非甾体抗炎药相关性上消化道出血64例分析

目的探讨非甾体抗炎药（NSAIDs）相关性上消化道出血的临床特点。方法回顾性分析360例上消化道出血住院患者的临床资料，根据出血前10d内是否服用过NSAIDs将患者分为服药组和未服药组，对比分析两组患者的临床资料。结果360例上消化道出血患者中有64例（17．78％）服用过NSAIDs。两组比较，服药组患者年龄偏大、多有消化性溃疡和心脑血管病史（P〈0．05）；出血前消化道症状不明显（P〈0．01）；血红蛋白下降更多（P〈0．05）；胃溃疡和复合性溃疡、多发黏膜病损的情况在服药组更多见（P〈0．05）。但两组患者的性别、Hp阳性率差异无显著性（P〉0．05）。结论老年友具有消化性溃疡、心脑血管病史者更易发生NSAIDs相关性上消化道出血，无腹痛性消化道出血是其临床表现的特点。     

老年人与中青年人消化性溃疡的临床比较分析

目的对不同年龄的消化性溃疡作分析，以提高对该病的诊治水平。方法将331例溃疡患者分2组，老年组129例、中青年组202例，就不良影响因素、主要临床症状、溃疡灶部位，幽门螺杆菌检测、并发症和伴发病等进行比较分析。结果长期吸烟、饮酒、服用NSAIDs者在2组比例居高；35．6％老年人临床症状不典型；胃溃疡老年组34．8％高于中青年组17．3％（P〈0．01）；穿孔在中青年人多见，上消化道出血是老年人主要并发症之一；过半数以上老年人溃疡伴发三种及以上慢性疾病。结论不同年龄的溃疡病特点各异，老年人溃疡病以不典型症状和胃角、高位、巨大溃疡多见，出血机率高，需治疗基础病，明确诊断，降低死亡率。     

上消化道出血中青年与老年患者临床特点分析

目的探讨中青年人与老年人上消化道出血的原因、主要临床特点及治疗方法。方法选择本院2004年9月～2010年9月住院治疗的64例中青年上消化道出血患者和64例老年上消化道出血患者为研究对象,回顾性的分析并比较两组患者的差异。结果两组上消化道出血的首要原因均为消化性溃疡,但中青年组十二指肠溃疡患病率显著高于老年组;老年患者各种伴随疾病史、服用NSAIDs史均显著高于青年组,差异均具有统计学意义（P〈0.05）。本组药物治疗结合内镜下止血116例,112例有效,有效率高达96.6%。结论上消化道出血病因复杂,应及时内镜检查明确,并针对老年与中青年特点进行诊治。内镜技术是诊断和治疗上消化出血的一种重要手段。     

非甾体类抗炎药致上消化道出血56例临床分析

目的分析非甾体类抗炎药导致上消化道出血的临床特征和有效的预防和控制方法。方法收集经胃镜及实验室检查证实上消化道出血、且在出血前10d内有服用NSAIDs史的患者56例,分为老年和中青年两个年龄组,按照使用NSAIDs的不同和患者的性别进行分类研究。结果老年组发病较中青年组有增高的趋势;老年组服用的NSAIDs药物以阿司匹林为主（65.63%）,与中青年组6例（25%）比较差异有统计学意义（P〈0.01）;中青年组以布洛芬为主15例（62.5%）,与老年组3例（9.38%）比差异有统计学意义（P〈0.001）;老年组以消化性溃疡为主要表现,其中以为溃疡居首位占75%,与中青年组24例（29.17%）比差异有统计学意义（P〈0.001）,而中青年组以粘膜糜烂为主占62.5%,与老年组18.75%相比差异有统计学意义（P〈0.001）。结论临床上应尽可能的对患者进行年龄、服用药物种类等风险因素评估,进行个体化的预防和治疗。对需要采用NSAIDs进行治疗的患者,我们主张短疗程、适宜的药物种类和剂型,提前做好预防措施,做到防治结合。     

老年人非甾体类抗炎药致消化道出血的临床特点和预后

目的：观察非甾体抗炎药（NSAIDs）致老年人消化道出血的临床特点和预后。方法：将2011年1月至2012年9月收治的38例因服用NSAIDs药物后出现消化道出血症状的患者,分为老年组（n=27例）和中青年组（n=11例）,对两组临床症状、原发病、服药特点、出血情况结果、凝血功能、生化指标、Hp感染、住院天数和胃镜检查结果进行比较。结果：老年组以黑便及呕血为主要症状,而中青年组以黑便为主;27例老年患者中原发病以高血压（18例）和冠心病（16例）为主,而中青年组患原发病较少;老年组用药以服用阿司匹林为主（63.3%）,中青年组以止痛药为主（64.6%）;血红蛋白含量老年组较中青年组低且输血量和住院天数比中青年组高;老年组凝血功能异常较中青年组明显且有统计学意义（P〈0.05）。结论：老年患者服用NSAIDs致消化道出血以黑便及呕血多见,凝血功能多异常且出血量大,住院时间长,多数不能及时进行内镜检查和治疗,预后不良。     

老年非甾体抗炎药相关性溃疡58例临床分析

目的探求老年非甾体抗炎药相关性溃疡的临床特点。方法调查我院2002年6月～2009年8月期间经胃镜检查确诊为胃十二指肠溃疡或/和出血的60岁以上住院患者,根据入院前有无服用NSAIDs将患者分为NSAIDs组（58例）及非NSAIDs组（51例）,对两组病人的临床资料进行分析比较。结果NSAIDs组腹痛发生率明显低于非NSAIDs组;黑便或/和呕血发生率则明显高于非NSAIDs组,两组差异显著,有统计学意义（P〈0.05）。胃镜下表现：NSAIDs组胃、十二指肠溃疡、多发溃疡、大溃疡（直径〉10mm）发生率均明显高于非NSAIDs组,差异显著,有统计学意义（P〈0.05）。但两组Hp感染率相近,无统计学意义（P〉0.05）。结论应加强对老年人NSAIDs相关性溃疡临床特点的认识,采取适宜策略降低NSAIDs的不良反应。     

非甾体类抗炎药相关性上消化道出血的临床特点

目的:探讨非甾体类抗炎药(NSAIDs)相关性上消化道出血的临床特点.方法:根据出血前10 d内是否服用过NSAIDs,将187例上消化道出血住院患者分为服药组(A组)92例和未服药组(B组)95例,对比分析两组患者的临床资料.结果:服药组出血前胃溃疡和复合性溃疡、胃黏膜损伤比未服药组更多见且症状不明显(P＜0.05).但Hp阳性率差异无统计学意义(P＞0.05).结论:服用NSAIDs导致上消化道出血的患者起病隐匿,症状不明显,胃溃疡及复合性溃疡、胃黏膜损伤更多见,应该在临床工作多加注意.     

老年人上消化道出血176例临床分析

目的探讨老年人上消化道出血的临床特点,为临床防治工作提供依据。方法回顾分析176例老年人消化道出血的临床资料,并与同期中青年病例比较。结果老年人上消化道出血仍以消化性溃疡多见;胃溃疡出血发生率高于十二指肠溃疡,与中青年十二指肠溃疡比较有显著性差异;胃癌出血率占病因第二位,与中青年相比有显著差异;老年病人伴发病、再出血率和死亡率均显著高于中青年组。结论老年人上消化道出血仍以消化性溃疡多见,胃溃疡、胃癌出血发生率较高,伴发病、再出血率和死亡率高。     

320例老年上消化道出血病人临床分析

目的：探讨老年上消化道出血病人的病因及临床发病特点。方法：将老年上消化道出血病人320例与非老年上消化道出血病人482例临床资料进行回顾性分析对比。结果：（1）老年上消化道出血病人的病因依次是消化性溃疡、胃癌、食管胃底静脉曲张、急性胃黏膜病变；非老年上消化道出血病人的病因依次是消化性溃疡、急性胃黏膜病变、食管胃底静脉曲张、胃癌。（2）老年上消化道出血病人的伴发疾病的比例明显高于非老年病人。（3）老年上消化道出血病人的死亡率明显高于非老年病人。结论：老年病人胃癌发病率增加、伴发疾病的比例及死亡率高，成为临床治疗的重点。     

老年人上消化道出血临床分析

目的：探讨老年人上消化道出血的发病特点。方法：选取2004年1月-2007年10月我院上消化道出血病例140例，以老年人（≥65岁）70例为观察组，以70例中青年患者为对照组进行临床回顾性分析比较。结果：老年人上消化道出血常见病因依次为消化性溃疡、黏膜病变、食管和胃的肿瘤、食道胃底静脉曲张等。结论：老年人上消化道出血病程长，伴发病及并发症多，出血难控制，肿瘤发病率明显高于对照组，应早发现、早治疗。     

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.     

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.