胆道铸型扫描电镜观察

用扫描电镜铸型法观察大鼠肝内胆道系统以及与肝组织间的空间结构关系。结果：当用中等剂量的铸型剂（８０μｌ）从总胆管逆向注入时，可见小叶间及小叶内胆管及Ｍａｌｌ＇ｓ间隙内有铸型剂充，胆小管中未见铸型剂；当用较大量（２００μｌ）注入时，除上述部位充盈外，还可见肝锹氏间、直血窦内有铸型剂。表明：铸型剂通过胆管上皮间隙，进入胆管周围淋巴而入Ｍａｌｌ＇ｓ间隙；当铸型剂增多时，可经Ｍａｌｌ＇ｓ间隙进入锹氏间隙和     

肝外胆道闭锁肝内胆管的三维构形变化——检测预后的一种 …

目的：通过肝内胆管三维结构重建，预测肝外胆道闭锁的预后。方法：对２例肝外胆道闭锁和１例对照的肝组织进行二维病理观察。系列组织切片在计算机辅助下，重建肝内胆管的三维构形。结果：二维病理学研究显示，胆道闭锁、肝内胆管增生，炎症和肝组织纤维化明显，胆道闭锁２例的肝内胆管三维构形是相似的，小叶间胆管弯曲扩张并形成微囊肿；增生的胆管主要来自赫令管，多数赫令管管腔开放并且互相连结形成网络状，少数赫令管形成膨大     

逆行胆道造影的体位改进方法

逆行胆道造影，是手术后放入T形管（或直接穿入胆管）并注入造影剂以显示胆管的检查。目的是使胆总管、左右肝管及分支充盈显示，以帮助了解胆管内有无炎症、结石、蛔虫及狭窄等。肝分泌的胆汁，经过一套管道系统排至十二指肠，在肝外的部分称胆道系统。胆道系统包括左右肝管、肝总管、胆总管、胆囊等。胆囊俗称苦胆，象一个鸭梨，位于肝下面的胆囊窝内，可分为底、体、颈三部。胆囊底为钝圆形，突出在肝前缘，与腹前壁相贴，它的表面投影在右锁骨中线与右肋弓相交处，此处为胆囊触诊区。胆囊颈移行为胆囊管并与肝总管汇合成胆总管，胆总管…     

肝外胆道闭锁肝内胆管的三维构形变化──检测预后的一种依据

目的：通过肝内胆管三维结构重建，预测肝外胆道闭锁的预后。方法：对２例肝外胆道闭锁和１例对照的肝组织进行二维病理观察。系列组织切片在计算机辅助下，重建肝内胆管的三维构形。结果：二维病理学研究显示，胆道闭锁、肝内胆管增生、炎症和肝组织纤维化明显。胆道闭锁２例的肝内胆管三维构形是相似的，小叶间胆管弯曲扩张并形成微囊肿；增生的胆管主要来自赫令管，多数赫令管管腔开放并且互相连结形成网络状，少数赫令管形成膨大盲端。结论：①肝外胆管闭锁的三维构形变化是检测预后的依据之一；②小叶间胆管的微囊肿和赫令管膨大盲端，指示肝外胆道闭锁不适合肝肠吻合术而需要肝移植治疗     

小儿先天性肝外胆道畸形活检肝组织的光镜和电镜观察

对２０例小儿先天性肝外胆道畸形的肝脏活俭组织进行了光镜和电镜观察，肝汇管区扩大，纤维细胞及胶原纤维增生。小胆管增多，腔内有大小及密度不同的胆汁块，肝细胞之间的毛细胆管扩张，腔内亦有大小及密皮不同的胆汁块，肝血多内皮细胞普遍极度肿胀甚至破裂。枯否氏细胞增生增大，胞质内有大量的溶酶体和胆汁块。部分肝细胳肿胀，其间有坏死灶，部分肝细胞呈浓缩状。多数肝组织中有多核巨肝细胞存在。肝细胞胞质中有胆汁淤积，膜性细胞器减少，其中滑面内质网消失或坏死。结果提示，小儿肝外胆道畸形有类似的肝脏病变，但胆道完全闭塞者病变重。     

肝脏双功能对比剂Gd-BOPTA胆道成像临床初步研究

目的探讨肝脏双功能对比剂Gd-BOPTA应用于胆道成像的可行性及临床价值。方法应用GdBOPTA对15例患者（对照组10例,梗阻性黄疸组5例）进行胆道成像。比较胆系结构的显示（高信号对比剂充盈）率。测量计算肝脏和胆囊信号强度的变化值及其比值。结果对照组10例均能够显示胆总管、胆囊和肝总管,左右肝内胆管和胆囊管的显示率大于60%。梗阻性黄疸组1例于扩张胆总管内高信号胆汁对比下可见软组织信号充盈缺损。其余4例总胆红素大于131.4μmol/L,胆道未能显影。两组延迟扫描胆囊、肝脏信号强度变化及其比值差异有显著性（p=0.001,004,0.001）,对照组均高于梗阻性黄疸组。结论Gd-BOPTA在非梗阻性黄疸患者中可以得到较为满意的胆道二维及三维图像,为评价肝脏功能以及诊断或排除胆道病变提供了新的安全、无创检查手段。     

血吸虫病兔肝内血管壁的三色染色观察

以Ｍａｓｓｏｎ三色染色法，观察血吸虫病兔肝内门静脉、肝动脉、肝窦、中央静脉和小叶间静脉的改变。结果发现，管壁纤维结缔组织增多，中膜平滑肌增殖肥大，中央静脉移位。提示肝内的血管性病变在血吸虫病性门脉高压中具有重要作用。     

胆管残余结石的内镜治疗(附306例分析)

目的：探讨内镜治疗肝内外胆管残余结石的效果。方法：对1994年1月～2004年1月间306例胆道残余结石的治疗效果进行回顾性分析，采用十二指肠镜127例，胆道镜116例，经皮经肝胆道镜(PTCS)63例。结果：306例．1中有286例成功(93．46％)。十二指肠镜治疗127例成功125例；胆道镜经T管窦道治疗116例，成功109例；PTCS治疗肝内结石63例，成功52例。结论：内镜治疗肝内外胆道结石效果显著，可使绝大多数患者避免再次手术。     

PTCSL治疗胆总管结石的相关因素临床分析研究

目的 分析研究经皮肝胆道穿刺硬质胆道镜探查取石术（PTCSL）治疗胆总管结石梗阻的影响疗效的相关因素，以进一步提高手术疗效及安全性。方法 收集广州医科大学附属第一医院总院和海印分院于2013年1月至2019年3月约5000例行胆道结石手术病人的病案资料，从中筛出罹患胆总管结石并行经皮肝胆道穿刺胆道镜探察取石术（PTCSL）治疗的患者43例，其中男26人，女17人，年龄22～93岁；手术全部成功。每例取石 1～2 次。结果 经统计分析得出，穿刺胆管直径和穿刺胆管与胆总管夹角对PTCSL是否能一期手术取净结石有较大的影响，而进一步相关性分析可见穿刺胆管直径mm与ptcsl一期取净间有着负相关关系；穿刺胆管与胆总管夹角（冠状位）与ptcsl一期取净间有着正相关关系。结论 进行经皮肝胆道穿刺硬质胆道镜探查取石术时，穿刺胆管直径越大，一期取净效果越差，穿刺胆管与胆总管夹角越大对一期取净结石效果越好，     

小肠对颗粒性物质排除功能的初步观察

为确定颗粒性物质进入机体后的排除途径而进行了本实验，取成年Ｗｉｓｔａｒ大鼠经尾静脉注射印度墨水后，结扎胆管，观察到小肠全段对注入的碳粒具有清除作用，以十二指肠最为显著，镜可见小肠壁结缔组织内有大量碳粒存在。小肠绒毛顶端有上皮间通道形成，绒毛中轴内的碳粒由此而进入肠腔，而粘膜上皮小肠腺和十二指肠腺内均无碳粒，实验结果证明，小肠进入机体内的颗粒物具有排除作用，其排除作用主要借助小肠绒毛顶端的上皮细胞间     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.