化学镀法制备32P放射性支架预防血管成形术后再狭窄的实验研究

目的：评价^32P放射性支架对兔髂动脉狭窄的预防作用。方法：以化学镀法制备^32P放射支架，与普通支架配对后，随机植入兔双侧髂动脉，于术前、术后即刻及术后30d血管造影观察动脉狭窄程度，病理组织学观察内膜面积及管腔内径的变化。结果：术后30d，两种支架植入后的动脉最小腔径（MLD）均较术后即刻显著减小，放射性支架组的MLD显著大于对照组（P＜0．01），而其后期丢失、丢失指数、狭窄程度3项指标则显著小于对照组（P＜0．01）。两种支架植入均使血管内膜增生；放射性支架侧血管管腔面积显著大于对照侧（P＜0．05），而其新生内膜面积显著小于对照侧（P＜0．01）。两种支架植入后对支架边缘部位均无影响。结论：化学镀法制备的新型32P放射性支架安全有效，较低的放射活度即可有效防止支架内狭窄；短球囊扩张支架可能会避免边缘部位狭窄的发生。     

白蛋白纳米t-PA 基因涂层支架的研制及其抗血栓作用

制备白蛋白纳米组织型纤溶酶原激活物（t-PA ）基因涂层支架,观察其预防实验兔支架内血栓形成和内膜增生的效果。方法用不锈钢支架为龙骨模拟血管基底膜主要成分（透明质酸+Ⅳ型胶原蛋白+层粘连蛋白+ 纤维连接蛋白）,配制涂层液涂于金属支架表面;制备- 基因质粒白蛋白纳米粒,并将其连接于涂层表面,制备成白蛋白纳米- 基因涂层支架。用球囊导管损伤兔髂动脉内膜制备血管内膜增生模型,将上述涂层支架植入局部血管,并用治疗性超声辅助转染。分别于术前,以及术后1、2和4周取血检测t-PA、D-二聚体含量及凝血酶原时间的变化。体视镜和常规病理观察支架植入血管堵塞及血栓形成情况。形态测量法测量内膜厚度及面积,判断内膜增生。用免疫组织化学法检测血管壁t-PA和增殖细胞核抗原的表达。结果成功制备纳米t- PA基因涂层支架。涂层支架植入血管后可见血管壁高效表达t-PA,减少支架内血栓形成和内膜增生,伴随t-PA及D- 二聚体含量的增加,凝血酶原时间无明显变化。结论- 基因涂层支架可减少兔支架内血栓形成和内膜增生,而未影响全身凝血。将支架术与基因治疗同步完成,为该纳米基因涂层支架的研制及支架内血栓形成的防治提供实验基础。     

^3H-TdR涂层支架转移细胞内照射预防兔骼动脉支架后再狭窄的实验研究

目的:探讨3H-TdR探讨涂层支架置入对涂层支架预防兔骼动脉支架后再狭窄的预防作用.方法:12只新西兰大白兔,按支架放射性活度分为三组,每组4只,能量分别为:2.12、6.21、8.22MBq,于每只动物一侧骼动脉内置入不同活度的3H-TdR支架,对侧骼动脉内置入非放射性支架作对照.高脂饲养28 d后进行骼动脉血管造影和组织病理学分析,放射性自显影检测,观察治疗效果,同时检测外周血及组织中放射量.结果:组织病理学分析显示不同剂量3H-TdR支架组新生内膜狭窄百分比均明显低于对照组,支架内细胞增生厚度明显低于对照组,内膜光滑,少血栓形成.放射性自显影显示大量平滑肌细胞核内有显像颗粒,内层到外逐渐递减,中层以外很少.血液及外周组织检测未见放射性物质.结论:3H-TdR支架能明显抑制支架置入后兔骼动脉新生内膜增生和支架后再狭窄的发生,外周血及组织中无明显放射性物质检出.     

新型血管内支架生物相容性研究的初步结果

目的考察一种新型血管内支架的生物相容性和理化稳定性。方法共24个网状自展型金属内支架被置入到16只大的腹主动脉和（或）下腔静脉内，术后分别在1、3、4、8、16和36wk行血管造影，并对支架金属丝行扫描电镜观察以明确其腐蚀情况。结果观察期内所有支架血管保持良好通畅，无血栓形成、内膜过度增生和支架移位。支架跨越区各分支血管保持通畅。支架置入3wk时光镜和电镜观察见支架表面已由新生内膜组织完全覆盖，血管未见炎症及异物反应。结论该支架具有良好的生物相容性和耐腐蚀性，易于被新生内膜组织覆盖，可保持血管长期通畅。     

雷公藤内酯醇洗脱支架预防猪冠脉支架内再狭窄

目的 观察雷公藤内酯醇洗脱支架植入后对冠脉支架内再狭窄的影响,初步探讨其预防支架内再狭窄的作用机制.方法 采用20只国内杂种幼猪,分别植入雷公藤内酯醇洗脱支架和普通支架(裸金属支架)各10个.术后28 d取冠脉行组织病理检查内膜增生程度,并用免疫组化方法 检测内膜平滑肌细胞中增殖细胞核抗原(PCNA)和血小板源性生长因子(PDGF)的表达.结果 支架部位血管腔面积裸支架组小于雷公藤内酯醇组、支架内增生内膜面积及内膜增生程度裸支架组大于雷公藤内酯醇组(P＜0.05).支架植入后28 d两组血管新生内膜均可见增殖细胞(PCNA阳性细胞),雷公藤内酯醇组比裸支架组明显减少,PDGF阳性细胞数雷公藤内酯醇组亦明显少于裸支架组,差异均有显著性(P＜0.05).结论 雷公藤内酯醇洗脱支架能抑制新生内膜的形成,其通过影响PDGF的表达,抑制新生内膜平滑肌细胞的增殖,从而减少支架内再狭窄的发生.     

高血压对高脂饮食兔腹主动脉内膜巨噬细胞和平滑肌细胞数量的影响

目的观察高血压对高脂饮食兔腹主动脉内膜巨噬细胞和平滑肌细胞(SMCs)数量的影响。方法将同批兔随机分为高脂饲料组(15只)和普通饲料组(10只),喂养28周后对高脂组10只、普通组5只手术结扎腹主动脉造成管腔缩窄,余普通组5只和高脂组5只均给予假手术,术后分为高脂手术组,普通手术组,普通假手术组和高脂假手术组,继续喂养4周后对各组兔腹主动脉多处测量血压,取血管行免疫组化染色,观察随血压的变化,内膜巨噬细胞和SMCs的数量变化。结果高脂组兔腹主动脉近端血压高于远端血压,且高脂手术组血压差异更明显。普通假手术组血管内膜薄而光滑;普通手术组缩窄近端内膜比远端内膜稍有增厚;高脂饮食组血管内膜有大量泡沫细胞堆积,缩窄近端内膜厚于缩窄远端,且高脂手术组差异大于高脂对照组。高脂手术组缩窄近端内膜巨噬细胞和SMCs数量多于远端,且巨噬细胞多于SMCs;随着远端血压的降低,巨噬细胞与SMCs数量逐渐减少,巨噬细胞少于SMCs。结论高血压促进高脂饮食兔腹主动脉内膜进一步增厚,内膜巨噬细胞和SMCs数量增多,且巨噬细胞多于SMCs,推测斑块不稳定性增加;随着血压的降低,内膜逐渐变薄,内膜巨噬细胞和SMCs数量减少,且SMCs多于巨噬细胞,推测斑块稳定性增强。     

去纤酶对冠状动脉损伤后C-fos基因表达的影响

目的：探讨去纤酶抑制血管损伤后内膜增生的机制。方法：以犬冠状动脉内植入过大钽丝支架致血管内膜过度增生为动物模型,用常规组织方法,免疫组化及ｍＲＮＡ原位杂交技术分别检测新生内膜厚度,新生内膜中血管平滑肌细胞增生及Ｃ－ｆｏｓ基因的转当情况,并采用随机对照方法观察去纤酶对血管损伤后内膜增生程度,α平滑肌肌动蛋白表达及Ｃ－ｆｏｓ基因转录的影响。结果：去纤酶组新生内膜厚度,α平滑肌肌动蛋白的表达及Ｃ－ｆｏｓ     

高脂饮食兔腹主动脉缩窄前后内膜平滑肌细胞和胶原平均光密度变化的研究

目的 研究动脉粥样硬化(AS)兔腹主动脉缩窄近端及远端内膜平滑肌细胞(SMCs)和胶原的变化.方法 将25只新西兰大白兔随机分为普通对照组、高脂手术组、高脂组,第8周和第28周检测总胆固醇(TC)、甘油三酯(TG)和低密度脂蛋白(LDL),28周后高脂手术组行腹主动脉缩窄术,其余组行假手术.32周后利用生物机能实验分析系统测量各组腹主动脉缩窄近端和远端的压力.行HE染色、苦味酸-天狼猩红染色及免疫组化方法分别观察腹主动脉形态学特征、胶原及SMCs.结果 ①高脂手术组缩窄近端内膜胶原较高脂组相同位置明显增多;高脂手术组缩窄远端内膜胶原较高脂组相同位置明显减少.②高脂手术组缩窄近端SMCs较高脂组相同位置增多,高脂手术组缩窄远端内膜SMCs 较高脂组相同位置减少.结论 AS兔腹主动脉缩窄近端血管内膜增厚,内膜胶原和SMCs增多;缩窄远端内膜变薄,内膜胶原和SMCs减少.     

不同血管损伤法对小型猪实验性髂动脉内膜增生病变形成的影响

目的：观察实验性内膜损伤后的增生性改变，探索制作适合于介入性治疗的具有高度狭窄病变的动物模型。方法：２１头贵州小型猪分高血脂球囊组、正常血脂球囊组和钽丝支架组，通过球囊扩张和钽丝支架移置法损伤其髂动脉。结果：１２周后病理检查显示：三组管腔狭窄率≥Ⅲ级者分别为４６．９％、２０．８％和４２．９％，前两组间比较，Ｐ＜０．０５；球囊损伤后共有４例发生急性血管闭塞，而钽丝支架组无１例。新生内膜组织主要由增生的平滑肌细胞组成。结论：（１）两种方法均可产生严重程度的内膜增生病变，球囊损伤后易出现急性血管闭塞；（２）病变与人类典型动脉粥样硬化（ＡＳ）构成有明显的差异。     

不同设计的两代国产铂—铱合金支架对兔颈动脉血管反应的影响

目的：评估不同金属丝直径、不同结构设计的国产铂-铱合金支架对血管反应的影响。方法：将家兔分为三组,第一组置入直径0.13mm单丝缠绕成螺旋形结构的第一代支架（n=5),第二置入直径0.175mm单丝缠绕成“之”字形结构的第二代支架（n=5),第三组置入第二代明胶蛋白涂层支架（n=7)。术后7d行病理形态分析及扫描电镜观察。结果：所有动物均成功置入支架,组织病理学检查显示：一代和二代支架组各有1例不完全性血栓形成;涂层支架组无血栓形成。支架置入血管无明显炎症反应和异物巨细胞聚集。涂层支架组平均新生内膜厚度与新生内膜面积最小,而管腔面积最大（P均＜0.05)。扫描电镜显示支架表面几乎完全内皮化。结论：支架金属丝直径与结构设计的不同对新生内膜增殖及管腔面积有影响;明胶蛋白涂层具有良好的组织相容性。     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

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.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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…     

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.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.