脂质沉积性肌病19例临床病理分析

目的分析临床少见的脂质沉积性肌病(LSM)临床特点和肌肉活检特征。方法收集我院LSM患者19例,分析临床表现、肌电图、肌酶、肌力等以及肌活检时组织结构和酶组化染色特点。结果LSM临床表现为四肢近端肌萎无力,运动不持久。肌力大多在III级左右,其中1例肌力为V级;实验室检查肌酶均有增高,患者血脂和载脂蛋白异常;肌电图检查为肌源性损害。病理特点为皮肤厚度增加,肌肉结构清楚,肉色浅,质软,病理诊断主要靠镜下以I型肌纤维为主的肌纤维空泡,脂肪染色(SBB)阳性。结论脂质沉积性肌病的确诊手段是肌肉活检的脂肪染色,具体分型还需进行生化检测各种酶缺陷。     

脂质沉积性肌病的临床及病理学分析

脂质沉积性肌病（LSM）是由于脂质代谢通路上肉碱或酶的缺乏,直接或间接影响肌肉细胞内的脂质代谢,导致脂肪在肌纤维细胞中积聚而引起的一组代谢性疾病。临床主要表现为以近端为主的四肢无力,易被误诊为重症肌无力、多发性肌炎及肢带型肌营养不良等。现将LSM临床和病理特征及相关辅助检查结果进行总结,报道如下。     

三例成年起病的线粒体肌病临床与病理研究

目的报道3例曾被误诊为多发性肌炎而后被确诊为成年起病的线粒体肌病的临床、MRI及病理学表现. 方法对3例病人进行临床、电生理、MRI和肌肉活检特殊染色、组织酶学等病理检查. 结果3例患者均表现为四肢近端肌无力与肌萎缩,肌酶升高,EMG示肌源性损害,MRI示近端肌肉萎缩较明显.肌肉病理学检查,MGT特染及NADH-TR和SDH组织酶学染色中发现典型的"玻碎红纤维",电镜证实肌纤维胞浆内线粒体增多.结论对临床成年起病的进行性对称性四肢近端肌无力与萎缩的患者应考虑线粒体肌病的可能;特殊染色及组织酶学在诊断线粒体肌病中起重要作用,激素治疗可能有效.     

脂质沉积性肌病的临床和病理特点分析(附2例报告)

目的探讨脂质沉积性肌病脂质沉积性肌病(LSM)的临床和病理学特点。方法分析2例LSM的临床特点、实验室检查和病理学资料,并复习相关的文献资料。结果2例患者的临床表现和肌酶水平存在差异,但病理学检查类似:肌纤维内空泡样或裂隙样改变,脂肪染色脂滴增多;电镜下有大量脂滴伴有线粒体的异常。结论LSM具有多样的临床表现,确诊依靠肌肉活检。及早诊断、综合治疗,有利于提高LSM患者的临床预后。     

脂质沉积性肌病21例临床分析

目的:探讨脂质沉积性肌病(LSM)临床特点、误诊原因及诊治。方法:分析21例LSM的临床特点、神经电生理、肌肉病理资料,并复习相关文献。结果:21例均表现为四肢近端无力、肌酶升高,肌电图呈肌源性损害或合并神经源性损害,或无异常,12例被误诊为多发性肌炎、病毒性心肌炎、重症肌无力等,经病理证实为LSM。结论:LSM临床表现缺乏特异性,临床容易误诊,病理检查是诊断该病的主要依据。     

脂质沉积性肌病的临床和神经电生理特征

脂质沉积性肌病(lipid stoage myopath,LSM)是指由于肌肉中长链脂肪酸代谢障碍,致使脂质沉积在肌纤维内而引起的脂代谢异常性肌病,临床上容易误诊为多发性肌炎、肌营养不良症、重症肌无力、心肌炎等。作者收集了1998年3月至2012年5月经肌肉活检病理证实为LSM的19例的临床资料,探讨其临床和神经肌肉电生理特点。     

糖原贮积症伴脂质贮积症

目的 探讨糖原贮积症伴脂质贮积症的临床与病理特点。方法 报告１例患者,结合文献复习,描述其临床与病理特征。结果 本病多见于婴儿或青少年女性,进行性或抒发性广泛性肌张力减低,四肢近端肌无力或萎缩,可伴有肌肉酸痛。病理特点为肌纤维出现弥温性空泡,Ⅰ型纤维受累可比Ⅱ型肌纤维明显,电镜下发现糖原和脂滴贮积于肌纤维内。结论 当患者因条件受限、无法进行生化检查时,光、电镜结合的活检肌组织形态观察有助于诊断。     

脂质沉积性肌病15例临床及病理分析

结合肌肉病理改变,探讨脂质沉积性肌病的诊断及治疗。方法对１５全ＬＳＭ患者进行临床及病 镜与电镜观察。结果患者均有进行性四肢无力,血清肌酶不同程度升高,肌肉病理苏丹黑染色及电镜示肌纤维中大量脂质沉积,以Ⅰ型纤维为主,结论ＬＳＭ是一组以肌无力和肌疲劳为主要表现的肌纤维内脂肪代谢障碍病。肌肉病理检查有助于确定诊断。激素治疗有效。     

三例成年起病的线粒体肌病临床与病理研究

目的：报道3例曾被误诊为多发性肌炎而后被确诊为成年起病的线粒体肌病的临床、MRI及病理学表现。方法：对3例病人进行临床、电生理、MRI和肌肉活检特殊染色、组织酶学等病理检查。结果：3例患者均表现为四肢近端肌无力与肌萎缩，肌酶升高，EMC示肌源性损害，MRI示近端肌肉萎缩较明显。肌肉病理学检查，MGT特染及NADH-TR和SDH组织酶学染色中发现典型的“玻碎红纤维”，电镜证实肌纤维胞浆内线粒体增多。结论：对临床成年起病的进行性对称性四肢近端肌无力与萎缩的患者应考虑线粒体肌病的可能；特殊染色及组织酶学在诊断线粒体肌症中起重要作用，激素治疗可能有效。     

脂质沉积性肌病三例误诊分析

目的分析3例被误诊的脂质沉积性肌病的临床及病理特点,探讨脂质沉积性肌病被误诊的原因。方法总结3例误诊的脂质沉积性肌病患者的临床特点、肌活检资料,并复习相关文献。结果3例患者均以四肢近端无力和运动不耐受为首发症状,被误诊为重症肌无力、多发性肌炎或假肥大型肌营养不良,经肌活检证实为脂质沉积性肌病。结论脂质沉积性肌病临床表现为非特异性肌无力,应与相关肌病相鉴别,病理检查是确诊该病的主要根据。     

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.