先天性心脏病患儿术后发生急性肾损伤的危险因素 及早期检测血清microRNA-203 的意义

目的 探讨先天性心脏病（以下简称先心病）患儿体外循环术后发生急性肾损伤（AKI）的危险因素, 以及血清microRNA-203（miR-203） 对AKI 的早期临床价值。方法 选取2016 年9 月—2018 年1 月 在华中科技大学同济医学院附属同济医院住院的178 例先心病患儿,根据AKI 诊断标准将患儿分为AKI 组53 例和非AKI 组125 例。观察AKI 发生率,比较两组患儿的临床特征。采用多因素Logistic 回归分析 AKI 的危险因素,qRT-PCR 检测两组患儿术前,以及术后2、12、24 和48 h 的miR-203、肾损伤分子-1 （KIM-1）水平表达量。采用受试者工作特征（ROC）曲线确定术后2 h 血清miR-203 对AKI 的预测价 值,计算曲线下面积（AUC）。结果 术后48 h 内,53 例（29.78%）患儿发生AKI,125 例（70.22%）患儿 未发生AKI。AKI 组患儿年龄小于非AKI 组（P <0.05）,术前紫绀型先心病比例、体外循环时间、阻断升主 动脉时间及采用间断性灌注4 ∶ 1 含血高钾停跳液（以下简称血灌）进行心肌保护的比例高于非AKI 组患 儿（P <0.05）。术后AKI 组患儿循环血中KIM-1 和miR-203 水平呈升高趋势（P <0.05）,且术后12 h 血清 miR-203 水平达峰值,早于KIM-1 水平达峰时间。ROC 曲线分析,术后2 h 血清miR-203 截断值为1.700, 其预测AKI 发生的AUC 为0.851（95% CI ：0.775,0.928）,敏感性为85.42%（95% CI ：0.825,0.874）,特异 性为54.17%（95% CI ：0.537,0.587）。经二分类变量Logistic 回归分析,年龄<4 岁[Ol ^ R=1.823（95% CI ： 1.594,3.953）,P =0.000]、紫绀型先心病[Ol ^ R=1.461（95% CI ：1.254,1.726）,P =0.005]、体外循环时间> 175.68 min [Ol ^ R=2.105（95% CI ：1.587,5.265）,P =0.000]、阻断升主动脉时间>101.45 min [Ol ^ R=1.217 （95% CI ：1.082,1.339）,P =0.000] 及术后2 h 血清miR-203>1.70。[Ol ^ R=1.331（95% CI ：1.160 ,3.241）, P =0.022] 是发生AKI 的独立危险因素;血灌心肌保护[Ol ^ R=0.729（95% CI ：0.558,0.894）,P =0.004] 是发生 AKI 的独立保护因素。结论 先心病纠正术后AKI 的发生与患儿年龄、术前紫绀、体外循环时间、阻断升主 动脉时间、血灌及术后2 h 血清miR-203 有关,且术后miR-203 水平可作为AKI 发生的早期预测因子。     

脓毒症急性肾损伤患者血清尿调节素 水平及临床意义

目的 探讨脓毒症急性肾损伤（AKI）患者血清尿调节素水平及临床意义。方法 选取2017 年 1 月—2017 年12 月浙江医院收治的脓毒症AKI 患者80 例作为AKI 组,同期脓毒症无AKI 患者80 例作为非 AKI 组。收集两组临床资料和生化指标,采用酶联免疫吸附试验测定血清尿调节素水平。结果 AKI 组急性 生理与慢性健康状况评估Ⅱ（APACHE Ⅱ）评分、血清肌酐（Scr）、尿素氮（BUN）、胱抑素C（CysC）高 于非AKI 组（P <0.05）,而肾小球滤过率（eGFR）、尿调节素低于非AKI 组（P <0.05）。Ⅱ、Ⅲ期AKI 患者 血清尿调节素水平低于Ⅰ期（P <0.05）,且Ⅲ期AKI 患者血清尿调节素水平低于Ⅱ期（P <0.05）。死亡组血 清尿调节素水平低于存活组（P <0.05）。AKI 患者血清尿调节素水平与Scr、BUN、CysC 呈负相关（r =-0.612、 -0.426 和-0.523,均P =0.000）,而与eGFR 呈正相关（r =0.631,P =0.000）。血清尿调节素诊断脓毒症AKI 的敏感性为61.00%（95% CI ：0.546,0.675）,特异性为64.00%（95% CI ：0.584,0.693）;BUN 诊断脓毒症AKI 的敏感性为60.00%（95% CI ：0.542,0.637）,特异性为69.00（95% CI ：0.641,0.732）;Scr 诊断脓毒症AKI 的 敏感性为85.00%（95% CI ：0.826,0.874）,特异性为83.00%（95% CI ：0.802,0.861）。结论 脓毒症AKI 患者 血清尿调节素水平降低,其水平在脓毒症AKI 严重程度和预后评估中具有一定价值,在脓毒症AKI 诊断中也 具有一定价值。     

高氯血症与感染性休克患者急性肾损伤发生发展的相关性研究

目的：探讨高氯血症与感染性休克患者急性肾损伤(acute kidney injury, AKI)发生发展的相关性。方法：收集2016年1月—2018年4月收治的所有成年感染性休克患者的临床资料,记录入组患者的血清氯离子浓度,72 h内每日测量的血氯为基础,分析AKI与血氯相关参数,终点指标是AKI。结果：共纳入94例患者,其中高氯血症39例(41.5%),高氯血症组AKI的发病率显著升高(69.2% vs 38.2%, P＜0.001),72 h内血氯的最高值([Cl-]max)与AKI显著相关,逻辑回归分析中,[Cl-]max与AKI独立相关[AKI的校正OR=1.28(1.02~1.62), P=0.037],血氯上升幅度(△[Cl-])=[Cl-]max-首个血氯浓度([Cl-]0),与AKI严重程度呈线性关系。非AKI组患者的平均△[Cl-]是2.9 mmol/L,AKI 1、2、3级患者的平均△[Cl-]分别为5.04、5.63、6.22 mmol/L,血氯上升幅度(△[Cl-]≥5 mmol/L)与AKI相关[OR=5.5(2.96~10.61), P＜0.001],甚至在无高氯血症的患者中亦呈相关性[OR=8.17(3.50~18.59), P＜0.001]。结论：感染性休克患者高氯血症常见,且与AKI独立相关,即使在无高氯血症的患者中,血氯上升幅度(△[Cl-]≥5 mmol/L)也与AKI有关。     

尿微量白蛋白/ 尿肌酐比值预测体外循环心脏 手术后急性肾损伤及预后的价值分析

目的 探讨尿微量白蛋白/ 尿肌酐比值（uACR）预测体外循环心脏手术后发生急性肾损伤 （AKI）及短期治疗结局的临床价值。方法 选取2018 年2 月—2019 年5 月在上海市第一人民医院治疗的心 脏停跳条件下全身麻醉行体外循环心脏手术的82 例患者。根据术后7 d 内是否发生AKI,分为AKI 组30 例 和非AKI 组52 例。比较两组患者入重症监护病房（ICU）当日uACR、血清肌酐（Scr）、急性生理学与慢 性健康状况评估Ⅱ（APACHE Ⅱ）评分和估算的肾小球滤过率（eGFR）。受试者工作特征（ROC）曲线确 定uACR 预测AKI、重症AKI 及术后28 d 死亡的效能。多因素Cox 回归模型分析体外循环心脏手术患者 发生AKI 的危险因素。结果 AKI 组入ICU 时APACHE Ⅱ评分、Scr 及uACR 高于非AKI 组（P <0.05）, 而eGFR 值低于非AKI 组（P <0.05）。经多因素Cox 回归分析,年龄[Rl ^ R=1.078（95% CI ：1.002,1.315）]、 高血压[Rl ^ R=2.184（95% CI ：1.294,5.165）]、糖尿病[Rl ^ R=1.297（95% CI ：1.046,1.485）]、体外循环时 间[Rl ^ R=3.882（95% CI ：2.127,5.089）]、主动脉阻断时间[Rl ^ R=1.406（95% CI ：1.079,2.178）] 及入ICU 时uACR[Rl ^ R=1.914（95% CI ：1.453,3.162）] 是体外循环心脏手术患者术后发生AKI 的独立危险因素 （P <0.05）。经ROC 曲线分析,入ICU 时uACR 预测AKI、重症AKI、术后28 d 内死亡的ROC 曲线下的 面积分别为0.784（95% CI ：0.691,0.835）、0.550（95% CI ：0.507,0.615）及0.716（95% CI ：0.680,0.782）。 结论 uACR 在一定程度上可以反映肾脏早期损伤程度,有望成为体外循环心脏手术后发生AKI 的早期预警 和预后判断指标。     

血清microRNA-122a、microRNA-124a 及 microRNA-125b 对脓毒症休克并发肝损伤 早期诊断及预后评估的临床价值

目的 探讨microRNA-122a（miR-122a）、microRNA-124a（miR-124a） 及microRNA- 125b（miR-125b）对脓毒症休克合并肝损伤的早期诊断及预后评估的临床价值。方法 选取2016 年 12 月—2019 年2 月沧州市中心医院急诊重症监护室收治的254 例脓毒症休克患者作为研究对象。将患者分为 肝损伤组和无肝损伤组。肝损伤组按肝损伤严重程度分为轻、中、重度肝损伤组。肝损伤组根据28 d 转归分 为存活组和死亡组。选取同期该院健康体检者40 例作为对照组。采用RT-PCR 测定血清miR-122a、miR- 124a 及miR-125b 的相对表达量,并绘制受试者工作特征曲线分析其对脓毒症休克合并肝损伤的早期诊断价 值。采用二元Logistic 回归法分析影响脓毒症休克合并肝损伤患者预后的危险因素。结果 肝损伤组急性生理 学和慢性健康状况评估Ⅱ（APACHE Ⅱ）评分、序贯器官衰竭估计（SOFA）评分、28 d 后的病死率及降钙 素原（PCT）高于无肝损伤组（P <0.05）,重度肝损伤组APACHE Ⅱ评分、SOFA 评分、28 d 后的病死率及 PCT 高于轻度、中度肝损伤组（P <0.05）,肝损伤组、无肝损伤组血清miR-122a、miR-124a 及miR-125b 相对表达量均高于对照组（P <0.05）,重度肝损伤组血清miR-122a、miR-124a 及miR-125b 相对表达量高于 轻、中度肝损伤组（P <0.05）,血清miR-122a、miR-124a 及miR-125b 诊断脓毒症休克合并肝损伤的AUC 分别为：0.796（95% CI ：0.728,0.854）、0.771（95%CI ：0.701,0.832）和0.784（95% CI ：0.715,0.840）,死 亡组治疗28 d 后APACHE Ⅱ评分、SOFA 评分、PCT、乳酸、肝损伤严重程度,血清miR-122a、miR-124a 及miR-125b 相对表达量高于存活组（P <0.05）。肝损伤严重程度[Ol ^ R=5.396（95% CI ：2.024,9.631）]、 APACHE Ⅱ评分[Ol ^ R=4.565（95% CI ：1.965,7.323）]、SOFA 评分[Ol ^ R=4.623（95% CI ：2.538,6.835）] 和miR-122a[Ol ^ R=2.818（95% CI ：1.082,5.726）] 是影响脓毒症休克合并肝损伤患者预后的危险因素。 结论 血清miR-122a、miR-124a 及miR-125b 可作为脓毒症休克患者合并肝损伤早期诊断的新型生物标志 物,且miR-122a 对脓毒症休克合并肝损伤患者的预后评估有一定的临床价值。     

脓毒症患者肾损伤程度与血浆血管生成素-1、2水平相关性的研究

目的：探讨脓毒症患者肾损伤程度与血浆血管生成素-1、2水平的相关性。方法96例入住 ICU 的脓毒症患者,按 AKIN 急性肾损伤标准分为脓毒症非 AKI 组（NAKI,n =46）,AKIⅠ组（n =23）,AKIⅡ组（n =11）,AKIⅢ组（n =16）,另选取30例健康体检者作为健康对照组（CON, n =30）。登记一般情况并进行急性生理和慢性健康状况（APACHEⅡ）评分、序贯器官衰竭（SOFA）评分,采血检测血浆 Ang-1、 Ang-2、血肌酐（Scr）,计算肌酐清除率（Ccr）,统计分析其相关性。结果①与 CON 组比较,NAKI 、AKIⅠ、AKIⅡ、AKIⅢ组血浆 Ang-1水平明显降低（P 〈0.01）,四组间差异无统计学意义（P 〉0.05）;血浆 Ang-2水平明显升高（P 〈0.01）,且随 AKI 分级增高而明显升高（P 〈0.05）。②各组血浆 Ang-1水平与 Ccr 值无相关（P 〉0.05）,各组血浆 Ang-2水平与 Ccr 值呈正相关（P 〈0.01）,多元回归分析显示 Ang-2与 Ccr 值呈显著独立相关（P 〈0.01）。③血浆 Ang-1水平与 APACHEⅡ评分、SOFA 评分无相关（P 〉0.05）,血浆 Ang-2水平与 APACHEⅡ评分、SOFA 评分呈正相关（P 〈0.01）,多元回归分析显示 Ang-2与 APACHEⅡ评分、SOFA 评分均呈显著独立相关（P 〈0.05）。结论血浆 Ang-2水平是影响脓毒症患者肾损伤程度的独立危险因素。     

探讨uKIM-1、IL-6、T细胞亚群在脓毒症急性肾损伤中早期检测的意义

目的:研究尿肾损伤分子-1（uKIM-1）、血清肌酐（sCr）、白介素-6（IL-6）及T细胞亚群在脓毒症致急性肾损伤（ AKI）中的临床应用价值。方法:选择 ICU脓毒症患者69 例,根据有无肾功能损害分为脓毒症急性肾损伤组（AKI组）、非肾损伤组（非AKI组）,其中AKI组患者39例,非AKI组患者30例。选择同期门诊健康体检者30例作为对照组。测定研究对象入科0、6、24、48 h血清肌酐与uKIM浓度以及入科24 h血清IL-6、T细胞亚群浓度,根据24 h内最差临床指标计算急性生理和慢性健康计算（APACHEⅡ）评分;采用统计软件SPSS13.0进行统计学分析。结果:脓毒症AKI组患者sCr、uKIM-1和血清IL-6检测结果均明显高于脓毒症非AKI组(P均<0.05),与sCr诊断AKI时间相比,uKIM-1能更早地诊断脓毒症急性肾损伤,且IL-6、uKIM-1与APACHEⅡ评分呈正相关。AKI组与非AKI组患者,外周血CD3+T、CD4+T和CD8+T细胞及CD4+T/CD8+T均明显低于对照组,AKI组低于非AKI组,差异均有统计学意义（P均<0.05）。结论:uKIM-1、血清IL-6及T细胞亚群监测可用于评估脓毒症致急性肾损伤病情及预后,uKIM-1比sCr对脓毒症急性肾损伤有更好的诊断效能。     

脓毒症相关急性肾损伤患者血清NGAL、CysC水平变化及诊断价值研究

目的探讨并发急性肾损伤（AKI）的脓毒症患者血清中性粒细胞明胶酶相关载脂蛋白（NGAL）、半胱氨酸蛋白酶抑制剂C（CysC）水平的变化及其临床诊断效能。方法选取ICU收治的脓毒症患者156例,根据是否发生AKI分为AKI组（71例）与无AKI组（85例）。采用ELISA法检测患者血清NGAL、CysC水平,分析NGAL、CysC水平与临床指标的相关性,采用ROC曲线评估诊断效能。结果AKI组患者血清NGAL水平高于无AKI组[（91.63±33.14）ng/mlvs（59.26±22.32）ng/ml,P＜0.001],血清CysC水平也高于非AKI组[（1.50±0.60）滋g/dlvs(0.94±0.44)滋g/dl,P＜0.001]。AKI组患者血清NGAL水平与年龄（r=0.258,P=0.003）、血清肌酐（r=0.439,P＜0.001）、APACHEⅡ评分（r=0.516,P=0.001）、CysC（r=0.406,P＜0.001）、AKI分期（r=0.639,P＜0.001）均呈正相关,与估算的肾小球滤过率（eGFR）（r=-0.392,P＜0.001）呈负相关;血清CysC水平与年龄（r=0.360,P=0.002）、血清肌酐（r=0.491,P＜0.001）、APACHEⅡ评分（r=0.311,P=0.008）、AKI分期（r=0.387,P=0.001）均呈正相关,与eGFR（r=-0.456,P＜0.001）呈负相关。NGAL诊断脓毒症相关AKI的AUC为0.784（95%CI：0.711～0.857,P＜0.001）,CsyC诊断脓毒症相关AKI的AUC为0.776（95%CI：0.703～0.850,P＜0.001）,NGAL联合CsyC诊断的AUC为0.830（95%CI：0.764～0.896,P＜0.001）。结论血清NGAL、CysC水平在并发AKI的脓毒症患者中明显升高,且两项指标诊断脓毒症相关AKI的价值均较高。     

脓毒血症患者血清钙离子浓度与近期预后的相关性分析

目的探讨脓毒血症患者血清钙离子浓度与近期预后的关系。方法根据入院24 h内血清钙离子浓度将86例脓毒血症患者分为Ⅰ组（Ca^2＋≥2.10 mmol/L）、Ⅱ组（1.80 mmol/L≤Ca^2＋〈2.10 mmol/L）及Ⅲ组（Ca^2＋≤1.79mmol/L）;按照入院24 h内APACHEⅡ评分分为APACHEⅡ评分≤20组和APACHEⅡ评分〉20组;按照28 d是否死亡分为死亡组和生存组。比较各组入院24 h内的血生化、血常规及全身性感染相关性器官功能衰竭（SOFA）评分等;并应用Logistic回归模型评估脓毒症患者28 d死亡的预测因素。结果 （1）与Ⅰ组比较,Ⅱ组及Ⅲ组的APACHEⅡ评分、SOFA评分、C-反应蛋白（CRP）、白细胞计数（WBC）、多器官功能衰竭（MODS）发生率及28 d病死率均明显增高（均P〈0.05）;而血清白蛋白（ALB）降低（P〈0.05）。与APACHEⅡ评分≤20组比较,APACHEⅡ评分〉20组的血清Ca^2＋浓度、SOFA评分、CRP及WBC计数均明显升高（均P〈0.05）,而ALB明显降低（P〈0.05）。与生存组比较,死亡组的血清Ca^2＋浓度、SOFA评分、APACHEⅡ评分、CRP及WBC计数均明显升高（均P〈0.05）,而ALB明显降低（P〈0.05）。（2）血清Ca^2＋浓度水平与APACHEⅡ评分、SOFA评分、CRP及WBC计数均呈负相关（r=-0.568、-0.488、-0.322、-0.277,均P〈0.05）,与血清ALB呈正相关（r=0.215,〈0.05）;（3）血清低Ca^2＋浓度为28d死亡的独立危险因素。结论血清Ca^2＋浓度是脓毒血症患者近期预后的独立预测因素,可作为评估脓毒血症患者病情严重程度及预后不良的有效指标。     

α1 抗胰蛋白酶与脓毒症患者发生急性 肾损伤的关系及其预测价值

目的 探讨α1 抗胰蛋白酶（α1-AT）与脓毒症患者急性肾损伤（AKI）发生的关系及其预测 价值。方法 选取2017 年9 月—2019 年10 月在宁波大学医学院附属医院重症医学科住院的脓毒症患者90 例。 28 例AKI 患者作为AKI 组,其余62 例患者未合并AKI 作为非AKI 组。连续监测患者7 d 血清和尿α1- AT,并绘制受试者工作特征（ROC）曲线分析AKI 确诊前48 和24 h 及当日对脓毒症患者发生AKI 的预 警或诊断价值。结果 ①与非AKI 患者入组当日数据比较,AKI 组患者AKI 确诊前48 和24 h 及确诊当 日血清α1-AT 含量降低（P <0.05）,而尿α1-AT 含量升高（P <0.05）。②经ROC 曲线分析,AKI 确诊 前48 和24 h 尿α1-AT 对AKI 的预警效能高于血清α1-AT（P <0.05）。③多因素非条件一般Logistic 回 归分析结果显示,尿α1-AT 是AKI 发生的独立影响因素[Ol ^ R=1.813（95% CI ：1.230,2.974）,P =0.001]。 结论 脓毒症合并AKI 患者血清α1-AT 含量升高,而尿α1-AT 含量降低,对AKI 发生具有早期预警和诊 断效能,且尿α1-AT 是AKI 发生的独立影响因素。     

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.