早发型重度子痫前期病例分析

目的：探讨早发型重度子痫前期的病例特点及妊娠结局。方法回顾分析2013年3月至2015年3月郑州大学第二附属医院收治的89例单胎早发型重度子痫前期患者（试验组）、同期110例晚发型重度子痫前期患者（对照组）,比较两组患者相关病史资料、辅助检查结果、孕产妇并发症发生率、围生儿并发症发生率。结果试验组孕产妇及新生儿住院时间、孕产妇并发症发生率及围生儿并发症发生率、死亡率、腹腔积液及眼底改变发病率及严重程度高于对照组（P＜0．05）,眼底改变程度与疾病严重程度呈正比;试验组围生期保健率低于对照组（P＜0．05）;试验组脐动脉S／D值升高率高于对照组（P＜0．05）;S／D值与新生儿出生体质量呈负相关（sig＝0．000,r＝－0．984）;“是否围生期保健”是试验组孕产妇严重并发症发生的独立危险因素（B＝1．266,OR＝3．546,sig＝0．001,95％CI1．726～7．285）。结论早发型重度子痫前期孕产妇并发症发生率,围生儿并发症发生率、死亡率均较高,并发症发生率及严重程度大于晚发型;加强围生期保健可减少孕产妇严重并发症发生率;伴有S／D值升高的早发型重度子痫前期围生儿结局不良。     

早发型与晚发型新生儿败血症临床分析

目的了解早发型与晚发型新生儿败血症的临床特点、病原菌分布和药敏情况,以指导临床的诊断和治疗。方法选择新生儿败血症71例,其中早发型28例,晚发型43例,对其临床表现、实验室检查等进行回顾性分析。结果早发型患儿硬肿、反应差发生率显著高于晚发型（均P〈0.01）。感染性休克、弥散性血管内凝血发生率显著高于晚发型,而晚发型化脓性脑膜炎显著高于早发型（均P〈0.05）。早发型PLT值明显低于晚发型（P〈0.05）,WBC及CRP值两组无显著差异（P〉0.05）。早发型败血症病原菌以大肠埃希菌、肺炎克雷伯菌为主;晚发型以凝固酶阴性葡萄球菌（CNS）、金黄色葡萄球菌、大肠埃希菌为主。结论早发型与晚发型败血症在临床表现、实验室指标及病原菌方面都有其不同特点,应根据不同特点来指导临床诊断和治疗。     

早发型重度子痫前期母婴结局临床分析

目的探讨早发型重度子痫前期对妊娠结局的影响。方法对2000年1月。2008年12月郑州市妇幼保健院产科收治的早发型重度子痫前期患者（早发组）和晚发型重度子痫前期患者（晚发组）各110例的病例资料进行回顾性分析,比较两组患者并发症及围生儿情况。结果早发组子痫、HELLP综合征、肝肾功能损害、胎盘早剥、心功能不全发生率均高于晚发组,差异有统计学意义（P〈0．05）,早发组低蛋白血症发生率明显高于晚发组,差异有统计学意义（P〈0．01）;早发组早产、胎儿生长受限、新生儿窒息、围生儿死亡率均高于晚发组,差异有统计学意义（P〈0．01）。结论早发型重度子痫前期严重影响母婴健康,恰当选择病例,在严密监测下适当行期待治疗,可改善围生儿的结局。     

早发型重度子痫前期的临床监控防范

目的探讨早发型重度子痫前期终末器官损害及其监测指标,指导期待治疗、个体化处理以降低母婴死亡率。方法对早发型重度子痫前期34例患者（A组）,晚发型重度子痫前期45例患者（B组）进行回顾性分析,监测各项实验室指标及临床指标。结果早发型组肝损害、血小板减少、D二聚体升高、血脂升高、LDH升高、抗心磷脂抗体阳性的发生率高于晚发型组（P〈0．05）,而肾功能损害、眼底改变、低蛋白血症、子痫、心衰,肺水肿、脑血管意外等发生率之间差异则无统计学意义（P〉0．05）。同时,早发型组的FGR、死胎、新生儿窒息发生率比晚发型组高（P〈0．05）。结论早发型重度子痫前期母体可发生严重并发症,伴有较高FGR发生率,通过严密监测各项指标,进行个体化处理是改善母婴预后的关键。     

早发型重度子痫前期患者甲状腺功能和24h尿蛋白特征

目的：研究早发型重度子痫前期患者的甲状腺功能和24 h尿蛋白特征。方法选择183例重度子痫前期患者,按其发病孕周分为早发型组114例（＜34周）和晚发型组69例（≥34周）。随机抽取280例同期孕周、年龄与之相匹配的血压正常、尿常规蛋白阴性、无产科合并症健康孕妇为对照组。采用化学发光微粒免疫分析技术测定促甲状腺素（ TSH）、游离三碘甲状腺原氨酸（ FT3）和游离甲状腺素（ FT4）水平,采用化学发光法测定甲状腺过氧化物酶抗体（ TPOAb）、甲状腺球蛋白抗体（ TGAb）,采用免疫比浊法检测24 h尿蛋白定量。对各组孕妇甲状腺功能、24 h尿蛋白定量和新生儿出生体重进行分析。结果（1）与对照组比较,早发型组和晚发型组FT3及FT4水平均明显降低（P＜0.01）,TSH水平明显升高（P＜0.01）。（2）与早发型组比较,晚发型组TSH水平明显升高（P＜0.05）,FT3和FT4水平无显著变化（P＞0.05）。（3）早发型组与晚发型组TPOAb、TGAb阳性率比较差异无统计学意义（P＞0.05）。（4）早发型组和晚发型组甲状腺疾病发生率无显著变化（P＞0.05）。（5）与晚发型组（7.5±5.7）g比较,早发型组24 h尿蛋白定量（10.8±8.4）g明显升高（P＜0.01）。（6）与晚发型组比较,早发型组新生儿体重明显降低（P＜0.01）。新生儿体重和24 h尿蛋白定量呈负相关（r＝－0.323,P＜0.01）。结论早发型重度子痫前期患者血清FT3和FT4水平降低,伴有甲状腺功能减退。晚发型重度子痫前期中TSH水平升高较早发型更为明显。早发型子痫前期患者24 h尿蛋白丢失较晚发型严重,直接导致病情加重和影响能存活的新生儿体重。应重视早发型子痫前期患者甲状腺功能和24 h尿蛋白定量的监测,及时发现甲状腺功能减退并给予甲状腺激素替代治疗。     

101例新生儿败血症的病原学和临床特点分析

目的分析新生儿败血症的病原学和临床特点。方法对2012年7月至2013年6月淮安市妇幼保健院住院的101例血培养阳性结果且诊断为新生儿败血症患儿的临床资料进行回顾性分析。依据败血症发病时间将病例分为早发型组和晚发型组,比较两组间的差异。结果住院新生儿败血症的发生率是3.2%,临床表现以黄疸、反应低下、肺炎、合并局部感染灶、体温异常、血C反应蛋白升高和需要机械通气为主。早发型组羊水污染的发生率高于晚发型组(χ2=3.918,P=0.048);早发型组黄疸的发生率(79.0%)高于晚发型组(23.1%)(χ2=30.659,P=0.000);早发型组合并局部感染灶的发生率(9.7%)低于晚发型组(38.5%)(χ2=12.044,P=0.001);早发型组肺炎的发生率(27.4%)低于晚发型组(51.28%)(χ2=5.873,P=0.015)。败血症致病菌中,革兰阳性菌占80.2%,革兰阴性菌占13.86%,真菌感染占5.94%。革兰阳性菌大多对力奈唑胺和万古霉素高度敏感;革兰阴性菌对碳青霉烯类抗生素高度敏感;真菌对氟康唑、两性霉素B均敏感。结论早发型和晚发型新生儿败血症临床表现具有各自的特点。临床医师应根据其临床表现和常见致病菌的特点选用抗生素,再根据血培养及药敏试验结果及时调整。     

早发型重度子痫前期终止妊娠时机及分娩方式与围生儿结局的关系研究

目的：研究早发型重度子痫前期终止妊娠时机及分娩方式与围生儿结局的关系。方法：选取2014年1月至2016年9月该院收治的60例早发型重度子痫前期患者作为观察对象,依据不同的终止妊娠的时间分为3组,即A组（n＝12,＜32 w）、B组（n＝24,32～33＋6 w）、C组（n＝24,≥34 w）。依据病情严重程度和宫颈成熟条件又分为阴道分娩组和剖宫产组,各30例,对围生儿结局进行观察和比较。结果：C组新生儿死亡、新生儿窒息率显著低于A组和B组（P＜0．05）,A组与B组比较,B组低于A组（P＜0．05）;阴道分娩组的新生儿窒息率、死亡率均显著高于剖宫产组,组间差异明显（P＜0．05）。结论：早发型重度子痫前期患者在妊娠34 w以后终止妊娠可显著围生儿结局,合理选择剖宫产分娩方式可有效防止新生儿窒息或死亡,提高围生儿存活几率。     

早发型和晚发型难治性抑郁患者的临床特征比较

目的比较早发型与晚发型难治性抑郁患者的临床特点。方法采用中位数切割法将370例成年难治性抑郁患者分为早发型组（n=193）和晚发型组（n=177）,对两组患者的临床特征进行比较和分析。结果与晚发型组比较,早发型组男性、性格内向及完成9年制义务教育者的构成比更高（P〈0．001）;当前发作病程更长,分别为（17．32±25．94）个月和（12．47±18．42）个月（P=0．015）;与早发型组比较,晚发型组已婚者构成比和抑郁程度17项汉密尔顿抑郁量表（HAMD-17）总分和因子睡眠障碍得分均显著增高（P〈0．001）,躯体共病构成比更高（P=0．008）。结论早发型与晚发型难治性抑郁患者的临床特征存在差异,可能与其潜在的病理生理学机制有关。     

巨噬细胞集落刺激因子、促肾上腺皮质激素释放因子在早发型重度子痫前期胎盘中的表达

目的研究早发型重度子痫前期患者胎盘组织中巨噬细胞集落刺激因子（M—CSF）、促肾上腺皮质激素释放因子（CRF）的表达,并比较它们在早发型、晚发型重度子痫前期及正常妊娠对照组三者之间表达的差异。方法选择早发型重度子痫前期患者20例,晚发型13例及正常妊娠对照组20例进行实验对照研究,应用免疫组织化学方法研究M—CSF、CRF的表达情况。结果早发型及晚发型重度子痫前期患者胎盘中M—CSF表达均明显高于正常妊娠妇女,差异均有统计学意义（P〈0．05）;早发型重度子痫前期组显著高于晚发型组,差异有统计学意义（P〈0．05）。CRF在早发型及晚发型重度子痫前期患者胎盘中表达升高,与正常妊娠组比较差异均有统计学意义（P〈0．05）,早发型重度子痫前期组显著高于晚发型组（P〈0．05）。结论胎盘中M—CSF、CRF的表达增加可能与早发型重度子痫前期的发病有关。     

早发型与晚发型子痫前期患者的血管反应性分析

目的：探讨早发型与晚发型子痫前期（preeclampsia,PE）患者血管结构和功能的特征。方法选取 PE患者80例作为观察组,其中早发型 PE（妊娠＜34周）组40例,晚发型 PE（妊娠≥34周）组40例;对照组为匹配相同年龄和妊娠时间的健康孕妇80例。通过 B 超检查颈动脉内膜中膜厚度、动脉扩张性、血管壁周向应力、下腔静脉塌陷指数。结果与对照组比较,早发型 PE 孕妇收缩压、舒张压和平均血压、子宫动脉平均搏动指数、剖宫产率、收缩期和舒张期颈动脉内径、血管壁周向应力、平均颈动脉内膜中膜厚度、最大颈动脉内膜中膜厚度高于对照组（均 P ＜0．05）,而胎儿脑－胎盘率、分娩时胎龄、新生儿出生体质量、下腔静脉塌陷面积及塌陷指数、脐动脉血 pH值低于对照组（均 P ＜0．05）。结论早发型 PE 与晚发型 PE 患者血管具有明显不同的血管适应性,存在不同的病理生理机制。     

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.     

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.     

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.