心肌连接蛋白Cx43在冠心病心肌梗死病例中的表达

目的:观察冠心病猝死伴心肌梗死时缝隙连接蛋白43(connexin 43,Cx43)的分布特征,探讨Cx43在冠心病伴心肌梗死的变化规律及其诊断意义。方法:运用免疫组化和图象分析技术,观察实验组冠心病猝死伴心肌梗死者心室肌梗死区、梗死区边缘和非梗死区Cx43分布情况。结果:冠心病猝死伴心肌梗死患者中不同心肌部位的缝隙连接蛋白Cx43阳性表达差异性较大,部分梗死中心区Cx43已完全消失,而部分梗死中心区Cx43有极少部分蛋白发生了重新分布;在梗死边缘带绝大部分Cx43已消失,只有极少数Cx43分布于心肌细胞侧-侧相接处;在非梗死处心肌基本正常,但细胞闰盘的Cx43阳性严重崩解破坏,而重新分布于细胞侧-侧相接处。结论:冠心病猝死伴心肌梗死时心肌梗死病灶及其邻近区域Cx43的数量及分布的高度不均一性是发生猝死性心律失常的结构基础,同时表明在诊断冠心病猝死伴心肌梗死时,脱磷酸化Cx43具有非常重要的诊断价值。     

兔早期心肌缺血不同时段Connexin43的表达

目的 探讨急性心肌缺血不同时间心肌缝隙连接蛋白43的分布特征。方法 结扎兔左冠状动脉造成急性心肌缺血模型,于结扎后不同时间取左心室前壁心肌。用HBFP染色定位心肌缺血区域,用SP法观察心肌缺血区、交界区及非缺血区Cx43的分布,用图像分析系统分析。结果 急性心肌缺血30 min,Cx43阳性面积减少约40％,此后Cx43逐渐降低,大约480 min,Cx43几乎消失。结论 兔急性心肌缺血时,Cx43的减少有时间特点。     

连接蛋白43在急性心肌缺血时不均一降解的实验研究

目的探讨急性心肌缺血时心肌细胞连接蛋白43(Cx43)含量和分布模式的改变.方法20只犬随机分为4组,通过结扎冠状动脉造成分别为0、1、3、6 h的急性心肌缺血,应用激光共聚焦显微镜技术和双重标记的荧光免疫组织化学方法对缺血心肌Cx43含量和分布的改变进行定量研究.结果①对照组Cx43象素密度2.25±0.12;1 h缺血组Cx43象素密度1.75±0.15,较对照组减少了22.2%;3 h缺血组1.35±0.21,减少了40.0%;6 h缺血组1.04±0.14,减少了53.8%,各组间差异有统计学意义;②对照组心肌细胞端对端连接处Cx43含量约为侧对侧连接处的1.36倍,缺血6h后,侧对侧连接处Cx43含量反而为端对端连接处的1.6倍;③对照组各层心肌细胞Cx43含量差异无统计学意义,缺血后中间层心肌Cx43含量较其他层心肌Cx43含量下降更明显,差异有统计学意义.结论急性短时间心肌缺血时Cx43已开始大量降解,分布也发生明显的改变,各层心肌Cx43降解程度明显不同.     

替米沙坦对急性心肌梗死大鼠心肌缝隙连接蛋白43的影响

目的：观察替米沙坦对大鼠急性心肌梗死心肌缝隙连接蛋白43（CX43）的影响，探讨其防治急性心肌梗死时心律失常的可能机制。方法：将27只大鼠随机分为三组（每组9只）：假手术组、急性心肌梗死组（模型组）、替米沙坦＋急性心肌梗死组（替米沙坦组）。采用免疫细胞化学法显示急性心肌梗死区、边缘带及非缺血区CX43表达的分布；半定量分析不同部位CX43的分布密度。结果：模型组、替米沙坦组CX43排列紊乱，CX43表达的平均光密度值、阳性表达面积和积分光密度较假手术组显著降低。替米沙坦组平均光密度值和积分光密度均显著高于模型组。结论：急性心肌梗死时心室肌CX43的数量和分布呈现高度不均一性。替米沙坦能有效减轻急性心肌梗死所致CX43的重构，增加正常大鼠的心室肌CX43的含量。     

初探奥美沙坦减少大鼠心肌梗死后室性心律失常的机制

目的评估血管紧张素受体拮抗剂奥美沙坦对心肌梗死后大鼠室性心律失常发生发展及对心肌梗死区连接蛋白43的表达变化的影响。方法 60只大鼠分为假手术组(Sham组)20只,急性心肌梗死模型组(MI组)20只和急性心肌梗死+奥美沙坦组(OM组)20只。超声心动图评价大鼠心脏功能,应用程序性电刺激检测大鼠室性心律失常发生情况,并测定各组大鼠心肌梗死边缘区和非梗死区连接蛋白43的m RNA及蛋白表达。结果与MI组相比,奥美沙坦可以改善心功能(t=1.85,P0.01),减少心梗后室性心律失常的发生率(t=1.59,P0.05);OM组心肌梗死边缘区和非梗死区连接蛋白43的m RNA表达量高于MI组(t=1.48,1.52,P0.05),而其蛋白的表达量也在梗死边缘区高于MI组(t=1.45,P0.05)。结论奥美沙坦可以改善心肌梗死后大鼠心功能,减少室性心律失常的发生率,这些可能都与奥美沙坦上调梗死边缘区和非梗死区连接蛋白43的表达有关。     

美托洛尔对大鼠心肌梗死周边区缝隙连接蛋白43的影响

目的:探讨美托洛尔对大鼠心肌梗死(心梗)后梗死周边区缝隙连接蛋白43(Cx43)的影响。方法:80只大鼠随机分为假手术组(20只)、心梗组(30只)和美托洛尔组(30只),用结扎冠状动脉左前降支的方法制备心梗模型,美托洛尔组给予美托洛尔5mg/(kg.d)灌胃,心梗组给予安慰剂。手术8周后,测量梗死周边区心室颤动阈值(室颤阈值)。用蛋白印记分析和RT-PCR分别观察心梗后梗死周边区缝隙连接蛋白43(Cx43)磷酸化的蛋白质及总量表达和mRNA表达的变化;免疫荧光法观察梗死周边区Cx43的分布。结果:8周后,美托洛尔组室颤阈值高于心梗组[(11.0±2.65)V比(7.1±4.1)V,P<0.05],美托洛尔组Cx43磷酸化的蛋白质及总量均显著高于心梗组,Cx43mRNA的表达也明显高于心梗组。Cx43的密度和分布均显著高于心梗组。结论:美托洛尔能显著改善梗死周边区缝隙连接重构,这可能是美托洛尔能够抑制心梗后室性心律失常的一个机制。     

人心脏间隙连接蛋白43的时空表达

目的探讨人心脏间隙连接蛋白43(Cx43)的时空表达规律。方法应用SP免疫组化和图像分析方法,检测胎儿、新生儿和成人心肌Cx43蛋白表达和含量变化。结果(1)胎儿和新生儿Cx43呈斑点状遍布于整个心肌的细胞质内和细胞膜表面,少数位于闰盘处;(2)成人Cx43在心房肌细胞非均质分布于细胞侧面连接处和端闰盘处;心室肌典型地排列在闰盘处;(3)Cx43分布密度随年龄增长而降低,且具有腔室差异,胎儿和新生儿心房<心室,成人心房>心室。结论随着年龄的增长Cx43从细胞侧表面向端-端闰盘处转移。这种位置移动是心脏机械收缩和电传导的生理性调整。     

超声彩色室壁动力学对梗死区存活心肌诊断的研究

目的：建立早期诊断梗死区存活心肌的方法。方法：应用超声彩色室壁动力学（CK）分析技术，根据超声CK图像的变化诊断梗死区存活心肌。结果：68例健康人超声CK图像由“红－黄－绿－蓝”色组成，色彩分布均匀，心内膜彩色移位（SEM）值为5．03－11．45mm。76例心肌梗死区SEM值明显降低，超声CK图像“绿－蓝”色可分完全消失和不完全消失。结论：心肌梗死区CK图像“绿－蓝”色不完全消失，表示有存活的心肌组织，这对防止梗死区心室扩展、变薄,形成室壁瘤，及预防心功能减退等具有重要的临床意义。     

脑利钠肽对兔心肌梗死后缝隙连接蛋白重构及炎症因子的影响

目的探讨脑利钠肽对兔急性心肌梗死后梗死周边区缝隙连接蛋白43（Cx43）及炎症因子的影响。方法通过结扎冠状动脉前降支的方法制备兔心肌梗死模型,随机分为假手术组（Sham组）,心肌梗死组（MI组）,心肌梗死后人重组脑利钠肽（recombinan human brain natriuretic peptide）干预组（rh BNP组）。rh BNP组自术后即刻给予rh BNP 0.01μg/kg/min持续静脉泵入24 h;MI组、Sham组给予同等剂量的生理盐水静脉泵入。术后8周行电生理实验,并通过RT-PCR方法检测IL-1β、TNF-αmRNA的表达水平;用免疫荧光结合激光共聚显微镜技术检测Cx43的分布及表达。结果 MI组心肌细胞有效不应期（ERP）明显延长,且室性心律失常诱发率明显高于Sham组;脑利钠肽干预后室性心律失常诱发率降低。MI组梗死灶周IL-1βmRNA、TNF-αmRNA水平均较Sham组相应部位均明显增高（P〈0.01）,rh BNP组较MI组IL-1βmRNA、TNF-αmRNA水平减低（P〈0.05）。Sham组的Cx43荧光斑分布较均匀,MI组Cx43的数量较Sham组明显减少,且分布紊乱,rh BNP组较MI组梗死灶周Cx43数量增加,不均一分布的程度减轻。结论脑利钠肽可能对心梗后心肌的急性炎症过程产生影响,部分逆转缺血对缝隙连接的损伤作用,抑制心肌梗死后室性心律失常的发生。     

猪缺血再灌注损伤与心肌细胞凋亡的实验研究

目的探讨猪心肌梗死不同区域细胞凋亡的分布。方法滇南小耳猪10只,随机分为两组,每组5只。(1)假手术组(S组),在X线的监控下,经右股动脉置入冠状动脉球囊导管至左前降支,不行冠脉封堵心肌缺血;(2)缺血再灌注组(I/R组),冠脉球囊扩张阻断冠脉血流60min致心肌缺血,撤除球囊恢复冠脉灌注。再灌注72h,行猪心肌末端标记法(TUNEL法)检测凋亡细胞及免疫组化法检测Bcl-2和Bax的蛋白表达。结果再灌注后72h,S组未发生心肌梗死及心肌细胞凋亡,I/R组在心肌梗死区、边缘区、非梗死区的心肌组织均存在细胞凋亡现象,梗死区和边缘区的心肌细胞凋亡指数(AI)明显高于非梗死区,且相应区域的Bax蛋白表达及Bax/Bcl-2比值均较非梗死区增加(P<0.05)。结论猪心肌缺血再灌注损伤后心肌梗死区、梗死边缘区、非梗死区均存在心肌细胞凋亡现象,细胞凋亡主要分布在梗死区和边缘区。     

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.