万爽力对顿抑心肌能量代谢及功能的恢复作用

目的 :应用兔冠脉前降支结扎缺血再灌模型 ,观察万爽力对顿抑心肌能量代谢及功能的影响并分析其可能机制。方法 :18只日本大耳白兔随机分为对照组、心肌顿抑组和万爽力组。结扎兔冠脉左前降支 2 0min ,再灌36 0min ,观察血流动力学、抗氧化酶、脂质过氧化物、血清游离脂肪酸、乳酸以及心肌组织ATP含量和超微结构的变化。结果 :①万爽力可缓解顿抑心肌收缩舒张功能明显降低 ;②万爽力可抑制顿抑组血清游离脂肪酸 (FFA)、乳酸 (LD)、丙二醛 (MDA)水平明显升高 ,超氧化物歧化酶 (SOD)活性明显下降 ;③顿抑组心肌组织ATP含量较对照组明显下降 ,万爽力可升高顿抑心肌组织ATP含量 (P <0 .0 1) ;④万爽力可减轻顿抑心肌损伤。结论 :万爽力对顿抑心肌功能与能量代谢的恢复作用与其直接参与心肌细胞脂肪酸代谢有关。     

槐定对离体大鼠心脏心肌顿抑的保护作用

利用大鼠心脏灌注等容收缩模型，观察槐定对顿抑心肌功能、代谢及超微结构的影响。实验分心肌顿抑组1）、槐定保护组（组2）和正常对照组。结果：组1左室压力峰值（LVSP）、左心室压力最大上升速率（ dp/dt-max)及其最大下降速率（-dp/dt-max)均比其它两组显著减低；其冠脉流出液乳酸脱氢酶（LDH）在灌注过程中进行升高；左心室组织超氧化物歧化酶（SOD）活力降低，丙二醛（MDA）含量升高，心肌细胞内钙含量增加；心肌超微结构呈可逆性损害，组2中上述变化程度明显减轻，说明槐定能促进顿抑心肌功能恢复，减轻心肌细胞膜及其超微结构的损害，其机理可能与提高SOD活力，减轻脂质过氧化反应及心肌细胞钙超载有关。     

黄芪对急性心肌梗塞溶栓后再灌注损伤中心肌顿抑功能恢复的促进作用的研究

目的探讨黄芪对急性心肌梗塞（AMI）溶栓后再灌注损伤中顿抑心肌功能恢复的促进作用。方法将110例溶栓后冠脉再通的AMI患者随机分为治疗组（56例）和对照组（54例）。对照组采用常规尿激酶溶栓治疗和肝素抗凝，而治疗组在对照组的治疗基础上加用黄芪针每次30ml静滴，1次／d，连用3周。结果再灌注后心肌均表现不同程度顿抑现象，两组顿抑程度并无显著差异（P〉0．1），但随着时间推移追踪观察发现治疗组顿抑心肌功能恢复时间明显短于对照组（P〈0．01）。结论黄芪对溶栓后再灌注心肌有较强的保护作用，可提早恢复顿抑心肌的功能。     

缺血预处理结合心麻痹液保护未成熟兔心肌的效果

目的 探讨缺血预处理（IPC）结合心麻痹液对未成熟兔心肌的保护作用。方法 采用体外左心作功模型,比较缺血5min再灌注5min的缺血预处处理加ST.ThomasⅡ液（IPC组）和仅ST,ThomasⅡ液（对照组）对幼兔（3-4周）心脏缺血再灌注后心脏功能,冠脉微循环、能量代谢及超微结构的影响。结果 IPC组心脏收缩功能、冠脉流量及阻力恢复更佳,冠脉流出液中的一氧化氮含量较高而内皮素较低,能量物质含量高,心肌细胞超微结构的影响。结果 IPC组心脏收缩功能、冠脉流量及阻力恢复更佳,冠脉流出液中后 氧化氮含量较高而内皮素较低,能量物质含量高。心肌细胞超微结构损害轻,结论 缺血预处理结合心麻痹液对未成熟兔心肌提供更佳的保护。     

心肌顿抑的研究进展

心肌顿抑(myocardlal Stunnlng)是心肌短暂缺血后再灌注心功能延迟恢复的现象.研究表明氧自由基、钙超载、能量代谢障碍及微血管痉挛均参与其发病过程,并且心肌顿抑时伴有多种基因表达的改变,积极防治心肌顿抑,保护心功能,将为治疗缺血性心脏病提供新的策略.     

心肌活力评价的研究进展

1概述伴左室（LV）功能障碍的冠心病（CAD）患者经血管重建（GABG／PTCA）治疗后，功能可以得到恢复。功能障碍室壁冬眠心肌[1]（hiberatingmyocardium）和顿抑心肌[2]（stunnedmyocndium，SM）的存在是主要原因。HM是指长期低血流灌注心肌，能量代谢不能满足心肌收缩却足以维持心肌结构的完整性，而当血流恢复灌注后心肌功能可以改善或恢复；主要存在于慢性CAD。SM指心肌急性缺血及再灌注血流恢复后功能延迟恢复，临床见于急性心梗溶栓治疗和不稳定心绞痛及运动诱发缺血等。两者均为暂存功能障碍的存活心肌，且经治疗功能可恢复。…     

大鼠心肌顿抑模型中血管紧张素Ⅱ受体表达的实验研究

目的：探讨大鼠心肌顿抑（Ms）之后血管紧张素Ⅱ1型受体（ATR1）和2型受体（ATR2）在缺血再灌注之后表达的变化。方法：将48只大鼠随机分为6组,每组8只：A组（对照组）、B组（MS后1h）、C组（MS后4h）、D组（MS后8h）、E组（MS后24h）、F组（MS后72h）。经过HE染色后观察大鼠的心肌组织结构,免疫组化SP法观察心肌ATR1、ATR2细胞的定位以及表达的变化。结果：大鼠心肌顿抑模型心肌组织结构HE染色检查无明显变化,免疫组化检查发现心肌顿抑后ATR1和ATR2都呈现动态变化,顿抑后1h两者都升高,其中ATR2达到峰值,在顿抑后4hATR1达到峰值,而后两者都呈现缓慢下降的趋势,到顿抑后72h,均达到最低值,但是此时ATR2高于ATR1,仍然维持较高的水平,ATR2表达增高可能发挥对心肌的保护作用。结论：ATR1在心肌顿抑后4h后达到峰值,ATR2在1h后达到峰值,心肌顿抑后可能通过局部的RAS系统激活,细胞内钙离子超负荷,ATR1表达上升后可能损伤心肌功能;ATR2表达上升则可能发挥对心肌的保护功能,早期阻断ATR1,提高ATR2可能对于心肌顿抑后心功能的恢复有帮助。     

斑点追踪技术在评价犬心肌不同顿抑状态力学特征中的应用

目的：应用斑点追踪技术评价犬不同顿抑状态心肌与正常心肌的力学参数差异及动态变化过程。方法制作冠状动脉左前降支阻断后再灌注犬心肌顿抑模型,分为短顿抑组（阻断15 min）、长顿抑组（阻断45 min）和假手术组（不阻断）。分别于阻断前、再灌注即刻、再灌注10、30、60、90、120 min对心肌的径向应变、环向应变参数进行比较。结果再灌注即刻,长顿抑组缺血心肌的径向应变、环向应变（绝对值）低于结扎前及假手术组（P＜0.01）,且低于短顿抑组缺血心肌（P＜0.05）,短顿抑组缺血心肌的径向应变低于结扎前及假手术组（P＜0.01）,短顿抑组缺血心肌的环向应变（绝对值）低于结扎前及假手术组（P＜0.05）;至再灌注30 min,上述指标进一步降低。再灌注60、90、120 min时,长顿抑组和短顿抑组缺血心肌径向应变及环向应变（绝对值）有所恢复,但仍低于基础状态和假手术组（P＜0.05,P＜0.01）。再灌注120 min时长顿抑组缺血心肌径向应变低于短顿抑组（P＜0.05）。结论斑点追踪技术可以定量评估不同顿抑状态的心肌力学差异及其动态变化,能为临床治疗和疗效评价提供有力证据。     

茶多酚改善大鼠缺血/再灌注心脏功能和能量代谢并抑制体外培养心肌细胞的钙内流

目的：探讨茶多酚对缺血/再灌注心脏损伤的保护作用,并研究心脏能量代谢和心肌细胞钙内流是否参与了心脏缺血/再灌注损伤的保护作用。方法在大鼠Langendorff离体心脏上实施缺血/再灌注各30 min,用一导管经压力换能器连接放大器记录心功能指标;用31P NMR技术测定心脏的能量代谢,全细胞膜片钳技术记录心肌细胞钙内流。结果与对照组比较,茶多酚（2.5 mg/L）能使缺血/再灌注心脏的心室发展压、左心室压最大收缩速率（+dp/dtmax）、左心室压最大舒张速率（-dp/dtmax）和冠脉流量显著增加（P<0.05）,并显著改善缺血/再灌注心脏的能量代谢,增加心肌ATP和PCr含量（P<0.05）。浓度为2.5和5.0 mg/L的茶多酚均能显著抑制培养心肌细胞的钙内流（P<0.01）。结论茶多酚对大鼠离体心脏缺血/再灌注损伤的保护作用可能与其改善心肌能量代谢、抑制心肌细胞钙内流的作用有关。     

益心口服液对大鼠体外心脏缺血再灌注损伤心功能的影响

心肌缺血再灌注后心肌血流灌注虽然恢复，但可引起心肌较长时间的功能障碍以及机械性和某些生理学指标异常，主要表现为心肌收缩功能异常、恢复延迟，称为心肌顿抑。目前防止再灌注损伤心肌顿抑主要从缺血预适应方面考虑，本实验利用大鼠体外心脏缺血再灌注损伤模型，观察中药复方益心     

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.