78例顽固性良性阵发性位置性眩晕诊疗体会

目的研究分析顽固性良性阵发性位置性眩晕临床诊治方法及其效果。方法针对本院2013年内6月至2015年7月间收治入院的78例顽固性良性阵发性位置性眩晕患者进行观察分析,回顾性分析本组患者临床病例资料。结果顽固性良性阵发性位置性眩晕临床可结合患者的临床症状以及眼震分析综合诊断。本组患者中经过耳石复位法治疗4次者41例,5次者20例,6次者11例,且有6例经过反复多次治疗后均未治愈,最终通过Brandt-daroff习服疗法治疗后,得到显著改善。结论绝大多数顽固性良性阵发性位置性眩晕患者通过耳石复位法均可痊愈,少部分治疗无效的患者最终可采用Brandt-daroff习服疗法,其能够缓解患者的症状。     

耳石复位联合药物治疗对老年人良性阵发性位置性眩晕的临床疗效

目的根据老年人良性阵发性位置性眩晕这一病症,分析探究耳石复位联合药物治疗的临床疗效。方法选取该院2010年5月‐2015年5月治疗老年人良性阵发性位置性眩晕患者89例,按照住院时间顺序依次编号,前44例患者给予单纯耳石复位治疗,设为对照组;后45例患者给予耳石复位联合药物治疗,设为试验组。比较两组患者治疗前后的临床疗效及不良反应发生情况。结果两组患者经过系统治疗后,临床症状基本得到改善。试验组患者临床总有效率明显高于对照组患者临床总有效率(P0.05);试验组患者总并发症发生率明显低于对照组患者总并发症发生率(P0.05)。结论对老年人良性阵发性位置性眩晕患者运用耳石复位联合药物治疗有较好的的临床效果,患者眩晕症状减轻,预后恢复较好,临床效果更佳。     

耳石复位转椅治疗300例BPPV患者的临床疗效分析

目的分析耳石复位转椅(TRV耳石治疗仪)对300例良性阵发性位置性眩晕(BPPV)患者进行耳石复位治疗的临床疗效。方法对300例BPPV患者进行耳石复位转椅治疗,于一周和一个月后复查,并对病例数据的临床疗效进行统计分析。结果 300例患者进行耳石复位转椅治疗后症状明显改善,首次治疗痊愈138例、有效160例、无效2例,有效率为99.33%;一周后复查痊愈262例、有效37例、无效1例,有效率为99.67%;一个月后复查痊愈273例、有效26例、无效1例,有效率为99.67%,复发率为2.33%。结论对于初诊为良性阵发性位置性眩晕的患者,通过耳石复位转椅治疗有效率高,复发率低。     

难治性良性阵发性位置性眩晕的诊疗体会

目的总结难治性良性阵发性位置性眩晕(BPPV)的诊疗体会。方法回顾分析我院神经内科2008年1月-2012年12月收治的53例难治性BPPV患者全部临床资料。结果有29例、13例、7例患者分别经过4次、5次、6次耳石复位法治疗痊愈,另有4例患者无法通过耳石复位法痊愈,后经过Brandt-daroff习服疗法取得改善疗效。结论绝大部分BPPV经耳石复位法治疗可获得痊愈,其难治性原因为多方面,最终无法通过耳石复位法治疗痊愈时,宜采用Brandt-daroff习服疗法缓解症状。     

良性阵发性位置性眩晕临床分析

目的探讨不同类型良性阵发性位置性眩晕的临床特征和治疗效果。方法对2010年1月-2012年1月来我院治疗的200名良性阵发性位置性眩晕患者进行回顾性分析,根据不同患者的类型采用不同的耳石复位技术治疗,观察治疗后的效果。结果上半规管患者15例,占7.5%,采用Epley耳石复位法治疗;水平半规管患者41例,占20.5%,采用Barbecue翻滚耳石复位法治疗;下半规管患者134例,占67.0%,采用Epley耳石复位法治疗;混合型患者占10例,占5.0%,采用Epley加Barbecue翻滚耳石复位法联合治疗。2周后随访总有效率为80.5%,5个月后随访总有效率为90.5%。结论根据患者的病史,对不同类型的良性阵发性位置性眩晕患者采用不同的耳石复位技术治疗,能够有效的治疗患者的病情,可在临床上大力推广。     

耳石复位法治疗良性发作性位置性眩晕

目的:探讨良性阵发性位置性眩晕(BPPV)的临床特点和耳石复位法治疗的效果。方法:回顾分析17例BPPV患者临床资料及耳石复位治疗的疗效。结果:本组17例,应用Epley、semont、Barbecue三种复位手法对患者进行耳石复位治疗,在2周内痊愈,改善15例,有效率81.2%。结论:耳石复位治疗BPPV有效、简便、安全,可作为首选治疗方法 .     

耳石复位法治疗良性阵发性位置性眩晕病人的临床研究进展

良性阵发性位置性眩晕症又称为变为性眩晕,其是临床常见的周围性眩晕,主要表现为头部某些特定动作之后出现短暂阵发性发作的眩晕及眼震。该病的发病率较高,约占16%-20%。目前临床多采用半规管耳石复位法治疗本病,具有操作简单、无创、经济实惠的优点,被越来越多的患者所接受。由此,本文对良性阵发性位置性眩晕病人采取耳石复位法治疗的临床研究进展进行综述。     

后半规管良性阵发性位置性眩晕46例手法复位治疗

目的:对后半规管良性阵发性位置性眩晕进行手法复位治疗,观察手法复位治疗的效果。方法:对46例后半规管良性阵发性位置性眩晕进行改良Epley手法复位治疗,效果不佳者再行Semont手法复位。结果:经1次改良Epley手法治疗,首次治疗成功率为76.1%。眩晕无明显改善的3例患者进一步行Semont手法复位,眩晕缓解。两种手法复位总治疗有效成功率为95.7%。另2例患者症状始终无明显缓解,无效率为4.3%,可能为非耳石因素引起的眩晕。随访1年,4例复发,复发率9.1%,复发者再行手法复位治疗仍有效。结论:改良Epley手法复位及Semont手法复位,对于后半规管良性阵发性位置性眩晕患者疗效肯定,短期复发率低,可为治疗后半规管位置性眩晕首选的方法。     

反向Semont耳石复位法治疗前半规管良性阵发性位置性眩晕疗效观察

目的：观察反向Semont耳石复位法治疗前半规管良性阵发性位置性眩晕（ AC－BPPV）疗效。方法：对12例AC－BPPV患者使用反向Semont耳石复位法治疗,复发病例重复治疗,观察治疗后1周内及1个月时的疗效。结果：12例患者应用反向Semont耳石复位法进行治疗,首次治疗后症状痊愈5例,改善3例;1周时痊愈8例,改善1例;1个月时痊愈9例,改善1例,1例症状反复治疗无效,1例出现水平半规管良性阵发性位置性眩晕,治疗后痊愈。结论：AC－BPPV临床少见,采用反向Semont耳石复位法治疗AC－BPPV疗效较好,可作为主要治疗方法。     

耳石复位法治疗良性阵发性位置性眩晕的临床研究

目的 探究、分析耳石复位法治疗良性阵发性位置性眩晕的临床效果。方法 此次研究中,随机选取100例良性阵发性位置性眩晕患者作为实验研究对象,均为我院自2015年2月至2015年12月期间所接收,为了保证实验结果的公平性和公正性原则,将患者按照挂号的编号顺序,随机均分成两组,就常规治疗(对照组n=50)与采取耳石复位法治疗(实验组n=50)的临床疗效展开探讨。结果 实验组总有效率为88%,对照组总有效率为60%,实验组显著优于对照组,差异具有统计学意义(P0.05)。结论 采用耳石复位法治疗良性阵发性位置性眩晕的疗效显著,在临床中具有重要的意义。     

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.