高血压患者内皮依赖血管舒张功能的研究

目的研究高血压（ＥＨ）患者内皮依赖血管舒张功能的变化及意义。方法应用Ｃｅｌｅｒｍａｊｅｒ方法观察肱动脉对增加流量（引致内皮依赖血管舒张）、含服硝酸甘油（引致非内皮依赖血管舒张）的反应性。结果对照组增加流量介导血管舒张（ＦＭＤ）与静息时血管内径（ＢＤ）呈负相关（ｒ＝－０．５７７，Ｐ＜０．０１）。ＥＨ患者ＦＭＤ较对照组显著减低（Ｐ＜０．０１），经协方差分析矫正ＢＤ的影响，ＥＨ患者ＦＭＤ仍低于对照组（Ｐ＜０．００１）。而硝酸甘油介导血管舒张（ＮＣＤ）两组间无明显差异（Ｐ＞０．０５）。　结论ＥＨ患者内皮依赖血管舒张功能减弱，可能与ＥＨ患者肱动脉内皮衍化舒张因子／一氧化氮（ＥＤＲＦ／ＮＯ）的贮备能力下降有关。     

硝苯吡啶,培垛普利对高血压病患者血管内皮功能的影响

目的：探讨硝苯吡啶、培哚普利对高血压病患者血管内皮功能的影响。方法：分别观察硝苯吡啶和培哚普利治疗的４０例高血压病患者治疗前后血浆内皮素和一氧化氮含量的变化。结果：硝苯吡啶治疗组的血浆内皮素和一氧化氮含量无明显变化（Ｐ〉０．０５）,而培哚普利治疗组的血浆内皮素含量明显下降（Ｐ〈０．０１）,一氧化氮含量明显增高（Ｐ〈０．０１）。结论：提示培哚普利可改善高血压病患者的内皮功能。     

人工肾代替人工肺治疗Ⅱ型呼吸衰竭的实验研究

应用人工肾空心纤维透析器持续正压（８～１２ｋＰａ）通入Ｏ２代替人工肺治疗５只Ⅱ型呼吸衰竭的家犬，经Ａ─Ｖ接体外转流２小时获得满意的效果。血流通过人工肾前、后氧分压（ＰＯ２）由９．１５±０．９５ｋＰａ上升到７２．５５±１４．０３ｋＰａ（Ｐ＜０．００１），二氧化碳（ＰＣＯ２）由６．３４士０．９６ｋＰａ下降到４．０８±０．９９ｋＰａ（Ｐ＜０．０１）。实验动物在治疗前、后氧分压（ＰＯ２）由７．１１±０．６１ｋＰａ上升到１０．６９±１．８１ｋＰａ（Ｐ＜０．０５），二氧化碳分压（ＰＣＯ２）由７．８３±０．９６下降到５．４７±１．４４ｋＰａ（Ｐ＜０．０５），５只实验动物无１例死亡。     

NO与(O_2)~同时生成对离体兔肺动脉反应性影响的初步研究

目的：检测ＮＯ与Ｏ－·２共同或分别作用对兔肺动脉反应性变化的影响。方法：将制备的离体兔肺动脉环分为ＮＯ组，Ｏ－·２组，ＮＯ＋Ｏ－·２组和溶剂对照（ＮＳ）组。用离体血管环技术观察肺动脉对乙酰胆碱（ＡＣｈ）、Ｃａ２＋载体Ａ２３１８７和苯肾上腺素（ＰＥ）的反应性变化。结果：肺动脉对ＡＣｈ的舒张反应（ｇｔｅｎｓｉｏｎ／ｍｇｄｗ）和舒张反应百分率（％），在Ｏ－·２组明显降低（Ｐ＜０．０１，与ＮＳ组比较）；在ＮＯ＋Ｏ－·２组显著高于Ｏ－·２组（Ｐ＜０．０５），但与ＮＳ组也有明显差异（Ｐ＜０．０５）；在ＮＯ组肺动脉的舒张反应接近ＮＳ组，与Ｏ－·２组有明显差异（Ｐ＜０．０５）。对Ａ２３１８７的舒张反应（用占预收缩的百分比表示），在ＮＳ、ＮＯ＋Ｏ－·２和Ｏ－·２组分别为７３．６７％，６４．８６％和５９．２６％。各组肺动脉对ＰＥ的收缩反应大致相同。Ｌ－精氨酸预孵育后，对ＰＥ的收缩反应在ＮＯ＋Ｏ－·２组收缩降低，为预孵育前收缩的５３．８９％；而在Ｏ－·２组无明显变化。结论：Ｏ－·２损害了肺动脉的内皮依赖和受体依赖性舒张反应；ＮＯ同时生成时可部分逆转Ｏ－·２的损伤作用；Ｏ－·２似通过清除内源性ＮＯ或直接累及ｅｃＮＯＳ，而发挥其损伤     

血管内皮依赖性舒张功能的无创性检测

采用高分辨超声测定２２名健康人休息时、反应性充血时和含服硝酸甘油（ＧＴＮ）后的肱动脉内径变化。结果表明：在反应性充血试验和含服ＧＴＮ后肱动脉明显扩张，与基础值比较分别增加１３．８±３．９％和２４．９±９．７％（Ｐ＜０．０１）。提示在正常人中血流增加可引起肱动脉内皮依赖性舒张，而含服ＧＴＮ后引起肱动脉非内皮依赖性舒张。介绍了无创性血管内皮依赖性舒张功能的测定方法，并证实该方法简便易行、可靠实用。     

吸入一氧化氮对急性肺损伤实验犬肺循环的影响

目的 明确吸入ＮＯ对肺循环及血气的影响，观察吸入ＮＯ对急性肺损伤实验犬肺循环的效应，以寻找选择性肺血管舒张剂。方法 给１２只实验犬制备急性肺损伤（ＡＬＩ）模型。通过特制装置吸入４０ｐｐｍＮＯ与５０％Ｏ２的混合气体。分别于造模后、吸入ＮＯ前后及停吸ＮＯ后记录各种实验参数。结果 造模后平均肺动脉压（ｍＰＡＰ）由２．０２±０．３０ｋＰａ升至３．７７±１．０５ｋＰａ，吸入ＮＯ使ｍＰＡＰ下降而平均动脉压（Ｍ     

左旋精氨酸对吸入一氧化氮降低肺动脉高压的延长作用

目的观察一氧化氮底物左旋精氨酸（Ｌ一ａｒｇ）延长吸入一氧化氮（ＮＯ）选择性降低肺动脉高压过程中的作用。方法８只猪麻醉后制成急性缺氧性肺动脉高压模型,在 Ｓｗａｎ－Ｇａｎｚ导管和动脉导管监测下吸入 ＮＯ（１２— １５ｐｐｍ）的过程中静脉注入 Ｌ－ ａｒｇ（共 １０ｇ）,观察停用 ＮＯ后体循环和肺循环血流动力学的变化情况。结果单纯吸入 ＮＯ能选择性降低急性缺氧性肺动脉高压,肺动脉压力从 ４ ２± ０ ４ｋＰａ降至 ２． ５± ０ ．５ｋＰａ（１ｋＰａ＝ ７．５ｍｍＨｇ, Ｐ＜ ０．０１）,肺血管阻力从 ５６±２５ｋＰａ·ｓ·Ｌ－１降至３１±１３ｋＰａ·ｓ·Ｌ－１（Ｐ＜０．０１）,但持续时间短;ＮＯ吸入加静脉注射Ｌ－ａｒｇ没有使肺动脉压进一步下降,但能显著延长吸入ＮＯ对肺动脉压的降压时间（２０倍）,对体循环血压则无影响。结论提供内源性ＮＯ的底物Ｌ－ａｒｇ能延长ＮＯ的降压作用,提示急性缺氧时ＮＯ的生成可能有相对不足。     

硝苯吡啶治疗哮喘性支气管炎疗效观察

将１０２例哮喘性支气管炎患儿随机分为治疗组和对照组各５１例。治疗组用硝苯吡啶每次０．２５～０．５ｍｇ·ｋｇ－１，每日３次，舌下含服或口服；对照组用氨茶碱、激素等常规治疗。气喘症状和肺部体征在用药后２４ｈ内明显减轻为显效；２４～４８ｈ内明显减轻为有效，结果显示：治疗组总有效率为９２．２％，明显高于对照组的４３．１％（Ｐ＜０．０５），疗效也较快（Ｐ＜０．０１）。表明硝苯吡啶治疗哮喘性支气管炎效果良好。     

经皮穿刺球囊二尖瓣成形术25例分析

采用Ｉｎｏｕｅ球囊导管对２５例二尖瓣狭窄病人行经皮穿刺球囊成形术，术后左房平均压自３．０７±０．９５ｋＰａ降为１．２７±０．５７ｋＰａ（Ｐ＜０．００１），肺动脉压自５．７４±２．２１ｋＰａ降为３．８３±１．８５ｋＰａ（Ｐ＜０．００１），二尖瓣口面积自１．１７±０．３３ｃｍ２增至２．２５±０．４１ｃｍ２（Ｐ＜０．００１），左房内经自４３．３０±５．１０ｍｍ减小为３７．１０±５．９１ｍｍ。     

高血压患者血管内皮依赖性舒张功能失调的无创性检测

采用无创性高分辨超声技术，检测３１例原发性高血压患者和３０例正常人休息时、反应性充血及含服硝酸甘油后肱动脉内径的变化。结果显示：原发性高血压组肱动脉血管内皮依赖性舒张较正常组明显减弱（Ｐ＜０．０１），二者对硝酸甘油的反应差异无显著性（Ｐ＞０．０５）。提示原发性高血压患者存在血管内皮依赖性舒张功能障碍     

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.