330例小儿动脉导管未闭的外科治疗

目的：探讨小儿动脉导管未闭（ＰＤＡ）的外科治疗。方法：回顾分析３３０例小儿动脉导管未闭的外科治疗情况。３０５例经左后外侧切口第４肋间进胸，用１０号丝线结扎导管，１５例在低温体外循环（ＣＰＢ）下结扎导管，１４例在深低温低流量体外循环下经肺动脉缝闭导管。结果：随访３个月￣１４ａ，除６例有气急、心悸外，均恢复正常。结论：（１）不合并肺动脉高压的单纯ＰＤＡ，可在学龄前择期手术；（２）抗心衰治疗无效的早产儿     

369例动脉导管未闭的外科治疗

目的：探讨小儿动脉导管未闭（ＰＤＡ）外科治疗中的特殊问题及处理方法。方法：回顾分析３６９例ＰＤＡ的外科治疗情况，３３９例经左胸入路结扎导管，其中一个月内早产儿６例。１６例在体外循环下（ＣＰＢ）结扎导管。１４例在深低温低流量ＣＰＢ下经肺动脉缝闭导管，结果：随访３个月￣８年，除６例有气急、心悸外，均恢复正常。结论：①不合并肺动脉高压（ＰＨ）的单纯ＰＤＡ，可在学龄前择期手术。②抗心衰治疗无效的早产儿应急     

动脉导管未闭外科治疗的方式选择(附165例报告)

目的报告外科多种方式治疗动脉导管未闭１６５例，探讨选择合适的手术方式。方法左后外侧切口胸腔内未闭动脉导管（ＰＤＡ）结扎、缝扎术８２例，切断缝合术３５例；左后外侧切口胸膜外ＰＤＡ结扎、缝扎术１３例；正中切口体外循环下ＰＤＡ缝闭术２３例；左侧腋下直切口ＰＤＡ结扎术１０例，切断缝合术２例。结果１６５例无手术死亡，仅１例结扎术后导管再通。结论手术方式的选择应根据患者的年龄、动脉导管的粗细长短及并发症决定     

直视下动脉导管缝闭术40例

作者报道４０例体循环下直视缝闭动脉导管未闭（ＰＤＡ）患者的手术情况，手术在深低温转流下，经肺动脉切口缝闭动脉导管，无手术死亡，手术后３０例病人获随访，随访期４￣１２０个月，无远期死亡。作者认为手术关键为：体外循环转流主动阻断应尽早切开肺动脉，用手指堵住导管开口，保证有效的降温和预防灌注肺。     

动脉导管未闭手术方法的选择

目的：分析１３０例动脉导管未闭患者手术治疗，探讨其手术适应证。方法：左后外侧开胸，单纯结扎７７例，加垫结扎８例，单纯胸膜外结扎１２例，体外循环下经肺动脉切口缝合动脉导管３３例。结果：本组无死亡。动脉导管结扎后再通３例，１例再手术，另２例超声心动图提示肺动脉水平有微量的左向右分流，无需再手术，喉返神经损伤１例。结论：我们认为有心脏复合畸形，严重肺动脉高压需在体外循环下手术，鹕膜外处理导管最适用于小儿     

动脉导管未闭外科治疗的方式选择

报告外科多种方式治疗动脉导管未闭１６５例，探讨选择合适的手术方式，方法 左后外侧切口胸腔内未闭动脉导管结扎，缝扎术８２例，切断缝合术３５例；左后外侧切口胸膜外ＰＤＡ结扎，缝扎术１３例；正中切口体外循环下ＰＤＡ缝闭术２３例，左侧腋下直切口ＰＤＡ结扎术１０例，切断缝合术２例。     

合并心内畸形动脉导管未闭的外科治疗

目的 探讨合并心内畸形的动脉导管未闭（ＰＤＡ）的外科治疗,并就其常见并发症进行分析。方法 ６３例患者,分别采用正中劈胸骨经心包内分离双重结扎ＰＤＡ,或体外循环辅助下切开肺动脉直视下缝闭ＰＤＡ,同期行心内畸形矫治。结果 早期死亡３例（４．７６％）。发生呼吸衰竭７例,肾功能衰竭１例,严重室性心律紊乱１例。６０例痊愈出院,随访２个月至８年,恢复良好。结论 心内畸形合并ＰＤＡ应早行同期矫治,浅低温心脏跳动     

369例动脉导管未闭的外科治疗

目的探讨小儿动脉导管未闭(PDA)外科治疗中的特殊问题及处理方法.方法回顾分析369例PDA的外科治疗情况,339例经左胸入路结扎导管,其中一个月内早产儿6例.16例在体外循环下(CPB)结扎导管.14例在深低温低流量CPB下经肺动脉缝闭导管,结果随访3个月～8年,除6例有气急、心悸外,均恢复正常.结论①不合并肺动脉高压(PH)的单纯PDA,可在学龄前择期手术.②抗心衰治疗无效的早产儿应急诊手术.③特殊类型的PDA应在CPB下手术.     

体外循环直视下动脉导管未闭手术的麻醉

我院自１９９１年来,对动脉导管未闭（ＰＤＡ）肺动脉高压（ＰＨ）或动脉导管未闭先天性心脏病（ＣＨＤ）病人选用体外循环,深低温、低流量直视下,施行动脉导管内口缝合,同时纠正其他心脏畸形共６例,收到良好效果,报告如下。１临床资料１．１基本情况：本组男性３例...     

体外循环下动脉导管未闭的手术治疗：附36例报告

本文报告３６例体外循环下动脉导管未闭的手术治疗，主要合并畸形为房间隔缺损、室间隔缺损、法鲁氏三联症、四联症、肺静脉异位引流、主动脉缩窄，２例系导管结扎手术后再通者，２６例合并肺动脉高压征，均在全麻体外循环下施行手术。术后主要并发症：高血压反应１０例，低温反跳性高热１４例。痊愈３３例，死亡３例。     

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.