肌瓣包裹自体气管移植体复合BMP诱导软骨再生

目的:研究BMP复合肌瓣在自体移植中对软骨再生的作用.方法:将15只杂种犬随机等分为3组,均切取颈部5环气管段作为移植段,行自体移植.A组:肌瓣包裹组;B组:肌瓣复合BMP/I型胶原复合物组;C组:空白对照组.术后1,2,4,8及10 wk处死动物取材,观察和比较实验动物存活情况、移植体气管标本的大体和组织学改变,新生微血管密度(MVD)等指标,用改良钙-钴法测定软骨组织中碱性磷酸酶(ALP)的分布.结果:A, B组移植体均有不同程度的软骨再生:C组基本无再生;B组最明显.术后8 wk前,ALP染色阳性面积有统计学意义(t=3.269,P<0.05),在术后8 wk以后其差别无统计学意义.结论:BMP可提高移植段软骨的ALP表达,抑制软骨吸收.肌瓣包裹移植段,能够诱导出新生血管,利于软骨再生,二者复合可有效促进软骨再生.     

BMP诱导同种异体气管移植体的软骨再生

目的 :重组人骨形态发生蛋白 2 (rhBMP 2 )植入犬的同种异体气管移植体内诱导软骨再生 .方法 :1 4只犬 ,两两配对 ,随机分为A ,B 2组 .配对者两两交换移植体 ,异位移植(植入腹腔大网膜内 ) .移植体一端环间植入rhBMP 2 ,另一端做对照 .B组术后加服免疫抑制剂 .术后 4wk处死动物 ,标本行大体及组织学观察 .结果 :2组实验动物均于术后 4wk处死 .移植段气管植入rhBMP 2后新生软骨面积为 (pix el) 1 4 1 8.7± 5 1 2 .3,对照组为 2 78.2± 1 83.1 (P <0 .0 1 ) .应用免疫移植剂后 ,植入rhBMP 2组新生软骨面积 (pixel)增加为 1 936 .0± 6 0 9.8(P <0 .0 5 ) .结论 :rhBMP 2可刺激同种异体气管移植体软骨再生 ;免疫抑制剂的应用将会增强其作用效果 .     

肌瓣对自体及异体气管移植段血液循环建立的促进作用

目的: 探讨采用肌瓣包裹促进自体及异体气管移植段重建血运的方法. 方法: 将30只杂种犬随机等分为3组,均切取颈部5环气管段作为移植段.A组:无肌瓣包裹自体移植组;B组:采用自体双侧胸骨舌骨肌-胸骨甲状肌联合肌瓣包裹组;C组:采用异体双侧胸骨舌骨肌-胸骨甲状肌联合肌瓣包裹组. 于术后1,2,4和8 wk处死动物取材,观察和比较实验动物的存活情况、移植体气管标本的大体和组织学改变,以及新生微血管密度(MVD)等指标. 结果: 无肌瓣包裹自体移植组不能维持管腔结构;自体肌瓣包裹组移植段血供良好,管腔通畅,狭窄程度轻,存在炎症反应. 异体肌瓣包裹组移植体血供尚可,炎症反应重,管腔狭窄,但仍可维持通畅. 结论: 移植体的狭窄现象与血供关系密切. 肌瓣包裹气管自体移植段能够诱导出新生血管,维持气管形态,移植的气管可以存活8 wk以上. 自体较异体移植段血供好,虽可维持气管通畅,但存在狭窄.     

移植气管软骨再生的实验

目的 研究同种异体移植气管软骨的再生能力。方法 将供体犬气管置于受体犬腹腔内，以带蒂大网胞包绕，分别在术后1，2，3，4，5，6，7，8及12wk时，共9个时间段将移植段气管取出作病理及透射电镜检查，部分标本软骨用^3H-TDR(^3H-脱氧胸苷）标记，行放射自显影检查。结果 软骨再生存在于移植后的各个时间段的气管软骨膜下，其再生的程度与良好的血液循环有关。结论 同种异体气管移植，血液循环充分建立的条件下，软骨具有良好的再生能力。     

骨形态发生蛋白诱导犬的自体及异体气管移植段软骨再生的比较

目的：将重组人骨形态发生蛋白—2(rhBMP—2)植入犬的自体及异体气管移植段内，促进新生软骨形成，比较rh—BMP—2在自体及异体气管移植段内诱导软骨再生的作用．方法：16只杂种犬随机等分为4组，颈部切去5环气管埋入腹腔大网膜中作为移植段．A．B组为自体移植．C．D组为异体移植，其中A，C组移植段植入rhBMP—2，B和D组移植段不植入任何物质作为对照。术后4wk处死动物，标本行大体及组织学观察．结果：4组移植段软骨环均有不同程度的软骨再生，且以A，C组再生更明显．结论：rhBMP—2可刺激气管移植段软骨再生，但在自体及异体移植段内的作用效果不同.     

不同时间段内骨形态发生蛋白诱导移植气管软骨再生

目的:研究不同时间段内骨形态发生蛋白诱导犬自体移植气管软骨再生的作用.方法:36只杂种犬,随机分为A,B两组,颈部切去5个气管环,A组气管环间植入重组人骨形态发生蛋白2/胶原复合物,B组为空白对照组,然后植入自体腹腔大网膜中.在术后1,2,3,5,9,12wk分别从两组中各取3例移植段气管行组织学检查和骨钙素(BGP)的放免测定.结果:rhBMP2植入区内软骨再生存在于移植后的各个时间段,且以术后2wk至5wk较为明显.两组标本BGP水平测定均随着时间的延长而增高,除术后1wk无显著性差异(P>0.05),其余各时间段两组差异均有显著性(P<0.05).结论:rhBMP2可诱导气管移植段软骨再生,但在不同时间段的作用效果不同.     

BMP诱导自体气管移植段软骨再生的量效关系

目的：将重组人骨形态发生蛋白-2(rhBMP-2)植入犬的自体异位气管移植段内诱发新生软骨,寻求rhBMP-2在气管移植段内诱发软骨的量效关系及最佳的rhBMP-2用量．方法：8只杂种犬,颈部切取5环气管段作为移植段．移植段各环间软组织中植入不同含量的rhBMP-2后埋入自体的腹腔大网膜中．不同含量的rhBMP-2均以胶原为缓释载体．术后4wk处死动物取材,并行大体及组织学观察．结果：各组移植段固有软骨环均被轻度吸收．rhBMP-2植入组移植段环间均有不同程度的软骨再生,且各组新生软骨量随植入物中rh—BMP之含量的增加而增加．结论：rhBMP-2可刺激气管移植段软骨再生,且存在量效关系,以每环间植入5mg的rhBMP-2较为合适．     

免疫排斥反应影响移植气管存活的实验研究

气管移植后机体的免疫反应对移植段气管存活的影响、目前仍不清楚。文章对同种异体气管移植后机体免疫状态进行实验研究。研究分二期,所用动物为杂种犬,均行5个环的气管移植,定期取出并行病理观察。结果表明:移植段气管靠带蒂大网膜可早期建立血液循环,同种异体移植段气管存活与免疫排斥反应无关。     

经Triton处理的气管异体移植后的转归

目的：确定经Triton处理的异体气管移植后的转归。方法：以犬为实验对象，将异体气管经Triton处理后移植于受体的胸段气管缺损处，大网膜包裹吻合口，3个月后行病理检查，观察移植物的转归。结果：实验组(6只)：4只犬存活至处死，病理检查显示移植物软骨环完整、无软化，表面被上皮覆盖。1只犬术后4d死于张力性气胸。1只犬术后15d死于移植物感染；对照组(4只)：4只犬分别于术后24～29d死于排斥反应。结论：经Triton处理的异体气管段移植后，软骨无吸收、脱落，实验犬可长期存活。     

深低温冷冻对rhBMP-2诱导犬气管移植体软骨再生的影响

目的: 研究应用重组人骨形态发生蛋白-2 (rhBMP-2)/胶原缓释系统诱导犬冷冻气管移植软骨再生的作用.方法: 将32只杂种犬随机等分为4组,行5个颈部气管环原位异体移植,带血管蒂大网膜包绕.A组为未冷冻组,气管环间植入rhBMP-2/胶原组标记为A1组,空白对照标记为A2组;B组术前将移植体气管经深低温液氮保存2 mo,处理同A组,分别标记为B1、B2两组.所有实验犬于术后8 wk处死,行大体及病理学检查,评测各组新生软骨面积. 结果: B组犬移植气管结构保持较好、狭窄程度低.4组均有软骨再生, B1组新生软骨面积1835.9(527.2)高于A1组1408.5(492.6)及B2组336.8(121.3),各组新生软骨面积差异有显著性(χ2 = 24.010 ,df=3 ,P <0.01).结论: 应用rhBMP-2可刺激冷冻气管移植体软骨再生,其刺激深低温冷冻犬气管移植体成骨效果优于未冷冻气管移植体.     

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.