内支架缓解食管狭窄的临床研究

目的：研究应用镍钛记忆合金网状及带膜内支架,“Z”型不锈钢丝带膜内支架缓解食管狭窄的疗效。方法：食管狭窄70例分别在X线透视下,食管镜下和手术中置入内支架。结果：70例中,随访45例,早期置放网状内支架2例食管腔内黏液堵塞,带膜支架术后吞咽困难缓解,能进半流质,平均存活8个月。结论：带膜内支架可明显提高食管狭窄患者的存活质量,但不能显著延长食管癌患者带瘤存活时间。     

覆膜镍钛合金支架治疗恶性食管-气管瘘21例临床疗效分析

目的评价应用镍钛记忆合金带膜网状支架治疗癌性食管-气管瘘的疗效。 方法2002～2009年病理、胃镜或上消化道造影证实食管-气管瘘患者21例,根据食管狭窄的程度、长度、瘘口部位及狭窄上缘距门齿距离,确定支架长度和支架位置,随后行食管内带膜支架置入术.结果20例病人均1次成功放置镍钛记忆合金带膜网状支架,患者呛咳及吞咽困难症状消失,术后均能进普通流食。1例重度肺部感染合并心衰,患者不能耐受,放弃支架治疗。结论内镜下置入带膜支架是治疗晚期食管癌合并食管-气管瘘病人的一种有效方法。     

食管癌狭窄内支架的临床应用

目的：对食管癌不同影像类型、不同病变位置的食管狭窄进行带膜网状支架置入临床应用总结。方法：在模拟定位机下钡剂显影，胃管套导丝插入食管，萨氏扩张器扩张后进行带膜网状支架置入。结果：46例患者。45例顺利置入，1例置入失败，1例置入后呕吐加重，1例食管上段癌置入后疼痛明显取出支架，6例置入后轻微胸疼对症治疗后缓解。结论：不同影像类型、不同病变位置的食管癌狭窄影响支架置入的成功率及置入后的并发症。     

应用金属内支架缓解食管狭窄的临床研究

应用镍钛记忆合金网状内支架缓解食管狭窄３４例，经临床和放射学检查及随访，所有患者内支架均放置成功，吞咽困难症状均得到缓解，未发生严重并发症。随访过程中未见内支架移位。表明置入镍钛记忆合金网状内支架能迅速、安全、有效地缓解食管狭窄，减轻患者痛苦，提高生存质量     

应用金属内支架缓解食管狭窄的临床研究

应用镍钛记忆合金网状内支架缓解食管狭窄３４例，经临床和放射学检查及随访，所有患者内支架均放置成功，吞咽困难症状的得到缓解，未发生严重工发症，随访过程中未见内支架移位，表明置入镍钛记忆合金网状内支架能迅速，安全，有效地缓解食管狭窄，减轻患者痛苦，提高生存质量。     

内支架置入治疗晚期食管癌的临床应用

目的 探讨带膜内支架置入治疗晚期食管癌所致食管恶性狭窄及伴有食管-气管瘘、食管-纵隔瘘的临床应用价值 方法 23例晚期食管癌患者,男17例,女6例,7例合并食管-气管瘘,1例合并食管-纵隔瘘,均在透视下一次性成功置入自膨式带膜内之架。结果 15例单纯性食管抉窄患者内支架置入后,吞咽困难得以缓解．进食级别提高2～3级：合并有食管-气管瘘患者7例、食管-纵隔瘘患者1例在置入带膜内支架后,瘘口完全封闭通过后期抗感染治疗,肺炎和纵隔炎症得以有效控制。结论 带膜内支架置入是治疗晚期食管癌所致的食管狭窄和封堵食管-气管、食管-纵隔瘘瘘口．解决患者进食困难,增加营养的有效方法。其方法简单、安全,近期效果显著,无明显并发症发生。     

内镜下食管内支架置入术治疗恶性食管狭窄

为探讨应用带膜自膨式金属支架治疗晚期食管癌引起的恶性食管狭窄的效果 ,对 13例食管恶性狭窄者行内镜下食管内支架置入术 ,均一次安置成功。 12例患者摄食能力有不同程度改善。其中 1例合并食管—气管瘘症状得到缓解。1例摄食能力无变化 ,总有效率达 92 .3 % (12 /13 )。术后吞咽困难明显好转 ,未发生出血、穿孔等严重的并发症。认为应用带膜金属自膨式支架治疗食管恶性狭窄 ,方法简便、安全、有效。     

不同类型食管内支架治疗食管支气管瘘和食管恶性狭窄比较

目的:采用金属内支架置入的方法对食管气管瘘、食管支气管瘘和食管恶性严重狭窄患者进行姑息性治疗,观察并比较不同类型食管支架应用情况。方法:对56例晚期食管癌置入金属内支架。其中,进口Sneider被膜支架5个,“Z”形被膜支架9个,国产Premium支架(无被膜覆盖)8个、双圆口支架11个,国产网状被膜支架3个,国产“Z”形被膜支架22个(两例分别置入2枚支架)。结果:吞咽困难消失或明显缓解,食管气管瘘、食管支气管瘘完全封闭。结论:食管内支架置入术简单、安全,近期疗效明显,无严重并发症,合理选择不同类型金属内支架,是治疗晚期食管癌形成食管气管瘘、食管支气管瘘和食管严重狭窄的良好的姑息治疗方法。     

带膜镍钛记忆合金支架在晚期食管癌食管狭窄治疗中的应用

目的　评价带膜镍钛记忆合金网状支架在治疗晚期食管癌食管狭窄中的价值。方法　本组 17例 ,在X线电视监视下 ,用交换导丝、Cobra导管引入超硬导丝 ,将支架置入病变段。结果　 17例共置入支架 18枚 ,成功率10 0 %。患者吞咽困难症状明显改善 ,未出现食管穿孔、大出血或死亡等严重并发症。结论　带膜镍钛记忆合金支架治疗晚期食管癌食管狭窄安全有效。     

内镜下置入食管支架治疗食管恶性狭窄的临床效果及并发症

目的：探索内镜下置入带膳食管支架治疗食管恶性狭窄的临床效果,并发症及其影响因素。方法：对４０例不能手术的中晚期食管癌狭窄患者,采用胃镜下放置带膜记忆合金网状食管支架进行治疗。结果：近期效果显著,吞咽困难缓解超过二级,但对生存期无明显改善,主要并发症除了肿瘤内生性及过生性生长和致死性大出血,鳞状上皮坪生及肉芽组织反应也是造成再狭窄的主要原因。     

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.