甲氨蝶呤联合环磷酰胺治疗类风湿关节炎的疗效观察

目的探讨甲氨蝶呤（MTX）联合环磷酰胺（CTX）治疗类风湿性关节炎（RA）的临床疗效和安全性。方法将50例活动期RA患者随机分为治疗组和对照组各25例。治疗组给予甲氨喋呤（MTX）＋环磷酰胺（CTX）;对照组给予甲氨喋呤（MTX）＋来氟米特（LEF）。两组均治疗12周。观察两组治疗后的临床疗效和不良反应。结果治疗12周后,治疗组在关节肿胀、关节压痛、晨僵时间、ESR及CRP等临床和实验室指标的改善均优于对照组,差异均有统计学意义（P〈0.05）;治疗组不良反应少于对照组,差异有统计学意义（P〈0.05）。结论 MTX联合CTX治疗RA临床疗效好,不良反应小,安全性高。     

云克联合甲氨蝶呤治疗类风湿关节炎的疗效观察

目的观察云克联合甲氨蝶呤治疗类风湿关节炎的临床疗效。方法将68例活动期类风湿性关节炎（RA）患者随机分为两组,实验组38例,给予云克联合甲氨蝶呤治疗12周;对照组30例,应用甲氨蝶呤加柳氮磺吡啶治疗12周,以晨僵时间、关节肿胀数、关节压痛数、C反应蛋白（CRP）、血沉（ES8）等作为疗效判断指标观察治疗效果。结果实验组有效率为89．9％,对照组有效率为51．5％,两组比较差异有统计学意义。结论云克联合甲氨蝶呤治疗可明显改善类风湿性关节炎患者的临床症状和实验室指标,对治疗类风湿性关节炎有明显疗效。     

羟氯喹联合甲氨蝶呤治疗类风湿性关节炎临床疗效观察

目的观察羟氯喹联合甲氨蝶呤对活动期类风湿性关节炎（RA）的疗效和不良反应。方法将60例活动期类风湿性关节炎患者随机分成治疗组和对照组，治疗组30例，予以羟氯喹联合甲氨蝶呤治疗，对照组30例，单用甲氨蝶呤治疗。结果总有效率治疗组为90．00％，对照组为83．33％，两组比较差异显著；治疗3个月后，治疗组与对照组患者休息痛、晨僵、关节肿胀数、关节压痛数、握力、关节功能、日常生活能力、医生和患者评价等方面，进行组内和组间比较差异显著。结论羟氯喹联合甲氨蝶呤治疗活动期类风湿性关节炎临床症状及理化指标改善明显优于单用甲氨蝶呤，且无严重不良反应。     

青蒿联合甲氨蝶呤治疗类风湿关节炎的临床研究

目的观察青蒿联合甲氨蝶呤治疗类风湿性关节炎（RA）的疗效,研究两药联合应用对治疗RA的临床价值。方法选取2009年5月～2009年10月收取的76例类风湿性关节炎患者,随机分成治疗组和对照组两组,治疗组38例患者采用青蒿联合甲氨蝶呤进行治疗,对照组的38例患者采用单独的甲氨蝶呤进行治疗,3个月后观察两组患者的临床病情活动性指标及不良反应情况。结果治疗组3个月后的总有效率达78.9%,而对照组最后的总有效率为63.2%,两组比较有显著差异（P〈0.05）;两组患者的不良反应发生率比较无显著性差异（P〈0.05）。结论青蒿联合甲氨蝶呤对类风湿性关节炎的治疗效果比单独用甲氨蝶呤的治疗效果更佳,两药联合对治疗甲氨蝶呤具有一定的临床应用价值。     

从痰瘀湿毒论治类风湿关节炎的临床研究

目的探讨从痰瘀湿毒论治类风湿关节炎（RA）的临床疗效和安全性。方法RA患者100例随机分为观察组和对照组各50例。对照组给予甲氨蝶呤、来氟米特治疗,观察组给予化痰祛瘀利湿解毒中药及甲氨蝶呤、来氟米特治疗。分析治疗前及治疗第24周对疼痛目视模拟测试表（VAS）评分、患者对自身健康状况的总体评估（PGA）、医生对患者健康状况的总体评估、压痛关节数（TJC）、肿胀关节数（SJC）、健康评估问卷（HAQ）评分,以及血、尿常规、血生化、血沉（ESR）、C反应蛋白（CRP）等实验室指标。结果观察组46例、对照组44例完成24周治疗,观察组上述指标方面优于对照组,差异有统计学意义（P〈0．05）。达到ACR20,ACR50,ACR70缓解率组间比较差异有统计学意义（P〈0．05）;观察组不良反应较对照组少且轻,组间比较差异有统计学意义（P〈0．05）。结论化痰祛瘀利湿解毒法能显著改善RA患者的病情,且安全性、耐受性高,不良反应的发生率低。     

定量超声在评价早期类风湿性关节炎病人骨量变化中的应用价值

目的：探讨定量超声诊断早期类风湿性关节炎（RA）病人骨量变化的临床应用价值。方法：采用跟骨超声仪测量早期RA病人30例及与其相匹配的健康人30例的双足跟骨,主要诊断参数包括宽带超声振幅衰减（BUA）、超声传导速度（SOS）和超声硬度指数（STI）,对两组的测量参数进行比较,并同时分析RA者骨质疏松发生率。结果：RA组BUA和STI明显低于对照组（均P〈0．01）,差异有显著性;而SOS和OP发生率与对照组比较差异均无统计学意义（均P〉0．05）;两组左右跟骨的BUA、SOS及STI比较差异均无统计学意义（P〉0．05）。RA病人中活动组BUA及STI值显著低于非活动组（均P（0．01）,SOS两组间比较差异无显著性（P〉0．05）。结论：跟骨定量超声BUA测值减低可反映早期RA骨量丢失的程度及评价疾病的活动性。STI作为骨质量的综合评价指标,对早期RA病人的骨量丢失也有一定的意义。     

自然杀伤T细胞在髋关节骨关节炎的表达与临床意义

目的：探讨自然杀伤T细胞（NKT）在髋关节骨关节炎（HO）患者的表达与临床意义。方法收集45例HO患者外周血，采用流式细胞术检测其内NKT及其胞内细胞因子γ干扰素（IFN-γ）及白介素4（IL-4）的含量。并与45例类风湿性关节炎（RA）患者进行对比。结果与健康对照组比较，RA及HO组患者NKT及IFN-γ均显著降低差异有统计学意义（P〈0.05）；在IL-4的比较方面，RA组显著低于对照组，但HO组IL-4与对照组比较，差异无统计学意义（P=0.098）。治疗后RA及HO组NKT、IFN-γ及IL-4均较治疗前不同程度上升，均以HO回升幅度明显，差异有统计学意义（P〈0.05），但治疗后RA组IFN-γ频率较前无统计学变化，而HO组较治疗前明显上升，且HO组IFN-γ频率明显高于RA组（P=0.006）。结论 NKT在HO免疫机制当中起到重要作用，其细胞因子IL-10在HO与RA的鉴别起到重要作用，且IFN-γ与疗效密切相关。     

关节炎丸对类风湿性关节炎大鼠血清IL-1、IL-6和TNF-α含量的影晌

目的探讨关节炎丸对类风湿性关节炎大鼠血清IL-1、IL-6和TNF-α含量的影响。方法建立类风湿性关节炎大鼠模型。用放射免疫法检测大鼠血清IL-1、IL-6和TNF-α的含量。结果与空白组比较,模型组各指标含量均增高,差异有统计学意义（P〈0．01）;与模型组比较,关节炎丸大、小剂量组及雷公藤阳性对照组各指标含量均有不同程度下降,差异有统计学意义（P〈0．05）;与雷公藤阳性对照组比较。关节炎丸大、小剂量组各指标含量下降,差异有统计学意义（P〈0．05）。结论关节炎丸能控制类风湿性关节炎大鼠血清IL-1、IL-6和TNF-α等炎性细胞因子的活性,对类风湿性关节炎有很好的治疗作用。     

艾拉莫德治疗类风湿性关节炎临床疗效观察

目的：观察艾拉莫德治疗类风湿性关节炎的临床疗效。方法依治疗药物不同将60例确诊为类风湿性关节炎患者分为两组,对照组30例,给予甲氨蝶呤口服;治疗组30例,给予艾拉莫德口服,两组患者观察治疗12周。对比治疗前后两组患者的临床疗效,并分别评定关节疼痛指数、肿胀指数、晨僵及血沉、C-反应蛋白的变化情况。结果治疗组总有效率（93.33%）明显优于对照组总有效率（80.00%）,差异具有统计学意义（P〈0.05）;两组患者治疗后的主要症状、体征及血液学检查均有改善,与治疗前比较有显著性差异（P〈0.05）;治疗组治疗后的主要症状、体征及血液学检查与对照组治疗后比较,差异具有统计学意义（P〈0.05）。结论艾拉莫德治疗类风湿性关节炎有较好的临床疗效,且不良反应发生率低,值得在临床上推广。     

痹痛方治疗类风湿性关节炎活动期临床疗效观察

目的：观察痹痛方治疗类风湿性关节炎活动期临床疗效。方法：将50例病人分为痹痛方治疗组和风湿骨痛胶囊对照组各25例。结果：治疗组总有效率为88％，优于对照组68％（P〈0．05）；治疗组治疗减少关节压痛数、关节肿胀数、晨僵时间与对照组比较有明显差异（P〈0．05或P〈0．01）；治疗组治疗后ESR、CRP、RF均有显著下降，与对照组比较有明显差异（P〈0．05或P〈0．01）。结论：痹痛方治疗RA活动期具有较好的临床疗效及安全性。     

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.