利用X-刀治疗重症肌无力的临床疗效分析

对8例重症肌无力（myasthenia gravis,MG)伴胸腺瘤患者行X-刀治疗，结果显示稳定缓解5例，药物缓解2例，部分缓解1例，未见明显的肌无力加重或诱发危象及其它不良反应，其中5例术后6个月复查纵隔CT或MRI发现胸腺瘤体积较治疗前缩小，1例无明显变化，8例患者治疗前后的AchRab和CAEab滴度均有下降，提示：该方法疗效可靠，具有微侵袭。高精度，准确安全的特点，对病情危重，年龄大，不宜手术治疗的合并胸腺异常的MG患者是一种安全有效的治疗方法。     

40例重症肌无力手术治疗体会

目的总结1993年3月～2005年12月手术治疗重症肌无力并发胸腺瘤，胸腺增生的手术疗效。方法对40例MG并发胸腺瘤，胸腺增生患者行胸腺及胸腺瘤切除术，随访结果进行分析。结果术后患者肌无力症状缓解13例（占32．5％），改善19例（占47．5％），无效5例（占12．5％），恶化2例（占5．0％），死亡1例（占2．5％），患者手术后的疗效与Osserman分型、胸腺的病理类型及术前病程的长短有关，与性别、年龄无关。结论胸腺切除治疗MG的效果满意，对MG患者应及早手术治疗。     

135例胸腺瘤的诊断和外科治疗

目的:总结胸腺瘤的诊断和外科治疗经验.方法:回顾性分析2001年1月至2008年12月在我科手术治疗的135例胸腺瘤患者的临床资料.结果:肿瘤完整切除123例,部分切除12例,肿瘤完整切除率91%(123/135).住院死亡1例.5年内复发8例,复发率6%(8/134);11例失随访.重症肌无力(MG)发生率为40%(54/135),术后MG症状完全缓解21例(溴吡啶斯的明停药),改善30例(溴吡啶斯的明剂量显著减少),改善不明显或加重3例(溴吡啶斯的明需维持原剂量、增加剂量或加用皮质激素等).结论:胸部增强CT等影像学检查是诊断胸腺瘤的主要手段.重症肌无力是常见伴随症状;胸腺瘤不宜单纯切除,无论病理分期如何均应行扩大切除,以降低复发率;Ⅱ期及以上病变进行综合治疗可提高疗效.     

胸腺瘤合并重症肌无力扩大根治术146例分析

目的探讨胸腺瘤合并重症肌无力(MG)扩大根治术术式的疗效.方法该院在1996～2002年共收治胸腺瘤合并MG者146例,采用了扩大根治术切除胸腺及前纵隔脂肪结缔组织,随访0.5～7.0年,复习文献对比,经统计学处理.结果术后并发重症肌无力危象39例,94例完全缓解,术后停用抗胆碱酯酶(吡啶斯的明)药物治疗,明显改善29例,改善15例,无效3例;围术期死亡2例,远期死亡1例.病理检查,发现前纵隔脂肪内异位胸腺19例.结论扩大根治术治疗胸腺瘤合并MG,术后症状改善率提高,远期存活率高,能显著提高胸腺瘤合并MG的手术效果.     

小儿重症肌无力的外科治疗

目的：探讨小儿重症肌无力(myasthenia gravis，MG)胸腺切除术的手术适应证、围手术期的处理及影响预后的因素。方法：分析1995年1月至2001年1月手术治疗小儿MG32例的随访结果，按Osserman临床分型分为Ⅰ型17例，ⅡA型10例，ⅡB型5例。胸腺病理检查：增生19例，合并胸腺瘤3例，正常组织学表现11例。结果：全组无手术死亡。术后发生肌无力危象3例，总有效率87．5％。结论：胸腺切除术是治疗小儿MG的有效方法，围手术期的处理至关重要。     

32例胸腺瘤合并重症肌无力的外科治疗分析

目的总结、探讨胸腺瘤合并重症肌无力（MG）诊断及治疗经验。方法回顾分析1993年6月~2007年6月接受手术治疗的32例胸腺瘤合并MG的临床资料。分析其临床特点、手术径路及围手术期处理等。结果术后28.1%的患者发生MG危象,在院死亡率为6.2%。MG临床分型与胸腺瘤病理类型的关系差异无统计学意义。结论胸部CT检查有助于早期发现胸腺瘤。完善围手术期管理,减少MG危象发生,手术治疗MG合并胸腺瘤可获良好疗效。     

纵隔病变405例临床病理分析

目的：探讨纵隔病变的临床病理特征。方法：对1967－1997年外科切除的405例纵隔病变组织进行分析。结果：男216例,女189例,中位年龄26岁;肿瘤及瘤样病变230例（56．8％）,重症肌无力（MG）172例（42．5％）;在肿瘤性病变中,胸腺肿瘤113例（49．1％）居首位,平均年龄40岁;生殖细胞瘤36例（15．7％）,神经源性肿瘤30例（13％）,淋巴瘤仅6例（2．6％）,囊肿29例（12．6％）。前纵隔肿瘤165例（71．7％）,主要为胸腺肿瘤;中纵隔肿瘤6例;后纵隔肿瘤30例,主要系神经源性肿瘤。非肿瘤性病变中,MG胸腺淋巴滤泡性增生145例（84．3％）,无增生者27例（15．7％）;MG伴胸腺肿瘤38例（22．1％）,其中微小胸腺瘤12例（6．9％）。结论：MG胸腺伴有淋巴滤泡性增生者,预后好于胸腺非增生和胸腺瘤者,MG胸腺病理诊断对于发现微小胸腺瘤具有一定重要性。纵隔内胸腺肿瘤几乎占肿瘤病变的半数,国人淋巴瘤发病率较低,多数（84．3％）MG患者胸腺表现淋巴滤泡性增生。     

胸腺瘤合并重症肌无力的外科治疗(附26例报告)

重症肌无力(MG)是一种针对神经肌肉接头处乙酰胆碱受体的自身免疫性疾病，约10％～15％的患者伴有胸腺瘤。手术切除胸腺瘤和胸腺组织是治疗MG伴胸腺瘤的基本方法，有明确的效果。现将我科近年来行手术治疗的胸腺瘤合并重症肌无力26例回顾分析如下。     

重症肌无力胸腺切除术后复发22例治疗分析

目的 分析重症肌无力(MG)胸腺切除术后复发肌无力的因素及治疗。方法 对确诊为(MG)作胸腺切除术后肌无力加重的22例应用类固醇激素和／或硫唑嘌呤治疗，并作40个月随访。结果 MG伴胸腺增生10例全部缓解、缓解率100．0％，其中完全缓解9例(90．0％)，药物缓解1例(10．0％)，缓解率和肌无力改善程度随术后时间延长而增高；MG伴胸腺瘤12例、缓解10例、缓解率83．3％，其中完全缓解3例(25．0％)、药物缓解6例(50．0％)、显著改善1例(8．3％)、死亡2例(16．7％)。结论 MG在胸腺切除后宜常规应用类固醇激素和其他免疫抑制剂，以提高远期疗效，避免再发肌无力加重。     

重症肌无力胸腺瘤手术及围术期临床研究

目的：探讨胸腺瘤合并重症肌无力（MG）患者胸腺瘤的手术方法、围术期的处理和治疗效果。方法：回顾分析本院86例胸腺瘤伴MG患者临床资料，包括手术前准备、术中处理、术后危象的预防及处理等。结果：手术86例术后发生肌无力危象（MGC）共16例（18．60％），除术后死亡2例外，其余病例恢复出院。术后肌无力症状完全缓解42例、改善30例，有效率83．72％，其余14例症状无缓解或加重。结论：胸腺瘤切除是治疗胸腺瘤合并重症肌无力的一种较安全而有效方法。术前充分准备，术中彻底切除胸腺瘤及前纵隔淋巴结脂肪组织．术后延长呼吸机辅助通气，合理及时使用胆碱酶抑制剂及激素，加强呼吸道管理控制感染等综合措施，是预防及治疗肌无力危象的有效方法．有利于降低MGC发生率及围术期死亡率。     

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.