安理申联合克林澳治疗早期血管性痴呆的临床研究

目的观察安理申(盐酸多奈哌齐)联合克林澳(马来酸桂哌齐特)治疗早期血管性痴呆的临床疗效。方法100例血管性痴呆患者随机分为两组,治疗组50例采用安理申5mg每晚临睡前口服,共治疗4周。另给予克林澳注射液160mg加入生理盐水250mL中静滴,每日1次,共2周。对照组50例采用安理申5mg每晚临睡前口服,共治疗4周。治疗4周前后评价简易智能精神状态评估量表(MMSE)、日常生活功能量表(ADL)、长谷川痴呆量表(HDS)、痴呆严重程度临床评定量表(WMS)、TCD的变化。将结果进行统计学处理。结果治疗组治疗后MMSE、ADL、HDS、WMS评分和TCD及脑动脉血流较对照组均有明显改善,差异有统计学意义(P<0.05)。治疗组治疗前后评分及TCD亦有显著改善,差异有统计学意义(P<0.05)。结论安理申联合克林澳治疗早期血管性痴呆疗效显著,优于单独使用安理申。     

安理申与脑复康治疗血管性认知功能障碍的疗效比较

目的 比较安理申与脑复康两种药物治疗血管性认知功能障碍(VCI)的疗效.方法 入选79例患者随机分为两组,安理申组36例,口服安理申5mg,每日夜晚睡前服用,连服12个月;脑复康组43例,口服脑复康0.8g,每天3次,连服12个月,治疗前后分别使用MMSE及ADL评估疗效.结果 安理申组治疗后MMSE得分明显高于脑复康组(P＜0.05),ADL得分低于脑复康组(P＜0.05).结论 安理申治疗VCI安全有效,早期应用可预防及延缓痴呆的发生.     

安理申、易培申、喜恩开治疗阿尔茨海默病患者不同阶段认知功能的变化

目的 探讨安理申、易培申、喜恩开治疗阿尔茨海默病(AD)患者不同阶段认知功能的变化。方法 选取AD患者195例,随机分为A、B、C三组,每组各65例。A、B、C组分别给予盐酸多奈哌齐(安理申)、盐酸美金刚片(易培申)、复方海蛇胶囊(喜恩开) 治疗,均治疗3个月。比较治疗前、治疗1、2、3月末患者的简易智能状态量表(MMSE)评分、日常生活能力量表(ADL)、阿尔茨海默病评估量表的认知分量表(ADAScog)以及临床痴呆量表(CDR) 评分,比较三组的不良反应情况。结果 治疗1月末,三组MMSE评分均较治疗前增加(t=3.57~4.11,P＜0.05),而ADL、ADAScog、CDR评分则无明显变化(t=1.02~2.60,P>0.05),治疗2月末、治疗3月末与治疗前比较,三组MMSE、ADL评分均增加(t=3.62~5.03,P＜0.05),ADAScog、CDR评分均降低(t=3.85~6.22,P＜0.05或P＜0.01)。除治疗2月末MMSE评分三组比较无统计学意义外,治疗2月末、治疗3月末,A、B组同一时点MMSE、ADL评分均低于C组(t=3.27~4.97,P＜0.05),ADAScog、CDR评分均高于C组(t=3.82~5.14,P＜0.05),而A、B组同一时点MMSE、ADL、ADAScog、CDR评分比较,差异均无统计学意义(t=0.56~2.20,P>0.05)。A、B、C组不良反应发生率分别为7.69%、6.15%、1.54%,A、B组间无统计学差异(χ2=0.53,P＞0.05),但均高于C组(χ2=5.11、4.87,P＜0.05)。结论 安理申、易培申、喜恩开治疗AD均具有一定的临床疗效,经一段时间的规律治疗后有效提高了患者的认知功能和日常生活能力,降低了痴呆症状评分,且喜恩开的临床疗效优于安理申和易培申,且具有更高的安全性,对AD患者的临床治疗具有一定的指导和借鉴意义。     

自由基清除剂及高压氧治疗血管性认知功能障碍的研究

目的观察自由基清除剂(FRS)联合高压氧(HBO)治疗血管性认知功能障碍(VCI)的临床疗效。方法 153例血管性认知功能障碍患者,随机分为自由基清除剂组、高压氧+自由基清除剂组及对照组。比较治疗前后各组简易智力状态检查量表(MMSE)、韦氏成人记忆量表(WMS)及日常生活能力评定量表(ADL)的评分。结果治疗后,自由基清除剂组、高压氧+自由基清除剂组的MMSE、WMS及ADL评分均较治疗前明显改善,且均优于对照组,高压氧+自由基清除剂治疗组又优于单纯自由基清除剂组。结论自由基清除剂联合高压氧治疗可明显改善VCI患者的MMSE、WMS及ADL评分,疗效提高,值得临床进一步推广应用。     

银杏达莫注射液联合盐酸多奈哌齐治疗老年人血管性痴呆的近期疗效

目的 观察银杏达莫注射液联合安理申(盐酸多奈哌齐)治疗早期血管性痴呆的临床疗效.方法 60例血管性痴呆患者随机分为两组,治疗组30例采用安理申5 mg每晚临睡前口服,共治疗4周.另给予银杏达莫注射液20 ml加入生理盐水250 ml中静滴,每日1次,共3周.对照组30例采用安理申5 mg每晚临睡前口服,共治疗4周.治疗4周前后评价简易智能精神状态评估量表(MMSE)、日常生活功能量表(ADL)、长谷川痴呆量表(HDS)、痴呆严重程度临床评定量表(WMS)、TCD、血流动力学的变化.将结果进行统计学处理.结果 治疗组治疗后MMSE、ADL、HDS、WMS评分和TCD及脑动脉血流较对照组均有明显改善,差异有统计学意义(P<0.05).治疗组治疗前后评分、血流动力学及TCD亦有显著改善,差异有统计学意义(P<0.05).结论 银杏达莫注射液联合安理申治疗早期血管性痴呆疗效显著,优于单独使用安理申.     

安理申联合尼麦角林治疗阿尔茨海默病的临床研究

目的观察安理申和尼麦角林联合应用对老年期痴呆的疗效。方法将60例阿尔茨海默病患者随机分为3个组:A组应用安理申;B组应用安理申+尼麦角林;C组应用安慰剂;3组患者分别于治疗前、治疗12周使用简易精神状态检查量表、日常生活能力量表测定患者智能水平,进行临床疗效观察。结果治疗后,A组、B组智能水平明显改善(P0.05)。且在治疗12周时B组MMSE评分明显增加,优于A组(P0.05)。结论安理申、尼麦角林能有效治疗阿尔茨海默病,对患者的认知功能、痴呆程度和日常生活自理能力均有改善,联合用药的疗效更佳。     

安理申联合赛乐特治疗老年性痴呆的临床疗效观察

目的：探讨安理申（盐酸多奈哌齐）联合赛乐特（盐酸帕罗西汀）治疗老年性痴呆的临床疗效和安全性。方法：对2011年1月—2012年6月在本院住院或门诊就诊的60例老年性痴呆患者分为两组：对照组给予安理申口服;试验组给予安理申联合赛乐特口服,观察12周。于治疗前及治疗12周末分别采用蒙特利尔认知评估量表（MoCA）、简易智能量表（MMSE）、日常生活能力量表（ADL）、简明精神量表（BPRS）评定疗效。结果：治疗前,两组MoCA、MMSE、ADL、BPRS差异均无统计学意义（P均〉0.05）;治疗后两组MoCA、MMSE较治疗前明显升高;ADL、BPRS较治疗前明显降低,差异均有统计学意义（P均〈0.05）;治疗后,两组治疗后MoCA、MMSE、ADL差异无统计学意义（P〉0.05）,BPRS差异有统计学意义（P〈0.05）。两组治疗前后血、尿常规及肝肾功能指标均无明显变化,对照组有6例出现不良反应,试验组有7例出现不良反应,均为头晕、头痛、胃肠道反应等常见药物不良反应,未发生心脏功能障碍等严重不良反应。结论：安理申联合赛乐特在改善行为和心理症状上比单一的安理申明显,但对患者的认知功能、日常生活能力的改善无明显增加;药物不良反应无明显增加。故老年性痴呆患者如果伴发精神行为症状时使用安理申联合赛乐特治疗疗效肯定,安全性高。     

安理申联合赛乐特治疗老年性痴呆的临床疗效观察

目的:探讨安理申联合赛乐特治疗老年性痴呆的临床治疗效果。方法:选取60例老年性痴呆患者,随机分为观察组和对照组,对照组患者给予口服安理申,观察组患者在对照组治疗基础上添加口服赛乐特,治疗前后分别采用日常生活能力量表(ADL)和简明精神量表(BPRS)评定疗效。结果:治疗后两组患者ADL和BPRS评分均明显下降,与治疗前相比差异均具有统计学意义(P<0.05),观察组患者治疗后ADL和BPRS评分明显低于对照组,对比差异具有统计学意义(P<0.05),两组患者不良反应发生率对比差异不具有统计学意义(P>0.05)。结论:安理申联合赛乐特治疗老年性痴呆可有效改善患者的日常生活能力,尤其可以改善患者的精神行为症状,疗效确切,且安全性高。     

认知功能训练联合银杏叶片治疗脑卒中后认知障碍患者疗效观察

目的 探讨认知功能训练联合银杏叶片对脑卒中后认知障碍患者的临床疗效.方法 选择我院2013年1月—2016年6月收治的脑卒中后认知障碍患者71例分为2组,对照组予以认知功能训练,观察组在此基础上联合银杏叶片口服.治疗前后,采用MMSE量表和MoCA评价量表评价患者认知功能.结果 治疗前,2组患者MMSE评分MoCA评分差异无统计学意义(P>0.05).治疗3个月后,2组MMSE评分MoCA评分均提高(P<0.05),且观察组改善幅度优于对照级,差异有统计学意义(P<0.05).结论 认知功能训练联合银杏叶片治疗可改善脑卒中后认知障碍患者的认知功能.     

丁苯酞联合尼莫地平对血管性痴呆的疗效观察

目的：观察丁苯酞联合尼莫地平对血管性痴呆的疗效及安全性。方法将90例血管性痴呆患者随机分为3组,在常规治疗的基础上,A组给予丁苯酞及尼莫地平口服,B组给予丁苯酞口服,C组给予尼莫地平口服,分别于治疗前和治疗12周后对患者进行蒙特利尔认知评估量表（MoCA）、日常生活能力量表（ADL）评分,比较各组治疗效果。记录治疗过程中的不良事件。结果3组治疗后MoCA、ADL评分均优于治疗前,且差异有统计学意义（P<0.05）。对血管性痴呆患者MoCA评分的改善,A组明显优于C组,差异有统计学意义（P<0.05）;对血管性痴呆患者ADL 评分的改善,A、B组明显优于C组,差异有统计学意义（P<0.05）,A、B组差异无统计学意义（P>0.05）。3组不良反应发生率比较无统计学意义（P>0.05）。结论对血管性痴呆患者认知功能的改善,联合使用丁苯酞及尼莫地平优于单一用药;对血管性痴呆患者生活能力的改善,联合用药及单用丁苯酞效果均优于单用尼莫地平。3组用药安全性良好。     

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.