乌司他丁治疗大鼠海水淹溺型急性肺损伤的实验观察

目的观察乌司他丁对海水淹溺型急性肺损伤(SW-ALI)的治疗作用,并探讨其作用机制。方法将30只健康雄性SD大鼠随机分为空白对照组、模型组和治疗组。气管内注入4 mL/kg人工海水建立SW-ALI动物模型。治疗组建模成功后腹腔注入乌司他丁10万U/kg,模型组相同条件下注入等体积生理盐水。于实验0、0.5、4 h检测各组大鼠PaO2。实验4 h处死大鼠,留取肺标本检测肺湿/干重比(W/D),检测支气管肺泡灌洗液(BALF)中TNF-α、IL-10、IL-1β、IL-6含量,检测肺组织匀浆中髓过氧化物酶(MPO)活性,观察肺组织病理学变化。结果海水淹溺后0.5 h大鼠PaO2明显下降,淹溺后4 h治疗组大鼠PaO2明显改善(P<0.05)。治疗组大鼠BALF中TNF-α、IL-1β、IL-6含量,肺组织MPO活性,肺W/D比值均高于空白对照组(均P<0.05),但较模型组明显降低(均P<0.05);治疗组BALF中IL-10含量明显高于模型组及空白对照组(均P<0.05)。治疗组大鼠肺泡壁完整性的破坏,以及肺间质水肿、出血、炎症细胞浸润的程度均较模型组明显改善。结论乌司他丁对SW-ALI有明确治疗作用,可通过抑...     

清热解毒药配伍桔梗汤对急性肺损伤模型大鼠TLR4 mRNA表达的影响

目的 观察清热解毒中药配伍桔梗汤对内毒素致急性肺损伤(ALI)模型大鼠肺Toll样受体4(TLR4) mRNA表达的影响,探讨桔梗汤的配伍增效机制.方法 雄性SD大鼠按随机数字表法分为生理盐水组、ALI模型组、清热解毒药组、清热解毒药加桔梗汤组.股静脉注射内毒素脂多糖制备ALI大鼠模型,检测各组大鼠血清肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)含量及肺组织髓过氧化物酶(MPO)活性、TLR4 mRNA的表达.结果 与生理盐水组相比,ALI模型大鼠血清TNF-α、IL-10含量明显升高(P<0.01或P<0.05),肺组织MPO活性、TLR4 mRNA表达明显增强(P<0.01或P<0.05).中药干预后大鼠血清TNF-α、IL-10含量及肺组织MPO活性、TLR4 mRNA表达均明显下降(P<0.01或P<0.05),且清热解毒药与桔梗汤配伍疗效优于单纯清热解毒药(P<0.05).结论 桔梗汤对清热解毒药降低血清TNF-α、IL-10含量、抑制MPO活性及TLR4 mRNA基因表达、发挥解毒抗炎功效,具有促进作用.     

地塞米松对兔海水淹溺型急性肺损伤肺组织NF-κB活性改变的影响

目的探讨海水淹溺型急性肺损伤时NF-κB活性及TNF-α、IL-1β、IL-10等细胞因子表达量的改变以及地塞米松对其可能的影响。方法42只新西兰兔随机分成对照组(n=18)、模型组(n=12)和地塞米松治疗组(n=12)。模型组经气管插管灌注2ml/kg海水造成海水淹溺型急性肺损伤,地塞米松治疗组在造模同时经颈总动脉插管给予地塞米松1mg/kg。观察各组动物血气分析的动态变化,计算肺湿干质量比(W/D)、肺通透指数(LPI)。以非放射性凝胶迁移实验分析肺组织NF-κB活性,ELISA法检测肺组织TNF-α、IL-1β、IL-10浓度。H-E染色进行病理学检查,并计算肺病理评分(LPS)。结果与对照组比,模型组兔肺大体标本淤血水肿严重,体积明显增大,显微镜下可见炎性细胞浸润等急性肺损伤病理学征象;氧合指数迅速低至300mmHg(1mmHg=0.133kPa)以下,持续时间长达6h;W/D于海水灌注后3h达高峰,肺通透指数及肺病理评分以海水灌注后6h数值最高;肺组织NF-κB活性及TNF-α、IL-1β、IL-10等细胞因子表达量明显增高(P0.05,P0.01)。地塞米松治疗组病理学改变比对照组重,但比模型组轻;W/D、肺通透指数及肺病理评分也都比模型组低;氧合指数在海水灌注后6h亦得到明显改善;NF-κB活性及TNF-α、IL-1β、IL-10浓度均显著低于模型组(P0.05,P0.01)。结论地塞米松可抑制海水淹溺型急性肺损伤时肺组织NF-κB活性及TNF-α、IL-1β、IL-10等细胞因子的表达,减轻肺组织的炎症反应和病理损害。     

创伤性脑水肿合并海水淹溺大鼠IL-1β和TNF-α表达的变化

目的:观察创伤性脑水肿合并海水淹溺后大鼠血清、脑组织、肺组织IL-1β和TNF-α含量的变化,探讨其变化规律及临床意义.方法:脑侧方液压打击伤加气管内灌注海水建立大鼠创伤性脑水肿合并海水淹溺模型.伤后1、6、12、24及48 h检测大鼠脑、肺组织含水量及脑、肺组织匀浆和血清中IL-1β、TNF-α的含量;观察伤后24 h脑、肺组织病理学变化.以颅脑创伤合并淡水淹溺、单纯颅脑创伤、单纯海水淹溺、假手术大鼠作为对照.结果:脑损伤合并海水淹溺后,大鼠脑组织含水量较单纯脑损伤、单纯海水淹溺以及脑损伤合并淡水淹溺均显著增高(P＜0.05);脑组织、肺组织IL-1β和TNF-α含量有显著变化.脑、肺组织病理学损伤明显.结论:海水的损伤性作用是重要致伤因素之一,炎症反应在创伤性脑水肿合并海水淹溺性肺水肿的病理生理过程中起了重要作用.     

大鼠输血相关性急性肺损伤后活化巨噬细胞表面TLR4及CD40的表达情况

目的:研究大鼠输血相关性急性肺损伤后活化巨噬细胞表面TLR4及CD40的表达情况。方法:选择SD大鼠作为实验动物,依次输注脂多糖和血浆,建立输血相关性急性肺损伤(TRALI)动物模型,取肺组织测定湿干比以及TLR4、NF-κB、CD40、TNF-α、IL-1β、MIP-2、GRP78的mRNA表达量,取血清检测TNF-α、IL-1β、MIP-2的含量,取外周血巨噬细胞检测TLR4、NF-κB、CD40的mRNA表达量。结果:TRALI组大鼠肺组织湿干比显著高于Sham组;TRALI组大鼠巨噬细胞中TLR4、NF-kB、CD40的mRNA表达量均显著高于Sham组;TRALI组大鼠肺组织中TLR4、NF-kB、CD40、TNF-α、IL-1β、MIP-2、GRP78的mRNA表达量均显著高于Sham组;TRALI组大鼠血清中、TNF-α、IL-1β、MIP-2的含量显著高于Sham组;TRALI组大鼠肺脏组织中SOD、GSH的含量低于Sham组,MDA、8-OhdG含量高于Sham组。结论:大鼠输血相关性急性肺损伤后活化巨噬细胞表面TLR4及CD40的表达量显著升高,进而会通过炎症反应、氧化应激反应、内质网应激等环节来造成肺损伤。     

己酮可可碱预处理对单纯性失血性休克致小鼠急性肺损伤的影响及其机制

目的观察给予己酮可可碱(PTX)预处理对失血性休克致急性肺损伤(ALI)小鼠的影响,初步探讨PTX的作用机制。方法小鼠分为对照组、失血性休克组及PTX组。通过肺组织HE染色观察病理改变,同时检测肺干湿比(W/D)和髓过氧化物酶(MPO)活性。通过ELISA方法检测肺组织肿瘤坏死因子α(TNF-α)和IL-1β变化,通过逆转录-聚合酶链反应(RT-PCR)检测肺组织Toll样受体4(TLR4)mRNA的表达,通过Western blot检测肺组织TLR4蛋白的变化。结果失血性休克诱导小鼠产生ALI,肺W/D和MPO活性明显增加,TNF-α、IL-1β、TLR4 mRNA和TLR4蛋白表达也增高,与对照组有显著性差异(P0.01)。PTX预处理能减轻失血性休克所致ALI,降低肺W/D和MPO活性,同时导致TNF-α、IL-1β、TLR4 mRNA和TLR4蛋白表达下降。结论 PTX预处理对失血性休克所致ALI起保护作用,可能与通过下调TLR4抑制促炎症因子表达有关。     

TNF-α和IL-8在幼兔机械通气肺损伤炎症反应中的作用

目的探讨肿瘤坏死因子-α(TNF-α)和白细胞介素-8(IL-8)在幼兔机械通气肺损伤炎症反应中的作用.方法 27只健康幼兔随机等分为对照组、小潮气量组和大潮气量组,建立给予不同潮气量机械通气的动物模型.用RT-PCR和ELISA法观察肺组织匀浆中细胞因子(TNF-α、IL-8)的mRNA表达和蛋白含量变化,同时测定髓过氧化物酶(MPO)含量和肺湿/干重(W/D)比值,并观察肺组织病理改变.结果大潮气量组机械通气后肺组织TNF-α和IL-8的蛋白含量和mRNA表达较小潮气量组和对照组明显增高(P<0.01);通气4 h后, TNF-α蛋白含量和mRNA表达达高峰;6 h明显降低,继TNF-α后,IL-8在通气6 h达高峰.大潮气量组机械通气后MPO含量和肺W/D比值较小潮气量组和对照组明显增高(P<0.01).光镜下,大潮气量组有明显肺组织损伤,小潮气量组则较轻,而对照组无明显损伤表现.结论 TNF-α和IL-8在幼兔机械通气肺损伤炎症反应中可能发挥重要作用.     

乌司他丁对急性坏死性胰腺炎大鼠肺组织Toll样受体4表达的影响

目的 研究乌司他丁对急性坏死性胰腺炎肺组织Toll-样受体4(TLR4)表达的影响及其意义.方法 56只SD大鼠经逆行胰胆管注射5%牛磺胆酸钠(TAC)制作大鼠急性坏死性胰腺炎肺损伤动物模型,大鼠分为对照组(n=8)、急性坏死性胰腺炎组(n=24)和治疗组(n=24).对照组和急性坏死性胰腺炎组给予尾静脉注射生理盐水,治疗组给予尾静脉注射乌司他丁.分别测定各组血清淀粉酶和肺组织髓过氧化物酶(MPO)活性,计算肺组织学评分和肺损伤指数以评价肺损伤程度,荧光实时定量逆转录-聚合酶链反应(RT-PCR)检测各组不同时间点肺组织TLR4 mRNA表达.结果 与对照组比较,急性坏死性胰腺炎组大鼠各时点肺组织TLR4 mRNA表达明显增高(均P＜0.01),并在12 h达到峰值,同时肺组织MPO活性增高,肺损伤加重(P＜0.05或P<0.01).与急性坏死性胰腺炎组相比,治疗组肺组织TLR4 mRNA表达明显降低,肺损伤减轻,MPO活性降低(均P＜0.05).结论 急性坏死性胰腺炎时,肺组织内TLR4 mRNA表达明显上调,肺部炎症反应及肺损伤加重;乌司他丁可以降低急性坏死性胰腺炎大鼠肺组织TLR4 mRNA表达,减轻肺部炎症和肺损伤.     

溺水脑损伤大鼠脑组织低氧诱导因子及血管内皮生长因子表达的变化

目的:观察淡水淹溺大鼠脑组织形态及病理学改变,检测脑内低氧诱导因子(HIF-1α)和血管内皮生长因子(VEGF)表达的变化,探讨淹溺治疗的新途径.方法:制备淡水淹溺大鼠模型,随机分为淹溺致死组、淹溺2 min后存活3、6、12、24、40 h组,分别于溺水2 min后相应时间点处死大鼠,另设正常对照组(n=10).测定各组大鼠脑指数;观察脑组织病理改变;免疫组化法检测脑组织HIF-1α、VEGF的表达,并分析二者相关性.观察淹溺2 min后存活大鼠不同时间点(10、30 min,1、3、6、12、24、40 h)血氧饱和度的动态变化.结果:淹溺致死组、溺水后存活24、40 h组脑指数明显高于正常对照组;溺水后存活3、12 h组明显低于淹溺致死组,但高于正常对照组(P＜0.05).淹溺后即刻血氧饱和度为(59±5)%,以后逐渐上升,到12 h已基本恢复正常.脑水肿于淹溺后3 h出现,12～24 h逐渐加重,24 h最重,40 h水肿较前略有减轻.正常对照组脑组织无HIF-1α表达,淹溺致死组表达较低,随淹溺时间的延长HIF-1α表达逐渐上升,至淹溺后12 h达高峰(P＜0.05);VEGF表达结果类似.HIF-1α与VEGF表达呈正相关(r=0.629,P＜0.05).结论:淡水淹溺易导致严重脑损伤,机体可能通过促进HIF-1α合成进而上调VEGF表达来发挥脑保护作用.     

淡水接近淹溺肺损伤的病理生理研究

用 Carlen 管隔开左右肺,仅向右肺灌入淡水(25 ml/kg),观察淹溺后导致直接(右肺)和间接(左肺)肺损伤的病理变化,探讨 TNF,TXB_2,ACE 等介质在淹溺后肺损伤的作用。结果表明,淡水淹溺的直接和间接作用都可以引起肺损害。淹溺后,肺细胞表现为进行性损伤;1型肺上皮细胞出现损伤变化较Ⅱ型肺上皮细胞早;血气屏障破坏是喷射性肺水肿的病理学基础;TXB_2和 ACE 都参与于淹溺后肺损伤作用,但它们不是淹溺后肺损伤的标志;TNF 不是淹溺后肺损伤的重要介质,但可能参与淹溺后期的肿损伤作用。     

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.