入院高血糖对中重型创伤性脑损伤患儿死亡的影响

目的：探讨入院高血糖对中重型创伤性脑损伤（traumatic brain injury,TBI）患儿死亡的影响。方法：回顾性分析2012年5月至2014年10月在重庆医科大学附属儿童医院重症医学科治疗的中重型TBI患儿[入院格拉斯哥昏迷评分（Glasgow Coma Scale,GCS）≤13]的临床资料,采用多因素logistic回归分析中重型TBI患儿死亡的独立危险因素。将血糖>11.1 mmol/L定义为高血糖;双瞳孔不等大或瞳孔散大固定设定为瞳孔异常。结果：共109例患儿进入分析,21名患儿入院血糖>11.1 mmol/L。存活92例,死亡17例。死亡组患儿血糖水平、合并损伤率和入院瞳孔异常率明显高于存活组[（14.31±6.46） vs. （7.08±3.38）,76.5% vs. 47.5%,88.2% vs. 7.6%;P=0.000,P=0.010,P=0.000],而死亡组入院GCS评分低于存活组（4 vs. 9;P=0.000）。多因素logistic回归分析发现早期高血糖（OR=6.36,95%CI=1.20~33.68;P=0.029）、入院瞳孔异常（OR=17.09,95%CI=3.26~89.70;P=0.001）和入院GCS（OR=0.62,95%CI=0.39~1.00;P=0.048）是中重型TBI患儿死亡的独立危险因素;而合并其他脏器损伤（OR=1.20;95%CI=0.15~9.40;P=0.859）并不是此类患儿死亡的独立危险因素。结论：入院高血糖是中重型TBI患儿死亡的独立危险因素。     

查尔森合并症指数对老年慢性阻塞性肺疾病患者预后的评估价值

目的探讨查尔森合并症指数(CCI)评估老年慢性阻塞性肺疾病(简称慢阻肺)预后的价值。方法回顾性分析2010年1月至2015年1月首都医科大学宣武医院呼吸科住院的350例大于65岁的慢阻肺患者的临床资料。采集年龄、体重指数(BMI)、合并症、第1秒用力呼气容积占预计值百分比(FEV1%pred)、入院前1年慢阻肺急性加重次数和出院时转归。计算CCI分值,分析慢阻肺急性加重及住院死亡的相关因素。结果慢阻肺急性加重次数≥2次/年患者177例,慢阻肺急性加重次数2次/年患者173例。经多因素Logistic回归分析,CCI[OR=1.559,95%CI(1.309,1.856),P=0.000]及FEV1%pred[OR=0.979,95%CI(0.964,0.994),P=0.006]是慢阻肺急性加重的独立危险因素。住院死亡率为10.3%(36/314)。经多因素Logistic回归分析,CCI[OR=1.894,95%CI(1.422,2.523),P=0.000],年龄[OR=1.153,95%CI(1.063,1.251),P=0.001],FEV1%pred[OR=0.916,95%CI(0.878,0.955),P=0.000],BMI[OR=0.849,95%CI(0.749,0.962),P=0.011],慢阻肺急性加重≥2次/年[OR=6.340,95%CI(1.469,27.366),P=0.013]是慢阻肺患者死亡的独立危险因素。结论 CCI是慢阻肺急性加重及死亡的独立危险因素,对评估慢阻肺预后有一定价值。     

老年急性脑卒中院内死亡相关危险因素分析

目的分析导致老年急性脑卒中患者院内死亡的相关危险因素,以利于对临床老年脑卒中患者的治疗及降低其院内死亡率。方法收集我科2009年1月—2010年12月治疗的老年急性脑卒中患者778例。采集患者入院时的临床特征、既往史、影像学检查等资料,以住院30 d内死亡为结局将患者分为死亡组(43例)和存活组(735例),并对影响老年急性脑卒中患者院内死亡的危险因素进行Logistic多元逐步回归分析。结果死亡组的年龄,卒中类型,既往糖尿病史、冠心病史和脑卒中史,入院时美国国立卫生研究院卒中量表(NIHSS)和Glasgow评分,鼻饲管、导尿管和中心静脉置管,并发肺部感染、尿路感染、脑心综合征、消化道出血和下肢静脉血栓形成共15项危险因素与生存组比较,差异均有统计学意义(P<0.05)。调整年龄及性别因素后,经Logistic回归分析结果显示:糖尿病史、冠心病史、入院时NIHSS高、鼻饲管、导尿管、中心静脉置管、并发肺部感染、尿路感染、脑心综合征、消化道出血、下肢静脉血栓形成共11项危险因素OR值>1,为老年急性脑卒中患者院内死亡的危险因素。Glasgow评分高为保护性因素〔OR=0.65,95%CI(-7.26,0.82)〕。进一步调整其他危险因素后,入院时Glasgow评分高亦为保护性因素〔OR=0.32,95%CI(-6.43,0.53)〕。合并肺部感染〔OR=6.57,95%CI(2.16,26.79)〕、脑心综合征〔OR=3.18,95%CI(2.07,9.55)〕、消化道出血〔OR=3.42,95%CI(1.98,7.86)〕均为急性脑卒中死亡的独立危险因素。结论老年急性脑卒中患者的院内死亡有多种危险因素。独立危险因素为入院时Glasgow评分低、合并肺部感染、脑心综合征和消化道出血,故应积极预防和治疗急性脑卒中合并症。     

主动脉最大直径与急性A型主动脉夹层患者早期预后的相关性研究

目的:探讨A型急性主动脉夹层(acute aortic dissection,AAD)患者入院时主动脉最大直径(maximum aortic diameter,MAD)与患者早期预后的相关性。方法:纳入就诊于四川大学华西医院胸痛中心并经主动脉CT造影确诊的A型AAD患者。根据患者30 d是否存活分为存活组和死亡组。采用ROC曲线分析找出A型AAD中MAD判断死亡的最佳截点值,根据其是否高于截点值,将患者分为高MAD组和低MAD组;Kaplan-Meier生存分析判断MAD与A型AAD患者死亡结局的关系;多因素COX生存回归分析A型AAD患者死亡的独立危险因素。结果:共纳入A型AAD患者95例,其中死亡组38例,存活组57例。死亡组患者入院时MAD大于存活组[(57.6±10.1)mm vs.(49.3±10.3)mm,P<0.05],差异有统计学意义。ROC曲线分析提示,MAD判断A型AAD患者死亡的曲线下面积为0.751(P<0.05),约登指数最大时,敏感度=70%,特异度=81.7%,最佳截点值为47.05 mm。Kaplan-Meier生存曲线分析显示高MAD组的累计生存率明显低于低MAD组(41.4%vs.89.2%,P<0.001)。多因素COX回归分析显示,入院时高MAD是A型AAD患者死亡的独立危险因素(HR=1.039,95%CI 1.014～1.065,P<0.05)。结论:入院时主动脉最大直径可作为急性A型主动脉夹层患者早期死亡风险的预测因素。     

冠心病患者血管重建后吸烟状态对临床预后的影响

目的 探讨冠心病患者血管重建后吸烟状态对其长期临床预后的影响.方法 将893例冠心病患者根据血管重建术前及术后的吸烟状态分为3组:不吸烟组(n=458)、戒烟组(n=287)及吸烟组(n=148),详细记录随访时主要不良心脑血管事件(MACCE)的发生情况.Kaplan-Meier生存分析描述术后累计生存率,并比较吸烟状态对全因性死亡及MACCE的影响,Cox多元逐步回归分析全因性死亡及MACCE的影响因素.结果 平均随访时间约为27个月,术后吸烟率较术前吸烟率明显降低(16.57％ vs.48.71％),且吸烟组患者较年轻(P＜0.0l);不吸烟组患者多为女性(P＜0.01),体质量指数(BMI)较小(P＜0.01).吸烟组全因性死亡(1.53％ vs.1.05％ vs.6.76％,P=0.002)和MACCE(4.37％ vs.5.23％ vs.15.54％,P=0.001)的发生率较高,Cox多元逐步回归分析显示,术后持续吸烟是导致全因性死亡[HR=2.753,95％CI(1.695～4.473),P＜0.01]和MACCE[HR=1.552,95％CI(1.049～1.754),P=0.001]发生的重要危险因素.结论 冠心病患者血管重建后持续吸烟是导致术后发生全因性死亡和MACCE的独立危险因素.     

B型利钠肽联合TIMI危险积分对STEMI患者远期死亡风险预警价值的研究

目的:评价B型利钠肽(B-type natriuretic peptide,BNP)联合心肌梗塞溶栓(Thrombolysis in myocardial infarction,TIMI)危险积分对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者远期死亡率预警价值.方法:345例STEMI患者在首发胸痛24 h内采血测定血浆BNP水平,并进行TIMI风险积分评定.对纳入病例进行长期随访,随访终点为全因性死亡,包括心血管病死亡和非心血管病死亡.结果:平均随访(314±208)d,死亡率为(69人)20.0%.远期死亡率与高TIMI积分密切相关(P＜0.001).血浆BNP水平升高与远期死亡率增加相关(中位数[全距]ng/L,存活者447.5[8～2 854]vs死亡者986.0[31～4 986],P＜0.001).多因素Cox分析表明,发病24 h内血浆BNP水平升高和TIMI危险积分均为预测远期死亡风险升高的独立可靠指标(BNP,2.608[95%CI,1.840～3.696],P＜0.001;TIMI危险积分,1.227[95%CI,1.138～1.323],P＜0.001).Kapian-Meier生存曲线分析结果为BNP低于中位数者较高于中位数者远期预后明显较佳(P＜0.001).远期生存曲线下面积(Area undera cunre,AUC)BNP为0.797(P＜0.001),而TIMI危险积分0.780(P＜0.001),TIMI积分联合BNP可以提高预测死亡率的价值(AUC,0.853,P＜0.001).结论:发病24 h内测定BNP水平和TIMI危险积分评定能可靠的预测STEMI患者远期死亡风险,BNP水平与TIMI危险积分两者联合能提高其预测远期死亡风险的价值.     

脓毒症并发胃肠道功能不全综合征死亡危险因素分析

目的 探讨脓毒症患者并发胃肠道功能不全综合征(GIDS)的影响预后的有关危险因素.方法 回顾分析2011年10月～2012年10月间北京市海淀医院ICU收治的72例并发GIDS的脓毒症患者.GIDS为入选患者在ICU期间的病例资料中至少具有下列三项因素之一者:即肠内喂养不耐受(FI)、胃肠道出血(GIH)和麻痹性肠梗阻(PI).记录其人口统计学和入选研究时的临床基本资料等25项指标,以及并发GIDS的基本情况,对上述资料先进行单因素分析,然后选择有统计学差异的因素进行多因素非条件Logistic回归分析.主要研究终点为ICU病死率.结果 共有34例并发GIDS的脓毒症患者(47.2％)死亡,与存活组患者相比,非存活组患者病情更重(SOFA评分)[(7.76±3.6)vs(5.53±3.9),P=0.003],ICU住院时间更长[(22.6±15.9)vs(15.0±10.0),P=0.019)];Logistic回归分析结果显示,患者来源分类(OR=6.834,95％CI1.713～27.265,P=0.006)、血小板计数(PLT)(OR=2.01,95％CI2.004～2.017,P=0.002)是发生GIDS的脓毒症患者的独立死亡危险因素.结论 脓毒症患者并发GIDS预后较差;来源手术科室和早期PLT降低的GIDS患者死亡风险较高.     

55例狼疮性肾炎合并血栓性微血管病变临床危险因素分析

目的 分析狼疮性肾炎(lupus nephritis,LN)伴血栓性微血管病变(thromboticmicroangiopathy,TMA)的临床表现、实验室特点、病理特点、临床治疗结果,探讨其临床危险因素.方法 选取2008年8月至2016年7月在本科接受肾活检、病理诊断为LN伴TMA患者55例,分为存活组(34例)与死亡组(21例);利用Logistic回归分析发生死亡的临床危险因素.结果 从临床表现、实验室检查、病理特点、临床治疗结果等因素进行分析,与存活组比较,死亡组急诊血液透析、感染发生率较高(P＜0.01),补体C3较低(P=0.04),CRP(P =0.047)、24 h尿蛋白定量(P=0.02)、血肌酐(serum ereatinine)水平较高(P=0.04),SLEDAI-2000评分较高(P=0.02);当血小板计数(PLT) ＜50×109/L 时,死亡风险明显增加.Logistic回归分析结果显示,急诊透析、感染、PLT＜ 50×109/L时为患者死亡的独立危险因素.结论 急诊透析、感染、血小板降低是伴TMA狼疮性肾炎患者临床危险因素.     

Nrf2 mRNA表达水平与2型糖尿病患者微血管病变发生风险的相关性

目的探究核因子E2相关性因子2(Nrf2) mRNA的表达水平与2型糖尿病患者微血管病变发生风险的相关性。方法选取我院2015年4月至2017年3月2型糖尿病患者188例,随访2年,根据微血管病变发生与否将其分为对照组和病变组。比较两组患者治疗前的基线资料,血糖、血脂、肾功水平、超敏C反应蛋白和Nrf2的表达情况;应用Cox回归分析2型糖尿病患者微血管病变的独立危险因素。结果本研究中,共发生微血管病变50例(26.60%),两组患者在病程、收缩压、空腹血糖、餐后2小时血糖、糖化血红蛋白(HbA1c)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hs-CRP)、Nrf2 mRNA表达水平上存在明显差异(P<0.05)。Cox回归分析结果表明收缩压(HR=1.054,P=0.020),病程(HR=20.413,P=0.001),HbA1c(HR=3.168,P=0.001),hs-CRP(HR=3.131,P=0.020),Nrf2 mRNA表达(HR=20.413,P=0.000)是2型糖尿病微血管病变的独立危险因素,差异有统计学意义。结论 Nrf2 mRNA参与了2型糖尿病...     

重症监护病房感染相关性淤积性黄疸患者的临床分析

目的探讨重症监护病房(ICU)收治的重症感染相关性淤积性黄疸(SSICJ)患者的流行病学特点及其死亡危险因素,提高对ICU中SSICJ的认识并指导临床救治与预后评估。方法采用回顾性研究方法,选取2011年1月至2013年12月皖南医学院附属芜湖市第二人民医院重症医学科收治的重症感染并发淤积性黄疸患者60例,根据死亡结果分为存活组与死亡组,收集临床资料,进行临床特征分析与统计描述,采用Logistic回归分析明确SSICJ患者死亡的独立危险因素。结果最常见感染部位为肺部感染42%(25/60),腹腔感染22%(13/60),血流感染12%(7/60),52例患者共分离出病原菌73株,其中革兰阳性菌22株(30%),革兰阴性菌35株(48%),真菌16株(22%),院内感染29例(48%)。ICU SSICJ患者病死率为35%(21/60),并发院内感染患者病死率达41%(12/29),合并慢性疾病者病死率为54%(13/27),真菌感染病死率为64%(9/14),伴有脓毒性休克患者的病死率高达77%(17/22)。死亡组患者胆红素持续上升例数较存活组明显增加:[0(0/31)和86%(18/21),P<0.01],转氨酶上升不明显[(82±21)U/L和(89±27)U/L,P=0.30]。Logistic回归分析显示:APACHEⅡ评分[优势比(OR)=2.34,95%CI 1.20~5.81,P=0.032]、合并脓毒性休克[OR=4.43,95%CI 1.76~7.38,P=0.049]、入ICU前治疗时间长短[OR=1.56,95%CI1.05~3.78,P=0.015]为ICU重症感染相关性淤积性患者死亡的独立危险因素。结论 SSICJ是ICU常见疾病,合并死亡危险因素的患者应给予更为密切的监测和积极的治疗。     

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.