右美托咪定对体外循环下心内直视手术患者外周血单核细胞信号通路的影响

目的评价右美托咪定对体外循环(CPB)下心内直视手术患者外周血单核细胞Toll样受体(TLRs)/髓样分化因子(My D)88/核转录因子(NF)-κB信号通路的影响。方法择期在CPB下行心脏瓣膜置换术患者90例,年龄30~64岁,体重45~68 kg,ASA分级Ⅱ或Ⅲ级,NYHA心功能分级Ⅱ或Ⅲ级,左室射血分数50%,采用随机数字表法分为3组(n=30):右美托咪定组1(D1组)、右美托咪定组2(D2组)和对照组(C组)。D1组和D2组分别在麻醉诱导前静脉泵注右美托咪定0.5μg/kg和1.0μg/kg负荷量,随后分别以0.2μg/(kg·h)和0.4μg/(kg·h)速率输注至术毕,C组则以等容量生理盐水代替。分别在麻醉诱导前(T0)、CPB后1 h(T1)、3 h(T2)、5 h(T3)、12 h(T4)和24 h(T5)这6个时间点采集血标本,采用流式细胞仪检测外周血CD14+单核细胞TLR2、TLR4和NF-κB的表达量及My D88的平均荧光强度;采用ELISA法检测血浆中肿瘤坏死因子-α(TNF-α)浓度。结果与T0比较,三组患者在T1~T5时外周血CD14+单核细胞TLR2、TLR4和NF-κB阳性表达率及My D88荧光强度,血浆中TNF-α浓度均增高(P0.05);与C组比较,D1和D2组在T1~T5时外周血CD14+单核细胞TLR2、TLR4和NF-κB阳性表达率及My D88荧光强度,血浆中TNF-α浓度均降低(P0.05);与D1组比较,D2组在T1~T5时外周血CD14+单核细胞TLR2、TLR4和NF-κB阳性表达率和My D88荧光强度,血浆中TNF-α浓度均降低(P0.05)。结论右美托咪定减轻CPB下心内直视手术患者全身炎症反应且呈剂量依赖,其机制与抑制TLRs/My D88/NK-κB信号通路的激活有关。     

体外循环围手术期单核细胞TLR4表达的动态观察

目的研究体外循环围手术期不同时点Toll样受体4（TLR4）的表达变化。方法选取20例体外循环下心内直视手术病人，分别于麻醉诱导前（T1）、体外循环前（T2）、体外循环后即刻（T3）、体外循环后4h（T4）、体外循环后24h（T5）抽取外周静脉血，分离单核细胞，用逆转录聚合酶联反应（RT—PCR）法检测TLR4的表达变化。结果与术前比较，体外循环前、体外循环结束后即刻单核细胞TLR4的表达下调，体外循环结束后4h表达上调，体外循环结束后24h进一步升高。结论体外循环围手术期，TLR4的表达呈现动态变化，TLR4可能与体外循环术后炎症反应等病理生理有一定关系。     

乌司他丁对体外循环下瓣膜置换术患者TNF-α、MDA、PMN的影响

目的 观察体外循环(cardiopulmonary bypass,CPB)下瓣膜置换围术期应用乌司他丁药物对肺保护作用.方法 选择30例择期行心脏瓣膜置换术的患者随机分为乌司他丁组和对照组,每组15例.乌司他丁组给予乌司他丁12000 IU·kg-1于切皮后至CPB前缓慢静注半量,另半量加入预充液中随转机进入体内;对照组给予等量0.9%氯化钠注射液,用法同乌司他丁组.两组分别麻醉诱导后即切皮前(T1)、体外循环45min时(T2)、体外循环停机前5min(T3)、停机后6h(T4)及停机后2Ah(T5)5个时间点,T1～T3时间点即刻送动脉血检测中性粒细胞(PMN)值;分离血清检测T1～T3时点丙二醛(MDA)浓度和T1～T5时点TNF-α浓度.结果 两组CPB开始后血清TNF-α、MDA、PMN浓度逐渐升高,CPB停机前5min三者血清浓度达到高峰,CPB后24 h FNF-α仍维持在很高的水平;乌司他丁组T3～T5时点的血清TNF-α浓度及T2～T3时点的血清MDA浓度、PMN值低于对照组相同时点值,差异有统计学意义(P<0.05).结论 乌司他丁可降低体外循环心脏瓣膜置换术CPB期间血液PMN及血清TNF-α、MDA的表达,起到肺保护的作用.     

利多卡因对体外循环病人炎症反应的影响

目的 通过测定血浆中肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及白细胞介素-8(IL-8)在体外循环(CPB)心内直视手术不同阶段的浓度变化,研究利多卡因对体外循环所致的机体炎症反应的影响.方法 30例择期行瓣膜置换术的风湿性心脏病病人,随机分为对照组(A组)、大剂量抑肽酶组(B组)、利多卡因组(C组).所有病人均应用静脉复合全身麻醉,常规建立体外循环,分别于麻醉后切皮前(T1)、主动脉阻断30min(T2)、CPB结束时(T3)、CPB后2 h(T4)、CPB后24 h(T5)取桡动脉血6 mL,即刻离心,留取上清液,-72℃深低温保存,酶联免疫吸附反应(ELISA)法检测血浆中细胞因子TNF-α、IL-6、IL-8水平.结果 3组TNF-α、IL-6、IL-8在CPB后即开始升高,至术后2 h达高峰,术后24h降至正常水平.各组T3、T4时间点细胞因子浓度与其他时间点相比差异有显著性(F=81.91～183.99,q=3.18～30.39,P<0.05).B、C组T3、T4时间点各指标与对照组相比差异有显著性(F=13.60～149.10,q=5.31～23.67,P<0.05).而B组和C组相比差异无显著性(P>0.05).结论 体外循环诱发全身炎症反应,导致炎性细胞因子的释放增加,利多卡因能减少细胞因子的释放,从而减轻CPB所致的机体炎症反应.     

基质金属蛋白酶-9在体外循环炎性反应中的作用

目的：通过测定血浆基质金属蛋白酶-9(MMP-9)和肿瘤坏死因子-α(TNF-α)的变化及中性粒细胞(PMN)粘附分子CD11b的表达，了解其在体外循环(CPB)炎性反应中的作用。方法：选择20例接受CPB的患者，分别在CPB开始前、开始后5min、结束时、结束后1h和结束后6h采集血标本，采用酶联免疫吸附分析方法检测血浆MMP-9和TNF-α浓度，流式细胞仪测定CD11b。结果：①血浆MMP-9和TNF-α的浓度及粘附分子CD11b的活性在CPB期间逐渐升高，在CPB结束时达到最高峰值，之后呈下降趋势。②围CPB期血浆MMP-9、TNF-α浓度变化与CD11b之间呈正相关性，CPB结束时血浆MMP-9浓度与主动脉阻断时间最有相关性。结论：缺血再灌注损伤在CPB炎性反应中起重要作用，MMP-9可能通过转化TNF-α，调节PMN粘附分子CD11b的表达而参与CPB炎性反应。     

盐酸戊乙奎醚对瓣膜置换术患者体外循环前后白介素及肿瘤坏死因子的影响

目的观察盐酸戊乙奎醚对体外循环(CPB)瓣膜置换术患者血浆炎性因子的影响。方法选择择期体外循环下瓣膜置换术患者20例,随机分为盐酸戊乙奎醚组(A组,n=10)和对照组(B组,n=10)。A组于CPB前10min静注盐酸戊乙奎醚3mg,对照组给予等量生理盐水。分别于麻醉诱导前(T0)、CPB30min(T1)、主动脉开放后10min(T2)、CPB后3h(T3)、24h(T4)抽取桡动脉血,测定血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、和白细胞介素-10(IL-10)浓度。结果组内比较,B组TNF-α浓度于T3时点高于T0(P<0.01),而A组T1、T2时点TNF-α浓度较T0显著降低,其余时点与术前比较无明显变化。B组IL-6于T4时点高于A组(P<0.05),IL-10浓度明显低于A组。组间比较,B组TNF-α浓度于T1~T4各时点均高于A组(P<0.05)。结论盐酸戊乙奎醚可部分抑制CPB导致的炎性反应,对CPB术后全身炎性反应综合征有一定的预防作用。     

小球藻多糖对人树突状细胞成熟的作用和机制研究

目的：探讨小球藻多糖（PFC）对人树突状细胞（DC）的成熟作用及其相关机制的初步研究。方法：使用纯化后的PFC对外周血单核细胞来源的不成熟DC进行干预，使用流式细胞术检测PFC干预后DC表面CD83和CD86表达变化，利用酶联免疫法（ELISA）检测细胞因子IL-6、TNF-α和IL-10水平的变化；继而通过比较PFC处理组和对照组的转录谱基因表达差异及通路富集分析，寻找其作用途径，并使用相关分子通路抑制剂进行初步验证。结果：PFC可上调DC表面CD83和CD86的表达，促进DC细胞因子IL-10的释放；生信分析结果提示PFC可能通过Toll样受体2/4(TLR2/4)发挥作用，利用TLR2和TLR4通路抑制剂下调了PFC诱导的DC CD86表达。其中TLR4抑制剂干预后CD86表达水平显著下降（P<0.05）。结论：PFC可能通过TLR2和TLR4通路上调人外周血单核细胞来源DC表面标志物CD83和CD86表达水平的提高，从而促进DC成熟。     

体外循环期间细胞因子TNF-α?IL-6与中性粒细胞的变化及其相互影响

目的:观察体外循环(CPB)炎症反应过程中致炎性细胞因子TNF-α?IL-6 与中性粒细胞的变化规律及其相关性?方法:选择30例体外循环下行瓣膜置换术的患者,分别于CPB前?CPB 40 min?CPB停机和停机后2?6?24 h以酶联免疫法(ELISA)测定血清TNF-α?IL-6 浓度,全血细胞分析仪测定外周血中性粒细胞数量?结果:CPB后各个时间点的血清TNF-α?IL-6浓度和中性粒细胞值较CPB前明显升高,差异有显著性(P < 0.01)?血清TNF-α?IL-6水平在CPB开始后,逐渐升高?CPB结束后2 h,TNF-α的血清水平达到高峰,CPB结束后24 h TNF-α仍维持在很高的水平?血清IL-6水平在 CPB结束后6 h达到高峰,然后下降,CPB结束后24 h仍维持在较高水平?中性粒细胞的变化趋势同TNF-α?2组TNF-α?IL-6血清水平(高峰值)与CPB时间及主动脉阻断(ACC)时间正相关(P < 0.01)?围手术期中性粒细胞值与TNF-α?IL-6血清水平有一定的相关性?结论:CPB可触发全身炎症反应,表现为外周血中性粒细胞数量升高与血清TNF-α?IL-6水平升高;CPB和ACC的时间长短影响TNF-α?IL-6的释放,可能影响到术后患者炎性反应的程度;CPB期间血清TNF-α水平与血清IL-6水平?中性粒细胞的升高相关?     

心脏瓣膜置换术患者围手术期细胞因子TNF-α,IL-6的变化及痰热清注射液对其的影响

目的:观察心脏瓣膜置换术患者围体外循环(CPB)期间细胞因子TNF-α,IL-6的变化及痰热清注射液对其的影响.方法:选取心脏瓣膜置换术患者30例,随机分为实验组与对照组(n=15).实验组患者于术前晚、CPB开始前分别予以痰热清注射液20mL入250mL生理盐水静脉滴注,对照组予以生理盐水250mL静滴.于CPB前、CPB40min,CPB停机、停机后2,6,24h取左桡动脉4mL,采用酶联免疫法测定两组血清中TNF-α和IL-6的浓度.结果:对照组和实验组CPB后各个时间点的TNF-α,IL-6血清浓度较CPB前的浓度明显升高,差异有显著性(P<0.01).CPB结束后2h,TNF-α的血清水平达到高峰,CPB结束后24hTNF-α仍维持在很高的水平.IL-6的血清水平在CPB结束后6h达到高峰,然后下降,CPB结束后24h仍维持在较高水平.两组TNF-α,IL-6血清水平(高峰值)与CPB时间及主动脉阻断(ACC)时间正相关(P<0.05或P<0.01).两组TNF-α,IL-6血清水平术前无统计学差异,实验组在其余时间点TNF-α,IL-6血清水平较对照组降低.差异有显著性(P<0.05或P<0.01...     

心脏手术不停搏与停搏对心肌细胞因子表达的影响

目的探讨心脏不停搏和停搏心内直视手术对心肌肿瘤坏死因子α-mRNA的表达的影响。方法30例年龄5～10岁的先天性室间隔缺损患儿,随机等分为两组。组1在中低温体外循环心脏停搏下完成手术,组2在浅低温体外循环心脏跳动下完成手术。在打开与关闭右心房时取心肌组织检测TNF-αmRNA表达。分别于麻醉诱导后(T1),CPB转流20min(T2),CPB结束时(T3),停机后6h、12h、24h(T4-6)抽血检测血浆TNF-α浓度。结果两组患者心肌TNF-αmRNA表达水平在关闭右房时均明显升高(P<0.05),且组1明显高于组2(P<0.05)。组1血浆TNF-α浓度在T4～6时间点明显高于组2(P<0.05)。结论心脏不停搏心内直视手术较传统心脏停搏手术方式能减少的TNF-α表达与释放,有利于小儿体外循环期的心肌保护。     

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.