喘宁碟与喘乐宁气雾剂治疗中重度哮喘的疗效观察

采用支气管舒张试验比较舒喘灵新剂型喘宁碟与喘乐宁气雾剂治疗中重度哮喘的疗效。中度哮喘患者用药后ＦＶＣ喘宁碟组改善显著（Ｐ＜０．０１），而喘乐宁组则无明显改善；ＦＥＶ１两组均有显著改善（ｐ＜０．０１）。重度哮喘患者用药后ＦＶＣ喘宁碟组改善显著（Ｐ＜０．０１），喘乐宁组无明显改善；ＦＥＶ１喘宁碟和喘乐宁两组均有显著改善（分别为Ｐ＜０．０１，Ｐ＜０．０５），但喘宁碟组显著高于喘乐宁组（Ｐ＜０．０５）。支气管舒张试验阳性率喘宁碟组也高于喘乐宁组，但只有重度哮喘患者两组差异有显著性意义（Ｐ＜０．０５）。结果表明，喘宁碟治疗哮喘疗效优于喘乐宁，而且更适于治疗重度哮喘患者。     

速尿雾化吸入治疗支气管哮喘的疗效与安全性探讨

目的：为探讨速尿雾化治疗哮喘的疗效与安全性，方法：观察组１２例支气管哮喘患者使用速尿２０ｍｇ雾化吸入，每日２次，对照组１２例用必可酮２００μｇ雾化吸入，每日２次然后观察临床疗效，动脉血氧分压（ＰａＯ２）肺功能第一秒最大呼气量（ＦＥＶ１）及第一秒最大呼气率（ＦＥＶ１％）结果：两组之间临床疗效无显著性差异（Ｐ〉０．０５）。两组治疗前后ＰａＯ２，ＦＥＶ１，ＦＥＶ１％各自对比均有明显提高（Ｐ〈０．０１），     

两种β兴奋剂对痉挛支气管的疗效对比

用舒喘宁控释剂（全特宁）与博利康尼进行对比，共治疗支气管哮喘和慢阻肺病患者３８例，结果显示两者总有效率相似（Ｐ〉０．０５）。用全特宁或博利康尼后３０分钟，８小时，１０天后与用药前比较，ＦＥＶ１．０和ＰＥＦ均有显著改善（Ｐ〈０．０１）。但用药后８小时，博利康尼对ＦＥＶ１．０和ＰＥＦ的作用减退，全物宁仍有疗效（Ｐ〈０．０１），我们认为两种药物均有显著效果，但对夜间发作的支气管哮喘，应用博利康尼需增加用     

哮喘患者末梢血及支气管粘膜内嗜酸粒细胞与 FEV_(1.0)的关系

对支气管哮喘（简称哮喘）发作期患者的末梢血及支气管粘膜内的嗜酸粒细胞（ＥＯＳ）与一秒钟用力呼气容积（ＦＥＶ１．０）的关系进行了研究，结果发现：哮喘发作期患者末梢血及支气管粘膜内ＥＯＳ显著增高（Ｐ＜０．０１），ＦＥＶ１．０明显下降，它们之间有相关性（ｒ＝０．６２３０，Ｐ＜０．０５）。提示：哮喘发作期患者ＦＥＶ１．０降低与末梢血及支气管粘膜内ＥＯＳ增多有关。     

支气管扩张试验肺功能参比较和临床应用探讨

为探讨支气管扩张试验在支气管哮喘中的价值，对２２４例已确诊的发作期哮喘患者进行了支气管扩张试验，比较扩张试验前、后用力肺活量（ＦＶＣ）、一秒钟用力呼气容积（ＦＥＶ１．０）、最大呼气流率（ＰＥＦＲ）、最大呼气中段流量（ＭＭＥＦ）的阳性率和变化率。结果显示ＦＶＣ阳性率４０．２％，变化率１５．３％，ＦＥＶ１．０阳性率７６．８％，变化率２３．８％，ＰＥＦＲ阳性率７９．９％，变化率３４．５％，ＭＭＥＦ阳性率     

双盲对照吸入倍氯米松一年对气道高反应性与哮喘的防治作用

目的探讨长期吸入糖皮质激素对哮喘患者的治疗作用和对无症状的气道高反应性（ＢＨＲ）者发生哮喘的预防作用。方法以随机、双盲对照法比较５９例ＢＨＲ学生,年龄１２～１８岁,吸入倍氯松干粉剂（ＢＤＰ,６００μｇ／ｄ）或安慰剂１年对气道反应性及哮喘症状的作用。结果试验１年后哮喘 ＢＤＰ组气道高反应性（使 ＦＥＶ１较基础值下降 ２０％的累积吸入组胺量的对数 ｌｇＰＤ２０－ ＦＥＶ１）显著下降（分别为０．３８５±０．４２４、１．１８７±０．６０３μｍｏｌ组胺,Ｐ＜０．０２）,只有３０％哮喘者仍有喘息,而对照组则有 ８６％仍有喘息（Ｐ＝０．０７６）;无症状 ＢＨＲ学生的 ｌｇＰＤ２０－ ＦＥ Ｖ１在 ＢＤＰ组及对照组间差异无显著性,但 ＢＤＰ组不出现喘息症状,而对照组则有 ３例出现喘息 （１５％）;ＢＨＲ者吸入 ＢＤＰ组的累积症状计分显著低于对照组（分别为１．５０±２．５４分、５．５８±６．２２分,Ｐ＜０．０）。结论ＢＤＰ能降低哮喘患者的 ＢＨＲ及减轻其症状,且可能有预防无症状 ＢＨＲ者发生哮喘的作用。     

气道阻力测定对支气管哮喘诊断价值的评价

测定３５例正常人、５２例缓解期支气管哮喘患者、１１０例缓解期慢性支气管炎或合并阻塞性肺气肿患者，分别对其气道阻力（Ｒａｗ）、比气道传导率（ｓＧａｗ）以及最大呼气流量－容积曲线（ＭＥＦＶ）进行了观察。结果表明：单纯哮喘患者Ｒａｗ明显高于正常人与阻塞性支气管炎（ＣＯＢ）患者（Ｐ＜０．００１），而ＭＥＦＶ测值正常。慢性支气管炎组Ｒａｗ高于正常组，但明显低于哮喘组（０．０５＞Ｐ＞０．０２），而ＭＥＦＶ曲线指标ＦＥＶ１、ＭＭＥＦ、Ｖ７５在ＣＯＢ时期已明显降低，其中ＭＭＥＦ下降最为突出。提示Ｒａｗ是诊断单纯哮喘的敏感指标，若能结合ＭＥＦＶ曲线，对单纯哮喘与ＣＯＢ的鉴别诊断，有一定的临床价值     

慢性阻塞性肺病及慢性咳嗽者的气道反应性测定与分析

测定１５例慢性阻塞性肺疾病（ＣＯＰＤ）及３０例慢性咳嗽患者的气道反应性与肺通气功能，气道高反应性（ＢＨＲ）发生率均高于对照组。ＣＯＰＤ组的Ｐｃ２０ＦＥＶ_１与基础％ＦＥＶ_１呈正相关（ｒ_ｓ＝０．６７７２，Ｐ＜０．０５），ＢＨＥ与基础％ＦＥＶ_１低有关。激发试验后吸入喘乐宁ＦＥＶ_１有所回升表明支气管扩张剂对组织胺诱发的气道痉挛有一定缓解作用。慢性咳嗽组８例ＢＨＲ者激发试验中出现哮鸣音，在随后的１．５～１２个月内出现喘息症状，因此应考虑为不典型哮喘。     

慢性阻塞性肺病患者静息能量消耗

研究慢性阻塞性肺病（ＣＯＰ）患者机体能量消耗变化并探讨其与肺功能损害程度的关系。测定 ６２例ＣＯＰＤ缓解期患者静息能量消耗（ＲＥＥ）并与４１例健康老人测定值比较。结果：各年龄组ＣＯＰＤ患者ＲＥＥ占预计值百分比（ＲＥＥ％）均明显高于对照组（Ｐ＜０.００１），气道阻塞程度越严重，ＲＥＥ％越高，第一秒用力呼气容积（ＦＥＶ１）预计值百分比（ＦＥＶ１％）与 ＲＥＥ％呈负相关（ｒ＝－０．７３， Ｐ＜０．００１），ＦＥＶ１与用力肺活量之比（ＦＥＶ１／ＦＶＣ与ＲＥＥ％也呈负相关（ｒ＝－０．５９，Ｐ＜０．００１）。结论：研究结果可用于ＣＯＰＤ患者营养治疗时营养处方的计算，也便于对肺功能损害程度不同的ＣＯＰＤ患者营养素摄入情况进行比较。     

雷公藤甲素对哮喘动物模型气道反应性的作用及机理

用卵白蛋白致敏和激发豚鼠，形成哮喘动物模型（哮喘组）。用雷公藤甲素（简称“雷公藤组”）处理哮喘模型后，测定以上二组和正常对照组豚鼠对组织胺的气道反应性、支气管肺泡灌洗液（ＢＡＬＦ）中的嗜酸性粒细胞（Ｅｏｓ）绝对计数、低密度Ｅｏｓ（ＨＥｏｓ）百分比以及ＥＡＬＦ中的嗜酸性粒细胞活力增强活性（ＥＶＥＡ）。发现哮喘组气道反应性非常显著高于正常组（Ｐ＜０．００１）、雷公藤组（Ｐ＜０．０１），雷公藤组显著高于正常组（Ｐ＜０．０５）。而且，哮喘组Ｅｏｓ绝对计数和ＨＥｏｓ％均与气道反应值（ＰＣ２０值）显著相关（ｒ＝－０．７６和－０．８８，Ｐ＜０．０５和０．０１）。雷公藤甲素处理不能抑制哮喘模型肺内的Ｅｏｓ聚集，但却降低ＨＥｏｓ％至正常组水平。哮喘组ＢＡＬＦＥＶＥＡ显著高于对照组、雷公藤组。哮喘组ＢＡＬＦＥＶＥＡ与ＨＥｏｓ％呈显著的正相关（ｒ＝０．７５，Ｐ＜０．０５）。以上结果表明，雷公藤甲索具有降低哮喘动物模型气道反应性的作用，其机理可能与减少“活化”的ＨＥｏｓ有关。雷公藤甲素可能有潜在的临床应用价值。     

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.