近交系大鼠心脏移植模型建立的实验研究

目的：建立近交系大鼠同种异位腹腔心脏移植动物模型。方法：采用改良的ono术式建立Brown Norway到Lewis大鼠的腹部异位心脏移植,将供心升主动脉、主肺动脉分别与受体腹主动脉、下腔静脉进行端侧吻合。采用分别结扎右上腔和下腔静脉后一次性集束结扎法取心,行端侧血管吻合连续缝合法。结果：共进行了48例大鼠心脏异位移植,经过预实验16只的技术总结,正式实验32只手术成功率为96．88％,供心冷、热缺血时间和心脏复跳时间明显缩短,手术时间减少至60min。结论：加强供心的综合保护和围手术期的处理,是移植模型建立的关键因素。     

同种异位不停跳心脏移植模型的建立

目的:建立不停跳心脏移植模型,以便于与传统供心保存方法对比,研究缺血再灌注损伤对移植心脏各方面的影响.方法:采用活鼠替代体外循环机,经活鼠下腔静脉输血,腹主动脉氧合血灌注给供体心脏,维持供心有节律地跳动,并用双血管套管连接法把供心移植给受体,从而建立大鼠颈部不停跳心脏移植模型.结果:连续正式试验53次,移植成功50次,手术成功率94.3%.每例手术总时间90～120min,其中,受体颈部血管套管准备(18±3)min,供心摘取(33±5)min,颈部移植(8士1)min,体外灌注(15±2)min.结论:活鼠替代体外循环机模型辅助下,能够常规建立大鼠颈部不停跳心脏移植模型,不需要体外循环机,无需显微外科操作,是一种无缺血再灌注损伤、经济可靠、易于复制、新的器官移植研究动物模型.     

小鼠腹部同种异体心脏移植模型的建立及改进

目的 :建立并改进小鼠腹部同种异体心脏移植模型。 方法 :在放大 2 6倍视野下用 10 0线将小鼠供体心脏的升主动脉和肺动脉分别与受体腹主动脉和下腔静脉行端侧吻合 ,术后观察移植心存活时间并做病理检查。结果 :手术成功率达 90 % ,平均取心时间和血管吻合时间分别为 (5 .9± 0 .97)min和 (38.5± 5 .5 )min ;Balb/c小鼠 昆明小鼠移植心平均存活时间为 (6 .2± 1.0 3)d ,昆明小鼠 昆明小鼠移植心存活时间超过 2 0d。 结论 :小鼠心脏移植模型与大鼠模型相比 ,技术操作难度大 ,术者需更长时间的训练 ,可作为大鼠心脏移植模型的补充 ,是利用纯系鼠进行移植研究的廉价选择     

大鼠异位心脏移植模型的改进

目的 改进制作大鼠心脏移植模型的方法。方法 在陈忠华术式的基础上加以改进,用含肝素的冰生理盐水自下腔静脉直接灌注;采用腹腔异位移植方法,将供心主动脉和肺动脉分别与受者的腹主动脉和下腔静脉端侧吻合,以长哈巴狗夹代替两个弯血管夹。结果 72例大鼠心脏移植手术成功率提高到90%以上,手术时间缩短为70 min。 结论 采用作者所改进的方法能提高手术成功率,缩短手术时间。     

改良大鼠腹腔异位心脏移植模型的建立

目的:探讨大鼠腹部异位心脏移植模型的外科技巧并改良此模型的制作方法,使其更加简便且成功率高.方法:对传统Ono术式的受体准备、供心切取和吻合方法等环节进行改进,采用此改良方法建立SD大鼠的腹部异位心脏移植模型.结果:共实施100例大鼠腹部异位心脏移植术,89例成功.供心缺血时间(32±5)min,整个手术耗时(60±10)min.结论:经典的Ono术式经改进后,术中缩短了供心缺血时间,降低了吻合难度,手术成功率高.整个过程均可单人操作,无需显微镜,使其易于掌握与开展.     

大鼠异位心脏移植模型的改进

目的 改进制作大鼠心脏移植模型的方法。方法 在陈忠华术式的基础上加以改进，用含肝素的冰生理盐水自下腔静脉直接灌注；采用腹腔异位移植方法，将供心主动脉和肺动脉分别与受者的腹主动脉和下腔静脉端侧吻合，以长哈巴狗夹代替两个弯血管夹。结果 72例大鼠心脏移植手术成功率提高到90%以上。手术时间缩短为70min。结论 采用作用所改进的方法能提高手术成功率，缩短手术时间。     

大鼠心脏移植急性排斥反应动物模型的建立

目的为探索器官移植后急性排斥反应的一种快速可靠的诊断方法。方法先暴露和游离受体的吻合段血管,再获取供心以缩短移植心脏冷缺血时间;保留供者的心脏及右上肺,将其胸主动脉与受者的腹主动脉间断端侧吻合;开放血流时,先开放远心端再间断开放近心端,同时按摩心脏至心脏搏动规律、有力,其色泽恢复红润,右上肺亦充盈良好。结果A组(n=20)成功16只,动脉吻合口出血2只、心脏复跳失败1只、吻合口狭窄1只;B组(n=20)成功17只,2只死于吻合口出血,1只死于吻合口狭窄。A组手术成功率为80%,B组为85%(P>0.05)。结论(1)先暴露并游离好受体血管吻合段,再获取供心,可以缩短移植心冷缺血时间。(2)边灌注边获取的方法利于快速而又完整的获取供心。(3)在切取和植入的过程中一定要注意低温保护。(4)利用腹主动脉段进行移植,使手术方便易行。左心做功的大鼠腹部心脏移植模型简单、安全、实用,因其左心参与循环而使血流动力学更接近生理状态,是进行心脏移植及血流动力学研究的较理想模型。     

大鼠异位心脏移植模型80例制作体会

目的　总结制作大鼠腹腔异位心脏移植模型的体会。方法　健康雄性Wistar大鼠为供体 ,SD大鼠为受体 ,各 80只。供心的升主动脉及主肺动脉分别与受体的腹主动脉和下腔静脉做端侧吻合 ,供心移植于受体的腹腔内。结果　共建立 80只大鼠异位心脏移植模型 ,供心缺血时间 (2 5± 5 )min ,手术成功率为 92 5 %。结论　手术成功的关键 :①麻醉及肝素化剂量合适 ;②供心的灌注及保护 ,缩短供心缺血时间 ;③提高血管吻合质量和速度 ,减少出血 ;④术后保温 ,及时补充液体     

改良移植技术建立豚鼠至大鼠异位心脏移植模型

目的 建立简便易行的豚鼠至大鼠异种颈部心脏移植模型.方法 采用Cuff技术(对照组,n=40)和改良Cuff技术(实验组,n=40)行豚鼠-大鼠异种异位心脏移植.结果 进行正式实验80例,成功率分别为为95%(对照组)和97.5%(实验组),移植后平均存活时间分别为(16.89±3.00)min和(50.64±1.95)min, 应用改良方法移植可使供心总缺血时间由(20.97±1.05)min缩短至(7.95±0.97)min.结论 改良移植技术建立豚鼠至大鼠异位心脏移植模型操作简便,重复性好,适合非协调性异种心既移植超急性血管排斥机制及抗排斥方面的研究.     

小鼠腹部心脏移植模型的显微外科技巧及并发症的预防

 目的 探讨小鼠腹部心脏移植术的手术技巧及并发症的预防和处理。 方法 雄性昆明（KM）小鼠60只,随机分供、受体2组,采用大鼠Ono术式进行小鼠腹部异位心脏移植,小鼠供体升主动脉与受体腹主动脉端侧吻合,供体肺动脉与受体下腔静脉吻合,实验30例。 结果 实验成功率86.7％(26/30)。取供心时间(9.4±1.2)min,供心修取时间(14.8±1.2)min,受体手术时间(60.4±2.4)min,其中吻合时间(29.8±2.5)min。结论 掌握小鼠心脏移植的显微外科技巧和正确的处理手术并发症,可以成功建立小鼠腹部心脏移植模型。     

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.