2型糖尿病患者的静息能量消耗及底物氧化利用研究

目的：研究2型糖尿病患者不同糖化血红蛋白（HbA1c）水平的静息能量消耗（REE）及蛋白质、脂肪和碳水化合物的氧化利用情况,了解其物质、能量代谢特点。方法：随机选择住院2型糖尿病患者86例,根据HbA1c水平分为3组,HbA1c≤7%为A组、7%～9%为B组和≥9%为C组,同时选择门诊健康体检者20例作为对照组,采用间接测热法检测REE、呼吸商（RQ）、非蛋白呼吸商（npRQ）及蛋白质、脂肪和碳水化合物氧化利用率,并进行组间比较;另外,REE采用体重和体表面积分别进行校正。结果：糖尿病实测REE高于对照组,约12.3%,但只有B组与对照组比较有统计学差异。经体重或体表面积校正后,糖尿病各组REE/体重或REE/体表面积均高于对照组（P〈0.05）。不同HbA1c水平组间实测REE、REE/体重和REE/体表面积均无差异。各组RQ和npRQ均值为0.80～0.82。脂肪氧化所占比例为48.90%～52.50%,高于碳水化合物和蛋白质。糖尿病各组脂肪氧化率较对照组高,且随HbA1c升高而升高,而碳水化合物氧化率随HbA1c升高而降低,但均无统计学差异。结论：糖尿病患者具有较高的静息代谢率;HbA1c指标不能真实反映REE水平;糖尿病组呼吸商较低、脂肪氧化率较高,可能与糖尿病患者存在糖氧化受阻、脂肪氧化作用增强有关。     

酒精性肝硬化患者IL-6、TNF-α与能量代谢的相关性

目的 探讨酒精性肝硬化患者IL-6、TNF-α与能量代谢的相关性.方法 采用Luminex 200对30例酒精性肝硬化(酒精组)和30例乙肝肝硬化(乙肝组)患者检测IL-6、TNF-α血清浓度;应用Med Graphic CCM/D营养代谢测试系统进行能量和物质代谢测定;将两者进行相关分析.结果 酒精组IL-6、TNF-α血清浓度分别为(18.00±10.22)pg/ml和(34.12±17.61)ng/ml,明显高于乙肝组(11.33±5.34)pg/ml和(23.19±13.91)ng/ml,差异有统计学意义(P＜0.01).酒精组呼吸商(RQ)为(0.79±0.03),脂肪代谢率(FAT％)高达(43.57±5.70)％,蛋白代谢率(PRO％)为(20.57±7.29)％,与乙肝组比较差异均有统计学意义(P=0.000).相关性分析,IL-6与RQ值呈负相关(r=-0.484,P=0.007),与碳水化合物氧化率呈正相关(r=0.397,P=0.030);TNF-α与静息能量消耗(REE)、PRO％和FAT％均呈正相关(r=0.362,P=0.049;r=0.464,P=0.010;r=0.553,P=0.002).结论 酒精性肝硬化患者IL-6 、TNF-α水平明显升高,与异常的能量和物质代谢指标存在一定相关性.     

四种营养评估方法对老年慢性心力衰竭患者预后评估价值的比较研究

背景 慢性心力衰竭是多种心血管疾病的终末期状态,患者多存在食欲不振、腹泻、腹胀、便秘等营养及代谢问题,营养及代谢问题反过来又影响其预后,目前对于营养评估与慢性心力衰竭患者预后的关系已有一些研究,但关于老年慢性心力衰竭患者营养评估的研究较少,且尚无公认的有效评估方法。 目的 分析影响老年慢性心力衰竭患者预后的营养指标,同时比较其预后评估价值。 方法 选取2018年6月至2020年6月在临沂市人民医院心内科、重症监护室、老年病科住院且符合纳入及排除标准的老年慢性心力衰竭患者199例为研究对象。按照不同预后情况进行分组：按照住院期间是否死亡分为住院死亡组43例与住院存活组156例,按照1年内是否死亡分为1年死亡组51例与1年存活组148例,按照半年内是否再入院分为半年再入院组69例与非半年再入院组130例。通过查阅病历、电话随访,收集患者的性别、年龄、身高、体质量、血清白蛋白（ALB）水平、体质指数（BMI）、老年人营养风险指数（GNRI）、营养风险筛查评分简表（NRS2002）评分。采用多因素Logistic回归分析探讨老年慢性心力衰竭患者预后的影响因素;绘制不同营养评估方法评估老年慢性心力衰竭患者预后的受试者工作特征（ROC）曲线,计算ROC曲线下面积（AUC）并比较其评估价值。 结果 住院死亡组与住院存活组年龄、ALB、GNRI、NRS2002评分比较,差异有统计学意义（P<0.05）;1年死亡组与1年存活组年龄、身高、ALB、GNRI、NRS2002评分比较,差异有统计学意义（P<0.05）;半年再入院组与非半年再入院组BMI、ALB、GNRI、NRS2002评分比较,差异有统计学意义（P<0.05）。ALB、NRS2002评分是老年慢性心力衰竭患者住院死亡的影响因素,年龄、ALB、NRS2002评分是患者1年死亡的影响因素,NRS2002评分是患者半年再入院的独立影响因素（P<0.001）。ALB、NRS2002评分评估老年慢性心力衰竭患者住院死亡的AUC分别为0.76〔95%CI（0.68,0.84）,P<0.001〕、0.80〔95%CI（0.73,0.86）,P<0.001〕;ALB、NRS2002评分评估老年慢性心力衰竭患者1年死亡的AUC分别为0.75〔95%CI（0.67,0.82）,P<0.001〕、0.82〔95%CI（0.76,0.88）,P<0.001〕;NRS2002评分评估老年慢性心力衰竭患者半年再入院的AUC为0.73〔95%CI（0.65,0.80）,P<0.001〕。 结论 NRS2002评分在评估老年慢性心力衰竭患者住院死亡、1年死亡、半年再入院的发生风险时均有统计学意义,可作为老年慢性心力衰竭患者预后评估的首选方法,与BMI、血清ALB水平、GNRI相比更具优越性。     

脓毒症患者血浆乳酸水平轻度升高与病死率相关性研究

目的既往的研究表明，乳酸水平高于2mmol／L与预后不良相关，但目前还不清楚当乳酸水平在正常范围内升高对预后的影响。本研究拟比较存活组与死亡组乳酸水平的差异，从而明确乳酸相对增高与死亡率的关系，同时寻找提示预后不良的最佳乳酸值。方法采用回顾性分析，研究对象为107例脓毒症患者，所有患者入院时血乳酸水平均波动在0．5—2．0mmol／L范围。首先根据患者住院期间临床结局将患者分为存活与死亡2组，采用独立样本t检验明确两者乳酸水平是否有统计学差异。用ROC曲线寻找预测患者死亡率的最佳乳酸值，进一步根据该值将患者分为高、低乳酸血症2组，再比较2组患者死亡率是否有统计学差异。结果107例患者中32例死亡75例存活。存活组患者血浆乳酸平均值为（0．8347±0．2310）mmol／L，而死亡组为（1．2188±0．3881），t=14．377，P〈0．001，乳酸水平大于1．15mmol／L时预测患者死亡率的敏感性为59．4％，特异性为90．7％（AUC=0．79，P〈0．001，95％CI=0．687～0．893）。高乳酸血症组患者26例，死亡19例，低乳酸血症患者81例，死亡13例，差异有统计学意义（P〈0．001）。结论入院时患者乳酸水平即使轻度升高（1．16—2．00mmoL／L）也与脓毒症患者死亡率增高相关。当乳酸水平大于1．15mmol／L时提示患者预后不良。     

睡前加餐对乙肝肝硬化合并糖尿病患者能量代谢及血糖的影响研究

背景　肝硬化合并糖尿病患者很多存在蛋白质-能量营养不良症和糖代谢紊乱,由于患者肝糖原储备差和胰岛素抵抗,易发生晨起低血糖。既往研究发现睡前加餐（LES）能够缩短患者饥饿时间,降低肝硬化患者自身脂肪和蛋白质的氧化分解供能,预防次晨低血糖,但是否适用于肝硬化合并糖尿病人群值得探讨。目的　探究200 kcal LES对乙肝肝硬化合并糖尿病患者能量代谢、糖代谢的影响。方法　选取2015-01-01至2017-12-30于首都医科大学附属北京佑安医院肝病重症医学科住院的符合研究标准的乙肝肝硬化合并糖尿病患者25例,依据随机数字表法分为低升糖指数、高碳水化合物LES管理组（干预组,n=13）和肝硬化糖尿病饮食组（非干预组,n=12）。患者均继续使用抗病毒、护肝、降糖治疗。非干预组维持肝硬化糖尿病3餐饮食;干预组患者将传统3餐改为4餐,3餐各减少67 kcal（每餐减少16.7 g碳水化合物）食物,放在睡前1 h进行加餐。比较两组患者基线人口学资料（性别、年龄）,基线和干预结束3个月人体测量学资料（体质量、BMI）、饮食摄入情况（碳水化合物、脂肪、蛋白质、能量）、能量代谢指标〔静息能量消耗（REE）、预计静息能量消耗（PREE）、REE占PREE百分比（PREE%）、呼吸商（RQ）、碳水化合物氧化率（CHO%）、脂肪氧化率（FAT%）、蛋白质氧化率（PRO%）〕、糖代谢指标〔糖化血红蛋白（HbA1c）、空腹血糖（FBG）、空腹胰岛素（FINS）〕、胰岛素抵抗指数（HOMA-IR）、胰岛B细胞功能指数（FBCI）、肝功能指标〔丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、总胆红素（TBIL）、总蛋白（TP）、白蛋白（ALB）、前白蛋白（PALB）、胆碱酯酶（CHE）、凝血酶原活动度（PTA）〕。结果　两组患者基线和干预结束3个月体质量、BMI、碳水化合物摄入量、脂肪摄入量、蛋白质摄入量、能量摄入量比较,差异无统计学意义（P>0.05）。两组患者干预结束3个月REE、PREE、PREE%比较,差异无统计学意义（P>0.05）;干预组患者干预结束3个月RQ、CHO%高于非干预组,FAT%、PRO%低于非干预组（P<0.05）。干预组患者干预结束3个月RQ、CHO%高于同组基线,FAT%、PRO%低于同组基线（P<0.05）。干预组患者干预结束3个月HbA1c、FBG、FINS、HOMA-IR低于非干预组（P<0.05）;两组患者干预结束3个月FBCI比较,差异无统计学意义（P>0.05）。干预组干预结束3个月HbA1c、FBG、FINS、HOMA-IR低于同组基线（P<0.05）。干预组患者干预结束3个月TP、ALB、PALB高于同组基线（P<0.05）。结论　睡前给予200 kcal低升糖指数、高碳水化合物的食物,能够改善乙肝肝硬化合并糖尿病患者的营养代谢状况及血糖控制情况,降低胰岛素抵抗,预防糖代谢紊乱可能引发的低血糖。     

肿瘤相关抗原指标在慢性乙型肝炎中的临床意义

目的 探讨肿瘤相关抗原指标在慢性乙型肝炎中的临床意义.方法 选取感染科住院治疗的乙型病毒性肝炎患者80例,按有无黄疸分为两组（无黄疸组与黄疸组）,所有患者分别检测入院时及出院前清晨空腹血清中肿瘤相关抗原指标：甲胎蛋白（AFP）、癌胚抗原（CEA）、糖链抗原199（CA199）、糖链抗原125（CA125）.结果 入院时无黄疸组与黄疸组间CEA比较差异无统计学意义（P＞0.05）;AFP、CA199、CA125比较差异有统计学意义（P＜0.01）.出院前无黄疸组与黄疸组间CEA比较差异无统计学意义（P＞0.05）;AFP、CA199、CA125比较差异有统计学意义（P＜0.01）.黄疸组入院时与出院前CEA比较,差异无统计学意义（P＞0.05）,AFP、CA199、CA125比较差异有统计学意义（P＜0.01）.无黄疸组入院时与出院前AFP比较差异有统计学意义（P＜0.05）,CEA、CA199、CA125比较差异均无统计学意义（P＞0.05）.结论 CEA在慢性乙肝患者中一般无明显异常.慢性乙肝患者如出现AFP、CA199、CA125异常增高,应积极作影像学检查或内镜检查排除肿瘤,通常这些异常指标随肝炎病情好转而明显降低.CA199、CA125异常增高常见于伴有黄疸的慢性乙肝患者.     

食管胃静脉曲张破裂出血患者死亡危险因素分析

目的分析探讨食管胃静脉曲张破裂出血患者死亡危险因素,临床防治提供参考依据。方法选取128例食管胃静脉曲张破裂出血患者,对其临床资料进行回顾性分析,研究相关的临床参数和各项实验室指标与患者死亡的关系。结果128例患者经积极治疗后,15例（11．72％）患者死亡（死亡组）、113例好转或治愈出院（存活组）。对两组患者的临床参数及各项实验室指标进行统计分析结果显示,死亡组肝硬化并发HCC、Child—Pugh分级、腹水、PSE及初次内镜治疗后24h内发生再出血者与存活组比较,差异具有统计学意义（P〈0．05）。死亡组血钠水平明显低于存活组,血清胆红素及血清肌酐水平明显高于存活组,差异具有统计学意义（P〈0．05）。结论食管胃静脉曲张破裂出血患者死亡危险因素有多种,临床上应加强相关指标的监测,同时采取必要的防治措施,以降低患者死亡率,改善预后。     

PiCCO监测指标与老年脓毒性休克患者预后的相关性研究

目的探讨PiCCO监测指标与老年脓毒性休克患者预后的相关性。方法分析36例脓毒性休克患者．采用常规集束化治疗,并行PiCCO监测,比较存活病例和死亡病例的首次PiCCO指标。结果28d存活17例,生存率为47．22％,死亡19例,死亡率为52．78％,存活组和死亡组APACHEII的差异有统计学意义（P〈0．05）,入组时两组CI、EVLWI、PVPI之间差异有统计学意义（P〈0．05）,CI与EVLWI的ROC曲线下面积分别为0．853、0．743,两者水平评估患者预后差异有统计学意义（P〈0．05）。结论PiCCO监测能为评估脓毒性休克患者预后提供依据,其中CI和EVLWI水平与患者预后密切相关。     

低T3综合征对危重患者死亡的预测价值研究

目的：探讨低三碘甲状腺原氨酸（triiodothyronine,T3）综合征对危重患者死亡的评估价值。方法按照甲状腺功能检查结果是否显示低T3综合征,将收治的危重患者68例分为低T3组（18例）和非低T3组（50例）,记录入院时急性生理与慢性健康状况评分（APACHE Ⅱ评分）,以及入院时与住院第3天的甲状腺功能,随访30 d。统计分析危重患者低 T3综合征的发生率、30 d病死率,受试者工作特征（ROC）曲线判断T3水平对危重患者死亡的预后。结果（1）随访30 d,低 T3组（44．4％,8／18）和非低T3组（28．0％,14／50）的病死率差异无统计学意义（χ2＝1．635,P＝0．201）。（2）随访30 d,低T3组和非低T3组死亡者的T3水平（0．22±0．04）、（0．89±0．12）ng／mL均显著低于两组存活者的（0．63±0．09）、（1．21±0．39）ng／mL,T3水平差异有统计学意义（P＜0．05）;而低T3组死亡与存活者的T3水平均显著低于非低T3组死亡与存活者（P＜0．05）。低T3组和非低 T3组死亡者的 APACHEⅡ评分（33．1±6．2）、（31．3±5．6）分均显著高于存活者的（28．2±2．4）、（28．1±2．1）分（P＜0．05）。（3）经ROC曲线对所有患者30 d预后分析,T3水平、APACHE Ⅱ评分 ROC曲线下面积分别为0．759（95％CI：0．622～0．886）、0．770（95％CI：0．648～0．896）,二者比较差异无统计学意义（P＞0．05）。T3值以0．40 ng／mL为临界点,对死亡预后的敏感度为75．8％,特异度为77．6％。二者联合预测死亡时曲线下面积为0．836,与单独使用 T3水平、APACHE Ⅱ评分预后之间差异有统计学意义（P＜0．05）。结论伴发低T3综合征的危重患者病死率高,T3值可作为危重患者死亡的预测指标。     

添加益生菌的早期肠内营养对脓毒血症休克患者血清炎症因子的影响

目的 探讨添加益生菌的早期肠内营养对脓毒血症休克患者血清炎症因子的影响.方法 选取2015年2月15日至2017年3月15日来该院接受治疗的脓毒血症休克患者60例作为研究对象,将其分为A(早期肠道内营养+抗生素治疗)、B(益生菌+早期肠道内营养+抗生素治疗)两组.观察两组患者治疗前后营养状况指标、血清炎症因子指标,观察随访3个月内死亡和存活患者入院时炎症因子指标,并进行Logistic回归分析.结果 两组患者治疗后各指标均显著降低,且B组显著低于A组,差异具有统计学意义(P＜0.05);两组患者治疗后白细胞介素(IL)-1、IL-6、IL-8和肿瘤坏死因子(TNF)-α与治疗前相比,均显著降低,差异具有统计学意义(P＜0.05).B组各项指标显著低于A组,差异具有统计学意义(P＜0.05);死亡组入院时各项炎症因子均显著高于存活组,差异具有统计学意义(P＜0.05).Logistic回归分析可知,IL-1(OR=1.591,95％CI1.005～1.863)、IL-6(OR=1.347,95％CI 1.121～1.684)、IL-8(OR=1.529,95％CI 1.225～1.645)、TNF-α(OR=2.545,95％CI 1.658～2.664)是脓毒血症休克患者死亡的危险因素,差异具有统计学意义(P＜0.05).结论 添加益生菌的早期肠内营养对脓毒血症休克患者血清部分炎症因子具有下调作用,抗炎作用明显,减少患者病死率,值得推广.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.