合并足溃疡下肢动脉粥样硬化闭塞症患者截肢的影响因素分析

目的：探究下肢动脉粥样硬化闭塞症(PAD)合并足溃疡患者截肢的影响因素。方法：回顾性分析上海市中西医结合医院脉管病诊疗中心2020年1月至2020年12月收治的179例PAD合并足溃疡患者的病例资料,采用单因素、多因素分析筛选潜在因素,采用Keplan - Meier分析探究高危因素与截肢的关系。结果：179例PAD患者在研究期间发生截肢41例,经Logistic回归分析发现,血清白蛋白水平、中性细胞/淋巴细胞比值(NLR)、降脂治疗、溃疡部位是合并足溃疡PAD患者截肢的相关因素(P<0.05);校正年龄、溃疡分级、溃疡面积的影响后,NLR与溃疡部位是截肢的独立影响因素。进一步的Keplan - Meier分析发现,高NLR(>2.00)对合并足溃疡PAD患者截肢的发生具有预测作用。结论：血清白蛋白水平、中性细胞/淋巴细胞比值、降脂治疗、溃疡部位是影响PAD患者足溃疡截肢的相关因素,其中NLR对截肢的发生具有预测价值。     

血磷变异程度对终末期肾病血液透析患者预后的影响及其危险因素分析

目的观察血磷变异程度对终末期肾病血液透析患者生存状况的影响。方法选取2010年6月—2015年6月大连大学附属中山医院肾内科进行血液透析的终末期肾病患者180例作为研究对象,搜集患者的临床资料、检测指标以及临床预后资料根据患者血液透析结果,按照血磷变异系数(CV)的中位数将患者分为高变异组95例(CV≥0.226 mmol/L)和低变异组85例(CV<0.226 mmol/L)。分析血磷变异对终末期肾病血液透析患者预后的影响。结果 180例患者全因死亡43例(23.9%),因心血管病死亡24例(13.3%),高变异组患者的全因病死率28.4%(27/95)高于低变异组18.8%(16/85)(χ~2=2.071,P=0.027)。Logistic回归分析发现,老龄、血磷变异度高、低血清白蛋白是血液透析患者全因死亡的独立危险因素(OR=0.082,95%CI 1.712~4.467;OR=0.323,95%CI1.022~2.137;OR=0.372,95%CI 1.621~13.721)。结论终末期肾病血液透析血磷高变异组患者的全因死亡和心血管死亡的风险明显高于血磷低变异组患者。     

膝骨性关节炎发病主要危险因素的Meta分析

目的： 探讨分析我国膝关节骨性关节炎发生的主要危险因素,并评估其危险度,为预防决策提供依据。 方法：运用Meta分析方法综合国内外1990-2015年关于我国膝骨性关节炎发病危险因素的十二个病例对照研究结果进行统计分析,共计样本量13695例,其中病例数4754例,对照组数8941例,软件采用RevMan5.2,用固定效应模型或随机效应模型合并比值比(OR)值及95％可信区间(CI)进行评价,用漏斗图评估文献的发表偏倚。 结果：各危险因素因素合并比值比分别为：高强度运动(OR=6.79,95%CI：4.74~9.72),经常负重(OR=6.11,95%CI：4.02~9.28),潮湿阴暗环境(OR=5.15,95%CI：2.34~11.31)、盘坐习惯(OR=4.63,95%CI：2.98~7.19),膝关节既往史(OR=3.40,95%CI：3.07~5.21),膝关节外伤史(OR=3.75 ,95%CI：1.09~12.90),绝经(OR=3.16,95%CI：1.02~9.80),女性(OR=2.61,95%CI：2.61~2.62),家族史(OR=1.80,95%CI：1.32~2.45),BMI(OR=1.68,95%CI：1.34~2.10)。 结论：目前影响中国人群膝骨性关节炎发生的主要因素为高强度运动及经常负重,而且潮湿阴暗环境、盘坐习惯、膝关节既往史、膝关节外伤史、绝经、性别、家族史及BMI亦是其发病的危险因素,可为临床上膝骨性关节炎发生的早期预防提供依据。     

中性粒细胞与淋巴细胞比值对重型颅脑损伤预后的预测价值

目的 探索中性粒细胞与淋巴细胞比值（NLR）与重型颅脑损伤（STBI）的关系以及对 STBI 患者短期预后的预测价 值。 方法 选取 STBI 患者（外伤组）与健康体检者（对照组）各 126 例,比较两组 NLR,分析 STBI 患者临床特征与 NLR 的关系, NLR 与 1 周死亡、6 个月死亡和 6 个月神经功能预后不良[格拉斯哥昏迷评分（GCS）1~3 分]的关系及预测价值。 结果 外伤组 NLR 明显高于对照组 （P＜0.01）,NLR 与 STBI 患者受伤时 GCS 呈显著负相关 （r=-5.120,P＜0.01）。NLR 是外伤后 1 周死亡（OR=2.051,95% CI：1.051~4.005）、6 个月 死亡 （OR=2.047,95% CI：1.233~3.397） 和 6 个月 预 后不良 （OR=2.113,95% CI：1.329~3.360）的独立危险因素。NLR 预测外伤后 1 周死亡（AUC=0.807,95%CI：0.727~0.871）、6 个月死亡（AUC=0.813,95% CI：0.734~0.877）和 6 个月预后不良（AUC=0.804,95%CI：0.724~0.869）的价值较大。NLR 与 GCS 对 STBI 预后的预测价值比较,差异无 统计学意义（P ＞0.05）。 结论 STBI 患者 NLR 明显升高,与 STBI 受伤时 GCS 呈负相关;NLR 与 STBI 患者短期死亡和神经功能预 后不良密切相关,具有临床预测价值。     

中性粒细胞/淋巴细胞比值联合C反应蛋白/白蛋白比值对直肠癌术后吻合口瘘的预测价值

摘要：目的 探讨中性粒细胞/淋巴细胞比值 (neutrophil-to-lymphocyte ratio, NLR)联合C-反应蛋白/白蛋白比值(C-reactive protein/albumin ratio, CAR)对直肠癌术后吻合口瘘(Anastomtic leakage, AL)的预测价值。方法 回顾性分析2016年8月- 2020年8月期间就诊于解放军总医院第一医学中心普通外科的187例直肠癌患者的临床资料,根据AL发生与否,分为AL组(27例)和非AL(Non-AL)组(160例), 比较两组不同时间节点的NLR和CAR之间的差异。采用受试者工作特征 (receiver-operating characteristic, ROC)曲线和Logistic回归分析,评价NLR和CAR对AL的预测价值和分析AL的危险因素。结果 AL组的NLR在术后第3、5天显著高于Non-AL组(P＜0.05,P＜0.001),AL组的CAR在术后第5天显著高于Non-AL组(P＜0.001)。ROC曲线分析结果表明：术后第5天的NLR联合术后第5天的CAR预测AL的曲线下面积(area under curve, AUC)大于术后第3、5天的NLR和第5天的CAR单独预测(0.814 vs 0.652,0.746,0.789)。多因素分析显示：饮酒(OR=13.511, 95%CI: 2.772～65.861, P=0.001)、术后第3天(NLR≥5.610, OR=4.924, 95%CI: 1.219～19.888, P=0.025)、术后第5天(NLR≥11.259, OR=36.092, 95%CI: 4.639~280.797, P=0.001)和术后第5天(CAR≥0.245, OR=5.219, 95%CI: 1.683~16.184, P=0.004)可能与AL的发生相关(P＜0.05)。结论 术后第5天NLR联合术后第5天的CAR对直肠癌术后AL的发生具有较准确的预测价值。     

新型口服抗凝剂治疗静脉血栓栓塞有效性及安全性的Meta分析*

目的：评价新型口服抗凝剂治疗静脉血栓栓塞(venous thromboembolism, VTE)的有效性及安全性。方法：通过计算机检索美国国立医学图书馆PubMed/Medline数据库、荷兰ScienceDirect全文数据库、荷兰医学文摘、美国Highwire学术文献数据库、Cochrane图书馆临床随机对照试验资料库、中国知网全文期刊数据库及万方数据库2000年1月—2017年6月发表的评价新型口服抗凝剂治疗VTE有效性及安全性的随机对照临床试验。观察组采用新型口服抗凝剂治疗;对照组采用华法林治疗。观察指标包括复发性VTE发生率、血栓栓塞相关死亡/致命肺栓塞(pulmonary thromboembolism, PTE)发生率、复发性深静脉血栓形成(deep vein thrombosis, DVT)发生率、非致命PTE发生率、全因病死率、大出血发生率及临床相关出血发生率。按照纳入标准筛查文献,由2名研究员提取资料并进行质量评价。采用RevMan 5.1软件进行Meta分析,并进行敏感性检验,采用漏斗图分析纳入文献发表偏倚。结果：共纳入7项研究、29 879例患者,其中接受新型口服抗凝剂治疗14 943例,接受华法林治疗14 936例。与华法林比较,应用新型口服抗凝剂治疗VTE时复发性VTE发生率[优势比(odds ratio, OR)=0.94, 95%可信区间(confidence interval, CI)=0.81~1.11, P=0.47]、血栓栓塞相关死亡/致命PTE发生率(OR=1.00, 95%CI=0.63~1.60, P=0.99)、DVT发生率(OR=0.88, 95%CI=0.72~1.09, P=0.24)、非致命PTE发生率(OR=1.03, 95%CI=0.82~1.30, P=0.81)及全因病死率(OR=0.92, 95%CI=0.76~1.12, P=0.42)差异均无统计学意义;但新型口服抗凝剂治疗VTE时大出血发生率较华法林治疗明显降低(OR=0.61, 95%CI=0.50~0.75, P<0.000 01),临床相关出血发生率也较华法林治疗明显降低(OR=0.67, 95%CI=0.53~0.85, P=0.001)。分别采用固定效应模型与随机效应模型分析时合并效应量无差异。7项研究的效应点大致呈以合并效应量为中心、大体对称分布的倒漏斗型,但研究数量偏少,不能完全排除文献发表偏倚。结论：新型口服抗凝剂与华法林治疗VTE的有效性无明显差异,但在安全性方面,新型口服抗凝剂略占优势。     

妊娠晚期母体血清中性粒/淋巴细胞比值可作为预测与胎盘炎症的指标

目的探讨妊娠晚期母体血清中性粒/淋巴细胞比值（NLR）水平与胎盘炎症反应程度相关性。方法回顾性分析2016年1 月~2016年12月在南方医科大学南方医院妇产科进行常规产前检查并在我院分娩的478例孕妇的临床资料,根据分娩后胎盘 病理结果分为PIR组（238例）和非PIR组（240例）。分别比较两组孕妇晚孕期的几种血清炎症指标（外周血白细胞、中性粒细胞 数、淋巴细胞数、CRP、NLR）水平与胎盘炎症相关性进行比较,并利用多因素logistic回归分析确定胎盘炎症反应发生独立危险 因素,建立logistic回归模型,绘制模型受试者工作特征曲线（ROC）,并记录曲线下面积以分析晚孕期不同血清炎症指标预测 PIR发生的临床价值。结果外周血白细胞、中性粒细胞数、淋巴细胞数、CRP、NLR预测PIR的曲线下面积分别为0.698（95% CI：0.485~0.766）、0.716（95%CI：0.453~0.783）、0.329（95%CI：0.228~0.431）、0.725(95%CI：0.677~0.765）和0.801（95%CI： 0.742~0.856）。校正混杂因素后,多因素logistic 回归分析显示,孕妇早产（OR=2.446,95%CI：1.003~4.590）、胎膜早破（OR= 2.304,95%CI：1.049~4.161）、NLR>7（OR=3.268,95%CI：2.071~6.920）、CRP>15 mg/L（OR=2.137,95%CI：1.412~8.236）均为PIR 发生的独立危险因素。结论晚孕期NLR增高可作为预测胎盘炎症发生风险的一项有效指标。     

术前外周血中性粒细胞淋巴细胞比值对Ⅰ-Ⅲ期非小细胞肺癌患者预后的影响

目的:探讨术前外周血中性粒细胞计数与淋巴细胞计数比值(NLR)对非小细胞肺癌(NSCLC)患者预后的影响。方法:收集行根治性手术切除的Ⅰ-Ⅲ期非小细胞肺癌患者136例。应用ROC曲线分析确定对患者生存结局有预测意义的最佳NLR值,以此值为界限划分为NLR高组及NLR低组,应用COX比例风险回归模型进一步行多因素分析以验证NLR是否为Ⅰ-Ⅲ期非小细胞肺癌患者的独立预后因素;如果为其独立预后因素,应用Kaplan-Meier计算总生存时间(OS)及无疾病生存时间(DFS),应用Log-rank法对比NLR高组与NLR低组两组患者的生存差异是否有统计学意义。结果:NLR对患者死亡的预测有意义的最佳值为2.98,AUC=0.721,95%CI:0.627～0.815,P=0.000。将136例分为NLR≤2.98和NLR>2.98两组。术前NLR为Ⅰ-Ⅲ期非小细胞肺癌患者的独立风险因素,RR 1.315,95%CI(1.083～1.659),P=0.044。低NLR组中位OS 52个月,95%CI(41.0～62.9),高NLR组中位OS 41个月,95%CI(30.04～51.96),P=0.021;低NLR组中位DFS 26个月,95%CI(13.36～38.64),高NLR组中位DFS 15个月,95%CI(7.85～22.15),P=0.009。结论:术前NLR可能是Ⅰ-Ⅲ期可手术患者的独立不良预后因素;术前高NLR可能预示较短的总生存时间及较早复发。     

衰弱对社区老年人骨折预测作用的系统评价

目的:确定衰弱与社区老年人骨折的相关性,作为社区老年人骨折的预测指标。方法:使用Embase(OVID)、Pubmed、Cochrane Library、Wan Fang、CNKI和VIP数据库进行全面检索,搜索2000年1月至2019年1月发表的衰弱与骨折风险之间关系的前瞻性队列研究。两位研究人员独立从文献中提取数据优势比(OR)、风险比(RR)和危险比(HR),采用STATA统计学软件进行分析。结果:最终纳入7项研究,共97640例社区老年人。以OR为指标的研究异质性检验(I~2=79.5%,P=0.000),随机效应模型合并后,衰弱增加骨折的风险[OR=1.722,95%CI(1.222～2.426),P=0.002];异质性检验(I~2=39%,P=0.194),固定效应模型合并后,衰弱前期不能增加社区老年人骨折的风险[OR=1.178,95%CI(0.972～1.429),P=0.094]。以HR为指标的研究,异质性检验(I~2=64%,P=0.095),随机效应模型合并后,衰弱增加骨折的风险[OR=1.529,95%CI(0.837～2.221),P=0.000],异质性检验(I~2=41.9%,P=0.190),固定效应模型合并后,衰弱前期增加社区老年人骨折的风险[OR=1.063,95%CI(0.789～1.338),P=0.000]。结论:系统评价表明,衰弱是社区老年人骨折的预测因子,衰弱前期与骨折的关系需进一步验证。     

糖尿病与血液透析患者心血管预后的关系

目的探讨糖尿病（diabetes mellitus, DM）对维持性血液透析（maintenance hemodialysis, MHD）患者全因、心血管死亡和非致死性心血管事件的影响。方法选取2015年4月1日—2015年9月1日在上海市浦东新区人民医院、上海市浦东医院接受规律血液透析的患者为研究对象,所有患者均随访至死亡、失访或至本研究截止日期,收集期间患者心血管不良事件及死亡原因。采用Cox回归模型分析DM与死亡、心血管预后的关系,结果采用风险比例（hazard ratios, HR）及95%可信区间（confidence intervals, CI）表示。结果最终367例MHD患者入选,DM组118例,非DM组249例。随访期间共87（23.7%）例患者死亡,其中合并DM患者死亡45例、心血管死亡27例及非致死性心血管事件64例。Kaplan-Meier生存分析显示DM组的全因、心血管死亡率及非致死性心血管事件发生率明显高于非DM组（均P<0.001）。多因素Cox回归分析显示,合并DM是全因死亡（HR=1.74,95%CI: 1.06~2.88）、心血管死亡（HR=2.17,95%CI: 1.01~4.64）、非致死性心血管事件（HR=1.72,95%CI: 1.19~2.48）的独立危险因素。MHD患者中全因死亡（HR=0.92,95%CI: 0.86~0.98）及心血管死亡（HR=0.90,95%CI: 0.82~0.98）风险与血浆白蛋白水平有关。结论合并DM是MHD患者全因、心血管死亡和非致死性心血管事件的独立危险因素,降低DM发病率可能改善MHD患者预后。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.