周围神经端侧吻合术吻合口位置选择的实验研究

目的:观察周围神经损伤后行端侧吻合术时吻合口位置对术后神经再生的影响。方法:取新西兰大白兔58只,随机选10只为定位组,行胫神经干功能束鉴定,分别确定运动神经纤维和混合神经集中的位置;余48只随机分为A、B组,各24只,切断腓总神经远端,并与外膜开窗的胫神经端侧缝合。A组为实验组,吻合口位于运动神经纤维集中处;B组为对照组,吻合口位于混合神经纤维集中处。于术后1,2,3个月,A、B组每次各取8只,于吻合口近端行电生理检测,取吻合口远端0.5cm的腓总神经进行组织学及抗神经丝蛋白免疫组化检测。结果:光镜下可区分有髓神经纤维及无髓神经纤维团块并定位。随着术后时间延长,两组再生神经诱发电位的潜伏期逐渐缩短,波幅逐渐增大、肌湿重和肌纤维截面积逐渐增大、腓总神经有髓神经纤维数和神经束截面积显著增大,抗神经丝免疫组化阳性表达逐渐增强,且A组均优于B组,差异均具有统计学意义。结论:周围神经损伤后行端侧吻合术时,吻合口选在运动神经束集中处时,其再生的运动神经纤维数目多,再生神经纤维束截面积大,质量高,所支配肌肉的功能恢复较好。     

雪旺细胞源神经营养因子对端侧吻合后神经再生的影响

目的研究雪旺细胞源神经营养因子对神经端侧吻合后神经再生的影响.方法取SD大鼠24只,随机分为实验组和对照组,每组12只;随机切断一侧腓总神经,与胫神经外膜开窗处行端侧吻合,另一侧作为正常对照.术后于实验组端侧吻合侧小腿外侧肌肉注射雪旺细胞源神经营养因子(10 μg/ml),而于对照组注射等量的生理盐水,隔天一次,共用2周;术后12周,行腓总神经传导速度测定、组织学检查及胫前肌湿重测定.结果实验组再生的腓总神经纤维质量、数目、运动神经传导速度和胫前肌湿重均优于对照组,但不如正常的腓总神经和胫前肌.结论雪旺细胞源神经营养因子对神经端侧吻合后的再生具有一定的促进作用.     

施万细胞源神经营养因子促进神经端侧吻合后再生的实验研究

目的观察神经端侧吻合后给予施万细胞源神经营养因子（SDNF）是否能促进神经再生。方法将24只SD大鼠随机分为实验组和对照组,每组12只;随机切断一侧腓总神经,与胫神经外膜开窗处行端侧吻合,另一侧作为正常对照。实验组在术中即刻于神经端侧吻合区给予SDNF,术后于该侧小腿外侧肌肉继续给予SDNF,每周1次,共用4周;对照组在相应部位给予等量的0.9%氯化钠注射液;术后第13周行腓总神经电生理检测、组织学检查及胫前肌湿重测定。结果实验组再生的腓总神经纤维质量、数目、电生理特性和胫前肌湿重均优于对照组,但不如正常的腓总神经。结论SDNF对端侧吻合后的神经再生具有一定的促进作用。     

应用端侧吻合方法治疗失神经肌肉萎缩的实验研究

目的 探讨应用端侧吻合方法防治失神经肌肉萎缩的作用,为临床治疗提供实验依据.方法 选用SD雌性大鼠作为研究对象,共32只,分为四组,每组8只.A组:将右侧腓总神经切断后,于相邻胫神经干上行外膜“开窗”,将腓总神经远侧断端以端侧吻合的方式吻合于胫神经干上.B组:将一神经移植段的两端分别与正常胫神经干和切断腓总神经远端行外膜“开窗”端侧吻合.C组:将右侧腓总神经切断后,两断端均结扎并翻转缝合于临近肌肉上.D组:正常对照组:大鼠右侧腓总神经不做任何处理.术后12周行神经肌肉形态学检查,胫前肌肌纤维横截面积,肌湿重及神经电生理检测,评价端侧吻合方法对失神经肌肉萎缩的防治作用.结果 ①神经肌肉形态学检查:A,B,D三组均可见再生的轴突和髓鞘,并且见正常肌肉形态结构,C组神经远断端纤维化并且肌纤维萎缩变细.②胫前肌肌纤维横截面积:A,B两组间差异无显著性(P＞0.05),C组与A,B,D三组比较,差异有显著意义(P＜0.05)③胫前肌肌湿重:A,B两组较D组稍轻,统计学上无显著差异(P＞0.05),C组与A,B,D三组比较,差异有显著意义(P＜0.01)④神经传导速度比较:C组测不出运动神经传导速度,A,B两组运动神经传导速度慢于D组,A,B两组间运动神经传导速度比较,无统计学意义(P＞0.05),A,B两组与D组比较,差异有统计学意义(P＜0.01).结论 端侧吻合法为防治肌肉失神经萎缩的有效方法,但其再生神经对肌肉支配功能不足以代替原支配神经.     

周围神经端侧吻合再生纤维来源的实验研究

目的:探索周围神经端-侧吻合后再生纤维(侧芽)的来源。方法:将Wistar大鼠左侧腓总神经切断后端-侧吻合到外膜开窗的胫神经干上,术后8周对胫神经和腓总神经分别用快兰和核黄作神经干注射标记,取脊髓背根神经节(DRG)荧光显微镜下观察被标记细胞;取吻合口附近的胫、腓神经段经锇酸染色后在光镜下观察腓总神经内轴突与胫神经轴突的关系。结果:实验组背根节内未发现双标细胞。光镜下,可清晰地见到左侧腓总神经内的再生纤维来自于胫神经近侧端。结论:周围神经端-侧吻合腓总神经内的再生纤维来自于胫神经的侧芽缺乏依据,因而无法排除来自腓总神经近端生长锥和受损胫神经纤维生长锥的可能。     

低位神经侧侧吻合术防止失神经肌萎缩的实验研究

目的：通过建立周围神经损伤的模型，观察早期在受损神经低位行神经侧侧吻合术，是否对相应的骨骼肌有延缓萎缩的作用，以期寻找防止失神经肌萎缩的方法。方法：24只新西兰兔分成A、B两大组，每组12只，各组中均将右后肢为实验组，左后肢为对照组，A组：（1）实验组：大腿上段切断右侧腓总神经，近端结扎，翻转固定，在其远端远侧距胫前肌1cm处与附近的同侧胫神经行外膜开窗并以侧侧缝合术式吻合；（2）失神经组：大腿上段切断左侧腓总神经，并将两断端翻转固定为失神经对照侧。B组：（1）实验组：处置同A组的实验组；（2）正常对照组：右侧腓总神经不作处理，术后3月行胫前肌肌电图检查记录神经传导速度，神经吻合口远段5mm处神经组织及对照组相应处腓总神经组织作HE染色和S－100免疫组织化学染色观察神经再生情况并计数有髓神经纤维数，胫前肌肌湿重称重，肌肉组织作HE染色观察肌细胞形态并测量肌纤维横截面积，SYN免疫组织化学染色观察运动终板形态。实验结果（神经传导速度，有髓神经纤维数，肌湿重，肌纤维横截面积）用t检验进行统计学分析。结果：（1）实验组肌电图检查可记录到神经传导速度，神经吻合口远段5mm处可见大量再生有髓神经纤维，而失神经组均测不到神经传导速度，远段神经呈纤维化；实验组胫前肌肌湿重与肌纤维横截面积数值均大于失神经组，其差异具有非常显著性意义（P＜0．01），（2）实验组再生有髓神经纤维数少于正常腓总神经，实验组肌电图检查的神经传导速度慢于正常组，差异均有非常显著性意义（P＜0．01），实验组胫前肌肌湿重与肌纤维横截面积数值均小于正常神经组，差异有非常显著性意义（P＜0．01），（3）肌肉组织学检查显示实验组肌肉细胞及运动终板形态有一定程度恢复，虽不及正常组，但明显不同于肌肉萎缩较严重的失神经组，结论：利用神经侧枝性生芽机制对受损神经早期实行低位神经侧侧吻合，可有效保护失神经肌肉的运动终板功能，避免失神经肌肉过早出现严重萎缩而影响神经再生后功能恢复，但侧侧吻合再生的神经支配肌肉的功能不足以替代原支配神经。     

大鼠腓总神经端侧吻合于胫神经再生神经的逆行追踪

 【目的】 研究大鼠腓总神经被切断端侧吻合于胫神经后, 再生的腓总神经纤维的来源。【方法】 将大鼠腓总神经切断,将其远端与胫神经施行端侧吻合,存活24个月后,再次手术暴露并将HRP（辣根过氧化物酶）注入远段腓总神经干内,72h后取大鼠脊髓L3-6节段和L4、L5脊神经节冰冻切片,用四甲基联苯胺显色显示神经细胞;并取腓总神经远段、腓总神经近段中部行电镜观察神经纤维超微结构,正常腓总神经作对照。【结果】 模型鼠远段腓总神经再生神经纤维清晰、明显,神经纤维略细;脊髓L3-6节段双侧灰质前角和双侧L4、L5脊神经节均见到蓝染细胞,均以手术侧为少;腓总神经近段与正常腓总神经比较无差异、未见华勒氏变迹象。【结论】 断裂腓总神经端侧吻合于胫神经,再生神经纤维不支持因腓总神经近段溃变轴突退缩形成生长锥引导所致,来源于胫神经可能性大。     

大鼠腓总神经端侧吻合于胫神经再生神经的逆行追踪

【目的】研究大鼠腓总神经被切断端侧吻合于胫神经后，再生的腓总神经纤维的来源。【方法】将大鼠腓总神经切断，将其远端与胫神经施行端侧吻合，存活24个月后，再次手术暴露并将HRP（辣根过氧化物酶）注入远段腓总神经干内，72h后取大鼠脊髓L3。节段和k、L5脊神经节冰冻切片，用四甲基联苯胺显色显示神经细胞；并取腓总神经远段、腓总神经近段中部行电镜观察神经纤维超微结构，正常腓总神经作对照。【结果】模型鼠远段腓总神经再生神经纤维清晰、明显，神经纤维略细；脊髓L3-6节段双侧灰质前角和双侧L4、L5脊神经节均见到蓝染细胞，均以手术侧为少；腓总神经近段与正常腓总神经比较无差异、未见华勒变迹象。【结论】断裂腓总神经端侧吻合于胫神经，再生神经纤维不支持因腓总神经近段溃变轴突退缩形成生长锥引导所致，来源于胫神经可能性大。     

神经端侧吻合研究进展

神经端侧吻合法就是将受损神经的远断端缝合到正常神经的侧面或将神经片段桥接于正常神经和损伤神经远端侧面的方法。其神经再生的机制尚不清楚。影响端侧吻合神经再生的因素有 :端侧吻合的角度、神经营养因子、神经预变性处理与否、神经束膜吻合法和外膜缝合法、神经端端和端侧吻合法、外膜开窗与否、吻合处与效应器的距离及神经桥接与否。     

经皮电刺激对大鼠周围神经端侧吻合效果的影响

目的观察和探索经皮电刺激促进神经端侧吻合后神经再生的效果及其临床价值。方法选取雄性SD大鼠32只,随机分为正常对照组(A组),肌皮神经损伤后端端吻合至尺神经组(B组),肌皮神经损伤后端侧吻合至尺神经组(C组),肌皮神经损伤后端侧吻合至尺神经+术后经皮电刺激组(D组)。观察各组大鼠患侧肢体的肌力恢复情况以及神经纤维的再生情况。结果 C组和D组大鼠振幅、传导速度低于A组,潜伏期高于A组;而D组大鼠振幅、传导速度低于C组,潜伏期高于C组;B、C、D三组大鼠肱二头肌湿重比以及肌纤维横截面积均低于A组,且C组肌肉恢复最差;B、C、D三组大鼠NF-200表达明显低于A组,D组NF-200表达明显强于C组,但仍显著少于B组,差异均具有显著性(P0.05)。电镜检查显示B组神经纤维髓鞘成熟,C组以无髓神经纤维为主,髓鞘成熟度差。D组髓鞘增生情况较C组好转,但仍有部分无髓神经纤维存在。结论神经端侧吻合术后经皮电刺激能有效促进神经轴突再生以及延缓靶肌的失神经萎缩,尽管较之神经端端吻合存在差距,仍不失为临床修复周围神经损伤的有效方法之一。     

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.