异丙酚局部动脉灌注对缺血再灌注兔脊髓损伤的作用

目的通过观察脊髓组织中IL-6水平的变化及神经行为学、脊髓病理学改变,探讨异丙酚局部动脉灌注的脊髓保护作用及可能机制。方法56只健康新西兰大白兔,随机分为正常对照组(n=4)、生理盐水组(n=26)和异丙酚组(n=26)。通过腹主动脉阻断30min建立脊髓缺血再灌注损伤模型,异丙酚组经腹主动脉阻断远端持续泵注50mg/kg异丙酚,生理盐水组则泵入等量生理盐水,复灌0h及2h取L4-6节段脊髓组织测定IL-6水平,复灌48h行动物神经行为学评分,取脊髓观察病理改变。结果复灌后2h异丙酚组和生理盐水组脊髓组织内IL-6水平明显高于复灌0h(P<0.05),生理盐水组各时点均明显高于对照组和异丙酚组(P<0.05),异丙酚组与对照组差异无统计学意义;复灌后48h,异丙酚组截瘫率(30%)明显低于生理盐水组(80%)(P<0.05);异丙酚组脊髓前角正常神经元计数〔8.4(4.0～11.5)〕较生理盐水组〔2.2(0～4.3)〕明显增加(P<0.05)。结论腹主动脉阻断30min脊髓组织中IL-6水平明显升高,50mg/kg异丙酚经腹主动脉局部灌注可降低脊髓组织中IL-6水平,降低术后截瘫率,提示异丙酚局部灌注具有明显的脊髓保护作用,其机制可能与抑制局部炎性反应有关。     

腹主动脉灌注利多卡因对兔脊髓缺血/再灌注损伤的保护作用

目的 建立兔脊髓缺血/再灌注损伤模型,研究经腹主动脉灌注利多卡因对脊髓缺血/再灌注损伤的作用.方法 新西兰大耳白兔16只,随机分为两组:A组为对照组(8只),B组为利多卡因组(8只).静脉麻醉后气管插管,持续监测平均动脉压、心率、脉搏血氧饱和度及直肠温度.手术暴露腹主动脉和双侧髂总动脉,经股动脉置一细导管至腹主动脉内距左肾动脉1.0 cm处,并于左肾动脉开口远端0.5 cm处阻断腹主动脉,同时阻断左、右侧髂总动脉,阻断即刻开始经导管向阻断的腹主动脉远端以12 mL·kg~(-1)·h~(-1)的速度灌注实验药物.A组灌注常温0.9%氯化钠溶液(12 mL·kg~(-1)·h~(-1)),B组灌注以常温0.9%氯化钠溶液稀释的等容量利多卡因溶液(40 mg/kg),30 min后开放血管.于动物完全清醒即刻及再灌注后6、24、48 h对双后肢神经功能进行评估;再灌注48 h,取脊髓L_3～L_5 3个节段制作石蜡切片,光学显微镜下观察并计数正常的前角运动神经元.结果 清醒即刻及再灌注后6、24、48 h,B组的神经行为学评分均显著高于A组(P值均<0.05);再灌注48 h,A、B两组脊髓前角正常神经元中位数(四分位间距)分别为1(2)、9(6)个,B组显著多于A组(P<0.05).结论 腹主动脉阻断期间动脉内灌注利多卡因可减轻脊髓缺血/再灌注损伤.     

缺血预处理对兔脊髓缺血保护效应的实验研究

目的　探讨缺血预处理对兔脊髓缺血性损伤的作用。方法　夹闭腹主动脉肾下段 ,建立脊髓缺血模型。2 1只新西兰兔随机分为 3组 :假手术组 5只 ,缺血预处理组 8只 ,缺血组 8只。假手术组只进行麻醉和手术操作 ,不阻断腹主动脉 ;缺血预处理组先阻断腹主动脉 5min ,开放 15min ,再阻断 4 0min后开放灌注 ;缺血组阻断腹主动脉 4 0min后开放灌注。 3组术后均进行神经功能评分 ,再灌注 7d后处死动物 ,取L3～ 5段脊髓行病理学观察。结果　缺血预处理组神经功能评分在各时间点明显高于缺血组 (P <0 .0 1) ,脊髓前角正常神经元数量较缺血组明显增多 (P <0 .0 1)。结论　缺血预处理对主动脉阻断所致的兔脊髓缺血性损伤具有保护作用。     

川芎嗪对兔脊髓缺血损伤依剂量的治疗作用

目的研究川芎嗪（TMP）注射液对兔脊髓缺血损伤治疗作用的剂量效应关系. 方法 26只新西兰雄性大白兔,随机分成四组:对照组即C组（n=6),单组缺血再灌注;T1组(n=6)、T2组(n=8)和T3组(n=6),分别在肾下主动脉阻断20 min后开放时恒速静脉泵入TMP注射液15,30和60 mg*kg-1. 采用肾下主动脉（IRA）阻断法造成脊髓缺血(20 min)/再灌注模型,观察再灌注后4,8,12,24和48 h神经功能评分（neurologic deficit score）,并于48 h处死动物取脊髓（L5-L7）制标本行病理组织学观察. 结果用不同剂量TMP治疗的T1,T2和T3组在各时间点神经功能评分和再灌注48 h脊髓前角正常神经元数均明显高于C组（P<0.01）,且T2组和T3又明显高于T1组（P<0.05）,而T2组和T3组无显著差异, 神经功能评分与其对应脊髓前角正常神经元计数之间有显著相关性(r=0.776, P<0.01). 结论 TMP注射液对脊髓缺血损伤有治疗作用,并呈一定的剂量效应关系.     

葛根素对兔脊髓缺血再灌注损伤的保护作用

目的：研究葛根素对兔脊髓缺血再灌注损伤的作用。方法：20只雄性新西兰大白兔随机分成缺血组（A组,n=10）及葛根素组（B组,n=10),夹闭腹主动脉肾下段20min,建立兔脊髓腰尾段血模型,B组于夹闭前10min静脉注射葛根素30mg.kg^-1,A组则静脉注射生理盐水,测定夹闭前、后及再灌注后血浆中丙二醛（MDA）浓度及超氧化物歧化酶（SOD)活性,再灌注4,8,12,24及48h分别对动物后肢运动功能评分;再灌注48h后,处死动物,制作切片,观察其组织病理变化。结果缺血及再灌注后B组MDA值明显低于A组（P＜0．05）,而OD活性明显高于A组（P＜0．05）;再灌注后4,8,12,24及48h时的神经功能评分B组明显高于A组（P＜0．05）;光镜下,与A组相比,B组脊髓组织损伤显著减轻,形态基本正常的前角细胞较多。结论葛根素对兔脊髓缺血再灌注损伤有显著的保护作用。     

生酮饮食对在体兔脊髓缺血再灌注损伤的影响

目的探讨生酮饮食对兔脊髓缺血再灌注损伤的影响。方法选用健康雄性兔45只,随机分为三组,A组行假手术,B组给予正常饮食（normal diet,ND）＋缺血再灌注,C组生酮饮食（ketogenic diet,KD）6周后＋缺血再灌注,B、C组结扎兔腹主动脉（A组只穿线不接扎）30 min后,再灌注48 h,观察三组神经功能评价、病理组织学观察神经元细胞,评价KD对兔心肌缺血再灌注损伤的保护作用。结果 A组神经功能评价、病理组织学观察神经元细胞正常。B组神经功能出现明显障碍,神经元细胞形态异常。C组神经功能障碍程度、神经元细胞形态异常较B组轻。结论用生酮饮食干预后脊髓缺血再灌注损伤减轻。     

缺血后处理上调内源性抗氧化物酶活性诱导兔脊髓保护效应

目的 观察缺血后处理是否通过增加再灌注期间内源性抗氧化物酶的活性以减轻兔脊髓缺血-再灌注损伤.方法 雄性新西兰大白兔78只随机分为3组:假手术组(Sham组,n=18):操作同I/R组,但不阻闭腹主动脉;缺血.再灌注组(I/R组,n=30):阻闭腹主动脉20 min后再灌注;缺血后处理组(PostC组,n=30):阻闭腹主动脉20 min,再灌注即刻行30 s再灌注/30 s缺血,3个循环,其他同I/R组.在再灌注的30 min、1、3、6、24和48 h分别取材,采用分光光度法行脊髓抗氧化物酶活性及丙二醛(MDA)含虽测定(各时间点n=5,Sham组n=3).再灌注6、24和48 h在取材前分别行后肢运动功能评分.结果 ①再灌注6、24和48 h时PostC组后肢运动功能评分显著高于I/R组(均P<0.05).②PostC组脊髓组织中超氧化物歧化酶(SOD)及过氧化氢酶(CAT)活性在再灌注早期(30 min～6 h)显著高于I/R组(均P<0.05).PostC组各时间点脊髓组织谷胱甘肽过氧化物酶(GSH-px)活性与I/R组相比,差异无统计学意义.③PostC组脊髓组织MDA含量在再灌注24 h和48 h明显低于I/R组(P<0.01).结论 缺血后处理可通过上调脊髓SOD及CAT活性,减轻脊髓缺血再灌注损伤,产生保护效应.     

缺血再灌注损伤时iNOS通过激活BAD诱发脊髓神经元凋亡

目的:探讨大鼠脊髓缺血再灌注损伤过程中诱导型一氧化氮合酶(iNOS)调控脊髓神经元凋亡的具体机制?方法:42只SD大鼠随机分为假手术组(A组,6只)?缺血再灌注组(B组,18只)和iNOS抑制组(C组,18只)?A组动物麻醉后仅腹腔切开,B组及C组采用腹主动脉阻断法(夹闭腹主动脉1 h后松开,再灌注6?12?24 h)建立脊髓缺血再灌注损伤模型?手术后,A组及B组动物按5 ml/kg腹腔注射5%二甲基亚砜,C组动物按150 mg/kg腹腔注射同等量氨基胍?Tarlov运动功能评分法评估三组大鼠的后肢运动功能?取腰段脊髓组织,透射电镜观察脊髓神经细胞形态学变化,神经元特异性抗体NeuN免疫荧光计算各组脊髓组织中存活神经元数目,Western blot检测iNOS?Bcl－xL/Bcl－2 相关死亡启动因子(Bcl－xL/Bcl－2 associated death promoter,BAD)?磷酸化BAD(p－BAD)?14-3-3及细胞色素C的表达,免疫共沉淀检测BAD与14-3-3的结合状态?结果:Tarlov运动功能评分显示A组大鼠后肢运动功能无损害,B组和C组大鼠后肢功能明显损害,但C组大鼠后肢功能好于B组(P < 0.05)?NeuN免疫荧光结果显示B组和C组大鼠脊髓神经元数目明显减少,但C组大鼠脊髓神经元数目多于B组(P < 0.05)?电镜结果示B组及C组中脊髓组织均有明显凋亡现象,但C组大鼠凋亡程度较轻?Western blot结果表明iNOS和细胞色素C表达量在B组及C组中随再灌注时间延长而增加,但相同再灌注时间C组表达强度明显弱于B组(P < 0.05);p－BAD表达量则随着灌注时间延长而下降,但C组中下降程度明显小于B组(P < 0.05)?免疫共沉淀结果表明:BAD与14-3-3结合力随着再灌注时间的延长在B组和C组中逐渐降低,但是C组程度更慢(P < 0.05)?结论:脊髓缺血再灌注过程中,iNOS通过促进p－BAD去磷酸化,降低BAD与14-3-3的结合力,进而诱发脊髓神经元的凋亡?     

腹主动脉阻断术后合并脓毒症大鼠肺脏损伤SOD的变化

目的:观察大鼠腹主动脉阻断缺血再灌注后合并脓毒症时肺脏组织的病理改变及肺脏组织中SOD1和SOD2表达的变化.方法:将wistar大鼠40只随机分为4组(为实际造模成功数目,不计死亡动物数):对照组(A组);腹主动脉阻断组(B组);脓毒症组(C组);腹主动脉阻断合并脓毒症组(D组).所有动物均于再灌注后8 h处死,取肺...     

脊髓缺血再灌注损伤模型的改进及脊髓耐受缺血时限的研究

目的 建立并改进兔脊髓缺血再灌注损伤模型,研究常温下脊髓耐受缺血的时限.方法 新西兰大白兔按不同阻断时间随机分为C20、C25、C30、C40和C60 5组,每组10只.股动脉置管至腹主动脉分出左肾动脉远端并测压,肾下阻断腹主动脉20～60 min,分别于清醒即刻、再灌注6 h、24 h和48 h评定动物神经功能;再灌注48 h观察脊髓形态学变化并计数L4～L6节段前角正常运动神经元.结果 C20组在各时间点均未出现截瘫;再灌注48 h后,C25、C30和C40组分别有30%、80%和90%出现截瘫,C60组全部截瘫,各组比较差异有统计学意义(P＜0.05).再灌注48 h后,脊髓组织出现神经细胞肿胀、坏死等改变,且随阻断时间的延长,损伤程度逐渐加重;C20、C25和C30组前角正常运动神经元中位数分别为12.5、10和2,C40和C60两组均为0,各组比较差异有统计学意义(P＜0.05).结论 成功改进兔脊髓缺血再灌注损伤模型.改进后模型的脊髓耐受缺血的时限为20 min以内,为脊髓损伤的研究提供了又一判定标准.     

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.