16SrRNA基因检测在新生儿化脓性脑膜炎早期诊断中的应用

目的:探讨脑脊液中16SrRNA基因检测在新生儿化脓性脑膜炎早期诊断中的应用价值。方法:对疑似化脓性脑膜炎的40例患儿的脑脊液进行16SrRNA基因PCR检测,并同时做脑脊液常规、生化及细菌培养,将其结果进行比较。结果:40例患儿脑脊液16SrRNA基因PCR检测阳性率32.5%(13/40),脑脊液细菌培养阳性率0%(0/40)。根据脑脊液常规、生化检测参数临床诊断为化脓性脑膜炎的患者为12.5%(5/40)。16SrRNA基因PCR检测阳性率明显高于脑脊液培养和临床诊断(P<0.05)。结论:16SrRNA基因PCR检测方法特异性强、敏感性高,可为临床新生儿化脓性脑膜炎的早期诊断提供可靠的依据。     

16SrRNA基因检测在儿童细菌性脑膜炎早期诊断中的应用

目的 探讨脑脊液(cerebrospinal fluid,CSF)中16SrRNA基因检测在儿童细菌性脑膜炎(BM)早期诊断中的应用价值.方法 收集40例2019年1月至2020年6月间,在昆明市儿童医院确诊为BM患者的CSF标本进行16SrRNA基因PCR检测,16SrRNA基因PCR检测阳性标本进行基因测序,测序结果通过NCBI BLAST进行序列比对和同源性分析,同时进行CSF细菌培养,将CSF 16SrRNA基因PCR检测结果与CSF培养结果进行比较.结果 40例患儿CSF中16例16SrRNA基因PCR检测阳性,阳性率40％;7例细菌培养阳性,阳性率17.5％,PCR检测法阳性率高于细菌培养法(χ2=4.93,P<0.05),以CSF培养为"金标准",PCR检测法的灵敏度为71.4％(5/7),特异度为66.7％(22/33);16SrRNA基因测序结果与CSF培养结果一致,且检测出CSF培养未检出的5种细菌;CSF培养时间为(61.21±12.62)h,PCR检测法所需时间为(7.09±0.45)h,两者之间差异有统计学意义(P<0.05).结论 CSF中16SrRNA基因PCR检测法能提高BM患者CSF中病原菌的检出率,且能降低漏检率,具有特异、快速特点能及时为临床BM早期诊断提供可靠的病原学依据.     

16SrRNA基因检测在儿童细菌性脑膜炎早期诊断中的应用

目的 探讨脑脊液(cerebrospinal fluid,CSF)中16SrRNA基因检测在儿童细菌性脑膜炎(BM)早期诊断中的应用价值.方法 收集40例2019年1月至2020年6月间,在昆明市儿童医院确诊为BM患者的CSF标本进行16SrRNA基因PCR检测,16SrRNA基因PCR检测阳性标本进行基因测序,测序结果通过NCBI BLAST进行序列比对和同源性分析,同时进行CSF细菌培养,将CSF 16SrRNA基因PCR检测结果与CSF培养结果进行比较.结果 40例患儿CSF中16例16SrRNA基因PCR检测阳性,阳性率40％;7例细菌培养阳性,阳性率17.5％,PCR检测法阳性率高于细菌培养法(χ2=4.93,P<0.05),以CSF培养为"金标准",PCR检测法的灵敏度为71.4％(5/7),特异度为66.7％(22/33);16SrRNA基因测序结果与CSF培养结果一致,且检测出CSF培养未检出的5种细菌;CSF培养时间为(61.21±12.62)h,PCR检测法所需时间为(7.09±0.45)h,两者之间差异有统计学意义(P<0.05).结论 CSF中16SrRNA基因PCR检测法能提高BM患者CSF中病原菌的检出率,且能降低漏检率,具有特异、快速特点能及时为临床BM早期诊断提供可靠的病原学依据.     

氧化应激指标及S100B在低龄化脓性脑膜炎患儿病情严重程度评估中的价值

目的评价早期联合氧化应激指标与S100B在预测低龄化脓性脑膜炎患儿病情严重程度中的价值,并探讨脑脊液氧化应激指标水平与血清S100B水平的相关性。方法选取年龄＜2岁的低龄化脓性脑膜炎患儿49例,其中普通化脓性脑膜炎组33例,重症化脓性脑膜炎组16例,同时选取36例排除颅内感染的患儿作为对照组。应用ELISA法测定脑脊液中超氧化物歧化酶（SOD）、丙二醛（MDA）、一氧化氮（NO）和血清S100B的浓度。结果重症化脓性脑膜炎组脑脊液SOD活性及MDA、NO、血清S100B水平显著高于普通化脓性脑膜炎组和对照组（P<0.01）;普通化脓性脑膜炎组脑脊液MDA、NO、血清S100B水平显著高于对照组（P<0.01）。血清S100B水平与脑脊液中MDA、NO水平呈显著正相关（r=0.398、0.389,P<0.05）,但与SOD相关性不显著(r=0.185, P=0.203）。ROC曲线显示,SOD、MDA、NO、S100B预测重症的曲线下面积（AUC）分别为0.565、0.803、0.844、0.851;联合检测MDA、NO与S100B化脓性脑膜炎的AUC可提高至0.968,其敏感度和特异度可分别高达0.938、0.970。联合检测对重症化脓性脑膜炎预测的准确性优于单一检测指标。结论联合CSF-MDA、CSF-NO和血清S100B可提高早期识别低龄患儿重症化脓性脑膜炎的准确性。     

化脓性脑膜炎患儿血清、脑脊液中蛋白C水平的变化及意义

目的:探讨化脓性脑膜炎患儿血清和脑脊液中蛋白C(PC)水平的变化和意义.方法:62例化脓性脑膜炎患儿作为实验组,以同期健康体检儿童60例作为对照组,采用ELISA法分检测两组(实验组患几分别于急性期和恢复期采集标本)受试儿童血清和脑脊液的PC水平.结果:实验组患儿急性期血清和脑脊液PC水平均明显低于对照组和本组恢复期(P＜0.05);实验组患儿恢复期血清和脑脊液PC水平与对照组比较,差异无统计学意义(P＞0.05).在急性期,重症化脓性脑膜炎患儿血清、脑脊液PC水平均明显低于轻症患几(P＜0.05).结论:检测血清和脑脊液PC水平可为化脓性脑膜炎的诊断、病情判断和疾病转归提供客观依据.     

血清降钙素原联合C反应蛋白、白细胞检测对脑膜炎患儿的诊断价值

目的 探讨降钙素原(PCT)、血白细胞(WBC)及C反应蛋白(CRP)水平对化脓性脑膜炎和病毒性脑膜炎的诊断价值.方法 选取该院2014年4月至2016年6月收治的168例脑膜炎患儿(感染组)及56例结缔组织疾病患儿(对照组)作为研究对象,将感染组患儿分为化脓性脑膜炎组(n=72例)、病毒性脑膜炎组(n=96),对各组患儿治疗前后血浆、脑脊液PCT、WBC、CRP水平进行比较分析.结果 感染组患儿血清和脑脊液PCT水平均明显高于对照组患儿(P＜0.05);与对照组相比,病毒性脑膜炎组患儿治疗前、治疗72 h及治疗1周后的血清和脑脊液PCT水平差异无统计学意义(P＞0.05);化脓性脑膜炎组患儿治疗前血清和脑脊液PCT均明显升高(P＜0.05);与对照组相比,病毒性脑膜炎组血CRP水平明显升高(P＜0.05),而血WBC水平差异无统计学意义(P＞0.05),化脓性脑膜炎组血WBC及CRP水平均明显增高(P＜0.05),差异有统计学意义(P＜0.05).结论 血清PCT水平结合WBC和CRP的水平变化及治疗过程中PCT水平的变化可对早期病毒性脑膜炎和化脓性脑膜炎进行鉴别并指导治疗方案的制订.     

脑脊液胱抑素C和血清降钙素原检测在化脓性和病毒性脑膜炎鉴别诊断中的意义

目的 探讨脑脊液胱抑素C （Cys-C）和血清降钙素原（PCT）在诊断与鉴别诊断化脓性脑膜炎与病毒性脑膜炎的应用.方法 选取50例化脓性脑膜炎患者与50例病毒性脑膜炎患者为研究组,30例疑似颅内感染患者为对照组.收集治疗前脑脊液和血清样本,检测脑脊液Cys-C和血清PCT浓度.结果 化脑组脑脊液Cys-C浓度高于病脑组和对照组（P＜0.01）,病脑组Cys-C低于对照组（P＜0.05）;化脑组PCT含量高于病脑组和对照组（P＜0.01）.脑脊液Cys-C对化脓性脑膜炎的诊断灵敏度、特异度、准确度分别为86.0％、77.5％、80.8％,PCT检测对化脓性脑膜炎的诊断灵敏度、特异度、准确度分别为82.0％、90.0％、86.2％.两项实验诊断指标平行联合检测可明显提高对化脓性脑膜炎的诊断灵敏度（97.5％）.结论 脑脊液Cys-C和血清PCT可作为早期鉴别化脓性脑膜炎与病毒性脑膜炎标志物.联合检测该二项指标可提高鉴别诊断的效率,对化脓性脑膜炎和病毒性脑膜炎鉴别诊断具有重要意义.     

中枢神经系统感染患儿脑脊液SICAM-1含量测定及评价

目的:检测中枢神经系统感染患儿脑脊液(CSF)中可溶性细胞黏附分子(SICAM-1)浓度并探讨其临床意义.方法:病毒性脑(膜)炎(VME)患儿43例,化脓性脑膜炎(PM)患儿20例,结核性脑膜炎(TM)患儿12例,对照组16例.用放射免疫法ELISA检测各组患儿脑脊液SICAM-1含量,并做比较分析.结果:中枢神经系统感染患儿各组脑脊液(CSF)中SICAM-1水平明显高于对照组(P＜0.05);而重症VME组脑脊液SICAM-1水平明显高于轻症组(P＜0.01),细菌感染组(PM、TM)的水平显著高于非细菌感染组(P＜0.05).结论:SICAM-1在中枢神经系统感染的发病机制中起重要作用,CSF SICAM-1可作为临床诊断、衡量病情轻重的辅助指标之一,有助于细菌性与非细菌性中枢神经系统感染的鉴别诊断.     

16S rRNA基因检测在自发性细菌性腹膜炎快速诊断中的应用

目的 评估16S rRNA基因检测在自发性细菌性腹膜炎(SBP)快速诊断中的应用价值.方法 采用16S rRNA基因荧光定量多聚酶链反应检测76例疑似SBP及6例非感染性腹腔积液患者腹水细菌DNA,并与腹水细菌培养结果进行比较.结果 16S rRNA检测疑似SBP患者腹水标本的阳性率为22.4%,明显高于腹水细菌培养的7.9%(P<0.01) .6例非感染性腹腔积液患者的腹水16S rRNA基因荧光定量PCR检测结果和细菌培养结果均为阴性.结论 16S rRNA检测可做为SBP的快速诊断方法,其敏感性优于腹水细菌培养.     

化脓性脑膜炎患儿脑脊液白细胞水平与早期临床症状、降钙素原及细菌类型的相关性研究

为了解脑脊液白细胞数量与化脓性脑膜炎患儿早期临床症状、降钙素原及病原菌类型的相关性,回顾分析300例化脓性脑膜炎患儿(观察组)与100例非化脓性脑膜炎脑病患儿(对照组)病例资料,结果显示,观察组脑脊液中白细胞(WBC)数量显著高于对照组;观察组脑脊液WBC数量升高的同时,患儿早期症状发生率和降钙素原水平也随着升高,早期症状与降钙素原水平是影响患儿脑脊液中白细胞水平的独立性影响因素(P＜0.05)。结果说明,化脓性脑膜炎患儿脑脊液中白细胞数量显著升高,且与早期临床症状、降钙素原存明显相关关系,但与病原菌类型无明显关系。     

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.