生物物理治疗仪联合布地奈德福莫特罗治疗过敏性支气管哮喘的疗效

目的:观察生物物理治疗仪联合布地奈德福莫特罗治疗过敏性支气管哮喘的疗效。方法:选择中重度过敏性支气管哮喘患者60例,通过随机数字表法将其分为研究组和对照组各30例,对照组给予吸入布地奈德福莫特罗治疗;研究组在对照组基础上应用MORA生物物理治疗仪进行治疗。比较两组临床疗效、症状消失时间,以及治疗前后第一秒用力呼气容积(FEV1)、FEV1占预计值百分比(FEV1%)、最高呼气流量(PEF)和哮喘控制得分(ACT)、哮喘生命质量问卷(AQLQ)调查及日间/夜间症状评分。结果:研究组总有效率为96.67%(29/30),明显高于对照组83.33%(25/30)(P<0.05);研究组治疗后ACT评分、AQLQ评分、FEV1、FEV1%和PEF均明显高于对照组(P<0.05);研究组症状消失时间、治疗后日间症状、夜间症状评分均明显低于对照组(P<0.05)。结论:生物物理治疗仪联合布地奈德福莫特罗治疗过敏性支气管哮喘的疗效优于单纯布地奈德福莫特罗治疗疗效。     

布地奈德雾化吸入联合硫酸镁静脉滴注治疗支气管哮喘的疗效

目的:观察布地奈德雾化吸入联合硫酸镁静脉滴注治疗支气管哮喘的临床疗效及安全性。方法:对25例确诊为支气管哮喘的患者进行布地奈德雾化吸入联合硫酸镁静脉滴注治疗,检测治疗前后用力肺活量(FVC),第1秒用力呼气量与肺活量比值(FEV1),最大呼气流速与预计呼气流速比值(PEF),哮喘控制测试评分(ACT),治疗过程中发生的不良反应次数与严重程度。结果:患者治疗后,各肺功能指标都有显著改善且差异有统计学意义(P<0.05),不良反应少,主要是眩晕和手抖。结论:布地奈德雾化吸入联合硫酸镁静脉滴注治疗支气管哮喘的临床疗效好,不良反应少。     

吸入性糖皮质激素联合茶碱对支气管哮喘患者的疗效

目的 探讨吸入性糖皮质激素(ICS)联合小剂量茶碱对未控制支气管哮喘的治疗效果.方法 筛选郑州大学人民医院门诊2011年1至12月门诊未控制支气管哮喘患者280例,用简单随机化分组平均分为试验组和对照组.试验组吸入布地奈德,200μg/吸,2吸/d,联合口服氨茶碱片0.1g,3次/d;对照组吸入布地奈德福莫特罗粉吸入剂(160 μg/4.5 μg)/吸,2吸/d;疗程均为6个月.比较两组患者治疗前后第1秒用力呼气容量占预计值百分比(FEV1％预计值)、外周静脉血白细胞介素(IL)-4、IL-5、IgE值的变化.结果 对照组(134例)及试验组(132例)患者平均年龄分别为(46±13)、(47±12)岁,男女构成比为1∶1.两组治疗前和治疗6个月后的FEV1％预计值、IL-4、IL-5、IgE值:试验组分别为68％±6％和76％±6％,(14.5±4.4)和(7.2±2.6) ng/L,(27.4±6.2)和(24.2±5.9)ng/L,(771±130)×103和(592±104) ×103 U/L,对照组分别为66％±8％和77％±6％,(13.7±4.3)和(7.7±4.0)ng/L,(26.9±5.8)和(24.6±4.8)ng/L,(752±154)×103和(604±122) ×103 U/L;两组治疗前比较差异均无统计学意义(均P＞0.05),治疗后两组组内比较差异均有统计学意义(均P＜0.05),组间比较差异均无统计学意义(均P＞0.05).结论 ICS联合茶碱,在改善哮喘患者肺功能、控制气道炎症方面与ICS联合长效β2受体激动剂有相似的疗效.     

比较吸入糖皮质激素(ICS)联合茶碱与联合长效β2受体激动剂(LABA)治疗哮喘的效果

目的研究与分析吸入糖皮质激素(ICS)联合茶碱与联合长效β2受体激动剂(LABA)治疗哮喘的效果。方法将82例患者分为两组,每组各41例。其中联合茶碱组患者采取吸入糖皮质激素(ICS)联合茶碱药物治疗,而联合β2受体激动剂组患者采取糖皮质激素(ICS)联合长效β2受体激动剂(LABA)治疗,观察两组患者的FEV1、PEFR、ACT评分以及嗜酸性粒细胞情况。结果联合茶碱组患者的FEV1、PEFR、ACT评分以及嗜酸性粒细胞情况显著优于联合β2受体激动剂组,具有统计学意义(P0.05)。结论吸入糖皮质激素(ICS)联合茶碱治疗哮喘的效果显著,值得临床广泛应用。     

茶碱缓释片联合布地奈德福莫特罗粉吸入剂治疗中度支气管哮喘的临床效果

目的探讨茶碱缓释片联合布地奈德福莫特罗粉吸入剂治疗中度支气管哮喘的临床效果。方法选取2018年1月至2019年1月河南省人民医院省直第二医院收治的102例中度支气管哮喘患者,按照随机数表法分为对照组和观察组,各51例。给予对照组布地奈德福莫特罗粉吸入剂治疗,观察组在对照组基础上接受茶碱缓释片治疗。比较两组治疗前后哮喘控制情况[哮喘控制测试量表(ACT)评分]、生活质量[圣乔治呼吸问卷(SGRQ)评分]及肺功能指标[第1秒用力呼气量(FEV_1)、用力肺活量(FVC)、第1秒用力呼气量占预计值百分比(FEV_1%pred)]。结果治疗后,两组ACT评分均较治疗前升高,SGRQ评分较治疗前降低,且观察组ACT评分高于对照组,SGRQ评分低于对照组,差异有统计学意义(均P<0.05)。治疗后,两组FEV_1、FVC、FEV_1%pred均较治疗前升高,且观察组FEV_1、FVC、FEV_1%pred均高于对照组,差异有统计学意义(均P<0.05)。结论茶碱缓释片联合布地奈德福莫特罗粉吸入剂治疗中度支气管哮喘,可有效控制患者哮喘发作,改善肺功能,提高生活质量。     

多索茶碱联合布地奈德雾化吸入治疗对支气管哮喘急性发作的疗效观察

目的:临床研究多索茶碱联合布地奈德雾化吸入治疗在支气管哮喘急性发作的疗效观察。方法:选取125例支气管哮喘急性发作患者,进行回顾性抽取与分析。以不同的治疗方式将患者归为多索茶碱组(多索组):64例患者采取多索茶碱联合布地奈德雾化吸入方案治疗;布地奈德组(布地组):61例患者采取布地奈德雾化吸入方案治疗,分析组间变化意义。结果:多索组血清以及痰液炎性指标对比布地组明显较小,差异有统计学意义(P<0.05)。结论:多索茶碱联合布地奈德雾化吸入治疗能够有效治疗支气管哮喘急性发作,同时能够抑制炎性反应。     

小剂量布地奈德联合茶碱缓释片对哮喘症状控制的临床观察

目的:探讨小剂量布地奈德联合茶碱缓释片控制支气管哮喘症状的效果。方法:将46例支气管哮喘患者随机分为对照组(23例)和观察组(23例),在常规治疗基础上对照组使用大剂量布地奈德(800～1 000μg/d),观察组使用小剂量布地奈德(200～400μg/d)加茶碱缓释片(200 mg/d),比较两组治疗2周、4周、8周、12周的哮喘控制评分。结果:两组均可有效控制哮喘症状,治疗2周、4周的评分差异无统计学意义(P>0.05),观察组治疗8周和12周的评分显著低于对照组(P<0.05)。结论:小剂量布地奈德吸入联合茶碱缓释片控制哮喘症状的效果优于单独应用大剂量布地奈德,且不良反应少,值得临床推广应用。     

吸入性皮质类固醇联合茶碱治疗支气管哮喘患者的临床疗效及安全性观察

目的:观察吸入性皮质类固醇(ICS)联合茶碱治疗支气管哮喘患者的临床疗效及安全性。方法:选取118例支气管哮喘患者临床资料,将其分为对照组和观察组,每组各59例。对照组患者给予布地奈德福莫特罗吸入治疗;观察组患者给予ICS+茶碱治疗,观察比较两组患者的治疗效果及不良反应情况。结果:治疗后,两组患者的IL-4、IL-5、Ig E指标均较治疗前下降,且观察组患者的下降程度明显优于对照组(P<0.05);治疗后,两组患者的ACT、FEU1%指标及哮喘发作次数均较治疗前改善,且观察组患者的改善情况明显优于对照组(P<0.05);对照组患者的不良反应率20.33%,高于观察组的10.16%,但差异无统计学意义(P>0.05)。结论:ICS结合茶碱治疗支气管哮喘患者,可快速改善其各项指标,缓解临床症状,且不良反应率较低,安全性高。     

完全控制支气管哮喘患者用药情况及其对哮喘急性发作的影响研究

目的 了解完全控制哮喘患者的用药情况,并探讨不同用药情况对哮喘急性发作的影响。方法 选取2007年1月—2013年12月在武汉大学人民医院呼吸内科门诊就诊或治疗后出院的501例完全控制哮喘患者为研究对象。根据用药情况,以单纯采用吸入药物进行治疗的患者为吸入治疗组,以联合采用口服药物和吸入药物进行治疗的患者为联合治疗组。入组后两组患者均维持达到完全控制时的治疗方案,随访24周。记录患者随访期间的临床表现、哮喘控制测试量表（ACT）得分、肺功能以及因哮喘急性发作退出试验的病例数、存在1次及以上急性发作的病例数、累计急性发作次数。结果 共有371例患者按要求完成了24周随访,吸入治疗组和联合治疗组分别为208例（占56.1%）和163例（占43.9%）。两组完成24周随访患者的性别、平均年龄、第1秒用力呼气容积（FEV1）占预计值百分比、第1秒用力呼气容积占用力肺活量百分比（FEV1/FVC）及FEV1改善率比较,差异均无统计学意义（P＞0.05）;而25%～75%用力肺活量时呼吸流速（FEF25%～75%）占预计值百分比比较,差异有统计学意义（P＜0.05）。163例联合采用口服药物和吸入药物进行治疗的患者中,131例（占80.4%）的口服药物为茶碱缓释片,124例（占76.1%）为吸入大剂量糖皮质激素未获得完全控制者。吸入治疗组和联合治疗组因哮喘急性发作退出试验的病例数比较,差异有统计学意义（P＜0.05）;完成24周随访的患者中,急性发作次数≥1次的病例数比较,差异有统计学意义（P＜0.05）;累计急性发作次数比较,差异亦有统计学意义（P＜0.05）。结论 吸入药物疗法仍然是目前控制哮喘的主要治疗方法,对于单纯采用吸入疗法无法达到完全控制的患者,可适当联合采用口服药物进行治疗,茶碱缓释片是目前常用的口服治疗哮喘药物。与单纯采用吸入药物进行治疗的患者相比,联合采用口服药物和吸入药物进行治疗的患者哮喘急性发作水平较低。     

孟鲁司特治疗成人支气管哮喘合并变应性鼻炎的疗效观察

目的评价孟鲁司特治疗成人支气管哮喘合并变应性鼻炎（AR）的疗效。方法将90例患者分为孟鲁司特组、布地奈德组及对照组,各30例。3组患者均吸入沙美特罗替卡松粉吸入剂,50～250 g/次,2次/d。孟鲁司特组加服孟鲁司特10mg,每晚1次;布地奈德组加鼻内吸入布地奈德鼻喷剂64 g,每天1次。治疗时间均为8周。观察3组治疗前后哮喘控制测试（ACT）评分、变应性鼻炎评分、生存质量评分和第1秒用力呼气容积占预计值百分比（FEV1%）值的变化。结果与治疗前比较,孟鲁司特组和布地奈德组在ACT评分、变应性鼻炎评分、生存质量评分和FEV1%值方面均有显著改善（〈0.05）。孟鲁司特组在控制鼻炎症状方面优于对照组（〈0.05）,而与布地奈德组比较,差异无统计学意义（〉0.05）。但孟鲁司特组在改善ACT评分、生存质量评分和FEV1%值方面均优于布地奈德组及对照组（〈0.05）。结论孟鲁司特可同时改善支气管哮喘与AR的症状,改善肺功能,提高患者的生存质量。     

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.