长春新碱与强的松联合治疗小儿肾病综合征30例疗效观察

报道用长春新碱与强的松联合治疗小儿肾病综合征30例(单纯性20例,肾炎性10例)。9例作肾活检,病理诊断:系膜增殖性肾炎5例,膜增殂性肾炎2例,膜性肾病和微小病变肾病各1例。18例因肾病复发来治。治疗结果:27例(90%)得完全缓解,其中包括2例膜增殖性肾炎、1例膜性肾病、1例微小病变肾病和4例系膜增殖性肾炎。经平均4年的随访,6例(22.2%)复发。在长春新碱用药过程中未见明显副作用。由于缓解率高、复发率低、副作用轻、无性腺抑制之虞,联合疗法为小儿肾病综合征提供了一种安全有效的治疗措施。     

环磷酰胺联合强的松治疗儿童肾病综合征型紫癜性肾炎的效果探讨

目的探讨环磷酰胺联合强的松治疗儿童肾病综合征型紫癜性肾炎(HSPN)的临床效果。方法回顾性分析我院2017年3月至2018年7月期间诊治的肾病综合征型HSPN患儿52例,其中接受强的松治疗的26例患儿为对照组,另外26例患儿接受环磷酰胺联合强的松治疗,为观察组,对比分析两组的临床疗效和不良反应发生率。结果观察组治疗总缓解率(96.15%)高于对照组(69.23%),差异存在统计学意义(P0.05);对照组不良反应发生率为7.69%,观察组为19.23%,组间数据无统计学差异(P 0.05)。结论环磷酰胺联合强的松疗法应用于儿童肾病综合征型HSPN治疗中具有显著效果,且安全性良好,值得临床推广。     

静脉注射丙种免疫球蛋白预防早产儿感染

由于早产儿未能从母体中获得足够的ＩｇＧ,故易发生各种感染。目前,早产儿感染的发生率和死亡率仍较高,因此,预防早产儿感染尤为重要。笔者采用静脉注射丙种免疫球蛋白(ＩＶＩＧ)预防早产儿感染,疗效颇佳,现报道如下。对象和方法为单纯性肾病),部分缓解３例(２５%,单纯性肾病１例,肾炎性肾病２例),无效１例(８．３%,为肾炎性肾病)。５例频繁复发患儿完全缓解４例,部分缓解１例。３例激素依赖患儿完全缓解２例,部分缓解１例。４例激素耐药患儿完全缓解２例,部分缓解１例;３例ＦＳＧＳ患儿缓解１例,部分缓解１例,无效１例。２例ＭＣＮＳ患儿均…     

小儿肾病综合征246例临床分析

目的 对小儿肾病综合征作临床分析。方法 运用病例回顾性分析方法，分析246例临床资料完整的肾病综合征。结果 单纯性肾病156例，肾炎性肾病90例；单独使用激素治疗单纯性肾病109例和肾炎性肾病52例达到完全缓解；联合使用免疫抑制剂治疗85例，59例达到完全缓解，18例部分缓解。32例复发病例中，有12例为单纯性肾病，20例为肾炎性肾病。结论 单纯用激素治疗可使大部分病例达到完全缓解，加用免疫抑制剂可提高疗效。单纯性肾病预后较肾炎性肾病好，复发率低。     

环磷酰胺冲击治疗难治性肾病综合征的临床探讨

目的探讨环磷酰胺冲击疗法对难治性肾病综合症的疗效。方法选择19例难治性肾病综合症患儿,分别给予环磷酰胺(CTX)8-12mg/kg静脉滴注,每日1次,连用2天为1个疗程,每2-4周应用1个疗程,连用8-10个疗程,积累量小于200mg/kg。CTX冲击同时联合应用强的松方案常规治疗。结果19例难治性肾病患儿中13例完全缓解(68.4%),4例部分缓解(21.05%),总缓解率89.4%。13例完全缓解者中8例持续缓解(3例>2年,5例>1年)。结论环磷酰胺冲击疗法对难治性肾病可获得较好疗效。     

强的松和环磷酰胺等治疗肾病综合征的疗效比较(附61例随访报告)

文中介绍收治肾病综合征115例。82例单独用强的松治疗的患儿中58例完全缓解。完全缓解率为70.7％,如将部分缓解的病例包括在内,则总的缓解率为85.4％。但是这组的复发率高,41例随访病人中有29例复发,复发者的平均缓解期为3.23月,复发率为70.7％。其余12例平均随访13.96月未复发。 37例强的松治疗无效或激素依赖或强的松治疗后复发的病人,采用环磷酰胺加小剂量强的松治疗,其中27例完全缓解(73％)。总的缓解率(包括部分缓解在内)为86.5％。随访31例,其中8例复发,复发者平均缓解期为11.4月。其余23例平均随访15.3月未复发,复发率为25.8％,环磷酰胺组的复发率较强的松组为低,统计学上具有显著性(P<0.01),比较两组复发者的缓解期和未复发者的随访期表明,环磷酰胺组的缓解期比强的松组明显延长(P<0.01)。     

强的松、环磷酰胺联合治疗肾病综合征远期疗效观察

报告经强的松和环磷酰胺(CTX)联合治疗34例肾病综合征(NS)的远期疗效。34例中,原发性肾病综合征Ⅰ型(单纯型)22例,原发性肾病综合征Ⅱ型(肾炎型)12例;均用强的松长期治疗加CTX8～12周。随访观察2.5～14年。未曾复发者23例(67.6％),有过一次复发经治疗又获长期缓解者5例(14.7％),总有效率为82.3％。     

霉酚酸酯治疗小儿频复发肾病综合征的疗效观察

目的:观察霉酚酸酯(MMF)治疗小儿频复发肾病综合征的疗效和毒副作用.方法:37例频复发肾病综合征患儿(24例单纯型肾病综合征和13例肾炎型肾病综合征),每日口服MMF(20～30 mg/kg),泼尼松(1 mg/kg),疗程3～6个月.结果:37例肾病患儿中,24例单纯型肾病经MMF治疗后完全缓解17例(70.8%),部分缓解4例(16.7%),未缓解3例(12.5%);而肾炎型肾病13例经MMF治疗后完全缓解6例(46.2%),部分缓解3例(23.1%),未缓解4例(30.7%).8例微小病变(MCD)经MMF治疗后均完全缓解;以增生为主要病变的系膜增生性肾小球肾炎(MsPGN)和膜增生性肾小球肾炎(MPGN)共23例,MMF治疗后完全缓解17例(73.9%),部分缓解4例(17.4%),未缓解2例(8.7%).结论:MMF治疗单纯型肾病综合征频复发病例的效果明显优于肾炎型肾病综合征频复发病例;且对于以增生性病变为主要病理改变的频复发肾病疗效更佳.     

环磷酰胺冲击治疗小儿难治性肾病20例

目的：探讨大剂量环磷酰胺（CTX）冲击联合激素治疗小儿难治性肾病的临床疗效。方法：选择符合难治性肾病的诊断标准患儿20例,环磷酰胺8—12mg／kg,加入5％～10％葡萄糖100～200ml于1～2h内静脉滴注,治疗日停用泼尼松口服,同时按20ml／kg予以水化治疗,适当补充电解质,鼓励饮水以配合水化治疗,每天1次,连用2d为1个疗程。每2周给予1个疗程。完全缓解后,用药间期可逐渐延长,总剂量≤200mg／kg。强的松参照中长程方案。结果：20例治疗后完全缓解14例,基本缓解3例,部分缓解3例,总有效率100％。结论：大剂量环磷酰胺（CTX）冲击疗法联合激素治疗小儿难治性肾病,可有效提高缓解率,减少复发和不良反应发生率。     

22例老年肾病综合征临床表现和病理分析

目的：了解老年肾病综合征的临床表现和病理特点。方法：选择我院2001年1月～2007年1月老年肾病综合征患者21例行肾穿刺活捡。结果：22例老年肾痛综合征原发性肾小球肾炎占14例。继发性肾小球肾炎占7例，肾活检膜性肾病7例，给强的松或强的松联合环磷酰胺治疗，总缓解率77．3％。结论：老年肾病综合征病理复杂，主张行肾活捡以明确诊断及指导治疗，对激素或激素联合免疫抑制荆治疗反应较好。     

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.