缺血预处理及后处理对家兔肾脏缺血-再灌注损伤的保护机制研究

目的探讨缺血预处理及缺血后处理对家兔肾脏缺血-再灌注损伤的保护作用。方法首先建立家兔肾脏缺血-再灌注模型。40只雄性家兔随机分为4组（n=10）：假手术组（Sham组）、缺血再灌注组（I/R组）、缺血预处理组（IPC组）及缺血后处理组（IPO组）。再灌注60min后分别检测血清中丙二醛（MDA）含量及超氧化物歧化酶（SOD）活性,光镜下观察肾组织病理学改变。结果与Sham组比较,I/R组、IPC组和IPO组血清SOD活性降低,MDA含量升高,病理损伤明显;与I/R组相比,IPC组和IPO组血清SOD活性升高,MDA含量降低,病理损伤减轻。结论缺血预处理及后处理能够减轻家兔肾脏缺血-再灌注损伤,其机制与增强机体的抗氧化损伤能力有关。     

虎杖对肾缺血再灌注损伤大鼠血清超氧化物歧化酶和丙二醛的影响

目的：探讨虎杖对肾缺血/再灌（ischemia/reperfusion,I/R）注损伤大鼠肾脏的保护作用及其机制。方法：健康雄性SD大鼠72只随机分为4组,假手术组、缺血再灌注组、虎杖及虎杖苷（PD）预处理组。采用切除大鼠右侧肾脏,左侧肾蒂夹闭60min肾I/R模型。在缺血前10min、缺血再灌注6、12h后分别检测血清肌酐（Scr）、血清尿素氮（BUN）、肾组织丙二醛（MDA）水平及超氧化物歧化酶（SOD）活性,观察肾组织的病理变化,并分别进行比较。结果：虎杖及PD预处理组肾组织病理变化轻于肾缺血再灌注组,与假手术组比较,在不同时间点肾缺血再灌注组的Scr、BUN、MDA水平明显升高（P〈0.05）,SOD活性明显降低（P〈0.05）。虎杖及PD预处理组的Scr、BUN、MDA水平均较肾I/R组明显降低（P〈0.05）,而SOD活性明显增强（P〈0.05）。结论：在肾缺血再灌注损伤的过程中,虎杖可增强SOD活性,减少MDA,改善肾功能,其中PD起了主要作用但还有其他成分起作用。     

肢体缺血预处理对兔肾急性缺血再灌注损伤的保护作用

目的观察肢体缺血预处理对肾脏急性缺血再灌注损伤(IRI)能否产生保护作用,并通过肾功能、组织病理学等检测评估其效果。方法(1)建模:40只新西兰大白兔随机分为3个组,假手术(S)组8只,缺血再灌注(IR)组和预处理(LIP)组各16只,后2个组兔采用右肾切除、左肾动静脉阻断1h开放法建立肾脏缺血再灌注模型,S组仅切除右肾,游离左肾动静脉但不阻断。(2)肢体缺血预处理方法:LIP组在阻断前,先以止血带在双下肢根部绑扎,阻断血流5min,完全开放10min,反复4次。(3)评估指标:对比各组兔在再灌注后8、24h和3、7d时肾功能、肾组织MDA含量和SOD活性以及组织病理学差异。结果LIP组再灌注后血清Scr和BUN升高幅度要明显低于IR组(P<0.05),在再灌注后3d内血Scr和BUN明显低于IR组(P<0.05);LIP组再灌注后24h内SOD活性和MDA含量的变化幅度明显低于IR组(P<0.05),且在各时间点SOD活性均明显高于IR组(P<0.05),MDA含量均明显低于IR组(P<0.05);LIP组光镜下病理改变轻于IR组。结论肢体缺血预处理能减轻肾脏缺血再灌注引起的组织病理改变,降低肾组织MDA含量并增加SOD活性,改善肾功能,对急性肾脏IRI起到明显的保护作用。     

缺血预处理与川芎嗪对大鼠肠缺血再灌注时远隔脏器P-选择素和细胞间黏附分子-1的影响

目的:探讨缺血预处理和川芎嗪及两者联合应用对肠缺血再灌注大鼠肺、心P-选择素(P-selectin)和细胞间黏附分子-1(ICAM-1)的影响及其发生机制.方法:健康SD大鼠,随机分为假手术对照(SC)组、肠缺血再灌注(IIR)组、川芎嗪治疗(LGT)组、缺血预处理(IPC)组和川芎嗪 缺血预处理(LGT IPC)组,测定比较各组血清SOD、GSH-PX、XOD活性,MDA含量,心、肺组织MPO活性;以免疫组化法检测心、肺组织P-selectin和ICAM-1的表达.结果:①与IIR组比较,LGT组、IPC组和LGT IPC组的SOD、GSH-PX活性明显升高,且LGT IPC组的XOD活性和MDA含量明显低于LGT组和IPC组.②LGT IPC组的肺、心肌组织MPO活性明显低于IIR组、LGT组和IPC组,IPC组心肌MPO亦比IIR组有明显下降.③除SC组外,LGT IPC组的肺、心P-selectin和ICAM-1表达均明显较另3组减少,IPC组心肌P-selectin表达较IIR组减弱.④血清SOD活力与P-selectin、ICAM-1表达之间存在负相关.结论:缺血预处理抑制肠缺血再灌注所致心肌P-selectin表达,缺血预处理与川芎嗪联合应用抑制心、肺P-selectin和ICAM-1表达,其发生机制与抗氧化作用有关,二者联用有显著的协同作用.     

麦芽醇对大鼠缺血再灌注血管内皮细胞损伤的保护作用

目的：研究麦芽醇对缺血再灌注血管内皮细胞损伤的保护作用。方法：选用健康wistar大鼠32只，随机分成：（1）假手术对照组(Control组）；（2）缺血再灌注组（IR组）；（3）缺血预处理组（IPC组）；（4）麦芽醇处理组（Maltol组），测定各组血中循环内皮细胞数量，NO及ET的含量，以及心肌组织中SOD活性及MDA的含量。结果：IR组循环内皮 细胞数量增多，NO含量下降，ET含量升高，SOD活性下降，MDA含量升高；IPC组和Maltol组循环内皮细胞数量减少，NO含量升高，ET含量下降，SOD活性增强，MDA含量下降。结论：麦芽醇对缺血再灌注所致的血管内皮细胞损伤有保护作用。     

缺血预处理对在体大鼠缺血再灌注损伤心肌ICAM—1mRNA表达的影响

目的：利用大鼠在体心肌缺血再灌注模型,应用原位杂交来观测ICAM－1mRNA在各组大鼠心肌中的表达,以了解缺血预处理对ICAM－1表达的影响,并探讨其机制。方法：雄性Sprague-Dawley大鼠60只,随机分为心脏缺血／再灌注组（IR,n=20),预处理组（IPC,n=20)及假缺血组（Sham,n=20),术毕抽血5ml,查血清SOD,MDA,应用原位杂交方法检测ICAM－1mRNA在各组大鼠心肌中的表达,结果：再灌注2hIR组血清MDA较Sham组及IPC组有明显升高（P＜0．01）,IR组血清SOD较Sham组及IPC组有明显降低（P＜0．01）,再灌注2h后,IR组心肌ICAM－1mRNA表达较IPC组明显增加（P＜0．01）,结论：缺血预处理可有效的保护缺血再灌注心肌,同时对于心肌ICAM－1mRNA表达具有下调作用,且后者有可能是前者的原因。     

缺血预处理对肾缺血再灌注损伤的影响

目的 探讨缺血预处理对家兔肾缺血再灌注损伤后血清电解质及SOD和MDA的影响及作用机制。方法健康新西兰兔27只，随机分为对照（Control）组、单纯缺血再灌注（IR）组和缺血预处理＋缺血再灌注（IPC-IR）组。分别检测缺血再灌注后2h和24h的血清中肌酐（Cr）、尿素氮（BUN）、Na^＋、K^＋、Ca^2 ＋、Cl^＋、丙二醛（MDA）和超氧化物歧化酶（SOD）的含量。结果缺血再灌注24h后，IR组和IPC-IR组血清BUN均高于Control组,而血清Cr,IR组显著高于Control组（P≤0．05）。缺血再灌注后，IR组血清Na^＋显著低于Control组和IPC-IR组（P≤0．05）．而血清中K^＋，IR组显著高于Control组和IPC-IR组（P≤0．05）。血清Ca^2＋在缺血再灌注2h后，IR组显著低于Control组和IPC-IR组（P≤0．05）．但缺血再灌注24h后，IPC-IR组显著高于Control组和IR组（P≤0．05）。血清Cr在再灌注24h后，IR组显著低于Control组和IPC-IR组（P≤0．05）。肾缺血再灌注2h和24h后，血清MDA,IR组最高、IPC-IR组其次，而Control组最低，血清SOD活性为IPC-IR组最高、Control组其次，而IR组最低。结论缺血预处理可以明显改善缺血再灌注损伤后肾脏的功能，尤其在调节血清电解质平衡方面有更好的作用．其机制与预处理后机体抗氧化能力的增强有关。     

延迟预适应对缺血再灌损伤冠脉内皮保护作用的研究（摘要）

目的探讨延迟缺血预适应（ischemic procondition-ing,IPC）对缺血再灌注（ischemia/reperfusion,IR）冠脉内皮的保护作用,观察IR及IPC过程中一氧化氮（nitricoxide,NO）丙二醛（malondialehyde,MDA）及超氧化物歧化酶（superoxide dismutase，SOD）含量变化，通过免疫组化方法了解此过程中冠脉内皮细胞诱导型一氧化氮合成酶（inducible，NO synthase，iNOS）及内皮型一氧化氮合成酶（endothelial NO synthase，eNOS）蛋白的表达情况．     

重组人促红细胞生成素对大鼠肾脏缺血再灌注损伤的保护作用

 目的 探索不同剂量及给药时间的重组人促红细胞生成素（recombinant human erythropoietin,rhEPO）对大鼠肾脏缺血再灌注损伤（ischemia-reperfusion injury,IRI）的保护作用。方法 48只雄性SD大鼠随机分为假手术组（S组）、缺血对照组（IR组）、EPO-1组（再灌注时给药1 000、2 000和3 000 U/kg）和EPO-2组（再灌注前给药1 000、2 000和3 000 U/kg）。阻断左侧肾蒂45 min后切除右侧肾脏,建立IRI模型。检测血液中血肌酐（Scr）、血浆尿素氮（BUN）、超氧化物歧化酶（SOD）、丙二醛（MDA）、IL-6和Caspase-3水平,观察肾脏的病理学改变,采用TUNEL法检测肾小管上皮细胞凋亡。结果 EPO组血清Scr、BUN和肾组织MDA、Caspase-3、IL-6水平明显低于IR组（P<0.05）;EPO组肾组织SOD水平明显高于IR组（P<0.05）,并在组织损伤上较IR组轻;TUNEL染色观察到EPO组阳性细胞数明显少于IR组（P<0.05）。再灌注前给药优于再灌注时给药（P<0.05）。结论 rhEPO对肾脏IRI有较好的保护作用,该作用可能通过抗氧自由基、减轻炎症反应、减少肾小管上皮细胞凋亡的协同机制来实现。保护作用与药物剂量呈正相关,再灌前给药优于再灌注时给药。     

大蒜素及缺血预处理对大鼠肾缺血再灌注损伤的影响及机制研究

目的:探讨缺血预处理和大蒜素注射液预处理对大鼠肾缺血再灌注损伤的影响及机制.方法:建立大鼠肾缺血再灌注损伤模型.将75只SD大鼠随机分成对照组(Control group,CON组)、缺血再禳注(Ischemia reperfusion,IR组)、缺血预处理组(Ischemic preconditioning group,IPC组)、大蒜素预处理组(Allitride preconditioning group,APC组)、大蒜素及缺血预处理(Allitride preconditi oning and ischemic preconditioning group,AIPC组)共5组,每组15只.各组均于术后24 h采集肾组织及血样标本,用HE法观察肾组织病理形态、测定血尿素氮(Blood urea nitrogen,BUN)、肌酐(Creatinine,Cr)含量、TBA法测定丙二醛(Malonaldehyde,MDA)含量、黄嘌呤氧化酶法测定超氧化物歧化酶(Superoxide dismutase,SOD)活性;免疫组化法观察肾组织中粘附分子(Interce llular adhesion molecule-1,ICAM-1)的表达.结果:IPC或APC后HE染色坏死较IR组减少,BUN、Cr、MDA含量较IR组下降(P＜0.01),SOD活性较lR组升高(P＜0.01),肾组织ICAM-1表达较IR组下降(P＞0.01). AIPC处理后各项指标较IPC或APE单一处理有显著区别(P＜0.01).结论:缺血预处理和大蒜素预处理对肾缺血再灌注有保护作用,两种处理因素对大鼠肾缺血再灌注损伤的保护有协同作用,可能是通过下调ICAM-1的表达实现的.     

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.