流行性出血热实验病理研究

为探讨流行性出血热(EHF)感染动物是否发病,以及EHF的血管病理变化和出血机制,本文通过EHF—V感染沙鼠和黑线姬鼠实验,观察内脏器官的病理改变。人工感染后14天于颈动脉放血处死,取心、肺、脑、肾、肝、胃肠组织作免疫荧光检测以及光镜电镜观察。并与三例EHF死亡患者的尸检材料做了对比研究。结果表明:感染鼠可以发病。主要病理改变为肺、肾、脑、肝的间质血管和微血管内皮细胞肿胀、退变、坏死脱落,管壁弹力纤维和嗜银纤维断裂,基底膜裸露。尤以肺、肾间质血管损伤较明显,器官的实质细胞有不同程度的变性坏死,但鼠的病变较人的为轻,且心、胃肠无明显病变,说明EHF的出血与血管壁的损害有明显关系。     

流行性出血热微血管的免疫病理改变

对42例流行性出血热患者的皮疹血管和13例患者的肝脾肺肾微血管做了免疫病理观察。HE染色表明上述微血管内皮细胞肿胀、退变、坏死,基底膜破坏,管腔狭窄或闭塞,微静脉比微动脉重。42例皮疹中26例(92.3％)兔抗人C_3-HRP-SPA染色示皮疹血管内皮细胞和基底膜呈阳性,对照组阴性。肺肾血管抗IgG、IgM,IgA荧光抗体染色阳性,说明微血管病变与免疫复合物沉积有关。39例患者循环免疫复合物升高。上述结果表明其病理变化属于Ⅲ型变态反应。     

2型糖尿病血小板α颗粒膜蛋白测定的临床意义

以毛细血管增殖、基底膜增厚、微血栓形成为特点的微血管病变是糖尿病慢性并发症的基础病变,其发生机理涉及多种因素.研究认为,血小板活化与血管内皮细胞损伤是微血栓形成的始动环节,而血小板聚集功能亢进在微血管病变的整个病理过程中起重要作用.本组通过测定46例2型糖尿病患者的血小板α颗粒膜蛋白(GMP-140),探讨血小板活化在糖尿病微血管病变的早期诊断和病情分析中的临床意义.     

特发性血小板减少性紫癜1年后转变为血栓性血小板减少性紫癜1例

特发性血小板减少性紫癜( ITP)现称原发免疫性血小板减少症,与血栓性血小板减少性紫癜( TTP)均属于出血性疾病范畴,前者常见,后者少见.血栓性血小板减少性紫癜是以微血管病性溶血性贫血、血小板消耗性减少,以及广泛的微血栓形成造成器官损害为特征的一种弥漫性血栓性微血管病变,最先由Moschcowitz于1924年提出,...     

重型流行性出血热42例护理要点

流行性出血热(EHF)是由EHF病毒所引起的自然疫源性疾病。临床上以广泛的小血管和毛细血管损伤、多发性出血、严重的各组织器官水肿、血浆渗出、组织器官实质细胞凝固性坏死、广泛的微血栓形成为病理特征。在近几年的临床护理和观察中，我们体会到现在的EHF所表现的症状和体征都不象教科书上那样典型，各期的变化较为复杂，尤其是重型EHF更是如此。我院从1991-01/2000-08共收治重型EHF142例，现就护理要点介绍如下。     

1例血栓性血小板减少性紫癜患者的护理体会

血栓性血小板减少性紫癜（TTP）是以微血管内弥散性血小板血栓形成为特征的血栓性微血管病,临床以溶血性贫血、血小板减少、神经系统症状、发热和肾损害为主要特征。称为TTP五联征。本病的病因不明,可能与细菌、病毒感染、药物、妊娠、结缔组织病及恶性肿瘤等因素有关,本病起病急,发展迅速,临床上以10～40岁女性多见,其发病机制主要与各种病因损害微血管内皮细胞有关,以致内皮细胞抗血栓能力减低,     

血栓性血小板减少性紫癜的护理

血栓性血小板减少性紫癜（TTP）是一种体内广泛微血栓形成性疾病,病情发展迅速,病死率极高,其致命点在于微血管血小板血栓形成。临床上以血小板减少性紫癜、微血管病性贫血、神经精神症状、肾脏损害和发热典型五联征表现为特征。     

血栓性微血管病的研究进展

血栓性微血管病（thrombotic microangiopathy，TMA），共同的病理损害包括：血管壁增厚（主要为动脉和毛细血管）伴肿胀或内皮细胞从基底膜脱落，内皮下绒毛状物质沉积，血管腔血小板栓塞或完全堵塞。几乎所有患者存在血小板减少和溶血性贫血，是一组急性临床病理综合征，主要特征是微血管病性溶血性贫血、血小板下降以及微血管内血栓形成。     

2型糖尿病患者微血管病变与血小板参数关系初探

众所周知,糖尿病(DM)已日渐成为1种常见病〔1〕,严重影响人们的健康。微血管病变是2型DM患者的重要并发症之一,DM微血管病变与患者体内的血栓前状态、血管内皮细胞损伤、血小板(PLT)黏附、聚集和释放等活化功能及抗凝功能减退等因素有密切关系〔2〕。PLT在血栓形成过程中起着关键作用。近年来的研究表明,2型DM患者血小板平均体积(MPV)增大,在2型DM微血管病变的发生和发展过程中起着重要作用。本文测定270例2型DM患者外周血PLT及其参数-平均血小板容积(MPV)、血小板分布宽度(PDW)等的改变,探讨其在2型DM微血管病变早期诊断和病…     

血栓性微血管病的发病机制和诊治

血栓性微血管病（thrombotic microangiopathy,TMA）是一组以微血管性溶血性贫血、血小板减少、微循环中血小板血栓造成的器官受累为主要表现的急性临床综合征。其病理特点为小血管内皮细胞肿胀、管腔狭窄,部分小血管内可见血栓形成。     

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.