大鼠实验性高原肺水肿中T-AOC、MDA、SOD、CAT和IL-6的表达

目的 观察氧化应激反应在急性缺氧致大鼠高原肺水肿发生中的变化,并探讨其病理生理学意义.方法 成年雄性SD大鼠72只,体质量(200±20)g,按随机数字表法分为平原对照?组、模拟急性高原缺氧(H)6、12、24、48和72 h组(n=12).H组动物置于减压舱内模拟海拔6000m高原暴露相应时间;分别在平原和模拟高原环境取材,检测肺组织湿干质量比值、总抗氧化能力(total-antioxidant capacity,T-AOC)、丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、过氧化氢酶(catalase,CAT)、血浆及肺组织IL-6.结果 与平原对照组比较:缺氧各组大鼠肺组织湿干质量比值均显著增加(P ＜0.05,P＜0.01);MDA随缺氧时间延长逐渐增加,缺氧72 h达到最高(P＜0.01);SOD在缺氧12、24 h显著降低(P＜0.05),在缺氧48、72 h进一步降低(P＜0.01);T-AOC、CAT随缺氧时间延长在24、48、72 h显著降低(P＜0.05);血浆IL-6在缺氧24、48、72 h组显著增加(P＜0.01),肺组织IL-6在缺氧48(P＜0.01)、72 h (P＜0.05)组显著增加.结论 急性缺氧诱导大鼠高原肺水肿的发生和氧化应激有关,机体抗氧化能力降低、自由基增加是HAPE发生的重要机制.     

大白鼠实验性高原肺水肿

正常成年大白鼠在环境温度为5℃左右,经受摸拟5000米高原,72小时后观察到轻度的间质性肺水肿。切除左肺的大白鼠,在摸拟5000米高原,48小时后出现明显的间质性肺水肿。其中部分动物的单个肺泡或局灶肺泡中出现水肿液。 根据组织学检查,在本实验条件下,以间质性肺水肿为主,水肿液漏出部位在肺泡壁毛细血管水平,而后液体聚积在肺泡壁外的血管周围而形成血管周围“袖套”,血管周围水肿可扩展到支气管周围,并形成支气管周围水忡“袖套”。 切除左肺动物比非手术动物表现显著的间质性肺水肿,似可支持在局限性水肿区域肺动脉高压和过度灌流是发生高原肺水肿的主要机制。     

高原肺水肿动物模型的初步建立

目的：通过模拟高原低压低氧环境,建立高原肺水肿大鼠动物模型,探讨低氧时间对大鼠肺水肿程度影响。方法：雄性Wistar大鼠随机分为3组,分别为对照组、24 h低氧组、48 h低氧组。比较大鼠肺湿干比、肺组织匀浆中一氧化氮合酶（NOS）、内皮素-1（ET-1）及肺组织病理形态学的变化。结果：与地面对照组比较,24 h低氧组与48 h低氧组大鼠肺湿干比及肺组织匀浆内ET-1升高、NOS降低,差异均有统计学意义（均P〈0.05）;病理学显示,24 h低氧组与48 h低氧组均有肺泡间隔增宽、间质充血等间质性肺水肿表现,与24 h低氧组相比,48 h低氧组肺湿干比、ET-1升高,肺组织匀浆内NOS降低,差异有统计学意义（P〈0.05）。结论：低压低氧可以有效诱导大鼠产生间质性肺水肿,且48 h低氧大鼠肺水肿程度较24 h低氧更严重,更适合应于现实研究。     

缺氧复合运动大鼠心肌线粒体功能的变化

目的 观察缺氧及缺氧复合运动条件下大鼠心肌线粒体功能的变化.方法 将Wistar大鼠分为4组:平原对照组、缺氧组、平原运动组和缺氧复合运动组.缺氧复合运动组大鼠持续暴露于模拟海拔5 000 m高原5周,每天降至4 000 m 的高原进行游泳运动1 h(6 d/周),运动结束后回升至5 000 m;缺氧组大鼠同时在低压舱内相同海拔高度饲养,但不进行游泳运动;平原运动组和平原对照组在舱外同时饲养,其中平原运动组每天进行游泳运动1 h(6 d/周).在末次运动结束后24 h处死大鼠,分离心室肌提取线粒体.用clark氧电极法测定线粒体呼吸功能.结果 与单纯缺氧组比较,缺氧复合运动后心肌线粒体ST3、ST4显著增加,呼吸控制率降低;各组线粒体膜电位无显著改变;与平原对照组比较缺氧组大鼠心肌线粒体ATP合成酶α亚基表达显著下降;与单纯缺氧组比较,缺氧复合运动组线粒体ATP合成酶α亚基表达显著增加.结论 结果表明缺氧复合运动可改善心肌线粒体3态呼吸,ATP合成酶α亚基表达增加.提示缺氧复合运动后心肌ATP产生效率增加,有氧氧化代谢增强.     

急性低压缺氧对大鼠肺泡超微结构的影响

本实验应用电镜和硝酸镧示踪电镜技术，对模拟６０００ｍ高原缺氧４８ｈ大鼠肺泡超微结构进行了观察。结果表明，急性低压缺氧可引直肺泡超微结构的明显改变。其主要改变如下：（１）肺泡上皮和肺泡隔内有许多镧颗粒：（２）Ⅱ型肺泡细胞损伤：（３）肺泡隔内毛细血管床的改变。这些改变可能与高原肺水肿的发生密切相关。     

骨髓间充质干细胞移植对大鼠急性肺水肿病理学影响

目的:探讨骨髓间充质干细胞移植对SD大鼠急性肺水肿模型的病理学影响。方法:将80只大鼠随机分为肺水肿组、干细胞治疗组、干细胞预防组、空白对照组、干细胞对照组5组,每组16只。对SD大鼠腹腔注射6%NH4Cl建立急性肺水肿模型,预防组、治疗组分别于肺水肿模型建立前后30min移植干细胞,移植后不同时间(30min,2h,1d,7d)活杀SD大鼠取肺脏,固定后用常规光镜及扫描电镜观察大鼠肺脏病理学变化。结果:肺水肿模型大鼠30min肺泡结构基本正常,2h时肺泡腔内可见大量渗出物,肺泡壁毛细血管明显充血。7d时部分肺泡壁增厚。干细胞治疗组大鼠30min肺组织结构基本正常,2h时部分区域肺泡腔内可见少许渗出物。7d时肺组织结构基本正常。干细胞预防性移植大鼠的肺组织在30min,2h,1d,7d病理学改变基本同肺水肿模型大鼠。结论:腹腔注射氯化铵可建立急性肺水肿模型,骨髓间充质干细胞治疗性移植可减轻急性肺水肿病理学改变,而骨髓间充质干细胞预防性移植不能减轻急性肺水肿病理学改变。     

急性高原缺氧大鼠肺组织损伤及其机制研究

【目的】通过建立低压缺氧模型,模拟急性高原缺氧损伤,观察不同缺氧时间点大鼠肺组织损伤情况。【方法】选取清洁级雌性SD大鼠60只,随机分为正常对照组、缺氧6、12及24 h组。利用数控低压缺氧舱,建立急性高原缺氧损伤模型,通过HE染色观察大鼠肺组织形态学改变,利用干湿比重法检测肺组织含水量,采用生化手段检测血清乳酸脱氢酶(lactatedehydrogenase,LDH)及过氧化氢酶(catalase,CAT)活性,应用Western blotting技术检测肺组织水通道蛋白(aquaporin,AQP)1/4的表达情况。【结果】HE染色:正常对照组可见多边形或圆形薄壁囊泡,边界清楚,肺泡上皮细胞间为薄壁肺泡隔,隔内可见毛细血管断面,各低压缺氧组肺泡上皮细胞明显肿大,肺泡壁增厚,肺间隔内毛细血管扩张;与正常对照组相比,各缺氧组大鼠肺含水量显著升高(P<0.01),且随缺氧时间的延长而逐渐增高;与正常对照组相比,各缺氧组大鼠血清LDH活性显著升高(P<0.01),CAT活性显著下降(P<0.05或P<0.01);与正常对照组相比,各缺氧组大鼠肺组织中AQP1/4蛋白表达量均明显升高(P<0.01),且随缺氧时间的延长而逐渐增高。【结论】急性高原缺氧可造成实验大鼠肺水肿,且损伤程度与缺氧时间密切相关,其机制可能为上调水通道蛋白(AQP)1/4的表达所致。     

初发性复发性高原肺水肿血浆VEGF变化的研究

高原肺水肿(HAPE)是快速进入高原后,由于缺氧引起的以肺间质或/和肺泡内液体聚集过多的急性重症高原病.其发病机制尚不完全清楚,主要有缺氧性肺动脉高压,钠水潴留、肺毛细血管栓塞及其应激衰竭[1]等.血管内皮生长因子(vascular endothelial growth factor,VEGF)能增加微血管的通透性,使血管内皮细胞分裂与增殖,促进血管再生,在许多疾病的病理生理过程中发挥特殊作用[2].为此对HAPE的VEGF进行了测定,分析如下.     

高原肺水肿的发病机制——炎症并非致病因素

一般认为高原肺水肿（high-altitude pulmonary edema,HAPE)的发生为肺泡-毛细血管屏障通透性改变所致。后者继发于强烈的肺血管收缩和高毛细血管压，但是既往在明确诊断的HAPE，支气管肺泡灌洗（bronchoalveolar lavage,BAL)所见亦与炎性致病特征相一致。目的：确定炎症是否为HAPE的主要病变。并明确HEPA病变的时间顺序。     

急性肺水肿的临床诊断

肺水肿是肺脏血管外液体增多的病理状态,是一动态的病理生理过程.过多的液体来自肺血管,积聚于肺间质和肺泡腔内.分别为间质性肺水肿和肺泡性肺水肿.肺水肿不是一个独立的疾病,它是许多疾病引起的一个综合征.按基本病因分为心源性肺水肿和非心源性肺水肿.急性肺水肿的主要病理改变是肺泡实变.     

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.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.