胱抑素C水平与急性脑梗死神经功能缺损评估及预后相关研究

目的:研究血清胱抑素C水平与急性脑梗死神经功能缺损及其对患者神经功能恢复的影响。方法:选取芜湖市第一人民医院2017年1月～2018年6月诊断为急性脑梗死患者91例。对入院病例采集病史,根据美国国立卫生研究院卒中量表(NIHSS)进行评分,分为低缺损组46例,高缺损组45例;根据日常生活活动能力量表进行评分,分为能力不良组34例,能力良好组57例。根据不同评分比较患者的血尿酸、同型半胱氨酸及血清胱抑素C水平。结果:高缺损组患者同型半胱氨酸、胱抑素C水平均高于低缺损组(P<0.05),而两组患者尿酸水平差异无统计学意义(P>0.05)。能力不良组尿酸、胱抑素C水平均高于能力良好组(P<0.05),而两组患者同型半胱氨酸水平差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,胱抑素C水平增高(OR=6.013)是脑梗死神经功能缺损的危险因素,胱抑素C水平增高(OR=9.043)是脑梗死预后不良的危险因素。结论:高胱抑素C水平是急性脑梗死神经功能缺损的相关因素,并可用来评估急性脑梗死患者的日常生活能力预后情况。     

脑梗死患者血清胱抑素C,hs-CRP及D-二聚体与颈动脉斑块稳定性的研究

目的： 探讨脑梗死患者中血清胱抑素C（cystain C,Cys C）、超敏C-反应蛋白（hypersensitive C-reactive protein,hs-CRP）及D-二聚体（D-Dimer）水平与颈动脉斑块稳定性的关系。方法：选取我院急性脑梗死患者100名,并选取同期我院行健康体检的健康对照者80名,测定所有受试者的血清胱抑素C,hs-CRP及D-二聚体的水平,并应用彩色多普勒超声检测受试者的颈动脉内中膜厚度（IMT）及动脉粥样硬化斑块性质,加以分析评价。结果：脑梗死组血清胱抑素C、hs-CRP及D-二聚体水平显著高于对照组（P<0.01,P<0.01及P<0.05）,病例组中不稳定斑块组中血清胱抑素C、hs-CRP及D-二聚体高于稳定斑块组（P<0.01,P<0.01及P<0.05）。结论：血清胱抑素C、hs-CRP及D-二聚体水平升高不仅与脑梗死的发生发展有关,还与颈动脉斑块的性质及稳定性相关,临床中应早期监测,早期预防和治疗。     

血清胱抑素C、同型半胱氨酸、超敏C反应蛋白与不同类型脑梗死的相关性分析

目的：探讨血清胱抑素C（cystatin C,Cys C）、同型半胱氨酸（homocysteine,Hcy）、超敏C反应蛋白（high sensitivity C reactive protein,hs CRP）水平与不同类型急性脑梗死的关系。方法：选择神经内科收治的100例急性脑梗死患者为观察组,并按照TOAST分型标准进行病因分型;选择80例非脑卒中病例为对照组,分别测定和比较两组患者血清Cys C、Hcy以及hs CRP的水平。结果：脑梗死组患者血清Cys C、Hcy、hs CRP水平高于对照组（P〈0.05）,经Logistic回归分析三者均为脑梗死的危险因素（OR值分别为1.989、2.013、1.601）;观察组中大动脉粥样硬化型（LAA）、小动脉闭塞型（SAA）患者血清Cys C、Hcy、hs CRP水平均高于对照组（P〈0.05）,其中以LAA型增高显著（P〈0.01）。结论：血清Cys C、Hcy和hs CRP水平升高均与脑梗死密切相关,可能是脑梗死的危险因素,但不同亚型脑梗死可能有不同病因。     

肾功能衰竭患者血清胱抑素C含量测定的临床意义

目的：测定肾功能衰竭患者血清胱抑素C（Cystatin C,Cyst）的含量并探讨其临床意义。方法：采用免疫比浊法测定36例慢性肾功能衰竭患者的血清胱抑素C含量,同时测定17例血清肌酐含量正常的急性肾小球肾炎患者血清胱抑素C含量。24例正常者做为对照组。结果：慢性肾功能衰竭患者的血清胱抑素C含量显著高于正常对照组（P〈0.01）。急性肾小球肾炎组血清胱抑素C含量高于正常对照组（P〈0.05）。结论：血清胱抑素有助于评价肾小球滤过功能的评价,血清胱抑素C可能是肾功能衰竭患者肾小球损害程度判断和疗效观察的一项有价值的检测指标。     

血尿酸及胱抑素C与急性缺血性脑卒中发病及预后的相关性研究

目的 探讨急性缺血性脑卒中患者尿酸和胱抑素C 水平与疾病严重程度和短期预后等的关系。方法 选取浙江省舟山医院2018 年1～12 月间收入院的80 例急性缺血性脑卒中患者进行回顾性分析,按美国国立卫生研究院卒中量表（National institute of health stroke scale,NIHSS）评分将患者分为高、中、低三组及按影像学检查脑梗死的面积分为大、中、小面积脑梗死三组,并于入院后24 h 完善尿酸、胱抑素C 检测,将各组尿酸及胱抑素C的水平进行比较;通过入院及治疗2 周后两次NIHSS 评分变化情况评估患者预后情况,比较尿酸及胱抑素C 水平的高低与患者预后情况的关系;分析尿酸与胱抑素C 指标的内在相关性。结果 （1）高NIHSS 评分患者的尿酸及胱抑素C 水平均高于相对低NIHSS 评分患者（P＜0.05）,且NIHSS 评分与尿酸、胱抑素C 水平呈正相关（均P＜0.05）。（2）大面积脑梗死患者的尿酸及胱抑素C 水平高于中、小面积脑梗死患者（P＜0.05）,中面积脑梗死患者也高于小面积脑梗死的患者。（3）急性缺血性脑卒中患者的尿酸及胱抑素C 水平随预后不同存在差异,但仅尿酸表现为疾病预后越良好（NIHSS 评分改善）,尿酸水平越高。结论 尿酸及胱抑素C 水平与急性缺血性脑卒中疾病严重程度密切相关,而在急性缺血性脑卒中患者中尿酸升高可能预示着神经功能有着更良好的结局。     

76例急性脑梗死患者血清胱抑素C检测结果分析

目的：观察急性脑梗死患者血清胱抑素C水平的变化情况,探讨血清胱押素C水平检测在急性脑梗死诊断、治疗和病情监测中的意义。方法：采用微粒子增强比浊法对76例急性脑梗死患者和35例正常对照进行血清胱抑素C含量测定,并将两组结果作对比分析。结果：急性脑梗死组血清胱抑素C含量明显高于正常对照组（P〈0．01）。结论：血清胱抑素C是反映肾功能损伤的敏感指标,血清胱抑素C水平变化对急性脑梗死患者的治疗和病情监测有重要意义。     

急性脑梗死患者血清同型半胱氨酸与尿酸及血脂水平变化的临床意义

目的 探讨急性脑梗死患者血清同型半胱氨酸、尿酸及血脂水平变化的临床意义。方法 回顾性分析2019年4月至2020年4月本院收治的80例急性脑梗死患者和于本院体检的80名体检者的临床资料,其中急性脑梗死患者作为实验组,体检者作为对照组。比较两组临床资料和血清同型半胱氨酸、血脂及尿酸水平。根据实验组短期预后情况分为预后不佳组（n=20）和预后良好组（n=60）,采用多因素Logistic回归方程分析急性脑梗死患者短期预后不佳的危险因素。结果 实验组血清同型半胱氨酸、总胆固醇、低密度脂蛋白及尿酸水平均高于对照组,高密度脂蛋白水平低于对照组（P<0.05）。单因素分析结果显示,预后不佳组和预后良好组年龄、血脂水平、尿酸水平及血清同型半胱氨酸水平比较差异有统计学意义（P<0.05）。多因素Logistic分析结果显示,年龄、高血脂、尿酸及血清同型半胱氨酸水平是急性脑梗死患者短期预后不佳的危险因素（OR>1,P<0.05）。结论 年龄、血清同型半胱氨酸水平、血脂水平和尿酸水平与急性脑梗死发生发展密切相关,也是导致急性脑梗死预后不佳的危险因素。因此,临床需监测患者血清同型半胱...     

急性脑梗死患者血清胱抑素C的临床检验评价

目的探讨血清胱抑素C在急性脑梗死患者临床诊断中的价值。方法将我院收治的急性脑梗死患者作为研究组,与同期健康组进行血清胱抑素C水平比较。结果观察组患者在发病时间段内的血清胱抑素C水平明显高于正常组（P〈0.05）,且随着发病时间延长,患者的血清胱抑素C水平随之增加。结论急性脑梗死患者的血清胱抑素C水平与正常人群之间具有明显差异,因而可以作为急性脑梗死诊断或治疗中的一个检测指标,具有一定的临床价值。     

血清胱抑素C与多发性肌炎心血管危险因素的临床分析

目的 探讨多发性肌炎患者血清胱抑素C与传统心血管危险因素的关系。 方法 选择2006年1月—2017年9月成都市第三人民医院住院部收治的多发性肌炎患者88例,根据血清胱抑素C水平分为血清胱抑素C升高组(53例)和非血清胱抑素C升高组(35例)。比较2组患者临床特征,采用Spearman相关分析评估血清胱抑素C与传统心血管疾病相关危险因素如年龄、收缩压、甘油三酯的关系,最后采用多因素logistic回归分析评估与血清胱抑素C相关的心血管疾病危险因素。 结果 60.2%(53/88)的多发性肌炎患者血清胱抑素C升高。与血清胱抑素C正常组比较,血清胱抑素C升高组的年龄(P=0.008)及甘油三酯(P=0.004)差异有统计学意义。Spearman相关性分析显示,多发性肌炎患者血清胱抑素C水平与年龄、甘油三酯呈正相关(r分别为0.296、0.282,均P＜0.05)。多因素logistic回归分析结果显示:甘油三酯水平(OR=2.415,95% CI:1.189~4.905)与血清胱抑素C水平密切相关(P＜0.05)。 结论 多发性肌炎患者血清胱抑素C水平与甘油三酯有关。      

血清胱抑素C、尿酸水平与帕金森病伴认知功能障碍的相关性分析

目的探讨帕金森病（PD）病人血清半胱氨酸蛋白酶抑制剂C（胱抑素C）、尿酸水平的变化,并分析血清胱抑素C、尿酸水平与PD伴认知功能障碍的相关性。方法选择60例PD病人为PD组,年龄及性别相匹配的30名健康体检者为对照组。对PD组病人行简易智力状况检查量表（MMSE）评分,根据MMSE评分将PD组分为PD伴认知功能障碍组、PD不伴认知功能障碍组。检测各组血清胱抑素C及尿酸水平。结果PD组血清胱抑素C水平高于对照组（P < 0.05）,血尿酸水平明显低于对照组（P < 0.01）。PD伴认知功能障碍组血清胱抑素C水平明显高于不伴认知功能障碍组（P < 0.01）,血尿酸水平低于不伴认知功能障碍组（P < 0.05）。血清胱抑素C水平与MMSE评分呈负明显相关关系（r=-0.403,P < 0.01）;血清尿酸水平与MMSE评分呈正相关关系（r=0.286,P < 0.05）。结论血清胱抑素C及尿酸水平与PD伴认知功能障碍有关,可作为PD伴认知功能障碍的早期生物学评估指标。     

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.