急性心肌梗死时心电图ST段抬高恢复时间对预测溶栓治疗后心室壁运动的临床意义

目的：探讨急性心肌梗死时（AMI）心电图ST段抬高恢复时间对预测溶栓治疗后心室壁运动的临床意义。方法：将监护病房（CCU）收治并接受静脉尿激酶溶栓治疗且符合梗死相关血管再通标准的360例AMI患者,根据溶栓后心电图ST段抬高达到稳定性下移50%的时间,分成A组（t≤30min,n=92）、B组（30〈t≤60min，n=126）及C组（60〈t≤90min，n=142），分别测定3组的梗死血管室壁运动的幅度。结果：ST段抬高达到稳定性下移50％所需要的时间不同，梗死相关心室壁运动幅度存在差异[急性前壁心肌梗（AAMI）相关室间隔运动幅度A、B、C3组分别为（8．15±1．62）、（7．84±1．43）及（6．56±2．15）mm，P〈0．05；急性下壁心肌梗死（AIMI）相关左室后壁运动幅度3组分别为（8．78±1．92）、（7．32±1．54）、及（6．15±2．05）mm，P〈0．05，且随需要的时间的延长，梗死相关的心室壁运动幅度有下降的趋势。结论：抬高的ST段恢复时间越短，梗死相关的心室壁运动改善越明显。     

急性心肌梗死冠状动脉介入治疗后心电图ST段回落与心朋组织灌注的观察

目的 探讨急性心肌梗死急诊经皮冠状动脉介入治疗(PCI)再通后心电图ST段下降幅度与心肌组织灌注的关系.方法 将PCI再通后1小时的18导联ECG与入院当时ECG比较,分别测定梗死相关导联最大ST段高度,按抬高的ST段下降幅度分为A组:ST段下降≥50%,B组:ST段下降＜50%,根据对ST段回落和心肌水平有效再灌注相关临床因素的观察而进行比较.结果 两组患者在非致死性心脏事件、LVEF、室壁运动异常和住院死亡病例方面差异有统计学意义(P＜0.05),A组患者心肌水平有效再灌注明显好于B组.结论 急性心肌梗死经急诊PCI再通后心电图ST段回落程度可以预示心肌水平有效再灌注,井进一步指导临床治疗.     

影响急性心肌梗死急诊PCI后心电图ST段恢复的相关因素分析

目的分析影响急性心肌梗死急诊经皮冠状动脉介入治疗（PCI）后心电图ST段恢复的相关因素。方法患者行急诊PCI术后1h和术前患者的18导联心电图（ECG），测量并比较急诊PC／前后梗死相关导联最大ST段抬高幅度。按抬高的ST段下降幅度分为：A组，卯段下降≥50％；B组，ST段下降〈50％。分析患者相关临床资料与ST段下降之间的关系。结果2组患者性别、年龄未见明显差异；在糖尿病、梗死前心绞痛、梗死部位、Killips心功能分级、Q波计数、发病至急诊时间方面有显著差异；而在急诊至球囊开通时间以及梗死血管直径方面无显著差异。结论急性心肌梗死经急诊PCI术后心电图ST段恢复程度与糖尿病、梗死前心绞痛、梗死部位、Killips心功能分级、Q波计数、发病至急诊时间等有关，它们可能是影响ST段恢复的因素。     

急性心肌梗死冠状动脉介入治疗后心电图ST段回落与心肌组织灌注的观察

目的探讨急性心肌梗死急诊经皮冠状动脉介入治疗(PCI)再通后心电图ST段下降幅度与心肌组织灌注的关系。方法将PCI再通后1小时的18导联ECG与入院当时ECG比较,分别测定梗死相关导联最大ST段高度,按抬高的ST段下降幅度分为A组:ST段下降≥50%,B组:ST段下降<50%,根据对ST段回落和心肌水平有效再灌注相关临床因素的观察而进行比较。结果两组患者在非致死性心脏事件、LVEF、室壁运动异常和住院死亡病例方面差异有统计学意义(P<0.05),A组患者心肌水平有效再灌注明显好于B组。结论急性心肌梗死经急诊PCI再通后心电图ST段回落程度可以预示心肌水平有效再灌注,井进一步指导临床治疗。     

急性前壁心肌梗死ST段抬高类型与梗死后左室重构的关系

目的 :探讨急性前壁心肌梗死 ST段抬高类型与梗死后左室重构的关系。方法 :用超声心动图和心电图观察、比较急性前壁心肌梗死 ST段弓背向上型 6 2例 (A组 )和 ST段弓背向下型 4 3例 (B组 )患者的左室重构。结果 :A组心肌梗死后 2周和4周时 L VESV、L VEDV、RWMI均比 B组明显增加 (P <0 .0 5或 P <0 .0 1)。结论 :ST段弓背向下型左室重构较 ST段弓背向上型轻 ,其左室重构较轻的原因可能与该组患者在梗死前有较频繁的心绞痛 ,而诱发的心肌缺血预适应和有丰富的侧支循环形成有关。     

急性心肌梗死静脉溶栓后ST段恢复时间对近期预后的预测价值

目的 探讨急性心肌梗死静脉溶栓后ST段恢复时间对近期预后的预测价值.方法 观察接受尿激酶静脉溶栓治疗的急性心肌梗死患者68例,于治疗前后测量ST段,记录ST段下降50%的时间,并于发病后1d、5d、10d测定左室射血分数（LVEF）及梗死相关室壁运动幅度进行对比.结果 急性前壁心肌梗死静脉溶栓治疗后ST段下降50%的时间不同,LVEF及梗死相关室壁运动幅度存在明显差异（P＜0.05）,且随病程进展该差异变大 急性下壁心肌梗死时相关室壁运动幅度有相同的特点,但LVEF无明显差异（P＞0.05）.结论 急性心肌梗死静脉溶栓后ST段恢复时间与LVEF、梗死相关室壁运动幅度有良好的相关性,结合临床资料,可作为预测早期临床预后的重要指标.     

急性心肌梗死合并心律失常60例心电图研究

目的：分析60例急性心肌梗死合并心律失常患者的心电图资料。方法：选择2012年7月至2015年7月期间收治的60例急性心肌梗死合并心律失常患者为此次研究对象,对所有患者进行心电图检测,且根据患者心电图ST段分布情况分为ST段抬高组（A组）和非ST段抬高组（B组）。结果：急性心肌梗死合并室性心律失常时,总死亡率为8.33％,而合并其他心律失常时死亡率为0.00％,同时A组患者死亡率4.17％明显低于B组患者死亡率（16.67％,P＜0.05）。结论：心电图可分辨急性心肌梗死患者心律失常类型,其可使临床治疗方式更具有针对性,从而降低患者死亡率。     

急性心肌梗死经皮腔内冠脉介入治疗后心电图ST段回落不良对临床预后的影响

目的 探讨ST段抬高型急性前壁心肌梗死急诊直接经皮腔内冠状动脉介入治疗(PCI)后,心电图ST段回落(STR)对临床预后的影响.方法 对65例ST段抬高型急性前壁心肌梗死患者进行急诊直接PCI术前、术后1h各记录心电图1次,检测STR情况.PCI术后1 h STR≥50％患者为STR组(46例),STR＜ 50％者为STR不良组(19例),术后1、6、12个月各进行三维彩色超声心动图检查1次,测量患者左室射血分数(LVEF)、左室舒张末径(LVEDd).随访1年,观察患者PCI术后1年内心血管事件发生率.结果 STR不良组1、6、12个月的LVEF值低于STR组(P均＜0.05),LVEDd值大于STR组(P均＜0.05),心血管事件发生率稍高于STR组,但差异无统计学意义(P＞0.05).结论 ST段抬高型急性前壁心肌梗死直接PCI后1h STR不良者预后差、心血管事件发生率较高、左室心功能恢复不良.     

急性前壁心肌梗死患者下壁导联ST变化和左前降支的关系

目的:结合冠状动脉造影(CAG)探讨下壁导联ST变化和左前降支(LAD)形态和梗死位置的关系.方法:78例急性前壁心梗患者,根据入院时心电图下壁导联ST段改变分为2组:A组为下壁导联(Ⅱ、Ⅲ、AVF)ST段抬高组;B组为下壁导联ST段压低组.比较二组临床特点和梗死相关血管(IRCA).结果:IRCA部位A组90.63%为LAD远端,B组80.43%为LAD近端;LAD折返在A组占81.25%,B组中占0%.结论:急性前壁心肌梗死时下壁导联ST段压低提示LAD近端梗死,此组患者急诊PCI术成功率高.急性前壁心肌梗死时ST段抬高提示LAD远端梗死且大部分存在LAD返折.     

ST段抬高恢复时间对预测溶栓治疗后室壁运动的临床意义

目的　探讨ST段抬高恢复时间对预测溶栓治疗后室壁运动的临床意义。方法　将 10 5例患者溶栓治疗后据ST段抬高达到稳定下移 5 0 %的时间分成A组 (ST段抬高达到稳定下移 5 0 %的时间≤ 30分钟 ) ;B组(ST段抬高达到稳定下移 5 0 %的时间 >30分钟而≤ 6 0分钟 ) ;C组 (ST段抬高达到稳定下移 5 0 %的时间 >6 0分而≤ 90分 )。发病后 2周行超声心动图检查 ,观察梗死相关室壁运动幅度。结果　ST段抬高达到稳定下移 5 0 %所需时间不同 ,梗死相关室壁运动幅度存在着差异 ,且随需要时间的延长梗死相关的室壁运动幅度有下降的趋势。结论　溶栓治疗后ST段抬高达到移定下移 5 0 %的时间 ,可作为梗死相关动脉再通及溶栓治疗疗效的无创指标     

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.