米索前列醇联合利多卡因在人工流产术中的作用

目的观察舌下含服米索前列醇联合利多卡因宫颈旁注射用于人工流产术中的效果,以选择最佳的人工流产方法。方法将170例早孕拟行人工流产术的妇女,随机分为A组（舌下含服米索前列醇）、B组（舌下舍服米索前列醇联合利多卡因宫颈旁注射）、C组（行常规人工流产术）,观察三组镇痛效果、人工流产综合征反应、宫颈松弛程度、扩张宫颈的时间及术中出血量。结果B组镇痛有效率明显,与A、C两组比较差异有统计学意义（P〈0．01）,A、B两组宫颈松弛、人工流产综合征发生率低,扩宫时间短,术中出血少,与C组比较差异有统计学意义（P〈0．01）。结论米索前列醇联合利多卡因用于人工流产术中,镇痛效果好,人工流产综合征发生率低,宫颈松弛,扩宫时间短,术中出血少,值得推广。     

人工流产术中米索前列醇经不同给药途径的临床效果观察

目的:探析人工流产术中不同途径应用米索前列醇的疗效。方法:本研究随机选取我院2011年10月~2013年3月期间接诊的180例行人工流产患者为研究对象,采用随机数字法分为3组,A组60例术前3h舌下含服米索前列醇400ug,B组60例术前3h阴道后穹窿给予400ug米索前列醇,C组60例术前3h直肠给予米索前列醇400ug,观察3组患者扩张宫颈有效率、术中出血量、手术时间、人流综合征以及术后不良反应发生情况。结果:B、C组患者宫颈扩张有效率、术中出血量、手术时间、疼痛程度A组(P0.05),B、C组患者在上述指标方面比较差异不显著(P0.05);A组患者术后恶心、呕吐、腹泻、术前阴道出血等不良反应发生率明显高于B、C组(P0.05),B组上述不良反应发生率明显低于C组,比较差异显著(P0.05)。结论:无痛人流术前舌下含服、阴道后穹窿、直肠给予米索前列醇400ug均能有效扩张患者宫颈,减少术中出血量、缩短手术时间、降低术后疼痛程度;但是阴道后穹窿给药能明显降低术后不良反应发生率,效果优于舌下含服、直肠给药,值得在临床上广泛应用和推广。     

无痛人工流产术前舌下含服米索前列醇的临床观察

目的探讨无痛人工流产术前舌下含服米索前列醇对宫颈的扩张作用。方法将早孕待行人工流产者随机分为观察组和对照组。观察组无痛人工流产术前3h将米索前列醇0．4mg舌下含服;对照组常规行无痛人工流产术前准备。比较两组术中宫颈松弛度,术中出血情况,手术时间,术后阴道流血停止时间。结果观察组与对照组比较术中宫颈松弛度、术中出血量,经统计学处理差异均有统计学意义（P〈O．01）,手术时间及术后阴道流血时间差异无统计学意义。结论无痛人工流产术前舌下含服米索前列醇简便、安全、有效,可以作为人工流产术前常规用药。     

人工流产术前应用米索前列醇的效果观察

目的：探讨人工流产术前舌下含服米索前列醇对手术的影响。方法：选择在我院门诊2009年6月～2010年11月要求行人工流产术终止妊娠的早孕妇女200例,将其随机分成对照组（100例）和观察组（100例）,观察组术前给予舌下含服米索前列醇600μg,对照组术前不使用扩张宫颈的药物,其他与观察组相同。观察两组宫颈松弛度、人工流产术时间、术中出血量及人流综合征等并发征情况。结果：观察组舌下含服米索前列醇2 h,可以使宫颈充分扩张,成功率为76%,有效率为82%,与对照组相比差异有统计学意义（P〈0.05）,观察组手术时间、术中出血量及术后人流综合征发生率明显小于对照组,差异有统计学意义（P〈0.05）。结论：人工流产术前应用米索前列醇具有明显的扩张宫颈作用,减少了术中出血量,缩短了手术时间,降低了人工流产综合反应发生率,临床效果好,值得推广。     

负压吸引术中扩张宫颈及镇痛方法的比较性研究

目的 :通过随机对照研究评价负压吸引人工流产术中三种宫颈扩张及镇痛方法的效果。方法 :将122例早孕拟行人工流产术的妇女 ,随机分为舌下含服米索前列醇组、宫颈旁阻滞组、舌下含服米索前列醇 宫颈旁阻滞组、无任何扩宫镇痛方法组 ,比较宫颈扩张情况、扩宫及吸宫疼痛、术中出血及全身情况。结果 :碳酸利多卡因具有明显的镇痛作用 ;米索前列醇可扩张宫颈、缩短扩宫时间、减少术中出血量 ,与对照组相比具有显著性差异 (P<0.01)。结论 :舌下含服米索前列醇联合宫颈旁阻滞为负压吸引流产术中扩张宫颈及镇痛的首选方法。     

笑气吸入联合利多卡因及米索前列醇应用于人工流产的临床观察

目的：探讨笑气吸入联合利多卡因及米索前列醇对人工流产术的镇痛作用及宫颈松弛度等临床效果。方法：将180例宫内妊娠40d～65d，年龄24岁～40岁的妇女分为观察组和对照组各90例。观察组术前半小时舌下含服米索前列醇0.2mg。术中宫颈注射2％利多卡因5mL。同时嘱受术者吸入笑气两大口。观察两组的镇痛效果、宫颈松弛、术中出血量。结果：观察组的镇痛效果、宫颈松弛度均较对照组效果好，且术中出血量较对照组少（P〈0．01），不良反应发生率无差异（P〉0．05）。结论：笑气联合利多卡因与米索前列醇用于人工流产术中镇痛效果明显。     

不同方法行人工流产术的临床观察

目的：观察米索前列醇用于无痛人工流产的临床效果。方法：A组为米索前列醇0．4mg在无痛人工流产术前2h舌下含服；B组为无痛人工流产术；C组为一般人工流产术。比较三组间镇痛效果、宫颈松弛度、手术时间、术中出血量及人工流产综合反应发生率、不良反应等指标。结果：米索前列醇应用于无痛人工流产手术前，镇痛率100％，宫颈松弛软化率高，缩短手术时间，减少了术中出血量，有效地避免了人工流产综合征的发生，无不良反应。结论：米索前列醇用于无痛人工流产，能充分软化宫颈，改善宫颈松弛度，缩短手术时间，减少手术中的出血量。适于临床推广应用。     

米索前列醇在初孕妇及瘢痕子宫孕妇人工流产术前的应用

目的:观察舌下含服米索前列醇在初孕妇及瘢痕子宫孕妇人工流产术前软化扩张宫颈的临床效果。方法:将89例早孕要求人工流产的初孕妇及瘢痕子宫孕妇随机分为A组53例,术前1～2 h舌下含服米索前列醇200 mg,阴道出血后开始手术;B组36例为对照组。观察两组宫颈松弛程度、手术时间及术中出血量。结果:A组宫颈松弛有效率94%,B组55%,两组比较差异有统计学意义(P<0.05);A组手术时间及术中出血量均低于B组,两组比较差异有统计学意义(P<0.05)。结论:术前1～2h舌下含服米索前列醇200 mg可有效地软化扩张宫颈,手术易于操作,术中出血少,值得临床应用。     

米索前列醇在无痛人工流产中的应用

目的探讨无痛人工流产术前米索前列醇含服及阴道给药的临床效果。方法选择自愿要求无病人工流产终止妊娠的早孕妇女300例随机分成三组，A组在人工流产术前半小时含服米索前列醇0．4mg，B组人工流产前1小时阴道放置米索前列醇0．4mg，C组直接行无痛人工流产术。观察三组术中宫颈松弛扩张情况、宫缩幅度、术中出血量及手术时间。结果宫颈软化比较。A组与C组，B组与C组比较均有显著差异（P〈0．01），宫缩幅度、术中出血量，A组与C组、B组与C组比较有差异性（P〈0．05），A组与C组、B组与C组比较，手术时间明显缩短，有显著差异性（P〈0．01）。结论无痛人工流产术前米索前列醇含服及阴道给药均可增强子宫收缩，易于手术操作，减少手术时间，术中出血少，值得临床推广应用。     

利宁凝胶配伍米索前列醇用于人工流产的临床观察

目的：探讨利宁凝胶配伍米索前列醇用于人工流产的疗效。方法将要求人工流产的孕妇150例随机平均分为三组：A组：术前1h舌下含服米索前列醇0．2mg，利宁凝胶5ml注入宫腔；B组：术前利宁胶浆5ml注入宫腔；C组：行常规人工流产术。对3组镇痛效果、扩宫情况、术中出血量、子宫收缩幅度及人流综合征的发生进行比较。结果3组镇痛及扩宫效果有显著性差异（P〈0．05），A组宫颈松弛程度和镇痛效果最佳。子宫出血量及子宫收缩幅度3组无显著性差异（P〉0．05），人流综合征的发生有显著差异（P〈0．01）。结论利宁凝胶配伍米索前列醇应用于人工流产镇痛效果及宫颈松弛效果良好，是一种安全、经济、简便、有效的方法，值得临床推广和应用。     

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.