葫芦素片治疗慢性乙型肝炎50例临床观察

目的观察葫芦素片治疗慢性乙型病毒性肝炎的疗效及安全性。方法98例患者随机分为2组，治疗组在一般护肝治疗基础上应用葫芦素片，2片／次，3次／d，口服。对照组在此基础上应用菌栀黄注射液，静脉滴注，20ml/d。4周为1疗程。治疗期间每周检测肝功能，同时记录用药不良反应。结果治疗组ALT复常率82％，SB复常率72％，总有效率96％，明显优于对照组的52．1％，43．8％，77.1％，P〈0．01。结论葫芦素片治疗慢性乙型病毒性肝炎疗效显著，无明显不良反应。     

拉米夫定联合复方鳖甲软肝片治疗乙型病毒性肝炎肝硬化疗效观察

目的观察拉米夫定联合复方鳖甲软肝片治疗乙型病毒性肝炎肝硬化的疗效。方法将60例乙型病毒性肝炎肝硬化患者随机分为治疗组和对照组。两组均采用常规内科综合治疗,治疗组加用拉米夫定和复方鳖甲软肝片口服,疗程1年。观察并比较两组治疗前后的症状、体征和肝功能、肝纤维化指标变化及HBV—DNA阴转率等。结果治疗组总有效率为96．7％,对照组总有效率为76．7％,治疗组疗效高于对照组（P〈0．01）。治疗组在治疗后ALT、TBIL、HA较治疗前明显改善（P〈0．01或P〈0．05）;且ALT、HA的下降优于对照组（P〈0．01或P〈0．05）。治疗组的HBV—DNA转阴率为76.7％,优于对照组的16．7％（P〈0.01）。结论拉米夫定联合复方鳖甲软肝片治疗能够通过抑制病毒和抗纤维化明显改善乙型病毒性肝炎肝硬化患者的病情及预后。     

腺苷蛋氨酸治疗淤胆型肝炎164例疗效观察

目的：观察腺苷蛋氨酸治疗淤胆型病毒性肝炎的疗效；方法：164例淤胆型病毒性肝炎患者随机分为A组（治疗组）、B组（对照组）两组，分别用腺苷蛋氨酸和门冬氨酸钾镁治疗，疗程为4周；结果：腺苷蛋氨酸对淤胆型病毒性肝炎的总有效率为95％，与对照组有明显差异，对淤胆型肝炎患者皮肤瘙痒、纳差的有效率分别为85％、83％，与对照组差异有显著性（P＜0．05），腺苷蛋氨酸治疗后，淤胆型肝炎的血清总胆红素（STB）、血清结合胆红素（SCB）、总胆汁酸（TBA）、ALT、AST的降幅明显高于对照组（P＜0．05），STB、SCB、TBA的复常率显著高于对照组（P＜0．05）；结论：腺苷蛋氨酸治疗淤胆型肝炎疗效较好，优于门冬氨酸钾镁，没有明显不良反应。     

谷氨酰胺颗粒干预重度慢性乙型病毒性肝炎内毒素血症的临床疗效观察

目的观察谷氨酰胺颗粒干预重度慢性乙型病毒性肝炎内毒素血症的临床疗效。方法将60例重度慢性乙型病毒性肝炎内毒素血症患者随机分成对照组和治疗组,每组30例。对照组采用常规护肝、抗病毒治疗,而治疗组在对照组治疗方案的基础上加用谷氨酰胺颗粒10g,3次／a,疗程为2周。观察治疗前后两组患者的血清内毒素、肝功能的变化以及治疗后的总有效率。结果治疗组总有效率（83．3％）优于对照组（50．0％）,差异有统计学意义（P〈0．01）。两组肝功能、血清内毒素较治疗前均有不同程度好转,治疗组与对照组比较差异有统计学意义（P〈0．05或P〈0．01）。结论谷氨酰胺颗粒治疗重度慢性乙型病毒性肝炎内毒素血症是一种有效的辅助治疗方法。     

安胎清肝法治疗妊娠期慢性乙型病毒性肝炎的临床研究

目的 观察安胎清肝方药治疗妊娠期慢性乙型病毒性肝炎的疗效。方法 选择胎药菟丝子，黄芪，黄芩等和清肝药叶下珠，蒲公英等组成安胎清肝方治疗妊娠期慢性乙型病毒性肝炎50例，观察治疗后妊娠情况，肝功能，乙肝病毒标志物和肝纤维化指标的变化。结果 经治疗后无1例出现流产，谷丙转氨酶，血清胆红素，血清透明质酸等均明显降低，与治疗前比较，差异均有显著性（P＜0．01）；HBeAg和HBV－DNA的阴转率分别达到30％和32．5％。结论 安胎清肝法对妊娠期慢性乙型病毒性肝炎有较好的保胎，护肝作用。     

更昔洛韦治疗小儿巨细胞病毒性肝炎的临床研究

目的：观察更昔洛韦对小儿巨细胞病毒(CMV)肝炎的疗效。方法：将50例CMV肝炎患儿随机分为两组，治疗组30例在常规护肝的基础上加用更昔洛韦5mg／kg静滴，每日2次，连续14d。对照组20例予以常规护肝治疗。结果：治疗组和对照组血清CMV-IgM及血清CMV-DNA转阴率分别为85％和17．5％，P＜0．01；治疗总有效率分别为86．7％和20％，P＜0．01，且治疗组血清胆红素(STB)复常时间及谷丙转氨酶(ALT)复常时间均较对照组明显缩短，治疗组在治疗过程中未见明显毒副作用。结论：更昔洛韦治疗小儿CMV肝炎，疗效确切，可推广应用。     

干扰素联合大剂量胸腺肽治疗慢性乙型病毒性肝炎

目的：探讨干扰素联合大剂量胸腺肽对慢性乙型病毒性肝炎的治疗作用及机制。方法：按诊断标准选择慢性乙型病毒性肝炎100例，随机分为干扰素联合大剂量胸腺肽治疗组（50例）和干扰素对照组（50例），观察比较两组患者的转氨酶及HBeAg、HBVDNA的变化。结果：干扰素联合大剂量胸腺肽治疗组的转氨酶复常率，HBeAg及HBVDNA阴转率均明显高于对照组（P＜0.05)，结论：大剂量胸腺肽能促进HBeAg的阴转，抑制HBV的复制，提高细胞免疫应答能力；干扰素联合大剂量胸腺肽治疗慢性乙型病毒性肝炎有较好的疗效，且使用安全。     

腺苷蛋氨酸联合茵栀黄治疗乙型病毒性肝炎高胆红素血症临床观察

目的：观察腺苷蛋氨酸联合茵栀黄注射液治疗乙型病毒性肝炎高胆红素血症的疗效。方法：将64例乙型病毒性肝炎高胆红素血症患者随机分为两组，对照组（31例）采用甘草酸二胺注射液和枯黄注射液静滴，治疗组（33例）在同量甘草酸二胺注射液保肝基础上加用腺苷蛋氨酸注射液和茵栀黄注射液静滴，疗程4周。观察比较两组治疗前后的症状、体征和肝功能变化等情况。结果：治疗组总有效率93．9％，对照组总有效率71．0％，治疗组疗效优于对照组（P〈0．01）。治疗组在治疗后肝功能较治疗前明显改善（P〈0．01），且ALT、TBIL的下降优于对照组（P〈0．05）。结论：腺苷蛋氨酸联合茵栀黄注射液能有效改善乙型病毒性肝炎高胆红素血症。     

温阳活血化痰法治疗慢性乙型病毒性肝炎临床观察

目的 观察中医温阳活血化痰法治疗慢性乙型病毒性肝炎的临床疗效。方法应用温阳活血化痰法治 疗慢性乙型病毒性肝炎30例,并与西药(肌苷、复方维生素B、维生素C、甘利欣等)治疗的20例及常规 清热解毒、疏肝健脾法治疗的20例作对照。观察三组治疗前后ALT、AST、ALB、HBeAg、HBV—DNA等指 标。结果中药治疗组能明显改善慢性乙型病毒性肝炎临床证候和肝功能等指标,总有效率为90．0％,与西 药对照组(85．0％)总体疗效一致(p>0．05),无显著性差异;与中药对照组(70．0％)比较,治疗组疗效明 显高于中药对照组(p<0．05),有显著性差异。结论采用温阳活血化痰法治疗慢性乙型病毒性肝炎,能显 著改善肝功能,抑制乙肝病毒,改善临床症状。     

黄芪静脉滴注对慢性乙型病毒性肝炎患者细胞免疫功能的影响

目的：探讨黄芪静脉滴注对慢性乙型病毒性肝炎患细胞免疫功能的调节作用。方法：黄芪与甘草酸二胺（甘利欣）合用治疗慢性乙型病毒性肝炎轻度（CLH）及中度（CMH）患各15例,并设轻度及中度患各10例单用甘利欣治疗作对照,另设健康正常组10例。结果：治疗组CD3^ 、CD4^ 和CD4^ /CD8^ 治后均较对照组显升高（P＜0．05或P＜0．01）。治疗组CLH型治后自然杀伤（NK）细胞活性、T淋巴细胞转化率（LTR）增加,血浆可溶性白细胞介素－2受体（SIL－2R）水平降低,与对照组比较均有显性差异（P＜0．05）;CMH型与对照组相比无显变化。结论：黄芪能显提高慢性乙型病毒性肝炎患的细胞免疫功能,对轻度患的疗效优于中度患。     

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.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

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.