肝缺血再灌注时肠道损伤对肝脏损伤的影响

目的 了解肝缺血再灌注对肠道损伤对肝脏损伤的影响及作用机制。方法 SD大鼠24只,雌雄各半,随机分为分流组（组1）、不分流组（组2）和假手术组（组3）。组1、2在全麻下行肝门阻断45min,再灌注2h制备2h制备肝缺血再灌注损伤模型。组1在肝缺血再灌注前行门腔分流;组3仅作剖腹术,不经受肝缺血再灌注过程。极前术后均抽取门静脉血并于术后切取部分肝脏及回肠以检测血清酶学、细胞因子水平及组织病理学改变。结果 术前各组动物血中丙氨酸氨基转移酶、天门冬酶氨基转移酶、肿瘤坏死因子－α（TNF-α）、Ⅰ型白细胞介素（IL－1）水平均无显性差异。在分流组和未分流组,肝脏缺血再灌注前后,上述四项指标比较有显性差异（P＜0．05）,术后明显高于术前。缺血再灌注后两组间上述指标亦有显性差异（P＜0．05）,分流组明显低于不分流组。假手术组各项指标术前术后无显性差异,肝脏及肠粘膜组织病理学检查在分流组基本正常,未见细胞结构的改变。结论 本实验研究表明：肝缺血再灌注时,缺血本身可对肝脏造成损伤。同时,由于肝门被阻断,肠道血液回流受阻淤血,肠道受到损伤。肠道的多种毒性物质,如TNF－α,IL-1等细胞因子的增加可加重肝缺血再灌注损伤。分流组由于解除了肠道淤血,减轻了肠道的损伤,从而间接地减轻了肝脏的损伤。     

大鼠肝缺血再灌注后不同时相ICAM-1分子表达和肝损伤的关系

目的：探讨大鼠肝缺血再灌注后不同时相细胞间粘附分子（ICAM－1）表达和肝损伤的关系。方法：Wistar大鼠随机分为假手术组、再灌注30min组、再灌注60min组、再灌注24h组、再灌注72h组共5组；建立大鼠肝缺血再灌注模型，观察不同时相血清丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）水平，以及应用免疫组化方法（SP法）检测肝组织中不同是相ICAM－1分子的表达。结果：大鼠血清ALT和AST水平在再灌注30min升高显著（P＜0．05），再灌注60min组达高峰（P＜0．01），再灌注24h、72h组血清ALT和AST水平降至正常水平；再灌注后不同时相ICAM－1分子表达水平与血清ALT和AST水平呈显著正相关（P＜0．05）。结论：ICAM－1分子参与肝再灌注损伤的过程，其表达的强弱与肝损伤程度密切相关。     

缺血预处理对大鼠肝脏缺血再灌注损伤的保护作用

目的：探讨缺血预处理（ＩＰＣ）对肝脏缺血再灌注损伤的保护作用及其机理。方法：采用大鼠部分肝脏原位缺血再灌注损伤模型,随机分成：（１）下沉对照组,不作肝门阻断。（２）再灌注对照组;进行４５ｍｉｎ的肝门阻断及６０ｍｉｎ的再灌注;（３）预处理组：４５ｍｉｎ的肝门阻断前先进行５ｍｉｎ肝脏缺血及５ｍｉｎdisplay structure     

银杏叶提取物对大鼠肝脏缺血再灌注损伤的保护作用

目的 研究银杏叶提取物对大鼠急性肝脏缺血再灌注损伤的保护作用及其机制。方法 SD大鼠随机分为假手术对照组、单纯缺血再灌注组、缺血再灌注＋银杏叶提取物处理组。通过阻断大鼠肝门30min后再开放建立肝缺血再灌注损伤模型，在肝脏再灌注90min时测肝组织丙二醛（MDA）、超氧化物歧化酶（SOD）和测血ALT、AST，并观察肝组织病理学改变。结果再灌注90min时缺血再灌注（1／R）＋银杏叶提取物处理组的肝组织MDA生成，SOD消耗，血清ALT、AsT升高值均少于L／R组（P〈0．01），且L／R＋银杏叶提取物处理组的肝细胞显微结构损害的改变较L／R组轻。结论 银杏叶提取物通过抗氧化，对急性肝脏缺血再灌注损伤有保护作用。     

环孢素A对大鼠肝脏缺血再灌注损伤影响的实验研究

目的 :探讨环孢素A对肝脏缺血再灌注损伤的作用。方法 :雄性SD大鼠 2 4只 ,实验组 (A组 )术前 4d用环孢素A10mg/kg/d灌胃 ,对照组 (B组 )和假手术组 (C组 )则用生理盐水 5ml/kg/d灌胃 ,建立大鼠部分肝脏缺血再灌注模型。采用生化分析仪 ,肝组织切片HE染色 ,免疫组织化学分别测定血浆谷草转氨酶 (AST)、谷丙转氨酶 (ALT)、乳酸脱氢酶 (LDH)水平 ,肝脏病理改变。血管内皮细胞间粘附分子ICAM - 1的表达。结果 :与对照组比较 ,应用环孢素A的大鼠再灌注 10min后血浆中AST、ALT和LDH的浓度无明显差异 (P >0 .0 5 ) ,再灌注 60min后AST、ALT和LDH的浓度明显低于对照组 (P <0 .0 5 ) ;组织病理损伤减轻 ;肝血窦内皮细胞间粘附分子ICAM - 1的表达减少。结论 :环孢素A可以减轻肝脏缺血再灌注损伤     

暂时性肝门阻断时门体分流对大鼠肝脏能量代谢的影响

目的 比较暂时性肝门阻断时,门静脉分流和阻断对大鼠缺血再灌注后肝脏能量代谢的影响,为临床上减轻肝缺血再灌注损伤选取手术方式提供参考.方法 将大鼠分为假手术组、实验组和对照组3组,制作门颈静脉转流下大鼠肝脏缺血再灌注模型,观察大鼠术后1h、6h、24h、3d及7d肝脏能量代谢变化.结果 ①术后各时相点对照组RCR值和P/O均显著低于实验组,恢复正常时间对照组也晚于实验组;②实验组于术后各相应时相点肝细胞ATP含量均高于对照组,并且恢复正常也比对照组较早.结论 暂时性肝门阻断时门体分流处理能够改善能量代谢,提高缺血再灌注后肝脏的抗损伤能力.     

前列地尔注射液对犬肝脏缺血再灌注损伤的保护作用

目的探讨前列地尔注射液对犬肝脏缺血再灌注损伤的保护作用。方法24只健康杂交犬随机分为3组：假手术组,缺血再灌注损伤组（IR组）,前列地尔注射液预处理组（前列地尔组）,每组8只。建立犬肝脏缺血模型,IR组和前列地尔组选择性阻断第一、第二肝门30min,再灌注60min。各组经门静脉分别于肝门阻断前、缺血30min、再灌注60min取血测定血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、肿瘤坏死因子（TNF-α）。结果肝门阻断前,三组间血清ALT、AST、TNF-α浓度无明显差异。与假手术组比较,缺血30min和再灌注60min时,IR组及前列地尔组血清ALT、AST、TNF-α浓度明显升高;与IR组比较,缺血30min和再灌注60min后前列地尔组ALT、AST、TNF-α浓度明显降低（P〈0．01）。结论缺血前应用前列地尔注射液可以有效减轻肝脏缺血再灌注损伤程度。     

NO与肝脏缺血再灌注损伤预处理保护效应

目的：研究缺血预处理对SD大鼠肝脏缺血再灌注损伤保护机制中NO的作用;方法：建立大鼠肝脏缺血再灌注模型并进行缺血预处理,实验分组如下：假手术组（Sham-operation,S组）;缺血再灌注组（Ischemic Reperfusion,I/R组）;缺血预处理组（Ischemic Preconditioning,PC组）;预处理加左旋硝基精氨酸组（Preconditioning L-NNA,PC L组）,各组再灌注后检测血清丙氨酸转氨酶（ALT）及丙二醛（MDA）含量,肝组织石蜡切片HE染色及电镜观察;结果：PC组ALT及MDA含量明显低于I／R组（P＜0．01）,肝组织损伤程度明显减轻;PC＋L组在0－3h阶段ALT和MDA含量与I／R组无显著区别（P＞0．05）,而在6－48h阶段则显著低于I／R组（P＜0．01）但仍高于PC组（P＜0．05）。结论：缺血预处理对大鼠肝脏缺血再灌注损伤具有明显保护作用,0－3h为早期保护效应,可能为NO所触发或介导。     

异丙酚对肝癌切除术中肝脏缺血再灌注损伤的作用研究

目的观察肝癌术中肝门阻断前后及应用异丙酚后血中脂质过氧化产物丙二醛（ＭＡＤ）的含量变化规律,探讨 异丙酚预防肝癌切除术肝脏缺血再灌注损伤的作用。方法ＡＳＡⅠ－Ⅱ级拟行肝叶切除手术的肝癌患者３０例（全部行肝门阻断）随机分为Ａ组（对照组）和Ｂ组（异丙酚组）,每组１５例。异丙酚组于麻醉插管后全程用微泵持续静脉输注异丙酚６ｍｇ／ｋｇ·ｈ。检测不同时段血中 ＭＤＡ含量,记录相应时间的ＭＡＰ、ＨＲ、各组阻断肝门时间、麻醉恢复时间。结果两组各时点 ＭＡＰ、ＨＲ、ＳＰＯ２无显著差异。两组术前ＭＤＡ无差异,Ａ组肝门阻断１０分钟、停阻断１０分钟和４０分钟血中ＭＤＡ升高,与术前比较差异显著（Ｐ＜０．０１或Ｐ＜０．０５）。Ｂ组术中ＭＤＡ与术前比较无差异（Ｐ＞０．０５）,两组比较差异显著。两组麻醉恢复时间无差异。结论异丙酚可以消除肝癌术中阻断肝门导致的缺血再灌注损伤,不影响麻醉恢复时间,临床上应用于肝癌手术是安全的。     

超氧化物歧化酶对骨骼肌I/R后粘附分子表达的影响

目的：探讨超氧化物歧化酶（SOD）在骨骼肌缺血再灌注（I／R）后对白细胞表面粘附分子CD11b/CD18和骨骼肌血管中细胞间粘附分子（ICAM）－1表达的影响。方法：建立大鼠后肢缺血再灌注模型,102只大鼠随机分为假手术组（Ⅰ组,n=6)、缺血组（Ⅱ组,n=6)、缺血再灌注组（Ⅲ组,n=30）、生理盐水组（Ⅳ组,n=30),SOD组（Ⅴ组,n=30)。Ⅱ组在缺血4h末,Ⅲ、Ⅳ、Ⅴ组分别于再灌注1、2、4、8、12h末,测定血浆中的丙二醛（MDA）、骨骼肌组织中的髓过氧化物酶（MPO）,白细胞上粘附分子CD11b/CD18和骨骼肌血管中ICAM－1的表达情况及各组的组织学改变。结果：Ⅲ组各时相点MDA、MPO、CD11b/CD18、ICAM－1的表达与Ⅰ组比较,差异有非常显著意义,骨骼肌组织损伤也随再灌注时间的延长而逐渐加重,Ⅴ组中则这种变化明显抑制（P＜0．05）。Ⅳ组和Ⅲ组之间比较,差异无显著意义。结论：粘附分子CD11b/CD18和ICAM－1与骨骼肌I／R损伤密切相关,SOD不仅可以清除I／R时产生的氧自由基,还可以抑制粘附分子的表达,减少白细胞在骨骼肌组织中的浸润,从而减轻骨骼肌I／R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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.