股深动脉血流重建加大隐静脉动脉化治疗下肢动脉硬化闭塞症

目的探讨股深动脉血流重建加大隐静脉动脉化治疗下肢动脉硬化闭塞症的经验及疗效。方法选择无理想旁路术流出道,股浅动脉、动脉及其分支全段或多节段闭塞或严重狭窄,股深动脉起始部狭窄、闭塞的FontaineⅢ期、Ⅳ期下肢动脉硬化闭塞症患者25例,施行股深动脉血流重建加大隐静脉原位Ⅰ期动脉化。结果23例患者得到随访,随访时间3个月-4年,10例FontaineⅢ期术后静息痛消失,15例FontaineⅣ期术后静息痛消失13例,减轻2例,5例足（趾）坏死者术后2周行截足（趾）术。患者手术前后进行踝/肱血压指数比较,差异有统计学意义。结论股深动脉血流重建加大隐静脉动脉化治疗严重的下肢动脉硬化闭塞症安全、简单、有效,特别适合年老体弱且下肢无理想旁路术流出道的患者。     

股深动脉重建治疗下肢动脉硬化闭塞症

目的总结股深动脉血流重建治疗下肢动脉硬化闭塞症的经验。方法选择FontaineⅢ、IV期下肢动脉硬化闭塞症患者24例,采用旁路术、取栓术及股深动脉成形术重建股深动脉血流。结果15例FontaineⅢ期患者于术后肢体静息痛消失;9例FontaineIV期患者中术后肢体静息痛消失7例,减轻1例,无效1例;无效者于术后1周行膝上截肢术,6例足坏死者于术后10天行截足（趾）术。22例患者得到随访,随访时间2个月-6年。移植血管3年通畅率为82％。结论股深动脉血流重建治疗严重肢体缺血具有简单、安全、有效的优点,适合年老体弱不能耐受复杂手术以及膝上无理想的用于旁路术的流出道者。     

人工血管旁路移植术治疗下肢动脉硬化闭塞症

目的：评价人工血管旁路移植术治疗下肢动脉硬化闭塞症的效果。方法：对30例下肢动脉硬化闭塞患者进行不同方式的人工血管旁路移植术。结果：27例患者术后均有不同程度的下肢血运改善，表现为间歇性跛行消失或跛行距离明显增大，静息痛好转，肢体溃疡愈合。术后检查踝肱指数为0．63±0．18，与术前（0．37±0．16）比较有显著提高（P〈0．05）。随访期间2例患者出现人工血管感染，1例出现人工血管内血栓形成，2例于术后1年出现吻合口狭窄，均于治疗后好转。结论：人工血管旁路移植术治疗下肢动脉硬化闭塞症能取得较满意的疗效。     

西洛他唑治疗糖尿病合并下肢动脉硬化闭塞症介入术后疗效观察

目的:观察糖尿病(DM)合并下肢动脉硬化闭塞症(ASO)介入术后应用西洛他唑(Cilostazol CS)的疗效。方法:DM合并下肢ASO患者34例,随机分为对照组(氯吡格雷及阿司匹林联用)及治疗组,治疗组在对照组用药基础上加用CS口服,比较两组治疗后患者的间歇性跛行及静息痛发生率、血管踝臂指数(ABI,足背动脉的收缩压与肱动脉的收缩压之比)、截肢率。结果:CS明显降低DM合并下肢ASO患者介入术后半年间歇性跛行及静息痛发生率和截肢率,提高ABI。结论:CS在预防下肢动脉硬化闭塞症介入术后血管再堵塞方面有较高的应用价值。     

杂交手术治疗下肢动脉硬化闭塞症并血栓形成体会

目的:探讨杂交手术治疗下肢动脉硬化闭塞症并血栓形成的疗效。方法:回顾分析我科2012年1月-2016年2月收治的39例下肢动脉硬化闭塞症并血栓形成患者,病变均累及髂动脉,均行全麻下杂交手术治疗,先尝试患侧股总动脉切开双向取栓,其中髂动脉球囊扩张并支架置入39例,股浅动脉球囊扩张并支架植入10例,膝下3分叉球囊扩张4例,股浅动脉病变旷置未处理3例。结果:39例患者术后发凉、疼痛症状消失,间歇性跛行缓解,踝肱指数(ABI)值平均升高至0.91±0.10;坏疽趾头截趾10例,一期愈合;出院后随访1-4年,其中死亡5例,股浅动脉血栓复发3例,股浅动脉支架再狭窄2例。结论:杂交手术是治疗下肢动脉硬化闭塞症并血栓形成的有效方法。     

脉血康胶囊治疗下肢动脉硬化闭塞症60例疗效观察

目的探讨脉血康胶囊对下肢动脉硬化闭塞症的疗效。方法 60例患者给予脉血康胶囊治疗后2个疗程末对自觉症状、疼痛程度、超声测足背动脉血流量和踝肱指数进行测评,观察治疗前后变化。结果自觉症状明显好转、疼痛程度减轻、足背动脉血流量增加、踝肱指数升高。结论脉血康胶囊治疗下肢动脉硬化闭塞症有较好效果。     

杂交技术在治疗下肢动脉硬化闭塞症的应用

目的:研究并探讨杂交技术治疗下肢动脉硬化闭塞症的治疗效果。方法:回顾性分析2014年1月-2017年1月本院收治的下肢动脉硬化闭塞症患者33例的临床资料。患者均接受传统外科手术+血管腔内治疗的杂交技术治疗。观察患者的手术、术后、死亡情况,比较治疗前后患者的踝肱指数(ABI),评估其临床疗效。结果:33例下肢动脉硬化闭塞症患者治疗总有效率为93.94%,术后并发症发生率为18.18%,围手术期无死亡;治疗后患者大部分患者的肢体发凉、麻木、静息痛、间歇性跛行等症状消失或明显改善;治疗后ABI高于治疗前(P0.05);术后6个月通畅率96.97%,术后1年通畅率93.94%。结论:在下肢动脉硬化闭塞症患者临床治疗中应用杂交技术治疗切实可行,使其下肢动脉血流灌注有效恢复,可有效改善患者临床症状。     

西洛他唑联合血府逐瘀胶囊治疗动脉硬化性闭塞症

目的:评估血府逐瘀胶囊联合西洛他唑用于动脉硬化性闭塞症的疗效探讨。方法:选择128例动脉硬化性闭塞症的患者,均分为两组,分别使用血府逐瘀胶囊联合西洛他唑和西洛他唑进行治疗,并比对治疗前后最大行走距离、超敏C-反应蛋白、踝肱指数的相关指数变动。结果:两组在最大行走距离、间歇性跛行、疼痛感觉方面差异有统计学意义(P<0.05)。结论:血府逐瘀胶囊联合西洛他唑用于动脉硬化性闭塞症的疗效理想,建议推广使用。     

糖尿病合并下肢动脉硬化闭塞症的临床分析

目的 分析糖尿病合并下肢动脉硬化闭塞症的临床治疗.方法 回顾性分析我院收治的30例糖尿病合并下肢动脉硬化闭塞症患者,根据患者的动脉闭塞程度、部位以及坏疽情况进行对应处理:4例肢体进行了保守治疗,其余26例进行了药物及手术治疗.其中:8例行自体大隐静脉移植术、5例行髂动脉-股动脉人工血管移植术、3例行下肢静脉动脉化手术、4例行经皮腔内血管成形术PTA、2例行截趾手术、4例行膝上截肢手术.结果 本组患者没有一例手术死亡,术后随访3个月至3年.其中,2例死亡.3例术后并发股部暂时性淋巴瘘,经保守治疗后愈合.1例髂动脉-股动脉人工血管移植术后1年闭塞,给予药物保守治疗后,下肢皮温恢复正常,跛行距离为200m.结论 针对糖尿病合并下肢动脉硬化闭塞症的患者,必须长期有效控制血糖,及早发现下肢大血管的病变,并及时进行相关治疗.     

股深动脉成形术治疗下肢动脉硬化闭塞症

目的当股浅动脉广泛闭塞时,股深动脉由于其独特的解剖条件和生理功能,为重建下肢血液循环起到重要的作用,股深动脉成形术治疗下肢动脉硬化闭塞症是一种有效的治疗方法。方法对20例病人施行股深动脉成形术,通过观察下肢血运改善情况及并发症等资料观察治疗下肢动脉硬化闭塞症的临床疗效。结果术后3个月,踝/肱指数从术前0-0.35(0.16±0.17)上升为0.34-0.75(0.66±0.32)。随访时间为3-36个月,平均(32.4±2.4)个月,全部手术成功,显效17例,好转3例。结论在股浅动脉广泛闭塞时,选用股深动脉成形术作为重建患肢血液循环的通道是一种有效的手术方法。手术创伤小,操作方便,更适宜老年患者。     

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.