颅脑损伤并发脑耗盐综合征的临床特点

目的探讨颅脑损伤后并发脑耗盐综合征（Cerebral Salt Wasting Syndrome，csws）的临床特点和处理。方法回顾分析23例颅脑损伤后并发CSWS的临床资料，治疗方法和效果。结果颅脑损伤并发CSWS的23例患者，22例CSWS治愈，1例需长期高钠饮食以维持血钠正常。结论颅脑损伤并发CSWS的患者，有低血容量的临床表现少，多需补充高渗盐水治疗以纠正低钠血症，大部分患者CSWS并发症可治愈。     

颅脑损伤术后并发脑性耗钠综合征的观察及护理

目的:探讨颅脑损伤术后并发脑性耗钠综合征(CSWS)的观察和临床护理方法。方法:对15例颅脑损伤术后并发脑性耗钠综合征的住院患者临床资料进行回顾性分析。结果:15例CSWS患者均治愈,无1例死亡。结论:在CSWS患者护理环节上要有预见性,熟练掌握补钠、补液的量、速度,维持血容量和钠的平衡,加强患者饮食指导及心理护理,对减少并发症发生,促进患者早日康复有着极其重要的意义。     

重型颅脑损伤并发低血钠综合征

目的:探讨严重型颅脑损伤患者并发低血钠综合征的诊断和治疗方法。方法:回顾分析我院2004年6月至2006年6月收治的18例重型颅脑损伤并发低血钠综合征患者的临床资料。结果:颅脑损伤后低血钠综合征主要分为抗利尿激素分泌异常综合征(SIADH)和脑盐耗综合征(CSWS)两种类型。SIADH行限水治疗;CSWS给予补充盐水治疗,全部患者低钠血症均得到纠正。结论:颅脑损伤并发低血钠综合征有两种不同表现形式,且治疗方法不同。     

36例重症颅脑损伤低血钠综合征的治疗

目的探讨重度颅脑损伤后低血钠综合征的水钠代谢观察方法及治疗策略。方法对36例重度颅脑损伤后低血钠患者依缺钠程度分别补钠,并在治疗中鉴别不同类型的低钠血症。结果 32例脑性盐耗综合征（CSWS）和4例抗利尿激素异常分泌综合征（SIADH）中34例治愈,2例因脑干损伤呼吸衰竭死亡。结论重度颅脑损伤后低钠血症中CSWS占多数,弥漫性轴索损伤患者易出现低血钠综合征,SIADH和CSWS明确诊断后应采取不同治疗策略。     

重症颅脑损伤患儿低钠性多尿的原因分析及诊疗

目的探讨重症颅脑损伤患儿低钠性多尿的原因及诊疗方法。方法回顾性分析湛江中心人民医院2013年1月—2018年7月收治的40例重症颅脑损伤后低钠血症患儿临床资料,分析其诊治过程,探讨其发病原因及治疗方法。结果20例诊断为脑性耗盐综合征(CSWS),10例诊断为中枢性尿崩(CDI),10例诊断为CSWS合并CDI。在积极治疗原发颅脑损伤的基础上,给予补液补钠、维持水电解质平衡、去氨加压素、氢化可的松等治疗,CSWS患儿中治愈18例(90.00%),死亡2例(10.00%),CDI患儿中治愈8例(80.00%),永久性尿崩未愈1例(10.00%),死亡1例(10.00%),CSWS合并CDI患儿中治愈7例,死亡3例。结论重症颅脑损伤患儿低钠性多尿原因有多种,应尽早监测血钠、24小时尿钠、血渗透压及尿液渗透压,辨明原因,对症治疗,可获得较好的预后。     

颅脑损伤并发抗利尿激素分泌失调综合征临床探讨

目的探讨颅脑损伤并发抗利尿激素分泌失调综合征（SIADH）机制、临床特点。方法回顾分析15例颅脑损伤并发SIADH资料。结果15例颅脑损伤合并SIADH均具有低血钠、高尿钠、低血浆渗透压、红细胞压积降低、中心静脉压升高、尿比重升高不明显的特点;治愈14例、死亡1例。结论颅脑损伤并发SIADH的发病机制及治疗措施不同于低钠血症,早期诊治有利于颅脑损伤患者的恢复,降低病残率及死亡率。     

11例脑性耗盐综合征的诊断与治疗

目的:探讨颅脑疾病并发脑性耗盐综合征(CSWS)的诊断与治疗方法。方法:对我院收治的11例颅脑疾病并发CSWS患者的临床表现、实验室检查、治疗方法进行回顾性分析。结果:11例患者血钠均恢复到正常水平,低钠血症症状缓解。结论:低血钠、高尿钠、低血容量是CSWS的诊断依据,在积极治疗颅脑原发疾病的同时,水化和补盐治疗安全有效。     

重型颅脑损伤后脑性盐耗综合征17例诊治分析

目的：探讨重型颅脑损伤后脑性盐耗综合征的诊治方法及临床效果。方法：回顾性总结分析2010年3月～2014年4月我科诊治的17例重型颅脑损伤并发脑性盐耗综合征患者临床资料。结果：17例患者均确诊为重型颅脑损伤并发脑性盐耗综合征，治疗后患者精神、神智好转，消化道症状减轻，尿钠逐渐下降，血钠回升，12～19天后患者血钠、尿钠均恢复正常，平均时间14．5天。术后3个月后格拉斯哥预后评分（ GOS）恢复良好8例，中残5例，重残2例，1例死于原发性重型颅脑损伤。结论：重型颅脑损伤后CSWS诊治不当可致严重后果，临床应注重鉴别诊断，注意补钠速度，严密监测电解质、尿钠及24小时尿量，积极治疗原发病，可提高患者生存率。     

颅脑损伤后的脑性盐耗综合征22例临床分析

目的分析22例颅脑损伤后的脑性盐耗综合征(cerebral salt wasting syndrome,CSWS)的临床诊断和治疗体会。方法回顾性分析22例颅脑损伤患者CSWS的临床表现,患者平均年龄为(53.2±17.1)岁,中位发病时间11 d,中位病程11 d。结果所有病例均符合CSWS诊断金标准,其中8例患者血清钠<120 mmol/L,为重症患者,临床表现为短期内出现意识障碍。轻、中症患者临床表现为消化道症状和渐进性意识下降。经适当补充液体量,应用速尿,白蛋白和积极补钠等综合治疗,4例重症患者死亡,其余治愈。结论CSWS在颅脑损伤后并不少见,诊断并不困难,但需提高警惕。治疗的重点是预防和控制脑水肿。     

颅脑损伤后脑盐耗综合征20例临床分析

目的 探讨颅脑损伤后的病人并发脑盐耗综合征(Cerebral Salt Wasting Syndrome,CSWS)的病因、诊断及治疗方法.方法 回顾性分析20例颅脑损伤后发生脑盐耗综合征的病例.结果 18例低钠血症症状恢复,2例死于急性脑肿胀.结论 颅脑损伤后若发生高尿钠、低血钠、中心静脉压下降的情况应诊断为CSWS.并需与尿崩症及抗利尿激素分泌异常综合症(inappropriate secretion of antidiuretic hormone,SIADH)鉴别.     

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.