152例输卵管造影近端阻塞与手术对比分析

目的探讨输卵管近端阻塞的病因,HSG(子宫输卵管造影hysterosal pingography,HSG)假阳性发生的相关因素及处理方法。方法 2011年5月-2012年5月HSG检查提示近端阻塞性不孕患者152例,入院行宫腹腔镜联合探查术,术中通液证实阻塞者行宫腔镜下选择性输卵管近端插管,仍不通者酌情导丝疏通。结果术中通液48例双侧通畅(31.6%),104例仍阻塞者行选择性输卵管插管/导丝疏通78例112条,62例88条(78.6%)疏通,16例24条(21.4%)插管失败,26例放弃插管。结论输卵管近端阻塞HSG假阳性率高,多见于盆腔子宫内膜异位症患者;真性阻塞多见于盆腔及输卵管慢性炎症患者,对比有统计学差异(P<0.001)。对于HSG诊断为输卵管近端阻塞的患者,应首先排除造影结果的假阳性,宫腹腔镜联合检查,宫腔镜选择性输卵管插管,必要时导丝疏通是合理有效的诊断及治疗方法。     

宫腔镜下输卵管口插管疏通术在不孕症中的应用(附307例分析)

目的讨论宫腔镜下输卵管插管疏通术在不孕症患者诊治中的应用价值。方法2003年5月-2007年5月对122例原发性不孕患者(原发组)和185例继发性不孕患者(继发组)行宫腔镜检查并镜下输卵管口插管疏通术,记录输卵管疏通情况。结果与术前比较,术后两组的输卵管通畅病例明显增加;术前为输卵管阻塞的病例,术后输卵管双侧通畅与一侧通畅率分别达16.9%和16.2%,而术后仍双侧阻塞的病例减少至34.5%。结论宫腔镜下输卵管口插管疏通术对输卵管因素的不孕症患者的诊治效果比较理想,值得推广应用。     

宫腹腔镜行宫颈输卵管插管疏通术53例临床分析

目的：探讨宫腹腔镜行输卵管插管疏通术治疗输卵管近中段阻塞的临床分析。方法：选择2010年5月--2012年2月在我院经子宫输卵管造影确诊为单侧或双侧输卵管近端阻塞患者53例,应用宫腹腔镜行宫颈输卵管插管疏通术及输卵管粘连松解术,并对疏通效果及术后1年妊娠情况统计分析。结果：53例患者81条输卵管近中段阻塞。输卵管外周有粘连者78条,输卵管外观正常仅管腔阻塞5条。术后输卵管通畅56条,疏通率69．14％（56／81）。输卵管插管失败25条。随访经插管疏通成功者46例,宫内妊娠17例,宫内妊娠率36．96％;插管侧输卵管妊娠4例,输卵管妊娠率8．69％,宫内妊娠率明显高于输卵管妊娠率。结论：宫腹腔镜宫颈输卵管插管疏通术对输卵管近中段阻塞有较好的治疗效果,是治疗输卵管性不孕尤其是治疗近中端梗阻的理想选择。     

宫腔镜下输卵管插管疏通术在不孕妇女中的应用

2002年6月至2004年12月，我院对38例经输卵管造影诊断为输卵管至少一侧间质或峡部阻塞的不孕患者。进行宫腔镜下输卵管插管疏通术治疗。取得一定的效果。现报告如下。     

宫腔镜治疗输卵管阻塞临床效果分析

不孕症由输卵管阻塞或输卵管通而不畅所致者较多,治疗较为困难.据文献报道66.7%的不孕症是因输卵管阻寒所致.我院应用超声监控官腔镜下输卵管口插管疏通术,治疗输卵管阻塞性不孕取得了较好的疗效.但如何防止术后再粘连、再阻塞仍是临床需要解决的难点.我院超声监控宫腔镜下输卵管口插管疏通术加用透明质酸钠预防术后再粘连、再阻塞取得满意效果.现报道如下:     

宫腔镜治疗输卵管阻塞临床效果分析

不孕症由输卵管阻塞或输卵管通而不畅所致者较多,治疗较为困难。据文献报道66．7％的不孕症是因输卵管阻塞所致。我院应用超声监控宫腔镜下输卯管口插管疏通术,治疗输卯管阻塞性不孕取得了较好的疗效。但如何防止术后再粘连、再阻塞仍是临床需要解决的难点。我院超声监控宫腔镜下输卵管口插管疏通术加用透明质酸钠预防术后再粘连、再阻塞取得满意效果。现报道如下：     

输卵管阻塞性不孕的宫腹腔镜联合诊治效果分析

目的探讨宫腔镜、腹腔镜联合诊治输卵管阻塞性不孕的效果。方法观察分析95例输卵管阻塞性不孕患者经宫、腹腔镜联合诊治的情况。结果95例患者经宫、腹腔镜联合输卵管插管通液及疏通术后1个月输卵管总复通率为71.8%(以输卵管条数计),对输卵管远端阻塞、子宫内膜异位症及盆腔炎所致的输卵管阻塞疗效较好,而对输卵管近段阻塞疗效较差。经1~24个月的随访,妊娠51例,妊娠率53.7%(宫内妊娠48例,宫外妊娠3例),术后一年内妊娠占96.1%。结论宫腔镜与腹腔镜联合输卵管插管通液及疏通术治疗输卵管阻塞性不孕是理想的诊治策略。     

宫腔镜下输卵管口插管疏通术在不孕症中的应用

目的讨论宫腔镜下输卵管插管疏通术在不孕症患者诊治中的应用价值。方法2004年5月～2008年5月对122例原发性不孕患者（原发组）和185例继发性不孕患者（继发组）行宫腔镜检查并镜下输卵管口插管疏通术,记录输卵管疏通情况。结果与术前比较,术后两组的输卵管通畅病例明显增加。术前为输卵管阻塞的病例,术后输卵管双侧通畅与一侧通畅率分别达169％和162％,而术后仍双侧阻塞的病例减少至34．5％。结论官腔镜下输卵管口插管疏通术对输卵管因素的不孕症患者的诊治效果比较理想,值得推广应用。     

宫腔镜下输卵管插管疏通术112例疗效分析

目的　借助宫腔镜治疗技术 ,对 112例输卵管阻塞性不孕症进行输卵管插管疏通术。方法　在宫腔镜直视下 ,将外径 1 4mm的医用塑料导管插至输卵管开口 ,进行选择性通液 ,使液体的流体静压直接作用于输卵管腔内 ,以疏通输卵管。若未能疏通 ,则改行输卵管插管粘连分离疏通术 ,即把 3F橄榄头型输尿管导管插入输卵管腔内 ,利用机械推力 ,分离粘连 ,疏通阻塞。结果　 112例 187条阻塞的输卵管 ,插管成功率 97 33%。输卵管再通率 86 81% ,其中近段阻塞的再通率 95 77% ,较中远段阻塞的再通率 5 7 5 %为高 (P <0 0 0 5 ) ,术后半年以上患者的实际受孕率 4 0 91%。结论　宫腔镜直视下输卵管插管疏通术是输卵管阻塞 ,尤其是输卵管近段阻塞性不孕症的一种微创、安全、简便、高效和经济的现代内镜治疗技术。     

宫腔镜输卵管插管疏通术在不孕症诊治中的应用

目的探讨宫腔镜下输卵管口插管疏通术在不孕症患者诊治中的应用价值。结论 1999年1月至2009年1月,对250例原发性不孕患者(原发组)和250例继发性不孕患者(继发组)行宫腔镜检查及镜下输卵管口插管疏通术,记录输卵管疏通情况。结果与术前比较,术后两组的输卵管通畅病例增加,原发组、继发组输卵管通畅率分别为32%(80/250)和60%(150/250)。结论宫腔镜下输卵管口插管疏通术对不孕症患者的诊治效果非常理想,方法简单、安全、不需住院、经济,值得临床推广应用。     

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.