改良心肌保护液对短暂常温热缺血供心移植后的保护作用

①目的　探讨改良心肌保护液对短暂常温热缺血供心移植后的保护作用。②方法　 1 8只家猪随机分为 3组 ,对照组 (C组 ) :供心低温灌注Thomas保护液后切取心脏 ,4℃保存 4h后行原位心脏移植 ;热缺血组 (W组 ) :供心低温灌注Thomas保护液前常温缺血 5min ,4℃保存 4h后行原位心脏移植 ;改良心肌保护液组 (E组 ) :供心常温缺血 5min后用改良保护液灌注 ,4℃保存 4h后行原位心脏移植。以心排血量 (CO)、心肌含水率、丙二醛 (MDA)、ATP、肌钙蛋白I(cTnI)水平和心脏超微结构作为观察指标。③结果　E组心肌含水率、MDA含量和cTnI含量明显低于W组 (F =4 .0 1～ 5 .78,q =2 .5 5～ 3.2 2 ,P <0 .0 5 ) ;E组CO和ATP含量明显高于W组 (F =4 .82～ 5 .6 3,q =2 .80～ 3.1 2 ,P <0 .0 5 ) ;E组与C组各指标相比差异无显著性 (q=1 .90～ 2 .4 8,P >0 .0 5 ) ;超微结构显示 ,E组心肌损伤较W组明显减轻。④结论　改良心肌保护液可有效改善供心因短暂常温热缺血而造成的结构和功能损害     

不同心肌保护液对供心移植保护作用的对比研究

目的　研究改良心肌保护液对短暂常温热缺血供心移植后的保护作用。方法　 18只家猪随机分为 3组 ,对照组 (C组 ) :不缺血下供心低温灌注St.Thomas液后切取 ,4℃保存 4h后行原位心脏移植 ;热缺血组 (W组 ) :供心灌注低温St.Thomas保护液前常温缺血 5min ,4℃保存 4h后行原位心脏移植 ;改良心肌保护液组 (E组 ) :供心常温缺血 5min后用改良保护液灌注和保存 ,4℃保存 4h后行原位心脏移植。以心脏排出量 (CO)、心肌含水率、丙二醛(MDA)和ATP含量、肌钙蛋白I(cTnI)和心脏超微结构作为观察指标。结果　心肌含水率、MDA含量和cTnI含量E组明显低于W组 (P <0 .0 5 ) ;CO和ATP含量E组明显高于W组 (P <0 .0 5 ) ;E组与C组相比无显著差异 (P>0 .0 5 ) ;超微结构 ,E组损伤较W组明显减轻。结论　改良心肌保护液可有效改善供心因短暂常温热缺血而造成的结构和功能损害。     

改良心肌保存液热缺血冷保存对猪心保护的作用

目的 研究改良心肌保存液在心脏移植术中对热缺血冷保存猪供心的心肌保存效果.方法 16对供猪随机分为2组,建立猪同种异体原位心脏移植模型.A组以St Thomas 液、B组以自制液作为停搏液、灌注冲洗液和保存液.供心心脏停搏热缺血5 min后,以停搏液灌注,切取心脏,4 ℃灌注冲洗并低温浸泡保存4 h,施行同种异体原位心脏移植.观察移植后心脏复搏的一般情况及血清肌酸激酶同工酶(CK-MB)变化,常规苏木精-伊红、PAS染色,光镜观察心肌组织.结果 浸泡保存后B组心肌含水量低于A组,复灌后CK-MB含量也低于A组(t=2.89～3.38,P<0.05).B组PAS糖原染色评分高于A组(T=24,P<0.01).结论 改良的新型心肌保存液能较好恢复热缺血冷保存的猪供心心脏功能,减轻复灌后的心肌再灌注损伤,减少保存期间细胞内糖原的消耗,其对心肌的保护明显优于St Thomas液.     

猪心脏移植缺血再灌注损伤中NO和NOS的表达

①目的　了解猪同种原位心脏移植术后早期一氧化氮 (NO)、一氧化氮合酶 (NOS)含量的变化 ,及其与早期缺血再灌注损伤的关系。②方法　建立猪同种原位心脏移植模型。供心在移植前低温保存 (Thomas液 ,4℃ ) 4h ,移植成功心脏复搏后 2h取材。应用组织化学方法测定心肌组织中NO、NOS的含量 ,应用核酸原位末端标记法 (TUNEL)测定心肌细胞凋亡指数 ,作为评价心肌缺血再灌注损伤的指标。以正常心肌及单纯缺血心肌组织作为对照。③结果　移植后心肌组织NO、NOS的含量较缺血组与正常组低 ,差异有显著意义 (F =2 7.2 2 9、16 .2 0 3,q =5 .716～ 6 .4 12 ,P <0 .0 1)。移植组心肌细胞凋亡指数与正常组及缺血组比较明显升高 ,差异有显著性(F =16 3.884 ,q =7.4 82、6 .975 ,P <0 .0 1)。心肌组织NO、NOS含量与心肌细胞凋亡指数呈负相关关系 (r =- 0 .886、- 0 .795 ,P <0 .0 1)。④结论　猪心脏移植后早期心肌缺血再灌注损伤所致的细胞死亡主要表现为心肌细胞凋亡 ;再灌注期间内源性NO、NOS的减少参与了心脏移植后早期缺血再灌注损伤的发生     

低温含血保护液微流量持续灌注对热缺血猪心的保护

目的研究低温含血保护液微流量持续灌注对热缺血猪心的保护作用,探讨心脏移植中供心保护的有效方法。方法24只离体猪心随机分为实验组（n=12,热缺血10min,4℃含血保护液持续灌注8h）和对照组（n=12,热缺血10min,4℃保护液浸泡保存8h）,进行原位心脏移植,分别监测心脏复跳及血流动力学情况：心率（HR）、平均动脉压（MAP）、心输出量（CO）,心肌肌钙蛋白T（cTnT）、肌红蛋白（Mb）水平。结果实验组心脏复跳情况、血流动力学优于对照组;对照组心肌蛋白显著高于实验组（P〈0．05）。结论低温含血保护液微流量持续灌注对热缺血猪心的心功能以及心肌组织有较好的保护作用。     

含血Plegisol液持续微流量灌注对猪离体供心水肿的影响

目的:观察含血Plegisol液持续微流量灌注对猪离体供心水肿的影响,探讨心脏移植中保护供心的有效方法。方法:28只瑞典家猪,随机分为实验组和对照组,每组14只,每组随机选7只为供体,7只为受体。实验组离体猪心在热缺血10min,4℃含血保护液持续微流量灌注10h后行原位心脏移植,对照组离体猪心在热缺血10min,低温静置10h后行原位心脏移植。主动脉开放24h后取心肌组织行组织学检查,记录24h冠状动脉平均血流量,计算心肌含水量。结果:组织学检查显示对照组冠脉内皮及心肌组织水肿程度比实验组严重;实验组冠状动脉平均血流量高于对照组,心肌含水量低于对照组(t=6.058和18.066,P<0.001)。结论:含血Plegisol液持续微流量灌注可显著减轻离体猪心冠脉内皮及心肌的水肿程度。     

HOE642对大鼠停跳心脏供体心肌细胞凋亡的影响

目的研究HOE642对热缺血死亡大鼠颈部异位停跳心脏供体心肌细胞凋亡的作用。方法取清洁级雄性Sprague-Dawley大鼠112只,随机分成7组,每组16只,各有8只分别作为移植受体和供体。具体如下:C组为正常心脏对照组;S10、S30、S45组分别为心脏停搏后10、30、45 min取心组;SH10、SH30、SH45组分别为心脏停搏后10、30、45 min取心并用HOE642灌注组。对6组实验组大鼠进行热缺血死亡处理,取得供体后,用STH-1液对S10、S30、S45组供体灌注30 min,加20μmol/L的HOE642对SH10、SH30、SH45组供体灌注30 min,再用颈部Cuff法进行异位心脏移植。S10、SH10、S30、SH30组于移植后48 h取供心,S45、SH45组于移植术后取供心。脱氧核糖核苷酸末端转移酶介导的生物素脱氧尿嘧啶核苷酸缺口末端标记法检测供体心肌细胞凋亡,免疫组织化学法检测Bcl-2、Bax、Caspase-3蛋白的表达。结果大鼠腹主动脉横断放血后9~11 min,平均(10.11±0.59)min死亡。S10、S30组的凋亡心肌细胞数显著高于SH10、SH30组(P<0.05);S10、S30组的Bcl-2表达水平显著低于SH10、SH30组(P<0.05),而Bax、Caspase-3表达水平显著高于SH10、SH30组(P<0.05)。结论热缺血死亡大鼠颈部异位心脏移植模型是进行停跳心脏供体的心肌保护研究的理想模型;HOE642能抑制热缺血死亡后(30 min内)大鼠心脏心肌细胞凋亡的发生。     

肝细胞生长因子对大鼠心脏移植再灌注损伤保护作用的实验研究

目的:探讨肝细胞生长因子(HGF)在心脏移植缺血再灌注损伤的保护作用.方法:健康雄性Wistar大鼠40只,建立大鼠同系异位心脏移植模型.随机分为3组:假手术组、对照组、实验组(供心切取时用含HGF100 mg/L 4 ℃改良ST.Thoms液10 ml主动脉根部灌注停跳).术后5 h测定血清中丙二醛(MDA)、超氧化物歧化酶(SOD)、肌酸激酶同工酶(CK-MB)含量,TUNEL法染色检测心肌细胞凋亡,电镜观测心肌细胞超微结构变化.结果:实验组MDA、CK-MB明显减少(P<0.01),SOD明显增加(P<0.01),心肌细胞凋亡指数显著减低(P<0.01),心肌超微结构改变明显减轻.结论:HGF能抑制心肌细胞凋亡,对心脏移植缺血再灌注损伤有保护作用.     

心肌缺血预处理与离体心脏的保存

目前，心脏移植作为终末期心脏病的治疗方法，已被广泛接受。供心的保护，尤其是适当的离体心脏保存已成为影响手术经过，决定移植后生活质量的重要因素，它不同于日常心脏手术，供心的缺血从切取心脏时阻断主动脉开始，包括心脏切取、运送、修剪至移植完成后主动脉开放，缺血时间长；移植后的心脏必须马上承担受体全负荷的工作；而且供     

133例心脏移植供心保护回顾分析

目的总结133例心脏移植的供心获取及其保护经验并做回顾分析。方法武汉协和医院心脏外科2008年9月至2014年5月共完成133例原位心脏移植,其中非停搏供心103例,停搏供心30例。非停搏供心经主动脉根部灌注4℃改良St.Thomas液,供心快速停搏,取下供心后再灌注8℃康斯特保护液(HTK液)并置于HTK液中低温浸泡保存。停搏供心经主动脉根部灌注8℃HTK液,取下供心后再灌注HTK液并置于HTK液中保存。在供心修剪时均经主动脉根部再次灌注HTK液。结果非停搏供心组,92例供心自动复跳,11例电除颤复跳;热缺血时间(3.25±2.25)min,冷缺血时间(253.22±136.73)min,术后主动脉内球囊反搏(IABP)使用率9.5%,术后三周左室射血分数(LVEF)值(65.52±6.72)%,术后一年生存率92.55%。停搏供心组,23例供心自动复跳,7例电除颤复跳。热缺血时间(5.78±2.82)min,冷缺血时间(179.12±52.43)min,术后IABP使用率10.1%,术后三周LVEF值(65.78±7.22)%,术后一年生存率91.07%。结论本中心对两类供心采用不同获取及保护方法均确切有效,扩大了边缘供心的使用范围,提高了手术疗效。     

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.