近红外光谱技术实时监测创伤性脑水肿的可行性研究

目的:探讨近红外光谱技术(NIRS)用于创伤性脑水肿活体实时监测的可行性.方法:采用Feeneys自由落体撞击法建立急性局灶性脑挫裂伤模型,以NIRS实时监测静脉注入脱水剂后脑组织优化散射系数(μs)的变化情况.结果:脑组织受到创伤后水肿即开始发生,μs值呈抛物线形上升,但伤侧水肿的程度和速度明显大于健侧,1 h后两者之间差异具有统计学意义(P<0.05);注入脱水剂后μs值呈U形变化,先迅速降低,达到并维持一个平台期2.5~3.0 h,然后逐渐回升,于注射后4.5~5.5 h回复到注射前水平;相同渗透浓度的高渗盐水与甘露醇相比,起效更快,发挥最大效用所需要的时间更短,维持时间更长.结论:μs是监测创伤性脑水肿的良好指标,能够较好地反映脑组织水肿程度以及脱水剂的作用效果.NIRS可以用于创伤性脑水肿的实时监测.     

急性创伤性脑水肿NO变化及低温保护效应的研究

目的 探讨急性创伤性脑水肿后NO变化及低温脑保护作用。方法 建立急性脑创伤模型,分常温组和低温组,按不同时段取伤侧颈内静脉血清测NO及伤侧脑组织测脑水含量。结果脑损伤后30min脑组织水肿及颈内静脉血清NO开始增高,8h达高峰。低温组NO及脑水含量均较常温相应组低。结论脑损伤后脑水肿发展与血清NO增加具有同步效应,低温(31～32℃)对创伤性脑水肿则有保护作用。     

开放性颅脑损伤合并海水浸泡脑组织病理变化的实验研究

目的观察重型开放性颅脑损伤后海水浸泡对脑组织病理改变的影响。方法利用改进的兔重型开放性颅脑损伤模型进行30min海水浸泡,对照组不进行海水浸泡。分别在干预结束后0、3、8h在挫裂伤区取材,固定于10%福尔马林,作HE染色,光镜下观察创伤组织的病理改变。结果浸泡组和对照组在伤后先后出现了严重的创伤性脑水肿,但水肿高峰期出现时间不一致,对照组早在干预结束后3h即出现创伤性水肿改变,干预结束后8h水肿依旧;而海水浸泡组在干预结束后8h才出现明显的水肿,但水肿呈现进一步加重趋势。结论海水浸泡延迟了创伤性脑水肿高峰的出现,但发生的创伤性脑水肿重于单纯创伤。     

开放性颅脑损伤合并海水浸泡脑组织病理变化的实验研究

目的 观察重型开放性颅脑损伤后海水浸泡对脑组织病理改变的影响。方法 利用改进的兔重型开放性颅脑损伤模型进行30min海水浸泡，对照组不进行海水浸泡。分别在干预结束后0、3、8h在挫裂伤区取材，固定于10％福尔马林，作HE染色，光镜下观察创伤组织的病理改变。结果 浸泡组和对照组在伤后先后出现了严重的创伤性脑水肿，但水肿高峰期出现时间不一致，对照组早在干预结束后3h即出现创伤性水肿改变，干预结束后8h水肿依旧；而海水浸泡组在干预结束后8h才出现明显的水肿，但水肿呈现进一步加重趋势。结论 海水浸泡延迟了创伤性脑水肿高峰的出现，但发生的创伤性脑水肿重于单纯创伤。     

亚低温对鼠脑外伤后血浆内皮素含量变化的影响

目的 :研究亚低温对鼠脑外伤后血浆内皮素含量变化的影响并探讨机理。方法 :应用 Feeney法制成鼠脑损伤模型 ,给予亚低温治疗后研究血浆内皮素及伤侧半球脑组织含水量的变化。结果 :大鼠脑创伤后脑水肿迅速发生 ,创伤组血浆内皮素含量及伤侧半球脑含水量均明显高于假手术组 (P<0 .0 1 ) ,亚低温治疗组血浆内皮素含量及伤侧半球脑含水量均较创伤组明显降低 (P<0 .0 1 )。结论 :亚低温对创伤性脑水肿有明显的治疗作用 ,其作用机理可能与抑制血浆内皮素的产生和释放有关。     

实验性脑出血大鼠脑水肿变化规律及其行为学改变

目的　研究大鼠脑出血后脑水肿的变化规律和脑水肿对行为学的影响。方法　应用立体定向技术 ,用大鼠自体尾动脉不抗凝动脉血液 5 0 μl缓慢注入大鼠尾壳核 ,制成中等量脑出血 ,动态观察脑水肿的变化规律和脑水肿对其行为学的影响 ,脑水肿的测定应用干 /湿重法 ,行为学评分采用Longa评分法、肢体对称试验评分法、Berderson评分法和平衡木评分法。结果　脑出血血肿周围组织含水量与对照组间差别有显著性意义 ,出血侧脑组织含水量与出血对侧脑组织含水量间差别有显著性意义 ,以出血后 4 8～ 72h最明显 ,至脑出血后第 7d大致恢复正常。 4 8h出血侧脑组织含水量为 (79 4 9± 0 2 5 ) %,出血对侧为 (78 33± 0 0 3) %;72h出血侧为 (78 4 7± 0 2 7) %,出血对侧为(77 97± 0 2 5 ) %;假手术组手术侧为 (77 6 9± 0 38) %,手术对侧为 (77 11%± 1 12 ) %。大鼠脑出血后其行为学改变以出血后 72h内最明显 ,至脑出血后第 7d大致恢复正常 ,与脑水肿的规律一致。结论　大鼠脑出血后脑水肿规律和行为学改变一致 ,提示脑出血后脑水肿是导致病情加重的主要原因之一。     

高渗脱水药物对大鼠脑皮质优化散射系数的影响及其临床意义

目的利用内置双光纤微创探头的近红外测量(NIRS)技术观察高渗脱水药物对大鼠脑皮质优化散射系数(μ′s)的影响。方法将SD大鼠随机分成3组:对照组(n=15)尾静脉推注0.9%氯化钠,甘露醇组(n=15)尾静脉推注20%甘露醇,7.5%氯化钠组(n=15)尾静脉推注7.5%氯化钠;剂量均为10 m l.kg-1。使用内置双光纤微创探头活体在位连续动态观察大鼠局部脑皮质μ′s的变化情况。结果对照组静脉推注0.9%氯化钠前后大鼠脑皮质μ′s未见明显变化,甘露醇组和7.5%氯化钠组μ′s分别下降了(2.67±0.35)%和(5.62±0.46)%;甘露醇组与7.5%氯化钠组与对照组之间、甘露醇组与7.5%氯化钠组之间差异均有统计学意义(P<0.05)。结论大鼠脑皮质局部μ′s可以作为高渗药物脱水作用的评估指标之一。     

亚低温对大鼠脑外伤后血浆内皮素含量变化的影响

目的 研究亚低温对鼠脑外伤后血浆内皮素含量变化的影响并探讨机理。方法 应用Ｆｅｅｎｅｙ法制成鼠脑损伤模型,给予亚低温治疗后研究血浆内皮素及伤侧半球脑组织含水量的变化。结果 大鼠脑创伤后脑水肿迅速发生,创伤组血浆内皮素含水量及伤侧半球脑含水量均明显高于假手术组（Ｐ〈０．０１）,亚低温治疗组血浆内皮素含量及伤侧半球脑含量均较创伤组明显降低（Ｐ〈０．０１）。结论 亚低温对创伤性脑水肿有明显的治疗作用,其     

AQP4在人脑挫裂伤早期的表达及临床意义

目的观察人脑挫裂伤后早期AQP4在脑水肿形成中的不同时间点的变化特征,探讨脑水肿的形成机制,为颅脑损伤后脑水肿的治疗和预后提供客观依据。方法选取经颅脑CT证实为脑挫裂伤且需手术治疗的患者。手术过程切取小部分正常脑组织及挫裂伤脑组织,取脑挫裂伤区组织标本60例(观察组),10例非功能区正常脑组织标本(对照组)。正常对照组不做任何处理,观察组于按时间伤后2h、6h、8h、12h、24h、72h分6个亚组,每组10只(n=10)。采用免疫组化和图像分析技术测定各组相应时间点水肿区AQP4的表达水平,同时用干湿重法检测脑水肿含水量。结果与正常组相比较,脑挫裂伤组在伤后2h后AQP4表达开始增加(P<0.05),6h、8h、12h明显增加(P<0.01),24～72h达到最高(P<0.01)。AQP4表达与脑含水量的变化规律趋于一致(r=0.912,P<0.01)。结论脑挫裂伤后AQP4表达明显增强,提示AQP4与颅脑损伤的发生、发展过程密切相关,在损伤后脑水肿的形成过程中起重要作用。     

微创清除血肿治疗大鼠脑出血后脑水肿的实验研究

目的探讨大鼠急性脑出血超早期微创清除血肿治疗前后脑水肿的变化情况.方法90只成年雄性SD大鼠随机分为生理盐水组、脑出血组和微创组（出血后3 h）.以自体血注入大鼠尾状核方法建立脑出血模型,应用干-湿重法观察脑水肿变化,苏木精-伊红染色观察水肿细胞形态.每组每时相点（12 h,24 h,48h,72 h,7d）各6只大鼠.结果脑出血组和微创组脑含水量与生理盐水组在12 h,24h,48h比较P＜0.05.7 d时各组间无明显差异（P＞0.05）,微创组与脑出血组组间比较P＜0.05.结论脑出血后24～48h水肿达高峰;脑出血后早期（＜3 h）予以微创清除血肿术后水肿有明显减轻（P＜0.05）,为临床脑出血微侵袭治疗提供了理论依据.     

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.