综合治疗新生儿缺氧缺血性脑病50例疗效评价

目的对缺氧缺血性脑病中、重度患儿进行综合治疗加早期干预，以提高治愈率，降低致残率。方法将50例患儿随机分为治疗组及对照组，分别采用传统治疗及传统治疗加早期干预，跟踪随访至2岁，并对结果进行统计学处理。结果完成全程随访的50例HIE患儿中接受早期干预的26例，对照组24例。干预组预后正常率96．2％，较对照组75％有显著差异（Х^2=4．64，P〈0．05），发育商（DQ）明显高于对照组（t=2．051、3．060、3．281、3．990、2．987，P〈0．05、0．01、0．01、0．01、0．01）。结论早期干预能有效改善HIE患儿的预后，降低其后遗症的发生率。     

早期护理干预对新生儿缺氧缺血性脑病患儿智力和运动功能及预后的影响

目的探讨早期护理干预对新生儿缺氧缺血性脑病（HIE）患儿的智力和运动功能及并发症的影响。方法90例新生儿HIE随机分为护理干预组和常规护理组。常规护理组予以常规护理干预,护理干预组予以早期护理干预,两组均干预24个月。结果随访6、12个月,护理干预组患儿MDI和PDI均明显高于常规护理组（P〈0．05）;随访24个月．护理干预组患儿适应能力、大运动能力、精细运动能力、语言能力和社交能力均明显优于常规护理组（P〈0．05）;同时护理干预组神经系统后遗症发生率明显低于常规护理组（x2=5．07,P〈0．05）。结论早期护理干预可提高新生儿HIE患儿运动发育和智力发育水平,减少神经系统后遗症发生率。     

早期康复护理对新生儿缺氧缺血性脑病预后的影响

目的探讨早期康复护理对新生儿缺氧缺血性脑病（HIE）预后的影响。方法选择64例HIE患儿,随机分为常规护理组和康复护理组,分别予以常规护理和早期康复护理干预,干预时间12个月。比较两组患儿出生后3、6、12个月的智力发育指数（MDI）和运动发育指数（PDI）的变化及后遗症发生率。结果两组患儿出生后6、12个月的MDI和PDI均较出生后3个月明显升高（P〈0．05）,且康复护理组升高的幅度明显高于常规护理组（P〈0．05）。康复护理组发生后遗症3例,常规护理组发生后遗症10例,康复护理组后遗症的发生率明显低于常规护理组（X2=4．73。P〈0．05）。结论早期康复护理干预能明显促进HIE患儿智能和运动发育,减少后遗症的发生率,改善预后。     

早期干预对新生儿缺氧缺血性脑病患儿预后影响的临床观察

目的探讨早期干预对新生儿缺氧缺血性脑病患儿预后影响。方法将67例HIE患儿随机分为干预组35例，对照组32例；仅干预组从新生儿期开始接受为期24个月的干预治疗。两组患儿接受相同的综合治疗和育儿知识，所有的病例均于3．6、12、24月龄进行体格发育和智能发育检测。结果相同月龄时干预组的智力发育指数和运动发育指数均高于对照组（P〈0．05），干预组中脑瘫、智力低下、后遗症发生率明显低于对照组（P〈0．05）。但两组在体格发育方面比较差异无显著性（P〉0．05）。结论对新生儿缺氧缺血性脑病患儿给予早期持续的干预可改善其智力及运动发育，有效的降低后遗症的发生率。     

早期干预对新生儿缺氧缺血性脑病预后影响的临床研究

目的：探讨早期干预对新生儿缺氧缺血性脑病（HIE）预后的影响。方法：对32例NBNA加分法评分基础分〈35分的HIE患儿自恢复期起随机分成干预组和对照组，于0-2岁时进行智能发育随访。结果：干预组发育商（DO）明显高于对照组，其后遗症发生率低。结论：早期干预治疗能有效地促进HIE患儿的智能发育，是降低其后遗症发生率的有效手段。     

系统干预对新生儿缺氧缺血性脑病预后的影响

目的探讨系统干预对新生儿缺氧缺血性脑病预后的影响。方法对观察组患儿早期进行药物和高压氧治疗,定期复查及功能训练和行为矫治。结果DDST筛查异常率观察组明显低于对照组（P＜0．05）,发育商明显高于对照组（P＜0．01）,两组病死率和后遗症发生率无差异。结论系统干预可以有效地降低HIE患儿智能迟缓发生率及发育偏离程度,但对病死率和后遗症发生率无影响。     

醒脑静及早期干预对中、重度新生儿缺氧缺血性脑病预后的影响

目的 探讨醒脑静及早期干预对中、重度新生儿缺氧缺血性脑病预后的影响。方法 两组患儿均在采用相应的支持、对症、应用脑活素等治疗基础上，治疗组用醒脑静及早期干预；对照组用复方丹参。结果 治疗组生后28d新生儿20项行为神经测定优于对照组（X^2=6．972，P〈0．01）；生后半年治疗组智力发育指数、精神运动发育指数均优于对照组（t=4．785，P〈0．01；t=5．847，P〈0．01）；生后1年治疗组的智力发育指数、精神运动发育指数均优于对照组（t=5．21，P〈0．01；t=9．763，P〈0．01）。结论 醒脑静及早期干预对中、重度新生儿缺血缺氧性脑病（HIE）有较好的影响。     

早期综合干预对缺氧缺血性脑病新生儿神经行为发育及血清SIOOB水平的影响

目的探讨早期综合干预对新生儿缺氧缺血性脑病（HIE）神经行为的影响及与血清S100B蛋白的关系。方法将120例HIE患儿随机分为对照组和干预组,干预组在药物治疗的基础上,给予各种感知觉刺激、视听刺激、主动及被动肢体训练等早期综合干预,对照组只给予药物治疗。采用婴幼儿智力发育量表删智力发育指数（mental developmental index,MDI）和运动发育指数（psychomotor developmental index,PDI）分别在于预后3,6,12,18个月进行测定。采用酶联免疫法检测S100B蛋白水平。结果干预组HIE患儿MDI评分从12个月开始,明显高于对照组,差异有显著性[12个月：干预组（96．6±9．4）分,对照组（86．8±9．5）分,P〈0．01]。于预组HIE患儿PDI评分从6个月开始,明显高于对照组,差异有显著性[6个月：干预组（91．6±9．2）分,对照组（82．2±11．0）分,P〈0．01]。两组HIE患儿随着月龄的增长．血清S100B蛋白的水平有下降的趋势。在出生后两组患儿血清S100B蛋白水平较高,且没有差异（P〉0．05）;从3个月开始,干预组患儿的血清S100B蛋白水平降低较明显,与对照组比较,各时间点的水平差异有显著性[3个月：干预组（1．29±0．15）ng/L,对照组（1．40±0．14）ng／L;6个月：干预组（1．06±0．21）ng／L,对照组（1．26±0．22）ng／L,P〈0．05,P〈0．01]。结论早期综合干预能够改善HIE患儿的智力和运动发育,血清S100B蛋白是可能的机制之一。     

早期干预治疗新生儿缺氧缺血性脑病41例预后观察

目的观察早期干预治疗对缺氧缺血性脑病（HIE）的临床效果。方法将81例中重度HIE患儿恢复期开始随机分成干预组和对照组,所有病例均在7d、15d、30d进行新生儿行为神经测定法（NBNA）;在42d、6月、12月、18月龄进行体格发育指标及神经行为检查。结果干预组康复早,后遗症发生率低（x^2=4699,P〈0.05）。结论对HIE早期给予持续干预,能有效促进其动静力发育,是改善预后、降低后遗症发生率的有效手段。     

早期干预对改善新生儿缺氧缺血性脑病预后的影响

目的：探讨早期干预对新生儿缺氧缺血性脑病（HIE）预后的影响。方法：将120例HIE患儿随机分为对照组和干预组,两组均分为轻度、中度、重度HIE组,通过将各种感知觉刺激、视听刺激、主动及被动肢体训练与药物治疗相结合的方法对干预组进行系统的早期干预,对其智能发育进行随访。结果：中度和重度HIE组患儿的发育商（DQ）明显优于对照组（P〈0.01）,轻度HIE组患儿的DQ与对照组比较无明显差异（P〉0.05）;干预组患儿脑瘫和智力低下的发生率明显低于对照组（P〈0.05,P〈0.01）,癫痫的发生率与对照组比较无明显差异（P〉0.05）。结论：早期干预不仅能提高中、重度HIE患儿的DQ,而且可降低其后遗症的发生率,这对改善患儿的预后、全面提高其生存质量有重要的意义。     

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.