118例不明原因发热病因分析

目的:探讨不明原因发热的病因。方法:回顾性分析2007年1月-2009年12月住院诊治的符合不明原因发热患者118例。结果:118例患者中经各种检查或诊断性治疗最终明确诊断者103例,确诊率为87.2%;感染性疾病69例,其中结核病15例,占12.7%;非感染性疾病中结缔组织病27例,占22.9%;肿瘤性疾病13例,占11.0%,其中出院时仍未确诊的20例,占16.9%。结论:感染性疾病是不明原因发热患者的主要病因,结核病是其中的主要病种,非感染性疾病中结缔组织病、肿瘤性疾病为主要病因;大多数不明原因发热经细致的临床检查和分析是可以得到确诊的。     

不明原因发热108例病因分析

目的:探讨不明原因发热(FUO)的病因。方法:对符合FUO诊断标准的108例病因作回顾性分析。结果:108例中97例确诊,确诊率89.8%。病因为感染性疾病58例,其中结核病19例;结缔组织病-炎性血管性疾病18例,其中成人Still病7例;肿瘤性疾病16例,其中淋巴瘤6例;其他疾病5例。结论:感染性疾病是FUO患者的主要病因,结核病是主要病种。结缔组织病-炎性血管性疾病和肿瘤性疾病是FUO常见病因。     

不明原因发热182例临床分析

目的探讨不明原因发热(FUO)的病因分布特点。方法对符合不明原因发热诊断标准的182例病人资料进行分析研究。结果182例病人中有153例最终确诊,确诊率为84.1%。病因分布如下:感染性疾病92例(60.1%),其中结核病51例,位居FUO病因第一位;肿瘤性疾病27例(17.6%),其中淋巴瘤、白血病占66.7%;结缔组织病23例(15.0%),其中Still病占52.2%;其他疾病11例(7.2%),包括坏死性淋巴结炎、药物热、伪热;29例病人最终未被确诊,占15.9%。结论FUO病人的主要病因是感染性疾病,其中结核病是感染的主要病种。另外,肿瘤性疾病和结缔组织病也是FUO常见的病因。     

197例不明原因发热患者病因临床资料分析

目的：探讨不明原因发热病例的病因和临床特点。方法回顾性分析2011年10月至2013年12月住院诊治的197例不明原因发热病例的病因和诊断方法。结果197例不明原因发热患者中,最终明确诊断181例,确诊率为91.8%;感染性疾病120例,占总发病人数比例为60.9%,感染性疾病以一般细菌感染为主,占34.0%,一般细菌感染中败血症和肺部感染最为常见,分别占35.8%和29.8%;非感染性疾病中,肿瘤性疾病占13.2%,其中淋巴瘤占50%;结缔组织病占12.2%,其中成人Still 病占结缔组织发病比例最高(33.3%),其次是系统性红斑狼疮(25.0%);其他原因中药物热占4.1%;原因未明确病例占8.1%。结论不明原因发热患者病因以感染性疾病为主,其中以败血症和肺部感染最为常见,几乎所有的不明原因发热通过询问病史、临床检查和影像学诊断是可以得到确诊的。     

不明原因长期发热121例的病因分析

目的探讨不明原因长期发热(feverofunknownorigin,FUO)的病因,提高FUO的早期诊断的水平。方法回顾性地总结分析符合FUO诊断标准的成年患者121例的临床资料。结果总确诊率为85.1%。感染性疾病、结缔组织-血管性疾病、肿瘤性疾病及其他疾病分别占48.8%,16.5%,15.7%及4.1%。发热原因仍未查明者18例,占14.9%。结论感染性疾病仍然是FUO的主要病因;注重病史询问及病原检测,关注用药史、完善免疫学指标的检测及掌握非典型疾病的临床特点,对提高FUO的早期诊断有帮助。     

发热待查254例临床分析

目的 探讨发热待查(FUO)的病因及发病趋势,以利于临床早期诊断.方法 回顾性地分析1994-2005年宁夏医学院附属医院收治的符合FUO诊断标准、年龄≥14岁的254例患者的临床资料.结果 254例患者通过多种方法最终确诊223例(87.8%),包括感染性疾病123例(48.4%),其中结核病23例,占感染性疾病的18.7%;结缔组织病40例(15.7%);肿瘤性疾病21例(8.3%);其他疾病39例(15.4%).最终仍原因不明者31例(12.2%).1994-1999年与2000-2005年的资料相比,结核病、恶性肿瘤及原因不明者比例增加,伤寒比例减少.结论 感染性疾病是发热待查的主要病因,其次为结缔组织病和肿瘤性疾病.     

不明原因发热患者122例临床诊断及病因分析

目的探讨不明原因发热（FUO）的病因。方法回顾性分析122例FUO患者的病因。结果122例FUO患者明确诊断者有106例,确诊率86．9％。其中感染性疾病61例（包括细菌感染42例,病毒感染14例,真菌感染3例,其他2例）,非感染性疾病45例（包括血管结缔组织病18例,肿瘤性疾病22例,其他疾病5例）。最后仍有16例患者诊断不明。结论感染性疾病仍是FUO的主要病因,结核病、结缔组织病和肿瘤性疾病在本组FUO病因中也占重要地位,大多数FUO经仔细的临床检查可以得到确诊。     

成人不明原因发热急诊的临床研究

目的 探讨不明原因发热(FUO)的原因.方法 回顾性分析2004年10月至2010年9月间在我院急诊科收治的不明原因发热的患者140例.结果 140例患者中经各种检查或诊断性治疗最终明确诊断是120例,确诊率85.7%.病因包括感染性疾病63例(52.5%),其中结核病21例(33.3%);结缔组织病42例(31.7%),其中系统性红斑狼疮16例(38.1%);肿瘤性疾病12例(10.0%);其他疾病3例,出院时仍未确诊的20例.结论 感染性疾病是本组FUO患者主要病因,细菌感染是主要病种,结缔组织病和肿瘤性疾病在本组FUO病因中也占重要地位,大多数FUO经仔细的临床检查和分析是可以得到确诊的.     

病因不明发热患者致热原因分析

目的：探究发热原因和发热时机不明的发热患者的致热原因。方法选取2012年3月至2016年1月在我院治疗的14周岁以上的发热原因和发热时机不明的发热患者198例,对其发热病因进行分析。结果198例发热原因不明的患者中感染病患者96例,占48.5%,肿瘤性疾病患者56例,占28.3%,结缔组织-血管性疾病患者39例,占19.7%,诊断不明患者7例,占3.5%;感染性疾病发热患者病因分布结果显示,普通细菌和病毒感染、肺结核、结核性脑膜炎、结核性脑脊髓膜炎、布氏杆菌感染、结核性胸膜炎、肝结核、伤寒患者分别占19.8%、15.6%、13.5%、11.5%、11.5%、10.4%、9.4%、8.3%;肿瘤性疾病发热患者病因分布结果显示,恶性组织细胞病、淋巴瘤、骨髓瘤、急性淋巴细胞性白血病、原发性肝癌患者分别占42.9%、21.4%、14.3%、10.7%、10.7%;结缔组织-血管性疾病患者病因分布结果显示,成人斯蒂尔氏病、系统性红斑狼疮、干燥综合征、坏死性血管炎、多发性肌炎、混合性结缔组织病、类风湿性关节炎患者分别占28.2%、23.1%、15.4%、12.8%、10.3%、5.1%、5.1%。结论大多数发热原因和发热时机不明的发热患者中,感染性疾病最多,其次是肿瘤性疾病、结缔组织-血管性疾病。     

192例不明原因发热的临床病因分析

目的分析不明原因发热患者的病因及其在诊断中的意义。方法对我科收治的96例不明原因发热的患者的一般资料及发热原因进行分析总结。结果 192例不明原因发热患者的具体病因分布比例：感染性疾病占38.5%（74/192）,结缔组织及炎性血管性疾病占31.3%（60/192）,恶性肿瘤性疾病占12.5%（24/192）,其他疾病占14.1%（27/192）,未明确诊断的疾病占3.6%（7/192）。结论通过分析不明原因发热患者病因的分布特征,有助于对不明原因发热进行诊断与鉴别诊断。     

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.