脑梗死患者急性期降压治疗对脑功能及预后的影响

目的：观察脑梗死患者急性期降压治疗对脑功能及预后的影响。方法：本文对120例脑梗死急性期合并高血压的患者分组进行降压及非降压治疗对比观察,发现未使用降压药物组其水肿带在病后（2～4）周较少出现,应用降压药物组血压明显降低,但其病灶容积（4～12）周的神经缺损未见明显好转。结果：观察（6～36）个月后,降压治疗组发生脑梗死及总死亡率大于非降压组,P〈0．05。发生心肌梗死者二者无明显差别。结论：提出降压治疗对该类病人并无益处,脑梗死患者急性期血压升高有利维持脑血流量和脑功能及预后。     

61例高血压脑梗死急性期血压调控对残疾的影响

目的观察高血压脑梗死患者急性期血压调控对患者残疾的影响。方法对61例高血压脑梗死急性期患者密切观察其住院15d内的血压变化和残疾的影响，根据血压自动下降与否，将患者分为血压自动下降组和药物降压组，比较两组的神经功能残疾改善情况。结果血压自动下降组神经功能恢复达有效以上者占96．87％，药物降压组神经功能恢复达有效以上者占13．79％。结论脑梗死患者急性期血压自动下降者神经功能残疾改善较药物降压组差异有统计学意义（P〈0．01）。     

拜新同治疗高血压动脉硬化性脑梗死临床疗效观察

目的：观察拜新同治疗高血压动脉硬化性脑梗死临床疗效。方法：选择住院的高血压动脉硬化性脑梗死急性期患者，入院后随机分成治疗组和对照组，两组综合治疗方法相同，在治疗急性脑梗死的同时控制高血压治疗组同拜新同控释片30mg，每日一次口服，对照组用复方降压片1－2，每日三次口服，根据血压情况调整用药量。疗程规定为三周。观察两组患者的临床和降压疗效，同时观察血脂、血流变、经颅多普勒（TCD）变化及药物的副作用。结果：1、临床疗效：治疗组总有效率为84．4％，对照组总有效率80．0％，治疗组临床疗效略高于对照组，但两组比较差异无显著性（P＞0．05）；2、降压疗效：治疗组总有效率为86．7％，对照组总有效率为76．6％，治疗组降压疗效高于对照组，两组比较差异有显著性（P＜0．05）。3、拜新同能降低全血粘度，改善血脂代谢，增加脑血流量。4、拜心通的不良反应少见。结论：拜新同控释片能有效地降低血压，使血压得到稳定控制，并能促进急性脑梗死患者的神经功能恢复。     

脑梗死急性期血压干预对预后的影响

目的：探讨血压干预对急性脑梗死神经功能缺损恢复的影响。方法：将94例脑梗死患者随机分为两组：降压干预治疗组和非干预组，在发病后48h内给予治疗并观察两组患者的血压变化、神经功能评分及神经功能缺损加重病例数。结果：两组患者血压在人院24h内下降幅度最大，以干预组明显，非干预组患者人院第5天血压趋于稳定状态。6个月后干预组患者神经功能恢复差，与非干预组比较差异有统计学意义（t=2．7l3，P〈0．05），且2周时神经功能缺损加重病例数明显增多。结论：脑梗死急性期降压治疗可增加神经功能缺损症状恶化的风险。     

脑卒中病人急性期血压的变化

①目的观察脑卒中病人急性期血压变化的规律,探讨其发生机制及治疗方法.②方法对110例经颅脑CT检查确诊的脑卒中病人急性期血压进行了连续7d的动态观察,并与100例普外科住院病人血压变化进行了比较.③结果脑卒中组与对照组病人均以入院后首次血压(FBP)为最高,不采取任何降压措施,脑卒中组病人血压迅速下降,4～5d达低值,以后血压在此水平上下波动;24h内下降幅度以发病前有高血压者为著(F=5.47,q=3.70,P＜0.01).入院后第10天仅有1/3的病人血压仍呈高水平,而对照组血压下降不明显.④结论脑卒中病人急性期血压存在着先升高后下降的变化规律,急性期降压应慎重.     

血压调控对急性脑梗死预后的影响

目的探讨脑梗死急性期血压调控对神经功能恢复的影响。方法系统回顾215例急性脑梗死患者,将其分为合理血压调控组（治疗组）与传统降压组（对照组）。记录患者入院时及第1d,7d晨起血压,记录住院时及第14d神经功能缺损程度评分。结果脑梗死急性期血压呈自然下降规律,第7d与第1d比较,差异有统计学意义（P〈0．01）;住院14d时对照组神经功能缺损程度与治疗组比较,有统计学意义（P〈0．05）。结论合理调控急性脑梗死患者血压,能明显提高神经功能恢复,降低致残率。     

脑梗死患者急性期的血压变化及抗高血压治疗的影响

目的：分析脑梗死患者急性期的血压变化情况,并研究抗血压治疗对其的影响。方法：选取该院在2013年5月至2016年1月收治的93例急性期脑梗死患者作为研究对象,按照患者是否接受治疗划分为降压治疗组与非降压治疗组,分别为53例、40例,动态的对本研究的两组患者发病7日内的各级高血压变化情况进行观察。结果：比较两组患者的相关情况,两组患者单纯收缩期高血压和1级高血压的住院天数在7 d 以已恢复正常的有效率明显优于2级高血压和3级高血压患者（P ＜0.05）;抗高血压治疗组的恢复明显优于未进行高血压治疗的患者（P ＜0.05）。结论：在脑梗死急性期,根据高血压分级,为患者采取个体化的抗高血压治疗是十分重要的,能够有效的对患者的血压变化情况进行控制,促进患者的更好恢复。     

脑动脉供血不足与高血压关系探讨

目的：探讨脑动脉供血不足与高血压的关系及高血压的治疗特点。方法：观察85例脑动脉供血不足并高血压患者，治疗组45例，对照组40例，治疗组使用脑益嗪改善脑供血，观察高血压的降压效果。结果：治疗组血压下降明显，对照组血压下降不明显，治疗组与对照组血压变化有明显差异。结论：脑动脉供血不足伴高血压患者，血压升高不是药物治疗的指征，使用改善脑供血药物，既可改善脑供血减轻症状，也有助于降低高血压。     

硝苯地平加卡托普利(或倍他乐克)含服治疗高血压急症

目的：观察硝苯地平加卡托普利（或倍他乐克）含服治疗高血压急症的降压效果。方法：高血压急症患者，入院后即静滴酚妥拉明或硝酸甘油，2h内血压不能下降或下降不理想者，改用硝苯地平加卡托普利（或倍他乐克）含服治疗。结果：6例高血压急症患者，采用该治疗后2h内血压下降均达到25%，未发现有血压急速大幅度下降和引起心脏缺血的严重后果。结论：高血压急症患者先静滴降压药，若效果不理想，权衡利弊后，仍可采用含服硝苯地平加卡托普利（或倍他乐克）。     

社区老年高血压患者心理干预的效果观察

目的：探讨心理干预对老年高血压患者的效果。方法：将61例高血压患者随机分为观察组30例和对照组31例。两组均给予生活方式干预及口服降压药物,观察组在口服药物的同时给予心理干预,3个月后观察两组的血压水平。结果：两组患者血压均有下降,但观察组血压下降更明显,达标率高,两组比较,差异有统计学意义（P〈0.05）。结论：心理干预对老年高血压的治疗有辅助作用。     

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.