高脂饮食对大鼠肝脏和骨骼肌脂联素受体表达的影响

目的观察高脂饮食对大鼠肝脏和骨骼肌脂联素受体表达的影响。方法利用高脂饮食制造肥胖倾向(OP)和肥胖抵抗(OR)大鼠模型,采用逆转录聚合酶链反应(RT-PCR)方法检测各组肝脏和骨骼肌组织脂联素受体(AdipoR1和AdipoR2)表达的水平差异。结果(1)喂食高脂饮食的OP和OR大鼠肝脏和骨骼肌组织的AdipoR1mRNA表达水平与对照组间差异均无统计学意义(P>0.05);(2)喂食高脂饮食的OP和OR大鼠骨骼肌组织的Adi-poR2mRNA表达水平与对照组间差异无统计学意义(P>0.05);(3)OP大鼠肝脏的AdipoR2mRNA表达水平与OR大鼠和正常对照大鼠间差异均有统计学意义(P<0.05)。结论高脂饮食能促进大鼠肝脏组织AdipoR2表达,提示AdipoR2很可能是调节肝组织脂联素敏感性的主要受体。     

饮食诱导非酒精性脂肪性肝病大鼠脂联素受体2基因的表达及其意义

[目的]探讨脂联素受体-2（AdipoR2）在饮食诱导非酒精性脂肪性肝病大鼠模型肝脏组织中的表达差异[方法]采用反转录PCR（FIT—PCR）法检测饮食诱导非酒精性脂肪性肝病与对照组大鼠肝脏中的AdipoR2 mRNA表达差异,同时检测大鼠脂联素、胰岛素抵抗指数及血糖水平。[结果]模型组大鼠肝脏组织中AdipoR2 mRNA为0．3964±0．0988,而对照组为1．2254±0．1462,两者间差异有显著性意义（P〈0．01）。模型组血糖为（5．44±0．58）mmol／L,与对照组（5．25±0．14）mmol／L比较差异无显著性意义;模型组脂联素水平（3．56±0．78）mg／mL,低于对照组的（4．71±0．30）mg／mL,P〈0．05,而前者胰岛素抵抗指数为2．39±0．16,较后者1．32±0．30明显增高（P〈0．01）。[结论]肝脏脂联素受体2表达下调可能是引起非酒精性脂肪性肝病的原因;与糖、脂肪代谢障碍,胰岛素抵抗程度提高有关。     

非酒精性脂肪肝大鼠脂联素及其受体与肝脏病理改变的关系

目的:探讨非酒精性脂肪性肝病(NAFLD)大鼠血清脂联素水平、肝脏脂联素受体(adipoR)mRNA表达与肝组织病理改变的关系。方法:喂养高脂饲料建立NAFLD大鼠模型,分别于第2、4、8、12周处死,ELISA法检测血清脂联素及其他生化指标,测肝指数,RT-PCR法检测肝脏adipoR mRNA表达,肝组织切片苏丹Ⅲ脂肪染色、H-E常规染色和Masson三色纤维染色,显微镜下观察。结果:模型组大鼠第2、4、8、12周血清脂联素水平逐步下降,均低于同期对照组(P均＜0.01);血清脂联素水平与肝指数(r=-0.383,P=0.015)、肝脏炎症评分(r=-0.475,P=0.002)、纤维化评分(r=-0.459,P=0.003)均显著负相关。模型组肝脏adipoR1 mRNA表达逐步上升,adipoR2表达逐步下降,分别于4周、2周开始与对照组相比具有统计学差异(P均＜0.01);肝脏adipoR2 表达与肝指数(r=-0.431,P=0.006)、纤维化评分(r=-0.353,P=0.025)均显著负相关。结论:NAFLD大鼠肝脏adipoR mRNA表达异常、血清脂联素水平降低,后者与肝脏脂肪性炎症、纤维化程度相关,提示血清脂联素降低,肝脏adipoR表达异常,尤其是adipoR2 mRNA降低与NAFLD密切相关。     

胰岛素抵抗大鼠脂联素与IKK mRNA表达的相关性研究

目的:探讨胰岛素抵抗大鼠脂联素(APN)与核因子κB(NF-κB)抑制因子激酶(IKK)mRNA表达的关系。方法:采用高脂饲料喂养建立胰岛素抵抗大鼠模型,并用正常血糖-高血浆胰岛素钳夹技术评估。应用RT-PCR方法检测大鼠脂肪组织中APN和IKK mRNA的表达。结果:高脂饲料组大鼠的葡萄糖输注率明显低于基础饲料组[GIR60～120(0.76±0.28vs4.26±0.70)mg·kg-1·min-1,P<0.01];与基础饲料组相比,高脂饲料组大鼠脂肪组织APN mRNA的表达显著降低(A值APN/β-actin0.39±0.23vs1.26±0.30,P<0.05)、IKK mRNA的表达显著升高(A值IKK/β-actin0.99±0.10vs0.17±0.02,P<0.05),APN与IKK mRNA的表达相关(r=-0.83,P<0.05)。结论:胰岛素抵抗大鼠脂肪组织APN与IKK mRNA的表达显著负相关,提示IKK引起的NK-κB的活化可能与胰岛素抵抗时脂肪组织APN合成减少有关。     

脂联素及其受体研究进展

脂联素（adiponectin）是来源于脂肪组织的脂肪细胞因子之一，具有抗炎、抗糖尿病、抗动脉粥样硬化和增敏胰岛素的作用。脂联素的这些效应必须通过脂联素受体1（AdipoR1）和AdipoR2的介导。近年的研究发现，AdipoR1在骨骼肌中有丰富表达，AdipoR2主要在肝中表达；AdipoR1和AdipoR2也在人和鼠的胰岛β细胞中表达，其水平与肝中类似，比骨骼肌更高；AdipoR1和AdipoR2也可在单核细胞和巨噬细胞中表达。过氧化物酶体增殖物激活受体-α（PPAR-α）、PPAR-γ和肝X受体（LXR）的激动剂以及生长激素（GH）可影响脂联素受体的表达和调节。     

脂联素及其受体在吡格列酮抑制ApoE基因敲除小鼠主动脉粥样硬化中的作用

目的：观察吡格列酮对ApoE基因敲除小鼠（ApoE^-/-小鼠）主动脉粥样硬化病变的影响,并初步探讨血清脂联素及其受体在其中的作用。方法：ApoE^-/-小鼠动脉粥样硬化模型组：随机分成3个亚组,安慰剂组（n=10）、小剂量吡格列酮治疗组［10 mg/(kg·d),n=10］、大剂量吡格列酮治疗组［20 mg/( kg·d),n=10］。以野生型C57BL/6J小鼠（n=9）为对照组。观察ApoE^-/-小鼠主动脉病理学改变、腹主动脉超声改变及血清脂联素水平、主动脉脂联素受体R1(adiponectin receptor 1,AdipoR1)及脂联素受体R2(adiponectin receptor 2,AdipoR2) mRNA表达水平。结果：与野生型C57BL/6J小鼠相比,ApoE^-/-小鼠有较明显的主动脉内膜增厚及粥样斑块的形成,而经吡格列酮治疗后病变减轻。ApoE^-/-小鼠安慰剂组腹主动脉平均内膜中层厚度（intima media thickness ,IMT）较野生型C57BL/6J小鼠明显增加［（0.290±0.063 vs 0.178±0.012） cm,P＜0.01］,而经大剂量吡格列酮治疗后IMT显著减轻［（0.208±0.012 vs 0.290±0.063） cm,P＜0.05］。ApoE^-/-小鼠安慰剂组血清脂联素水平低于野生型C57BL/6J小鼠［（12.41±3.84 vs 18.96±4.89） μg/L, P＜0.05］,而经低剂量及高剂量吡格列酮治疗后,与安慰剂组比较,均可增加血清脂联素水平（18.78±7.24 μg/L vs 12.41±3.84 μg/L,P＜0.05; 24.00±4.71 μg/L vs 12.41±3.84 μg/L,P＜0.05）。ApoE^-/-小鼠安慰剂组主动脉脂联素受体AdipoR1 mRNA的表达低于野生型C57BL/6J小鼠（0.789±0.167 vs 0.950±0.071,P＜0.05）,并且AdipoR1/AdipoR2比值显著下降（1.039±0.062 vs 0.940±0.102,P＜0.05）,而经吡格列酮治疗可轻度上调AdipoR1和AdipoR2型受体mRNA的表达,大剂量吡格列酮治疗可显著增加AdipoR1/AdipoR2比值（1.063±0.051 vs 0.940±0.102,P＜0.01）。结论：吡格列酮可抑制动脉粥样硬化的形成,其作用机制可能与提高血清脂联素水平和上调主动脉脂联素受体（尤其是AdipoR1型）表达有关。     

葡萄糖调节蛋白78 mRNA在高脂喂养大鼠肝脏中的表达和意义

目的 检测高脂饲料喂养大鼠的肝脏葡萄糖调节蛋白7S(GILP78)mR2qA的表达情况,探讨内质网应激与胰岛素抵抗之间的关系及GKP78在胰岛素抵抗发生机制中的作用.方法 采用高脂饲料喂养建立胰岛素抵抗大鼠模型,30只雄性Wistar大鼠被随机分为基础饮食喂养组(NC,n=15)和高脂饮食喂养组(HF,n=15),分别喂养10用后,用正常血糖-高血浆胰岛素钳夹技术进行评估.应用Real Time PCR方法检测大鼠肝脏中GRP78 mRNA的表达.结果 ①高脂饲料组大鼠的葡萄糖输注率明显低于基础饲料组[GIR60-120(0.90±0.15)vs(4.97±0.68)mg/(ks·min),P<0.01].②高脂饲料组肝脏GRP78 mRNA的表达明显高于基础饲料组[(1.13±0.50)vs(0.43±0.10,P<0.01].③肝脏GRP78 mRNA表达与内脏脂肪占体质量的百分比(r=0.52,P=0.019)、总胆固醇(TC)(r=0.51,P=0.022)成正相关.结论 高脂诱导的胰岛素抵抗大鼠肝脏中GILP78mRNA表达增加,表明大鼠肝脏发生内质网应激和未折叠蛋白反应.     

过氧化物酶增殖体激活受体-γ辅助激活因子1 mRNA在OLETF大鼠组织表达的变化

目的过氧化物酶增殖体激活受体-γ辅助激活因子1(peroxisome proliferator-activated receptor-γco-activator 1,PGC-1α)是一种重要的核受体辅助激活因子,参与调节肝糖分解、糖异生以及周围组织对葡萄糖的利用,在维持机体能量代谢平衡和糖脂代谢中起重要作用。本研究通过观察PGC-1αmRNA在OLETF大鼠肝脏、骨骼肌、脂肪和胰腺组织中表达的变化,初步探讨PGC-1α在胰岛素抵抗及糖尿病发病中的作用。方法①实验动物模型建立:从第8周开始喂养OLETF和LETO大鼠10%蔗糖水,每周测体质量,于第14、18、22、28周时进行OGTT并测定大鼠血脂值。OLETF大鼠在第18周时全部成为糖尿病大鼠,动物模型建立成功。②第8周和28周分别取LETO和OLETF大鼠肝脏、骨骼肌、脂肪和胰腺组织,提取总RNA,应用实时定量PCR方法分析组织中PGC-1αmRNA的表达量。结果①OLETF大鼠体质量和三酰甘油(triglyceride,TG)随周龄增加逐渐增加,从14周起高于同周龄LETO大鼠,差异均有统计学意义;空腹和糖负荷后胰岛素浓度从22周起OLETF大鼠高于同周龄LETO大鼠。②第8周时,OLETF大鼠肝脏、骨骼肌、脂肪和胰腺组织PGC-1αmRNA的表达与LETO大鼠比较差异无统计学意义。③第28周时,与LETO大鼠相比,OLETF大鼠PGC-1αmRNA在肝脏(0.040±0.006vs0.074±0.003,P=0.029)和胰腺(0.659±0.299vs1.610±0.091,P=0.029)中表达明显下降,而在骨骼肌(0.192±0.065vs0.104±0.012,P=0.029)中表达则明显增加。在脂肪组织(0.055±0.036vs0.161±0.124,P=0.100)中表达有下降趋势,差异无统计学意义。结论OLETF大鼠28周时表现出2型糖尿病早期胰岛素抵抗和高血糖的病理变化,PGC-1αmRNA在肝脏、胰腺和脂肪组织表达减少,骨骼肌组织表达增加,可能是2型糖尿病早期胰岛素抵抗和高血糖状态下的一种代偿性反应,提示PGC-1αmRNA在组织内表达变化可能与胰岛素抵抗和2型糖尿病密切相关。     

短期胰岛素治疗对糖尿病大鼠内脏脂肪抵抗素mRNA表达的影响

目的观察短期胰岛素治疗后糖尿病(DM)大鼠内脏脂肪组织抵抗素(resistin)mRNA表达及血清抵抗素水平的变化。方法采用小剂量链脲佐菌素(STZ)注射联合高糖高脂饲料喂养制备糖尿病大鼠模型,予胰岛素控制部分糖尿病大鼠血糖,设立空白对照组、血糖未控制组、血糖控制组。分别检测3组大鼠血清抵抗素水平及内脏脂肪组织抵抗素mRNA的表达;观察3组大鼠血清抵抗素、游离脂肪酸(FFA)、三酰甘油(TG)、总胆固醇(TC)水平及内脏脂肪抵抗素mRNA表达的变化。结果与空白对照组比较,血糖未控制组大鼠血清抵抗素及内脏脂肪组织抵抗素mRNA的表达显著增高[(696.23±187.77)vs(538.31±142.14);(62.26±25.79)vs(10.15±12.13),P<0.05];与血糖控制组大鼠比较,血糖未控制组大鼠内脏脂肪组织抵抗素mRNA的表达亦显著增高[(62.26±25.79)vs(10.45±2.99),P<0.05]。血糖控制组大鼠FFA较血糖未控制组大鼠FFA水平显著降低[(0.53±0.16)vs(0.73±0.19),P<0.05],而TC水平显著增高[(1.92±0.16)vs(1.22±0.38),P<0.05]。结论短期的胰岛素治疗能降低糖尿病大鼠内脏脂肪组织抵抗素mRNA的表达,可能与血糖控制后胰岛素抵抗改善及胰岛素负调节抵抗素mRNA表达有关。     

5-脂氧化酶通路在非酒精性脂肪性肝炎中的作用和机制

目的探讨5-脂氧化酶(5-LO)通路在非酒精性脂肪性肝炎(NASH)的作用。方法将4周龄ApoE-/-雄性小鼠16只随机分为两组:对照组(普通饲料)、NASH模型组(高脂高胆固醇饲料)。连续喂养12周后,肝组织油红染色观察脂肪变,采用HE染色进行NAFLD活动度评分(NAFLD activity score,NAS)。荧光定量RT-PCR检测5-LO、BLT1等mRNA表达,Western Bot法检测5-LO蛋白,酶联免疫法检测肝脏白三烯B4(leukotriene B4,LTB4)。结果高脂高胆固醇饮食12周能诱导ApoE-/-小鼠出现NASH表现,建模成功。NASH模型组较对照组肝组织5-LO mRNA及蛋白表达明显升高(P0.01),肝匀浆LTB4水平[(71.09±18.23)pg/mL vs(46.71±11.71)pg/mL]升高(P0.01),其受体BLT1 mRNA水平显著升高(P0.01),中性粒细胞趋化因子和相应受体MIP2、CXCR2以及黏附分子ICAM1、VCAM1 mRNA的表达均较对照组明显升高(P0.01)。结论 5-LO炎症通路通过上调中性粒细胞粘附浸润相关因子,诱导中性粒细胞浸润,促进非酒精性脂肪性肝炎进展。     

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.     

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.     

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.