充血性心力衰竭患儿血浆内皮素和心钠素水平变化及氨力农对其影响

目的了解少儿充血性心力衰竭（CHF）时血浆内皮素（ET）和心钠素（ANP）的变化及氨力农对其影响。方法用放免法测定34例CHF患儿静脉滴注氨力农前、后血浆田和ANP的浓度，并与对照组35例健康少儿作分析比较。结果少儿CHF患者血浆田和ANP的浓度显著增高，静滴氨力农后，血浆ET和ANP的浓度下降，与治疗前比较差异有统计学意义（P〈0．01）。结论CHF患儿血浆ET和ANP的浓度增高，应用氨力农可降低田和ANP的浓度。     

充血性心衰患者血浆内皮素、心钠素的变化及其意义

应用放射免疫法测定56例充血性心力衰竭（CHF）患者血浆内皮素（ET）、心钠素（ANF）浓度，结果较正常对照组明显增高（P＜0.01～0．001），并与CHF的严重程度一致；ET与ANF呈正相关趋势。提示ET、ANF共同参与CHF的病理生理过程，可作为判断心功能严重程度的一项指标。     

血管紧张素Ⅱ受体拮抗剂对充血性心力衰竭患者血浆内皮素和心钠素水平的影响

目的研究血管紧张素Ⅱ受体拮抗剂（ARB）对充血性心力衰竭（CHF）患者血浆内皮素（ET）和心钠素（ANP）水平的影响。方法根据患者入院先后按随机原则将47例CHF患者分为对照组和ARB治疗组，其中对照组（23例）给予强心剂和利尿剂治疗，ARB治疗组（24例）在上述治疗基础上加用ARB（代文，80～160mg／d）治疗8周，观察治疗前后CHF患者心功能以及血浆ET和ANP浓度的变化。结果经8周治疗后，ARB治疗组患者心功能明显改善，而且这些患者血浆ET、ANP水平较对照组明显降低（P〈0．01）。结论在常规治疗基础上加用ARB可以显著改善CHF患者心功能，其原因可能与ARB能明显降低患者血浆ET、ANP水平相关。     

慢性充血性心力衰竭患者血浆脑钠素、心钠素浓度与心功能的关系

目的观察慢性充血性心力衰竭（CHF）患者血浆脑钠素（BNP）和心钠素（ANP）浓度与心功能之间的关系，探讨其临床意义。方法75例CHF患者为实验组，按NYHA分级分为四个亚组，另选21例健康者为对照组，采用放免法测定各组血浆BNP和ANP浓度，用超声心动仪（SONO1000）测定左室射血分数（LVEF）。结果CHF组血浆BNP浓度显著高于对照组（P〈0.01），且心功能越差升高越明显；血浆BNP浓度与LVEF之间具有良好的负相关（r=-0．59，P〈0.01）。结论CHF患者血浆BNP、ANP浓度显著升高，且随心衰严重程度增加而升高，血浆BNP、ANP浓度（尤以BNP浓度）能较好的评价CHF患者的心功能状态。     

丹红对充血性心力衰竭患者血浆内皮素的影晌

目的：观察丹红注射液对充血性心力衰竭患者血浆内皮素（ET）和血液流变性的影响。方法：将80例慢性充血性心力衰竭患者随机分为两组，每组40例，入院时均检测血浆ET和血液流变指标。两组均予以强心、利尿和扩血管等药物治疗，疗程相同。丹红组在常规治疗基础上加用丹红注射液静脉滴注，1天1次，4周为1个疗程，4周后再次检测上述指标，比较两组ET值和血液流变指标。结果：丹红组ET值和全血黏度高切、全血黏度低切、血浆黏度、红细胞比积和纤维蛋白原较治疗前有显著下降（P〈0．01或P〈0.05），其改善程度明显优于对照组（P〈0．05）。结论：丹红注射液可改善慢性充血性心力衰竭患者的血管内皮功能，降低血黏度，对心力衰竭有辅助治疗作用。     

心力衰竭与甲状腺激素水平的关系及小剂量甲状腺素治疗心力衰竭疗效观察

目的：探讨甲状腺激素水平与充血性心力衰竭心衰程度的关系，观察小剂量甲状腺素治疗心力衰竭的效果。方法：对50例充血性心力衰竭患者（心力衰竭组）及30例健康对照者（对照组）的血清三碘甲状腺原氨酸（T3）、四碘甲状腺原氨酸（T4）、促甲状腺素（TSH）水平进行检测。同时检测30例低T3充血性心力衰竭患者和20例非低T3心力衰竭患者的左室射血分数（LVEF）。观察低T3充血性心力衰竭患者常规治疗组和加用小剂量甲状腺素治疗组治疗前后心功能变化情况。结果：充血性心力衰竭患者T3水平明显低于对照组（P〈0．001）。低T3心力衰竭患者的心衰程度严重。甲状腺素治疗组心功能改善优于常规治疗组。结论：充血性心力衰竭患者T3水平降低与心衰严重程度相关。小剂量甲状腺素治疗心力衰竭是安全、有效的。     

充血性心力衰竭患者血浆内皮素与心钠素关系的探讨

分析了２０例正常人和４６例充血性心力衰竭患者血浆内皮素（ＥＴ）和心钠素（ＡＮＰ）浓度，结果表明充血性心力衰竭患者的ＥＴ和ＡＮＰ浓度显著高于正常人（Ｐ〈０．０１）。ＥＴ、ＡＮＰ的浓度与病程的严重程度有明显的一致性（各组间Ｐ〈０．０１）。ＥＴ与ＡＮＰ浓度变化呈高度负相关（ｒ＝０．９８７，Ｐ〈０．０１）。提示ＥＴＴ可作为衡量充血性心力衰竭程度的一个指标；ＡＮＰ可能为ＥＴ的拮抗剂，对充血性心力衰竭的治疗和     

充血性心力衰竭患者血浆一氧化氮、内皮素含量变化及其意义

目的探讨充血性心力衰竭（CHF）患者血浆一氧化氮（NO）和内皮素（ET）含量变化及其意义。方法检测68例CHF患者血浆NO和FT含量，另选30例健康体检者作为对照组。结果CHF患者血浆NO和ET水平明显高于对照组（P〈0．01）。且心衰程度越重，NO和ET水平越高。NO与ET呈直线正相关（r=0．6368，P〈0．001）。结论血浆NO和ET水平增高是CHF病理生理特征之一，NO和ET共同参与CHF的发生发展过程。     

老年慢性充血性心力衰竭122例贫血情况分析

目的探讨慢性充血性心力衰竭患者贫血的发生率以及贫血对慢性充血性心力衰竭患者心功能的影响。方法统计分析122例不同程度慢性充血性心力衰竭患者贫血的发生率,以及轻度贫血组中重度贫血组和非贫血组住院期间的心功能情况与有关超声指标改变。结果随着心功能分级增高,贫血的发生率也随之增高（P〈0.05）,且心脏超声贫血病人与非贫血者相比LVEF降低,LVEED增大（P均〈0.05）。结论充血性心力衰竭患者常伴有不同程度贫血,贫血的发生率与心衰的严重程度有关。     

血尿酸水平与慢性充血性心力衰竭患者心功能相关性研究

目的探讨血尿酸水平与慢性充血性心力衰竭患者心功能水平的相关性。方法比较134例不同心功能水平的慢性充血性心力衰竭患者血尿酸浓度。结果慢性充血性心力衰竭患者心功能Ⅰ、Ⅱ、Ⅲ和Ⅳ级血尿酸浓度分别为（242．60±92．09）μmol／L、（302．32±41．94）μmol／L、（435．24±66．35）μmol／L、（511．76±16．39）μmol／L,相关分析显示各组具有明显相关性（P〈0．01）;排除高脂血症、糖尿病、高血压等影响血尿酸水平的因素,血尿酸水平仍然和心力衰竭的程度有显著相关性（r=0．756,P〈0．01）。结论血尿酸水平与慢性充血性心力衰竭患者心功能显著相关。     

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.