血管性认知损害与血浆同型半胱氨酸的关系及临床意义

目的 探讨血管性认知损害(VCI)与血浆同型半胱氨酸(HCY)的关系及意义.方法 运用简易智能状态量表(MMSE)和画钟试验(CDT)测定认知功能.用酶免疫分析法(EIA)测定血浆同型半胱氨酸水平.健康对照组50名,非痴呆血管性认知功能损害(VCIND)组53名,血管性痴呆(VaD)组52名.结果 VaD组患者的血浆HCY浓度[(27.64±6.42)μmol/L]浓度高于VCIND组,VCIND组患者HCY浓度[(18.01±5.23)μmol/L]高于健康对照组HCY浓度[(7.24 3.20)μmol/L],均差异具有显著性.VCI患者MMSE评分与血浆HCY浓度无明显相关(r=-0.23;P＞0.05),但在HCY＞14.1μmol/L时其与MMSE的评分呈负相关(r=-0.39,P=0.006),且高HCY与注意力和执行功能有明显相关(P＜0.05).结论 HCY可能是血管性认知功能损害的重要生化指标.     

脂蛋白相关磷脂酶A2与血管性认知功能障碍的相关性研究

目的 探讨血管性认知功能障碍(vascular cognitive impairment, VCI)的两个亚型:非痴呆型血管性认知障碍(Vascular Cognitive Impairment No Dementia,VCIND)、血管性痴呆(Vascular dementia,VaD)患者血清中脂蛋白相关磷脂酶A2(lipoprotein - associated - phospholipase A2,LP-PLA2)含量变化及临床意义.方法 VCIND患者47例、VaD患者29例,对照组 31例,测定各组血清中Lp-PLA2水平.结果 VaD组血清Lp-PLA2含量(60.23±1.37)μg/L较VCIND组血清Lp-PLA2含量(20.26±1.28)μg/L高(P＜0.05);VCIND组血清Lp-PLA2含量(20.26±1.28)μg/L较对照组血清Lp-PLA2含量(10.18±0.19)μg/L高(P＜0.05).结论 血清Lp-PLA2水平能客观地反映VCI的认知功能损害程度,血清Lp-PLA2水平与VCI的认知功能障碍具有相关性,Lp-PLA2可能是血管性认知功能障碍的独立危险因素,对VCI有一定的临床诊断价值.     

脑小血管病患者非痴呆性血管性认知功能障碍与血浆同型半胱氨酸、低密度脂蛋白胆固醇水平的相关性研究

目的探讨新疆脑小血管病患者非痴呆性血管性认知功能障碍(VCIND)与血浆同型半胱氨酸(Hcy)以及低密度脂蛋白胆固醇(LDL-C)水平之间的关联。方法选取2015年2月至2017年2月在新疆医科大学第一附属医院、新疆医科大学附属中医医院收治的符合脑小血管病诊断标准的患者284例,依据认知相关神经量表进行认知功能评定后,所有入组对象分为:非痴呆性血管性认知功能障碍患者(VCIND)组共156例。VCIND组与对照组的性别、族别、年龄比较,均差无统计学意义(P0.05)。结果 VCIND组血浆Hcy水平(17.23±8.79)μmol/L高于对照组(12.38±5.41)μmol/L(P0.05);脑小血管病患者Hcy水平与蒙特利尔评估量表总分及相关项目相关性。结论 Hcy及LDL-C水平升高可能为脑小血管病患者发生认知功能障碍的危险因素,可能参与脑小血管患者认知功能损害。     

血管性认知损害的临床研究进展

血管性认知损害（vascular cognitive impairment，VCI）是指各种脑血管疾病导致的认知功能下降综合征。1995年Bowler等首次提出VCI的概念，认为VCI必须具有认知功能损害和血管性疾病因素，并且二者之间存在因果关系。VCI的提出是对血管性痴呆（vascular dementia，VaD）概念的修正和扩展，避免了VaD定义上的狭隘和对不同程度认知损害的人为忽略。目前普遍认为VCI包括：非痴呆血管性认知功能损害（vascular cognitive impairment no dementia，VCIND）、血管性痴呆、伴有血管性因素的混合性痴呆。与VaD概念相比，VCI的含义更加宽泛包括了所有与血管因素有关的认知改变。尤其是VCIND概念的提出，为血管病引起的认知功能损害的早期预防和干预提供了理论依据。     

纤维蛋白原与血管性认知功能障碍的关系研究

目的纤维蛋白原（fibrinogen,FIB）与痴呆的发生相关,可能与其作为凝血和炎性因子有关。文中拟探讨在缺血性脑血管病患者中,血浆FIB水平与血管性认知功能障碍（vascular cognitive impairment,VCI）之间的关系,为VCI的防治提供理论依据。方法从南京卒中注册系统中提取符合血管性认知障碍无痴呆型（vascular cognitive impairmentno dementia,VCIND）患者246例,测定血浆FIB水平。将患者分为高FIB组（FIB≥3.0g/L,84例）和正常组（FIB〈3.0g/L,162例）,运用简易智能状态量表（mini-mental state examination,MMSE）评估患者的认知功能,随访1年半时间,观察患者是否进展为血管性痴呆（vascular dementia,VaD）。结果随访过程中有8例患者死亡,14例患者失访,64例患者进展为VaD;认知功能下降程度与血浆FIB水平呈显著正相关（R=0.293,P〈0.001）;高FIB水平是VaD的危险因素之一（OR=2.152,95%CI=1.266～3.658）。结论血浆FIB水平与VCI患者认知功能下降程度呈显著相关,血浆高FIB水平增加VCI患者进展为痴呆的风险。     

简明精神状态量表联合蒙特利尔认知评估量表在血管性痴呆认知功能障碍中的初步应用

目的:通过对脑梗死以及有明确血管危险因素患者登记,予简明精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分,探讨血管性认知功能障碍(VCI)发生率、表现及相关因素。方法:选取2017年1月-2018年2月本院神经内科收治的发病时间在两周左右的急性缺血性脑卒中且经本院神经内科认定患有缺血性脑血管病危险因素的患者98例均行影像学检查,同时也为其进行了MMSE、MoCA评分并认真记录患者最终的认知受损程度,将其设置为VCI组,其中不符合DSM-Ⅳ痴呆诊断标准的54例患者设置为非痴呆性血管性认知功能障碍(VCIND)组,符合的44例则设置为血管性痴呆(VaD)组;同时选取本院健康查体者100例设置为健康组。结果:MoCA评分为(16.63±6.83)分与MMSE评分(23.71±4.63)分呈高度正相关(r=0.876,P0.01)。各组间的MoCA、MMSE评分比较,差异均有统计学意义(P0.05)。VCIND组的MMSE、MoCA评分均明显低于健康组,VaD组均明显低于VCIND组及健康组,差异均有统计意义(P0.05)。结论:MoCA评分相对于MMSE评分而言,其对VCIND的评价更为敏感。将MMSE评分联合MoCA评分能够对血管性痴呆认知功能障碍进行识别与诊断,为早期干预和治疗提供参考与借鉴。     

非痴呆型血管性认知功能损害与血同型半胱氨酸、C-反应蛋白及卒中部位的相关性分析

目的探讨非痴呆型血管性认知功能损害（VCIND）与血同型半胱氨酸（HCY）、超敏C-反应蛋白浓度（hs-CRP）及卒中部位的关系。方法采用中文版蒙特利尔认知评估量表（MOCA）将卒中后患者分为VCIND组和对照组,比较两组血HCY、hs-CRP浓度及卒中部位。结果 （1）VCIND组HCY、hs-CRP浓度均高于对照组,差异具有统计学意义（P〈0.05）;（2）血HCY、hs-CRP浓度与MOCA评分呈负相关（P〈0.05）,血HCY浓度与血hs-CRP浓度未见直线相关（P〉0.05）;（3）经χ2检验发现,皮层、基底节、丘脑卒中与认知功能损害的发生相关（P〈0.05）,并且双侧、多灶性梗塞患者更易导致认知功能损害（P〈0.01）。结论非痴呆型血管性认知功能损害的发生与血HCY、hs-CRP浓度及卒中部位有关。     

轻度血管性认知损害患者血浆同型半胱氨酸浓度变化的临床研究

目的探讨轻度血管性认知损害（mild vascular cognitive impairment,MVCI）与血浆同型半胱氨酸浓度间的关系。方法对46例MVCI患者及38例认知功能正常对照组的老年人进行血浆同型半胱氨酸（homocysteine,Hcy）测定,比较组间血浆Hcy浓度。结果MVCI组血浆总Hcy浓度（23.41±1.49μmol/L）显著高于对照组（17.01±2.48）μmol/L（t=14.61,P〈0.001）;结论增高的血浆Hcy浓度可能通过引起脑内小动脉硬化及神经细胞毒性作用而参与VMCI的患病。     

血浆同型半胱氨酸水平与血管性认知损害及海马体积的相关性研究

目的 探讨高同型半胱氨酸(Hcy)血症与海马体积及血管性认知功能损害的相关性.方法 采用病例对照研究,纳入脑梗死患者194例,所入选患者均测定血浆Hcy浓度,用脑磁共振三维测量方法测量海马体积,采用蒙特利尔认知评估量表(MoCA)进行认知测定,根据血浆Hcy水平分为正常Hcy组(血浆Hcy＜15 μmol/L,49例);Hcy轻度升高组(血浆Hcy 16～30μmol/L,78例);Hcy中重度升高组(血浆Hcy 31～100μmol/L,52例);Hcy重度升高组(Hcy＞ 100μmol/L,15例).结果 血浆Hcy不同水平组间认知功能MoCA总分差异有统计学意义(P＜0.05),血浆Hcy不同水平组间左、右侧海马体积差异有统计学意义(P＜0.05),血浆Hcy水平与认知功能MoCA总分呈负相关(r=-0.504,P＜0.05),血浆Hcy水平与左、右侧海马体积均呈负相关(r=-0.472,P＜0.05;r=-0.647,P＜0.05).左、右侧海马体积均与认知功能MoCA总分呈正相关(r=0.569,P＜0.05;r=0.671,P＜0.05).结论 高Hcy血症可能与脑梗死患者的海马体积缩小及认知损害相关.     

代谢综合征患者血浆同型半胱氨酸、内皮素与颈动脉内膜中层厚度的相关研究

目的探讨代谢综合征患者血浆同型半胱氨酸（HCY）、内皮素（ET）与颈动脉内膜中层厚度（IMT）的关系。方法选择代谢综合症征患者组52例,健康对照组32例,两组均测定血浆HCY和ET浓度,及颈动脉超声检测IMT。结果代谢综合征组血浆HCY浓度、ET浓度及IMT均高于对照组即（12.97±3.81）μmol/L对（7.81±2.86）μmol/L;（58.59±14.65）ng/L对（38.15±3.48）ng/L;（0.89±0.13）mm对（0.68±0.075）mm,差异有统计学意义（P均〈0.01）。代谢综合征IMT增厚组患者血浆HCY浓度、ET浓度明显高于代谢综合征IMT正常组患者即（13.70±3.73）μmol/L对（10.68±2.91）μmol/L;（60.62±13.54）ng/L对（44.52±11.01）ng/L;差异有统计学意义（P〈0.05,P〈0.01）。代谢综合征患者血浆HCY浓度IMT呈正相关（r=0.456,P〈0.05）;ET浓度与IMT呈正相关（r=0.431,P〈0.05）。结论代谢综合征患者存在颈动脉硬化,高同型半胱氨酸血症及内皮功能损害与其有一定的相关性。     

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.     

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…     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.