实验性高血压犬交感神经末梢去甲肾上腺素的释放调节

肾性高血压和正常犬股动脉内注入可卡因阻断突触前去甲肾上腺素(NE)的回摄取,注入酪胺促进交感神经末梢释放NE,观察α_1和α_2受体阻断前后NE分泌率和灌流压的变化。结果显示,酪胺促进NE释放后高血压犬NE分泌率较正常犬高,这是由于高血压犬突触前α_2受体对NE释放的负反馈调节能力减弱所致。可卡因及酪胺灌注后高血压犬灌流压升高比正常犬明显,这是由于突触后α_1受体向上调节所致。     

心脏交感神经突触前膜和突触后膜的肾上腺素能受体

肾上腺素能受体是细胞膜的组成成份,可能是一种大分子的蛋白质脂旦白。Ahlquist 首先提出肾上腺素能受体可分为两种类型,即α—肾上腺素能受体(简称α受体)和β—肾上腺素能受体(简称β受体)。随后,Lands 又把β受体再分为β_1和β_2两种亚型。近来,Langer 通过大量实验,提出将α受体分为两种亚型,突触前膜的α_2受体和突触后膜的α_1受体。迄今,在心交感神经纤维突触前膜除发现有α受体、β受体外,还发现有胆硷能 M、胆硷能 N、多巴胺、前列腺素、血管紧张素、组     

充血性心力衰竭病人的交感活性

本文研究心衰病人血浆去甲肾上腺素(PNE)含量与血流动力学关系,观察到心功能Ⅲ、Ⅳ级病人PNE明显增高,心衰病情越重,肺毛细血管楔压,周围血管阻力越高,心搏出量越低,PNE越高。病人口服硝苯吡啶后,即时血流动力学明显改善,单独用药3天,PNE明显下降,提示硝苯吡啶不引起反射性交感兴奋。在α_2受体阻断剂作用后,心衰病人血小板聚集性较健康对照组低,提示心衰病人血小板膜上α_2受体功能减弱或数量减小。     

多巴酚丁胺对充血性心衰病人血循环细胞α_2、β受体功能的影响

连续静滴多巴酚丁胺3d,显著降低淋巴细胞在异丙肾上腺素刺激下的 cAMP产生能力;不论预先是否用α_2受体拮抗剂 rauwolscine 阻断血小板α_2受体,肾上腺素诱导的血小板聚集均无显著变化。停用多巴酚丁胺后,淋巴细胞β受体反应性逐渐恢复,药后二周基本达到药前水平。结果提示,即使短暂使用多巴酚丁胶也可使心肌细胞β受体失敏感和(或)向下调节。     

α—受体研究进展

肾上腺素受体分为α,β两大类。α受体又可分为两种亚型,位于突触前膜的为α_1,激活时产生兴奋效应;位于突触后膜的为α_2,兴奋时产生抑制效应。但随着越来越多的高选择性试药的应用,人们对有关α受体的分类,分布,作用机制乃至与疾病的关系的认识,正在发生着变化。 一、突触后膜也存在有兴奋性α_2受体 给毁髓大鼠分别静注选择性α_1受体激动剂甲氧明和选择性α_2受体激动剂B-HT920,可获得两条药物剂量——升压反应曲线.选择性α_1受体阻滞剂哌唑嗪能显著拮抗甲氧明的效应而不影响到B-HT920,选择性α_2受体阻滞剂育亨宾则相反。类似的结果亦见于哌唑嗪和萝芙素(选择性α_2受体阻滞剂)对肾上腺素和α-甲基去甲肾上腺素升高毁髓大鼠血压反应的阻滞。     

高血压病人中枢α_2受体功能紊乱以及β受体阻断剂对它们的影响

观察10例健康人与12例高血压病人可乐定(clonidino)诱导生长激素释放的区别以及在β受体阻断剂普洛茶尔(propranolol)作用1周后10例高血压病人可乐定/生长激素(C/GH)试验的变化。研究证明中枢神经α_2受体激动剂可乐定(150ug)静注后30、60 min,正常人血清生长激素分别增加7.8和6.4倍,高血压病人分别增加2.3和1.7倍(P<0.01),提示高血压病人有中枢神经α_2受体功能紊乱。10例病人接受普洛萘尔治疗1周后,在已经出现明显心率减慢,可乐定降压作用被拮抗的同时,病人可乐定/生长激素试验反应低下的状态未能纠正,提示高血压病人视丘下部的α_2受体有选择性损害。     

左旋四氢巴马汀对α1和α2肾上腺素受体的作用

左旋四氢巴马汀(I-THP)选择性地抑制~8H-prazosin和~3H-clo-nidine与大鼠脑细胞膜上α_1和α_2肾上腺素受体的结合,与α_1、α_2受体的亲和力(Pki)分别为5.84和5.87。其拮抗苯肾上腺素收缩大鼠离体主动脉条作用PA_2值为5.59,它使利血平化大鼠出现升压效应,并为育亨宾所阻滞。大剂量I-THP能拮抗可乐定的升压作用,表明I-THP有阻滞α_1受体的作用,小剂量时能激动突触前膜α_2受体,大剂量亦能阻滞突触后的α_2受体。     

α—肾上腺素受体激动剂的降压和镇静作用:与α_1—和α_2—肾腺素受体效能的关系

目前已确认,不仅有位于突触后的α—肾上腺素受体,也有位于突触前的α—肾上腺素受体,该受体的激活导致肾上腺素能神经释放去甲肾上腺素减小。突触后肾上腺素受体称α_1—受体,突触前肾上腺素受体称α_2—受体。     

α_(2c)-肾上腺素能受体多态性与扩张型心肌病患者无事件生存率改善相关

目的:交感神经系统在心脏发育中起重要作用,但其过度刺激与慢性心衰患者的死亡率增加有关。突触前α2-受体是控制去甲肾上腺素自交感神经释放的重要反馈调节子。在本研究中,测试了人类α2c-受体基因(α2cDel322-325)的缺失多态性是否影响扩张型心肌病(DCM)患者的心衰进展。方法     

可乐宁对高血压病人细胞内游离钙及交感神经活性的影响

观察了２１例原发性高血压病人口服可乐宁前后血小板胞浆游离钙、血浆去甲肾上腺素（ＮＥ）、血浆血管紧张素Ⅱ（ＡＴⅡ）、肾上腺素诱导的血小板聚集率的变化。结果发现，高血压病人上述指标均比正常人明显增高，血小板胞浆内游离钙增高程度与血压增高呈正相关，其余３项指标增高程度与血压增高程度无明显相关。可乐宁治疗后高血压病人ＮＥ水平明显降低，但细胞游离钙无明显变化。提示交感神经活性增加、细胞内游离钙增高作为两个独立的因子参与高血压发病。     

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.