血清S100B蛋白联合STESS量表评分对癫痫持续状态患儿近期预后的预测价值

目的探讨血清S100B蛋白联合STESS量表评分对癫痫持续状态患儿近期预后的预测价值。 方法回顾性分析97例SE患儿的临床资料,根据格拉斯哥预后评分量表(GOS)评分分为预后不良组和预后良好组。比较两组血清S100B蛋白水平和STESS量表评分。Logistic回归分析近期预后的影响因素,ROC曲线分析S100B蛋白、STESS量表评分对SE患儿近期预后的预测价值。 结果预后不良组与预后良好组患儿SE发作时间、生长发育落后史、发作类型、气管插管、头颅影像学异常、脑电图异常、S100B蛋白水平及STESS评分比较,差异均有统计学意义(P＜0.05)。SE发作时间＞1 h、头颅影像学异常、脑电图异常、S100B蛋白、STESS评分是SE患儿近期预后不良的危险因素(P＜0.05)。ROC曲线分析结果发现,血清S100B蛋白和STESS量表评分联合应用对预测SE患儿近期预后具有较高价值(P＜0.05)。 结论血清S100B蛋白水平、STESS评分是SE患儿近期预后不良的危险因素,二者联合应用对预测SE患儿近期预后具有较高价值。     

小动脉硬化脑血管病危险因素分析及sTM、CD62P、VE-cadherin对其预后的预测

目的分析小动脉硬化脑血管病的危险因素,及可溶性血栓调节蛋白(sTM)、P选择素(CD62P)、钙黏蛋白(VE-cadherin)对其预后的预测价值。 方法选择小动脉硬化脑血管病患者180例为观察组,根据预后分为预后不良组和预后良好组,另设50例健康者为对照组。检测各组血清sTM、VE-cadherin、CD62P血小板水平,分析其与预后的相关性,以及三者联合检测对预后的评估价值,分析小动脉硬化脑血管病的危险因素。 结果sTM、VE-cadherin、CD62P血小板水平观察组高于对照组,预后不良组高于预后良好组(P＜0.05)。sTM、VE-cadherin、CD62P血小板水平与预后呈正相关(P＜0.05)；三者联合检测对预后的诊断效能高于单独检测(P＜0.05)。sTM、VE-cadherin、CD62P血小板水平是小动脉硬化脑血管病的危险因素(P＜0.05)。 结论sTM、VE-cadherin、CD62P是小动脉硬化脑血管病的危险因素,三者联合应用对其预后的预测价值较高。     

孕中期胎儿大脑中动脉、孕妇子宫动脉血流参数联合血清miR-424对FGR胎儿预后的评估价值

目的探究孕中期胎儿大脑中动脉(MCA)、孕妇子宫动脉(UtA)血流参数联合血清miR-424对生长受限(FGR)胎儿预后的评估价值。 方法选取FGR孕妇87例为观察组,同期产检健康的孕妇124例为对照组。FGR孕妇按照预后分为预后不良组和预后良好组。比较各组胎儿MCA、孕妇UtA血流和血清miR-424情况。采用ROC评估胎儿MCA、孕妇UtA血流和血清miR-424对FGR胎儿预后的评估价值。 结果孕妇血清miR-424观察组高于对照组,预后不良组高于预后良好组(P＜0.05)。胎儿MCA搏动指数(PI)及血流阻力指数(RI)观察组低于对照组,预后不良组低于预后良好组(P＜0.05)。孕妇UtA PI及RI观察组高于对照组,预后不良组高于预后良好组(P＜0.05)。胎儿MCA、孕妇UtA血流和血清miR-424联合检测对FGR胎儿预后具有良好的预测价值(P＜0.05)。 结论胎儿MCA、孕妇UtA血流和血清miR-424联合检测对FGR胎儿预后的预测效果更优,具有更高临床应用价值。     

STEMI患者PCI术后血清PDGF、Ang-1水平与预后的关系

目的探讨急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后血清血小板源性生长因子(PDGF)、血管生成素-1(Ang-1)水平与预后的关系。 方法选取行PCI治疗的STEMI患者126例,根据术后主要不良心血管事件(MACE)分为预后不良组和预后良好组。采用ELISA法检测血清PDGF、Ang-1水平,比较不同PDGF、Ang-1水平患者的预后情况。采用Cox风险回归模型分析STEMI预后不良的影响因素。采用ROC曲线分析PDGF、Ang-1对STEMI患者预后的预测价值。 结果预后不良组PDGF、Ang-1高于预后良好组(P＜0.05)。高PDGF组与高Ang-1组患者MACE发生率高于低PDGF组、低Ang-1组(P＜0.05)。多支病变、高PDGF、高Ang-1均是STEMI患者预后不良的危险因素(P＜0.05)。血清PDGF、Ang-1对STEMI患者预后的预测效能较高。 结论高PDGF、Ang-1水平STEMI患者PCI术后更易发生MACE,二者有望作为预测STEMI患者预后的有效生物标志物。     

急性脑梗死患者血清hs-CRP、CaM、miR-365的变化及临床意义

目的探讨急性脑梗死(ACI)患者血清超敏C反应蛋白(hs-CRP)、钙调蛋白(CaM)、miR-365的变化及临床意义。 方法选取ACI患者100例为ACI组,同期体检健康者50例为对照组；ACI组根据神经缺损严重程度、预后分为轻中度组和重度组、预后不良组和预后良好组。比较各组血清hs-CRP、CaM、miR-365水平,并分析其与神经缺损严重程度的相关性和对预后的预测价值。 结果hs-CRP、CaM、miR-365水平ACI组高于对照组；重度组高于轻中度组；预后不良组高于预后良好组(P＜0.05)。hs-CRP、CaM、miR-365水平与神经缺损严重程度呈正相关(P＜0.05)。hs-CRP、CaM、miR-365联合预测ACI预后的诊断效能高于单独预测(P＜0.05)。 结论ACI患者血清hs-CRP、CaM、miR-365水平升高,联合检测有助于ACI预后评估。     

COPD急性加重期患者血清SIRT1与炎症因子水平的相关性及临床意义

目的研究慢性阻塞性肺疾病急性加重期(AECOPD)患者血清沉默信息调控因子1(SIRT1)与炎症因子水平的相关性及临床意义。 方法选择188例COPD患者,按照是否急性加重期分为AECOPD组和稳定期组；按照病情严重程度分为1级、2级、3级；按照预后分为预后良好组和预后不良组。另取同期体检健康者100例为对照组。比较各组SIRT1、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、高迁移率族蛋白B1(HMGB1)水平；分析SIRT1与炎症因子的相关性,及其对AECOPD患者病情严重程度和预后的意义。 结果患者SIRT1水平AECOPD组＜稳定期组＜对照组,1级＞2级＞3级,预后良好组＞预后不良组;IL-6、TNF-α、HMGB1水平AECOPD组＞稳定期组＞对照组,1级＜2级＜3级,预后良好组＜预后不良组(P＜0.05)。AECOPD患者血清SIRT1与IL-6、TNF-α、HMGB1呈负相关(P＜0.05)。SIRT1对AECOPD患者预后具有良好的预测价值(P＜0.05)。 结论AECOPD患者血清SIRT1水平与炎症因子相关,SIRT1对判断AECOPD患者病情和预后有临床意义。     

RDW、PDW与su-PAR对重度创伤性颅脑损伤患者预后的评估价值

目的研究红细胞体积分布宽度(RDW)、血小板体积分布宽度(PDW)、可溶性尿激酶型纤溶酶原激活物受体(su-PAR)对重度创伤性颅脑损伤(TBI)患者预后的评估价值。 方法120例TBI患者根据格拉斯哥昏迷评分(GCS)分为重度组64例、轻中度组56例,另选50例健康者为对照组。比较各组血清RDW、PDW及su-PAR水平,ROC曲线分析其在预测重度TBI患者预后中的价值。 结果重度组相较于轻中度组和对照组,RDW和PDW水平均升高,三组su-PAR依次下降(P＜0.05)。随访3个月,重度组预后不良33例,预后不良组RDW、PDW及su-PAR均高于预后良好组(P＜0.05)。重度组RDW、PDW、su-PAR与入院时GCS评分呈负相关(P＜0.05),su-PAR与RDW和PDW呈正相关(P＜0.05)。ROC曲线分析发现,三指标联合预测重度TBI患者预后不良的价值最高。 结论重度TBI患者RDW、PDW及su-PAR均异常升高,可作为评估TBI病情及预后的潜在指标。     

血清ALP、hs-CRP对冠心病PCI术后不良心血管事件的预测价值

目的探讨血清碱性磷酸酶(ALP)、高敏C反应蛋白(hs-CRP)对冠心病(CHD)经皮冠状动脉介入治疗(PCI)术后不良心血管事件(MACE)发生的预测价值。 方法回顾性选取行PCI的CHD患者113例,依据是否发生MACE分为MACE组(n＝41)和非MACE组(n＝72)。比较两组临床资料和血清ALP、白蛋白(ALB)、hs-CRP水平。多因素Logistic回归分析CHD患者行PCI术后发生MACE的危险因素,ROC曲线分析ALP、hs-CRP对CHD患者行PCI后发生MACE的预测价值。 结果MACE组ALP和hs-CRP高于非MACE组,ALB低于非MACE组(P＜0.05)。MACE组年龄≥70岁、心肌梗死患者、BNP≥500 ng/L、左主干病变及支架数≥2个的占比均高于非MACE组(P＜0.05)；其他指标两组间比较差异无显著性(P＞0.05)。多因素Logistic回归分析显示,年龄、BNP、ALP、hs-CRP、冠心病类型、左主干病变及支架数≥2个均为CHD患者PCI术后发生MACE的危险因素(P＜0.05)。ROC曲线分析发现,血清ALP、hs-CRP联合检测对冠心病患者PCI术后MACE发生的预测价值最高(P＜0.05)。 结论血清ALP及hs-CRP联合检测可作为CHD患者PCI术后是否发生MACE的预测指标。     

难治性癫痫患儿血清lncRNA NKILA、miR-124表达及临床意义

目的探究难治性癫痫(RE)患儿血清lncRNA NKILA、miR-124的表达水平变化及临床意义。 方法选取收治的61例RE患儿作为RE组,63例可控性癫痫(CE)患儿为CE组,另选取同期本院体检健康儿童66例作为对照组。采用qRT-PCR法测定各组血清lncRNA NKILA、miR-124的表达水平；采用ROC分析血清lncRNA NKILA、miR-124对RE的诊断价值；采用多因素Logistic回归分析影响RE的危险因素。 结果与对照组比较,CE组患儿和RE组患儿血清lncRNA NKILA、miR-124水平明显升高(P＜0.05)。与CE组比较,RE组患儿血清lncRNA NKILA、miR-124水平明显升高(P＜0.05)。ROC曲线分析显示,lncRNA NKILA、miR-124诊断RE患儿的ROC曲线下面积分别为0.781、0.783。多因素Logistic回归分析表明,lncRNA NKILA、miR-124是RE发生的独立危险因素(P＜0.05)。 结论lncRNA NKILA、miR-124的表达升高与RE的发生有关,可作为RE患儿诊断的血清学标志物。 [     

转移性中低位直肠癌患者同步放化疗后外周血miR-29a miR-345水平对预后的预测价值

目的 分析转移性中低位直肠癌患者同步放化疗后外周血微小RNA-29a(miR-29a)、微小RNA-345(miR-345)水平对预后的预测价值。方法 选择2015年4月至2018年5月无锡市太湖医院收治的98例接受同步放化疗(长程放疗,期间同时口服卡培他滨)且随访3年的转移性中低位直肠癌患者为研究对象。患者均于同步放化疗5周后检测血清miR-29a、miR-345水平,根据随访3年结果分为预后良好组45例与预后不良组53例。比较两组同步放化疗5周后血清miR-29a、miR-345水平及临床资料(组织学分化程度、原发灶肿瘤直径、脏器转移个数、单个脏器转移个数转移肿瘤数目等),Cox多因素分析同步放化疗后3年内患者预后不良的影响因素,绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)分析患者血清miR-29a、miR-345水平单独及联合检测对同步放化疗后3年预后的预测价值。结果 预后不良组血清miR-29a、miR-345水平高于预后良好组,差异有统计学意义(P＜0.05);单因素分析显示,预后不良组组织学分化为低分化、原发灶肿瘤直径≥5 cm、脏器转移个数>1个、同步放化疗后血浆清蛋白≤35 g/L例数占比均高于预后良好组,差异有统计学意义(P＜0.05);Cox多因素分析显示,脏器转移个数＞1个、血清miR-29a、miR-345水平为患者3年内预后不良的影响因素(P＜0.05);ROC曲线结果显示,患者同步放化疗后血清miR-29a、miR-345水平二者联合检测预测3年内预后不良的AUC值为0.740,高于单独检测miR-29a、miR-345水平的AUC值(0.687、0.667),差异有统计学意义(P＜0.05)。结论 转移性中低位直肠癌同步放化疗后血清miR-29a、miR-345水平是患者预后不良的独立影响因素,二者联合检测对患者3年预后判定具有较高价值。     

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.     

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.     

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.     

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.