小剂量阿托伐他汀钙对血脂及颈动脉斑块的影响

目的观察小剂量阿托伐他汀钙（10 mg/d）对无症状颈动脉斑块患者血脂及斑块的影响。方法选取2008年10月—2010年10月在我科住院患者78例,经颈动脉彩超证实有颈动脉斑块,分别于治疗前、治疗后3、6、12个月测定血脂及颈动脉斑块情况,并观察终点事件及不良反应情况。结果治疗3个月起血胆固醇、低密度脂蛋白、三酰甘油明显降低,6个月起高密度脂蛋白明显升高,与治疗前比较差异有统计学意义（P〈0.01或0.05）。斑块面积从治疗6个月起,较治疗前明显减少,至治疗12个月与治疗前比较,差异有统计学意义（P〈0.05）。治疗后斑块总数有减少趋势,稳定斑块逐渐增多,不稳定斑块逐渐减少,但与治疗前比较,差异无统计学意义（P均〉0.05）。治疗过程中未发生严重副反应。结论 10 mg/d阿托伐他汀钙能够显著改善无症状颈动脉斑块患者血脂及颈动脉硬化的程度。     

强化降脂治疗对脑梗死患者颈动脉粥样斑块厚度和稳定性的影响

目的探讨强化降脂治疗对脑梗死患者颈动脉粥样斑块厚度和稳定性的影响。方法选取90例脑梗死合并颈动脉粥样硬化斑块患者,随机分为两组（观察组50例,对照组40例）。在常规治疗基础上,对照组接受瑞舒伐他汀20 mg/d治疗,观察组接受瑞舒伐他汀40mg/d强化降脂治疗,比较两组用药前及用药3个月、6个月后颈动脉斑块厚度、面积、斑块评分及血脂水平变化。结果治疗3个月后两组颈动脉粥样斑块评分、厚度和面积均较治疗前明显改善,但两组比较无统计学差异（P〉0.05）;治疗6个月后观察组斑块评分、颈动脉斑块厚度、面积及血脂水平均低于对照组（P〈0.01）。结论大剂量瑞舒伐他汀强化降脂治疗,可有效逆转和缩小颈动脉粥样斑块,值得临床推广。     

辛伐他汀治疗颈动脉粥样硬化的疗效观察

目的观察辛伐他汀对颈动脉内膜-中层厚度（IMT）及颈动脉粥样硬化斑块的治疗效果。方法应用彩色多普勒超声检测有不同颈动脉粥样硬化患者62例,给予辛伐他汀20mg/d,睡前顿服,共6个月。观察患者治疗前后颈动脉内膜-中层厚度、颈动脉斑块消退、血脂水平变化及副作用。结果全部患者治疗前有112个斑块,治疗后为78个,斑块消失率30.4%,未消失斑块纵径有明显缩小（P〈0.05）;颈动脉IMT明显缩小（P〈0.05）;治疗后血清TC、TG、LDL-C明显下降（均P〈0.05）,HDL-C明显升高（P〈0.05）,且无明显副作用。结论辛伐他汀调脂疗效良好,对斑块的稳定和消退作用明显。     

阿托伐他汀联合氯吡格雷治疗对脑梗死患者超敏C反应蛋白、血脂、颈动脉粥样硬化的影响

目的探讨阿托伐他汀联合氯吡格雷对脑梗死患者超敏C反应蛋白（hs-CRP）、血脂、颈动脉粥样硬化影响。方法将123例伴有颈动脉粥样硬化的脑梗死患者按随机数字表分为氯吡格雷组（61例）和阿托伐他汀联合氯吡格雷组（62例）。观察治疗8个月后2组血清hs-CRP、血脂水平及颈动脉内膜中层厚度（IMT）、颈动脉斑块面积的变化及脑血管病复发率。结果氯吡格雷组治疗前后血脂无明显变化,阿托伐他汀联合氯吡格雷组血脂水平下降明显（P均〈0.05）。2组患者治疗后8个月血清hs-CRP、IMT均显著下降,颈动脉粥样硬化斑块面积缩小（P均〈0.01）;阿托伐他汀联合氯吡格雷组CRP下降幅度、IMT变薄及颈动脉粥样硬化斑块面积缩小较氯吡格雷组更明显（P均〈0.05）。结论阿托伐他汀联用氯吡格雷应用于脑梗死患者能更有效地降低血hs-CRP浓度,使IMT变薄及颈动脉粥样硬化斑块面积缩小,更有利于抑制炎症、稳定斑块及降低卒中发病率。     

瑞舒伐他汀对冠心病患者颈动脉粥样硬化斑块的影响

目的评价瑞舒伐他汀对冠心病患者血脂、高敏C反应蛋白（hs-CRP）及颈动脉粥样硬化斑块的影响。方法对65例冠心病伴颈动脉粥样硬化的患者口服瑞舒伐他汀一日10mg,每晚1次,治疗6个月,分别测定其治疗前及治疗后总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、高敏C反应蛋白的水平及颈动脉中内膜厚度（IMT）,并计算颈动脉斑块积分。结果瑞舒伐他汀治疗后6个月,患者TC、TG、LDL-C、CRP显著低于治疗前水平（P〈0.01）,HDL-C水平明显升高（P〈0.01）。颈动脉IMT及颈动脉斑块积分明显下降,与治疗前比较有显著差异（P〈O.05）。结论瑞舒伐他汀通过降低血脂、降低hs-CRP水平,从而改善冠心病患者颈动脉粥样硬化程度。     

阿托伐他汀钙预防高危患者急性脑梗死复发的前瞻性研究

目的:探讨阿托伐他汀钙预防高危患者急性脑梗死复发的临床药理疗效,观察阿托伐他汀钙对脑梗死患者血脂、血清炎性因子及颈动脉粥样硬化的影响,以指导临床用药。方法:156例首发急性脑梗死患者分为两组:对照组(n=66)给予常规治疗,观察组(n=90)加服阿托伐他汀钙20mg/d,疗程6个月。全部患者治疗前、治疗后6个月均测定血脂、炎性因子水平及颈动脉粥样硬化情况。结果:治疗6个月后观察组血脂、血清炎性因子水平及IMT、颈动脉斑块面积明显优于对照组(P<0.05或0.01);观察组6个月脑梗死复发率显著低于对照组(5.56%vs.21.2%,P<0.01)。结论:阿托伐他汀钙能够显著改善脑梗死患者血脂、血清炎性因子水平,稳定颈动脉粥样硬化斑块,促进斑块逆转,降低脑梗死复发风险。     

阿托伐他汀治疗脑梗死患者颈动脉粥样硬化斑块的效果分析

目的探讨阿托伐他汀治疗脑梗死患者颈动脉粥样硬化斑块的治疗效果。方法随机抽取该院2010-2012年治疗的患者90例,随机分为干预组和对照组。其中干预组中患者46例,对照组中患者44例。对患者在入院时、治疗3个月、6个月、12个月的血脂水平变化进行详细的记录,并且对患者进行颈动脉超声检查,评估颈动脉粥样硬化斑块内膜中层的厚度（IMT）。结果干预组和对照组中的患者无显著性血脂变化（P〉0．05）,在6个月后干预组中颈动脉斑块ITM的厚度明显缩小,对照组中厚度明显增加,两组治疗后与治疗前比较,差异有统计学意义（P〈0．05）。结论阿托伐他汀具有良好的降脂作用,并且有助于减轻动脉粥样硬化的作用,对治疗脑梗死患者颈动脉粥样异化斑块具有良好的效果。     

辛伐他汀对冠心病合并短暂性脑缺血发作颈动脉粥样硬化软斑块的疗效观察

目的观察辛伐他汀对冠心病合并短暂性脑缺血发作（TlA）患者的疗效。方法 96例有颈动脉粥样硬化斑块的TIA患者随机分为观察组和对照组,每组48例。观察组口服辛伐他汀、倍他乐克和阿司匹林6个月;对照组仅口服倍他乐克和阿司匹林。治疗前后进行颈动脉超声检查,测量颈动脉内-中膜厚度（IMT）、动脉粥样硬化软斑块面积,检测血脂水平。结果观察组治疗前后颈动脉IMT、软斑块面积变小,与治疗前比较差异有统计学意义（均P〈0.05）。对照组以上参数治疗前后比较差异无统计学意义（均P〉0.05）。观察组治疗后血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）水平显著下降,高密度脂蛋白（HDL）水平显著升高,与治疗前比较差异有统计学意义（均P〈0.01）。而对照组血清TC、TG、LDL水平治疗前后差异均无统计学意义（均P〉0.05）。结论辛伐他汀具有降低血脂、缩小软斑块、保护血管内皮的作用。     

永血康胶囊联合阿托伐他汀钙对颈动脉粥样硬化及血清超敏C反应蛋白的影响

目的观察脉血康胶囊联合阿托伐他汀钙对颈动脉粥样硬化及血清超敏C反应蛋白（hs—CRP）的影响。方法将80例颈动脉粥样硬化患者分为治疗组（40例）和对照组（40例）。两组患者在给予常规基础药物治疗的同时,治疗组给予脉血康胶囊合用阿托伐他汀钙片,对照组给予阿托伐他汀钙片。两组疗程均为24周。观察两组患者治疗前及疗程结束后血清hs—CRP、血脂及颈动脉内膜一中层厚度（IMT）、斑块总积分的变化。结果两组患者治疗后血清hs—CRP、血脂及颈动脉IMT、斑块总积分均较治疗前显著降低（P〈0．01或P〈0．05）,且治疗组上述指标下降幅度优于对照组（P〈0．01或P〈0．05）。结论脉血康胶囊与阿托伐他汀钙联合应用对颈动脉粥样硬化发挥协同作用。在抗炎、调脂、抗动脉粥样硬化方面较单用阿托伐他汀钙更为有效。     

阿托伐他汀干预对急性脑梗死患者临床疗效及预后的影响

目的探讨阿托伐他汀对急性脑梗死患者的临床疗效及早期预后。方法选择入院的急性脑梗死患者70例,随机分为对照组（常规治疗）和阿托伐他汀组（常规治疗的基础上加用阿托伐他汀钙片20mg.d-1,连续治疗6个月）,分别于治疗前、治疗后1个月、治疗后3个月检测血脂、C反应蛋白（CRP）、双侧颈动脉B超、颈动脉内膜中层厚度（IMT）;对伴有颈动脉斑块的脑梗死患者测量斑块面积及斑块Crouse积分,并在治疗6个月进行生活自理量表（ADL）评分。结果 （1）阿托伐他汀组治疗1个月后比治疗前低密度脂蛋白胆固醇（LDL-C）和CRP的水平降低（P均〈0.05）,对照组CRP水平也比其治疗前降低（P〈0.05）,但阿托伐他汀组降低更明显（P〈0.05）。阿托伐他汀组治疗3个月后比治疗前TC和LDL-C及CRP水平降低（P均〈0.01）,阿托伐他汀组治疗3个月后比治疗1个月后TC、LDL-C和CRP水平降低（P均〈0.05）,但治疗3个月后CRP水平在两组间比较差异无统计学意义（P〉0.05）。（2）两组治疗1个月后与治疗前IMT比较差异均无统计学意义（P〉0.05）,阿托伐他汀组治疗3个月后比其治疗前、治疗1个月后IMT均降低（P均〈0.01）;两组斑块面积在各时间点之间比较差异均无统计学意义（P〉0.05）;阿托伐他汀组治疗3个月后Crouse积分较其治疗前及治疗1个月后均降低（P均〈0.05）。（3）阿托伐他汀组治疗6个月后较对照组ADL评分增加（P〈0.05）。结论阿托伐他汀在早期对急性脑梗死患者有降脂和抗炎的作用,并能稳定或逆转颈动脉斑块,改善患者早期预后。     

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.