营养干预模式降低妊娠期糖尿病孕妇血糖及并发症的研究

目的探讨两种不同的营养干预模式对妊娠期糖尿病孕妇的血糖及产科并发症的影响。方法 220名妊娠期糖尿病孕妇按1:1随机分为连续性医学营养治疗组(研究组)和传统营养健康教育组(对照组),研究组给予个性化医学营养治疗及自我血糖监测方法,整个孕期连续性营养监测指导不少于6次,对照组给予传统饮食指导和健康教育,整个孕期只进行1次指导,2周监测一次餐后2h血糖直至妊娠结束。观察两组血糖控制情况及产科并发症。结果两组孕妇在教育前餐后2h血糖无统计学意义(t=0.87,P=0.39)。而两组干预后餐后2h血糖均有下降,两组干预前后均有统计学意义(t=15.78,P0.01;t=9.04,P0.01)。研究组干预前后的下降值明显高于对照组,组间比较差异有统计学意义(t=4.71,P0.01)。两组的产科并发症比较中发现,在早产儿发生率、产时失血量方面差异没有统计学意义;在羊水过多、妊高征、巨大儿、新生儿体重、分娩方式、胎膜早破等方面,研究组低于对照组,差异有统计学意义。结论连续性医学营养治疗模式更有助于妊娠期糖尿病孕妇控制血糖和降低产科并发症,值得临床推广。     

孕期血糖管理对妊娠期糖尿病胎盘超微结构的影响

目的 探讨孕期血糖管理对妊娠期糖尿病胎盘超微结构的影响,为优化孕期管理提供科学佐证.方法 将2013年1月至2014年12月于南通市第一人民医院常规产检至分娩的妊娠期糖尿病孕妇,根据血糖控制情况分为血糖控制满意组及血糖控制不满意组;同期产检的正常孕妇为对照组.检测3组孕妇的血糖水平并采用透射电镜观察相应的胎盘超微结构.结果 (1)经整个孕期的管理及追踪,最终共有57例孕妇纳入研究.妊娠期糖尿病孕妇占56.14％(32/57),其中血糖控制满意组占35.09％(20/57),血糖控制不满意组占21.05％(12/57);对照组孕妇占43.86％(25/57).(2)3组孕妇的年龄、口服葡萄糖耐量试验(OGTT)检查时孕周、分娩时孕周、血压及体质量指数差异均无统计学意义(P＞0.05).(3)经孕期血糖管理,3组孕妇的空腹血糖差异无统计学意义(P=0.099);血糖控制满意组与对照组的餐后2h血糖、夜间血糖及糖化血红蛋白差异均无统计学意义(P＞0.05);血糖控制不满意组的餐后2h血糖、夜间血糖及糖化血红蛋白均高于血糖控制满意组及对照组,差异有统计学意义(.P＜0.01).(4)血糖控制满意组与对照组的胎盘超微结构有改变者所占比例差异无统计学意义(P＞0.05),血糖控制不满意组的胎盘超微结构有改变者所占比例与血糖控制满意组、对照组相比差异均有统计学意义(P＜0.01).结论 高血糖是胎盘超微结构改变的危险因素,孕期需加强血糖管理,减少或避免妊娠期糖尿病孕妇胎盘超微结构的改变,减少不良妊娠结局的发生.     

数字健康个性化营养管理对妊娠期糖尿病孕妇妊娠结局的影响

目的:探讨通过数字健康管理平台进行的个性化饮食指导和营养管理对妊娠期糖尿病孕妇妊娠结局的影响.方法:将120例妊娠期糖尿病孕妇分为干预组和对照组,每组各60例.对照组采取常规护理管理措施,观察组在对照组的基础上加用数字健康个性化营养管理.比较两组孕妇孕期增重、产前血糖和血脂变化情况、母婴结局.结果:干预组孕妇孕期增重、产前空腹血糖(FBG)、产前餐后2h血糖(2 h PBG)、孕期胰岛素使用率均低于对照组(P＜0.05);干预组孕妇剖宫产、早产发生率均低于对照组(P＜0.05);干预组分娩孕周大于对照组(P＜0.05),但胎盘重量、新生儿体重、巨大儿发生率、新生儿低血糖发生率均低于对照组(P＜0.05).结论:数字健康个性化营养管理有利于妊娠期糖尿病孕妇体重的合理增长,可有效控制血糖水平,降低母婴结局不良的发生率,改善预后.     

妊娠期糖代谢异常早期干预对巨大儿发生率效果分析

目的：对妊娠期糖代谢异常的早期规范治疗巨大儿的发生率效果进行分析。方法：将2008年1月～2010年1月在我所进行定期检查糖代谢异常的孕妇142例随机分为两组,同意规范治疗设为干预组（80例）,不同意规范治疗设为对照组（62例）。结果：两组围生儿结局的比较,差异有统计学意义（P〈0.05、P〈0.01）。巨大儿组孕妇空腹血糖、餐后2 h血糖较正常体重儿组孕妇更高,差异有统计学意义（P〈0.05）。结论：早期规范治疗妊娠期糖代谢异常,有效降低巨大儿的发生率,有助于减少母儿并发症。     

不同控制方法对妊娠期合并糖尿病孕妇血糖控制的比较

目的:了解不同控制方法对妊娠期合并糖尿病孕妇血糖控制效果。方法:将52例妊娠期合并糖尿病孕妇按随机数字表法分成研究组和对照组各26例。对照组给予常规指导,研究组采用饮食、运动治疗等综合性干预方式。对比两组控制前、后的空腹血糖水平、餐后血糖水平、糖化血红蛋白水平及妊娠结局。结果:两组控制前空腹血糖水平、餐后血糖水平、糖化血红蛋白水平及体重均差异无统计学意义(P>0.05);研究组控制后空腹血糖水平、餐后血糖水平及糖化血红蛋白水平均较对照组低,差异有统计学意义(P<0.05);研究组不良妊娠结局发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:以饮食、运动治疗为主的综合性控制方式可有效的对妊娠期合并糖尿病孕妇的血糖水平进行控制,从而改善妊娠结局。     

孕期营养指导在围产期孕妇保健工作中的应用研究

目的分析围产期孕妇保健工作中应用孕期营养指导的效果。方法选取该院2011年1月—2013年12月接诊的180例围产期孕妇作为研究对象,回顾性分析她们的临床资料。随机均分为研究组与对照组,各自90例,其中对照组孕期保健给予常规性教育,而研究组孕期保健则给予营养指导,对比分析两组孕妇保健效果。结果研究组孕妇在蛋白质、铁、锌、钙、维生素等方面皆明显高于对照组,组间对比差异有统计学意义（P〈0.05）;而研究组孕妇在脂肪摄入量与并发症发生率上皆明显低于对照组,组间对比差异有统计学意义（P〈0.05）,其中研究组孕妇妊娠期并发症发生率为27.78%（25/90）,对照组则为40.00%（36/90）。结论加强围产期孕妇保健工作,给予定期孕期营养指导,可改善妊娠结局,提高孕妇营养水平,值得借鉴。     

医学营养治疗对妊娠糖尿病围生期结局的影响

目的探究对妊娠期糖尿病妇女采用医学营养治疗的效果及对围生期结局的影响。方法选取该院2014年4月‐2015年4月收治的妊娠期糖尿病患者共121例,随机分为对照组与研究组,对照组患者接受常规营养指导,观察组患者接受医学营养治疗(MNT),比较两组患者血糖控制情况、围生期结局。结果观察组患者治疗后空腹血糖、餐后2 h血糖明显低于对照组,差异有统计学意义,P0.05。观察组患者围生期结局包括早产、妊娠期高血压、子痫前期、巨大儿及剖宫产的发生率明显低于对照组,差异有统计学意义,P0.05。结论对妊娠期糖尿病患者实施医学营养治疗可以较好地控制孕妇的血糖,减少围生期相关并发症的发生率,利于母婴,且无相关不良反应发生,适合临床营养治疗推广运用。     

妊娠期糖尿病孕妇产后糖代谢异常的影响因素

目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)患者产后糖代谢转归情况及产后糖代谢异常的相关因素。方法收集并分析2008年1月至2010年12月在北京妇产医院进行产前检查、分娩及产后随访的624例妊娠期糖尿病孕妇的临床资料,根据产后6～8周糖代谢恢复情况分为糖代谢正常组(444例)和糖代谢异常组(180例),了解两组转归的相关因素。结果 1)444例孕妇产后6～8周糖代谢恢复正常,占71.2%,180例孕妇产后6～8周糖代谢仍然异常,占28.8%,其中糖尿病(diabetes mellitus,DM)18例,空腹血糖受损(impaired fasting glucose,IFG)32例,糖耐量受损(impaired glucose tolerance,IGT)130例;2)产后糖代谢异常组孕期GDM诊断的孕周较糖代谢正常组早,空腹血糖、孕前及产后体质量指数(body mass index,BMI)、血脂均较正常组高,孕期应用胰岛素控制血糖、合并相关合并症、DM家族史的比例较正常组高,差异有统计学意义(P<0.05),而两组母乳喂养比例差异无统计学意义(P>0.05);3)两组孕妇的年龄、孕产次以及孕期体质量增长相比较,差异无统计学意义(P>0.05)。结论 1)大部分GDM孕妇产后6～8周糖代谢可恢复正常,28.8%(180例)的孕妇产后仍然存在糖代谢异常;2)孕妇GDM诊断孕周早、孕期空腹血糖高、DM家族史、孕期应用胰岛素控制血糖、孕期合并相关合并症、孕前及产后高BMI、高脂血症等均为产后糖代谢异常的高危因素。     

双胎妊娠孕妇体重指数对妊娠结局及并发症、新生儿体重的影响

目的 探讨双胎妊娠孕妇孕前体重指数(BMI)及其孕期增长对妊娠结局及并发症、新生儿出生体重的影响.方法 双胎妊娠产妇333例,根据孕前BMI不同分为低BMI组(BMI＜ 18.5 kg/m2)64例、正常BMI组(BMI 18.5 ～25.0 kg/m2)221例、高BMI组(BMI ＞25.0 kg/m2)48例.分析双胎妊娠孕妇孕前BMI及其孕期增长与妊娠结局、并发症、新生儿出生体重的关系.结果 高BMI组妊娠期糖尿病、妊娠期高血压、剖宫产发生率均高于低BMI组和正常BMI组(P＜0.05);低BMI组妊娠期糖尿病、妊娠期高血压发生率均低于正常BMI组(P＜0.05).3组早产、产后出血发生率比较,差异无统计学意义(P＞0.05).有妊娠期糖尿病组孕期与无妊娠期糖尿病组BMI增长幅度比较,差异无统计学意义(P＞0.05).有子痫前期组孕期BMI增长幅度明显大于无子痫前期组(P＜0.05).新生儿出生体重与孕产妇孕期BMI增长呈正相关性(r=0.178,P＜0.001).正常BMI组新生儿出生体重为2 500 ～3 999 g的比例明显大于低BMI组(P＜0.05),但与高BMI组比较差异无统计学意义(P＞0.05).结论 双胎妊娠孕妇的孕前BMI、孕期BMI增长与妊娠结局及并发症、新生儿体重存在一定关系.     

个体化孕期体质量管理对孕妇妊娠结局的影响

目的：分析个体化孕期体质量管理对孕妇妊娠结局的影响。方法选取200例孕妇为研究对象,数字法随机分为2组,对照组进行常规产前检查,研究组在上述基础上实施个性化孕期体质量管理,对比2组孕妇的妊娠结局。结果研究组孕期平均增重（12.4±2.6）kg,明显低于对照组的（16.0±2.7）kg,差异具有统计学意义（P＜0.05）。研究组体质量管理目标实现率90.0%,对照组体质量管理目标实现率36.0%,差异具有统计学意义（P＜0.05）。对照组的贫血率、剖宫产率、产后出血率明显高于研究组,差异具有统计学意义（P＜0.05）。研究组妊娠期糖尿病发生率3.0%,明显低于对照组的11.0%,差异具有统计学意义（P＜0.05）。结论个体化孕期体质量管理可明显改善孕妇妊娠结局,适合于临床推广。     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.