华南理工大学动物实验申请.docx

1、华南理工大学动物实验申请华南理工大学动物实验申请South China University of Technology Animal Protocol动物伦理号：Animal Ethics Committee Number提交日期：Date Submitted批准日期：Approval DatePROPOSAL #:APPROVAL DATE:EXPIRATION DATE:P POSAL #:ROPOSAL #:PROPOSAL #:APPROVAL DATE:EXPIRATION DATE:Section A. 项目信息 PROJECT INFORMATIONA1. 项目资料 Appli

2、cation Data项目名称 Project Title首次提交 Initial submission: 更新Renewal: 修改 Modification: 项目来源 Funding Source Section B. 人员及培训 PERSONNEL AND TRAININGB1. 课题组负责人(PI) Principal Investigator (Co-Investigators may follow) 姓名 Name单位 Unit部门 Department手机号码 MP办公电话 TEL邮箱 E-maiB2. 课题组负责人是否亲自操作？Does the PI have direct

3、contact with animals? 是 Yes 否 No B3. 动物实验操作人员Who will perform the experimental manipulations on animals? 姓名Name曾开展动物实验的种类和期限Years of Working Experience with the Species何时何地获得的工作经验When & Where Experience Received手机号码Mobil Phone邮箱E-mail可增加行Repeat rows when neededB4. 操作者是否有相关的操作经验？Are the persons perfo

4、rming the experiments or surgeries with animals experienced with the specific procedures involved? 是 Yes 否。注明他们在进行实验之前如何受到相关培训No. Indicate how they will receive training before the experiments begin 由PI培训Training by PI 由实验动物中心培训Training by laboratory animal center 由其它单位或个人培训（姓名）Training by other (Na

5、me)Section C. 实验概要 EXPERIMENTAL SUMMAR C1. 实验的目的或预期目标是什么？What are the objectives or underlying hypotheses of the experiments?C2. 你的实验最终如何让患者（人或动物）受益？How might a patient population (human or animal) ultimately benefit from your experiments? C3. 动物使用原理（叙述使用动物的理由，证明所选物种的适宜性）Explain your rationale for a

6、nimal use. The rationale should include reasons why it is necessary to use animal models.Justify the appropriateness of the species selected. The species selected should be the lowest possible on the phylogenetic scale.C4. 请详述所采用的动物实验程序（涉及动物的实验方法及操作顺序，药物的剂量、给药方式、药物剂型、取样方法和次数等）Provide a complete desc

7、ription of the procedure(s) to be performed using animals (i.e., nature and time sequence of animal related procedures, dose/route/regimen of drug administration, sampling methods and frequencies, etc.)C5. 所需动物数量。Number of animals requested (by species) . 种Species品种/品系Strain/Stock性别Sex年龄Age重量Weight突

8、变系的数量Number of Mutant Strains动物总数Total Number of Animals 可增加行Repeat rows when neededC6. 请说明所需实验动物数量的科学依据。列出每次动物实验所需的动物数量和每个实验所用到的对照组动物数目。Provide scientific justification for the number of animals requested. List the number of animals for each experimental and control group for each experiment.C7. 是否

9、需要特殊的护理条件（如笼具、温度、光照、卫生条件、食物、饮水等）。Will special husbandry conditions be needed (e.g., caging, temperature, light cycle, sanitation, diet, water, etc.)? 是 Yes 否 NoSection D. 采血 BLOOD COLLECTION 若采血，请填写下表If section D is applicable,Complete the table below. 不采血Section D is NOT applicable 品种/品系Species/Str

10、ain采血量Volume to Be Collected采血周期Frequency of Collection采血方法Method of Collection麻醉或镇静Anesthesia or Sedation Used可增加行Repeat rows when neededSection E. 镇静过程 SEDATION FOR PROCEDURES 若适用，请填写E1-E4项。 If section E is applicable, complete E1-E4. 不适用。 Section E is NOT applicable.E1. 品种/品系 Species/Strain E2. 何

11、时镇静 When is sedation used? E3. 药名Drug name 剂量Dose 给药方式Route E4. How will the depth of anesthesia be monitored? 如何监控麻醉深度 脚趾收缩反应丧失 Absence of withdrawal reflex to toe pinc 眼脸反应消失 Absence of blink reflex 其它 OtherSection F. 手术程序 SURGICAL PROCEDURES 如做手术，请完成F1-F13。If section F is applicable, complete F1-

12、F13. 不做手术。Section F is NOT applicable. 术前准备事项PRE-OPERATIVE CAREF1. 实验动物需要术前用药吗？ Will the animal require pre-operative drugs? 需要 Yes 药名Drug name 剂量Dose 途径Route 周期Frequency 不需要 NoWithholding food and water is not recommended for rodents.不建议对啮齿动物采取禁食禁水。F2. 是否让实验动物存活？Is this a survival procedure? 是 Yes

13、否 NoThe animal will be euthanized after anesthesia. 请将动物麻醉后安乐处死.F3. 是否是大手术？Is this a “major” procedure? 是 Yes 否 No F4. 是否为多重存活手术？Will more than one survival procedure be performed on any one animal? 如是，请提供科学依据。Yes. If so, provide scientific justification. 没有No.F5. 手术过程的描述 Describe the surgical proce

14、dure(s)F6. 怎样缝合皮肤？How will skin be closed? 夹子或不可吸收性缝合Clips or non-absorbable sutureMust be removed no later than two weeks post-op. 夹子或不可吸收性缝合须在术后两周内去除。 其它方法（请描述）Other (Please describe)F7. 手术操作者？Who will perform the surgical procedure? F8. 手术将在一般消毒条件还是无菌条件下进行？Will surgery take place under sterile conditions or aseptic conditions? 消毒 Sterile 无菌 Aseptic啮齿类动物手术可以在无菌操作条件下进行，要求(1)手术区域干净用消毒液擦拭过（例如碘酊和75%乙醇溶液）, (2)器械经高压灭菌或化学消毒15min以上，手术相关人员要戴口罩、无菌手套或用75%乙醇或其他消毒剂彻底清洗消毒过的乳胶手套。Rodent surgery