防止角膜移植传播乙型肝炎病毒的研究

为了检测角膜有无ＨＢＶ－ＤＮＡ，防止角膜移植传播乙型肝炎病毒（ＨＢＶ），应用ＰＣＲ技术对２９例乙型肝炎、乙型肝炎病毒感染患者和１０例健康人角膜的ＨＢＶ－ＤＮＡ进行了检测。同时对１１例乙型肝炎病毒感染患者的结膜和２６例乙型肝炎患者的泪液也进行了检测。结果ＨＢｓＡｇ阳性的１６例角膜有１１例（６８．７％）检测到ＨＢＶ－ＤＮＡ，１３例ＨＢｓＡｇ阴性的角膜有４只（３６．６％）ＨＢＶ－ＤＮＡ阳性，１０例健康人角膜无１例ＨＢＶ－ＤＮＡ阳性。１１例乙型肝炎病毒感染患者的结膜中，有７例（６３．６％）ＨＢＶ－ＤＮＡ阳性，２６例乙型肝炎患者的泪液中，有１４例（５３．８％）检测到ＨＢＶ－ＤＮＡ。说明角膜也是ＨＢＶ的贮存场地，临床不能应用乙型肝炎病毒感染者的角膜作供体行角膜移植术     

乙型肝炎病毒感染者前C区A83位点突变

目的：分析乙型肝炎病毒（HBV）感染者前C区A83位点突变情况及其与HBeAg表达的关系。方法：对122例乙型病毒感染者采用Amplification refactory mutations system(ARMS)方法进行检测，扩增前C区基因片段经过酶联反应显色。结果：在HBeAg阳性的54例患者血清中检测出5例A83位点突变，占9．3％，在HBeAg阴性的68例患者血清检测出48例A83位点突变，占70．6％。15例急性乙型肝炎（AH）患者未检测到A83位点突变，70例慢性乙型肝炎患者（CH）检测到26例A83位点突变（35．6％），29例乙肝肝硬化患者（HLC）中有19例A83位点突变（65．5％），8例乙肝肝癌患者（HCC）均有A83位点突变（100％）。结论：HBeAg阴性患者A83位点突变率高于HBeAg阳性患者，前C区A83位点突变与乙型肝炎病毒感染后的慢性化有关。     

受血者输血前5项检测及临床意义

目的 通过对受血者输血前5项的检测，探讨对受血者输血前相关项目检测的意义。方法采用酶联免疫吸附试验（ELISA）法，检测丙肝抗体（抗-HCV），艾滋抗体（抗-HIV），梅毒（TPPA），乙型肝炎表面抗原（HbsAg）；用全自动生化分析仪检测谷丙转氨酶（ALT）。结果对2800例患者进行检测，丙肝（HCV）阳性有41例，占1．46％；梅毒（TPPA）阳性有32例，占1.14％；艾滋（HIV）阳性有1例，占0．04％；乙型肝炎阳性有531例，占18．96％：谷丙转氨酶（ALT）高于正常（〉40U／L）有398例，占14．21％。结论对受血者输血前5项的检测，明确患者的健康状况，杜绝医源性经血传播疾病而引起医疗纠纷，对保护医患双方利益而具有重大的意义。     

e抗原阴性重症乙型肝炎患者HBV前C区热点变异研究

目的：研究HBV信号肽区热点变异与重症乙肝炎发生及转归的关系。方法：采用错聚合酶反应（PCR）和限制性片段长度多态（RFLP）分析方法检测68例HBeAg阴性的重症乙型肝炎病人（其中急性重肝6例，亚急性重肝38例，慢性重肝24例）及44例慢乙型肝炎患者的T1862，A1896变异情况。结果：急性重肝的A1896，T1862变异分别为6６．７％（４／６），０）９／６）；亚急性重肝42．1％（16／38），15．8％（6／38）；慢性重肝25．0％（6／24），16．7％（4／24）；慢性肝炎45．5％（20／44），2．3％（1／44）。重症乙型肝炎组与乙型肝炎的重症化密切相关。而A1896变异与乙型肝炎重症化进程是否有关还不能确定。     

TTV与HBV重叠感染的研究

目的：研究乙型肝炎病毒（HBV）感染者重叠感染输血传输病毒（TTV）的状况。方法：采用斑点杂交法检测乙型肝炎病毒感染者血清TTV DNA。结果：在364例乙型肝炎病毒感染者中检出血清TTV DNA阳性者82例，阳性率22．53％。其中，急性乙型肝炎患者组阳性率23．21％，慢性乙型肝炎患者组阳性率26．25％，HBsAg携带者组阳性率15．22％，三者之间的差异无统计学意义P＞0．05。结论：在我国存在TTV感染，但其致病性值得进一步探讨。     

成都地区196例乙肝患者重叠感染其他型肝炎病毒的状况分析

目的 调查成都地区乙型肝炎患者重叠感染其他型肝炎病毒的情况。方法 采用ELISA方法对196例乙型肝炎患者血清进行HAV-IgM、HCV-IgM、HDV-IgM、HEV-IgM、HEV-IgC扣HGV-IgM的检测。结果 196例乙型肝炎患者中重叠感染其他型肝炎病毒的共有18例（9．12％），其中HBV-HCV2例（1．02％），HBV-HDV1例，HBV-HEV12例（6．12％）。HBV-HGV1例（0．51％），本次调查未发现HBV-HAV重叠感染。不同乙肝两对半模式重叠感染率无显著差异（χ^2=1．72，P〉0．05）。结论 乙肝患者重叠感染其他型肝炎具有地区特异性，对于乙肝患者同时注意检查有无其他型肝炎病毒的重叠感染，对估计病情和治疗都将有重要意义。     

乙型肝炎患者和无症状HBVM携带者血清HBV-DNA与HBVM模式相关性研究

目的探讨乙型肝炎患者和无症状ＨＢＶＭ携带者血清ＨＢＶ－ＤＮＡ与ＨＢＶＭ模式的相关性。方法应用ＰＣＲＥＢ法对１７８３例乙型肝炎血清学标志（ＨＢＶＭ）模式不同的乙型肝炎患者（包括急性乙型肝炎８７例，慢性乙型肝炎８９１例，乙型肝炎后肝硬化１９３例）和无症状ＨＢＶＭ携带者（６１２例），做了血清乙型肝炎病毒ＤＮＡ（ＨＢＶ－ＤＮＡ）检测。结果①乙型肝炎患者和无症状ＨＢＶＭ携带者血清ＨＢＶ－ＤＮＡ与ＨＢＶＭ模式密切相关（Ｐ＜０．０１），不同ＨＢＶＭ模式患者和携带者血清ＨＢＶ－ＤＮＡ阳性率有较大差异（Ｐ＜０．０１）。②患者血清ＨＢＶ－ＤＮＡ阳性率（５６．８％）明显高于携带者（４５．６％）（Ｐ＜０．０１）。③相同ＨＢＶＭ模式患者和携带者血清ＨＢＶ－ＤＮＡ阳性率与性别差异无显著性（Ｐ＞０．０５），男性乙型肝炎患者血清ＨＢＶ－ＤＮＡ阳性率（６０．７％）明显高于女性（４８．８％）（Ｐ＜０．０１）。结论无论何种ＨＢＶＭ感染者均应检测血清ＨＢＶ－ＤＮＡ，以判断其病毒复制情况和传染性高低     

甘肃矿区2002-2004年食品公共场所从业人员HBsAg携带情况调查分析

我国是乙型肝炎的高发区，全国约45．00％～70．00％的人群感染过乙型肝炎病毒（HBV），其中10．00％的人群为HBsAg携带者，为了了解甘肃矿区食品公共场所从业人员乙型肝炎表面抗原（HBsAg）携带情况，以便更好地监督管理，采取有效的防治措施预防乙型肝炎的传播，本文对甘肃矿区2002-2004年进行健康体检的食品公共场所从业人员HBsAg结果进行了整理分析。结果如下。     

2506例乙型肝炎病毒标志物检测结果分析

目的探讨乙型肝炎病毒标志物的感染模式。方法对2506例乙型肝炎病毒标志物的检测结果进行分析。结果抗-HBc阳性2430例（96．97％）;抗-HBe阳性910例（36．31％）;HBeAg阳性316例（12．61％）;抗-HBs阳性26例（1．04％）。HBV血清免疫学标志物的感染模式较为复杂,HBsAg、HBeAg、抗-HBc均为阳性者306例（12．21％）;HBsAg、抗-HBe、抗-HBc均为阳性者1792例（71．51％）;HBsAg、抗-HBc均为阳性者316例（12．61％）。结论要认识到HBV血清免疫学标志物感染模式的复杂性,对检测结果进行综合分析,并正确理解这些血清标志物的临床意义,以指导对疾病作出正确的诊断及治疗。     

重叠感染SEN病毒对乙肝后肝硬化发展的影响

目的：通过检测慢性乙型肝炎和乙肝肝硬化患者SEN病毒（SENV）的感染情况，了解重叠感染SENV对乙肝后肝硬化发展的影响。方法：采用巢式聚合酶链反应（nPCR）对148例慢性乙型肝炎患者、119例乙肝肝硬化患者和80例健康体检者进行SENV—D／H亚型的检测，并对部分阳性血清的PCR产物进行测序。结果：SENV—H在乙肝肝硬化患者血清中的检出率（为37．8％）高于慢性乙型肝炎患者（为26．4％），两者差异有显著性（P〈0．05），而SENV—D的检出率分别为34．5％和30．4％，两者差异无显著性（P〉0.05）；健康体检者血清中，SENV—H和D的检出率分别为13．8％和16．3％，与上述两组患者相比差异有显著性（P〈0.05）；此外，在77例有输血史患者和190例无输血史患者血清中，SENV的总检出率分别为53．2％和55．8％，两者差异无显著性（P〉0.05）。结论：重叠SENV—H感染可能对乙肝后肝硬化发展具有一定的影响，并且SENV的主要传播方式除输血外可能还存在其他途径。     

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.