复发性口腔溃疡患者血清肿瘤坏死因子α变化及组织病理学改变

目的:研究肿瘤坏死因子(TNF-α)在复发性口腔溃疡患者中的变化和病理改变,并讨论其临床意义。方法:选择复发性口腔溃疡患者112例,选择体检健康人29例作正常对照。血清TNF-α含量用双抗体夹心ELISA法测定,并对18例重型患者进行病理组织学检查。结果:复发性口腔溃疡患者血清TNF-α含量明显高于正常对照(56.2±16.7与26.3±11.2,P<0.01)。复发性口腔溃疡重型(69.7±29.2,P<0.01)和中型(65.1±14.4,P<0.01)明显高于轻型(39.1±17.6,P<0.01),即TNF-α含量重型>中型>轻型。18例组织病理学检查表明,14例以淋巴细胞、浆细胞及单核巨噬细胞浸润为主的炎性反应,4例为炎性反应伴有增生。结论:复发性口腔溃疡患者TNF-α含量可明显增高,病理改变是炎性反应或伴增生,提示TNF-α参与疾病的发生、发展过程。     

检测颅脑外伤患者血清S100B蛋白和一氧化氮浓度的临床意义

目的 探讨颅脑外伤患者脑损害程度与血清S100B蛋白和一氧化氮浓度的关系.方法 用双抗体夹心ELISA法和硝酸还原法检测30名健康人和108例颅脑损伤患者血清S100B蛋白和一氧化氮水平(男65例,女43例,年龄为16～65岁;格拉斯哥昏迷分级(GCS)评分为3～5分,平均10.4分.其中重型颅脑外伤38例,中型颅脑外伤患者组36例,轻型颅脑外伤患者组34例.结果 108例颅脑外伤患者在伤后12 h重型、中型和轻型血清S100B水平分别是[(1.67±0.21)μg/L、(1.22±0.37)μg/L及(0.84±0.25)μg/L],与对照组[(0.38±0.12)μg/L]相比,差异有统计学意义,P<0.01.而重型患者伤后12 h血清S100B蛋白水平比轻、中型患者也明显增高,P<0.01.重型颅脑外伤患者的血清一氧化氮浓度[(72±19)μmol/L]均明显高于对照组[(50±7)μmol/L],P<0.01;重型颅脑外伤患者与轻型、中型组比较差异有统计学意义(P<0.05);而轻、中型组与对照组比较差异无统计学意义(P>0.05).结论 血清S100B可作为诊断早期脑损伤的指标.     

颅脑损伤患者血清抗利尿激素及心钠素水平分析

目的探讨血清中心钠素(ANP)及抗利尿激素(ADH)水平在颅脑损伤患者发生低钠血症中的作用机制。方法采用放射免疫分析(RIA)法,对29例重型及17例中型颅脑损伤患者血清ANP及ADH水平进行检测。结果重型颅脑损伤患者血清ANP水平(35.8±14.09)明显低于中型颅脑损伤患者(79.7±30.75)及正常对照(162.3±38.41)(P<0.01),中型颅脑损伤患者血清ANP水平亦明显低于正常对照(P<0.01)。重型颅脑损伤患者血清ADH水平(21.7±9.38)明显高于中型颅脑损伤患者(14.9±6.15)及正常对照(8.07±4.03)(P<0.01),中型颅脑损伤患者血清ADH水平亦明显高于正常对照(P<0.01),此种变化在发生低钠血症的颅脑损伤患者中表现更为明显。结论ANP及ADH水平变化在颅脑损伤患者发生低钠血症的过程中起着重要的作用,检测血清ANP及ADH对监测患者病情发展、指导临床药物使用及制定治疗方案具有重要临床应用价值。     

颅脑损伤早期血清Mg2+含量的变化及临床意义

目的研究急性中、重型颅脑损伤早期患者血清Mg2+含量的变化及临床意义.方法用MTB比色法对53例急性中、重型颅脑损伤早期患者(重型颅脑损伤36例,中型颅脑损伤17例),26例非颅脑损伤患者及21例健康人的血清Mg2+含量进行检测.结果颅脑损伤组血清Mg2+含量[(0.64±0.11)mmol/L]显著低于非颅脑损伤组[(0.73±0.88)mmol/L](P＜0.05),并显著低于健康人组[(0.86±0.05)mmol/L](P＜0.01).重型颅脑损伤组血清Mg2+含量[(0.63±0.11)mmol/L]明显低于中型颅脑损伤组[(0.72±0.09)mmol/L](P＜0.05).硬膜下血肿、脑挫裂伤、脑干损伤组Mg2+含量[(0.61±0.11)mmol/L]明显低于单纯颅骨骨折、硬膜外血肿组[(0.68±0.11)mmol/L](P＜0.05).结论Mg2+可能参与了继发性颅脑损伤的病理生理过程,病情越重,伤后早期血镁下降越低.早期血清Mg2+水平可作为观察急性颅脑损伤严重程度及判断预后的指标.     

老年口腔溃疡患者血清肿瘤坏死因子α变化研究

目的：研究老年口腔溃疡患者血清肿瘤坏死因子（ TNF-α）变化并讨论其临床意义。方法：老年口腔溃疡患者102例，年龄69．1±11．6岁。选择体检健康人26例作正常对照，年龄66．3±6．4岁。血清TNF-α含量用双抗体夹心ELISA法测定，8例重型患者进行病理组织学检查。结果：老年口腔溃疡血清TNF-α含量（g/L）明显高于正常对照（46．1±11．7 vs 25．3±10．4，P＜0．01），重型（n＝14，53．7±19．1，P＜0．01）和中型（n＝53，43．1±10．5， P＜0．01）明显高于轻型（n＝35，34．1±9．6，P＜0．01），即重型TNF-α含量＞中型＞轻型。8例组织病理学检查包括5例是淋巴细胞、浆细胞和单核巨噬细胞浸润的炎症，3例是炎症伴有增生。结论：老年口腔溃疡血清TNF-α含量可明显增高，病变越重增加越明显，且病理改变是炎症或伴增生，疾病发生发展与TNF-α变化有关。     

流行性出血热患者血浆心钠素测定及其意义

本文报道用RIA对27例EHF患者血浆ANF测定的结果。资料表明:(1)EHF患者血浆ANF含量(1441.85±898.3pg/ml)明显高于健康人(268.4±86.9pg/ml)(P<0.01)。(2)血浆ANF含量的高低与病情轻重呈平行的关系,即轻型患者虽有增高,但与健康人无明显差异(P>0.05);中型患者增高较显著,重型及危重型患者上升最高,均与健康人有显著性差异(P<0.01)。(3)血浆ANF含量也与病期有一定的关系,即ANF自发热期开始增高,休克期与少尿期达到高峰,多尿期逐渐下降,至恢复期接近正常。(4)有7例急性肾衰患者进行GID治疗后,ANF与ALD、β_2-MG、BUN均较透析前有明显下降(P<0.01)。最后,对EHF患者血浆ANF增高的机理及其临床意义进行了讨论。     

复发性阿弗他溃疡患者TNF-α的表达及临床意义

目的：研究肿瘤坏死因子（TNF-α）在复发性阿弗他溃疡患者血清中的表达及临床意义。方法：采用双抗体夹心ELISA法对60例复发性阿弗他溃疡患者（分为轻型、重型、疱疹样阿弗他溃疡三种血清中TNF-α的含量进行了检测,并以30例健康人血清做对照。结果：三组复发性阿弗他溃疡60例患者中TNF-α的平均含量均比健康人TNF-α的平均含量明显升高（P〈0.05）,且重型阿弗他溃疡患者（99.51±31.35）pg/mL和疱疹样阿弗他溃疡患者（74.51±16.38）pg/mL,TNF-α平均含量均明显高于轻型（59.54±16.92）pg/mL,即重型〉疱疹样型〉轻型。结论：复发性阿弗他溃疡患者血清中TNF-α的含量明显高于健康对照,说明TNF-α参与了其病理过程。     

急性细菌性肺炎患者血浆纤维结合蛋白测定的初步观察

作者采用免疫扩散法,测定40例正常健康人和80例急性细菌性肺炎患者的血浆纤维结合蛋白(Plasma fibronectin,PFn)。结果表明:急性细菌性肺炎患者的PFn(214.49±77.84μg/ml)低于正常健康人(292.48±43.11μg/ml),两者间有极显著性差异(P<0.001)。患者中,10例重型急性细菌性肺炎患者的PFn(127.45±31.02μg/ml)显著低于20例轻中型急性细菌性肺炎患者(255.11±54.16μg/ml),两者间有极显著性差异(P<0.001);11例急性细菌性肺炎患者恢复期的PFn(213.13±41.32μg/ml)较急性期(154.52±51.27μg/ml)明显升高(P<0.001)。作者认为,血浆PFn的含量可作为判定急性细菌性肺炎患者病情和预后的一项指标。     

肝硬化患者血清锌、视黄醇结合蛋白和维生素A的含量

作者测定了17例肝硬化患者和8例健康人的血清锌、视黄醇结合蛋白(RBP)和维生素A(Vit A)的含量。结果表明:肝硬化患者组血清中3者含量分别为10.26±3.17,0.36±0.22和0.85±0.43μmol/L,均明显低于健康对照组(分别为12.73±1.15,1.61±0.43和2.13±0.37μmol/L),肝硬化患者组的血清RBP与Vit A的比值(0.47±0.27)也明显低于对照组(0.76±0.14),而8例健康人的血清RBP与Vit A含量存在显著的正相关(r=0.695 P<0.05)。结果提示,肝硬化患者缺锌和Vit A缺乏,应注意防治。     

创伤性颅脑损伤后白介素-6、18、27变化及临床意义

目的 动态监测创伤性颅脑损伤(TBI)患者血清白介素-6(IL-6)、白介素-18(IL-18)和白介素-27(IL-27)的浓度变化.方法 选取伤后24 h内入院的TBI患者112例,分3组(轻型组、中型组、重型组)并选取27名健康人作为对照组,采用双抗体夹心ELISA法检测不同时间段(第1、3、5、7天)血清IL-6、IL-18和IL-27的浓度变化,对TBI与IL-6、IL-18、IL-27的关系进行分析.结果 3组患者入院的血清IL-6、IL-18、IL-27浓度均升高,重型组升高幅度明显高于对照组、轻型组和中型组,差异有显著性.颅脑损伤严重分级与血清IL-6浓度(r=0.891,P<0.01)、血清IL-18浓度(r=0.833,P<0.01)、血清IL-27浓度(r=0.922,P<0.01)呈正相关;血清IL-27浓度与血清IL-6浓度(r=0.925,P<0.01)、血清IL-18浓度(r=0.843,P<0.01)呈正相关;血清IL-18浓度与血清IL-6浓度(r=0.673,P<0.01)呈正相关.结论 颅脑损伤患者体内存在不同程度的炎症反应;IL-6、IL-18和IL-27水平与颅脑损伤程度密切相关;如浓度持续保持较高水平,提示脑组织损伤严重,预后不良.     

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.