慢性酒精中毒性肌病的临床及病理特点研究

目的探讨慢性酒精中毒性肌病患者的临床表现、骨骼肌活检病理特点。方法总结12例临床确诊的酒精中毒性肌病患者的临床资料,对确诊病例行骨骼肌活检,行组织化学染色,光镜下观察、摄片,进行病理分析。结果慢性酒精中毒肌病患者以肌无力、肌萎缩为主要表现,辅助检查无明显特异性;肌肉病理可见坏死、萎缩肌纤维,以Ⅱ型肌纤维萎缩为主,可见不整红边纤维（RRF）。结论慢性酒精中毒性肌病的病理变化多样,综合病史、病理检查,完善相关辅助检查是诊断该病的关键。     

慢性酒精中毒性肌病的临床观察

目的探讨慢性酒精中毒性肌病患者的临床表现特点.方法对60例慢性酒精中毒患者进行详细询问病史、查体,并记录酒精摄入量、测定酒精依赖程度和完成相关辅助检查.结果 (1)酒精中毒性肌病的主要临床表现为肢带肌的无力、肌肉疼痛和萎缩,肌病的症状和体征往往先于周围神经的损害.(2)46.9%的酒精中毒性肌病患者合并周围神经损害,46.2%的患者同时有心肌损害的表现.结论 (1)酒精中毒性肌病的主要临床表现为肢带肌的无力、肌肉疼痛和萎缩.(2)酒精中毒性肌病患者常合并周围神经和心脏损害.     

慢性酒精中毒性肌病的电生理表现

目的探讨慢性酒精中毒性肌病的电生理改变特点.方法对26例慢性酒精中毒性肌病、13例慢性酒精中毒性周围神经病、21例慢性酒精中毒性神经和肌肉混合损害患者,以及20例正常受试者,检测肌电图、单纤维肌电图、肌纤维传导速度、周围神经传导速度和诱发电位.结果肌病组患者9例呈肌源性肌电图异常改变,周围神经病组患者7例为神经源性改变,混合损害组患者中有4例同时出现两种类型改变.与正常对照受试者比较,各组患者神经肌肉颤抖值均增大(P＜0.05),纤维密度增加(P＜0.05),周围神经病组患者的神经肌肉颤抖值和纤维密度改变尤为显著(P＜0.01).肌病组患者肌纤维传导速度明显减慢(P＜0.05),其余两组患者无显著变化(P＞0.05).周围神经病和混合损害组患者中,感觉神经传导速度减慢28例(82.35%).结论肌电图检查和神经传导速度测定可帮助鉴别酒精中毒性肌病和周围神经病,肌纤维传导速度的异常可确定肌肉病变.     

慢性酒精中毒性肌病25例临床分析

目的分析慢性酒精中毒性肌病患者的临床表现特点及治疗。方法对我院25例慢性酒精中毒性肌病患者作综合性分析。结果3例患者在3个月后大部分症状消失，肌张力Ⅴ级，肌肉萎缩明显好转；17例患者在3～9个月后大部分症状消失，肌张力Ⅲ～Ⅴ级，肌肉萎缩较前好转；5例患者未能坚持戒酒，在9～12个月后大部分症状仍未消失，肌张力Ⅱ～Ⅲ级，肌肉萎缩无明显好转。结论戒酒并配合肢体功能锻炼是治疗慢性酒精中毒性肌病最为重要的措施。     

氯丙烯对运动终板超微结构的影响

氯丙烯染毒后大鼠膈肌Ⅰ型及Ⅱ型肌纤维内运动终板超微结构的改变主要是接头前部分突触小泡显著减少或消失及线粒体变性,提示氯丙烯通过影响突触小泡和线粒体,改变神经肌肉间的传递。氯丙烯对Ⅱ型肌纤维内突触后膜有皱褶的运动终板毒害较重,而Ⅰ型肌纤维内突触后膜无皱褶的运动终板相对较轻。     

慢性酒精中毒性肌病（附9例临床及病理报告）

慢性酒精中毒性肌病（chronic aleoholic myopathy，CAM）是由长期酗酒引起的一种肌病，随着世界各国酒精消耗量的日益增加，其发病率逐年上升。大约有1／3—2／3的酗酒者有骨骼肌功能障碍。目前对酒精中毒性脑病及周围神经病的病理机制、临床特点、治疗已有较多研究报道，而对酒精中毒性肌病报道较少。本文就2000年～2005年经我院行肌活检病理证实的慢性酒精中毒性肌病患者9例临床及病理报告如下。     

糖原贮积症伴脂质贮积症

目的 探讨糖原贮积症伴脂质贮积症的临床与病理特点。方法 报告１例患者,结合文献复习,描述其临床与病理特征。结果 本病多见于婴儿或青少年女性,进行性或抒发性广泛性肌张力减低,四肢近端肌无力或萎缩,可伴有肌肉酸痛。病理特点为肌纤维出现弥温性空泡,Ⅰ型纤维受累可比Ⅱ型肌纤维明显,电镜下发现糖原和脂滴贮积于肌纤维内。结论 当患者因条件受限、无法进行生化检查时,光、电镜结合的活检肌组织形态观察有助于诊断。     

去神经后骨骼肌的组织化学观察

用18只健康的成年大鼠,切断其一侧坐骨神经,于术后第1,2,4周及第2,6个月取双侧趾长伸肌、比目鱼肌、腓肠肌,进行组织化学观察,发现氧化酶、脱氢酶类变化缓慢,而磷酸化酶变化明显。去神经后1周,Ⅱ型肌纤维萎缩较显著,2周后两型肌纤维萎缩速率相同。     

PKC/CUGBP1信号通路与强直性肌营养不良骨骼肌病理特征的关系

目的探讨强直性肌营养不良(DM)骨骼肌中蛋白激酶C/CUG三联体重复RNA结合蛋白(PKC/CUGBP1)信号通路与骨骼肌纤维病理特征的关系。方法选取11例DM患者(DM组)与11例无肌不良骨折患者(正常组),均行肌肉活检病理检查;组织化学染色(HE、MGT、NSE、NADH-TR、ACP、ATP)观察病理特征;免疫印迹检查肌肉组织中PKC/CUGBP1信号通路关键蛋白PKCδ、p-PKCδ、CUGBP1的表达,并分析PKCδ、p-PKCδ、CUGBP1蛋白表达水平与DM患者病理特征的相关性。结果组织化学染色显示,DM患者骨骼肌出现大量肌纤维异常、肌纤维核内移;DM组肌肉组织中p-PKCδ、CUGBP1蛋白表达水平均明显高于正常组(t=-23.907、-36.743,均P<0.001),且均与肌纤维萎缩、肌纤维肥大、肌纤维核内移发生率呈正相关(均P<0.05)。结论PKC/CUGBP1信号通路在DM中的活性与患者骨骼肌发生肌纤维异常、肌纤维核内移的病理特征存在相关性。     

Joseph病黄氏家系患者的周围神经及肌肉病变

本文观察3例Joseph病黄氏家系患者的周围神经、肌肉及皮肤活检病理。根据临床症状,3例分别为Ⅰ型、Ⅱ型及Ⅲ型,所有病例均有共同的病理学改变,即周围神经的有髓纤维减少、轴索粗细不等;电镜证实轴索退变,所绕髓鞘或增厚,或分层,雪旺氏细胞有轻度增生;肌肉呈不同程度的神经性肌萎缩,Ⅲ型者萎缩尤著,肌组织大部分为脂肪结缔组织所取代,残留的萎缩肌纤维一部分有继发退变,电镜下可见肌原纤维排列紊乱,线柱体退变及肌纤维坏死;第Ⅰ、Ⅲ型取皮肤活检,均示真皮弹力纤维断裂。以上所见说明Joseph病具有明显的慢性周围神经病变及肌肉萎缩,病变程度与临床亚型及病程有关。     

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.