经皮穿刺纤维环法诱导兔腰椎间盘退变模型

目的：建立兔腰椎间盘退变模型制作方法。方法：普通级新西兰大白兔10只,以腰5—6椎间盘为模型,18G穿刺针体表定位下,经皮穿刺损伤腰5—6椎间盘前外侧纤维环,X线摄片确认穿刺针头位置,随后将其处死,留置穿刺针位置不变,解剖确定穿刺路径以及针尖位置。结果：①X线摄片示穿刺针均位于椎间隙内;②解剖发现,经皮穿刺针均穿刺到椎间盘纤维环而未进入椎管,未损伤神经根,未刺穿腹膜伤及腹部大血管。结论：本实验可为椎间盘退行性变提供一种操作简单．损伤小．感染机会小,动物存活率高,操作时间短的模型制作方法。     

纤维环穿刺法建立兔椎间盘退变模型

目的:拟建立一个有效的可重复的椎间盘退变模型.方法:取健康成年新西兰大白兔40只,体质量2.5~3.0 kg,雌雄不限,随机分为纤维环穿刺组和对照组,每组20只.经腹膜外入路暴露L4/5、L5/6两个椎间隙,采用21号针头从椎间隙侧前方刺入L4/5、L5/6椎间盘的纤维环,深度控制在5 mm.对照组仅分离暴露椎间盘,不做任何处理.术后1、2、4、6、8周每组随机选取4只兔子行MRI、HE染色及Ⅱ型胶原免疫组化观察退变椎间盘的变化.结果:MRI观察发现,纤维环穿刺组术后椎间盘T2信号强度呈持续减弱趋势,椎间隙高度也不断下降.从术后2周开始两组差异有统计学意义(P<0.05).HE染色观察发现,随着时间进展,纤维环穿刺组髓核细胞逐渐减少,8周时组髓核组织几乎完全变性,被纤维软骨组织替代.Ⅱ型胶原免疫组化染色示,纤维环穿刺组Ⅱ型胶原表达随时间呈进行性下降,从术后第2周开始两组差异有统计学意义(P<0.05).结论:纤维环穿刺法可以诱导兔椎间盘缓慢退变,为深入研究椎间盘退变机制及治疗手段提供可靠的动物模型.     

纤维环穿刺法诱导兔椎间盘退变模型的组织学和影像学分析

目的探讨纤维环穿刺法诱导椎间盘退变模型的可行性和科学性。方法新西兰大白兔18只,经右侧腹膜外入路用弯血管钳夹持16G穿刺针准确刺入L3-4、L4-5、L5-6椎间盘的纤维环,深度控制在5 mm。于术前及术后4、8、12周对造模后的椎间盘及对照组的椎间盘（以L1-2、L2-3、L6-7为对照）行计算机X线摄影（computed radiography,CR）、MRI检查,并进行组织学观察。结果从手术后第4～12周,造模后的椎间盘高度指数（disc height index,DHI）呈递减趋势,MRI T2WI信号呈现持续减弱趋势（P〈0.01）;组织学观察发现4、8周造模组髓核细胞逐渐减少,12周组髓核细胞几乎被纤维软骨组织替代,纤维环排列不整齐,与髓核界限不清。结论纤维环穿刺法可以诱导兔椎间盘的缓慢退变,为临床深入研究椎间盘的退行性变提供了切实可行的动物模型。     

穿刺抽吸法诱导兔椎间盘退变模型

目的:实验通过纤维环穿刺抽吸法建立兔椎间盘退变模型,并通过病理组织学、影像学检测分析此种方法的特点。方法:取10月龄健康日本大耳白12只,雌雄不限,利用21 G穿刺针分别在兔L3～4、L4～5、L5～6节段刺入纤维环并抽吸髓核约8～10 mg;L1～2、L2～3及L6～7节段只暴露不做穿刺抽吸。造模完毕后,实验兔分别于术后4、8、12、16周各取3只进行指标检测MRI检查,然后处死实验动物获取椎间盘,利用病理组织学观察。结果:L3～4、L4～5、L5～6椎间盘髓核MRIT2WI信号强度在术后随时间延长呈现逐渐降低趋势,髓核面积逐渐缩小,椎间隙高度也逐步下降,从术后4周开始两组差异有统计学意义(P<0.05)。随着时间的进展,番红"O"染色显示纤维环穿刺组髓核内细胞外基质含量逐渐减少。结论:纤维环穿刺法可成功建立椎间盘退变模型,比较真实地模拟了人类椎间盘损伤后的退变过程。     

兔纤维环损伤椎间盘退变模型观察神经长入的实验研究

目的:用2种不同方法损伤纤维环诱发椎间盘退变,观察椎间盘退变及神经纤维长入退变间盘的病理过程.方法:分别用11号刀片(刀片损伤组)和16号针刺(针刺组)5 mm深度损伤纤维环,致髓核突出椎间盘退变;在不同时间点采用X线、MRI和组织学方法进行椎间盘退变的评价,免疫组化方法PGP 9.5和GAP 43特异性神经抗体染色观察退变椎间盘神经纤维长入的过程.结果:与正常对照组相比,刀片损伤组和针刺组术后2周,受损椎间盘高度和T2信号强度开始逐渐下降(P<0.01),与此同时其组织结构也发生退变,其中刀片损伤组椎间盘退变过程和程度较针刺组快.术后12周纤维环损伤处髓核突出瘢痕组织形成.免疫组化:正常椎间盘仅在纤维环最外层有神经纤维分布且与纤维环相平行;刀片损伤组瘢痕组织表面及深部散在分布神经纤维,深度>1 mm;针刺组仅在瘢痕组织外层及浅部区域有神经纤维分布,且刀片损伤组较针刺组有更广泛的神经长入.结论:5 mm深度11号刀片损伤、16号针刺兔纤维环退变模型在损伤后发生一种进展的逐渐退变过程,而且刀片损伤纤维环退变快,神经纤维分布广而深.这种进展的病理过程可能与源性腰痛密切相关.     

兔腰椎间盘退变模型的建立及影像学分析

目的探讨针刺抽吸法建立椎间盘退变动物模型的可行性。方法新西兰大白兔18只,用持针器夹持21 G皮肤穿刺针从椎间隙正前方刺入L3-4、L4-5、L5-6椎间盘的纤维环,深度控制在5 mm,拔出针芯,抽吸出部分髓核组织。术前及术后4、8、12周分别对造模后椎间盘及对照椎间盘（L2-3）行MRI及CR检查。结果术后第4周到第12周,造模后的椎间盘MRI的T2W1信号呈现持续减弱趋势;椎间盘高度指数持续下降,差异有高度统计学意义（P〈0.01）。结论针刺抽吸法可诱导兔椎间盘的缓慢退变,从而为研究椎间盘退行性变的机制及治疗提供有效的动物模型。     

转基因髓核细胞移植对兔腰椎间盘退变的影响

目的：椎间盘退变是引起腰背痛的主要原因。将腺相关病毒（adeno-associated virus,AAV）介导的结缔组织生长因子（connective tissue growth factor,CTGF）和基质金属蛋白酶组织抑制因子1(tissue inhibitor of metalloproteinases 1,TIMP1) 双基因体外联合转染兔椎间盘髓核细胞后,再移植于退变椎间盘内,观察椎间高度、II型胶原和蛋白多糖合成的变化,以探讨体外延缓或逆转椎间盘细胞退变的方法。方法 20只新西兰大白兔应用CT引导下的微创穿刺法建立兔椎间盘退变模型。以rAAV2-CTGF-IRES-TIMP1体外转染培养的兔髓核细胞,再将其显微注射于退变椎间盘内作为细胞移植组;退变椎间盘内注入磷酸盐缓冲液（PBS）作为退变对照组;正常椎间盘作为空白对照组。分别于6、10、14周行X线和MRI检查观察椎间高度的变化及椎间盘信号的改变,Western-blot鉴定细胞因子CTGF和TIMP1在椎间盘内的表达,35S整合法测定兔髓核组织蛋白多糖合成率,RT-PCR检测II型胶原及蛋白多糖mRNA的表达。结果 MRI证实CT引导下经皮微创穿刺2周后椎间盘开始退变。与退变对照组相比,MRI显示细胞移植组椎间盘退变明显减轻,转基因兔髓核细胞移植可减缓椎间高度(DHI)下降的发生率,转基因细胞移植组较退变对照组相比,Ⅱ型胶原含量和蛋白多糖的生物合成明显增加,差别有统计学意义（P﹤0.05）。结论 经皮CT 引导下穿刺可成功建立兔椎间盘退变模型。转双基因CTGF和TIMP1 髓核细胞移植可有助于椎间高度的维持,促进椎间盘内蛋白多糖和II型胶原的生物合成,明显延缓椎间盘退变。     

纤维环针刺法建立兔椎间盘退变模型的实验研究

目的建立一种稳定可靠、可重复性好、成功率高,且与人类退变相似的椎间盘退变模型。方法38只普通级新西兰大白兔,雌雄不计,随机选取2只动物用于研究兔腰椎的解剖学特点,另外36只动物用随机数字表法均分为模型组和对照组。模型组手术取右侧腹膜后入路,暴露至L5/L6、L4/L5椎间盘纤维环,予16G穿刺针针刺纤维环;对照组同法暴露不进行针刺。分别于术前及术后4周对实验动物行X线和MRI检查,术后4周处死实验动物,取椎间盘标本行病理学检查。结果术后4周,X线和MRI检查显示模型组椎间盘高度明显降低、部分骨赘形成、终板硬化,T2加权像信号较术前明显降低、椎间盘颜色变黑变暗,髓核缩小或消失,纤维环变厚;而对照组椎间盘未见明显变化,T2加权像呈均匀高信号;取椎间盘标本经HE染色,电镜下见模型组髓核组织明显缩小,结构紊乱,细胞密度较小,纤维向内塌陷,纤维环板层出现明显断裂,排列不整齐,纤维环内层见少量毛细血管长入;对照组腰椎间盘病理学检查无明显退变表现;免疫组化见模型组椎间盘内TNF-a数量较对照组明显增多。结论该方法具有操作简单、可行、高效等优点,是建立椎间盘退变模型的一种可靠方法。     

胸腰椎骨折内固定术后相邻椎间盘的影像学特点

目的：回顾性分析胸腰椎骨折伴随椎间盘损伤经内固定术治疗后,损伤椎间盘转归的影像学特点。方法收集因单一节段胸腰椎椎体骨折行后路骨折复位内固定术,并在椎体骨性愈合后返院复诊的患者35例。通过骨折复位内固定手术前胸腰椎CT和（或） MRI观察责任椎体相邻椎间盘损伤与否,将患者分为椎间盘完整组与椎间盘损伤组。所有患者均行后路骨折复位及椎弓根螺钉内固定术,没有实施椎间盘切除及椎间融合术。通过X线侧位片测量内固定术前及末次随访责任椎体相邻椎间隙的椎间高度并分析两组椎间隙高度值的差异;通过CT检查统计椎体边缘骨赘增生、椎间不稳、许莫氏结节、椎间盘真空征的发生率。结果35例70个椎间盘中,完整组为30个,损伤组为40个。末次随访时完整组中椎间盘总退变数为3个,退变发生率为10.0％;而损伤组中椎间盘退变数为33个,退变发生率为82.5％。其中损伤组中许莫氏结节和椎间盘真空征的发生率明显高于完整组（55％vs 0、17.5％vs 0）,差异有统计学意义。结论（1）椎间盘创伤后的自我修复过程十分缓慢并且效果不甚明显,随访期内可见许莫氏结节及真空征为高发的椎间盘退变征象;（2）在椎间盘自身损伤的病理学基础上,随着内固定取出后,损伤椎间盘的退变可能因此而加快。     

纤维环穿刺法与腰椎失稳法建立椎间盘退变模型

目的应用纤维环穿刺法与腰椎失稳法建立大鼠腰椎间盘退变模型,比较两种方法的异同。方法针刺组选用21G穿刺针对大鼠L3,4、L4,5、L5,6椎间盘行全层针刺;失稳组切除大鼠L3～L6棘突、棘上、棘间韧带和两侧关节突。于术后2周、4周和8周每组各取6只大鼠行腰椎影像学和组织学检查。结果针刺组大鼠2周时出现椎间隙狭窄,纤维环断裂,T2信号强度减低;4周时退变进展;8周时出现髓核皱缩、纤维化,T2呈完全低信号。失稳组4周时出现退变征象,8周时退变加重。结论两种方法均能建立大鼠腰椎间盘退变模型,针刺法较失稳法退变出现早、进展快且程度严重。     

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.