低温对创伤失血性休克后早期炎症反应影响的研究

目的通过观察全身降温和局部降温对创伤失血性休克家兔血清IL-1β、IL-6、IL-10、TNF-α水平的影响,研究探讨全身降温和局部降温是否能抑制创伤后早期炎症反应,从而防治创伤后多器官功能衰竭综合征的发生.方法30只新西兰大白兔,随机分为正常对照组、常温组(Ⅰ组)、全身浅低温组(Ⅱ组)、全身中低温组(Ⅲ组,)、创伤局部降温组(Ⅳ组),采用ELISA法测定血清IL-1β、IL-6、IL-10、TNF-α含量.结果Ⅱ组、Ⅲ组、Ⅳ组血清IL-1β、IL-6、TNF-α的含量低于相应相点Ⅰ组血清IL-1β、IL-6、TNF-α的含量(除T4时相点Ⅲ、Ⅳ组血清IL-6含量高于Ⅰ组血清IL-6含量外);而血清IL-10的含量高于相应时相点Ⅰ组血清IL-10的含量.结论系统低温和创伤局部降温能抑制创伤后早期炎症因子的表达,增加抗炎因子的表达,从而抑制创伤后早期炎症反应.     

限制性液体复苏对创伤失血性休克患者炎性因子的影响

IL-1β、IL-6以及IL-10水平在任啊时间点均高于正常人群组,两组随着创伤时间的延长TNF-α、IL-1β、IL-6以及IL-10水平都有逐渐上升的趋势,但在创伤后120 min及创伤后240 min快速大量液体复苏组外周血中的TNF-α、IL-1β、IL-6以及IL-10水平明显高于限制性液体复苏组(P＜0.05).结论 限制性液体复苏可以有效抑制创伤失血性休克患者炎性因子的过度释放,对预防创伤失血性休克患者发生全身炎症反应综合征有一定的作用.     

参麦对大鼠失血性休克早期炎症反应的抑制作用研究

目的探讨参麦对大鼠失血性休克后早期炎症反应的抑制作用。方法将30只Wistar大鼠随机分为3组,每组10只,分别为对照组(A组)、失血性休克组(B组)和失血性休克参麦治疗组(C组)。采用ELISA法测定血清白细胞介素1β(IL-1β)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)含量;采用化学反应法测定过氧化物歧化酶(SOD)活性及丙二醛(MDA)含量。结果 B组血清IL-1β、IL-6、TNF-α及MDA含量均显著高于A组(P<0.01),SOD活性明显低于A组(P<0.01)。而C组与B组比较,血清IL-1β、IL-6、TNF-α及MDA含量显著降低(P<0.05),SOD活性显著升高(P<0.05)。结论参麦能有效抑制大鼠失血性休克后早期炎症因子的表达,增强SOD的活性,从而抑制大鼠休克后早期炎症反应。     

参附对大鼠失血性休克炎症因子的抑制作用

目的探讨参附对大鼠失血性休克后早期炎症反应的抑制作用。方法将30只Wistar大鼠随机分为3组,每组10只,分别为空白对照组(A组)、失血休克模型组(B组)和参附治疗组(C组)。采用ELISA测定血清中IL-1β、IL-6、IL-10和TNF-α的浓度。结果 B组和C组血清IL-1β、IL-6、IL-10和TNF-a明显高于A组(P<0.01);B组和C组大鼠相比较,血清IL-1β、IL-6和TNF-α的含量增加,IL-10的含量降低,差异均有统计学意义(P<0.01)。结论参附可有效降低失血性休克后炎症因子的产生。     

醒脑静注射液对大鼠创伤失血性休克合并内毒素血症模型的保护作用

目的：研究醒脑静注射液对创伤失血性休克复合内毒素血症模型大鼠的保护作用。方法：制作大鼠创伤失血性休克合并内毒素血症动物模型,经静脉给予醒脑静注射液干预治疗,检测血清中TNF-α、IL-1β、IL-10含量的变化及大鼠肺组织的病理改变。结果：醒脑静注射液干预治疗组大鼠血清中TNF-α、IL-1β的水平较致伤组降低（P〈0.05）,血清中IL-10的含量较致伤组明显升高（P〈0.01）,大鼠肺组织炎症病理改变较致伤组明显减轻。结论：醒脑静注射液对大鼠创伤失血性休克合并内毒素模型有明显保护作用。     

高压氧对重型脑创伤大鼠血清中炎症细胞因子水平的影响

目的:观察高压氧治疗对大鼠重型脑创伤后血清中炎症细胞因子水平的影响,探讨高压氧治疗的作用机理.方法:采用气体冲击法复制大鼠重度脑创伤模型.将66只SD大鼠随机分为假手术组、脑创伤组(TBI组)及脑创伤加高压氧治疗组(HBO组),采用放射免疫技术检测各组术后3 h、1 d、3 d、5 d、7 d时相点大鼠血清中TNF-α、IL-6、IL-8和IL-10的水平.结果:各时相点TBI组TNF-α、IL-6、IL-8及IL-10含量显著高于假手术组,差异有统计学意义(P＜0.05);与相应时间点的脑创伤组比较,高压氧治疗组各细胞因子均有所降低,IL-6从伤后3h,TNF-α从伤后1d,IL-8、IL-10从伤后3 d开始显著性降低,并均持续到7 d.结论:高压氧可抑制外周血中炎症细胞的活性,降低各炎症细胞因子的水平,从而减轻或阻断机体的过度炎症反应,使紊乱的免疫系统趋于平衡.     

高渗盐羟乙基淀粉液早期复苏兔肺挫伤合并失血性休克对肺组织局部炎症反应的影响

目的 观察复方高渗盐溶液(高渗盐羟乙基淀粉液,HSH)在兔肺挫伤合并失血性休克早期复苏中对肺组织肿瘤坏死因子(TNF)-α、白细胞介素(IL-8)含量的影响.方法 建立兔肺损伤合并失血性休克模型后,分别用等渗液(乳酸钠林格平衡液)、高渗液(7.5%生理盐水)、高渗高胶液(75 g/L NaCl 羟乙基淀粉母液)进行复苏治疗,动态观察4h肺水含量、肺组织TNF-α和IL-8含量及光镜下病理改变.结果 高渗高胶液组的兔肺水含量较另两组有所减轻,而反映肺组织中炎症反应强弱的TNF-α、IL-8含量也较对照组低,差异有统计学意义(P<0.05).结论 高渗高胶液是目前用于严重胸部创伤抗休克治疗效果较好的复苏液,对肺组织炎症反应具有一定的抑制作用.     

限制性液体复苏对创伤失血性休克患者发生SIRS的影响

目的:研究限制性液体复苏对创伤失血性休克患者炎性因子以及产生全身炎症反应综合征(SIRS)的影响。方法:选择180例创伤失血性休克患者随机分为快速大量液体复苏组(A组,n=90)和限制性液体复苏组(B组,n=90),另选择30例正常人作为对照组(C组)。A组出血未控制前进行快速大量的液体复苏,B组在出血未控制前行限制性液体复苏,1h后均接受手术止血治疗。观察患者外周血中TNF-α、IL-1β、IL-6以及IL-10等炎性因子等水平的变化以及SIRS的发病率。结果:四种不同的炎性因子变化趋势基本一致,快速大量液体复苏组与限制性液体复苏组外周血中的TNF-α、IL-1β、IL-6以及IL-10水平在任何时间点均高于正常人群组,两组随着创伤时间的延长TNF-α、IL-1β、IL-6以及IL-10水平都有逐渐上升的趋势,但在创伤后120min及创伤后240min快速大量液体复苏组外周血中的TNF-α、IL-1β、IL-6以及IL-10水平明显高于限制性液体复苏组(P<0.05);A组出现SIRS62例(68.9%),B组出现SIRS38例(42.2%),B组SIRS的发病率显著低于A组。结论:限制性液体复苏可以有效抑制创伤失血性休克患者炎性因子的过度释放,对创伤失血性休克患者发生SIRS有明显的抑制作用。     

“通利大肠”对COPD大鼠细胞因子含量的影响

目的 观察“通利大肠”对慢性阻塞性肺疾病(COPD)模型大鼠外周血及肺泡灌洗液中白介素-8(IL-8)、白介素-1β(IL-1 β)、肿瘤坏死因子-α(TNF-α)和白介素-10 (IL-10)含量变化,从炎症调控角度探讨COPD“从肠论治”的效应机制.方法 用气管注射脂多糖加熏香烟联合造模方法建立COPD大鼠模型,随机分为正常组、模型组、治肠组、治肺组及肺肠同治组.正常组、模型组灌胃纯净水,各给药组灌胃相应中药,连续14 d.用酶联免疫法(ELISA)测定外周血和肺泡灌洗液中细胞因子IL-8、IL-1β、TNF-α和IL-10的含量.结果 ①与正常组比较,模型组大鼠外周血和肺泡灌洗液的IL-8、IL-1β、TNF-α和IL-10含量均升高(P＜0.01或P＜0.05).②与模型组比较,治肠组外周血和肺泡灌洗液的IL-8、IL-1β、TNF-α和IL-10含量均降低(P＜0.01或P＜0.05).③与治肺组比较,肺肠同治组外周血IL-1 β含量和肺泡灌洗液IL-8含量降低(P＜0.01或P＜0.05).结论 通利大肠或在治肺的基础上增加通利大肠,能降低COPD模型大鼠的外周血和肺泡灌洗液中的细胞因子含量,从而减轻全身及局部的炎症反应,这可能是COPD“从肠论治”效应产生的作用环节之一.     

白细胞介素10对失血性休克大鼠肺的保护作用

目的探讨白细胞介素10(IL-10)对失血性休克大鼠肺的保护作用。方法24只雄性SD大鼠随机分为3个组,每组8只:假失血性休克对照(Control)组,休克(Shock)组,IL-10+Shock(IL-10)组。测定各组动脉血氧分压(PaO2),pH值,二氧化碳分压(PaCO2),肺湿/干重比值,测定血清丙二醛(MDA)含量以及超氧化物歧化酶(SOD)活性;检测支气管肺泡灌洗液(BALF)中性粒细胞比例及肺通透性指数,采用ELISA法测定灌洗液上清液及血清中IL-1I、L-6、TNF-α含量。结果与Shock组相比,IL-10组PaO2和pH值升高、PaCO2降低(P<0.01),IL-10组大鼠肺湿/干重(W/D)、支气管肺泡灌洗液中上清及血清中IL-1I、L-6、TNF-α含量均低于Shock组(P<0.01)。结论给于IL-10能够抑制IL-1I、L-6、TNF-α激增并减轻失血性休克大鼠的肺部炎症反应。     

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.