Milrinone在离体肺保护中应用的实验研究

目的 :本研究是探讨Milrinone(米力农 )对离体肺保护的作用。材料与方法 :以离体兔肺模型为肺保护实验对象 ,以肺动脉灌洗再次肺动脉灌注为实验方法 ,以新西兰兔 2 4只为实验动物 ,随机分为两组 ,每组 12只。一组用LPD液行肺动脉灌洗和保存 ,另一组用米力农加LPD液组成实验组 ,用同样的方法灌洗和保存。保存 18h后 ,观察病理形态、含水量以及测量NO(一氧化氮 )、SOD(超氧化物歧化酶 )及MDA(丙二醛 )的含量。结果 :肉眼见组织新鲜红润 ,部分组织充血、水肿及淤血 ;光镜下两组的肺泡、支气管及毛细血管结构完整 ,高倍视野下对照组较实验组肺泡上皮及毛细血管上皮细胞肿胀、肥大 ,少部分组织可见肺泡内有红细胞渗出、间隔增宽等。实验组的含水量低于对照组 (P <0 0 5 )。实验组肺组织中的NO及SOD含量高于对照组 (P <0 .0 5 ) ,MDA含量低于对照组 (P <0 0 5 )。结论 :米力农能清除氧自由基 ,有较强的抗氧化性 ,能较明显的减轻肺的再灌注损伤。在LPD液中加入米力农 ,能够对离体肺起到更好的保护效果。离体兔肺再灌注模型是一种较理想的实验动物模型。     

兔肺动脉栓塞/再灌注损伤中肺泡细胞凋亡及其Fas/FasL表达的变化

目的:观察兔肺动脉栓塞/再灌注损伤中肺泡细胞凋亡及其Fas及FasL蛋白表达的变化,探讨肺损伤的可能机制.方法:健康新西兰白兔30只,雌雄不拘,运用5F Berman球囊堵塞左下肺动脉,然后球囊放气,复制肺动脉栓塞缺血再灌注模型,随机分为5组(n=6):假手术组,肺动脉栓塞1 h组、肺动脉栓塞2 h组,肺动脉栓塞2 h再灌注1 h组、肺动脉栓塞2 h再灌注2 h组;另设6只正常未手术白兔为对照组.实验结束取肺组织,测定肺组织湿/干重比,采用流式细胞分析法检测肺组织细胞凋亡率,免疫组织化学法检测肺上皮细胞Fas及FasL蛋白表达的变化.结果:与对照组、假手术组相比,肺动脉栓塞1、2 h组兔肺组织细胞凋亡率明显增加,再灌注后凋亡细胞进一步增多,并随着再灌注时间延长而逐渐增多(P＜0.05或0.01);Fas及FasL蛋白表达在肺动脉栓塞及再灌注后明显上调(P均＜0.01).肺泡上皮细胞凋亡指数与肺组织湿干比、Fas及FasL蛋白表达呈显著正相关(r分别为0.769,0.820,0.820;P＜0.01).结论:肺动脉栓塞缺血/再灌注可能通过激活Fas/FasL系统,诱导肺组织细胞凋亡,从而导致肺损伤的发生.     

离体兔肺灌注模型的建立及不同成份保存液的肺保护研究

目的:建立离体兔肺灌注模型,研究不同成分保存液对离体兔肺的保存作用.方法:将30只兔分为5组分别为对照组(A组)、uw液 硝酸甘油组(B组)、uw液 前列腺素E1(C组)、UW液与自身动脉血1:2混合组(D组)、UW液与自身动脉血1:4混合组(E组).切取兔心肺作为离体心肺模型,对心肺模型进行冷灌注、低温保存.分别在2 h和4 h取肺部分标本做电镜分析.4 h末检测肺湿干重比、肺气道压力.离体肺接呼吸机后将自身静脉血用泵从主肺动脉泵入,用负压吸引真空试管取左心房血液做血气分析.结果:E、D组对于肺组织气体交换功能的保护相当,明显优于其他组.B、C组对于肺实质细胞的气体交换功能的保护结果相当,明显优于A组.结论:本实验模型可靠.稳定性好.在UW液中加入自体动脉血对离体肺灌注可以使肺保存时间明显延长、肺气体交换功能保存良好,明显优于其他组.在UW液中加入前列腺素E1和硝酸甘油对离体肺保护作用再次得到肯定,明显好于对照组,但和自体动脉血组相比仍有不足.     

评价含抑肽酶肺保护液疗效的实验研究

目的：利用兔在体肺保存模型．评价含抑肽酶的改良肺保护液对肺的保护作用。方法：新西兰白兔30只,随机分为对照组、低钾右旋糖酐液（LPD液）组、抑肽酶组．每组10只。制备免在体左肺保存模型,对照组仅阻断肺门和冷藏．不灌肺保护液,LPD液组和抑肽酶组分别经肺动脉插管,在体灌注LPD液和含抑肽酶的LPD液,完毕后将左肺下叶放入特制的肺保存器内在体低温冷藏2h．移去肺保存器。开放肺门再灌注2h。在实验过程中抽取肺静脉血标本行血气分析,取肺组织行病理学检查．同时检测支气管灌洗液中性粒细胞百分比及肺湿／干重比以评价肺保存效果。结果：抑肽酶组再灌注5min和2h两个时间点肺静脉血氧分压显著高于LPD液组和对照组（P〈0．05）。抑肽酶组肺泡出血及肺结构损害分级均较对照组及LPD组轻微（R0．05）。肺湿／干重比抑肽酶组较对照组和LPD液组均有非常显著的差异（P〈0．01）。结论：含抑肽酶的肺保护液对肺的保护效果确切,其保护作用明显优于单纯LPD液。     

前列腺素E1?腺苷对离体兔肺保护作用良好

目的:研究前列腺素E1以及腺苷对离体兔肺的保护作用.方法:将18只新西兰大白兔分为3个实验组,分别为单纯UW液(A组、对照组)、UW液+前列腺素E1(B组)、UW液+腺苷(C组).切取实验兔整体心肺作为离体心肺模型,对心肺模型进行冷灌注、低温保存.分别在2 h末和4 h末,取肺部分标本做电镜分析.于4 h末,结扎右肺门,取右肺检测肺湿/干重比(W/D)、测肺气道压力(Paw).左侧离体心肺接呼吸机模拟移植手术后呼吸,并将自身静脉血用泵从主肺动脉泵入,用负压吸引真空试管取左心房血液做血气分析.结果:B组肺组织气体交换功能的保护作用以及降低供体肺保存过程中含水量的作用明显优于其他组;降低气道压力和C组相当,明显优于对照组.C组肺实质细胞的气体交换功能的保护、降低肺含水量以及降低气道压力明显优于A组.结论:UW液中加入前列腺素E1进行离体肺灌注可以使肺保存时间明显延长、肺气体交换功能保存良好.     

含HOE642的新型器官保存液对离体兔肺移植供肺细胞凋亡的影响

目的 探索含Ⅰ型钠氢通道拮抗剂HOE642的新型器官保存液对离体兔肺移植供肺细胞凋亡的影响.方法 24只雄性成年新西兰大白兔分2组[低钾葡聚糖(LPD)组和HOE组],分别用LPD液及新型器官保存液灌洗供肺,建立兔改良离体单肺移植模型并再灌注2h.测定供肺细胞凋亡指数、caspase-3、Fas/Fas-L及Bax/Bcl-2表达水平.结果 与LPD组比较,HOE组供肺细胞凋亡指数和caspase-3的阳性细胞计数明显下降(P＜0.05),Fas、Fas-L、Bax表达水平明显降低,Bcl-2表达升高(P＜0.05).结论 含HOE642的新型器官保存液可通过抑制细胞内外源性凋亡途径抑制细胞凋亡.     

丹参酮在离体肺保护中应用的实验研究

目的本研究是探讨丹参酮对离体肺保护的作用。方法以离体兔肺模型为肺保护实验对象，以肺动脉灌洗再次肺动脉灌注为实验方法，以新西兰兔为实验动物，随机分为两组。一组用LPD液行肺动脉灌洗和保存．另一组用丹参酮加LPD液组成实验组，用同样的方法灌洗和保存。保存18h后，观察病理形态、含水量以及测量NO（一氧化氮）、SOD（超氧化物歧化酶）及MDA（丙二醛）的含量。结果肉眼见组织新鲜红润，部分组织充血、水肿及淤血；光镜下两组的肺泡、支气管及毛细血管结构完整，高倍视野下对照组较实验组肺泡上皮及毛细血管上皮细胞肿胀、肥大，少部分组织可见肺泡内有红细胞渗出、间隔增宽等。实验组的含水量低于对照组（P〈O．05）。实验组肺组织中的NO及SOD含量高于对照组（P〈O．05）．MDA含量低于对照组（P〈O．05）。结论丹参酮能清除氧自由基，有较强的抗氧化性，能较明显的减轻肺的再灌注损伤。在LPD液中加入丹参酮，能够对离体肺起到更好的保护效果。离体兔肺再灌注模型是一种较理想的实验动物模型。     

改进的保存供体离体兔肺再灌注模型的建立

目的 :建立一个简单可靠的保存供体离体兔肺灌注模型 ,并将其应用于供肺保存研究 .方法 :将日本大耳白兔 12只作为供体 ,随机分为两组 ,肝素化后以高钾液处死 .建立改进的离体兔肺再灌注模型 ,其中A组 (n =6 ) ,供肺未经历温缺血 ,直接进行持续灌注 ;B组 ,供肺在室温下经历温缺血 1h ,然后给予再灌注 .监测再灌注前及再灌注期间的平均肺动脉压 (MPAP)、血气、湿干比等指标 .结果 :整个灌注期间 ,A组动、静脉血PvO2 、PvCO2 、MPAP及供肺湿干比均在正常范围 ;B组动脉血PaO2 低于A组 (P <0 . 0 1) ,湿干比高于A组 (P <0 . 0 5 ) .结论 :改进的新模型是供肺保存研究的简单、可靠的动物模型     

肺动脉灌注低温肺保护液抑制肺组织细胞凋亡的研究

目的探讨体外循环（cardiopulmonary bypass,CPB）期间肺动脉灌注低温肺保护液对肺组织细胞凋亡的影响。方法将20例风湿性二尖瓣病变患者随机分为肺保护组和对照组,每组10例。2组患者均在CPB下行单纯二尖瓣人工机械瓣置换术。肺保护组CPB期间经肺动脉灌注低温肺保护液,对照组CPB期间经肺动脉灌注等量生理盐水。监测2组患者CPB术后0、6、122、4 h呼吸功能,取动脉血1 mL进行血气分析,计算氧合指数。同时于CPB术前及停止CPB术后分别取2组患者右下肺组织（1.0 cm×1.0 cm×1.0 cm）活检标本,原位DNA末端标记法（TUNEL法）检测肺组织细胞凋亡情况。结果肺保护组CPB术后0、6、12、24 h氧合指数均高于对照组（P〈0.01或P〈0.05）。2组CPB术后肺组织细胞凋亡率均较CPB术前明显增多（P均〈0.01）。肺保护组、对照组CPB术后肺组织细胞凋亡率分别为（10.46±1.96）%、（18.68±1.34）%,2组比较差异有统计学意义（P〈0.01）。结论（1）常规低温CPB术可以诱导肺组织细胞的细胞凋亡。（2）CPB期间经肺动脉灌注低温肺保护液可显著抑制肺组织细胞的凋亡,减轻CPB肺损伤,提示其具有肺保护作用。     

肝脏低温保存—再灌注期间肝细胞凋亡及其与氧自由基变？…

目的 研究临床肝移植过程中离体供肝低温保存－再灌注期间肝实质细胞凋亡及其相关机制。方法 应用细胞凋亡原位末端标记法并结合电镜观察，检测低温保存时间分别为０、３、６、及９ｈ的４组兔肝脏在低温保存－再灌注过程中肝细胞凋亡发生情况，同时，对４组肝脏再灌注前、后组织内氧自由基相关指标进行测定。结果 各组肝脏于低温保存后的再灌注期间，组织内可见明显的肝实质细胞凋亡现象，且低温保存时间延长的肝脏，再灌注后凋亡     

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.