经食道超声对射频消融术前房颤患者左房及左心耳血栓的诊断价值

目的探讨经食道超声（transesophageal echocardiography, TEE）对射频消融术前房颤患者左房及左心耳血栓的诊断价值。方法对52例房颤拟行射频消融术患者同时进行经胸超声（transthoracic echocardiography, TTE）和经食道超声检查,比较分析左房和左心耳血栓检出情况。结果52例房颤患者经胸超声检出左房血栓4例(7.69%）,左心耳血栓3例(5.77%）,其中1例假阳性,左心房自发显影（spontaneous echo contras, SEC）2例(3.85%）;经食道超声检出左房血栓8例(15.38%）,左心耳血栓9例（17.31%),左心房SEC 8例（15.38%）,左心耳SEC 6例（11.54%）,两种方法比较均有显著差异性。超声图像显示：左心房及左心耳内可见异常回声团块,附着于心房或心耳内壁,形态不规则,不活动,提示为左房或左心耳血栓形成,左房或左心耳内漩涡状或云雾状回声为血流自发显影现象,提示血流高凝状态。结论经食道超声明显提高了左房及左心耳血栓的检出率,是房颤射频消融治疗前的有效检查手段。     

经食道及经胸超声检测房颤患者左心耳血栓的对比研究

目的：比较经食道超声（TEE）及经胸超声（TTE）在检测房颤患者左心耳血栓中的价值。方法对74例非瓣膜性房颤患者同时进行TEE和TTE检查,比较左心耳血栓的检出情况。结果74例房颤患者中,TTE检出左心耳血栓9例（12.16%）,其中假阳性3例;检出左心耳自发显影（SEC）5例（6.76%）,其中假阳性2例;TEE检出左心耳血栓24例（32.43%)、左心耳SEC18例（24.32%）,两种方法比较具有统计学差异。超声表现：左心耳血栓表现为左心耳内壁异常回声团块附着,为低回声或稍强回声,左心耳SEC表现为左心耳内漩涡状或云雾状回声,提示血栓形成高危状态。结论 TEE对左心耳血栓的检出率明显高于TTE,对房颤治疗具有重要的临床价值。     

左心房、左心耳自发声学显影影响因素的对比研究

目的：对比研究慢性非瓣膜性心房颤动患者(房颤)左房、左心耳入口和左心耳尖部自发声学显影(SEC)的影响因素。方法：非瓣膜性房颤患者23例，测定其外周静脉血凝血标记物；经胸超声心动图测量左房内径、左室壁厚度等；经食管超声心动图测量左心耳和肺静脉血流速度；应用背向散射积分(IBS)技术定量测定左心房、左心耳入口和左心耳尖部SEC。结果：左心房IBS值与左室壁厚度呈正相关，与左心耳血流流速积分(AVi)和肺静脉血流平均流速(PVDm)呈负相关；左心耳入口IBS与左心耳血流峰值流速(AVp)、平均流速(AVm)、AVi呈负相关，与肺静脉血流D波峰值流速(PVDp)、PVDm呈负相关；左心耳尖部IBS值与左房内径、左室壁厚度呈正相关，与肺静脉血流S波峰值流速(PVSp)、PVSm和PVDm呈负相关，与血浆纤维蛋白原呈正相关。结论：左心房、左心耳入口SEC主要受局部血流动力学异常的影响，左心耳尖部SEC与血流动力学和血浆纤维蛋白原异常有关；定量分析左心耳入口处和左心耳近尖部SEC可能对预测血栓前状态和栓塞事件更有价值。     

非瓣膜性房颤经食道超声心动图的研究

目的探讨TEE检测非瓣膜性房颤左心耳的大小及功能与左心耳内血栓形成之间的关系,为临床进行风险评估、判断愈后及指导治疗等方面提供重要依据。方法采用TEE对41例非瓣膜性房颤伴有或不伴有高血压患者进行左心耳检测,根据左心耳的形态特点,测量出左心耳入口的宽度、左心耳顶部到入口的长度,同样用描记法测出左心耳舒张末容积,运用脉冲多普勒测出左心耳血流充盈与排空速度,检测左心耳内透声情况及有无血栓。结果41例房颤患者中左心耳血栓7例,有血栓组与无血栓组的左心耳的大小、容积无显著性差异,而左心耳的峰值血流排空速度差异具有显著性;随房颤病程变化,左心耳容积具有显著性差异(P<0.05);房颤伴高血压组与不伴高血压组上述指标亦具有显著性差异。结论左心耳大小、形态的改变,功能的减低,血流速度的减慢是房颤患者左心耳内血栓形成的重要危险因素。因此,对左心耳大小、形态及功能的检测可以帮助临床进行风险评估、判断愈后以及指导治疗等方面都有着重要的临床价值。     

多平面经食道超声心动图估测左心耳功能及血栓的评价

目的 评价应用经食道超声心动图(TEE)估测左心耳功能及诊断左房血栓的价值。方法 采用TEE对33例伴有或不伴有房颤患者检测左心耳容量及收缩功能，探测左房和左心耳内有无明确血栓征象。并与经胸多普勒二维超声心动图(TTE)比较。结果 33例患者中左房血栓6例，左心耳血栓6例，排除左房血栓3例。根据左心耳面积测定计算出左心耳射血分数(Efv)与左心耳峰值血流排空速度(Per)相关性良好(r=0．84)。结论 TEE不仅可定性诊断左房血栓，还可测量左心耳射血分数，房颤患者左心耳面积扩大，左心耳射血分数减低，评价左心耳功能较二维超声心动图更为准确。     

非瓣膜性房颤经食道超声心动图的研究

目的探讨TEE检测非瓣膜性房颤左心耳的大小及功能与左心耳内血栓形成之间的关系，为临床进行风险评估、判断愈后及指导治疗等方面提供重要依据。方法采用TEE对41例非瓣膜性房颤伴有或不伴有高血压患者进行左心耳检测，根据左心耳的形态特点，测量出左心耳入口的宽度、左心耳顶部到入口的长度，同样用描记法测出左心耳舒张末容积，运用脉冲多普勒测出左心耳血流充盈与排空速度，检测左心耳内透声情况及有无血栓。结果41例房颤患者中左心耳血栓7例，有血栓组与无血栓组的左心耳的大小、容积无显著性差异，而左心耳的峰值血流排空速度差异具有显著性；随房颤病程变化，左心耳容积具有显著性差异（p〈0．05）；房颤伴高血压组与不伴高血压组上述指标亦具有显著性差异。结论左心耳大小、形态的改变，功能的减低，血流速度的减慢是房颤患者左心耳内血栓形成的重要危险因素。因此，对左心耳大小、形态及功能的检测可以帮助临床进行风险评估、判断愈后以及指导治疗等方面都有着重要的临床价值。     

窦性节律伴左心室功能减退的卒中患者中左心房超声自发性显影或血栓形成的预测指标

本研究旨在确定窦性节律伴左心室功能障碍的卒中患者中左心房超声自发性显影(SEC)或血栓形成的预测指标。在500例卒中患者中,48例窦性节律伴左心室射血分数(EF)降低至≤45%的患者接受了检查。10例患者出现了SEC或血栓。出现SEC或血栓的患者左房内径较大(47±4m m vs42±6m m,P<0.05),EF较低(30%±9%vs38%±8%,P<0.01),左心耳(LAA)血流速度较低(42±13cm/s vs61±17cm/s,P<0.01)。多变量分析显示,EF≤35%和LAA血流速度≤55cm/s可以作为SEC或血栓的预测指标(P<0.05)。窦性心率伴左心室EF中至重度降低的卒中患者具有左心房源性栓塞…     

经食道超声心动图评估特发性房颤左心房左心耳及意义

目的:总结经食道超声心动图对特发性房颤左心房/左心耳的评估及意义.方法:采用经食道超声心动图对特发性房颤和对照组左心房/左心耳检查,检测左心房大小和回声、左心耳面积变化率、左心耳血流最大排空速度和最大充盈速度,比较这些参数的改变.结果:经食道超声心动图检查能清晰显示所有患者左心房/左心耳及其它相关结构声像图和准确测量有关参数,不良反应轻微.特发性房颤患者中阵发性房颤与持续性房颤患者之间及其与对照组的差别均有统计学意义(P＜0.05).比较伴有和不伴有左心房自发性显影的特发性房颤患者之间及其与对照组的年龄、病程、左心房左右径、左心房前后径、左心耳面积变化率、左心耳血流最大排空速度及左心耳血流最大充盈速度参数,差异均具有统计学意义(P＜0.05).结论:经食道超声心动图能够客观地评价特发性房颤患者的左心房/左心耳,发现自发性显影、血栓和血流速度异常,可为临床制定治疗方案提供客观依据.     

经食管超声对风湿性二尖瓣狭窄患者自发显影的研究

为探讨风湿性二尖瓣狭窄(MS)患者自发显影(SEC) 与左心耳功能状态、心房纤颤及血栓形成的关系,作者采用经胸及经食管超声测量了117例风湿性二尖瓣狭窄患者的左房径(LAD)、二尖瓣口面积(MVA)、左心耳最大面积(LAA-area)、最大充盈速度(L AA-Vpf)和最大排空速度(LAA-Vpe),并观察了左心房和左心耳血栓及SEC程度.结果: 该117例患者中,窦性心律57例,房颤60例;无血栓者98例,血栓19例;无SEC 者46例,SEC 71例;与无SEC 组比较,SEC组LAA-Vpf明显减低 (0.18±0.01m/s∶0.31±0.03m/s,P ＜0.05);LAA-Vpe亦明显减低(0.17±0.01m/s∶0.32±0.02m/s,P＜0.05);血栓和房颤出现率明显增高(P＜0.05), LAD增大 (46.39 ±0.85mm∶41.76±1.05mm,P ＜0.05),LAA-area增大(8.06±0.32 cm2 ∶6.92±0.31 cm2,P＜0.05),MV A减小(1.07±0.33 cm2∶1.32±0.45 cm2,P＜0.05).上述结果提示,心房纤颤、二尖瓣口面积和左房大小是SEC形成的独立相关因素, SEC与左心耳功能呈显著负相关( F1=33.2,F2=46.7), SEC与血栓形成有显著相关(Odds Ratio＝2.50).     

心房颤动患者左心房血清炎性因子和血管内皮损伤标志物水平变化与血栓的相关性研究

背景心房颤动(以下简称房颤)容易合并脑卒中和外周动脉栓塞。研究房颤血栓形成的具体机制并进行有效干预以降低血栓形成的风险,是目前房颤基础和临床研究的重要方向。目的 探讨房颤患者左心房血清炎性因子和血管内皮损伤标志物水平变化与血栓的相关性。方法 选取2017年7月至2019年12月在广西医科大学第一附属医院接受开胸心脏手术的瓣膜性心脏病患者29例和冠心病患者10例,依据心律情况分为窦性心律组15例和房颤组24例。房颤组的24例患者再依据血栓情况分为无左心耳血栓和有左心耳血栓两个亚组,分别为房颤+左心耳血栓亚组和房颤无左心耳血栓亚组,各12例。收集患者的一般资料,并检测左心房内径(LAD)、左心室射血分数(LVEF),术中抽取左心房血液标本检测蛋白激酶B(AKT)、核转录因子κB(NF-κB)、超敏C反应蛋白(hsCRP)、白介素(IL)-6、IL-8、肿瘤坏死因子α(TNF-α)、内皮素(ET-1)、一氧化氮(NO)、血管性血友病因子(vWF)、细胞间黏附分子(ICAM-1)及血管细胞黏附因子(VCAM-1)水平,并检测房颤+左心耳血栓亚组患者血栓面积。房颤+左心耳血栓亚组患者LAD、LV...     

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.