妇女年龄对体外受精-胚胎移植结果的影响

目的：探讨妇女的年龄对体外受精－胚胎移植（Ｉｎｖｉｔｒｏ　ｆｅｒｔｉｌｉｚａｔｉｏｎ－ｅｍｂｒｙｏ　ｔｒａｎｓｆｅｒ，ＩＶＦ－ＥＴ）结果的影响。方法：对在本院进行ＩＶＦ－ＥＴ治疗的１７９例病人进行回顾性分析，按病人的年龄（≤３０岁、３１～３５岁、３６～４０岁、≥４１岁）分为４组，应用方差分析成ｘ~２检验对不同年龄组的ＩＶＦ－ＥＴ结果进行分析。结果：各年龄组间的卵泡均数、取卵均数、可移植胚胎均数、移植胚胎均数均随年龄增大而下降，差异有显著性（ Ｐ＜ ０．０５）；卵子回收率、受精率各组间无显著差异。胚胎移植取消率随年龄增大而显著上升（ Ｐ＜ ０．０５），≥４１岁组的取消率高达２６．７％，而临床妊娠率和胚胎种植率则随年龄增大而下降（Ｐ＜０．０５），３６岁以下妇女的临床妊娠率可达３０％以上，而３６岁以上妇女的临床妊娠率则下降至１５％以下。结论：妇女的年龄对ＩＶＦ－ＥＴ程序存在着多样的不利作用，这些不利作用共同影响了ＩＶＦ－ＥＴ最后的结果。     

胚胎移植管血染情况对胚胎移植临床妊娠率的影响

摘 要： 【目的】 探讨胚胎移植管血染情况对于体外受精－胚胎移植（ＩＶＦ－ＥＴ）中胚胎种植率及临床妊娠率的影响。【方法】回顾性分析２０１１年１月至２０１２年１２月于中山大学孙逸仙纪念医院生殖医学中心行黄体期长方案ＩＶＦ,并行新鲜周期胚胎移植患者的资料,按照胚胎移植时移植管是否血染及血染程度分组,比较各组的助孕情况和结局。【结果】一共纳入１ ７６２个ＩＶＦ周期,其中血染组共有５９３个周期,无血染组有１ １６９个周期。两组患者的年龄、不孕年限、基础ＦＳＨ、ＨＣＧ日内膜厚度、获卵数、Ｇｎ总数、２ＰＮ受精率及移植胚胎数均没有统计学差异（Ｐ＞ ０．０５）,血染组种植率低于无血染组（３１．３％ ｖｓ． ３６．５％,Ｐ ＝ ０．００１）;血染组临床妊娠率低于无血染组（４８．９％ ｖｓ． ５５．１％,Ｐ＝ ０．０１４）。血染组按血染程度分为少许血染、中－多量血染两组,种植率及临床妊娠率在两组间无明显统计学差异（Ｐ ＝ ０．５０３,Ｐ ＝ ０．２７７）。多因素Ｌｏｇｉｓｔｉｃ回归分析显示移植管血染是影响临床妊娠的危险因素（ＯＲ＝ ０．７５,９５％,ＣＩ ０．６－０．９）。【结论】 移植管血染可降低胚胎种植率、临床妊娠率,移植管血染程度对胚胎种植率、临床妊娠率的影响有待于进一步研究。     

小儿心力衰竭定量诊断标准的研究

用多普勒超声心动图测定２８６名正常儿童和４１例心衰患儿的５８项心脏血流参数，选出主动脉峰值流速（ＰＦＶＡ）、肺动脉峰值流速（ＰＦＶＰ）、二尖瓣Ｅ峰峰值流速（ＰＦＶＭＥ）、三尖瓣Ｅ峰流速（ＰＦＶＴＥ）、心脏指数（ＣＩ）等５项作为心衰定量诊断标准。这５项指标为ＰＦＶＡ：６个月以下＜７３．１ｃｍ／ｓ，６个月～＜８７．１ｃｍ／ｓ，４岁～＜１０１．９ｃｍ／ｓ，１０～１４岁＜１１０ｃｍ／ｓ；ＰＦＶＰ：６个月以下＜６９．２ｃｍ／ｓ，６个月～１４岁＜８２．４ｃｍ／ｓ；ＰＦＶＭＥ：６个月以下＞７８．５或＜５０．１ｃｍ／ｓ，６个月～１４岁＞１０１．６或＜７５．２ｃｍ／ｓ；ＰＦＶＴＥ：６个月以下＞６５．９或＜３７．１ｃｍ／ｓ，６个月～１４岁＞６７．１或＜４３．１ｃｍ／ｓ；ＣＩ＜２．６Ｌ／ｍ~２·ｍｉｎ~（－１）。     

In vitro fertilization in China: past and future.

Ａｓｓｉｓｔｅｄｒｅｐｒｏｄｕｃｔｉｖｅｔｅｃｈｎｏｌｏｇｙ,ｅｓｐｅｃｉａｌｌｙｉｎｖｉｔｒｏｆｅｒｔｉｌｉｚａｔｉｏｎａｎｄｅｍｂｒｙｏｔｒａｎｓｆｅｒ（ＩＶＦＥＴ）ｗｈｉｃｈｈａｓｓｅｔｕｐａｍｏｄｅｌｆｏｒｈｕｍａｎｒｅｐｒｏｄｕｃｔｉｖｅｐｒｏｃｅｓｓ,ｉｓａｔｐｒｅｓｅｎｔａｈｏｔｓｐｏｔｉｎｍｅｄｉｃａｌｒｅｓｅａｒｃｈｗｏｒｌｄｗｉｄｅ－ＩＶＦＥＴｉｓａｈｉｇｈｔｅｃｈｎｏｌｏｇｙ,ｗｈｉｃｈｉｎｖｏｌｖｅｓｍａｎｙｓｔｅｐｓ,ａｌｌｏｆｗｈｉｃｈａｒｅｃｒｕｃｉａｌｔｏｔ…     

体外受精—胚胎移植17例报告

解决输卵管必不孕者的生育问题。方法采用体外受精－胚胎移植（ＩＶＦ－ＥＴ）技术治疗１７例不孕患者,共１８个周期。结果受精率７５．７％;卵裂率８０．７％;４例临床妊娠,周期妊娠率２２．２＄（４／１８）,２例已分娩,１例继续妊娠,１例流产。结论ＩＶＦ－ＥＴ是治疗输卵管性不孕的有效方法。     

女性乳腺癌危险因素的多因素分析

应用１１配比病例对照研究方法，对１４６例女性乳腺癌患者及１４６例配对对照的危险因素进行了调查，并应用Ｌｏｇｉｓｔｉｃ回归分析和主成分分析方法进行了综合探讨。结果：Ｌｏｇｉｓｔｉｃ回归分析建立了一个包括５个自变量的Ｌｏｇｉｓｔｉｃ回归方程，主成分分析从２２个乳腺癌危险因素中提取了１０个主成分，其方差累积贡献率达６４．８％。提示：职业为干部、初产年龄晚、常吃香肠和腊肉、结婚年龄晚、被动吸烟时间长、既往有乳腺良性肿瘤史、有乳腺炎史及有乳腺肿瘤家族史等，为乳腺癌发病的主要危险因素；而生育胎数多、哺乳时间长、经常服用维生素类药物和蔬菜摄入量多等，则有保护作用     

不同底物对HUVEC在血管内支架上粘附生长的影响

目的研究不同底物对人脐静脉内皮细胞（ＨＵＶＥＣ）在支架上粘附及生长的影响。方法：分别用Ｆｉｂｒｉｎｅｃｔｉｎ、ｐｏｌｙＬｌｙｓｉｎｅ处理血管内支架后将其置入ＨＵＶＥＣ悬液,定时旋转血管内支架,使内皮细胞在支架上充分粘附。比较ＨＵＶＥＣ在底物处理的支架与裸支架上粘附率及生长状况的差异。结果：ＨＵＶＥＣ在裸支架、ｐｏｌｙＬｌｙｓｉｎｅ及Ｆｉｂｒｉｎｅｃｔｉｎ处理血管内支架上的粘附率分别为１９．９２％、３９．８２％、６４．９％,３者比较有统计学上的差异;ＨＵＶＥＣ在Ｆｉｂｒｉｎｅｃｔｉｎ处理的支架上的生长状况也优于其它两种情况。结论：底物Ｆｉｂｒｉｎｅｃｔｉｎ和ｐｏｌｙＬｌｙｓｉｎｅ处理能提高内皮细胞在支架上的粘附率。     

声振刺激后观察胎心率基线波形诊断脐带缠绕

目的：通过观察声振刺激（ＶｉｂｒｏａｃｏｕｓｔｉｃＳｔｉｍｕｌａｔｉｏｎＴｅｓｔ，ＶＡＳＴ）引起胎心率基线波形的改变，分析分娩时脐带缠绕情况。方法：对８１５例足月妊娠胎儿进行产前ＶＡＳＴ，分析波形改变，如胎心基线出现深窄的形似“Ｖ”、“Ｎ”、“Ｍ”、“Ｗ”等的双向波，考虑胎儿存在脐带缠绕，跟踪观察分娩时脐带缠绕情况。结果：ＶＡＳＴ中有２７２例出现双向波，分娩后证实有２１８例脐带绕颈，阳性预测值８０．１％，阴性预测值８６．１％，敏感性７４．４％，特异性８９．６％，总符合率８４．２％。结论：ＶＡＳＴ后胎心基线出现“Ｖ”波等提示存在脐带缠绕，这是一种快速、方便、经济、实用的检测手段。     

169个周期体外受精胚胎移植的结果

目的 观察１６９个周期体外受胎移植的效果。方法 从１９９８年１０月起至１９９９年３月底,半年来,对１４４对夫妇进行１６９个周期的体外受精及胚胎移植（ＩＶＦ－ＥＴ）或浆内单精子穿刺术与胚胎移植（ＩＣＳＩ－ＥＴ）,１５２例完成了周期。结果 ＩＶＦ－ＥＴ组７６例,妊娠成功率为２８例,成功率为３６．８％;ＩＣＳＩＥＴ组为７１例,妊娠成功２２便,成功３１％;另有５例胚胎冷冻,复苏后胚胎移植,成功２例。结论     

心率变异指数对老年高血压患者心脏事件的预测价值

目的：了解心率变异指数（ＨＲＶＩ）对老年高血压心脏事件的预测价值。方法：２３１例老年（≥６０岁）高血压患者经超声心动图和２４ｈ动态心电图测定心率变异指数（ＨＲＶＩ）、左室质量指数（ＬＶＭＩ）及左室射血分数（ＬＶＥＦ）,并通过多元回归分析评估在为期２年的随访期中ＨＲＶＩ对患者的心脏事件（心肌梗死、心力衰竭、心脏停搏）的预测价值。结果：ＨＲＶＩ减低的发生率及ＨＲＶＩ平均值在左室肥厚组（ＬＶＨ）为６１．９％,１９．８±９．４;无ＬＶＨ组为２９．５％,２２．４±７．１（Ｐ＜０．０５）;在ＬＶＥＦ＜５０％组为６４．２％,１８．８±８．５,ＬＶＥＦ≥５０％组为３１．５％,２２．７±１１．１（Ｐ＜０．００１）;在有心脏事件组为９７．８％,１７．３±８．２,无心脏事件组为３３．０％,２３．４±７．９（Ｐ＜０．００１）。多元回归分析结果显示,对老年高血压患者心脏事件的预测价值ＨＲＶＩ最高（ｒ＝０．６４５３,Ｐ＝０．０００１）,其次是ＬＶＥＦ（ｒ＝－０．４９８３,Ｐ＝０．００２８）,ＬＶＭＩ（ｒ＝０．３８７９,Ｐ＝０．００２４）和年龄（ｒ＝０．２８４５,Ｐ＝０．０００１）。结论：ＨＲＶＩ减低作为独立的危险因素,对老年高血压患者     

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.     

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.