表现为肾病综合征的IgM肾病及非IgA系膜增殖性肾炎的临床病理差异

分析临床表现为原发性肾病综合征的微小病变肾病（ＭＣＤ）、ＩｇＭ肾病（ＩｇＭＮ）和非ＩｇＡ、ＩｇＭ系膜增殖性肾炎（ＭｓＰＧＮ）病理改变（微机定量图像分析）和临床表现的联系。发现：（１）３种疾病以ＩｇＭＮ发生率最高（４８．８９％），一过性肾功损害、激素依赖比例以ＭｓＰＧＮ为高，ＩｇＭＮ、ＭｓＰＧＮ存在明显血尿；（２）病理定量分析表明：ＩｇＭＮ和ＭｓＰＧＮ的系膜细胞数、系膜基质增宽及间质改变较ＭＣＤ明显增高（Ｐ＜０．０１），ＭｓＰＧＮ系膜区增宽比ＩｇＭＮ更明显（Ｐ＜０．０１）；（３）ＩｇＭＮ、ＭｓＰＧＮ间质病变越重，越易伴有高血压、血尿、一过性肾功损害和激素依赖，其中以ＭｓＰＧＮ更明显。表明ＩｇＭＮ肾病预后相对较好，而ＭｓＰＧＮ相对较差。     

表现为肾病综合征的IgM肾病及非IgA系膜增殖性肾炎的临床病…

分析临床表现为原发性肾病综合征的小病变肾病（ＭＣＤ）、ＩｇＭ肾病（ＩｇＭＮ）和非ＩｇＡ、ＩｇＭ系膜增殖性肾炎（ＭｓＰＧＮ）病理改变（微机定量图像分析）和临床表现的联系。发现：（１）３种疾病以ＩｇＭＮ发生率最高（４８．８９％），一过性肾功损害、激素依赖比例以ＭｓＰＧＮ为高，ＩｇＭＮ、ＭｓＰＧＮ存在明显血尿；（２）病理定量分析表明：ＩｇＭＮ和ＭｓＰＧＮ的系膜细胞数、系膜基质增宽及间质改变较ＭＣＤ明显增     

儿童肾小球疾病临床病理研究

为了探讨肾小球疾病的病理类型与临床治疗的关系，对肾小球疾病１３１例行肾穿刺活组织检查。其中原发性肾小球疾病１２０例，继发性肾小球疾病１１例，前者以系膜增生性肾小球肾炎（ＭｓＰＧＮ）居多，占２９．２％，其次是ＩｇＡ肾病（ＩｇＡＮ），占２５．８％。临床诊断与病理诊断符合率为５７．２％。治疗后，随访６个月至６年，总痊愈率和好转率为７６．７％，病理类型中的微小病变（ＭＣＮＳ）、轻度ＭｓＰＧＮ、ＩｇＭ肾病（ＩｇＭＮ）、毛细血管内增生性肾小球肾炎（ＥｎＰＧＮ）等的疗效及预后好，膜增生性肾小球肾炎、重度ＭｓＰＧＮ及组织损害严重的ＩｇＡＮ等疗效差。提示治疗效果、预后与病理类型密切相关     

成人原发性肾小球疾病205例病理与临床分析

２０５例成人原发性肾小球疾病肾活检结果显示系膜增生性肾小球肾炎（ＭｓＰＧＮ）最常见，占４０．５／，其次是微小病变肾病（ＭＣＤ），占１４，６％，局灶节段性肾小球硬化（ＦＳＧＳ）占１２，７％。临床表现以肾病综合征最常见共１０２例，占５０．０％，其中以ＭｓＰＧＮ和ＭＣＤ居多，分别占３６．３％和２９．４％。     

60例原发性肾病综合征临床病理观察

对６０ 例原发性肾病综合征（ＮＳ） 临床及病理进行了分析,结果表明：成人ＮＳ病理类型主要为ＭｓＰＧＮ,随着病变程度的加重,高血压及肾功能异常的发病率增加;还对ＮＳ的诱因、实验室检查及治疗进行了分析,认为早期联合用药可提高治疗效果。     

儿童单纯性蛋白尿的病因诊断分析

对２０例单纯性蛋白尿的临床和病理资料进行分析。结果发现，肾功能性蛋白尿９例（４５％），其中直立性蛋白尿（ＯＰ）、胡桃夹现象（ＮＣＰ）各３例，ＯＰ并ＮＣＰ３例；肾料质性蛋白尿１１例（５５％），其中肾小球性蛋白尿９例（系膜增生性肾炎（ＭｓＰＧＮ）３例，ＩｇＡ肾病（ＩｇＡＮ）１例，特发性膜性肾病（ＩＭＮ）２例，局部性节段性小球硬化（ＦＳＧＮ）、轻微病变（ＭＬ）、Ａｌｐｏｒｔ综合征（ＡＳ）各１例），肾小管     

儿童单纯性蛋白尿的病因诊断分析

对２０例单纯性蛋白尿的临床和病理资料进行分析。结果发现,肾功能性蛋白尿９例（４５％）,其中直立性蛋白尿（ＯＰ）、胡桃夹现象（ＮＣＰ）各３例,ＯＰ并ＮＣＰ３例;肾实质性蛋白尿１１例（５５％）,其中肾小球性蛋白尿９例〔系膜增生性肾炎（ＭｓＰＧＮ）３例,ＩｇＡ肾病（ＩｇＡＮ）１例,特发性膜性肾病（ＩＭＮ）２例,局灶性节段性肾小球硬化（ＦＳＧＮ）、轻微病变（ＭＬ）、Ａｌｐｏｒｔ综合征（ＡＳ）各１例〕,肾小管性蛋白尿２例。对两类蛋白尿的临床特征及鉴别要点和病因进行了讨论,建议应先初筛有无ＯＰ和ＮＣＰ,然后再酌情进行肾活检。     

糖皮质激素加重对激素不敏感儿童肾病蛋白尿

目的：有报道糖皮质激素（ Ｇ Ｃｓ） 亦可加重肾脏病蛋白尿。本课题旨在探讨 Ｇ Ｃｓ 是否加重激素不敏感肾病综合征（ Ｎ Ｓ） 蛋白尿及其机制，以指导临床合理使用 Ｇ Ｃｓ。方法：１９ 例对激素不敏感的 Ｎ Ｓ 患儿予泼尼松每日１５ ～２ ｍｇ／ｋｇ 隔日早上０８∶００ 顿服。同时检测激素日和无激素日的尿蛋白及其成分、白蛋白和免疫球蛋白 Ｇ 及肌酐的清除率、肾有效血浆流量（ Ｅ Ｒ Ｐ Ｆ） 、尿前列腺素等并进行比较。结果：与无激素日比较，激素日尿蛋白明显增加（２４ ｇ ±０５ ｇ ｖｓ １５ ｇ ±０４ ｇ／２４ ｈ ， Ｐ ＜００１） ，其中以尿白蛋白、 Ｉｇ Ｇ 增加为主，尿β２微球蛋白无明显变化。激素日的内生肌酐清除率、白蛋白清除率及 Ｉｇ Ｇ 清除率亦明显增高，３ 例 Ｅ Ｒ Ｐ Ｆ在激素日均高于无激素日，而尿血栓素 Ｂ２ 和６酮前列腺 Ｆ１ａ 、血清总蛋白、白蛋白和 Ｉｇ Ｇ 均无明显改变。结论： Ｇ Ｃｓ 可能通过增加肾小球滤过膜的通透性及改变肾小球血流动力学，而加重激素不敏感的 Ｎ Ｓ患儿的蛋白尿；其加重蛋白尿机制并非通过肾前列腺素系统；对 Ｇ Ｃｓ 疗效不可靠的 Ｎ Ｓ 患者，不宜长期、大剂量使用 Ｇ Ｃｓ 。     

国产丙种球蛋白预防肾病综合征患儿医院感染的观察

为观察静脉用丙种球蛋白（ＩＶＩｇＧ）对肾病综合征（ＮＳ）患儿医院感染（ＮＩ）的预防效果,将５４例ＮＳ患儿随机分为两组,观察组２２例,对照组３２例。全部病例按ＮＳ治疗常规治疗。观察组加用ＩＶＩｇＧ１００～３００ｍｇ·ｋｇ－１·ｄ－１,以５％的葡萄糖溶液使其浓度稀释成３％,静脉滴注,疗程２～３ｄ。结果：观察组患儿ＮＩ的发生率为１３６３％,明显低于对照组的４６８８％（Ｐ＜０．０５）;住院时间由对照组的（６４５０±１８５２）ｄ缩短为（２７３３±１５５１）ｄ（Ｐ＜０．０５）。提示ＩＶＩｇＧ能改善ＮＳ患儿免疫状态,在一定程度上有效地预防医院感染。     

双倍剂量雷公藤公甙治疗原发性肾病综合征疗效观察

目的 :探讨双倍剂量雷公藤多甙以间歇用药维持方案治疗原发性肾病综合征的疗效。方法 :对原发性肾病综合征患者服用雷公藤多甙片 2mg/kg·d诱导治疗 4周后改间歇疗法 ,服 1周停 1周 ,交替进行 ,并观察相关指标及副反应。结果 :5 2例原发性肾病综合征患者获完全缓解 12例 (2 3 .0 8% ) ,显著缓解 2 0例 (3 8.46% ) ,部分缓解 11例(2 1 15 % ) ,无效 9例 (17.3 1% ) ,总有效率为 82 .69%。所有患者副反应轻微 ,有 5例患者因药物减量及继发上呼吸道感染后复发 ,重新双倍剂量雷公藤多甙或延长治疗时间仍有效。结论 :双倍剂量雷公藤多甙继以间歇用药维持方案治疗原发性肾病综合征具有较好的疗效 ,可作为首选治疗     

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.