多模式眼底影像联合房水细胞因子检测对糖尿病视网膜病变患者黄斑水肿严重程度的诊断价值

目的观察经肛括约肌间切开术(TROPIS)联合改良Hanley术治疗高位经括约肌肛瘘的临床疗效。 方法将本院收治的高位经括约肌肛瘘患者100例均分为观察组(TROPIS联合改良Hanley术治疗)和对照组(传统切开挂线术治疗)。记录两组肛门疼痛、渗出和肿胀评分,比较两组肛肠动力学指标、创面愈合时间、便血时间、脓腐脱落时间、创面瘢痕面积、血清炎症因子和免疫功能水平。 结果两组术后7天肛门疼痛、渗出和肿胀评分较术后1天降低,且观察组均低于对照组(P＜0.05)；两组术后直肠静息压、肛管静息压水平较术前降低,观察组高于对照组(P＜0.05)；观察组术后创面愈合时间、便血时间、脓腐脱落时间、创面瘢痕面积均低于对照组(P＜0.05)；两组术后TNF-α、IL-6、IL-8和CRP水平较术前升高,且观察组低于对照组(P＜0.05)；观察组术后CD3⁺、CD4⁺、CD4⁺/CD8⁺比值和NK细胞水平高于对照组(P＜0.05)。 结论TROPIS联合改良Hanley术,创伤更小,可减轻炎症反应,有利于机体免疫功能的恢复。     

基于括约肌间感染机制经肛括约肌间切开术治疗高位肛瘘临床研究

目的 探讨经肛括约肌间切开(TROPIS)术治疗高位肛瘘的效果.方法 选取2018年1月至2019年4月该院收治的高位肛瘘患者62例,采用随机数字表法分为观察组(30例)和对照组(32例).对照组采用传统切开挂线法,观察组采用TROPIS术.比较两组患者术后疼痛、住院时间、创面愈合时间、术后1年肛门功能和复发率.结果 ...     

经括约肌间瘘管结扎术联合生物补片治疗经括约肌肛瘘疗效观察

目的探讨经括约肌间瘘管结扎术（LIFT）联合生物补片治疗经括约肌肛瘘的临床效果。方法收集经括约肌肛瘘患者63例,分对照组（31例）和观察组（32例）,对照组采用肛瘘切开挂线术式;观察组采用LIFT术联合生物补片治疗。观察两组患者手术时间、住院时间、术后疼痛程度、创面愈合时间、术前及术后肛门形态、功能等指标。并随访半年,观察复发率。结果观察组手术时间、愈合时间、疼痛分级及尿潴留均低于对照组,差异均有统计学意义（均P〈0.05）;观察组住院时间低于对照组,差异有统计学意义（P〈0.05）;观察组肛门形态正常和肛门功能正常率均高于对照组,差异均有统计学意义（均P〈0.05）;观察组复发率低于对照组,差异有统计学意义（P〈0.05）。结论经括约肌间瘘管结扎术联合生物补片能够显著缩短手术时间,创面愈合快、住院时间短、可减轻术后肛门疼痛及对肛门形态、功能具有良好的保护作用。     

中西医结合治疗对Graves病患者外周血T、B淋巴细胞亚群的影响

目的：研究中西医结合治疗对Graves病患者外周血T、B淋巴细胞亚群及部分协同刺激分子表达的影响。方法：运用流式细胞术测定20例Graves病初发患者、11例他巴唑治疗患者（西药组）、16例他巴唑合用中药五岳抗甲丸治疗患者（中西医结合组）及16例正常对照外周血淋巴细胞CD19、CD40、CD80、CD3、CD4、CD8、CD28等分子的表达水平。结果：Graves病初发患者CD19⁺、CD40⁺、CD19⁺ CD40⁺、CD80⁺细胞比率高于正常对照组(P＜0.01或P＜0.05)，CD3⁺CD8⁺细胞比率降低(P＜0.05)，CD3⁺CD4⁺/CD3⁺CD8⁺比值高于正常对照(P＜0.05)；西药组患者CD80+细胞恢复正常，CD3⁺CD4⁺细胞比率及CD3⁺CD4⁺/CD3⁺CD8⁺比值高于正常对照(P＜0.05，P＜0.01)，而CD3⁺CD8⁺及CD8⁺CD28⁺细胞比率低于正常对照(P＜0.01，P＜0.05)；除CD80+细胞比率高于正常对照外，中西医结合组所测各种分子的表达同正常对照组比较，差异无统计学意义；同西药组比较，中西医结合组CD3⁺CD4⁺细胞降低(P＜0.01)，CD3⁺CD8⁺及CD8⁺CD28⁺细胞比率升高(P＜0.01，P＜0.05)， CD3⁺CD4⁺/CD3⁺CD8⁺比值降至正常水平(P＜0.01)。结论：Graves病患者体液免疫处于较高水平，存在细胞免疫调节失衡，中西医结合治疗较单纯西药治疗更有利于患者免疫状态的恢复。     

MDT模式的营养干预对妊娠期糖尿病糖脂代谢、妊娠结局及新生儿免疫功能的影响

目的探讨基于多学科团队协作(MDT)模式的营养干预对妊娠期糖尿病(GDM)孕妇糖脂代谢、妊娠结局及新生儿免疫功能的影响。方法选取规范产检并分娩的GDM孕妇150例,采用随机数字表法将其分为对照组及观察组,每组各75例。对照组给予常规营养干预,观察组给予基于MDT模式的营养干预。对比两组GDM孕妇糖脂代谢指标、妊娠结局及新生儿免疫功能。结果观察组孕妇干预后空腹血糖(FBG)、餐后2h血糖(2hPBG)、糖化血红蛋白(HbA1c)、稳态模型-胰岛素抵抗指数(HOMA-IR)及甘油三酯(TG)低于对照组(P＜0.05);观察组孕妇顺产率高于对照组(P＜0.05);观察组孕妇剖宫产率、妊娠期高血压、新生儿低血糖、巨大儿发生率低于对照组(P＜0.05);观察组新生儿外周血免疫球蛋白G(IgG)水平高于对照组(P＜0.05);观察组新生儿CD3⁺、CD4⁺、CD8⁺及CD4⁺/CD8⁺低于对照组(P＜0.05)。结论基于MDT模式的营养干预可有效调控GDM孕妇糖脂代谢,提升新生儿免疫功能,改善妊娠结局。     

非小细胞肺癌患者外周血CD8+CD39+T细胞水平及临床意义

目的探讨非小细胞肺癌(NSCLC)患者外周血CD8⁺CD39⁺T细胞水平及临床意义。方法选取60例NSCLC患者为NSCLC组,60例健康人群为对照组。检测两组外周血CD8⁺CD39⁺T细胞水平,分析NSCLC患者外周血CD8⁺CD39⁺T细胞水平与其临床特征和预后的关系。结果NSCLC组外周血CD8⁺CD39⁺T细胞水平显著高于对照组(P＜0.05)。肿瘤直径＞3 cm、低分化、TNMⅢ期的NSCLC患者外周血CD8⁺CD39⁺T细胞水平高于肿瘤直径≤3 cm、中高分化、TNMⅠ~Ⅱ期的患者(P＜0.05)。CD8⁺CD39⁺T细胞高水平组术后1年肿瘤无进展生存率及无进展生存期均低于低水平组(P＜0.05)。TNM分期、外周血CD8⁺CD39⁺T细胞水平是NSCLC患者预后的影响因素(P＜0.05)。结论CD8⁺CD39⁺T细胞在NSCLC患者外周血中呈高水平,且与临床病理特征及预后关系密切,可作为患者病情和预后的评估指标。     

括约肌间瘘管结扎术结合脱细胞异体真皮基质 填塞治疗经括约肌肛瘘的疗效分析

目的 探讨括约肌间瘘管结扎术（LIFT）结合瘘管脱细胞异体真皮基质（AEM）填塞治疗经括 约肌肛瘘的临床疗效。方法 选取2013 年10 月-2016 年10 月该院收治的66 例经括约肌肛瘘患者。采用随 机数字表法将患者分为治疗组（行LIFT 和AEM）和对照组（行肛瘘切开术或切开挂线术）,每组各33 例。 主要观察指标：创面愈合时间,术前、术后1、3、6、12 个月肛门失禁评分和总有效率。患者术后1 个月至 门诊复诊,术后3、6、12 个月采用门诊、问卷及电话方式进行随访,了解创面愈合情况、肛门控便能力及 治愈情况。结果 筛选出符合研究条件的患者61 例,治疗组31 例,对照组30 例,两组患者术前均无肛门失 禁。对照组30 例患者中,21 例行肛瘘切开术,9 例行切开挂线术。两组创面愈合时间比较,差异有统计学意 义（P <0.05）,治疗组少于对照组。肛门失禁评分两组术前比较差异无统计学意义（P >0.05）,两组术后肛门 失禁评分比较,差异有统计学意义（P <0.05）,治疗组术后1、3、6、12 个月肛门失禁评分均低于对照组。治 疗组和对照组总有效率分别为90.32% 和93.33%,两组比较,差异无统计学意义（P >0.05）。结论 LIFT 结合 AEM 治疗经括约肌肛瘘与传统肛瘘切开术疗效相当,而且创面愈合时间短,肛门功能保护良好,无肛门失禁 的发生。     

匹多莫德辅助治疗婴幼儿支原体肺炎疗效观察及免疫功能变化

目的 探讨匹多莫得辅助治疗对婴幼儿支原体肺炎患儿的T淋巴细胞亚群的百分比的影响及细胞因子和免疫球蛋白表达的变化。方法选取100例婴幼儿支原体肺炎患儿,随机分为观察组(n=50)和对照组(n=50)。对照组给予红霉素治疗,观察组采用红霉素联合匹多莫德治疗,比较两组患儿T淋巴细胞亚群、血清细胞因子、血清免疫球蛋白及临床疗效。结果与对照组比较,观察组患儿外周血中CD3⁺、CD4⁺和CD4⁺/CD8⁺细胞数显著升高,而CD8⁺细胞数则显著下降,两组间比较,其差异有显著性(P＜0.05);观察组患儿血清中白细胞介素(IL)-12、IFN-γ的水平显著升高,而IL-6和IL-8的水平则明显下降(P＜0.05);此外,观察组患儿血清IgM、IgG和IgA的水平较对照组增高(P＜0.05),并且观察组的临床疗效要优于对照组(92.0% vs 66.0%,P＜0.05)。结论匹多莫得佐治婴幼儿支原体肺炎,可显著改善患儿免疫功能,提高临床疗效,值得临床推广使用。     

丙种球蛋白联合大剂量地塞米松治疗原发免疫性血小板减少症疗效观察

目的 探讨丙种球蛋白联合大剂量地塞米松治疗原发免疫性血小板减少症(ITP)的疗效。方法 选取2017年1月～2019年8月我院就诊的ITP患者76例,应用常规剂量糖皮质激素治疗的35例为常规组,应用丙种球蛋白联合大剂量地塞米松治疗的41例为大剂量组。比较2组疗效、出血症状消失时间、血小板开始上升时间、血小板恢复正常时间、住院天数及不良反应、治疗前后CD4⁺、CD4⁺/CD8⁺水平。结果 与常规组总反应率74.29%对比,大剂量组92.68%较高(P＜0.05);2组出血症状消失时间、血小板开始上升时间、血小板恢复正常时间、住院天数对比,大剂量组短于常规组(P＜0.05);治疗后大剂量组血清CD4⁺、CD4⁺/CD8⁺水平高于常规组(P＜0.05);大剂量组不良反应发生率4.88%(2/41)低于常规组25.71%(9/35,P＜0.05)。结论丙种球蛋白联合大剂量地塞米松治疗ITP疗效显著,副作用小。     

改良LIFT 治疗复杂性肛瘘的临床疗效研究

目的 比较改良经括约肌间瘘管结扎术（LIFT）和切开挂线术治疗复杂性肛瘘的临床疗效。方法 将80 例复杂性肛瘘患者随机分为治疗组和对照组,治疗组采用改良LIFT,对照组采用切开挂线术。对两组疗效、复发率及并发症等进行对比观察。结果 两组患者在手术时间、愈合时间、术中出血量、术后创面面积、术后疼痛时间、住院时间、总有效率、术后尿潴留、术后感染、术后3 个月复发、术后第7、14天疼痛和首次排便疼痛视觉模拟评分法（VAS）评分及术后肛门失禁Wexner 评分比较,差异有统计学意义（P <0.05）;但在术后第1 天视觉VAS 疼痛评分及术前肛门失禁Wexner 评分比较,差异无统计学意义（P >0.05）。结论 改良LIFT 较传统切开挂线术治愈率高,是治疗复杂性肛瘘的有效术式。     

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.