HIV/AIDS孕妇经HAART后不同分娩方式对母婴传播的影响

目的 探讨HIV/AIDS孕妇经规范抗病毒治疗后不同分娩方式对婴儿传播的影响. 方法 对孕期已进行高效抗反转录病毒药物治疗( HAART)的HIV/AIDS孕妇入院后无剖宫产指征者100例行阴道分娩,有剖宫产指征者100例行剖宫产,两组婴儿均早期抗病毒治疗及行人工喂养. 婴儿出生后 12 个月、18 个月检测 HIV 感染情况. 结果 100 例HIV/AIDS孕产妇阴道分娩者中, HIV阳性婴儿1例,阴性99例,100例剖宫产婴儿HIV均为阴性. 两组婴儿HIV感染率比较,差异无统计学意义( P>0.05). 结论 孕期行HAART,婴儿进行人工喂养,HIV/AIDS孕产妇经阴道分娩或剖宫产其母婴传播率无明显差异.     

艾滋病母婴阻断的临床观察

目的探讨艾滋病母婴阻断的临床特点及效果。方法选择本院2007年4月-2011年3月住院分娩的HIV阳性孕妇47例,自孕14周开始服用抗病毒药物,新生儿出生后服用抗病毒药物、人工喂养进行母婴阻断,分析临床疗效。结果 47例孕妇均坚持服用抗病毒药物,38例出现轻微胃肠道反应,6例出现贫血,2例出现肝肾功能损伤,1例出现药物过敏。新生儿采取顺产及剖宫产方式,全部顺利出生,均未早产,无身体畸形。出生后2个月进行HIV-DNA的PCR检测,1例为阳性,其余全部为阴性,阳性新生儿3个月再进行HIV-DNA的PCR检测时为阳性,阻断失败,阻断成功率为97.87%。结论对HIV阳性孕妇产前、产时、产后进行母婴阻断,能有效控制艾滋病病毒传播,临床疗效较好。     

孕产妇母婴阻断管理分析

目的探讨孕产妇母婴阻断管理方法。方法回顾性研究从2011年1月至2015年12月嵩明县预防艾滋病母婴传播工作报表中,艾滋病病毒感染孕产妇个案42例,总结管理方法。结果全县分娩22例感染产妇中,分娩地点均在县级及以上助产机构,仅1例临产时县医院未及时报告而未阻断。结论在预防艾滋病母婴传播工作中,孕期检测十分重要,是提高HIV感染孕产妇抗病毒药物服用率、优选抗病毒方案实施最佳分娩方式,自愿选择妊娠结局等多项工作的基础。     

服用抗病毒药物预防艾滋病母婴传播的应用研究

目的对艾滋病病毒感染孕产妇采取服用抗逆转录病毒药物等干预措施,降低艾滋病母婴传播的发生率。方法按照全国预防艾滋病母婴传播的方案,2012年1月~2013年12月对来宾市81例感染艾滋病病毒产妇及其所生82例婴儿(双胞胎1例)按疗程给予足量的抗逆转录病毒药物。按照全国预防艾滋病母婴阻断技术方案要求在婴儿出生42d、12个月和18个月进行随访3次并进行艾滋病早期诊断抗体检测。结果 81例艾滋病病毒阳性孕产妇中74例按疗程服用抗逆转录病毒药物,服药率91.36%。82例艾滋病病毒阳性孕产妇所生婴儿按疗程服用抗逆转录病毒药物,服药率100%。对产后婴儿按照全国预防艾滋病母婴阻断技术方案要求在婴儿出生42d、12个月和18个月进行追踪随访并进行HIV抗体检测,共检出1例艾滋病抗体阳性婴儿,婴儿艾滋病抗体阳性率为1.22%,艾滋病母婴传播阻断效果显著。结论应用抗逆转录病毒药物对感染艾滋病病毒产妇及其所生婴儿进行艾滋病母婴阻断综合干预,对减少艾滋病母婴传播有重要意义。     

HIV阳性孕产妇分娩期护理干预效果评价

目的：探讨分娩期艾滋病病毒母婴传播的阻断措施以及相应的护理方法。方法：对11例感染艾滋病病毒孕产妇实施产前检测咨询、母婴药物阻断、分娩方式选择、产后人工喂养等阻断处理。结果：1例HIV阳性孕妇终止妊娠、5例孕妇及新生儿接受药物阻断治疗、7例采取人工喂养，剖宫产手术7例、阴道分娩4例。结论：正确规范实施HIV母婴阻断措施，可降低HIV母婴传播。     

联合用药阻断艾滋病母婴传播的效果及阻断药物对肝功能的影响

目的探讨药物及相关阻断措施对降低抗艾滋病病毒抗体阳性孕产妇母婴传播的疗效及阻断药物对肝功能的影响。方法经实验室快速检测初筛后经云南省疾控中心确诊为抗艾滋病病毒抗体阳性孕产妇31例,其中28例联合用药,选择剖宫产,婴儿出生后72h内一次性服用NVP2mg/kg,最大剂量不超过6mg。结果对满3个月、6个月、12个月、18个月的25例婴儿和满3个月的3例幼儿追踪检测,无艾滋病病毒感染;12例3个月的婴儿转氨酶升高,6个月时转氨酶正常;9例孕产妇临产时转氨酶升高。结论孕产妇联合用药、新生儿出生后服艾滋病阻断药物奈韦拉平及采取婴儿人工喂养等干预措施能有效阻断艾滋病病毒母婴传播,阻断药对用药者的转氨酶有影响。     

奈韦拉平在艾滋病母婴阻断中的应用

目的观察奈韦拉平用于艾滋病母婴阻断治疗效果。方法单用奈韦拉平进行艾滋病母婴阻断。用法：母亲在产前2h服用奈韦拉平200mg，婴儿出生后，服用奈韦拉平6mg，如果母亲在服药后2h内分娩者，婴儿出生后服奈韦垃平6mg两次。结果通过118例临床观察，满18个月随访检测77例，75例全程检测为阴性，2例阳性，母婴阻断成功率97．4％，，结论通过自愿咨询、检测、阻断、临床观察证明奈韦拉平用于母婴阻断，临床效果好、价廉、服用方便、安全可靠、无毒副作用、不影响婴幼儿生长发育。     

2008-2010年贵州省黔南州27例感染艾滋病病毒孕产妇母婴阻断效果分析

目的分析贵州省黔南州预防艾滋病病毒母婴传播综合干预措施及母婴阻断效果,为进一步开展与推广感染艾滋病病毒孕产妇母婴阻断的预防工作提供参考.方法对2008-2010年我州三个艾滋病示范区通过自愿咨询检测发现的27例HIV感染孕产妇进行综合干预措施(人工终止妊娠或抗病毒治疗+住院分娩+人工喂养指导)资料进行回顾性分析.结果27例HIV阳性的孕产妇中有8例人工终止妊娠(29.63%),19例住院分娩(9例阴道分娩、10例剖腹产)所生儿童均采用人工喂养(国家项目补贴3000元/例奶粉),其中18例孕产妇及所生新生儿予抗病毒治疗,所生儿童有16例满12月龄或18月龄HIV抗体检测阴性,1例于2月龄因“腹泻”死亡,1例于1+月龄因意外窒息死亡,母婴阻断成功率达94.12%.1例孕产妇及所生新生儿拒绝抗病毒治疗(母亲已死亡,儿童送人失访).结论贵州省黔南州HIV感染孕产妇母婴传播的综合干预措施是有效的,通过对HIV抗体阳性的孕产妇做好围产期保健,实施综合性干预措施,可有效降低HIV母婴垂直传播的发生率,值得大力推广实施.     

艾滋病母婴阻断技术在广西少数民族地区的应用

目的探讨艾滋病母婴阻断技术在来宾地区婚检、产检人群的临床应用提供科学依据。方法利用免费婚检、免费产检平台对婚检、产检人群进行艾滋病（HIV）咨询检测筛查,找出艾滋病（HIV）感染者,对艾滋病（HIV）感染孕妇建议终止妊娠。坚持生育者对其及其所生婴儿进行母婴阻断干预,以避免艾滋病母婴传播发生。结果全市2011—2012年平均婚检率95．87％（90555／94454）、平均产检率98．99％（73591／74341）;婚检、产检人群二年内检出艾滋病（HIV）阳性291例,检出阳性率0．18％。其中检出艾滋病（HIV）阳性孕产妇103例,检出阳性率0．14％。103例孕产妇中,巳终止妊娠18例、分娩活产79例、死胎1例、仍在孕5例。分娩活产孕产妇服用抗病毒药物76例,服药率96．20％,婴儿服用抗病毒药物77例,婴儿系统管理服药率97．47％,死亡婴幼儿1例,失访2例,阳性孕产妇所生婴幼儿产时未检出（HIV）感染者。结论利用婚检、产检平台进行艾滋病咨询检测筛查,可以尽早发现艾滋病（HIV）感染者;对艾滋病（HIV）感染者建立档案并进行跟踪、开展婚育卫生指导、怀孕者建议终止妊娠,可避免艾滋病儿出生;坚持生育者进行艾滋病母婴阻断系统管理,对预防艾滋病母婴传播发生具有非常重要的意义。     

广西壮族自治区来宾市艾滋病母婴阻断项目效果评价

目的对艾滋病母婴阻断项目在广西来宾市的实施进行效果评估,为全市预防艾滋病母婴传播提供科学依据。方法在全市实施艾滋病母婴阻断技术,对凡参加孕检的孕产妇免费进行艾滋病咨询检测,对检出阳性者进行艾滋病母婴阻断(感染母亲及所生婴儿按艾滋病母婴阻断技术方案服用抗逆转录病毒药物、实行安全助产和人工喂养指导等)。结果 2010—2015年全市共有207 861例孕产妇参加艾滋病咨询检测,检测率99.17%(207 861/209 600),检出艾滋病抗体阳性325例,检出阳性率0.16%(325/207 861);对检出艾滋病抗体阳性的孕妇纳入艾滋病母婴阻断系统管理,通过卫生咨询指导,告知患者艾滋病的传播方式及其危害性、预防措施和伦理等知情选择,最后自愿选择终止妊娠87例,选择生育的238例;238例艾滋病抗体阳性者中有227例按艾滋病母婴阻断技术方案全程足量服用抗逆转录病毒药物,服药率95.38%(227/238);活产婴儿232例,按艾滋病母婴阻断技术方案全程足量服用抗逆转录病毒药物221例,服药率95.26%(221/232);而后按艾滋病母婴阻断技术方案对出生婴儿满42天和3个月进行艾滋病早期诊断,检出阳性1例,检出阳性率0.45%;最后对198例出生满18个月婴儿,进行艾滋病抗体检测,未捡出艾滋病抗体阳性者。结论孕产妇在进行正常孕产检时同时进行艾滋病咨询检测,对艾滋病的早期发现,可以取得事半功倍的效果;对检出艾滋病阳性孕妇及所生婴儿采取艾滋病母婴阻断综合性预防措施,是预防艾滋病母婴传播的有效方法。     

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.