克罗米酚兴奋试验在预测卵巢储备功能中的作用

目的　应用克罗米酚兴奋试验 (CCT)预测不孕妇女卵巢储备功能。方法　对 169例进行体外受精 -胚胎移植 (IVF -ET)的不孕妇女于促排周期前月经第 3天测血FSH ,LH及E2 ,月经第 5～ 9天口服克罗米酚 10 0mg/d ,月经第10天再测血FSH及E2 。接受IVF后观察临床妊娠率、周期取消率及卵巢反应性。结果　CCT异常组每促排周期临床妊娠率为 2 1 1% ,CCT正常组妊娠率为 3 0 6% ,CCT异常组周期取消率、促排反应不良发生率分别为 3 1 5 %及 5 2 6% ,均高于CCT正常组的 11 3 %及 18 8% (P值分别为 <0 0 5 ,<0 0 1)。结论　CCT能较好的预测卵巢储备功能 ,指导超促排卵。     

两种基础激素对体外受精-胚胎移植妊娠结局的影响

目的 探讨基础卵泡刺激素（FSH）、抑制素B（inhibinB）水平对体外受精-胚胎移植（IVF-ET）结局的预测价值。方法 随机选择180例接受IVF—ET治疗的不孕症病人,于月经第2天抽取空腹血检测FSH、inhibinB水平,并按不同FSH、inhibinB水平分组,比较各组卵巢反应性及IVF-ET结局。结果 随FSH升高,卵巢反应性呈递减趋势,而妊娠率在FSH〉10U／L才有显著性变化;随inhibinB升高,卵巢反应性呈递增趋势,当inhibin B≤50ng／L,妊娠率显著降低,差异均有显著意义（F=12．36、18．82,P〈0．01;χ^2=8．10～14．22,P〈0．05）。结论 FSH是评价卵巢储备功能的较好指标,但在临床上对妊娠结局的预测实用价值不大。inhibinB能够更好反映卵巢储备功能,且对IVF-ET结局预测优于FSH。     

基础卵泡刺激素水平和获卵数对IVF-ET结局的影响

目的：探讨体外受精一胚胎移植（in vitro fertilization and embryo transfer，IVF-ET）过程中基础卵泡刺激素（FSH）水平及获卵数对IVF-ET结局的影响。方法：对180例不孕患者共180个IVF-ET周期的资料进行回顾性分析，比较不同FSH水平和不同获卵数患者年龄、受精率、卵裂率、优质胚胎率和临床妊娠率等指标的差异。结果：不同FSH水平患者年龄、促性腺激素（Gn）剂量、Gn促排时间、移植胚胎数、卵裂率、妊娠率经统计学检验，差异均无统计学意义（P〉0．05）。FSH：〉8．78IU／L者获卵数明显低于FSH〈3．85IU／L和FSH3．85～8．78IU／L组（P〈0．05），而受精率和优质胚胎率却明显高于其它2组（P〈0．05）。随年龄增长、FSH水平增加获卵数逐渐减少，差异有统计学意义（P〈0．05）；不同获卵数者的受精率、卵裂率、优质胚胎率、临床妊娠率及中重度卵巢过度刺激综合征（OHSS）发生率，差异均有统计学意义（P〈0．05），获卵数≤5个受精率最高，获卵数〉15个受精率最低；获卵数6～15个卵裂率、优质胚胎率最高；随着获卵数的增加，临床妊娠率和中重度OHSS发生率也逐渐增高。获卵数和FSH水平呈显著性负相关（r=-0．246，P〈0．01）；经多因素Logistic回归分析，年龄、获卵数、移植胚胎数与IVF-ET妊娠结局具有相关性（P〈0．05）。结论：基础FSH水平不能预测IVF-ET的临床结局，而获卵数可以预测IVFET临床结局。     

达因-35与来曲唑序贯用于多囊卵巢综合征的临床观察

目的观察多囊卵巢综合症（PCOS）无排卵性不孕患者达因_35预处理后来曲唑诱发排卵的临床效果。方法对2006年10月-2009年4月我院就诊的PCOS患者,测定基础女性激素,达因-35周期治疗3月,来曲唑组（LE组）20例,月经第3～7天口服来曲唑2．5mg／d,连用5d,克罗米酚组（cc组）32例,月经第3～7天口服克罗米酚50133g／d,连用5d。记录两组患者HCG注射日子宫内膜情况、≥16mm卵泡数,比较排卵率、妊娠率以及OHSS发生率。结果52例患者应用达因-35后,LH、T及LH／FSH明显下降,与用药前相比差异有统计学意义（P〈0．05）;注射HCC日LE组三线型内膜患者多于CC组,差异有统计学意义（P〈0．05）,注射HCG日LE组≥16mm卵泡数高于CC组,但无统计学意义（P〉0．05）;LE组排卵率与CC组相当,妊娠率高于CC组,但差异均元统计学意义（P〉0．05）;LE组无OHSS发生,与CC组差异有统计学意义（P（0．05）。结论PCOS患者予达因-35预处理后,LE促排卵效果与妊娠率和CC相似,但并发症明显减少。     

补充DHEA对卵巢储备功能降低患者TVF＋ET的影响

目的探讨补充脱氢表雄酮对卵巢储备功能降低患者卵巢功能及IVF—ET妊娠结局的影响。方法选择89例进行IVF／ICSI—ET的DOR患者进行随机对照研究,对照组为未服用DHEA的患者（n=47）。研究组（n=42）患者口服DHEA75mg／d,3个月后接受IVF—ET周期。分析比较研究组患者服用DHEA前后卵巢储备功能指标（基础卵泡数、基础内分泌水平等）;同时比较两组患者IVF周期治疗参数（获卵数、受精率、卵裂率、胚胎种植率、周期取消率、临床妊娠率、流产率等）的变化。结果研究组用药后FSH值较前下降（P〈0．05）,窦卵泡数较前增加（P〈0．05）;DHEA预治疗组较对照组基础卵泡计数、获卵数较对照组均显著增加（P〈0．05）,促排周期中Gn总量明显低于对照组（P〈0．05）,胚胎种植率、临床妊娠率呈提高趋势（P〉0．05）,周期取消率呈降低趋势（P〉0．05）,而卵裂率、受精率、流产率无差异（P〉0．05）。结论对卵巢储备功能降低患者补充DHEA能有效改善其卵巢储备功能,提高卵巢反应性,增加促排卵效果,进而提高IVF—ET的临床妊娠率。     

石斛汤联合尿促性素对克罗米芬抵抗多囊卵巢综合征不孕症的疗效观察

目的：观察石斛汤联合尿促性素（HMG）治疗克罗米芬抵抗多囊卵巢综合征不孕症的疗效,并探讨其作用机理。方法：将60例克罗米芬抵抗多囊卵巢综合征不孕症患者随机分为治疗组（石斛汤＋HMG治疗）和对照组（单独应用HMG治疗）,每组30例,连续观察3个月经周期,统计每组排卵率及妊娠率,测定排卵前卵泡平均直径、最大最小直径差值、子宫内膜厚度及月经第22d血清睾酮（T）、促卵泡生成素（FSH）、促黄体生成素（LH）。结果：治疗组排卵23例（76．7％）,妊娠13例（43．3％）,对照组排卵21例（70％）,妊娠7例（23．3％）,2组排卵率相近（P〉0．05）,治疗组妊娠率高于对照组（P〈0．05）;2组排卵前卵泡平均直径相近,无明显差异（P〉0．05）;治疗组排卵前卵泡最大、最小直径差值小与对照组,排卵前子宫内膜厚度高与对照组,有明显差异（P〈0．05）;2组I．H、FSH治疗后比较及2组分别治疗前与治疗后相比较,水平无明显变化（P〉0．05）;但治疗组T治疗后较治疗前降低（P〈0．05）;2组治疗后T相比,治疗组明显低于对照组（P〈0．05）：结论：石斛汤联合尿促性素治疗克罗米芬抵抗多囊卵巢综合征不孕症有较好疗效,能促进卵泡生长、增加子宫内膜厚度,降低睾酮水平,从而提高妊娠率。     

腹腔镜卵巢打孔术治疗克罗米芬抵抗的多囊卵巢综合征临床疗效观察

目的探讨腹腔镜卵巢打孔术治疗克罗米芬抵抗的多囊卵巢综合征临床疗效。方法2011年7月至2013年9月对66例克氯米芬（clomiphene citrate CC）抵抗的多囊卵巢综合征合并不孕症行经腹腔镜卵巢打孔术。观察手术前后黄体生成素（LH）、卵泡刺激素（FSH）、睾酮（T）、雌二醇（E2）水平的变化,术后随访监测月经恢复、排卵及妊娠情况。结果术后LH、T、LH／FSH、FSH较术前明显降低,差异有统计学意义（P〈0．05）。66例患者术后随访时间1a,61例月经恢复正常（92．42％）,63例恢复排卵（95．45％）,46例妊娠（69．70％）。结论腹腔镜卵巢打孔术治疗克罗米芬抵抗的多囊卵巢综合征有效。     

腹腔镜下卵巢巧克力囊肿剥离术中“PK刀”和“热能刀”分离止血对卵巢功能的影响

目的探讨腹腔镜下卵巢巧克力囊肿剥离术中“PK刀”和“热能刀”两种器械分离止血方法对卵巢功能的影响。方法对116例腹腔镜下卵巢巧克力囊肿剥离术中创面采用5mm“PK刀”电凝（48例）和“热能刀”烧伤（68例）两种方法止血,术前（月经第2、3天）及术后（第2次月经第2、3天）采取静脉血4mL检验卵泡刺激素（FSH）、黄体生成素、雌二醇3种女性激素以判断卵巢储备功能。结果两组激素比较,术前差异无显著性（P〉0．05）,术后差异有显著性（P〈0．05）,“PK刀”电凝组术后复查FSH〉12U／L者10例（20．9％）,“热能刀”烧伤组术后复查FSH〉12V／L者4例（5．89％）,差异有统计学意义（P〈0．05）。结论“PK刀”较“热能刀”易造成卵巢储备功能的降低。     

基础激素水平在判断卵巢储备功能中的作用

目的 :探讨不孕症患者基础激素水平在判断卵巢储备功能中的作用。方法 :采用放射免疫方法测定 6 0例 110个促排卵周期第三天血卵泡刺激素 (FSH)、黄体生成素 (LH)水平 ,B超观察卵泡发育情况 ,监测有无妊娠发生 ,分析基础激素水平与卵巢反应性 ,优势卵泡数目及周期妊娠率的关系。结果 :周期第 3天血FSH≥ 10IU L者 ,卵巢反应性差的发生率高 ,优势卵泡数目少 ,周期妊娠率低。周期第 3天血LH值与周期妊娠率无关。结论 :周期第 3天血FSH可作为判断卵巢储备功能的指标。     

来曲唑与克罗米芬在多囊卵巢综合征中诱导排卵疗效比较

目的比较来曲唑与克罗米芬在多囊卵巢综合征（PCOS）患者中诱导排卵的疗效。方法将PCOS排卵障碍患者78例分成两组，分别应用来曲唑（5mg，1次／d，连用5d）、克罗米芬（100mg，1次／d，连用5d）。超声监测卵泡发育，当最大卵泡的平均直径≥20mm时，肌注HCG5000IU诱发排卵。观察排卵率、妊娠率、流产率、子宫内膜厚度。结果来曲唑组的排卵率和周期妊娠率与克罗米芬组相似（P〉0．05），但来曲唑组流产率显著低于克罗米芬组（P〈0．05）。来曲唑组在hCG日子宫内膜的厚度显著厚于克罗米芬组（P〈0．01）。结论来曲唑用于PCOS无排卵的不孕症妇女，具有良好的排卵率和妊娠率，流产率显著低于克罗米芬组。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.