基于16S rDNA高通量测序分析2型糖尿病腹泻患者肠道菌群的变化

目的 利用16S rDNA高通量测序技术,研究2型糖尿病腹泻患者肠道菌群的变化。方法 收集18例2型糖尿病腹泻患者和23例健康受试者的粪便样本,提取肠道菌群基因组,采用二代高通量基因测序技术,对16S rDNA V3～V4高变区进行扩增测序、生物信息学分析,比较两组人群肠道菌群结构和种类的差异。结果 Alpha多样性分析显示2型糖尿病腹泻患者肠道中菌群的丰度和多样性低于健康对照组,P<0.05。在门水平上,2型糖尿病腹泻患者组拟杆菌门占比低于健康组,P<0.05;而厚壁菌门,疣微菌门高于健康组,P均<0.05。另外,厚壁菌门/拟杆菌门比值,患者组高于健康组,P<0.05。在属水平上,2型糖尿病腹泻患者组中粪杆菌属低于健康对照组,P<0.05。结论 16S rDNA高通量测序技术有助于分析2型糖尿病腹泻患者肠道菌群多样性,为研究肠道菌群与2型糖尿病腹泻的关系提供新的思路和理论依据。     

Graves病患者促甲状腺素受体抗体与肠道菌群及短链脂肪酸的相关性

目的 探讨甲状腺功能正常的Graves病患者与健康对照者之间粪便肠道菌群结构及短链脂肪酸的差异,并明确促甲状腺素受体抗体(thyrotropin receptor auto-antibodies,TRAb)与差异菌群的相关性。 方法 选取30名治疗后甲状腺功能恢复正常的Graves病患者和32名健康对照者为研究对象,采用16S rRNA测序分析肠道菌群构成,气相色谱-质谱联用法(gas chromatography-mass spectrometry, GC-MS)方法测定短链脂肪酸浓度,分析TRAb抗体滴度与差异菌群的相关性。 结果 与对照组比较,Graves组患者的肠道菌群α多样性指数显著降低。在科水平,Graves组患者的拟杆菌(Bacteroidaceae)及瘤胃球菌(Ruminococcaceae) 等相对丰度下降,普雷沃菌(Prevotellaceae)及韦荣球菌(Erysipelotrichaceae)丰度升高。在种水平,Graves组患者的霍氏真杆菌(Eubacterium _hallii)、瘤胃球菌及反刍动物真杆菌(Eubacterium-ventriosum)相对丰度升高,而瘤胃球菌(Ruminococcus-bicirculans)及普通拟杆菌(Bacteroide_vulgatus)等丰度下降,差异均有统计学意义。LEfSe分析显示,Graves组普雷沃菌(f_Prevotellaceae及g_unidentified_Prevotellaceae)及厌氧菌(s_Prevotella copri)富集。作为肠道菌群的重要代谢产物,Graves组患者的丙酸及丁酸浓度显著下降,丙酸浓度与瘤胃球菌丰度正相关。关联分析显示,血清TRAb抗体滴度与瘤胃球菌丰度呈负相关。 结论 即使甲状腺功能恢复正常,Graves病患者的肠道菌群及丙酸等浓度仍发生显著性改变,这一改变可能与血清TRAb抗体滴度相关。     

非酒精性脂肪肝与慢性肾脏病关系的回顾性队列研究

目的 探讨非酒精性脂肪肝(NAFLD)对慢性肾脏病(CKD)发病的影响。 方法 以山东大学附属省立医院健康体检中心接受常规健康体检的人群建立回顾性队列。队列人群为2005~2010年期间体检3次及以上并且在首次体检无CKD者。应用t检验、 χ2检验比较基线有无NAFLD两组人群的特征,应用Kaplan-Meier法分别估计基线有无NAFLD两组人群CKD的累计发病率,Log-rank检验用于比较其差异。单因素Cox用于探索CKD发生风险与相关因素如人口统计学特征、生化指标等的关系,应用多元Cox回归模型控制混杂因素后,分析NAFLD与CKD的关联。 结果 研究队列包含10 775人,共随访34 878人年(平均3.24±0.99年/人)。研究期间,CKD共发生1 068例,发病密度为30.62/1 000人年。基线有NAFLD组CKD的累计发病率显著高于无NAFLD组(22.76% vs 12.07%, P<0.01)。多因素Cox回归模型中,调整年龄、性别、体质量指数(BMI)、收缩压、空腹血糖、甘油三酯、高密度脂蛋白、血红蛋白、血小板压积、是否患高血压、是否患糖尿病、是否患代谢综合征及有无冠心病病史后,HR值为1.20(95% CI:1.05~1.38,P=0.01)。 结论 调整多种已知的CKD危险因素后,NAFLD与CKD发病的关系仍具有统计学差异,说明NAFLD为CKD发病的独立危险因素。该结果对CKD的预防有重要意义。     

慢性肾脏病1~3期患者希望水平对自我效能及自我管理的影响效应

目的 了解慢性肾脏病(CKD)1~3期患者希望水平、自我效能及自我管理的现状,探讨3个变量之间的相互影响效应。方法 应用Herth希望量表、美国Stanford大学慢性病管理自我效能量表、早期慢性肾脏病患者自我管理量表对北京协和医院153例CKD(1~3期)住院患者进行调查,采用结构方程建模法建立患者希望水平、自我效能及自我管理的结构方程模型。结果 患者希望水平总体中位得分为40.0(36.0,44.5)分,85.0%患者处于高等希望水平;中位总体自我效能得分为8.3(7.1,9.4)分;自我管理总体得分为(89.0±13.4)分。不同年龄段、性别、婚姻状况、文化程度、病程及CKD分期者,其在希望水平和自我管理状况方面差异均无统计学意义(P均>0.05)。年龄及婚姻状况与患者自我效能有关,年龄大于65岁者自我效能明显高于其他年龄段患者(P均<0.05),已婚者自我效能明显高于单身者(P<0.05)。希望水平对自我效能(β=0.67,P<0.05)和自我管理均有直接影响效应(β=0.46,P<0.05)。结论 CKD1~3期患者希望水平普遍较高。希望水平在一定程度上可影响患者的自我效能和自我管理状况。     

具核梭杆菌灌胃对大鼠肠道菌群的影响

目的 探究具核梭杆菌(Fusobacterium nucleatum)灌胃对健康大鼠肠道菌群的影响。 方法 将16只SD雄性大鼠随机分为2组(每组8只),处理组在大鼠第4、5、6、7、8周龄分别用具核梭杆菌灌胃1次,对照组在相同时间点以等量生理盐水灌胃。在大鼠第3、8、12周末收集粪便,提取DNA后通过Illumina Miseq平台进行16S rRNA基因高通量测序。应用蛋白印迹法检测大鼠粪便中针对具核梭杆菌的特异性IgA。 结果 第3周时,两组在菌群多样性、主要菌门水平方面的差异无统计学意义。第8周时,处理组菌群多样性明显低于对照组(P=0.009);处理组的厚壁菌门、变形菌门含量低于对照组,拟杆菌门含量高于对照组,差异均有统计学意义(P<0.05)。第12周时,处理组菌群多样性明显高于对照组(P=0.021),两组大鼠肠道菌群的主要菌门水平差异无统计学意义。同时,具核梭杆菌灌胃刺激机体产生了特异性IgA。 结论 具核梭杆菌通过未定植方式,对肠道菌群产生了影响,并可持续一定时间。具核梭杆菌刺激产生的特异性IgA可能是其不能在肠道定植的原因之一。     

1型糖尿病伴认知功能损伤小鼠脑组织肠道菌群代谢物的改变

目的 探讨在发生认知功能损伤的1型糖尿病(type 1 diabetes mellitus,T1DM)小鼠脑组织中肠道菌群代谢物的变化。方法 选取20只6周龄C57BL/6小鼠,适应性喂养1周后采用数字表法随机分为对照组(Control组,n=10)和1型糖尿病模型组(DM组,n=10)进行处理。采用链脲佐菌素(streptozotocin,STZ)诱导T1DM小鼠,造模成功8周后进行Morris水迷宫检测,随后收集小鼠脑组织采用宏代谢组学检测肠道菌群代谢产物,并分析差异代谢物以及代谢通路。结果 STZ腹腔注射后8周DM组小鼠空间学习和记忆能力明显受损,表现为Morris水迷宫中逃避潜伏期显著增加(P<0.001),平均游泳距离显著增加(P=0.001),目的象限所在时间(P=0.043)和穿越平台次数显著减少(P=0.004)。采用宏代谢组学鉴定了脑组织中123种肠道菌群代谢物并发现了谷氨酰胺(Log₂FC=0.262,P=0.002)、酒石酸(Log₂FC=0.847,P=0.017)、乳酸(Log₂FC=0.326,P=0.002)和间氨基苯甲酸(Log₂FC=1.028,P=0.046)、3-氨基异丁酸(Log₂FC=-1.466,P=0.049)、葡萄糖酸内酯(Log₂FC=-0.796,P=0.043)和苏糖酸(Log₂FC=-0.310,P=0.042)、吲哚乳酸(Log₂FC=-1.252,P=0.030)、酮亮氨酸(Log₂FC=-0.922,P=0.040)、3-羟基丁酸(Log₂FC=-0.372,P=0.009)以及肉豆蔻酸(Log₂FC=-0.563,P=0.035)11种显著差异代谢物,涉及14个主要相关代谢通路,包括嘧啶代谢、氨基酸代谢、糖代谢、短链脂肪酸代谢等。结论 DM小鼠脑组织中多种肠道菌群代谢物水平发生显著变化,靶向肠道菌群及其相关代谢通路有望成为治疗T1DM诱导的认知功能障碍的有效策略。     

初诊IgA肾病患者的肠道菌群及其与疾病进展因素的相关分析

目的: 观察慢性肾脏病(chronic kidney disease，CKD)1~2期的初诊IgA肾病患者肠道微生物群的特征，进一步探索IgA肾病疾病进展因素与肠道微生物之间的关系。方法: 收集19例CKD 1~2期的初诊IgA肾病患者和15例年龄、性别相匹配的健康对照组的新鲜粪便样本，提取粪便细菌DNA，针对V3-V4区域进行16S核糖体RNA(16S ribosomal RNA，16S rRNA)高通量测序分析肠道菌群的组成，应用Illumina Miseq平台对粪便菌群测序结果进行分析。收集初诊IgA肾病患者的疾病进展因素，研究肠道菌群与IgA肾病疾病进展因素之间的相关性。结果: (1) 与健康对照组相比，在门水平上，拟杆菌门(Bacteroidetes)的丰度显著降低(P=0.046)，放线菌门(Actinobacteria)的丰度显著升高(P=0.001)。在属水平上，埃希菌-志贺菌属(Escherichia-Shigella)、双歧杆菌属(Bifidobacterium)、Dorea等菌属的丰度显著升高(P < 0.05)，毛螺菌属(Lachnospira)、粪球菌属_2(Coprococcus_2)、萨特氏菌属(Sutterella)等菌属的丰度显著降低(P < 0.05)。(2)初诊IgA肾病患者与健康对照组之间肠道菌群的丰度比较差异无统计学意义(P>0.05)，但两组肠道菌群的组成存在差异。LEfSe分析结果显示，初诊IgA肾病患者和健康对照组比较有16个差异菌，其中，初诊IgA肾病患者肠杆菌目(Enterobacteriales)、放线菌门、埃希菌-志贺菌属等的丰度升高，健康对照组拟杆菌门、毛螺菌属的丰度升高。(3)冗余分析(redundancy analysis，RDA)的结果显示，初诊IgA肾病患者粪便中双歧杆菌属与血清IgA水平、24 h尿蛋白定量和合并高血压呈正相关，Lachnoclostridium菌属与合并高血压呈正相关，埃希菌-志贺菌属与尿红细胞数量呈正相关，双歧杆菌属与毛细血管内增殖呈正相关，粪杆菌属与细胞/纤维细胞性新月体呈正相关，瘤胃球菌属_2(Ruminococcus_2)与系膜细胞增殖、肾小球节段硬化、肾小管萎缩/间质纤维化呈正相关。结论: 初诊CKD 1~2期IgA肾病患者的肠道菌群与健康对照相比存在差异，肠道的某些菌属与IgA肾病疾病进展因素呈相关性，需要进一步的研究来了解这些菌属在IgA肾病中的潜在作用。     

代谢综合征对慢性肾脏病患者生存预后的影响

目的 明确代谢综合征(metabolic syndrome,MS)对慢性肾脏病(chronic kidney disease,CKD) 1~5期患者生存预后的影响。方法 选取2006年1月至2008年9月于北京大学第三医院肾内科规律复诊的CKD患者作为研究对象。收集所有研究对象的一般资料、化验检查结果。随访截止时间为2016年12月31日,以全因死亡作为终点事件,采用Kaplan-Meier法及Cox回归分析筛选出影响CKD患者生存预后的独立危险因素。结果 共纳入CKD分期为1~5期并完成随访的存活患者881例,其中合并MS者307例,未合并MS者574例。共有82例患者随访死亡。单因素生存分析及多因素Cox回归分析结果显示,年龄≥65岁、血清白蛋白<42 g/L、合并MS、合并心脑血管疾病是影响CKD患者生存预后的独立危险因素(P<0.05)。结论 MS是影响CKD 1~5期患者生存预后的独立危险因素,合并MS的CKD 1~5期患者死亡风险增大。     

阿卡波糖对冠心病合并糖耐量受损患者YKL-40和肠道菌群的影响

目的 探讨阿卡波糖在冠心病合并糖耐量受损(IGT)患者中对于炎症因子YKL-40和肠道菌群的作用。 方法 选取冠心病合并IGT患者57例,随机分为对照组(A组,n=27)和阿卡波糖300 mg/d干预组(B组,n=30),分别在基线水平和24周实验结束时进行体质指标评估、空腹血糖(FBG)、餐后2 h血糖(PBG)、血清胰岛素(FINS), 血脂、糖化血红蛋白(HbA1C)和血清YKL-40测定;应用实时荧光定量PCR检测粪便中双歧杆菌和乳酸菌的含量。 结果 A组和B组基线资料差异无统计学意义(P>0.05),Pearson相关结果分析表明,双歧杆菌和乳酸菌水平与YKL-40呈负相关。24周研究终点时B组YKL-40、FBG、PBG、HbA1c、胰岛素抵抗指数HOMA-IR等指标较A组显著降低(P<0.05);粪便双歧杆菌和乳酸菌含量显著增加(P<0.05)。 结论 应用300 mg/d阿卡波糖治疗24周后,冠心病合并IGT患者血糖得到改善, YKL-40显著下降, 肠道内有益细菌菌群数量增加。     

溃疡性结肠炎的微生态学改变及双歧杆菌治疗作用分析

目的 研究溃疡性结肠炎肠道微生态改变, 并观察双歧杆菌制剂对溃疡性结肠炎的治疗效果。方法 选取2018年5月至2019年10月北京中医药大学孙思邈医院收治的60例活动期溃疡性肠炎患者(A组)、60例缓解期溃疡性肠炎患者(B组)及60例同期体检健康者(对照组)作为研究对象。比较3组新鲜粪便中菌群变化情况。采用随机数字表法将A组、B组分为A1亚组(30例)、A2亚组(30例)、B1亚组(30例)和B2亚组(30例)。给予A1亚组和B1亚组患者口服双歧杆菌活菌胶囊, 给予A2亚组和B2亚组患者口服柳氮磺吡啶。比较4组患者临床疗效、组织学疗效及肠道菌群改变情况。结果 A组和B组大肠杆菌属、肠球菌属菌群数均显著大于对照组, 拟杆菌属、梭菌属、乳酸杆菌属和双歧杆菌属菌群数均显著低于对照组(P＜0.05);与B组比较, A组大肠杆菌属菌群数显著增加, 拟杆菌属、梭菌属、乳酸杆菌属和双歧杆菌属菌群数显著减少(P＜0.05)。A1组临床总有效率和组织学总有效率分别显著高于A2组, B1组临床总有效率和组织学总有效率分别显著高于B2组(P＜0.05)。各组治疗后大肠杆菌属和肠球菌属菌群数显著低于治疗前, 但拟杆菌属、梭菌属、乳酸杆菌属和双歧杆菌属菌群数显著高于治疗前;A1组和B1组患者治疗后大肠杆菌属和肠球菌属菌群数分别显著低于A2组和B2组, 拟杆菌属、梭菌属、乳酸杆菌属和双歧杆菌属菌群数分别显著高于A2组和B2组(P＜0.05)。结论 溃疡性结肠炎患者肠道内条件致病菌增加, 有益菌减少。双歧杆菌治疗溃疡性结肠炎疗效显著, 能够有效改善肠道微生态平衡。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.