新生儿缺氧缺血性脑病血清TNF-α、Fn的变化及替代治疗研究

目的　观察新生儿缺氧缺血脑病 (HIE)外周血TNF α(肿瘤坏死因子 α)、Fn(纤维连接蛋白 )变化及探索治疗的新方法。方法　设对照组 (正常新生儿 ) 2 0例 ,观察组 (HIE患儿 ) 4 9例。分别用双抗体夹心酶联免疫法 (ELISA)与免疫透射比浊法于生后第 1天、7天测定其外周血TNF α、Fn含量 ,并作对比分析。将中、重度HIE 4 0例随机分为输冷沉淀治疗组与非冷沉淀治疗组 ,观察其治疗效果。结果　HIE患儿和正常新生儿生后第 1天血清TNF α分别为 (1.4 5± 0 .2 1)和 (1.0 3± 0 .12 ) μg/L(P <0 .0 1) ,Fn分别为 (14 1.37± 4 6 .77)和 (2 5 8.30± 2 9.95 )mg/L(P <0 .0 1) ,而且病情越重改变越明显 ,至生后 1周TNF α逐渐降低 ,Fn逐渐回升 ,但均未达正常水平。输注冷沉淀后 ,上述指标恢复正常对照组水平。并进行 1～ 2年随访观察远期疗效 ,输冷沉淀组近、远期治疗效果明显优于非输冷沉淀组 (P<0 .0 1)。结论　HIE患儿外周血TNF α水平升高 ,Fn水平降低 ,它们可能参与了HIE的某些发病过程 ;冷沉淀可作为血浆Fn的替代疗法以提高抢救成功率 ,改善预后。     

败血症大鼠肺纤维连接蛋白含量与分布的变化

作者对25只盲肠结扎后败血症大鼠体内的纤维连接蛋白(Fn)进行了研究。血浆Fn(pFn)用免疫火箭电泳法,组织中(肝、肺)可浸出的Fn含量用ELISA和Fn在肺中的定位分布用间接免疫荧光法检测。结果发现,盲肠结扎后22h肝中Fn含量明显减少(P<0.05),肺组织中Fn含量与炎症轻重有关,炎症轻微处Fn含量比正常及假手术对照明显减少(P<0.05),炎症严重处Fn明显增加(P<0.05)。但此时pFn增高。肺中的Fn抗原主要集中在微血管周围,其分布与嗜中性白细胞的浸润一致。作者认为,上述变化与败血症时肺功能衰竭的发生有一定关系。     

急性脑梗死患者细胞因子测定及其临床意义

目的探讨急性脑梗死患者血浆中血栓与止血检验相关标记物含量变化及其与临床之间的关系。方法测定急性脑梗死患者53例血浆组织型纤溶酶原激活剂(t-PA)、血管性血友病因子(vWF)、纤维连接蛋白(Fn)、内皮素(ET)、6-酮-前列腺素(6-K-PGF1α)含量,并与正常对照组比较。结果急性脑梗死患者血浆中t-PA含量较正常对照组低(P<0.01);vWF、Fn、ET、6-K-PGF1α含量较正常对照组高(P<0.01)。结论血浆中t-PA、vWF、Fn、ET、6-K-PGF1α含量的变化与急性脑梗死的发病有关。     

烧伤后血浆和焦痂下组织纤维结合蛋白的动态观察 专业 外科(烧伤)

严重烧伤后进行纤维结合蛋白(Fn)的动态观察,对烧伤脓毒血症的诊断、治疗和估计预后等方面可能具有一定意义。为此,我们使用单向火箭免疫电泳法和电凝法,对35例不同程度烧伤伤员进行血浆以及痂下组织中 Fn 的含量和活性检测。初步结果显示了 Fn的含量变化与烧伤的严重程度、脓毒血症及其预后存在着一定的关系。第一组16例伤员,烧伤总面积>50％(平均烧伤面积为76±15％,Ⅲ°烧伤面积平均为38.12±22％)。结果伤后第一个24小时血浆中 Fn 含量明显降低至197.2±69.5μg/ml,伤后第三天逐渐开始恢复,但在伤     

SARS患者血浆纤维结合蛋白水平变化及其意义

目的:探索急性期SARS患者和康复期SARS患者血浆纤维结合蛋白(plasma Fibronectin,Fn)的水平变化及输注血浆Fn纠正治疗急性期SARS患者的可行性。方法:急性期SARS组为4名住院的急性期SARS患者;康复期SARS组为111名康复期SARS住院患者;对照组为随机26名体检合格的无偿献血者。采用ELISA法测定各族组血浆Fn水平。结果:急性期SARS组血将Fn浓度为(42.2±23.0)mg/L;恢复期SARS组血浆Fn浓度为(379.45±93.27)mg/L;对照组血浆Fn浓度为(359.21±52.54)mg/L。急性期SARS组血浆Fn浓度显著低于对照组(P=0.001);急性期SARS组与恢复期SARS组血浆Fn浓度差异极显著(P=0.000);恢复期SARS与对照组血浆Fn浓度无显著差异(P=0.289)。结论:急性期SARS患者血浆纤维结合蛋白水平显著降低,为输注外源性的纤维结合蛋白治疗SARS提供了依据。SARS患者血浆Fn水平的变化可能是辅助诊断和判断SARS病情的指标之一。     

败血症大鼠肺纤维连接蛋白含量与分布的变化

作者对25只盲肠结扎后败血症大鼠体内的纤维连接蛋白（Fn)进行了研究。血浆Tu(pFn)用免疫火箭电泳法，组织中（肝、肺）可浸出的Fn含量用ELISA和Fn在肺中的定位分布用间接免疫荧光法检测。结果发现，盲肠结扎后22h肝中Fn含量明显减少（P＜0．05），肺组织中Fn含量与炎症轻重有关，炎症轻微处Fn含量比正常及假手术对照明显减少（P＜0．05），炎症严重处Fn明显增加（P＜0．05）。但此时pFn增高。肺中的Fn抗原主要集中在微血管周围，其分布与嗜中性白细胞的浸润一致。作者认为，上述变化与败血症时肺功能衰竭的发生有一定的关系。     

内毒素性休克时血浆纤维连接蛋白与微血管通透性的关系

用异硫氰酸荧光素右旋糖酐-150作示踪剂,观察内毒素性休克时兔和大鼠微血管通透性变化。结果发现,内毒素性休克兔微血管通透性随休克进展进行性升高,血浆纤维连接蛋白(Fn)含量随之下降,两者呈显著相关(P<0.05)。在内毒素性休克大鼠中补充纯化大鼠Fn后,血浆Fn恢复,在静脉补充后2h内,微血管通透性升高受明显抑制,但2h后作用消失。与对照组(补充缺乏大鼠Fn血浆的内毒素性休克大鼠)相比,治疗组(补充纯化大鼠Fn)内毒素性休克大鼠的存活时间并无明显延长。     

肝病患者血浆纤维连结蛋白含量分析

本文通过火箭电泳法测定30例正常人血浆纤维连结蛋白(Fn),其含量为289.3±38.7mg/L(x±s),其中各种肝病183例,除急性肝炎含量高于正常对照组外,慢活肝、肝硬化失代偿,原发性肝癌,Fn值均明显低于正常对照组,有显著差异(P<0.05),以肝硬化失代偿为著。同时测定常规肝功、血浆蛋白,其与Fn值,肝病病程均无明显相关性,84例甘胆酸(CG)测定,其结果与Fn呈负相关,提示血浆Fn与CG同样可做为判断肝硬化代偿功能及预后的指标之一。     

肺心病患者血浆纤维结合素测定的临床意义

血浆纤维结合素(Fibronectin,Fn)含量的改变与多种疾病有关,尤与肺疾病的关系密切。作者用免疫扩散法对56例肺心病患者进行了99例次血浆Fn水平检测,并动态观察Fn与血气改变、呼吸衰竭等的关系,初步探讨其临床意义,现报道如下。 正常对照组40例为献血员和本院职工,无急、慢性呼吸系统病史及临床表现。测得血浆Fn均值为292.48±43.11μg/ml;56例肺心病     

充血性心力衰竭治疗前后内皮素，肿瘤坏死因子和血管紧张素转化酶含量比较

目的探讨充血性心力衰竭(CHF)患儿不同心功能级数及分组治疗前后血浆ET、TNF和ACE含量的变化及其意义。方法用放免法和比色法分组测定充血性心力衰竭(CHF)80例患儿血中ET、TNF和ACE含量的变化。结果80例CHF患儿中血中ET、TNF和ACE含量分别为(141.33±8.56)ng/L、(168.25±35.14)ng/L和(429.45±61.33)IU,与正常对照组比较均明显升高(P＜0.05);心功能Ⅱ级与心功能Ⅲ级、心功能Ⅳ级TNF、ET含量间比较均有显著性差异(P＜0.05～0.01),相关有显著性意义;不同心功能级数CHF患儿血浆TNF、ET和ACE含量治疗后较治疗前明显降低,均有显著性差异(P＜0.05～0.01),而且心功能越差,血浆TNF、ET水平恢复越慢,洛汀新组心功能改善较常规组明显,两者含量间比较有显著性差异(P＜0.05)。结论血浆ET、TNP和ACE含量的测定有助于判断心力衰竭的程度,洛汀新组的疗效明显优于常规组。     

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.