吸入性糖皮质激素对稳定期慢性阻塞性肺疾病治疗效果的Meta分析

目的：系统性评价吸入性糖皮质激素对稳定期慢性阻塞性肺疾病(COPD)患者生命质量及肺功能一秒用力呼气容积(FEV1)改善情况。方法计算机检索The Cochrane Library、中国知网、万方及维普等数据库中关于吸入性糖皮质激素治疗稳定期COPD患者的随机对照研究(RCT),检索时限均为从建库至2014年10月1日。同时手工检索纳入研究的参考文献。由两名研究者按照纳入与排除标准独立筛选文献,提取资料和评价纳入研究的方法学质量后,采用RevMan 5.2软件进行Meta分析。结果共纳入8项研究,844例患者。 Meta分析结果显示：与对照组比较,吸入性糖皮质激素使稳定期COPD患者肺功能第1秒用力呼气量(FEV1)显著改善[SMD=0.83,95%CI：0.49~1.16,P<0.00001]、呼吸困难减轻[SMD=-2.34,95%CI：-3.15~-1.53,P<0.0001]、6 min步行距离增加[SMD=0.33,95%CI：0.17~0.49,P<0.0001]、生命质量提高[SMD=-1.89,95%CI：-2.3~-1.48,P<0.0001],急性加重患者的门诊和住：次数减少。结论吸入性糖皮质激素的应用可改善稳定期COPD患者FEV1,增加6 min步行距离,改善生命质量、减轻呼吸困难,减少急性加重次数。     

COPD患者尿锁链素的检测及其与肺功能相关性分析

目的:观察慢性阻塞性肺疾病(COPD)患者尿锁链素(DES)水平及其与病期及肺功能相关性。方法:选取COPD急性加重期住院患者30例(急性加重期组),稳定期患者30例(稳定期组),另选同期健康体检者30例做对照组。采用间接竞争性酶联免疫吸附法(IC-ELISA)法检测各组尿锁链素,并测定三组肺功能第1秒用力呼气容积占用力肺活量比(FEV_1/FVC)及第1秒用力呼气容积占预计值百分比(FEV_1%Pred)。结果:急性加重期组、稳定期组及对照组受试者尿锁链素水平组间比较差异均有统计学意义(P0.05);急性加重期组和稳定期组COPD患者尿锁链素水平与FEV1/FVC及FEV1%Pred均呈负相关(r=-0.735、-0.643,P0.05)。结论:COPD患者尿锁链素水平可能与COPD病情的严重程度相关,有望作为病情评估、疗效评价的标志物。     

CD163对判断慢性阻塞性肺疾病急性加重的临床价值

目的 探讨血清可溶性清道夫受体CD163在慢性阻塞性肺疾病（COPD）患者血清中的表达及临床意义。方法 选取文昌市人民医院100例COPD患者,其中,急性加重期患者45例（急性加重期组）,稳定期患者55例（稳定期组）;同期选取该院50例健康体检者为对照组。比较3组血清CD163含量的变化,检测肺功能相关指标,分析血清CD163与患者肺功能的相关性,采用受试者操作特征（ROC）曲线分析血清CD163诊断COPD的临床价值。结果 3组血清CD163水平比较,差异有统计学意义（P?<0.05）;与对照组比较,急性加重期组和稳定期组患者血清CD163水平升高（P?<0.05）;与稳定期组比较,急性加重期组患者血清CD163水平升高（P?<0.05）。3组第1秒用力呼气容积（FEV1）、最大呼气流量（PEF）、第1秒用力呼气容积与用力肺活量比值（FEV1%）及第1秒用力呼气容积占预计值百分比（FEV1%预计值）比较,差异有统计学意义（P?<0.05）;与对照组比较,急性加重期组和稳定期组患者FEV1、PEF、FEV1%及FEV1%预计值降低（P?<0.05）;与稳定期组比较,急性加重期组患者FEV1、PEF、FEV1%及FEV1%预计值降低（P?<0.05）。Spearman相关性分析结果显示,急性加重期组患者血清CD163水平与FEV1%及FEV1预计值呈负相关（rs=-0.833和 -0.805,均P?=0.000）;稳定期组患者血清CD163水平与FEV1%及FEV1%预计值呈负相关（rs=-0.714和-0.643,均P?=0.000）;血清CD163诊断COPD急性加重期的曲线下面积为0.821（95% CI：0.629,0.976）,诊断敏感性为0.928,特异性为0.803;其诊断COPD稳定期的曲线下面积为0.784（95% CI：0.436,0.761）,诊断敏感性为0.872,特异性为0.741。结论 CD163在COPD患者血清中呈高表达,其表达与患者肺功能密切相关,或将成为COPD临床诊断的一项新指标。     

慢性阻塞性肺疾病患者CAT评分、呼出气一氧化氮、肺功能之间的相关性研究

目的:探讨慢性阻塞性肺疾病(COPD)患者生活质量及呼出气一氧化氮(Fe NO)与肺功能之间的相关性,探索一种简单、易行、准确的监测及管理COPD患者的气道炎性反应和控制情况的方法。方法:纳入81例COPD急性加重期到COPD稳定期患者及78例健康对照组,并行常规肺功能检查记录第1秒用力呼气容积(FEV1)、第1秒用力呼气容积占预计值百分比(FEV1%pred),采用瑞典耐尔斯NIOX一氧化氮测定仪检测FENO值,对COPD患者急性加重进行CAT评分,治疗稳定后再次进行CAT评分。结果:急性加重期CAT评分显著高于稳定期,急性加重期FENO水平显著高于稳定期,急性加重期及稳定期FENO均显著高于健康对照组,差异均有统计学意义(P<0.05)。急性加重期与稳定期FENO与CAT评分均呈显著正相关,差异有统计学意义(P<0.05),急性加重及稳定期CAT评分与FEV1、FEV1%均无显著相关性,急性加重期及稳定期FENO与FEV1、FEV1%均无显著相关性,差异无统计学意义(P>0.05),但急性加重期到稳定期FEV1、FEV1%的改善与CAT评分的改善及FENO的改善均呈显著正相关性,急性加重期到稳定期CAT评分改善与FENO改善呈显著正相关,差异有统计学意义(P<0.05)。结论:FeN O可比较简单、快速地反应COPD患者的气道炎性反应及控制情况,FeN O值越高,则CAT评分越高,COPD患者生活质量越差、病情控制程度越差。FeN O结合肺功能指标及CAT评分更能全面反映COPD生活质量及控制情况。     

慢性阻塞性肺疾病患者血清CRP与肺功能的相关性

目的:探讨慢性阻塞性肺疾病(COPD)患者血清C-反应蛋白(CRP)的水平与肺功能的关系.方法:收治COPD患者5O例,其中处于急性加重期者(AECOPD)31例(加重期组),稳定期19例(稳定期组)和健康对照者(对照组)23例,取空腹静脉血,测定血清中CRP的浓度,并对COPD患者进行肺功能检查.结果:COPD急性加重期患者血清CRP显著高于稳定期组和对照组(均P＜0 01),COPD稳定期组上指标均较对照组为高(P＜0 O1),加重期组和稳定期组患者血清CRP与第1秒用力呼气容积(FEV1)/最大用力肺活量(FVC)和FEV1%呈负相关,结论:血清CRP可作为判断COPD急性加重期的指标;血清CRP可能与COPD患者的肺功能下降有关.     

沉默信息调节因子2相关酶1在慢性阻塞性肺疾病患者血清中的表达水平及临床意义

目的探讨沉默信息调节因子2相关酶1(SIRT1)在慢性阻塞性肺疾病(简称慢阻肺)患者血清中的表达水平及临床意义。方法选取本院慢阻肺急性加重期患者40例、慢阻肺稳定期患者30例作为研究组,另选体检健康者20例作为对照组。对所有受试者进行肺功能检查。应用酶联免疫吸附法和蛋白免疫印迹检测血清SIRT1、核因子-κB(NF-κB)、基质金属蛋白酶-9(MMP-9)水平。结果与对照组相比,慢阻肺稳定期组和慢阻肺急性加重组患者第1秒用力呼气容积占预计值百分比(FEV1%pred)及第1秒用力呼吸容积占用力肺活量百分比(FEV1/FVC)均显著降低(均P0.05)。与慢阻肺稳定期组相比,慢阻肺急性加重组患者FEV1%pred及FEV1/FVC均显著降低(P0.05)。与对照组相比,慢阻肺稳定期组和慢阻肺急性加重组患者血清SIRT1水平均显著降低,而NF-κB和MMP-9水平均显著增加(P0.05)。与慢阻肺稳定期组患者相比,慢阻肺急性加重组患者血清SIRT1水平显著下降,而NF-κB和MMP-9水平均显著增加(均P0.05)。经Pearson直线相关法分析,血清SIRT1水平与慢阻肺患者FEV1%pred(P0.05)、FEV1/FVC(P0.05)等肺功能指标呈显著正相关。血清SIRT1水平与NF-κB(P0.05)、MMP-9(P0.05)蛋白表达水平呈显著负相关。结论慢阻肺患者血清SIRT1水平降低与肺功能下降相关,有可能作为慢阻肺的潜在生物标志物。     

慢性阻塞性肺疾病患者外周血单个核细胞CD36 mRNA、血清ApoE水平对急性加重期发生的预测价值

目的：分析慢性阻塞性肺疾病（COPD）患者外周血单个核细胞（PBMCs）白细胞分化抗原36（CD36）信使核糖核酸（mRNA）、血清载脂蛋白E（ApoE）水平对急性加重期发生的预测价值。方法：选取2021年6月-2022年5月在湖州市中心医院就诊的COPD患者96例,其中急性加重期COPD患者为AECOPD组（n=50）,稳定期COPD患者为稳定组（n=46）,选取健康人群40例为对照组。检测所有受试者血清炎性因子[肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-6、IL-1β、C反应蛋白（CRP）]、ApoE、肺功能指标[第1秒用力呼气容积与用力肺活量的比值（FEV1/FVC）、第1秒用力呼气容积占预计值百分比（FEV1%pred）]和PBMCs中CD36 mRNA水平;分析COPD患者PBMCs中CD36 mRNA、血清ApoE水平与炎性因子、肺功能指标的相关性以及PBMCs中CD36 mRNA、血清ApoE对COPD患者急性加重期发生的预测价值。结果：对照组、稳定组、AECOPD组吸烟史比例、TNF-α、IL-6、IL-1β、CRP、PBMCs中CD36 mRNA和血清ApoE水平依次升高,FEV1/FVC、FEV1%pred水平依次降低（P＜0.05）;COPD患者PBMCs中CD36 mRNA与血清ApoE水平呈正相关（P＜0.05）,COPD患者PBMCs中CD36 mRNA、血清ApoE水平均与血清TNF-α、IL-6、IL-1β、CRP呈正相关（P＜0.05）,与FEV1/FVC、FEV1%pred呈负相关（P＜0.05）;PBMCs中CD36 mRNA单独、血清ApoE单独、二者联合预测COPD患者急性加重期发生的曲线下面积（AUC）分别为0.887、0.871、0.966,二者联合预测的AUC高于CD36 mRNA、ApoE单独预测的AUC（P＜0.05）。结论：COPD患者PBMCs中CD36 mRNA和血清ApoE均呈高表达,二者对COPD患者急性加重期发生具有一定的预测价值。     

灯盏细辛注射液在高龄老年中重度慢性阻塞性肺疾病稳定期治疗中的应用

目的：观察灯盏细辛注射液在高龄老年中重度慢性阻塞性肺疾病（ COPD）稳定期治疗中的应用效果,并探讨其作用机制。方法将68例80岁以上中重度COPD稳定期患者随机分为两组,各34例。对照组采用常规西药治疗;观察组在对照组治疗基础上加用灯盏细辛注射液静脉滴注,1次／d,每月使用20 d为一疗程,总共3个疗程。观察两组治疗前后肺功能指标：用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、第1秒用力呼气容积占用力肺活量百分比（ FEV1／FVC）;血液流变学指标：血黏度、红细胞压积、纤维蛋白原及炎性因子：白细胞介素－8（IL－8）、肿瘤坏死因子α（TNF－α）、C－反应蛋白（CRP）水平的变化。同时分别记录两组治疗前后3个月COPD急性加重（ AECOPD）发作次数。结果治疗后两组肺功能指标、血浆IL－8、TNF－α、CRP水平以及血黏度、红细胞压积、纤维蛋白原较治疗前均有改善（P＜0.05,P＜0.01）;组间各指标比较显示,观察组更为明显（P＜0.05）。与此同时,观察组AECOPD发作次数明显减少（ P＜0.05）。结论灯盏细辛注射液能显著改善高龄老年中重度COPD患者稳定期肺功能,并能减少其急性加重发作次数。其作用机制可能与其降低COPD患者细胞炎症因子水平及血液高黏状态等因素有关,值得临床推广应用。     

血清25（OH）D对COPD患者肺功能及炎性因子的影响

目的探讨血清25羟维生素D[25（OH）D]对慢性阻塞性肺疾病（COPD）患者肺功能及炎性因子的影响。方法选取2018年1月至2019年8月在台州市中心医院诊治的COPD患者80例,其中急性加重期COPD（AECOPD）患者40例作为AECOPD组,稳定期COPD（SCOPD）患者40例作为SCOPD组;另选取同期在本院进行健康体检的人员40例作为对照组。测定患者第一秒用力呼气容积（FEV1）/预计值和第一秒用力呼气容积/用力肺活量（FEV1/FVC）等肺功能指标。采用ELISA法测定25（OH）D和TNF-α水平,免疫层析法测定CRP水平。比较3组对象肺功能指标、25（OH）D、TNF-α及CRP水平。采用Pearson相关分析血清25（OH）D水平与肺功能指标及炎性因子水平的相关性。结果与对照组相比,AECOPD组和SCOPD组患者FEV1/预计值、FEV1/FVC和25（OH）D水平均降低,CRP和TNF-α水平均升高,差异均有统计学意义（均P＜0.05）;与SCOPD组相比,AECOPD组患者FEV1/预计值、FEV1/FVC和25（OH）D水平均降低,CRP和TNF-α水平均升高,差异均有统计学意义（均P＜0.05）。Pearson相关分析显示,25（OH）D水平与FEV1/预计值及FEV1/FVC均呈正相关（r=0.532和0.638,均P＜0.05）,与TNF-α和IL-6水平均呈负相关（r=-0.693和-0.522,均P＜0.05）。结论血清25（OH）D通过影响COPD患者的肺功能指标和炎性因子水平参与其发生、发展,其水平与疾病的进展呈负相关。     

呼吸功能锻炼联合营养护理对COPD稳定期患者生命质量的影响

【摘要】 目的 探讨呼吸功能锻炼联合营养护理对慢性阻塞性肺疾病（COPD）稳定期患者生命质量的影响。方法 以2015年1月～2017年1月四川大学华西医院呼吸与危重症医学科收治并坚持随访的92例COPD稳定期患者为研究对象,随机分为研究组和对照组,每组46例。研究组采用呼吸功能锻炼联合营养护理,对照组采用常规护理,比较两组患者圣乔治呼吸问卷（SGRQ）得分及用力肺活量（FVC）、第1秒用力呼气量（FEV1）、第 1 秒用力呼气容积占用力肺活量的百分比（FEV1/FVC）、第1秒用力呼气容积占预计值百分比（FEV1%pred）、呼气峰值流速（PEF）等肺功能指标变化。结果 与对照组比较,研究组在SGRQ症状部分、活动部分、影响部分得分及总分降低（P＜005）。与对照组比较,研究组FVC、FEV1、FEV1/FVC、PEF等指标与升高（P＜005）,与对照组比较,研究组FEV1%pred无统计学意义（P＞005）。结论呼吸功能锻炼联合营养护理能有效改善COPD稳定期患者的肺功能及生命质量,值得临床推广应用。     

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.