银翘散加减治疗小儿多发性抽动症的临床研究

目的：观察银翘散加减对小儿多发性抽动症的疗效,并分析其作用机制。方法选取2013年6月至2015年7月我院收治的小儿多发性抽动症患儿64例为研究对象,采用随机数字表法分为观察组和对照组各32例,对照组给予西药氟哌啶醇治疗,观察组在此基础上加用银翘散,均治疗3个月。比较两组治疗有效率,应用美国耶路综合抽动严重程度量表（YGTSS）分析其抽动程度,采用原子吸收光谱仪分析两组血清微量元素铁（Fe）、锌（Zn）水平,同时以酶联免疫法（ELISA）检测血清免疫球蛋白（IgE）水平,并记录不良反应发生率。结果观察组治疗有效率93.7％明显高于对照组75.0％（P<0.05）;治疗后观察组运动性抽动评分、发声性抽动评分、YGTSS评分总分、IgE水平明显低于对照组（P<0.05）,观察组血清Fe、Zn水平较对照组高（P<0.05）;两组不良反应发生率比较无显著差异（P>0.05）。结论银翘散可能通过调节血清IgE及微量元素Fe、Zn水平有效治疗小儿多发性抽动症,且安全性高,值得在临床推广应用。     

自拟健脾熄风汤配合针刺治疗小儿多发性抽动症的疗效观察

【目的】观察自拟健脾熄风汤配合针刺治疗小儿多发性抽动症的临床疗效及安全性。【方法】将65例多发性抽动症患儿随机分为观察组33例和对照组32例。观察组给予自拟健脾熄风汤中药配方颗粒口服并配合针刺治疗(取穴:太冲、三阴交、足三里、神门、内关、合谷、百会、风池等),对照组给予口服盐酸硫必利片治疗。4周为1个疗程,连续治疗3个疗程。采用耶鲁抽动症整体严重程度量表(YGTSS)分别于治疗前和治疗4、8、12周后对2组患儿的运动性抽动、发声性抽动、综合损害及总评分等进行综合评分并评价临床疗效,同时观察2组患儿治疗过程中的不良反应及复发情况。【结果】(1)治疗4、8、12周后,观察组的总有效率分别为87.88%、93.94%、96.97%,对照组分别为90.63%、93.75%、93.75%。组间比较,治疗4周后,对照组疗效优于观察组(P0.05);治疗8周后,2组疗效相当(P0.05);治疗12周后,观察组疗效优于对照组(P0.05)。(2)治疗后,2组患儿运动性抽动、发声性抽动、损害性抽动等YGTSS量表各维度评分及总评分均较治疗前明显改善(P0.05),且观察组在治疗4、8、12周后各个时点对运动性抽动、发声性抽动、损害性抽动各维度评分及总评分的改善作用均优于对照组(P0.05或P0.01)。(3)观察组的副反应明显少于对照组,总复发率明显低于对照组,差异均有统计学意义(P0.05)。【结论】健脾熄风汤配合针刺治疗小儿多发性抽动症疗效显著,能明显改善患儿临床症状,且安全性更高,复发率更低。     

布地奈德气雾剂治疗咳嗽变异性哮喘疗效观察

目的 探讨布地奈德气雾剂治疗儿童咳嗽变性哮喘疗效及对血清IgE水平的影响.方法 88例咳嗽变异性哮喘患儿随机分为2组,给予支气管扩张、平喘及祛痰等常规治疗,对照组使用丙酸氟替卡松气雾剂,观察组使用布地奈德气雾剂,对比患儿治疗后临床效果,并观察治疗前后2组患儿血清IgE水平的变化.结果 观察组患儿治疗后总有效率为93.18％较对照组的77.27％总有效率明显升高,差异有统计学意义（P＜0.05）;2组患儿治疗前血清IgE水平无统计学差异（P＞0.05）,但观察组治疗后血清血清IgE水平明显低于对照组（P＜0.05）.结论 布地奈德气雾剂治疗儿童咳嗽变异性哮喘可有效抑制炎症反应,从而提高临床治疗效果.     

中西药结合治疗儿童过敏性鼻炎

目的 观察中西药结合对儿童过敏性鼻炎(AR)治疗效果及安全性.方法 60例过敏性鼻炎患儿依据治疗方案不同分为治疗组与对照组,各30例,对照组予布地奈德鼻喷雾剂(雷诺考特)喷鼻,治疗组在此基础上加辛芩颗粒口服治疗.对比2组临床疗效、不良反应及治疗前后血清免疫球蛋白E(IgE)、白细胞三烯E4(LTE4)水平变化.结果 治疗组总有效率93.3％,明显高于对照组70.0％ (P＜0.05);2组治疗后血清IgE、LTE4水平均较治疗前明显降低(P＜0.05),但治疗组较对照组更低(P＜0.05);2组治疗期间均未发生明显不良反应.结论 中西医结合治疗AR,能有效降低患儿血清IgE、LTE4水平,提高疗效,且无明显不良反应.     

小儿多发性抽动症肝风内动夹痰证的临床研究

目的评定理气健脾、熄风化痰法在治疗小儿多发性抽动症肝风内动夹痰证的有效性和安全性。方法将66例符合诊断标准的多发性抽动症患儿随机分为观察组和对照组,每组各33例。试验组采用理气健脾、熄风化痰法,给予止抽片治疗;对照组给予氟哌啶醇口服治疗。两组均以12周为1疗程,共2个疗程。随访病例以研究结束6个月为期。通过耶鲁综合抽动症严重程度量表（YGTSS）观察两组治疗前后总疗效、抽动分类疗效、远期疗效、中医证候改善、不良反应与安全性。结果①试验组和对照组总有效率分别为100%、93.9%,两组中医证候改善率分别为90.9%、84.8%,两组比较差异无统计学意义（P〉0.05）。随访后,两组总有效率分别为84.0%、38.1%,远期疗效比较差异有统计学意义（P〈0.05）。②试验组运动性抽动疗效优于对照组（P〈0.05）。两组发声性抽动疗效、总疗效差异无统计学意义（P〉0.05）。③试验组无不良反应,对照组有6例出现不良反应,不良反应发生率为18.2%,两组比较差异有统计学意义（P〈0.05）。表明了中医药在治疗该病方面具有显著优势和开发应用前景。结论理气健脾、熄风化痰法是治疗小儿多发性抽动症肝风内动夹痰证的有效方法 。     

除湿解毒汤治疗湿热型急性湿疹的疗效及对血清总IgE水平的影响

目的 观察除湿解毒汤治疗湿热型急性湿疹的临床疗效及患者治疗前后血清总IgE水平的变化.方法 将150例湿热型急性湿疹患者分为治疗组(77例)和对照组(73例),治疗组以中药除湿解毒汤每日1剂,早晚水煎服;对照组给予氯雷他啶胶囊10 mg,1次/d,2组外治均用马齿苋水煎进行中药塌渍,外涂益康唑/曲胺奈德(T)乳膏.2周为1个疗程,1个疗程结束后统计积分,最后进行疗效评价,检测治疗前后血清总IgE水平.结果 治疗组治疗总有效率为100.00%,而对照组治疗总有效率为90.41%,2组比较差异有统计学意义(P<0.01).治疗组治疗前患者血清IgE水平较正常值升高(P＜0.01),2组治疗后血清总IgE水平均较治疗前明显下降,差异有统计学意义(P均＜0.01).结论 除湿解毒汤治疗湿热型急性湿疹有显著疗效,并能有效降低血清总IgE水平.     

疏肝活络养阴法治疗儿童多发性抽动症54例临床观察

目的：比较中药疏肝活络养阴法和氟哌啶醇治疗儿童多发性抽动症的临床疗效。方法：将108例儿童多发性抽动症患儿随机分为中药治疗组54例和西药对照组54例,中药治疗组每次50~100ml,1日3次,每日1剂：西药对照组口服氟哌啶醇冶疗,2组均治疗8周。按照耶鲁综合抽动严重程度量表（YGTSS）标准进行疗效评价,并观察治疗前后疗效及。结果：两组治疗前后自身对照YGTSS评分比较差异有统计学意义（P〈0．05）,组间比较差异无统计学意义（P〉0．05）。两组疗前疗后用尼莫地平法评分,中药治疗组总有效率为87．04％,西药对照组总有效率为83．33％,2组间疗效对比差异无统计学意义（P〉0．05）。结论：中药疏肝活络养阴法治疗儿童多发性抽动症较之西药氟哌啶醇可取得相当的临床疗效,鉴于西药氟哌啶醇副作用较大,笔者建议可在临床上使用中药疏肝活络养阴法治疗本病。     

左乙拉西坦治疗儿童多发性抽动症的临床分析

目的研究左乙拉西坦治疗儿童多发性抽动症的临床效果。方法选取80例多发性抽动症患儿作为研究对象,采用随机数字法分为对照组和观察组,各40例。对照组给予氟哌啶醇治疗,观察组则给予左乙拉西坦。观察对比2组治疗前后运动抽动YGTSS(耶鲁综合抽动严重程度量表)评分、治疗前后发声抽动YGTSS评分及不良反应发生率。结果 2组治疗前运动抽动YGTSS评分及发声抽动YGTSS评分无明显差异(P0.05),治疗后第6周、第10周评分有明显差异,且观察组低于对照组;观察组不良反应发生率2例(5.00%)低于对照组12例(30.00%),差异具有统计学意义(P0.05)。结论在治疗儿童多发性抽动症中附加左乙拉西坦临床效果显著,可有效改善患者身体状态,并降低不良反应发生率。     

清肝达郁汤合平搐膏治疗儿童多发性抽动症30例

目的观察中药清肝达郁汤配合平搐膏贴敷治疗儿童多发性抽动症临床疗效。方法选取我院60例多发性抽动症患儿,按随机数字表法分为治疗组和对照组各30例。治疗组口服中药清肝达郁汤并配合平搐膏贴敷涌泉穴,对照组单纯口服中药。观察2组疗效、中医各症候疗效以及抽动治疗起效时间。结果治疗组总有效率为96.6%,对照组为80.0%,2组比较,P<0.05;治疗组烦躁易怒、夜寐不安、面红而赤的各症候疗效均优于对照组（P<0.05）;治疗组抽动治疗起效时间为（9.14±1.95）d,优于对照组的（18.75±5.44）d（P<0.05）。结论中药清肝达郁汤配合平搐膏贴敷治疗儿童多发性抽动症疗效优于单纯口服中药治疗。     

痛泻宁颗粒联合美沙拉秦口服治疗溃疡性结肠炎的疗效观察

目的：观察痛泻宁颗粒联合美沙拉秦颗粒治疗轻度、中度溃疡性结肠炎（U C ）的临床疗效。方法选择380例内镜检查临床确诊的轻度、中度U C患者,将其分为观察组（190例）与对照组（190例）。观察组给予痛泻宁颗粒联合美沙拉秦颗粒口服治疗,对照组予美沙拉秦颗粒口服治疗,疗程均为8周。分别统计两组的总有效率,并测定两组患者治疗前、后血清基质金属蛋白酶‐2（MMP‐2）与基质金属蛋白酶‐9（MMP‐9）水平,免疫组织化学SP法检测肠道标本S100钙结合蛋白A12（S100A12）及晚期糖基化终末产物受体（RAGE）的表达。结果观察组总有效率为94．74％,对照组为89．47％,差异有统计学意义（P＜0．01）;治疗后,两组MMP‐2、MMP‐9表达水平均降低,且观察组低于对照组,差异有统计学意义（P＜0．01）。治疗后,观察组RAGE及S100A12表达水平降低,与对照组比较差异有统计学意义（P＜0．01）。结论痛泻宁颗粒联合美沙拉秦颗粒口服治疗轻度、中度UC较单用美沙拉秦颗粒口服能更好地改善患者的临床症状,具有更好的临床疗效。     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

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.