丁苯酞软胶囊治疗脑小血管病伴认知功能损害病人的临床疗效及对血流灌注的影响

目的:探讨丁苯酞软胶囊治疗脑小血管病病人认知功能损害的临床疗效及对血流灌注的影响。方法:选取脑小血管病病人120例,按照随机数字法分为观察组和对照组,每组60例,对照组给予常规降压、调脂、改善循环等治疗,观察组在对照组基础上给予丁苯酞治疗,疗程均为1个月,观察治疗前后简易精神状态检查量表（MMSE）及蒙特利尔量表（MOCA）评分,并对所有病人治疗前后进行64 排螺旋 CT 灌注成像检查,计算血流灌注参数值变化。结果:治疗前,2组MMSE和MOCA评分比较差异均无统计学意义（P>0.05）,治疗后2组MMSE 及 MOCA 评分均较治疗前显著升高（P<0.01）,且观察组升高更为明显（P<0.01）。治疗前2组血流速度、脑血流量及平均通过时间差异均无统计学意义（P>0.05）,治疗后2组血流速度、脑血流量及平均通过时间均较治疗前显著改善（P<0.05~P<0.01）,且观察组改善均更为明显（P<0.01）。结论:丁苯酞软胶囊可改善脑小血管病病人的认知功能,提高病灶区脑血流量,且安全有效,值得临床推广。     

丁苯酞对慢性脑缺血低灌注患者脑血流量的影响及临床疗效观察

目的探讨丁苯酞对慢性脑缺血低灌注的临床疗效及治疗前后脑血流量变化的影响;方法纳入60例慢性脑缺血低灌注患者,随机给予基础治疗或基础治疗联合丁苯酞氯化钠注射液静脉滴注2周及丁苯酞软胶囊口服12周。在治疗前和治疗第14周后分别应用ASL脑灌注成像检查监测脑血流量并观察临床疗效;结果 (1)治疗组有效率为77%,而对照组有效率仅为37%;(2)治疗组患者病变区域治疗后CBF均较治疗前有不同程度增加,而对照组患者相应病变区域治疗前CBF均无明显变化;(3)治疗组和对照组患者治疗前后非低灌注区域CBF均无显著变化。结论丁苯酞能明显改善缺血区脑血流量;丁苯酞能够明显改善慢性脑缺血低灌注患者神经功能缺损的症状,促进神经功能恢复;ASL可作为判断脑缺血低灌注患者恢复情况的指标,并可以用于观察和评价药物的治疗效果。     

丁苯酞软胶囊治疗脑梗死的效果

目的:观察丁苯酞软胶囊治疗脑梗死的效果。方法:选取80例脑梗死患者根据随机数字表法分为对照组(n=40,采用常规治疗)和观察组(n=40,在对照组的基础上应用丁苯酞软胶囊治疗)。比较治疗3个月后的两组患者的缺血区域脑血流量、临床疗效及生命质量。结果:治疗3个月后,观察组患者缺血区域脑血流量改善程度明显优于对照组;观察组的总有效率为95.00%,明显高于对照组的80.00%;观察组患者的Barthel评分明显高于对照组,差异均有统计学意义(P<0.05)。结论:应用丁苯酞软胶囊联合阿托伐他汀钙片治疗脑梗死,可有效提高患者的缺血区域脑血流量,提高临床疗效及生命质量。     

丁苯酞联合阿托伐他汀钙对脑梗死的疗效

目的观察丁苯酞联合阿托伐他汀钙对脑梗死的疗效。方法选取2015年1月至2017年1月西平县人民医院收治的80例急性脑梗死患者,采用随机数表法分为对照组和观察组,每组40例。对照组接受常规治疗并阿司匹林肠溶片及舒血宁注射液治疗,观察组在对照组基础上加用丁苯酞及阿托伐他汀钙治疗。采用美国国立卫生研究院卒中量表(NIHSS)评估两组治疗前后神经功能,比较两组Barthel指数及缺血区域脑血流量。结果治疗后两组NIHSS评分均较前降低,Barthel指数均较前提高,观察组NIHSS评分低于对照组,Barthel指数高于对照组,差异有统计学意义(均P<0.05)。治疗后,对照组患者缺血区域脑血流量与治疗前差异无统计学意义(P>0.05),观察组患者缺血区域脑血流量高于治疗前,同时高于对照组,差异有统计学意义(均P<0.05)。结论丁苯酞联合阿托伐他汀钙可进一步提高脑梗死疗效,有效增加缺血区域脑血流量,改善患者神经功能缺损情况,提高患者日常生活能力。     

CT灌注成像对急性脑梗死患者静脉溶栓治疗的指导作用

目的 探讨CT灌注成像对急性脑梗死患者静脉溶栓治疗的指导作用.方法 选取发病6h内的急性脑梗死患者30例,行颅脑CT灌注成像检查,观察静脉应用尿激酶溶栓前后病变区相对脑血流量(rCBF)、相对脑血容量(rCBV)、相对平均通过时间(rMTT)的变化,于溶栓前、后进行NIHSS评分.结果 急性脑梗死发病6h内CT灌注成像均发现与临床症状相对于的脑灌注异常区,表现为脑血流量(CBF)、脑血容量(CBV)降低,平均通过时间(MTT)延迟,表明存在缺血半暗带.溶栓后大部分患者脑灌注情况明显改善,梗死核心区rCBF,rCBV与溶栓前比较无统计学差异(P>0.05);缺血半暗带区rCBF显著增加(P＜0.01),rMTT减小(P＜0.01).溶栓后NIHSS评分显著降低(P＜0.05).结论 急性脑梗死患者超早期行CT灌注成像能显示缺血半暗带,溶栓后缺血半暗带区脑灌注异常明显改善,对静脉溶栓治疗具有临床指导意义.     

丁苯酞软胶囊联合阿托伐他汀钙片治疗脑梗死的效果观察

目的:观察丁苯酞软胶囊联合阿托伐他汀钙片治疗脑梗死的效果。方法:选取352例脑梗死患者作为研究对象,依据随机数字表法分成观察组与对照组各176例。对照组采用常规治疗,观察组在对照组基础上采用丁苯酞软胶囊联合阿托伐他汀钙片治疗,比较治疗前后两组神经功能、日常生活能力、缺血区域脑血流量的变化情况及不良反应发生率。结果:治疗后观察组美国国立卫生院神经功能缺损评分(NIHSS)为(14.12±2.84)分,明显低于对照组的(19.06±3.02)分;观察组日常生活能力(ADL)量表评分为(87.76±9.72)分,明显高于对照组的(80.13±9.61)分,差异均有统计学意义(P<0.05)。治疗后观察组缺血区域脑血流量明显高于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论:常规治疗基础上加用阿托伐他汀钙片联合丁苯酞软胶囊治疗脑梗死的效果优于单纯常规治疗效果,可安全有效地增加患者缺血区域脑血流量,改善神经功能,提高患者日常生活能力。     

家犬急性缺血性脑梗死模型炫速双源CT灌注成像超早期诊断实验研究

目的 探讨炫速双源CT灌注成像在急性脑梗死超早期诊断中的价值,观察缺血再灌注对于神经元凋亡的影响。方法 健康杂种家犬12只,通过介入手段建立犬急性缺血性脑梗死模型,均在栓塞前以及栓塞后1、2、3、4、5、6 h,进行CT平扫检查、炫速双源CT脑灌注成像(Computed tomography perfusion,CTP)。测定梗死区和对侧正常对照区的血流灌注值脑血流量(cerebral blood flow,CBF),脑血流容积(cerebral blood flow volume, rCBV),灌注达到峰值时间(Time to peak,TTP)等,并获得相应脑灌注CT成像,做完CT检查后24 h后处死动物,取其脑组织行病理检查。结果 12只犬均成功建立脑梗死模型,CTP检查示11只梗死区CBF、CBV较对侧减少,TTP、MTT较对侧延长,1只无明显的变化。1 h组及2 h组ΔCBF、ΔCBV下降较明显,具有统计学意义,1-6h组ΔTTP数值具有统计学意义;24 h后实验动物均未死亡,通过术后病理检查发现家犬脑组织出现梗死灶,直径约2.3～8.3 mm。结论 CT灌注成像能快速、准确反映犬急性缺血性脑卒中动物模型缺血半暗带的部位、范围,可以准确判断栓塞血管部位,对早期诊断缺血性卒中和抓住动脉溶栓时机有较好的指导作用。     

64排CT全脑灌注成像在急性脑梗死早期诊断价值的初步探讨

目的探讨64排cT全脑灌注成像（CTP）在急性期脑梗死早期诊断中的应用价值。方法使用Philips公司生产的Brilliance64排螺旋CT机对21例发病6h或12h内的急性期脑梗死患者进行CT平扫及CTP检查，分析比较平扫及灌注成像表现，测量病变区与对侧相应区域的脑灌注参数值。结果21例患者中，C平扫5例显示局部脑沟较对侧变窄、脑实质密度稍微降低等可疑早期脑梗死征象，4例有陈旧腔隙性脑梗死，11例未发现异常征象。CTP检查21例患者均发现脑灌注异常，其中5例患者发现2处异常，4例发现3处异常。CTP表现为脑血流量及脑血容量减低，达峰时间延迟。结论CTP能够早期、快速显示脑缺血的部位及程度，预测缺血半暗带；对急性脑梗死的早期诊断和指导治疗有重要的临床价值。     

依达拉奉结合丁苯酞软胶囊对急性期脑梗死患者的临床疗效及神经功能缺损评分的影响研究

目的:观察和分析对急性期脑梗死患者采用依达拉奉结合丁苯酞软胶囊进行治疗的临床效果,并探讨药物对患者神经功能缺损评分的影响。方法:选取本院脑血管病科2016年6月-2017年12月接收的急性期脑梗死患者80例作为研究对象,按照随机数字表法将其分成试验组和对照组,每组40例。对照组单纯使用依达拉奉治疗,试验组在对照组的基础上联合使用丁苯酞软胶囊治疗,观察比较两组治疗前后的神经功能缺损评分、血小板聚集率、全血浆黏度和血栓形成系数血流指标水平,以及临床疗效。结果:经治疗2、4周后,两组神经功能缺损评分与治疗前比较均明显改善,且试验组均明显低于对照组,差异均有统计学意义(P0.05)。用药治疗后,两组血小板凝聚率、全血浆黏度、血栓形成系数水平与治疗前比较均明显改善,且试验组均明显低于对照组,差异均有统计学意义(P0.05)。试验组的总有效率为97.5%,明显高于对照组的65.0%,差异有统计学意义(字2=13.867,P0.05)。结论:采用依达拉奉结合丁苯酞软胶囊治疗急性期脑梗死,可有效改善患者血流指标和脑部功能,临床效果显著。     

尿激肽原酶对急性缺血性脑梗死患者血流动力学及神经功能的影响

目的:利用CT灌注成像(CTP)分析人尿激肽原酶1(Human urine kallikrein,HUK1)对急性缺血性脑梗死患者血流动力学及神经功能的影响。方法:筛选69例符合要求的急性脑梗死患者,按2∶1比例随机分为观察组与对照组。对照组给予基础抗血小板治疗(阿司匹林片0.1 g/d,氯吡格雷片75 mg/d);治疗组在上述基础上增加注射用HUK1(0.15 p NA U),行静脉滴注,1次/d,连用3周。治疗前及治疗3周后行CTP检查,观察病变区CTP检测参数(相对脑血流量r CBF、相对脑血容量r CBV及相对达峰时间r TTP);记录入院24 h内及治疗3周患者的NIHSS评分,随访3个月时患者的日常生活能力(mRS评分)。结果:与对照组相比,治疗3周后观察组梗死灶半暗带r CBF(0.84±0.17)、r CBV(0.89±0.25)及r TTP(1.29±0.37)的指标均优于对照组,灌注参数差异有显著性(P<0.05);NIHSS评分(3.48±5.69)优于治疗前(11.71±5.62)及对照组(4.98±5.04)(P<0.01);治疗3月后随访mRS评分(1.58±1.77)优于对照组(2.36±1.52)(P<0.05)。结论:HUK1可以增加缺血区域的血流量,促进急性缺血性脑梗死患者大脑侧支循环的建立,并可以显著改善患者的神经功能缺损程度及日常生活能力。     

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.