多普勒组织成像对PTCA术后远期疗效的评价

目的 评价经皮腔内冠状动脉成形术(PTCA)及支架植入术对急性心肌梗死患者左室局部与整体心功能的远期影响.方法 40例择期行PTCA及支架植入术的急性心肌梗死患者(心梗组),应用脉冲多普勒组织成像(PW-DTI)技术检测PTCA术前及术后6、12个月室壁梗死区域及二尖瓣环的DTI指标:收缩期峰值速度(Vs)、舒张早期峰值速度(Ve)、舒张晚期峰值速度(Va)及(Ve/Va),并与20例健康体检者(对照组)作对照分析.结果 心梗组术前左室局部与整体舒缩功能指标较对照组显著降低,表现为梗死区域各室壁及二尖瓣环的Vs、Ve和Ve/Va均显著降低(P<0.01,P<0.001);心梗组术后6、12个月左室局部与整体舒缩功能较术前明显改善,尤其是术后12个月改善更为显著,表现为梗死区域各室壁及二尖瓣环的Vs、Ve和Ve/Va均显著增高(P<0.05,P<0.01).结论 PTCA 及支架植入术能改善急性心肌梗死患者远期左室局部与整体心功能,且疗效与时间有关.     

多普勒成像技术在冠心病室壁运动速度变化分析中的应用

目的:采用多普勒成像技术(DTI)对冠心病患者及健康人进行局部室壁运动速度测定,以了解DTI是否可作为反映局部功能的检查手段。方法:本文选择了经冠状动脉造影证实的冠心病患者36例作为研究组,另取20例健康人作为对照组,分别测定DTI收缩期峰值速度(Vs),舒张早期峰值速度(Ve),舒张晚期峰值速度(Va)及Ve/Va等指标,将各病变室壁指标与对照组相应指标比较,以了解DTI是否可反映局部室壁的收缩、舒张功能变化。结果:前壁病变组Vs、Ve、Va、Ve/Va均低于对照组(P<0.05);下壁病变组Vs、Ve、Ve/Va也显著低于对照组(P<0.01或P<0.05);而侧壁病变组的Vs、Va与对照组比较无统计学差异,Va、Ve/Va较对照组明显降低(P<0.05)。结论:DTI能很准确地将心脏室壁运动的信息实时显示出来,冠脉组病变室壁的Vs、Ve/Va明显低于对照组,因而Vs可反映局部收缩功能的变化,Ve、Ve/Va可反映局部舒张功能的变化。     

联合DTI技术与Tei指数评价高血压心脏病心功能的研究

目的通过联合多普勒组织速度成像(DTI)和Tei指数对高血压患者左、右室整体功能进行定量研究,并与健康者对照,探讨高血压患者左室局部和整体心功能的改变。方法选取高血压组80例与健康对照组50例分别运用彩色多普勒血流图测量左、右室Tei指数值,将两组左、右室Tei指数进行对照分析,及运用彩色多普勒组织速度图两分别获取组受检者3个不同切面6个室壁24个取样点的速度图,定量分析及对照两组各节段测量参数:收缩期最大速度(Vs)、舒张早期峰值速度(Ve)、舒张晚期峰值速度(Va)、位移(Ds)、Ve/Va等。结果高血压组左、右室Tei指数值均低于健康对照组。高血压组Ve/Va值低于健康对照组,两组受检者同一室壁心肌组织多普勒Vs、Ve、Va、Ds测值从二尖瓣环水平至心尖水平逐渐降低。结论本研究将DTI与多普勒Tei指数联合定量评价高血压心脏病患者心室收缩、舒张功能与左、右室整体功能,弥补了常规超声心动图的不足,有利于对高血压患者病情进展的分析。     

彩色室壁运动技术与多普勒组织成像联合应用诊断心肌梗塞室壁运动异常

目的：探讨彩色室壁运动技术（CK）与多普勒组织成像（DTI）联合应用对心肌梗塞局部室壁运动异常（RWMA）的诊断价值。 方法：应用CK和DTI技术对67例确诊为心肌梗塞患者和40例正常对照者的左室壁节段运动进行检测。CK指标为收缩期内心内膜位移（CK）,DTI指标包括：收缩期波峰值（Vs）,舒张早期波峰值（Ve）,舒张晚期波峰值（Va）。 结果：心肌梗塞患者CK检测的室壁运动幅度及DTI检测的室壁沿长轴运动速度均减低,有梗塞节段室壁运动减低更明显,单独CK与DTI指标诊断室壁运动异常和判定梗塞节段的敏感度均较低,CK和DTI对RWMA的敏感度分别为85.07%,86.56%,CK和DTI对梗塞节段的敏感度分别为87.62%,85.33%,而CK与DTI指标相结合后,对RWMA的敏感性达99.51%,判定梗塞节段的敏感性达99.11%。 结论：CK和DTI联合应用能更准确地诊断心肌梗塞患者的局部室壁运动异常,判定梗塞节段。     

应用多普勒组织成像技术评价冠心病左右心室功能及其相关性

目的:应用多普勒组织成像(DTI)技术评价冠心病患者左右心室功能及其相关性.方法:冠心病患者128例,分为两组,其中不稳定心绞痛组52例,急性心肌梗死组76例;正常对照组60例.应用多普勒组织成像技术于二尖瓣内环、二尖瓣外环、三尖瓣侧环和右室游离壁中点处测量收缩波(Vs)、舒张早期波(Ve)、舒张晚期波峰值速度(Va),计算Ve/Va,比较3组左右心室功能,并评价其左右心室功能的相关性.结果:不稳定心绞痛患者左右心室收缩功能无明显变化,左右心室舒张功能均下降.急性心肌梗死患者左室收缩功能下降,右室收缩功能无变化,左右心室舒张功能均下降.冠心病患者左右心室收缩和舒张功能存在着一定的相关性.结论:应用DTI技术测量左右房室瓣环的运动和速度可以用来评价左右心室整体舒缩功能,左右心室在舒缩功能上有一致性的内在联系.     

脉冲组织多普勒技术对神经症患者二尖瓣环指标的评估

目的 探讨脉冲组织多普勒(PW-DTI)技术对神经症患者二尖瓣环指标的定量评估。方法选择不同年龄段的神经症患者40例,测量心脏6个室壁二尖瓣环PW-DTI指标：收缩期峰值速度(Vs)、舒张早期峰值速度(Ve)、舒张晚期峰值速度(Va)、射血前期(PEP)、射血期(ET)。结果心脏6个室壁二尖瓣环Vs、Ve、Va存在统计学差异,而反映收缩时间间期的指标PEP、ET各室壁间无统计学差异;年龄、心率与Ve、Ve／Va呈负相关关系。结论神经症患者心脏6个室壁二尖瓣环存在收缩、舒张速度的异质性和收缩的同步性;年龄、心率均分别与Ve、Ve／Va呈负相关。     

组织多普勒显像与二维超声心动图的相关性分析

目的 通过组织多普勒显像技术（DTI）局部心功能指标与二维超声心动图（2DE）整体心功能指标的相关分析,探讨DTI检测局部心功能的价值。方法 选择经冠脉造影证实的36例冠心病患者及20例健康查体者为研究对象。DTI测定指标：收缩期峰值速度VS、舒张早期峰值速度Ve、舒张晚期峰值速度Va、Ve／Va,以及2DE指标：左室舒末内径（LVDD）、小轴缩短率（△D％）、左室射血分值（LVEF）、二尖瓣血流频谱E峰、A峰比值（E／A）。结果 （1）DTI收缩功能指标与2DE相关指标Vs1、Vs2与LVEF、ZXD％存在显著正相关;（2）DTI舒张功能指标与2DE相关指标e1、e2、（e／a）1、（e／a）2与E／A存在正相关;（3）Vs1、Vs2与年龄、心率无相关关系,E／A、（P／a）1、（e／a）2与年龄、心率存在负相关。结论 （1）DTI心功能指标与2DE指标相关良好,DTI能准确地将心脏局部室壁运动信息显示出来,Vs可反映局部收缩功能的变化,Ve／Va可反映局部舒张功能的变化;（2）DTI舒张功能指标中（e／a）1、（e／a）2随年龄、心率增加而减低。     

左室急性心肌缺血对右心功能影响的超声组织速度成像研究

目的:应用组织速度成像(TVI)技术研究犬左室急性心肌缺血状态下右心功能的变化特点及其相互关系.方法:10只犬行右冠状动脉前降支结扎,制作急性心肌缺血模型,分别于冠状动脉左前降支结扎前、后10min采集心尖四腔切面图像,测量缺血前后右室壁、右房壁及三尖瓣环的收缩期峰值速度(Vs)、舒张早期峰值速度(Ve)、舒张晚期峰值速度(Va)、右室射血分数(RVEF),用导管法测肺动脉收缩压(PASP).结果:与缺血前比较,左室局部急性心肌缺血后PASP增加(P＜0.05),RVEF降低(P＜0.05),右室壁和三尖瓣环的Vs、Ve及Va降低(P＜0.05),右房壁Vs和Va增加(P＜0.05).心肌缺血前,右室壁与右房壁的运动速度无明显相关性;心肌缺血后两者呈负相关,RVEF与右室壁及三尖瓣环的Vs均呈正相关,PASP与RVEF呈负相关.结论:急性心肌缺血可引起右室壁运动功能减退,右房壁运动功能代偿性增加.     

定量组织多普勒评价急性下壁心肌梗死患者右室壁运动

目的探讨定量组织多普勒成像技术（QTVI）评价急性心肌梗死患者（AMI）右室壁运动速度及心肌同步性运动的价值。方法A组为正常对照26例，B组为急性下壁或下后壁心肌梗死急诊行经皮冠状动脉介入术（percutaneous coronary intervention PCI）后1周内患者24例，应用QTVI获得右室游离壁基底段中段心肌的组织多普勒速度曲线，分别测量各阶段的收缩期（Vs）舒张早期（Ve）舒张晚期（Va）运动速度收缩期S波持续时间（ET）及Ve／Va比值，同时测量各节段自QRS波起始至心肌收缩期及舒张早期峰值速度的时限收缩期同步性指标（Ts）和舒张期同步性指标（Te）。结果B组右室游离壁基底段中段的Ve均较A组显著减小（均P〈0．01），基底段的ET及中段的Ve／Va比值均较A组减小（均P〈0．05），B组右室游离壁内各节段间的Ts和Te无差别（P〉0．05）。结论QTVI可简便敏感地评价急性心肌梗死患者右室壁运动异常，AMI患者急诊行PCI术后右室游离壁内各节段收缩和舒张同步。     

定量组织多普勒评价急性下壁心肌梗死患者右室壁运动

目的 探讨定量组织多普勒成像技术(QTVI)评价急性心肌梗死患者(AMI)右室壁运动速度及心肌同步性运动的价值.方法 A组为正常对照26例,B组为急性下壁或下后壁心肌梗死急诊行经皮冠状动脉介入术(percutaneous coronary intervention PCI)后1周内患者24例,应用QTVI获得右室游离壁基底段﹑中段心肌的组织多普勒速度曲线,分别测量各阶段的收缩期(Vs)﹑舒张早期(Ve)﹑舒张晚期(Va)运动速度﹑收缩期S波持续时间(ET)及Ve/Va比值,同时测量各节段自QRS波起始至心肌收缩期及舒张早期峰值速度的时限收缩期同步性指标(Ts)和舒张期同步性指标(Te).结果 B组右室游离壁基底段﹑中段的Ve均较A组显著减小(均P＜0.01),基底段的ET及中段的Ve/Va比值均较A组减小(均P＜0.05),B组右室游离壁内各节段间的Ts和Te无差别(P＞ 0.05).结论 QTVI可简便﹑敏感地评价急性心肌梗死患者右室壁运动异常,AMI患者急诊行PCI术后右室游离壁内各节段收缩和舒张同步.     

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.