不稳定型股骨粗隆间骨折治疗中小粗隆骨折的处理

目的：探讨对小粗隆骨折的处理在治疗不稳定型股骨粗隆间骨折的临床效果。方法：选取2011年1月-2012年7月间来我院接受治疗的伴有小粗隆骨折的不稳定型股骨粗隆间骨折患者73例，随机分为观察组和对照组；所有患者均接受动力髋螺钉内固定治疗，在治疗中观察组患者对小粗隆骨折进行固定，而对照组对小粗隆骨折不进行固定，观察患者治疗效果以及并发症发生情况。结果：观察组患者出血量（94．4±7．2）ml，骨折愈合时间（4．2±1．2）个月，术后有1例发生感染；对照组患者出血量（102．1±9．6）ml ，骨折愈合时间（5．1±1．6）个月，术后有3例发生感染，2例发生钉板断裂，3例出现髋内翻。结论：使用动力髋螺钉内固定治疗不稳定型股骨粗隆间骨折时对小粗隆骨折的处理能有效提高内侧即压力侧的稳定性，促进患者恢复，降低治疗中并发症的发生，因此临床治疗不稳定型股骨粗隆间骨折时应注意对小粗隆骨折进行处理。     

动力髋螺钉内固定法治疗股骨粗隆间骨折83例疗效分析

目的：探讨动力髋螺钉（DHs）治疗股骨粗隆间骨折的II缶床疗效。方法：总结本院1996年1月～2006年4月间使用DHS进行内固定治疗股骨粗隆间骨折患者的病例资料，评价其疗效。结果：术后平均随访12个月（10-15个月），骨折全部愈合。平均愈合时间4个月，无髋内翻及内固定失败发生，髋关节优良率95％。结论：对股骨粗隆间骨折包括大粗隆下方存在骨折的EvansⅢ型，EvansⅣ型等不稳定型股骨粗隆间骨折的患者使用DHS进行内固定治疗，可以有效降低内固定物失败及髋内翻的发生率，临床效果满意。     

动力髋螺钉内固定法治疗股骨粗隆间骨折83例疗效分析

目的:探讨动力髋螺钉(DHS)治疗股骨粗隆间骨折的临床疗效。方法:总结本院1996年1月～2006年4月间使用DHS进行内固定治疗股骨粗隆间骨折患者的病例资料,评价其疗效。结果:术后平均随访12个月(10～15个月),骨折全部愈合,平均愈合时间4个月,无髋内翻及内固定失败发生,髋关节优良率95%。结论:对股骨粗隆间骨折包括大粗隆下方存在骨折的EvansⅢ型,EvansⅣ型等不稳定型股骨粗隆间骨折的患者使用DHS进行内固定治疗,可以有效降低内固定物失败及髋内翻的发生率,临床效果满意。     

DHS治疗股骨粗隆间骨折

目的 探讨DHS内固定治疗股骨粗隆间骨折的方法及应注意的问题。方法 对53例股骨粗隆间骨折患者运用DHS内固定治疗，并进行平均2年6个月随访。结果 本组病例中2例出现髋螺钉自股骨头上方穿出，余51例维持复位满意，骨折愈合，按Harris评分标准功能恢复结果优良。结论 应用DHS内固定治疗股骨粗隆间骨折应注意髋螺钉穿入位置。小粗隆骨折移位的患者应复位并固定小粗隆，对不稳定骨折应保持骨折复位后的稳定性，避免早期负重。     

捆绑带辅助DHS固定股骨粗隆间骨折合并小粗隆撕脱疗效观察

目的 观察动力髋螺钉(DHS)结合股骨捆绑带治疗股骨粗隆间骨折合并小粗隆撕脱的疗效.方法 对13例股骨粗隆间骨折合并小粗隆撕脱患者,采用切开复位、DHS结合股骨捆绑带内固定治疗.结果 13例患者均得随访,时间6～26个月,平均12.6个月.13例骨折全部愈合,优良率为100％.结论 应用DHS结合股骨捆绑带治疗股骨粗隆间骨折合并小粗隆撕脱是一种较好的治疗方法,可提供良好的复位及稳定的股骨近端内后侧重建,能促进骨折愈合和功能恢复,同时可简化手术难度,缩短手术时间.     

DHS内固定治疗股骨粗隆间骨折

目的应用DHS内固定治疗股骨粗隆间骨折18例疗效观察。方法对18例采用切开复位DHS内固定治疗的股骨粗隆间骨折病例进行回顾性分析。结果经5—12个月，平均8个月的随访，骨折愈合率达100％，无1例髋内翻发生，功能恢复良好，疗效满意。结论股骨粗隆间骨折早期切开复位DHS内固定治疗，可以降低死亡率，有效防止髋内翻的发生，提高患者生活质量。     

动力髋螺钉加防旋钉治疗股骨粗隆间骨折

评价动力髋螺钉（DHS）加空心加压螺钉内固定治疗老年股骨粗隆间骨折的疗效。方法回顾43例采用DHS加空心加压螺钉治疗股骨粗隆间骨折病例,对其骨折类型、临床疗效、并发症进行分析。结果43例患者得到7～25个月的随访,平均17.3个月,骨折愈合良好,无内固定松动、髋内翻畸形、感染等并发症。结论DHS加空心加压钉能有效固定粗隆间骨折,防止骨折旋转移位,利于骨折愈合,减少并发症的发生,且创伤少,适合老年股骨粗隆间骨折的治疗。     

动力髋螺钉加防旋钉治疗股骨粗隆间骨折

评价动力髋螺钉(DHS)加空心加压螺钉内固定治疗老年股骨粗隆间骨折的疗效。方法回顾43例采用DHS加空心加压螺钉治疗股骨粗隆间骨折病例,对其骨折类型、临床疗效、并发症进行分析。结果43例患者得到7～25个月的随访,平均17.3个月,骨折愈合良好,无内固定松动、髋内翻畸形、感染等并发症。结论DHS加空心加压钉能有效固定粗隆间骨折,防止骨折旋转移位,利于骨折愈合,减少并发症的发生,且创伤少,适合老年股骨粗隆间骨折的治疗。     

DHS加拉力螺钉内固定治疗股骨粗隆间骨折

目的探讨应用DHS（动力髋螺钉）加拉力螺钉内固定治疗股骨粗隆间骨折的疗效。方法1999年8月～2005年1月对42例股骨粗隆间骨折采用DHS加拉力螺钉内固定治疗。结果全部病例均得到10-36个月随访，主要指标为颈干角、髋关节伸屈活动等。骨折全部愈合，无钢板松动、断裂、骨不连等并发症，2例轻度髋内翻。优28例，良12例，优良率95．2％。结论DHS加拉力螺钉内固定治疗股骨粗隆间骨折。操作简单，易达解剖复位，固定可靠，抗旋转作用强。     

动力髋内固定治疗高龄股骨粗隆间骨折

目的探讨动力髋(DHS)内固定治疗高龄患者股骨粗隆间骨折的临床效果。方法用DHS内固定治疗26例高龄股骨粗隆间骨折患者，术前行骨牵引，间接复位，手术在C臂X线机透视下进行，复位后置入DHS内固定。结果26例患者骨折骨性愈合，时间3～4个月，平均3．5个月。1例出现下肢深静脉栓塞，1例出现髋内翻、螺钉穿透股骨头。髋关节功能优良率92．3％，内固定失败7．7％。结论应用间接复位、DHS内固定治疗高龄股骨粗隆间骨折具有手术操作简单、损伤小、出血少、固定可靠、骨折愈合快、并发症少的优点。部分A2、A3型骨折慎用DHS内固定。     

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.