原发性与继发性急性胃肠功能损伤临床特征的差异及对预后的影响

目的观察原发性与继发性急性胃肠功能损伤（AGI）临床特征的差异及对预后的影响。方法选取2014年3月1日至8月30日浙江省内14家医院ICU收治时发生AGI的患者470例,其中原发性AGI65例,继发性AGI405例;均给予肠内营养（EN）或静脉营养支持。收集并比较原发性与继发性AGI患者基本资料、营养支持情况及胃肠道症状和临床预后,采用Cox风险回归模型分析AGI患者60d死亡的影响因素。结果继发性AGI患者收缩压低值、舒张压低值、合并糖尿病比例、入ICU时急性生理与慢性健康评分（APACHEⅡ）、综合AGI分级Ⅰ及Ⅱ级比例、48h内建立EN比例、7d内腹泻发生率及第1、4、7天EN热量均明显高于原发性AGI患者（均P＜0.05）,合并脓毒症比例、乳酸水平、7d平均残胃量、7d平均腹内压均明显低于原发性AGI患者（均P＜0.05）。继发性AGI患者ICU住院时间、机械通气时间、第7天APACHEⅡ及28、60d死亡率均明显高于原发性AGI（均P＜0.05）;而第7天序贯器官衰竭评分比较,差异无统计学意义（P＞0.05）。年龄（HR=1.01）、综合AGI分级（HR=2.32）、APACHEⅡ（HR=1.04）、乳酸水平（HR=1.06）、AGI类型为继发性（HR=2.26）是AGI患者60d死亡的独立影响因素（均P＜0.05）。结论继发性AGI患者入ICU后胃肠功能损伤程度相对较轻,但机械通气时间及ICU住院时间较原发性AGI患者明显延长。继发性AGI是AGI重症患者60d死亡的独立危险因素。     

ARDS患者合并胃肠功能障碍的严重程度与预后的关系

目的:探讨ARDS患者胃肠功能障碍与预后的关系。方法:回顾性分析68例ARDS患者胃肠功能障碍临床资料,将其分为AGIⅠ级、Ⅱ级、Ⅲ级、Ⅳ级共4个级别组,评价胃肠功能障碍与急性生理和慢性健康(APACHEII)评分、多器官功能障碍综合征(MODS)及预后的关系。结果:所有ARDS患者均发生不同程度的胃肠功能障碍,随着程度的加深,ARDS患者APACHElI评分、MODS发生率和病死率等呈逐步增高的趋势,并且AGIⅣ级较AGIⅠ级和AGIⅡ级有统计学意义(P0.05)。结论:ARDS患者胃肠功能障碍程度和预后相关。     

瓜氨酸对重症病人急性胃肠功能障碍的评估价值

目的：探讨瓜氨酸对重症病人急性胃肠功能障碍的评估价值。方法：采用前瞻性研究方法，选择ICU及EICU的重症病人113例，根据是否发生急性胃肠损伤(AGI)分为AGI组(n=73)和非AGI组(n=40),统计分析2组病人的血清瓜氨酸水平，并分析AGI组病人的急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)、多器官功能障碍综合征(MODS)评分、28 d死亡率，然后分析其相关性。结果：AGI组不同临床分级病人第3天的血清瓜氨酸水平均低于第1天(P<0.05);第1天、第3天的血清瓜氨酸水平，AGI组Ⅰ级病人高于Ⅱ级和Ⅲ级，Ⅱ级和Ⅲ级病人高于Ⅳ级，差异均有统计学意义(P<0.01);AGI组各分级病人均低于非AGI组(P<0.01)。AGI组Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级病人的MODS评分和28 d死亡率均逐渐升高(P<0.01),APACHEⅡ评分Ⅰ级病人低于Ⅱ级、Ⅲ级和Ⅳ级(P<0.05～P<0.01)。AGI组病人的血清瓜氨酸水平与临床分级(r_s=-0.731)、APACHEⅡ评分(r=-0.573)、MODS评分(r=-0.61...     

血浆瓜氨酸对重症患者肠内营养时机选择的价值研究

目的 探讨针对重症患者实施血浆瓜氨酸水平测定对其肠内营养时机选择的价值。方法 本院于2018年9月至2020年9月纳入240例ICU重症患者开展研究。根据急性胃肠损伤(AGI)诊断标准观察患者AGI发生情况并开展AGI分级(其中AGIⅠ～Ⅳ级患者各60例),随后对所有患者进行血浆瓜氨酸水平测定,比较不同AGI分级患者一般资料、病情严重程度、预后情况及各阶段(入组时、肠内营养开始实施时、出现胃肠道相关并发症时)血浆瓜氨酸水平;再根据血浆瓜氨酸检测水平分组,其中浓度≥12μmol/L的137例患者纳入试验组,将血浆瓜氨酸浓度12μmol/L的103例患者纳入对照组;探讨肠内营养时机的选择。结果 AGIⅣ级患者APACHEⅡ评分、SOFA评分及28 d病死率显著高于AGIⅠ、Ⅱ、Ⅲ级,其ICU治疗时间明显长于其他三级,而AGIⅣ级患者血浆瓜氨酸水平显著低于AGIⅠ、Ⅱ、Ⅲ级;试验组患者肠内营养24 h喂养量明显多于对照组,其喂养目标达标时间显著短于对照组;试验组喂养不耐受、胃潴留、腹泻及腹胀、胃肠道出血、腹腔高压等胃肠道相关并发症发生率及28 d病死率均低于对照组,差异有统计学意义(P0.05)。结论 重症患者血浆瓜氨酸水平与其病情严重程度及AGI分级呈反比,通过测定血浆瓜氨酸含量可预测患者发生胃肠道并发症的风险,从而明确肠内营养开展时机(血浆瓜氨酸浓度≥12μmol/L)。     

肠内营养对质子泵抑制剂导致的胃肠道不良反应的保护作用

目的：观察肠内营养对危重患者质子泵抑制剂（proton pump inhibitors，PPIs）相关的消化道不良反应的作用。方法：采用横断面研究，对全国100家医院ICU内2017年4月25日住院的所有患者（不包括当天新入院患者）进行问卷调查。所用问卷包括自行设计问卷和标准化问卷，了解患者一般情况、使用的药物和治疗、营养实施情况、喂养耐受性评估、实验室检查结果、体重指数（body mass index，BMI）、急性胃肠损伤（acute gastrointestinal injury，AGI）分级、SOFA（sepsis?related organ failure）评分、急性生理功能和慢性健康状况评分系统Ⅱ（acute physiology and chronic health evaluation Ⅱ，APACHE?Ⅱ）评分等。采用单因素分析使用PPIs是否对胃肠功能有所影响，多因素Logistic回归模型考察肠内营养是否为患者发生AGI的影响因素。结果：①未给予肠内营养的508例患者中，使用PPIs的401例（78.9%），未使用PPIs的107例（21.1%）。使用PPIs组的AGI 2~3级和AGI 4级的患者比例（17.0%和3.8%）明显高于非PPIs组（9.3%和1.9%），差异有统计学意义（P=0.027）；②1 138例使用过PPIs的患者中，已开始肠内营养的724例（63.6%）患者AGI分级评分（AGI 2~3级为10.5%，AGI 4级为0.7%）优于未开始肠内营养的401例（35.2%）患者（AGI 2~3级为17.0%，4级为3.8%），差异有统计学意义（P＜0.001）。但两组在28 d转归方面差异无统计学意义。多因素Logistic回归结果显示，肠内营养为AGI评分的独立保护因素（OR=0.353，95%CI：0.242~0.513，P＜0.001）。结论：肠内营养与保护PPIs所导致的ICU患者胃肠功能损伤存在关联性，但未发现其与患者死亡率降低有关。     

小承气汤合四君子汤加减治疗脓毒症胃肠功能障碍临床研究

目的 探讨小承气汤合四君子汤加减治疗脓毒症胃肠功能障碍的临床疗效。方法 将60例脓毒症患者随机分为观察组和对照组,每组30例。对照组给予常规西医治疗,观察组在对照组基础上给予小承气汤合四君子汤加减治疗,2组均治疗14d。比较2组治疗前后急性胃肠损伤（acute gastrointestinal injury,AGI）分级,胃肠功能障碍、急性生理学及慢性健康评估Ⅱ（acute physiology and chronic health evaluationⅡ,APACHEⅡ）、序贯器官衰竭评估（sequential organ failure assessment,SOFA）评分,血清白细胞（white blood cell,WBC）、高敏C-反应蛋白（high-sensitivity C reactive protein,hs-CRP）、降钙素原（procalcitonin,PCT）水平。结果 治疗72h后,观察组AGI分级中Ⅰ级患者占比升高（P<0.05）,Ⅲ级患者占比降低（P<0.05）,且观察组Ⅲ级患者占比低于对照组（P<0.05）;对照组AGI分级占比治疗前后比较,差异无统计学意义（P>0.05）;2组Ⅱ级患者占比治疗前后及组间比较,差异均无统计学意义（P>0.05）。治疗后,2组胃肠功能障碍、APACHEⅡ、SOFA评分,血清WBC、hs-CRP、PCT水平均较前降低（P<0.05）,且观察组上述指标显著低于对照组（P<0.05）。结论小承气汤合四君子汤加减能有效地抑制脓毒症患者机体炎症反应,改善胃肠道功能障碍。     

体外循环及非体外循环冠状动脉旁路移植术后患者急性胃肠功能损伤的对比研究

目的 比较体外循环及非体外循环冠状动脉旁路移植术后患者急性胃肠功能损伤的发生情况。方法 回顾性分析2010年1月-2012年12月南华大学附属第二医院行冠状动脉旁路移植术治疗的冠心病患者536例,根据手术方式分为体外循环组412例,非体外循环组124例。观察两组患者一般情况、基础疾病、超声心动图结果、术后血流动力学、血管活性药物总量、日均尿量,术后急性胃肠功能损伤发生率及急性胃肠功能损伤分级。结果 体外循环组与非体外循环组患者性别、年龄、体质量、纽约心脏病学会（NYHA）心功能分级、高血压发生率、糖尿病发生率、高脂血症发生率、慢性阻塞性肺疾病发生率、左心室舒张末期内径、左心室射血分数、术后日均心率、日均动脉压、日均中心静脉压、血管活性药物总量（去甲肾上腺素、多巴胺、多巴酚丁胺、肾上腺素）比较,差异均无统计学意义（P＞0.05）;体外循环组患者日均尿量较非体外循环组增多（P＜0.05）。体外循环组22例（5.3%）发生急性胃肠功能损伤,其中Ⅰ级7例、Ⅱ级13例、Ⅲ级1例、Ⅳ级1例;非体外循环组6例（4.8%）发生急性胃肠功能损伤,均为Ⅰ级。两组患者急性胃肠功能损伤发生率比较,差异无统计学意义（χ2=0.048,P=0.519）。结论 体外循环与非体外循环冠状动脉旁路移植术后患者急性胃肠功能损伤发生率无差异,但非体外循环冠状动脉旁路移植术后均为Ⅰ级。     

肠内营养对质子泵抑制剂导致的ICU患者胃肠道不良反应的保护作用：一项横断面调查研究

目的 观察肠内营养对危重患者质子泵抑制剂（PPIs）相关的消化道不良反应的作用。方法 横断面研究，调查对象为全国100家医院ICU内2017年4月25日住院的所有患者（不包括4月25日当天新入的病人）。所用的问卷包括：自行设计问卷由病人一般情况、使用的药物和治疗、营养实施情况、喂养耐受性评估、实验室检查结果组成，标准化问卷内容包括BMI、急性胃肠损伤（AGI）分级、SOFA评分、APACHE-Ⅱ评分等。采用单因素分析使用PPIs是否对胃肠功能有所影响，多因素logistic回归模型被用来考察肠内营养是否为患者发生AGI的影响因素。结果 ①未给予肠内营养的共508名患者中，使用PPIs的401（78.9%）名，未使用PPIs的107（21.1%）名。使用PPIs组的AGI分级为2-3级和AGI4级的患者比例（分别为17.0%，3.8%）明显高于非PPIs组（分别为9.3%，1.9%），差异有统计学意义（P=0.027）。②1138名使用过PPIs的患者中，已开始肠内营养的724（63.6%）名患者AGI分级评分(AGI2-3级为10.5%, AGI4级为0.7%)优于未开始肠内营养的401（35.2%）名患者（AGI2-3级为17.0%，4级为3.8%）,P＜0.001。但两组在28天转归方面差异无统计学意义。多因素logistic回归结果显示，肠内营养为AGI评分的独立保护因素（OR=0.353，95%CI:0.242-0.513，P＜0.001）结论 肠内营养与保护PPIs所导致的ICU患者胃肠功能损伤存在关联性，但未发现其与患者死亡率的降低有关。     

原发性高血压病患者室性期前收缩与室间隔厚度的关系研究

目的 探讨原发性高血压病患者室性期前收缩与室间隔厚度的关系。方法 选取2015年1-10月在郑州大学第二附属医院诊断为原发性高血压病患者229例为研究对象。采用彩色多普勒超声诊断仪行心脏检查,测定室间隔厚度、左心室射血分数（LVEF）、左房室瓣口舒张早期最大流速与心房收缩期最大流速比值（E/A）。采用动态心电图监测仪行24 h动态心电图检查,将患者分为无室性期前收缩组(104例)和室性期前收缩组（125例）,并对室性期前收缩组患者进行Lown分级。结果 室性期前收缩组室间隔厚度大于无室性期前收缩组,差异有统计学意义（P＜0.05）。不同Lown分级室性期前收缩患者室间隔厚度分布比较,差异有统计学意义（χ2=15.362,P＜0.05）。Lown分级为Ⅰ级者室间隔厚度以8.0～11.9 mm为主（40例,66.7%）,Lown分级为Ⅱ、Ⅲ级者室间隔厚度以12.0～13.9 mm为主（10例,58.8%;18例,60.0%）,Lown分级为Ⅳ级者室间隔厚度以8.0～11.9 mm为主（10例,55.6%）。结论 原发性高血压病患者室性期前收缩发生与室间隔厚度增加有关,且室间隔厚度的增加会影响室性期前收缩的数量、性质。     

肾脏囊性占位超声造影及CT增强的表现与Bosniak分级的临床应用研究

目的 探讨超声造影和增强CT于肾脏囊性占位Bosniak分级的诊断及鉴别诊断的临床应用价值。方法 回顾性分析2013年3月至2022年8月共50例经手术病理明确诊断的肾脏囊性占位患者临床资料,所有患者均于同时段进行超声造影与CT增强检查,并予Bosniak分级。结果 手术患者中超声造影分级为Ⅰ级3例（6%）,Ⅱ级10例（20%）,ⅡF级10例（20%）,Ⅲ级14例（28%）,Ⅳ级13例（26%）,CT增强分级为Ⅰ级3例（6%）,Ⅱ级15例（30%）,ⅡF级5例（10%）,Ⅲ级12例（24%）,Ⅳ级15例（30%）。此两种检查方法诊断结果均与手术金标准结果高度一致（Kappa值分别为0.841和0.682）。结论 超声造影与CT增强对于肾脏囊性占位有相仿的定性诊断准确率,超声造影具有独立的临床应用优势价值。     

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.