不同剂量鞭毛蛋白致大鼠急性肺损伤的对比研究

目的 研究经大鼠尾静脉注入不同剂量鞭毛蛋白后,观察不同时相点急性肺损伤(acute lung injury,ALI)发生的情况,探讨其发生的可能机制.方法 240只清洁级雄性Wistar大鼠分为4组:对照组、致伤1组、致伤2组和致伤3组.对照组给予生理盐水,各致伤组分别给予5、50、500μg/kg的鞭毛蛋白,于静注后2、4、6、12、24、48 h,测定动脉血氧分压(PaO2)、肺组织湿干比值(W/D)、血清与支气管肺泡灌洗液(BALF)中肿瘤坏死因子-α(TNF-α)和白介素-1β(IL-1β)细胞因子的含量以及观察肺组织的病理改变.结果 静注鞭毛蛋白后,在对应时相点,鞭毛蛋白注入剂量越大,大鼠PaO2越低,肺W/D越高;外周血及BALF中,细胞因子TNF-α、IL-1β含量越高;肺组织病理改变越明显.以上各指标在各对应时相点,致伤2、3组与对照组比较差异有统计学意义(P<0.01);致伤2、3组与致伤1组间也有显著性差异(P<0.01);致伤2组与致伤3组间仅TNF-α含量比较差异有统计学意义(P<0.01).结论 鞭毛蛋白可致大鼠急性肺损伤,且其具有剂量和时间的差异性.     

乌司他丁明显减轻肠源性脓毒症大鼠炎性因子介导性肺损伤

目的 观察乌司他丁（Ulinastatin, UTI）对肠源性脓毒症大鼠促炎因子介导性肺损伤的影响。方法 健康Wistar大鼠114只,雌雄各半,体重180～220 g,分为正常对照组（NC组,n=6）、假手术对照组（SC组,n=30）、脓毒症组(SEP组,n=30)、乌司他丁3 h治疗组（UTI3h组,n=30）和乌司他丁12 h治疗组（UTI3h组,n=18）。利用经典盲肠结扎穿孔法建立大鼠脓毒症模型。分别取正常大鼠组及各组制模后6、12、24、48、72 h小组心脏血液中进行TNF- 、IL-6、IL-10的测定;取左上肺用于湿干重（W/D）比检测。结果 ⑴SEP组血浆TNF-α、IL-6水平较NC组显著升高(P<0.01);UTI3h组用药后TNF-α水平较SEP组明显降低,12、24、48 h与SEP组比较差别有统计学意义(P<0.05);⑵血浆IL-10在SEP组在CLP后呈现先升后下降、再升高的变化,与SC组比较差别有显著统计学意义(P<0.01);乌司他丁给药两组血浆IL-10水平均明显升高,持续至CLP后72h,与SC组、SEP组比较差别均有统计学意义(均P<0.05);⑶SEP组W/D比值自制模后开始升高,24 h时达高峰（P<0.01）;UTI3h组及UTI12h组造模后肺W/D值逐渐升高,但升高程度较SEP组低,与SEP组24、48及72 h比较差别均有统计学意义（P<0.01）,但仍高SC组（P<0.05）;W/D比值的变化与血浆TNF- 、IL-6和IL-10均有显著正相关（TNF- >IL-6>IL-10）。结论 肠源性脓毒症大鼠血浆促炎细胞因子明显增加,其中IL-6升高最为明显,而IL-10呈先升后降、再升高的变化,而且与肺组织W/D比值呈显著正相关,而CLP后腹腔内注射乌司他丁可有效地阻抑血浆促炎细胞因子的升高和减轻肺组织W/D,提示乌司他丁可有效地减轻CLP后促炎细胞因子介导性肺损伤。     

高迁移率族蛋白B1在脓毒症大鼠心肌损害中的表达和作用

目的:探讨脓毒症大鼠心肌高迁移率族蛋白B1(HMGB1)在脓毒症心肌损害中的表达和作用。方法:48只清洁级健康雄性Wistar大鼠随机分成正常对照组(Normal组)、假手术组(Sham组)、脓毒症模型组(CLP组),各16只。于手术后24 h、48 h分别检测HMGB1、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、肌钙蛋白(Tn)I浓度,光镜观察心肌病理变化。结果:与Normal及Sham组比较,CLP组在24 h、48 h HMGB1、TNF-α、IL-6及Tn I水平均显著升高,差异有统计学意义(P<0.01);CLP组术后48 h较24 h HMGB1增加值与TNF-α、IL-6及Tn I增加值间分别呈显著正相关(r=0.886,P<0.05;r=0.943,P<0.05;r=0.829,P<0.05)。光镜下CLP组可见心肌损伤。结论:HMGB1与脓毒症心肌损害密切相关,其介导的炎性反应在心肌损害的发生发展过程中起着重要的作用。     

蕨麻正丁醇提取物对急性卵巢缺血再灌注损伤大鼠肿瘤坏死因子-α的影响

目的探讨蕨麻正丁醇(Pa)提取物对卵巢缺血再灌注损伤大鼠肿瘤坏死因子-α(TNF-α)的影响。方法 60只Wistar大鼠随机分为对照组(C组)、缺血24 h组(I24 h组)、缺血+再灌注24 h组(R24 h组)、缺血+再灌注48 h组(R48 h组)、Pa提取物预处理+缺血再灌注24 h组(Pa+R24 h组)和Pa提取物预处理+缺血再灌注48 h组(Pa+R48 h组),每组10只。放射免疫法检测各组大鼠血清TNF-α水平;反转录聚合酶链反应、蛋白质印迹法检测各组大鼠卵巢组织中TNF-αmRNA和蛋白的表达水平。结果与C组比较,I24 h组、R24 h组、R48 h组大鼠血清TNF-α水平、卵巢组织TNF-αmRNA和蛋白水平均明显升高,差异有统计学意义(P<0.05);与I24 h组比较,R24 h组、R48 h组大鼠血清TNF-α水平、卵巢组织TNF-αmRNA和蛋白表达水平均显著升高,差异有统计学意义(P<0.05);Pa干预后,Pa+R24 h组和Pa+R48 h组大鼠血清TNF-α水平、卵巢组织TNF-αmRNA和蛋白表达水平与R24 h组、R48 h组比较明显降低,差异有统计学意义(P<0.05)。结论 TNF-α在大鼠卵巢缺血再灌注损伤过程中表达上调,用Pa提取物进行干预可降低TNF-α的表达水平。     

阿托伐他汀对脓毒症大鼠肺组织病理及血清TNF-α、HMGB-1的影响

目的探讨阿托伐他汀对脓毒症大鼠肺组织病理及血清肿瘤坏死因子(TNF-α)、高迁移率族蛋白1(H4MGB-1)表达的影响。方法将75只健康SD大鼠随机分为假手术组、脓毒症组及干预组各25只。每组在术后12、24、36、48、72 h各取大鼠5只处死并取心脏血及肺组织,常规行HE染色观察肺组织病理变化,ELISA法检测血清TNF-α水平,Western Blot法检测HMGB-1表达水平。结果假手术组大鼠肺组织可见少量炎性细胞;脓毒症组肺组织及肺泡内可见水肿,大量炎性细胞浸润及红细胞;干预组大鼠肺组织炎性细胞较脓毒症组明显减轻,肺泡结构尚完整,病理改变明显减轻。脓毒症组、干预组肺组织W/D较假手术组明显升高(P<0.01),其中干预组在36 h后明显降低,且低于脓毒症组(P<0.05)。各时间点干预组和脓毒症组TNF-α及HMGB-1表达水平均较假手术组明显升高(P<0.05),且干预组表达水平较脓毒症组明显降低(P<0.05),36 h后干预组和脓毒症组TNF-α及HMGB-1表达水平有所降低(P<0.05)。结论阿托伐他汀可改善脓毒症大鼠肺组织病理炎性损伤,降低血清TNF-α及HMGB-1表达水平。     

脓毒症大鼠DAO与TNF-α变化研究

目的研究TNF-α在脓毒症大鼠肠道损伤中的作用。方法 60只SD大鼠随机分成假手术组(n=30),脓毒症组(n=30)。假手术组仅行盲肠探查术,脓毒症组采用CLP制作大鼠脓毒症模型。各组均于术后3、6、12、24与48 h时相点,经腹主动脉采血检测血清DAO、TNF-α水平。结果血清DAO水平逐渐升高,于48 h时达到最高值,高于假手术组(P0.05);血清TNF-α水平在CLP术后即明显高于假手术组(P0.05),在24 h达峰值,随后虽有下降,但仍显著高于假手术组(P0.05)。TNF-α与DAO具有正相关(r=0.897,P0.05)。结论 TNF-α的异常升高,可能在脓毒症大鼠肠道损伤中具重要作用。     

TNF-α在大鼠脓毒症肝损伤发病机制中的作用及丹参的干预影响

目的采用大鼠盲肠结扎穿孔(CLP)复制脓毒症模型造成急性肝损伤,探讨肿瘤坏死因子(TNF-α)在脓毒症肝损伤发病机制中的作用及丹参的干预影响。方法将W istar大鼠随机分为对照组(Control)、假手术组(Sham)、模型组(CLP)及丹参干预组(Salvia)。动态观察血清丙氨酸转氨酶(ALT)、血清及肝组织中TNF-α的变化。结果CLP组与Sham组相比,血清和肝组织TNF-α水平在12 h升高,于24 h达到峰值。Salvia组峰值滞后于CLP组,在48 h达其峰值,并在12 h及24 h分别显著低于CLP组。结论脓毒症所致的肝细胞损伤与TNF-α增加有关,丹参对脓毒症肝细胞损伤保护作用可能与抑制TNF-α生成有关。*     

盐酸纳洛酮对大鼠脑神经损伤保护作用要机制的研究

目的 研究纳洛酮对脑神经损伤后神经细胞培养中肿瘤坏死因子α(TNF-α)含量的测定,探讨纳洛酮对神经保护作用的机制.方法 大鼠脑神经细胞培养种α的水平,观察损伤后不同时间段不同组TNF-α含量变化.结果 TNF-α在损伤后2h开如升高,12h达到高峰,随后有所降低,至24h趋于平缓.纳各酮治疗组神给细胞2h开如升高,12h达到高峰,随后有所降低,至24h趋于平缓.纳各酮治疗组神给细胞损伤后12h、24h、48h、72hTNF-α的水平与损伤组比较有差异(P<0.05).结论 纳洛酮能够通过降低TNF-α的含量起到神经保护作用.     

小剂量地塞米松对脓毒症大鼠金属基质蛋白酶9等炎症因子的影响

目的探讨建立大鼠盲肠结扎穿刺（CLP）模型,研究地塞米松对炎症因子金属基质蛋白酶9（MMP-9）及肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）、白介素-8（IL-8）水平变化以及大鼠生存率影响。方法 78只SD大鼠完全随机分为CLP手术组、地塞米松（DEX）0.1 mg/mL治疗组（DEX）,并建立假手术组（Sham）。DEX治疗组在手术完成后立即给予对应剂量的地塞米松。动物成模在各对应时间点取材,检测各组生存率、肺干湿重系数（W/D）,MMP-9及TNF-α、IL-6、IL-8血清水平。结果在使用DEX干预后大鼠生存率有所改善,尚无统计学意义（P〉0.05）。各组炎症介质均出现下降,24 h组IL-6差异有统计学意义（P〈0.05）,48 h组IL-6、MMP-9及IL-8差异有统计学结果（P〈0.01）。12 h组DEX干预后W/D差异有统计学意义（P〈0.05）。DEX干预组W/D24 h组和48 h均高于CLP组。结论脓毒症早期小剂量使用地塞米松可以有效的改善脓毒症的预后。地塞米松通过抑制炎症因子改善脓毒症预后,地塞米松对于脓毒症晚期炎症因子水平MMP-9及IL-8的调控作用可能较TNF-α等早期炎症因子更为重要。     

延肾1号冲剂对肾缺血再灌注大鼠肾组织肿瘤坏死因子和细胞间黏附因子的影响

目的 探讨延肾1号冲剂抗肾缺血再灌注损伤的作用机理.方法 将72只大鼠随机分为假手术组、对照组、治疗组,各24只.治疗组给予延肾1号冲剂,假手术组及对照组灌胃相应量的自来水.检测大鼠肾缺血1 h,再灌注24、48 h后肾功能(BUN、Cr)的变化及肾组织肿瘤坏死因子(TNF-α)和细胞间黏附因子(ICAM-1)的变化情况.结果 假手术组大鼠肾小管上皮细胞内可见微量TNF-α、ICAM-1表达.与假手术组相比,治疗组、对照组TNF-α、ICAM-1分子表达增强,在肾缺血再灌注24、48 h有显著差异(P<0.01);与对照组比较,治疗组TNF-α、ICAM-1分子表达下调,肾缺血1 h无显著差异(P>0.05),再灌注24、48 h有显著差异(P<0.01).结论 延肾1号冲剂能够保护肾缺血再灌注大鼠的肾功能并抑制其肾组织中TNF-α、ICAM-1的蛋白表达.     

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.     

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.     

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.