东莨菪碱在心肌再灌注损伤中的作用

目的：研究东莨菪碱的心肌保护作用，探讨其可能的机制。方法：将Wistar大鼠24只随机分为对照组（C组，n=12，用KHB进行灌注）和实验组（S组，n=12，用KHB^ 东莨菪碱进行灌注），建立离体缺血再灌注心脏模型，测定再灌注前后心功能、心肌组织中NO的含量、NOS同功酶（iNOS、cNOS）的活性以及心肌NOS同功酶(iNOS、cNOS）mRNA表达。结果：（1）S组心功能得到明显改善；（2）形态学检查发现S组的心肌细胞结构保存明显优于C组；（3）S组再灌注后NO含量明显减少，iNOS活性显著下降，cNOS活性略有下降，iNOS的mRNA表达显著下降,而cNOS的mRNA改变不明显。结论：东莨菪碱对离体缺血再灌注大白鼠心脏具有较明显的保护作用。其机制可能为：（1）通过阻断M受体，扩张血管、促进心肌收缩；（2）保持心肌组织内的NO含量正常。     

肿瘤坏死因子α和一氧化氮合酶在脓毒症大鼠心功能中的作用初探

目的初步探讨肿瘤坏死因子α（TNF-α）和一氧化氮合酶（NOS）在脓毒症大鼠心功能中的作用。方法制作脓毒症大鼠模型,监测血流动力学,测定大鼠心肌组织中TNF-α和一氧化氮（NO）浓度,检测各型NOS的活性。结果大鼠心肌组织中TNF-α含量2h时达高峰,心肌组织NO 6h时达高峰,与心功能改变时间一致。给予脂多糖（LPS）6h后心脏中cNOS的表达减少;iNOS表达量明显增加。结论脓毒症时,TNF-α和NO发挥重要作用,并且心肌细胞上iNOS表达升高、cNOS表达减少可能在心功能降低中发挥作用。     

气体信号分子硫化氢和一氧化氮在代谢综合征大鼠心脏保护中的相互作用

目的 研究硫化氢(H2S)/胱硫醚-γ-裂解酶(CSE)体系和一氧化氮(NO)/一氧化氮合酶(NOS)体系在代谢综合征(MS)大鼠心脏功能损伤中的作用及相互关系.方法 41只雄性Sprague-Dawley大鼠随机分为6组:正常对照组、模型组、模型+H2S供体组、模型+CSE抑制剂组、模型+NOS抑制剂组、模型+NO供体组.对照组普通饲料喂养16周,其余5组高脂饲料喂养16周复制MS动物模型,随后4周对照组和模型组注射生理盐水、其余4组分别注射硫氢化钠(56μmol/kg)、炔丙基甘氨酸(37.5mg/kg)、N-硝基-L-精氨酸甲酯(18mg/kg)、L-精氨酸(500mg/kg)进行干预后,测定肥胖指标、血糖、血脂;采用生物信号采集系统检测心功能;比色法检测血浆、心肌H2S及NO含量,心肌CSE、结构型NOS(cNOS)及诱导型NOS(iNOS)活性;RT-PCR方法检测心肌CSE及内皮型NOS(eNOS)表达的变化.结果 与对照组相比,模型组各时间点血糖、血脂及肥胖指数升高,心功能降低(P<0.05);血浆和心肌H2S、NO含量,心肌CSE、cNOS活性,CSE、eNOS表达降低,心肌iNOS活性升高(P<0.05).与模型组相比,模型+CSE抑制剂组血浆、心肌NO含量,心肌cNOS、iNOS活性增加,eNOS表达增强(P<0.05);模型+H2S供体组心肌cNOS、iNOS活性和eNOS表达均降低(P<0.01),心功能改善(P<0.05);模型+NOS抑制剂组血浆、心肌H2S含量,心肌CSE表达均升高(P<0.05);模型+NO供体组心肌CSE活性、CSE表达降低(P<0.05),心功能改善(P<0.05).结论 H2S/CSE和NO/NOS体系在MS大鼠心脏中呈相互负性调节作用.外源性补充H2S和NO对MS大鼠心脏功能有一定保护作用.     

灌注保存对猪离体供心冠脉和心肌保护效果的研究

目的：观察不同保存方法及不同灌注容量对猪离体供心冠脉血管因子表达和心肌细胞保护效果的影响。方法巴拿马小型香猪共36只,根据保存技术不同分为浸泡保存组和间断灌注保存组,间断灌注容量分别为50、100、150、200、250ml,每组6只。灌注液为30μmol/L二氮嗪强化Celsior液,保存温度为4℃,时间10h。保存后比较各组间冠脉血管中内皮型一氧化氮合成酶（eNOS）、内皮素-1（ET-1）、细胞黏附分子-1（ICAM-1）表达情况,以及心肌细胞凋亡情况、心肌组织ATP含量（ATPC）、心肌含水量（MWC）。结果间断灌注保存各组较浸泡保存组能维持较高的ATP水平,减少心肌细胞凋亡,降低MWC;而eNOSmRNA表达量高于浸泡保存组,ET-1mRNA和ICAM-1mRNA表达量却低于浸泡保存组（P＜0.05）。当灌注容量为50~200ml时,随着灌注容量的增加,ATPC和eNOSmRNA表达量逐渐增高,凋亡指数、MWC、ET-1mRNA和ICAM-1mRNA表达量则逐渐降低;继续增加灌注容量至250ml时,各指标并无显著变化。结论在长时间心脏保存中,每隔2h灌注1次,每次灌注容量为200ml能较好保护供心;当灌注容量低于200ml时,随着灌注容量的增加供心保护效果逐渐增强,且对冠脉和心肌的保护作用具有等同性。     

缺血-再灌注心肌诱导型一氧化氮合酶基因表达及其活性的变化和卡托普利的影响

目的探讨心肌诱导型一氧化氮合酶（iNOS）mRNA表达及其活性的变化在心肌再灌注损伤中的作用；研究卡托普利对缺血再灌注心肌保护作用的机制。方法采用Langendorff离体鼠心灌流模型；将18只SD大自鼠随机均分为3组：对照组、缺血一再灌组及卡托普利组；观察心肌iNOS mRNA表达及其活性、丙二醛（MDA）含量、过氧化物歧化酶（SOD）活性、肌酸激酶（CK）含量和冠状静脉流出液一氧化氮（NO）的变化。结果缺血再灌注后心肌iNOS mRNA表达显著上调（P〈0．001），iNOS活性增高（P〈0．001）；卡托普利组再灌注30min，心肌iNOS mRNA表达及其活性、心肌MDA含量均低于缺血-再灌组（P〈0．01，P〈0．05），而心肌SOD活性（P〈0．01）和CK含量（P〈0．05）高于缺血-再灌组，再灌注期间冠状静脉流出液NO含量高于缺血-再灌组（P〈0．01）。结论缺血-再灌注心肌iNOS基因表达上调，心肌iNOS活性增高；影响心肌iNOS mRNA表达、调节心肌iNOS活性可能是卡托普利抗心肌脂质过氧化作用的机制之一。     

前列腺素A1对供心缺血再灌注损伤心肌一氧化氮合酶的表达的影响

目的研究前列腺素A1(PGA1)对同种异位大鼠心脏移植供心一氧化氮合酶(iNOS)表达的影响。方法建立同种异位大鼠心脏移植模型,供心给予生理盐水、PGA1或脂多糖(LPS)处理,观察供心存活时间,通过酶联免疫吸附试验测定iNOS的表达,采用凝胶电泳迁移率测定NF-κB的活性。结果一次给予40 ng.kg-1PGA1组供心存活时间明显延长,心肌组织iNOS的蛋白表达明显增加,核转录因子-κB(NF-κB)的活性显著下降。结论在同种异位大鼠心脏移植中,PGA1通过抑制NF-κB的活性,上调供心缺血再灌注损伤心肌一氧化氮合酶的表达,延长供心存活时间。     

HGF对脑缺血/再灌注大鼠脑iNOS,NO及IL-1β的影响

目的：探讨肝细胞生长因子(HGF)对脑缺血/再灌注(I/R)大鼠脑诱导型一氧化氮合酶(iNOS)、NO及白细胞介素-1β(IL-1β)的影响。方法：SD大鼠随机分为以下5组：假手术组(Sham组);I/R组;HGF1,HGF2,HGF3组,即I/R大鼠分别注射15,30,60 μg/kg HGF。线栓法建立局灶性脑I/R模型,脑缺血1.5 h再灌注24 h后,测定缺血区脑组织iNOS活性及NO含量,检测iNOS及IL-1β mRNA水平的变化,测定iNOS蛋白表达水平及IL-1β含量。另取体外培养的大鼠大脑皮层神经元行 I/R 处理,检测iNOS和IL-1β 蛋白表达水平及NO含量。结果：大鼠缺血区脑组织iNOS活性升高、NO含量增加,iNOS和IL-1β mRNA表达上调,iNOS 蛋白表达增多,IL-1β含量增加。注射不同剂量HGF均能降低缺血区脑组织iNOS活性及NO含量,下调iNOS和IL-1β mRNA的表达,抑制iNOS蛋白的表达,降低IL-1β含量。此外,HGF可明显下调体外 I/R 神经元IL-1β和iNOS蛋白的表达,降低NO含量。结论：抑制IL-1β的表达,减少iNOS的表达,降低NO含量可能是HGF减轻脑缺血损伤的机制之一。     

血必净对大鼠下肢缺血再灌注损伤的影响

目的研究血必净对大鼠下肢缺血再灌注损伤的影响。方法制备大鼠下肢缺血再灌注模型,观察实验组不同组间血清中髓过氧化酶（MPO）、乳酸脱氢酶（LDH）、总一氧化氮合酶（TNOS）、诱导型一氧化氮合酶（iNOS）、结构型一氧化氮合酶（cNOS）活性的变化。结果与SOG组比较,I/R组XBJ组血清中MPO、LDH、TNOS、iNOS的活性均增高（P〈0.05）,I/R中血清中cNOS活性降低（P〈0.05）,XBJ组血清中cNOS活性增高（P〈0.05）。与I/R组相比较,XBJ组血清中MPO、LHD、iNOS活性均降低（P〈0.05）,XBJ组血清中TNOS、cNOS活性增高（P〈0.05）。结论血必净可以稳定中性粒细胞,降低iNOS活性,减少iNOS源性NO;增高cNOS活性,使eNOS源性NO增加,减轻对细胞的毒性,对下肢缺血再灌注损伤有保护作用。     

芦丁对大鼠缺血再灌注心肌组织iNOS和eNOSmRNA表达的影响

目的：研究芦丁对大鼠心肌缺血再灌注损伤的保护作用及其机制。方法通过左冠状动脉结扎建立SD大鼠心肌缺血再灌注模型,将大鼠随机分为对照组、模型组、芦丁组、L-NAME（eNOS 抑制剂）组,ELISA 法检测血清一氧化氮（NO）水平,免疫抑制法检测血清肌酸激酶同工酶（CK-MB）浓度,实时荧光定量 PCR分析各组心肌组织iNOS 和eNOS mRNA 表达的变化。结果与模型组比较,芦丁组血清 NO 水平增高（P＜0.01）,CK-MB 浓度下降（P＜0.01）,eNOS mRNA 表达升高（P＜0.01）,iNOS mRNA 表达下降（P＜0.01）。结论芦丁缺血预处理对心肌起到了保护作用,其机制可能与上调心肌组织eNOS mRNA 、下调iNOS mRNA 表达有关。     

ATP-MgCl2对缺血再灌注损伤大鼠心肌细胞一氧化氮合成酶的影响

目的寻找心肌缺血再灌注损伤与一氧化氮（NO）的关系，进一步探讨高能磷酸盐制剂ATP—MgCl2对缺血再灌注大鼠心肌保护作用的机制。方法选用健康SD大鼠16只，随机分为两组（n=8），开胸取心，在Langgendorff灌流装置上进行主动脉灌注10min，待心肌收缩稳定后，停止灌流30min，再分别以相应灌注液灌注20min，对照组：使用Krebs—Henseleit（KH）缓冲液；ATP—MgCl2组：使用KH缓冲液＋ATP—MgCl2（0．1mmol／L）。以Knowles方法测定心肌原生型NOS（cNOS）和诱导性NOS（iNOS）活性。结果对照组iNOS活性显著高于ATP—MgCh组，而对照组cNOS活性则显著低于ATP—MgCh组。结论ATP—MgCl2通过减少因iNos所产生的氧自由基浓度而起到心肌保护作用。     

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.