舒必利降低文拉法辛副作用的观察

目的评价舒必利与文拉法辛合用治疗抑郁症的疗效和不良反应。方法将本院门诊抑郁症病例120例分为两组。研究组60例,使用文拉法辛合用小剂量舒必利治疗;对照组60例,单用文拉法辛治疗。疗程6周。采用汉密顿抑郁量表(HAMD)和副反应量表(TESS)评定疗效和不良反应。结果两组治疗抑郁症的疗效无明显差异,合用组恶心等不良反应明显减少,组间比较差异具有统计学意义(P﹤0.05)。结论舒必利明显减少文拉法辛在治疗抑郁症中产生的恶心呕吐等胃肠道不良反应,使文拉法辛的依从性提高。     

两种激素补充治疗方案对绝经后妇女更年期症状、血脂及骨代谢影响

[目的] 观察单用醋酸甲孕酮(MPA)和结合型雌激素(CE)加MPA对绝经后妇女的作用.[方法] 将88例自然绝经后健康妇女随机分两组,A组48例,每日MPA 10 mg;B组40例,每日口服CE 0.625 mg加MPA 2 mg,服药期均为6个月,用药前后分别对更年期症状、血脂及载脂蛋白、腰椎2～4骨矿质面密度(BMSD)、成骨指标血骨钙素(BGP)及破骨指标尿吡啶酚/肌酐(Pyr/Cr)进行评价.[结果] ①用药后两组更年期症状评分均降低(P<0.01);②两组BMD均稍有上升;③A组血BGP水平升高(P<0.05),尿Pyr/Cr无明显变化(P>0.05),B组血BGP无明显变化(P>0.05),尿Pyr/Cr明显下降(P<0.05);④A组血脂、载脂蛋白浓度差异不显著(P>0.05),B组TG、HDL-C及ApoA上升(P<0.05),TC、LDL-C下降(P<0.05),ApoB(P>0.05).[结论] ①MPA和CE加MPA均能有效缓解更年期症状;②MPA、CE加MPA均能轻度增加BMSD;③CE加MPA抑制骨吸收,MPA促进骨形成;④MPA对血脂代谢无明显影响,CE加MPA可以改善血脂构成,使其有利于心血管系统.     

艾司西酞普兰合并雌激素治疗女性更年期(综合征)抑郁症的研究

目的:探讨艾司西酞普兰合并雌激素治疗女性更年期(综合征)抑郁症的疗效.方法:对64例女性更年期(综合征)抑郁症患者分别采用艾司西酞普兰合并雌激素尼尔雌醇(戊酸雌二醇)治疗组(33例,A组)和单用雌激素尼尔雌醇(戊酸雌二醇)治疗组(31例,B组),治疗前及治疗4周末用症状自评量表(SCL-90)、Zung氏焦虑自评量表(SAS)及Zung氏抑郁自评量表(SDS)评定疗效.结果:经4周治疗A组SCL-90评分降低值显著高于B组,两组有效率分别为84.38%和41.94%,有显著性差异(x2=12.23,P＜0.01);治疗后艾司西酞普兰合并雌激素尼尔雌醇(戊酸雌二醇)治疗组的SAS、SDS评分明显低于单用雌激素尼尔雌醇(戊酸雌二醇)治疗组(P＜0.05).结论:艾司酞普兰合并雌激素尼尔雌醇对女性更年期(综合征)抑郁症有明显治疗作用,特别是能改善女性更年期患者的躯体化、抑郁、焦虑、恐怖症状,具有明显改善临床症状的功效.     

舍曲林合并小剂量舒必利治疗女性抑郁症60例疗效观察

目的:探讨舍曲林合并小剂量舒必利静脉滴注治疗女性抑郁症患者的疗效和安全性。方法:将60例女性抑郁症患者随机分为两组,舍曲林治疗8周。研究组患者在疗程前2周合并舒必利静脉滴注,对照组患者仅给予舍曲林。采用汉密尔顿抑郁量表(HAMD)评定临床疗效,不良反应症状量表(TESS)评定不良反应情况。结果:治疗8周末两组患者HAMD评分均下降,差异有统计学意义(P<0.05),显效率差异无统计学意义(P>0.05),但研究组起效较快;两组患者TESS评分差异无统计学意义(P>0.05),不良反应均较轻微。结论:舍曲林合并小剂量舒必利静脉滴注治疗女性抑郁症起效快,安全性高。     

西肽普兰合并舒必利治疗伴躯体症状老年抑郁症86例对照研究

目的 探讨西肽普兰合并舒必利治疗伴躯体症状老年抑郁症的疗效和安全性.方法 将86例伴躯体症状老年抑郁症患者随机分为两组(各43例),研究组以西肽普兰合并舒必利治疗,对照组单用西肽普兰治疗,两组疗程均为8周.采用汉密尔顿抑郁量表(HAMD)和临床总体评定量表(CGI)评定临床疗效,采用不良反应量表(TESS)评定不良反应.结果两组治疗前后HAMD和CGI-SI分值比较差异均有统计学意义(P＜0.05),而且两组间疗效比较差异也有统计学意义(P＜0.05).不良反应评分差异无统计学意义(P＞0.05).结论西肽普兰合并舒必利比单用西肽普兰更能提高对伴躯体症状老年抑郁症的治疗效果,而且不增加其不良反应.     

单用氟西汀与联合理性情绪疗法治疗抑郁症对照

目的观察理性情绪疗法在抑郁症治疗中的效果。方法将69例抑郁症患者随机分为两组,A组34例单用氟西汀治疗,B组35例采用理性情绪疗法合并氟西汀治疗。疾病严重程度及疗效采用汉密顿抑郁量表和抑郁自评量表评定,进行了为期12周的观察。结果A、B两组疗效在4周前无显著性差异,但在4～6周开始显示出差异(P<0.05),8～12周有非常显著性差异(P<0.01)。B组疗效明显优于A组。结论氟西汀联合理性情绪疗法对抑郁症的疗效比单纯氟西汀治疗更有效。     

参松养心胶囊治疗更年期妇女失眠的疗效观察

目的 观察参松养心胶囊治疗更年期妇女失眠的临床疗效.方法 将66例以失眠为主要表现的更年期综合征患者随机分成2组,分别给予参松养心胶囊(治疗组,33例)和更年安片(对照组,33例)治疗1个月,采用匹兹堡睡眠指数量表(PSQI)进行疗效评定.结果 治疗组在PSQI评分和总有效率方面均明显优于对照组,P<0.05.结论 参松养心胶囊对更年期妇女的失眠症状有一定疗效.     

复方地西泮辅助治疗精神分裂症对照研究

目的:探讨复方地西泮辅助治疗精神分裂症的疗效.方法:对符合中国精神疾病分类方案与诊断标准(CCMD-2-R)的病人,按入院顺序随机分为A、B两组.A组服用氯氮平合并复方地西泮;B组单服氯氮平.治疗前及治疗后2、4、6周末用简明精神病量表(BPRS)评定疗效,用副反应量表(TESS)评定副反应.结果:两组病人疗效相当,但起效时间A组显著快于B组.A组副反应少于B组.A组氯氮平用量(220.97±16.14) mg/d显著低于B组(320.16±70.83) mg/d.结论:服用氯氮平后,前4周合并复方地西泮治疗精神分裂症,起效快,用量小,减轻了副反应,不产生复方地西泮依赖,可以应用.     

艾司西酞普兰合用低剂量舒必利治疗抑郁症临床观察

目的:探讨艾司西酞普兰联合低剂量舒必利治疗抑郁症的疗效与不良反应。方法:将52例抑郁症患者随机分为合用组(艾司西酞普兰联合小剂量舒必利)和单用组(单用艾司西酞普兰)各26例,疗程6周。采用汉密尔顿抑郁量表(HAMD)及治疗中出现的症状量表(TESS)评定疗效与不良反应。结果:两组HAMD评分治疗后均显著下降(P<0.01),以合用组更明显;两组不良反应差异无统计学意义(P>0.05)。结论:艾司西酞普兰联合低剂量舒必利治疗抑郁症疗效好,起效快,且不良反应轻微。     

舒必利合用西酞普兰治疗阻滞性抑郁症的临床研究

目的:观察舒必利治疗阻滞性抑郁症的疗效和不良反应。方法:对62例阻滞性抑郁症患者,随机分为合用组(舒必利合并西酞普兰,31例患者)和单用组(单用西酞普兰,31例患者),治疗8周,采用汉密顿抑郁量表(HAMD)和副反应量表(TESS)评定不良反应。结果:治疗第4、6、8周末两组患者间HAMD总分和阻滞症状项目评分比较,合用组患者低于单用组,差异有统计学意义(P<0.01或P<0.05);治疗8周末合用组和单用组患者的显效率分别为83.87%和58.06%,差异有统计学意义(P<0.01);两组患者间TESS评分比较,单用组患者主要以恶心、呕吐等胃肠道反应为主,而合用组患者则无明显不良反应发生,两组患者比较差异显著。结论:小剂量舒必利合并西酞普兰治疗阻滞性抑郁症疗效较单用西酞普兰好,且起效快,舒必利可消除西酞普兰所致的恶心、呕吐等胃肠道不良反应。     

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.     

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.     

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.