宏基因组二代测序技术对AECOPD患者病原学诊断价值

目的：探究宏基因组二代测序技术（mNGS）对感染导致的慢性阻塞性肺疾病急性加重（AECOPD）患者病原学诊断价值。方法：AECOPD患者58例,观察组38例采集肺泡灌洗液同时作mNGS检测和细菌培养;对照组20例采集肺泡灌洗液仅作细菌培养。结果：观察组mNGS检测病原体阳性率（94.7%）高于灌洗液培养（31.6%）,差异具有统计学意义（χ2=22.04,P<0.01）。观察组平均住院时间9.89±2.01天,短于对照组的12.00±2.74天,差异具有统计学意义（t=3.344,P<0.01）。结论：mNGS对AECOPD患者病原学检测较传统方法更敏感,有助于更早获得致病菌信息,及时调整抗感染治疗。     

宏基因组二代测序在社区获得性肺炎中的应用价值

目的 探讨宏基因组二代测序(metagenomic next-generation sequencing, mNGS)检测支气管肺泡灌洗液(bronchoalveolar lavage fluid, BALF)中病原微生物在社区获得性肺炎中的诊断价值。方法 选取2018年11月～2021年7月至苏州市立医院住院的初始治疗失败的社区获得性肺炎患者57例,所得BALF同时进行传统方法和mNGS检测,比较两种方法的诊断价值。结果 在57例患者BALF病原学检测中,mNGS的检出率高于传统方法(80.70%vs 33.33%),差异有统计学意义(P<0.05)。mNGS检测的采信率为84.78%,敏感度为90.70%,特异性为50.00%,阳性预测值为84.78%,阴性预测值为63.64%。mNGS检测细菌阳性率高于传统方法(43.86%vs 15.79%),差异有统计学意义(P<0.05),但两者检测真菌、结核及病毒的阳性率比较,差异无统计学意义(P>0.05)。mNGS联合传统方法检测后,75.44%(43/57)患者确诊,43.86%(25/57)患者根据mNGS检测结...     

宏基因组二代测序在重症肺炎病原学诊断中的价值

目的探讨宏基因组二代测序（mNGS）对重症肺炎患者病原学诊断的价值。方法选择2021年5月至2023年5月宁波市泌尿肾病医院收治的60例重症肺炎患者。收集肺泡灌洗液5~10mL分别行常规检测与mNGS检测。比较mNGS检测与常规检测病原微生物阳性率。结果mNGS检测病原微生物阳性率为81.67%,显著高于常规检测的58.33%（P=0.002）。mNGS检测细菌阳性率为53.33%,显著高于常规检测的35.00%（P=0.005）;检测真菌阳性率为36.67%,显著高于常规检测的20.00%（P=0.005）;检测病毒阳性率为21.67%,显著高于常规检测的8.33%（P=0.011）。结论mNGS对重症肺炎病原学诊断阳性率较高,具有临床意义。     

不同取材方法及检测技术在重症肺炎病原学诊断中的应用

目的：不同取材方法标本的合格率、不同微生物检测技术结果阳性率有差异,探究不同取材方法及检测技术在重症肺炎病原学诊断中的应用,以期提高病原学诊断的准确性。方法：回顾性分析2018年1月—2020年12月中国人民解放军联勤保障部队第九〇四医院收治的123例重症肺炎患者的临床资料,同时收集患者经鼻或气管插管留痰培养、肺泡灌洗液培养、肺泡灌洗液宏基因组二代测序技术（mNGS）病原检测等数据,对标本的合格率及阳性率进行分析。结果：123例患者中经鼻或者气管插管留痰标本合格率70%、病原菌生长41例（33.3%）,肺泡灌洗液标本合格率92%、病原菌生长76例（61.8%）、肺泡灌洗液mNGS病原菌核酸片段检出107例（86.9%）。经抗感染、抗休克、器官支持等治疗后,115例患者治愈出院,8例死亡。结论：肺泡灌洗液mNGS可以提高重症肺炎患者病原诊断阳性率,可为临床治疗提供依据。     

支气管肺泡灌洗液ADA定量检测对不明原因肺部阴影的临床诊断意义

目的探讨支气管肺泡灌洗液中腺苷脱氨酶（ADA）定量检测在不明原因肺部阴影诊断中的临床价值。方法对76例不明原因肺部阴影患者在行支气管镜检查时留取支气管肺泡灌洗液进行ADA定量检测。根据最终病理确诊结果分为结核组（35例）和肺癌组（41例）。结果结核组患者支气管肺泡灌洗液中的ADA浓度明显高于肺癌组患者支气管肺泡灌洗液中的ADA浓度,差异有统计学意义（P〈0.05）;结核组患者患侧支气管肺泡灌洗液中的ADA浓度明显高于健侧ADA的浓度,差异有统计学意义（P〈0.05）。结论支气管肺泡灌洗液中ADA定量检测在肺部不明原因阴影的鉴别诊断,尤其是肺结核的诊断中具有较高的应用临床价值。     

床边纤维支气管镜支气管肺泡灌洗在难治性肺部感染中的应用

目的探讨床边纤维支气管镜支气管肺泡灌洗在难治性肺部感染中的应用价值。方法将60例难治性肺部感染患者随机分为治疗组和对照组,各30例。对照组采用抗感染等常规治疗,治疗组在常规治疗基础上加用纤支镜支气管肺泡灌洗治疗。治疗2周后对两组进行疗效评价。结果治疗组治愈率为73.3%,总有效率为93.3%,痰菌培养阳性率为76.7%,平均住院天数为（18.6±7.1）d;对照组治愈率为40.0%,总有效率为70.0%,痰菌培养阳性率为43.3%,平均住院天数为（25.7±7.8）d。两组比较,差异均有统计学意义（P〈0.05、P〈0.01）。结论纤支镜支气管肺泡灌洗治疗难治性肺部感染能提高治疗效果,缩短住院时间,值得推广。     

纤维支气管镜肺泡灌洗治疗重症肺部感染临床观察

目的:观察纤维支气管肺泡灌洗术在重症肺部感染中的治疗效果.方法:总结近3年来收治的重症肺炎患者72例,分为支气管肺泡灌洗组及常规治疗临床症状,痰培养阳性率住院天数对比进行临床疗效评估.结果:支气管肺泡灌洗组有效率96.5%,常规治疗组有效率80.2%(P＜0.05),痰培养阳性率,支气管肺泡灌洗组71.43%,常规治疗组47.51%(P＜0.05).住院平均天数支气管肺泡灌洗组14.2天,常规治疗组23.8天.结论:经纤维支气管镜肺泡灌洗对重症肺部感染性疾病疗效优于常规治疗组.     

支气管肺泡灌洗术对儿童支原体肺炎的病原诊断及治疗的影响

目的研究支气管肺泡灌洗术对儿童支原体肺炎病原诊断及治疗的意义。方法研究对象：2008年4月至2009年4月收住我院呼吸科病房的肺炎支原体（MP）感染肺炎患儿,共104例。随机分为2组：A组：大环内酯类为主的抗感染及对症治疗;B组：在A组基础上,予以纤维支气管镜进行支气管肺泡灌洗,收集支气管肺泡灌洗液行肺炎支原体RT-PCR测定,同时观察2组病人的临床疗效。结果 （1）支气管肺泡灌洗液MP-DNA,痰液MP-DNA及血清MP抗体检测阳性率无明显统计学差异。（2）B组与A组患儿相比在总咳嗽时间、肺部体征消失时间、治疗转归上存在显著性差异。结论 （1）气管肺泡灌洗液MP-DNA测定作为MP感染实验室诊断手段,临床应用价值有限。（2）支气管肺泡灌洗术能促进呼吸道症状的改善及体征恢复,能提高治疗的有效率。     

肺泡灌洗液Xpert MTB/RIF联合血清TSPOT-TB在病原学阴性肺结核中的诊断价值

目的：分析肺泡灌洗液利福平耐药实时荧光定量核酸扩增检测技术（Xpert MTB/RIF）联合血清结核感染T细胞斑点试验（TSPOT-TB）在病原学阴性肺结核中的诊断价值。方法：选取2021年2月至2022年2月在我院收治的120例可疑痰病原学阴性的肺结核患者为研究对象,研究对象的三次痰抗酸杆菌涂片检测均为阴性,且同时进行肺部CT、支气管镜检查等临床诊断,最终将120例肺结核患者分为肺结核组和非结核组,同时进行肺泡灌洗液Xpert MTB/RIF、血清TSPOT-TB检测、MGIT 960药敏试验。结果：经血清TSPOT-TB检测涂阴肺结核阳性预测值为75.00%（48/64）、阴性预测值为73.21%（41/56）;经支气管肺泡灌洗液Xpert MTB/RIF检测涂阴肺结核阳性预测值为75.34%（55/73）、阴性预测值为82.97%（39/47）;支气管肺泡灌洗液Xpert MTB/RIF、血清TSPOT-TB及二者联合诊断涂阴肺结核的ROC曲线下面积（AUC）值分别为0.741、0.779、0.865;以MGIT 960药敏试验结果为金标准,Xpert MTB/RIF诊断利福平耐药性的阳性预测值和阴性预测值分别为88.89%（8/9）和96.86%（62/64）。结论：肺泡灌洗液Xpert MTB/RIF联合血清TSPOT-TB在病原学阴性肺结核诊断中有较好的应用价值,且肺泡灌洗液Xpert MTB/RIF检测利福平耐药性较可靠,值得临床推广使用。     

呼吸机相关肺炎不同病原学诊断方法的评价

目的 探讨评价不同病原学诊断方法对呼吸机相关肺炎诊断和治疗的指导意义.方法 采用随机、对照实验,将接受人工气道和机械通气患者临床肺部感染评分(CPIS)在6分以上者分为吸出物组与灌洗液组两组,比较支气管肺泡灌洗液定量培养和气管内吸出物培养的优劣.结果 吸出物组与灌洗液组治疗前后CPIS评分比较有统计学意义(P<0.05);应用支气管肺泡灌洗液培养阳性率高于气道吸出物培养阳性率(X2=10.418,P<0.01).结论 应用支气管肺泡灌洗液可提高呼吸机相关肺炎病人细菌培养阳性率.     

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.