心包积液的二维超声诊断

心包积液是心包的常见病，病因诸多，临床易误诊、漏诊。二维超声心动图对心包积液有确定诊断意义。本文总结了我院1995～1996年超声心动图诊断的59例心包积液患者资料，分协讨论超声在心包积液诊断上的应用价值。l资料和方法本组心脏超声检查1200例，男802例，女398例。年龄12～78岁。采用HP500型彩色多普勒超声诊断仪，探头频率2．5MI－IZ。患者取仰卧位或左侧卧位或坐位，取心脏常规探测切面进行二维超声检查。心包积液的良恶性均由病理或临床证实。2结果1200例心脏超声检查中，检出心包积液59例，其中少量积液36例，中量积液2例，大…     

便携式超声心动图在心血管危重患者诊治中的应用

目的探讨便携式超声心动图在心血管危重病患者诊治中的应用价值。方法分析267例中197例急症和心血管危重病患者的床边超声检查资料。结果197例急症和危重症患者有62例存在收缩功能减退，93例急性心肌梗死患者全部存在节段性运动异常，33例收缩功能减退，12例存在心包积液，13例存在室壁矛盾运动，1例提示存在附壁血栓，4例心超支持右室梗死。19例修正和补充了临床诊断，部分修改了治疗方案。结论便携式超声心动图能为急症和重症心血管疾病的诊治快速提供明确的诊断信息，参与及指导临床干预，增加临床干预的准确性、科学性和有效性。     

超声心动图对心脏肿瘤的回顾性分析

目的 探讨超声心动图对心脏肿瘤的诊断价值及临床意义。方法 采用彩色多普勒超声心动图对进行此项检查的37896例患者超声心动图回顾性分析，分析心脏肿瘤的超声心动图特征及检出率。结果 共检出心脏肿瘤23例，检出率0．06％。其中心脏黏液瘤18例，右房4例、左房14例、右房心脏转移瘤4例、左室横纹肌瘤1例。18例心脏黏液瘤均造成二尖瓣、三尖瓣相对性狭窄及关闭不全，2例左房黏液瘤造成脑梗塞。1例右房黏液瘤造成肺梗塞。有3例右房心脏转移瘤超声表现类似黏液瘤，造成三尖瓣相对性狭窄及关闭不全，2例伴中等量心包积液，1例大量心包积液。1例左室横纹肌肉瘤造成左室流出道狭窄，伴大量心包积液。结论 超声心动图是国内外公认诊断心脏肿瘤的最佳方法，对临床治疗方案的选择有重要的临床价值。     

20例心脏外伤患者的超声心动图影像学特征及其诊断价值分析

目的:分析心脏外伤患者的超声心动图影像学特征及其诊断价值。方法:回顾性分析20例心脏外伤患者的临床资料。14例患者在普通门诊经GE Vivid 7超声诊断仪检查,6例患者经Philips Optigo床旁彩色超声仪进行急诊检查。记录患者的病变部位及其超声心动图影像学特征,以手术探查结果为金标准,计算超声心动图的检测准确度。结果:除游离壁损伤外,超声心动图对心包积液、室间隔穿孔、室壁瘤、假性室壁瘤、瓣膜损伤和心腔内血栓的检出率均为100%。各类型损伤均具有明显的影像学特征。结论:超声心动图检测心脏外伤的准确度较高,对临床治疗具有积极的指导意义。     

心包积液的二维超声诊断

心包积液是心包的常见病,病因诸多,临床易误诊、漏诊。二维超声心动图对心包积液有确定诊断意义。本文总结了我院1995～1996年超声心动图诊断的59例心包积液患者资料,分协讨论超声在心包积液诊断上的应用价值。l资料和方法本组心脏超声检查1200例,男802例,女398例。年龄12     

便携式超声仪在灾害医疗救援中的应用

目的探讨便携式超声仪在灾害医疗救援中的应用。方法总结巴基斯坦、印度尼西亚两次地震国际救援中便携式超声仪在检查298例伤病员时的应用效果。结果298例患者中超声诊断发现腹腔出血12例，胸腔出血6例，急性胆囊炎2例，胆囊结石6例，肾结石17例（其中合并肾积水11例），怀疑宫外孕1例，心包腔积液1例；超声诊断肝脓肿并在超声引导下行肝脓肿穿刺、抽液、注药1例。结论便携式超声仪在灾害医疗救援中起重要作用。     

甲状腺功能减退性心脏病超声心动图分析

①目的　探讨二维多普勒超声检查对甲状腺功能减退性心脏病的诊断价值。②方法　应用二维多普勒超声心动图仪,检查了５３ 例甲状腺功能减退性心脏病病人。③结果　心包积液４６ 例,占８６．８％ ;心脏扩大１４例,占２６．４％ ;左室舒张功能减退１１ 例,占２０．８％ ．④结论　二维多普勒超声检查是了解甲状腺功能减退性心脏病病人心脏结构、功能及血流动力学改变的简便、客观、无创的诊断方法。     

259例心包积液超声鉴别诊断及病因分析

目的：为探讨超声心动图检查在心包积液鉴别诊断中的作用，并对其病因进行分析。方法：对我院1998-2003年经超声确诊的259例心包积液患者的超声特征、临床表现及诊治经过进行分析总结。结果：心包积液的病因中结核、尿毒症、结缔组织病、恶性肿瘤、甲减占前5位，3个年龄组与男女性别之间心包积液的检出率相近，但引起心包积液的病因有一定差别，55岁以上患者引起的心包积液以恶性肿瘤、结核性居多。结论：超声心动图检查结合临床及必要的实验室检查可明确心包积液的诊断及鉴别诊断。     

老年心包积液的超声诊断价值及临床意义

目的 探讨老年心包积液的病因，超声诊断价值及临床意义。方法 对45例平均年龄60岁以上老年心包积液经超声半定量诊断与临床引导心包穿刺分析。结果 45例心包积液中，大量、极大量心包积液7例，中量心包积液12例。少量心包积液20例，微量心包积液6例。结论 超声心动图是目前临床上诊断心包积液的一项最敏感、最可靠的无创性检查方法，其敏感性与特异性优于X线。老年少量心包积液的病因多由心血管疾患、心力衰竭所引起。     

超声心动图对感染性心内膜炎的诊断价值

目的：探讨感染性心内膜炎（infective endocarditis IE）的临床特点和超声心动图的诊断价值。方法：对36例IE患者进行超声心动图检查,并结合临床资料进行分析比较。结果：36例IE患者较为常见的症状和体征为发热21例（58．33％）、心脏杂音33例（91．67％）、心脏增大29例（80．55％）,心力衰竭21例（58．33％）,心包积液3例（8．33％）,细菌培养阳性10例（27．78％）;超声心动图瓣膜赘生物检出34例（94．44％）,并且赘生物大小与预后密切相关。结论：超声心动图不仅对IE患者作出准确的诊断,而且尚能评判患者的病情和预后,值得临床广泛推广应用。     

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.