活性维生素D3加钙剂对绝经后骨质疏松症患者骨代谢生化指标的影响

目的：观察活性维生素D3加钙剂对绝经后骨质疏松症患者血Ca,P,ALP和尿Ca/Cr,尿HYP／Cr及跟骨骨密度（BMD）的影响,评价活性维生素D3加钙剂对绝经后骨质疏松症的治疗作用。方法：活性维生素D3 0．25ug,每天2次,钙天奇1粒,每天1次,连用4个月,于用药前后测定血Ca,P,ALP和尿Ca/Cr,尿HYP／Cr,并测定跟骨BMD。结果：用药后血Ca升高,血APL,尿Ca/Cr,尿HYP／Cr明显下降,跟骨BMD增加,结论：活性维生素D3加钙剂对绝经后骨质疏松症有治疗作用。     

小剂量利维爱治疗绝经后骨质疏松的临床疗效观察

目的:研究小剂量利维爱治疗绝经后骨质疏松的临床效果。方法:应用利维爱治疗绝经后骨质疏松症25例。绝经年龄（49.1±9.2）岁,使用利维爱每天剂量为1.25mg（1/2量）,于用药前及用药后每6个月随诊,分别观察骨密度、血 ALP、Ca、P、尿Ca/Cr、血脂、肝功。结果:DXA和QCT测量骨密度（BMD）均有升高,以QCT更为明显,与治疗前相比有显著差异（P<0.01）;血ALP、甘油三脂及尿Ca/Cr比值用药后明显下降,骨痛改善率为88％,全组未出现严重不良反应。结论:小剂量利维爱能有效提高BMD,是防治绝经后骨质疏松症的安全有效药物。     

阿仑膦酸钠对绝经后女性骨质疏松骨代谢的作用研究

目的 探讨阿仑膦酸钠(alendronate,ALN)对绝经后女性骨质疏松症的疗效以及对骨代谢的作用.方法 选取用双能X线骨密度仪测定的绝经后女性骨质疏松症患者30例,以ALN联合钙剂治疗6个月,检测骨密度(bone mineral density,BMD)变化,并测定治疗前后血清骨钙素(bone gla protein,BGP)、碱性磷酸酶(alkaline phosphatase,ALP)、钙(calcium,Ca)、磷(phosphorus,P)等水平的变化.结果 绝经后女性骨质疏松症患者服用ALN 6个月后腰椎(L2～L4)BMD显著增高(P<0.01),血清BGP、ALP、P水平显著降低(P<0.01).结论服用ALN 6个月可提高绝经后女性骨质疏松症患者腰椎BMD,降低骨代谢指标BGP水平.     

补肾方药骨疏康防治原发性骨质疏松机理研究

目的：研究补肾方药骨疏康冲剂防治原发性骨质疏松的机制。方法：用维甲酸致Wistar大鼠骨质疏松模型,分别给与骨疏康、钙（Ca）、骨疏康＋Ca治疗,保留一组模型不给药为对照;同时取相同数量正常大鼠为正常组。检测各组骨矿物质密度（BMD）骨生物力学性能、骨生化代谢指标。临床观察绝经后骨质疏松病人30例,服骨疏康并用钙剂6个月为观察组,单用钙剂组30例为对照组,检测骨代谢相关生化指标。结果：骨疏康＋Ca组大鼠BMD增加;生物力学最大载荷、刚性系数、极限强度、弹性模量等指标达到正常水平,优于单钙组。单用骨疏康组大鼠骨吸收指标尿钙／肌酐（Ca/Cr）、尿羟脯氨酸／肌酐（Hop/Cr）、血抗酒石酸盐酸性磷酸酶（TRAP）下降;骨形成指标血碱性磷酸酶（ALP）、骨钙素（BGP）上升。绝经后骨质疏松病人服用骨疏康和钙剂血TRAP下降;血中雌激素（E2）、睾酮（T）上升。结论：骨疏康通过增加血中E2、T水平,降低骨吸水,增加骨形成;与钙剂合用促进BMD增加并能加强骨生物力学性能。     

鲑鱼降钙素对绝经后骨质疏松症骨密度和骨生化指标的影响

目的　观察鲑鱼降钙素对绝经后骨质疏松症骨密度 (BMD)和骨生化指标的影响。方法　 41例绝经后骨质疏松症患者随机分为两组 :鲑鱼降钙素加钙剂治疗组 2 2例 ,肌注鲑鱼降钙素 5 0IU ,每日一次 ,2周后改为每周 2次 ,同时每日口服元素钙 60 0mg ;钙剂对照组 19例 ,每日口服元素钙 60 0mg ,疗程 6个月。 结果　治疗 6个月后 ,鲑鱼降钙素组与治疗前比较 ,腰椎 1～ 4(L1-4)骨密度分别升高 5 .2 %、6.2 %、6.5 %和 8.1% (P <0 .0 5 ) ,股骨颈和大转子骨密度分别升高 4.6%和 6.5 % (P <0 .0 5 ) ,wards三角区无明显变化 ,桡骨远端骨密度升高 2 5 .7% (P <0 .0 1)。对照组与治疗前比较 ,所测各部位BMD无明显变化。降钙素组血ALP、BGP及尿HOP/Cr、尿DPD/Cr排泄率在治疗 6个月时较治疗前明显下降 (P值均 <0 .0 0 1)。对照组用药前后无明显改变。结论　鲑鱼降钙素治疗绝经后骨质疏松症 ,具有抑制骨吸收 ,保持并增加骨量的作用     

鳗鱼降钙素对绝经后骨质疏松症的疗效观察

目的 探讨鳗鱼降钙素治疗绝经后骨质疏松症的疗效.方法 将70例绝经后骨质疏松症患者随机分为两组,治疗组40例,应用鳗鱼降钙素治疗,20 IU肌注每周一次,疗程6个月;对照组30例.两组均口服钙尔奇D(含元素钙600 mg,维生素D125 IU)每天一片,疗程6个月.两组治疗前后均测定2～4腰椎、骨股颈及wards三角骨密度(bone mineral density,BMD),记录患者临床症状.结果 治疗组2个月后骨痛改善率高于对照组(P<0.01),治疗组患者腰2、腰3、腰椎均值BMD较前明显升高(P<0.05).对照组BMD治疗前后无明显变化(P>0.05).结论 鳗鱼降钙素与钙剂联合应用对治疗绝经后骨质疏松症有减轻疼痛,改善症状,同时增加骨密度作用.     

绝经妇女骨质丧失与雌激素水平的关系

对76例绝境前后妇女进行了血清性激素水平、血清碱性磷酸酶(ALP)、空腹尿钙/肌酐(Ca/Cr)、羟脯氨酸/肌酐(Hyp/ Cr)比值及桡骨骨矿含量(BMC)测定.结果 绝经妇女血清ALP、空腹Ca/Cr比值显著高于为绝经妇女,及绝经后骨质生成及吸收增强,其中以骨吸收为主.从绝经妇女中随机选出14例,给予口服觉雌醇每日5ug,观察1个月,血清ALP、空腹尿/Ca/Cr及Hyp/Cr比值显著降低,其中以骨吸收抑制为主.     

甲亢患者治疗前后骨生化指标和骨密度变化的临床研究

目的了解甲亢病人治疗1年前、后骨生化指标和骨密度的变化,提高对甲亢性骨代谢异常的认识。方法对136例甲亢病人经抗甲状腺药物治疗或加用维生素D（或活性维生素D）和钙剂治疗1年前、后的骨生化代谢指标血钙、磷、碱性磷酸酶、24h尿钙、尿磷以及骨密度进行测定和分析。结果与正常对照组比较,甲亢患者FT3、FT4、ALP和24h尿钙均明显升高,而TSH和骨密度均明显降低;其骨量减少和骨质疏松发生率亦明显增高。治疗1年后,随着甲亢的控制,甲亢患者的血ALP和24h尿钙水平恢复正常;骨密度明显升高,但仍低于正常对照组;其骨量减少与骨质疏松发生率也有不同程度降低;进一步分析发现,加用维生素D（或活性维生素D）和钙剂治疗的患者上述指标改善较单纯抗甲状腺药物治疗者明显。结论甲亢性骨代谢异常是一种高骨转换状态,可以引起骨量减少和骨质疏松。及早并有效地控制甲亢,尤其加用维生素D（或活性维生素D）和钙剂治疗可以纠正这一异常,并有助于改善骨质量。     

阿仑膦酸钠联合钙剂治疗妇女绝经后骨质疏松症的效果观察

目的 探讨阿仑膦酸钠联合钙剂治疗绝经后骨质疏松症的效果.方法 60例绝经后骨质疏松症患者分成治疗组及对照组,治疗组(31例)予口服阿仑膦酸钠胶囊联合钙尔奇-D片治疗,对照组(29例)予口服钙尔奇-D片,连续用药6个月;分别于治疗前后对患者的腰背疼痛进行评价,分别测定腰椎、股骨颈及Wards三角区骨密度(BMD),血钙、血磷、血清骨钙素(BGP)、血清骨原性碱性磷酸酶(BAP)和尿Ⅰ型胶原羟基端交联肽(NTx).结果 治疗后,与对照组比较,治疗组腰背疼痛明显缓解,腰椎L2～4、股骨颈及Wards三角区部位BMD均有不通程度的上升,BAP、BGP和尿NTx有所下降,差异均有统计学意义(均P＜0.05).结论 阿仑膦酸钠联合钙剂对可以有效增加绝经后骨质疏松症妇女的BMD,缓解骨痛,降低骨转化,且耐受性好.     

帕米膦酸二钠治疗绝经后妇女骨质疏松症3年临床观察

目的观察帕米膦酸二钠治疗绝经后妇女骨质疏松症（PMOP）3年疗效。方法选取2007年8月至2008年6月PMOP患者97例,每月3次静脉输注帕米膦酸钠30 mg,同时每天补充钙剂800～1 200 mg和活性维生素D 0.25μg,疗程3年。定期测定治疗前后腰椎、股骨颈与全髋骨密度值（BMD）及骨转换标记物（血清CTX、尿CTX、NTX、血清TRACP5b）。结果①治疗3年后,腰椎、股骨颈和全髋部位BMD均较治疗前相比,差异有统计学意义（P〈0.001）;②治疗6个月,血清I型胶原交联羧基端肽（CTX）、I型胶原交联氨基端肽（NTX）、尿CTX/Cr、尿NTX/Cr、尿吡啶啉/肌酐（PYD/Cr）、尿脱氧吡啶啉/肌酐（DPYD/Cr）和血浆抗酒石酸酸性磷酸酶均较治疗前显著下降（P〈0.01）,其后各骨转换标记物仍维持较低水平,但无进一步下降。Pearson相关分析显示治疗6个月时尿吡啶啉和脱氧吡啶啉、血浆抗酒石酸酸性磷酸酶的变化与3年后腰椎、股骨颈和全髋部位BMD的变化值均呈负相关（P〈0.01）。③治疗后疼痛明显缓解生活能力明显改善,治疗期间新发骨折2例。结论帕米膦酸二钠治疗PMOP安全有效,早期骨转换标记物的下降与3年后骨密度的改善呈负相关。     

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.