农村60岁以上COPD焦虑和抑郁症状调查

目的：调查枣庄市农村60岁以上中度慢性阻塞性肺疾病（COPD）稳定期患者焦虑和抑郁症状的严重程度。方法：采用Zung进行焦虑白评量表（SAS）和抑郁白评量表（SDS）评定入组患者焦虑和抑郁症状，用峰流速仪测定稳定期患者和正常对照组的肺功能。结果：60岁以上中度COPD稳定期患者焦虑和抑郁自评量表与国内常模及对照组比较均有显著差异（P＜0．01）；COPD患者肺功能与对照组相比具有统计学显著差异（P＜0．01）；60～69岁组肺功能与70-79岁组比较具有显著差异（P＜0．01）。结论：60岁以上COPD稳定期患者存在明显的焦虑和抑郁症状；COPD患者随着病程和年龄增加肺功能明显降低。     

慢性阻塞性肺疾病患者血清瘦素水平与营养不良的关系

目的：了解慢性阻塞性肺疾病（COPD）患者血清瘦素水平及其与营养不良和疾病严重度之间的关系。方法：采用放射免疫法测定90例稳定期COPD患者及48例健康对照者血清瘦素水平，并测量身高、体重、颈围、胸围、腹围及用力肺活量（FVC）和第一秒用力呼气容积（FEVI），计算体质指数及理想体重百分比。其中40倒COPD患者及25例健康对照者同时测定了血清白蛋白、淋巴细胞总数、24h尿肌酐含量及肌酐身高指数。分析血清瘦素水平与营养参数及肺功能指标的关系。结果：血清瘦素水平COPD组显著低于健康对照组（P〈0．01），COPD患者营养不良组显著低于非营养不良组（P〈0．01）；COPD血清瘦素水平与绝大多数营养参数及FEVI／FVC呈显著正相关（P〈0．01）。结论：COPD患者血清瘦素水平下降；病情越重，营养状况越差，血清瘦素水平亦越低。     

连续护理干预对COPD老年患者肺功能改善及生活质量的影响

目的：评价连续护理干预对COPD老年患者肺功能改善及生活质量的影响。方法收集2012年1-12月期间该院呼吸科住院收治的老年COPD病人150例,依照就诊顺序编号并随机分入两组：对照组（n=71）给予常规呼吸科护理,干预组（n=79）在此基础上给予连续性护理干预,随访1年后评价干预效果。结果干预组患者FVC1%、FVC%及PEF均明显好转,较干预前及同期对照组均明显提高（P＜0.05）;SGRQ问卷各项评分、总评分较干预前及同期对照组均显著降低（P＜0.05或0.01）;随访期间急诊次数、住院天数均明显低于对照组（P＜0.05）。结论在稳定期内对COPD老年患者实施连续护理干预有助于病人改善肺功能,延缓疾病进展,提高生活质量。     

稳定期慢性阻塞性肺疾病患者营养不良的护理干预效果研究

目的探讨对稳定期慢性阻塞性肺疾病（COPD）合并营养不良患者膳食营养护理干预的疗效。方法选取100例便于随访的稳定期COPD合并营养不良的患者，随机分为试验组48例，对照组52例。对试验组患者的膳食营养进行护理干预并详细记录体重，求得理想体重百分比（IBW）、三头肌皮肤皱褶厚度（TSF）、上臂中部周径（MAC）、血白蛋白（ALB）、稳定期时间及急性发作次数。结果试验组IBW、TSF、MAC、ALB与对照组间差异有显著性意义（P〈0，05）。结论对稳定期COPD合并营养不良患者的膳食营养进行护理干预能改善患者的营养状况，延长稳定期．减少急性发作次数．值得临床推广．     

合理肠内营养治疗慢性阻塞性肺疾病合并呼吸衰竭的临床应用

目的评价慢性阻塞性肺疾病（COPD）合并呼吸衰竭进行合理的肠内营养支持治疗后,患者的营养状况和临床疗效改善情况。方法选取COPD急性加重期合并呼吸衰竭患者48例,随机分成营养组与对照组各24例,营养组除加用口服或鼻饲喂养肠内营养液外,与对照组接受相同的抗感染和对症支持治疗。结果治疗4周后,营养组与对照组相比,体质量、肱三头肌皮褶厚度、上臂肌围、血清白蛋白、前白蛋白、胆固醇、甘油三酯水平、二氧化碳分压、氧分压、治疗天数、临床疗效等,差异均有显著性（P〈0．05或P〈0．01）;营养组治疗前后体质量、肱三头肌皮褶厚度、上臂肌围、血清白蛋白、前白蛋白、胆固醇、甘油三酯水平、二氧化碳分压、氧分压等,差异也有统计学意义（P〈0．05或P〈0．01）。结论为COPD急性加重期合并呼吸衰竭的患者提供合理的肠内营养支持可显著改善其营养状况,提高临床疗效,缩短带机和住院时间,节省医疗费用。     

吸入糖皮质激素对稳定期慢性阻塞性肺疾病的肺功能治疗效果

目的：观察吸入糖皮质激素对稳定期慢性阻塞性肺疾病（COPD）的肺功能治疗效果。方法：72例稳定期COPD患者分为支气管舒张试验阳性，阴性两组。观察吸入糖皮质激素前后其FVC，FEV1，PaO2,PaCO2的变化情况。结果：支气管舒张试验阳性组FVC，FEV，PaO2较治疗前明显提高，PaCO2明显下降（P＜0．01）。支气管舒张试验阴性者FVC，FEV1无改善（P＞0．05），PaO2,PaCO2得到了改善（P＜0．05）。结论：糖皮质激素对存在可逆性气流阻塞的COPD患者的肺功能有很好的治疗价值。     

稳定期慢性阻塞性肺病患者营养评价及短期静脉营养支持

为探讨稳定期慢性阻塞性肺病（COPD）患者营养状况及短期静脉营养支持的疗效。测定60例稳定期COPD患者的营养状况指标、最大口腔吸气压（MIP）及最大口腔呼气压（MEP）、并观察短期静脉营养支持后的疗效。结果发现60例患者中48．3％体重低于90％理想体重。低体重患者MIP、MEP及外周血淋巴细胞数明显低于正常体重患者（P＜0．05），低体重患者经静脉营养支持治疗2周后体重，低体重患者MIP、MEP及外周血淋巴细胞数明显低于正常体重患者（P＜0．05）。低体重患者经静脉营养支持治疗2周后体重、MIP、MEP及外周血淋巴细胞数明显增加。认为稳定期COPD患者存在营养不良，伴有呼吸肌力减弱。短期静脉营养支持能增强呼吸肌力、改善营养状况。     

健康教育对老年慢性阻塞性肺疾病缓解期病人的效果

①目的探讨健康教育对慢性阻塞性肺疾病（COPD）缓解期病人肺功能和生活质量的影响。②方法选取自愿参加第1秒用力呼气容积（FEVl）％〈69％的中重度老年COPD缓解期病人34例，人院即进行肺功能检查并采用生活质量评分表（QOL）评分，然后随机分为健康教育组18例和对照组16例，两组均给予常规治疗护理，健康教育组自人院至出院整个过程对病人进行有计划的健康教育，出院前两组病人均再次复查肺功能，并进行生活质量评分。③结果治疗后健康教育组肺功能、QOL总均分、社会活动分、日常生活分、抑郁分及焦虑分较治疗前均有明显改善（t=2．124～3．436，P〈0．05、0．01）；与对照组相比，差异有显著意义（t=2．101～7．149，P〈0．05、0．01）。④结论健康教育能明显改善老年COPD缓解期病人肺功能和生活质量。     

慢性阻塞性肺疾病患者血清视黄醇结合蛋白4水平及其与营养状况关系

目的了解慢性阻塞性肺疾病（COPD）患者血清视黄醇结合蛋白4（RBP-4）水平及其与营养状况的关系,探讨其临床意义。方法采用酶联免疫吸附测定法（ELISA）检测62例COPD稳定期患者和20例健康对照者血清RBP-4水平,分析其相关因素。结果COPD组血清RBP-4水平显著低于健康对照组（P〈0．01）;其中COPD营养不良组降低更显著（P〈0．01）;COPD营养正常组较健康对照组也显著降低（P〈0．01）。多元逐步回归分析表明,体质指数（BMI）和上臂肌围（MAMC）是血清RBP-4的独立相关因素。结论COPD稳定期患者血清RBP-4水平下降,营养状况越差降低越显著;营养正常的COPD患者血清RBP-4水平亦降低,提示这种改变并非均由营养不良引起,可能与疾病本身有关。     

护理干预对长期鼻饲匀浆膳食患者营养状况的影响

目的 探讨护理干预对长期鼻饲匀浆膳食患者营养状况的影响。方法 采用膳食调查、人体测量、实验室检查方法对31例长期鼻饲患者进行营养状况调查，根据调查结果采用健康教育、制定膳食建议等护理干预措施，确保患者每日摄入热量、三大营养成分供能比值符合合理的营养要求。比较患者干预前、后的营养状况。结果 护理干预后患者的营养状况[每天摄入的热量、蛋白质、碳水化舍物及上臂肌围（MAMC）、三头肌皮褶厚度（TSF）、淋巴细胞总数、白蛋白等观察指标]得到明显改善（P〈0.01）；呕吐、吸入性肺炎的发生率较护理前明显降低，差异有显著性意义（P〈0．01）。结论 护理干预能改善长期自制匀浆膳食患者的营养状况，降低并发症率。     

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.