老年急性冠脉综合征患者血小板活化和血管内皮损伤指标的改变及其临床意义

目的观察老年急性冠脉综合征（ACS）患者血小板活化指标[CD62p、CD63、GPⅡb/Ⅲa受体复合物以及纤维蛋白原（FIB-C）]和血管内皮损伤指标[假血友病因子（vWF）、内皮素1（ET-1）、一氧化氮（NO）和内皮依赖性血管舒张功能（FMD）]的改变及其临床意义。方法60例ACS患者入院后次日采用流式细胞仪检测CD62p、CD63及GPⅡb/Ⅲa;用散射比浊法测定血浆FIB-C的水平;用双抗体夹心固相酶联免疫吸附试验测定血浆vWF的表达水平;用放射免疫测定法测定血浆ET-1表达水平;用酶法测定血浆NO的含量;用彩色多谱勒超声诊断仪测量FMD。选择健康体检者和稳定型心绞痛患者各30例作对照,观察ACS患者上述指标的变化,并与对照组比较。结果ACS患者血小板活化指标CD62p、CD63、FIB-C及GPⅡb/Ⅲa受体复合物较健康对照组明显增高（均P〈0.01）,较稳定型心绞痛组也增高（P〈0.01或P〈0.05）。血管内皮损伤指标vWF和ET-1的表达水平较健康对照组明显增高（均P〈0.01）,较稳定型心绞痛组也增高（均P〈0.01）;FMD和血浆NO的表达水平较健康对照组显著降低（P〈0.01或P〈0.05）,较稳定型心绞痛组也显著降低（P〈0.01或P〈0.05）。结论血小板活化和血管内皮损伤在老年ACS患者发生和发展过程中起重要的作用。     

印度草药方Body Revival对人类血小板聚集及大鼠心肌缺血的作用（英文）

目的：观察印度草药方Body Revival（BR）对人类血小板聚集及异丙肾上腺素引起的大鼠心肌缺血的作用。方法：BR悬浮液（分别含BR10、20和30μg）与富血小板血浆混合后,37℃下培养30min,分别将二磷酸腺苷（20mmol/L）或胶原蛋白（2μg）加入混合液中,与混合了等体积的BR悬浮液的贫血小板血浆对比观察BR对于血小板凝集的作用。Wistar大鼠分为4组以检测BR对于异丙肾上腺素引起的心肌缺血的作用。使用标准的商业化试剂盒测量大鼠血清中肌酐激酶、天冬氨酸氨基转移酶及丙氨酸氨基转移酶的水平,同时测量大鼠血清中氮氧化物的含量及大鼠心肌中脂质过氧化物及蛋白质的含量。结果：BR能够剂量依赖性地抑制二磷酸腺苷或胶原蛋白引起的人类血小板聚集。此外,BR对于异丙肾上腺素引起的大鼠心肌缺血具有保护作用。与对照组比较,BR能够显著降低大鼠血清中肌酐激酶、天冬氨酸氨基转移酶、丙氨酸氨基转移酶和氮氧化物的含量以及大鼠心肌中脂质过氧化物的含量（P〈0.01）。结论：BR能够抑制人类血小板聚集并对异丙肾上腺素引起的大鼠心肌缺血具有保护作用。     

H型高血压患者血浆ET-1、vWF因子变化的相关研究

【目的】本研究通过测定H型高血压患者血浆中内皮素-1（Endothelin-1,ET-1）、血管性血友病因子（Von Willebrandfactor,vWF）的水平变化,初步探讨H型高血压血管内皮损伤的状态。【方法】将70例H型高血压患者根据血同型半胱氨酸水平分为两组,中度升高组34例,男18例,女16例;轻度升高组36例,男19例,女17例。再选取20例单纯高血压组,其中男11例,女9例;另选健康体检者18例,其中男9例,女11例作为正常对照。采取所有受试者空腹肘静脉血,应用酶联免疫吸附法（ELISA）测定血浆ET-1、vWF分子标志物水平。【结果】（1）H型高血压组血浆ET-1、vWF水平均高于单纯高血压组（P〈0.05）,并高于正常组（P〈0.05）;（2）同型半胱氨酸中度升高组血浆ET-1、vWF均高于轻度升高组（P〈0.05）。【结论】（1）H型高血压患者血浆ET-1、vWF水平明显增高,表明存在血管内皮损伤;（2）H型高血压组随着血同型半胱氨酸水平的升高,血浆ET-1、vWF水平增高,提示高同型半胱氨酸血症加重血管内皮损伤,增加血管性疾病发生的危险性。     

儿茶酚胺对大鼠血管内皮功能的影响

目的探讨儿茶酚胺对大鼠血管内皮分泌功能的影响。方法利用大鼠异丙肾上腺素（ISP）心肌损伤模型,采用放免的方法测定血中内皮素（ET-1）,前列腺素代谢产物6-酮前列腺素F1α（6-keto-PG1α）和血栓素B2（TXB2）的含量。结果试验组ISP导致血浆中ET-1明显增高;6-keto-PG1α含量明显降低而TXB2的含量明显增高。结论异丙肾上腺素损伤血管内皮分泌功能,从而可能影响血管的舒缩功能、血小板的凝血与止血的平衡状态,进一步导致心肌损伤及其他脏器的损伤。     

高压氧对慢性疲劳综合征大鼠血管内皮功能的影响

目的制作慢性疲劳综合征（chronic fatigue syndrome,CFS）大鼠模型,观察高压氧对CFS大鼠血管内皮功能,即血浆内皮素-1（endothelin-1,ET-1）、一氧化氮（nitric oxide,NO）及血管性假血友病因子（von wille-brand factor,vWF）的影响。方法将SD大鼠随机分为空白对照组、高压氧对照组、CFS模型组、CFS高压氧组及CFS休息组,采用负重力竭游泳的方法建立CFS动物模型,采用放射免疫法检测血清ET-1、NO及vWF水平。结果相对于空白对照组,CFS模型组血清ET-1、vWF升高（P〈0.05）,而NO降低（P〈0.05）;CFS高压氧组以上指标较CFS模型组呈反向变化,差异具有统计学意义（P〈0.05）。结论慢性疲劳综合征大鼠血管内皮功能受损或功能紊乱,这种血管内皮功能障碍在高压氧治疗下能够得到积极改善。     

山豆根碱与山豆根苏林碱对血小板聚集和粘附的影响

观察山豆根碱（Ｄａｕ）及山豆根苏林碱（Ｄａｓ）对人血小板聚集和粘附功能的影响，并探讨其作用机制。结果表明，两者可抑制由二磷酸腺苷、花生四烯酸和胶原引起的血小板聚集，药物浓度与聚集抑制率表现出明显的量效关系。Ｄａｕ处理的血小板其对二磷酸腺苷、花生四烯酸和胶原诱导聚集抑制的ＩＣ５０（ｍｍｏｌ／Ｌ）分别为０．０４２（ｎ＝５），０．０２８（ｎ＝９）及０．０４６（ｎ＝１０）；Ｄａｓ则分别为０．０４２（ｎ＝５     

抗血小板药物与急性冠脉综合征

急性冠脉综合征(ACS)是由于各种原因导致血管内皮损伤，动脉粥样斑块破裂，诱发血小板激活聚集而引起的临床急性表现。包括急性心肌梗死(AMI)和不稳定型心绞痛(UAP)。血栓形成是ACS发生的病理生理基础。冠状动脉粥样硬化斑块的内皮损伤和功能失调，使血小板激活黏附，在组织损伤释放的二磷酸腺苷(ADP)、胶原组织、肾上腺素或凝血     

吲哚布芬对血小板聚集及血栓形成的影响

目的 通过动物实验,研究注射剂型吲哚布芬静脉给药后对血小板聚集及血栓形成的影响。方法 每项实验用动物50只,分5组,每组10只,动物按体质量随机分为生理盐水对照组（NS组）、吲哚布芬低、中、高剂量组及阿司匹林（ASA组）对照组,药后30min,分别检测由二磷酸腺苷（ADP）、花生四烯酸（AA）及血小板活化因子（PAF）诱导的Wistar大鼠血小板1min、5min的聚集率及最大聚集率;胶原-肾上腺素诱发的KM小鼠血栓性偏瘫甚至死亡的时间及电刺激Wistar大鼠颈动脉血栓形成的时间。结果 大鼠血小板聚集实验显示,与NS组比较,吲哚布芬中、高剂量组和ASA组能抑制由ADP、AA及PAF诱导的大鼠血小板不同时间点的聚集（P<0.05或P<0.01）,与ASA组比较,在ADP及AA诱导的实验中,吲哚布芬高剂量组对血小板1min/5min聚集率的抑制作用有统计学差异（P<0.05）;胶原-肾上腺素诱导的小鼠肺栓塞实验显示,与NS组比较,吲哚布芬中、高剂量组及ASA组小鼠存活时间明显延长（P<0.01或P<0.05）,与ASA组比较,吲哚布芬高剂量组的小鼠存活时间延长有统计学差异(P<0.05);电刺激大鼠颈动脉血栓形成实验显示,与NS组比较,吲哚布芬中、高剂量组和ASA 组均能明显抑制血管栓塞时间（P<0.05或P<0.01）,与ASA组比较,吲哚布芬抑制血管栓塞时间虽无统计学差异,但吲哚布芬高剂量组抑制血栓形成时间明显高于ASA组。结论 吲哚布芬具有显著的抑制血小板聚集和血栓形成作用,且呈现一定的量效关系,吲哚布芬抑制血小板聚集及血栓形成作用强于ASA。     

丹红对急性冠脉综合征患者介入治疗术后血管内皮功能的影响

目的探讨丹红注射液对急性冠脉综合征介入治疗后血管内皮功能的影响。方法 100例急性冠脉综合征（ACS）患者随机分为丹红治疗组（简称丹红组,50例）和常规治疗组（简称常规组,50例）,两组病例在冠脉介入治疗前后次日采血,用酶联免疫吸附试验（ELISA）测定血浆假血友病因子表达水平;用放射免疫测定法测定血浆内皮素1（ET-1）的表达水平;用酶法测定血浆一氧化氮（NO）的含量;用彩色多谱勒超声诊断仪测量内皮依赖性血管舒张功能（FMD）。静脉滴注丹红注射液治疗14天复查上述指标并比较。结果与健康对照组比较,ACS患者术前vWF及ET-1均显著升高（P〈0.01）,FMD和NO显著降低（P〈0.01）。冠脉介入术后vWF因子升高（P〈0.05）,FMD降低（P〈0.05）,但ET-1和NO水平差异无统计学意义（P〉0.05）。与常规组比较,丹红组vWF、ET-1水平明显降低（P〈0.05）,FMD水平增加（P〈0.05）。结论冠状动脉介入术前、后给予丹红治疗可以有效防治冠脉内血栓及保护血管内皮功能。     

毛果芸香碱的抗血小板作用的探讨

在发现毛果芸香碱抗血小板聚集作用的基础上,在家兔血小板实验中进一步证明(1)毛果芸香碱有抑制腺苷二磷酸、花生四烯酸和胶原诱发血小板聚集和释放ATP的作用;对腺苷二磷酸和花生四烯酸诱发的血小板变形无抑制作用,对胶原诱发的变形则有抑制作用。(2)毛果芸香碱对腺苷二磷酸和花生四烯酸诱发的血小板聚集团有解聚作用,但对胶原诱发的则无解聚作用。Nachman等证明的血小板间桥模式不能解释此现象。我们提出了两种有糖蛋白G参与的血小板间桥模式的设想。     

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.