普米克令舒在鼻内镜术后的应用

目的:探讨普米克令舒在鼻内镜术后使用的临床观察.方法:随机选取60例慢性鼻-鼻窦炎伴鼻息肉Ⅱ型2期或Ⅱ型3期型患者,采用随机两组病人对照,选取30例患者为围手术期使用的米克令舒治疗组,另外30例患者为对照组.比较观察术后患者术腔黏膜的转归过程.结果:普米克令舒治疗组,术后3个月内鼻腔黏膜肿胀反应明显轻,治愈20例,治愈率66.7%,好转10例;对照组治愈12例,占40%,好转16例,未愈复发2例.两组相比较.P=0.0384、P<0.05,有统计学意义.结论:鼻内镜术后使用普米克令舒能有效减轻鼻腔黏膜肿胀炎症反应情况,促进黏膜上皮化进程和黏膜的顺利转归,有利于恢复.     

鼻内窥镜术后普米克令舒鼻雾化吸入对ENaC蛋白表达的影响

目的探讨鼻内窥镜术（ESS）后普米克令舒鼻雾化吸入对鼻腔黏膜上皮钠离子通道（ENaC）蛋白表达的影响。方法44例行ESS的鼻息肉患者随机分为普米克令舒治疗组（n=21）和雷诺考特对照组（n=23）,治疗组术后予以普米克令舒鼻雾化吸入治疗,对照组术后予以常规雷诺考特喷鼻治疗,连续10d。两组患者均于术后第14天鼻内窥镜下行术侧中鼻甲残端黏膜活检,术中及术后标本均于显微镜下行嗜酸性粒细胞（Eos）和中性粒细胞（Neu）计数,免疫荧光检测ENaC蛋白的表达。结幕治疗后,两组Eos和Neu计数均下降,但普米克令舒治疗组Neu低于雷诺考特对照组（P〈0．05）;普米克令舒治疗组上皮细胞ENaC蛋白的表达也低于雷诺考特对照组（P〈0．01）。结论ESS术后应用普米克令舒治疗可减少Neu的浸润,抑制ENaC蛋白的表达,有利于减轻鼻黏膜急性炎症和水肿反应。     

鼻内窥镜术后普米克令舒鼻雾化吸入对ENaC蛋白表达的影响

目的 探讨鼻内窥镜术(ESS)后普米克令舒鼻雾化吸入对鼻腔黏膜上皮钠离子通道(ENaC)蛋白表达的影响.方法 44例行ESS的鼻息肉患者随机分为普米克令舒治疗组(n=21)和雷诺考特对照组(n=23),治疗组术后予以普米克令舒鼻雾化吸入治疗,对照组术后予以常规雷诺考特喷鼻治疗,连续10 d.两组患者均于术后第14天鼻内窥镜下行术侧中鼻甲残端黏膜活检,术中及术后标本均于显微镜下行嗜酸性粒细胞(Eos)和中性粒细胞(Neu)计数,免疫荧光检测ENaC蛋白的表达.结果 治疗后,两组Eos和Neu计数均下降,但普米克令舒治疗组Neu低于雷诺考特对照组(P<0.05);普米克令舒治疗组上皮细胞ENaC蛋白的表达也低于雷诺考特对照组(P<0.01).结论 ESS术后应用普米克令舒治疗可减少Neu的浸润,抑制ENaC蛋白的表达,有利于减轻鼻黏膜急性炎症和水肿反应.     

普米克应用鼻内窥镜术后鼻腔冲洗疗效观察

目的观察普米克应用于鼻内窥镜术后鼻腔冲洗的效果。方法将80例鼻内窥镜术后患者随机分为实验组40例和对照组40例。两组综合治疗与常规护理相同,对照组采用鼻内窥镜术后抗生素治疗及鼻内窥镜下鼻腔清理。实验组采用鼻内窥镜术后抗生素治疗,应用普米克鼻腔冲洗及鼻内窥镜下鼻腔清理。结果鼻内窥镜术后采用普米克冲洗鼻腔配合鼻内窥镜清理术腔,优于单纯的鼻内窥镜术后术腔清理,可减少术腔结痂,清除分泌物,保持鼻腔湿润与清洁,促进粘膜修复,缩短了临床疗程,提高了治愈率。     

藻酸钙纤维联合普米克令舒在鼻内镜术后填塞效果的临床观察

目的探讨Sorbaglon藻酸钙纤维及普米克令舒在鼻内镜术后填塞的临床疗效。方法随机选取80例慢性鼻窦炎的患者,其中Ⅱ型1期27例,Ⅱ型2期34例,Ⅱ型3期19例,采用双侧鼻腔自身对照,随机选取一侧鼻腔作为藻酸钙纤维填塞组（对照组）,另一侧鼻腔作为藻酸钙纤维和普米克令舒填塞组（治疗组）,观察术后患者术腔粘膜的转归过程。结果普米克令舒治疗组,术后鼻腔粘膜肿胀反应轻,肉芽、瘢痕粘连发生率低于对照组,两组术腔上皮化的平均时间经t检验,P〈0.05,可以认为上皮化的时间差异有统计学意义。从疗效分析,治疗组治愈48例,好转23例,治疗有效率88.75%;对照组治愈45例,好转22例,治疗有效率83.75%,经2χ检验,P〉0.05,不能认为两组疗效不同。结论慢性鼻窦炎术后使用藻酸钙纤维联合普米克令舒填塞鼻腔能进一步减轻术腔的术后反应,促进粘膜上皮化进程和粘膜的顺利转归。     

老年慢性鼻-鼻窦炎患者术后普米克令舒鼻雾化吸入的疗效观察

目的探讨老年慢性鼻-鼻窦炎患者功能性鼻窦内镜手术（FESS）后应用普米克令舒鼻雾化吸入的疗效。方法 60例老年慢性鼻-鼻窦炎患者,均行FESS治疗,随机分为两组,每组30例。治疗组术后第2天应用普米克令舒鼻雾化吸入治疗,每日1次,每次2 mL,由空气压缩雾化吸入机（PARI,德国百瑞公司）从鼻腔喷入,连续3周;对照组采用雷诺考特喷鼻,每日2次,每次2喷,两组其他的围术期常规治疗均相同。结果根据视觉模拟量表（VAS）和Kennedy鼻内镜评分,治疗组和对照组总有效率分别是96.7%和80.0%,治疗组明显高于对照组（P〈0.05）。结论普米克令舒配合PARI鼻雾化吸入机用于老年慢性鼻-鼻窦炎术后,安全性高,明显减轻黏膜的水肿,促进术腔上皮化,缩短术后恢复时间。     

蜂蜜麻油混悬液在鼻窦内窥镜术后的应用

目的用蜂蜜麻油混悬液在鼻窦内窥镜术后局部留置及点鼻以加速筛窦腔创面上皮化.方法将80例慢性鼻窦炎患者按病型及病期配对分成两组.甲组患者术后4 d用浸泡蜂蜜及麻油混悬液的明胶海绵填塞筛窦腔,以后每天用该混悬液点鼻3次,每次2滴;乙组患者术后不用蜂蜜及麻油,其余治疗方法相同.比较两组术后上皮化时间,统计方法用配对t检验.结果各型各期配对病例中,甲组病例术后上皮化时间皆明显短于乙组(P<0.01).结论蜂蜜及麻油混悬液能使鼻窦内窥镜术后筛窦腔早期上皮化,可以减轻水肿,减少痂块.     

功能性鼻窦内窥镜术后术腔黏膜修复的研究

目的探讨功能性鼻窦内窥镜术后局部应用布地奈德鼻喷雾剂对术腔黏膜修复的影响。方法将60例实施功能性鼻窦内窥镜手术的患者随机分为观察组和对照组各30例，对照组术后局部使用传统的雾灵鼻治疗，观察组术后局部应用布地奈德鼻喷雾剂喷鼻治疗，观察比较2组患者鼻腔黏膜修复情况。结果治疗2，4，8周后，观察组临床好转或治愈率明显高于同期对照组水平，差异有统计学意义（P〈0．05）。结论功能性鼻窦内窥镜术后局部使用布地奈德鼻喷雾剂喷鼻治疗，可以加快术腔的上皮化进程，提高治愈率，值得临床推广。     

功能性鼻内窥镜术后康复新鼻腔冲洗疗效观察

目的:观察功能性鼻内窥镜术后应用康复新液冲洗鼻腔对术腔黏膜的修复疗效。方法:将2009年6月至2010年12月在本院手术治疗的68例诊断为慢性鼻-鼻窦炎鼻息肉患者随机分为两组,研究组34例,功能性鼻内窥镜术后用康复新液冲洗鼻腔,对照组34例,功能性鼻内窥镜术后用0.9%氯化钠注射液冲洗鼻腔,随访6个月以上,分析两组疗效。结果:经x2检验,两组比较差异有统计学意义(P<0.05),研究组术腔黏膜的修复明显优于对照组。结论:康复新液在功能性鼻内窥镜术后鼻腔冲洗中对术腔黏膜的修复效果肯定。     

自制简易鼻腔冲洗器在鼻内镜术后应用的效果研究

目的:观察鼻内镜术后使用自制简易鼻腔冲洗器冲洗鼻腔的效果。方法:将160例行功能性鼻内镜手术患者采用抽签法随机分成观察组80例(在鼻内镜下换药后使用自制简易鼻腔冲洗器冲洗鼻腔)和对照组80例(仅在鼻内镜下换药),比较两组鼻腔黏膜恢复情况,评价两组患者疗效。结果:观察组使用自制简易鼻腔冲洗器冲洗鼻腔,患者耐受性良好,未见不良反应发生,治愈率和总有效率分别为88.8%(71/80)和97.5%(78/80),对照组治愈率和总有效率分别为63.8%(51/80)和82.5%(66/80),两组比较差异有统计学意义(χ2=15.187 8,P<0.01)。结论:术后使用自制简易鼻腔冲洗器冲洗鼻腔,鼻内窥镜检查窦口开放良好,窦腔黏膜上皮化,无脓性分泌物或有少量脓性分泌物,能够有效促进鼻腔黏膜恢复和黏膜上皮化,大大提高了手术治愈率,值得临床推广使用。     

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.