奥拉西坦治疗儿童脑性瘫痪临床研究

目的:探讨奥拉西坦对小儿急性脑瘫的疗效.方法:选择2005～2007年我院儿科住院及及门诊脑性瘫痪患儿64例,随机分为对照组和治疗组,对照组采用常规功能锻炼和脑神经营养药,治疗组在常规治疗基础上加用奥拉西坦进行治疗(均为10mg/kg+150ml 5%葡萄糖液静脉滴注, 1次/d,连续使用14天).观察两组患儿的运动、语言、应物能、认人能的变化.结果:用药后,奥拉西坦组运动、语言、应物能、认人能均有提高, 其差异显著(P<0.05).结论:奥拉西坦能显著改善儿童脑瘫患者的脑功能,未发现明显不良反应,可治疗儿童脑瘫.     

脑瘫患儿血清神经元特异性烯醇化酶及髓鞘碱性蛋白浓度的变化及其临床意义

目的: 探讨脑瘫患儿血清神经元特异性烯醇化酶(neuron specific enolase,NSE)和髓鞘碱性蛋白（myelin basic protein,MBP）水平的变化及其临床意义。方法: 选取进行康复治疗的符合脑瘫诊断标准的脑瘫患儿46例（脑瘫组）,同时选取性别、年龄与脑瘫组患儿匹配的健康儿童45名作为健康对照组。采用酶联免疫吸附试验(ELISA)法检测健康组儿童体检时及脑瘫组患儿治疗前、常规康复治疗3个月后的血清NSE和MBP浓度。采用脑瘫粗大运动功能分级系统（GMFCS）和粗大运动功能88项量表（GMFM 88）对脑瘫组患儿治疗前、后的粗大运动功能进行分级和评估。结果： 健康组儿童血清NSE、MBP浓度分别为（6.77±2.08）μg/L、（0.38±0.10）μg/L;脑瘫组患儿治疗前血清NSE、MBP浓度分别为（16.26±2.94）μg/L、（1.21±0.41）μg/L,治疗3个月后浓度分别为（13.56±2.29）μg/L、（0.85±0.33）μg/L;脑瘫组患儿治疗前、后的GMFM 88评分分别为（132.33±81.60）分、（147.07±83.13）分。健康组儿童的NSE、MBP浓度与年龄之间均无显著相关性（P＞0.05）,而脑瘫组患儿治疗前的NSE、MBP浓度与年龄之间均呈负相关(P＜0.05)。脑瘫组儿童治疗前的NSE、MBP浓度均明显高于健康组(均P＜0.05)。脑瘫组治疗前的NSE、MBP浓度与脑瘫粗大运动功能分级（GMFCS）之间均呈正相关(P＜0.05),与GMFM 88评分之间均呈负相关(P＜0.05)。脑瘫组治疗前、后组内NSE、MBP浓度、GMFM 88评分间的差异均具有统计学意义(P＜0.05)。 结论： 脑瘫患儿血清NSE和MBP浓度较健康儿童显著升高,随年龄增加而降低,且与脑瘫的障碍程度及粗大运动功能相关。     

采用小组形式开展作业疗法治疗学龄前脑瘫儿童的疗效观察

目的：观察以小组形式开展作业疗法治疗学龄前脑瘫儿童的临床效果。方法20例痉挛型双瘫的脑瘫患儿按随机数字表法分为对照组（ n＝10）和观察组（ n＝10）。对照组的作业治疗采用一对一的训练方法,观察组采用2名脑瘫儿童为一小组形式开展作业治疗,1次/d,30 min/次,每周5 d,治疗3个月。结果两组治疗后,精细运动功能及日常生活活动能力显著提高（P＜0.01）,观察组与对照组效果差异无统计学意义（ P＞0.05）。结论以小组形式与传统一对一形式开展作业治疗均能明显提高脑瘫患儿的精细运动功能及日常生活活动能力,治疗效果差异无统计学意义。     

引导式教育理念在脑性瘫痪患儿护理中的应用价值

目的探讨引导式教育理念在脑性瘫痪患儿护理中的应用价值。方法选取2016年12月至2017年7月在郑州大学第三附属医院儿童康复科接受治疗的40例脑瘫患儿作为对照组,选取2017年8月至2018年3月在郑州大学第三附属医院儿童康复科接受治疗的40例脑瘫患儿作为观察组。对照组患儿接受常规护理,观察组患儿接受引导式教育理念护理,共干预6个月。干预6个月后,采用Gesell发育量表(1992北京修订版)评估患儿适应性发育商(DQ),包括细动作、粗动作、言语能力、应物能力及应人能力。结果两组干预前细动作、粗动作、言语能力、应物能力及应人能力评分相比,差异无统计学意义(均P>0.05)。干预后,观察组细动作、粗动作、言语能力、应物能力及应人能力评分均较前提高,差异有统计学意义(均P<0.05),观察组细动作、粗动作、言语能力、应物能力及应人能力评分均高于对照组,差异有统计学意义(均P<0.05)。结论引导式教育理念运用到脑性瘫痪患儿的护理过程中,可有效促进患儿发育,有利于患儿运动和言语等功能的康复。     

中西医结合家庭医学康复模式在脑瘫康复治疗中的应用

目的探讨中西医结合家庭医学康复模式在脑瘫康复治疗中的作用。方法治疗组及对照组各选择100例脑瘫患儿,治疗组接受系统的中西医结合家庭医学康复3个月,对照组接受不规律的家庭康复或不接受家庭康复。采用粗大运动功能量表（GMFM）评估患儿运动功能,采用盖什尔发育商（DQ）评估患儿智力水平,采用儿童生存质量测定量表（PedsQL4.0）评估患儿生存质量。结果治疗组各能区GMFM数值较治疗前均有显著性提高（P〈0.05）,在Ⅲ、Ⅳ、Ⅴ能区治疗后与对照组比较差异有统计学意义（P〈0.05）;治疗组大运动能区DQ值较治疗前有显著性提高。接受中西医结合家庭医学康复的患儿,其生理功能、社交功能、PedsQL总分较治疗前有显著提高（P〈0.05）。结论中西医结合家庭医学康复可提高脑瘫患儿的运动功能及生存质量。     

“平衡疗法”理念在脑瘫康复治疗中的运用研究

目的：观察“平衡疗法”对脑瘫患儿粗大运动功能的改善效果,为临床小儿脑瘫康复训练提供借鉴和参考。方法：将符合入选标准的脑瘫患儿40例,随机分为实验组和对照组。实验组和对照组分别接受“平衡疗法”和常规按摩干预。3个月后采用粗大运动功能评定量表（GMFM）评定患儿粗大运动功能的变化。结果：治疗3个月后,2组患儿得分均明显增加（p〈0.05）,但与对照组比较,实验组的GMFM评分提高更为显著（p〈0.01）。结论：与常规按摩干预相比平衡疗法对改善脑瘫患儿粗大运动功能具有更加显著的疗效,值得从事小儿脑瘫康复训练的治疗师和特教老师们借鉴和参考,以更好地促进脑瘫患儿功能的康复。     

引导式教育对痉挛型脑瘫儿童综合能力影响的研究

目的 探讨引导式教育对痉挛型脑瘫儿童综合能力的影响.方法 2011年1月至2012年12月将就诊的75例痉挛型脑瘫患儿纳入研究,随机分成研究组（25例）、对照组1（25例）和对照组2（25例）.研究组采用常规康复治疗结合引导式教育;对照组1采用常规康复治疗;对照组2仅给予一次性家庭康复指导.治疗前及治疗后6个月均采用粗大运动功能测试量表、精细运动功能测试量表和儿童功能独立性量表评定.结果 3组患儿的粗大运动功能均较治疗前有改善,差异有统计学意义（研究组t=19.271,P＜0.01;对照组l t=15.464,P＜0.01;对照组2=2.416,P＜0.05）.研究组和对照组l的精细运动功能和日常生活独立能力均较治疗前显著改善,差异均有统计学意义（P＜0.01）,而对照组2治疗后精细运动功能及日常生活活动能力与治疗前比较差异无统计学意义（P＞0.05）.治疗后,研究组的粗大运动功能、精细运动功能及日常生活独立能力改善均优于对照组1和对照组2,差异有统计学意义（P＜0.01）.结论 常规康复治疗结合引导式教育能更有效提高痉挛型儿童脑瘫的整体疗效.     

肌电生物反馈联合高压氧干预对脑性瘫痪患儿运动功能及日常生活能力的影响

目的 探讨肌电生物反馈联合高压氧干预对脑性瘫痪（以下简称脑瘫）患儿运动功能及日常生活能力的影响。方法 选取2020年2月—2022年2月江南大学附属医院和常州市第一人民医院门诊就诊脑瘫患儿108例，根据治疗方法分为常规组和实验组，每组54例。常规组采用常规康复治疗；实验组在常规组基础上采用肌电生物反馈联合高压氧干预治疗。比较两组的疗效、运动功能[粗大运动功能量表（GMFM）、精细运动功能量表（FMFM）]、脑电功率（θ波值、β波值、θ/β比值）及日常生活能力。结果 实验组总有效率高于常规组（P <0.05）；实验组治疗前后GMFM评分、FMFM评分的差值高于常规组（P <0.05）；实验组θ波值、β波值、θ/β比值的差值高于常规组（P <0.05）；实验组治疗前后日常生活能力差值高于常规组（P <0.05）。结论 肌电生物反馈联合高压氧干预对脑瘫患儿疗效显著，能改善运动功能和脑电功率，提高日常生活能力。     

家庭健康教育对脑瘫患儿口部运动功能的影响

目的探讨家庭健康教育对脑瘫患儿口部运动功能的影响。方法将40例脑瘫患儿随机分为对照组（给予综合康复治疗和常规家庭健康教育）和治疗组（给予综合康复治疗和系统的家庭健康教育），于治疗前和治疗6个月时，进行口部运动功能（下颌、唇、舌）的评估。结果治疗前两组患儿口部运动评分组间差异无显著性意义（P〉0.05），治疗6个月后口部运动评分下颌运动评分、唇运动评分及舌运动评分均较治疗前有所提高（P〈0.05），且以治疗组改善的幅度较显著，与对照组比较，组间差异有统计学意义（P〈0.05）。结论系统的家庭健康教育能进一步提高脑瘫患儿的口部运动功能。     

虚拟现实技术结合常规康复治疗对痉挛型脑性瘫痪患儿下肢运动功能的影响

目的 探讨虚拟现实技术结合常规康复治疗对痉挛型脑性瘫痪（以下简称脑瘫）患儿的尖足、粗大运动功能及日常生活活动能力的影响。方法 回顾性分析2017年1月1日—2022年12月31日在扬州大学附属淮安市妇幼保健院儿童康复科门诊康复治疗的痉挛型脑瘫患儿80例,采用随机数字表法分为对照组和治疗组,各40例。对照组采用物理治疗、生物反馈等常规康复治疗;治疗组在常规康复治疗基础上加用虚拟现实技术。两组均康复治疗3个月,康复治疗前后采用改良Tardieu量表（MTS）、粗大运动功能量表88项（GMFM-88）及日常生活活动能力量表（ADL）进行评定。结果 经3个月康复治疗,治疗组康复治疗前后踝关节MTS角度R1、R2差值均高于对照组（P <0.05）;治疗组康复治疗前后GMFM量表D区、E区得分及ADL得分差值均高于对照组（P <0.05）。结论 在常规康复治疗基础上联合虚拟现实技术能够明显改善痉挛型脑瘫患儿的尖足症状,提高粗大运动功能及日常生活活动能力。     

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.