液基薄层细胞学筛查门诊人群宫颈癌的研究

目的探讨TCT技术和TBS方案对妇科门诊人群子宫颈癌筛查的准确性.方法随机收集妇产科门诊人群5 000例宫颈脱落细胞液基标本,采用TCT技术和TBS方案诊断.对细胞学阳性的即意义不明的不典型鳞状/腺细胞(ASCUS/AGUS)以上病变200例病例行阴道镜活检和组织病理学诊断.所有诊断均双盲进行.结果 TCT细胞学检出100%(9/9)的鳞状细胞癌(SCC),1例腺癌(AC),检出95%(38/40)的鳞状上皮内高度病变(HSIL),70.77%(92/130)的鳞状上皮内低度病变(LSIL).经统计学处理,液基细胞学对HSIL及SCC诊断与活检组织病理诊断的符合率显著高于对LSIL的诊断符合率(P＜0.01),两者差异有显著性.结论生育年龄段的妇女应定期进行液基细胞学筛查,TCT技术和TBS方案对宫颈上皮内病变,尤其是HSIL及其以上病变的筛查敏感性高.     

液基薄层细胞学用于宫颈病变筛查的研究

目的:探讨液基薄层细胞学TCT制片技术在宫颈病变筛查的临床应用价值。方法:在2006年1月至2006年4月在我院妇科门诊就诊的宫颈病变患者中,采用TCT制片技术,结合Bethesda2001报告,随机对1620例患者进行宫颈细胞学筛查。并对非典型鳞状上皮以上病例进行宫颈组织病理学检查。结果:1620例患者取材均为满意涂片:检出异常结果有不明确意义的非典型鳞状上皮(ASC-US)45例,不除外高度病变的非典型鳞状上皮(ASC-H)12例,低度鳞状上皮内病变(LSIL)39例,高度鳞状上皮内病变(HSIL)7例。病理组织学结果为上皮内病变(≥LSIL)43例,病理符合率为93.48%。结论:液基薄层细胞学TCT制片技术用于宫颈病变筛查,可提供早期发现宫颈病变和癌前病变的信息,具有重要的临床实用价值。     

新柏氏液基细胞学检查在宫颈病变中的应用

目的探讨TCT技术和TBS方案应用于宫颈病变筛查的可靠性。方法收集我院妇科门诊4629例宫颈液基细胞学标本，采用TBS方案诊断，对170例细胞学阳性片行阴道镜及活检诊断，并对其发病年龄进行分析。结果TCT检出100％（4／4）的鳞状细胞癌（SCC），检出94％（47／50）的鳞状上皮内高度病变（HSIL），78．8％（41／52）的鳞状上皮内低度病变（LSIL）。经X^2检验，液基细胞学对HSII．与阴道镜活检，病理组织学诊断的符合率显著高于LSII，（P＜0．05）。细胞学阳性患者年龄分布主要发生于25-50岁年龄段，特别是35-40岁组发生率最高，达30．59％。结论TCT技术和TBS方案对宫颈病变的筛查具有良好的实用性，对宫颈上皮内瘤变，特别是对HSIL及以上的病变敏感性高。25～50岁年龄段妇女应定期做TCT筛查，对35～40岁组应做重点筛查。     

宫颈液基细胞检查在宫颈病变筛查中的应用

目的 探讨宫颈液基细胞检查(TCT)在宫颈病变筛查中的临床价值.方法 对2008年在笔者所在医院就诊的1358例患者行宫颈液基细胞检查,采用细胞学分类诊断(TBS),对TCT异常的患者进行宫颈活检.结果 140例涂片异常统计显示:小于30岁年龄段阳性率21.43%,30~39岁阳性率27.14%,40~49岁阳性率29.29%,说明宫颈癌的好发年龄提前,性生活活跃期的妇女仍为宫颈癌的好发人群.TCT检测技术与病理检查的符合率:低度鳞状上皮内病变(LSIL)为80%,高度鳞状上皮内病变(HSIL)为87%,鳞状细胞癌(SCC)为100%,故病变程度越高,TBS细胞学检查与组织病理学诊断的符合率越高.结论 TCT检查是筛查宫颈病变的可靠手段.     

液基超薄细胞技术及TBS系统检测1713例宫颈涂片的临床分析

目的 对液基超薄细胞技术(thinperp cytologic test,TCT)和Bethesda系统(TBS)在宫颈病变临床应用价值进行评价.方法 2008年1月～2010年5月对在笔者所在医院妇产科门诊就诊的1713例患者行TCT检查和TBS细胞学分类诊断,对TCT检查发现异常的患者进行阴道镜下宫颈取材病理学检查.结果 1713例涂片中检查出异常涂片180例(10.51%),其中不典型鳞状细胞(ASCUS)98例(5.44%),低度鳞状上皮内病变(LSIL)68例(3.75%),高度鳞状上皮内病变(HSIL)21例(1.17%),鳞状细胞癌(SCC)3例(1.6%),子宫内膜腺癌1例(0.55%).30～39岁年龄段,异常涂片最高69例(38.36%),其次是40～49岁年龄段54例(29.83%),与其他年龄组相比差异有统计学意义(P<0.05).TCT与阴道镜病理学检查符合率分别为LSIL 71.42%、HSIL 93.33%、SCC 100%,两者比较差异无统计学意义.结论 TCT技术结合TBS应用于宫颈细胞涂片配合阴道镜活检,是筛查和诊断子宫颈癌前病变的可靠手段.     

液基薄层细胞学检测筛查宫颈上皮内病变的研究

目的探讨液基薄层细胞学检测（TCT）及TBS细胞学分类法在宫颈病变筛查中的应用价值。方法随机对3455例患者进行TCT检测。采用TBS分类法,按年龄分为4组,其中上皮异常者进行阴道镜检查和活检作病理诊断对照,随诊3～6个月。结果细胞学异常者97例（2．81％）,其中未明确诊断意义不典型的鳞状细胞42例,未明确诊断意义的不典型腺细胞2例,低度鳞状上皮内病变35例,高度鳞状上皮内病变16例,鳞状细胞癌2例。细胞学诊断鳞状细胞内病变53例,检出率为1．53％,组织病理学检出宫颈上皮内瘤变75例,检出率为2．17％,细胞学与组织学诊断符合率为70．6％。结论宫颈疾病患病年龄趋于年轻化。TCT技术应用于早期宫颈癌筛查能明显提高异常细胞检出率。TBS报告方法直观、具体,便于临床医生与细胞学医生之间的沟通。     

液基细胞学检查在宫颈疾病中的诊断价值

目的探讨液基超薄细胞技术（thinprep cytologic test,TCT）和Bethesd系统（TBS）在早期宫颈病变诊断中的临床价值。方法 2 187例患者进行TCT检查和TBS细胞学分类诊断,对TCT检查发现异常者行病理检查。结果 2 187例TCT中检出细胞学异常的139例,其中不典型鳞状细胞（ASC）93例,低度鳞状上皮内病变（LSIL）22例,高度鳞状上皮内病变（HSIL）24例。大于55岁年龄段,细胞学阳性检出率最高,其次是36～45岁年龄段;TCT与病理检查符合率分别为ASCUS 69.64%、LSIL 45.45%、HSIL94.44%。结论 TCT技术结合TBS应用于宫颈细胞学涂片配合阴道镜下活检是筛查和诊断子宫颈癌前病变的有效手段。     

液基薄层细胞学筛查宫颈上皮病变的临床研究

目的 评价液基薄层细胞学检查(TCT)结合阴道细胞命名系统(TBS)诊断宫颈病变的准确性.方法 TCT结合TBS对668例受检者的宫颈脱落细胞进行细胞学诊断,将TBS报告的意义不明的不典型鳞状细胞(ASCUS)、低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)以及鳞状细胞癌(SCC)列为细胞学阳性病例.对阳性病例进一步采用阴道镜下活组织病理学检查.采用Spearman等级相关分析对细胞学和组织学检查结果的相关性进行评价.结果 TCT共检出76例细胞学阳性病例,占全部受检病例的11.38%.其中ASCUS 42例,LSIL 28例,HSIL 5例,SCC 1例.阴道镜下活组织病理诊断结果为良性细胞改变(BCC)37例,宫颈上皮内瘤变(CIN)Ⅰ级31例、Ⅱ级4例、Ⅲ级3例,SCC 1例.Spearman等级相关分析显示细胞学和组织学检查结果呈高度正相关(rs=0.808 1,P＝0.000).结论 TCT技术结合TBS的细胞学检查对于宫颈癌及癌前病变的诊断有很高的敏感性,是一种可靠的宫颈癌及癌前病变筛查手段.     

液基细胞学检查在诊断宫颈病变中的临床应用

目的探讨液基细胞学(TCT)配合阴道镜检查对诊断宫颈病变的价值。方法535例患者进行液基细胞学检查,对其中73例细胞学提示阳性者行阴道镜下活组织病理检查,细胞学诊断采用TBS分段系统。结果共检出阳性涂片73例,占13．6％,其中不典型鳞状细胞(ASCUS)46例,占8．6％;低度鳞状上皮内瘤变(LSIL)11例,占2．1％;高度鳞状上皮内瘤变(HSIL)10例,占1．9％;鳞状上皮癌(SCC)5例,占0．9％;腺癌(AC)1例,占0．2％。与阴道镜下活组织病理诊断符合率分别为LSIL 72．7％,HIL90．0％,SCC 100％。结论生育年龄段(20—50岁)的妇女,应定期进行液基细胞学检查,可早期发现宫颈病变,细胞学阳性者应配合阴道检查及镜下活检病理诊断,以便进一步明确诊断,早期治疗。     

液基细胞学联合阴道镜检查在子宫颈病变筛查中的应用

目的探讨液基细胞学(TCT)联合阴道镜检查对子宫颈病变筛查的可行性。方法时在我院妇科门诊及体检中心检查的2490例妇女行液基细胞学筛查，其中273例细胞学提示阳性和86例临床高度可疑的患者行阴道镜检查及镜下活组织病理检查。结果液基细胞学筛查所检出阳性涂片273例，其中不典型鳞状上皮细胞(Ascus)219例，鳞状上皮内低度病变(LSIL)36例．鳞状上皮内高度病变(HSIL)8例，鳞状细胞癌(SCC)2例，病变栓出率7857％。阴道镜检查发现异常图像248例，病变检出率86．90％。二者联合应用病变检出率96．43％。结论TCT和阴道镜联合应用，可明显提高对子宫颈病变诊断的准确性，能满足早期子宫颈癌及癌前病变筛查的需要。     

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.