阿立哌唑作为增效剂治疗难治性强迫症的临床观察

目的 探讨阿立哌唑作为增效剂治疗难治性强迫症的疗效和耐受性.方法 对31例难治性强迫症患者在原SRI类药物治疗的基础上联合阿立哌唑治疗并以28例继续应用SRI类药物治疗的难治性强迫症患者为对照.阿立哌唑起始量为第1周5mg/d,第2周为10mg/d,第3周为15mg/d口服,之后可根据个体的疗效和耐受情况调整剂量,最大剂量不超过20mg/d,疗程8周;采用Yale-Brown强迫量表、汉密尔顿焦虑量表、总体评定量表及副反应评定量表分别在治疗前、治疗第4周末及治疗第8周末各评定1次,并进行对比分析.结果 治疗第8周末,研究组Yale-Brown强迫量表[(12.00±5.32)分]、汉密尔顿焦虑量表[(13.75±3.27)分]、大体评定量表总分[(48.75±11.73)分]与治疗前[分别为(29.80±5.44)分,(23.50±3.61)分,(26.95±10.61)分]比较差异均有显著性(P＜0.01);Yale-Brown强迫量表减分率判定:痊愈率16%,有效率48%,无效36%;不良反应程度较轻微,患者均可耐受并与对照组在各项量表评分上差异具有显著性.结论 小剂量阿立哌唑可作为常规抗抑郁剂的增效剂治疗难治性强迫症.     

小剂量奥氮平作为增效剂辅助治疗31例难治性强迫症的对照研究

目的:探讨小剂量奥氮平作为增效剂治疗难治性强迫症的疗效和耐受性.方法:选取59例难治性强迫症患者为研究对象,对31例难治性强迫症患者在原SSRI类药物治疗的基础上联合奥氮平治疗,同时以28例继续应用SSRI类药物治疗的难治性强迫症患者为对照.奥氮平起始量为第1周5 mg/d,第2周为10 mg/d,第3周为15 mg/d口服,之后可根据个体的疗效和耐受情况调整剂量,最大剂量不超过20 mg/d,疗程8周;采用Yale-Brown强迫量表,汉密尔顿焦虑量表,总体评定量表及副反应评定量表分别在治疗前,治疗第4周末及治疗第8周末各评定1次,并进行对比分析.结果:治疗第8周末,研究组Yale-Brown强迫量表(12.0±5.4)分,汉密尔顿焦虑量表(13.7±3.2)分、大体评定量表总分(48.2±11.7)分与治疗前分别为(29.8±5.4)分,(23.50±3.61)分,(26.95±10.61)分,治疗前后比较差异均有显著性(P<0.01);Yale-Brown强迫量表减分率判定:痊愈率16%,有效率48%,无效36%;不良反应程度较轻微,患者均可耐受并与对照组在各项量表评分上差异具有显著性.结论:小剂量奥氮平可作为常规抗抑郁剂的增效剂治疗难治性强迫症,疗效较好.     

小剂量奥氮平辅助治疗难治性强迫症疗效观察

目的探讨奥氮平辅助治疗难治性强迫症的临床疗效和安全性.方法对28例难治性强迫症患者在原用药物基础上联合小剂量(5～10 mg/d)奥氮平治疗;奥氮平日剂量平均为(5.98±1.95) mg,疗程6周;在治疗前及治疗后6周末分别评定Yale-Brown强迫量表、Marks强迫恐怖量表、汉米尔顿焦虑量表、副反应评定量表,并检测体型指数、血糖、血脂变化等;对数据进行统计分析.结果治疗后6周末Yale-Brown强迫量表、Marks恐怖强迫量表、汉米尔顿焦虑量表与治疗前比较均有显著性差异(P＜0.01).治疗6周末体型指数比治疗前有显著性差异(P＜0.05).结论合用小剂量奥氮平治疗难治性强迫症疗效明确,但须注意体重变化.     

无抽搐电痉挛治疗难治性强迫症的对照研究

目的 探讨无抽搐电痉挛治疗难治性强迫症的疗效及安全性.方法 采用入院顺序分层随机法,将79例难治性强迫症患者随机分为研究组(无抽搐电痉挛治疗合并抗强迫药物)和对照组(抗强迫药物治疗),共观察4周,在治疗前及治疗第1周末、第2周末、第4周末采用Yale-Brown强迫量表、汉密尔顿焦虑量表、副反应量表评定疗效及不良反应.结果 治疗第1周末,研究组Yale-Brown强迫量表[(22.47±3.09)分]及汉密尔顿焦虑量表评分[(19.59±3.51)分]较治疗前[分别为(27.07±1.34)分、(24.99±3.76)分]均有显著性降低(t=6.10,7.69,P<0.05),而对照组均无显著性改善(t=1.32,1.78,P0.05).治疗第1周末、第2周末及第4周末,研究组的Yale-Brown强迫量表[分别为(22.47±3.09)分、(14.93±2.92)分、(10.93±4.23)分]及汉密尔顿焦虑量表评分[分别为(19.59±3.51)分、(16.60±2.97)分、(11.40±2.68)分]均显著低于对照组的Yale-Brown强迫量表[分别为(26.33±4.49)分、(21.40±3.58)分、(19.60±4.26)分]及汉密尔顿焦虑量表评分[分别为(24.38±3.34)分、(20.78±4.05)分、(19.79±3.08)分],均差异有显著性(t=4.36,21.30,P<0.05).在治疗第1周末、第2周末及第4周末,研究组[分别为35.90%、58.97%、74.36%]和对照组[分别为0.00%、17.50%、32.50%]的治疗有效率差异有显著性(X2=13.90～14.42,P<0.05).研究组未出现严重不良反应.结论 无抽搐电痉挛治疗是治疗难治性强迫症快速、有效、安全的首选方法之一.     

序贯心理治疗合并5-羟色胺再摄取抑制剂治疗难治性强迫症的临床疗效

目的 探讨序贯心理治疗合并5-羟色胺再摄取抑制剂(SSRIs)治疗难治性强迫症的疗效.方法 对50例难治性强迫症患者在原SSRIs类药物治疗的基础上给予序贯心理治疗,在第一阶段、第二阶段、第三阶段分别给予精神分析疗法、森田疗法/认知行为疗法、现实疗法.每阶段疗程8周.采用Yale-Brown强迫量表分别在治疗前、治疗第8周末、治疗第16周末及治疗第24周末各评定1次,并进行对比分析.结果 治疗前及治疗第24周末Yale-Brown强迫量表分别为[(21.10±4.69)分]和[(10.18±6.14)分].第24周末Yale-Brown强迫量表减分率判定痊愈率34.0%(17/50),显进率42.0%(21/50).结论 在SSRIs类药物治疗的基础上给予序贯心理治疗是治疗难治性强迫症一种有效的方法.     

氟伏沙明联合阿立哌唑治疗难治性强迫症临床观察

目的 研究氟伏沙明联合阿立哌唑对难治性强迫症的疗效.方法 80例难治性强迫症患者,随机分为氟伏沙明单用组和合用阿立哌唑治疗组,治疗8周.治疗前后分别采用Yale-Brown强迫症量表(Y-BOCS)和治疗中出现的症状量表(TESS)评价疗效和不良反应.结果 氟伏沙明联合阿立哌唑治疗难治性强迫症的疗效显著,不良反应少.结论 两药联合应用治疗难治性强迫症的疗效显著,值得推广.     

阿立哌唑合并舍曲林治疗难治性强迫症的对照研究

目的:探讨阿立哌唑合并舍曲林治疗难治性强迫症的疗效.方法:将符合CCMD- 3 强迫症诊断标准的患者60例随机分为研究组和对照组,研究组28 例,采用阿立哌唑合并舍曲林治疗;对照组32 例,采用舍曲林治疗;疗程均为8周.应用耶鲁布朗强迫量表( YBOCS)和药物副反应量表( TESS) 于治疗前、疗后2 、4 、6 、8 周末评价其疗效及不良反应.结果:研究组疗效优于对照组(x2 = 4.1,P＜0.05);两组6、8 周末TESS评分比较无显著性差异(P＞0.05).结论: 阿立哌唑合并舍曲林对难治性强迫症不失为一种有效的治疗途径.     

阿立哌唑治疗利培酮所致男性高催乳素血症68例疗效分析

目的:探讨联合使用小剂量阿立哌唑治疗利培酮所致男性高催乳素血症的有效性及安全性。方法:将68例利培酮所致的高催乳素血症的男性患者,在维持原治疗的同时随机分为两组,分别加用阿立哌唑5 mg(34例)及安慰剂(34例)对照治疗,疗程均为6周。于治疗前、治疗后检测血清催乳素(PRL);观察血清催乳素的浓度变化及临床表现,以简明精神病评定量表(BPRS)及不良反应量表(TESS)评定其对原治疗疗效的影响及不良反应。结果:治疗第6周末,治疗组血清催乳素[(24.6±7.6)μg/L]较治疗前(92.3±30,7)μg/L]下降,差异有统计学意义(P<0.001);对照组催乳素[(93.5±41.2)μg/L]与治疗前[(95.2±28.2)μg/L]比较,差异无统计学意义(P>0.05);治疗6周末,两组BPRS评分均较治疗前无显著差异,两组不良反应发生率均低。结论:阿立哌唑治疗利培酮所致的血高催乳症安全有效,且不良反应少。     

阿立哌唑合并氟伏沙明治疗难治性强迫症的对照研究

目的探讨阿立哌唑合并氟伏沙明治疗难治性强迫症的疗效。方法将符合CCMD-3强迫症诊断标准的患者60例随机分为实验组和对照组。实验组28例,采用阿立哌唑合并氟伏沙明治疗。对照组32例,采用氟伏沙明治疗。疗程均为8周。应用耶鲁布朗强迫量表（YBOCS）和药物副作用量表（TESS）于治疗前、疗后2、4、6、8周末评价其疗效及副作用。结果实验组效优于对照组（χ2=4.1,P〈0.05）;两组6、8周末TESS评分比较无显著性差异（P〉0.05）。结论阿立哌唑合并氟伏沙明对难治性强迫症不失为一种有效的治疗途径。     

西酞普兰联合阿立哌唑治疗难治性强迫症患者的疗效观察

目的：探讨西酞普兰与阿立哌唑治疗难治性强迫症的疗效和不良反应。方法：将难治性强迫症患者64例随机分为两组,Ⅰ组西酞普兰加阿立哌唑组及Ⅱ组西酞普兰加安慰剂组,治疗8周。采用强迫症量表（Y-BOCS）和不良反应量表（TESS）评价疗效及不良反应。结果：西酞普兰治疗后显著改善强迫症状,西酞普兰联合阿立哌唑也能显著改善强迫症状,后者改善效果更好;两组不良反应轻微。结论：西酞普兰联合阿立哌唑较单用西酞普兰的抗强迫效果更好,安全性高,不良反应轻微,依从性好。西酞普兰适用于难治性强迫症。     

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.