托里透毒法促进大鼠慢性胃溃疡黏膜谷氨酰胺表达的研究

目的：在前期托里透毒法促进大鼠慢性胃溃疡黏膜修复的研究成果之上,从谷氨酰胺（Gln）因子,揭示托里透毒法促进慢性胃溃疡黏膜修复的机制。方法：采用乙酸烧灼型慢性胃溃疡模型,测定溃疡指数,光学显微镜观察病理,ELISA法测定Gln水平。结果：给药14天,体现托里透毒法各中药复方对乙酸烧灼型慢性胃溃疡均有不同程度抗溃疡和缩短溃疡修复时间,从而保护胃黏膜和促进溃疡修复作用,且以透脓散中剂量和低剂量作用较强。体现托里透毒法透脓散高剂量和透脓散中剂量均有增加胃黏膜Gln水平的作用。结论：透脓散高剂量和透脓散中剂量可能通过促进胃黏膜Gln的合成、表达,从而改善胃溃疡修复的营养状况,促进溃疡愈合,预防其复发。     

病理性瘢痕中丙二醛、羟脯氨酸含量以及黄嘌呤氧化酶、总超氧化物歧化酶活力变化

目的：观察病理性瘢痕中丙二醛（malonalldehyde MDA）、羟脯氨酸（hydroxyproline Hyp）含量以及黄嘌呤氧化酶（xanthine oxidase XOD）、总超氧化物歧化酶（total superoxide Dismutase T-SOD）活力的变化,探讨自由基在瘢痕过度增生中的作用。方法：收集手术切除标本35例,其中增生性瘢痕、瘢痕疙瘩各10例,成熟瘢痕标本6例以及正常皮肤标本9例,取组织匀浆上清液应用化学比色法检测MDA及HyP含量,XOD及T-SOD活力。结果：与正常皮肤比较,增生性瘢痕和瘢痕疙瘩中MDA、Hyp含量以及XOD、T-SOD活力明显升高（P〈0.05）,成熟瘢痕与正常皮肤组比较无统计学意义（P〉0.05）;与成熟瘢痕组比较,增生性瘢痕和瘢痕疙瘩中MDA、Hyp含量以及XOD、T-SOD活力明显升高（P〈0.05）,增生性瘢痕组与瘢痕疙瘩组比较无统计学意义（P〉0.05）。结论：病理性瘢痕中胶原沉积,瘢痕过度增生可能与自由基水平升高有关。     

当归饮子对复合型慢性荨麻疹致敏小鼠模型细胞因子的影响

目的 研究当归饮子对气血两虚型慢性荨麻疹治疗机理。方法 KM小鼠,雌雄各半,采用利血平+乙酰苯肼,联合IV型变态反应模拟荨麻疹模型,选择模型制作成功的动物,随机分为模型组、氯雷他定组、当归饮子加减方高剂量组、中剂量组和低剂量组,每组8只动物,另取8只作为空白对照组。实验结束时,各组动物眼眶取血,分离血清,光镜检测外周血嗜酸性粒细胞（EOS）变化;采用双抗夹心ELISA法测试血清IgE含量;剖取血管壁组织,免疫组织化学检测血管壁组织中IL-4、IFN-γ表达量。结果 与模型组比较,当归饮子各剂量组可显著降低动物外周血嗜酸性粒细胞（P<0.01）;降低血清IgE含量（P<0.01）;降低血管壁组织IL-4（P<0.01）,升高IFN-γ（P<0.01）。结论 当归饮子可通过干预T细胞异常分泌相关细胞因子抑制荨麻疹发病。     

托里透毒法对乙酸烧灼型慢性胃溃疡模型的影响

目的 通过透脓散和托里消毒散对大鼠胃溃疡进行干预,研究托里透毒法对胃溃疡的影响,揭示托里透毒法治疗体内胃溃疡的作用.方法 采用乙酸烧灼型慢性胃溃疡模型,测定溃疡指数,光学显微镜观察病理.结果 大鼠胃浆膜下注射10%乙酸后,可使胃壁组织受损,溃疡呈圆形或椭圆形,中心凹陷,4W微隆起,14d后没有愈合.镜下可见胃溃疡模型胃组织溃疡部位既有炎性细胞浸润期（P《0.001）,又有肉芽组织增生及纤维化（P《0.001）,还有黏膜再生（P《0.001）.给药14d,体现托里透毒法各中药复方对乙酸烧灼型慢性胃溃疡均有不同程度抗溃疡和缩短溃疡修复时间的作用.结论 托里透毒法具有保护胃黏膜和促进溃疡修复作用.     

血液中炎性指标与脓毒血症细菌感染患者病情的相关性研究

目的  探讨血液中炎性指标与脓毒血症细菌感染患者病情的相关性。方法  选取2010年9月-2015年2月该院收治的脓毒血症细菌感染患者109例，依据病情程度分为脓毒性休克组、严重脓毒血症组、脓毒血症组。统计感染菌分布情况，比较各亚组脓毒血症患者的急性生理和慢性健康评分（APACHE-Ⅱ）、降钙素原（PCT）、C反应蛋白（CRP）、脂多糖（LPS）、白细胞介素-6（IL-6）、白细胞计数（WBC）、中性粒细胞比例（NEUT）等炎性指标水平，并对炎性指标与APACHE-Ⅱ评分进行相关性分析。结果  脓毒血症患者主要感染菌为大肠埃希菌、肺炎克雷伯菌、血浆凝固酶阴性葡萄球菌、金黄色葡萄球菌、假丝酵母菌，感染率分别为22.94%、21.10%、13.76%、11.93%和9.17%，其次为鲍曼不动杆菌（7.34%）、阴沟肠杆菌（5.50%）。脓毒性休克组、严重脓毒血症组、脓毒血症组患者的APACHE-Ⅱ评分分别为（26.27±5.68）、（21.08±4.96）和（12.14±3.75）分。脓毒性休克组、严重脓毒血症组、脓毒血症组患者血液中PCT、CRP、LPS、IL-6、WBC、NEUT等炎性指标水平依次降低，差异有统计学意义（P <0.05）。脓毒血症细菌感染患者的血液中PCT、CRP、LPS、IL-6与APACHE-Ⅱ评分呈正相关（r =0.579、0.734、0.621和0.685，P <0.05）。结论  脓毒血症患者细菌感染以大肠埃希菌、肺炎克雷伯菌、血浆凝固酶阴性葡萄球菌为主，患者血液中PCT、CRP、LPS、IL-6水平与病情呈正相关，可作为预测病情及预后的重要指标。

     

清肠化湿方对实验性大鼠结肠炎结肠黏膜上皮细胞紧密连接蛋白claudin-1的影响

目的 观察清肠化湿方对实验性大鼠结肠炎结肠组织肿瘤坏死因子-α（TNF-α），紧密连接跨膜蛋白claudin-1表达水平的影响，以探讨其治疗溃疡性结肠炎(UC)的可能机制。方法 使用TNBS/无水乙醇造模成功后，分为空白组、模型组、清肠化湿方组12.8 g/(kg·d）、美沙拉嗪组（0.67 g/（kg·d）。一次性ig给药，连续10 d后，处死大鼠，留取结肠组织；ELISA法检测结肠组织TNF-ａ水平，免疫组化法观察结肠上皮claudin-1蛋白的表达情况，实时荧光定量PCR法检测claudin-1 mRNA相对表达水平。结果 清肠化湿方可以降低大鼠结肠炎模型结肠组织TNF-α水平[模型组，清肠化湿组分别为（99.40±32.37），（55.07±12.80）pg/mL]，（P<0.01），提高claudin-1 mRNA相对表达水平[模型组，清肠化湿组分别为(2.18±0.78)，(3.94±0.91)]（P<0.01），减轻对claudin-1蛋白的损伤（P<0.05），清肠化湿方组与美沙拉嗪组疗效无明显差异。结论 清肠化湿方降低结肠组织TNF-α水平，保护紧密连接蛋白claudin-1，是其治疗UC的机制之一。     

健脾清化方对肾纤维化大鼠肾功能、蛋白尿及肾组织Col-IV表达的影响

目的 探讨健脾清化方对肾切除联合阿霉素诱导局灶节段性肾小球硬化模型大鼠肾功能、蛋白尿及肾组织IV型胶原（Col-IV）表达的影响。方法 建立单侧肾切除合并阿霉素3 mg/kg尾静脉2次注射大鼠肾硬化模型,分别予以健脾清化方、健脾清化方拆方（益气健脾方及清热化湿方）、尿毒清颗粒干预8周。测定用药后各组肾功能及24 h尿蛋白定量,实时荧光定量PCR法测定肾组织Col-IV表达水平。结果 模型组与空白组及假手术组相比,血清肌酐、尿素氮、24 h尿蛋白定量及肾组织Col-IV表达水平均明显升高（P<0.01）。与模型组相比,健脾清化方组血清肌酐、尿素氮、24 h尿蛋白定量及肾组织Col-IV表达水平均明显下降（P<0.01）,清热化湿方组血清肌酐及肾组织Col-IV表达水平明显下降（P<0.01）,尿素氮降低（P<0.05）,尿毒清组尿素氮及肾组织Col-IV表达水平明显下降（P<0.01）,血清肌酐、24 h尿蛋白定量降低（P<0.05）,益气健脾方组各项指标均无明显下降（P>0.05）。结论 健脾清化方能下调肾组织IV型胶原的表达,从而抑制细胞外基质的积聚和肾小球系膜增殖,发挥抗肾纤维化和保护残存肾功能的效用。其拆方清热化湿方在改善肾功能和肾纤维化方面的疗效与健脾清化方接近,提示清热化湿类药物是健脾清化方抗肾纤维化的关键。     

SPECT/CT门控心肌显像相位分析对慢性心力衰竭患者心脏再同步治疗的疗效评价

目的  探讨单光束发射断层扫描（SPECT）/计算机断层显像（CT）门控心肌显像相位分析是否可指导心脏再同步治疗（CRT）植入，以及对CRT的远期效果进行评价。方法  选取2009年6月-2014年6月该院因诊断慢性心力衰竭行CRT或心脏再同步除颤起搏器植入术（CRTD）的患者37例，分为治疗有反应组和无反应组。两组患者在术后6个月行SPECT/CT门控心肌显像相位分析，应用相位分析技术检测左心室瘢痕负荷，评价左室收缩协调性指标（峰相位、收缩期相位时间标准差和带宽），观察两组左心室瘢痕负荷和同步性指标有无差异。结果  两组治疗后，左心室瘢痕负荷和同步性指标（瘢痕负荷、峰相位、收缩期相位时间标准差和带宽）比较，差异有统计学意义。结论  SPECT/CT门控心肌显像相位分析可以评价CRT术前适应证、预测术后效果、判断术中电极植入的位置，是术后随访的重要方法。

     

前列腺素E1后处理对大鼠移植肝缺血再灌注损伤的保护作用

目的  探讨前列腺素E1（PGE1）后处理对大鼠移植肝缺血再灌注损伤（IRI）的保护作用及其机制。方法  建立SD大鼠肝移植模型,随机分为3组：IRI组、PGE1后处理组（PGE1组）及假手术组（S组）。检测各组血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、超氧化物岐化酶（SOD）及丙二醛（MDA）的含量;采用逆转录聚合酶链式反应（RT-PCR）方法检测移植肝组织内肿瘤坏死因子（TNF-α）信使核糖核酸（mRNA）的表达水平;苏木精-伊红染色（HE）观察移植肝病理形态学变化。结果  供肝再灌注后2及6 h,PGE1组的大鼠血清ALT、AST和MDA水平及TNF-α mRNA的表达低于IRI组（P <0.05）,血清SOD水平高于IRI组（P <0.05）,光镜下PGE1组肝组织损伤较IRI组轻。结论  PGE1后处理可通过提高肝组织的抗氧化能力,降低TNF-α来减轻大鼠移植肝IRI。

     

组织型纤溶酶原激活物突变体对鼠急性脑梗死及脑组织保护作用实验研究

目的  评价新型组织型纤溶酶原激活物突变体（t-PAm）对鼠急性脑梗死溶栓作用及脑组织保护作用。 方法  84只成年Wistar大鼠随机分为对照组、组织型纤溶酶原激活物组（t-PA）、低剂量组织型纤溶酶原激活物突变体组（低剂量t-PAm组）及常规剂量组织型纤溶酶原激活物突变体组（常规剂量t-PAm组）,大脑中动脉血栓形成3 h后进行相应治疗。观察溶栓24 h后脑梗死面积、神经损伤评分、脑出血的情况,并通过中性粒细胞浸润及蛋白酶激活受体1（PAR-1）浓度的变化了解t-PAm对脑组织的保护作用。结果  梗死后应用低剂量t-PAm[（108.5±27.3）mm3]及常规剂量t-PAm[（68.3±17.2）mm3]组梗死面积均较对照组降低,同时梗死面积与神经评分有明确的相关性（r =0.613,P =0.000）,且低剂量t-PAm在溶栓的同时没有明显增加脑出血的概率。t-PAm还减少髓过氧化物酶的生成,并与t-PA组相比减少PAR-1的生成（P <0.001）。结论  新型组织型纤溶酶原激活物突变体有较好的溶栓作用,同时对缺血脑组织有明显的保护作用。

     

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.