水通道蛋白4和 P65在肠道病毒71型感染合并神经源性肺水肿脑与肺组织的表达及意义

目的：探讨水通道蛋白4（AQP4）及P65在肠道病毒71型（EV71）感染合并神经源性肺水肿（NPE）发病中的意义。方法以10例EV71感染合并肺水肿（ PE）死亡病例为研究对象（ PE组）,以同时期10例非EV71感染合并PE死亡病例为对照组。采用免疫组织化学法对两组尸检病例的肺、脑组织AQP4及P65进行定性检测,采用积分光密度值（ IOD）进行半定量检测。结果免疫组化结果示PE组肺组织P65和AQP4均为强阳性表达,其IOD值高于对照组,在两组肺组织两者IOD值比较,差异有统计学意义（P＜0.05）。 P65及AQP4在PE组脑组织呈中度阳性表达,其IOD值高于对照组,差异有统计学意义（ P＜0.01）。结论 AQP4及P65在EV71感染合并NPE脑与肺组织高表达,提示AQP4和P65可能参与了EV71致NPE形成的发病机制。     

血清神经特异性烯醇化酶与C反应蛋白对手足口病并发脑炎患儿的早期诊断价值

目的：分析手足口病（HFMD）患儿血清神经特异性烯醇化酶（NSE）与C反应蛋白（CRP）水平的变化,探讨其在H FM D并发脑炎中的早期诊断价值。方法以120例 H FM D患儿及50例健康儿童（健康对照组）为研究对象,并按临床表现将HFMD患儿分为普通HFMD组（70例）与HFMD并发脑炎组（50例）,采用定量PCR法检测咽拭子肠道病毒71型（EV71）,采用酶联免疫吸附试验检测NSE及CRP水平,同时检测白细胞（WBC）计数,并分析NSE与CRP的诊断价值。结果 HFMD并发脑炎组患儿血清NSE、CRP水平高于HFMD普通组及健康对照组,差异均有统计学意义（P＜0．05）;EV71阳性患儿NSE及CRP水平均高于EV71阴性患儿,差异均有统计学意义（P＜0．05）,但WBC计数差异无统计学意义（P＞0．05）。血清NSE与CRP水平呈正相关（r＝0．43,P＜0．01）。NSE、CRP的受试者工作特征（ROC）曲线下面积（AUC）及其95％置信区间（CI）分别为0．893（0．833～0．952）、0．867（0．799～0．934）,最佳工作点（OOP）分别为11．6 ng／mL、14．15 mg／L ,此时NSE、CRP诊断 HFMD并发脑炎的灵敏度分别为80．0％、86．0％,特异度分别为81．4％、78．6％;二者串联检测的诊断灵敏度与特异度分别为88．0％和85．7％,AUC及其95％ CI为0．927（0．845～0．969）。结论 HFMD并发脑炎患儿早期NSE及CRP水平明显升高,EV71阳性者更为显著,联合检测血清NSE及CRP水平可作为诊断HFMD并发脑炎的早期敏感指标。     

2159例儿童手足口病流行病学及临床分析

目的分析2012年度本院收治住院的重症手足口病患儿的流行病学及临床特点,寻找重症相关危险因素。方法对本院2012年收治的2159例手足口病患儿临床资料进行回顾性研究,分析其流行病学与临床特点。结果2159例重症手足口病住院患儿中,男1252例（58．0％）,女907例（42．O％）,男女比为1．38：1。年龄以0—3岁为主,达1835例（85．0％）。春夏季节发病率高于秋冬季节。乡村发病率高于城市。普通病例以肠道病毒71（EV71）和柯萨奇病毒16（CoxA16）共同主导流行,重症病例合并并发症和死亡病例以EV7I为流行优势株。EV71组和CAl6组患儿均有发热、皮疹,EV71组患儿手足皮疹与CA16组比较,差异无统计学意义（P〉0．05）。CA16组口腔黏膜病变较EV71组多见,差异有统计学意义（P〈0．05）。CA16组患儿平均热峰（39．34±1．47）℃,热程（4．10±1．40）d,EV71组患儿平均热峰（39．57±0．46）℃,热程（5．05±1．05）d。EV71组患儿热程长于CAl6组（P〈0．05）。EV71组与CA16组血白细胞计数、心肌酶谱、脑脊液异常率、胸片比较,差异有统计学意义（P〈0．01,P〈0．05）,而血糖差异无统计学意义（P〉0．05）。结论手足口病发病与年龄、性别、季节有关,3岁以下幼儿为手足口病高发年龄,外周血白细胞、心肌酶谱水平的升高,胸片等影像学检查可作为实验室预警指标。     

组织因子及组织因子途径抑制物在急性脑血管意外并发神经源性肺水肿中的变化初探

目的：探索组织因子及组织因子途径抑制物在急性脑血管意外并发神经源性肺水肿中的临床变化特点。方法：选取我院于2014年10月至2015年10月间收治的80例急性脑血管意外患者作为临床研究对象，其中脑出血患者40例，脑梗死患者40例，并选取同一时期40例健康体检者作为对照，分别将急性脑血管意外患者和健康体检患者分为观察组和对照组。采用酶联免疫吸附抗原法对患者和健康检查者的血浆 TFPI 以及 TF 进行检测，并对比。结果：经统计发现，观察组中脑出血患者和脑梗死患者的 TF 值均显著高于对照组，且差异具有统计学意义（P ＜0．05）；在 TFPI 方面，观察组中脑出血患者的水平显著高于对照组（P ＜0．05），且具有统计学意义，而脑梗死患者的水平则明显低于对照组（P ＜0．05），同样具有统计学意义。此外，脑出血患者中并发神经源性肺水肿患者的 TFPI 和 TF 水平均未并发神经源性肺水肿（p ＜0．05），脑梗死患者中并发神经源性肺水肿患者的 TFPI 和 TF 水平同样高于未并发神经源性肺水肿患者（p ＜0．05），以上差异均具有统计学意义。结论：急性脑血管意外并发神经源性肺水肿患者在临床上凝血功能异常，且伴随有炎症反应，组织因子以及组织因子抑制物对肺部损伤具有紧密的关联。     

线粒体 ATP 敏感性钾通道开放对大鼠肺缺血－再灌注损伤的保护作用

目的：探讨线粒体 ATP 敏感性钾通道（mitoKATP）开放对大鼠肺缺血－再灌注损伤（I ／R）的保护作用。方法：建立大鼠肺 I ／R 模型,设立假手术组、肺 I ／R 组、mitoKATP 开放剂二氮嗪（DE）＋I ／R 组、mitoKATP 阻断剂5-羟基葵酸（5-HD）＋DE ＋I ／R 组,每组10只大鼠;检测各组肺组织湿／干重比,HE 染色法观察各组肺组织形态学变化,免疫组织化学染色法检测肺组织细胞色素 C 的表达,TUNEL 法检测肺细胞凋亡指数。结果：与假手术组相比,I ／R 组肺组织湿／干重比明显增加（P ＜0．05）,肺组织出现出血、水肿等损伤性病理学变化,细胞色素 C 表达明显增多（P ＜0．01）、肺细胞凋亡指数明显增大（P ＜0．01）;与 I ／R 组相比,DE ＋I ／R 组肺组织湿／干重比明显降低（P ＜0．05）、肺组织损伤性病理变化明显减轻、肺细胞色素 C 表达明显减少（P ＜0．05）、细胞凋亡指数明显减小（P ＜0．05）,而5-HD ＋DE ＋I ／R 组各项指标与 I ／R 组比较无差异（P ＞0．05）。结论：mitoKATP 的开放可减轻肺水肿、抑制细胞凋亡,对大鼠肺缺血－再灌注损伤具有保护作用。     

不同剂量的1，25（OH）2D3对大鼠Thy1肾炎系膜细胞凋亡的影响

目的：探讨不同剂量的1,25（OH）2D3对大鼠抗胸腺细胞抗体（Thy1）肾炎系膜细胞凋亡的影响。方法将SD大鼠120只分为空白对照组（A组）、肾炎模型组（B组）、低剂量1,25（OH）2D3组（C组）和高剂量1,25（OH）2D3组（D组）,每组30只。C、D两组造模成功后给药干预,4组分别于干预后第1、3、7、14、21天每组随机处死6只大鼠,取肾组织标本经HE及PAS染色后确定肾脏病理损害分级;免疫组化法检测肾组织中半胱氨酸天冬氨酸蛋白酶3（Caspase‐3）的表达;TUNEL试剂盒检测其肾小球内细胞凋亡。结果与A组比较,B组Caspase‐3表达增强（P＜0．05）;与B组比较,C、D组Caspase‐3表达增强,但差异无统计学意义（P＞0．05）;D组表达最高,但与C组比较差异无统计学意义（P＞0．05）。与A组比较,B组肾小球内凋亡细胞明显增多（P＜0．05）,且随时间推移逐渐增强;与B组比较,C、D两组凋亡明显增多（P＜0．05）,并在3d达高峰,7、14d逐渐下降,21d趋于正常（P＜0．05）;C、D两组比较,D组凋亡细胞增多明显,但差异无统计学意义（P＞0．05）。结论1,25（OH）2D3具有诱导大鼠肾小球系膜细胞凋亡的作用,其参与了对Caspase‐3的调节,诱导系膜细胞凋亡,促进肾炎的修复,可延缓肾脏疾病进展。     

组织因子及组织因子途径抑制物在急性脑血管意外并发神经源性肺水肿中的变化研究

目的：探讨急性脑血管意外并发神经源性肺水肿（NPE）中组织因子（TF）及其抑制物（TFPI）的变化情况。方法：选择我院2007年6月～2010年5月收治的急性脑血管意外患者80例为研究组,其中,脑出血36例,脑梗死44例,选择同期健康体检者40例为对照组,分别采用酶联免疫吸附抗原法检测患者血浆TF、TFPI,并进行组问比较。结果：研究组患者血TF值均高于对照组,差异均有高度统计学意义（均P〈0．01）;研究组中,脑出血患者血TFPI高于对照组,脑梗死患者血TFPI低于对照组,差异均有统计学意义（均P〈0．05）。脑出血及脑梗死患者中并发神经源性肺水肿的患者,血TF、TFPI均高于未并发的神经源性肺水肿患者,差异有统计学意义（P〈0．05）。结论：急性脑血管意外并发神经源性肺水肿的发生与凝血异常、炎症反应有关,组织因子及组织因子抑制物可能参与了肺损伤发生发展的过程。     

急性中毒心肌损伤早期检测和肽素与缺血修饰白蛋白的临床价值

目的：探讨急性中毒心肌损伤早期检测和肽素与缺血修饰白蛋白（ IMA）的临床意义。方法将急性中毒3 h内患者255例,根据是否存在心肌损伤分为心肌损伤组160例（其中轻度30例、中度60例、重度70例）和非心肌损伤组95例,另选健康体检者50例作为对照组。比较3组心肌酶、心肌肌钙蛋白 I（ cTnI）、和肽素、IMA 水平。结果心肌损伤组、非心肌损伤组患者和肽素水平明显高于对照组（P＜0．05）,且心肌损伤组明显高于非心肌损伤组（P＜0．05）,重度组高于心肌损伤轻、中度组（P＜0．05）;心肌损伤组IMA水平明显低于对照组和非心肌损伤组（P＜0．05）,重度组低于心肌损伤轻、中度组（P＜0．05）。心肌损伤组、非心肌损伤组、对照组肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、cTnI水平比较,差异均无统计学意义（P＞0．05）。心肌损伤重度组患者cTnI水平明显高于轻、中度组（P＜0．05）,但轻、中度两组间cTnI水平比较无统计学意义（P＞0．05）。心肌损伤轻、中、重度组患者CK、CK-MB比较,差异均无统计学意义（P＞0．05）。心肌损伤组患者和肽素与IMA水平呈负相关（r＝－0．603,P＜0．01）。结论和肽素、IMA水平可在早期反映急性中毒性心肌损伤程度并评估预后转归情况。     

753例再次剖宫产病例的临床分析

目的：通过分析再次剖宫产患者的妊娠风险及妊娠结局,认识降低剖宫产率的重要性。方法收集2010年12月至2012年6月,该院再次剖宫产病例753例,随机抽取同期首次剖宫产病例760例作为对照组,将两组资料进行对比分析。结果研究组高龄孕妇明显多于对照组（P＜0．05）;孕检次数明显少于对照组（P＜0．05）;孕期并发贫血、子痫前期、糖尿病均明显高于对照组（P＜0．05）;合并妊娠期胆汁淤积症者,两组间差异无统计学意义（P＞0．05）;术中胎盘早剥的发生两组差异无统计学意义（P＞0．05）;前置胎盘和严重的胎盘粘连发生均明显多于对照组（P＜0．05）;产后大出血发生两组差异无统计学意义（P＞0．05）;胎儿生长受限（FGR）的发生两组差异无统计学意义（P＞0．05）;巨大儿的发生两组差异有统计学意义（P＜0．05）;新生儿窒息率两组差异无统计学意义（P＞0．05）;转入新生儿重症监护病房（NICU）率研究组高于对照组（P＜0．05）。结论再次剖宫产孕妇的并发症增多,新生儿转入 NICU率升高,风险明显大于首次剖宫产孕妇。     

利血平治疗手足口病并发神经源性肺水肿23例的疗效观察

目的观察利血平治疗手足口病并发神经源性肺水肿的疗效。方法46例手足口病并发神经源性肺水肿患者按随机数字表法分为对照组及治疗组，各23例，均按卫生部《手足口病诊疗指南》进行救治。治疗组在血压增高时给予利血平注射液肌注。观察两组治疗后72 h心率、血压、空腹血糖、氧合指数急性生理学与慢性健康状况评分系统评分等指标变化。结果治疗前两组心率、血压、空腹血糖、氧合指数急性生理学与慢性健康状况评分系统评分等指标比较，差异无统计学意义（P＞0．05）。与对照组相比，治疗后治疗组心率、血压、空腹血糖、急性生理学与慢性健康状况评分系统评分改善明显（P＜0．05）。治疗后两组氧合指数比较，差异无统计学意义（P＞0．05）。结论手足口病并发神经源性肺水肿早期血压增高时予抑制儿茶酚胺治疗，效果好，值得临床推广。     

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.     

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.