超声检测卵巢间质血流动力学对多囊卵巢的诊断价值

目的探讨经阴道超声检测卵巢间质血流对多囊卵巢综合征的诊断价值。方法用酶联免疫发光法对多囊卵巢患者的血清黄体生成素（LH）、卵泡刺激素（FSH）、雌二醇（E2）、泌乳素（PRL）及孕酮（PGH）,睾酮（TES）水平的监测结合经阴道彩色多普勒超声（TRS）对卵巢间质内动脉血流动力学测量及观察,并与60例正常组相对照分析。结果 PCOS患者卵巢间质动脉血流阻力指数降低,血管分布面积增加PCOS患者卵巢间质血流较对照组丰富,卵巢间质动脉血流阻力指数较对照组减低。卵泡数和卵巢间质内动脉血流与睾酮和黄体生成素的水平均有明显的正相关性,T比LH相关性更明显。结论卵巢间质血流动力学与性激素六项结合可为PCOS不孕症患者提供相对准确、可靠的定量评估指标。     

腹腔镜卵巢穿刺内凝术治疗多囊卵巢综合征前后子宫卵巢动脉血流动力学的研究

目的　探讨多囊卵巢综合征 (PCOS)患者经腹腔镜卵巢穿刺内凝术 (LOPE)前后血流动力学的特征及经阴道彩色血流显像 (TV -CDFI)在不孕症领域的应用价值。方法　采用TV -CDFI对 2 8例PCOS患者手术前后的子宫、卵巢动脉进行检测。结果　PCOS患者手术前后 ,左右侧卵巢血流阻力指数分别为 0 .5 2± 0 .0 5、0 .4 7± 0 .0 4(P <0 .0 1) ,0 .5 4± 0 .0 5、0 .4 6± 0 .0 5 (P <0 .0 1) ,统计学上有非常显著性意义。术后出现优势卵泡侧卵巢术前后子宫动脉RI分别为 0 .86± 0 .0 5、0 .80± 0 .0 6 (P <0 .0 5 ) ,有显著性意义。结论　LOPE术后可显著改善卵巢的微循环及增加优势卵泡侧子宫动脉的血流灌注 ,TV -CDFI可评价LOPE治疗PCOS患者短期和长期疗效并指导妊娠     

经阴道超声检查结合血激素检测诊断多囊卵巢综合征

目的 评价经阴道超声(TVS)检查卵巢形态学特征、卵巢间质内血流动力学结合血激素水平在多囊卵巢综合征(PCOS)诊断中的价值.方法 采用经阴道超声对35例PCOS患者的卵巢进行形态学和卵巢间质内血流动力学的观察和测量,同时检测血液中卵泡刺激素(FSH)、促黄体生成素(LH)、雌二醇(E2)及睾酮(TESTO)的水平,设立正常对照组30例进行对比分析.结果 PCOS患者卵巢体积(OV)、卵泡数(FN)、卵巢间质面积(SA)、卵巢间质面积/总面积(SA/ TA)较正常对照组明显增高(P<0.05,P<0.01);其中SA/TA的敏感性和特异性最高;PCOS患者卵巢间质内血流阻力明显减低,同时血液中睾酮激素水平明显高于正常组(P<0.01).结论 通过阴道超声检测卵巢形态学特征、卵巢间质内血流阻力变化并结合血液中睾酮激素水平,有助于提高经阴道超声诊断多囊卵巢综合征的敏感性及特异性,并可作为多囊卵巢综合征治疗随访的重要评价指标.     

多囊卵巢综合征的超声形态学特征及量化分析

目的探讨多囊卵巢综合征(PCOS)的二维超声及多普勒超声特征。方法选择2014年10月至2015年10月大连市妇女儿童医疗中心妇科诊治的PCOS患者60例为PCOS组,选择同期确诊为卵巢多囊性改变(PCOM)的患者35例为PCOM组,选择同期35例健康志愿者为对照组。根据体质指数(BMI)不同将PCOS患者分为肥胖型PCOS组(BMI≥25 kg/m~2)25例和非肥胖型PCOS组(BMI<25 kg/m~2)35例。观察PCOS患者二维超声及多普勒超声特征,比较各组患者的超声特征。结果 PCOS二维超声表现为双侧卵巢体积明显增大,卵泡体积增大,直径1.5~8.3 mm,数量增多,数量8~23个。卵巢间质回声不均质增强。多普勒超声显示卵巢内点状及粗条状血流,呈高速低阻型。PCOS组搏动指数(PI)及阻力指数(RI)显著低于PCOM组及对照组[(0.72±0.21)比(0.91±0.21),(0.91±0.32);(0.52±0.11)比(0.61±0.21),(0.61±0.22)],收缩期峰值血流速度(PSV)显著高于PCOM组及对照组[(12.7±3.3)cm/s比(8.3±2.3)cm/s,(8.7±2.1)cm/s],差异有统计学意义(P<0.05)。PCOS组卵巢体积、卵泡直径显著大于PCOM组及对照组[(48±15)cm~3比(36±9)cm~3、(14±4)cm~3;(4.7±1.1)mm比(3.3±1.0)mm、(2.1±0.6)mm],卵泡数目显著多于PCOM组及对照组[(15.4±4.5)个比(10.6±3.1)个、(6.4±2.1)个],差异有统计学意义(P<0.05)。肥胖型PCOS组与非肥胖型PCOS组患者PI、RI、PSV、粗条状血流、卵巢体积、卵泡直径、卵泡数目比较差异无统计学意义(P>0.05)。结论 PCOS具有特征性的超声特征及多普勒血流特征。PCOS患者的超声形态学特征及血流动力学特征与肥胖并无必然联系。超声检查软组织分辨率高,并可以进行量化测量,在PCOS的诊断和鉴别诊断中具有较高的临床应用价值。     

经阴道彩色多普勒超声在多囊卵巢综合征中的应用探讨

目的探讨经阴道彩色多普勒超声对多囊卵巢综合征（PCOS）的诊断价值,为其临床诊断和治疗提供证据。方法回顾35例PCOS患者的彩色多普勒声像图资料,并加以分析。结果声像图显示患者双侧卵巢体积增大、中间的实质回声增强,卵泡数目增多;卵巢间质内血管丰富,可见一支纵向贯穿卵巢间质的较大血管,血流参数为RI（0.52±0.04）、PSV（12.64±2.31）cm/s、PDV（6.90±1.27）cm/s。结论经阴道彩色多普勒超声可以清晰、准确显示PCOS患者卵巢内部特征,测量血流动力学参数,对其临床诊断和治疗提供重要的参考依据。     

多囊卵巢综合征经阴道彩色多普勒超声诊断效果分析

目的探讨经阴道彩色多普勒超声(TVCDS)诊断多囊卵巢综合征(PCOS)的效果。方法选取2010年1月至2013年9月来湖北省新华医院妇产科就诊42例PCOS患者(PCOS组)和42例健康育龄妇女(对照组)为研究对象,两组研究对象均行TVCDS检查,比较两组患者的卵巢物理指标和血流动力学指标。结果 PCOS组患者的卵泡数、卵巢间质面积(SA)、卵巢总面积(TA)以及SA/TA均显著多于或大于对照组[(12.6±3.4)个比(5.9±1.8)个、(2.86±0.40)m2比(1.23±0.28)m2、(5.95±0.93)m2比(4.37±0.70)m2,(0.48±0.09)比(0.28±0.06),P<0.01],而最大卵泡直径、卵巢体积则明显小于对照组[(6.4±1.2)mm比(12.3±3.1)mm、(32±12)m L比(37±13)m L,P<0.05或P<0.01];PCOS组患者的收缩期峰值血流(PSV)、舒张期末期血流速度(EDV)均显著高于对照组[(30.7±5.5)cm/s比(17.6±4.8)cm/s,(14.7±3.9)cm/s比(6.6±3.2)cm/s,P<0.01],而搏动指数、血流指数则显著小于对照组[(0.70±0.09)比(0.85±0.12)、(0.55±0.10)比(0.67±0.12),P<0.01]。结论 TVCDS可较直观、准确地显示卵巢特征,对辅助诊断PCOS具有重要临床价值。     

卵巢储备功能下降妇女行促排卵疗法后经阴道彩超结果分析

目的 分析经阴道彩超检查卵巢储备功能下降妇女行促排卵疗法后的变化.方法 选取2013年6月至2016年6月期间我院收治的116例卵巢储备功能下降患者为研究对象,所有患者均经彩色多普勒超声检测卵巢间质动脉血流收缩期最大血流速度/舒张期末期血流速度(S/D)、卵巢最大切面平均直径(MOD)、窦卵泡数(AFC)、卵巢间质冬眠峰值流速(PSV)、卵巢动脉搏动指数(PI)、阻力指数(RI)、血清卵泡雌激素(FSH)、促黄体生成素(LH)、雌二醇(E2)水平、子宫体积、子宫内膜厚度和卵巢平均容积和妊娠率.分别于自然月经周期第2~3天测定和经促排卵疗法治疗后测定,并指导患者同房或进行宫腔内人工授精.结果 治疗后卵巢储备功能下降患者的S/D较治疗前差异无统计学意义(P>0.05),治疗后卵巢储备功能下降患者的MOD、AFC、PSV、PI、E2水平、子宫体积、子宫内膜厚度、卵巢平均容积和妊娠率分别为(25.34±2.16)cm、(9.47±1.95)个、(15.13±2.15)cm/s、(2.31±1.15)、(74.82±9.28)pg/mL、(105.18±49.39)cm、(6.35±1.74)mm、(7.59±3.44)cm、27.59%,高于治疗前的(20.75±2.93)cm、(6.14±0.32)个、(9.11±2.86)cm/s、(1.95±0.62)、(32.47±10.78)pg/mL、(100.37±56.86)cm、(5.52±1.75)mm与(5.41±2.34)cm、0,RI、血清FSH和LH水平为(0.54±0.06)、(27.08±13.47)mIU/mL、(21.72±14.44)mIU/mL,较治疗前[(0.63±0.08)、(67.32±29.09)mIU/mL、(60.83±18.67)mIU/mL]显著降低,差异具有统计学意义(P<0.05).结论 促排卵疗法能够显著改善卵巢储备功能下降患者的卵巢储备功能,改善子宫状况和血清性激素水平,且经阴道彩超检查能够较好反映出患者治疗后的变化,对卵巢储备功能具有较好评价作用.     

多囊卵巢综合征血清骨调素水平及对卵巢间质血流的影响研究

目的:探讨多囊卵巢综合征(PCOS)患者血清骨调素水平,并且分析其与卵巢间质血流的关系。方法:选择2015年6月-2017年6月在我院进行诊治的PCOS患者86例作为观察组;另外选择51例同期健康体检者作为对照组。所有研究对象于卵泡早期或闭经2个月以上抽取空腹血测定黄体生成素(LH)、促卵泡刺激素(FSH)、雌二醇(E2)、孕激素(P)、泌乳素(PRL)、睾酮(T)。采用酶联免疫吸附法测定血清骨调素(OC)。所有研究对象均于采血当日监测患者双侧卵巢间质血流,计算搏动指数(PI)和阻力指数(RI)。结果:两组血清FSH、E_2、P、PRL的差异无统计学意义(P>0.05);观察组血清LH、LH/FSH、T明显高于对照组(P<0.05)。观察组患者卵巢血流PI、RI均明显低于对照组(P<0.05);观察组血清OC明显低于对照组(P<0.05)。PCOS患者血清OC与血清LH、LH/FSH、T呈负相关关系(P<0.05);血清OC与卵巢血流PI、RI呈正相关关系(P<0.05)。结论:PCOS患者血清骨调素明显降低,并且与患者卵巢间质血流有密切关系,可能通过改变机体内性激素水平而调节卵巢血流量。     

彩色多普勒超声在评价中药调经方治疗多囊卵巢综合征疗效中的价值

目的:探讨彩色多普勒超声在评价中药调经方治疗多囊卵巢综合征(PCOS)疗效中的价值。方法;对60例PCOS患者应用中药调经方治疗前后的超声指标进行对比分析,观察子宫、卵巢形态、卵泡发育情况,子宫螺旋动脉、卵巢间质动脉彩色多普勒血流搏动指数、阻力指数,结合性激素测定结果评估药物治疗的效果。结果:伴随临床疗效及内分泌性激素的改善,子宫螺旋动脉及卵巢间质动脉的搏动指数(PI)及阻力指数(RI)治疗前后有显著性差异(P<0.05)。结论:超声可敏感地检测卵泡发育情况及卵巢、子宫血流动力学的改变,为临床提供可靠的诊断依据及疗效评价指标。     

经阴道彩色多普勒超声在多囊卵巢综合征中的诊断价值

目的:探讨经阴道超声对多囊卵巢综合征(Polycystic Ovary Syndrome,PCOS)的诊断价值。方法:回顾分析我院2年来52例PCOS患者的卵巢超声表现,并检测患者卵巢间质血流及彩色多普勒能量图(Color Doppler En-ergy,CDE)表现。结果:PCOS患者卵巢体积增大,呈多囊样改变,卵巢间质回声增强,血流较丰富,卵巢间质动脉血流阻力指数降低,血管分布面积(CDE信号面积)增加。结论:经阴道超声对PCOS的诊断有较好的临床应用价值。     

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.