溫州醫(yī)科大學實驗動物中心動物實驗倫理審查表范例

1、溫州醫(yī)科大學實驗動物中心動物實驗倫理審查表范例the tab of animal experimental ethical inspection of laboratory animal centre, wenzhou medical university 批準編號(id number)：申請人填寫的相關信息(relatedinformationfilledbyapplicant)申請單位(name of organization): 溫州醫(yī)科大學藥學院school of pharmaceutics sicience, wenzhou medical university申請人學歷(educa

2、tion of applicant)：碩士 master技術職稱(professional title)：副教授 associate professor實驗名稱(experiment title)：淫羊藿苷丙二醇脂質(zhì)體小鼠腹腔注射后藥動學與分布研究pharmacokinetics and tissue distribution profile of icariin propylene glycol liposomes intraperitoneal injection in mice項目來源(project sources)：溫州市科學技術局medicine and health grant

3、from wenzhou bureau of science and technology (s20100049) et al. 實驗目的(aim of experiment)：研究淫羊藿苷丙二醇脂質(zhì)體在小鼠體內(nèi)的藥動學特點和組織分布to investigate pharmacokinetics and tissue distribution of icariin propylene glycol-liposomes suspension (ica-pg-liposomes) 實驗動物使用許可證號(number of the using of laboratory animal)：syxk（浙

4、）2010-0150 擬進動物情況動物來源(source of animal)：溫州醫(yī)科大學實驗動物中心 laboratory animal centre, wenzhou medical university品種品系(species or strain)：swiss hasse 等級(grade)： spf 規(guī)格(specifications)：25-30g數(shù)量(number)： 35 只( 0 只； 35 只)申請日期(application date)： 2009 年 03月 21 日進駐日期(entering date)：2009 年 8 月 6 日結束日期(ending date)：

5、2010 年 9 月 3 日實驗要點，包括實驗方法、觀測指標、實驗結束后處死動物的方法等：(outline of experiments, experimental methods, observational index, executing animal method, et. al)：該研究本著實驗動物福利和倫理的原則，本實驗項目優(yōu)化設計方案，嚴格計劃動物需要數(shù)量，計劃需要35只 swiis hasse 小鼠。實驗方法涉及動物單次給藥后的藥物動力學和分布研究。在設定的給藥時間點0, 0.083, 0.167, 0.333, 0.667, 1.333, 2.0, 4.0, 8.0 h和 2

6、4h，采用水合氯醛麻醉下采集血液，分離心、肝、脾、肺、腎和腦用于淫羊藿苷的檢測。各藥均無毒性。實驗結束后，麻醉小鼠，使小鼠安樂死，經(jīng)打包，最后統(tǒng)一焚燒。in this study, the one hundred swiss hasse male mice were used for pharmacokinetics and distriburtion evaluation of icariin propylene glycol-liposomes (n=5 each time point). after ica-pg-liposomes or ica-pg-solution i. p., t

7、he mice were sacrificed by anesthesia with chloral hydrate at 0, 0.083, 0.167, 0.333, 0.667, 1.333, 2.0, 4.0, 8.0 and 24h. plasma collected at 0 min were served as blank samples. blood samples were collected in haprinized tubes. spleen, kidney, liver, lung, heart and brain were also collected from a

8、ll mice. the concentration of ica in plasma and tissues were determined by hplc. after the experiments, all mice were burned. 申請人簽名 (signature of applicant)： 王小明（旁邊簽字）聯(lián)系電話 (telephone)664500）項目負責人簽名(signature of project director)：愛因斯坦（旁邊簽字）聯(lián)系電話 (telephone)：10086聲明(statement)：我將自覺遵守實驗動物福利

9、倫理原則，隨時接受委員會的監(jiān)督與檢查，如違反規(guī)定，自愿接受處罰。(i will conscientiously abide by the ethical principles of animal welfare, accept the supervision and inspection of the committee at any time, and voluntarily accept the punishment if any infringement.)項目負責人簽名(signature of project director)：（項目負責人比如導師，這里直接簽名）項目執(zhí)行人簽章(s

10、ignature of project implementation)：（項目執(zhí)行人比如研究生，這里直接簽名）審查依據(jù)(inspection contents)1. 該項目是否必須用實驗動物進行實驗，即能否用計算機模擬、細胞培養(yǎng)等非生命方法替代動物或用低等動物替代高等動物進行實驗?(does laboratory animal must be used in the project? could other methods such as computer simulation, cell cultivation or using the low-grade animal instead of

11、 the high-grade animal?)2. 表中所填申請人資格和所用動物的品種品系、質(zhì)量等級、規(guī)格是否合適，能否通過改良設計方案或用高質(zhì)量的動物來減少所用動物的數(shù)量?(are the qualification of applicant，species or strain, grade and specifications of animals suitable? could the quantity of animals be reduced by improving the study design or using high quality animals?)3. 能否通過改進

12、實驗方法、調(diào)整實驗觀測指標、改良處死動物的方法，來優(yōu)化實驗方案、善待動物?(could the study design and animal treatment be refined by ameliorating experimental method, adjusting observational index, executing animal method?)審查結果(是否同意申請人的實驗方案)(results ofinspection)實驗動物管理和倫理委員會意見(attitude of the animal management and ethics committee)：同意(agree)不同意(disagree)修改后同意（agree after revised）倫理委員會主任委員簽名(signature of ethi