99mTc标记抗心肌肌钙蛋白I单克隆抗体在实验性急性心肌损伤大鼠体内分布的研究

目的:研究99mTc标记的抗心肌肌钙蛋白I单克隆抗体(AcTnIMA)在实验性急性心肌损伤大鼠体内的分布,探讨99mTc-AcTnIMA是否可以作为心脏放射免疫显像剂.方法:实验组:20只急性心肌损伤大鼠注射99mTc-AcTnIMA 0.2mci,分别于注射后2、4、6、8 h处死(每次5只),取血液、肝、脾、肾、正常肌肉、肺和心脏,以计算每克组织放射性计数占总注入计数的百分比(ID%/g)及心-肺ID%/g比(HLR).药物对照组:20只急性心肌损伤大鼠注射99mTc标记的非特异性免疫球蛋白(N-IgG)0.2mci,处死方法同实验组.取肺及心脏,计算ID%/g及HLR;空白对照组:20只正常大鼠注射99mTc-AcTnIMA 0.2mci,处理方法同药物对照组.结果:急性损伤心肌对99mTc-AcTnIMA为特异性摄取,摄取的高峰时间为4 h.结论:99Tc-AcTnIMA有望作为心脏放射免疫显像剂诊断急性心肌损伤.     

心肌显像肺摄取定量分析对心肌梗塞患者临床和预后判断的价值

目的：探讨^99mTc-MIBI静息心肌显像肺摄取对心肌梗塞患者临床和预后判断的价值。方法：74例行静息心肌显像的心肌梗塞患者按肺摄取值分为肺摄取增加组和正常组,并对其随访,随访时间平均为23个月,心脏事件包括：心源性死亡,非致死性心肌梗塞,心肌显像3个月后的血运重建术（CABG或PTCA）,结果：肺摄取增加组较正常组有较高比例的心力衰竭（P＜0．001）和左室扩大（P＜0．01）,较多的心肌缺损节段数（P＜0．01）和病变血管数（P＜0．01）,较高的心肌异常灌注积分（P＜0．05）,逐步判别分析显示,心力衰竭是肺摄取增加最重要的影响因素（F＝26．20,P＜0．001）,肺摄取增加组心脏事件发生率（53．8％）显著高于正常组（18．8％）（P＜0．01）,Log-rank统计分析两组未发生心脏事件率差异有显著性（P＜0．05）,Cox多元回归显示,肺摄取增加是发生心脏事件独立的影响因素（RR＝6．05,95％CI 1．92－16．83％,P＜0．01）,结论：^99mTc－MIBI静息心肌显像肺摄取分析能提供左心功能等有用信息,肺摄取增加是心肌梗塞患者不良预后的独立预测指标。     

131I-Herceptin放射免疫显像用于Herceptin相关心脏毒性机制的实验研究

目的探讨Herceptin相关心脏毒性的机制。方法^131I-Herceptin采用Iodogen法制备。取家兔5只,注射^131I-Herceptin 3h～5d,以放射免疫显像观察Herceptin的分布,以肌肉为参照,计算并比较各组织、器官的计数与肌肉计数的比值（O/M）。于注射后第5天处死家兔,取心、肺等组织,称重并测定放射性计数,计算并比较每克组织摄取分数（%ID/g）。以免疫组化测定并比较家兔各脏器HER2表达。结果注射后3h心脏O/M比值显著高于肺（P=0.032）和肝（P=0.019）,但24h后显著降低（P=0.001）。各组织器官的每克组织的摄取分数以血液最高,为12.6%ID/g;其次为肝,为8.6%ID/g;心肌、肺和脾的摄取分数相近;肌肉最低,为1.6%ID/g。血液的摄取分数与其它脏器比较,除肝脏外（P=0.098）,其它均显著低于血液。心肌摄取仅高于肌肉（P=0.041）和小肠（P=0.034）,数值上甚至低于肝、肾、脾。心肌、肺和脾的摄取分数相近。心肌HER2表达水平与肝、肺、肾等组织未见显著差异（H=3.236,P=0.172）。结论心肌属于HER2低表达组织,对Herceptin的摄取量并不高于其它组织器官。     

^99mTc—Q3与^201Tl在不同流量冠脉灌注的离体兔心肌中的清除及存留特性研究

目的 探讨不同流量冠脉灌注的离体兔心肌对^99mTc-Q3和^201Tl的清除及存留特性,进一步揭示^99mTc-Q3和^201Tl在不同流量冠脉灌注的离体兔心肌中的摄取、清除及存留量之间的关系。方法 选用20只新西兰大白兔,于麻醉下开胸,摘除心脏,建立离体兔心脏灌注模型。采用双核素法进行离体兔心脏灌注。结果 心肌对^201Tl的净摄取值大于^99mTc-Q3,但其改变受血流灌注量影响也比^99mTc-Q3更明显。高流量灌注组,注射示踪剂后4－25分钟内,^201Tl的清除比^99mTc-Q3清除更快;低流量灌注组,注射示踪剂后40分钟内^201Tl清除比^99mTc-Q3快,高流量灌流组中观察到的^201Tl早快速清除现象在低流量灌注组中未出现,而^99mTc-Q3在两组中均未见早期快速清除。结论 由于^201Tl的清除比^99mTc-Q3清除更快,其较高摄取的优势在药物注射后10分钟时已完全丧失,故^99mTc-Q3仍不失为一种优良的心肌灌注显像剂,值得进一步研究。     

99mTc-TRODAT-1显像早期诊断帕金森病的研究

目的研究多巴胺转运蛋白（DAT）显像剂^99mTc-2β-[N，N’-双（2-巯乙基）乙撑二胺基]甲基，3β-（4-氯苯基）托烷（^99mTc-TRODAT-1）对帕金森病（PD）早期诊断的价值。方法将43只SD大鼠分成3组：（1）正常组20只；（2）单侧PD模型组17只（行颅内单侧纹状体毁损）；（3）多发性腔梗模型组6只（行颈动脉注射自体血栓术）。经尾静脉注入^99mTc-TRODAT-1，观察其在正常大鼠体内及纹状体内的分布情况，比较单侧PD模型组健侧与毁损侧及多发性腔梗模型组双侧纹状体^99mTc-TRODAT-1的摄取比值。结果正常大鼠纹状体明显摄取^99mTc-TRODAT-1，单侧PD模型鼠毁损侧纹状体^99mTc-TRODAT-1摄取较健侧明显减少，多发性腔梗模型鼠的结果与正常组相似。结论^99mTc-TRODAT-1显像剂被纹状体特异性摄取，其单光子发射型计算机断层显像（SPECT）能为PD病早期诊断提供有利依据。     

帕金森病SD大鼠模型的99Tcm-TRODAT-1放射自显影实验研究

目的：研究多巴胺转运蛋白（DAT）显像剂^99Tc^m -2β-[N，N’-双（2-巯乙基）乙撑二胺基]甲基3-β-（4-氯苯基）托烷（^99Tc^m -TRODAT-1）用于帕金森病（PD）早期诊断的价值。方法：将SD大鼠分成三组：①正常组；②单侧帕金森病（PD）模型组（颅内单侧纹状体毁损）；③多发性腔隙性脑梗死（简称多发性腔梗）模型组（颈动脉注射自体血栓术）。观察正常大鼠纹状体内^99Tc^m-TRODAT-1分布情况。比较各组纹状体^99Tc^m-TRODAT-1的摄取情况。结果：正常大鼠纹状体明显摄取^99Tc^m-TRODAT-1，单侧PD模型鼠毁损侧纹状体^99Tc^m-TRODAT-1摄取较健侧明显减少，多发性腔梗模型鼠的结果与正常组相似。结论：^99Tc^m-TRODAT-1显像剂被纹状体特异性摄取。能为PD病早期诊断提供有利依据。     

^99mTc标记Laminin—YIGSR肿瘤小显像的实验研究鼠模型

目的探讨^99mTc—YIGsR作为一种新型的肿瘤显像剂在埃氏腹水肿瘤受体显像中的应用价值。方法①制备^99mTc—MAG3-YIGSR探针．以S-乙基-琥珀酰亚胺-巯乙苷肽（S—Acetly-NHS-MAG3）为螯合剂，将^99mTc标记到层黏素多肽片断YIGSR上；②对肿瘤模型组及封闭模型组行^99mTc—YIGSR生物学分布实验；③观察肿瘤模型组、炎症模型组及封闭模型组动物模型显像。结果①反相Sep-PakC18柱层析结果表明，YIGSR可以很好地与S-Acetly—NHS-MAG3偶联，偶联物在室温及中性条件下可完成^99mTc标记，标记率为62形．纯化后放射化学纯度〉95％。室温放置1、2、4h，放射化学纯度分别是91％，86％及81％。未与S—Acetly—NHS-MAG3偶联之YIGSR进行标记时，标记率为4％；②生物学分布结果显示^99mTc—YIGSR在小鼠血液内清除迅速，主要经。肾脏排泄，其次为肝脏；③^99mTcYIGSR静脉注入肿瘤模型组小鼠体内后，15min肿瘤部位有摄取．3h摄取达高峰，肿瘤／对侧肢体比值为11．36．此后显像剂清除较为缓慢，8h时下降至7．50。封闭模型组肿瘤细胞的摄取明显低下，肿瘤／对侧肢体比值是4．61（3h）、0．89（8h）；炎症模型组中，炎症／对侧肢体比值是3．72（3h）、1．29（8h）。与炎症模型组及封闭模型组比较．肿瘤模型组3h、8h肿瘤／对侧肢体的比值明显增高（P〈0．01）。结论通过螯合剂S-Acetly—NHS-MAG。可顺利完成层黏素多肽片段YIGSR的^99mTc标记^99mTcTc—YIGSR用于肿瘤显像具有显像时间早，显像清晰．灵敏度高．特异性强，靶／非靶比值高等特点，是一种有发展前景的新型肿瘤受体显像剂。     

99mTc-CL3-Bt的制备、质控及生物分布研究

目的 制备99mTc-CL3-Bt并对其质量控制、生物分布进行研究。方法 将单抗CL3生物素（Bt）化,以2-巯基乙醇（2-ME）还原后以直接法进行99mTc 标记。以细胞结合实验测定并比较99mTc-CL3-Bt 和99mTc-CL3的免疫活性;然后将两种标记物注入荷大肠癌裸鼠模型,6 h后处死裸鼠,计算并比较99mTc-CL3-Bt 和99mTc-CL3在体内的每克组织摄取分数（ID%/g）值和肿瘤ID%/g/其它组织ID%/g（T/NT）比值。结果99mTc-CL3-Bt和99mTc-CL3的细胞结合率分别为90%、94%;在瘤体的ID%/g值分别为（6.3±1.1）、（6.7±0.9）,二者无显著差异（t=0.6293, P>0.05）;瘤/血比值分别为（0.70±0.24）、（0.80±0.12）,二者亦无显著差异（t=0.8333, P>0.05）。结论 99mTc-CL3-Bt免疫活性高,能特异性被肿瘤摄取,可广泛用于临床放射免疫显像研究。     

心肌营养素-1在扩张型心肌病大鼠心肌的表达

目的探讨心肌营养素-1（CT-1）在DCM大鼠心肌的表达及作用。方法30只成年雄性Wistar大鼠随机分为两组：DCM组20只,腹腔内注射阿霉素（ADM）2．5mg／kg,2次／周,共6周,诱导大鼠DCM模型;对照组10只,同法注射等量生理盐水。第8周时行心脏超声检测,用VG染色观察心肌组织病理改变,用半定量RT—PCR检测CT-1在对照组大鼠与DCM大鼠心肌的表达。结果DCM组的心脏较对照组明显扩大,且心肌纤维化明显,心肌CT-1表达明显升高（P〈0．01）。结论在阿霉素诱导的DCM大鼠心肌中CT-1过度表达,可能与其保护心肌细胞、促进心肌细胞肥大有关。     

Lewy体病患者损伤心肌对^123I-间碘苄胍的摄取情况：Lewy体型痴呆和帕金森病的比较

背景：^123I标记的间碘苄胍（^123I—MIBG）心肌闪烁扫描曾被用以评估Lewy体病（LBD）患者的心脏交感神经去神经支配，LBD包括帕金森病（PD）与Lewy体型痴呆（DLB）。LBD患者的心肌MIBG累积显著减少，表明患者的心脏交感神经系统严重损伤。然而，DLB和PD患者之间的闪烁扫描差异尚不确定。目的：本研究旨在对比在疾病的早期阶段采用^123I—MIBG闪烁扫描所测DLB和PD患者的心脏交感神经功能。方法：在22例早期DLB患者、41例早期原发性PD患者和15例正常对照受试者（年龄与病程与患者相匹配）中进行^123I—MIBG心肌闪烁扫描检查。计算心脏／纵隔对^123I—MIBG的摄取比（H／M）。结果：早期DLB患者心肌对^123I—MIBG的摄取明显低于对照者。DLB患者的平均H／M明显低于PD患者，并且不依赖于Hoehn和Yahr阶段。结论：本研究结果表明，DLB患者心脏交感神经功能即使在疾病的早期阶段就已经严重受损。     

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.