评价含抑肽酶肺保护液疗效的实验研究

目的：利用兔在体肺保存模型．评价含抑肽酶的改良肺保护液对肺的保护作用。方法：新西兰白兔30只,随机分为对照组、低钾右旋糖酐液（LPD液）组、抑肽酶组．每组10只。制备免在体左肺保存模型,对照组仅阻断肺门和冷藏．不灌肺保护液,LPD液组和抑肽酶组分别经肺动脉插管,在体灌注LPD液和含抑肽酶的LPD液,完毕后将左肺下叶放入特制的肺保存器内在体低温冷藏2h．移去肺保存器。开放肺门再灌注2h。在实验过程中抽取肺静脉血标本行血气分析,取肺组织行病理学检查．同时检测支气管灌洗液中性粒细胞百分比及肺湿／干重比以评价肺保存效果。结果：抑肽酶组再灌注5min和2h两个时间点肺静脉血氧分压显著高于LPD液组和对照组（P〈0．05）。抑肽酶组肺泡出血及肺结构损害分级均较对照组及LPD组轻微（R0．05）。肺湿／干重比抑肽酶组较对照组和LPD液组均有非常显著的差异（P〈0．01）。结论：含抑肽酶的肺保护液对肺的保护效果确切,其保护作用明显优于单纯LPD液。     

丹参酮在离体肺保护中应用的实验研究

目的本研究是探讨丹参酮对离体肺保护的作用。方法以离体兔肺模型为肺保护实验对象，以肺动脉灌洗再次肺动脉灌注为实验方法，以新西兰兔为实验动物，随机分为两组。一组用LPD液行肺动脉灌洗和保存．另一组用丹参酮加LPD液组成实验组，用同样的方法灌洗和保存。保存18h后，观察病理形态、含水量以及测量NO（一氧化氮）、SOD（超氧化物歧化酶）及MDA（丙二醛）的含量。结果肉眼见组织新鲜红润，部分组织充血、水肿及淤血；光镜下两组的肺泡、支气管及毛细血管结构完整，高倍视野下对照组较实验组肺泡上皮及毛细血管上皮细胞肿胀、肥大，少部分组织可见肺泡内有红细胞渗出、间隔增宽等。实验组的含水量低于对照组（P〈O．05）。实验组肺组织中的NO及SOD含量高于对照组（P〈O．05）．MDA含量低于对照组（P〈O．05）。结论丹参酮能清除氧自由基，有较强的抗氧化性，能较明显的减轻肺的再灌注损伤。在LPD液中加入丹参酮，能够对离体肺起到更好的保护效果。离体兔肺再灌注模型是一种较理想的实验动物模型。     

蛇床子素注射液对心肺联合移植供肺保护作用的实验研究

目的：研究蛇床子素注射液（Osthole injection）在心肺联合移植中对供肺的保护作用及可能机制。方法：将健康成年犬20只随机分为两组，对照组以4℃低钾右旋糖酐（Low—Potassium Dextran LPD）液灌注及保存供肺，实验组以4℃含蛇床子素注射液（40mg／kg）的LPD液灌注及保存供肺。分别监测受体麻醉后和心肺移植后主动脉开放5min和主动脉开放30min的血气分析（PaO2、PaCO2），测定肺组织中超氧化物歧化酶（SOD）、丙二醛（MDA）的含量及肺组织的湿／干重比（W／D），并观察移植肺组织的超微结构变化。结果：实验组动物PaO2高于对照组（P〈0．05，P〈0．01），主动脉开放5min PaCO2明显低于对照组（P〈0．05）。实验组肺组织中sOD的含量较对照组增高（P〈0，01），MDA的含量较对照组降低，差异有显著性（P〈0．05）。实验组较对照组的W／D低，差异有显著性（P〈0．05）。电镜检查实验组的肺组织损伤明显轻于对照组。结论：蛇床子素注射液可改善移植肺的肺功能，减轻供肺损伤，增加心肺联合移植的成功率。     

Euro-Collins液、LPD液、前列腺素E1及硝酸甘油对离体肺保护作用的比较

目的 应用兔离体肺再灌注模型研究Euro-Collins液，低钾保护液（LPD）及LPN液（前列腺素E1，硝酸甘油加入LPD）在离体肺保护中的作用。方法 27只实验用兔随机分为3组（n=9)，分别以Euro-Collins液（E组），LPD液（L组）及LPN（LPN组）进行肺灌洗及保存。每组再分为3小组（各含6个肺）分别保存2，4，8h后进行再灌注，测定再灌注后肺血管阻力（PVR),肺通气阻力（LR），肺含水量（LW）及PO2以了解肺保护效果。结果 保存8h后E组LR显著增高，且明显高于L组及LPN组LPN组PVR在保存各时间明显低于E组及L组。结论 LPN组在保护肺血管内皮细胞及降低肺血管阻力方面优于E组及L组，作用机制可能通过扩张肺动脉，改善肺早期灌洗及抑制中性粒细胞，血小板在肺内聚集而减轻肺再灌注损伤。     

乌司他丁对缺血再灌注肺组织细胞间黏附分子-1和P-选择素基因mRNA表达的影响

目的探讨乌司他丁（UTI）对在体缺血再灌注后肺组织细胞间黏附分子（ICAM）-1和P-选择素基因mRNA表达的影响。方法新西兰兔18只随机分为3组：低钾右旋糖酐液（LPD）组、UTI组和对照组。建立兔在体肺缺血冷存再灌注模型,阻断左肺门后将左肺下叶在体冷存于10℃肺保存器内2 h,再灌注2 h。LPD组灌注LPD液,UTI组灌注含UTI的LPD液,对照组不灌注肺保护液。分别于左肺门阻断前、缺血2 h、再灌注2 h取左肺组织,以RT-PCR技术检测ICAM-1和P-选择素基因mRNA表达。结果缺血2 h及再灌注2 h,UTI组ICAM-1基因mRNA表达量显著低于LPD组和对照组;再灌注2 h,LPD组和对照组P-选择素基因mRNA的表达量明显高于缺血前和缺血2 h,UTI组则无明显变化。结论乌司他丁可抑制缺血冷存再灌注后肺组织ICAM-1和P-选择素基因mRNA表达上调,有利于肺保护。     

依达拉奉对离体兔肺脏保存效果的实验研究

目的探讨依达拉奉对离体兔肺脏保存质量的影响。方法健康大白兔12只,按照随机原则,分为LPD组(n=6)和E组(n=6)。LPD组用低钾右旋糖酐(LPD)液行肺灌洗及肺保存,E组用含依达拉奉20 mg/L的LPD液行肺灌洗及肺保存。实验结束时取肺静脉血标本作血气分析及制备血清测定丙二醛(MDA)含量与超氧化物歧化酶(SOD)活性;取肺组织标本测干/湿重及送病理。结果两组肺静脉血PaO2、PaCO2、血浆丙二醛(MDA)含量及SOD活性、肺组织干/湿重比(D/W)均无显著差异(P>0.05)。肺组织病理结果显示两组均有肺组织毛细血管轻度充血,肺泡结构尚可,肺泡间质少量粒细胞浸润,肺泡腔内轻度渗出及少量红细胞。结论在离体冷保存6 h再灌注的兔肺模型,依达拉奉未显示出明显优于低钾右旋糖酐液(LPD)的保护效果。     

ATP敏感的钾通道开放剂对离体肺保护的实验研究

目的研究ATP敏感的钾离子通道开放剂(PCOs)吡那地尔(pinacidil)在离体兔肺保护中的作用。方法将18只杂种灰色家兔随机分成3组,建立离体肺缺血再灌注模型。对照组(n=6)以自体温血直接再灌注2 h;缺血组(n=6)用低钾右旋糖酐保存液(LPD) 二甲基亚砜(DMSO)灌洗,4℃保存8 h后自体温血再灌注2 h;实验组(n=6)用LPD 100μmol.L-1吡那地尔(溶于DMSO中)灌洗,4℃保存8 h后自体温血再灌注2 h。每隔30 min分别经肺动脉和左房插管取血行血气分析,评估离体肺功能;测量湿/干重比,估计肺水含量;光镜下行肺组织形态学检查;制作肺组织匀浆测定超氧化物歧化酶(SOD)、肿瘤坏死因子-α(TNF-α)和白细胞介素-8(IL-8)含量。结果实验组氧分压差(ΔPO2)和SOD与缺血组比较明显升高(P<0.05);组织形态学检查显示,实验组损伤较缺血组轻;实验组的TNF-α和IL-8含量明显低于缺血组(P<0.05)。结论在保存时间不超过8 h的情况下,用加入吡那地尔的LPD灌洗和保存肺能更好地保护肺功能。     

环磷酰胺对兔离体肺保护的作用

目的 应用兔离体肺再灌注模型研究环磷酰胺对兔离体肺保护的作用。方法 20只实验兔随机平均分为两组,对照组术前腹腔注射生理盐水10 ml,实验组术前腹腔注射环磷酰胺50 mg/kg（溶解在10 ml生理盐水中）。48 h后进行实验,由实验兔右室流出道尽量抽取兔血,造成肺组织热缺血。1 h后以低钾右旋糖苷肺保护液（LPD）进行肺灌洗及保存,保存4 h后用开始时抽取的兔血进行再灌注。再灌注10 min、30 min、60 min分别测定肺血管阻力（PVR）、肺通气阻力（LR）、以及肺静脉血氧分压（PvO2）,再灌注结束后取肺组织进行肺含水量（LW）测定以了解肺保护效果。结果 实验组再灌注后PVR明显低于对照组（P〈0.05）,PO2明显高于对照组（P〈0.05）。LR、LW两组无明显差别。结论 环磷酰胺对兔离体肺保存具有一定保护作用,其可能的机制是通过免疫抑制以及细胞毒作用减轻了炎性反应。     

体外循环中低流量肺动脉灌注对肺功能的影响

 【目的】探讨体外循环中低流量肺动脉灌注对肺功能影响的作用机理。【方法】体质量18-22kg的杂种犬10只，随机分为对照组（n=5）和肺灌注组（n=5）。常规建立体外循环。肺灌注组用氧合血30mL／（kg·min）灌注肺动脉。分别于转流前，停体外循环即刻，转流后1h，转流后2h采集数据，计算氧合指数、肺动态顺应性。检测肺静脉血丙二醛（MDA）、超氧化物歧化酶（SOD）、细胞间黏附分子1（ICAM-1）和P选择素。【结果】转流后肺灌注组犬的肺动态顺应性和氧合指数明显高于对照组（P〈0．05）。两组肺静脉血MDA和SOD总体差异有统计学意义（P〈0．05），肺灌注组MDA含量低于对照组，SOD活性高于对照组。肺灌注组肺静脉血ICAM-1、P选择素含量均低于对照组（P〈0．05）。【结论】低流量持续肺动脉灌注通过减轻肺缺血再灌注损伤和粘附分子的激活来降低体外循环中的肺损伤。     

单肺移植的手术方法

通常供肺离体后缺血时间不能超过6h，缺血时间超过5h，其生存率下降。因此，应尽可能缩短移植器官的缺血时间。现在大多数医院应用专为肺移植发展的细胞外低钾右旋糖酐液LPD(low-potasium dexfran)为肺灌注液，并在此基础上进行了改良，加入棉子糖及前列腺素EI。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.