参麦注射液对兔离体心脏缺血-再灌注损伤的保护作用

目的探讨参麦注射液对免离体灌流心脏缺血-再灌注损伤的保护作用.方法离体兔心采用Langendorff法灌流,灌注参麦注射液10min,然后结扎冠状动脉左前降支90min,再灌注40min.记录左室内压(LVP)、左室内压最大上升速率(+dp/dtmax)、左室舒张末压(LVEDP)、心率(HR),定时收集冠脉流出液测定冠脉流量(CF)和肌酸激酶(CK)活性,再灌注结束时测定心肌梗死面积.结果缺血-再灌注可显著降低LVP、+dp/dt max,升高LVEDP,增加CK释放,心肌梗死面积为(42.9±4.8)%;预先用参麦注射液(用K-H液按体积比稀释成1320或1160)灌流心脏10min,可显著缩小心肌梗死面积,改善缺血-再灌注所致心功能损伤,减少CK释放.结论参麦注射液对兔离体灌流心脏缺血-再灌注损伤具有明显保护作用.     

银杏叶提取物对缺血-再灌注心脏功能的影响

目的 研究银杏叶提取物(EGb)对心肌缺血-再灌注损伤的保护作用。方法 结扎家兔左冠状动脉前降支30min，复灌60min，测定左心室功能。结果 EGb可改善缺血-再灌注左室的收缩和舒张功能，左室收缩压(LVSP)、左室内压上升和下降速率( dp／dt、-dp／dt)升高，左室舒张未压(LVEDP)降低。结论 EGb对心肌缺血-再灌注损伤有保护作用，而且有剂量依赖现象。     

生长激素对离体大鼠缺血再灌注心脏泵功能的影响

目的应用离体大鼠心脏缺血再灌注模型观察基因重组生长激素(GH)对缺血再灌注心脏泵功能的影响.方法大鼠随机分为二组,分别每天皮下注射GH 0.5IU/kg(GH组)或等量生理盐水(对照组),7d后进行离体心脏缺血再灌注,分别测定缺血前、后再灌注10min、30min的心脏泵功能指标和冠脉流量的恢复率.结果 GH组离体心脏缺血前基础水平的左室收缩峰压(LVSP)、收缩期左室压力上升速度峰值(+dp/dt max)、舒张期左室压力下降速度峰值(-dp/dt max)和冠脉流量(CF)与对照组比较呈显著差异(P＜0.01),缺血后再灌注10min、30min的LVSP、±dp/dt max、CF与自身缺血前基础水平比较的恢复百分率明显高于对照组(P＜0.05),而GH组心率(HR)的恢复率与对照组比较无显著差异((P＞0.05)).结论提示预先应用GH可增强心脏泵功能并改善缺血再灌注心脏泵功能的损伤.     

加味丹参饮预处理对缺血再灌注损伤家兔心功能的影响

目的 探讨加味丹参饮预处理对缺血再灌注损伤家兔心功能的影响。方法 32只健康家兔，随机分为假手术组(Sham)、缺血再灌注组(I／R)、加味丹参饮预处理组(DP)和缺血预处理组(IP)，每组8只，分别预处理24h后行心肌缺血60min，再灌注120min，观察家兔左室收缩压(LVSP)、左室舒张期末压(LVDP)、左室压力最大上升速率( dp/dt max)、最大下降速率(-dp/dt max)。结果 DP和IP对缺血再灌注所致的LVSP和LVDP下降有显著的抑制作用，其中DP对LVDP作用尤为明显。两者对 dp/dt max和-dp/dt max变化无明显的影响。结论 加味丹参饮预处理对缺血再灌注损伤家兔心功能改变具有调节作用。     

刺五加苷预适应对大鼠心肌缺血再灌注损伤的保护作用

目的 观察刺五加苷预适应对大鼠离体心脏缺血再灌注损伤的保护作用,并明确相应量效关系.方法 30只SD大鼠随机分为5组,每组各6只.对照组(C组)为单纯缺血再灌注组,P1、P2、P3、P4组给予不同剂量浓度(30 mg/kg、40 mg/kg、60 mg/kg和80 mg/kg)刺五加苷预适应.采用Langendorffl离体心脏灌流模型,各组均平衡灌流15 min后全心停灌25 min,再灌注30 min.P1、P2、P3、P4组在缺血再灌注前分别用含相应浓度刺五加苷的K-H灌注液灌注10 min.记录各组心功能和冠脉流量的动态变化,并对再灌注期间的心律失常进行评分.结果 平衡末5组大鼠左室舒张末压(LVEDP)、左室舒张压(LVDP)、左心室内压最大上升速率(+do/dt max)、左室舒张末压最大下降速率(-do/dt max)间差异均无统计学意义(P>0.05).再灌注30 min后,5组LVDP、+do/dt max、-do/dt max间差异均有统计学意义(P<0.05),P2、P3组与C组LVDP、+dp/dt maxx、-do/dt max间差异均有统计学意义(P<0.05).5组大鼠再灌注后各时点(5、10、15、20、30 min)冠脉流量间差异均有统计学意义(P<0.05),P2、P3组与C组各时点冠脉流量间差异均有统计学意义(P<0.01).5组大鼠心律失常评分间差异有统计学意义(P<0.05).P2、P3组与C组评分间差异有统计学意义(P<0.05).结论 刺五加苷对缺血再灌注心肌能产生预适应样保护作用--改善心功能、增加冠脉流量和抗心律失常.刺五加苷对缺血再灌注心肌保护作用呈量效关系,其中40 mg/kg和60 mg/kg优于30 mg/kg和80 mg/kg.     

硝酸甘油对兔急性缺血和再灌注后心肌收缩性的影响

结扎家兔冠脉左室支10min、松结重灌流60min时,其血压(Bp)、左心室收缩压(LVSP)恢复程度与对照组水平相比仅差3～4%,而其心肌收缩成分实际最大缩短速度(dp/dt/p_(max))、心肌收缩成分最大缩短速度(V_(max))却差13.9%。硝酸甘油(NTG)静脉输入可使家兔缺血重灌注后心肌的dP/dt/p_(max)、V_(max)与Bp、LVSP快速恢复接近正常。前两项指标与对照组同类指标水平只差5.5%(P>0.05),与不给NTG的心肌缺血组相比,有显著性差异(P<0.05)。对正常家兔静输NTG降低Bp、LVSP、左心室舒张末压(LVEDP)(P<0.05),不改变dp/dt/p_(max)、V_(max)和心率。结果表明NTG促使缺血心肌收缩性更快的恢复。     

牛磺酸预处理对大鼠离体心脏缺血再灌损伤血流动力学的影响

目的:观察牛磺酸对大鼠离体心脏缺血再灌损伤血流动力学的影响.方法:40只大鼠随机分为4组:缺血再灌组(I/R),预适应组(IPC),牛磺酸Ⅰ组,牛磺酸Ⅱ组.采用Langendorff离体心脏灌流方法,经主动脉用K-H液平衡灌注.记录左室舒张末压(LVEDP)、左室收缩压(LVSP)、左室压力上升和下降最大变化速率(±dp/dt max)、冠脉流量(OF).结果:与I/R组比较,牛磺酸预处理能提高大鼠离体心脏停灌再灌期的CF,升高LVSP、±dp/dt max而降低LVEDP,其差异有显著性(P<0.05).结论:牛磺酸预处理对大鼠离体心脏停灌再灌注损伤具有保护作用.     

促红细胞生成素对心肌缺血再灌注损伤大鼠心肌的保护作用

目的:探讨促红细胞生成素(EPO)对心肌缺血再灌注(I/R)大鼠缺血及梗死面积的影响,阐明EPO对心肌I/R损伤的保护作用的机制。方法:采用在体大鼠心肌I/R模型,将24只健康雄性SD大鼠随机分为假手术组（n=8）,以6-0号丝线在冠状
动脉左前降支下穿过,不予以结扎;I/R组（n=8）,以6-0号丝线在冠状动脉左前降支下穿过,并结扎,在结扎线中埋置松解线,45 min后,松解结扎线,实现再灌注; EPO组（n=8）,手术过程同I/R组,在再灌注开始即刻,给大鼠腹腔内注射重组人促红细胞生成素(rhEPO),5 000U?kg-1。再灌注24 h后用多导生理仪记录大鼠血流动力学指标,包括收缩压(SP)、舒张压(DP)、左室收缩压(LVSP)、左室舒张压(LVDP)、左室舒张末期压(LVEDP)、心室收缩期室内
压上升最大速率(dp/dtmax)和心室舒张期室内压下降最大速率(dp/dtmin)的变化;用原位缺口末端标记法(TUNEL)检测心肌细胞凋亡;用Evan’s blue和氯化三苯基四氮唑(TTC)进行心肌染色,测量心肌缺血及梗死范围。结果:45 min的缺血和24 h的再灌注血流动力学检测显示, 3组大鼠SP、DP和LVSP无明显差异(均P>0.05);与假手术组比较,I/R组大鼠LVDP和LVEDP明显升高,但dp/dtmax和dp/dtmin明显下降(均P<0.05);与I/R组比较,EPO组 LVDP、LVEDP、dp/dmax和dp/dtmin均有明显改善(均P<0.05)。TUNEL结果显示,与假手术组比较,I/R组和EPO组大鼠心肌细胞凋亡明显增加(均P<0.05);与I/R组比较,EPO组大鼠心肌细胞凋亡显著减少(P<0.05)。心肌染色显示,假手术组大鼠心肌无缺血区和梗死区;与假手术组比较,I/R组和EPO组大鼠心肌有明显缺血区和梗死区;与I/R组比较,EPO组大鼠缺血范围略为缩小,但差异无统计学意义(P>0.05),梗死范围明显减少(P<0.05)。结论:EPO能够显著缩小I/R大鼠的心肌缺血及梗死范围,减少心肌细胞凋亡,显著改善其血流动力学和心脏功能,进而对心肌I/R损伤起保护作用。     

硝苯地平恶化低钾状态下心脏缺血再灌注后舒张功能

目的评价钙通道阻断剂硝苯地平对低钾状态下心脏功能的影响。方法离体大鼠心脏接受低钾KH液灌注,其中K^＋浓度为3．1mmol／L,实验全程记录左室发展压（LVDP）、左室舒张末压（LVEDP）和左室内压变化速率（dp／dt）的变化。结果1h全心缺血和1h再灌注处理后,LVDP、dp／dt均较缺血前显著降低,LVEDP显著升高;与对照组相比,再灌注开始后前15min使用含0.5mmol／LCa^2＋的KH灌注,检测指标均明显改善,但是再灌注开始后前10min给予1mol／L硝苯地平显著升高LVEDP。结论钙稳态失衡是低钾灌注心脏缺血再灌注后功能损伤的重要原因,硝苯地平恶化心脏舒张功能,其机制有待进一步研究。     

西红花酸对大鼠心肌缺血再灌注损伤的保护作用

目的 研究西红花酸对大鼠心肌缺血再灌注损伤的保护作用及可能的机制.方法 梗死模型,结扎大鼠左前降支冠状动脉45 min,再灌注180 min测定心肌梗死率,并于缺血前和再灌注5、60、180 min测定血清中的肌酸激酶(CK)和乳酸脱氢酶(LDH)活性.顿抑模型,结扎大鼠左前降支冠状动脉15 min,再灌注180 min测定缺血和非缺血心肌组织中Na ,K -ATP酶、Ca2 ,Mg2 -ATP酶活性、总腺苷酸(TAC)的量、能荷(EC)和血清中丙二醛(MDA)的量.并于缺血前、缺血末.再灌注5、30、90、180 min时测定心率、左心室内收缩压、舒张压、射血分数、最大和最小左心室内压变化速率(±dp/dt)、最大和最小左心室容积变化速率(±dV/dt)以及每搏功.结果 缺血前或者再灌注前给予西红花酸能够显著降低心肌梗死率.呈剂量依赖关系;并且降低血清中CK和LDH的活性.50 mg/kg西红花酸可以改善心脏功能,减轻心肌顿抑的程度,升高心肌组织ATP的量及EC.结论 西红花酸可以有效抑制因心肌缺血和再灌注引发的心肌梗死,缓解心肌顿抑,西红花酸可能是通过改善心肌能量代谢发挥其抗心肌缺血再灌注损伤作用的.     

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.     

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.     

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.     

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.