肝硬化与胆囊结石的相关性研究

目的 探讨肝硬化与胆囊结石的相关性。方法采用B型超声检查、临床分析、比较肝硬化代偿期与失代偿期患者胆囊结石发生的情况并与健康对照组比较。结果 肝硬化患者胆囊结石明显高于对照组(P＜0．001)，并且失代偿组高于代偿组(P＜0．05)。肝硬化患者阻囊壁厚度≥4mm发生胆囊结石阳性率高于胆囊壁厚度＜4mm(P＜0．05)。肝硬化患者门静脉内径≥13mm发生胆囊结石阳性率高于门静脉内径＜13mm(P＜0．01)。结论 肝硬化患者胆囊结石发生率与胆囊壁厚度，门静脉内径、肝功能受损严重程度有关。     

肝硬化患者胆囊结石的成因探讨

目的　探讨肝硬化与胆囊结石的相关性。方法　采用B超检查、分析 ,比较肝硬化代偿期与失代偿期患者胆囊结石的发生情况与健康对照组比较。结果　肝硬化患者胆囊结石的发生率明显高于对照组 (P <0 .0 1 ) ,失代偿组高于代偿组 (P <0 .0 5)。肝硬化患者胆囊壁厚度≥ 4mm胆囊结石的阳性率高于胆囊壁 <4mm者 (P <0 .0 5)。肝硬化患者门静脉内径≥ 1 3mm胆囊结石的阳性率高于内径<1 3mm者 (P <0 .0 1 )。结论　肝硬化患者胆囊结石发生率与胆囊壁厚度 ,门静脉内径、肝功能受损严重程度有关。     

肝硬化患者与胆囊壁厚度的关系

目的 研究肝硬化患者胆囊壁厚度的变化并探讨其临床意义.方法 回顾性分析43例肝硬化患者B超及肝功能检查资料,并进行统计学处理.结果 肝硬化患者有胆囊壁增厚者达76.7%,且有腹腔积液者胆囊壁增厚发生率为87.1%,高于无腹腔积液者的50.0%（P＜0.05）.胆囊壁厚度与门静脉宽度呈正相关关系（P＜0.01）,与血清白蛋白呈负相关关系（P＜0.01）.结论 肝硬化患者往往伴有胆囊壁增厚,且伴发腹腔积液者胆囊壁增厚发生率高于无腹腔积液者.其原因是多方面的,与门静脉高压及低蛋白血症等有关的综合因素所致.     

探讨肝硬化合并胆囊结石患者的相关因素及其临床特点

目的研究并探讨肝硬化合并胆囊结石患者的相关因素及其临床特点。方法以该院2008年12月—2011年12月期间共收治的100例肝硬化以及36例肝硬化合并胆囊结石的患者为研究对象,并对所有研究对象的临床资料进行了较为科学与全面的回顾性分析。结果肝硬化合并胆囊结石的发生率为26.5%,且男女之间的发病无显著的差异。患者的年龄≥60岁,胆囊壁厚度≥4mm,门静脉内径≥13mm,血浆白蛋白<35g/L的患者发生率较高。肝硬化合并胆囊结石患者的死亡率较无结石的单纯肝硬化患者高。结论肝硬化患者合并胆结石在临床中的发生率较高,且其临床症状较为隐匿、缺乏特异性,胆囊结石发生肝硬化的患者往往与其体内的胆囊壁厚度、门静脉内径、白蛋白水平以及年龄等因素密切相关,临床中应该采用保守治疗的方式来进行治疗。     

肝硬化合并胆囊结石患者32例临床特征观察

目的分析肝硬化合并胆囊结石患者的临床特征。方法选择肝硬化合并胆囊结石患者32例为观察组,另选择肝硬化未合并胆囊结石患者33例为对照组,比较2组患者性别、年龄、肝功能分级、血浆白蛋白水平、门静脉内径宽度、内毒素水平、内毒素血症发生率及低密度血浆脂蛋白(Lp-X)阳性率。结果观察组患者年龄>60岁的比例高于对照组(P<0.05),门静脉内径均值为(16.54±2.31)mm、白蛋白浓度为(28.34±3.23)g/L,与对照组相比差异均有统计学意义(P<0.05),观察组患者内毒素水平(71.13±34.55)pg/ml高于对照组的(24.32±12.34)pg/ml(P<0.05),内毒素血症发生率及Lp-X阳性率均高于对照组(71.88%vs 48.48%,56.26%vs 30.30%,P<0.05)。结论年龄≥60岁,门静脉内径宽、白蛋白较低者更易发生胆囊钻石;合并胆囊结石患者内毒素血症发生率与Lp-X阳性率均较未合并者高。     

肝硬化合并胆囊壁增厚影响因素研究

目的 探讨肝硬化患者合并胆囊壁增厚的影响因素及其临床意义.方法 选择334例肝硬化合并胆囊壁增厚患者,根据胆囊壁增厚程度对患者进行分组:轻度组(154例)、中度组(114例)、重度组(66例).分析胆囊壁增厚程度与性别、年龄、血清清蛋白(ALB)及总胆红素(STB)水平、门静脉(PV)压力[用PV内径表示]、血浆凝血酶原时间(PT)、肝功能Child-Pugh分级、腹腔积液、脾大的关系.结果 肝硬化患者胆囊壁增厚程度不同,其性别、年龄间差异无统计学意义(P＞0.05).胆囊壁增厚程度与肝功能Child-Pugh分级呈正相关(rs=0.404,P＜0.01).不同程度的胆囊壁增厚患者血清ALB、STB水平及PV内径、PT比较,差异均有统计学意义(P＜0.01).组间两两比较:中度及重度胆囊壁增厚患者上述指标与轻度胆囊壁增厚患者比较,差异有统计学意义(P＜0.05);重度胆囊壁增厚患者PV内径及PT与中度胆囊壁增厚患者比较,差异亦有统计学意义(P＜0.05).中度胆囊壁增厚患者腹腔积液及脾大的发生率显著高于轻度胆囊壁增厚患者,且重度胆囊壁增厚患者的腹腔积液发生率显著高于中度胆囊壁增厚患者,差异均有统计学意义(P＜0.05).结论 肝硬化患者胆囊壁增厚程度与性别、年龄无关,而与肝功能Child-Pugh分级,血清ALB、STB水平,PV压力,PT,腹腔积液,脾大有关,可以将胆囊壁厚度作为肝硬化失代偿期的一项辅助观察指标.     

彩色多普勒超声对慢性乙型肝炎后肝硬化患者胆囊病变的诊断价值

目的探讨彩色多普勒超声对慢性乙型肝炎后肝硬化患者胆囊病变的诊断价值。方法选择2014年12月至2016年12月到我院就诊肝硬化患者100例为病例组,另选择同期体检健康者50名为对照组,所有人员均进行彩色多普勒超声检测。统计2组空腹胆囊壁厚度及前后径、餐后胆囊壁增厚值及前后径缩短值,并检测不同类型胆囊壁增厚患者门静脉内径、血流量、血流速度。结果肝硬化C级空腹胆囊壁厚度、前后径大于A级、B级及对照组(P<0.05);肝硬化C级餐后1、2 h胆囊壁厚度增厚值、前后径缩短值小于A级、B级及对照组(P<0.05);双边型胆囊壁增厚患者门静脉内径、血流速度均高于单纯增厚组(P<0.05)。结论采用彩色多普勒超声检测慢性乙型肝炎后肝硬化患者发现随着肝功能分级增加,胆囊增厚更显著。     

急性胆囊炎患者腹腔镜胆囊切除术中转开腹的危险因素分析

目的探讨引起急性胆囊炎患者行腹腔镜胆囊切除术中转开腹的危险因素,为临床提供参考。方法回顾性分析1 128例急性胆囊炎行腹腔镜胆囊切除术患者的病历资料,以中转开腹的36例患者为中转开腹组,随机选取100例顺利完成腹腔镜胆囊切除术患者为腹腔镜组,分析相关因素。结果将腹腔镜组与中转开腹组患者相关因素进行分析,结果显示两组患者在年龄、体重指数、病程、有无合并疾病、手术时间、术中出血量、有无胆囊管结石嵌顿、有无坏疽性胆囊炎、有无胆囊三角解剖不清、术前白细胞计数、总胆红素水平等方面比较差异有统计学意义（P〈0.05）;多因素logistic回归分析结果显示病程≥72 h、胆囊三角解剖不清、胆囊壁厚度≥5 mm、坏疽性胆囊炎是引起急性胆囊炎患者腹腔镜胆囊切除术中转开腹的独立危险因素（P〈0.05）。结论急性胆囊炎行腹腔镜胆囊切除术时引起中转开腹的主要危险因素有病程≥72 h、胆囊三角解剖不清、胆囊壁厚度≥5 mm、坏疽性胆囊炎,如合并有以上一种或多种危险因素则中转开腹的风险明显增高。     

肝硬化患者胆囊壁厚度变化及其临床意义

目的: 研究肝硬化患者胆囊壁厚度的变化并探讨其临床意义。方法: 回顾性分析43例肝硬化患者B超及肝功能检查资料,并进行统计学处理。结果: 肝硬化患者有胆囊壁增厚者达76.7%,且有腹腔积液者胆囊壁增厚发生率为87.1%,高于无腹腔积液者50.0%(P<0.05)。胆囊壁厚度与门静脉宽度呈正相关关系(P<0.01),与血浆清蛋白呈负相关关系(P<0.01)。结论: 肝硬化患者往往伴有胆囊壁增厚,且伴发腹腔积液者胆囊壁增厚发生率高于无腹腔积液者.其原因是多方面的,门脉高压及低蛋白血症可能是主要因素。     

肝炎后肝硬化胆囊壁厚度与肝功能分级的关系

目的 :探讨肝硬化患者胆囊壁厚度与肝功能分级的关系。方法 :正常对照组 30例 ,临床确诊的肝炎后肝硬化 10 7例均行B超检测 ,将其胆囊壁厚度变化与肝功能Child分级进行对比分析。结果 :正常组 ,肝硬化A、B、C三级 (组 )胆囊壁厚度分别为 (2 .6 8± 0 .5 3)mm ,(3.89± 0 .78)mm ,(4.6 9± 1.19)mm ,(6 .5 5± 1.83)mm ,以胆囊壁厚度≥ 4mm为标准 ,各组异常率分别为 6 .6 7% (2 / 30 ) ,45 .45 % (30 / 6 6 ) ,71.43% (15 / 2 1) ,10 0 % (2 0 / 2 0 )。正常组、A、B、C三级组胆囊壁厚度逐级比较经q检验 ,P均 <0 0 1,胆囊壁异常发生率经 χ2 检验 ,P均 <0 .0 5。胆囊壁厚度与肝硬化患者血清白蛋白含量呈负相关 (r=- 0 .5 0 ,P <0 .0 1)。结论 :胆囊壁厚度变化检测对肝硬化临床分型 ,判断病情预后和疗效观察有重要的参考价值。     

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.