曲美他嗪对慢性心力衰竭患者心功能和运动耐量的影响

目的观察曲美他嗪(TMZ,商品名万爽力)对慢性心力衰竭(简称心衰)患者心功能和运动耐量的影响,分析其产生作用的可能机制.方法本实验为随机、开放、对照临床研究,选取39例因缺血性心肌病和扩张性心肌病而导致的慢性心衰患者(NYHAⅡ、Ⅲ级),随机分为对照组和TMZ组.用药观察期为3个月.全部入选患者在用药前和用药3个月时行超声心动图(用LVEF、EDD、ESD、FS、SV等指标)评价心脏收缩功能的改善情况,6min步行实验评价患者运动能力的改善情况.结果入选时两组资料有可比性.用药12周后,TMZ组的6min步行距离、FS、SV和EF值与对照组相比增高.两组患者血生化检查、血压、心率在组间和组内比较均无显著性差异.本研究无严重不良事件者.结论在常规心衰治疗的基础上加用曲美他嗪可以改善慢性心衰患者的心脏收缩功能,提高慢性心衰患者的运动耐量,并具有较好的耐受性.     

环磷腺苷葡胺治疗缺血性心肌病心力衰竭的临床研究

目的:探讨环磷腺苷葡胺(MAC)对缺血性心肌病(ICM)心力衰竭患者心功能的影响。方法:选取78例ICM心力衰竭患者随机分为两组,MAC组(39例)采用常规治疗及静脉滴注环磷腺苷葡胺120mg,1次/d,2周为1个疗程,每月1个疗程,连续2个疗程。对照组(39例)采用常规治疗。全部入选患者在用药前和用药2月时行超声心动图(用EDD、ESD、FS、SV、LVEF等指标),并观测治疗前后6min步行距离,评价心脏收缩功能及运动耐量的改善情况.结果:入选时两组资料有可比性。用药2月后,MAC组的ESD、FS、SV、LVEF及6min步行距离较常规治疗组明显改善(P<0.05)。结论:环磷腺苷葡胺可以改善缺血性心肌病心力衰竭患者的心脏收缩功能,提高患者的运动耐量,且具有较好的耐受性.     

老年心力衰竭患者QRS时限6分钟步行试验分析

目的探讨老年慢性心力衰竭（心衰，CHF）患者QRS时限（QRSD）与心功能、运动耐量相关性。方法47例老年慢性心衰患者（心衰组），20例健康对照组常规心电图测量QRS时限，在心衰组根据QRSD分为QRSD≤120ms组、QRSD〉120ms组。以左心室射血分数（LVEF）、左室舒张末期内径（LVDED）作为心脏功能指标与6分钟步行试验（6-MWT）进行组间比较。结果心衰组QRSD、LVDED值均明显高于对照组（P〈0．001），LVEF、6-MWT值均明显低于对照组（P〈0．005）。在心衰组QRSD与LVDED呈正相关，与LVEF、6-MWT呈负相关。结论在慢性心衰患者中监测QRS时限和6分钟步行试验，2种方法联合应用尤其适合于基层医院，可指导临床采取相应的社区干预模式，制定最佳治疗方案。     

曲美他嗪治疗缺血性心肌病心力衰竭的临床观察

目的 用6分钟步行试验(6MWT)和多普勒超声心动图,评价曲美他嗪辅助治疗缺血性心肌病心力衰竭的疗效.方法 采用随机、单盲及组间对照,共选取96例因缺血性心肌病而导致慢性心力衰竭者(NYHA Ⅱ～Ⅳ级).将患者分为两组,曲美他嗪组(50例,常规治疗 曲美他嗪20 mg/次,3次/天)和对照组(46例,常规治疗),疗程为3个月,观察两组治疗前后左室收缩末期内径(ESD)、左室舒张末期内径(EDD)、左室收缩末期客积(ESV)、左室舒张末期容积(EDV)、短轴缩短分数(FS)、心搏量(SV)、左室射血分数(EF)、6分钟步行距离.结果 用药3个月后,组间比较显示曲美他嗪组的ESD、ESV、FS、SV、EF及6分钟步行距离比对照组有进一步的改善.结论 常规治疗缺血性心肌痛心力衰竭的基础上加用曲美他嗪可以进一步改善患者的心脏收缩功能,提高患者的运动耐量,耐受性良好.     

曲美他嗪治疗缺血性心肌病心力衰竭的临床观察

目的 用6分钟步行试验和多普勒超声心动图评价曲美他嗪辅助治疗缺血性心肌病心力衰竭的疗效。方法 选取116例因缺血性心肌病而导致慢性心力衰竭患者（纽约心脏病学会分级Ⅱ～Ⅳ级）。采用随机、单盲试验,将病人分为两组,曲美他嗪组60例,采用常规治疗及口服曲美他嗪,每次20mg,每日3次;对照组56例,采用常规治疗,疗程3个月,观察两组治疗前后左心室收缩末期内径、左心室舒张末期内径、左室收缩末期容积、左心室舒张末期容积、左心室射血分数、心搏出量、短轴缩短分数、6分钟步行距离。结果用药3个月后,组间比较显示曲美他嗪组的、左心室收缩末期内径、左心室收缩末期容积、射血分数、心搏出量,短轴缩短分数及6分钟步行距离较常规治疗组有进一步的改善。结论在常规治疗缺血性心肌病心力衰竭的基础上加用曲美他嗪可以进一步改善患者的心脏收缩功能,提高患者的运动耐量,耐受性良好。     

曲美他嗪治疗缺血性心肌病心力衰竭37例疗效观察

目的 探讨曲美他嗪对缺血性心肌病(ICM)心力衰竭患者心功能的影响.方法 选取74例ICM心力衰竭患者,37例服用曲美他嗪片20 mg,3次/d;常规治疗组37例.疗程均为3个月,分别采用多普勒超声心动图对其测量治疗前后EDD、EDV、ESD、ESV、FS、SV、LVEF,并观测治疗前、后6 min步行距离, 评价心脏收缩功能及运动耐量的改善情况.结果 入选时两组资料有可比性.用药3个月后,曲美他嗪组的ESD、ESV、FS、SV、LVEF及6min步行距离较常规治疗组明显改善.常规治疗组除去失访1例,因心力衰竭的加重再住院13例(占35.1%).曲美他嗪组因心力衰竭的加重再住院4例(占10.8%).结论 曲美他嗪可以改善患者的心脏收缩功能,提高患者的运动耐量,降低再住院率,患者耐受良好.     

康复锻炼对慢性心力衰竭患者心功能和运动耐量的影响探讨

目的：观察康复锻炼对慢性心力衰竭患者心功能和运动耐量的影响。方法：选取我院收治的90例慢性心力衰竭患者按照随机数字表法随机分为观察组与对照组各45例,观察组在对照组常规抗心衰治疗基础上给予康复锻炼,连续治疗3个月后比较两组患者的心功能及运动耐量水平变化。结果：两组患者治疗前心功能及运动耐量水平比较无明显差异（P＞0．05）,治疗3个月后观察组CO、SV、LVEF、CL、6min 步行试验及心功能NYHA 分级水平均较治疗前、同期对照组有明显差异（ P＜0．05）,具有统计学意义。结论：慢性心力衰竭患者采用康复锻炼有利于改善心功能及运动耐量水平,对提高生活质量水平有重要价值。     

老年慢性心力衰竭患者QRS时限临床分析

目的探讨老年慢性心力衰竭（简称心衰,又称CHF）患者QRS时限（QRSD）与心功能、运动耐量相关性。方法40例老年慢性心衰患者根据QRSD分为QRSD≤120ms组为甲组,QRSD〉20ms组为乙组。以LVEF（左心室射血分数）,LVDED（左室舒张末期内径）作为心脏功能指标及6分钟步行试验（6-MWT）进行组间比较。结果甲组LVDED值均明显低于乙组（P〈0．01）,LVEF、6-MWT值均明显高于乙组（P〈0．05）。在心衰患者QRSD与LVDED呈正相关,与LVEF、6-MWT呈负相关。结论在慢性心衰患者中监测QRS时限和6min步行试验,可以有效地评价心功能,预测预后,指导临床。     

曲美他嗪对慢性心力衰竭患者氧化应激的影响

目的曲美他嗪对慢性心力衰竭患者氧化应激及其临床疗效的影响,探讨其治疗心衰的可能机制。方法采用随机对照研究,将80例慢性心衰患者随机分为对照组(常规抗心衰治疗)和曲美他嗪组(常规抗心衰+曲美他嗪治疗),两组疗程均为6月。两组患者在给药前和用药6月后观察氧化应激、超声心动图指标,并行6min步行实验评价患者运动耐量的改善情况。结果用药6月后,两组6 min步行距离较用药前均明显增加(P<0.05)。与对照组比较,曲美他嗪组血浆超氧化物歧化酶(SOD)水平升高,丙二醛(MDA)水平降低,射血分数和6 min步行距离增加更为显著(P<0.05)。结论曲美他嗪能降低氧化应激水平,改善心功能,增加慢性心衰患者运动耐量。     

运动康复对慢性心力衰竭患者的疗效评估

目的评价运动康复对慢性心力衰竭（心衰）患者的临床疗效。方法入选60例慢性心衰患者，随机分为实验组及对照组各30例，对照组常规药物治疗，实验组在药物治疗同时进行6周运动康复治疗。2组分别于住院第2天及第6周检测6min步行实验的距离、完成运动平板所需要的时间和运动平板的最大代谢当量（METS），行明尼苏达心衰生活质量表评分。结果治疗前后实验组和对照组6min步行实验的距离及运动平板时间均有延长（P〈0．01），METS均有提高（P〈0．05），明尼苏达心衰生活质量表评分均有降低（P〈0．01）；治疗后实验组各指标改善程度均显著高于对照组（P〈0.01）。结论在药物治疗基础上对慢性心衰患者进行运动康复治疗可提高运动耐量，改善生活质量。     

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.