脾肾合剂联合格拉司琼对化疗呕吐

通过脾肾合剂联合格拉司琼对化疗呕吐神经递质改变的影响，来探讨其防治化疗引起恶心呕吐（CINV）的作用机制。采用SD大鼠尾静脉注射川页铂制作动物模型，随机分为正常对照组（Ⅰ组），病理模型组（Ⅱ组），阳性对照组（Ⅲ组），中西医结合组（Ⅳ组）。各组给药7d，通过对SD大鼠脑干5-HT及DA水平检测，脾肾合剂加盐酸格拉司琼，能够降低脑干中5-HT及DA水平。说明肾脾合剂联合格拉司琼可以更好地防治化疗引起CINV的作用。     

急性心肌缺血模型大鼠内关、心俞穴穴区肥大细胞的分布及特征*

目的 观察急性心肌缺血模型大鼠不同穴区肥大细胞（MC）活化情况。方法 健康SD雄性大鼠12只,随机分为对照组、模型组各6只。皮下多点位注射盐酸异丙肾上腺素（ISO）制备大鼠急性心肌缺血模型,氯化三苯基四氮唑（TTC）染色法测定心肌缺血面积验证造模成功与否,甲苯胺蓝染色法检测左侧心俞穴、左侧内关穴穴区MC分布及活化情况。结果 ①模型组心肌缺血面积明显大于对照组（P<0.05）;②与对照组相比,模型组左侧心俞穴MC数目和MC脱颗粒率显著增大（P<0.05）;左侧内关穴MC脱颗粒率升高显著（P<0.05）,MC数目没有显著差异;③对照组左侧内关穴MC数目大于左侧心俞穴MC数目（P<0.05）,模型组左侧内关穴与心俞穴MC数目没有明显差异。结论 急性心肌缺血可引起心俞穴和内关穴穴位敏化,穴区呈现MC募集和脱颗粒活化表达;正常状态下不同部位穴位MC含量不同,推测四肢部位腧穴MC含量高于背部腧穴。     

“化湿和胃饮”联合盐酸阿扎司琼治疗恶性肿瘤化疗性恶心呕吐疗效研究

目的 研究基于“脾阴理论”应用“化湿和胃饮”联合盐酸阿扎司琼治疗恶性肿瘤化疗性恶心呕吐(CINV)患者临床疗效。方法 将我院肿瘤科CINV患者100例随机分为联合组(采用化湿和胃饮联合盐酸阿扎司琼治疗)与对照组(采用盐酸阿扎司琼治疗)各50例。比较两组恶心呕吐症状分级、恶心呕吐生活功能量表(FLIE)、Karnofsky功能状态(KPS)评分,血清5-羟色胺(5-HT)、多巴胺(DA)含量,不良反应发生率。结果 治疗后,联合组恶心、呕吐症状严重程度低于对照组(P<0.05);两组患者FLIE评分明显降低,KPS评分明显升高,联合组FLIE评分明显低于对照组,KPS评分明显高于对照组(P<0.05);两组患者5-HT、DA含量明显降低,联合组5-HT、DA含量低于对照组(P<0.05);两组患者不良反应发生率对比,无统计学差异(P>0.05)。结论 基于“脾阴理论”应用“化湿和胃饮”联合盐酸阿扎司琼对治疗恶性肿瘤化疗性恶心呕吐患者,能有效改善症状,降低血清5-HT、DA含量,改善功能状态,且并未增加不良反应。     

腹腔镜下肾上腺神经母细胞瘤摘除术6例

背景与目的：证据表明肠易激综合征（IBS）餐后去血小板血浆的5-羟色胺（5-HT）浓度可能异常。然而，这些资料的解释由于研究方法论变化和先前研究数目较少而受到质疑。因此该研究目的是测量一大组腹泻型IBS和便秘型IBS患的去血小板血浆5-HT浓度及其代谢产物5-羟吲哚乙酸（5-HIAA）在空腹和进食状态下的水平，并与对照组相比较。并同时评定血浆5-HIAA与5-HT的比值和血小板贮存。方法：29例便秘型IBS患（年龄19—53岁），55例腹泻型IBS患（年龄19—52岁）和35例健康志愿（年龄18-46岁），标准餐前和餐后利用反相高效液相色谱法测量去血小板血浆中5-HT或5-HIAA浓度。结果：腹泻型IBS患空腹和进食状态去血小板血浆中5-HT水平升高（P〈0．05）。然而餐后相对于空腹时的浓度与对照组相似。相反，便秘型IBS患与对照组相比未表现出进餐增高的去血小板血浆5-HT水平（P〈0．01）。     

嗜酸细胞性胃肠炎小鼠胃黏膜肥大细胞数量和脱颗粒变化

目的：探讨嗜酸细胞性胃肠炎（eosinophilic gastroenteritis,EG）小鼠胃黏膜肥大细胞（mast cell,MC）数量、脱颗粒变化及其意义。方法：选用卵清蛋白（ovalbumin,OVA）诱导的Balb/c小鼠制备EG模型12只为OVA?EG组,同时选用同龄SPF级Balb/c小鼠12只作为正常对照组。两组均计算胃黏膜嗜酸性粒细胞（eosinophil,EOS）、MC数量,qPCR检测胃黏膜白细胞介素（interleukin,IL）?5 mRNA表达,电镜观察胃黏膜MC脱颗粒变化。结果：OVA?EG组小鼠胃黏膜组织中EOS数量、MC数量及IL?5 mRNA表达高于正常对照组（P < 0.05）,电镜观察OVA?EG组小鼠胃黏膜MC有脱颗粒改变。结论：OVA?EG组小鼠胃黏膜组织MC数量增加,分泌IL?5增多,并出现MC脱颗粒改变,提示胃黏膜MC数量和部分功能变化可能与EG有关。     

腹腔镜胆囊切除术后恶心呕吐反应相关因素分析及昂丹司琼治疗效果观察

目的探讨腹腔镜胆囊切除术（LC）后恶心呕吐反应的相关因素并对昂丹司琼预防恶心呕吐疗效进行观察。方法将76例行LC治疗的患者随机分为治疗组与对照组,治疗组在LC术后静脉注射4mg昂丹司琼．观察患者术后恶心呕吐（PONV）的发生率、体重指数（BMI）、气腹压力、手术时间、芬太尼用量、麻醉复苏时间、术后VAS评分、肌松剂用量、住院天数以及血清5-羟色胺（5-HT）浓度等,并针对PONV发生率进行Logistic回归分析。结果PONV发生率与BMI、芬太尼用量、麻醉恢复时间以及血清5-HT水平显著相关,差异有统计学意义（P〈0．05）;患者LC术后5-HT水平显著升高（P〈0．05）,术后应用昂丹司琼可明显抑制5-HT水平升高与PONV发生率。结论PONV与BMI、芬太尼用量、麻醉恢复时间以及血清5-HT水平相关,昂丹司琼可有效抑制血清5-HT水平升高并降低PONV发生率。     

痛泻要方干预大鼠肠易激综合征肝郁脾虚证的作用及机制

目的探讨痛泻要方对肝郁脾虚型肠易激综合征大鼠内脏敏感性的干预作用。方法采用番泻叶加束缚应激刺激制备肝郁脾虚型肠易激综合征动物模型。予痛泻要方灌胃治疗（西药匹维溴铵对照）。观察大鼠结肠黏膜肥大细胞数目及脱颗粒情况;检测血标本中5-羟色胺（5-HT）、P物质（SP）、降钙素基因相关肽（CGRP）的含量。结果模型对照组大鼠结肠黏膜肥大细胞数目及脱颗粒显著增加;西药组和中药组大鼠5-HT、SP含量显著下降,CGRP含量显著增加,差异均有高度统计学意义（均P〈0.01）,且有一定的量效关系。结论痛泻要方可能通过减少肥大细胞脱颗粒,降低模型大鼠血清5-HT、血浆SP含量,增加血浆CGRP含量,从而改善胃肠动力并降低内脏敏感性,发挥治疗肠易激综合征的效应。     

功能性消化不良患者精神心理因素与十二指肠肥大细胞的相关性

目的探讨精神心理因素和十二指肠黏膜肥大细胞(mast cell,MC)在功能性消化不良(functional dyspepsia,FD)中的作用。方法应用医院焦虑抑郁量表(hospital anxiety and depression scale,HADS)评定焦虑(HADS-A)和抑郁积分(HADS-D),甲苯胺蓝染色计数十二指肠黏膜MC总数及脱颗粒比率。直线相关分析HADS-A、HADS-D与十二指肠黏膜MC的相关性。结果 FD患者HADS-A和HADS-D显著高于对照组(P<0.05),十二指肠黏膜MC显著高于对照组(P<0.01),MC脱颗粒比率显著高于对照组(P<0.001)。HADS-A、HADS-D与十二指肠MC计数、脱颗粒比率呈正相关(P<0.05)。结论 FD患者的精神心理异常,可能与十二指肠黏膜MC的数目及脱颗粒比率增高有关。     

静脉注射昂丹司琼对腰硬联合麻醉后不良反应的影响

目的：本研究旨在调查静脉注射5－羟色胺受体拮抗剂昂丹司琼对椎管内麻醉诱发低血压、心动过缓、寒颤影响。方法：210位接受腰硬联合麻醉患者随机分为对照组（C组）、低剂量昂丹司琼组（A组）、高剂量昂丹司琼组（B组），在麻醉前5分钟C组给予生理盐水，A组给予6mg昂丹司琼，B组给予12mg昂丹司琼。记录患者麻醉前后平均动脉压（ MAP）、心率（ HR）、寒颤。结果：各组一般情况比较无显著差别，C组麻醉后低血压、心动过缓和寒颤发生率显著高于A组和B组，A组与B组之间无显著差异。结论：昂丹司琼可以显著减少腰硬联合麻醉诱发的低血压、心动过缓、寒颤，6 mg与12 mg昂丹司琼在此方面效果无显著差异。     

鞘内注射昂丹司琼对慢性脊神经炎性痛大鼠的影响

目的探讨鞘内给予5-HT3受体阻滞剂昂丹司琼对慢性脊神经炎性痛大鼠行为学及脊髓背角c-Fos蛋白表达的影响。方法成年雄性SD大鼠48只随机均分为6组（n=8）：空白组（A组）、模型组（B组）、生理盐水组（C组）和昂丹司琼10μg/kg组（D1组）、25μg/kg组（D2组）、50μg/kg组（D3组）。制作大鼠脊神经炎性痛模型后14 d行鞘内注射,并测定大鼠机械缩足反射阈值和热缩足反射潜伏期的变化情况;应用免疫组化技术观察大鼠脊髓c-Fos表达变化情况。结果与B组相比,D2组机械缩足反射阈值、热缩足反射潜伏期明显增高、脊髓背角中c-Fos蛋白表达显著减少（P〈0.01）,D1组与B组比较,无明显变化（P〉0.05）;D2与D3组间差异无统计学意义（P〉0.05）。结论鞘内给予昂丹司琼25μg/kg可以减轻大鼠慢性脊神经炎性痛导致的痛觉过敏。     

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.     

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.     

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.