深低温停循环中不同脑灌注方式脑保护的实验研究

目的 比较深低温停循环（DHCA）中不同脑灌注方法下脑组织氧代谢、脑组织温度变化及脑皮质超微结构改变,评价不同灌注方式的脑保护效果。方法 健康成年杂种犬15只,随机分为3组。Ⅰ组单纯行DHCA,Ⅱ组DHCA＋RCP,Ⅲ组DHCA＋SACP。转流降温至鼻咽部温18℃时停循环90min,期间采用不同脑灌注保护技术,然后复温,再灌注90min。结果 降温期颈静脉氧饱和度（SjvO2）上升;停循环后各组SjvO2均有不同程度下降,DHCA90min时,Ⅲ组SjvO2明显高于Ⅰ、Ⅱ组,差异显著（P=0．000）。停循环期各组脑组织温度均有缓慢升高,以Ⅰ组最为明显,与Ⅱ、Ⅲ组相比有显著性意义（P=0．000）;电镜观察DHCA组的脑组织超微结构损害最重,RCP组次之,SACP组脑组织超微结构基本正常。结论 单纯DHCA、DHCA＋RCP中脑氧供需不平衡,RCP不能提供足够的脑营养,对DHCA期脑氧代谢无明显改善,但可保持脑部低温,有助于脑保护。SACP能保持脑氧供需平衡,提供充足的氧和营养供应,有效保持脑部低温．有明显的脑保护意义。     

不同脑保护方法的实验研究

目的　比较单纯深低温停循环(DHCA)、逆行性脑灌注(RCP)和选择性脑灌注 (SCP)不同脑保护技术的效果。方法　15头小型猪随机分成 3组,DHCA组、RCP组和SCP组,三组动物在实验中均降温至食管温度 18℃,90min停循环期间采用不同的脑保护技术,然后复温至 37℃,再灌注时间为 90min。结果　DHCA组血液中PvO2、PvCO2 和脑组织氧摄取率(OER)在低温停循环(DHCA)开始后直线下降,在DHCA60min、90min时,DHCA组与其它两组相比有显著性差异(P<0. 05), DHCA90min时,RCP组与ACP组相比也有显著性差异 (P<0.05),复温再灌注 30min、60min时,三组之间PvO2 值、PaCO2 值以及OER之间存在显著性差异 (P<0. 05),实验结束时,DHCA组PvCO2 仍然较高,未恢复到术前水平,与其它两组相比有显著性差异 (P<0. 05 ),脑组织水含量和电镜检测DHCA组的脑组织水肿严重,RCP组次之,ACP组没有发生脑水肿。结论　DHCA方法简单,但安全时间较短,RCP能在DHCA期间的一定时间内较好地向脑组织提供氧及营养物质,有一定的使用价值。SCP在停循环过程中确保脑的血液供应,保证有足够的时间完成手术,避免了长时间的DHCA所造成脑部并发症。     

深低温停循环中脑氧代谢平衡与自由基改变

目的 观察深低温停循环(DHCA)前后及不同脑灌注方法中脑氧供需平衡及自由基变化,比较不同灌注方式的脑保护效果.方法 健康成年杂种犬15只,随机分为3组(n=5).Ⅰ组单纯行DHCA,Ⅱ组DHCA RCP,Ⅲ组DHCA SACP.体外循环降温至鼻咽部温18℃时停循环,期间Ⅱ、Ⅲ组分别行逆行脑灌注(RCP)及选择性顺行脑灌注(SACP),90 min后复温,再灌注90 min.结果 Ⅰ,Ⅱ组停循环后犬颈静脉氧饱和度(SjvO2)下降(P＜0.001),脑氧供需不平衡,自由基活动升高.恢复循环复温后SjvO2回升,而自由基活动进一步升高达峰值.而Ⅲ组SjvO2变化差异无显著性(P=0.057)并显著高于Ⅰ,Ⅱ组(P＜0.001),Ⅱ,Ⅲ组SOD,MDA变化明显轻于Ⅰ组(P＜0.01).结论 DHCA中存在脑氧供需不平衡及明显自由基损伤.RCP和SACP可改善DHCA中脑氧供需平衡,减轻自由基损害,SACP脑保护效果优于RCP和DHCA.     

不同灌注方法对深低温停循环下脑保护的实验研究

目的探讨不同灌注方法在深低温停循环下（DHCA）的脑保护的作用。方法实验动物选用健康白乳猪幼猪（农科院提供）40只。随机分为4组,每组10只。A组：单纯DHCA组;B组：DHCA＋逆行性脑灌注（RCP）;C组：DHCA＋单侧顺行性脑灌注（U—SACP）;D组：DHCA＋双侧顺行性脑灌注（B—SACP）。对照分析四组组间分别于CPB前（T1）、DHCA后30min（T2）、60min（T3）、90min（T4）和复温再灌注30min（T5）氧摄取率的变化。采用原位末端标记法（TUNEL染色法）观察和测定脑组织神经细胞凋亡的情况。结果与A组相比,B组、C组和D组可显著减少幼猪DHCA后神经细胞凋亡数目（P〈0．05）,T2、T3和T4 3个时间窗脑氧摄取率明显低于A组,差异有显著意义（P〈0．05）。A组可见明显神经细胞凋亡改变,B组仅见中等程度神经细胞凋亡改变,C组和D两组见少量神经细胞凋亡改变,A组与B组,C组和D组、B组与C组和D组差异具统计学意义（P〈0．05）,但是C组和D组差异没有统计学意义（P〉0．05）。结论SACP与RCP脑保护作用均优于DHCA,U—SACP与B—SACP脑保护作用好于RCP,但是两者差距没有统计学意义。     

深低温停循环经右锁骨下动脉持续脑灌注的实验研究

目的:研究深低温停循环(DHCA)时经右锁骨下动脉持续脑灌注对脑组织的保护效果.方法:36只杂种猫随机分为3组(n＝12).组Ⅰ:单纯DHCA 90 min.组Ⅱ:DHCA 经上腔静脉逆行脑灌注90 min.组Ⅲ:DHCA 经右锁骨下动脉脑灌注90 min.检测各组脑组织超微结构变化及颈静脉血氧饱和度、颈静脉血乳酸含量、脑组织ATP含量.结果:复温后组Ⅰ颈静脉血氧饱和度为(61.7±7.0)%,低于组Ⅱ(69.0±6.1)%和组Ⅲ(71.2±5.5)%(P<0.05).光镜、电镜下组Ⅱ和组Ⅲ脑组织缺血、缺氧改变均显著轻于组Ⅰ,且组Ⅲ优于组Ⅱ.复温开始和复温完全后组Ⅱ乳酸含量为(7.36±0.44) mmol/L及(7.24±0.38) mmol/L;组Ⅲ为(6.88±0.30) mmol/L及(7.02±0.27) mmol/L,均低于组Ⅰ的(11.88±0.58) mmol/L及(11.59±0.57) mmol/L(P<0.01).复温后,组Ⅱ、组ⅢATP含量分别为(1.72±0.21) μmol/g、(2.02±0.19)μmol/g,均高于组Ⅰ的(1.08±0.24) μmol/g(P<0.01),且组Ⅲ高于组Ⅱ(P<0.05).结论:深低温停循环经右锁骨下动脉持续脑灌注更有利于脑组织的氧供需平衡,可以避免严重的脑缺血性损伤和保持满意的脑能量代谢水平.     

逆行灌注氧合浓缩红细胞对深低温停循环鼠脑的影响

目的观察逆行灌注浓缩红细胞对深低温停循环鼠脑的影响。方法将SD大鼠随机分成假手术组(Shamop组,n=12)、单纯深低温停循环组(DHCA组,n=12)和逆行灌注浓缩红细胞组(DHCArcp组,n=12),建立深低温停循环模型(18℃,90min)。模型成功后取脑作光镜和电镜分析并测量脑组织湿/干重比。结果光镜和电镜结果均证明DHCArcp组比单纯DHCA组脑组织损伤程度轻(P<0.05);两组脑组织的湿/干重比值没有明显差异(P>0.05)。结论逆行灌注氧合浓缩红细胞具有脑保护作用,并且不增加术后的脑水肿。     

逆行灌注氧合浓缩红细胞对深低温停循环鼠脑的影响

目的观察逆行灌注浓缩红细胞对深低温停循环鼠脑的影响.方法将SD大鼠随机分成假手术组(Sham op组,n=12)、单纯深低温停循环组(DHCA组,n=12)和逆行灌注浓缩红细胞组(DHCArcp组,n=12),建立深低温停循环模型(18 ℃,90 min).模型成功后取脑作光镜和电镜分析并测量脑组织湿/干重比.结果光镜和电镜结果均证明DHCArcp组比单纯DHCA组脑组织损伤程度轻(P<0.05);两组脑组织的湿/干重比值没有明显差异(P>0.05).结论逆行灌注氧合浓缩红细胞具有脑保护作用,并且不增加术后的脑水肿.     

区域性脑灌注与婴幼儿脑保护的研究进展

婴幼儿复杂先天性心脏病和主动脉弓重建术后发生的脑损伤仍是对机体的一个严重威胁。区域性脑灌注（regional cerebral perfusion,RCP）是婴幼儿深低温停循环（deep hypothermic circulatory arrest,DHCA）中的一种有效脑保护方法,     

选择性脑灌注对深低温停循环脑组织兴奋性氨基酸含量的影响

目的观察选择性脑灌注(SCP)对深低温停循环(DHCA)兔脑组织兴奋性氨基酸(EAA)含量的影响。方法健康大耳白兔16只,随机分为2组,每组8只:对照组(DHCA组):DHCA 60 m in;实验组(SCP组):DHCA 60m in 经右锁骨下动脉顺行性选择性脑灌注。每组均经体外循环降温至鼻咽温18℃,停循环,实验组停循环期间经右锁骨下动脉SCP。DHCA 60 m in,复温,停机,取脑组织。氨基酸自动分析仪检测脑皮质中的谷氨酸(G lu)和天冬氨酸(Asp)的含量。结果实验组脑组织G lu含量明显高于对照组(137.3±23.6)vs(87.0±15.9)μg/100 mg(P<0.01)。结论选择性脑灌注可抑制EAA的释放,可能是其脑保护机制之一。     

左旋精氨酸对犬深低温停循环脑组织代谢的影响

目的 利用犬深低温停循环(DHCA)动物模型,观察左旋精氨酸(L-arg)预处理对深低温停循环中犬脑组织代谢的影响.方法 健康成年杂种犬15只,随机分为3组(n=5).对照组:生理盐水假处理;L-arg预处理组:停循环前60 min给予L-arg 100 mg/kg预处理;联合处理组:停循环前60 min给予L-arg 100 mg/kg、7-Ni 25 mg/kg联合处理.按临床方法建立体外循环转流降温至鼻咽部温18 ℃停循环,90 min后恢复循环复温.分别于停循环前30 min、停循环时(0 min)、停循环45 min、停循环90 min、复温再灌注60 min抽取颈静脉、颈动脉血测乳酸含量,取脑顶叶皮质测ATP酶活性.实验犬处死后立刻取脑测干湿重.结果 L-arg预处理和联合处理脑乳酸净生成及ATP消耗均小于对照组(P＜0.05),二处理组间差异无统计学意义(P＞0.05).联合处理组DHCA后脑组织含水量最低,L-arg处理次之,对照组最高,差异有统计学意义(P＜0.05).结论 DHCA前给予L-arg预处理能降低脑组织代谢水平,有助于脑保护.     

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.