急性冠状动脉综合征患者双联抗血小板治疗期间提前停服替格瑞洛情况分析

目的 探究提前停服替格瑞洛（PTD）在急性冠状动脉综合征（ACS）患者中的发生率、原因及影响因素。方法 回顾性纳入2018年1月至10月于海军军医大学（第二军医大学）长海医院心血管内科使用阿司匹林和替格瑞洛双联抗血小板治疗的ACS住院患者400例,收集患者基线资料并随访,分析ACS患者PTD的发生率、原因和影响因素。结果 出院12个月时PTD患者49例（12.2%）,未PTD患者351例（87.8%）。PTD组年龄>75岁、有心力衰竭病史、既往行经皮冠状动脉介入（PCI）的患者比例和血钾、尿素水平均高于未PTD组（P=0.004、0.031、0.028、0.037、0.001）,使用β受体阻滞剂的患者比例和血管病变严重程度均低于未PTD组（P=0.041、0.018）。呼吸困难（22.4%,11/49）、当地无药（18.4%,9/49）和出血（12.2%,6/49）是导致PTD最常见的3个原因,改良英国医学研究理事会呼吸困难指数（mMRC）评分为2级及2级以上的呼吸困难患者均停服替格瑞洛（mMRC评分1级2例,2级6例,3级2例,4级1例）。Kaplan-Meier曲线分析PTD累积发生率结果显示,67.3%（33/49）的患者PTD发生在出院后90 d内。多因素logistic回归分析结果显示,年龄>75岁（OR=2.58,95% CI 1.26~5.26,P=0.009）和尿素水平升高（OR=1.17,95% CI 1.04~1.30,P=0.007）均为ACS患者PTD的独立预测因素,血管病变严重（OR=0.95,95% CI 0.92~0.98,P=0.001）是ACS患者坚持服用替格瑞洛的相关因素。结论 ACS患者双联抗血小板治疗期间PTD的发生率为12.2%。对于呼吸困难且mMRC评分为2级及2级以上的患者,临床应及时更换P₂Y₁₂受体拮抗剂。年龄>75岁为ACS患者PTD的独立预测因素,临床实践中应该高度重视服用替格瑞洛的高龄患者,关注其有无发生呼吸困难及PTD。     

急性冠状动脉综合征行PCI术后氯吡格雷和替格瑞洛引起心律失常的比较

目的 分析急性冠状动脉综合征（ACS）患者行冠状动脉介入（PCI）术后氯吡格雷和替格瑞洛引起心律失常的作用差异。方法 选择PCI择术期224例ACS患者为研究对象,按入院顺序随机分为替格瑞洛组和氯吡格雷组,每组112例。所有患者在PCI术后给予100mg/d阿司匹林基础治疗,在此基础上,替格瑞洛组给予负荷剂量180mg,维持剂量为90毫克/次,2次/天,氯吡格雷组给予负荷剂量300mg,维持剂量为75毫克/次,1次/天。随访1年,分别在PCI术后1、6和12个月时,对两组患者进行24h动态心电图监测,记录两组患者的心律失常相关的不良事件。结果 术后1个月和6个月,两组患者的心率（HR）、左心室射血分数（LVEF）、左心室收缩末期内径（LVESD）和左心室舒张末期内径（LVEDD）无明显变化（P>0.05）;12个月后,替格瑞洛组的HR和LVEF明显下降,LVESD和LVEDD明显增高,与氯吡格雷组比较,差异有统计学意义（P<0.05,P<0.01）。两组患者在术后1、6和12个月时,无明显症状的快速性心律失常发生率、缓慢性心律失常发生率和总心律失常发生率差异均无统计学意义（P>0.05）。两组患者发生房性期前收缩和室性期前收缩的次数亦均无显著变化（P>0.05）。另外,术后12个月,替格瑞洛组停搏11例（9.82%）,明显高于氯吡格雷组的7例（6.25%）,差异有统计学意义（P<0.01）;在两组患者中, ≥ 4s的停搏率、多次停搏率和白天停搏率均高于2~4s停搏率、1次停搏率和夜间停搏率,在术后12个月时,以上差异均有统计学意义（P<0.01）。结论 PCI术后抗血小板治疗中,使用替格瑞洛导致的无症状心律失常不良事件主要以心脏停搏为主,其发生率明显高于氯吡格雷,必要时可给予抗心律失常药物。     

抗血小板药物替格瑞洛临床相关呼吸困难的危险因素分析

目的 探讨经皮冠状动脉介入(PCI)治疗的急性冠状动脉综合征(ACS)患者服用抗血小板药物替格瑞洛后出现呼吸困难的危险因素.方法 采用回顾性研究和前瞻性研究相结合的方法.回顾性纳入2016年1月至2019年11月上海交通大学附属新华医院心血管内科收治的418例接受PCI治疗后服用替格瑞洛的ACS患者,根据呼吸困难发生情况将患者分为替格瑞洛相关呼吸困难组和未发生呼吸困难组,收集并比较两组患者的临床及实验室检查资料.在前瞻性研究中选择2020年1月至8月上海交通大学附属新华医院心血管内科收治的PCI术后服用替格瑞洛的ACS患者367例,根据回顾性研究结果并参照临床指南将患者分为低密度脂蛋白胆固醇(LDL-C)组(LDL-C<2.6 mmol/L)和高LDL-C组(LDL-C≥2.6 mmol/L),比较两组患者资料,并采用多因素logistic回归分析替格瑞洛相关呼吸困难的危险因素.结果 回顾性研究的418例ACS患者中71例(17.0％)发生替格瑞洛相关呼吸困难.与未发生呼吸困难组相比,替格瑞洛相关呼吸困难组的出血事件更多[23.9％(17/71)vs 10.1％(35/347),P=0.001]、LDL-C水平更高[(2.54±0.88)mmol/L vs(2.32±0.81)mmol/L,P=0.045].多因素logistic回归分析结果显示出血事件(OR=3.128,95％CI 1.613～6.065,P=0.001)、LDL-C升高(OR=1.451,95％CI 1.071～1.964,P=0.016)是PCI术后ACS患者发生替格瑞洛相关呼吸困难的危险因素.前瞻性研究的367例ACS患者中64例(17.4％)发生替格瑞洛相关呼吸困难.高LDL-C组患者替格瑞洛相关呼吸困难的发生率高于低LDL-C组[23.4％(33/141)vs 13.7％(31/226),P=0.018],同时两组在吸烟史、PCI史、心肌梗死史、超敏CRP、空腹血糖、总胆固醇、总甘油三酯、高密度脂蛋白胆固醇、左心室射血分数、植入支架数目方面的差异均有统计学意义(P均<0.05).经多因素logistic回归分析发现吸烟史是PCI术后ACS患者发生替格瑞洛相关呼吸困难的独立预测因素(OR=2.695,95％CI 1.236～5.878,P=0.013).结论 PCI术后服用替格瑞洛的ACS患者呼吸困难的发生率为17.4％(64/367),血清LDL-C≥2.6 mmol/L的PCI术后ACS患者服用替格瑞洛后呼吸困难发生率更高,吸烟史是替格瑞洛相关呼吸困难的独立预测因素.     

替格瑞洛、阿司匹林、替罗非班联合用于经皮冠状动脉介入治疗术后患者的疗效与安全性观察

目的 观察替格瑞洛、替罗非班、阿司匹林联合用于PCI术后患者的疗效与安全性。方法 选取符合标准的200例患者,将其随机分为替格瑞洛观察组100例,氯吡格雷对照组100例。所有患者入院均给予阿司匹林负荷剂量300mg,随后100mg,1次/天;观察组给予替格瑞洛负荷剂量180mg,随后90mg,2次/天;对照组给予氯吡格雷负荷剂量300mg,随后75mg,1次/天;所有患者术后均给予替罗非班持续泵入36h。研究的主要有效终点为三联抗血小板治疗期间的主要不良心血管事件;主要安全性结果为出血、血小板减少、心动过缓与呼吸困难。结果 观察期间对照组发生1例支架内急性血栓事件,观察组无主要不良心血管事件发生,差异无统计学意义(P>0.05);两组均无主要及其他主要出血事件发生,次要出血和轻微出血观察组均多于对照组,差异无统计学意义(P>0.05);呼吸困难观察组多于对照组,血小板减少事件对照组多于观察组,差异无统计学意义(P>0.05)。结论 与氯吡格雷相比,替格瑞洛与替罗非班、阿司匹林联合用于PCI术后患者不增加主要及其他主要出血。     

替格瑞洛对大鼠心肌缺血再灌注损伤的影响

目的 观察替格瑞洛对大鼠心肌缺血再灌注的影响,探讨其可能的作用机制。方法 成年健康雄性SD大鼠32只,采用随机区组法将其分为假手术组(SO组)、心肌缺血再灌注组(I/R组)、替格瑞洛组、替格瑞洛合并腺苷拮抗剂(CGS15943)组(替格瑞洛+CGS15943组)。制作大鼠缺血/再灌注损伤模型,SO组只穿线不结扎,替格瑞洛组术前连续强饲替格瑞洛,替格瑞洛+CGS15943组术前连续强饲替格瑞洛,术前腹腔内注射CGS15943。计算心肌梗死面积百分比,观察再灌注心律失常发生情况,检测血清中磷酸肌酸激酶(CK)和乳酸脱氢酶(LDH)水平及心肌组织超氧化物歧化酶(SOD)活力及丙二醛(MDA)含量。结果 替格瑞洛组大鼠心肌梗死面积小于I/R组(P<0.01);而替格瑞洛+CGS15943组则大于替格瑞洛(P<0.01);替格瑞洛组大鼠心律失常发生率、心律失常评分均低于I/R组(P均<0.05);而替格瑞洛+CGS15943组大鼠心律失常发生率、心律失常评分均高于替格瑞洛组(P均<0.05)。替格瑞洛组CK、LDH水平低于I/R组(P<0.05);而替格瑞洛+CGS15943组CK、LDH水平高于替格瑞洛组(P<0.05)。替格瑞洛组SOD活力高于I/R组(P<0.05),MDA含量低于I/R组(P<0.05);而替格瑞洛+CGS15943组SOD活力低于替格瑞洛组(P<0.05),MDA含量高于替格瑞洛组(P<0.05)。结论 替格瑞洛具有抗大鼠心肌缺血再灌注损伤保护作用,可能与其抑制腺苷代谢,从而减少氧自由基的产生有关。     

替格瑞洛和氯吡格雷在冠状动脉旁路移植术后抗血小板治疗中应用的有效性和安全性比较

目的：比较替格瑞洛和氯吡格雷在冠状动脉旁路移植术（CABG）后患者抗血小板治疗中应用的有效性和安全性,以提供更合理的抗血小板治疗策略。方法：选取行CABG术患者260例,随机分为替格瑞洛组（129例）和氯吡格雷组（131例）,分别给予替格瑞洛（90 mg·d^-1）+阿司匹林（100 mg·d^-1）、氯吡格雷（75 mg·d^-1）+阿司匹林（100 mg·d^-1）行抗血小板治疗。12个月后随访收集有效性相关不良事件,即主要不良心血管事件（MACE）（心血管死亡、非心血管死亡、再发心肌梗死、因再发不稳定心绞痛入院及因再发心力衰竭入院）和安全性相关不良事件（呼吸困难和出血事件）的发生情况,并进行统计学分析。结果：本研究最终完成随访共241例,其中替格瑞洛组122例,氯吡格雷组119例。替格瑞洛组共发生MACE 10例（8.2%）,氯吡格雷组共发生MACE 19例（16.0%）,2组间MACE发生率比较差异无统计学意义（P>0.05）;替格瑞洛组发生因心力衰竭再次入院事件1例（0.8%）,氯吡格雷组发生6例（5.0%）,2组因心力衰竭再次入院事件发生率比较差异有统计学意义（P<0.05）。替格瑞洛组共发生安全性相关不良事件27例（22.1%）,氯吡格雷组共发生安全性相关不良事件17例（14.3%）,2组间安全性相关不良事件发生率比较差异无统计学意义（P>0.05）。结论：CABG术后患者应用替格瑞洛抗血小板治疗的有效性和安全性与氯吡格雷比较无明显差别,二者均可作为CABG术后抗血小板方案应用。     

替格瑞洛对急性冠脉综合征患者安全性和有效性的初步评价

目的：观察口服替格瑞洛对急性冠脉综合征（ACS）的临床疗效及安全性。方法：选择我院ACS患者196例,按入院顺序随机分为对照组(氯吡格雷组)98例和治疗组(替格瑞洛组)98例,观察6个月,观察2组患者主要不良心血管事件(MACE)及治疗期间并发症发生以及对肝肾功能血尿酸的影响情况。结果：氯吡格雷组MACE发生率明显大于替格瑞洛组（P＜0.05);两组均无严重出血并发症,轻度出血发生率差异无统计学意义(P＞0.05);替格瑞洛组有5例因呼吸困难、乏力而停药;两组对肝功能(丙氨酸氨基转移酶,ALT)肾功能（血肌酐,Cr）及血尿酸(UA)无明显影响,P＞0.05。结论：替格瑞洛治疗ACS,可明显减少MACE发生率,对严重出血风险无增加,临床应用安全有效。     

PCI术中冠状动脉内注射重组人尿激酶原对STEMI患者高血栓负荷的影响

目的 评估经皮冠状动脉介入治疗（PCI）时,冠状动脉内注射重组人尿激酶原（rh-pro UK）对ST段抬高型心肌梗死（STEMI）患者高血栓负荷的影响。方法 回顾性分析2018年1月至2020年1月于六安市人民医院行PCI的88例高血栓负荷STEMI患者的临床资料。根据患者PCI术中冠脉内用药的不同,将冠状动脉内注射替罗非班的43例患者作为对照组,冠状动脉内联合注射替罗非班和rh-pro UK的45例患者作为观察组。比较两组患者TIMI血流分级、TIMI心肌灌注分级（TMPG）、ST段回落百分比（STR）、左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、住院期间出血及主要不良心血管事件（MACE）发生情况。结果 观察组患者TMPG 3级的比例为97.78%、STR>70%的比例为26.67%,均高于对照组,差异有统计学意义（P<0.05）;观察组患者术后1个月LVEF、LVEDD改善,差异有统计学意义（P<0.05）;两组患者TIMI分级、住院期间出血及MACE发生率比较,差异无统计学意义（P>0.05）。结论 冠状动脉内注射rh-pro UK可更好地改善STEMI心肌灌注水平及左心室功能,同时不增加住院期间出血及MACE发生率。     

促甲状腺激素水平与非ST段抬高型ACS患者PCI术后不良事件的关系

目的 比较促甲状腺激素（TSH）水平与非ST段抬高型急性冠脉综合征（ACS）患者经皮冠状动脉介入（PCI）术后不良事件的关系。方法 收集2016年1月至2017年12月于亳州市人民医院行PCI术治疗的184例非ST段抬高型ACS患者的临床资料,按TSH水平分为A组（TSH为0.45~1.49 mIU/L,n=71）、B组（TSH为1.50~2.49 mIU/L,n=59）、C组（TSH为2.50~3.49 mIU/L,n=36）、D组（TSH为3.50~4.49 mIU/L,n=18）,所有患者均完成术后6个月随访调查,记录其不良事件发生情况,分析TSH水平与非ST段抬高型ACS患者PCI术预后的关系。结果 ①4组对象性别、年龄、基础疾病、ACS类型、高密度脂蛋白胆固醇浓度、血压、冠脉病变数目、置入支架数目、服药情况比较差异均无统计学意义（P>0.05）,总胆固醇、三酰甘油水平及心功能分级比较差异有统计学意义（P<0.05）;D组总胆固醇、三酰甘油浓度及心功能分级为Ⅲ~Ⅳ级所占比例高于A、B、C组（P<0.05）。②4组对象心肌梗死血运重建、心力衰竭再入院、心脏不良事件总发生率比较差异均有统计学意义（P<0.05）,不良反应发生率比较,D组最高。③正常范围内TSH水平与非ST段抬高型ACS患者PCI术后不良事件发生呈线性相关,经多因素校正后,TSH水平与非ST段抬高型ACS患者PCI术后不良事件率仍呈正相关（P<0.05）。结论 TSH水平与非ST段抬高型ACS患者PCI术后不良心脏事件的发生呈正相关,正常范围内TSH水平上调,患者不良心脏事件发生风险增加。     

血清载脂蛋白B/载脂蛋白A联合非高密度脂蛋白胆固醇检测对急性冠脉综合征事件的预测价值

目的 探究载脂蛋白B/载脂蛋白A（apoB/apoA）联合非高密度脂蛋白胆固醇（non-HDL-C）对急性冠脉综合征（ACS）患者出现事件的预测价值。方法 选择2010年2月至2014年2月就诊于安徽医科大学第二附属医院急诊内科,并获电话随访的ACS患者520例,分析apoB/apoA联合non-HDL-C对随访期间初级终点事件（全因死亡、非致死性心肌梗死及卒中）及次级终点事件（IV级心功能衰竭和再血管化治疗）的预测价值。结果 ①初级终点事件组患者血清non-HDL-C水平高于未发生事件组患者[（3.77±1.13）mmol/L vs （3.02±0.55）mmol/L,P < 0.05],apoB/apoA水平高于无事件组[（1.08±0.256） vs （0.88±0.2）,P < 0.05）]。②亚组分析发现,non-HDL-C与apoB/apoA均处于高水平时,初级终点事件的发生率最高,高于其他3组（62.96% vs 1.63%、12.07%、10.53%,P < 0.05）;且次级终点事件发生率较两者均为低水平时有较显著的增高（18.5% vs 4.9%,P < 0.05）。③亚组分别行多因素logistic回归发现,血清non-HDL-C（HR：6.534,95% CI：2.081~12.05,P=0.011）和apoB/apoA（HR：6.983,95% CI：3.189~13.48,P=0.009）对初级终点事件均有预测价值,但对次级终点事件的发生无预测价值,两指标联合对初级终点事件的预测作用更强（HR：13.52,95% CI：3.215~58.76,P=0.002）,且对次级终点事件有一定预测价值（HR：5.943,95% CI：1.764~18.34,P=0.034）。结论 血清apoB/apoA联合non-HDL-C较其中之一,对ACS患者终点事件发生有更强的预测价值。     

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.     

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.