心率变异非线性分析评估急性脑梗死心脏自主神经功能

目的应用心率变异非线性分析评估脑梗死患者心脏自主神经功能损害情况。方法采用24h动态心电图对44例脑梗死患者和60例健康人监测,以Poincare散点图进行心率变异性(HRV)非线性分析,并与部分时域指标比较。结果脑梗死组Poincare散点图大多数呈鱼雷状,其定量指标VLI:99.23±41.01和VAI:0.44±0.16明显低于对照组VLI:176.31±41.77,VAI:0.78±0.30,P<0.01,并与时域指标相关。结论HRV非线性分析可作为无创伤性定量评价脑梗死患者心脏自主神经功能的可靠方法,心脏自主神经功能受损可能是脑梗死患者发生心脏意外的危险信号。     

Poincare散点图评估尿毒症患者心脏自主神经功能

目的　应用Poincare散点图评估慢性肾衰 (CRF)尿毒症患者的心脏自主神经功能损害情况。方法　采用2 4h动态心电图对 2 8例CRF尿毒症病人和 5 4例健康人监测 ,以Poincare散点图进行心率变异性 (HRV)非线性分析 ,并与部分时域指标比较。结果　尿毒症组Poincare散点图大多数 (80 % )呈鱼雷状 ,其定量指标VLI(98 2 9±40 5 9)和VAI(0 46± 0 16 )明显低于对照组 (VLI:175 6 8± 42 77,VAI :0 75± 0 30 ) ,P <0 0 1,并与时域指标相关。结论　Poincare散点图是定量评价尿毒症患者心脏自主神经功能的有效方法 ,尿毒症患者心脏自主神经功能受损可能是其发生心脏意外的危险信号。     

慢性肺源性心脏病的心率变异性分析

目的：分析心率变异性（HRV）的非线性分析与时域分析评价慢性肺源性心脏病（肺心病）患者心脏自主神经功能损害的效果。方法选择50例慢性肺心病患者作为观察组,并选取同期体检的50例健康者作为对照组。观察比较2组患者的HRV时域指标以及Poincare标绘图定量参数。结果观察组患者HRV的各项时域指标中的SDNN（ms）、SDSD、RMSSD、PNN50、三角指数分别为(67.71±22.55)ms、(11.58±4.84)ms、(20.31±5.45)ms、(1.97±1.04)%、(18.52±8.62),对照组的分别为(112.31±31.29)ms、(19.91±8.51)ms、(30.11±11.18)ms、(6.37±3.26)%、(38.37±17.22),另外观察组的Poincare散点图定量指标中VLI、VAI以及DI参数分别为(91.88±31.91)、(0.54±0.17)、(1.10±0.52),对照组的分别为(182.55±40.68)、(0.79±0.28)、(1.61±0.70),2组之间的各项指标参数比较差异有统计学意义（P<0.05）。结论慢性肺心病患者通常心脏自主神经功能受到严重损害,HRV分析能准确评价患者自主神经功能情况,并且无创。     

不同程度冠心病患者心率变异性及Poincare散点图分析

目的　探讨不同程度冠心病患者心率变异性 (HRV)及Poincare散点图的变化特征。方法　选择住院病人 14 2例 ,其中 ,冠心病组 5 2例 ,陈旧性心肌梗死组 60例 ,将冠脉造影阴性的 3 0例患者作为对照组。对性别、年龄、血压、血糖、尿酸、胆固醇、甘油三脂、2 4hHRV的部分时域指标及Poincare散点图进行统计学分析和比较。结果　病例组与对照组相比 ,年龄增大 ,男性患者及合并高血压、高血糖、高尿酸、高甘油三脂的患者比率明显增高 ,HRV中的SDNN、彗星状散点图比率及定量指标VLI明显降低。随着冠脉病变程度的加重 ,SDNN、VLI及彗星状散点图比率进行性降低 ,较临床指标改变明显。结论　提示冠心病患者伴有心脏自主神经功能损害 ,并随着冠脉病变程度的加重而加重 ,二者互为影响 ,Poincare散点图更具直观性     

原发性高血压患者的心率变异性改变

目的探讨原发性高血压患者自主神经功能的变化。方法随机选择56例原发性高血压患者和40例正常人进行24h心率变异性(HRV)分析。结果原发性高血压患者HRV时域指标SDNN、SDANN、RMSSD、PNN50较对照组明显降低(P均<0.01),左心室肥厚组HRV时域各项指标较非左心室肥厚组明显降低(P均<0.01)。结论高血压患者自主神经功能失调,心率变异性降低,而且心率变异降低程度与心脏受损害程度有关。     

心率变异非线性分析评估血管性痴呆患者心脏自主神经功能

目的:应用心率变异非线性分析评估血管性痴呆患者心脏自主神经功能损害情况.方法:应用动态心电图对124例血管性痴呆患者和102例对照瘸倒进行24h监测,以Poincare散点图进行心率变异性(HRV)菲线性分析,并比较两组定量指标矢量角度指数(VAI)及矢是长度指数(VLI).结果:血管性痴呆组VAI(0.54±0.14)低于对照组(0.67±0.13),血管性痴呆组VLI(154.10±18.91)低于对照组(193.62±25.20),差异均有显著统计学意义(P<0.01);Poincare标绘散点图形状呈彗星状者盘管性痴呆组50.8%(63例),对照组93.1%(95例),呈鱼雷状者血管性痴呆组患者31.5%(39例),对照组2.9%(3例),差异均有显著统计学意义(P<0.01).结论:HRV非线性分析可作为无创伤性定量评价血管性痴呆患者心脏自主神经功能的可靠方法,有必要对痴果患者的进行HRV检查,评估患者的自主神经功能状态.     

慢性心力衰竭患者心率变异性的临床研究

目的探讨慢性心力衰竭窦性心律患者的心率变异性(HRV)特点及其与心功能损害程度的关系。方法用动态心电图仪测定85例慢性心力衰竭患者和79例健康对照组患者的HRV时域指标及频域指标,并进行对比分析,同时比较不同程度慢性心力衰竭患者的HRV的差异。结果慢性心力衰竭组HRV指标中反映心脏交感和迷走神经平衡状况的LF/HF高于对照组(P<0.05),其他时域指标及频域指标均低于对照组(P均<0.05);随着心脏功能损害级别的上升,心力衰竭患者的HRV各指标进一步降低,其中低频功率较敏感。结论心力衰竭患者HRV的变化可反映自主神经功能受损情况,同时为心力衰竭程度的判断提供参考指标。     

心脏神经症患者心率变异性相关分析

近年来,心率变异性（heart rate variability,HRV）分析被证明是反映心脏自主神经调节功能的敏感、无创性客观指标[1].笔者对心脏神经症患者进行心率变异性（HRV）24 h时域指标分析比较,旨在探讨心脏神经症患者与HRV的关系.     

急性脑梗死患者44例心率变异性分析

目的:探讨脑梗死患者的心率变异性,从而了解脑梗死对心脏自主神经功能的影响。方法:采用HRV时域及频域分析方法对44例脑梗死患者和60例正常人的心率变异作对比分析。结果:脑梗死患者的SDNN、SDSD、RMSSD、PNN5 0三角指数及HF明显低于正常组,有显著性差异( P<0 .0 1 )。结论:脑梗死患者心率变异明显减低,心脏自主神经受损,HRV时域及频域分析可作为无创伤性评价脑梗死患者心脏自主神经功能的可靠方法     

冠心病患者心率变异性及其昼夜变化临床分析

目的:研究冠心病(CAD)患者的心率变异性(HRV)及其昼夜变化规律,探讨冠心病患者心脏自主神经变化的临床意义。方法:分析64例冠心病组及52例正常对照组进行24h动态心电图HRV时域、频域指标。结果:冠心病组较对照组24h、日间、夜间HRV各项指标有明显差异(P<0.05),正常组日间与夜间HRV各项指标有明显差异,冠心病组日间与夜间HRV各项指标无明显差异。结论:冠心病患者心脏自主神经功能失调,昼夜节律消失。     

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.