超声引导下穿刺置管引流在重症急性胰腺炎治疗中的应用

目的:探讨超声引导下穿刺置管引流术在重症急性胰腺炎治疗中的应用。方法:10例重症急性胰腺炎患者均行腹腔穿刺置管引流,配合常规内科治疗。结果:所有患者穿刺置管过程顺利,1例拔管后复发脓肿,胰腺坏死严重,实行外科手术后治愈,余内科治疗临床治愈。结论:超声引导下穿刺置管引流术微创、方便,病人痛苦少,在重症急性胰腺炎治疗中有重要价值。     

穿刺置管治疗细菌性肝脓肿37例分析

目的：探讨细菌性肝脓肿的治疗方法，提高治愈率。方法：选择37例细菌性肝脓肿在B型超声波引导下穿刺置管引流。结果：本组37例一次性穿刺成功36例，脓肿数目47个，失败1例，后经保守治疗痊愈。1例术后第2天脓栓阻塞管腔，改经腹腔脓腔引流。术后均恢复顺利，无并发症发生，全部治愈。结论：穿刺置管引流治疗细菌性肝脓肿是一种创伤小，痛苦轻，治愈率高的方法。     

重症急性胰腺炎经腹腔镜手术引流20例

重症急性胰腺炎(SAP)经腹腔镜手术引流20例，适应证为胰腺尚未发生感染，但腹腔渗液较多者以及胰腺发生感染有手术指征。结果存活17例(85.0％)，因术后多器官功能障碍综合征3例死亡，有选择地对SAP施行早期灌洗引流有助于降低病死率，经腹腔镜手术引流集传统剖腹引流与穿刺引流优点于一身，以对机体极小的影响达到剖腹引流手术的效果。     

12例胰腺脓肿的诊治体会

目的探讨胰腺脓肿的诊断治疗。方法回顾性分析12例胰腺脓肿的临床治疗资料。结果12例胰腺脓肿患者中10例痊愈出院、1例死亡、1例术后并发胰瘘。结论胰腺脓肿是重症胰腺炎晚期严重并发症,诊断明确后应立即手术,术后保持有效通畅引流至关重要。     

重症胰腺炎57例手术治疗分析

目的分析重症胰腺炎的外科治疗。方法回顾我院2004年12月至2008年12月急性重症胰腺炎患者57例,均手术治疗,主要术式为简单的引流手术。结果本组病例中,死亡3例,其余均治愈,治愈率为94.7%。术后并发胰腺脑病的4例,心肺功能不全12例,切开裂开3例,对以上病例给予内科等治疗,无病例死亡,均痊愈。结论重症胰腺炎宜早期诊断,根据具体情况早期手术治疗;简单引流术对胰腺组织损伤小、清创彻底、引流充分,为重症胰腺炎的有效手术治疗方法。     

单房细菌性肝脓肿手术引流与经皮穿刺引流的比较(附100例报告)

目的：对比研究单房细菌性肝脓肿两种引流方法的临床疗效。方法：１００例单房细菌性肝脓肿患者，经腹手术置管引流６０例，经皮肝穿刺置管引流４０例。结果：经腹手术置管引流与经皮肝穿刺置管引流相比，组织损伤大，并发症多，病死率高。结论：经皮肝穿刺置管引流优于经腹手术置管引流。     

超声引导下经皮穿刺置管引流在重症胰腺炎治疗中的应用价值

目的探讨超声引导下经皮穿刺置管引流(percutaneous catheter drainage,PCD)治疗重症急性胰腺炎的应用价值。方法回顾性分析我科在2016年6月--2018年12月行PCD治疗的62例重症急性胰腺炎患者,有胆囊结石胆囊颈部梗阻者同时行经皮经肝胆囊穿刺置管术(PTGD),并联合内科支持治疗,胰腺炎治愈后均行胆囊切除术。结果 36例患者穿刺置管手术顺利,2例患者胰腺严重坏死,置管引流期间采取外科开腹手术,3例拔除引流管后感染复发,多次PCD,3例病情危重出现休克并伴有微循环障碍引出现皮下瘀斑,给予吸氧、血液透析治疗,急性呼吸窘迫综合征(ARDS)6例给予呼吸机支持治疗、16例胆囊结石梗阻置管患者2例出现寒战高热,用抗生素联合地塞米松治疗。所有患者均临床治愈。结论在重症胰腺炎的治疗中,超声引导下穿刺置管引流是主要的辅助治疗方法。     

单房细菌性肝脓肿手术引流与经皮穿刺引流的比较（附100例 …

目的：对比研究单房细菌性肝脓肿两种引流方法的临床疗效，方法：１００例单房细胞性肝脓肿患者，经腹手术置管引流６０例，经皮肝穿置管引流４０例，结果，经腹手术置管引流与经皮肤穿刺置管引流相比，组织损伤大，并发症多，病死率高，结论：经皮肝穿刺置管引流优于经腹手术置管引流。     

重症胰腺炎合并胰腺感染的手术治疗分析

目的探讨重症胰腺炎合并胰腺感染的手术治疗方法及效果，以寻找更合理的治疗方案，降低患者的病死率。方法选择江西省上高县南港中心卫生院2008年1月-2012年12月收治的45例重症胰腺炎合并胰腺感染患者为研究对象。所有纳入患者接受持续性的胃肠道减压、灌肠，营养支持，抗感染、促进肠道蠕动、抑制胰腺和胃酸的分泌等治疗。5例患者经腹腔穿刺检查发现有脓肿，入院后立即行急诊手术治疗。3例患者经保守治疗21d内无好转迹象，行腹膜间隙清创引流后行手术治疗。37例患者在发生感染后的21～58d内进行延期的手术治疗。结果本组患者共死亡3例，死因包括呼吸窘迫综合症1例，多器官功能衰竭1例，感染中毒性休克1例。其余患者均在术后痊愈，痊愈时间为（185±42）d。发生感染至手术时间≤3周的，息者与〉3周的患者比较，其死亡率无统计学意义，两组患者术后痊愈时间差异有统计学意义（P〈005），发生感染至手术时间〉3周的患者痊愈时间显著较短。术后合并心肺功能不全1例，2例出现胰周感染，1例出现腹腔脓肿，经对症治疗后患者均痊愈出院。结论重症胰腺炎合并胰腺感染的患者应积极的进行抗感染治疗，给予营养支持，适当延长手术治疗时间，可以减少患者的死亡率。     

膀胱穿刺针置管引流在重症急性胰腺炎中的应用

目的：探讨在B超引导下利用膀胱穿刺针穿刺置管引流,在重症急性胰腺炎并胰周积液治疗中的应用价值。方法：20例重症急性胰腺炎患者均行腹腔或后腹腔穿刺置管引流,其中膀胱穿刺针结合胆道引流管经腹壁腹腔内穿刺置管引流12例,后腹膜积液（脓肿）单纯采用膀胱穿刺针穿刺置管冲洗引流8例。结果：本组患者穿刺置管过程顺利,均未出现与穿刺相关的严重并发症如腹腔内出血、肠瘘、穿刺部位感染等。患者在常规抗感染、对症、支持治疗及肠内外营养支持治疗的基础上配合超声引导下穿刺置管引流,各项检测指标均较治疗前明显改善。结论：B超引导下采用膀胱穿刺针穿刺置管引流操作简单、创伤小、费用少,在重症急性胰腺炎治疗中有一定的临床实用价值。     

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.