丙泊酚对大鼠局灶性脑缺血再灌注后AQP-4mRNA表达的影响

目的探讨丙泊酚对大鼠局灶性脑缺血再灌注后AQP-4mRNA表达的影响。方法健康雄性SD大鼠192只,按随机数字表法分成丙泊酚组(n=64),生理盐水组(NS)(n=64),假手术组(n=64)。采用线栓法制备大鼠局灶性脑缺血再灌注模型,NS、丙泊酚组在阻断大脑中动脉lh后行再灌注,丙泊酚组在缺血前10min腹腔注射丙泊酚10mg/100g,NS组给予等量生理盐水,假手术组只作切口。各组分别在再灌注后3h、1d、3d、7d做神经功能测定,其后将大鼠断头处死,测量脑水含量,用RT-PCR法测定AQP-4mRNA表达水平。结果①与假手术组比较,丙泊酚组术后3h、1d、3d、7d神经功能评分均高于假手术组(P<0.05),与NS组比较,丙泊酚组术后各时间点神经功能评分均低于NS组(P<0.05)。②术后各时间点丙泊酚组与假手术组比较,脑含水量显著增加(P<0.05);与NS组比较,脑含水量显著减少(P<0.05)。与假手术组比较,NS组脑含水量也显著增加(P<0.05)。③丙泊酚组AQP-4 mRNA含量在各时间点表达与NS组比较均较低(P<0.05)。NS组在术后各时间点,AQP-4 mRNA含量均比假手术组高(P<0.05)。结论丙泊酚可下调脑缺血再灌注损伤大鼠脑组织AQP-4mRNA的表达,可能是其减轻大鼠脑缺血再灌注损伤的机制之一。     

瑞芬太尼对家兔缺血脑组织水通道蛋白-4表达的影响

目的观察瑞芬太尼对家兔缺血再灌注损伤脑组织水通道蛋白-4（AQP-4）表达的影响。方法健康家兔25只,随机分为假手术组、缺血模型组、瑞芬太尼组。以双侧颈总动脉阻断＋控制性低血压法建立家兔全脑缺血损伤模型,再灌注1h,6h,24h末,测定脑组织含水量,观察AQP4的表达,再灌注24h末,观察脑组织超微结构变化。结果与假手术组比较,模型组家兔脑组织含水量及脑组织内AQP4表达在1h,6h和24h逐渐升高（P〈0．05）;与模型组比较,瑞芬太尼组脑组织含水量与AQP-4表达明显降低（P〈0．05）。结论瑞芬太尼可能通过降低脑组织内AQP-4表达,减轻脑水肿,保护脑缺血损伤。     

大鼠脑缺血再灌注后水孔蛋白4表达的研究

目的:探讨水孔蛋白4(AQP-4)在脑缺血再灌注后的表达及意义.方法:采用线栓法制备大鼠大脑中动脉栓塞(MCAO)模型,分别于缺血再灌注后12,24,48,72,120,168 h的6个时相点用免疫组化方法观察大鼠模型缺血区AQP-4的表达,并与假手术组和正常组比较.结果:正常组和假手术组不同时相点均无AQP-4的表达;缺血再灌注组12 h在缺血周边区神经胶质细胞上有较弱表达,24h表达增强,48～120 h达到高峰,168 h后AQP-4持续表达.结论:脑缺血再灌注时缺血区域有AQP-4表达,AQP-4表达可能是脑缺血再灌注损伤的机制之一.     

短暂性脑缺血再灌注损伤对老年大鼠海马脑组织水通道蛋白4表达及神经元凋亡的影响

目的 探讨短暂性脑缺血再灌注损伤对老年大鼠海马脑组织水通道蛋白4表达及神经元凋亡的影响.方法 健康老年Wistar大鼠160只按Pnsinelli方法建立四动脉阻断法全脑缺血模型,随机分为脑缺血1 min组、脑缺血3 min组、脑缺血5 rain组和假手术组,每组40只.每组又按再灌注时间分为再灌注12 h、1 d.2 d.3 d和7 d 5个亚组,每个亚组8只.应用干湿重法计算脑含水量、组织病理学染色观察神经元微观结构,免疫组化方法观察AQP4的表达,TUNEL法检测神经元凋亡.结果 缺血1 rain及3 min组各再灌注时间点脑组织含水量及AQP4表达与假手术组比较差异无统计学意义(P0.05),而缺血5 min组各再灌注时间点脑组织含水量及AQP4表达与假手术组比较差异有统计学意义(P<0.05).假手术组及缺血1 min组有少量神经元凋亡,缺血3 min及缺血5 min后海马区神经元凋亡明显增加.神经元凋亡在缺血后再灌注12 h即有表达,在1 d达高峰,持续至第3天开始下降.结论 老年脑对缺血再灌注损伤的敏感性增加,短暂的脑缺血即可造成老年大鼠脑组织的水肿和AQP4表达及神经元凋亡的增加,神经元的凋亡较脑水肿或AQP4表达对缺血更为敏感;再灌注后神经元凋亡高峰出现得早,持续时间长.     

瑞芬太尼对小鼠脑缺血再灌注损伤的影响

目的 观察瑞芬太尼预处理对小鼠不完全性全脑缺血再灌注损伤的影响.方法 成年昆明小鼠80只随机分为5组:假手术(sham)组;缺血再灌注(I/R)组;瑞芬太尼2μg·kg-1(REM2)组;瑞芬太尼6μg·kg-1(REM6)组;瑞芬太尼18μg·kg-1(REM18)组.小鼠采用双侧颈总动脉结扎法建立不完全性全脑缺血再灌注模型,缺血30min.I/R,REM2、REM6和REM 18组分别于缺血前18min腹腔注射0.9%氯化钠溶液及瑞芬太尼2、6、18μg·kg-1,每次注射1min,间隔5min,共3个循环.再灌注24h后,每组各取8只小鼠,进行卒中指数和神经症状评分,随后断头取脑测脑含水量.各组剩余8只小鼠测脑组织MDA含量、SOD、CAT和GSH-Px活性.结果 再灌注24h后,与sham组比较,I/R组小鼠卒中指数和神经症状评分、脑含水量、脑组织MDA含量明显升高,脑组织SOD、CAT和GSH-Px活性明显降低;与I/R组比较,REM18组小鼠卒中指数和神经症状评分均明显降低(P<0.01),REM18组脑含水量和脑组织MDA含量降低(P<0.01,P<0.05),SOD、CAT和GSH-Px活性明显升高(P<0.05).结论 瑞芬太尼预处理(以18μg·kg-1为佳)对小鼠不完全性全脑缺血再灌注损伤具有保护作用,其机制可能与减轻脑水肿以及抑制自由基损伤有关.     

丙泊酚对大鼠脑缺血再灌注后脑水肿及EGFR与ERK1/2磷酸化的影响

目的观察丙泊酚对大鼠脑缺血再灌注后脑水肿及表皮生长因子受体(EGFR)和细胞外信号调节蛋白激酶(ERK1/2)磷酸化的影响。方法将60只SD大鼠按随机数字表法分为6组:假手术组(Sham组)、大脑中动脉栓塞(MCAO)2h模型组(I组)、MCAO 2h再灌注24h模型组(I/R组)、丙泊酚预处理假手术组(Pro组)、丙泊酚预处理MCAO 2h模型组(Pro+I组)及丙泊酚预处理MCAO 2h再灌注24h模型组(Pro+I/R组),每组10只。将各组制模成功后大鼠断头取脑组织,采用干重法测定缺血区脑组织含水量,采用Western Blot检测EGFR和ERK1/2磷酸化水平。结果 I/R组缺血区脑组织含水量较I组和Sham组显著增加(P<0.05),EGFR和ERK1/2磷酸化水平较I组和Sham组显著升高(P<0.05);Pro+I/R组脑组织含水量较I/R组显著降低(P<0.05),EGFR和ERK1/2磷酸化水平较I/R组显著下降(P<0.05)。Sham组、I组、Pro组、Pro+I组及Pro+I/R组的缺血区脑组织含水量、EGFR和ERK1/2磷酸化水平比较差异均无统计学意义(P>0.05)。结论丙泊酚能有效通过抑制EGFR和ERK1/2磷酸化降低脑缺血再灌注大鼠脑水肿程度。     

深低温停循环下尼莫地平的大鼠脑保护作用研究

目的 研究深低温停循环（DHCA）下尼莫地平对全脑缺血再灌注损伤的保护作用及其机制.方法 将96只DHCA模型SD雄性大鼠随机均分为模型组（DHCA）和尼莫地平组（DHCA＋尼莫地平）,每组48只,采用二血管阻断加低血压法制作全脑缺血再灌注模型.每组根据时相再分为缺血后再灌注0h（T1）、2h（T2）、6h（T3）、12h（T4）、24h（T5）和48h（T6）共6个亚组,每组8只;检测不同时间点大鼠血清S100β含量及脑含水量,并观察脑组织病理变化.结果 模型组和尼莫地平组的血清S100β蛋白含量及脑组织含水量在2h开始升高,24h达高峰,48h开始降低;与模型组相比,尼莫地平组的血清S100β蛋白含量各时间点均低于模型组（P＜0.05或P＜0.01）,脑含水量从T2～T5均低于模型组（P＜0.05或P＜0.01）;两组大鼠脑组织缺血再灌注24h均出现明显的病理变化,但尼莫地平组较模型组明显减轻.结论 尼莫地平能明显减轻脑损伤和脑水肿,对深低温停循环后的缺血大鼠脑组织有一定的保护作用.     

新生大鼠缺氧缺血脑组织水肿及水通道蛋白-4的表达变化

目的 探讨新生SD大鼠缺氧缺血不同时间点脑组织水肿及水通道蛋白-4 (AQP-4) 表达的功能意义。 方法 健康3 d龄SD大鼠60只, 分为对照组 (12只) 和缺氧缺血脑损伤模型 (HIBD)组 （48只)。HIBD 组行右侧颈总动脉结扎后,分为吸入80 mL/L O2+920 mL/L N2 4 h、8 h、16 h、24 h 四个亚组,每组12只大鼠。对照组仅行假手术, 不予右颈总动脉结扎和缺氧缺血。HIBD各亚组分别于持续缺氧缺血4 h、8 h、16 h、24 h后处死动物,对照组于手术后12 h处死。取脑组织分别进行HE染色观察脑组织病理改变、脑含水量测定、实时荧光定量PCR检测大脑海马AQP-4 mRNA表达。 结果 HE染色示:随着缺氧缺血时间延长,右脑神经细胞与胶质细胞肿胀进行性加重,24 h组神经细胞溶解损伤明显,胶质细胞稀疏变性。HIBD 组右侧大脑持续缺氧缺血8 h、16 h和24 h脑组织含水量均较对照组增加, 差异有统计学意义 (P<0.05);实时荧光定量PCR显示右脑海马AQP-4 mRNA表达较对照组减少 (P<0. 05)。 结论 新生大鼠缺氧缺血后脑组织水肿,海马AQP-4表达下调,提示AQP-4与脑组织水肿有关。     

亚低温对脑缺血再灌注损伤大鼠神经细胞凋亡和caspase-3释放的影响

目的 从信号转导及细胞凋亡角度,研究亚低温对大鼠脑缺血再灌注损伤(I/R)的脑保护作用及机制。方法 72只雄性健康SD大鼠,随机分成假手术组(S组)、缺血再灌注组(IR组)、亚低温组(M组),每组24只;三组缺血10min后分别按再灌注12h、24h、48h,再分为3个亚组,各亚组动物均为8只。大鼠脑缺血再灌注损伤模型制作采用改良四血管阻滞法,免疫组化SP法动态观察各个时间点海马CA1区caspase-3蛋白的变化;光镜和电镜分别观察再灌注48h亚组海马CA1区神经细胞形态和线粒体超微结构的改变。结果(1) 大鼠脑缺血再灌注损伤后12h海马CA1区caspase-3即有明显表达,24h达高峰,48h后仍有较高表达;(2) IR组和M组各时间点caspase-3表达水平比S组明显升高(P<0.05);24h亚组线粒体超微结构和神经细胞形态受损严重;(3) M组各个时间点caspase-3表达水平较IR组明显下降(P<0.05或P<0.01);24h亚组线粒体超微结构和神经元形态均有不同程度的改善。结论 亚低温对caspase-3依赖的线粒体凋亡通路有干预作用,通过维持线粒体膜稳定,抑制释放和激活caspase-3蛋白,保护线粒体的形态功能,从而减少神经细胞凋亡的发生,发挥脑保护作用。     

脑脉通对老龄大鼠脑缺血再灌注核转录因子NF-kB和一氧化氮合酶的影响

目的 从核转录因子kB(NF-kB)、热休克蛋白(HSP70)和一氧化氮合酶(eNOS、iNOS、nNOS)表达的变化揭示脑脉通抗老年脑缺血再灌注损伤的保护机制.方法 采用MCAO方法复制脑缺血动物模型,观察脑缺血(Ⅰ)3 h和再灌注(I/R)1、3、6、12 d大鼠神经症状积分、脑组织含水量、病理变化、NF-kB、HSP70和NOS表达的变化.结果 模型组脑组织含水量(I/R 1、3、6 d),神经症状积分(各时间点),NF-kB(I 3 h和I/R 1、3 d),HSP70(I/R 1、3、6、12 d),eNOS(I/R 1、3、6 d)、nNOS(各时间点)和iNOS(I/R 1、3、6 d)的表达均高于假手术组;脑脉通组神经症状积分,脑组织含水量(I/R 3、6、12 d),NF-kB(I/R 1、3、6、12 d),nNOS(I 3 h和I/R 1、3 d)、iNOS(I/R 1、3 d)的表达低于模型组,HSP70(I/R 1、3、6、12 d)和eNOS(I/R 1、3、6 d)的表达高于模型组;脑脉通组神经症状积分(I/R 6、12 d)和nNOS(I/R 1 d)、iNOS(I/R 1 d)的表达低于尼莫地平组,eNOS(I/R 1d)高于尼莫地平组.结论 脑脉通抗脑缺血再灌注损伤的机制与抑制NF-KB、nNOS、iNOS表达和上调HSP70、eNOS表达有关.     

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.