血清铁蛋白与2 型糖尿病周围神经病变的 相关性分析

目的 探讨血清铁蛋白（SF）与2 型糖尿病（T2DM）周围神经病变（DPN）的相关性。方法 选取 2016 年1 月-2016 年12 月该院T2DM 患者150 例,将其分为糖尿病无周围神经病变组（T2DM 组）66 例,糖 尿病周围神经病变组（DPN 组）84 例,同时选择健康体检者30 例作为对照组（NC 组）。测定各组血清SF 与空 腹血糖（FPG）、餐后2 h 血糖（2 hPG）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、三酰甘油（TG）、高密 度脂蛋白（HDL）、低高密度脂蛋白（LDL）、同型半胱胺酸（Hcy）及空腹胰岛素（FINS）;评价胰岛素抵抗指数 （HOMA-IR）、胰岛β 细胞分泌指数（HOMA-IS）,并分析血清SF 与相关指标的关系。结果 ① 3 组舒张压（DBP）、 FPG、2 hPG、HbA1c、TC、TG、LDL、FINS 及Hcy 比较,差异有统计学意义（P <0.05）;DPN 组与T2DM 组FPG、2 hPG、HbA1c、TG、FINS 及Hcy 均呈逐渐增高趋势（P <0.05）。3 组HOMA-IR、HOMAIS 比较,差异有统计学意义（P <0.05）;3 组HOMA-IR 逐渐增高,而HOMA-IS 逐渐降低。② 3 组血清SF 水平比较,差异有统计学意义（P <0.05）;DPN 组血清SF 水平>T2DM 组>NC 组。③血清SF 与HbA1c、 HOMA-IR 及Hcy 呈正相关（rs =26.600、14.055 及9.513,P =0.000、0.000 及0.043）,与HOMA-IS 呈负相关（rs = -0.895,P =0.004）。④多元线性回归分析显示,SF、Hcy、2 hPG、TG、FINS、HOMA-IR 及HOMA-IS 是 DPN 的危险因素（P <0.05）。结论 血清SF 水平的升高与血糖、血脂代谢紊乱、胰岛素抵抗及氧化应激有关, 其共同参与DPN 的发生、发展。     

血清网膜素-1 与糖尿病周围神经病变的相关性

目的 探讨血清网膜素-1 与糖尿病周围神经病变（DPN）的相关性。方法 选取2016 年6 月— 2017 年10 月海南省第三人民医院收治的100 例2 型糖尿病患者,根据是否合并周围神经病变,将其分为 DPN 和无DPN 组,各50 例。另选取同期该院健康体检者50 例作为对照组。测量各组的体重、身高、腰围、 臀围,计算体重指数（BMI）及腰臀比（WHR）;检测空腹血糖（FPG）、空腹胰岛素（Fins）、糖化血红蛋白 （HbA1C）、24 h 尿白蛋白排泄率（24 hUAER）、胱抑素C（Cys-C）、胆固醇（TC）、甘油三酯（TG）、高密 度脂蛋白（HDL-C）、低密度脂蛋白（LDL-C）及血清网膜素-1 水平,计算胰岛素抵抗指数（HOMA-IR） 和胰岛β 细胞功能指数（HOMA-β）。结果 各组BMI、WHR、TG、Fins、FPG、HOMA-IR、HbAlc、 血清网膜素-1、HDL-C 及HOMA-β 比较,差异有统计学意义（P <0.05）,DPN 组和无DPN 组患者血 清网膜素-1 水平均低于对照组（P <0.05）,DPN 组患者血清网膜素-1 水平均低于无DPN 组（P <0.05）。 血清网膜素-1 水平与HOMA-β 呈正相关（r =0.496,P =0.000）,与病程、WHR、TG、Cys-C、FPG、 HbA1c 及24 hUAER 呈负相关（r =-0.323、-0.127、-0.173、-0.326、-0.449、-0.328 和-0.331,P =0.009、 0.013、0.035、0.000、0.000、0.000 和0.023）。Logistic 回归分析结果表明血清网膜素-1 是影响DPN 发生的 危险因素[Ol ^ R=1.011（95%CI ：1.003,1.019）,P =0.013]。结论 DPN 的发生、发展可能与血清网膜素-1 水 平降低有关。     

无症状2型糖尿病周围神经病变患者监测血清NO和AGEs的临床意义

目的：研究一氧化氮（NO）、晚期糖基化产物（AGEs）监测对无症状2型糖尿病（T2DM）周围神经 病变（DPN）的临床意义。方法：选取2015年12月至2018年12月间浙江中医药大学附属第三医院的T2DM住 院患者80例,通过测定振动感觉阈值（VPT）联合神经传导速度（NCV）诊断为DPN的患者60例,其余20例为 单纯T2DM组。60例DPN患者再通过有无肢体麻木、烧灼感、疼痛等症状分为有症状DPN组29例和无症状DPN 组31例。比较3组患者的空腹血糖（FPG）、餐后2h血糖（PPG）、糖化血红蛋白（HbA1c）、甘油三酯（TG）、总 胆固醇（TC）、低密度脂蛋白胆固醇（LDL-c）、高密度脂蛋白胆固醇（HDL-c）、载脂蛋白a（APOa）、载脂蛋白b （APOb）水平;比较3组患者NO、AGEs水平差异。结果：有症状DPN组的FPG、PPG、HbA1c水平均明显高于无 症状DPN及单纯T2DM患者（ P ＜0.01）。无症状DPN组的FPG、PPG、HbA1c水平均高于单纯T2DM患者（ P ＜0.05）。 3组患者的TG、TC、LDL-c、HDL-c、APOa、APOb水平差异无统计学意义（ P＞ 0.05）。与单纯T2DM组比,DPN组 血清NO均明显下降,AGEs水平明显升高（ P ＜0.01）;2组DPN患者血清NO、AGEs水平差异有统计学意义（ P ＜ 0.01）。 结论：临床上早期无症状DPN发病率高,NO、AGEs是其重要的生物信号和效应分子,早期检测有助 于了解神经病变的程度。控制血糖对减少DPN的发生具有非常重要的临床意义。     

2型糖尿病患者骨钙素与血糖、血脂关系的研究

目的 通过在不同血糖水平和糖尿病病程人群中进行骨钙素（BGP）、体质量指数（BMI）、空腹血糖（FPG）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）、糖化血红蛋白（HbA1C）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）及高密度脂蛋白胆固醇（HDL-C）数值测定,探究在2型糖尿病患者中BGP与血糖、血脂间的相互关系及可能作用机制.方法 采用ELISA法、电化学发光法、高压液相法及全自动生化分析仪等检测BGP与相关实验室参数指标。结果 （1）BGP水平从NGT到IFG再到新诊断T2DM组最后到T2DM病程10年以上组逐渐降低（P＜0.01）.（2）BGP与FPG、HOMA-IR、HbA1C、TG呈负相关（P＜0.01）;BGP与BMI、TC无相关关系（P＞0.05）;BGP与FINS、HDL-C呈正相关,但相关性不显著（P＞0.05）.（3）新诊断T2DM组与T2DM病程10年以上组间BGP、FPG、FINS、HOMA-IR、HbA1C、TG、HDL-C水平均存在显著差异（P＜0.05）,且BGP与FPG、HOMA-IR、HbA1C、TG及病程呈负相关（P＜0.05）,BGP与FINS、HDL-C呈正相关（P＜0.05）。结论 BGP与血糖及血脂关系密切,是糖、脂代谢调节的重要参与因子。     

妊娠糖尿病患者负性情绪及危险因素分析

目的 调查妊娠糖尿病（GDM）患者负性情况的发生状况,并分析其危险因素。方法 选取2014 年 6 月—2016 年6 月海南省人民医内分泌科就诊的GDM 患者189 例,根据医院用焦虑抑郁量表（HADS）评分 结果,分为GDM 合并负性情绪组（GDM+ 负性情绪组,HADS>15 分）Ⅲ例和GDM 不合并负性情绪组（GDM 组,HADS ≤ 15 分）88 例。另根据HADS 评分将GDM+ 负性情绪组分为轻度负性情绪亚组（16 ≤ HADS ≤ 20） 39 例、中度负性情绪亚组（21 ≤ HADS ≤ 30）37 例及重度负性情绪亚组（31 ≤ HADS ≤ 42）35 例。采 用Pearson 相关分析HADS 评分水平的相关因素。采用Logistic 回归分析GDM 患者合并负性情绪的影响因 素。结果 ① GDM 患者合并负性情绪的发生率为58.73%（111/189）。GDM+ 负性情绪组孕前BMI、FPG、 HbA1c、TC、TG、HDL-C、HOMA-IR 及糖尿病家族史患者比例均高于GDM 组（P <0.05）;②重度负性 情绪亚组FPG、HbA1c、TC、TG、HDL-C 及HOMA-IR 水平均高于轻度负性情绪亚组和中度负性情绪亚组, 且中度负性情绪亚组FPG、HbA1c、TC 及HOMA-IR 水平高于轻度负性亚组（P <0.05）;③ Pearson 相关分 析显示,孕前BMI、孕期体重增加、FPG、HbA1c、TC、TG、HDL-C、HOMA-IR 及有糖尿病家族史均与 HADS 评分相关（P <0.05）;④孕前BMI、孕期体重增加、HbA1c 及糖尿病家族史是GDM 合并负性情绪的 危险因素（P <0.01）。结论 GDM 患者合并负性情绪的发生率仍较高,尤其是孕前BMI 高、孕期体重增加、 HbA1c 水平高及有糖尿病家族史的患者。因此,对该类孕妇应及早的进行心理干预,提供更多的心理辅导, 预防负性情绪的发生。     

皮肤晚期糖基化终末产物与2型糖尿病周围神经病变的相关性研究

目的分析2型糖尿病（T2DM）伴周围神经病变（DPN）患者皮肤晚期糖基化终末产物（AGEs）水平变化及其临床意义。方法选择99例 T2DM 患者,依据神经缺陷评分（NDS）将其分为 DPN 组和非 DPN 组,同时选取正常对照组（NC 组）35例,测定各组皮肤 AGEs 和糖化血红蛋白（HbA1c）水平并进行比较。结果与 NC 组相比,T2DM 患者皮肤 AGEs 水平明显升高（P ＜0.05）;与非 DPN 组相比,DPN 组患者皮肤 AGEs 水平明显增（P ＜0.05）,两组 HbA1c 水平差异无统计学意义（P ＞0.05）。结论T2DM 患者皮肤 AGEs 水平升高可能参与糖尿病周围神经病变的发生。     

TG/HDLc比值及HOMA-IR指数对老年2型糖尿病冠状动脉病变程度的预测价值

目的通过观察TG/HDLc比值及HOMA-IR指数与老年2型糖尿病冠脉病变程度的相关性,探讨其对糖尿病患者冠脉病变的预测价值。方法随机选择住院的老年2型糖尿病和冠心病患者176例,分为3组,单纯糖尿病组(DM,62例)、单纯冠心病组(CAD,46例),糖尿病合并冠心病组(DMCAD,68例);另外40例健康对照者(NC组)来自体检中心。分别测定各组身高、体重,计算BMI;全自动生化仪检测血脂谱(TG、HDLc、TC、LD-Lc、VLDLc)、FBG、Fins水平,计算TG/HDLc比值和HOMA-IR指数;经皮冠脉造影术法检测冠脉病变程度,记录冠脉阻塞积分(CAOS)。结果 DMCHD组患者血浆TC、LDLc、TG、VLDL、FPG、Fins、TG/HDLc、HOMA-IR的水平、CAOS积分均显著高于NC组(P<0.05),HDLc显著低于NC组(P<0.01);DM组及CAD组BMI、FPG、TG/HDLc、HOMA-IR显著高于NC组(P<0.05)。相关分析显示TG/HDLc比值与CAOS积分、HOMA-IR、FPG均呈正相关(r=0.427、0.347、0.273,P<0.05),IR与CAOS积分呈正相关(r=0.490,P=0.000)。结论 TG/HDLc比值及HOMA-IR指数与糖尿病冠脉病变程度呈正相关,是老年2型糖尿病人群冠脉病变程度较好的预测指标。     

糖尿病心肌病患者过氧化物酶增殖物激活受体水平变化的研究

目的 观察糖尿病心肌病（DCM）患者过氧化物酶增殖物激活受体（PPARs）水平变化,并探讨其影响DCM的可能机制。方法 选取2016年10月—2017年10月郑州大学附属南阳市中心医院住院治疗的DCM患者（DCM组）74例、单纯糖尿病患者（T2DM组）71例和同期健康体检者（NC组）70例,收集各组一般资料,采用ELISA检测PPARs水平并比较。结果 DCM组空腹血糖（FPG）、糖化血红蛋白（HbA1c）、甘油三酯（TG）及高敏感C反应蛋白（hs-CRP）高于T2DM组和NC组（P?<0.05）,T2DM组FPG、HbA1c及TG高于NC组（P?<0.05）;DCM组PPARα和PPARγ高于T2DM组和NC组（P?<0.05）,PPARβ/δ低于T2DM组和NC组,且T2DM组PPARα和PPARγ高于NC组,PPARβ/δ低于NC组（P?<0.05）。结论 DCM患者PPARα和PPARγ水平升高,PPARβ/δ水平降低,PPARs可能在DCM的发生、发展中起到重要作用。     

二肽基肽酶4 抑制剂对早期糖尿病慢性 肾脏疾病患者β2 微球蛋白水平的影响

目的 观察二肽基肽酶4（DPP-4）抑制剂对早期糖尿病慢性肾脏疾病（CKD）患者β2 微球蛋白 （β2-MG）水平的影响。方法 选取早期CKD 患者（CKD 组）72 例、正常蛋白尿糖尿病患者（DM 组）80 例及 体检健康者（NC 组）80 例,收集各组入组时的临床资料和生化指标并比较。另根据入院先后顺序将CKD 组分 为常规亚组和DPP-4 亚组各36 例,两组均采用糖尿病饮食管理、运动治疗,在控制血糖、血脂、血压的基础上, DPP-4 组给予DPP-4 抑制剂5 mg,1 次/d,持续12 周。比较两亚组治疗前后生化指标和炎症因子浓度的变化。 采用Pearson 相关分析β2-MG 与其他临床资料的相关性,采用多元线性回归分析β2-MG 的影响因素。结果 ① CKD 组和DM 组BMI、FPG、2 h PG、HbA1c、24 h UAlb、IL-6、TNF-α 及β2-MG 均高于NC 组（P <0.05）, 且CKD 组2 h PG、24 h UAlb、IL-6、TNF-α 及β2-MG 均高于DM 组（P <0.05）;②与治疗前比较,两 亚组FPG、2 h PG、HbA1c 及24 h UAlb 均降低（P <0.05）,治疗后DPP-4 亚组FPG、2 h PG、HbA1c 及 24 h UAlb 均低于常规亚组（P <0.05）;③与治疗前比较,两亚组IL-6、TNF-α 及β2-MG 均降低（P <0.05）, 治疗后DPP-4 亚组IL-6、TNF-α 及β2-MG 均低于常规亚组（P <0.05）;④ Pearson 相关分析发现,糖尿 病病程、BMI、2 h PG、HbA1c、24 h UAlb、IL-6、TNF-α 与β2-MG 水平相关（P <0.05）。多元线性回 归分析显示,糖尿病病程和HbA1c 是早期CKD 患者β2-MG 的影响因素（P <0.05）。结论 DPP-4 抑制剂 可以有效降低早期CKD 患者血糖水平,降低β2-MG 水平,消除或控制促炎因素,减轻肾小管损伤,进而延 缓CKD 进一步发展。     

不同糖代谢状态患者血清p选择素和sCD40L水平变化及意义

目的探讨不同糖代谢状态与血小板活化指标—可溶性p选择素(sP-selectin)、可溶性CD40L(sCD40L)的关系,并进一步研究其影响因素。方法分别选取正常对照组(NC组)、糖尿病前期组和2型糖尿病组(T2DM组)患者各30例,计算体质量指数(BMI),采集空腹静脉血测定血糖(FPG)、胰岛素(FINS)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、糖化血红蛋白(HbA1C)等指标,酶联免疫法(ELISA)测定静脉血清中sP-selectin、sCD40L水平,计算稳态模型胰岛素抵抗评估指数(HOMA-IR)。结果糖尿病前期组和T2DM组的sP-selectin和sCD40L较NC组明显升高(P<0.05)。sP-selectin的表达与FPG、TG、TC、LDL-C、HOMA-IR呈正相关,与HDL-C呈负相关(P均<0.05),其中与TG和FPG的相关性更高(P<0.01);sCD40L与FPG、BMI、HbA1c呈正相关(P均<0.05),与TG、TC、HOMA-IR无明显相关性(P均>0.05)。结论糖尿病前期及T2DM人群血清中sCD40L和sP-selectin水平已明显升高,提示血小板活化在糖尿病前期已启动。     

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.     

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.     

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.