老年轻度认知功能损害的随访研究

目的观察和评价老年轻度认知功能损害患者的转归及其认知功能的变化特点。方法对象为患轻度认知功能损害的老年人(MCI组)和认知功能正常的老年人(NC组)两组。主要认知评价工具为世界卫生组织老年认知功能评价成套神经心理测验(WHO-BCAI)和韦氏记忆测验(WMS),在基线和随访时分别评价。随访对象发展为痴呆的诊断标准为美国精神疾病诊断分类统计手册(DSM-IV)的相关标准。结果MCI共入组47例,NC组50例。平均随访时间为34·0个月±1·8月,随访期间MCI组13例,NC组1例发展为痴呆,MCI组痴呆的发病率为27·7%,NC组为2·0%,两组差异具有统计学意义(P<0·01)。3年间,MCI组的简明智力状态检查(MMSE)总分平均下降了2·2分±3·7分,NC组下降了1·0分±1·9分;MCI组的记忆商(MQ)下降了12·6分±17·3分,NC组下降了3·9分±8·4分;MCI组中发展为痴呆的患者的MMSE和MQ下降更为明显,分别下降了5·5分±2·8分和30·0分±18·0分。WHO-BCAI测验结果显示,MCI组随访终点的连线、分类、命名、运动、再认、延迟回忆诸测验的成绩明显差于基线水平和NC组(P<0·01或0·05);MCI中发展为痴呆者的词汇学习、连线、分类、命名、词汇流畅、小标记、再认、视觉推理、延迟回忆等测验成绩显著低于未发展为痴呆的MCI患者(P<0·01或0·05)。Logistic回归分析显示,MMSE总分及其定向因子分,WMS的定向记忆因子分和WHO-BCAI测验的连线、注意和延迟回忆测验对MCI是否发展为痴呆具有显著性预测意义,三类测验预测的总正确率分别为70·3%、78·4%和90·7%。结论根据我们制定的纯MCI或AD型MCI标准入组的随访研究证实,MCI是老年期痴呆,尤其是阿尔茨海默病的前驱期。MCI发展为痴呆的认知变化特点是定向、注意、言语和执行功能等认知水平的显著下降。神经心理测验有助于预测MCI患者是否发展为痴呆,对老年期痴呆的早期诊断和干预治疗具有参考价值。     

遗忘型轻度认知功能损害的神经心理学研究

目的了解遗忘型轻度认知功能损害(MCI)老年人的神经心理学和临床特点,寻找MCI的危险因素。方法对社区65位60岁以上老年人用剑桥认知能力测验中国修订版(CAMCOG-C)、简易智力状况量表(MMSE)、临床痴呆评定量表(CDR)、老年抑郁问卷(GDS)、日常生活能力问卷(ADL)、韦氏记忆量表中国修订版(WMS-C)理解记忆部分进行了评估。筛选出遗忘型MCI老年人20人,认知功能正常老年人23人。结果MCI组女性(80%)、文盲较多(85%)。在所有量表和分测验,MCI组得分都比正常对照值低。其中在MMSE总分、CAM-COG-C总分、定向总分、语言总分、记忆总分、知觉总分、地点定向分测验、言语表达分测验、动作表达分测验、视觉知觉分测验的差异有显著性意义(P<0·05)。结论早年学校教育时间短、脑力活动水平比较简单可能是晚年容易发生遗忘型轻度认知功能损害的危险因素,遗忘型轻度认知功能损害在定向、语言等方面也有显著损害。     

伴和不伴攻击行为精神分裂症患者认知功能的对照研究

目的比较伴和不伴攻击行为精神分裂症患者认知功能的差异。方法根据修改版外显行为攻击量表的评分将精神分裂症患者分为研究组(伴攻击行为组)和对照组(不伴攻击行为组),用韦氏成人智力量表、逻辑记忆测验、Benton线方向判断测验、威斯康星卡片分类测验评估其认知功能。结果研究组在逻辑记忆[(9.45±3.67)分vs(12.58±4.71)分]、Benton线方向判断测验[(19.78±5.21)分vs(25.21±4.37)分]、威斯康星卡片分类测验的总应答数[(119.53±5.65)次vs(105.68±5.79)次]、准确应答数、持续错误数[(42.23±20.29)次vs(25.15±21.48)次]、完成分类数均与对照组差异有显著性,但两组在总智商[(92.46±15.35)vs(94.12±14.68)]方面差异无显著性。结论伴有攻击行为的精神分裂症患者较不伴攻击行为的精神分裂症患者认知功能受损更严重。     

轻微认知功能损害的特点和老年记忆功能问卷的编制

目的 分析轻微认知功能损害(MCI)的特点和编制老年记忆功能问卷。方法 选择符合MCI诊断标准的就诊者16例，年龄、性别和教育程度与MCI组匹配的极轻微认知功能损害(VMCI)和正常老人样本各16例，采用自行编制的老年记忆调查问卷、简易智能检查量表(MMSE)、韦氏记忆量表(WMS-RC)、听觉词语回忆测验(AVMT)等测验工具进行评定。结果 即刻记忆和总体智力在MCI、VMCI两组之间无显著差异，短时记忆、延迟回忆及长时记忆在两组之间有显著差异。老年记忆功能问卷主要由MCI、VMCI两组比较有显著差异的项目组成，总分20分。其总分与AVMT长延迟回忆有非常显著的相关性。以10分为划界分，老年记忆功能问卷对于检出MCI的敏感性和特异性优于WMS-RC总分和MMSE总分。结论 老年记忆功能问卷有助于快速有效地识别MCI。     

轻微认知功能损害的特点和老年记忆功能问卷的编制

目的分析轻微认知功能损害(MCI)的特点和编制老年记忆功能问卷.方法选择符合MCI诊断标准的就诊者16例,年龄、性别和教育程度与MCI组匹配的极轻微认知功能损害(VMCI)和正常老人样本各16例,采用自行编制的老年记忆调查问卷、简易智能检查量表(MMSE)、韦氏记忆量表(WMS-RC)、听觉词语回忆测验(AVMT)等测验工具进行评定.结果即刻记忆和总体智力在MCI、VMCI两组之间无显著差异,短时记忆、延迟回忆及长时记忆在两组之间有显著差异.老年记忆功能问卷主要由MCI、VMCI两组比较有显著差异的项目组成,总分20分.其总分与AVMT长延迟回忆有非常显著的相关性.以10分为划界分,老年记忆功能问卷对于检出MCI的敏感性和特异性优于WMS-RC总分和MMSE总分.结论老年记忆功能问卷有助于快速有效地识别MCI.     

甲状腺功能减退症与亚临床甲状腺功能减退症患者认知功能的比较

目的 探讨甲状腺功能减退症与亚临床甲状腺功能减退症患者认知功能的特点.方法 用简易智力状态检查、韦氏成人智力量表、逻辑记忆测验、视觉再生测验、威斯康星卡片分类测验评估甲状腺功能减退症(甲减组)、亚临床甲状腺功能减退症(亚甲减组)患者及正常对照组的认知功能.结果 甲减组和亚甲减组在逻辑记忆[分别为(10.32±3.39)分、(13.57±4.49)分]、视觉再生[分别为(5.96±2.57)分、(7.97±2.83)分]方面均差于健康对照组[(16.38±3.95)分、(9.11±2.65)分],在威斯康星卡片分类测验的总应答数、准确应答数、持续错误数、完成分类数等方面亦差于健康对照组(亚甲减组的完成分类数除外),差异有显著性(P<0.05);甲减组较亚甲减组在以上认知功能方面受损更明显,差异有显著性;而3组在简易智力状态检查总分、总智商方面差异无显著性.结论 甲状腺功能减退症与亚临床甲状腺功能减退症患者均存在明显认知功能受损,前者较后者认知功能受损更明显.     

轻度认知损伤的临床特点

目的　对轻度认知损伤 (mild cognitive impairm ent,MCI)的临床特点进行初步研究 .方法　对 15例 MCI者 ,19例对照者进行临床记忆量表、韦氏成人智力量表 (WAIS- RC)操作项目 ,以及简易智力状态检查 (MMSE)等神经心理量表检测 ,并进行统计分析 .结果　 MCI组临床记忆量表各分测验分数均较对照组降低 (P<0 .0 1) ,WAIS- RC操作部分 MCI组的数字符号转换 ,摆积木 ,图片排列成绩均有显著意义的下降 (P<0 .0 5 ) ,在 MMSE量表中 MCI组在注意计算、延迟回忆及视空间技能三方面均表现为显著意义的衰退 (P<0 .0 5 ) .结论　 MCI患者存在多项认知功能的下降 ,在情景记忆、视空间技能及操作速度等方面表现出与早期阿尔茨海默病相类似的认知心理改变     

脑动脉狭窄患者认知功能障碍的研究

目的探讨脑动脉狭窄与认知功能障碍之间的关系。方法采用成人韦氏记忆测验(WMS)、成人韦氏智力量表(WAIS-RC)对72例脑动脉狭窄患者及18例健康者进行认知功能评估。结果记忆商(MQ)：椎-基底动脉狭窄组[(73．29±26．77)分]较颈内动脉狭窄组[(86．38±21．96)分]减退明显(P＜0．05),智商(IQ)：颈内动脉狭窄组[(72．25±23．46)分]较椎-基底动脉狭窄组[(80．65±25．22)分]减退明显(P＜0．05)。动脉狭窄各组的记忆功能和认知功能均较对照组差(P＜0．05),其中颈动脉狭窄组以领悟、算术、相似性、数字符号、填图、木块图等检测减退为主,椎-基底动脉狭窄组以背数、词汇、图形拼凑等检测减退为主(P＜0．01),而全脑动脉狭窄组的记忆认知功能减退是全面的。结论脑动脉狭窄与认知功能密切相关,动脉狭窄类型不同,引起的认知功能障碍类型不同。     

认知干预对2型糖尿病患者认知功能减退的影响

目的探讨认知干预对2型糖尿病患者认知功能减退的影响,为临床护理提供理论依据。方法采用韦氏记忆量表(WMS)、简易智力量表(MMSE),对62名2型糖尿病患者(研究组)和60名健康志愿者(对照组)进行记忆功能、临床智能精神检查测定。对研究组进行认知干预6个月,两组均随访1年。结果与对照组相比,研究组患者的长时记忆、短时记忆、瞬时记忆各项测验评分及记忆智商均明显低于对照组(P<0.01);研究组MMSE得分明显低于对照组,两组比较差异有显著性(P<0.01)。结论认知功能减退在2型糖尿病早期就已存在,主要表现为记忆力减退,思维能力、注意力下降,智力退化等,及早进行认知干预,对制定糖尿病的护理措施具有指导意义,有利于认知功能的恢复。     

西酞普兰合并奋乃静对精神分裂症患者认知功能的影响

目的观察西酞普兰合并奋乃静对精神分裂症患者认知功能的影响。方法采用入院顺序分层随机法,将120例慢性精神分裂症患者平均分为研究组(西酞普兰+奋乃静)和对照组(奋乃静+安慰剂)。在治疗前、治疗后4,8,12周末分别以阳性症状、阴性症状量表和副反应量表评定疗效和副作用,用韦氏成人智力量表、韦氏记忆量表和威斯康星卡片分类测验评定治疗前后患者认知功能的改变。结果治疗12周后,研究组的言语量表、操作量表、全量表和记忆量表分分别为(84.97±3.73)分、(80.41±5.93)分、(83.37±5.81)分、(77.26±13.31)分;对照组分别为(75.41±3.95)分、(72.43±5.56)分、(75.87±5.34)分、(72.15±13.19)分,两组差异有显著性(P<0.01)。PANSS总分、阴性因子分比治疗前明显降低,治疗后4,8,12周末TESS评分,研究组均低于对照组,且治疗后低于治疗前,均差异有显著性(P<0.05)。结论西酞普兰合并奋乃静治疗对精神分裂症患者认知功能有明显改善。     

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.