用多聚酶链式反应检测献血员巨细胞病毒感染

采用多聚酶链反应，检测了７６份血库献血员的巨细胞病毒感染情况，结果显示：３９份表现阳性，阳性率为５１．３５，同时还检测了其敏感性和特异性，结果可检测的巨细胞病毒ＤＮＡ最低限为５ｆｇ．μｌ＾－１，本方法简单，快速，特异性较好。灵敏度高，可适用于临床巨细胞病毒感染的检测。     

先天性巨细胞病毒感染与胎儿畸形关系的研究

通过1002份孕妇血清和372份新生儿脐血巨细胞病毒(CMV)IgM和IgA抗体的检测,发现青岛地区孕妇活动性及先天性CMV感染率均较高,分别为20.95%和9.14%。孕妇活动性巨细胞病毒感染传播给婴儿的危险度为36.96%。在110例活动性巨细胞感染孕妇所娩婴儿短期临床随访中发现,活动性巨细胞病毒感染孕妇所娩胎儿出现早产、死胎和发育异常现象显著多于非感染对照组。研究结果认为采用ELISA法检测孕妇血清中CMV-IgM和IgA可用于预测和监视先天性巨细胞病毒感染所致发育异常婴儿出生的危险程度,并可作为优生门诊防止畸形儿出生的一种检测手段。     

尿巨细胞病毒DNA、血清巨细胞病毒抗体检测应用于小儿巨细胞病毒感染意义评价

目的:探究临床诊断巨细胞病毒感染患儿的过程中,检测尿巨细胞病毒DNA与血清巨细胞病毒抗体的临床意义,为临床儿科诊断奠定基础。方法:自我院2015年5月-2016年9月期间收治的120例巨细胞病毒感染患儿,对比患儿应用不同诊断方案进行治疗,观察诊断效果。结果:予以不同的检测方法后,两种单一检测方法诊断结果的阳性率及特异性均无显著的差异(P0.05);但联合检测的诊断结果均显著高于两种单一检测结果,如阳性率、特异性结果,差异显著(P0.05)。对比治疗前后所有患儿的两项指标变化情况,发现两组指标均明显下降,存在显著的差异(P0.05)。结论:临床治疗巨细胞病毒感染患儿的过程中,联合检测尿巨细胞病毒DNA与血清巨细胞病毒抗体可予以准确的诊断,有利于后续的临床治疗,应广泛推广。     

尿液巨细胞病毒DNA联合血清巨细胞病毒特异抗体检测对婴儿巨细胞病毒感染的诊断价值研究

目的:研究探索在诊断婴儿巨细胞病毒感染中采用尿液巨细胞病毒DNA联合血清巨细胞病毒特异抗体检测的诊断价值,评估其临床意义。方法:选择2014年2月-2015年5月本院收诊的90例疑似巨细胞病毒感染的婴幼儿为研究对象,采用尿液巨细胞病毒DNA和血清巨细胞病毒特异抗体对患儿进行检测,比较单一检测及联合检测与治疗前后患儿检测结果。结果:尿液巨细胞病毒DNA检测的阳性率58.89%(53/90)、特异性62.22%(56/90)与血清巨细胞病毒特异抗体检测阳性率51.11%(46/90)、特异性61.11%(55/90)比较差异均无统计学意义(P0.05);联合检测的阳性率78.89%(71/90)、特异性91.11%(82/90)与两种单一检测比较差异均有统计学意义(P0.05);治疗后,患儿尿液巨细胞病毒DNA和血清巨细胞病毒特异抗体含量均低于治疗前(P0.05)。结论:在诊断婴儿巨细胞病毒感染中采用尿液巨细胞病毒DNA联合血清巨细胞病毒特异抗体检测的临床效果理想,值得推广应用。     

防治人巨细胞病毒感染的抗体类药物

人巨细胞病毒因易造成婴幼儿先天性感染、免疫抑制(器官/干细胞移植受体和重度艾滋病等)患者致死性并发症而备受关注。更昔洛韦等化学药物是目前防治巨细胞病毒感染的主要药物,同时,巨细胞病毒特异性的抗体类药物也是防治巨细胞病毒感染的努力方向之一。巨细胞病毒特异性的抗体类药物具有较强病毒中和能力,且可激活补体并介导调理作用,被证明为防治巨细胞病毒感染的有效被动免疫制剂。本文主要就巨细胞病毒感染的抗体类药物,即巨细胞病毒免疫球蛋白和巨细胞病毒特异的治疗性工程化抗体的研制、临床应用及目前存在问题进行综述。     

白组胞中巨细胞病毒及血清巨细胞病毒抗体检测与冠心病

巨细胞病毒属疱疹病毒科，是巨细胞包涵体病的病原体。在其基因结构上含有感染细胞特异性的多肽区段，都具有免疫原性。Fabricant首先用疱疹病毒成功诱导动脉硬化鸡的模型。巨细胞病毒基因组与单纯疱疹病毒一样是由L和S两个基因节段相连接而组成。1987年Adam首次报道了巨细胞病毒感染与动脉硬化有关。我们采取了不同方法检测了40例冠心病患者血清中巨细胞病毒IgM抗体及30例患者外周血单个核细胞的巨细胞病毒，旨在探讨人巨细胞病毒感染与冠心病发生之间的关系，现报告如下。     

胎儿先天性巨细胞病毒感染的产前超声诊断（附3例报告）

目的 探讨产前超声在胎儿先天性巨细胞病毒感染诊断中的价值。方法 回顾性分析2017年2月-2021年10月在浙江省温州市中心医院超声科检查并诊断为先天性巨细胞病毒感染的3例胎儿的产前超声图像,并总结声像图特征。结果 3例先天性巨细胞病毒感染胎儿其颅内声像图均可见两处及以上先天性巨细胞病毒感染征象,其中1例羊膜腔穿刺检测到巨细胞病毒DNA确诊。结论 产前超声可根据多个声像图异常指标提示先天性巨细胞病毒感染,结合血清学阳性结果可诊断,确诊可通过羊膜腔穿刺抽取羊水做病毒学检测。     

小儿巨细胞病毒感染65例临床分析

目的：分析小儿巨细胞病毒感染的流行情况、临床表现和诊断依据。方法：将病人按年龄分组，常规进行肝脏功能测定、病毒性肝炎和巨细胞病毒血清标记物测定，腹部B超扫描。结果：小儿巨细胞病毒感染始于胎儿期，出生后随着年龄的增长，感染率增加，但其临床表现年龄越小，症状越重，年龄越大症状越轻，胎儿期感染则致残、致死的机率增加，预后不良。小儿感染巨细胞病毒后血清中可出现特异性抗体IgG和／或IgM。结论：巨细胞病毒是儿科感染性疾病的重要病原，随年龄增长其发病率有逐渐增多的趋势。但其临床表现则随年龄增长反而减轻。巨细胞病毒感染后血清中出现的特异性抗体IgG和／或IgM是临床诊断的重要依据。     

巨细胞病毒对人群发生高血压的影响

目的：探讨巨细胞病毒对人群发生高血压的影响。方法收集2011年2月至2013年6月来我院接受治疗的168例高血压患者的血液标本作为观察组,同时收集160例体检正常者的血液标本作为对照组。检测并比较两组患者血浆标本中的巨细胞病毒特异性中和抗体、巨细胞病毒特异性IgG和IgM及巨细胞病毒UL93 DNA。结果观察组患者巨细胞病毒UL93DNA、巨细胞病毒特异性IgG和IgM的阳性率分别为73.21%、70.83%和4.20%,对照组患者分别为57.50%、49.38%和2.50%,观察组患者巨细胞病毒UL93DNA和IgG的阳性率高于对照组(P<0.05),而两组间巨细胞病毒特异性IgM阳性率差异无统计学意义(P>0.05)。观察组患者血浆巨细胞病毒特异性中和抗体的几何滴度平均为(40.12±19.89),对照组为(59.96±24.85),两组患者间差异有统计学意义(P<0.05)。结论高血压患者的巨细胞病毒感染率高于健康人群,高血压患者巨细胞病毒特异性中和抗体水平降低明显,这均表明巨细胞病毒感染与人群发生高血压存在相关性。     

婴儿黄疸巨细胞包涵体检查的临床意义

目的 利用巨细胞包涵体检测方法，探讨巨细胞病毒感染与要儿黄疸的关系．方法 取患儿的尿液及其母亲的尿液、乳汁和唾液标本进行涂片，瑞氏染色显微镜观察巨细胞包涵体，找到巨细胞包涵体为阳性，即巨细胞病毒感染．未找到巨细胞包涵体为阴性。结果 观察组31例要儿黄疸，巨细胞包涵体检查阳性21例，阳性率为67．7％；巨细胞包涵体阳性患儿母亲的尿液、乳汁和唾液标本，巨细胞包涵体阳性率分别为100％(21／21)、42．9％(9／21)、23．8％(5／21)；对照组30例正常要儿及其母亲的标本均为阴性．结论 巨细胞包涵体检查可明确巨细胞病毒感染，确定产毒性，巨细胞病毒感染是要儿黄疸的主要因素之一，要儿巨细胞病毒感染与其母亲密切相关．     

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.