曲美他嗪对冠心病校正QT间期离散度的影响

目的通过研究曲美他嗪对冠心病校正QT间期离散度(QTcd)的影响,探讨曲美他嗪治疗对冠心病缺血心肌的保护作用.方法72例冠心病患者随机分为曲美他嗪治疗组和非曲美他嗪治疗组,观察其治疗前后QTcmax,QTcmin和QTcd的变化.另设正常人20例作对照组.结果冠心病患者QTcmax和QTcd较正常人增大,与治疗前相比,两组冠心病患者治疗后QTcmax和QTcd均有显著减少(P＜0.01).其中以曲美他嗪治疗组更明显.同时,两组间比较,治疗后QTcmax和QTcd有显著差异(P＜0.01),曲美他嗪治疗组减少更明显.结论冠心病患者QTcmax和QTcd较正常人增大,曲美他嗪通过缩小QTcmax而减少冠心病患者QTcd.     

曲美他嗪对冠心病合并2型糖尿病患者心率变异性及Q-T离散度的影响

目的探讨曲美他嗪对冠心病合并2型糖尿病患者心率变异性（HRV）及Q—T离散度（QTd）的影响。方法58例冠心病合并2型糖尿病患者随机分为对照组及治疗组,对照组给予常规降糖、扩冠、抗血小板、调脂等治疗,治疗组除常规治疗外,加服曲美他嗪20mg,每日3次,两组均治疗2个月,测定两组患者用药前后HRV及QTd的变化。结果两组HRV各参数SDNN、SDNN index、SDANN、rMSSD、PNN50较治疗前均明显升高（P〈O．05）,治疗组升高更明显,对比有统计学意义;两组QTd较治疗前均明显缩短（P〈0．05）,治疗组缩短更明显,与对照组差异有统计学意义（P〈0．05）。结论曲美他嗪能提高冠心病合并2型糖尿病患者的心率变异性、缩短QTd,对改善冠心病合并2型糖尿病患者预后可能有良好作用。     

曲美他嗪联合辛伐他汀治疗不稳定型心绞痛疗效观察

目的 观察曲美他嗪联合辛伐他汀治疗不稳定型心绞痛的疗效。方法106例不稳定型心绞痛患者随机分为两组;观察组53例,在常规抗心绞痛治疗基础上采用曲美他嗪＋辛伐他汀治疗;对照组53例,除不使用曲美他嗪外,其他同观察组。结果观察组总有效率为83．02％,明显高于对照组的64．15％（P〈0．05）;在减少心绞痛发作频次,并使心电图上心肌缺血范围和程度减轻等方便比较,观察组明显优于对照组（P〈0．05）。结论曲美他嗪联合辛伐他汀联合治疗不稳定型心绞痛安全有效。     

曲美他嗪联合麝香保心丸治疗不稳定型心绞痛的疗效观察

目的探讨麝香保心丸联合曲美他嗪治疗不稳定型心绞痛的临床疗效。方法选择2009年3月～2011年3月在我院住院的140例不稳定型心绞痛患者,随机将其分为3组,分别为单用麝香保心丸组（50例）、单用曲美他嗪组（50例）和麝香保心丸联合曲美他嗪组（40例）。统计和分析治疗后不稳定型心绞痛患者的的临床疗效、心绞痛发作次数、硝酸甘油日耗量、改善心电图压低总和改变等。结果曲美他嗪联合麝香保心丸组能显著降低不稳定性心绞痛患者的心绞痛发作频率、持续时间,减少硝酸甘油的用量,缩短24h心肌缺血总时间以及∑ST等,且降低幅度显著高于单用组（P〈0．05）。联用组显效率和总有效率分别为40．0％（16／40）和95．0％（38/40）,显著高于单用组（P〈0．05）,无效率为5．0％（2／40）,显著低于单用组（P〈0．05）。结论在常规治疗的基础上,曲美他嗪联合麝香保心丸在治疗不稳定型心绞痛方面具有协同作用,可以提高不稳定型心绞痛的临床疗效。     

曲美他嗪对不稳定型心绞痛患者经皮冠状动脉介入治疗的心肌保护作用

目的：探讨曲美他嗪对经皮冠状动脉介入治疗（PCI）患者的心肌保护作用及其可能机制。方法：选择不稳定型心绞痛患者42例随机分为两组,常规治疗基础上术前加服曲关他嗪行PCI术21例为曲关他嗪组,不加服曲美他嗪行PCI术21例为对照组。两组均检测PCI术前、术后1h、6h、12h、24h的血清cTnI和MDA水平。结果：曲美他嗪组和对照组术后6h、12h和24h的cTnI水平均较术前升高（P均〈0．05）;对照组在术后12h和24h升高幅度较曲美他嗪组更大（P均〈0．05）。两组PCI术后各时间点MDA均较术前升高（P均〈0．05）;对照组在PCI术后12h和24h时MDA水平增加幅度较曲美他嗪组更大（P分别〈0．05和〈0．01）。结论：曲美他嗪能减少膜脂质的过氧化损伤,从而减轻PCI造成的心肌细胞损伤,为PCI患者提供心脏保护。     

河托伐他汀联合曲美他嗪治疗冠心病的临床疗效观察

目的探讨阿托伐他汀联合曲美他嗪治疗冠心病的临床疗效,旨在为临床治疗冠心病提供进一步的参考依据。方法将2010年1月～2012年1月我院确诊的70例冠心病患者随机分至阿托伐他汀联合曲美他嗪治疗组（A组,35例）和曲美他嗪治疗组（B组,35例）;比较两组治疗后的疗效以及运动持续时间、诱发心绞痛发作时间、ST段下移1mm时间、缺血事件及不良反应。结果A组的总有效率94．3％,明显高于B组（77．1％）（P〈0．05）;且A组患者治疗后的运动持续时间、诱发心绞痛发作时间、ST段下移1mm的时间均较B组长,差异有显著性（P〈0．05）;两组缺血发生率比较,差异有统计学意义（P〈0．05）。结论阿托伐他汀联合曲美他嗪治疗冠心病疗效确切,安全性好,值得推广。     

曲美他嗪治疗老年慢性充血性心力衰竭的疗效观察

目的：观察曲美他嗪对老年慢性充血性心力衰竭（CHF）的治疗效果。方法：选择CHF患者66例，随机分为2组．对照组30例，采用常规治疗方法，曲美他嗪组36例，在常规治疗的基础上加用曲美他嗪，6个月后比较NYHA心功能分级及左室射血分数，左室短轴缩短率的改善情况。结果：①两组治疗均有效，心功能明显改善。②治疗组的总有效率明显优于对照组（89％ vs 70％，P〈0．05）；心功能改善更为显著（P〈0．05）。结论：曲美他嗪可改善老年CHF患者的心功能状态，增加运动耐量。     

倍他乐克对冠心病劳累性心绞痛患者QT离散度的影响

目的：探讨倍他乐克对冠心病劳累性心绞痛患者QT离散度的影响。方法：将40例冠心病劳累性心绞痛患者随机分成两组，试验组给予倍他乐克50－150mg/ld，对照组不给倍他乐克，其它抗心肌缺血治疗同试验组，测定治疗前及治疗2周后两组心率，最大QT间期（QTmax），最小QT间期（QTmin），QT离散度（QTd）及心率校正QT离散度（QTcd）。结果：对照组各项观察指标无显著变化（P＞0．05）。试验组QTd,QTcd显著缩小（P＜0．01）。结论：倍他乐克在控制冠心病劳累性心绞痛患者症状的同时，显著减少QTd及QTcd，从而减少室性心律失常的发生，改善预后。     

曲美他嗪治疗不稳定型心绞痛49例临床疗效观察

目的观察曲美他嗪治疗UAP的临床疗效。方法将98例不稳定型心绞痛患者平均分为2组,对照组常规进行抗心绞痛药物治疗;曲美他嗪组在常规用药基础上加用曲美他嗪20mg／次,3次／d。结果用药5周后2纽心绞痛发作次数、硝酸甘油用药量、心电图改变,均有显著性差异（P〈0．05）。心绞痛症状的疗效比较：曲美他嗪组总有效率83．67％,对照组总有效率61．22％,2组比较有显著性差异（P〈0．05）。结论不稳定型心绞痛患者服用曲美他嗪可获得更好疗效,值得临床推广应用。     

曲美他嗪治疗冠心病合并糖尿病疗效观察

目的探讨曲美他嗪对冠心病合并糖尿病患者的临床治疗效果。方法选择本院2006年5月～2007年4月治疗冠心病合并糖尿病患者90例,随机分为观察组和对照组,对照组采用常规方法治疗,观察组在常规治疗的基础上加用曲美他嗪,比较两组心功能改善、心绞痛发作、血清超氧化物歧化酶（SOD）、丙二醛（MDA）和空腹血糖含量以及不良反应发生情况。结果观察组心功能改善总有效率为91％,对照组心功能改善总有效率为66％,差异具有统计学意义（P〈0．05）;观察组患者治疗后心绞痛发作频率、心绞痛持续时间和硝酸甘油用量均明显下降,与对照组相比差异有统计学意义（P〈0．05）;治疗后两组患者血清SOD含量上升,MDA含量下降,但与对照组相比,观察组血清SOD含量上升幅度更加明显（P〈0．05）;两组空腹血糖治疗前后比较,差异无统计学意义（P〉0．05）;无明显不良反应发生。结论在常规治疗的基础上加用曲美他嗪能明显改善心功能,减少心绞痛发作频率、心绞痛持续时间和硝酸甘油用量,是一种有效治疗冠心病合并糖尿病的药物。     

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.