补肾活血法对LPD复发性流产患者临床症状及妊娠结局的影响研究

目的观察补肾活血法对黄体功能不全(LPD)复发性流产患者临床症状及妊娠结局的影响。方法选择我院2016年8月～2018年7月收治的LPD复发性流产患者60例为本次研究对象,根据随机数字奇偶法分为单号30例为对照组,双号30例为观察组。对照组采取常规西药治疗,观察组采用补肾活血法治疗;对比两组患者临床症状改善情况及妊娠结局。结果中医证候疗效:对照组总有效率为73.33%,观察组总有效率为93.33%,两组差异有统计学意义(P0.05);中医症状积分:两组治疗前症状积分比较无统计学意义(P0.05),观察组治疗后症状积分与对照组比较,差异有统计学意义(P0.05);妊娠结局:对照组成功分娩率为70.00%,观察组成功分娩率为93.33%,两组比较差异有统计学意义(P0.05)。结论补肾活血法治疗LPD复发性流产患者能够显著改善其临床症状及妊娠结局,临床值得应用与推广。     

补肾活血法孕前治疗LPD复发性流产患者的临床疗效

目的探讨补肾活血法孕前治疗黄体功能不全(luteal phase defect,LPD)复发性流产患者,观察其对妊娠结局的改善情况。方法按照诊断标准纳入57例LPD复发性流产患者,并随机分为治疗组和对照组,治疗组予补肾活血法治疗3个月,妊娠后再予益肾安胎法保胎治疗,对照组于妊娠后予益肾安胎治疗。采用化学发光法检测血清激素指标(E_2、P、β-HCG),同时采用ELISA法检测血清Kisspeptin水平,并电话随访妊娠结局;比较治疗前后中医症状评分、血清激素及Kisspeptin指标、妊娠结局情况、安全性。结果两组患者治疗后中医症状积分、妊娠激素水平(E_2、P、β-HCG)、Kisspeptin水平、妊娠结局比较,差异有统计学意义(P0.05),两组患者均无严重不良反应。结论补肾活血法孕前治疗LPD复发性流产能显著改善其临床症状,调节妊娠激素及Kisspeptin水平,健全黄体功能,从而有效改善妊娠结局。     

补肾活血法联合低分子肝素治疗血栓前状态复发性流产的临床观察

目的探讨补肾活血法联合低分子肝素治疗血栓前状态复发性流产的临床疗效。方法 选取2018 年1～12 月杭州市中医院治疗的血栓前状态复发性流产早期妊娠患者60 例,随机分为对照组（30 例）和治疗组（30 例）,对照组采用低分子肝素保胎治疗,治疗组在对照组基础上加用补肾活血中药治疗,两组均保胎至孕12 周。观察两组患者治疗效果、凝血-纤溶相关指标、子宫动脉血流RI 值,随访两组患者妊娠结局。结果 治疗后治疗组总有效率为93.3%,高于对照组的70.0%,差异有统计学意义（P＜0.05）;两组治疗后纤维蛋白原（Fib）、血浆D-二聚体较治疗前显著降低,凝血酶原时间（PT）较治疗前显著升高,子宫动脉血流RI 值较治疗前显著下降,差异有统计学意义（P＜0.05）。治疗后治疗组Fib、D-二聚体、子宫动脉血流RI 值显著低于对照组,PT 显著高于对照组,差异有统计学意义（P＜0.05）。随访两组患者共分娩45 例,其中治疗组26 例,妊娠成功率为86.7%;对照组19 例,妊娠成功率63.3%,两组比较差异有统计学意义（P＜0.05）。结论 补肾活血法联合低分子肝素治疗,可有效改善复发性流产患者的血液高凝状态,改善妊娠结局,安全有效。     

补肾活血法治疗复发性流产的临床观察

[目的]观察比较基于补肾活血法的自拟补肾活血方与达芙通治疗对复发性流产患者妊娠结局的不同影响。[方法]选择符合本研究诊断、纳入标准的病人200例,随机分为2组,即治疗组100例和对照组100例。治疗组予自拟补肾活血方治疗,对照组采用达芙通治疗,观察比较两组的妊娠12周通过率和妊娠结局。[结果]治疗组妊娠12周通过83例,成功分娩80例,12周妊娠通过率87%,成功分娩率84.2%;对照组妊娠12周通过70例,成功分娩66例,12周妊娠通过率75%,成功分娩率71.0%。治疗组12周妊娠通过率及成功分娩率优于对照组,差异具有统计学意义(P0.05)。[结论]与达芙通相比,基于补肾活血法的自拟补肾活血方治疗复发性流产的12周妊娠通过率及妊娠结局均更优,值得进一步研究。     

补肾活血方联合低分子肝素钠治疗肾虚血瘀型抗磷脂抗体阳性复发性流产

目的:观察补肾活血方联合低分子肝素钠治疗肾虚血瘀型抗磷脂抗体阳性复发性流产患者的临床疗效。方法:60例肾虚血瘀型抗磷脂抗体阳性复发性流产患者随机分为观察组30例和对照组30例。对照组患者给予低分子肝素钠,观察组患者在对照组治疗基础上给予补肾活血方。比较两组患者临床疗效、中医证候积分、中医证候疗效、抗磷脂抗体转阴率、活产率及不良反应。结果:观察组临床疗效的有效率为93.33%,对照组为80.00%,两组有效率比较,差异有统计学意义(P0.05)。两组患者治疗后中医证候积分显著低于治疗前,差异有统计学意义(P0.05);观察组治疗后证候积分显著低于同期对照组(P0.05)。观察组中医证候疗效的有效率为90.00%,对照组为76.67%,两组有效率比较,差异有统计学意义(P0.01)。观察组抗磷脂抗体转阴率为96.67%,对照组为83.33%,两组比较,差异有统计学意义(P0.05)。观察组活产率为90.00%,对照组为76.67%,两组比较,差异有统计学意义(P0.01)。两组不良反应发生率比较,差异无统计学意义(P0.05)。结论:补肾活血方联合低分子肝素钠治疗肾虚血瘀型抗磷脂抗体阳性复发性流产疗效显著,可降低中医证候积分,提高中医证候疗效、抗磷脂抗体转阴率及活产率。     

益肾化瘀方治疗不明原因复发性流产的临床研究

目的 观察中药益肾化瘀方治疗不明原因复发性流产患者的临床疗效,及对血清D-二聚体水平、血小板聚集率（PAR）、子宫动脉阻力指数（RI）及妊娠结局的影响。方法 入组82例不明原因复发性流产患者,随机分为对照组41例和治疗组41例。对照组采用皮下注射低分子肝素钠联合口服阿司匹林治疗,治疗组在对照组基础上加服益肾化瘀方,观察2组患者治疗前后中医证候积分的变化,血浆D-二聚体水平、PAR、RI的变化,孕4周和孕8周的血清β-HCG水平及妊娠结局。结果 治疗后治疗组临床有效率高于对照组,差异有统计学意义（P＜0.05);中医证候积分较治疗前均下降（P<0.05~0.01）,治疗组优于对照组（P＜0.05）:2组患者治疗后PAR、RI、孕8周血清β-HCG水平差异有统计学意义（P＜0.05）;D-二聚体水平、孕4周血清β-HCG水平比较差异无统计学意义（P>0.05）;治疗组继续妊娠率高于对照组（P<0.05）。结论 益肾化瘀方联合西药能降低不明原因复发性流产患者的D-二聚体水平、PAR、RI,改善胎盘血流灌注,从而提高再次妊娠率。      

系统化管理干预辅助补肾活血法用于黄体功能不全性复发性流产的效果

目的探讨系统化管理F预辅助补肾活血法用于黄体功能不全(LPD)性复发性流产的效果。方法选取2016年1月至2017年1月浙江省丽水市中医院妇产科门诊治疗的IPD性复发性流产患者84例,采用随机数字表法分为联合组与对照组,每组各42例。对照组患者予补肾活血法治疗,联合组患者在对照组基础上加系统化管理干预,两组患者疗程为3个月经周期。比较两组患者治疗前后性激素[卵泡刺激素(FSH)和雌二醇(E)]水平和子宫内膜厚度的变化,并比较其临床疗效及2年内成功分娩率。结果治疗3个月经周期后,两组患者血清FSH和E.水平明显上升,子宫内膜厚度明显增厚(P<0.05或P<0.01),且联合组患者变化幅度与对照组比较更明显(P<0.05);同时联合组患者临床总有效率(95.24% )明显高于对照组(80.95%) ,差异有统计学意义(x24.090,P<0.05)。随访2年,联合组患者的分娩成功率为47.62%(20142).明显高于对照组的2.196/1142)(x"=4.141,P<0.05)。结论系统化管理F预辅助补肾活血法治疗LPD性复发性流产患者的疗效确切,可增加子宫内膜厚度,使成功分娩率明显提高,其作用机制与促进性激素FSH和E的分泌密切相关。     

补肾活血法治疗肝肾亏虚型后循环缺血性眩晕的疗效观察

【】：目的 观察李师自拟补肾活血汤配合盐酸氟桂利嗪胶囊治疗肝肾亏虚型后循环缺血性眩晕的临床疗效。方法 将90例患者随机分两组。观察组45例,采用补肾活血汤配合盐酸氟桂利嗪胶囊治疗;对照组45例,采用盐酸氟桂利嗪胶囊治疗。共治疗21天为一个疗程。结果 观察组缓解临床症状总有效率为93.33％,对照组总有效率为75.55％,两组比较差异有统计学意义(P＜0.05);观察组治疗后血液流变学指标有改善(P＜0.05);椎基底动脉血流速度增快(P＜0.05);中医证候积分较对照组下降(P＜0.05),无明显不良反应。结论 补肾活血汤配合盐酸氟桂利嗪胶囊治疗肝肾亏虚型后循环缺血性眩晕有较好疗效。     

补肾化瘀法治疗血栓前状态所致复发性流产临床疗效观察

目的探讨补肾化瘀法治疗血栓前状态所致复发性流产临床疗效。方法选取2018年8月—2018年12月我院收治血栓前状态所致复发性流产患者58例,依据随机数字表法随机分为对照组和治疗组,各29例,对照组给予基础黄体支持治疗,加予低分子肝素治疗,治疗组在此基础上应用补肾化瘀法进行治疗,两组患者进行为期28 d的治疗。观察两组患者治疗前后中医症状积分与凝血功能改善情况,并比较两组患者孕12周胚胎存活率及临床疗效。结果治疗组患者中医症状积分降低较对照组更为明显,结果差异具有统计学意义(P0.05);两组治疗前后凝血功能相关指标D-二聚体、纤维蛋白原均明显改善(P0.05),且治疗组较对照组改善更显著(P0.05);对照组孕12周胚胎存活率为62.07%,治疗组孕12周胚胎存活率为82.76%,治疗组存活率更高(P0.05);治疗后,治疗组临床总有效率为89.66%,对照组临床总有效率为72.41%,治疗组的临床疗效优于对照组(P0.05)。结论补肾化瘀法具有活血通经、化瘀止痛、补益肾气之效,可以改善血栓前状态所致复发性流产患者临床症状和体征,改善凝血功能,提高孕12周胚胎存活率,对于血栓前状态所致复发性流产有较好的治疗效果,值得临床推广应用。     

补肾活血法对自然流产血栓前状态早期干预研究

目的 观察补肾活血法对自然流产血栓前状态的临床疗效。方法 将50例自然流产血栓前状态患者随机分为治疗组和对照组,每组25例。对照组口服阿司匹林肠溶片治疗,治疗组在对照组治疗基础上服用补肾活血中药。观察治疗前后患者血清D-二聚体（D-dimer, D-D）、纤维蛋白降解产物（fibrinogen degradation product, FDP）水平、凝血功能相关实验室指标,并对患者妊娠结局进行评价。结果 与治疗前比较,两组治疗后FDP、纤维蛋白原（fibrinogen, Fib）显著降低（P<0.05）,活化部分凝血活酶时间（activated partial thromboplastin time,APTT）、凝血酶时间（thrombin time,TT）均显著延长（P<0.05）。治疗组Fib降低值和TT升高值显著大于对照组（P<0.05）。对照组治疗后19例妊娠,成功妊娠11例,妊娠成功率为57.9%;治疗组妊娠20例,成功妊娠18例,妊娠成功率为90.0%。两组妊娠成功率比较,差异有统计学意义（P＜0.05）。结论 补肾活血法协同阿司匹林能明显改善自然流产血栓前状态,提高患者妊娠成功率。     

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.