小儿伤寒的临床流行病学分析

我院１２ａ中收治的３４５例小儿伤寒的回顾性临床流行病学分析，１２ａ中小儿伤寒的发病数占同期住院病儿总数的０．５％，与前十年比较下降了５０％。其中１９８８年伤寒的发病率最高，发病年龄以学龄期儿童为多，男性为主，夏秋季高峰，伤寒的临床特征和以前无多大变化，仍以高热和消化道症状为主，并发症和重症病例上各，伤寒的诊断目前仍依赖于血培养，肥达氏试验，部分患还进行Ｔ细胞粥群检测。     

黔西南州2004～2013年伤寒、副伤寒流行病特征分析

目的：了解黔西南州伤寒、副伤寒流行特征,为制定防治策略提供依据。方法对黔西南州2004～2013年伤寒、副伤寒疫情作描述性流行病学分析。结果2004～2013年累计报告伤寒、副伤寒病例3943例,年均发病率13．17/10万;男女发病之比为1．31∶1;发病人群以农民为主（39．87％）,其次为学生（25．31％）。结论黔西南州伤寒、副伤寒发病有上升趋势,应开展以管理传染源为主的综合性防治措施,提供安全生活用水,开展健康宣教,提高全人群对伤寒、副伤寒的防病意识,控制局部暴发。     

328例食管癌临床分析

目的 总结本院1993～2006年间328例食管癌的临床资料，对了解嘉兴地区食管癌的发病特征和发病规律提供一定的参考。方法回顾性分析328例食管癌患者的临床资料。结果328例中男女比为5．19：1，发病年龄以50～69岁为主（66．46％），发病部位以中段癌为主（58．53％），病理分型以鳞癌为主（97．56％），分化程度以中分化癌为主（78．05％），癌细胞转移途径中淋巴转移以食管周围和贲门左右、胃大小弯淋巴转移多见，分别占41．35％和38．45％，血行转移以肺、肝多见，共占74．08％。随访216例中单纯手术治疗152例，术后5年存活率28．29％；单纯放射治疗31例，术后5年存活率16．13％；放射＋手术联合治疗19例，术后5年存活率36．84％；其余治疗方法患者均于5年内死亡。结论本地区食管癌的发病情况与一般文献报道相似，但病例确诊时以中晚期为主，应加强本地区食管癌的二级预防。     

伤寒60例临床分析

伤寒６０例临床分析广西柳江造纸厂职工医院（５４５０１１）梁中平近年来，伤寒发病不典型的报道日益增多。为提高对该病的认识，现将我院１９９２年３月～１２月收治的伤寒６０例分析报告如下。临床资料一般资料：本组男３７例，女２３例，年龄６～５８岁（平均２７岁）...     

伤寒误诊原因探讨

近年随着广谱抗生素广泛应用，伤寒发病率逐年降低，但临床变异性日趋增大，非典型病例增多，误诊率逐年上升[1]。我院1987～1995年共收治伤寒32例，其中20例（62．5％）被误诊。报告如下。1临床资料1．1一般资料20例中男15例，女5例。年龄3～59岁。其中20～40岁占65％。发病以秋冬季为多，占80％。发病6～52d经血培养或肥达反应确诊，平均21．3d。1．2临床特点起病急，伤寒五大特征表现变异大。早期症状复杂多样，后期并发症表现突出。20例中驰张热及不规则热型12例，稽留热型8例，热程4～40d。伴畏寒13例，其中5例伴寒战或出汗。出现皮疹1…     

连云港地区1994～1996年志贺菌,沙门菌型分布分析

１９９４～１９９６年我室分离连云港地区的２５６株志贺菌和９６株沙门菌，志贺菌共检出１４例个血清型，每年８～１０月份为感染高峰期以福氏２ａ型为主占６４．０６％，沙门菌共检出１６个血清型，以伤寒沙门菌为主占３０．２１％，其次为肠炎沙门菌及鼠伤寒沙门菌，分别占２５．０％和１７．７１％，同时作两类细菌的药物敏感试验。     

84例伤寒临床特征

1992年2月1993年1月，我市发生伤寒流行，我院收治细菌培养阳性和／或肥达反应阳性旮84例，其中1992年12月～1993年1月共69例，其特点志其他报告不同。1流行病学调查主要流行于冬季，城市高于农村，青壮年多见，周期无副伤寒发现。食物传播为主，84例中仅3例子1年内接种过伤寒疫苗。2临床资料门）一般资料：84例伤寒均属于确诊。男37例，女47例，成人68例，儿童16例；农民8例，非农民76例；均有发热，稳留热24例（286％），驰张热23例（27．3％），不规则热（44．1％）；热程l～20天，平均5天；脾肿大22例（26％），肝肿大11例（13％），相…     

汕头市1996～2005年儿童青少年传染病动态分析

目的了解汕头市儿童青少年传染病发病规律，探讨防治措施。方法采用描述流行病学分析方法对1996～2005年汕头市3-19岁儿童青少年的10种常见法定传染病发病情况进行统计分析。结果1996～2005年汕头市报告3～19岁儿童青少年10种常见法定传染病共7222例，其中呼吸道传染病（包括腮腺炎、肺结核、麻疹、猩红热）占48．32％住居首住，肠道传染病（包括甲肝、菌痢、伤寒）占32．76％，血源性疾病（乙肝）占18．37％，自然疫源性疾病（包括乙脑、疟疾）占0．54％；甲肝、乙肝发病呈逐年下降趋势，而肺结核、腮腺炎和麻疹发病有逐年上升趋势；乙肝、肺结核的发病以大年龄组为主，15～19岁组发病数最高，分别占72．45％和47．70％；菌痢、麻疹以3—5岁组发病数最高，分别占50．43％和48．85％。结论抓好学校、托幼机构传染病预防控制工作，是降低传染病发病率、保护儿童青少年身体健康的关键。     

小儿伤寒268例临床分析

１临床资料１．１一般资料我科１９８０～１９９６年诊断明确的小儿伤寒２６８例，男１６２例，女１０６例。发病年龄：３岁以下３５例，３～６岁４６例，７～１２岁１５１例，１３～１４岁３６例。发病季节：夏秋１６８例，冬季２８例，春季７２例。所有病例均以发热为主...     

老年肺炎细菌混合感染和耐药性的处理

自１９８９年１２月至１９９３年１２月，老年肺炎混合感染和耐药性的处理共１８８例，男１４０例，女４８例。年龄为６０～９３岁。分为两组：第１组１０８例，以对Ｇ＋细菌耐药性为主７６例，对Ｇ－细菌耐药性为主３２例，第２组８０例，对Ｇ＋细菌耐药性为主２８例，耐Ｇ－细菌为主５２例。第２组病人Ｇ－细菌感染较第１组病人为多，且病情重。两组采用不同治疗方案，第１组治愈５８例（５３．７％），死亡３１例（２８．７％）；第２组治愈５９例（７３．７５％），死亡８例（１０％）Ｐ值＜０．０１。     

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.