氧疗对慢性低氧高二氧化碳性肺动脉高压大鼠肺血管重构及血浆内皮素的影响

目的：探讨长期氧疗对慢性低氧高二氧化碳性肺动物高压大鼠肺动脉压，肺血管重构及血浆内皮素变化的影响。方法：将SD大鼠分4组：正常对照组（NC），慢性低氧4w后伴高二氧化碳2w组（HH），HH后吸空气3w组（HC）与HH后氧疗3w组（HO）。观察各组大鼠平均肺动脉压（mPAP),右心室，左心室＋空间隔重量比（RV／LV＋S），血浆内皮素－1（ET－1）浓度及肺细小动脉显微结构变化。结果：（1）mPAP,RV/V S及血浆ET－1浓度：HO组比HC组明显降低（P＜0．01）。(2)mPAP与血浆ET－1呈良好的相关性。（3）光镜下HH组肺细小动脉内弹力板扭曲，中膜平滑肌细胞增生，管腔明显狭窄，HO组肺细小动脉内弹力板扭曲明显减轻，中膜平滑肌层变薄，管壁较均匀一致。结论：长期氧疗可明显降低慢性低氧高二氧化碳肺动脉高压大鼠血浆ET－1的浓度及肺动脉压，减轻肺血管的重构。     

游泳对慢性低氧高二氧化碳大鼠一氧化氮代谢的影响

目的：探讨游泳锻炼对慢性低氧高二氧化碳大鼠一氧化氮(NO)代谢及脉动脉平均压(mPAP)的影响。方法：SD大鼠随机分成舱外正常对照组(NC)与慢性低氧高二氧化碳模型组。4w后，模型组又随机分为模型对照组(HH)与游泳锻炼组(SE)。用比色法测定NO代谢产物(NO2^-／NO3^-)的含量，用液体闪烁仪测定[^3H]-瓜氨酸的生成量，计算tNOS、iNOS和cNOS的活性。结果：SE组的血浆、肺与右心室组织的NO2^-／NO3^-的含量和cNOS的活性明显高于HH组；同时，SE组的mPAP显著低于HH组。结论：游泳锻炼有促使NO生成增加和降低肺动脉压的作用。     

氧疗对慢性低氧高二氧化碳大鼠肺动脉压的影响及其机制

目的探讨长期氧疗对慢性低氧高二氧化碳性大鼠肺动脉压及血浆NO2/NO3、血浆和右心室内皮素(EF)和心钠素(ANP)变化的影响。方法将SD大鼠分为四组,正常对照组(NC)、慢性低氧4周后伴高二氧化碳4周组(HH)、HH后吸空气4周组(HC)和HH后氧疗4周组(HO)。观察各组大鼠平均肺动脉压(mPAP)、右心室/左心室 室间隔[RV/(LV S)]、血浆NO2/NO3含量、右心室及血浆EF、ANP浓度变化。结果(1)mPAP和RV/(LV S),HO组较HC组降低(P<0.05),HH组明显高于NC组(P<0.01);(2)血浆NO2/NO3、EF和ANP浓度,HH组明显高于NC组(P<0.01),HO组较HC组下降(P<0.05);(3)HH组mPAP与血浆EF和ANP浓度相关。结论长期氧疗可明显降低低氧高二氧化碳大鼠肺动脉压,且与一氧化氮、内皮素和心钠素等神经内分泌因子变化相关。     

尾加压素Ⅱ及其受体UT在慢性低氧高二氧化碳性肺动脉高压大鼠右心室的表达

目的观察尾加压素Ⅱ(UrotensinⅡ,UⅡ)及其受体UT在慢性低O2高CO2肺动脉高压大鼠右心室的表达.方法 SD大鼠20只随机均分成正常对照组(正常对照)和低氧高二氧化碳4周(HH)组,分别测定平均肺动脉压力(mPAP),右心室游离壁(RV)和左心室加室间隔(LV+S)的重量比;放免法测定大鼠血浆UⅡ含量;免疫组化方法检测心肌细胞、心肌小动脉UⅡ蛋白的表达;组织原位杂交方法检测心肌细胞、心肌小动脉UⅡmRNA和UⅡ受体(UT)mRNA的表达.结果 (1)HH组mPAP和RV/LV+S比正常对照组分别高52.0%与25.4%(P均＜0.01).(2)HH组血浆UⅡ水平较正常对照组无明显增高(P＞0.05).(3)免疫组化显示HH组心肌细胞UⅡ蛋白表达阳性率和心肌小动脉UⅡ蛋白表达的平均吸光度值,均明显高于正常对照组(P＜0.01).(4)组织原位杂交可见HH组的心肌细胞UⅡmRNA表达阳性率和心肌小动脉UⅡmRNA表达的平均吸光度值,均明显高于正常对照组(P均＜0.01).(5)组织原位杂交可见HH组的心肌细胞UT mRNA表达阳性率和心肌小动脉UT mRNA表达的平均吸光度值,均较正常对照组明显增高(P均＜0.01).结论慢性低氧高二氧化碳性大鼠肺动脉高压及右室肥大形成过程中,心肌小动脉和心肌细胞的UⅡ及其受体UT的表达均呈现明显上调,提示UⅡ可能有促进心肌细胞增殖,导致右心室重构的作用.推测UⅡ在慢性低氧高二氧化碳性肺动脉高压及右室肥大的形成机制中具有重要的病理生理意义.     

多黏菌素B对慢性低O2高CO2大鼠血管内皮生长因子表达的影响

目的:探讨血管内皮生长因子(VEGF)在低氧性肺动脉高压形成中的意义及多黏菌素B(PMB)对其的影响.方法:将30只SD大鼠分成正常对照组(N组)、低O2高CO24 w组(F组)、低O2高CO24 w PMB组(P组),观察各组大鼠肺动脉平均压(mPAP)、右心室重量比(RV/LV S)、肺小动脉管壁面积/管总面积(WA/TA)、中膜厚度(PAMT)及超微结构,用ELISA法检测血清和肺组织VEGF含量,免疫组化法检测肺组织VEGF、蛋白激酶C(PKC)表达的变化.结果:①F组大鼠mPAP、RV/LV S、血清和肺组织VEGF的含量明显高于N组(P＜0.01),P组则低于F组(P＜0.01).②病理显示F组WA/TA、PAMT较N组增高(P＜0.01),内弹力板扭曲明显,胶原纤维增多,中膜平滑肌细胞增生.P组大鼠血管壁的改变明显减轻.③F组大鼠肺细小动脉VEGF蛋白及PKC的表达与N组比较明显增加(P＜0.01),而P组与F组比较,则明显降低(P＜0.05,＜0.01).结论:低氧诱导肺动脉VEGF的增加,后者参与了慢性低氧性肺动脉高压的形成,PKC可能是低氧时上调VEGF表达的重要因素.     

氧化应激在大鼠慢性低氧高二氧化碳肺动脉高压形成中的作用

目的:观察低氧高二氧化碳对肺组织超氧化物歧化酶(SOD)、过氧化氢酶(CAT)活力及丙二醛(MDA)含量的影响,探讨氧化应激于低氧高二氧化碳肺动脉高压形成发展中的作用.方法:复制低氧高二氧化碳肺动脉高压大鼠模型.测定平均肺动脉压(mPAP)、右心室/(左心室 室间隔)[RV/(LV S)]比.比色法测定肺组织SOD、CAT活力及MDA含量.电镜观察肺血管组织细胞超微结构.结果:与对照组相比,各低氧高二氧化碳组mPAP、RV/(LV S)比明显升高(均P＜0.01),肺组织SOD、CAT活力均显著降低,而MDA含量明显升高(分别P＜0.05,P＜0.01).电镜下,低氧高二氧化碳肺动脉高压大鼠肺中小肌型动脉内皮细胞及平滑肌细胞增殖、肥厚、肿胀,胶原纤维亦增生插入平滑肌细胞.结论:低氧高二氧化碳时大鼠肺组织氧化应激参与肺动脉高压的形成与发展.     

L-精氨酸调节大鼠低氧性肺血管结构重建与肺动脉平滑肌细胞凋亡

目的:探讨L-精氨酸(L-arginine,L-Arg)对低氧性肺血管结构重建大鼠肺动脉平滑肌细胞凋亡的影响及其机制.方法:将17只Wistar大鼠随机分为对照组(n=7)、低氧组(n=5)和低氧+L-Arg组(n=5).对大鼠肺血管进行显微形态学观测.通过末端转移酶介导的dUTP切口末端标记法(TUNEL)检测肺动脉平滑肌细胞凋亡,并以免疫组织化学方法研究肺动脉平滑肌细胞Fas表达.结果:低氧2周后出现大鼠肺血管结构重建.同时,肺中、小型动脉凋亡平滑肌细胞百分数均明显低于对照组(P均＜0.05),平滑肌细胞Fas表达明显降低.然而,L-Arg缓解了低氧性肺血管结构重建的形成.低氧+L-Arg组大鼠肺中、小型动脉凋亡平滑肌细胞百分数均明显高于低氧组(P均＜0.05).L-Arg使低氧大鼠肺动脉平滑肌细胞Fas表达明显增强.结论:L-Arg通过使肺动脉平滑肌细胞Fas表达上调,促进肺动脉平滑肌细胞的凋亡,从而对低氧性肺血管结构重建有重要的调节作用.     

低氧大鼠血清和肺小动脉Fractalkine的变化

目的 观察低氧性肺动脉高压形成过程中大鼠血清和肺小动脉fractalkine的表达变化,探讨fractalkine在低氧性肺动脉高压发病中的作用. 方法通过间断低氧复制大鼠肺动脉高压模型,右心导管插入法检测平均肺动脉压力(mPAP),图像分析法测量肺小动脉厚度,酶联免疫法检测血清可溶性fractalkine的浓度,免疫组化及原位杂交法观察肺小动脉fractalkine蛋白和mRNA的表达.结果 低氧14 d后的大鼠mPAP高于正常大鼠(P＜0.01),但是,在低氧21 d时,肺小动脉厚度指标(WA%和WT%)及右心室肥厚指数RV/(LV S)才增加(P＜0.01).与正常对照组比较,低氧21 d的大鼠肺小动脉fractalkine mRNA和蛋白表达明显增加,血清可溶性fractalkine浓度亦明显升高.相关分析显示fractalkine mRNA与WA%(r=0.749, P＜0.01)和 WT%(r=0.732, P＜0.01)呈正相关,fractalkine蛋白与WA%(r=0.727, P＜0.01)and WT%(r=0.683, P＜0.01)亦呈正相关.结论 慢性低氧刺激了fractalkine的合成和释放,fractalkine对于调节低氧性肺血管重建具有一定作用.     

慢性低氧高二氧化碳大鼠右心室尾加压素Ⅱ受体的变化

目的：探讨慢性低氧高二氧化碳大鼠右心室尾加压素Ⅱ受体的变化（UⅡ）受体的变化，方法：在慢性低氧高二氧化碳肺动脉高压、右心室肥大的大鼠模型上，采用放射性配基结合法，测定不同低氧时间（1w,2w,4w)右心室肌浆膜上UⅡ受体的结合率。结果：慢性低氧高二氧化碳碳大鼠的肺动脉平均压（mPAP）和右心室（RV）与左心室加室间隔（LV＋S）重量比（RV／LV＋S）明显增高（P＜0．01），1w组较正常对照组分别高26．2％和21．6％（P＜0．01），2w组又比1w组分别高22．5％和14．1％（P＜0．01），2w组与4w组差异有显性，右心室肌浆膜UⅡ受体数目（Bmax),1w组比正常对照组高24．4％（P＜0．01），4w组又比2w高19．85（P＜0．01），UⅡ受体亲和力（Kd值）各组间无差别（P＞0．05）。结论：慢性氧高二氧化碳使大鼠右心室肌浆膜上UⅡ受体增加，且有随低氧时间延长而增加的趋势，其变化可能是右室肥大的原因之一。     

慢性低O2高CO2肺动脉高压大鼠右心室骨桥蛋白及其整合素β3受体mRNA表达的变化

目的:观察慢性低O2高CO2肺动脉高压大鼠右心室心肌骨桥蛋白(OPN)及其整合素β3受体基因表达变化与右心室重塑的关系.方法:48只雄性SD大鼠随机分为四组:对照组(C组)、低O2高CO21 w、低O2高CO22 w和4 w组(1HH、2HH和4HH).除对照组吸入空气外,其他三组大鼠置于含9.O%～11.0%O2,5.5%～6.5%CO2的低O2高CO2氧舱内,每天8 h,每周6 d.测定平均肺动脉压(mPAP)和右心室肥厚指数;采用RT-PCR法测定不同低O2高CO2组大鼠右心室心肌骨桥蛋白(OPN)及其整合素β3受体mRNA的表达水平.结果:①低O2高CO2各组大鼠mPAP和RV/LV S均明显高于C组(P＜0.01),并且随着低O2高CO2时间的延长而增高.②C组大鼠右心室心肌OPN和整合素β3 mRNA表达水平均很低,低O2高CO2各组大鼠心肌OPN和整合素β3 mRNA表达水平增高,与C组比较差异均有显著性(P＜0.01和P＜0.05).相关性分析显示,骨桥蛋白mRNA表达水平与大鼠右心室肥大程度呈显著正相关性(P＜0.01).结论:慢性低O2高CO2大鼠肺动脉高压及右室肥大形成过程中,右心室心肌OPN及其受体整合素β 3基因表达增高,可能在右心室心肌重塑中起重要的作用.     

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.     

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.