局灶性脑缺血鼠血浆细胞因子变化及尼莫地平的治疗效果

目的：探讨脑缺血再灌注后血浆TNFα,IL－1β变化及尼莫地平对其含量的影响。方法：采用线栓法制备大鼠局灶性脑缺血再灌注模型,用放射免疫方法检测脑缺血再灌注后血浆TNFα,IL－1β变化,以及尼莫地平对TNFα,IL－1β的拮抗作用。结果：缺血再灌组与假手术组相比,血浆TNFα,IL－1β含量明显增加,应用尼莫地平组TNFα,IL－1β水平均降低。结论：TNFα,IL－1β参与了局灶性脑缺血再灌注损伤的病理过程,尼莫地平通过降低TNFα,IL－1β的含量发挥一定的脑保护作用。     

大鼠肾脏缺血再灌注后IL -6和TNF-α变化与时间的关系

目的：通过观察大鼠肾脏缺血再灌注（I－R）的不同时间IL－6和TNF－α的变化，探索细胞因子在肾脏I－R损伤中的作用。方法：采用大鼠肾脏I－R损伤模型，分别在缺血和再灌注1、4和24h时取血和肾组织，用双抗体夹心ELISA法测定IL－6和TNF－α的含量。结果：缺血组及再灌注4h(R4h)和24h(R24h)组IL－6含量均低于对照组（P＜0．05）；而再灌注1h组与对照组相当，但显著高于缺血组（P＜0．01）。IL－6含量的动态变化在肾组织和血液中呈直线正相关（P＜0．05）。肾组织中TNF－α含量在缺血和再灌注1h组均高于对照组（P＜0．05），血液中TNF－α与对照组无显著性差异。结论：大鼠肾脏I－R时肾组织和血液中IL－6含量随时间的推迟而降低，而肾组织中TNF－α含量在早期增加。     

尼莫地平对局灶性脑缺血鼠血浆细胞因子变化的影响

目的：探讨脑缺血再灌注后血浆INFα－IL－1β变化及尼莫地平对其含量的影响。方法：将大鼠随机分为假手术组，缺血再灌注模型组和尼莫地平组，采用线栓法制备大鼠局灶性脑缺血再灌注模型，用放射免疫方法检测脑缺血再灌注后和应用尼莫地平后血浆INFα，IL-1β变化。结论：缺血再灌注组血浆INFα，IL－1β含量明显增加，应用尼莫地平组INFα，IL－1β水平均降低。结论：INFα，IL－1β参与了局灶性脑缺血再灌注损伤的病理过程，尼莫地平通过降低INFα，IL－1β的含量发挥一定的脑保护作用。     

缺血再灌注损伤增加肾组织免疫原性的实验研究

目的：观察缺血再灌注损伤对肾组织免疫原性的影响。方法：在大鼠单肾热缺血再灌注损伤模型的基础上，利用逆转录－多聚酶链反应（RT－PCR）半定量技术检测不同损伤程度的肾组织中共刺激分子B7、炎性细胞因子IL－2、TNF－α的mRNA表达水平。结果：正常和缺血肾组织中B7、TNF－α、IL－2的mRNA表达处于极低水平，再灌注后肾组织中B7、TNF－α、IL－2的mRNA的表达开始逐渐升高，并于再灌注后72h达高峰，缺血60min再灌注组的B7、IL－2、TNF－α的mRNA的表达水平明显高于缺血30min再灌注组（P＜0.05）。结论：缺血再灌注损伤使共刺激分子B7、炎性细胞因子TNF－α、IL－2的mRNA表达升高，提示缺血再灌注损伤可使移植肾免疫原性升高，炎症反应加强，这些均能促进急性排斥反应的发生。     

肿瘤坏死因子α反义寡核甙酸对大鼠肝脏缺血再灌注损伤的保护作用

目的：探讨肿瘤坏死因子α(TNFα)反义寡核苷酸(ASODN)对大鼠肝脏缺血再灌注损伤的保护作用。方法：雄性SD大鼠160只，分为正常对照组、缺血再灌注组、TNFα错配ODN组和TNFα反义ODN组，观察了肝脏缺血60分钟及再灌注1、3、6及12小时后，检测血清丙氨酸氨基转移酶(ALT)，丙二醛(MDA)及肝组织病理学变化。结果：缺血再灌注组和TNFα错配ODN组肝脏缺血再灌注后，肝脏瘀血明显，血浆ALT和MDA含理均显著增高；肝脏缺血再灌注用TNFα反义ODN处理后，血浆ALT和MDA含量明显降低，肝组织瘀血减轻。结论：TNFα反义ODN可以抑制大鼠肝脏缺血再灌注所致的炎症反应，对大鼠肝脏缺血再灌注损伤有保护作用。     

缺血预处理对大鼠肝脏缺血再灌注后血清TNF—α和IL—l0水平的影响

目的：探讨缺血预处理(IPC)保护作用的发生机制。方法：建立大鼠部分肝脏缺血再灌注模型，观察IPC血清肿瘤坏死因子α(TNF—α)和白细胞介素10(IL—10)水平的变化。结果：IPC后肝组织中腺苷和N0水平明显高于对照组，但IPC前应用腺苷A2受体拮抗剂后NO的升高被抑制。缺血再灌注(I／R)2h后血清中TNF—α，AST，ALT，LDH及W／D水平与对照组比较明显增加，而IL—10含量降低：IPC、I／R前加入腺苷、IPC前应用腺苷A1受体拮抗剂显著地降低TNF—α释放和AST，ALT，LDH及W／D水平，提高IL—10含量，与I／R组比较差异显著；但IPC前应用腺苷A2受体拮杭剂和NO合成酶抑制剂NAME并没有能像IPC组那样有效降低TNF—α，AST，ALT，LDH及W／D的水平，提高IL—10的含量；而IPC前给IPC A2antag组提供NO前体精氨酸又获得和IPC组同样的结果。结论：IPC引起细胞外腺苷水平升高，腺苷A2受体活化，介导了NO合成增加，最终抑制效应器TNF—α的释放、增加IL-l0的合成来实施对缺血组织的保护作用。     

P38MAPK抑制剂FR167653对肝脏缺血再灌注损伤保护作用的研究

目的 探讨p38MAPK特异性活性抑制剂FR167653在大鼠肝脏缺血再灌注损伤中的保护作用及其机制.方法 利用封闭群SD大鼠制作缺血再灌注模型,将实验动物分为假手术组、对照组、治疗组.分别在各个时间点按照相应程序采集标本行血清肝功能检测、肝组织病理学检查、外周血细胞因子水平ELISA检测.结果 （1）再灌注后各时点大鼠外周血ALT、AST水平均明显升高,但治疗组明显低于对照组,两组间差异有统计学意义（P〈0.05）.（2）对照组肝细胞肿胀明显,可见散在坏死细胞;治疗组肝脏结构较对照组明显改善.（3）TNF-α及IL-1β在假手术组肝脏组织中表达水平较低,缺血再灌注后对照组的表达水平明显增高,治疗组的表达水平明显低于对照组,差异均有统计学意义（均P〈0.05）.结论 FR167653能对缺血再灌注肝脏起保护作用.     

七氟烷后处理对小鼠肾脏缺血再灌注损伤的保护作用及机制

目的：研究七氟烷后处理对肾脏缺血再灌注损伤的影响,探讨其保护机制是否与抗炎抗氧化有关。方法：雄性C57BL/6小鼠随机分成4组：假手术组（Sham组）、假手术+七氟烷后处理组（Sham+Sevo组）、肾脏缺血再灌注损伤组（IR 组）和肾脏缺血再灌注损伤+七氟烷后处理组（Sevo?Post C组）。摘除右肾后夹闭左肾蒂30 min建立肾脏缺血再灌注损伤模型,Sevo?Post C组于再灌注起吸入2%七氟烷1 h。再灌注24 h后检测肾功能参数、血清炎症因子及肾组织氧化应激指标。Western blot方法检测磷酸化蛋白激酶B（p?Akt）、磷酸化糖原合成酶激酶3β（p?GSK3β）、Akt及GSK3β表达水平。结果：与假手术组比较,缺血再灌注组血清肌酐（Scr）、尿素氮（BUN）、TNF?α、IL?6及丙二醛（MDA）的水平均升高（P＜0.05）;给予七氟烷后处理可以使Scr、BUN、TNF?α、IL?6、MDA的水平及肾损伤评分明显降低（P＜0.05）。在肾脏缺血再灌注损伤后p?Akt及p?GSK3β水平均有所升高,但与IR组比较,七氟烷后处理可以显著增加Akt及GSK3β的磷酸化水平（P＜0.05）。结论：七氟烷后处理对小鼠肾脏缺血再灌注损伤有保护作用,其机制可能与Akt/GSK3β通路调控的抗炎抗氧化有关。     

大鼠缺血再灌注心肌TLR4，TNF-α，NF-κB表达及其关系

目的：研究缺血再灌注大鼠心肌TLR-4,TNF-α仪和NF-κB的表达及相互关系．方法：建立大鼠缺血再灌注模型,大鼠随机分为假手术组、缺血组、再灌注30min组、再灌注60min组、再灌注90min组．以RT—PCR法检测心肌中TLR4及TNF—α mRNA的表达．结果：各种心肌中均检测到TLR4的表达,缺血及再灌注后TLR-4 mRNA含量显著增加,随着再灌注时间延长,TLR-4 mRNA含量增加更为显著．缺血组与假手术组TNF—α mRNA表达无统计学差异,而再灌注后表达显著增加,随再灌注时间延长,TNF-α mRNA含量继续增加更为明显．缺血及再灌注后心肌NF—κB mRNA表达增加,随再灌注时间延长,NF—κB mRNA含量继续增加,具有统计学意义．TLR-4表达增加时TNF—α和NF-κB表达也增加,三者有一定相关性．结论：心肌缺血再灌注损伤使TLR-4,TNF—α表达增高,阻断TLR-4可能有助于减轻缺血再灌注所致心肌损伤,并抑制急性炎症反应的发生．     

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.