阴道镜下活检诊断宫颈上皮内瘤样病变40例临床分析

目的评价阴道镜检查对宫颈上皮内瘤变（CIN）的诊断价值。方法回顾性分析3年来阴道镜检查800例中40例CIN的阴道镜检结果。结果800例中CIN发现40例，占23．25％。CIN的异常阴道镜图像主要为异常血管、醋酸白色上皮、白斑、碘不着色区、镶嵌。结论阴道镜下异常图像进行活检，对发现CiN具重要意义。     

阴道镜下醋酸白色上皮的病理分析

目的探究应用醋酸白色上皮检测宫颈上皮内瘤变（CIN）的准确度。方法随机选取我院180倒表现出阴道镜异常图象的活检结果。统计分析其病情与阴道镜下醋酸白色上皮的检查结果。结果阴道镜下醋酸白色上皮CIN敏感度为94．87％，特异度为39．72％，碘试验异常与CIN呈负相关。结论阴道镜下醋酸白色上皮与碘试验联合检测可以减少降低活检率，提高对CIN检测的准确度。     

阴道镜图像对宫颈上皮内瘤样病变诊断价值

目的通过阴道镜下定位活检,探讨宫颈上皮内瘤样病变(CIN)检出率、阴道镜图像特征及诊断价值。方法回顾分析2003～2004年阴道镜下定位活检796例,确诊CIN263例阴道镜图像特征。结果阴道镜下活检796例,发现CIN263例,占33%。CIN异常图像主要为醋酸白色上皮、点状血管、镶嵌。结论阴道镜是辅助诊断CIN的重要方法,对阴道镜下可疑图像应常规活检。     

2116例阴道镜下活检诊断宫颈病变的临床分析

目的:探讨阴道镜下活检对诊断宫颈病变的价值。方法:对2001年1月至2004年12月2116例阴道镜下对异常图像者定位活检以病理结果作对照进行宫颈病灶准确性的对照分析。结果:2116例阴道镜下定位活检经病理确诊宫颈上皮内瘤变(CIN)308例,其中包括CINⅠ226例,CINⅡ65例,CINⅢ17例;宫颈原位癌13例,浸润癌53例,慢性宫颈炎(包括宫颈息肉)1669例,子宫内膜异位症8例,宫颈湿疣65例。1例病人可有1种或多种阴道镜下异常图像。浸润癌阴道镜下图像主要是血管异常;原位癌(CIS)阴道镜下图像均见醋酸白色上皮,多数伴有点状血管、异型血管、镶嵌或白斑等;CIN以醋酸白色上皮出现率最高,异型血管、点状血管、镶嵌、白环白腺次之;慢性宫颈炎以不典型点状血管及醋酸白色上皮检出率居多。结论:阴道镜检查对宫颈癌,尤其是癌前病变的早期诊断有重要价值,阴道镜下定位活检可提高宫颈病变诊断的准确性和检出率。     

阴道镜下醋酸白色上皮的病理分析

目的：探讨阴道镜下醋酸白色上皮与宫颈上皮内瘤变（CIN）的相关性。方法：回顾分析83例异常阴道镜图像的病检结果。结果在61例醋酸白色上皮处活检CINI7例,占11.48%,CINⅡ21例,占34.43%,CINⅢ8例,占13.11%,宫颈炎15例,占24.59%,浸润癌10例,占16.39%。醋酸白色上皮诊断宫颈上皮内瘤变的敏感度91.52%,特异性为53.13%,薄的醋酸白色上皮65.22%为炎症,厚的醋酸白色上皮CIN占73.66%,宫颈癌占26.34%,结论：醋酸白色上皮与宫颈上皮内瘤变密切相关。     

阴道镜下活检诊断宫颈上皮内瘤变1038例体会

目的：评价电子阴道镜对子宫颈病变的诊断价值。方法：2004年8月-2006年5月1038例患者门诊行阴道镜检查，对阴道镜检查有图像异常者，直接在阴道镜下取材，送病理检查，电子阴道镜图像与宫颈组织学诊断对照分析，以病理结果作为确诊标准。结果：本组患者检出慢性宫颈炎90．08％，CIN8．29％，原位癌1．06％，浸润癌0．58％。浸润癌阴道镜图像主要是血管异常，原位癌阴道镜图像可见醋酸白色上皮，多数伴有点状血管、异型血管、镶嵌和白斑等；CIN醋酸白色上皮出现最多，点状血管、异型血管、镶嵌和白斑次之；慢性宫颈炎以不典型点状血管和醋酸白色上皮为主。结论：阴道镜检查是早期诊断和治疗下生殖道病变的重要手段．     

宫颈上皮内瘤样病变的阴道镜诊断与治疗后的随访观察

目的：总结我院经阴道镜检查并病理确诊为宫颈上皮内瘤样病变(CIN)59例的阴道镜下特征及其治疗的追踪。方法：采用YA-G-7000阴道镜检查,并根据已确诊的CIN的程度及患者的年龄和生育要求,分别采取不同的治疗方法。结果：CIN-Ⅰ级阴道镜下主要表现为边界模糊的平坦的醋酸白色上皮,可有模糊的细镶嵌;CIN-Ⅱ级镜下为边界清楚．的稍凸起的白色上皮,可合并有点状血管或细镶嵌;CIN-Ⅲ级可见边界明显突起的白色上皮,清晰的镶嵌、点状血管及多种构图。采用不同的治疗方法后,经定期随访尚未发现有复发或进展。结论：阴道镜检查是早期发现宫颈癌前病变的重要检查方法之一,结合镜下定位活检病理检查可提高CIN的诊断准确率,对CIN进行追踪随访,并合理治疗。     

763例阴道镜配合病理活检结果分析

目的探讨女性宫颈早期病变检出率、阴道镜图像特征及诊断价值。方法回顾性分析霞浦县妇幼保健院763例在阴道镜定位活检,确定宫颈病变与发病年龄,宫颈糜烂程度及阴道镜图像特征之间关系。结果①阴道镜下活检763例,年龄20~40岁,慢性宫颈炎,宫颈上皮内瘤样变,宫颈癌发病率分别都是高于其他年龄组,尤其是31~40岁年龄组最高。②发现慢性宫颈炎366例占47.97%,387例占50.72%,宫颈癌10例占1.31%。③慢性宫颈炎大部分无异常图像,宫颈上皮内瘤样变异常图像主要为醋酸白色上皮、点状血管、镶嵌、宫颈癌图像以猪油样或脑回状为主。结论阴道镜配合病理活检筛查可有效早期诊断CIN,阻断CIN升级,降低宫颈癌发生率。     

阴道镜对阴道上皮内瘤变的诊断价值

目的 通过阴道镜下定位活检,探讨宫颈上皮内瘤变（CIN）检出率,阴道镜图像特征及诊断价值.方法 回顾分析2006年至2009年阴道镜下定位活检224例,确诊46例,阴道镜图像特征.结果 阴道镜下活检224例,发现（CIN）46例,占20.5%,异常图像主要是酷酸白色上皮、点状血管、异形血管（包括点状血管和发央样血管）、镶嵌.结论 阴道镜是辅助诊断CIN的重要方法,对阴道镜可疑图像应常规活检.     

阴道镜对宫颈上皮内瘤变的诊断价值

目的探讨阴道镜对宫颈上皮内瘤变(CIN)的诊断价值。方法对792例患者行阴道镜检查子宫颈病变,将阴道镜检查结果与组织病理学检查结果进行对比分析。结果792例阴道镜下活检诊断宫颈癌15例,CIN 121例,共136例占17.2%;CIN和宫颈癌的患者异常阴道镜图像醋酸白色上皮占86.2%,其次是镶嵌占44.7%、异常血管占34.1%、猪油状改变占9.8%,同时出现3种及以上异常阴道镜图像的达41.2%。结论对生育年龄妇女定期行阴道镜检查,并对可疑病变部位进行活检,对宫颈癌及癌前病变的早期发现具有一定的诊断价值。     

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.