数（LPI）。结果与c组比较,V组血清TNF—Ot、IL一8浓度,肺组织TNF—a、IL一8含量、W／D比、LPI、白细胞显著升高（P〈O．05）;与V组比较,u组血清TNF—a、IL一8浓度,肺组织TNF—a、IL一8含量、W／D比、LPI、白细胞显著减少（P〈O．05）。u组肺组织病理学损伤较V组减轻。结论乌司他丁可减轻VILI,其机制与抑制炎性反应有关。     

吸烟大鼠肺泡灌洗液白细胞介素—2的研究

目的：动态了解吸烟大鼠肺泡灌洗液白细胞介素－2水平，探讨吸烟大鼠存在细胞免疫受损状况。方法：定量ELISA双抗体夹心法测定连续被动吸烟1月及2月的SD大鼠肺泡灌洗液（bronchoalveolar lavage fluid,BALF)内白细胞介素－2（IL－2）的水平。结果：A组内吸烟1月大鼠的BALF IL－2水平明显低于对照组B中相应时点大鼠（P＜0．05），A组内吸烟2月大鼠的BALF IL－2水平亦明显低于对照组B中相应时点大鼠（P＜0．01）。且B组内，吸烟2月的大鼠较吸烟1月大鼠IL－2水平下降得更低（Ｐ＜0．05）。结论：吸烟组大鼠存在细胞免疫功能下降的状态，且随着吸烟时间的延长表现得更为显。     

白介素10对急性肺损伤保护作用的实验研究

目的：探讨白介素10（IL－10）对急性肺损伤（ALI）的保护作用。方法：气道内滴注内毒素（LPS，10mg/kg）建立大鼠AIL模型。54只雄性SD大鼠随机分为对照组、内毒素组、内毒素加IL－10组，每组18只（2h 、6h、24h各6只）。按时相处死并采集标本，观察大鼠体重、动脉血气分析、肺系数、支气管肺泡灌洗液（BALF）总蛋白水平、BALF细胞总数及分类计数、血清及BALF中TNF－α水平、肺病理。结果：内毒素组大鼠体重、动脉血氧分压（PaO2）进行性降低，肺系数、BALF总蛋白水平、BALF细胞总数均明显增加，分类以中性粒细胞（PMN）为主，血清及BALF中TNF－α水平明显升高，肺病理示肺内PMN大量浸润伴出血、透明膜形成。IL－10组的各项指标均较内毒素组减轻。结论：①气道内滴注内毒素可成功复制ALI模型。②BALF的TNF－α水平比血中TNF-α水平与肺损伤具有更好的相关性。③IL－10可减轻LPS诱导的ALI。     

老年大鼠呼吸机相关肺损伤药物治疗的研究

目的：研究沙丁胺醇对老龄大鼠呼吸机相关肺损伤的防护作用。方法：24只健康雄性wista老龄大鼠随机分为3组,即正常对照组,大潮气量致伤组和沙丁胺醇防护组。通气4h后处死,分别测定肺湿干比（W／D）、支气管肺泡灌洗液（BALF）总蛋白含量、肺匀浆总一氧化氮合酶（tNOS）与诱导型一氧化氮合酶（iNOS）活性,并观察肺病理改变。结果：B组W／D值、总蛋白含量较A、C组显著升高（P〈0．01）。B组。NOS、iNOS活性显著降低,C组较B组显著提高。病理显示B组较A、C组肺内有更多的白细胞浸润。结论：在VILI老龄大鼠。NOS、iNOS活性降低,沙丁胺醇通过提高。NOS、iNOS活性对老龄大鼠VILI模型有较明显的防护作用。     

洛沙坦对大鼠呼吸机所致肺损伤保护作用的实验研究

目的研究洛沙坦(Losartan)对大鼠呼吸机所致肺损伤(VILI)的保护作用。方法45只SD大鼠随机均分成A、B、C组,A组为空白组(直接处死),B组为对照组,C为实验组。B、C两组均行大潮气量机械通气(VT=40ml/kg,RR=80次/分钟),通气时间为2小时。C组大鼠在进行实验1周前,每天用AT1受体特异性的阻断剂洛沙坦(Losartan)100mg灌胃1次。结果和A组相比,B组肺灌洗液(肺组织)中总蛋白、白细胞计数、MPO等值显著性增高,MIP-2、ICAM-1等基因的表达水平显著性升高(P<0.01);和B组相比,C组上述各项指标均显著性低于B组(P<0.05或0.01)。讨论大潮气量机械通气能产生明显的肺损伤,而AT1受体特异性的阻断剂洛沙坦能减轻VILI时肺损伤程度。     

大潮气量通气加重脂多糖所致急性肺损伤及谷氨酰胺的防护作用

目的观察不同潮气量通气对脂多糖所致大鼠急性肺损伤的影响,以及谷氨酰胺的防护作用。方法将30只健康雄性SD大鼠随机分为三组。实施麻醉和气管切开后,气管内注入脂多糖（LPS）5mg/kg,接小动物通气机进行机械通气,A组实施常规潮气量通气,B组实施大潮气量通气,C组大潮气量通气前1h静脉注入谷氨酰胺干预。每小时行1次动脉血气分析。通气4h后颈动脉放血处死大鼠。测定全肺湿重,并计算肺系数（肺湿重/体重×100）。测定BALF中白细胞及中性粒细胞计数、蛋白含量、TNF-α、IL-6和中性粒细胞趋化因子1（CINC-1）水平,肺组织匀浆髓过氧化物酶（MPO）、超氧化物歧化酶（SOD）水平。结果B组大鼠PaO2值、肺组织SOD水平较A组显著下降,肺系数、BALF中白细胞及中性粒细胞计数、蛋白含量、TNF-α、IL-6、CINC-1水平、肺组织MPO水平较A组显著增高;C组大鼠PaO2值、肺组织SOD水平较B组显著升高,肺系数、BALF中白细胞及中性粒细胞计数、蛋白含量、TNF-α、IL-6、CINC-1水平、肺组织MPO水平较B组显著下降。结论大潮气量通气能加重脂多糖所致大鼠急性肺损伤,而谷氨酰胺对此有较明显的防护作用。     

人参皂甙Rb1对机械通气大鼠肺组织NF-资B和iNOs表达的影响

目的观察人参皂甙Rb1对机械通气肺损伤（VILI）大鼠炎症信号通路蛋白NF-资B及诱导型一氧化氮合酶（iNOs）的影响。方法将30只SD大鼠随机分为假手术组（C组）、VILI组和人参皂甙Rb1预处理组（Rb1组）,每组10只。后两组大鼠潮气量40ml/kg机械通气4h建立大鼠VILI模型,Rb1组在通气前30min尾静脉注射40mg/kg人参皂甙Rb1,其他两组予等容量0.9%氯化钠溶液。观察各组大鼠肺组织病理改变,肺组织湿／干重比（W/D）,收集肺泡灌洗液（BALF）,采用ELISA法测定BALF中TNF-α、IL-6水平,硝酸盐还原酶法检测一氧化氮（NO）水平;RT-PCR测定肺组织中iNOsmRNA的表达水平,Westernblot检测肺组织的NF-资B蛋白水平。结果与C组相比,VILI组肺组织病理损伤严重,肺组织W/D显著增加,BALF中TNF-α、IL-6、NO水平增加,iNOsmRNA表达增加,NF-资B蛋白表达上调;与VILI组比较,Rb1组肺组织病理损伤程度减轻,肺组织W/D降低,BALF中TNF-α、IL-6、NO水平降低,iNOsmRNA表达降低,NF-资B蛋白表达下调。结论人参皂甙Rb1可下调机械通气大鼠NF-资B及iNOs活性,降低促炎因子TNF-α、IL-6、NO释放,减轻肺损伤。     

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.     

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.