肾活检术病人的护理

经皮肤肾活体组织检查，50年代初期已用于临床，60年代由于电镜，免疫荧光显微镜的应用，大大提高了这一诊断方法的质量，扩大了对多种肾小球疾病病因的了解，大量的肾活检取得了很多用其他方法得不到的有关肾疾病的组织病理学，病因学及分类的资料，肾活检为诊断确定有效治疗及随访，预后作了重要的贡献，我院自1999年开始开展肾活检术，现将我们在开展这一技术中的配合及护理情况介绍如下。     

B超引导下经皮肾穿刺活检的临床评价

目的探讨B超引导下对肾脏疾病患者进行经皮肾组织穿刺活检的临床应用价值。方法采用阿洛卡1400黑自超声仪、穿刺探头、自动活检枪及组织切割针对肾下极进行穿刺，穿刺组织分别送光镜、电镜及免疫学检查。结果49例患者利用组织切割针进行肾穿刺，取出肾组织96条，光镜共检出1700个肾小球送病理学检查，检出系膜增生性肾小球肾炎10例，IgA肾病8例，膜性肾病8例，肾小球轻微病变7例，局灶节段性肾小球硬化5例，急性间质性肾炎4例，新月体性肾小球肾炎3例，乙型肝炎相关肾炎3例，肾小球球性硬化1例。结论经皮肾穿刺活检，对了解肾脏疾病的病理类型、指导临床治疗及判断疾病预后具有重要的意义。     

80例小儿肾小球疾病的临床与病理关系

８０例小儿肾小球疾病的临床与病理关系杨青杨宇真林瑞霞肾活检可为肾脏疾病的治疗及预后判断提供重要依据，是肾脏疾病的重要诊断手段之一。本文对一年多来经我院肾活检的８０例肾小球疾病小儿进行病理及临床分析，并初步探讨其病理与临床的关系。１资料和方法１．１一般...     

CD44在胚胎肾组织和肾小球疾病患儿肾活检组织中的表达

目的观察ＣＤ４４在胚胎肾组织和肾小球疾病患儿肾活检组织中的表达，以探明ＣＤ４４在肾组织损伤发病机理中的作用。方法应用碱性磷酸酶标记抗体技术，观察ＣＤ４４在胚胎肾组织和肾小球疾病患儿活检组织中的表达。结果（１）在胎儿和正常人肾组织中，肾小球内ＣＤ４４表达阴性，间质弱阳性；（２）肾小球疾病患儿肾活检组织中，ＣＤ４４表达异常，其表达部位主要位于系膜细胞严重增殖的区域、硬化病灶形成处和明显纤维化的间质，且表达强度与病变的程度呈正相关。结论结果提示ＣＤ４４在增殖性肾小球肾炎的发病及肾小球疾病的慢性进展中发挥作用     

肾活检268例临床病例分析

目的分析268例肾活检病理类型,指导治疗并判断预后。方法本文收集268例肾活检病理、免疫病理资料及临床特点进行回顾性分析。结果原发性肾小球疾病占所有肾活检病例的80.58%,而原发性肾小球疾病中以lgA肾病最为常见。继发性肾小球疾病仍以狼疮性肾炎居于首位。结论在肾脏疾病中,以肾小球疾病的发病率最高,且以原发性肾小球疾病最常见,继发性肾脏病次之。     

肾穿刺组织活检40例临床病理分析

目的了解肾小球疾病临床与病理之间的联系,认识肾穿刺活检术在成人肾脏疾病中的重要性。方法 40例肾活检均行超声引导下穿刺,抽取肾组织进行光镜、免疫荧光及电镜检查。结果 40例肾活检病例中,原发性肾小球疾病29例（72.5%）,继发性肾小球疾病10例（25%）,小管间质病变1例（2.5%）;原发性肾小球疾病中以IgA肾病为主10例（34.48%）,继发性肾小球疾病中以狼疮性肾炎为主4例（40%）,且以女性为多。乙型肝炎病毒相关肾炎3例（30%）。结论肾活检术对肾脏疾病的诊断、指导治疗及判断预后均有非常重要的意义。     

原发性肾小球疾病97例临床病理分析

目的: 探讨原发性肾小球疾病患者临床表现与病理之间的关系、肾活检的并发症及其临床意义。方法: 分析97例原发性肾小球疾病患者的临床表现、病理类型及肾活检资料。结果: 97例原发性肾小球疾病中,IgA肾病30例,系膜增生性肾小球肾炎26例,膜性肾病10例,局灶性节段性硬化性肾小球肾炎14例,IgM肾病2例,毛细血管内增生性肾小球肾炎1例,肾小球轻微病变8例,增生硬化性肾小球肾炎4例,新月体性肾小球肾炎2例。肾活检术后并发症:肉眼血尿3例,肾包膜下小血肿2例,无其它严重并发症。结论: 肾活检病理检查与临床密切结合,有助于原发性肾脏疾病正确诊断和治疗。肾穿刺术虽有一定并发症,但多不严重,是一项安全、简便的诊断操作。     

小儿经皮肾活检病理类型及其临床意义

目的：探讨超声引导下小儿经皮肾穿刺活检术的成功率和安全性,并评价肾组织病理检查在小儿肾脏疾病的临床诊治中的指导意义。方法：实时超声引导下对20例肾脏疾病患儿行经皮肾穿刺活检术,标本进行光镜、免疫荧光和电镜检查,观察术后并发症的发生。结果：本组均成功获取肾组织,取材成功率100．0％。未见严重术后并发症。结论：超声引导下经皮肾组织活检操作简单、安全可靠、成功率高、并发症少,对小儿。肾小球疾病的诊断、治疗及评估预后有重要价值,值得基层医院推广。     

肾活检354例临床分析

目的：报道肾活检病例354例次，取材成功率99．2％。方法：经皮B超引导下肾活检。结果：IgA肾病共116例次，占32．7％，其次轻度系膜增生性肾小球肾炎71例，占20．1％，两者相加占整个肾活检总数52．8％，狼疮性肾炎43例，占12．1％，位于继发性肾小球疾病的首位。结论：肾活检病理检查可避免盲目治疗及其所带来的并发症。通过肾活检前后对比分析，约20％的临床诊断得到修正，15％的治疗方案得到修正。     

浅谈肾活检的临床应用

经皮肤肾脏活体组织检查(简称肾活检)，五十年代初期已用于临床(国内1958年)，六十年代初由于电镜、免疫荧光显微镜的应用，提高了诊断方法的质量，扩大了对肾小球疾病的病因了解．取得了很多用其它方法得不到的有关肾脏疾病的组织病理学、病因学及分类的资料，对了解病因、免疫发病机理、病理分型、诊断、指导治疗、估计预后、观察病情演变均有重要意义，已成为肾病诊治中必不可少的重要辅助检查项目，     

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.