血清降钙素原与超敏C反应蛋白及白细胞计数在儿童早期感染中的诊断价值

目的探讨血清降钙素原（PCT）与超敏C反应蛋白（hs-CRP）及白细胞计数（WBC）在儿童早期感染中的诊断价值。方法选取2017年3月至2018年3月感染性疾病患儿160例,根据感染病原纳入病毒组（75例）和细菌组（85例）,同时选取60名健康体检儿童纳入健康对照组,测定并比较各组儿童血清PCT、hs-CRP水平及WBC计数,计算并绘制三个指标的灵敏度、特异度和受试者工作特征（ROC）曲线。结果3组儿童血清PCT、hs-CRP及WBC测定值比较,组间差异均有统计学意义（P < 0.01）;细菌组患儿血清PCT、hs-CRP及WBC测定值较病毒组和健康对照组明显上升,病毒组患儿血清PCT、hs-CRP及WBC测定值明显高于健康对照组（P < 0.01）;PCT用于诊断细菌感染的ROC曲线下面积为1,灵敏度为100%,特异度为100%,均大于hs-CRP及WBC。结论血清PCT、hs-CRP及WBC在患儿早期细菌性感染疾病中均有一定的诊断价值,并且PCT的灵敏性和特异性更高,其诊断价值优于hs-CRP和WBC。     

血清降钙素原鉴别成人化脓性关节炎与非化脓性关节炎的价值

目的 评价血清降钙素原(PCT)鉴别成人化脓性关节炎与非化脓性关节炎的价值.方法 选择47例急性关节炎患者,根据细菌学培养或染色结果,分为化脓性关节炎(病例组)和非化脓性关节炎(对照组)两组,比较两组间血清PCT、超敏C反应蛋白(hs-CRP)、白细胞计数(WBC)、中性粒细胞计数(NEU)以及红细胞沉降率(ESR)水平的差异.根据受试者工作特征曲线(ROC曲线),比较上述指标鉴别化脓性关节炎与非化脓性关节炎的效能.结果 47例患者中,病例组13例,对照组34例.病例组PCT、hs-CRP、ESR水平明显高于对照组(P＜0.01),而两组间WBC、NEU比较差异无统计学意义(P＞0.05).PCT的ROC曲线下面积最大,95％ CI为0.83 ～0.99,其次分别是hs-CRP和ESR,WBC和NEU的曲线下面积差异则无统计学意义(P＞0.05).当PCT取大于截断点值0.93 ng/mL诊断为化脓性关节炎时,其灵敏度可达到100.0％,特异度可达到71.0％.结论 WBC和NEU在鉴别成人化脓性关节炎与非化脓性关节炎中意义有限,hs-CRP和ESR可作为初筛检测指标,PCT对鉴别化脓性关节炎有更好的应用价值.     

血清降钙素原测定在新生儿细菌感染性疾病中的诊断价值

目的评价血清降钙素原（PCT）在新生儿细菌感染性疾病中的诊断价值。方法选择2013年2—10月被蚌埠医学院第二附属医院NICU收治的经病原学检测,临床确诊为新生儿细菌感染性疾病的50例患儿作为研究对象,并根据感染严重程度评分（SSS）分组,其中重症感染组26例,一般感染组24例。另外选取32例健康新生儿作为对照。所有患儿在使用抗生素前采集血液标本检查降钙素原、血常规、生化常规以及超敏C反应蛋白。降钙素原≥0.5 ng/ml为阳性,超敏C反应蛋白≥8 mg/L为阳性,白细胞计数≥20×10^9/L为阳性。用统计软件SPSS 13.0进行数据分析。结果细菌感染组中PCT水平为（7.31±4.28）ng/ml,hs-CRP水平为（20.08±14.16）mg/L,白细胞计数（17.15±8.24）×10^9/L;细菌感染组PCT、hs-CRP水平及白细胞计数均高于健康对照组,与健康对照组相比差异有统计学意义（P〈0.05）。细菌感染组的PCT阳性率明显高于hs-CRP及WBC的阳性率,重症感染组的PCT阳性率明显高于一般感染组和健康对照组,一般感染组的PCT阳性率明显高于健康对照组,重症感染组88.5%的PCT水平在2 ng/ml以上,一般感染组仅20.8%的患儿PCT在2 ng/ml以上,以上差异均有统计学意义（P〈0.05）。结论相比于WBC和hs-CRP,PCT检测可作为临床早期诊断新生儿细菌感染的重要指标,PCT值越高,疾病的危险度越高。     

降钙素原和超敏C反应蛋白对关节置换术后感染诊断价值

目的比较全髋关节置换术(THA)术前血清降钙素原(PCT)和超敏C反应蛋白(hs-CRP)水平对假体周围感染(PJI)诊断中的临床参考价值。方法对84例患者进行前瞻性观察研究,术前测定PCT和hs-CRP浓度和白细胞(WBC)计数。通过受试者工作特征曲线(ROC)和曲线下面积(AUC)分析诊断准确性。结果翻修THA患者PJI发生率为34.5%。PJI组血清PCT、hs-CRP浓度及WBC计数均显著高于无PJI组(P0.05)。PCT、hs-CRP和WBC计数的AUC分别为0.860 (95%CI 0.778～0.940)、0.835 (95%CI 0.753～0.917)和0.643 (95%CI 0.524～0.762)。血清PCT和hs-CRP的诊断能力明显高于WBC计数(P0.05)。血清PCT与hs-CRP差异无统计学意义(P=0.380)。结论 PCT对PJI的诊断无明显优势,但是,PCT和hs-CRP结果比WBC计数更可靠。     

MR-pro ADM与PCT联合检测在新生儿败血症早期诊断中的价值

目的 探讨肾上腺髓质素前体中段肽（MR-proADM）与降钙素原（PCT）联合检测在新生儿败血症早期诊断中的价值。方法 选取2018年6月至2020年6月在丽水市中心医院治疗的败血症新生儿45例（败血症组）、脓毒性休克新生儿35例（严重感染组）为研究对象,选取同期非感染性疾病新生儿40例为对照组。败血症组和严重感染组患儿在抗生素治疗前、治疗24 h、治疗72 h后,对照组患儿在入院1 h内检测血清WBC、CRP、MR-proADM、PCT水平。采用ROC曲线评估CRP、MR-proADM、PCT单独检测及MR-proADM+PCT联合检测预测新生儿败血症的效能。结果 3组患儿WBC、CRP、MR-proADM和PCT水平比较差异均有统计学意义（均P<0.05）,且严重感染组患儿CRP、MR-proADM和PCT水平均高于败血症组（均P<0.05）。败血症组和严重感染组患儿治疗前、治疗24 h、治疗72 h后MR-proADM和PCT水平均呈下降趋势（均P<0.05）。ROC曲线显示,MR-proADM+PCT联合检测的AUC高于CRP、MR-proADM、PCT单独检...     

降钙素原检测在新生儿感染早期的临床应用

目的:探讨降钙素原(PCT)检测在新生儿细菌感染早期的临床应用价值。方法:选取136例新生儿细菌感染早期病例,分为重症感染和一般感染2个观察组,选取52例同期住院非感染性病例作为对照组,统计分析PCT检测值、超敏C反应蛋白、白细胞计数在各组间的差异。结果 :PCT值在2个观察组显著高于对照组,且重症感染组高于一般感染组,3组间比较差异显著(P<0.05),说明PCT值与新生儿细菌感染严重程度相关。在新生儿重症感染组,PCT阳性率与hs-CRP阳性率无显著性差异(P>0.05),但均高于WBC计数阳性率(均P<0.05);在一般感染组,PCT阳性率显著高于hs-CRP及WBC计数(均P<0.05);在对照组,PCT阴性率显著高于hs-CRP及WBC计数(均P<0.05)。结论 :PCT可以作为诊断新生儿细菌感染早期的参考指标和判断感染严重程度的敏感指标。     

新生儿重症监护病区院内感染的临床分析及降钙素原在新生儿感染性疾病中的临床应用

目的探讨新生儿重症监护病房院内感染的危险因素及降钙素原（PCT）对新生儿重症感染性疾病的临床应用。方法分析新生儿重症监护病房670例患儿的临床资料,统计院内感染的发生率和病原体培养结果,比较感染性疾病组患儿抗生素治疗前、后及出院前PCT、外周血白细胞计数（WBC）及C-反应蛋白（CRP）。结果 670例新生儿中85例发生院内感染,感染率为12.7%,最常见的病原菌有肺炎克雷伯菌、凝固酶阴性葡萄球菌和大肠埃细菌等。感染性和非感染性疾病组PCT、WBC、CRP检测结果比较,差异有统计学意义（P〈0.05）;感染性疾病组,PCT在经有效抗菌治疗后可快速下降,而WBC、CRP回落速度均晚于PCT,ROC曲线下面积PCT〉CRP〉WBC,PCT对院内感染的截断值（cutoff）为2.33 ng/ml时,诊断灵敏度为88.5%,特异性为91.05%。结论胎龄小、出生体质量低、住院天数长、应用广谱抗生素院内感染发生率高,而PCT对NICU并发新生儿院内感染的早期诊断具有较高的灵敏度和特异性。     

中西医结合治疗呼吸机相关性肺炎疗效及对感染诊断标志物的影响

目的：观察中西医结合治疗呼吸机相关性肺炎（VAP）的疗效及其对感染诊断标志物 PCT、WBC 及hs-CRP 的影响。方法选取本院重症监护病房（ICU）接受治疗的 VAP 患者72例,随机分为治疗组和对照组,各36例。对照组采用基础治疗加早期足量广谱抗菌药物控制感染,治疗组在对照组治疗基础上加用清肺解毒汤,疗程均为7 d。比较2组用药前后中医证候积分、WBC、血清 PCT、hs-CRP 及临床疗效变化。结果2组治疗前后在中医证候积分、WBC、PCT、hs-CRP 水平方面明显降低,差异具有统计学意义（P ＜0.05）,治疗组与对照组治疗后比较差异具有统计学意义（P ＜0.05）;治疗组临床总有效率94.44％,明显高于对照组的72.22％（P ＜0.05）。结论清肺解毒汤联合西药治疗 VAP 能够明显降低中医证候积分及 WBC、PCT、hs-CRP 水平,改善预后。     

血清降钙素原与超敏C反应蛋白、白细胞计数在儿童急性呼吸道感染中的早期诊断价值

目的探究降钙素原(PCT)、超敏C反应蛋白(hs-CRP)与白细胞计数(WBC)在儿童急性呼吸道感染早期诊断中的临床价值。方法收集本院收治的145例被确诊为儿童急性呼吸道感染患儿的临床资料(细菌感染组48例,支原体感染组39例,病毒感染组58例),同期健康体检儿童52例为对照组,检测PCT及hs-CRP、WBC的水平并比较其与感染性疾病关系的差异。结果细菌性感染组的PCT、WBC指标均显著高于对照组、病毒感染组(P0.01);比较四组间的hs-CRP指标,差异均有统计学意义(P0.05);细菌感染组阳性率PCT高于hs-CRP,差异有统计学意义(P0.05);各组血清PCT与hs-CRP水平呈正相关(r=0.49,P0.05)。结论 PCT与hs-CRP、WBC的联合监测可以提高儿童急性呼吸道感染早期诊断的准确率,根据结果判断呼吸道感染的严重程度,有助于儿童急性呼吸道感染疾病早期诊断、病情及预后的评估,值得临床推广。     

血清降钙素原、C反应蛋白、白细胞计数水平联合检测在新生儿脓毒症诊断中的价值

目的：探讨血清降钙素原（PCT）、C反应蛋白（CRP）、白细胞计数（WBC）水平联合检测在新生儿脓毒症诊断中的价值。方法：回顾性分析2018年3月至2019年4月该院收治的32例脓毒症患儿的临床资料,设为脓毒症组,选取同期24例普通感染患儿为非脓毒症组,另选取同期入院的30名健康新生儿为对照组。比较三组PCT、CRP、WBC水平,绘制受试者工作曲线（ROC）分析PCT、CRP、WBC水平单项及联合检测在脓毒症患儿诊断中的价值。结果：脓毒症组PCT、CRP、WBC水平均高于非脓毒症组和对照组,且非脓毒症组高于对照组,差异有统计学意义（P<0.05）;绘制ROC曲线结果显示,PCT、CRP、WBC单项及联合诊断脓毒症的曲线下面积分别为0.885、0.781、0.842、0.926,且联合检测诊断价值最高。结论：脓毒症患儿血清PCT、CRP、WBC水平均较高,且PCT、CRP、WBC联合检测在脓毒症患儿诊断中具有较高的价值。     

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.