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。     

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。     

欧洲腹部疾病工作组急性胃肠功能损伤工作指南在ICU患者中的应用

目的 依据2012年欧洲腹部疾病工作组（WGAP）制订的急性胃肠功能损伤（AGI）工作指南中AGI的临床分级标准,对ICU患者的胃肠功能和临床结局进行评估,探讨AGI分级在临床实践中的可行性。方法 选取2010年1月-2011年12月深圳市人民医院ICU患者874例,根据欧洲2012年AGI工作指南对患者胃肠功能进行分级,共0～Ⅳ级。记录不同病因患者病死率、不同AGI分级患者病死率及ICU住院时间,比较不同AGI分级的原发性与继发性AGI患者病死率。结果 874例患者中共159例死亡,病死率为18.2%。AGI 0级者471例,Ⅰ级者118例,Ⅱ级者180例,Ⅲ级者76例,Ⅳ级者29例。AGI分级与病死率、ICU住院时间呈正相关（rs=0.580、0.374,P＜0.001）。403例AGI患者中原发性AGI患者181例,继发性AGI患者222例。原发性AGIⅡ级和Ⅲ级患者病死率分别为7.7%（7/91）、53.1%（17/32）,均低于继发性AGIⅡ级和Ⅲ级者病死率52.8%（47/89）、84.1%（37/44）（χ2=43.613、8.637,P＜0.05）|原发性AGIⅠ级患者病死率为0,继发性AGIⅠ级患者病死率为7.3%（6/82）,两者比较,差异无统计学意义（χ2=1.466,P=0.106）|原发性AGI Ⅳ级患者病死率为90.9%（20/22）,继发性AGIⅣ级患者病死率为85.7%（6/7）,两者比较,差异无统计学意义（P=0.579）。结论 随着AGI分级升高,患者病死率增高,ICU住院时间延长。欧洲2012年AGI工作指南推荐的AGI定义及分级在临床实践中具有可行性和有效性,仍需进一步研究探讨。     

重症监护病房老年重症肺炎患者肠内营养不耐受的风险预测模型

目的 分析重症监护病房（intensive care unit,ICU）老年重症肺炎（severe pneumonia,SP）患者肠内营养不耐受的危险因素并构建其预测模型。方法 选取2021年1月到2022年12月宁波大学附属第一医院ICU病房老年SP患者140例,根据肠内营养耐受情况分为耐受组（n=82）和不耐受组（n=58）,采用单因素及多因素 Logistic回归分析ICU老年SP患者发生肠内营养不耐受的危险因素,构建风险预测模型,绘制受试者操作特征（receiver operating characteristic,ROC）曲线评估模型预测效果。结果 多因素 Logistic回归分析显示急性胃肠损伤分级（acute gastrointestinal injury,AGI）、腹内压（intra-abdominal pressure,IAP）、使用抗生素≥2种是ICU老年SP患者肠内营养不耐受的独立影响因素（P<0.05)。模型采用Hosmer-Lemeshow 拟合优度检验评估方程拟合效果,曲线下面积为0.867（95%CI：0.750~0.984）,敏感度为87.8%,特异性为85.1%。结论 本研究构建的风险预测模型可有效预测ICU老年SP患者肠内营养不耐受的发生风险。     

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)。     

早期床上分级运动联合肠内营养对ICU机械通气患者胃肠功能及肌力恢复的影响

目的：探究早期床上分级运动联合肠内营养对重症监护室（ICU）机械通气患者胃肠功能及肌力恢复的影响。方法：选取2022年5月—2023年5月南平市第一医院收治的ICU机械通气患者90例。按随机数字表法将90例患者分为观察组（45例）及对照组（45例）。对照组给予常规锻炼联合肠内营养治疗,观察组给予早期床上分级运动联合肠内营养。比较两组胃肠功能情况、肌力恢复情况[医学研究委员会肌力评定量表（medical research council scale,MRC）]、自理能力评分、睡眠质量评分[匹兹堡睡眠质量指数量表（PSQI）]、住院相关指标及并发症的发生情况。结果：干预后观察组急性胃肠功能损伤分级情况优于对照组（P<0.05）。干预后两组MRC评分、自理能力评分与干预前相比均提升,且观察组均高于对照组（P<0.05）。干预后两组的PSQI评分与干预前相比均下降,且观察组低于对照组（P<0.05）。观察组干预后机械通气、ICU住院、总住院时间均短于对照组（P<0.05）。观察组并发症总发生率（4.44%）低于对照组（26.67%）(P<0.05)。结论：早期床上...     

IL–27与急性胃肠功能损伤的相关性研究

目的 探讨重症监护病房（intensive care unit,ICU）中急性胃肠功能损伤（acute gastrointestinal injury,AGI）患者血清白细胞介素27（interleukin 27,IL–27）浓度变化及意义。方法 选择2019年6月至2021年6月入住杭州市中医院ICU的急性胃肠功能损伤患者90例。患者入ICU 1d、3d采用酶联免疫吸附试验（enzyme–linked immunosorbent assay,ELISA）测定血清IL–27浓度,并计算患者急性生理学与慢性健康状况评分系统Ⅱ（acute physiology and chronic health status scoring system II,APACHEⅡ）评分及序贯器官衰竭评分（sequential organ failure assessment,SOFA）,根据28d生存情况分为存活组（n=72）和死亡组（n=18）,根据有无AGI症状分为AGI组（n=90）和无AGI组（n=40）,比较两组患者IL–27浓度差异变化。结果 急性胃肠功能损伤患者28d死亡18例,死亡率20.0%。死亡组患者SOFA评分明显高于存活组,ICU住院时间明显短于存活组,差异有统计学意义（P<0.05）。与无AGI组比较,胃肠功能损伤患者第1天及第3天IL–27浓度水平均明显升高,差异有统计学意义（P<0.05）。与存活组比较,死亡组在第1天及第3天IL–27浓度均有升高,其中第1天有统计学意义;但AGI组1～3级组间各时间点血清IL–27浓度比较,差异均无统计学意义（P>0.05）。Logistic回归分析显示,IL–27浓度和SOFA评分为影响患者28d死亡的独立危险因素。结论 血清IL–27在评估急性胃肠功能损伤方面有一定的预示作用;对急性胃肠功能损伤患者的预后评价中有一定的价值,值得临床推广和应用。     

重症监护病房患者肠内营养相关性腹泻影响因素分析及干预对策

目的 探讨重症监护病房患者肠内营养相关性腹泻的影响因素及干预对策。方法 采取便利抽样法,回顾性选取2018年1月至2022年1月温州医科大学附属第二医院重症监护病房肠内营养患者,采用自行设计调查表收集ICU肠内营养患者的一般资料,并根据是否发生腹泻分为腹泻组（n=31）与未腹泻组（n=149）,通过Logistic回归分析探讨腹泻发生的影响因素。结果 180例ICU肠内营养患者中,31例发生腹泻,发生率为17.22%。单因素分析显示,两组患者在近5d内行腹部手术、低血清白蛋白水平（<25g/l）、使用抗生素超过2周、制剂的日用量≥1200ml、制剂未逐渐增量、肠内营养治疗前禁食、口服钾制剂的比较,差异有统计学意义（P<0.05）。Logistic回归分析结果显示,近5d内行腹部手术、使用抗生素超过2周、制剂未逐渐增量、肠内营养治疗前禁食是ICU患者肠内营养相关性腹泻的独立危险因素（P<0.05）。结论 ICU肠内营养患者腹泻发生率较高,近5d内行腹部手术、使用抗生素超过2周、制剂未逐渐增量、肠内营养治疗前禁食为影响腹泻发生的主要独立危险因素,临床医护人员可针对危险因素予合理干预并改善预后。     

ICU内科危重症患者肠内营养喂养不耐受情况及其影响因素分析

目的:分析ICU内科危重症患者肠内营养喂养不耐受情况及其影响因素。方法:回顾性分析2018年2月至2021年2月北京市丰台中西医结合医院ICU危重症患者884例,自行设计ICU内科危重症患者肠内营养喂养不耐受的流行病学调查表,单因素、多因素logistic回归分析内科危重症患者肠内营养喂养不耐受情况及其影响因素。结果:ICU内科危重症患者884例中,肠内营养喂养不耐受352例,发生率为39.82%,其中不同年龄、肠内营养开始时间、APACHEⅡ评分、添加膳食纤维、机械通气、低白蛋白血症、应用促胃动力药、口服钾制剂、应用镇静剂、应用血管活性药物、应用抗生素种类患者的肠内营养喂养不耐受发生率之间比较,差异有统计学意义(P<0.001,P<0.05)。多因素logistic回归分析显示,ICU内科危重症患者肠内营养喂养不耐受影响因素包括肠内营养开始时间、APACHEⅡ评分、添加膳食纤维、机械通气、低白蛋白血症、应用促胃动力药、口服钾制剂、应用抗生素种类(P<0.05)。结论:ICU内科危重症患者肠内营养喂养不耐受发生率较高,影响因素包括肠内营养开始时间、APACHEⅡ评分、添加膳食纤维、机械通气、低白蛋白血症、应用促胃动力药、口服钾制剂、应用抗生素种类。     

ICU患者医疗器械相关性压力性损伤发生特征及影响因素分析

目的 了解重症监护室（ICU）患者医疗器械相关性压力性损伤（MDRPI）发生特征,探讨其相关影响因素。方法 选取2021年6月至12月新疆医科大学第一附属医院ICU患者280例,依据是否发生MDRPI将其分为发生组和未发生组。比较两组一般资料、临床资料及器械使用情况,采用多因素logistic回归分析ICU患者发生MDRPI的影响因素。结果 55例发生了MDRPI,发生率为19.6%。两组年龄、Braden量表评分、急性生理与慢性健康评分表Ⅱ（APACHEⅡ）评分、ICU类型、手术、俯卧位通气、意识障碍、使用血管活性药、使用镇静药物、肠内营养、血红蛋白、ICU停留时间、医疗器械使用情况比较,差异有统计学意义（P<0.05）。年龄、俯卧位通气、APACHEⅡ评分、血红蛋白>120 g/L、医疗器械使用总数、使用无创通气面罩是ICU患者发生MDRPI的影响因素（P<0.05）。结论 ICU患者可因高龄、俯卧位通气、病情危重、医疗器械总数多、使用无创通气面罩等而易发生MDRPI。护理人员应对患者进行全面评估,预见性给予预防措施,以减少MDRPI的发生。     

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.     

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.     

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.