持续输注间羟胺对腰麻下剖宫产术中产妇血流动力学指标的影响

目的探讨持续输注间羟胺对腰麻下剖宫产术中产妇血流动力学指标的影响。方法选择嘉兴市妇幼保健院2019年9月至2020年3月单胎足月产妇80例,按随机数字表法分为间羟胺组和去氧肾上腺素组,每组40例。当鞘内注射时,间羟胺组预防性静脉输注间羟胺1.5μg/（kg·min）,去氧肾上腺素组输注去氧肾上腺素0.5μg/（kg·min）。记录两组产妇麻醉前5min（T0）、鞘内注射5min后（T1）、切皮（T2）和胎儿娩出后即刻（T3）不同时点血流动力学指标参数[平均动脉压（MAP）、心率（HR）、心输出量（CO）及外周血管阻力（PVR）]、麻醉平面、鞘内注射至胎儿娩出时间、胎儿娩出后行脐动脉血气分析及评估新生儿Apgar评分。记录产妇和胎儿不良反应的发生情况（低血压、心动过缓、心动过速、恶心、呕吐及新生儿酸血症等）。结果鞘内注射后两组T1时点MAP、HR及PVR与T0时点比较均显著下降,差异均有统计学意义（均P＜0.05）;T1时点两组MAP、HR、CO及PVR比较,差异均无统计学意义（均P＞0.05）;T2、T3时点间羟胺组MAP、HR、CO及PVR均高于去氧肾上腺素组,差异均有统计学意义（均P＜0.05）。两组产妇恶心、呕吐、心动过缓、低血压、心动过速及新生儿酸血症发生率比较差异均无统计学意义（均P＞0.05）,但去氧肾上腺素组心动过缓发生率明显高于间羟胺组,差异有统计学意义（P＜0.05）。结论与去氧肾上腺素比较,间羟胺能够增加腰麻下产妇MAP、HR、CO及PVR,降低心动过缓发生率,但不能降低术中低血压,恶心、呕吐发生率。     

去甲肾上腺素预防双胎产妇腰硬联合麻醉后低血压有效剂量的研究

  目的  确定去甲肾上腺素预防双胎产妇腰硬联合麻醉后低血压的90%有效输注剂量（90% effective dose, ED₉₀）,并与单胎产妇的ED₉₀进行对比。  方法  于2020年11月–2021年6月在四川大学华西第二医院,纳入200例拟在腰硬联合麻醉下行剖宫产的产妇,采用随机对照研究,其中单胎、双胎产妇各100例。按随机数字表,产妇被随机分入以下5个组:0.025、0.050、0.075、0.100和0.125 μg/（kg·min）去甲肾上腺素组,每组包含单胎和双胎产妇各20例。在注射腰麻药物同时,开始去甲肾上腺素输注,直至胎儿娩出。主要结局指标为腰硬联合麻醉后至胎儿娩出期间产妇的低血压发生率。对产妇的低血压发生情况进行生存分析（定义未发生低血压为生存）。根据低血压发生率,通过probit回归分析分别推算去甲肾上腺素预防单胎和双胎产妇腰硬联合麻醉下剖宫产中,使90%产妇不发生低血压的去甲肾上腺素输注剂量（即ED₉₀）及其95%置信区间（CI）。  结果  单胎产妇中、双胎产妇中,基线资料及麻醉手术数据差异无统计学意义（P>0.05）。以0.025、0.050、0.075、0.100和0.125 μg/（kg·min）输注去甲肾上腺素,单胎产妇中低血压发生率分别为50%（10/20）、35% （7/20）、20% （4/20）、10% （2/20）和5%（1/20）,ED₉₀为0.100 （95%CI: 0.082～0.130） μg/（kg·min）;双胎产妇中,低血压发生率则分别为60%（12/20）、20%（4/20）、20% （4/20）、10% （2/20）和5% （1/20）,ED₉₀为0.098 （95%CI: 0.080～0.127） μg/（kg·min）。单胎产妇各剂量组间的生存曲线差异有统计学意义,双胎产妇各剂量组间的生存曲线差异有统计学意义（P<0.05）。单胎产妇、双胎产妇的反应性高血压发生率,均随去甲肾上腺素输注剂量的升高而增加（P<0.05）,单胎产妇各剂量组间及双胎产妇各剂量组间,产妇其他不良反应、新生儿结局差异无统计学意义（P>0.05）。各剂量组单双胎产妇间的年龄、身高差异无统计学意义（P>0.05）,但产妇的孕周、体质量、体质量指数（BMI）差异有统计学意义（P<0.05）。相同剂量组单、双胎产妇间,低血压、反应性高血压、心动过缓、头晕、恶心呕吐发生率差异无统计学意义（P>0.05）。各剂量组内单双胎产妇间生存曲线差异无统计学意义。单、双胎产妇对去甲肾上腺素的ED₉₀差异无统计学意义。  结论  去甲肾上腺素预防双胎产妇与单胎产妇腰硬联合麻醉后低血压的ED₉₀差异不明显,临床需考虑孕周、体质量、BMI因素的干扰。     

25号腰穿针单刺麻醉在初产单胎剖宫产术的应用

目的：探讨25 G腰穿针单刺麻醉在初产单胎剖宫产术的应用。方法整群选取2014年1—11月在该院接受剖宫产术的260例产妇,随机分为单刺腰麻组（SA组n=130例）,腰硬联合麻醉组（CSEA组,n=130例）。观察两组产妇术中平均动脉压（MAP)、心率（HR）的变化,记录麻醉操作时间,穿刺成功率及麻醉效果,对术后并发症进行比较。结果两组产妇麻醉过程中HR、MAP的变化差异无统计学意义（P＞0.05）;穿刺成功率和麻醉效果比较差异无统计学意义（P＞0.05）;麻醉操作时间SA组短于CSEA组（P＜0.01);术后感觉运动障碍和硬脊膜穿破后头痛发生率CSEA组稍高于SA组,但差异无统计学意义（P＞0.05）。结论25G腰穿针单刺腰麻比腰-硬联合麻醉操作更快、更简单,损伤更小,可以满足初产单胎剖宫产术的要求,是良好选择。     

小剂量布比卡因复合芬太尼联合腰-硬麻醉对剖宫产产妇血流动力学的影响

目的探究应用FloTrac/Vigileo系统观察小剂量布比卡因复合芬太尼联合腰-硬麻醉对剖宫产产妇血流动力学的影响。方法将我院2012年1-12月孕足月、单胎剖宫产产妇随机选取50例分为两组,腰麻用药对照组采用布比卡因,研究组采用布比卡因复合芬太尼。观察两组患者麻醉后3 min(a)、10 min(b)、15 min(c),30 min(d)、手术结束时间(e)和麻醉前的心输出量、MAP、HR的变化,观察两组麻醉的效果、不良反应、新生儿1 min和5 min Apgar评分。结果 a~e时段,对照组患者的心输出量、MAP明显低于麻醉前和研究组患者(P<0.05)。研究组发生低血压和寒颤的概率显著低于对照组(P<0.05)。结论小剂量布比卡因复合芬太尼联合腰麻行剖宫产术能够有效维持患者的血流动力学的稳定,FloTrac/Vigileo系统能够有效检测血流动力学。     

高原肺水肿患者血流动力学变化研究

背景　高原肺水肿（HAPE）是一种严重危及生命的急性高原病，近年来对其研究越来越广泛，临床治疗效果也在不断提高。虽然国内有对HAPE患者应用有创血流动力学监测的相关研究，但报道的病例不多，对其监测的心脏指标有限，且目前国内尚未见关于HAPE患者应用无创血流动力学、流量、心脏前后负荷监测指标的研究。目的　探讨HAPE患者血流动力学的变化，为HAPE的治疗提供理论依据。方法　随机选择青海省交通医院急救中心2016年2月-2019年10月收治的HAPE患者22例为HAPE组，20名健康志愿者为对照组。对HAPE组治疗前、治愈后及对照组进行pH值、血氧饱和度（SaO2）、二氧化碳分压（PaCO2）、血乳酸（Lac）、心率（HR）、每分输出量（CO）、心指数（CI）、每搏输出量（SV）、总外周血管阻力（TPR）、总外周血管阻力指数（TPRI）、每分输出量绝对值（△CO）、每搏输出量绝对值（△SV）、下腔静脉宽度、下腔静脉呼吸变异度检测，同时对HAPE组治疗前及治愈后行中心静脉压（CVP）、中心静脉血氧饱和度（ScvO2）、静动脉血二氧化碳分压差（Pcv-aCO2）监测。结果　HAPE组治疗前pH值、Lac高于对照组，SaO2、PaCO2低于对照组（P<0.05）。HAPE组治疗前HR、TPR、TPRI、下腔静脉宽度大于对照组，CO、CI、SV、△CO、△SV、下腔静脉呼吸变异度小于对照组（P<0.05）。HAPE组治愈后HR、CO、CI、SV、TPR、TPRI、△CO、△SV、下腔静脉宽度、下腔静脉呼吸变异度与对照组比较，差异均无统计学意义（P>0.05）。HAPE组治愈后HR、TPR、TPRI、下腔静脉宽度、CVP、Pcv-aCO2小于治疗前，CO、CI、SV、△CO、△SV、下腔静脉呼吸变异度、ScvO2大于治疗前（P<0.05）。结论　HAPE患者心脏前后负荷增加，导致心力衰竭的发生，血流动力学表现为心输出量下降，外周血管阻力增高。     

腰麻硬膜外联合麻醉与硬膜外麻醉对剖宫产病人血流动力学影响的对比研究

目的：研究及完善剖宫产的麻醉管理,为临床提供借鉴,确保母婴安全。方法：将80例需剖宫产产妇随机分为腰麻硬膜外联合麻醉（combined spinal epidural anesthesia,CSEA）组和硬膜外麻醉（epiduralanaesthesia,EA）组,监测２组剖宫产患者血流动力学变化,并比较麻醉效果、新生儿Apgar评分、并发症及不良反应。结果：CSEA组产妇心率（heart rate,HR）在T4（胎儿娩出10 min）、T5（手术结束）高于EA组（P=0.023、0.022）;CSEA组产妇收缩压（systolic blood pressure,SBP）和舒张压（diastolic blood pressure,DBP）在T3（胎儿娩出）高于EA组（P=0.000、0.000）;CSEA组产妇平均动脉压（mean arterial pressure,MAP）在T2（麻醉平面满意-消毒前）、T5（手术结束）高于EA组（P=0.000、0.003）;2组产妇不同时刻心输出量（cardiac output,CO）、每博输出量（stroke volume,SV）、体循环阻力（systemic circulation resistance,SVR）及胸部液体含量（thoracic fluid content,TFC）比较,差异无统计学意义（P >0.05）;2组产妇不同时刻HR、SBP、DBP、MAP、CO、SV及SVR组内比较差异均具有统计意义（均有P<0.05）;CSEA组麻醉效果优于EA组,差异有统计学意义（P=0.000）;2组之间麻醉并发症、不良反应及新生儿出生后Apgar评分差异无统计学意义（P >0.05）。结论：硬膜外麻醉和腰麻硬膜外联合麻醉均为适合剖宫产手术的麻醉方式,但腰麻硬膜外联合麻醉：起效更快、麻醉效果更完善、对产妇血流动力学影响小,更为推荐。     

妊高征剖宫产术前使用盐酸戊乙奎醚对产妇及胎儿的影响

目的探讨妊高征剖宫产术前使用盐酸戊乙奎醚对产妇及胎儿的影响。方法将40例择期妊高征剖宫产术产妇随机分为东莨菪碱组（观察组）和盐酸戊乙奎醚组（治疗组）,各20例。治疗组术前肌注盐酸戊乙奎醚0.5mg,观察组术前肌注东莨菪碱0.3mg。观察两组HR、收缩压（SBP）、心脏每搏输出量（SV）、心排血指数（CI）及口干程度视觉摸拟评分（VAS）,新生儿1、5min Apgar评分。结果观察组给药后HR、SBP、SV、CI明显高于给药前（P〈0.05）。治疗组各时点SBP均较术前均显著降低（P〈0.05）,但均在正常范围之内;治疗组给药后HR、SV、CI与给药前比较差异无显著意义（P〉0.05）。治疗组与观察组给药后VAS评分、新生儿1、5min Apgar评分差异均无显著意义（P〉0.05）。结论盐酸戊乙奎醚比东莨菪碱更适合于妊娠合并心脏病患者剖宫产术前用药。     

预扩容与即时扩容对剖宫产产妇心输出量影响的比较

目的 比较预扩容与即时扩容对硬膜外麻醉下行剖宫产产妇心输出量的影响。方法 选择择期行剖宫产术的产妇40例,随机分为预扩容组（A组）和即时扩容组（B组）,每组各20例。A组以25mL/(kg·h)速度快速输注霍姆250mL+乳酸钠林格液500mL,输注完毕后常规速度输注乳酸钠林格液,开始行连续硬膜外麻醉;B组于硬膜外穿刺置管结束并开始推注局部麻醉药的同时,以25mL/(kg·h)速度快速输注霍姆250mL+乳酸钠林格液500mL。记录入室后基础值（T0）,麻醉诱导时（T1）,麻醉诱导后5min（T2）,麻醉诱导后10min（T3）,手术开始时（T4）,胎儿娩出时（T5）,胎儿娩出后5、10min（T6、T7）以及手术结束时（T8）的心输出量（cardiac output, CO）、每搏量（stroke volume, SV）、心率（heart rate, HR）、总外周阻力指数（total peripheral vascular resistance index, TPRI）、平均动脉压（mean arterial pressure, MAP）,记录新生儿Apgar评分,产妇低血压、恶心、呕吐发生次数。结果 A组产妇CO在T1时点高于B组,T7、T8时点低于B组（P＜0.05）,其余时点两组间差异无统计学意义（P>0.05）;A组产妇SV在T1时点高于B组,T8时点低于B组（P＜0.05）,其余时点两组间差异无统计学意义（P>0.05）。两组的MAP、HR和TPRI差异无统计学意义（P>0.05）。新生儿Apgar评分,产妇低血压及恶心、呕吐的发生次数差异均无统计学意义（P>0.05）。结论 预扩容在麻醉诱导前能有效地提升CO和SV,但在手术后期出现了明显的下降,而即时扩容在术中一直维持着较平稳的CO和SV,且可以节约麻醉前的准备时间。     

不同剂量催产素对剖宫产产妇心排量及子宫张力影响的比较

目的 比较在剖宫产术中胎儿娩出后静注不同剂量的催产素对心输出量等血流动力学参数的影响,并评估子宫张力,以选择最优的催产素剂量。方法 选择腰硬联合麻醉下的择期剖宫产术产妇（n=160）,随机分为4组,P1、P2、P3组（胎儿娩出后静脉注射1、2、3IU催产素）和P0组（注射生理盐水）。采用无创心排量监测仪（NICOM）观察心指数（cardiac index, CI）、每搏输出指数（stroke volume index, SVI）、心率（heart rate, HR）、血压（blood pressure, BP）、总外周血管阻力（total peripheral resistance, TPR）等血流动力学参数的改变,并记录产妇子宫张力评分、额外宫缩药物的使用、术中总出血量。结果 胎儿娩出推注试验药物后,4组产妇的HR、CI、SVI和BP等均无明显差异（P>0.05）;P3组BP、TPR用药后1.5min较其他3组明显降低（P<0.01）;P3组产妇的子宫张力评分明显高于其他3组,术中出血总量也明显减少（P<0.01）。结论 剖宫产术中胎儿娩出后静注3IU催产素,对产妇的血流动力学影响较小,但可达到满意的子宫张力,减少术中出血量和额外宫缩药物的使用。     

左侧斜卧位剖宫产妇应用腰硬联合麻醉对产妇血液动力学的影响

目的:探讨腰硬联合麻醉对左侧斜卧位剖宫产妇血液动力学的影响。方法:选取ASA麻醉评分Ⅰ~Ⅱ级的拟剖宫产妇160例,随机分成观察组和对照组各80例,观察组剖宫产时行左侧斜卧15o位,对照组行平卧位,观察比较两组产妇入手术室后5min(T_1)、行侧卧位后3min(T_2)、麻醉后3min(T_3)、切皮即刻(T_4)、婴儿娩出后3min(T_5)、手术结束时(T_6)各时间点的心输出量(CO)、每搏量(SV)、心率(HR)、平均动脉压(MAP)、总外周阻力(TPR)、胸腔体液含量(TFC)等血液动力学指标变化。结果:两组CO、SV、HR、TFC比较,差异无统计学意义(P>0.05);组内不同时间点比较,CO、SV差异有统计学意义(P<0.05);麻醉后对照组MAP、TRB下降较观察组明显,比较差异有统计学意义(P<0.05)。结论:剖宫产手术腰硬联合麻醉后,产妇围手术期血流动力学波动较大,发生时点主要是麻醉后和胎儿娩出前后,采用左侧斜卧位,可减少发生术中低血压。     

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.