输尿管部分梗阻致肾功能损害及肾间质纤维化的研究

目的:研究单侧输尿管部分梗阻后肾功能损害及肾间质纤维化的发生机理。方法:48只雄性SD大鼠,其中24只为对照组,另24只大鼠建立单侧输尿管部分梗阻动物模型,在术后1、2、4、8周各随机选取6只,测定血、尿肌酐浓度,计算肾小球滤过率,免疫组织化学半定量分析肾间质内Ⅰ、Ⅲ型胶原蛋白含量。结果:输尿管部分梗阻后1周血清肌酐和肾小球滤过率无显著改变,但肾间质纤维化明显(P<0.01),随着梗阻时间延长,肾间质纤维化加重,血清肌酐逐渐升高,肾小球滤过率进行性降低(P<0.01)。结论:输尿管部分梗阻后,肾小管间质纤维化发生在肾功能出现损害之前,肾间质纤维化及肾功能损害均呈进行性发展。     

单侧输尿管梗阻大鼠肾间质纤维化的产生机制

目的 探讨单侧输尿管梗阻后肾间质纤维化形成机制。方法 将30只大鼠采用单侧输尿管梗阻（uu0）模型，术后第3、7、14天观察双肾组织病理改变，并应用免疫组织化学方法检测肾间质中核转录因子（NF-KB），转移生长因子岛（TGF-β1），α-平滑肌肌动蛋白（α-sMA）的表达，并检测肾间质胶原蛋白的含量。结果随着梗阻时间延长，梗阻侧肾间质中NF-KB、TGF-β1、α-SMA及胶原蛋白的含量增加，对侧无明显变化，两组相比有明显差异（P〈0．05）。结论 单侧输尿管梗阻的大鼠肾间质NF-KB、TGF-β1、α-SMA的过度表达，可上调肾间质胶原蛋白的含量，是形成肾间质纤维化的主要原因之一。     

来氟米特阻抑UUO大鼠肾间质纤维化的实验研究

目的:观察来氟米特对单侧输尿管梗阻大鼠肾间质纤维化指标PCNA、α-SMA及ColⅠ、ColⅢ的表达程度的影响及相互关系,从而探讨其作用机制.方法:将36只健康、雄性SD大鼠中的24只行左输尿管结扎术,另外12只行假手术.术后第2天开始给药,结扎后的大鼠分为UUO组和治疗组.术后第7、14天分别处死各组中的6只大鼠,用免疫组化方法测定PCNA、α-SMA、ColⅠ、ColⅢ的表达情况.行HE和Masson染色,动态观察肾间质病理学改变.结果:来氟米特能显著减少UUO大鼠肾小管间质的PCNA、α-SMA表达,减轻ColⅠ和ColⅢ在肾小管间质的沉积.结论:来氟米特可抑制受伤的肾小管间质α-SMA的表达,减少基质的聚集从而减轻肾间质纤维化.     

梗阻性肾病肾纤维化与血清中Ⅲ型胶原变化的相关性研究

目的探讨梗阻性肾病时血清中Ⅲ型前胶原（PCⅢ）及Ⅲ型前胶原氨基末端肽（PⅢNP）浓度的变化与肾组织纤维化的相关性。方法将健康雄性新西兰大白兔40只通过手术分为单侧输尿管部分梗阻组、单侧输尿管完全梗阻组、假手术组、正常对照组,每组10只。术前及术后1～8周抽取大白兔静脉血,放射免疫法测定血清中PCⅢ及PⅢNP含量。术后第8周提取动物肾脏组织,免疫组化SP法染色测定Ⅲ型胶原含量,HE染色测定肾小管肾间质纤维化程度。结果①术后1～8周PCⅢ及PⅢNP值较术前升高（P＜0.05）。单侧输尿管部分梗阻组、单侧输尿管完全梗阻组PCⅢ及PⅢNP值较同期对照组、假手术组值升高（P＜0.05）;②单侧输尿管部分梗阻组、单侧输尿管完全梗阻组肾小管肾间质病变比率较对照组差异有统计学意义（P＜0.05）;③血清PCⅢ及PⅢNP浓度与病变肾小管肾间质比率呈正相关（P＜0.05）。结论血清PCⅢ及PⅢNP与肾积水时肾脏间质纤维化密切相关。在排除其他脏器纤维化的前提下,血清PCⅢ及PⅢNP可以作为早期判断肾积水肾脏纤维化的无创性检查指标。     

肾纤复元胶囊对单侧输尿管梗阻大鼠模型肾间质纤维化的抑制作用及机制探讨

目的观察肾纤复元胶囊对单侧输尿管梗阻（UUO）大鼠模型的治疗作用并探讨其机制。方法将48只SD大鼠随机分为假手术（SOR）组、UUO模型组、氯沙坦治疗组（LOS组）和肾纤复元胶囊治疗组（SXFYC组）。后三组采用经典的单侧输尿管梗阻术建立肾间质纤维化大鼠模型。观察术后第7、14天各组大鼠血尿生化指标变化、肾组织病理变化，检测转化生长因子β1（TGF—β1）、α-平滑肌肌动蛋白（α—SMA）、Ⅰ型胶原（ColⅠ）和纤维连接蛋白（FN）在肾组织中的表达及TGF-β1、α-SMA、ColⅠ和FN在基因水平的表达情况。结果不同组大鼠术后第7、14天24小时尿蛋白总量差异无显著性（P〉0．05），两治疗组血肌酐明显低于UUO模型组（P〈0．05），两治疗组间差异无统计学意义（P〉0．05）；光镜下肾组织病理切片显示两治疗组与同一时间点UUO模型组相比，肾间质纤维化程度显著降低（P〈0．05），两治疗组间差异无统计学意义（P〉0．05）；免疫组化和RT—PCR结果表明，两治疗组各时间点TGF—β1、α—SMA、ColⅠ和FN的表达均低于UUO模型组（P〈0．05），两治疗组间差异无统计学意义（P〉0．05）。结论肾纤复元胶囊可从一定程度上减轻UUO大鼠肾间质纤维化程度，其作用机制可能与下调TGF—β1和α—SMA表达、抑制ColⅠ和FN的合成有关。     

单侧输尿管部分梗阻后输尿管平滑肌细胞中M3受体改变的实验研究

目的测定大鼠单侧输尿管部分梗阻（PUUO）后输尿管平滑肌细胞中M3受体mRNA的转录水平和蛋白表达水平改变的规律,以探讨PUUO后输尿管平滑肌细胞中M3受体的作用。方法 Wistar雄性大鼠80只,随机分为4组：8周PUUO组、16周PUUO组、8周对照组及16周对照组,每组各20只。两PUUO组（n=40）采用把大鼠输尿管左侧上1/2段埋入腰大肌做成PUUO的大鼠模型,两对照组（n=40）只游离左侧输尿管。模型制作成功后于8周和16周时取出输尿管,分别用RT-PCR检测输尿管平滑肌M3受体mRNA的含量,Western-blotting检测输尿管平滑肌M3受体蛋白的含量。结果 RT-PCR结果示：M3受体mRNA的表达8周PUUO组高于8周对照组（55.16±3.94）vs（36.48±3.87）,16周PUUO组低于16周对照组（19.37±3.70）vs（37.39±3.65）,8周PUUO组高于16周PUUO组,差异均有统计学意义（均P〈0.05）。Western-blotting结果示：M3受体蛋白的表达8周PUUO组高于8周对照组（27.13±1.77）vs（21.36±2.69）,16周PUUO组低于16周对照组（19.41±1.37）vs（23.43±1.58）,差异均有统计学意义（均P〈0.05）,8周对照组与16周对照组比较差异无统计学意义（P〉0.05）。结论梗阻8周时大鼠输尿管平滑肌中M3受体的生物合成上调,梗阻至16周时输尿管平滑肌中M3受体生物合成下调,为后续与临床相结合的研究做了更进一步的铺垫。     

输尿管部分梗阻后平滑肌细胞中游离Ca^2＋浓度改变

目的：测定大鼠单侧部分输尿管梗阻后输尿管平滑肌细胞中游离Ca^2＋浓度改变。方法：将Wistar雄性大鼠80只随机分为4组：8周PUUO组20只,16周PUUO组20只,同期对照组各20只。PUUO组采用将大鼠左侧上1＼2段输尿管包埋入腰大肌造成单侧输尿管部分梗阻的动物模型,对照组仪分离左侧输尿管。成模后分别于8周和16周分离取出输尿管．分离单个输尿管平滑肌细胞应用Fura-2／AM荧光探针负载检测输尿管平滑肌细胞中游离Ca^2＋的浓度。结果：输尿管平滑肌静态细胞内Ca^2＋荧光比值测定结果显示：8周的PUUO大鼠组与对照组大鼠之间细胞内游离Ca^2＋浓度的差异无统计学意义,而16周的PUUO大鼠组细胞内游离Ca^2＋的浓度显著升高,且差异具有统计学意义（P〈0．05）。结论：细胞内钙超载是输尿管梗阻后平滑肌功能损害病理过程的重要原因,但是发生较晚,可能在输尿管部分梗阻后期起着重要作用。     

单侧输尿管梗阻大鼠肾间质纤维化的机制

目的 :探讨单侧输尿管梗阻后肾间质纤维化的形成机制。方法 :将 2 0只大鼠采用单侧输尿管梗阻(UUO)模型 ,术后 1周、2周观察双肾组织病理改变 ,并应用免疫组织化学方法检测肾间质Ⅲ型胶原、转化生长因子β1(TGF β1)和核因子 κB(NF κB)的表达。结果 :随着梗阻时间延长 ,梗阻肾间质Ⅲ型胶原、TGF β1和NF κB的表达增加 ,对侧无明显变化 ,两组相比有显著差异 (P <0 .0 5 )。结论 :单侧输尿管梗阻肾间质TGF β1、NF κB的过度表达 ,可上调肾间质Ⅲ型胶原的表达 ,是形成间质纤维化的重要原因之一     

阿魏酸钠对单侧输尿管梗阻大鼠肾脏保护作用的研究

目的 探讨阿魏酸钠对大鼠单侧输尿管梗阻模型肾问质纤维化的影响.方法 UUO大鼠给予阿魏酸钠100mg/(kg·d)腹腔注射,观察第14天血清肌酐、尿素氮的变化及肾间质纤维程度、Col Ⅰ、ColⅢ、t-PA、u-PA及PAI-1的表达.结果 与UUO组相比,治疗组血清肌酐、尿素差异均无显著性,肾小管纤维化程度、PAl-1及Ⅰ、Ⅲ型胶原的表达显著降低,t-PA、u-PA的表达显著增加.结论阿魏酸钠可以通过下调PAI-1及上调t-PA、u-PA而减轻UUO术后大鼠肾间质纤维化.     

红花黄色素对实验性肾间质纤维化大鼠TGF-β及Ⅰ型胶原表达的影响

目的观察红花黄色素注射液对肾间质纤维化大鼠TGF-β及Ⅰ型胶原表达的影响,并探讨其肾脏保护机制。方法45只雄性SD大鼠,随机分为假手术组（A组）、单侧输尿管梗阻（Unilateral ureteral obstruction;uuo）组（B组）、UUO＋红花黄色素治疗组（C组）,各15只。C组红花黄色素5mg／kg·d,造模术前1天开始腹腔注射给药,各组术后10d处死大鼠,处死后取术侧肾组织行HE、Masson染色,转化生长因子（Transforming growth factor-β;TGF-β1）,Ⅰ型胶原（Collagen Ⅰ,Col Ⅰ）免疫组化检测、结果应用图像分析系统进行半定量分析。结果B组、C组可见明显肾间质纤维化的病理改变。c组与B组相比,肾间质纤维化病变程度较轻。免疫组化结果提示：C组与B组相比TGF-β、ColⅠ表达减少（P〈0．01）。结论注射用红花黄色素对大鼠肾间质纤维化有保护作用,这种作用可能是通过抑制TGF-β1的表达,减少Ⅰ型胶原合成的作用实现的。     

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.