舍曲林联合穴位刺激调控法治疗抑郁症的效果及安全性

目的 探讨穴位刺激渊控法联合舍曲林治疗抑郁症的效果和安全性。方法 收集2013年5～10月在浙江省建德市第四人民医院住院的抑郁患者60例,随机分为两组,各30例,两组病例均给予舍曲林片,研究组在此基础上联合穴位刺激调控治疗,治疗6周。采用HAMD量表行疗效评价,同时观察记录不良反应,并行不良反应量表（TESS）评定。结果 研究组与对照组基线HAMD分值差异无统计学意义,从治疗后2周开始,两组总分比较差异有高度统计学意义（P〈0．01）。经治疗,两组减分率比较,第1、2、4、6周末结果 差异均有统计学意义（P〈0．05或P〈0．01）。研究组与对照组有效率分别为93.3％、56．7％,差异有统计学意义（χ^2=12．47,P〈0．05）。研究组与对照组不良反应发生率分别为3．3％、20．0％,差异有高度统计学意义（χ^2=20．22,P〈0．01）。治疗6周,研究组与对照组TESS评分分别为（1．20±0．28）、（3．40±1．20）分,差异有统计学意义（t=8．243,P〈0．05）。结论 穴位刺激调控法联合舍曲林治疗抑郁症起效快,副作用少,能明显改善患者的抑郁症状,值得推广。     

适龄儿童麻疹疫苗免疫后血清学保护效果监测

目的 对玉溪市适龄儿童麻疹疫苗（MV）常规免疫后抗体水平进行评价，为今后制定相关策略提供科学依据。方法 对674名适龄儿童血清标本采用ELISA法检测麻疹抗体IgG。结果 麻疹抗体阳性率90．06％，几何平均滴度（GMT）1：518．26，不同年龄抗体阳性率差异无显著性（χ^2=2．62，P〉0．05），保护率和GMT差异有显著性（χ^2=15．83，F=4．6，P均〈0．05）；不同地区儿童麻疹抗体阳性率、保护率和GMT差异均有显著性（χ1^2=9．39，χ2^2=56．6，F=18．4，P均〈0．01。）（χ^2=9．39，P〈0．01）；男女之间抗体阳性率、保护率和GMT差异无显著性（χ1^2=0．22，χ2^2=0．28，u=0．39，P均〉0，05）。结论 玉溪市适龄儿童麻疹抗体水平较高，并形成有效免疫屏障。     

5-HT2c受体基因cys23ser多态性与单相抑郁症的相关性

目的探讨5-HT2c受体基因cys23ser多态性与单相抑郁症及其症状群的遗传关联性，搜寻中国汉族人单相抑郁症可能的易感性基因。方法应用聚合酶链式反应扩增技术与限制性片断长度多态性分析技术（PCR-RFLP），对132例单相抑郁症患者和180名正常对照者进行关联分析；采用汉密顿抑郁量表（HAMD）评定病例组症状群，分析单相抑郁症症状群与基因型的关联性。结果病例组与对照组的基因型总体分布差异有显著性（χ^2=7．089，P=0．029），但进一步按性别分层分布差异无显著性（女性：χ^2=1．891，P=0．389；男性：χ^2=0．879，P=0．348）；病例组HAMD各因子评分基因型分布差异无显著性（P〉0．05）。结论 5-HT2c受体基因cys23ser多态性可能与中国汉族人单相抑郁症有关联。     

综合性心理护理干预对抑郁症患者治疗依从性及生活质量的影响

目的探讨综合性心理护理干预对抑郁症患者的疗效、治疗依从性及生活质量的影响。方法80例抑郁症患者随机分为干预组和对照组。两组患者入院后均予以帕罗西汀治疗,连用12周。干预组在此基础上予以综合性心理护理干预。结果治疗12周后,干预组抗抑郁治疗的总有效率明显高于对照组（χ^2=6．05,P〈0．05）;干预组治疗依从性明显高于对照组（χ^2=7．81,P〈0．01）;两组患者生活质量评分均有明显上升（P〈0．05或P〈0．01）,且干预组上升幅度比对照组更明显（P〈0．05）;干预组治疗后随访1年的复发率明显低于对照组（χ^2=5．16,P〈0．05）。结论综合性心理护理干预能明显改善抑郁症患者的抑郁负性情绪,提高患者的治疗依从性,从而提高抗抑郁治疗的临床疗效,改善患者的生活质量,并能降低治疗后的复发率。     

98例恶性肿瘤病人抑郁症及影响因素的调查

目的:探讨恶性肿瘤病人抑郁症的发生情况及其影响因素。方法:采用汉密尔顿抑郁量表(HAMD)对98例已确诊并了解病情的恶性肿瘤病人及90例健康人进行问卷调查。结果:恶性肿瘤病人抑郁症的发生率明显高于健康对照人群,差异有明显统计学意义(χ2=18.97,P<0.01)。不同文化程度恶性肿瘤病人抑郁症发生率比较,无显著差异(χ2=0.11,P>0.05)。不同年龄恶性肿瘤病人抑郁症发生率比较,差异有显著意义(χ2=4.03,P<0.05)。不同性别恶性肿瘤病人抑郁症的发生率无明显的性别差异(χ2=2.77,P>0.05)。肺癌病人较其他种类的恶性肿瘤病人有更明显的抑郁倾向,差异有统计学意义(χ2=15.28,P<0.05)。结论:恶性肿瘤病人较健康人群有明显的心理健康问题,且不同年龄、病种的病人之间存在显著差异,而与文化程度无关。在恶性肿瘤的宣教和治疗中不能忽视心理方面的指导和治疗。     

依那普利联合氯沙坦用药对肾性高血压的影响

目的探讨依那普利联合氯沙坦用药对肾性高血压的影响。方法选择2008年1月～2009年12月我院收治的肾性高血压患者98例，随机分为观察组和对照组各49例。对照组给予依那普利，观察组在对照组基础上加用氯沙坦。观察两组对血压、肾功能的影响。结果观察组血压明显低于对照组，差异有显著性意义（t=4.31、3．98，P〈0．05）；观察组血压达标率（83．7％）明显高于对照组（61．2％），差异有显著性意义（χ^2=6．19，P〈0．05）；观察组MAU、β2-M、BUN、SCr水平改善明显优于对照组，差异有显著性意义（t=4．18、3．95、4．65、4．12，P〈0．05）；两组不良反应发生率比较，差异无显著性意义（χ^2=0．49，P〉0．05）。结论依那普利联合氯沙坦用药可以发挥各自优势，起到协同作用，能够更有效降低血压，阻止或延缓肾脏疾病进展，且有良好的安全性，值得临床推广应用。     

口服特比萘芬加外用益康唑短程联合疗法治疗足癣的临床对照研究

目的评价口服特比萘芬片加外用益康唑乳膏短程联合疗法治疗足癣的疗效和安全性。方法采用随机数字表法将124名患者分为两组：试验组予特比萘芬片250mg口服,1次／d,联合盎康唑乳膏外用,2次／d,共7d;对照组予益康唑乳膏外用,2次／d,同时口服维生索C片0．1g,1次／d,共28d。于停药时和停药后4周时观察临床疗效和真蔺学疗效,停药后4同时观察复发情况。结果共有113例患者完成临床观察．脱落7例（试验组1例,对照组6例）,剔除4例（对照组4例）。停药时两组相比试验组治愈率明显低于对照组（χ^2=23．03,P〈0．01）,有效率及真菌清除率差异无统计学意义（χ^2=0．33,P〉0．05;χ^2=0．03,P〉0．05）;停药后4周时两组相比试验组治愈率、有效率及真菌清除率均显著高于对照组（χ^2=17．21,P〈0．01;χ^2=14．56,P〈0．01;）（χ^2=23．03,P〈0．01）;停药后4周时两组相比试验组复发率明显低于对照组（χ^2=14．04,P〈0．01）;两组不良反应发生率相比差异无统计学意义（χ^2=3．27,P〉0．05）。结论口服特比萘芬片加外用益康唑乳膏短程联合疗法治疗足癣依从性和安全性高、疗效好。     

艾司西酞普兰联合小剂量喹硫平治疗抑郁症临床观察

目的观察艾司西酞普兰联合小剂量喹硫平治疗抑郁症的临床疗效。方法将80例抑郁症患者随机分成单用组与联用组各40例。于治疗前和治疗1、2．4、6、8周末采用汉密尔顿抑郁量表（HAMD）、HAMD中焦虑／躯体化和睡眠障碍2因子评分以及副反应量表（TESS）评价不良反应。结果联用组显效率86．8％,明显高于单用组66．7％,差异有统计学意义（χ2=4．374,P〈0．05）;联用组在治疗1、2、4周末时HAMD评分明显低于单用组（P〈0．05）;两组治疗后在焦虑／躯体化和睡眠障碍两因子评分方面比较差异有统计学意义（P〈0．05）;两组治疗期间TESS量表总分比较差异无统计学意义（P〉0．05）;两组不良反应发生率无统计学意义（P〉0．05）。结论艾司西酞普兰联合小剂量喹硫平治疗抑郁症可以提高疗效,并迅速改善焦虑、躯体化症状和睡眠障碍。     

六神丸联合转移因子治疗阿弗他溃疡41例疗效观察

目的观察六神丸联合转移因子治疗阿弗他溃疡的疗效。方法将可回访病例按单双日分组，单日给予六神丸联合转移因子胶囊治疗，为治疗组（n=41）；双日给予西瓜霜喷剂治疗，为对照组（n=33）。两组疗程均为4周。随访12个月后观察疗效。结果两组治愈率、短期治愈率和总有效率经Pearsonx。检验，χ^2（治愈率）=16．82，P〈0．01；χ^2（短期治愈率）=0．05，P〉0．05；χ^2（总有效率）=17．18，P〈0．01，治愈率和总有效率的差异均有统计学意义，治疗组的疗效明显优于对照组，而近期疗效则无统计学差异。结论六神丸联合转移因子治疗阿弗他溃疡安全可靠，疗效满意。     

文拉法辛缓释片治疗抑郁症临床对照观察

目的：评价文拉法辛缓释片治疗抑郁症的疗效与安全性。方法：将76例抑郁症患者随机分为文拉法辛缓释片组38例、氟西汀组38例,疗程8周。以汉密尔顿抑郁量表（HAMD）和治疗中出现的症状量表（TESS）评定疗效和不良反应。结果：两组治疗2周后HAMD评分比较差异有统计学意义（P〈0．05）。两组疗效及治疗后4周、8周HAMD评分比较,均无明显差异（P〉0．05）;各组治疗后与治疗前的HAMD评分比较差异均有统计学意义（P〈0．05）,不良反应发生率无明显差异（P〉0．05）。结论：文拉法辛缓释片治疗抑郁症疗效确切,起效快,安全性好。     

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.