胎盘瘦素表达与胎儿宫内生长发育的相关性研究

目的探讨胎盘肥胖基因及其蛋白--瘦素(1eptin)表达水平与脐血瘦素和胎儿宫内生长发育的关系.方法40例产妇分娩时采集胎盘与脐血,其中26例来自上海新华医院,14例来自南京江北人民医院.采用逆转录聚合酶链反应(RT-PCR)检测胎盘瘦素mRNA相对表达水平,采用Westernblot检测胎盘瘦素表达水平,采用免疫组织化学观察胎盘瘦素表达位点,采用放射免疫法(RIA)检测脐血瘦素水平,采用Ponderal指数[PI=100×体重(g)/身长(cm)3]估测新生儿营养状态.结果RT-PCR显示胎盘组织瘦素mRNA呈现高效表达,免疫组化显示胎盘滋养层细胞胞质内瘦素阳性表达.均数差别t检验显示13例小于胎龄儿(SGA)胎盘组织瘦素mRNA与β-actin-mRNA表达水平之比为0.61±0.15,低于15例适于胎龄儿(AGA)0.83±0.20(P=0.0034),12例大于胎龄儿(LGA)胎盘组织瘦素mRNA与β-actin-mRNA表达水平之比为1.00±0.23,高于AGA(P=0.043).13例SCA胎盘组织瘦素含量(ng/mg)为0.26±0.05,低于15例AGA(0.340±0.086)(P=0.0076),12例LGA胎盘组织瘦素含量为0.43±0.10,高于AGA(P=0.021).胎盘肥胖基因mRNA及其瘦素表达水平与脐血瘦素水平显著相关(r=0.39和0.43,P＜0.05),与新生儿Ponderal指数(PI)显著相关(r=0.66和0.69,P＜0.01).结论胎盘是脐血瘦素重要来源,胎盘瘦素可能对胎儿宫内生长发育有促进作用.     

Placental leptin correlates with intrauterine fetal growth and development

目的　探讨胎盘肥胖基因及其蛋白表达水平与脐血瘦素和胎儿宫内生长发育的关系。方法　在 4 0例产妇分娩时采集胎盘与脐血 ,采用逆转录聚合酶链反应 (RT PCR)检测胎盘肥胖基因mRNA相对表达水平 ,采用Western Blot检测胎盘肥胖基因蛋白 (瘦素leptin)表达水平 ,采用免疫组化观察胎盘肥胖基因蛋白表达位点 ,采用放射免疫法 (RIA)检测脐血瘦素水平 ,采用Ponderal指数 [PI=10 0×体重 (g) /身长 (cm) 3]估测新生儿营养状态。结果　胎盘组织肥胖基因呈现高效表达 ,在胎盘滋养层细胞浆内肥胖基因蛋白阳性表达。胎盘肥胖基因及其蛋白表达水平与胎儿宫内生长发育状态显著相关 ,13例小于胎龄儿胎盘组织leptin mRNA及其蛋白表达水平显著低于 15例适于胎龄儿 (P =0 .0 0 3和 0 .0 0 8) ,12例大于胎龄儿胎盘组织leptin mRNA及其蛋白表达水平显著高于适于胎龄儿 (P =0 .0 4和 0 .0 2 )。胎盘肥胖基因mRNA及其蛋白表达水平与脐血瘦素水平显著相关 (r =0 .39和0 .4 3,P <0 .0 5) ,与新生儿Ponderal指数 (PI)显著相关 (r=0 .66和 0 .69,P <0 .0 1)。结论　胎盘是脐血瘦素重要来源 ,胎盘瘦素可能对胎儿宫内生长发育有促进作用。     

脐血及母血瘦素浓度相关性及其对胎儿生长发育的影响

目的探讨母血清与胎儿脐血瘦素的相关性和瘦素与胎儿生长发育的关系及瘦素的来源。方法采用ELISA方法测定55例母血及胎儿脐动脉、脐静脉血的瘦素浓度。根据新生儿的体重和胎龄的关系分成小于胎龄儿(SGA)、适于胎龄儿(AGA)及大于胎龄儿(LGA)3组,采用Ponderal指数估测新生儿营养状况。组间进行比较。结果55例新生儿的母血、脐动脉血、脐静脉血瘦素水平分别为16.58±8.13 ng/ml、12.05±9.87 ng/ml、13.24±10.58 ng/ml;母血瘦素水平高于脐动脉血,母血与脐动、静脉血瘦素水平无相关性,男、女婴之间瘦素水平无明显差异;不同胎龄组脐动脉、静脉之间瘦素水平差异显著,LGA组显著高于SGA及AGA组,AGA组高于SGA组。脐动脉、静脉血瘦素水平与新生儿体重、胎龄高度相关,母血瘦素与新生儿体重、胎盘重及胎龄不相关,与母亲体重、母亲体重指数高度相关。结论来自胎盘的瘦素参与了胎儿生长发育的调控,脐血瘦素可反映胎儿生长发育的状况。脐静脉血瘦素主要反映胎盘来源的瘦素,脐动脉血瘦素主要反映一部分胎盘来源的Leptin作用于胎儿后胎儿脂肪组织产生的瘦素。母血瘦素对胎儿体重没有直接的调节作用,它仅对自身的脂肪含量及能量代谢进行调节。     

胎儿肱骨头皮下软组织厚度、胎盘重量、新生儿脐血瘦素水平与体重的相关性研究

目的 研究足月胎儿肱骨头皮下软组织厚度(HSTT)、胎盘重量、新生儿脐血瘦素水平与新生儿体重的关系.方法 取51例正常妊娠妇女,根据其新生儿出生体重分为大于胎龄儿(LGA)15例、适于胎龄儿(AGA)26例和小于胎龄儿(SGA)10例.产前行B超测量足月胎儿HSTT;产后采用放射免疫法检测脐血瘦素水平,同时测量胎盘重量、新生儿体重等4项指标.结果 (1)同AGA组相比,LGA组和SGA组的足月胎儿HSTT和脐血瘦素水平均明显增厚(升高)和变薄(降低),除AGA组与SGA组的脐血瘦素水平无统计学差异(P＞0.05)外,余指标3组间两两比较均有统计学差别(P＜0.01).(2)足月胎儿HSTT、胎盘重量、新生儿脐血瘦素水平与新生儿体重4项指标间均呈明显正相关.结论 B超测定足月胎儿HSTT可预测新生儿体重;足月胎儿HSTT、胎盘重量、新生儿脐血瘦素水平与新生儿体重4项指标间均存在明显正相关.     

瘦素促胎儿生长作用及其与胰岛素和胰岛素样生长因子1关系的探讨

目的:探讨瘦素促胎儿生长作用及其与胰岛素和胰岛素样生长因子1(IGF-1)的关系.方法:采用放射免疫法检测100例足月新生儿脐血血清瘦素、胰岛素和IGF-1水平,根据新生儿出生体重分为大于胎龄儿(LGA)组19例,适于胎龄儿(AGA)组65例,小于胎龄儿(SGA)组16例.结果:(1)脐血瘦素水平与新生儿出生体重呈正相关关系(r=0.57,P＜0.01),其中LGA组脐血瘦素水平为(13.38±6.75)μg/L,显著高于AGA组(7.40±4.45)μg/L;SGA组(2.79±1.54)μg/L低于AGA组,差异有显著性(P＜0.01);(2)脐血胰岛素和IGF-1水平分别与新生儿出生体重呈显著正相关关系,相关系数(r)分别为0.30和0.35;(3)脐血瘦素和胰岛素水平呈正相关关系(r=0.32,P＜0.01),脐血瘦素与IGF-1水平之间元相关关系(r=018,P＞0.05).结论:脐血瘦素水平与胎儿生长发育状态密切相关,瘦素和胰岛素对胎儿体重有双向调节作用,IGF-1和瘦素具有各自独立的调控胎儿生长发育体系.     

脐血IGF和瘦素水平与胎儿宫内生长发育关系研究

目的探讨脐血胰岛素样生长因子(IGF)和瘦素水平与胎儿宫内生长发育的关系。方法采用放射免疫法检测80例足月新生儿脐血IGF-Ⅰ、IGF-Ⅱ和瘦素水平,根据胎龄和新生儿出生体重曲线,将新生儿分为大于胎龄儿(SGA),适于胎龄儿(AGA)和小于胎龄儿(LGA)3组,采用新生儿出生时体重、身长和Rohrer’s指数估测胎儿宫内生长发育状态。结果LGA组脐血IGF-Ⅰ和瘦素水平明显高于AGA组(12.03±1.22vs7.11±1.00,70.21±3.23vs43.48±0.96,4.03±1.12vs3.19±0.92),SGA组脐血IGF-Ⅰ和瘦素水平明显低于AGA组(2.66±1.03vs7.11±1.00,22.13±5.98vs43.48±0.96,2.34±3.63vs3.19±0.92);脐血瘦素水平与胎儿出生体重、身长和Rohrer’s指数呈显著正相关,LGA和AGA组脐血IGF-Ⅰ水平与胎儿出生体重、身长和Rohrer’s指数呈显著正相关。结论脐血IGF-Ⅰ和瘦素胎儿的体重、身长和Rohrer’s指数存在相关性,提示IGF-Ⅰ和瘦素在胎儿宫内生长发育中起重要作用。     

瘦素及其受体在胎盘组织中的表达及与新生儿出生体重的关系

目的 探讨瘦素(1eptin)及其受体在胎盘组织中的表达及其与新生儿出生体重的关系.方法 采用免疫组织化学方法检测leptin和瘦素受体(obR)在22例小于胎龄儿(SGA)和48例适于胎龄儿(AGA)胎盘组织中的表达,分析两组之间表达的差异.结果 胎盘组织中leptin和obR的表达呈正相关(r=0.525,P=0.000),SGA组leptin(x2=4.153,P=0.042)和obR(x2=9.291,P=0.002)的表达水平均显著低于AGA组.结论 胎盘组织中leptin和obR水平的降低可能与SGA的发生有关.     

母血、羊水、脐血中瘦素水平与胎儿生长发育的关系

目的探讨瘦素水平与胎儿宫内生长发育的关系。方法采用放射免疫法测定96例孕妇血清、羊水及新生儿脐血瘦素水平,根据不同出生体重分为小于胎龄儿（SGA）组（n=22）,适于胎龄儿（AGA）组（n=46）及大于胎龄儿（LGA）组（n=28）,对结果进行相关性分析。结果①母血瘦素水平与羊水、胎儿瘦素及胎儿体重均无明显相关性（P〉0．05）：羊水瘦素水平与胎儿体重无相关（P〉0．05）;脐血瘦素水平与胎儿出生体重呈正相关（P〈0．01）;②三组新生儿脐血瘦素水平差异有统计学意义,LGA组高于AGA、SGA组（P均〈0．01）,AGA组高于SGA组（P〈0．01）;③男女婴的脐血瘦素、羊水瘦素、母血瘦素水平差异无统计学意义。结论①脐血瘦素水平与胎儿体重呈正相关,提示其与胎儿的生长发育密切相关,而母血、羊水瘦素水平与胎儿体重无相关,故不能作为监控胎儿宫内发育的指标;②母血、羊水、脐血瘦素水平与胎儿性别无关,提示男女婴瘦素水平无差异。     

母血、脐血瘦素水平与新生儿出生体重的关系

目的:探讨孕母血清、脐血瘦素水平与新生儿出生体重的关系。 方法:采用放免法检测孕母外周静脉血与新生儿脐血瘦素水平。根据新生儿出生体重将新生儿分成 3组 ,大于胎龄儿组 (L GA组 ) 14例 ,适于胎龄儿组(AGA组 ) 2 9例 ,小于胎龄儿组 (SGA组 ) 15例。结果 :(1) L GA组脐血瘦素水平为 (11.93± 6 .75 ) ng/ ml,显著高于AGA组脐血瘦素水平 (6 .81± 4 .6 7) ng/ ml,SGA组脐血瘦素水平为 (3.2 9± 1.2 4 ) ng/ ml,显著低于 AGA组 ,差异均有统计学意义 (P<0 .0 5 )。 (2 )母血瘦素水平与新生儿出生体重无相关性 (γ=0 .12 ,P>0 .0 5 )。脐血瘦素水平与新生儿出生体重呈显著相关 (γ=0 .74 ,P <0 .0 5 )。 结论:瘦素是胎儿生长调节系统的重要调节因子 ,脐血瘦素水平与新生儿出生体重有密切相关性。     

瘦素与胎儿生长受限关系的观察

目的 探讨母血瘦素浓度与胎儿生长受限(fetal growth restriction,FGR)的关系.方法 用放射免疫方法测定分娩小于胎龄儿(small for gestational age,SGA)、适于胎龄儿(appropriate for gestational age,AGA)的132例正常孕妇及110例子痫前期孕妇血清瘦素水平.结果 分娩SGA的子痫前期患者血清瘦素水平明显高于分娩AGA的子痫前期患者及正常孕妇组;分娩SGA正常孕妇的瘦素水平明显高于分娩AGA的正常孕妇;子痫前期孕妇母血瘦素浓度与平均动脉压呈正相关,母血瘦素浓度与新生儿体重无明显的相关关系;正常孕妇母血瘦素水平与新生儿体重呈负相关关系.结论 母血瘦素水平反映了胎儿生长受限的程度.     

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.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.