万爽力对急诊PCI患者的心肌保护作用

目的:探讨万爽力对急诊经皮冠状动脉介入治疗(PCI)患者的心肌保护作用。方法:47例因急性心肌梗死(AMI)而行急诊PCI的患者随机分为曲美他嗪组(A组)和对照组(B组),A组在常规治疗的基础上于急诊PCI前后给予曲美他嗪口服,B组不用曲美他嗪。比较两组患者间血肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)峰值浓度、CK-MB恢复正常的时间、再灌注心律失常及2周后的左室功能。结果:CK-MB、cTnI峰值浓度,A组均显著低于B组(P<0.05);发病至CK-MB峰值时间和恢复正常的时间,A组均显著短于B组(P<0.05或0.01)。发生再灌注心律失常,A组显著少于B组(P<0.05)。2周后超声心动图检测的左室射血分数A组显著高于B组(P<0.05)。结论:对急诊PCI的急性心肌梗死患者,曲美他嗪可缩小梗死面积,减轻再灌注损伤,保护心脏功能。     

曲美他嗪对冠状动脉介入术后心肌缺血再灌注损伤的保护作用研究

目的:评价曲美他嗪对冠状动脉介入术(PCI)后心肌缺血再灌注损伤的保护作用。方法:入选拟行PCI的稳定性或不稳定性心绞痛患者72例,随机分为曲美他嗪组38例和对照组34例,曲美他嗪组PCI术前7 d开始口服曲美他嗪20 mg,每天3次,术后继续服用3个月;所有入选患者给予阿司匹林及常规药物治疗。每例在PCI术前及术后6、24 h测定血清肌钙蛋白I(cTnI)、磷酸肌酸激酶同工酶(CK-MB);在PCI术前及术后1、3个月分别超声心动图测定左室射血分数。结果:术前2组患者cTnI、CK-MB水平差异均无统计学意义(P0.05),与对照组比较,PCI术后曲美他嗪组在各个测量时段均能显著降低患者cTnI、CK-MB水平(P0.01),PCI术后1、3个月曲美他嗪组左室射血分数值均高于对照组(P0.01)。结论:PCI术前应用曲美他嗪能显著降低手术诱导的心肌损害,进一步改善PCI术后的左心功能。     

急性心肌梗死患者早期应用曲美他嗪临床研究

目的探讨急性心肌梗死溶栓患者早期应用曲美他嗪对心肌细胞的保护作用和对心功能的影响,特别是探讨确诊急性心肌梗死后即顿服曲美他嗪的疗效。方法 90例入选患者随机分为治疗组（A组）和对照组（B组）,治疗组入院后即给予曲美他嗪负荷剂量口服,比较2组溶栓成功后ST段抬高幅度及心肌酶CK和CK-MB的峰值浓度、峰值时间和恢复正常时间,12周后左心室射血分数和BNP的变化。结果 A组再灌注后ST段抬高幅度及心肌酶CK和CK-MB的峰值浓度、峰值时间和恢复正常时间明显低于B组,12周后左心室射血分数明显上升,BNP明显下降（P〈0.05）。结论急性心肌梗死溶栓再通患者应用曲美他嗪具有心肌保护作用,于入院后即给予曲美他嗪负荷剂量口服,可减轻再灌注损伤,改善左心室收缩功能和运动耐量,无不良反应,具有较好的耐受性和安全性。     

曲美他嗪对急性心肌梗死患者急诊冠脉介入治疗的影响及作用机制研究

目的:探讨曲美他嗪对急性心肌梗死(AmI)患者急诊冠脉介入治疗的影响,并分析其作用机制。方法:选择我院收治的96例因急性心肌梗死而进行急诊经皮冠状动脉介入(PCI)治疗患者作为研究对象,其中观察组48例患者在介入治疗的基础上加用曲美他嗪,对照组48例患者仅采用介入治疗,比较两组患者治疗效果。结果:治疗后,观察组患者的血肌钙蛋白(cTnI)和肌酸激酶同2酶(CK-MB)峰值浓度、发病至峰值时间、发病至恢复正常时间均明显优于对照组患者,且观察组患者左心室功能指标左室舒张末内径(LVEDD)和左室射血分数(LVEF)也较对照组患者出现了明显改善,差异均具有明显统计学意义(P<0.05),此外,观察组患者治疗后主要心脏不良事件发生率为2.1%,也明显低于对照组患者(P<0.05)。结论:曲美他嗪对心肌梗死患者急诊冠脉介入治疗具有较佳的心肌保护作用,其安全可靠,值得临床应用。     

曲美他嗪与尼可地尔对PCI治疗相关心肌损伤干预作用的比较

目的：探讨曲美他嗪与尼可地尔对经皮冠状动脉介入( PCI)治疗相关心肌损伤干预作用。方法将行PCI的不稳定型心绞痛患者70例随机分为对照组、曲美他嗪组和尼可地尔组,分别采用不同药物治疗,比较心肌损伤相关指标水平。结果术前3组CK-MB、IcTnI水平差异无统计学意义(P>0．05);3组术后6、12、24小时CK-MB与cTnI水平显著升高,差异有统计学意义(P<0．05);曲美他嗪组与尼可地尔组患者术后MPV水平降低,差异有统计学意义(P<0．05);曲美他嗪组与尼可地尔组术后CK-MB、cTnI水平较对照组显著降低,差异有统计学意义( P<0．05),但曲美他嗪组与尼可地尔组患者术后CK-MB与cTnI水平进行比较,差异无统计学意义(P>0．05)。结论 PCI术前使用曲美他嗪与尼可地尔,可减少PCI引起的心肌损伤,发挥心肌保护的作用。     

曲美他嗪对冠状动脉介入治疗后的临床疗效

目的 探讨分析曲美他嗪对冠状动脉介入治疗后的临床疗效.方法 回顾性分析心血管内科2009年2月～2011年10月收治的经皮冠状动脉介入治疗(PCI)的患者120例,将其随机分为实验组和对照组两组,每组各60例,实验组在术后服用曲美他嗪20mg tid,服用3周,同时接受常规手术用药.而对照组仅应用常规药物.术后24h测定患者的心肌肌钙蛋白(I cTnI)等含量,术后4周复查心脏彩超左室射血分数.结果 术后24h实验组cTnI升高幅度明显低于对照组,差异均具有统计学意义(P<0.05).而两组术后CK-MB变化幅度没有明显差异(P>0.05).实验组治疗后LVEF指数升高显著高于术前,差异具有统计学意义(P<0.05).表明实验组心功能在治疗显著好转.结论 曲美他嗪在PCI治疗后具有较好心肌保护作用,值得在临床上推广.     

曲美他嗪对急性心肌梗死患者急诊介入治疗后心功能及心率变异性的影响

目的:探讨曲美他嗪对急性心肌梗死(AMI)患者急诊介入治疗(PCI)后心功能及心率变异性(HRV)的影响。方法:AMI急诊PCI后患者70例,随机分为常规治疗组(A组,n=35)以及曲美他嗪治疗组(B组,曲美他嗪20 mg,3次/d,n=35),应用超声心动图检测患者左室射血分数(LVEF);应用24 h动态心电图(Holter)检测患者HRV。用药治疗2周,观察治疗前后的指标变化。结果:两组治疗前各项指标比较,差异无统计学意义(P>0.05)。治疗2周后两组患者LVEF及HRV均较治疗前升高。但曲美他嗪治疗组改善幅度较常规治疗组大。结论:曲美他嗪可以进一步改善AMI急诊PCI后患者的心功能和心率变异性。     

曲美他嗪联合远端缺血预处理对行PCI治疗的老年缺血性心脏病患者心肌损伤及预后的影响

目的 探讨曲美他嗪联合远端缺血预处理对行经皮冠状动脉介入治疗(PCI)的老年缺血性心脏病患者心肌损伤及预后的影响。 方法 选取2016年1月—2016年9月于温州市中医院及温州医科大学附属第二医院行PCI的老年缺血性心脏病患者96例,随机对照表法分为观察组和对照组,各48例。2组患者均行抗血小板等常规药物治疗,对照组在此基础上加用曲美他嗪进行治疗,观察组在此基础上,联合应用曲美他嗪和远端缺血预处理。观察2组患者治疗前及治疗24 h后心肌损伤指标肌钙蛋白I (cTnI)、肌酸激酶同工酶(CK-MB)变化及随访6个月不良心血管事件的发生情况。 结果 与治疗前相比,2组患者治疗24 h后心肌损伤指标cTnI、CK-MB均明显升高(P<0.05),但对照组cTnI、CK-MB升高更显著(P<0.05);随访6个月,观察组再发心绞痛者2例,再发心绞痛发生率为4.17%,心肌梗死0例,死亡0例,对照组再发心绞痛者10例,再发心绞痛发生率为20.83%,心肌梗死者5例,心肌梗死发生率为10.42%,死亡0例。观察组再发心绞痛发生率、心肌梗死发生率均明显低于对照组(P<0.05)。 结论 曲美他嗪联合远端缺血预处理应用于行PCI治疗的老年缺血性心脏病患者中,可明显降低cTnI、CK-MB水平,减少心肌损伤及不良心血管事件的发生。      

生脉注射液联合曲美他嗪治疗急性心肌梗死溶栓再通患者的临床疗效观察

目的观察生脉注射液联合曲美他嗪对急性心肌梗死再灌注治疗后心肌细胞的保护作用。方法将100例入进再灌注溶栓治疗的患者随机分成治疗组和对照组,治疗组配合生脉注射液40ml静滴、曲美畸他嗪20mg口服,3次/d。对照组只做溶栓治疗,比较两组再通患者间肌酸激酶同工酶（CK-MB）峰值浓度,CK-MB恢复正常的时间及再灌注心律失常;随访6个朋观察心脏事件发生率。结果①治疗组再通者CK和CK-MF峰值浓度分别为（1265±728）和（114±67）U／L,显著低于对照组的（1769±713）和（159±67）U／L（P〈0．05）;治疗组CK和CK-MB峰值时间和恢复正常的时间均显著低于对照组（P〈0．05,0．01）。②治疗组9例（30%）再灌注心律失常,显著低于对照组15例53.5％（P〈0．05）。③近期心脏事件发生率明显优于对照组（P〈0.05）。结论生脉注射液联合曲美他嗪对溶栓再通的急性心肌梗死患者可缩小梗死面积,减轻再灌注损伤,降低近期心脏事件发生率。     

曲美他嗪对PCI术相关心肌损伤及术后再发心绞痛症状的临床研究

目的探讨择期经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术前应用负荷剂量曲美他嗪(trimetazidine,TMZ)60 mg对不稳定型心绞痛患者PCI术相关心肌损伤的影响;探讨术后长期应用曲美他嗪对PCI术后再发心绞痛症状的影响。方法 93例拟行择期PCI手术的不稳定型心绞痛患者分为曲美他嗪组和对照组。2组患者均接受抗血小板药物等常规药物治疗。曲美他嗪组在常规药物的基础上,于PCI术前0.5～1.0 h一次性口服60 mg曲美他嗪,PCI术后长期口服常规剂量曲美他嗪(20 mg Tid)。分别测定PCI术前和术后16～18 h患者血清心肌肌钙蛋白I(cardiac troponin Ic,cTnI)浓度,电话随访2组患者PCI术后有无再发心绞痛症状。结果本研究最终纳入79例成功完成PCI手术的不稳定型心绞痛患者(曲美他嗪组35例,对照组44例)。PCI术后16～18 h时,曲美他嗪组与对照组患者的cTnI水平均较术前升高,差异有统计学意义(P<0.05);同对照组相比,曲美他嗪组患者术后cTnI水平升高>0.1 ng/mL患者的比例显著减少(P<0.05);平均随访9月后,与对照组相比,曲美他嗪组再发心绞痛症状患者的比例显著减少(P<0.05)。结论 PCI术前口服负荷剂量曲美他嗪可以减少手术相关心肌损伤,术后长期服用则可以降低再发心绞痛症状的发生率。     

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.