胃癌危险因素的病例对照研究

目的：探索湖南省胃癌发生的危险因素和保护因素,为综合防治提供流行病学依据。方法：采用1：1配对的病例对照研究,对175对病例及对照进行饮食及生活行为问卷调查,用比值比（OR）来估计各危险因素与胃癌的联系强度,采用Logistic回归进行单因素和多因素分析,筛选出胃癌的危险因素。结果：影响胃癌发生的主要危险因素有：饮酒（OR＝1．58,95％ CI1．18－2．13）,饮食不规律（OR＝2．00,95％CI 1．34－3．10）,高盐饮食（OR＝1．82,95％,CI1．21－2．74）等;饮绿茶（OR＝0．47,95％CI0．26－0．85）是胃癌发生的保护因素,结论：纠正不良的饮食及生活行为,经常饮绿茶可能减少胃癌的发生的危险性。     

长乐市饮食及其他生活习惯与胃癌关系的病例对照研究

目的 探讨饮食及其他生活习惯与胃癌发生的关系。方法1999年1～12月,在胃癌高发区福建省长乐市,收集了310例胃癌新发病例,每个病例配一个同年龄组与性别的对照。调整相对危险度(OR)及其95％可信区间(CI)的估计采用条件Logistic回归。结果 随食用盐渍食品的增加,胃癌的发病危险度亦随之增加(经常与从不吃,OR=2.55,95％ CI=1.04～6.29,趋势检验,P=0.01)。喜烫食、硬食及重盐亦可增加胃癌的发病危险,反之多食禽蛋、新鲜水果、大蒜对胃癌有保护作用。未见食用新鲜蔬菜、吸烟、饮酒、饮茶、冰箱使用与胃癌的关系。结论 食用盐渍食品、喜烫食、硬食及过量摄入食盐可能是胃癌的危险因素,而禽蛋、新鲜水果、大蒜类蔬菜则可能对胃癌有保护作用。     

心房颤动影响因素的非匹配病例对照研究

目的：分析心房颤动患者的影响因素,为制定相关干预措施提供科学依据。方法选取住院治疗资料完整的心房颤动患者作为病例组,并随机从同时期在心内科接受治疗的其他非心房颤动患者中选取同等数量作为对照组进行非匹配的病例对照研究,采用多因素非条件logistic回归方法分析心房颤动的影响因素。结果共有效调查556例患者,其中病例组和对照组分别为278例。多因素分析结果显示,年龄增加（OR＝1．037,95％CI：1．022～1．052）、高血压（OR＝2．395,95％CI：1．361～4．214）、糖尿病（OR＝2．374,95％CI：1．301～4．333）、冠心病（OR＝2．620,95％CI：1．480～4．638）、心脏病（OR＝3．468,95％CI：1．834～6．560）、心力衰竭（OR＝3．050,95％CI：1．741～5．345）、尿酸增加（OR＝1．011,95％CI：1．005～1．016）、左房内径增加（OR＝1．201,95％CI：1．130～1．276）是房颤的危险因素;女性（OR＝0．518,95％CI：0．321～0．837）、左室射血分数（OR＝0．097,95％CI：0．021～0．449）、三酰甘油（OR＝0．418,95％CI：0．252～0．693）、高密度脂蛋白（OR＝0．381,95％CI：0．213～0．683）以及低密度脂蛋白水平增加（OR＝0．230,95％CI：0．127～0．417）是房颤的保护因素。结论很多因素可以影响心房颤动的发生,相关部门应该从多方面制定综合的心房颤动预防控制措施。     

常饮牛奶及饮食口味偏咸与脑卒中的关系

目的 探讨某些饮食习惯与脑卒中的关系。方法 采用医院为基础的配比病例对照研究方法,对经颅脑CT扫描确诊的320例脑卒中病例及各自的对照通过条件logistic回归程序作1：1配比分析。结果 单因素分析结果表明,经常喝牛奶者脑卒中的OR为0．70（95％CI：0．53－0．92）,口味偏咸使脑卒中的危险性增加,OR为1．42（95％CI：1．06－1．91）。按高血压病史调整后,以上作用均失去显著意义（OR分别为0．59,95％CI：0．29－1．22和1．26,95％CI：0．87－1．82。结论 经常喝牛奶对中老年人脑卒中的发病具有保护作用,口味偏咸可使脑卒中的危险性增加,这些作用可能是借助于对高血压的影响来实现的。未发现饮茶习惯与脑卒中有关。     

系统性红斑狼疮合并肺部感染的预后分析

目的：探讨影响系统性红斑狼疮（SLE）合并肺部感染病人预后的因素。方法：以病例－对照研究为策略，研究对象为1999－2001年在两家教学医院住院的SLE合并肺部感染连续性病人126例。以32例死亡者为病例组，另外94例存活者的为对照组。研究因素包括性别、年龄、病理，病原体、SLE各种并发症，SLE疾病活动指数（SLEDAI）、主要的治疗方法，实验室各常规，生化、免疫学指标、各辅助检查等48项，统计学方法采用Logistic回归分析。结果：SLEDAI积分的OR＝1．18（95％CI：1．03－2．27），血浆白蛋白水平（g/L)的OR＝0．91（95％CI：0．82－0．98），尿量（L／24hr)的OR＝0．64（95％CI：0．46－0．81），静脉输注免疫球蛋白治疗的OR＝0．82（95％CI：0．74－0．89），环磷酰胺冲治疗的OR＝2．05（95％CI：1．02－4．13）。结论：合并肺部感染的SLE住院病人中，提高血浆白蛋白水平，增加尿量和运用免疫球蛋白治疗，可以降低病人率，而SLEDAI积分增高和环磷酰胺冲击治疗为其危险因素。     

烟酒茶嗜好因素与中国女性乳癌关系的Meta分析

目的综合分析评价烟酒茶嗜好因素与中国女性乳癌的关系,探索乳癌的危险因素。方法收集我国1994-2008年间有关烟酒茶嗜好因素和乳癌的病例对照研究文献,利用Meta分析的方法对检索出的符合要求的文献进行再分析,定量综合评价烟酒茶嗜好与乳癌的关系。结果纳入本次Meta分析的文献共8篇,乳癌病例共1580例,对照者共2399例。吸烟合并OR＝1．89（95％CI：1．27～2．81）,饮酒合并OR=0．73（95％CI：0．53～0．99）,饮茶合并OR=0．84（95％CI：0．70～1．02）。结论吸烟尤其是被动吸烟是乳癌发生的危险因素,倡导全民戒烟,减少乳癌的发生;饮酒饮茶与乳癌关系有待进一步研究。     

夏季急性腹泻危险因素—一次全法病例对照研究

目的：鉴别法国夏季急性腹泻（AD）的危险因素；方法：在全国500个综合医院（GPs)的患中进行配对病例对照研究，从1996年7月到9月间共选取468对病例和对照；结果：病例曾：（1）远离居住址（OR3．0：95％CI 1．6－5．7）；（2）从AD高发国家返回（OR4．6；95％CI0．9－2．31）；（3）与AD得接触（OR2．0；95％CI1．3－3．1）。使AD危险性降低的因素是食用良好烹饪的鸡肉（OR0．5；95％CI0．3－0．8）和生的或未熟的收制品（OR0．6；95％CI0．4－0．8）；结论：去高危地区旅游或在法国国内旅游，接触AD患是法国夏季AD发病的危险因素。     

吸烟在西安市食管癌病因中的作用

目的 探讨西安市食管癌的主要危险因素及遗传易感性的分子生物学基础。方法 病例对照研究和分子流行病学研究，并与林州市对比。结果 （1）西安市食管癌的主要危险因素为吸烟（合并OR＝1．79，95％CI＝1．49－2．14，P＜0．01）和食管癌家族史。林州市为食用酸菜（合并OR＝2．06，95％CI＝1．32－3．20，P＜0．001）和食管癌家庭史。（2）p53突变率在两市病例组均明显高于对照组，西安市p53第五外显子突变模式与吸烟作用相符。（3）与食管癌相关的CYP基因多态性，西安市为CYP1A1，林州市为CYP2E1。GSTM缺失与两市食管癌未见明显联系，但参与协同作用。结论 西安市食管癌的主要环境危险因素为吸烟，遗传易感性标志分析结果与之相符，而有别于林州市。主要危险因素不同地区食管癌的预防重点应不同。     

血脂水平及膳食、生殖等因素与乳腺癌发生的病例对照研究

目的探讨血脂、饮食、生殖等因素与乳腺癌发生的关系，寻找乳腺癌发生的危险因素。方法采用病例对照的研究方法，选择女性乳腺癌原发病例94例作为病例组，选择一般人群128例作为对照组。对研究对象分别进行问卷调查、人体测量以及血液标本的采集，采用全自动生化分析仪测定血清血糖、血脂水平。结果将单因素分析有意义的因素和文献认为可能的危险因素引入多因素非条件Logistic回归分析，结果水果食用频率（OR=0．58，95％ CI=0．40—0．66）、蔬菜食用频率（OR：0．75，95％CI=0．30—0．81）、虾类食用量（OR=0．31，95％CI：0．11—0．87）、乳腺良性病史（OR=3．15，95％CI=1．12—8．91）、乳腺外伤史（OR=9．85，95％CI：5．32—20．92）、月经不规律（OR=3．03，95％CI=1．01—9．13）、服用避孕药史（OR：6．44，95％CI=1．82—22．85）、血清FCH（OR=15．19，95％CI：4．11—56．19）、TG（OR=5．54，95％CI=2．33—9．89）、apoA1（OR=12．73，95％CI=2．44—66．31）、apoB（OR=0．05，95％CI=0．003—0．63）水平和腰臀比（OR=3．68，95％CI=1．34—10．11）进入回归模型。结论血清FCH、TG、apoA1水平高，月经不规律，使用雌激素，乳腺良性病史，乳腺外伤史可能为乳腺癌发生的危险因素。血清apoB水平高，食用虾类、水果、蔬菜为乳腺癌发生的保护因素。     

糖尿病合并肺结核的环境危险因素调查

目的：调查研究2型糖尿病（T2DM）合并肺结核（PTB）的环境危险因素,以为其临床预防提供理论依据。方法选择2006年7月至2013年8月梧州市第三人民医院收治的200例T2DM合并肺结核患者和200例T2DM患者进行病例对照研究,采用多因素条件Logistic回归分析T2DM合并肺结核的环境危险因素。结果人均居住面积（OR＝6．878,95％CI 0．956～6．778）,室内采光不良（OR＝5．675,95％CI 0．654～5．767）,室内通气不良（OR＝4．345,95％CI 0．567～7．675）,家庭或同事有结核患者（OR＝5．785,95％CI 0．753～6．677）,化学烟雾接触（OR＝4．242,95％CI 0．753～6．900）,粉尘接触（OR＝4．478,95％CI 0．867～6．896）是导致 T2DM 合并肺结核的环境危险因素。结论T2DM合并肺结核与多种环境因素有关,应积极控制环境危险因素,以减少 T2DM 合并肺结核的发生率。     

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.