依那普利联合倍他乐克治疗慢性充血性心力衰竭

目的:探讨依那普利联合倍他乐克对慢性充血性心力衰竭患者左心室重塑和功能的影响。方法:慢性充血性心力衰竭患者51例,给予常规抗心衰治疗(洋地黄、利尿剂、血管扩张剂),同时加用依那普利和倍他乐克,观察治疗前和治疗6个月后心功能分级(NYHA分级)、活动耐量(6min步行距离)、左心室结构和功能指标的变化。结果:治疗后心功能分级、活动耐量均较治疗前明显改善(P<0.01)。左心室结构和功能均有明显改善,左室舒张末径(LVEDD)和收缩末径(LVESD)明显减小(P<0.05);左心室射血分数(LVEF)显著提高(P<0.05)。结论:在洋地黄、利尿剂、血管扩张剂常规治疗基础上应用依那普利联合倍他乐克可显著改善慢性充血性心力衰竭患者左心室重塑和左心功能。     

参附针加倍他乐克治疗慢性心力衰竭疗效观察

目的了解慢性充血性心力衰竭患者在常规治疗的基础上加用倍他乐克、参附注射液的疗效和不良反应。方法选择病因不同的患者170例,随机分为对照组（86例）和治疗组（84例）,对照组常规应用利尿剂、血管紧张素转换酶抑制剂（ACEI）、洋地黄和（或）硝酸酯制剂治疗;治疗组在对照组的基础上加用倍他乐克、参附注射液。结果2组患者治疗后心功能均较治疗前有明显改善（P〈0.05）。结论在常规治疗慢性充血性心力衰竭的基础上加用倍他乐克、参附注射液可以明显改善心功能,改善心室重塑,提高治疗慢性充血性心力衰竭的疗效。     

长疗程倍他乐克治疗对慢性心力衰竭患者左心室重塑和功能的影响

目的探讨倍他乐克治疗对慢性充血性心力衰竭患者左心室重塑和功能的影响.方法61例慢性充血性心力衰竭患者随机分为治疗组和对照组,对照组常规给予抗心衰治疗.治疗组加服倍他乐克,治疗前和治疗6个月后观察左心室结构和功能指标的变化.结果治疗组左心室结构和功能均有明显改善,与对照组相比,左心室射血分数和心输出量明显增加(P＜0.05).结论在强心、利尿、血管紧张素转换酶抑制剂基础上应用倍他乐克可显著改善慢性充血性心力衰竭患者左心室重塑和左心功能     

倍他乐克治疗慢性充血性心力衰竭78例疗效观察

目的：观察倍他乐克治疗对慢性充血性心力衰竭（CHF）心功能的影响。方法：将78例CHF患者随机分为两组,对照组给予利尿剂、强心剂、ACEI、血管扩张剂等药物常规治疗,治疗组在利尿剂、强心剂、ACEI、血管扩张剂等治疗基础上加用倍他乐克治疗,观察治疗前后心功能、左室射血分数（LVEF）、左室舒张末期容积（EDV）、左室收缩末期容积（ESV）的变化。结果：治疗组总有效率明显高于对照组（P〈0.05）。结论：使用倍他乐克治疗CHF安全有效,能有效提高生活质量,值得推广。     

倍他乐克治疗慢性心力衰竭的疗效观察

目的：观察和评价倍他乐克治疗慢性充血性心力衰竭（CHF）的临床疗效和安全性。方法：选择心功能Ⅱ级-Ⅲ级的CHF的住院患者76例,并随机分为对照组和治疗组,基础药物为转换酶抑制剂、利尿剂、洋地黄治疗。治疗组在基础药物上加用倍他乐克。结果：对照组和治疗组控制CHF总有效率分别为84．2％和97．4％。两组间差异有显著性,P〈0．05。结论：全部患者在应用ACEI类药物、利尿剂、洋地黄治疗基础上,应用倍他乐克治疗1个月,心功能逐渐改善,治疗3个月心功能有所改善,6个月以上心功能显著改善。     

倍他乐克治疗慢性充血性心力衰竭的临床疗效观察

目的：观察倍他乐克治疗慢性充血性心力衰竭（CHF）不同疗程的临床疗效。方法：36例经常规洋地黄、利尿剂、血管扩张剂等治疗效果欠佳的CHF患，给予口服倍他乐克6．25－50mg/d，治疗12周。与治疗前比较，观察治疗后不同时间心率、心胸比、血压、左室舒张末期内径，左室射血分数及心功能变化。结果：治疗后6周各项指标均有改善（P＜0．05），治疗后12周各项指标改善更明显（P＜0．01）。结论：倍他乐克治疗CHF疗效好，掌握好适应症，副作用少，疗效与疗程成正比。     

依那普利对充血性心力衰竭及血管内皮依赖性舒张功能的影响

目的评估依那普利对充血性心力衰竭及血管内皮依赖性舒张功能的影响。方法56例慢性充血性心力衰竭(CHF)患者停用血管扩张剂1周,在使用洋地黄制剂及利尿剂的基础上,口服依那普利5~10mg,b id,用药前和用药后8周分别查肝、肾功能、电解质、超声心功能测定、血管内皮依赖性舒张功能测定及运动耐量检查。结果治疗后44例患者心功能明显改善,有效率79%,超声心功能测定LVS、LVD较前明显缩短,LVEF增加(P<0.05),E/A比值增大(P<0.01),6m in步行试验明显好转(P<0.01),血管内皮依赖性舒张功能明显好转(P<0.01)。结论依那普利可明显改善CHF患者的心功能、运动耐量及血管内皮依赖性舒张功能,对于改善患者的生活质量及预后有重要意义。     

倍他乐克治疗慢性充血性心力衰竭观察

目的：倍他乐克治疗慢性充血性心力衰竭（CHF）观察疗效。方法：40例CHF患者分为2组，对照组20例，单纯给予利尿剂洋地黄药物治疗；观察组20例，在原对照组治疗基础上加用倍他乐克，疗程均为2周。结果：观察组与对照组有效率分别为95％与65％（P〈0．05）。结论：在利用利尿剂及洋地黄基础上，倍他乐克治疗CHF效果优于传统治疗方法。     

卡托普利在慢性心衰中的应用观察

目的 观察慢性心衰在常规药物洋地黄类、速尿、血管扩张剂立其丁、硝酸甘油等治疗的基础上加用血管紧张素转换酶抑制剂（ACEl）卡托普利治疗的临床疗效。方法 慢性充血性心力衰竭患者56例，分为两组：对照组常规给予洋地黄、速尿、血管扩张剂、α受体阻滞剂治疗，而观察组在上述治疗基础上加用肾素-血管紧张索转换酶抑制剂卡托普利治疗。结果 观察组与对照组LVEF、LVDd均明显改善（P〈0．01），即加用ACEI治疗对心脏收缩及舒张功能的改善明显优于常规药物治疗。观察组治疗后心胸比例也较对照组明显缩小（P〈0．01），提示ACEI可以改善心肌重塑，从而对心功能的改善起到很大作用。结论 在应用洋地黄、速尿、血管扩张剂、α受体阻滞剂等药物治疗的基础上加用肾素-血管紧张索转换酶抑制剂，是目前对CHF较好的治疗方法。     

比索洛尔对扩张型心肌病伴充血性心力衰竭患者心功能的影响

目的 研究比索洛尔对扩张型心肌病（DCM）伴充血性心力衰竭患者心功能的影响。方法 将44例DCM充血性心力衰竭患者随机分为治疗组和对照组，两组均常规应用强心剂、利尿剂、血管紧张素转换酶抑制剂（ACEI）、醛固酮拮抗剂治疗。治疗组在此基础上加用比索洛尔直至最大剂量或推荐靶剂量10mg／d，疗程12周。治疗后比较心功能分级及左心室收缩功能指标。结果 治疗组心功能分级改善程度及左心室收缩功能指标均明显优于对照组，差异有统计学意义（P〈0．05）。结论比索洛尔能有效改善DCM充血性心力衰竭患者的心功能状态及临床症状，提高生活质量。     

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.