糖尿病患者经皮肾镜取石术后发生全身炎症反应综合征的危险因素分析

目的：分析合并糖尿病的尿路结石患者在经皮肾镜取石（percutaneous nephrolithotomy, PCNL）术后发生全身炎症反应综合征（systemic inflammatory response syndrome, SIRS）的可能危险因素。方法： 回顾北京大学人民医院泌尿外科2006年6月至2015年12月期间,因尿路结石行PCNL术且术前诊断为2型糖尿病的患者资料,分析患者的临床特征与术后SIRS之间的相关性。符合条件的患者共461例,其中男性281例,女性180例,平均年龄57岁,术后137例（29.7%）患者出现SIRS。根据术后是否发生SIRS,将患者分为两组,比较两组患者的各项临床参数的差异。结果： 与未发生SIRS的患者组相比,发生SIRS的患者组术前白细胞计数（×109/L）更高［7.76 (4.00~17.96) vs. 6.31 (2.00~17.40),P<0.001］;术前血糖（mmol/L）更高［7.30 (3.08~19.90) vs. 6.40 (3.42~16.78),P<0.001］;手术时间（min）更长［75 (20~270) vs. 60 (20~200),P<0.001］;相应的住院时间（d）也更长［12 (2~46) vs. 11 (3~29),P=0.019］。术前血糖偏高的患者术后SIRS的发生率高于术前血糖控制在正常范围内的患者［35.1% (100/285) vs. 21.0% (37/176),P=0.001］;鹿角形结石的患者术后SIRS的发生率高于非鹿角形结石的患者［38.8% (33/85) vs. 27.7% (104/376),P=0.042］;术前合并尿路感染的患者术后SIRS的发生率高于无感染患者［36.8% (50/136) vs. 26.6% (81/304),P=0.032］;两组间年龄、性别、体重指数（body mass index,BMI）、术前血红蛋白水平、是否输血、手术时间与术后SIRS发生率的差异无统计学意义。多因素Logistic回归分析结果显示,术后SIRS发生与患者的性别、术前是否合并尿路感染以及是否为鹿角形结石无显著相关性,而与术前白细胞计数高于正常（OR=3.194,95% CI：1.531~6.666,P=0.002）、手术时间大于60 min（OR=1.635,95% CI：1.088~2.456,P=0.018）以及术前血糖水平有显著相关性,术前血糖控制在正常值范围内（3.3~6.1 mmol/L）的患者与术前血糖>7.1 mmol/L的患者相比,PCNL术后SIRS的发生率差异有统计学意义。结论： 对于合并2型糖尿病的尿路结石患者,PCNL术后SIRS的发生与患者术前白细胞水平、手术时间、术前空腹血糖水平存在显著相关性。术前白细胞计数升高、手术时间大于60 min、术前空腹血糖较高的患者PCNL术后发生SIRS的风险增加。     

目标导向液体治疗对高龄胃肠道肿瘤患者术后的影响

［摘要］目的　探讨围术期目标导向液体治疗对高龄胃肠道肿瘤患者术后的影响．方法　择期行胃癌/结肠癌或直肠癌根治术患者60例,年龄≥60岁,ASAⅡ或Ⅲ级,随机分为2组,常规补液组（C组,n＝30）,目标导向液体治疗组（G组,n＝30）．C组根据术中血压变化进行常规补液,维持平均动脉压60～110 mmHg;G组行目标导向液体治疗（GDFT）,通过Flotrac/Vigileo监测仪连续获取SVV,CI,SVI等指标．术中维持SVV 2%～13%,CI2.5～4.0 L/(min.m),SVI 35～47 mL/m2,MAP 65～110 mmHg,记录总液体入量,晶体量,胶体量,术后首次排气时间,总住院天数、术后住院天数和医疗费用．结果　与C组相比,G组晶体量更少［（1 156.7±194.2） vs（1 558.3±211.4 ）,P＜0.05］,胶体量更少［（823.3±266.1） vs（1 013.3±248.8）,P＜0.05］;术后肺部并发症发病率更低;术后首次排气时间更早［（78.3±24.0）vs（97.8±31.9 ）h,P＜0.05］;术后住院天数和总住院天数更短;医疗费用更低．结论　目标导向性液体治疗能改善高龄患者行胃肠道肿瘤根治术的预后,减少术后并发症的发生率,节约医疗资源．     

长期高蛋白饮食对营养性肥胖大鼠胰岛素分泌和血浆Ghrelin水平的影响

目的  观察长期高蛋白饮食对营养性肥胖大鼠胰岛素分泌和血浆Ghrelin水平的影响。  方法    采用高脂饲料喂养,建立营养性肥胖大鼠模型。将肥胖大鼠分为高蛋白饲料组(HP组,n=12,36.7%蛋白质)和普通饲料组(NC组,n=11,22.4%蛋白质),正常等热量饲养24周。观察饲养期间大鼠体质量、空腹血糖的变化。至24周,测定内脏脂肪、空腹血浆Ghrelin（酶联免疫法）和空腹胰岛素（放射免疫法）等指标含量,并行静脉葡萄糖耐量试验(IVGTT),观察两组大鼠葡萄糖刺激下的胰岛素分泌状况。  结果   与NC组相比,HP组体质量明显减轻［(490.92±39.47)g vs（545.55±31.08）g,P＜0.01］,内脏脂肪含量明显减少［（22.42±7.04）g vs（32.33±9.27）g,P＜0.05］;IVGTT结果显示,HP组5、10min血清胰岛素含量显著降低［(91.56±21.72)μIU/mL vs（121.29±34.03）μIU/mL,P＜0.05;（58.62±15.80）μIU/mL vs（81.12±24.36）μIU/mL,P＜0.05］;HP组空腹血浆Ghrelin浓度有升高趋势［（2.36±0.82）ng/mL vs（1.95±0.64）ng/mL,P=0.20］。血浆Ghrelin浓度与体质量(r=-0.373,P＜0.05)、内脏脂肪含量(r=-0.454, P＜0.01)、空腹胰岛素含量(r=-0.390,P＜0.05)呈负相关。  结论   长期等热量高蛋白饮食可降低肥胖大鼠胰岛素的第一时相分泌,并可导致空腹Ghrelin升高。这种胰岛素分泌的减少可能系Ghrelin升高、体质量减轻所致。     

iAssist导航系统与传统方法实施全膝关节置换术的比较

目的：比较iAssist导航系统与传统方法行人工全膝关节置换术（total knee arthroplasty,TKA）的临床疗效。方法：2016年1月—2017年9月间利用iAssist导航系统实施TKA 24例,同期用传统方法实施TKA 26例。比较2组术前一般资料,并对术后植入假体位置的精确度、手术时间、术中出血量、术后引流量及关节活动度（range of motion,ROM）、美国特种外科医院（hospital for special surgery,HSS）评分、术后并发症等进行比较。结果：2组患者均获随访,随访时间6~18个月。iAssist组下肢力线偏离小于传统组［（1.15° ± 0.38°） vs. （2.26° ± 0.62°）,t=7.555,P＜0.05］;机械轴股骨远端外侧角偏离小于传统组（0.86° ± 0.49°vs. 1.75° ± 0.76°,t=4.875,P＜0.05）;胫骨近端内侧角偏离小于传统组（0.68° ± 0.42°vs. 1.25° ± 0.64°,t=3.690,P＜0.05）。iAssist组的手术时间与传统组无明显差别［（102.8 ± 17.4）min vs. （99.6 ± 13.5）min,t=0.730,P＞0.05］;iAssist组术中出血量少于传统组［（213.5 ± 29.2）mL vs. （290.5 ± 32.6）mL,t=8.770,P＜0.05］;术后24 h引流量iAssist组少于传统组［（30.2 ± 6.8）mL vs. （51.8 ± 8.9）mL,t=9.583,P＜0.05］。术后第6个月,HSS评分iAssist组和传统组均较术前明显提高（P < 0.05）,但两组间比较差异无统计学意义（t=0.782,P＞0.05）;术后ROM iAssist组和传统组与术前及两组间比较,差异均无统计学意义（P＞0.05）。2组患者均未出现血管及神经损伤、假体松动或下沉等并发症。结论：iAssist导航提高了实施TKA假体位置安放的精确度,减少了术中出血量和术后引流量,手术时间增加不明显,但功能方面无差异,其长期临床效果有待进一步观察。     

前列腺体积及前列腺突入膀胱长度与腹腔镜前列腺癌根治术后控尿功能恢复的相关性

目的：探讨前列腺体积（prostatic volume,PV）及前列腺突入膀胱长度（intravesical prostatic protrusion length,IPPL）与腹腔镜前列腺癌根治术后控尿功能恢复的相关性。方法：纳入经组织病理学诊断为前列腺腺癌并于北京大学第三医院行腹腔镜前列腺根治性切除术（laparoscopic radical prostatectomy,LRP）的患者88例,磁共振检查均于前列腺穿刺活检术前1周内完成。依据PV将患者分为小体积前列腺组（PV＜50 mL）和大体积前列腺组（PV≥50 mL）;依据IPPL（冠状位测量突入膀胱前列腺组织顶点至膀胱基底部的垂直距离）将患者分为前列腺未明显突入膀胱组（IPPL＜5 mm）和前列腺明显突入膀胱组（IPPL≥5 mm）。术后随访1年并记录患者术后控尿功能的恢复情况。结果：入组患者共88例,LRP手术均顺利完成,手术时间（155±67） min,出血量（145±159） mL。术前磁共振检查测量PV为11.83～151.53 mL,平均（44.54±26.58） mL,其中PV＜50 mL者65例（73.9%）,PV≥50 mL者23例（26.1%）;术前磁共振检查测量IPPL为0～27 mm,平均（5.2±5.7） mm,其中IPPL＜5 mm者56例（63.6%）,IPPL≥5 mm者32例（36.4%）。LRP术后3、6和12个月随访患者控尿功能恢复情况,完全控尿率分别为53.4%（47/88）、84.1%（74/88）和94.3%（83/88）。PV＜50 mL组和PV≥50 mL组术后3个月完全控尿率组间差异有统计学意义（61.5％ vs. 30.4％,P=0.010）, 6和12个月完全控尿率组间差异无统计学意义（87.7％ vs. 73.9％,P=0.120; 96.9％ vs. 87.0％,P=0.076）。IPPL＜5 mm组与IPPL≥5 mm组术后3、6和12个月完全控尿率组间差异均有统计学意义（66.1％ vs. 31.3％,P=0.002; 92.6％ vs. 68.8％,P=0.003; 98.2％ vs. 87.5％,P=0.037）。采用Kaplan-Meier法绘制PV＜50 mL、≥50 mL组和IPPL＜5 mm、≥5 mm组患者术后控尿功能恢复曲线,Log-rank检验提示PV＜50 mL组术后控尿功能恢复显著优于PV≥50 mL组（P=0.017）, IPPL＜5 mm组术后控尿功能恢复显著优于IPPL≥5 mm组（P=0.001）。结论：术前磁共振检查提示巨大体积前列腺及前列腺明显突入膀胱的前列腺癌患者LRP术后控尿功能恢复延迟,术后早期（3个月）尿失禁的发生率明显增高,在临床工作中应予以重视,此结果还需要更大规模的临床研究证实。     

兰索拉唑对2型糖尿病患者血糖及胃泌素的影响

目的 观察兰索拉唑能否缓解2型糖尿病(T2DM)患者口服二甲双胍引起的胃肠道不适,并探讨其对血糖、血清胃泌素(Gastrin)的影响及其可能的机制。方法 将51例患者分为兰索拉唑组（n=26）和对照组（n=25）,观察治疗前后空腹血糖（FBG）、糖化血红蛋白（HbA1C）、Gastrin、空腹胰岛素（FINS）、血脂、肝肾功及尿酸（UA）的变化。结果 兰索拉唑组治疗后胃部不适症状明显减轻,有效缓解率95.0%,症状缓解时间（3.05±1.07）d;空腹胃泌素水平较治疗前升高［(158.26±11.85) vs (95.61±4.48)ng/L,P＜0.05］,治疗后FBG［(7.22±0.45) vs (7.70±0.29)mmol/L,P＜0.05］和HbA1C［(7.28±0.76)% vs (7.85±0.05)%,P＜0.05］均显著低于对照组;治疗前后,兰索拉唑组FBG的变化［(1.16±0.62）vs (0.51±0.45)mmol/L,P＜0.05］及HbA1C的变化［(0.64±0.50) vs (0.33±0.43) mmol/L,P＜0.05］均较对照组具有统计学意义（P＜0.05）。相关回归分析显示,兰索拉唑组治疗后Gastrin升高与其HbA1C下降相关（r=-0.605,P＜0.05）。结论 兰索拉唑可以改善二甲双胍引起的胃部不适并能降低T2DM患者血糖水平,其作用可能与Gastrin的升高有关。     

1650例男性患者冠状动脉旁路移植术围术期临床回顾性研究

目的 冠状动脉旁路移植术（coronary artery bypass grafting,CABG）是治疗冠状动脉粥样硬化性心脏病（以下简称冠心病）主要手段之一,主要手术方式包括体外循环下冠状动脉旁路移植术（on-pump CABG,ONCABG）和非体外循环下冠状动脉旁路移植术（off-pump CABG,OPCABG）.本文拟通过回顾性分析1 650例男性患者施行OPCABG和不停跳ONCABG临床资料进行两种手术方式的临床效果分析.方法 采用首都医科大学附属北京安贞医院麻醉科2007年至2009年CABG数据库的有关数据.比较OPCABG组和不停跳ONCABG组近期疗效,并分别以术后死亡和术后应用连续性肾脏替代治疗（continuous renal replacement treatment,CRRT）为因变量进行Logistic危险因素回归分析.结果 OPCABG组搭桥时间和总手术时间均小于ONCABG组（P〈0.01）.OPCABG组搭桥数大于3的病例明显多于ONCABG组（20.9% vs 13.3%） （P〈0.01）,应用CRRT（1.33% vs 3.98%）和主动脉内球囊反搏（3.23% vs 6.63%）患者的比例较ONCABG组显著减少（P≤0.01）,两组术后院内病死率差异无统计学意义.CABG术后发生院内死亡的独立危险因素为术前左室射血分数（left ventricular ejection fraction,LVEF）〈40%（P=0.000,OR=8.321）、年龄〉70岁（P=0.003,OR=4.870）和术后应用CRRT（P=0.000,OR=45.500）.术后应用CRRT的独立危险因素为术前高血压病史（P=0.049,OR=2.665）、术前肾功能异常（P=0.045,OR=3.598）,OPCABG可以减少2/3的术后CRRT的使用率（P=0.008,OR=0.333）.结论 OPCABG可以降低术后CRRT和IABP的使用率,缩短手术时间.因此在年龄〉70岁,术前肾脏功能下降,心功能差等患者施行OPCABG手术对早期恢复是有益的.     

中性粒细胞/淋巴细胞比值对冠状动脉临界病变严重程度及斑块稳定性的预测价值

目的：探究外周静脉血中性粒细胞/淋巴细胞比值（neutrophil-to-lymphocyte ratio,NLR）与冠状动脉临界病变严重程度及斑块稳定性的关系。方法：将51例冠状动脉临界病变患者按NLR绝对值分为高NLR组（NLR＞2.73）23例和低NLR组（NLR≤2.73）28例,采集两组患者有关临床资料和实验室指标。通过冠状动脉造影（coronary angiography,CAG）及血管内超声（intravascular ultrasound,IVUS）比较2组病变严重程度和斑块组成。结果：（1）高NLR组非ST段抬高型急性冠状动脉综合征（non-ST-segment elevation acute coronary syndrome,NSTE-ACS）发生率明显高于低NLR组（70% vs. 39%,P=0.031）;（2）高NLR组的最小管腔直径小于低NLR组{（1.28±0.04） mm vs. （1.44±0.03） mm,P=0.002},而其狭窄百分比高于低NLR组{（61.69± 1.37）% vs. （55.03±0.91）%,P=0.000};（3）高NLR组斑块负荷及病变长度均明显高于低NLR组{（74.51±1.16）% vs （69.90± 1.22）%,P=0.010;（22.33±1.24） mm vs. （19.34 ± 0.55） mm,P=0.023};且高NLR组薄帽纤维斑块（thin-cap fibroatheroma,TC－FA）发生率及斑块坏死核心（Necrotic core,NC）比例明显高于低NLR组{57% vs. 25%,P=0.022;（24.70±0.70）% vs. （21.11± 0.74）%,P=0.001};（4）NLR与冠状动脉直径狭窄率（r=0.48,P=0.000）、斑块负荷（r=0.38,P=0.000）、病变长度（r=0.52,P=0.000）及斑块NC比例（r=0.28,P=0.047）呈正相关。结论：NLR与冠状动脉临界病变严重程度呈正相关,NLR可能可作为预测临界病变斑块稳定性的指标,对于冠状动脉临界病变治疗方案的选择有一定参考价值。     

人循环免疫细胞比值与卵巢癌患者临床病理特征及预后的关系

目的探讨循环免疫细胞比值与卵巢癌患者临床病理特征及预后的关系。方法选取行手术切除并经病理检查证实的卵巢癌患者116例,检测患者外周血中性粒细胞计数、淋巴细胞计数和PLT,并计算中性粒细胞/淋巴细胞比值（NLR）、PLT/淋巴细胞比值（PLR）。采用ROC曲线评价NLR、PLR预测患者预后的能力,确定最佳截点值,并以此分为高、低NLR及PLR组。采用Kaplan-Meier法分析高、低NLR及PLR组患者无病生存时间（RFS）和总生存时间（OS）,运用单因素及多因素Cox回归模型分析NLR、PLR与其他临床病理特征及预后的关系。结果NLR、PLR预测OS的最佳截点值为3.25和184,且两者呈正相关（r=0.69,P＜0.05）。NLR与卵巢癌患者的病理分级、FIGO分期、肿瘤病灶减灭是否理想、淋巴细胞计数、中性粒细胞计数和PLT均有关（均P＜0.05）,PLR与卵巢癌患者的FIGO分期、肿瘤病灶减灭是否理想、淋巴细胞计数和PLT均有关（均P＜0.05）。高NLR组患者RFS（HR=2.231,95%CI：1.511~3.825,P＜0.05）和OS（HR=2.112,95%CI：1.431~4.016,P＜0.05）均明显低于低NLR组;高PLR组患者RFS（HR=1.621,95%CI：1.225~3.224,P＜0.05）和OS（HR=2.021,95%CI：1.251~3.722,P＜0.05）均明显低于低PLR组。多因素Cox回归分析显示FIGO分期晚、肿瘤病灶减灭不理想、高NLR和高PLR均为卵巢癌患者术后RFS预后不良的独立因素（均P＜0.05）,病理分级差、FIGO分期晚、肿瘤病灶减灭不理想、高NLR和高PLR均为卵巢癌患者术后OS预后不良的独立因素（均P＜0.05）。结论循环免疫细胞比值NLR和PLR与卵巢癌预后密切相关,具有较好的预测预后的临床价值。     

机器人辅助腹腔镜下根治性前列腺切除术：经腹途径与经腹膜外途径的比较分析

目的：比较经腹途径与经腹膜外途径机器人辅助腹腔镜下根治性前列腺切除术的围手术期结果。方法：回顾性分析南京医科大学第一附属医院2016年6月—2016年9月53例行机器人辅助腹腔镜下根治性前列腺切除术前列腺癌患者的临床资料,其中经腹途径41例,年龄56～80岁,平均70岁;经腹膜外途径12例,年龄59～78岁,平均68岁。比较两组患者围手术期情况。结果：53例机器人辅助腹腔镜下根治性前列腺切除术均顺利完成,无中转开放手术者。比较经腹和经腹膜外两组年龄［(70.4±6.0)岁vs.(68.3±6.8)岁］、BMI［(23.7±2.5)kg/m2 vs.(24.1±3.2)kg/m2］、术前PSA［(22.2±21.6)ng/mL vs.(14.9±9.0)ng/mL］、Gleason评分［(7.5±0.7)分vs.(7.3±0.7)分］比较差异均无统计学意义(P＞0.05)。经腹组和经腹膜外组的总手术时间［(223.4±26.8)min vs.(186.5±16.6)min］、装机时间［(23.6±4.9)min vs.(27.9±5.5)min］、术后肠道恢复排气时间［(2.4±0.6)d vs.(1.9±0.6)d］、术后肠道恢复排便时间［(3.6±0.5)d vs.(3.2±0.6)d］差异均有统计学意义(P＜0.05)。两组的术中出血量、术后双侧盆腔引流管留置时间、术后下床活动时间、术后住院时间、术后导尿管留置时间比较差异均无统计学意义(P＞0.05)。结论：与经腹途径比较,经腹膜外途径机器人辅助腹腔镜下根治性前列腺切除术手术时间短,术后肠道恢复时间快,在术中出血量、术后双侧盆腔引流管留置时间、术后下床活动时间、术后住院时间、术后导尿管留置时间等方面无明显差异。     

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.     

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.     

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.     

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.