急性缺血性脑卒中静脉溶栓治疗后血压集束化管理对预后的影响

目的 探讨急性缺血性脑卒中静脉溶栓治疗后血压集束化管理方案对患者预后的影响。方法 收集2015年10月1日至2018年3月31日于我院脑血管病中心接受单纯静脉溶栓治疗的急性缺血性脑卒中患者286例,将其中静脉溶栓治疗后接受血压集束化管理的患者归为集束化组,未接受血压集束化管理者归为对照组。比较两组患者基线资料、入院时美国国立卫生研究院卒中量表（NIHSS）评分、溶栓前血压、溶栓后症状性颅内出血发生率和在院死亡率,以及溶栓后90 d改良Rankin量表（mRS）评分。采用多因素logistic回归分析研究血压集束化管理、NIHSS评分、发病至静脉溶栓时间、血压等对患者预后的影响。结果 286例患者中集束化组161例、对照组125例,两组年龄、性别、高血压病、糖尿病、心房颤动、入院时NIHSS评分和溶栓前血压差异均无统计学意义（P均>0.05）。集束化组患者静脉溶栓治疗后症状性颅内出血发生率低于对照组,差异有统计学意义[2.48%（4/161） vs 8.00%（10/125）,χ²=4.598,P=0.032];在院死亡率与对照组比较差异无统计学意义[3.73%（6/161）vs 3.20%（4/125）,χ²=0.058,P=0.810];90 d预后良好率（mRS评分为0～2分）高于对照组,差异有统计学意义[62.11%（100/161）vs 49.60%（62/125）,χ²=4.485,P=0.034]。集束化组患者收缩压连续变异和舒张压连续变异均小于对照组[（13.37±4.92）mmHg（1 mmHg=0.133 kPa）vs（18.42±3.87）mmHg,t=2.437,P=0.025;（11.23±4.02）mmHg vs（15.48±5.16）mmHg,t=1.842,P=0.046]。多因素logistic回归分析结果显示,接受集束化管理[比值比（OR）=0.798,P=0.002]、舒张压连续变异≤15 mmHg（OR=0.816,P=0.018）为急性缺血性脑卒中静脉溶栓治疗患者预后良好的独立预测因素。结论 应用血压集束化管理有助于改善静脉溶栓急性缺血性脑卒中患者的血压变异,降低症状性颅内出血的发生率,并改善预后。     

应用智能控压负压吸引输尿管软镜治疗肾铸型结石的临床研究

目的：　比较智能控压负压吸引输尿管软镜碎石术与普通输尿管软镜碎石术治疗肾铸型结石的临床疗效。方法：　回顾性分析2017年9月至2021年8月于重庆医科大学附属第一医院及赣州市人民医院行输尿管软镜碎石术的64名肾铸型结石患者临床资料。其中男性42例,女性22例,平均年龄50.9岁。41例行智能控压负压吸引输尿管软镜碎石术（控压组）,23例行普通输尿管软镜碎石术（非控压组）。运用t检验、χ²检验或Fisher确切概率法检验对2组患者的一期结石清除率、并发症发生率、术后血白细胞、手术时间、住院时间、住院总费用等进行比较。结果：　控压组手术时间长于对照组[（78.9±29.8）min vs.（60.7±32.1）min,t=2.278,P=0.026],一期结石清除率高于对照组（73.1% vs. 0%,χ²=28.808,P=0.000）,住院总费用低于对照组[（24 215.9±3 848.8）元 vs.（26 497.9±4 230.2）元,t=2.196,P=0.032]。2组并发症发生率（19.5% vs. 17.3%,χ²=0.044,P=0.835）、住院时间[（8.22±2.94）d vs.（6.87±1.79）d,t=1.997,P=0.05]、术后血白细胞[（9.83±5.72）×10⁹/L vs.（9.06±2.49）×10⁹/L,t=0.067,P=0.546]差异均无统计学意义。结论：　对于肾铸型结石,智能控压输尿管软镜吸引取石术较普通输尿管软镜一期结石清除率高、住院总费用少、患者获益更高。     

阿替普酶静脉溶栓治疗急性心源性缺血性脑卒中的预后影响因素分析

目的 分析急性心源性缺血性脑卒中患者静脉溶栓治疗预后的影响因素。方法 选择2013年9月至2017年9月在海军军医大学（第二军医大学）长海医院脑血管病中心接受阿替普酶静脉溶栓治疗的急性心源性缺血性脑卒中患者91例。以静脉溶栓后3个月改良Rankin量表（mRS）评分作为预后评价指标,mRS评分≤2分的患者纳入预后良好组（54例）,3～6分者纳入预后不良组（37例）。分析两组患者的年龄、性别、既往史、基线美国国立卫生研究院卒中量表（NIHSS）评分、基线格拉斯哥昏迷量表（GCS）评分、溶栓前Alberta脑卒中早期计算机断层扫描评分（ASPECTS）等指标,并采用多因素logistic回归分析急性心源性缺血性脑卒中患者阿替普酶静脉溶栓治疗预后的影响因素。结果 静脉溶栓后3个月预后良好率为59.3%（54/91）,预后良好组和预后不良组患者的年龄[（66.57±13.46）岁vs（75.95±6.06）岁]、卵圆孔未闭患者比例[11.1%（6/54）vs 0.0%（0/37）]、基线NIHSS评分[7.5（3.5,13.0）分vs 18.0（13.0,22.0）分]、基线GCS评分[14.5（12.0,15.0）分vs 10.0（8.0,14.0）分]、溶栓前ASPECTS[10.0（9.0,10.0）分vs 9.0（8.0,10.0）分]、症状性颅内出血（SICH）发生率[1.9%（1/54）vs 32.4%（12/37）]差异均有统计学意义（t=3.964,χ²=4.401,Z=5.235,Z=4.079,Z=2.519,χ²=16.768;P均<0.05）。多因素logistic回归分析表明年龄[比值比（OR）=3.236,95%置信区间（CI）：1.077～9.709,P=0.036]、基线NIHSS评分（OR=2.874,95% CI：1.074～6.329,P=0.034）、SICH（OR=9.346,95% CI：1.017～83.333,P=0.048）是急性心源性缺血性脑卒中静脉溶栓治疗患者预后不良的独立预测因素。结论 年龄、脑卒中严重程度和SICH是影响急性心源性缺血性脑卒中静脉溶栓患者预后不良的独立预测因素。阿替普酶静脉溶栓治疗急性心源性缺血性脑卒中患者的年龄越大、脑卒中严重程度越重或发生SICH,预后越差。     

创客教学在消化内镜教学中的应用研究

目的　在消化内镜检查教学中应用创客教学法,以期拓展学生的思维,激发其创新意识,从而获得较好的教学效果,达到提高学生成绩、教学满意度及学习兴趣的目的。方法　选取2020年1月到2021年9月于首都医科大学宣武医院进行临床见习的2个长学制班级的全体学生作为研究对象。1个班全体学生为试验组（SCS创客教学班）,共计55人;另外一个班全体学生为对照组（传统教学组）,共计56人。两组学生于教学前进行摸底考试并进行威廉斯创造力倾向测量表评分;于教学后再进行闭卷考试,并进行威廉斯创造力倾向测量表评分;最后以问卷形式对两组学生进行满意度评分及学习兴趣调查。应用SPSS 23.0软件对数据进行t检验和卡方检验。结果　试验组教学后考试成绩,理论总分（68.11±9.27 vs. 58.66±6.55,t=-6.19,P<0.001）、选择题（21.85±3.94 vs. 18.96±4.59,t=-3.56,P=0.001）、简答题（13.55±3.67 vs. 11.18±3.23,t=-3.61,P<0.001）、简单病例分析（12.67±3.82 vs. 11.14±2.82,t=-2.40,P=0.018）、复杂病例分析（20.04±5.62 vs. 17.38±5.30,t=-2.57,P=0.012）、阅片考试（36.53±7.59 vs. 33.14±7.82,t=-2.31,P=0.023）均高于对照组,差异有统计学意义。试验组威廉斯创造力倾向测量表评分（98.91±9.81 vs. 91.09±10.60,t=-4.03,P<0.001）、满意度评分（6.76±1.78 vs. 5.66±1.91,t=-3.14,P=0.002）、学习兴趣评分（6.49±2.00 vs. 5.41±1.82,t=-2.98,P=0.004）均高于对照组,差异有统计学意义。结论　创客教学法在消化内镜检查教学中的应用,可以培养学生的创新思维,提高医学生对消化内镜检查的理解,诱发他们对消化内镜的学习欲望,还可以提升学生对教学的满意程度。     

转诊对大血管闭塞急性缺血性脑卒中血管内治疗救治效果的影响

目的 探讨转诊对大血管闭塞急性缺血性脑卒中（AIS-LVO）患者血管内治疗救治效果的影响,并对影响AIS-LVO患者血管内治疗预后影响因素进行分析。方法 回顾性纳入2013年9月至2018年2月在我院脑血管病中心接受血管内治疗的AIS-LVO患者。按患者的就诊模式分成直接就诊组和转诊组,直接就诊组患者通过院前急救医疗服务体系或其他交通工具从发病地点直接至我院急诊就诊,转诊组患者从其他医院转至我院急诊就诊,分析两组的临床特征、疗效和预后。根据预后将患者分成预后良好组（术后90 d改良Rankin量表评分为0～2分）和预后不良组（>2分）,单因素分析两组的临床资料和就诊模式,并对其中P<0.1的变量进行多因素logistic回归分析。结果 共316例患者纳入研究,其中直接就诊组195例（61.7%）,转诊组121例（38.3%）。与直接就诊组比较,转诊组患者既往缺血性脑卒中、桥接治疗的患者比例低（χ²=4.549,P=0.033;χ²=29.319,P<0.001）。转诊组患者的发病至入院时间（ODT）和发病至血管再通时间（ORT）均长于直接就诊组[239（168,238）min vs 85（55,170）min,Z=1.779,P<0.001;397（306,472）min vs 285（214,364）min,Z=6.779,P<0.001],短期治疗有效率和预后良好率均较直接就诊组差[52.9%（64/121）vs 64.1%（125/195）,χ²=3.903,P=0.048;46.3%（56/121）vs 57.9%（113/195）,χ²=4.806,P=0.043]。预后良好组患者为169例（53.5%）,预后不良组为147例（46.5%）。与预后不良组相比,预后良好组患者年龄小、高脂血症比例少、桥接治疗比例高[（64.2±12.8）岁vs（69.9±11.9）岁,t=4.095,P<0.001;0.6%（1/169）vs 6.1%（9/147）,χ²=7.848,P=0.005;70.4%（119/169）vs 13.6%（20/147）,χ²=102.975,P<0.001]。预后良好组中直接就诊的患者比例高于预后不良组[66.9%（113/169）vs 55.8%（82/147）,χ²=4.086,P=0.043],并且ODT、ORT均短于预后不良组[106（59,214）min vs 184（91,281）min,Z=3.997,P<0.001;308（226,389）min vs 350（267,453）min,Z=2.999,P=0.003]。多因素logistic回归分析显示,桥接治疗、直接就诊和ODT短是AIS-LVO患者血管内治疗预后良好的独立预测因素（P均<0.01）。结论 AIS-LVO血管内治疗患者中,转诊患者的预后较直接就诊的患者差。桥接治疗、直接就诊和ODT短预示着AIS-LVO患者血管内治疗预后良好。     

可注射型生物玻璃在口腔骨缺损填充修复中的应用效果

目的 研究可注射型生物玻璃在口腔骨缺损填充修复中的应用价值。方法 2013年9月至2014年9月连续选择58例口腔骨缺损大于1 mm患者,随机分为对照组26例和试验组32例,其中对照组应用羟基磷灰石生物陶瓷,试验组应用可注射型生物玻璃,对比愈合情况。结果 术后6个月和12个月X线检查,试验组骨愈合情况优于对照组,差异有统计学意义（6个月：53.1% vs 26.9%,χ²=4.060,P=0.044;12个月：78.1% vs 46.2%,χ²=6.348,P=0.012）;局部排斥反应发生率差异无统计学意义（6.3% vs 11.5%,χ²=0.059,P=0.808）。术后6个月和个12月锥形束CT（CBCT）检查,试验组平均骨厚度小于对照组,差异有统计学意义[6个月：（2.9±0.2）mm vs（3.4±0.3）mm,t=4.724,P=0.036;12个月：（1.6±0.2）mm vs（2.3±0.2）mm,t=5.123,P=0.027]。试验组的血清骨形态发生蛋白-2（BMP-2）和转化生长因子-β（TGF-β）水平均高于对照组,差异均有统计学意义[BMP-2：（65.3±14.5）pg/mL vs（32.8±9.6）pg/mL,t=5.623,P=0.023;TGF-β：（102.3±35.7）μg/L vs（72.6±26.8）μg/L,t=6.237,P=0.014]。结论 可注射型生物玻璃在口腔骨缺损填充修复中效果优于羟基磷灰石生物陶瓷,有较大的应用价值。     

BDNF基因rs6265多态性与首发精神分裂症患者伴发糖代谢异常的相关性研究

目的 探讨脑源性神经营养因子（BDNF）基因rs6265多态性与首发精神分裂症发生糖代谢异常的关联性。方法 首发精神分裂患者经OGTT试验区分为糖代谢异常者（研究组）与糖代谢正常者（对照组）,分别收集120例,同时收集健康组120例。用高分辨率熔解曲线（HRM）对BDNFrs6265进行基因型检测,同时利用酶联免疫吸附技术测定血清BDNF水平。结果 研究组AA基因型、A等位基因频率高于对照组（χ²=9.82,P=0.00;χ²=4.70,P=0.03）及健康组（χ²=19.70,P=0.00;χ²=8.16,P=0.03）,差异有统计学意义。对照组与健康组的基因型及等位基因频率相比差异无统计学意义（χ²=1.12,P=0.57;χ²=0.50, P=0.48）。血清BDNF水平在各组中依次为研究组 < 对照组 < 健康组（F=40.09,P=0.00）,3组中AA基因型BDNF水平均低于GG型、GA型（F=634.55,P=0.00,F=337.62,P=0.00,F=106.78,P=0.00）。结论 BDNF基因rs6265多态性与首发精神分裂症伴发糖代谢异常有关,且AA基因型是影响患者BDNF表达的因素之一。     

职业卫生与职业医学开放性实验教学效果评价研究

目的 在预防医学专业本科学生中开展开放性实验,探索实验教学改革方法,提升学生的专业素养和科研能力。方法 针对预防医学专业大四学生,以职业卫生与职业医学实验课程为抓手,进行开放实验教学,然后用问卷调查评估实验效果。2016级预防医学专业学生147人为对照组,开展常规验证性实验;2017级预防医学专业学生176人为试验组,开展开放性实验。从综合考评成绩、教师自评、学生满意度调查3个方面进行评价。采用SPSS 22.0软件进行独立样本t检验、卡方检验。结果 试验组和对照组学生的职业卫生与职业医学期末考试理论成绩是[（84.37±10.45）分 vs. （81.44±9.22）分]（t=2.68,P=0.008）,实验技能成绩是[（93.66±3.89）分 vs. （88.41±5.67）分]（t=9.51,P<0.001）,两组相比,试验组高于对照组,差异有统计学意义。问卷调查显示,试验组学生对于学时安排（χ²=8.31,P=0.004）、小组协作（χ²=21.10,P<0.001）、考核形式（χ²=7.92,P=0.005）、提升科研论文撰写能力（χ²=17.56,P<0.001）、提高实践技能（χ²=11.70,P=0.001）、逻辑思维和语言组织表达能力（χ²=10.33,P=0.001）的满意度更高。学生认为开放实验有助于培养学生创新思维和能力,但是对于就业优势的培养作用有限。学生认为开设专业课的开放性实验具有充分必要性。结论 在预防医学专业学生中开展开放性实验对于学生提升专业素养、增强实践和科研能力是有益的。     

胸腺五肽对新辅助化疗的乳腺癌患者局部组织中浸润淋巴细胞的影响

目的 探讨胸腺五肽对新辅助化疗的乳腺癌组织微环境中浸润淋巴细胞的影响。方法 自2012年1月~2014年1月,前瞻性收集笔者医院收治的接受新辅助化疗的乳腺癌患者80例,将患者随机分为研究组和对照组,所有患者均行新辅助化疗,研究组在新辅助化疗期间给予胸腺五肽,化疗结束后进行手术切除肿瘤组织,留取乳腺癌组织标本,观察乳腺癌组织中和外周血中CD4⁺T细胞、CD8⁺T细胞、CD4⁺/CD8⁺T细胞比例、外周血中IL-6、IL-10、TGF-β1水平。结果 与对照组比较,研究组患者乳腺癌组织中CD4⁺T细胞显著降低（21.47%±3.29% vs 23.88%±3.43%,P=0.002）;CD8⁺T细胞显著增高（30.36%±4.38% vs 28.43%±4.16%,P=0.047）;CD4⁺/CD8⁺T细胞显著降低（0.71±0.14 vs 0.84±0.18,P=0.001）。两组患者治疗前外周血CD4⁺T细胞、CD4⁺/CD8⁺T细胞、IL-6、IL-10、TGF-β1等比较,差异均无统计学意义（P>0.05）。与对照组比较,研究组患者术后外周血CD4⁺T细胞水平显著增加（27.67%±4.24% vs 25.09%±3.68%,P=0.005）;CD4⁺/CD8⁺T显著增加（0.83±0.14 vs 0.75±0.18,P=0.029）;IL-6水平显著增高（12.39±2.87 vs 9.24±3.38ng/L,P=0.000）;IL-10水平显著降低（8.49±2.59 vs 12.59±3.65ng/L,P=0.006）;TGF-β1水平显著降低（12.47±3.88 vs 17.76±4.12ng/ml,P=0.000）。两组患者住院时间、切口感染、手术部位出血、复发率和病死率等比较,差异均无统计学意义（P > 0.05）。结论 胸腺五肽联合新辅助化疗可能有助于改善乳腺癌组织微环境中免疫状态和全身免疫功能。     

亚低温治疗对儿童癫痫持续状态的安全性及脑保护作用的临床研究

目的 分析亚低温治疗对儿童癫痫持续状态的安全性及脑保护作用。方法 选择2010年7月～2014年7月间接受住院治疗的癫痫持续状态患儿82例为研究对象,采用随机数字表法分为观察组和对照组各41例,对照组患儿采用癫痫持续状态常规治疗,观察组患儿在常规治疗基础上加入亚低温治疗。比较两组格拉斯转归量表评分（GOS）、氧化应激水平、并发症、治疗效果。结果 治疗效果：观察组有效率95.12%明显高于对照组80.49%（χ²=6.500,P<0.05）;GOS评分：观察组GOS评分（4.68±0.24）明显高于对照组（4.32±0.15）（t=8.145,P<0.05）;氧化应激反应：观察组超氧化物歧化酶（SOD）明显高于对照组,丙二醛（MDA）、晚期氧化蛋白产物（AOPP）、一氧化氮（NO）明显低于对照组（t=4.402～21.508,P<0.05）;不良反应：两组肺部感染、心律失常、凝血功能障碍等并发症比较,差异无统计学意义（χ²=0.346～1.051,P >0.05）。结论 亚低温治疗有助于保护癫痫持续状态儿童脑功能,缓解全身氧化应激状态,提高治疗效果。     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.