CT引导经皮肺穿刺活检术应用于肺门肿块的并发症分析

【摘要】目的：探讨CT引导经皮肺穿刺活检术应用于肺门肿块检查的并发症及其危险因素分析。方法：回顾性分析2013年2月至2015年2月136例在我院行肺门肿块CT引导经皮肺穿刺活检术的患者的病史资料,对并发症发生情况进行统计,并对相关危险因素进行Logistic回归分析。结果：CT引导经皮肺穿刺活检术的主要并发症为气胸和出血,发生率分别为为16.9%、14.0%。穿刺次数（OR=1.036,95% CI：1.025～1.047）、穿刺时间（OR=2.015,95% CI：1.055～3.849）是出血发生的独立危险因素（P＜0.05）;年龄（OR=1.275,95% CI：1.125～1.445）、穿刺次数（OR=2.253,95% CI：1.026～4.947）、穿刺时间（OR=3.365,95% CI：1.232～9.191）、穿刺深度（OR=2.336,95% CI：1.154～4.729）是气胸发生的独立危险因素（P＜0.05）。结论：年龄、穿刺次数、时间及深度是CT引导经皮肺穿刺活检术术后并发症发生的主要因素,临床上需要引起重视。【关键词】 肺肿瘤;活组织检查;CT;经皮肺穿刺活检术;并发症     

不同麻醉方法对髋部骨折老年患者术后转归的影响

目的：比较全身麻醉（general anesthesia, GA）和区域阻滞麻醉（regional anesthesia, RA）对接受手术治疗的髋部骨折老年患者术后心肺并发症和住院期间死亡率的影响。方法：回顾性分析我院骨科2005年1月至2014年12月间收治的572例髋部骨折老年患者的临床资料,分别记录患者性别、年龄、术前内科合并症、术前卧床时间、骨折原因、手术和麻醉方法、术后心肺并发症以及住院期间的死亡率。应用多重Logistic回归模型分析不同麻醉方法对髋部骨折老年患者术后住院死亡率的影响。结果：8例老年患者发生住院期间死亡（8/572,死亡率1.4%）,其中RA组5例（5/392,死亡率1.3%）,GA组3例（3/180,死亡率1.7%）,两组患者间住院死亡率的差异无统计学意义（P>0.05）,多重Logistic回归分析显示,性别（OR=0.18,95% CI：0.03~1.05,P=0.057）、年龄（OR=1.22,95% CI：1.07~1.38,P=0.002）、术前肺部合并症（OR=12.09,95% CI：2.28~64.12,P=0.003）和手术方式（OR=9.36,95% CI：1.34~64.26,P=0.024）是术后发生住院期间死亡的独立危险因素。36例患者术后发生心血管系统并发症（36/572,发生率6.3%）,其中RA组19例（19/392,发生率4.8%）,GA组17例（17/180,发生率9.4%）, 多重Logistic回归分析显示,年龄（OR=1.13,95% CI：1.07~1.19,P<0.001）、高血压（OR=2.72,95% CI：1.24~5.96,P=0.012）和术前脑血管合并症（OR=2.11,95% CI：0.99~4.52,P=0.054）是发生术后心血管系统并发症的独立危险因素。56例患者术后发生呼吸系统并发症（56/572,发生率9.8%）,其中RA组19例（19/392,发生率4.8%）,GA组37例（37/180,发生率20.6%）,多重Logistic回归分析显示,年龄（OR=1.13,95% CI：1.07~1.19,P<0.001）、术前肺部合并症（OR=2.89,95% CI：1.28~7.05,P=0.020）、术前卧床时间（OR=1.11,95% CI：1.04~1.18,P=0.003）和麻醉方法（OR=5.86,95% CI：2.98~11.53,P<0.001）是术后发生呼吸系统并发症的独立危险因素。结论：RA和GA对接受手术治疗的髋部骨折老年患者住院期间死亡率无显著影响,但RA组患者术后呼吸系统并发症的发生率低于GA组患者。     

体外循环术后延迟撤机患者预后因素分析

目的探讨ICU体外循环术后延迟撤机患者的预后相关因素。方法收集2004年10月～2007年10月体外循环术后机械通气时间超过24h的病例共35例,根据患者预后分为死亡组和生存组,对患者术前基础血糖、白蛋白、肌酐及射血分数,术中转机时间、主动脉阻断时间及输血量,术后生命体征、肌酐、24h引流量、APACHEⅡ评分及机械通气时间等围手术期临床指标进行回顾性分析。结果未脱机死亡12例（34．29％）,成功脱机并转出ICU23例（65．71％）,两组患者术前基础血糖、白蛋白和射血分数,术中转机时间、断流时间和血浆输入量,术后APACHEⅡ评分、肌酐、APTT、氧合指数比较均有显著差异（P均〈0．05）;Logistic多元回归分析显示术前射血分数（OR=0．7973,95％CI 0．6417—0．9906）和术后APACHEⅡ评分（OR=1．8588,95％CI 1．1071～3．1210）是体外循环术后延迟撤机患者预后的主要影响因素。结论体外循环术后延迟撤机患者病死率较高,影响预后的主要因素为术前射血分数及术后APACHEⅡ评分,心脏手术前应详尽评估患者病情,完善围手术期的监护治疗。     

心脏瓣膜术后急性肾损伤发生的危险因素分析

目的:分析心脏瓣膜手术后急性肾损伤（AKI）发生的危险因素。方法:回顾性分析696例择期行心脏瓣膜手术患者的临床资料,根据是否发生AKI分为AKI组（111 例）和非AKI组（585例）。对术后患者AKI发生的可能相关危险因素先进行单因素分析,再进行Logistic二元回归分析。结果:与非AKI组比较,AKI组年龄更大（t=6.020,P=0.003）、合并糖尿病的更多（χ2 =11.941,P=0.001）、术前心功能更差（t=5.911,P=0.014）、同期行搭桥手术的更多（χ2 =19.399,P=0.000）、体外循环时间更长（t=4.518,P=0.000）、主动脉阻断时间更长（t=3.115,P=0.000）、呼吸机应用时间更长（t=10.141,P=0.000）、肺炎发生率更高（χ2=76.872,P=0.000）、术后输血率更高（χ2=38.954,P=0.000）、ICU住院时间更长（t=4.577,P=0.000）、术后30 d内死亡率更高（χ2=42.520,P=0.000）。Logistic回归分析显示:术前左心室射血分数（LVEF）<40%（OR=4.338,95%CI:2.149～8.753）、呼吸机应用>72 h（OR=8.846,95%CI:4.621～16.933）、术中输血（OR=3.774,95%CI:2.024～7.040）、术后肺炎（OR=3.302,95%CI:1.152～9.467）是心脏瓣膜手术后患者发生AKI的独立危险因素。结论:术前LVEF<40%、术中输血、术后肺炎、呼吸机应用时间延长是心脏瓣膜术后AKI发生的独立危险因素,显著增加术后30 d死亡率。     

深低温停循环手术后急性肾损伤的影响因素分析

目的探讨深低温停循环手术后急性肾损伤发生的独立危险因素。方法收集2011年4月至2013年6月在深低温停循环下手术的91例患者的术后肌酐值。单因素分析引起术后肾损伤的各个因素,将有统计学差异的变量进行Logistic回归分析。结果多因素分析显示停循环时间(OR=1.038,CI:1.002~1.076,P=0.039)、既往高血压病史(OR=3.397,CI:1.007~11.457,P=0.049)、输血量(OR=1.001,CI:1.000~1.001,P=0.016)与术后急性肾损伤相关。急性肾损伤发生后呼吸机辅助时间、ICU停留时间延长。结论停循环时间、输血量、高血压病史是深低温停循环手术后急性肾损伤的独立危险因素,急性肾损伤发生后患者康复时间延长。     

冠状动脉旁路移植术后急性肾损伤影响因素探讨

目的：探讨急性肾损伤(acute kidney injury, AKI)在冠状动脉旁路移植(coronary artery bypass grafting,CABG)术后的发生率、相关影响因素以及对术后病情恢复的影响。方法：选择连续行择期CABG的68例患者为研究对象,根据急性肾损伤专家共识小组有关AKI的诊断标准,统计AKI在术后的发生率。以是否发生AKI把患者分为AKI组和对照组,对比分析两组间临床资料的差异。将差异有统计学意义的因素作为自变量进行Logistic退步法回归分析,寻找AKI的相关影响因素。结果：术后有27.94%（19/68）患者发生AKI,两组间比较显示性别、高血压、高血脂、移植血管桥数量、呼吸机使用时间、监护室停留时间、术后住院时间在两组间差异有统计学意义。 Logistic退步法多因素回归分析显示术前高血压（Wald 3.27, P＝0.07, 95% ＣI 0.85～53.59）、术中移植血管桥数量 （Wald 7.67, P=0.01, 95% CI 1.48～9.73）、呼吸机使用时间（Wald 4.94, P=0.03, 95% CI 1.00～1.18）是术后AKI的危险因素。 结论：CABG术后AKI有较高的发生率（27.94%）,单因素分析显示女性、高血压、高血脂、术中移植血管桥数量、呼吸机使用时间是AKI的危险因素,而术后发生AKI可导致监护室停留时间和术后住院时间延长。 Logistic退步法多因素回归分析提示高血压、移植血管桥数量以及呼吸机使用时间是AKI独立的危险因素。     

耐多药肺结核患者社区管理的影响因素

目的 了解耐多药肺结核患者在社区的治疗和管理方式,分析其对治疗转归的影响。方法 回顾性分析2013年1月至2014年12月期间在江苏省徐州市、南通市和镇江市完成治疗的耐多药肺结核患者,共158例。以病案调查为主、电话访谈方式为辅获取患者的治疗和管理相关资料。使用卡方检验进行单因素分析,Logistic回归分析进行多因素分析。P＜0.05为差异有统计学意义。结果 158例患者治疗成功率（治愈和完成治疗）为58.2%。患者居住地距离定点医院≤90 km的患者治疗成功率为63.6%,高于距离＞90 km的患者（P=0.020）;社区治疗期间随访检查≥10次患者的治疗成功率为74.8%,高于＜10次的患者（P=0.000）;社区治疗后继续接受注射剂治疗患者的治疗成功率为61.7%,高于未接受注射治疗的患者（P=0.011）;全疗程注射剂使用时间≥6个月患者的治疗成功率为66.7%,高于使用时间＜6个月的患者（P=0.002）;治疗期间无中断治疗患者的治疗成功率为76.3%,高于有中断治疗的患者（P=0.000）;社区治疗期间有督导员管理的患者治疗成功率为66.1%,高于无管理的患者（P=0.000）;多因素Logistic回归分析显示患者居住地与定点医院的距离（P=0.039,OR=2.626,CI：1.049~6.572）、随访检查次数（P=0.000,OR=10.523,CI：3.712~29.836）、中断治疗（P=0.001,OR=0.248,CI：0.105~0.585）、督导员督导管理（P=0.044,OR=2.734,CI：1.027~7.283）等因素与患者的治疗转归相关。结论 加强对耐多药肺结核患者出院后的社区督导服药管理,督促患者定期随访检查对耐多药肺结核患者的治疗转归有重要意义。     

冠状动脉旁路移植手术后早期谵妄与认知功能障碍的关系

目的：观察中国人冠状动脉旁路移植手术后谵妄与认知功能障碍的关系。方法：接受择期冠状动脉旁路移植手术的107例患者,记录术前基础指标、围术期相关指标及术后并发症发生情况。术后第1~7天采用CAM ICU法（Confusion Assessment Method-Intensive Care Unit）每天2次评估是否发生谵妄;分别在术前1天和术后第7天进行9项认知功能测验,术后认知功能障碍的诊断采用与ISPOCD1研究同样的标准。结果：术后谵妄的发生率为47.7%（51/107）,术后认知功能障碍的发生率为55.3%（57/103）。多因素Logistic回归分析显示术后谵妄的独立危险因素有年龄增加（OR 1.174,95% CI 1.085~1.269,P<0.001）、术前糖尿病史（OR 4.224,95% CI 1.543~11.563,P=0.005）、术后发生并发症（OR 3.667,95% CI 1.152~11.670,P=0.028）和术后监护室停留时间长（OR 1.024,95% CI 1.005~1.044,P=0.016）;术后认知功能障碍的独立危险因素有年龄增加（OR 1.065,95% CI 1.001~1.134,P=0.047）和术后谵妄持续时间长（OR 1.744,95% CI 1.173~2.593,P=0.006）。结论：谵妄和认知功能障碍是中国人冠状动脉旁路移植手术后早期常见的并发症,术后谵妄持续时间长是术后认知功能障碍的独立危险因素。     

针药复合麻醉对肛门部手术后尿潴留的影响： 一项基于电子医疗数据的真实世界研究

目的　基于真实世界数据分析针药复合麻醉对肛门部手术患者发生术后尿潴留（POUR）的影响，为肛门部手术选择最佳的麻醉方式提供循证依据。 方法　回顾性收集上海中医药大学附属曙光医院病案管理系统中2012年1月1日至2018年12月31日肛肠科实施肛门部手术的病例资料。提取患者性别、年龄、住院天数、麻醉方法、主要手术国际疾病分类第9版临床修订本第3卷（ICD-9-CM3）代码。以开具留置导尿医嘱和收取导尿管费用作为发生POUR的依据。对于术中麻醉方式变更病例，以最后采用的麻醉方式纳入研究。结果　共11 440例肛门部手术患者入组，年龄为39（32，51）岁，男女比例为1.94。其中采用针药复合麻醉6 083例（53.2%）、后会阴神经阻滞麻醉3392例（29.7%）、静脉麻醉1 420例（12.4%）、局部麻醉408例（3.6%）、椎管内麻醉65例（0.6%）、全身麻醉46例（0.4%）。术后留置导尿395例，POUR发生率为3.5%。单因素logistic回归分析显示，年龄≥60岁（OR=1.76，95% CI 1.33～2.27，P<0.01）和女性（OR=1.36，95% CI 1.11～1.67，P=0.003）是肛门部手术患者发生POUR的危险因素。多因素logistic回归分析显示，与后会阴阻滞麻醉、静脉麻醉和椎管内麻醉相比，针药复合麻醉有利于降低POUR风险（后会阴阻滞麻醉：OR=1.42，95% CI 1.13～1.78，P=0.002；静脉麻醉：OR=1.48，95% CI 1.10～1.99，P=0.009；椎管内麻醉：OR=2.75，95% CI 1.09～6.93，P=0.032）。亚组分析显示，与后会阴阻滞麻醉相比，针药复合麻醉能降低女性患者41%的POUR风险（OR=0.59，95% CI 0.42～0.84，P=0.003）及＜60岁患者30%的POUR风险（OR=0.70，95% CI 0.54～0.90，P=0.006）。 结论　年龄≥60岁和女性是肛门部手术患者发生POUR的危险因素，采用针药复合麻醉有利于降低POUR的风险。     

不停跳冠状动脉旁路移植术后急性肾损伤的影响因素探讨及3年随访结果

目的： 探讨急性肾损伤(acute kidney injury, AKI)在不停跳冠状动脉旁路移植(coronary artery bypass grafting,CABG)术后的发生率、相关危险因素以及比较AKI对围手术期并发症和术后3年的主要心脑血管不良事件（major adverse cardiovascular and cerebrovascular events,MACCE）的影响。 方法： 选择2010年1月至2012年3月连续行择期不停跳CABG的299例患者为研究对象,以是否发生AKI把患者分为AKI组和对照组,比较两组间围手术期临床资料的差异,使用Logistic后退法回归分析寻找AKI的危险因素;比较两组间术后并发症的差异,随访3年观察AKI对MACCE的影响。 结果： 术后37.1% (111/299) 患者发生AKI,Logistic后退法多因素回归分析显示术前血肌酐升高（Wald=9.276, P=0.002, 95%CI 1.006～1.028）、合并慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD, Wald=3.469, P=0.063,95%CI 0.950～7.630）、左心室射血分数（left ventricular ejection fraction, LVEF）降低（Wald=4.414, P=0.036,95% CI 0.965～0.999）、术前或术中植入主动脉内球囊反搏(intra-aortic balloon pump,IABP, Wald = 6.745, P=0.009,95% CI 1.336～7.925）是术后AKI的危险因素。AKI组患者术后并发症较多,如使用呼吸机时间、监护室停留时间、二次气管插管、肺部感染、脑卒中、消化道出血、术后住院时间、异体输血量（血浆和红细胞）和透析替代治疗均明显高于对照组（P＜0.05）。围术期两组间死亡率差异没有统计学意义,但是2例死亡患者均在AKI组。随访3年两组间MACCE差异没有统计学意义。 结论： 不停跳CABG术后AKI有较高的发生率（37.1%）,术前血肌酐升高、合并COPD、 LVEF降低、术前或术中植入IABP是术后AKI的独立的危险因素,AKI组围手术期并发症较多,随访3年两组间MACCE差异没有统计学意义。     

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.