L-NAME在实验性高眼压视网膜缺血再灌注损伤中的保护作用

目的 探讨NOS抑制剂L－NAME对高眼压缺血－再灌注损伤的保护作用。方法 观察L－NAME在眼缺血－再灌注中的作用。大鼠经股iv L-NAME后或未应用L－NAME，制作7.98kPa高眼压缺血眼，或进行再灌注。标本作病理切片HE染色。结果 ①注射L－NAME＋高眼压缺血组与高眼压缺血组：比较视网膜变化程度相对较轻。②注射L－NAME＋高眼压缺血2h＋再灌注组：视网膜损伤较轻，未继续加重，与注射L－NAME＋高眼压缺血2h损伤的程度相似。③高眼压缺血2h 再灌注组：视网膜损伤较重，病变继续发展，与高眼压缺血5h损伤的程度相似。结论 ①L－NAME对视网膜缺血损伤有部分的保护作用。②L－NAME对视网膜缺血－再灌注损伤有较强的保护作用。     

川芎嗪对SD大鼠视网膜缺血再灌注损伤的影响

目的 :观察川芎嗪对大鼠视网膜缺血再灌注损伤的影响。方法 :采用前房灌注生理盐水 ,形成13 0mmHg ( 17 3kpa)高眼压 ,诱导大鼠视网膜缺血 60min ,解除高眼压 ,建立RIR模型。治疗组 ,在缺血前3 0min和再灌注开始时 ,予川芎嗪 80mg/kg腹腔注射。对照组予等量生理盐水。缺血 60min ,再灌注 3 0min、2 4h、 72h测定视网膜丙二醛含量 ,再灌注 168h作光镜观察。结果 :川芎嗪治疗组视网膜中丙二醛含量较对照组显著性降低 (P <0 0 1)。组织病理学显示川芎嗪治疗组损害减轻。结论 :川芎嗪对视网膜缺血再灌注损伤具有防护作用     

大鼠视网膜缺血再灌注后IL-1β的免疫组化研究

目的：观察大鼠视网膜缺血再灌注(retinal ischemia reperfusion，RIR)后，白细胞介素1β(IL—1β)多肽在视网膜表达变化。方法：采用前房灌注生理盐水，形成130mmHg(17．3kPa)高眼压，诱导大鼠视网膜缺血60min，解除高眼压，建立RIR模型。缺血60min，再灌注12h、48h作视网膜冰冻切片，IL—1β免疫组化观察。结果：正常对照组未见IL—1β表达，RIR后12h、48h视网膜神经节细层可见IL—1β表达。结论：IL—1β多肽在蛋白质水平参与RIR损伤发生。     

大鼠视网膜缺血再灌注损伤中生存素和半胱氨酸蛋白酶-3及白细胞介素-1α的动态变化及意义

目的 研究大鼠视网膜缺血再灌注(RIR)损伤过程中生存素(Survivin)、半胱氨酸蛋白酶-3(Caspase-3)及血清中白细胞介素-1α(IL-1α)的动态表达及意义.方法 建立大鼠视网膜缺血再灌注损伤动物模型:选用SD大鼠42只,随机分为两组:A对照组6只;B实验组36只(每个时间段6只).B组采用结扎单侧颈总动脉的方法诱导大鼠视网膜缺血60 min,恢复视网膜血供,建立1、6、12、24、48、72 h 的RIR模型.A组仅暴露单侧颈总动脉不结扎.结果 ①视网膜缺血再灌注后对视网膜的损伤,在形态学上表现为视网膜内层细胞减少,层次变薄.②缺血再灌注12 h凋亡细胞数开始逐渐增加,24 h细胞凋亡数达到高峰,之后又逐渐减少.③实验组在RIR 1 h后视网膜神经节细胞层(GCL)和内核层(INL) Caspase-3表达开始出现,再灌注6 h明显升高,12 h达高峰,与对照组相比差异有统计学意义(P <0.01).Survivin表达延迟于Caspase-3 的表达,再灌注12 h开始增加,24 h后达到高峰,以后逐渐降低,与对照组相比差异有统计学意义(P <0.01).④IL-1α正常对照组有较低表达,在缺血再灌注后1 h表达升高,6 h达到高峰,并且持续到12 h后开始发生降低,72 h后基本上降为正常.结论 ①视网膜缺血再灌注后对视网膜的损伤,在形态学上表现为视网膜内层细胞减少,层次变薄.②细胞凋亡可能是视网膜缺血再灌注后视网膜损伤的主要方式,其发生与Survivin和Caspase-3的变化存在密切的关系.③ IL-1α在缺血再灌注早期即开始升高,参与了缺血再灌注的损伤过程.     

葛根素对大鼠视网膜缺血再灌注损伤中肿瘤坏死因子-α表达的影响及意义

目的探讨葛根素对大鼠视网膜缺血再灌注损伤中肿瘤坏死因子-α（TNF-α）表达的影响及对视网膜的保护作用。方法建立大鼠视网膜缺血再灌注模型，分缺血再灌注组、缺血再灌注＋葛根素组和对照组。每组按再灌注时间的不同分为缺血再灌注1h、6h、12h、24h、4gh、72h组。以免疫组织化学法检测各期视网膜中TNF-α的表达，同时记录各期大鼠ERGa、b波波幅。结果在缺血再灌注组，TNF-α在再灌注6h后开始表达，24h表达最强，以后逐渐下降。在缺血再灌注＋葛根素组，在再灌注6h可见TNF-α微弱表达，再灌注12h后开始表达较为明显，24h表达最强，但明显低于缺血再灌注未处理组同期TNF-α的表达。对照组中未见明显的TNF-α的表达。同时，缺血再灌注＋葛根素组各时期ERG a、b波波幅高于缺血再灌注组而低于对照组。结论葛根素对大鼠视网膜缺血再灌注损伤中TNF-α的表达具有抑制作用，从而对视网膜缺血再灌注损伤有保护作用。     

亚低温对大鼠视网膜色素上皮缺血再灌注损伤保护作用的电镜观察

目的 观察亚低温对缺血再灌注大鼠视网膜色素上皮细胞（retinal pigment epithelium，RPE）超微结构的影响，探讨亚低温对大鼠RPE缺血再灌注损伤是否有保护作用。方法 24只SD大鼠随机分正常组、缺血1h再灌注1h组和亚低温缺血再灌注组，每组8只。采用提高眼压所造成视网膜缺血后，恢复眼压形成血流再灌注。用透射电镜观察各组视网膜色素上皮细胞的超微结构。结果 缺血再灌注大鼠RPE微绒毛和质膜内褶逐渐稀疏、低平，甚至脱落；细胞器损害主要表现为线粒体的脱嵴、水肿和内质网的扩张；亚低温缺血再灌注组大鼠RPE超徽结构明显改善。结论亚低温可以减轻缺血再灌注大鼠RPE病变程度，对大鼠RPE缺血再灌注损伤有保护作用。     

核转录因子-κB及肿瘤坏死因子-α在大鼠视网膜缺血再灌注损伤中的表达及NAC对其表达的影响及对视网膜的保护作用

目的探讨核转录因子-κB（NF—κB）及肿瘤坏死因子-α（TNF-α）在大鼠视网膜缺血再灌注损伤中的表达及N-乙酰-L-半胱氨酸（N—acetylcysteine）对其表达的影响及对视网膜的保护作用。方法建立结扎左侧颈总动脉的大鼠视网膜缺血再灌注模型，60只SD大鼠随机分为缺血再灌注组和缺血再灌注＋NAC组。每组按再灌注后不同时间段分为1、6、12、24、48和72h组，每组5只，以原位杂交法检测视网膜中NF—κB和TNF-α的表达，每只大鼠处死前行视网膜电图（ERG）检测。并计算出左／右眼ERG的比值。结果缺血再灌注组在6h开始检测到NF-κB和TNF—α的表达，在24h表达最强，以后逐渐减弱。缺血再灌注＋NAC组在再灌注6h未能检测到NF-κB和TNF-α的表达，在第12h有NF-κB和TNF-α的表达，24h表达最强，但低于缺血再灌注组（P〈O．05）。缺血再灌注组在再灌注6h后各期ERG相对恢复率明显低于缺血再灌注＋NAC组（P〈0．05）。结论NF-κB及其诱导的TNF-α在视网膜缺血再灌注损伤中发挥重要作用，NAC可能通过抑制NF-κB的活性减轻视网膜缺血再灌注损伤。     

MCP-1在大鼠视网膜缺血再灌注损伤中的表达及意义研究

目的了解MCP-1在大鼠视网膜缺血再灌注损伤中的表达及意义。方法建立大鼠视网膜缺血再灌注模型，以SABC法检测MCP-1在视网膜中的表达，统计学分析。结果 MCP-1在视网膜缺血再灌注6h开始表达，第24小时达到最高峰，48h开始表达减弱。结论MCP-1在视网膜缺血再灌注损伤中起重要作用。     

葛根素对大鼠视网膜缺血再灌注损伤中NF-κB表达的抑制及对视网膜的保护作用

目的 探讨葛根素对大鼠视网膜缺血再灌注损伤中核转录因子-κB（neuclear factor-kappaB NF—κB）表达的抑制及对视网膜的保护作用。方法 建立大鼠视网膜缺血再灌注模型，分缺血再灌注组、缺血再灌注＋葛根素组和对照组。每组按再灌注时间的不同分为缺血再灌注1、6、12、24、48及72h组。以免疫组织化学法检测各期视网膜中NF—κB的表达，同时记录各期大鼠ERG a、b波波幅，通过透射电镜观察各期视网膜的超微结构。结果 在缺血再灌注组，NF—κB在再灌注6h后开始表达，24h表达最强，以后逐渐下降。在缺血再灌注＋葛根素组，在再灌注6h未见NF—κB的表达，再灌注12h后开始有表达，24h表达最强，但明显低于缺血再灌注未处理组同期NF—κB的表达。对照组中未见明显的NF—κB的表达。同时，缺血再灌注＋葛根素组各时期ERGanb波波幅高于缺血再灌注组而低于对照组。视网膜超微结构显示缺血再灌注＋葛根素组细胞受损情况明显好于缺血再灌注组。结论 葛根素对大鼠视网膜缺血再灌注损伤中NF-κB的表达具有抑制作用，从而对视网膜缺血再灌注损伤有保护作用。     

麦芽醇对大鼠视网膜缺血再灌注损伤的保护作用

目的观察大鼠视网膜缺血再灌注损伤后MDA值和超氧化物歧化酶(SOD)活性的动态变化及麦芽醇的保护作用。方法于Wistar大鼠前房灌注液体形成14.63kpa高眼压而建立视网膜缺血再灌注(RIR)模型。在损伤前30分钟给予防护组大鼠球后注射700μmol/L麦芽醇生理盐水0.5ml,对照组大鼠球后注射生理盐水0.5ml,缺血60分钟后,分别在再灌注(RIR)30分钟、24小时、72小时进行视网膜组织中丙二醛(MDA)、超氧化物岐化酶(SOD)活性的检测。结果再灌注30分钟、24小时、72小时后防护组视网膜中MDA含量均明显低于对照组,SOD活性明显高于对照组(P<0.01)。结论麦芽醇能清除氧自由基,减轻脂质过氧化反应,从而减轻大鼠视网膜缺血再灌注损伤。     

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.