二维超声检测蛛网膜下腔间隙诊断足月儿窒息后脑损伤

目的　探讨足月儿缺氧缺血性脑病 (HIE)新的量化诊断指标。方法　应用二维超声对 2 0 0例正常足月儿 ,39例足月儿HIE于日龄 1、3、5、7天进行动态观察。结果　蛛网膜下腔间隙 :正常足月儿大间隙 (蛛网膜与脑沟之间间隙 )为 1.96～ 2 .2 3mm ,小间隙 (蛛网膜与脑回之间间隙 )为 1.2 2～ 1.91mm ;HIE组大间隙为 0 .37～ 1.12mm ,小间隙为 0 .0 9～ 0 .2 9mm ,两组比较差异有极显著性 (P <0 .0 1)。结论　原沿用超声诊断HIE指标仍适用于足月儿HIE的诊断 ,蛛网膜下腔间隙的测量对于足月儿HIE的诊断多了一项新的量化指标     

新生儿缺氧缺血性脑病的CT诊断

通过对５３例临床符合诊断的新生儿缺氧缺血性脑病ＣＴ分析，进一步认识ＨＩＥ的ＣＴ表现及其意义。其病理改变主要是由脑缺氧缺血引起的脑水肿，蛛网膜下腔出血，脑室或脑质出血，脑水肿为其基本改变。ＣＴ表现中，脑水肿为脑实质片状或弥漫低密度区或脑沟，脑裂，脑室等变窄或消失。脑出血为脑实质，脑室或蛛网膜下腔出血，后纵裂池密变增高为蛛网膜下腔出血常见而可靠的征象。     

新生儿缺氧缺血性脑病78例脑CT检查分析

对７８例新生儿缺氧缺血性脑病患者（ＨＩＥ）进行了脑、Ｔ检查，发现ＨＩＥ在生后第一天即可见到脑损害的改变，其中蛛网膜下腔出血（ＳＡＨ）发生率为８７．１８％，脑水 发生率为７５．６４％。脑ＣＴ检查有助于ＨＩＥ的早期诊断。     

内源性激活素Ａ水平变化与窒息新生儿 致缺氧缺血性脑病的相关性分析

探讨内源性激活素Ａ（ＡＣＴＡ）在窒息新生儿中的变化及与新生儿缺氧缺血性脑病（ＨＩＥ）的相关 性。方法　选择２０１１年３月至２０１４年３月收治的窒息足月新生儿６８例（观察组,其中轻度３８例、重度３０例） 和正常足月新生儿４０例（对照组）,用ＥＬＩＳＡ法动态检测其出生时脐血、出生后７ｄ的ＡＣＴＡ、肿瘤坏死因子－α （ＴＮＦ－α）及成纤维细胞生长因子（ＦＧＦ）的水平;结合新生儿ＨＩＥ颅脑ＣＴ进行临床分度,将窒息组患儿的各项 临床指标量化赋分,与血清ＡＣＴＡ相关性分析采用直线相关分析。结果　与对照组比较,观察组出生时脐血的 ＡＣＴＡ［（３７５０７１）ｖｓ（２８４０２３） ｎｇ／ｍ１］、ＴＮＦ－α［（１０８３±１６１）ｖｓ（９０４０８８）ｎｇ／ｍｌ］ 及ＦＧＦ ［（７７６６２３２９）ｖｓ（３６３２±９４０）ｐｇ／ｍｌ］水平均显著升高（Ｐ均＜００５）;新生儿ＡＣＴＡ与出生后的１ｍｉｎＡｐｇａｒ 评分成负相关性（ｒ＝－０８３７,Ｐ＜００５）。观察组患儿出生后７ｄ的ＡＣＴＡ［（５６１１４４）ｖｓ（２８２０１４）ｎｇ／ｍｌ］、 ＦＧＦ［（６４３２１８８１）ｖｓ（４１７１±９１９）ｐｇ／ｍｌ］水平仍高于对照组（Ｐ均＜００５）;两组ＴＮＦ－α水平比较统计学 无差异（Ｐ＞００５）。直线相关分析显示ＡＣＴＡ与ＨＩＥ患儿的严重程度成正相关性（ｒ＝０８５１,Ｐ＜００５）。结 论　新生儿ＨＩＥ发病的过程会有内源性ＡＣＴＡ进行参与,动态检测内源性ＡＣＴＡ对判断窒息所导致新生儿 ＨＩＥ的严重程度及预测患儿的预后可能有很重要的价值。     

新生儿缺氧缺血性脑病血胆红素测定及其意义

缺氧是引起新生儿高胆红素血症的主要原因之一，但缺氧后主要并发症的缺氧缺血性脑病（ＨＩＥ）患儿黄疸的程度并不严重。为了解不同程度ＨＩＥ之间血胆红素的关系，对１９９７～２０００年收治的ＨＩＥ患儿４４例进行分析，结果报告如下。１ 资料与方法１.１ 一般资料 本组患儿共４４例，其中男 ２５例，女 １９例。根据１９９６年杭州第四届全国新生儿学术会议制定的新生儿诊断标准进行分度，重度ＨＩＥ ７例，其中早产儿３例，足月儿４例；并发脑室出血１例，蛛网膜下腔出血２例，吸入性肺炎２例，呼衰１例，肺出血１例。中度 ＨＩＥ例，…     

40例新生儿缺氧缺血性脑病的电解质改变分析

新生儿缺氧缺血性脑病（ＨＩＥ）可引起多脏器功能损害和部分血清酶类及电解质代谢的紊乱。近几年来有关新生儿窒息后血清电解质改变的文献报道较少，因此我院于１９９８～１９９９年对收住院的４０例ＨＩＥ ，患儿作了血生化测定，现报告如下。１临床资料１．１一般资料本组男２３例，女１７例，均为足月新生儿。本文的新生儿ＨＩＥ诊断均根据１９８９年济南会议标准［１］。临床分度：轻度２６例，中度８例，重度６例。经ＣＴ证实有１１例脑水肿，其中合并蛛网膜下腔出血８例，脑实质出血１例，脑室出血１例。本组合并中枢性呼吸衰竭６例…     

轻度窒息新生儿头颅CT平扫的临床诊断意义(附92例临床分析)

轻度窒息新生儿头颅ＣＴ平扫的临床诊断意义（附９２例临床分析）溧水县人民医院孙桂琴窒息是新生儿的主要死亡原因之一，常引起不同程度的脑损伤。而轻度缺氧缺血性脑病（ＨＩＥ），单纯蛛网膜下腔出血及硬脑膜下少量出血可无明显表现［１］，有很大隐蔽性。现将我院近二...     

64例新生儿缺氧缺血性脑病病因分析

新生儿缺氧缺血性脑病（ＨＩＥ）主要是指围产期窒息导致的脑缺氧缺血性损伤。本文对ＨＩＥ致病因进行回顾性分析,为预防和减少此病的发生积累经验。１　资料与方法１１　收集１９９６年４月至１９９８年１２月我院儿科和市妇幼保健院新生儿病房的ＨＩＥ患儿共６４例,其中足月儿４７例,足月小样儿８例,早产儿９例。依照全国新生儿会议制订的ＨＩＥ诊断依据和分型标准,轻度１９例,中度３８例,重度７例。１２　新生儿ＨＩＥ产生原因是产前、产时及产后多种缺氧原因并存而致,从临床角度分析本组主要原因有：①脐带因素（其中包括脐…     

小剂量甘露醇,苯巴比妥,脑活素联合治疗新生儿缺氧缺血性脑病临床观察

目的：探讨静脉滴注苯巴比妥、甘露醇及脑活素联合防治新生儿缺氧缺血性脑病（ＨＩＥ）的疗效。方法：对３０例重度窒息新生儿生后６ｈ内即开始应用苯巴比妥预防缺氧后脑损伤,如出现ＨＩＥ症状再予小剂量甘露醇及脑活素治疗。结果：观察组在减少ＨＩＥ的发生率、减轻脑损伤的严重程度、提高治愈率、降低病死率等临床指标与对照组有显著性差异（Ｐ〈０．０５或〈０．０１）。结论：应用苯巴比妥、小剂量甘露醇、脑活素联合防治新生儿     

纳络酮、脑活素治疗新生儿缺氧缺血性脑病34例

我院儿科对新生儿缺氧缺血性脑病（ＨＩＥ）在原有治疗基础上,采用纳络酮与脑活素联合治疗,取得了较好疗效,现报告如下。 １资料与方法 １．１对象：１９９８～２０００年３月我科收治新生儿ＨＩＥ患儿６７例,均符合１９８９年８月济南会议制定的新生儿缺氧缺血性脑病的诊断标准［１］。并随机分为两组,①对照组３３例,男１６例,女１７例。②治疗组３４例,男１５例,女１９例。两组在出生后小时龄、孕周、体重及临床症状等资料比较,差异无显著意义（Ｐ＜０．０５）,且其母亲分娩过程中无应用吗啡或其它特殊药物史。 １．２方法：…     

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.