不同亚型贲门失弛缓症的食管动力学特点的研究

目的 研究贲门失弛缓症患者的临床特点及不同亚型患者食管动力学特点的差异.方法 纳入24例贲门失弛缓症患者行食管测压检查并分型,观察贲门失弛缓症临床特点,同时对不同亚型患者的食管动力学参数进行比较.结果 ①24例贲门失弛缓症患者均有吞咽困难不适,伴有反流症状13例(13/24,54. 17％),I型患者伴发反流不适症状更为常见(P=0. 015);②24例贲门失弛缓症患者的食管测压结果均为食管同步蠕动,而且均存在食管下括约肌残余压升高和食管下括约肌松弛不完全,食管下括约肌静息压升高的患者有5例(5/24,20. 83％), Ⅱ型患者的食管体部近端蠕动压力和食管体部远端蠕动压力均高于I型患者(P＜0.05).结论 贲门失弛缓症不同亚型具有不同的临床特点和食管动力学特点,对于怀疑贲门失弛缓症的患者建议进行食管测压检查可以明确诊断和进行分型,有利于治疗方案的选择和预后评价.     

硝苯吡啶在消化系疾病中的应用

近年来,硝苯吡啶已逐渐用于消化系统某些疾病中,并取得一定进展.本文就硝苯吡啶在消化系统疾病中的应用,作一简要叙述.一、硝苯吡啶在食管疾病中的应用舌下含服硝苯吡啶有明显降低食管下端括约肌压力的作用,且药物的剂量和血浆浓度与括约肌压力呈正相关.有报道贲门失弛缓症患者,于餐前舌下含服硝苯吡啶10～20mg,在用药后15～20分钟,食管下端括约肌压力显著下降,药物作用可持续1小     

生长抑素对贲门失驰缓症食管运动的影响

目的 :观察生长抑素 (施他宁 )对贲门失驰缓症患者食管运动的影响。方法 :2 4例贲门失驰缓症患者食道测压后随机分为 3组 ,每组 8例 ,即假干预组 (I组 )、生理盐水组 (II组 )、施他宁干预组 (III组 )。在患者静脉给予施他宁 2 5 0 μg,或生理盐水或假干预后立即再次行食道测压检查 ,观察他们对食道运动的影响。 结果 :静脉注射施他宁后下食道括约肌压力 (LESP)明显降低 ,从 43.8± 6 .7mmHg,降至 2 6 .7± 4.8mmHg ,下食道括约肌 (LES)松驰率由干预前 6 4.1± 17.2 %增至 82 .7± 2 1.5 %。结论 :生长抑素 (施他宁 )对贲门失驰缓症患者食管运动有明显的影响。显著降低贲门失驰缓症患者下食道括约肌压力、升高下食道括约肌松驰率。     

经内镜球囊扩张术治疗贲门失弛缓症扩张持续时间的研究

目的　探讨内镜下球囊扩张治疗贲门失弛缓症的扩张时间。方法　采用扩张持续时间为 3min ,间隙 3min和扩张 1min、间隙 1min的方法对 2 0例贲门失弛缓症患者进行内镜下治疗 ,术前和术后 1周及 6月测定X线下食管最大宽度和食管下段括约肌的压力 (LESP)的变化。结果　两组治疗后吞咽困难均消失 ,食管最大宽度和LESP变化无显著差异。结论　采用扩张持续 1min、间隙 1min的方法治疗贲门失弛缓症可缩短时间 ,减轻患者痛苦     

贲门成形术治疗贲门失弛缓症72例疗效分析

目的:重建贲门功能,防止贲门失弛缓症术后并发症。方法:对72例贲门失弛缓症患者施行食管下段胃贲门部切除,贲门成形术。术后对68例患者进行了1~8年随访,行上消化道钡餐透视、胃镜及食管内测压检查,并与正常人测压结果进行对比。结果:本组无手术死亡,无吻合口瘘、吻合口狭窄等并发症。手术组的食管上、下括约肌静止压和压力区范围与正常人食管上下端括约肌静止压和压力区范围无显著性差异(P>0.05)。结论:贲门成形术是治疗贲门失弛缓症的一种安全、有效方法。     

继发性贲门失弛缓症(5例报告并文献复习)

目的 总结继发性贲门失弛缓症临床特征及误诊原因.方法 经计算机选取2000-2012年本院确诊的贲门失弛缓症患者149例,其中5例为继发性贲门失弛缓症,观察症状持续时间;钡餐下食管形态学改变,包括食管最大宽度及狭窄长度变化;胃镜下贲门黏膜改变;食管下段压力变化,CT检查结果.结果 本组继发性贲门失驰缓症平均年龄(54.0±23.7)岁,症状持续时间平均(4.6±0.7)个月,检查显示食管贲门狭窄长度平均(3.80±0.26)cm,食管最大径平均(4.32±0.64)cm,食管下端括约肌测压(LES)检查平均(40.50±0.70)cmH2O,CT检查提示食管下段贲门及纵隔占位,手术探查病理证实胃黏液腺癌1例,贲门腺癌2例,食管下段鳞状细胞癌1例,纵隔型肺腺癌1例.结论 继发性贲门失弛缓症少见,临床诊断中多存在误诊,延误治疗,应根据患者资料全面认真分析,做出正确判断.     

贲门失弛缓症下段食管壁顺应性和残余应力分布

目的:研究贲门失弛缓症下段食管的应力-生长关系.方法:将20只猫随机分为对照组和贲门失弛缓症病变模型组,病变组于胃镜下在下食管括约肌(LES)处分4点环行注射苄基二甲基十四烷氯化铵(BAC)0.5 ml/点,对照组注射等量生理盐水.病变组于4、6、8周后,对照组于8周后,测LES压力(LESP)和食管体部收缩波幅.取食管下1/3段测不同拉伸比下的压力-容积,并以指数曲线拟合.将实验段食管垂直轴向剪成长度约2 mm的环状,扫描读取管壁厚度、内外周径,再径向剪开食管环,扫描张开角,计算其残余应力.结果:病变组在注射BAC后4、6、8周,LESP分别为(31.2±5.11)、(30.6±3.61)、(32.2±3.76) mmHg(1 mmHg = 0.133 kPa),较注射前显著增高(P<0.05、P<0.01和P<0.01),而对照组较注射前无显著差异(P>0.05);两组动物食管体部收缩波幅均较注射前无显著变化.病变组4、6周后下段食管的顺应性均较对照组显著降低(P<0.05),以注射后4周最小.病变组下段食管内壁的残余应力较对照组均显著减小(P<0.05),但随病程的延长而逐渐接近对照组.结论:贲门失弛缓症食管下段的顺应性降低,并存在显著的异常力学特性.     

贲门失弛缓症的内镜诊断与治疗操作技巧

贲门失弛缓症(Achalasia)主要是以食管下段括约肌(Lower Esophagus Sphincter,LES)松弛障碍及食管体部缺乏推进性蠕动为特征的食管运动功能障碍性疾     

药物结合内镜下注射肉毒素治疗贲门失弛缓症13例疗效观察

目的:观察并比较药物结合内镜下注射肉毒素及单纯肉毒素注射治疗贲门失弛缓症的疗效。方法:治疗组采用硝酸异山梨醇酯口服结合内镜直视下于食管下段括约肌(LES)固有肌层处局部注射肉毒素治疗贲门失弛缓症。对照组采用肉毒素内镜下注射治疗。分别于治疗后1个月、3个月、6个月、12个月及停服药物1月后随访观察两组患者的吞咽困难Stooler分级及治愈率、有效率,比较两组患者近期及远期疗效。结果:两组治疗后1个月、3个月、6个月的治愈率及有效率之间进行比较均无显著性差别(P>0.05)。肉毒素注射+药物口服治疗组治疗后12个月的有效率高于单纯肉毒素注射治疗组,两组之间比较具有显著性统计学差别(P<0.05)。两组停服药物1月后有效率均显著下降,均为0%。结论:食管下段括约肌局部注射肉毒素治疗贲门失弛缓症技术操作简单,近期治疗效果好,是值得推崇的治疗贲门失弛缓症行之有效的治疗方法之一。     

贲门失弛缓症的研究进展

贲门失弛缓症是一种食管运动功能障碍性疾病，以下食管括约肌(LES)张力增高，食管正常蠕动消失，LES和贲门对吞咽动作的松驰反应障碍为特征，病因目前仍尚未明确，可能与基因遗传，自身免疫，病毒感染及食管肌问神经丛有关。现有治疗手段尚未能完全恢复食管正常运动功能，主要通过药物治疗，肉毒毒素注射治疗，贲门扩张及手术括约肌切除治疗来松弛LES，降低其周围压力，从而缓解症状。本文就近年来贲门失弛缓症基础研究及治疗的一些进展进行综述。     

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.