谷氨酰胺对内毒素性急性肺损伤大鼠肺组织细胞间黏附分子1的影响

目的:探讨谷氨酰胺(GLN)对内毒素致急性肺损伤大鼠肺组织细胞间黏附分子1基因(ICAM-1mRNA)及ICAM-1蛋白表达的影响。方法:静脉注射脂多糖(LPS)5mg/kg复制大鼠急性肺损伤模型,雄性SD大鼠50只随机分为5组。对照组、脂多糖组、谷氨酰胺预先给药组、谷氨酰胺即时给药组、谷氨酰胺延迟给药组,分别于LPS注入前1h,LPS注入即刻,LPS注入后1h,均静脉注射谷氨酰胺0.75g/kg。所有动物于注射LPS4h后颈动脉放血处死,逆转录聚合酶链反应检测肺组织ICAM-1mRNA表达水平,免疫组化法检测肺组织ICAM-1蛋白表达,HE染色光镜下观察肺组织形态学变化。结果:同脂多糖组相比,谷氨酰胺预先给药和谷氨酰胺即时给药使内毒素性急性肺损伤肺组织ICAM-1mRNA及ICAM-1蛋白表达减少,HE染色光镜下可见肺部炎症反应减轻。结论:谷氨酰胺早期给药对内毒素性急性肺损伤起保护效应,作用机制可能与抑制肺组织细胞间ICAM-1的过多生成有关。     

谷氨酰胺对脂多糖致急性肺损伤大鼠肺组织核因子-κB的影响

目的 探讨谷氨酰胺对脂多糖致急性肺损伤大鼠肺组织核因子(NF)-κB和肺组织病理学变化的影响.方法 静脉注射脂多糖(LPS)5mg/kg复制大鼠急性肺损伤模型.雄性SD大鼠50只,随机分为5组(n=10):对照组(A组);LPS组(B组);C、D、E组为谷氨酰胺+LPS组,分别于LPS注入前1 h、LPS注入同时、LPS注入后1h,静脉注射谷氨酰胺0.75g/kg.于注射LPS后4 h处死动物,测定肺组织NF-κB mRNA表达、肿瘤坏死因子-α(TNF-α)含量、超氧化物歧化酶(SOD)活性以及丙二醛(MDA)含量,HE染色光镜观察肺组织病理变化.结果 与B组比较,C、D组不同程度逆转肺组织SOD活性的下降,抑制肺组织NF-κB mRNA、TNF-α及MDA水平的升高(P＜0.01),光镜下可见肺组织损伤明显减轻.E组上述指标改善不明显.结论 谷氨酰胺早期给药对脂多糖性急性肺损伤起保护效应,其机制与抑制肺组织NF-κB mRNA的过度表达,从而抑制肺部炎症反应有关.     

丙氨酰谷氨酰胺对脓毒症大鼠肺损伤的保护作用

目的：探讨丙氨酰谷氨酰胺对脓毒症大鼠急性肺损伤的保护作用及其机制。方法：静脉注射内毒素（LPS）3mL（6mg／kg）复制大鼠脓毒症急性肺损伤模型，40只健康Wistar大鼠，分为4组，即对照组（静脉注射等量生理盐水28mL／kg）、内毒素组[先后静脉注射生理盐水25mL／kg和内毒素3mL／kg（6mg／kg）]、丙氨酰谷氨酰胺治疗组[先后静脉注射4．5％力太（丙氨酰谷氨酰胺注射液）25mL/kg和内毒素3mL／kg（6mg／kg）]、谷氨酰胺治疗组[先后静脉注射3％谷氨酰胺25mL／kg和内毒素3mL／kg（6mg／kg）]。在静脉注射前（T0），注射后6h（T1），各抽血1mL。注射6h后，处死大鼠，用EusA法测定各时点血清TNF-α，IL-1β，IL-8的浓度，测定肺组织湿／干重比、支气管肺泡灌洗液的总蛋白浓度，光学显微镜下观察肺组织病理改变，原位TUNEL技术进行肺组织细胞凋亡检测分析。结果：与LPs组比较，丙氨酰谷氨酰胺治疗组、谷氨酰胺治疗组的肺组织湿／干重比、支气管肺泡灌洗液的总蛋白浓度，血清TNF-α，IL-1β，IL-8浓度明显降低（P＜0．05）；丙氨酰谷氨酰胺治疗组、谷氨酰胺治疗组的肺组织损伤程度明显减轻而且凋亡指数也较LPS组显著降低（P＜0．05）。结论：静脉给予丙氨酰谷氨酰胺对脓毒症大鼠急性肺损伤有保护作用。     

肝素减轻内毒素致大鼠急性肺损伤的实验研究

目的探讨不同剂量肝素减轻内毒素（LPS）诱导大鼠急性肺损伤（ALI）的作用。方法股静脉注射LPS5mg/kg建立大鼠ALI模型。50只雄性SD大鼠随机分为5组：对照组（A组）;LPS组（B组）;C1-C3组为肝素＋LPS组,分别于LPS注入即刻静注肝素250u/kg,500u/kg,1000u/kg,每组10只。于LPS注射4h后行血气检测并股动脉放血处死大鼠,取肺组织测定肺组织湿/干重比、肺组织丙二醛（MDA）,取支气管肺泡灌洗液（BALF）检测肿瘤坏死因子-a（TNF-a）水平和蛋白浓度,光镜下观察肺组织形态学变化。结果B组肺湿/干重比、肺组织MDA、BALF中TNF-a水平和蛋白浓度显著增高;PaO2、PaCO2、BE值明显降低;光镜下肺组织损伤程度增加。C1-C3组各项指标均较内毒素组减轻,但随着剂量增大出血并发症增加。结论肝素早期给药可以减轻内毒素致急性肺损伤,250u/kg为最佳治疗剂量。     

内毒素致新生SD大鼠肺损伤模型的建立及鉴定

目的:探讨新生大鼠急性肺损伤模型的建立及其病理特征。方法:采用腹腔注射内毒素(LPS,5 mg/kg)的方法制备新生SD大鼠急性肺损伤动物模型,在光镜下观察肺的病理变化,观察支气管肺泡灌洗液(BALF)中细胞分类情况,用ELISA、RT-PCR法检测血清和肺组织中白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的表达。结果:LPS注射3 h后,光镜下可见明显的肺出血和中性粒细胞浸润;肺湿/干重比(W/D)增加,BALF中多形核白细胞(PMN)数量明显增加,血清中TNF-α和IL-6表达水平和肺组织中TNF-αmRNA水平均显著增高。结论:新生SD大鼠腹腔注射LPS后,能够引起显著的急性肺部炎症反应。     

体外膜肺氧合对急性肺损伤治疗的实验研究

目的 探讨体外膜肺氧合(ECMO)对内毒素(LPS)诱导大鼠急性肺损伤(aLI)的治疗效果.方法 LPS静脉注射复制大鼠急性肺损伤模型.40只健康雄性SD大鼠随机分为4组:LPS组(L组:静脉注射LPS)、对照组(C组:静脉注射生理盐水)、机械通气治疗组(LV组:ALI模型制备成功后,行机械通气2h)、ECMO治疗组(LE组:ALI模型制备成功后,行机械通气及ECMO治疗2h),每组10只.实验结束时,将4组大鼠在无菌条件下开胸取出两肺,取左肺下叶同一部位小块肺组织,测定肺湿/干质量比值;取右肺下叶同一部位两小块组织,分别用于HE染色观察肺组织的病理改变及作TUNEL法观察细胞凋亡数.结果 与C组比较,L组的肺组织湿/干质量比值增加(P<0.01);与L组比较,LV组、LE组的肺组织湿/干质量比值减少(P<0.05);LV组和LE组的肺组织湿/干质量比值差异无显著性(P>0.05).与C组比较,L组、LV组与LE组的肺组织凋亡指数升高(P<0.01);与L组比较,LE组的凋亡指数下降(P<0.05),L组和LV组的肺组织凋亡指数差异无显著性(P>0.05);与LV组比较,LE组的凋亡指数下降(P<0.05).凋亡指数分级为:C组0级,L组3级,LV组3级,LE组2级.光镜下观察发现L组的肺组织损伤及细胞凋亡程度最为严重,LV组次之,而LE组较LV组减轻.结论 体外膜肺氧合对内毒素诱导大鼠急性肺损伤有治疗作用.     

升压宁对内毒素休克肺损伤大鼠TNF-α和iNOS的影响

目的:观察升压宁对内毒素休克肺损伤大鼠肺组织中肿瘤坏死因子-α(TNF-α)和诱导型一氧化氮合酶(iNOS)的影响.方法:采用一次性静脉注射内毒素(LPS)10 mg/Kg复制内毒素休克模型.以升压宁预处理动物,并以地塞米松为阳性对照,HE染色光镜下观察肺脏的组织形态学变化;免疫组化法测定肺组织中TNF-α和iNOS的表达.结果:内毒素休克模型组存在严重肺损伤,肺组织中TNF-α和iNOS表达较空白对照组显著增强(P<0.01),升压宁组肺损伤较模型组减轻,TNF-α和iNOS的表达与模型组比较显著降低(P<0.01).结论:升压宁能减轻内毒素休克肺损伤,其机理与抑制TNF-α和iNOS的表达有关.     

内毒素性急性肺损伤小鼠肺组织中炎症介质的表达

目的 探讨内毒素性急性肺损伤过程中两类炎性介质的相互关系及其变化规律.方法 腹腔注射脂多糖(LPS)(20mg/kg)建立小鼠急性肺损伤模型.用放射免疫(ELISA)法分别测定各组各时相点肺组织匀浆上清液中TNF-α、IL-8、IL-10 3种细胞因子的含量,同时观察肺组织形态学改变,进行肺湿/干重比(W/D)测定.结果 与对照组比较,ALI组各时相点小鼠肺组织中3种炎症因子水平及W/D值均明显上升,差异有统计学意义(P＜0.05),表达峰值时间:TNF-α为4h,IL-8为2h,而IL-10为8h.结论 内毒素性急性肺损伤过程中相继发生了促炎反应和抗炎反应,促炎/抗炎失衡,炎症反应失控,可能是内毒素肺损伤的重要机制.     

抑制补体对内毒素致急性肺损伤的保护作用

目的 探讨抑制补体对内毒素致急性肺损伤的保护作用.方法 采用眼镜蛇毒因子(CVF)去除补体.以脂多糖(LPS)造成大鼠急性肺损伤.将40只健康雄性SD大鼠随机分为LPS损伤组、3个不同时间CVF组和生理盐水对照组.通过大鼠尾静脉注射5 mg/kg LPS,造成急性肺损伤模型.CVF组于注射LPS 前24 h,通过尾静脉注射50 u/kg CVF去除补体.在给予LPS后分别于0.5、2、4 h采集标本.分别测定各组血清补体活性和蛋白含量、肺泡灌洗液(BALF)中蛋白、TNF-α、IL-8、ICAM-1含量及多形核白细胞(PMN)比、计算肺通透指数(LPI )、测定肺湿/干质量比、检查肺组织病理学变化情况等.结果 LPS组肺间质水肿、出血,大量炎性细胞浸润,而CVF组肺组织损伤明显轻于LPS组; CVF组肺湿/干质量比、LPI、PMN比均明显低于LPS组(P<0.05),与对照组比较差异无统计学意义.而CVF各组BALF 中TNF-α、IL-8、ICAM-1浓度均低于LPS组,但差异无统计学意义.结论 补体在内毒素致急性肺损伤早期具有重要作用,抑制补体可以有效减轻肺组织损伤,减少肺组织液渗出和中性粒细胞聚集.     

沐舒坦注射液对大鼠急性肺损伤作用的研究

目的：观察沐舒坦对大肠杆菌内毒素脂多糖（lipopolysaccharide,LPS）所致大鼠急性肺损伤（acute lung injury,ALI）的作用,探讨其可能的作用机制。方法：将30只大鼠随机分为正常对照组（C组）、脂多糖组（L组）、沐舒坦组（M组）,每组10只。均经尾静脉注射,C组给予1 m L生理盐水,另2组给予LPS 5 mg/kg;M组再给予沐舒坦15 mg/kg,注射后观察4 h,测量肺湿干重比（W/D）、动脉血及肺组织肿瘤坏死因子-α（Tumor necrosis factor-α,TNF-α）、肺组织核因子-κB（Nuclear factor–kappa B,NF-κB）表达水平,观察肺组织形态学改变,并做病理切片进行显微镜下的形态学比较。结果：大鼠注射LPS后,嘴唇发绀、毛发竖起、呼吸深快、不活动、拒绝饮水、排稀便、抓取时无力逃避、肺部闻及大量湿啰音,注射沐舒坦后症状减轻;M组肺W/D、血清和肺组织TNF-α以及肺组织NF-κB表达细胞阳性率较L组降低,但高于C组;L组光镜下见肺微血管充血水肿、微血栓形成、肺间质和肺泡腔内大量炎症细胞聚集和浸润、肺泡间隔明显增厚,M组上述改变较轻。结论：炎症反应是LPS引起大鼠ALI的因素之一,沐舒坦对LPS所致大鼠ALI有保护作用。     

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.