四君子汤加减治疗小儿脾虚积食型厌食症的临床观察

目的研究四君子汤加减治疗小儿脾虚积食型厌食症的临床观察。方法选取2017年1月—2019年12月期间马鞍山市中医院儿科收治的102例脾虚积食型厌食症患儿作为研究对象,采用随机数字表法将患儿分为对照组和治疗组,各51例。对照组患者采用西药治疗,治疗组患者采用中西医结合治疗,疗程均为14 d。治疗后,对两组患者的临床效果进行比较,包括两组患者治疗总有效率,两组患儿治疗前后中医临床症状的变化,两组患儿治疗前后静脉血锌含量。结果治疗后治疗组总有效率90.20%(46/51)明显优于对照组72.55%(37/51),差异有统计学意义(P 0.05)。治疗后两组患儿中医证候评分与治疗前比较均明显降低,差异有统计学意义(P 0.05),且治疗组治疗后中医证候积分降低水平明显优于对照组,两组比较,差异有统计学意义(P 0.05)。治疗后两组患儿静脉血的锌含量水平与治疗前比较均明显升高,差异有统计学意义(P 0.05),且治疗组治疗后静脉血的锌含量水平明显高于对照组,两组比较,差异有统计学意义(P 0.05)。结论四君子汤加减可以有效地治疗儿童厌食症,其机制可能与四君子汤加减能够促进患儿对锌等重要微量元素的吸收有关。相较于西医的治疗,中医药治疗小儿厌食症副作用小且疗效确切,四君子汤加减用于小儿脾虚积食症的治疗值得进一步研究和推广。     

过敏性紫癜患儿血小板参数和免疫球蛋白测定结果分析

目的 探讨过敏性紫癜(HSP)患儿血小板参数和免疫球蛋白的变化及其临床意义.方法 对82例HSP患儿进行血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)和免疫球蛋白测定,并以健康儿童为对照组.结果 HSP无肾损害患儿与正常对照组相比PLT、IgG、IgM无明显变化,两组比较差异无统计学意义(P＞0.05);而MPV、PDW、IgA均增高,两组比较有统计学差异(P＜0.05).HSP伴肾损害即紫癜性肾炎(HSPN)患儿与HSP无肾损害患儿相比PLT明显降低,而MPV、PDW、IgA明显增高,差异均有统计学意义(均P＜0.05).结论 血小板参数和免疫球蛋白的变化与HSP发病和肾脏是否损害及损害程度密切相关,可作为判断病情和预后的指标.     

荆防方加减对慢性荨麻疹患者嗜酸性粒细胞变化的影响

目的观察荆防方加减对慢性荨麻疹患者嗜酸性粒细胞变化的影响。方法选取慢性荨麻疹患者58例，按照随机数字表法将所有患者随机分为对照组和试验组各29例。对照组患者使用枸地氯雷他定片治疗，试验组患者使用荆防方加减进行治疗。检测2组患者治疗前后嗜酸性粒细胞计数、嗜酸性细胞比例、白细胞计数、血小板计数，并对患者治疗前后临床症状、中医证候进行评价，统计治疗效果及不良反应发生率，并做组间比较。结果治疗前2组患者嗜酸性粒细胞计数、嗜酸性细胞比例、白细胞计数、血小板计数、临床症状评分、中医证候积分比较，无统计学差异（P＞0.05）；治疗后2组患者嗜酸性粒细胞计数、嗜酸性细胞比例、白细胞计数、血小板计数、临床症状评分、中医证候积分均低于治疗前（P＜0.05）；治疗后试验组患者嗜酸性粒细胞计数、嗜酸性细胞比例、白细胞计数、血小板计数、临床症状评分、中医证候积分均低于对照组（P＜0.05）。试验组治疗总有效率显著高于对照组，复发率低于对照组（P＜0.05）。试验组患者治疗过程中不良反应发生率低于对照组，无统计学差异（P＞0.05）。结论荆防方加减治疗慢性荨麻疹的效果明显，可有效改善患者免疫功能和临床症状，降低嗜酸性粒细胞数，不良反应较少。     

艾曲波帕与大剂量人免疫球蛋白联合激素治疗儿童慢性免疫性血小板减少性紫癜的疗效对比*

目的 对比艾曲波帕及大剂量免疫球蛋白联合激素治疗慢性免疫性血小板减少性紫癜（cITP）患儿的临床疗效及不良反应。方法 选取我院医学中心小儿血液与肿瘤科2009年7月～2020年8月收治的51例cITP患儿为研究对象，其中男性23例，女性28例，年龄3～15岁，平均(7.65±2.31)岁。51例cITP患儿分为艾曲波帕治疗组（n=19）与免疫球蛋白联合激素治疗组（n=32）。定期监测所有患儿肝肾功能、凝血功能、心肌酶谱及心电图检查。结果 治疗后，两组患儿出现完全反应、反应、持续反应、无效情况比较，差异无统计学意义(P＞0.05)。两组在治疗前及治疗后7 d、14 d、1个月血小板计数恢复情况比较，差异无统计学意义（P＞0.05）；治疗后3个月，两组血小板计数比较，差异有统计学意义（P＜0.05）。艾曲波帕治疗组不良反应发生率为15.79%，免疫球蛋白联合激素治疗组为71.88%；两组患儿不良反应发生率比较，差异有统计学意义(P＜0.05)。结论 艾曲波帕及大剂量免疫球蛋白联合激素治疗cITP，在促进血小板回升的疗效上基本相似，但艾曲波帕在提升血小板过程中作用更持久，疗效不易反弹，不良反应更少。     

抗病毒治疗对HIV阳性产后妇女血常规的影响

目的探讨抗病毒治疗对HIV阳性产后妇女血常规的影响。方法纳入符合条件的82例参加者,随机分为产后继续服抗病毒药物组(A组,40例)与产后停止服抗病毒药物组(B组,42例),检测并比较两组0周、4周、12周、24周、36周、48周红细胞、中性粒细胞与血小板的计数。结果 0周两组比较红细胞、中性粒细胞和血小板计数差异无统计学意义(P>0.05);与0周相比,B组产后48周内各时间点红细胞计数上升,中性粒细胞和血小板计数均下降,差异具有统计学意义(P<0.05或P<0.001)。与B组相比,A组红细胞从4周开始至48周持续降低于B组,差异有统计学意义(P<0.01或P<0.001);A组中性粒细胞从4周开始至24周低于B组,差异有统计学意义(P<0.05),从36周至48周两组比较差异无统计学意义(P>0.05);从12周开始至48周,A组血小板计数高于B组,差异有统计学意义(P<0.05或P<0.001)。结论 HIV阳性产后妇女48周红细胞计数上升,中性粒细胞和血小板计数均下降;抗病毒治疗使HIV阳性产后妇女48周内红细胞上升幅度减慢,产后早期中性粒细胞明显减少,但可改善HIV阳性产后妇女血小板下降情况。     

经皮冠状动脉介入治疗术后标准双抗血小板治疗和长期双抗血小板治疗的预后对比

目的:探讨经皮冠状动脉介入治疗(PCI)术后标准双抗血小板和长期双抗血小板对冠心病患者预后的影响。方法:回顾性分析2015年1月-2017年12月在上级医院行PCI术后回本院复诊的冠心病患者200例的临床资料,按治疗方法不同将其分为观察组和对照组,各100例。观察组给予长期双抗血小板治疗,对照组给予标准双抗血小板治疗。比较两组治疗前后的血小板聚集率、红细胞计数、血小板计数以及有效性终点事件和安全性终点事件发生率。结果:治疗前及治疗3、6、12个月,两组血小板聚集率、红细胞计数、血小板计数比较,差异均无统计学意义(P0.05);治疗18、24个月,两组红细胞计数比较差异均无统计学意义(P0.05),但观察组血小板聚集率、血小板计数均低于对照组,比较差异均有统计学意义(P0.05);观察组主要及次要有效性终点事件发生率均低于对照组,比较差异均有统计学意义(P0.05);两组大出血、小出血及安全性终点事件总发生率比较,差异均无统计学意义(P0.05)。结论:PCI术后使用长期双抗血小板治疗可安全有效地抑制血小板聚集,减少冠心病患者术后心血管不良事件的发生率。     

替罗非班辅助低分子肝素治疗急性冠脉综合征合并妊娠糖尿病的前瞻性研究

目的：探讨替罗非班辅助低分子肝素治疗急性冠脉综合征合并妊娠糖尿病的临床疗效及安全性。方法前瞻性选取本院2012年4月—2015年10月收治的80例急性冠脉综合征合并妊娠糖尿病患者,按随机数字表法分为对照组、实验组,每组40例,实验组采用替罗非班辅助低分子肝素治疗,对照组使用单独低分子肝素治疗方案,比较两组治疗后血浆蛋白-A （PAPP-A）以及超敏C反应蛋白（hs-CRP）水平;比较两组内出血情况以及血小板计数的变化。结果两组治疗后PAPP-A以及hs-CRP水平均有所下降,实验组下降幅度高于对照组,对比差异有统计学意义（P＜0.05）;两组内出血发生率分别为10.0％、40.0％,均无严重出血情况发生,实验组轻度出血3例,中度出血1例,对照组轻度出血10例,中度出血6例,实验组轻中度出血率低于对照组（P＜0.05）;两组治疗前血小板计数对比差异无统计学意义（P＞0.05）,治疗后实验组血小板计数下降明显,对照组血小板计数无明显变化,两组不同时间点血小板计数差异无统计学意义（P＞0.05）。结论替罗非班辅助低分子肝素治疗急性冠脉综合征合并妊娠糖尿病患者具有一定的效果,且用药安全性较高。     

加味升降散治疗阴虚热毒伏络型过敏性紫癜性肾炎辽效观察

目的 观察加味升降散治疗过敏性紫癜性肾炎的临床疗效.方法 将符合纳入标准的患者60例,随机分为治疗组和对照组,每组30例.在一般治疗的基础上,对照组用黄葵胶囊,治疗组用加味升降散治疗.观察两组患者治疗后中医证候积分、实验室指标[尿红细胞（RBC）计数、24小时尿蛋白定量（24 h Pro）、超敏C反应蛋白（hs-CRP）及血免疫球蛋白A（IgA）、免疫球蛋白M（IgM）、免疫球蛋白G（IgG）]的变化情况.结果 两组患者治疗后,治疗组与对照组总有效率分别为86.67％和56.67％,两组比较差异有统计学意义（P＜0.05）,治疗组疗效优于对照组.治疗组在控制中医证候积分,改善尿RBC计数、24 h Pro、hs-CRP方面明显优于对照组,两组比较差异有统计学意义（P＜0.05,P＜0.01）.结论 加味升降散治疗过敏性紫癜性肾炎疗效显著,值得临床推广.     

疟疾患者外周血常规指标变化的临床意义

目的探讨疟疾患者发作期和治疗期间外周血常规指标的变化。方法分析恶性疟患者与间日疟患者疟疾发作初期外周血细胞计数的改变情况,进一步探讨患者服用蒿甲醚一个疗程巩固治疗中其血常规指标的变化情况。结果恶性疟组和间日疟组血常规各参数比较差异均无统计学意义(P0.05)。与健康对照组相比,恶性疟、间日疟患者在发作期治疗前外周血常规中淋巴细胞计数(LYMPH)和嗜酸性粒细胞计数(EO)降低(P0.05);恶性疟组红细胞(RBC)、血红蛋白(Hb)、平均红细胞体积(MCV)、血小板(PLT)、血小板分布宽度(PDW)及平均血小板体积(MPV)与健康对照组比较,差异均有统计学意义(P0.05);间日疟组Hb、MCV、PLT、MPV及血小板压积(PCT)与健康对照组比较,差异均有统计学意义(P0.05)。恶性疟与间日疟患者服用蒿甲醚一个疗程期间外周血常规的中性粒细胞(NEUT)、单核细胞(MONO)、嗜碱性粒细胞(BASO)计数无明显变化(P0.05),WBC总数、LYMPH、EO和PLT计数均有升高趋势,而RBC、Hb计数有下降趋势,观察到血常规散点图也有相应的改变。结论疟疾发作初期观察血常规指标和散点图的变化可辅助诊断疟疾感染,在治疗过程中,应密切关注RBC、Hb计数降低程度。     

归脾汤加减治疗艾滋病合并血小板减少

目的观察归脾汤加减治疗艾滋病合并血小板减少的临床效果。方法以我院2017年9月至2018年10月60例艾滋病合并血小板减少患者为此次研究主体,根据随机分配法分为观察组(30例)和对照组(30例)。对照组使用常规西药服治疗,观察组在西药治疗基础上,使用归脾汤加减治疗,比较两组患者治疗效果。结果观察组不良反应发生率为3.33%,对照组为26.67%(P0.05)。两组治疗前血小板计数及调节性T细胞百分比对比无统计学意义(P 0.05);两组治疗后血小板计数及调节性T细胞百分比均有显著上升,且观察组改善更加显著(P0.05)。结论在艾滋病合并血小板减少患者治疗中应用归脾汤加减治疗,可获得显著的治疗效果,能够有效改善血小板计数及调节性T细胞百分比,降低不良反应发生率,安全性强,临床应用及推广价值极高。     

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.