主动脉转流对内脏缺血再灌注损伤的影响

目的：探讨不同流量主动脉转流对腹主动脉暂时性阻断所引起肝，肾和小肠等内脏缺血再灌注损伤的影响。方法：实验建立在小猪腹腔动脉开口以上阻断腹主动脉１ｈ和同时辅助主动脉转流的模型，检测在不同再灌注时点肝，肾，小肠组织及血液呈内二醛和超氧化物歧化酶的变化，同时检测主要肝肾功能，动脉血气分析。     

兔低位腹主动脉阻断后肢体缺血再灌注损伤指标变化的观察

目的观察兔低位腹主动脉阻断后肢体缺血再灌注损伤相关指标的变化及动物生存情况。方法建立兔腹主动脉阻断1 h、1.5 h的模型,检测阻断前、再灌注不同时点血液中丙二醛（MDA）和超氧化物歧化酶（SOD）的变化,并观察术后1周的生存情况。结果与对照组比较,阻断1 h组（B1）再灌注时点血液中MDA升高,SOD降低不明显（P〉0.05）;阻断1.5 h组（B2）再灌注时点血液中MDA升高,SOD降低（P〈0.05）。阻断1 h生存组（B3）,8只兔子均健康成活,术后动物后肢神经功能评分5级,不影响生存及下肢功能;阻断1.5 h生存组（B4）,有5只兔子成活,术后动物后肢神经功能评分3～4级,影响生存及下肢功能。结论兔低位腹主动脉阻断应控制在1 h以内。     

暂时低位腹主动脉阻断患者T-SOD及MDA的变化和临床意义

目的 研究暂时低住腹主动脉阻断技术临床应用的缺血-再灌注损伤风险.方法 选择子暂时低位腹主动脉阻断行骨盆或骶尾部肿瘤全切除术患者(A组)和腰椎病损或骨折行侧前入路行腰椎次全切除术患者(B组)各14例,测定和观察手术前后不同时间点静脉血浆T-SOD、MDA的数值和变化.结果 A组单次阻断时间52～84 min,平均68 min,无一例重复阻断.与阻断前比较,大多数再灌注时点血中MDA明显升高,而SOD明显降低(P<0.05),但再灌注后4 h两观察指标基本恢复到缺血期水平;B组各时间点间T-SOD、MDA值变化不大(P>0.05).结论 单次低位腹主动脉阻断时间≤68 min有一过性缺血一再灌注损伤表现.但损伤轻微并短时间内恢复,阻断时限内低位腹主动脉阻断技术是有效和安全的.     

暂时低位腹主动脉阻断患者T-SOD、MDA的变化和临床意义

目的 研究暂时低位腹主动脉阻断技术临床应用的缺血－再灌注损伤风险。方法 选择予暂时低位腹主动脉阻断行骨盆或骶尾部肿瘤全切除术患者（A组）和腰椎病损或骨折行侧前入路行腰椎次全切除术患者(B组)各14例,测定和观察手术前后不同时间点静脉血浆T-SOD,MDA的数值和变化。结果 A组单次阻断时间52～84min,无一例重复阻断。与阻断前比较,大多数再灌注时点血中MDA明显升高,而SOD明显降低(P<0．05),但再灌注后4h两观察指标基本恢复到缺血期水平;B组各时间点间T-SOD,MDA值变化不大（P＞0.05）。结论 单次低位腹主动脉阻断时间≤90min有一过性缺血-再灌注损伤表现,但损伤轻微并短时间内恢复,阻断时限内低位腹主动脉阻断技术是有效和安全的。     

丙泊酚后处理及缺血后处理对兔脊髓缺血再灌注损伤的影响

目的探讨丙泊酚后处理及缺血后处理对脊髓缺血再灌注损伤的影响。方法健康新西兰白兔32只,体重2.0～3.0 kg,随机分为4组,每组8只。假手术组仅行手术操作不阻断腹主动脉;模型(IR)组行单纯缺血再灌注;丙泊酚后处理(PA)组阻断腹主动脉30 min,再灌注即刻经肾下腹主动脉泵注丙泊酚;丙泊酚后处理联合缺血后处理(PB)组阻断腹主动脉30 min,再灌注30 s,再阻断30 s,反复3次全面恢复灌注,同时泵注丙泊酚。再灌注48 h比较各组脊髓组织中丙二醛(MDA)和超氧化合物歧化酶(SOD)含量;采用tartor评分法对后肢神经功能评分。结果 PA组和PB组后肢神经功能明显优于IR组(P<0.05);与IR组比较,PA组和PB组中MDA含量明显降低,SOD含量显著上升。结论丙泊酚后处理及缺血后处理抑制在灌注后氧自由基生成、增强抗氧化酶活性发挥对脊髓损伤的保护作用。     

卡托普利对家兔急性肾缺血再灌注损伤的保护作用

目的:探讨卡托普利(Captopril,CAP)对家兔肾上腹主动脉阻断所致急性肾缺血再灌注损伤(Acute Renal Ischemia-reperfusion Injury,ARIRI)保护效果。方法:于肾上阻断腹主动脉30min再灌注180min制成双侧急性肾缺血再灌注损伤(ARIRI)动物模型。将家兔24只,随机等分为假手术组、缺血再灌组和CAP治疗组。CAP治疗组于阻断腹主动脉前5min静注CAP 2mg/kg,继以微量泵持续输注15minCAP 0.5mg/(kg.h)。假手术组、缺血再灌组则以同样方法静注等容积生理盐水取代CAP,假手术组不阻断主动脉血流。动态检测血中尿素氮(BUN),肌酐(Cr),超氧化物歧化酶(SOD),丙二醛(MDA),血管紧张素Ⅱ(AT-Ⅱ),尿β2-微球蛋白(β2-MG)变化,以及肾皮质中SOD、丙二醛,AT-Ⅱ和肾组织形态学改变。接多导生理记录仪连续观察血压、呼吸、心电图的变化。结果:CAP治疗组在再灌注期血和肾皮质中丙二醛、AT-Ⅱ浓度明显低于缺血再灌组(P<0.01),SOD活性显著高于缺血再灌组(P<0.01),血尿素氮,肌酐及尿β2-微球蛋白含量明显低于缺血再灌组(P<0.05,<0.01)。CAP治疗组光镜下肾小管损伤Paller评分明显低于缺血再灌组(20.50±7.56vs82.50±16.69,P<0.05),缺血再灌组电镜见急性肾小管损伤及坏死,而CAP治疗组肾小管损伤轻微。结论:CAP对家兔肾上腹主动脉阻断所致ARIRI有良好的保护作用。     

腹主动脉转流对阻断所致脊髓缺血损伤的保护作用

目的 研究主动脉转流对阻断所致脊髓缺血损伤的保护.方法 选择24只健康小猪,随机分为3组:对照组、阻断组和70%转流组.阻断组在腹腔上动脉开口以上1 cm处阻断腹主动脉;70%转流组在阻断腹主动脉的同时行主动脉转流;对照组除不阻断腹主动脉外,其余操作同阻断组.术中监测动脉压、动脉血气、肝肾功能、尿量.术后观察小猪生存和截瘫情况,术后1个月观察截瘫恢复状况及肝肾功能并行病理学检查.结果 阻断组小猪术后1只死亡,全部出现截瘫,且不能恢复;阻断解除后,机体出现严重酸中毒;阻断腹主动脉1 h会引起肝肾功能损害,但能恢复.转流组小猪无死亡、无截瘫;阻断解除后,机体无酸中毒;肝肾功能也不会出现损害.病理结果显示:术后1个月时各组小猪的肝、肾组织病理学检查未发现异常.转流组小猪腰段脊髓病理切片未见异常改变;阻断组小猪在受损平面以下脊髓灰质前角呈液化坏死灶改变,神经元消失.结论 70%的转流量能很好地保护阻断所致的脊髓损害,且能达到个体化的目的.     

卡托普利对家兔急性肾缺血再灌注损伤的保护

目的 :探讨卡托普利 (Captopril,CAP)对家兔肾上腹主动脉阻断所致急性肾缺血再灌注损伤(AcuteRenalIschemia -reperfusionInjury ,ARIRI)保护效应。方法 :于肾上阻断腹主动脉 30min再灌注1 80min制成ARIRI动物模型。将家兔 2 4只 ,随机等分为假手术组 (A组 )、缺血再灌组 (B组 )和CAP治疗组 (C组 )。CAP治疗组于阻断腹主动脉前 5min静注CAP 2mg/kg ,继以微量泵持续输注 1 5minCAP 0 .5mg/(kg·h)。假手术组、缺血再灌组则以同样方法静注等容积生理盐水取代CAP ,假手术组不阻断主动脉血流。动态检测血中超氧化物歧化酶 (SOD) ,丙二醛 (MDA) ,血管紧张素II(AT -II) ,尿β2 -微球蛋白( β2 -MG)变化 ,以及肾皮质中SOD、,AT -II和肾组织形态学改变。接多导生理记录仪连续观察血压、呼吸、心电图的变化。结果 :CAP治疗组在再灌注期血和肾皮质中MDA、AT -II浓度明显低于缺血再灌组(P <0 .0 1 ) ,SOD活性显著高于缺血再灌组 (P <0 .0 1 ) ,尿β2 -微球蛋白含量明显低于缺血再灌组 (P<0 .0 1 )。CAP治疗组光镜下肾小管损伤Paller评分明显低于缺血再灌组 ( 2 0 .5 0± 7.5 6vs 82 .5 0± 1 6.69 ,P <0 .0 5 ) ,缺血再灌组电镜见急性肾小管损伤及坏死 ,而CAP治疗组肾小管损伤轻微。结论 :CAP对家兔肾上腹主动脉阻     

兔低位腹主动脉阻断后血流动力学、血管壁及下肢缺血再灌注损伤指标的观察

目的:观察兔低位腹主动脉阻断后血流动力学、血管壁、肢体缺血再灌注损伤相关指标的变化及动物生存情况.方法:建立兔腹主动脉阻断1,1.5 h的模型,检测阻断前、再灌注不同时点血液中丙二醛(MDA)和超氧化物歧化酶(SOD)的变化,股四头肌、腓肠肌及阻断部位血管壁的组织学变化,检测阻断前后、撤钳前后心率、血压的变化并观察术后一周的生存情况.结果:与对照组比较,阻断1 h组(B1)、1.5 h组(B2)再灌注时点血液中的MDA均升高(P＜0.05)、前者SOD降低不明显(P＞0.05),组织学表现腓肠肌出现轻度的细胞水肿,一周后基本恢复正常.阻断后两者血压均上升,心率减慢、撤钳后血压下降、心律增快(P＜0.05).阻断1,1.5 h动物后肢神经功能评分分别为5级、3～4级.B3组的8只兔子全部存活,而B4组中只有5只兔子存活.结论:兔腹主动脉阻断1 h引起的病理改变轻,不影响生存及下肢功能,阻断1.5 h引起的病理改变重,影响生存及下肢功能.兔低位腹主动脉阻断应控制在1 h以内.     

异丙酚对脊髓缺血再灌注大鼠脊髓自由基和超氧化物歧化酶的影响

目的 研究异丙酚预处理对脊髓缺血再灌注早期脊髓组织丙二醛(MDA)含量及超氧化物歧化酶(SOD)活性变化的影响,以探讨异丙酚在抗脊髓继发性损伤中的作用.方法 54只成年雄性SD大鼠随机分为3组:假手术组(S)、再灌注组(m)和异丙酚组(P),再灌注组和异丙酚组又各分1h、4h、8h、16h四个观察相点组(各组n=6).除假手术组外,所有动物均采用腹主动脉肾下夹闭法造成脊髓缺血再灌注模型,观察各组脊髓组织内MDA含量和SOD活性.结果 脊髓缺血再灌注后脊髓组织MDA立即上升,8h达最高峰,此后随之下降,但至16h仍高于正常对照组;而SOD活性显著下降,8h达最低,随后逐渐回升,至16h仍低于缺血前.与再灌注组比较,异丙酚组各相点MDA含量降低,SOD活性增强.结论 异丙酚预处理对脊髓缺血再灌注损伤具有保护作用.     

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.     

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.