氢吗啡酮复合右美托咪定在胸腔镜下肺叶切除术后镇痛的临床效果

目的 评价氢吗啡酮复合右美托咪定在胸腔镜下肺叶切除术患者术后镇痛中的临床效果。方法 选取择期拟行胸腔镜下肺叶切除术的患者120例,采用随机数字表法分为3组,每组40例：A组患者术毕给予舒芬太尼2.0μg/kg进行术后镇痛;B组患者术毕给予舒芬太尼1.5μg/kg+氢吗啡酮0.15mg/kg进行术后镇痛;C组患者术毕给予舒芬太尼1.0μg/kg+氢吗啡酮0.15mg/kg+右美托咪定2.0μg/kg进行术后镇痛。3组术后镇痛泵总量为100ml,持续镇痛量2ml/h,单次负荷剂量2ml,锁定时间15min。分别于术前（T₀）、术后2h（T₁）、4h（T₂）、8h（T₃）、12h（T₄）、24h（T₅）及48h（T₆）时记录3组患者心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO₂）及呼吸频率（RR）;记录3组患者T₁～T₆时疼痛视觉模拟评分（VAS）及Ramsay镇静评分;记录3组患者术后48h内单次自控镇痛（PCA）平均按压次数及不良反应发生率。结果 B组和C组患者T₁～T₆时HR、MAP均较A组更平稳,组间比较差异有统计学意义（P<0.05）。B组和C组患者T₁～T₃时的VAS和Ramsay镇静评分均低于A组（P<0.05）,且C组患者T₁～T₃时的VAS和Ramsay镇静评分均低于B组（P<0.05）。B组和C组患者术后48h内的PCA平均按压次数低于A组,而C组患者术后48h内的PCA平均按压次数低于B组（P<0.05）。B组和C组患者的总不良反应发生率显著低于A组（P<0.05）。结论 氢吗啡酮复合右美托咪定应用于胸腔镜下肺叶切除术患者的术后镇痛效果较好,可减少舒芬太尼的用量,且不良反应较少,安全性较高。     

三(3-乙炔基苯胺)-苯基硅烷改性含硅芳炔树脂的性能

以苯基三氯硅烷、3-氨基苯乙炔为原料,通过胺解反应合成了三（3-乙炔基苯胺）苯基硅烷（SZTA）,并通过傅里叶变换红外光谱（FT-IR）和核磁共振氢谱（¹H-NMR）表征了其结构。随后通过熔融共混的方法制备了不同配比的改性含硅芳炔树脂（PSA/SZTA）,借助黏度计、流变仪、差示扫描量热仪（DSC）、电子万能试验机、热重分析仪（TG）等考察了改性树脂的工艺性能、固化特性、弯曲性能、热稳定性能和热解动力学等。结果显示,引入SZTA后,改性PSA树脂的黏度降低62%;改性PSA树脂固化物的弯曲强度最高达到34.6 MPa,比未改性的PSA树脂提高了约54%;且改性树脂固化物在N₂中的5%热失重温度（T_d5）均高于500 ℃,保持了良好的耐热性能;PSA/SZTA-20固化物的热解表观活化能（E_a）的平均值为249 kJ/mol。     

右美托咪定辅助臂丛麻醉的镇静效果及安全性

目的 观察右美托咪定辅助臂丛麻醉的镇静效果和安全性。方法 选取2014年2月至2015年10月上海交通大学医学院附属第九人民医院行臂丛麻醉手术的120例患者为研究对象,采用随机双盲法分为A、B、C组,每组40例。A组术前予静脉注射咪达唑仑0.04 mg/kg;B组在阻滞前10 min静脉泵入0.5μg/kg右美托咪定,10 min泵完;C组在阻滞前10 min静脉泵入0.5μg/kg右美托咪定,10 min泵完,同时术前静脉注射咪达唑仑0.04 mg/kg。记录3组患者给药前（T₀）、给药10 min后（T₁）、20 min后（T₂）、30 min后（T₃）、60 min后（T₄）以及手术结束时（T₅）的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO₂）及警觉/镇静（OAA/S）评分。结果 与B、C两组比较,A组患者的感觉完全阻滞时间、运动完全阻滞时间显著缩短,差异有统计学意义（F=5.133、5.849,P=0.007、0.004）。与给药前（T₀）HR、MAP和OAA/S评分相比,A组仅T₁时显著降低,C组T₁～T₄均显著降低（P均<0.05）;B组各个时刻均保持平稳（P均>0.05）;组间上述各指标比较,A组患者T₁时刻低于B组,C组患者T₁～T₄时刻均低于B组,且T₂～T₄时刻低于A组（P均<0.05）;3组的SpO₂比较,差异无统计学意义（P>0.05）;C组患者术中因心率减慢而给予阿托品治疗的例数多于A、B两组,差异有统计学意义（χ²=7.50,P=0.02）。结论 右美托咪定辅助臂丛神经阻滞具有较高的镇静效果和安全性能。     

右美托咪定对慢阻塞肺患者腔镜手术时氧合和无效腔的影响

目的 探讨右美托咪定对老年中度慢性阻塞性肺疾病（COPD）患者择期行腹腔镜结直肠癌手术时氧合和无效腔通气的影响。方法 择期行腹腔镜结直肠癌手术COPD患者60例,按照随机数字表法分为两组（n=30）：右美托咪定组（D组）和对照组（C组）。D组诱导前静注右美托咪定0.5μg/kg（>10min）,随后0.3μg/（kg·h）泵注至术毕;C组给予相同容量的生理盐水。测定入室时（T₀）、气管插管成功后（T₁）、人工气腹体位后30min（T₂）和60min（T₃）动脉血气值。观察气管插管成功后（T₁）、人工气腹体位后30min（T₂）和60min（T₃）气道峰压（P_peak）、气道平台压（P_plat）和动态肺顺应性（C_dyn）,计算无效腔率（V_D/V_T）和氧合指数（OI）。结果 与C组比较,D组T₂和T₃时点氧合指数均升高（P<0.05,P<0.01）,P_peak下降和C_dyn显著升高（P<0.05,P<0.01）;而两组间pH、PaCO₂和P_plat比较差异无统计学意义。麻醉后D组V_D/V_T呈降低趋势,与C组比较,D组T₂和T₃时点V_D/V_T显著下降（P<0.05）。结论 右美托咪定术中输注可显著降低中度COPD患者的气道压力,降低无效腔通气率,改善肺内氧合。     

苯并噁嗪改性氰酸酯树脂的制备及性能

采用溶剂混合法制备了苯并噁嗪质量分数不同的苯并噁嗪改性氰酸酯树脂体系,采用差示扫描量热法（DSC）考察改性树脂的固化行为,采用密度法研究了改性树脂固化过程的收缩情况,考察了改性树脂的热稳定性和耐湿热性能等。结果表明：改性树脂体系的固化温度比氰酸酯树脂的固化温度至少降低25℃,具有自催化效果;苯并噁嗪开环聚合与氰酸酯发生环三嗪环的环三聚反应,改性树脂在固化过程中无收缩,固化物密度减小。改性树脂固化物的耐热性能略有下降,玻璃化转变温度（T_g）与起始分解温度（T_d5）均下降20℃左右,1 000℃时热解残留率提高0.2%;改性树脂吸湿率低,其在沸水中放置72 h时吸湿率小于3%;改性树脂浇铸体弯曲强度达144.6 MPa,弯曲模量为4.44 GPa,经湿热老化后弯曲强度保留率达到63%,弯曲模量上升到4.62 GPa,具有良好的耐湿热性能。     

3.0T磁共振不同序列检出妇科肿瘤盆腔淋巴结转移的比较

目的探讨3.0T磁共振(MRI)不同序列条件下,如何选择检出妇科肿瘤盆腔淋巴结转移的磁共振方法。方法选择符合入组条件的患者32例,于术前行常规T1加权序列（T₁WI）、T2加权序列（T₂WI）、增强扫描（T₁WI+C）、弥散加权成像（DWI）等序列检查,记录每例的盆腔检出淋巴结的组别分布及总淋巴结个数,与盆腔淋巴结清扫术记录对比,计算不同序列扫描对妇科肿瘤患者盆腔淋巴结转移的检出率并结合DWI序列扫描图分析分别以淋巴结短径及其表观弥散系数（ADC）阈值为判断标准时的阳性检出率。结果使用DWI序列对盆腔淋巴结转移检出率最高,为86.4%（51/59）,与DWI序列比较,T₁WI-MRI平扫、T₂WI-MRI平扫、T₁WI+C的检出率分别为61.0%（χ²=8.575,P＜0.05）、69.5%（χ²=3.996,P＜0.05）、72.9%（χ²=2.563,P＞0.05）,DWI序列的淋巴结转移检出率和增强扫描相仿。短径判断方法的检出率为81.4%,ADC阈值判断方法的检出率为89.8%,基于两种判断方法的检出率间差异无显著性（χ²=1.100,P＞0.05）。结论DWI序列扫描可以获得和增强扫描相似的检出率,优于常规T₁WI、T₂WI平扫,故推荐常规磁共振扫描时加扫DWI序列,其阳性判断方法可任意选用短径法和ADC阈值法。     

右美托咪定预防全身麻醉后导尿患者阴茎勃起和苏醒期膀胱刺激征

目的 观察右美托咪定对全身麻醉诱导后导尿患者阴茎勃起和苏醒期膀胱刺激征的预防作用。方法 拟行择期外科手术男性患者1000例,ASA分级Ⅰ~Ⅱ级,随机分为C、D两组（n=500）。C组为对照组,D组为右美托咪定组。C组和D组在麻醉诱导前15min分别静脉泵注生理盐水和右美托咪定1μg/kg,均在完成麻醉诱导并气管插管后10min内开始导尿,观察两组患者给药前（T₀）、全麻诱导前（T₁）、气管插管后导尿前（T₂）、导尿过程中（T₃）阴茎勃起的发生率及程度,记录两组患者苏醒期膀胱刺激征的发生率及程度。结果 C组在T₃时间点高发并分级最高（与T₂点相比,P<0.05）,D组两时间点发生例数及分级差异无统计学意义（P>0.05）。D组在T₂和T₃时间点阴茎勃起发生率分别为4.0%和5.6%,明显低于C组（15.4%、77.8%,P<0.05）;在T₃时间点阴茎勃起1级、2级和3级发生率分别为4.4%、1.0%和0.2%,明显低于C组（62.6%、11.4%、3.8%,P<0.05）。D组苏醒期膀胱刺激征发生率明显低于C组（28.4% vs 63.0%,P<0.05）,其中1分、2分及3分的发生率分别为15.6%、10.4%及2.4%,明显低于C组（22.0%、21.0%、20.0%,P<0.05）。结论 1μg/kg右美托咪定全身麻醉诱导前泵注可预防导尿过程中阴茎勃起和苏醒期膀胱刺激征的发生,提高患者的舒适度。     

血管紧张素Ⅱ受体拮抗剂对腹膜透析患者左心室肥厚的消退作用

目的 观察血管紧张素Ⅱ受体拮抗剂（ARB）对持续性非卧床腹膜透析（CAPD）高血压患者左心室肥厚和动脉硬化指数的影响。方法 65例接受CAPD患者,根据其服用降压药物不同分为ARB（缬沙坦）组（A组）和非血管紧张素转换酶抑制剂/ARB组（B组）两组,两组降压目标均为≤140mmHg/90mmHg,每间隔6个月定期至门诊随访,共随访24个月,即入选时（T₀）、6个月（T₆）、12个月（T₁₂）、18个月（T₁₈）、24个月（T₂₄）。于随访各时点记录两组患者的血压、血肌酐、脑钠肽、尿量、超滤和肌酐清除率及心脏超声测定左心室舒张末期内径、室间隔厚度、心胸比等,计算左心室质量指数（LVMI）。同时观察T₀、T₁₂和T₂₄时动态血压监测,测定血压变异率并通过一系列计算获取动态动脉硬化指数。结果 与基础值T₀比较,降压治疗第18个月后两组LVMI均明显下降（P<0.05）;与B组相应时点比较,A组T₆、T₁₂、T₁₈和T₂₄时点LVMI显著降低（P<0.05）。与各组基础值比较,治疗后心胸比值下降（P<0.05）;A组T₁₂、T₁₈和T₂₄时点心胸比和脑钠肽值较B组相应时点降低（P<0.05）。与B组比较,A组T₁₂和T₂₄时间点24h收缩压变异、24h舒张压变异和动脉硬化指数显著降低（P<0.05）。心力衰竭再次住院率A组（5.4%）显著低于B组（11.6%）。结论 ARB能促进其CAPD患者左心室肥厚的消退,降低血压变异和动脉硬化指数,可减少因心力衰竭再次住院发生率。     

不同剂量右美托咪定对食管癌根治术患者术后谵妄的作用

目的 评价不同剂量右美托咪定（Dex）对食管癌根治术患者术后谵妄的作用。方法 择期行食管癌根治术的患者90例,采用数字表法将患者随机分为Dex低剂量组（Dex-L组）、Dex高剂量组（Dex-H组）和生理盐水组（NS组）,每组30例。Dex-L组、Dex-H组患者分别静脉泵注Dex负荷量0.5μg/kg、1.0μg/kg,10min泵注完毕,后分别以维持量0.3μg/（kg·h）、0.5μg/（kg·h）继续泵注至手术结束前30min;相同时间内NS组患者静脉输注等量生理盐水。Dex负荷量泵注结束后开始麻醉诱导。分别观察麻醉诱导前（T₀）、诱导后10min（T₁）、单肺通气1h（T₂）、手术结束后1h（T₃）、6h（T₄）、24h（T₅）、48h（T₆）和72h（T₇）时抽取颈内静脉球部血液,测定颈静脉球部血氧饱和度（S_JvO₂）和血氧分压（P_JvO₂）,并检测T₀、T₃、T₅~T₇时血清中星型胶质细胞S-100β蛋白（S-100β蛋白）和神经元特异性烯醇化酶（NSE）水平;采用ICU意识障碍评估法（CAM-ICU）评估患者术后72h谵妄发生率。结果 与NS组比较,Dex-L组和Dex-H组S_JvO₂及P_JvO₂分别在T₁时点明显降低（P<0.01）;与NS组和Dex-L组比较,Dex-H组S_JvO₂及P_JvO₂分别在T₂~T₇时点明显升高（P<0.01）。与NS组和Dex-L组比较,Dex-H组S-100β蛋白及NSE水平分别于T₃、T₅~T₇时均降低（P<0.01）。与NS组和Dex-L组比较,Dex-H组患者术后72h谵妄发生率明显降低（P<0.05）。结论 1.0μg/kg剂量的Dex可明显降低食管癌根治术患者术后谵妄的发生率,其作用机制可能与其降低脑组织氧耗量、减轻脑损伤有关。     

右美托咪定喷鼻在小儿深静脉穿刺置管术中的临床效果

目的 评价右美托咪定（Dex）喷鼻在小儿深静脉穿刺置管术中的临床效果。方法 择期行深静脉穿刺置管术的患儿共90例,年龄2～6岁,采用数字表法随机分成3组,每组30例：A组患儿于穿刺前30min将咪达唑仑0.2mg/kg进行喷鼻;B组和C组患儿分别于穿刺前30min将Dex 1.0μg/kg或2.0μg/kg进行喷鼻。待患儿睫毛反射消失后即行深静脉穿刺置管术。记录3组患儿喷鼻前10min（T₀）、喷鼻后30min（T₁）、睫毛反射消失时（T₂）、穿刺开始即刻（T₃）、穿刺开始后5min（T₄）、穿刺结束时（T₅）、穿刺结束后10min（T₆）及30min（T₇）时的平均动脉压（MAP）、心率（HR）、呼吸频率（RR）及脉搏血氧饱和度（SpO₂）。记录3组患儿喷鼻前10min、喷鼻后10、20和30min时的脑电双频指数（BIS）及警觉与镇静评分（OAA/S评分）。记录3组患儿与家长分离时镇静情绪评分和静脉穿刺接受程度评分。记录3组患儿穿刺前后的不良反应发生情况。结果 3组患儿术中血流动力学均较平稳。与A组和B组同时点比较,C组患儿喷鼻后10～30min的BIS及OAA/S评分均降低（P<0.05）。与A组和B组比较,C组患儿与家长分离时的镇静情绪评分及静脉穿刺接受程度评分均升高（P<0.05）。与A组和B组比较,C组患儿睫毛反射消失时间缩短（P<0.05）,而麻醉苏醒时间无延长（P >0.05）。与A组和B组比较,C组患儿术中高血压、窦性心动过速、体动反应等发生率及术后躁动不安发生率均降低（P<0.05）。B组和C组患儿喷鼻刺激发生率均低于A组（P<0.05）。结论 Dex（2.0μg/kg）喷鼻用于小儿深静脉穿刺置管术,可有效地提高患儿的依从性,具有较好的镇静和镇痛效果,且不良反应发生率更低,可安全应于临床。     

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.