扩张型心肌病SD大鼠模型的建立

目的:探讨用多柔比星诱导建立扩张型心肌病(DCM)SD大鼠模型的可行性。方法:出生四周的雌性SD大鼠共32只,给予多柔比星每周2 mg/kg腹腔内注射连续8周,建立扩张型心肌病(DCM)SD大鼠模型,观察实验前后大鼠超声心动图左室收缩末期容积(LVES)、舒张末期容积(LVED)、左室收缩末期内径(SD)、左室舒张末期内径(DD)、左室内径缩短率(FS)、左室射血分数(LVEF)和体重(BW)、心率(HR)的变化及大鼠心肌组织病理学的改变。结果:多柔比星诱导的扩张型心肌病(DCM)SD大鼠模型超声心动图提示与实验前相比,LVES、SD均明显增加(P<0.01),LVED、DD、FS较实验前有显著性差异(P<0.05),LVEF、BW、HR均明显降低(P<0.01);大鼠心肌组织病理学的改变符合扩张型心肌病的病理学改变。结论:实验证明给予大鼠多柔比星每周2 mg/kg腹腔内注射连续8周建立扩张型心肌病(DCM)动物模型符合人类DCM的改变,以多柔比星诱导的扩张型心肌病SD大鼠模型是可行的。     

腺病毒介导的血管内皮生长因子165对扩张型心肌病大鼠心功能的影响

目的:观察经心包腔注射腺病毒介导的血管内皮生长因子165基因(Ad-VEGF 165)对扩张型心肌病(DCM)大鼠心功能的影响并探讨其作用机制。方法:35只雌性SD大鼠腹腔注射多柔比星建立扩张型心肌病模型,随机分为2组:VEGF组(18只)心包腔内注射0.1 mL Ad-VEGF 165 1.0×109pfu;DCM组(17只)注射生理盐水。比较4周后大鼠左室收缩末期容积(LVES)、舒张末期容积(LVED)、左室收缩末期内径(SD)、左室舒张末期内径(DD)、左室内径缩短率(FS)、左室射血分数(LVEF)和体重(BW)、心率(HR)的变化,观察大鼠心肌组织改变情况,ELISA法测定血清APO-1/Fas含量。结果:VEGF组BW、LVEF、HR、FS较DCM组明显增加(P<0.01);LVES、LVED、SD、DD均明显降低(P<0.05),APO-1/Fas水平较DCM组下降(P<0.01);注射VEGF后大鼠BW、LVEF、HR、FS较注射前明显增加(P<0.01);而LVES、LVED、SD、DD则明显降低(P<0.05),大鼠的心肌病变减轻。结论:心包注射Ad-VEGF165基因可改善DCM鼠心功能,降低其死亡率,有利于心肌细胞的存活,其机制可能与减少心肌细胞凋亡有关。     

解剖M型超声心动图快速评价扩张型心肌病患者干细胞移植术前、后心功能的临床应用价值

目的探讨解剖M型超声心动图评价扩张型心肌病(DCM)患者在干细胞移植术前及术后左心室收缩功能的临床应用价值.方法应用解剖M型超声心动图检测29例DCM患者干细胞移植术前1d与术后3d、30d的左室收缩功能,包括左房内径(LAd)、左室舒张末内径(LVDd)、左室收缩末内径(LVDs)、左室射血分数(LVEF)、左室短轴缩短率(FS).并将术前、术后各参数进行对比分析.结果干细胞移植术后3d、30d后DCM患者的LAd、LVd较术前明显减小,LVEF、FS明显提高,差异均具有显著性意义(P<0.05).结论解剖M型超声心动图能快速无创性评价骨髓干细胞移植术前及术后左心室收缩功能,具有一定的临床应用价值.     

缺血性心肌病与扩张型心肌病超声心动图的鉴别诊断

目的探讨超声心动图鉴别诊断缺血性心肌病(ICM)与扩张型心肌病(DCM)的临床价值。方法收集永城市人民医院2017年2月至2019年6月因心功能不全、心脏扩大而行冠状动脉造影检查的70例患者,经诊断分为DCM组和ICM组,各35例。所有患者均行超声心动图检查,比较超声心电图指标、各瓣膜返流状况。结果 DCM组射血分数(LVEF)、左室收缩末容积(ESV)、左室舒张末容积(EDV)、右室舒张末期内径(RVD)、左室舒张末内径(LVD)、左房收缩末内径(LAD)、二尖瓣口舒张早期峰值(E峰)及二尖瓣口舒张早期峰/舒张晚期峰值(E/A)均较ICM组高,差异有统计学意义(均P<0.05)。两组均存在二尖瓣、主动脉瓣、三尖瓣返流情况,且DCM组二尖瓣、主动脉瓣、三尖瓣返流情况较ICM组严重,差异有统计学意义(均P<0.05)。结论超声心电图显示ICM与DCM在心脏血流动力学、心脏结构等方面存在明显不同,超声心电图可为临床诊断鉴别ICM与DCM提供重要依据。     

异丙肾上腺素诱导慢性心力衰竭大鼠模型的建立

目的:建立异丙肾上腺素(isoprenaline,ISO)诱导SD大鼠慢性心力衰竭(CHF)模型,并对其进行评估。方法:用ISO (170 mg/kg)给SD大鼠皮下注射2次,建立大鼠CHF模型,分别在用药后3、6、18周进行心脏超声检测左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)、左室射血分数(LVEF)、缩短分数(FS),18周取心肌观察病理形态学特征。结果:随着时间的延长,大鼠CHF程度逐渐加重,病死率增加;随着LVEF和FS下降,LVEDD、LVESD扩大(P<0.01),左室重量指数明显增加(P<0.01)。结论:大剂量ISO诱导建立大鼠CHF模型的方法简便、可靠;超声心动图检测对于大鼠CHF模型的建立与评估具有指导意义。     

牛磺酸对扩张型心肌病大鼠左室基质金属蛋白酶1表达的影响

目的 :探讨牛磺酸对扩张型心肌病大鼠模型左室基质金属蛋白酶 1(m atrix m etalloproteinases,MMP1)表达的影响。方法 :随机选取 2周龄 Wistar大鼠 5 0只 ,雄性 ,体重 (6 2 .5 6± 5 .12 ) g,以呋喃唑酮诱导扩张型心肌病模型 ,随机分为模型组(DCM)、牛磺酸干预 组 ( Tau)、牛磺酸干预 组 ( Tau)、牛磺酸假干预组 (TC)及空白对照组 (NC) ,每组又根据不同时间点分为 4周和 12周二个亚组。应用多功能超声心动图诊断仪检测不同时间点大鼠模型左室舒张末期内径 (L VEDD)、左室收缩末期内径 (L VESD)、左室射血分数 (EF)及左室缩短率 (FS)。应用 HE染色光镜下观察心肌组织的病理学改变。应用免疫组化方法检测左室心肌 型胶原含量的变化。应用 RT- PCR技术检测左室心肌 MMP1的表达活性。结果 :DCM模型组及 TC组4、12周亚组大鼠与 NC组相应亚组比较 ,L VEDD和 L VESD均明显增大 (P均 <0 .0 5 ) ;FS、EF均明显降低 (P均 <0 .0 1) ;心肌细胞肥大 ,胞浆灶性溶解 ,呈不同程度的颗粒变性与空泡变性 ,细胞核增大、分裂、畸形 ,细胞间隙增宽 ,间质胶原纤维明显增生 ,左室心肌 型胶原明显升高 (P均 <0 .0 1) ;左室心肌组织 MMP1m RNA基因表达水平均明显升高 (P均 <0 .0 1)。而 Tau组和 Tau组上述指标无明显变化 (P     

扩张型心肌病的诊断

目的 讨论扩张型心肌病的诊断.方法 根据患者的临床表现结合检查结果进行诊断并鉴别.结论 DCM的诊断标准:(1)左心室舒张期末内径(LVEDd)>55cm;(2)左室射血分数(LVEF)<45%和/或左心室缩短速率(FS)<25%;(3)左心室舒张期末内径(LVEDd)>2.7cm/m2,体表面积(m2)=0.0061×身高(cm)+0.0128×体重(kg)-0.1529,LVEDd大于年龄和体表面积预测值的117%,即预测值的2倍SD+5%.临床上主要以超声心动图作为诊断依据,X线胸片、心脏同位素、心脏计算机断层扫描有助于诊断,核磁共振检查对于一些心脏局限性肥厚的患者具有确诊意义.诊断DCM时需排除:高血压、冠心病、酒精性心肌病、心动过速性心肌病、系统性疾病、心包疾病、先天性心脏病、肺心病和神经肌肉性疾病等.     

阿霉素诱导扩张型心肌病大鼠心功能的变化

目的：通过腹腔注射阿霉素诱导制备扩张型心肌病（dilated cardiomyopathy,DCM）大鼠模型,探讨其心功能的变化。方法：选取体质量为240~290 g的8周龄、SPF级近交系雄性SD大鼠85只,分为2组：DCM组（n=65）、正常对照组（n=20）。DCM组采用腹腔注射阿霉素的方法构建DCM模型;正常对照组则注射等容积的生理盐水。给药第10周对两组大鼠行心脏超声检查,观察左室舒张末期内径、左室收缩末期内径、左室射血分数、左室短轴缩短率。结果：心脏超声检查显示DCM组大鼠心腔扩大,室壁活动度弥漫性减弱,左室舒张末期内径、左室收缩末期内径显著大于正常对照组（P〈0.05）,而左室射血分数、左室短轴缩短率显著低于正常对照组（P〈0.05）。结论：腹腔注射阿霉素诱导DCM大鼠心功能下降。     

氟伐他汀对扩张型心肌病大鼠心室重塑的影响

目的:探讨氟伐他汀对扩张型心肌病(DCM)大鼠心室重塑的影响及其机制。方法:多柔比星腹腔注射建立DCM大鼠模型,将大鼠随机分为氟伐他汀组(F组),扩张型心肌病组(M组)和正常对照组(C组)。F组用氟伐他汀20 mg.kg-1.d-1灌胃,M组和C组用等量生理盐水灌胃。8周后进行心脏超声、血流动力学、组织病理学、心肌组织总抗氧化能力(TAOC)和丙二醛(MDA)浓度检测,并计算胶原容积分数(CVF)。结果:F组死亡率低于M组(P<0.05);与C组相比,M组大鼠的左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室舒张末压(LV-EDP)、心室相对质量、CVF和MDA均增高(P<0.05),左室射血分数(LVEF)、左室缩短分数(LVFS)、左室收缩压(LVSP)、左室内压最大上升及下降速率(±dp/dtm ax)和TAOC均降低(P<0.05);与M组相比,F组大鼠的LVEDD,LVESD,LVEDP,CVF,MDA和心室相对质量均降低(P<0.05),LVEF,LVFS,LVSP,±dp/dtm ax和TAOC均升高(P<0.05)。结论:氟伐他汀能够改善心室重塑和心功能,抗氧化应激作用可能是其机制之一。     

十一酸睾酮对心力衰竭雄兔心功能的影响

目的: 评价十一酸睾酮(TU)对心力衰竭雄兔心功能的影响.方法:将40只雄性新西兰大白兔随机分为假手术组(n=8)和模型组(n=32).3周后将模型组中20只经心脏超声检查证实心力衰竭的雄兔随机分为对照组和TU组,每组10只,其中对照组和假手术组予生理盐水1 ml肌肉注射,1次/2周;TU组予TU 3 mg/kg肌肉注射,1次/2周.治疗3个月后复查心脏超声,处死后称体重并取心脏标本称重.结果:(1)治疗前对照组和模型组的左心室射血分数(LVEF)、左室短轴缩短率(FS)、左室收缩内径(LVSD)、左室舒张内径 (LVDD)均显著低于假手术组;对照组以上参数治疗前、后无变化,但 FS、LVEF低于假手术组(P＜0.05),LVDD、LVSD则明显高于假手术组(P＜0.05);治疗3个月后TU组FS、LVEF较治疗前增加(P＜0.05),与假手术组比较无显著差异.(2)治疗3个月后假手术组心脏重量与体重比值(2.2±0.3)‰,对照组显著高于假手术组为(2.7±0.3)‰,而TU组与假手术组无显著差异为(2.4±0.4)‰,(P＞0.05).结论:TU替代治疗可改善心力衰竭雄兔的心功能.     

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.     

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.