食管癌高发区青年和中老年患者ER、PR表达的对比研究

目的探讨食管癌高发区青年和中老年患者ER、PR表达的变化特征。方法采用免疫组织化学（ABC）法，检测142例高发区青年（72例）与中老年（70例）食管癌患者手术切除标本ER和PR表达变化。结果≤40岁、40～60岁、〉60岁三组ER的免疫阳性表达率分别为51％、47％、33％，阳性率随年龄增大而递减（P〈0．05）；PR在三组不同年龄段的表达率分别为15％、40％、29％，中老年患者PR阳性率显著高于青年患者。40～60岁、〉60岁两组患者ER主要定位于细胞核，≤40岁组ER主要定位于细胞浆。男、女性食管癌患者ER表达率分别为40％、53％，女性高于男性，但差异无统计学意义（P〉0．05）；男女性食管癌组织PR表达率分别为37％、41％，但差异无统计学意义（P〉0．05）。结论高发区青年患者与中老年患者食管癌组织中性激素受体在细胞分布（青年患者以细胞浆为主，中老年患者以细胞核为主）和阳性率（青年患者〉中老年）的差异，提示性激素的变化可能是食管癌变的重要机制，并与食管癌的年龄分布有关。     

老年社区获得性肺炎130例临床分析

目的讨论老年社区获得性肺炎（CAP）患者的临床特点,为老年性肺炎的诊治提供参考。方法回顾性分析成人CAP 190例患者的临床资料,比较老年CAP患者（年龄≥60岁）与非老年CAP患者（年龄〈60岁）的临床特征。结果老年CAP患者合并基础疾病占的比率达75．38％,住院死亡率达10％,临床表现不典型占的比率达43．6％,与非老年患者比较差异有统计学意义（P〈0．05）。结论老年人CAP患者合并基础病多,临床表现不典型,预后差,死亡率高,应及早发现及积极治疗。     

河南食管癌高发区青年与中老年食管癌组织中P53蛋白和Rb蛋白表达

目的：探讨食管癌高发区河南省林州市青年（≤40岁）与中老年（≥50岁）食管癌患者的分子学变化特征及其意义。方法：青年食管癌患者43例，中老年食管癌患者73例，采用免疫组化卵白素－生物素－过氧化物酶复合物（ABC）法和组织病理学方法，分析食管鳞癌组织中P53和Rb蛋白的表达状况与病变程度和年龄差异之间的关系。结果：青年食管癌患者食管癌组织P53阳性率（10／43，23％）明显低于同一地区中老年患者（62／73，85％）（P＜0．001）。青年患者Rb变化阳性率（15／43，35％）亦低于中老年患者（38／73，52％），但差异无统计学意义（P＞0．05）。结论：结果提示食管癌高发区河南林州青年食管癌患者可能存在不同于中老年患者的分子发病机制。     

层粘连蛋白及其受体67KDLn-R在直肠癌中的表达及意义

目的探讨直肠癌中层粘连蛋白（laminin，Ln）及其受体（Lamininreceptor，Ln-R）表达的特征及与直肠癌临床病理参数的关系。方法应用免疫组化法检测68例直肠癌、20例正常直肠组织的Ln和67KDLn-R蛋白表达。结果Ln的表达在直肠癌的阳性率为60．3％，明显高于直肠正常组织的0％（P〈0．05）。Ln表达与浸润深度及分化程度密切相关（P〈0．05）。Ln在基膜和胞浆同时表达的患者中，有无淋巴结转移者，二者差异无统计学意义（P〉0．05）。在直肠癌中67KDLn．R表达阳性率为47．06％，明显高于直肠正常组织的5％（P〈0．05）。67KDLn-R在浸润深度及分化程度组中的表达上差异有统计学意义（P〈0．05）。结论Ln、67KDLn-R的表达与肿瘤良恶性有关，与直肠癌的分化程度、浸润深度相关，且Ln、67KDLn-R表达的阳性率随肿瘤分化程度的降低、浸润深度的增加而增高。     

活动性肝炎肝硬化349例临床特点

目的研究活动性肝炎肝硬化患者的临床特点。方法该科收治的活动性肝炎肝硬化患者349例,分析其年龄、性别与发病的关系,研究不同性别及老年、非老年患者常见并发症、合并症的差异。结果349例活动性肝炎肝硬化男性高发年龄为40～60岁,占男性患者的70.5％,女性高发年龄为50～70岁,占女性患者的71．6％;50岁以上女性患者构成比明显高于男性（80．3％：60．8％,P〈0．01）;并发原发性肝癌与合并酒精性肝病者男性多于女性（分别为12．6％、4．2％,P〈0．05）;老年活动性肝炎肝硬化患者构成比女性高于男性（分别为24．0％、14．2％,P〈0．05）;合并酒精性肝病者老年低于非老年患者（分别为4．2％、12．3％,P〈0．05）;合并心脑血管病、2型糖尿病和重叠其他肝炎病毒感染者老年明显多于非老年（分别为13.5％、1．2％,P〈0．001;18.8％、7．9％,P〈0.01;18．8％、5．1％,P〈0．001）。结论活动性肝炎肝硬化患者的高发年龄、原发性肝细胞癌和酒精性肝病的发生率有明显的性别差异,老年活动性肝炎肝硬化合并心脑血管疾病、2型糖尿病和重叠感染的发病率与非老年相比显著不同。     

40岁以下青年人直肠癌临床病理特征及预后

目的探讨〈40岁青年人直肠癌的临床病理特征及预后。方法将1995年1月～2001年12月收治并有完整手术资料的568例直肠癌病人分为两组：〈40岁（青年组，109例），≥40岁组（中老年组，459例），对这两组病例，临床病理及随访资料进行回顾性分析比较。结果两组的家族史、误诊率、组织类型、分化程度、分期、淋巴结转移及侵袭深度等有明显差异（P〈0．05），而在部位、大体类型上无明显差异（P〉0.05）。两组5a生存率分别为34％、66％，有明显差异（P〈0．0001）。结论青年人直肠癌在临床病理特征及预后上与中老年人有着明显不同的特征，要提高对青年直肠癌的认识，做到早发现、早诊断、早治疗。     

老年冠心病冠状动脉造影临床分析

目的：探讨老年冠心病患者的危险因素及冠状动脉造影临床特点。方法：对65例老年（〉60岁）和51例中青年（〈40岁）冠心病住院患者的临床和冠状动脉造影资料进行回顾性分析和比较。结果：危险因素中老年组高血压明显高于中青年组（P〈0．01）;但中青年组家族史和吸烟因素均明显高于老年组（P〈0．05或P〈0．01）;两组高血脂症、糖尿病因素均无显著性差异（P〉0．05）。老年组病变血管的支数以双支和多支病变为主（75．4％）,中青年组以单支病变为主（66．7％）。老年组病变血管狭窄程度以中、重度为主,共占92．3％,而中青年组占60．8％,两组比较有显著性差异（P〈0．05）。老年组阳性率为93．8％,中青年阳性率仅为70．6％,两组阳性率比较,有显著性差异（P〈0．05）。结论：高血压、高血脂症、糖尿病是老年冠心病患者的危险因素,其冠脉病变以双支、多支、中重度病变多见。     

青年直肠癌的临床特征及预后因素分析

目的：探讨青年直肠癌患者临床、病理特点及预后相关因素,以提高其诊断水平和治疗效果。方法：回顾性对比分析47 例青年直肠癌（≤40岁）与99 例老年直肠癌（≥65岁）患者在临床、病理特征及预后等方面的差异,进而总结青年直肠癌的特点。结果：青年组平均病程为6.98个月,短于老年组(9.16个月)。青年组直肠癌的误诊率达61.70％,明显高于老年组(28.28％)（P<0.05）。青、老年两组肿瘤距肛缘的平均距离分别为6.94和7.01 cm,两组比较差异无显著性。青年组分化差的癌占52.18%,发生淋巴结转移的占52.17％,高于老年组(30.52%和23.16%)（P<0.05）。青年组术前并发症和术后并发症的发生率分别为31.92％和34.04％,显著低于老年组(81.82%和55.56%)（P<0.05）。青、老年两组直肠癌的累计5年生存率分别为45.7%和56.2%,两组比较差异无显著性。结论：青年直肠癌病程短、误诊率高、分化差、易发生淋巴结转移、病理分期晚,但两组的累计5年生存率有相接近的趋势;肿瘤浸润深度和淋巴结转移是影响预后的重要因素,加强早期诊断和科学、规范的治疗有望进一步改善青年直肠癌的预后。     

青年及老年原发性肝癌的临床分析

目的：探讨青年及老年人原发性肝癌的临床特点。方法：对95例年龄≤39岁的青年肝癌和112例年龄≥60例的老年肝癌忠者进行临床分析。结果：（1）青年组HBV感染率为92．63％，其中HBsAg( )为84．21％，明显高于老年组的62．60％，P＜0．01。（2）青年组合并肝硬化者达72．63％，高于老年组的54．46％，P＜0．01。（3）青年组肝区疼痛症状明显高于老年组，前者以弥散型和巨块型多见，而后者则以单个局限为主。（4）青年组甲胎蛋白[AFP( )]为67．37％，老年组为46．63％，P＜0．05。（5）老年组AKP、γ－GT明显高于青年组，心脑血管合并症亦多于青年组，P＜0．01。结论：青年肝硬化患者是原发性肝癌最重要的高危因素，应对这些患者长期追踪观察以早期发现和诊断。老年肝病患者AFP阳性率低，当其出现AKP、γ－GT值升高时，应高度警惕肝癌。     

青年与老年大肠癌患者的内镜及病理特征探讨

目的：探讨青年大肠癌与老年大肠癌在内镜和病理 的特点及差异，方法：比较34例青年大肠癌（小于等于30岁）和37例老年大肠癌（大于等于60岁）在肿瘤部位，大小，生长方式，内镜分型及组织学类型间的对应关系，并经过统计学处理，了解二组患者的内镜及病理结果差异。结果：青年大肠癌多 见于直肠（27／34例），以浸润型为主(20/34),枘镜分型以Bormann分类法III，IV型为主，组织学分型以分化差的粘液癌（0上液腺癌及印戒细胞癌）最多见（22／34）；对此对照，老年大肠癌仍以直肠多见20／37例），但与青年大肠癌比较，明显减少（P＜0．05），老年大肠癌以大癌灶型（＞4cm)和小癌灶型（＜4cm)为主（分别为14例／37例，16／37例），而浸润型少见（7／37例）。从Bormann法内镜分型看，老年大肠癌以隆起型为主（＜18／37例），病理学活检大多分化良好。乳头状腺癌及高分化管状腺癌，分别为11／37例，13例／37例，上述各项指标与青年组比较均有显著差别。结论：青年大肠癌好发于直肠，具有由远端向近端逐渐减少的特点，以浸润性生长为主，分化程度低，预后不佳；老年大肠癌随年龄增长，具有由远端向近端逐渐增多的趋势，以息肉样生长为主，分化较高，预后较青年大肠癌为好。     

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.