类似脑卒中的低血糖症17例分析

目的分析低血糖症误诊为脑卒中的原因。方法对17例误诊为脑卒中的低血糖症进行回顾性分析。结果误诊原因主要为症状类似脑卒中及对低血糖认识不足。结论详细询问病史、全面体检、及时检查血糖可减少或避免低血糖的误诊。     

出血性输卵管炎误诊为其它妇科疾患40例临床分析

目的探讨出血性输卵管炎的临床特点和诊断依据，分析误诊原因。方法回顾分析1980—2005年临床误诊出血性输卵管炎40例患者的病史、临床表现及诊治经过。结果误诊为异位妊娠22例，误诊为阑尾炎3例，误诊为急性盆腔炎4例，腹痛待查1例，误诊为卵巢囊肿蒂扭转4例。均行手术探查术，病理确诊。结论出血性输卵管炎临床表现不典型，甚至术中也难鉴别，大多是经病理检查才能确诊，需综合分析病史、症状、辅助检查。提高诊断准确率。病理学检查可确诊，对无大量腹腔内出血或休克者，腹腔镜检查是简便可靠的方法。     

低血糖症误诊为脑血管病18例临床分析

目的 探索18例低血糖症误诊为脑血管病的原因.方法 对18例患者颅脑CT检查排除脑血管病,查血糖均低于2.5 mmol/L,确诊低血糖症后给予50%葡萄糖60~100 mL静注,继之给予10%葡萄糖静滴维持.结果 1例死亡,17例均恢复正常.结论 低血糖误诊为脑血管病的主要原因是低血糖时出现的神经系统局灶症状与脑血管病的症状极其相似,难以区分,为避免误诊,应详细询问病史,提高对低血糖症的认识.     

颅内肿瘤14例误诊临床分析

目的探讨颅内肿瘤误诊的原因。方法回顾性分析14例误诊的颅内肿瘤患者的临床资料。结果误诊主要与医生对肿瘤警惕性不高、询问病史、查体不详细、忽视胸部X线检查等有关。结论应高度警惕颅内肿瘤，详细询问病史，仔细查体，特别须注重眼底检查，常规查胸部X线片，尽早、及时行相关检查，综合分析病情，以尽早确诊，改善预后。     

低血糖症误诊精神病24例分析

目的：探讨低血糖症误诊精神病的原因。方法：对24例低血糖症误诊精神病的发病因素及临床特征进行整理分析。结果：低血糖症误诊精神病,为表现不典型,未及时检查血糖而误诊,多与调整降糖药物剂量和纳食减少而没有减少降糖药剂量有关。结论：糖尿病患者出现精神异常,应及时检查血糖,排除低血糖症,以免导致误诊。     

系统性红斑狼疮35例早期误诊分析

目的　探讨系统性红斑狼疮 (SLE)早期误诊原因及提高早期诊断率。方法　采用免疫学检查结合病史帮助确诊 35例误诊病例。结果　通过对 84例确诊为系统性红斑狼疮患者中早期误诊的 35例 (误诊率为 4 1.7% )进行分析 ,关节疼痛、发热、水肿为患者的早期主要表现。结论　SLE早期表现不典型 ,误诊率高 ,详细地询问病史 ,尽早行免疫学检查 ,必要时病理活检 ,有利于早期诊断     

早期梅毒106例误诊临床分析

目的 总结早期梅毒临床表现特点，提高临床医生对早期梅毒的诊断水平。方法对临床误诊的106例早期梅毒患进行详细的病史采集、体检和实验室检查，总结分析其误诊原因。结果早期梅毒，特别是二期梅毒的皮疹具有多形性特点，和许多皮肤病症状相似，容易误诊，实验室检查可资鉴别。结论对临床可疑病例，应详细追问病史，并行梅毒血清学检查以确诊。     

结核性盆腔炎误诊为子宫内膜异位症6例分析

目的 探讨结核性盆腔炎的误诊原因。方法 回顾分析6例结核性盆腔炎患者的病史、临床表现及诊治经过。结果 5例剖腹探查病理确诊，1例再次诊刮病理确诊，确诊后治疗效果满意。结论 结核性盆腔炎临床表现多样，需综合分析病史，症状，辅助检查，提高诊断准确率，腹腔镜检查的诊断价值较高。     

老年低血糖昏迷误诊为脑梗死16例分析

目的：通过对临床表现类似脑梗死的低血糖昏迷误诊病例进行分析，提高早期诊断正确性。方法：回顾低血糖昏迷48例的误诊病例，分析误诊原因，总结经验教训。结果：误诊16例，15例症状缓解。1例死亡。结论：正确认识低血糖症的神经系统表现，对交感神经和肾上腺素髓质兴奋性表现不典型者，需注意血糖检查，有助早期正确治疗。     

18例过敏性紫癜误诊分析

目的：探讨过敏性紫癜的临床特点及临床误诊的原因。方法：回顾性分析18例过敏性紫癜误诊病例主要临床表现，统计误诊种类。结果：114例过敏性紫癜中误诊18例．误诊率为15．79％。结论：对不典型的疾病应详细询问病史，仔细观察和鉴别患者的症状，重视腹部检查以排除其它引起腹痛的病因，提高临床医生对本病的认识以及作必要的辅助检查，可以提高确诊率并使患者得到早期治疗。     

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.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.