高压氧对大鼠血脑屏障通透性影响的实验研究

目的探讨高压氧对大鼠脑脊液中丙戊酸钠浓度的影响及其可能的机制。方法 32只SD雄性大鼠,随机分为4组,每组8只,分别为对照组(注射丙戊酸钠)、HBO-1组(高压氧治疗1 h结束后0.5 h注射丙戊酸钠)、HBO-2组(注射丙戊酸钠后立即高压氧治疗1 h),HBO-3组(注射丙戊酸钠0.5 h后高压氧治疗1 h),各组皆在丙戊酸钠注射后1.5 h取血液及脑脊液并测其浓度。4组大鼠,正常喂养一周后,以2%伊文思蓝注射液代替丙戊酸钠注射液,高压氧处理同前,各组皆在伊文思蓝注射后1.5 h取大鼠脑组织,在紫外分光光度计上测定吸光度值和含量。结果经LSD检验,与对照组相比,HBO-1组脑脊液丙戊酸钠和伊文思蓝浓度无显著性差异(P>0.05);HBO-2组、HBO-3组脑脊液丙戊酸钠和伊文思蓝浓度均明显增加(P<0.05),有显著性差异;各组血液浓度无显著性差异。结论高压氧有暂时性开放血脑屏障的作用,可以提高丙戊酸钠脑脊液浓度。     

阿立哌唑联合丙戊酸钠治疗双相障碍躁狂发作的疗效观察

目的：研究阿立哌唑联合丙戊酸钠治疗双相障碍躁狂发作的临床疗效。方法：将68例双相障碍躁狂发作患者根据随机数字表法分为两组,观察组（34例）患者采用阿立哌唑联合丙戊酸钠治疗,对照组（34例）患者接受奎硫平联合丙戊酸钠治疗。结果：治疗后两组BRMS分值与治疗前比较均明显下降（P〈0．05）;观察组从第2周开始BRMS分值下降快于对照组,组间比较差异有统计学意义（P〈0．05）;第8周末观察组总有效率为91．18％,对照组总有效率为88．24％（P〉0．05）;两组不良反应比较差异无统计学意义（P〉0．05）。结论：阿立哌唑联合丙戊酸钠治疗双相情感障碍躁狂发作与奎硫平联合丙戊酸钠疗效相同,但起效更快。     

脑脊液乳酸脱氢酶检测在脑膜炎诊断中的临床意义

目的探讨脑脊液乳酸脱氢酶（LDH）检测在鉴别细菌性脑膜炎和病毒性脑膜炎的临床应用价值。方法采用速率法检测48例细菌性脑膜炎、45例病毒性脑膜炎以及对照组40例脑脊液LDH和血清LDH的浓度。结果细菌性脑膜炎患者LDH浓度明显高于病毒性脑膜炎患者以及正常对照组（P〈0．05）;而病毒性脑膜炎患者脑脊液LDH浓度与对照组相比差异无统计学意义（P〉0．05）。细菌性脑膜炎血清LDH与病毒性脑膜炎比较差异无统计学意义（P〉0．05）。结论脑脊液LDH检测可作为细菌性脑膜炎和病毒性脑膜炎的鉴别诊断,对于临床药物的选择具有重要的指导意义。     

卡马西平与丙戊酸钠缓释片治疗脑炎后癫痫的疗效观察

目的：观察应用卡马西平与丙戊酸钠缓释片治疗脑炎后癫痫的临床疗效。方法从我院2013年1月至2014年6月收治的脑炎后癫痫患者中随机抽取78例作为本次研究对象,分为三组,卡马西平组、丙戊酸钠组及联合组,分析三组治疗疗效。结果治疗后,三组不良反应发生率比较无明显差异（P＞0．05）;且卡马西平组、丙戊酸钠组总有效率比较无明显差异（P＞0．05）;但联合组总有效率明显高于卡马西平组、丙戊酸钠组,组间比较差异有统计学的意义（P＜0．05）。结论卡马西平与丙戊酸钠缓释片用于治疗脑炎后癫痫的疗效相当,但两药联合的疗效更为显著,安全性高,值得在临床上推广应用。     

阿立哌唑与丙戊酸钠缓释片治疗双相障碍躁狂发作的临床效果比较

目的探讨双相障碍躁狂发作的患者给予阿立哌唑及丙戊酸钠后的治疗效果及安全性。方法收集来我院进行治疗的双相障碍躁狂发作的患者92例,随机分为两组。观察组（n=46）给予阿立哌唑进行治疗．对照组（n=46）给予丙戊酸钠缓释片进行治疗,比较两组患者治疗结束后CGI—S—BP及YMRS评分、疗效及不良反应发生情况。结果④对照组和观察组患者的治疗时间越长,其CGI—S—BP及YMRS评分越低,治疗后与治疗前比较差异具有统计学意义（P〈0．05）。两组治疗后前两周评分差异具有统计学意义（P〈0．05）,而在治疗的后两周无统计学意义（P〉0．05）。②观察组治疗有效率及痊愈率与对照组比较无统计学意义（P〉0．05）。③丽组的不良反应发生率比较差异无统计学意义（P〉0．05）。结论在双相障碍躁狂发作治疗中,阿立哌唑及丙戊酸钠具有较好的治疗效果及较高的安全性。     

托吡酯与丙戊酸钠治疗成人癫痫的疗效对比

目的探讨托吡酯与丙戊酸钠治疗成人癫痫的疗效及其不良反应。方法对我院2006年1月～2008年12月分别应用托吡酯与丙戊酸钠单独治疗成人癫痫的临床资料进行回顾性分析。结果托毗酯组总有效率（86．0％）明显高于丙戊酸钠组（68．1％）,差异具有统计学意义（X2=4．04,P〈0．05）;丙戊酸钠组不良反应发生率为40．4％,明显高于托吡酯组的16．0％,两组比较差异具有统计学意义（X2=7．20,P〈0．01）。结论托吡酯对各种癫痫均有显著疗效,是一种广谱、安全、高效的新型抗癫痫治疗药物,可作为新诊断的成人癫痫患者的首选药物单独使用,值得临床进一步推广应用。     

丙戊酸钠血药浓度监测对指导儿童癫痫病治疗的临床意义

目的：评价丙戊酸钠的血药浓度与剂量对治疗儿童癫痫病患者临床疗效的影响。方法：给576例儿童癫痫病患者长期口服丙戊酸钠，剂量为15～60mg／（kg·d），并进行血药浓度监测。利用SPSSIO．0统计软件对治疗结果产生的数据进行处理。结果：丙戊酸钠的有效浓度范围为50-100μg／ml，中毒浓度〉100μg／ml，观察组中癫痫完全被控制186例，好转331例，总有效率为89．76％。不同个体服用同等剂量丙戊酸钠后，稳态血药浓度差异有统计学意义（P〈0．05）。结论：测定丙戊酸钠的血药浓度对治疗儿童癫痫病的临床疗效有显著意义。临床监测其血药浓度十分必要。     

利培酮联合丙戊酸钠和碳酸锂与利培酮联合碳酸锂治疗躁狂发作的对照研究

目的：探讨利培酮联合丙戊酸钠和碳酸锂治疗躁狂发作的疗效与安全性。方法：将40例躁狂发作患者随机分为观察组和对照组,每组各20例,观察组应用利培酮联合丙戊酸钠和碳酸锂治疗,对照组应用利培酮联合碳酸锂治疗,疗程6周;应用Beck—Rafaelsen躁狂评定量表（BRMS）评价疗效。结果：观察组与对照组相比．在治疗后第2周末开始BRMS评分和痊愈率差异均具有统计学意义（P〈0．05）;观察组不良反应发生率低（P〈0．05）。结论：利培酮联合丙戊酸钠和碳酸锂治疗躁狂发作较利培酮联合碳酸锂疗效好、安全性高、副作用小。     

丙戊酸钠不同血药浓度对癫痫病患儿中毒反应发生率的影响

【摘要】 目的 探讨不同丙戊酸钠血药浓度对小儿癫痫病患者中毒反应的影响。方法 回顾性分析2014年5月~2017年6月期间入院经丙戊酸钠治疗的128例癫痫患儿病例资料,均采用高效液相色普法进行丙戊酸钠血药浓度监测。根据首次丙戊酸钠血药浓度分三组,59例＜50μmol/mL纳入A组;60例在50~100μmol/mL纳入B组;9例＞100μmol/mL纳入C组;分析各组临床疗效及中毒反应情况。结果 三组不同丙戊酸钠血药浓度所达到的临床疗效存在统计学差异（P＜001）;B组总有效率明显高于其他两组,组间差异有统计学意义（P＜005）。C组患儿肝功能指标（ALT、AST、GGT及TP）及肾功能指标（BUN、SCr）异常率明显较其余两组高,组间差异显著（P＜005）,C组其他不良反应发生率亦高于A组和B组,而B组又明显高于A组,组间差异显著（P＜005）。结论 不同丙戊酸钠血药浓度对小儿癫痫治疗效果有一定影响,高丙戊酸钠血药浓度会明显增加中毒反应发生率,临床应定期监测丙戊酸钠血药浓度,在提高疗效的同时注意降低中毒风险。     

阿立哌唑和丙戊酸钠治疗双相障碍躁狂发作的对照研究

目的比较阿立哌唑与丙戊酸钠治疗双相躁狂患者的临床疗效和安全性。方法48例患者随机给予阿立哌唑与丙戊酸钠治疗,于基线和治疗第1、2、3、4周末分别采用Young躁狂量表（YMRS）和临床总体印象量表——双相障碍版（CGI—S—BP）评定疗效。基线和终点时进行血生化、血常规、尿常规以及心电图检查,以评价其安全性。结果试验组和对照组的YMRS和CGI—S—BP得分随着治疗时间而逐渐下降,治疗前后差异有明显统计学意义（P〈0．01）;多重比较显示,第1周末和第2周末试验组和对照组之间差异有明显统计学意义（P〈0．01）,第3周末和第4周末试验组和对照组之间差异无统计学意义（P〉0．05）。两组间在有效率、痊愈率和病情改善方面比较差异无统计学意义（P〉0．05）,两组均未出现严重的不良事件。结论阿立哌唑治疗双相障碍躁狂急性发作的疗效与丙戊酸钠相当,起效更快,安全性高。     

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.