肺癌与人类巨细胞病毒感染关系的初步研究

目的：探讨肺癌与人类巨细胞病毒（HCMV）感染的关系。方法：对88例肺癌及117例肺非癌患者，用酶联免疫吸附试验（ELISA）法检测血清HCMV－IgG，IgM抗体，用聚合酶链反应（PCR）法检测尿HCMV－DNA。同时检测其中64例肺癌及67例肺非癌患者的病灶局部冲洗或支气管肺泡灌洗回收液HCMV－DNA。对肺癌组中抗癌化疗的患者于每一化疗周期复查血清HCMV－IgM，尿HCMV－DNA。结果：肺癌组血清HCMV－IgM阳性率26．1％，病灶局部冲洗或支气管肺泡灌洗回收液HCMV－DNA阳性率26．6％，均显著高于肺非癌组（P＜0．01）；血清HCMV－IgG及尿HCMV－DNA阳性率两组未见明显差别。42例肺癌到化疗第二周期时，血清HCMV－IgM16例由阴性转阳性，尿HCMV－DNA6例转阳性。结论：肺病与HCMV感染有统计学上的相关性；抗癌化疗使肺癌患者HCMV活动性感染明显增多，值得重视。     

143例巨细胞病毒感染婴幼儿的肝肾功能观察

目的探讨人巨细胞病毒（humail cytomegalovirus,HCMV）感染对婴幼儿肝肾功能的影响。方法回顾性分析143例HCMV感染的婴幼儿的肝肾功能指标,并与对照组比较,实验数据采用SPSS15．0统计软件处理并进行分析。结果观察组肝肾功能指标丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、r-谷氨酰转移酶（GCT）、血肌酐（Scr）均高于对照组,差异均有统计学意义（P值=0．000—0．05）。肝功能异常发生率为76．22％,肾功能异常发生率为6．99％。结论婴幼儿HCMV感染时多数存在肝功能损害,部分存在肾功能损害,诊治时应注意监测和保护肝肾功能。     

荧光定量聚合酶链反应与免疫印迹法检测人巨细胞病毒

目的比较荧光定量聚合酶链反应（FQ-PCR）与免疫印迹法（IBT）检测人巨细胞病毒效果。方法分别应用FQ-PCR和IBT检测疑似人巨细胞病毒（HCMV）感染小儿和成人各42例尿HCMV DNA和血清HCMV IgM。结果 42例疑似人巨细胞病毒感染小儿尿HCMV DNA阳性检出率为57.14%,血HCMV IgM阳性检出率为35.71%。前者的诊断阳性率高于后者,差异有统计学意义（χ^2=3.88,P〈0.05）;42例成人尿HCMV DNA阳性检出率为14.29%,血HCMV IgM阳性检出率为71.43%。后者的诊断阳性率显著高于前者,差异有统计学意义（χ^2=28,P〈0.005）;84例患者尿HCMV DNA阳性检出率38.10%,血HCMV IgM阳性检出率48.81%。2种方法检测HCMV活动性感染的差异无统计学意义（χ^2=1.96,P〉0.1）。结论 FQ-PCR检测HCMV DNA是早期诊断小儿HCMV感染的有效的方法;免疫印迹法检测血清HCMV IgM水平对于判断成人HCMV活动性感染具有一定意义;做人群HCMV普查时,免疫印迹法有较好的应用价值。     

人巨细胞病毒UL133基因型在婴幼儿肝功能损伤中的分子机制

目的探索人巨细胞病毒（HCMV）UL133基因型对婴幼儿肝功能损伤的分子机制。方法选择收治入院的68例HCMV肝炎患儿和66例同期门诊体检肝功能正常且确诊为HCMV感染的患儿为研究对象。其中UL133基因型筛查阳性的66例肝炎患儿为UL133阳性组,UL133基因型筛查阴性的64例体检患儿为UL133阴性组。检测并比较患儿尿液中HCMVUL133基因型,血液中Caspase-3、Caspase-6蛋白表达水平及肝功能指标。结果肝炎患儿尿液中UL133基因型筛查阳性率达94.1%,明显高于体检患儿的3.0%（P＜0.05）。UL133阳性组患儿血液中ALT、Caspase-3、Caspase-6蛋白表达水平均明显高于UL133阴性组（P＜0.05）。两组患儿血AST、TBiL、DBiL、谷氨酰转移酶（GGT）比较差异均无统计学意义（均P＞0.05）。结论携带有UL133基因型的HCMV感染婴幼儿后,可能通过诱导Caspase-3、Caspase-6蛋白表达上调,导致肝功能损伤。     

婴幼儿肝炎综合征血清总胆汁酸的表达和意义

目的研究血清总汁酸（TBA）在婴幼儿肝炎综合征中的表达及其临床意义。方法采用全自动生化分析技术，测定肝炎综合征患儿84例（感染组）与非肝胆疾病患儿45例（对照组）的TBA水平，并进行比较，其将感染组的TBA表达水平进行比较。结果对照组的TBA表达明显低于感染组的TBA，两组比较差异有统计学意义（P〈0．01），而与丙氨酸氨基转移酶（ALT）有显著相关性（P〈0．01），且TBA的阳性率高于谷氨酸氨基转移酶（ALT）的阳性率（P〈0．05）。结论血清TBA的表达在反映肝功能损伤方面是一个敏感的指标，对婴幼儿肝炎综合征患儿的早期诊断、治疗、改善预后有重要临床意义。     

母乳人巨细胞病毒定量检测在婴儿巨细胞病毒肝炎中的应用

目的了解母乳人巨细胞病毒（HCMV）感染状况及HCMV通过母乳对婴儿的传播情况。方法应用荧光定量聚合酶链反应（FQ-PCR）方法分别检测156份母乳和与其配对确诊或疑诊HCMV肝炎患儿尿液中HC-MV-DNA含量。结果确诊或疑诊HCMV肝炎患儿母亲母乳HCMV-DNA阳性率为72.44%;尿HCMV-DNA阳性母乳喂养的婴儿HCMV-DNA阳性率为72.57%,明显高于HCMV-DNA阴性母乳喂养的婴儿（48.84%）（P〈0.01）。结论HCMV感染母乳是婴儿后天获得性HCMV感染的重要途径。     

婴儿巨细胞病毒肝炎肝纤维化血清标志物检测及其临床意义

目的探讨肝纤维化血清标志物在巨细胞病毒（CMV）肝炎患儿中的动态变化和临床诊疗价值。方法收集47例婴儿肝炎综合征（IHS）患儿及33例健康婴儿的血清标本,采用全自动生化分析仪检测丙氨酸氨基转肽酶（ALT）、天冬氨酸氨基转肽酶（AST）、γ-谷氨酰转肽酶（GGT）、总胆红素（TBIL）、直接胆红素（DBIL）水平,采用化学发光法检测肝纤维化血清标志物透明质酸（HA）、层粘连蛋白（LN）、Ⅲ型前胶原氨基末端肽（PⅢNP）、Ⅳ型前胶原（ⅣC）水平。结果IHS组肝功能指标（ALT、AST、GGT、TBIL、DBIL）水平明显高于对照组（P〈0．01）,血清肝纤维化指标（HA、LN、PⅢNP、IVC）水平也明显高于对照组（P〈0．01）。CMV组与非CMV组患儿LN水平比较差异有显著性意义（P〈0．05）,GGT、TBIL、DBIL、HA、PIIINP、IVC水平比较差异有也高度显著性意义（P〈0．01）。结论IHS患儿存在一定的肝纤维化征象,而CMV感染引起的IHS患儿,其肝纤维化改变更为突出。     

EB病毒感染与婴儿肝炎综合征的临床研究

目的探讨EB病毒(EBV)感染在婴儿肝炎综合征(IHS)发病中的作用。方法选取45例HIS患儿为研究组,40例健康婴儿为对照组。采用ELISA法检测研究组和对照组血清EBV衣壳抗原(VCA)IgM抗体,采用PCR法检测研究组和对照组外周血单核细胞及咽分泌物中的EBV DNA,并进行比较分析。结果研究组45例患儿中有7例血清VCA-IgM抗体阳性,阳性率为15·6%;对照组40例婴儿血清VCA-IgM抗体均为阴性,两者间差异有统计学意义(P<0·05);研究组与对照组的外周血单核细胞EBV DNA的阳性率间差异有统计学意义(P<0·05),咽分泌物EBV DNA的阳性率间差异亦有统计学意义(P<0·01)。结论EBV感染是IHS的重要病因,由EBV感染导致的婴儿肝脏损害应引起临床高度重视。     

巨细胞病毒感染致婴儿肝炎综合征的实验室指标分析

目的 分析巨细胞病毒(CMV)感染致婴儿肝炎综合征(IHS)患儿血氨水平与肝功能指标之间的相关性,探讨血氨水平对评估CMV感染致IHS病情的临床价值。 方法 选取130例IHS患儿作为研究组,同期选取健康体检的130例婴儿作为对照组。采用化学发光法测定两组婴儿血清CMV-IgM水平,采用荧光定量PCR测定尿HCMV-DNA; 采用全自动生化分析仪检测52例CMV感染致IHS患儿的血氨及肝功能指标,并分析血氨与肝功能水平的相关性。随访12月,观察CMV感染与治疗后复发率的关系。 结果 研究组的血清CMV-IgM阳性率为36.15%,尿HCMV-DNA阳性率为40.0%,均显著高于对照组(P<0.001)。CMV感染致IHS患儿中不同血氨水平亚组各肝功能指标比较,差别均无统计学意义(P>0.05); 相关分析显示,CMV感染致IHS患儿血氨水平与各肝功能指标均无相关性(P均>0.05),而与血清白蛋白(ALB)呈负相关(Pearson相关系数为-0.594,P<0.001)。CMV感染阴性的IHS复发率为3.85%,明显低于CMV感染阳性患儿的11.54%(χ²=5.686, P=0.017)。 结论 血氨水平联合血清ALB可以反映CMV感染致IHS患儿的病情变化,有助于CMV感染致IHS的早期诊断和治疗。     

EBV感染与婴儿肝炎综合征相关分析

目的为探讨婴儿肝炎综合征EB病毒（EBV）感染的相关性。方法采用实时荧光定量PCR技术检测80例婴肝患儿外周血EBV-DNA的拷贝数。采用PCR-Southern方法检测患儿咽分泌物EBV DNA;酶联免疫吸附法（ELISA）检测80例婴肝患儿血清EBV VCA-IgM。结果 80例患儿血标本EBV DNA阳性率为20.0%（16/80）,40例正常对照儿童有1例外周血EBV DNA阳性,阳性率为2.5%,婴肝患儿组外周血EBV DNA阳性率明显高于对照组,差异有显著性（P〈0.05）。80例患儿咽分泌物标本EBV DNA阳性率为31.25%（25/80）,40例正常对照儿童有1例咽分泌物EBV DNA阳性,阳性率为2.5%（1/40）,患儿组咽分泌物EBV-DNA阳性率也明显高于对照组,差异有显著性（P〈0.01）。80例患儿血EBV VCA-IgM阳性率为11.25%（9/80）,40例正常对照儿童EBV VCA-IgM检测结果均为阴性,统计学分析表明,差异无显著性（P=0.066）。结论 EBV感染是婴儿肝炎综合征的致病因子之一,临床对年龄较小伴肝功能损害的患儿,在排除巨细胞病毒、乙肝病毒感染后,应考虑EBV感染的可能。     

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.