超声心动图Tei指数监测心脏移植术后排异反应的初步体会

目的 应用超声心动图多普勒技术测定心脏移植后左室的Tei指数，并与心内膜心肌活检EMB对比，探讨超声心动图TEI指数在监测心脏移植术后急性排异反应的价值。方法 16例心脏移植患者有5例患者共进行10次心内膜心肌活检，于进行心内膜心肌活检术时同期行超声心动图检查，用频谱多普勒测量左室Tei指数，并与心肌活检病理作对照。结果 心肌活检病理分级0或I级者左室Tei指数稍高于正常值，心肌活检病理分级III级以上者左室Tei指数明显增高。结论 超声心动图左室Tei指数，可较准确提示移植心脏急性排异反应，Tei指数在监测心脏移植术后排异反应有较高价值。     

超声心动图Tei指数监测心脏移植术后排异反应的体会

目的应用超声心动图多普勒技术测定心脏移植后左室的Tei指数,并与心内膜心肌活检(EMB)对比,探讨超声心动图Tei指数在监测心脏移植术后急性排异反应的价值。方法16例心脏移植患者有5例患者共进行10次心内膜心肌活检,于进行心内膜心肌活检术时同期行超声心动图检查,用频谱多普勒测量左室Tei指数并与心肌活检病理作对照。结果心肌活检病理分级0或1级者左室Tei指数稍高于正常值,心肌活检病理分级Ⅲ级以上者左室Tei指数明显增高。结论超声心动图左室Tei指数,可较准确提示移植心脏急性排异反应,Tei指数在监测心脏移植术后排异反应有较高价值。     

美敦力SSR303在心脏移植术后观测排异反应中的应用

目的 美敦力SSR303心肌内心电图在心脏移植术后观测排异反应中的应用价值.方法 采用双腔法原位心脏移植手术,电极植入病人右室心肌表面,连接起搏器,术后观测美敦力SSR303心肌内心电图R波振幅的变化(8例).结果 1例患者术后第6dR波振幅明显降低,第8d死亡;另1例患者术后第11d死干急性肾衰;余5例患者术后R波平均振幅较基数无降低,均长期存活;1例术后1周出现R波平均振幅下降达10%以上连续3天考虑急性排斥反应,应用抗排药物4天后,R波振幅明显回升,长期存活.结论 心肌内心电图可以进行永久无创性监测心脏移植后排斥反应的发生,明显减少了心内膜活检的次数.     

心脏移植术后非排异期超声心动图表现特点（附1例报告）

目的：动态观察原位心脏移植术后1年不同时间段移植心脏超声心动图表现，研究心脏移植术后非排异期超声心动图表现特点，方法：应用Acuson彩色多谱勒超声心动图诊断仪观察房室腔大小，室壁及室间隔厚度，二尖瓣及三尖瓣血流频谱，左室肌质量及肌质量指数，计算不同时间段数值平均值并同术前供体作对照。结果：患者在术后1年长期存活，无急性排斥反应发生，超声心动图监测表现为：左室，右室及右房内径显著下降，而左房内径则显著上升；室间隔，左室后壁及右室前壁显著增加，左室肌质量及肌质量指数显著增加。二尖瓣E、A峰及碱尖瓣E峰均显著下降，三尖瓣A峰变化不明显，术后4个月出现二尖瓣反流，术后持续存在三尖瓣反流，结论：心脏移植术后非排异期的形态，结构及功能具有特殊性，某些特点类似早期急性排斥反应，最终确诊尚需心内膜心肌活检。     

原位同种心脏移植术后早期急性排斥反应的监测与治疗

我院心外科于１９９４年３月成功地为１例１３岁晚期扩张型心肌病女性患者施行了原位同种心脏移植术。术后存活２８ｄ．因第三次心肌急性排斥反应抢救无效死亡。作者强调应采用多种抗排斥反应药物，且需小剂量，对使用抗胸腺细胞球蛋白药物应谨慎．尽管拥有众多的非侵入性检查，但没有一种非侵入检查技术能直接有效地诊断心肌排斥反应，心内膜心肌活检是监测心肌排斥反应最直接可靠的手段而不能被取代。     

原位同种心脏移植术后早期急性排斥反应的监测与治疗

我院心外科于１９９４年３为１例１３岁晚期扩张型心肌病女性患者施行了原位同种心脏移植术。术后存活２ｄ。因因第三次心肌急性排斥反应抢救无效死亡。作者强调应采用多种抗排斥反应药物，且需小剂量，对使用抗胸腺细胞球蛋白约物廑慎。尽管拥有众多的非侵入性检查，但没有一种非侵入检查技术能直接有效地诊断心肌排斥反应，心内膜心肌活检是监测心肌排斥反应最直接可靠的手段而不能补取代。     

心脏移植术后急性排斥反应的无创监测

心脏移植已成为治疗终末期心脏病的有效方法 ,目前影响其远期生存率的主要因素是移植后的急性和慢性排斥反应。经颈内静脉心内膜活检 ,已成为诊断心脏移植术后排斥反应的“金标准” ,但还存在一定局限性。心电图、超声心动图、免疫学及影像学等无创手段 ,能有效地监测心脏移植术后排斥反应的发生和指导心内膜活检的进行。     

原位心脏移植5例经验体会

对5例终末期心脏病患者实施了原位心脏移植手术。术后免疫抑制剂应用环孢素A 骁悉 泼尼松三联疗法。结合临床表现、超声心动图、化验检查及心肌内心电图,对心脏移植术后急性排斥反应的监测进行分析。5例手术均顺利,其中1例存活时间仅为9d,其余均近期存活,生活质量良好。原位心脏移植是治疗终末期心脏病的有效方法。心肌内心电图可以明显减少心肌活检的次数。低血管阻力受体的选择和合理的免疫抑制治疗方案的应用是心脏移植成功的关键。     

心脏移植术后非排异期超声心动图表现特点(附1例报告)

目的动态观察原位心脏移植术后1年内不同时间段移植心脏超声心动图表现,研究心脏移植术后非排异期超声心动图表现特点。方法应用Acuson彩色多谱勒超声心动图诊断仪观察房室腔大小、室壁及室间隔厚度、二尖瓣及三尖瓣血流频谱、左室肌质量及肌质量指数,计算不同时间段数值平均值并同术前供体作对照。结果患者在术后1年长期存活,无急性排斥反应发生。超声心动图监测表现为:左室、右室及右房内径显著下降,而左房内径则显著上升;室间隔、左室后壁及右室前壁厚度显著增加;左室肌质量及肌质量指数显著增加;二尖瓣E、A峰及三尖瓣E峰均显著下降,三尖瓣A峰变化不明显。术后4个月出现二尖瓣反流,术后持续存在三尖瓣反流。结论心脏移植术后非排异期的形态、结构及功能具有特殊性,某些特点类似早期急性排斥反应,最终确诊尚需心内膜心肌活检。     

心肌灌注断层显像与心内膜心肌活检远期监测心脏移植术慢性排斥反应

目的 评估心肌灌注断层显像与心内膜心肌活检在心脏移植手术后远期监测慢性排斥反应中的作用。方法 在同一时期对7列心脏移植术后远期存活患者行心肌灌注断层显像与心内膜心肌活检，将两种方法的结果对比研究。结果 7例受体中，有4例患者的心内膜心肌活检为轻度慢性排斥反应，相应地心肌灌注断层显像为心肌血流灌注尚均匀，特异度为66．7％，1例漏诊，2例误诊。结论 心内膜心肌活检和心肌灌注断层显像都是监测慢性排斥反应的方法，前者仍然是诊断慢性排斥反应的金标准，后者对诊断有一定的特异性。     

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.