不同剂量瑞舒伐他汀对老年高血压并射血分数保留型慢性心力衰竭患者心室重构的影响

目的:探讨不同剂量的瑞舒伐他汀对老年高血压并射血分数保留型慢性心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者心室重构的影响。方法:选择老年高血压并HFpEF患者128例,按照数字表法随机分为2组,在常规心力衰竭治疗的基础上,2组均给予瑞舒伐他汀晚上顿服,低剂量组(64例,10 mg/d)和高剂量组(64例,20 mg/d),2组疗程均为6个月。治疗前及治疗6个月后监测患者的左室重构相关指标[左室舒张末期后壁厚度(left ventricular end-diastolic posterior wall thickness,LVPWT)、舒张末期室间隔厚度(interventricular septum thickness,IVST)、左室质量指数(left ventricular mass index,LVMI)]、左室舒张功能相关指标[左室等容舒张时间(isovolumetric relaxation time,IVRT)、E峰减速时间(deceleration time,DT)、左房容积指数(left atr...     

重组人脑利钠肽联合左西孟旦治疗脓毒症心力衰竭的效果观察

目的 探讨重组人脑利钠肽(recombinant human brain natriuretic peptide, rh-BNP)联合左西孟旦治疗脓毒症心力衰竭的疗效及安全性,分析其对患者外周血miR-132、miR-31水平的影响。方法 选择2017年3月—2019年6月杭州师范大学附属医院收治的脓毒症并发心力衰竭患者117例,采用随机数字表法分为观察组(61例)和对照组(56例),对照组采用左西孟旦治疗,观察组采用左西孟旦联合rh-BNP治疗。比较2组急性生理与慢性健康评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、心功能指标[左室收缩末期内径(left ventricular end systolic diameter, LVESD)、左室舒张末期内径(left ventricular end diastolic diameter, LVEDD)、左室射血分数(left ventricular ejection fraction, LVEF)、左心室短轴缩短率(left ventricular fractio...     

尼可地尔治疗冠心病心绞痛的疗效及对患者左心室功能和斑块稳定性的影响

目的 探究在冠心病心绞痛患者的治疗中，应用尼可地尔对患者左心室功能以及斑块稳定性的影响。方法 选取2020年11月～2021年11月来本院进行治疗的冠心病心绞痛患者96例为研究对象，随机分为2组，每组48例。常规组采用常规治疗方式，实验组在常规治疗的基础上结合尼可地尔治疗，比较两组患者经过治疗后的左室射血分数(left ventricular ejection fraction, LVEF)、左室舒张末内径(left ventricular end diastolic diameter, LVEDD)、左室收缩末期内径(left ventricular end systolic diameter, LVESD)以及脂蛋白相关磷脂酶A2(lipoprotein related phospholipase A2,Lp-PLA2)水平。结果 实验组患者经过治疗后LVEF、LVEDD、LVESD以及Lp-PLA2等各项指标明显优于常规组，差异有统计学意义(P<0.05);实验组患者临床治疗疗效优于常规组，差异有统计学意义(P<0.05);实验组患者SQA评分优于常规组，差异有统计学...     

左室射血分数保留的心力衰竭应用美托洛尔缓释片治疗的疗效分析

目的分析在左室射血分数保留的心力衰竭（HFpEF）治疗中美托洛尔缓释片的疗效。方法将48例,HfpEF患者分成两组,均行抗心力衰竭常规治疗,对照组不使用β-受体阻滞剂,观察组使用美托洛尔缓释片,记录两组心率和心超左室舒张功能及血压变化。结果观察组左室射血分数明显升高,左室舒张压、收缩压降低,末期内径缩小,心率下降（P〈O.05）。结论美托洛尔缓释片对HFpEF疗效明显。     

心可舒片改善射血分数保留心力衰竭大鼠心脏功能及其作用机制探讨

目的 观察心可舒片对射血分数保留心力衰竭(Heart failure with preserved ejection fraction, HFpEF)大鼠心脏结构和功能的影响。方法 将30只自发性高血压大鼠(Spontaneous hypertension rat, SHR)分为SHR组、HFpEF组、心可舒组(334.8 mg/kg),10只Wistar-Kyoto(WKY)大鼠为对照组。心可舒组给予相应药物灌胃,其余组给予等量生理盐水,连续4周。测量血压和心脏重量指数(Heart mass index, HMI);超声心动图检测大鼠左心房内径(Left atrial diameter, LAD)、室间隔厚度(Interventricular septal thickness, IVST)、左室舒张末期内径(Left ventricular end diastolic diameter, LVEDd)、左室舒张末期后壁厚度(Left ventricular posterior wall thickness, LVPWd)、E/A、E/E′等容舒张时间(Isovolumic relax...     

达格列净治疗急性心肌梗死合并心力衰竭的疗效研究

目的 探讨联合达格列净治疗急性心肌梗死(acute myocardial infarction,AMI)合并心力衰竭患者的疗效及安全性。方法 选取2021年5月至2022年5月于浙江大学医学院附属金华医院住院的AMI合并心力衰竭患者80例,根据随机数字表法将患者分为达格列净组和对照组,每组各40例。比较两组患者治疗前后脑钠肽(brain natriuretic peptide,BNP)水平、心脏结构和功能指标,随访6个月,观察两组患者的心血管不良事件及达格列净不良反应发生情况。结果 治疗后,两组患者的BNP、左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricularend systolic diameter,LVESD)均显著低于本组治疗前,左室射血分数(left ventricular ejection fraction,LVEF)、左心室短轴缩短率(left ventricular fractional shortening,LVFS)均显著高于本组治疗前(P<0.05...     

左室射血分数保留的慢性心力衰竭患者心脏超声特点

目的探讨左室射血分数保留(heart failure with preserved ejection fraction,HFPEF)的慢性心力衰竭(chronic heart failure,CHF)患者的心脏超声特点。方法将CHF患者根据左室射血分数(left ventricular ejection fraction,LVEF)分为LVEF≥50%的HFPEF组,即研究组(33例),LVEF<50%的LVEF下降组,即对照组(61例)。对两组的年龄、性别、血浆钠尿肽(brain natriuretic peptide,BNP)、左室舒张末期内径(left ventricular end diastolic diameter,LVEDd)、左室后壁厚度(left ventricular posterior wall thickness,LVPWT)、室间隔厚度(inter-ventricular septal thickness,IVS)等资料进行对比分析。结果研究组LVEDd小于对照组,LVEF高于对照组,BNP低于对照组,LVPWT大于对照组。结论 HFPEF的CHF患者与左室射血分数下降的CHF患者相比,主要表现为左室肥厚突出,左室扩大较轻,BNP升高相对不显著,心力衰竭程度相对较轻。     

心力衰竭患者β1肾上腺素受体多态性对美托洛尔治疗的影响

目的探讨慢性心力衰竭(chronic heart failure,CHF)患者使用美托洛尔治疗前后心脏结构和心脏功能的变化情况与β1肾上腺素受体(β1-AR)基因多态性的关系。方法对于病情稳定的40例慢性心力衰竭患者在常规治疗基础上加用倍他乐克,从小剂量开始逐渐增至目标剂量或最大耐受剂量,维持两个月。治疗前后测定各项临床指标心率、血压、左房内径、左室舒张末内径(left ventricle end diastolic diameter,LVEDd)、左室收缩末内径(left ven-tricle systolic diameter,LVESd)、射血分数(left ventricular ejection fraction,LVEF)及6min行走距离(6 minute walk-ing test,6-MWT)。应用聚合酶链反应和限制性内切酶片段长度多态性技术(restriction fragment Length polymor-phism,RFLP)检测Arg389Gly和Ser 49 Gly两个β1肾上腺素受体单核苷酸多态性(single nucleotide polymorphisms,SNP)。结果美托洛尔治疗后,40例慢性心力衰竭患者心脏结构、心功能和运动耐量有明显改善(P<0.01)。AA组基因型和AG组基因型患者ΔLVEF分别为(4.23±3.13)和(1.89±2.40),前者约为后者的2倍。SR/GR组ΔLVEF(7.13±2.36)和Δ6-MWT(17.25±2.91)与其他三组患者相比明显改善(P<0.05)。而SR/SG组这两个指标比其他三组改善差。结论本研究显示β1肾上腺素受体多态性是影响美托洛尔治疗心力衰竭疗效的重要因素。本研究显示β1肾上腺素受体多态性是影响美托洛尔治疗心力衰竭疗效的重要因素。     

二尖瓣置换术中保留瓣下结构对心功能的影响

目的:探讨二尖瓣置换术术中保留二尖瓣瓣下结构对心功能恢复的影响及预后.方法:分析2016年3月至2019年9月在重庆医科大学第一附属医院行二尖瓣置换术的92例患者.其中保留二尖瓣后瓣及瓣下结构有48例(试验组),其余44例患者行传统二尖瓣置换术(对照组).分析试验组与对照组(包括组内与组间)术前、术后7d、术后3个月、术后6个月的心脏彩色多普勒检查情况,分析试验组与对照组围手术期情况及术后心功能恢复情况.结果:试验组术后血管活性药物运用时间[(4.25±1.19)d]明显短于对照组[(5.64±1.63) d](P＜0.05),试验组并发症发生率(8.34％)明显低于对照组(25.00％) (P=-0.031).术后6个月,试验组左心房内径(left atrial diameter,LAD)[(32.64±3.76) mm]、左室舒张末期内径(left ventricular end diastolic diameter,LVEDD)[(43.60±3.68) mm]、左室收缩末期内径(left ventricular end systolic diameter,LVESD)[(31.81±4.73) mm]均明显低于对照组,试验组左室射血分数(left ventricular ejection fraction,LVEF) (64.86±4.23)％、左室短轴缩短率(left ventricular fraction shortening,LVFS)[(36.04±2.90)％]均明显高于对照组(P＜0.05).结论:二尖瓣置换术中保留二尖瓣瓣下结构有助于术后心功能的恢复和短期改善左心功能.     

阻塞性睡眠呼吸暂停低通气综合征患者颈动脉内膜中膜厚度与左心结构功能的相关性研究

目的 分析阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)患者左心结构功能变化及其与颈动脉内膜中膜厚度(carotid intima-media thickness, CIMT)相关性。方法 选取OSAHS患者90例,根据呼吸暂停低通气指数分为轻度组28例,中度组36例,重度组26例。比较3组一般资料、左心结构功能指标[左心室收缩末期内径(left ventricular end-systolic diameter, LVESD)、左室舒张末期内径(left ventricular end-diastolic diameter(LVEDD)、左心室后壁厚度(left ventricular posterior wall thickness, LVPWT)、室间隔厚度(interventricular septal thickness, IVST)、左心室质量指数(left ventricular mass index, LVMI)、左心室射血分数(left ventricular ejection fra...     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.