大鼠部分肝移植后早期肝内细胞因子的变化

【目的】研究不同冷缺血损伤条件下,肿瘤坏死因子-α和白介素-6等细胞因子在大鼠部分肝移植后的变化规律与肝脏再生的关系。【方法】建立Lewis大鼠50%部分原位肝移植模型。实验组分为：冷缺血1h、8h和16h组,每组20只。观察各组的生存率,并在术后90min、1、2、4和7d收集标本。检测不同冷缺血时间肿瘤坏死因子-α、白介素-6等细胞因子的表达。检测溴脱氧尿核苷摄取观察肝细胞DNA合成情况。【结果】共行60例大鼠部分肝脏移植,肝移植手术的成功率是100%。冷缺血1h、8h组的部分肝移植物存活率均为100%（〉7d）。冷缺血16h后部分肝移植组存活率为20%（〉7d）。与冷缺血1h相比,8h和16h的冷缺血损伤诱导大鼠部分肝移植物白介素-6（P〈0.05）和肿瘤坏死因子-α（P〈0.05）等因子表达增加。与冷缺血1h相比,冷缺血8h组的移植肝在移植术后24h摄取溴脱氧尿核苷明显增多（P〈0.05）。冷缺血16h组的移植肝在移植术后24h仅有少数溴脱氧尿核苷染色阳性的肝细胞存在。【结论】肿瘤坏死因子-α和白介素-6等细胞因子的上调表达在启动和完成部分肝移植后早期肝脏再生的过程中非常重要。轻度（1h）和中度（8h）的冷缺血损伤可以启动并完成部分肝移植物移植后的肝脏再生,但重度（16h）的冷缺血损伤即使在早期启动信号存在的情况下,不能完成移植后的肝脏再生。     

大鼠部分肝移植后早期肝内细胞因子的变化

 【目的】 研究不同冷缺血损伤条件下，肿瘤坏死因子-α和白介素-6等细胞因子在大鼠部分肝移植后的变化规律与肝脏再生的关系。【方法】 建立Lewis大鼠50％部分原位肝移植模型。实验组分为： 冷缺血1 h、8 h和16 h组，每组20只。观察各组的生存率，并在术后90 min、1、2、4和7 d收集标本。检测不同冷缺血时间肿瘤坏死因子-α、白介素-6等细胞因子的表达。检测溴脱氧尿核苷摄取观察肝细胞DNA合成情况。【结果】 共行60例大鼠部分肝脏移植，肝移植手术的成功率是100％。冷缺血1 h、8 h组的部分肝移植物存活率均为100％(＞ 7 d）。冷缺血16 h后部分肝移植组存活率为20％(＞ 7 d）。与冷缺血1 h 相比，8 h和16 h的冷缺血损伤诱导大鼠部分肝移植物白介素-6（P<0．05）和肿瘤坏死因子-α（P<0．05）等因子表达增加。与冷缺血1 h相比，冷缺血8 h组的移植肝在移植术后24 h摄取溴脱氧尿核苷明显增多（P<0．05）。冷缺血16 h组的移植肝在移植术后24 h仅有少数溴脱氧尿核苷染色阳性的肝细胞存在。【结论】 肿瘤坏死因子-α和白介素-6等细胞因子的上调表达在启动和完成部分肝移植后早期肝脏再生的过程中非常重要。轻度（1 h）和中度（8 h）的冷缺血损伤可以启动并完成部分肝移植物移植后的肝脏再生，但重度（16 h）的冷缺血损伤即使在早期启动信号存在的情况下，不能完成移植后的肝脏再生。     

人IκBαM真核表达载体的构建及其对大鼠肝移植缺血再灌注中ICAM-1的影响

目的构建人IκBαM真核表达质粒,探讨人IκBαM对大鼠肝移植缺血再灌注中ICAM-1的影响。方法应用RT-PCR和重叠延伸PCR技术,得到点突变的人IκBαM,定向克隆至PcDNA3.0真核表达载体。将SD大鼠原位肝移植模型分4组：组Ⅰ为假手术组（行游离肝脏手术）,组Ⅱ为空白对照组（行大鼠原位肝移植手术）,组Ⅲ为PcDNA3.0空载体转染组（移植前两天行人PcDNA3.0转染供肝）,组Ⅳ为PcDNA3.0-IκBαM转染组（移植前两天行人PcDNA3.0-IκBαM转染供肝）。分别于术后2h、12h、24h和3d取材。应用免疫组化、RT-PCR测定肝组织中ICAM-1的表达,同时检测各时点肝脏酶学的变化。结果经酶切和DNA序列测定鉴定,证实重组质粒构建正确;PcDNA3.0-IκBαM转染组与组Ⅱ、组Ⅲ相比：免疫组化示ICAM-1于移植后12h、24h的表达差异具有显著性;术后12hICAM-1mRNA的表达水平具有显著性差异;肝脏受损指标（ALT）在各时点差异具有显著性,尤其在术后12h最为显著（P〈0.05）。各移植组与Ⅰ组差异有显著性,（P〈0.05）。结论真核表达质粒PcDNA3.0-IκBαM构建成功,IκBαM通过抑制ICAM-1的表达减轻大鼠肝移植缺血再灌注损伤。     

卵巢甲状腺肿类癌临床病理观察

目的探讨卵巢甲状腺肿类癌临床病理特征、鉴别诊断和预后。方法报道我院首例卵巢甲状腺肿类癌的临床资料,作临床病理分析及HE、免疫组织化学染色,并随防。结果巨检示：灰红色结节状肿物,切开呈囊实性,实性区切面呈灰红色,局部区域呈灰黄、灰白色,均质状。镜下示：肿瘤由卵巢成熟性畸胎瘤成分合并有甲状腺组织构成,瘤细胞呈梁状、或岛屿状分布,胞质丰富,核小,染色质均匀,核分裂像不易查见。免疫组化示：滤泡区甲状腺球蛋（TG）、甲状腺转录因子（TTF-1）阳性;类癌区细胞角蛋白（CK）、铬素A（CgA）、突触素（Syn）、神经元特异性烯醇化酶（NSE）均阳性,抑制素（inhibin-a）阴性。结论卵巢甲状腺肿类癌是一种伴有甲状腺滤泡分化的、罕见的低度恶性肿瘤。病变局限于年轻患者,行单侧病变卵巢切除即可;年龄较大者行全子宫加双附件切除,必要时补充化疗,一般预后较好。     

原发性肝脏癌肉瘤1例

<正> 患男,49岁。以右上腹持续性钝痛3月入院。查体:右上腹压痛,叩击痛,无反跳痛。腹软,肝脾未及。CT示:肝右叶10cm×10cm低密度影,周边为一亮晕,并见一直径2cm小灶。诊断:肝脏占位性病变,考虑肝癌。手术见肝脏右叶膈面有一直径10cm肿物、硬、浸润膈肌。行右半肝切除术。病理检查:切除肝脏右叶,一侧见一10cm×10cm×7cm肿物。切面实性灰白、质中等、边界较清、无包膜。部分区域有出血坏死、质脆,部分区域发亮、鱼肉状。肿物侵及被膜,其周边见一2cm灰白实性卫星结节。周围肝组织未见异常。显微镜下肿物由腺上皮细胞及梭形间叶细胞组成,均有明显异型性。腺细胞大多为椭圆形、较大,胞浆均质嗜伊红色,排列呈腺样。梭形细胞胞浆丰富嗜伊红色,核     

热休克蛋白70对大鼠心脏停搏供体肝移植的保护作用

目的：采用心脏停搏供体大鼠原位肝移植模型,观察热休克蛋白70（HSP70）对心脏停搏后不同时间的供肝缺血再灌注损伤的影响。 方法：以缺血预处理方法诱导大鼠肝脏组织产生HSP70,以预处理(IP)与否及供体心脏停搏45 min或60 min的不同,将供体大鼠分为4组(IP-45,IP-60,C-45和C-60)。于肝移植术后1 h采血检测肝功能,术后1 h及7 d切取肝脏,观察肝脏病理学改变,并观察各组大鼠术后存活时间。结果：缺血预处理后24~48 h,肝组织HSP70表达明显增强;肝移植术后1 h,血清ALT和AST水平IP组明显低于对照(C)组（P<0.05）;术后7 d,IP组移植肝光学显微镜下肝小叶结构完好,汇管区有少量淋巴细胞浸润,C组移植肝则出现了较多的肝细胞坏死和气球样变。C-45和C-60组1周存活率分别为12.5%和0;而IP-45和IP-60组1周存活率分别为62.5%和37.5%。 结论：HSP70明显改善术后肝脏功能和减轻肝脏病理学改变,显著提高心脏停搏供体肝移植的存活率,HSP70对心脏停搏供体肝移植缺血再灌注损伤具有明显保护作用。     

小体积肝移植后再生肝脏中受体来源骨髓干细胞跨分化的实验研究

目的研究小体积肝移植后受体来源的造血干细胞跨分化现象及影响因素。方法采用性别错配的大鼠不同体积肝脏移植，动态观察移植肝体积的大小和缺血损伤对术后骨髓干细胞向移植物内肝细胞跨分化促肝脏再生过程的影响。结果全肝移植组Y-染色体肝细胞阳性率为0．66％，而60％和30％肝移植组Y-染色体肝细胞阳性率分别增加到1．89％和3．78％，3组间差异均有显著性（P〈0、05）。延长冷缺血时间使得肝内Y-染色体阳性肝细胞率减少到0、73％，与1h缺血时间组差异有显著性（P〈0．05）。结论减体肝移植能增强HSCs在肝脏内向肝细胞跨分化。而延长冷缺血时间明显降低HSCs在肝内的跨分化。     

不同类型血清对大鼠脂肪干细胞分离培养的影响

目的研究不同血清培养基对脂肪干细胞分离培养的影响.方法用4种不同类型的血清培养基分离培养大鼠脂肪干细胞,免疫荧光法检测培养细胞CD34、CD90、CD133、Flk-1表面标志;成骨诱导液诱导分化,于14 d进行碱性磷酸酶和钙染色检验各细胞成骨分化特性.结果（1）新生牛血清组可见贴壁单个核细胞形态单一,呈梭形生长,无重叠现象;胎牛血清组均可见大量多角细胞呈巢状生长,形成铺路石样形态,间或有梭形细胞存在;（2）新生牛血清组梭形贴壁细胞免疫荧光检测可见CD90为阳性,CD34、CD133、Flk-1染色均为阴性;胎牛血清组多角形细胞CD34、Flk-1均为阳性,CD133组部分为阳性,CD90为阴性;（3）新生牛血清组贴壁细胞多数呈碱性磷酸酶阳性;胎牛血清组细胞多角状细胞死亡,形成空白区,梭形细胞呈碱性磷酸酶阳性;（4）新生牛血清组均可见大量红色钙结节影;胎牛血清组细胞多角状细胞死亡,形成空白区,梭形细胞红色钙结节影.结论（1）新生牛血清培养脂肪干细胞可以得到较纯的细胞;（2）胎牛血清组培养含有大量的血管内皮细胞.     

肝细胞腺瘤2例报道

例 1，女， 12岁，右上腹不舒隐痛 1天入院。查体：皮肤巩膜无黄染。肝脏右肋缘下触及，质硬、光滑。 B超：肝左叶有 10cm× 10cm的实质性结节光团，边界清楚。 CT：肝左叶 12cm× 12cm的低密度肿块，有包膜，其中有液化坏死灶，肿块紧贴第二肝门。 AFP阴性，入院诊断：“肝脏占位性病变”。入院后肝动脉造影：肝左动脉分支增粗，呈明显肿瘤血管状改变，肝瘤边界清楚。肝动脉造影诊断，肝脏突性占位性病变。入院后 2周在全麻下行肝左叶肿块切除术，术中见肿瘤占据整个肝左叶，腹腔内无积液，肝右叶完好。肿瘤约 12cm× 12cm× 9cm大小，…     

乳房色素性隆突性皮肤纤维肉瘤1例报告

1病历摘要 患者女,31岁,1年前无意中发现左乳房下方有一直径约1．0cm大小的肿物,自诉逐渐增大并有灼热感。查体：左乳房外下象限触及一活动性良好的肿块,无触痛,局部皮肤结节状隆起。在门诊处置室行肿物切除并送实验室病量检查。巨检示无包膜灰红色肿物,体积2．0cm×1．5cm×1．5cm,切面实性,质中等,呈灰白黄色。光镜检查示瘤细胞呈梭形,似纤维母细胞,大小及形态基本一致,无明显异型性,未见核分裂象。     

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.