椎间盘镜髓核摘除术治疗腰椎间盘突出症

目的：总结第二代椎间盘镜手术系统治疗腰椎间盘突出症的效果。方法：采用显微椎间盘镜髓核摘除术治疗58例，62个间隙腰椎间盘突出症，单间隙突出者54例，双间隙突出者4例，合并隐窝狭窄者26例，突出间隙：L3－4 8个，L4－5 24个，L5S1 22个，突出位置：后外侧型52间隙，中央型4障隙，极外侧型2间隙。结果：所有病例均随访1－13个月，平均6．1个月，优良率为93．1％，术后同间隙椎间盘突出复发1例，结论：显微椎间盘镜髓核摘除术具有手术创伤小，神经根减压彻底，术后恢复快的特点，选择合适的适应证和仔细的操作是手术成功的关键。     

后路显微椎间盘镜治疗老年性腰椎间盘突出症

目的：回顾性分析后路显微椎间盘镜治疗老年性腰椎间盘突出症的临床疗效，并评价其应用价值。方法：使用后路显微椎间盘镜治疗腰椎间盘突出症362例，其中老年患者41例（11．3％），分别为L4－5 18例，L5S1 25例，L4－5并LL5S1 2例。按下肢疼痛病程分为3组：I组6例，病程≤3个月，Ⅱ组21例，病程为4－12个月；Ⅲ组14例，病程＞12个月。结果：全部患者平均随讠2．3个月，按Nakai标准其优良率为80．5％，其中I组100％，Ⅱ组85．7％，Ⅲ组64．3％。全组无椎间隙感染、神经根损伤及脑脊液外瘘等并发症。结论：后路显微椎间盘镜作为脊柱微创外科的新技术，只要严格掌握适应证、充分处理合并症，呆以作为 治疗老年性腰椎间盘突出症的有效方法之一。     

极外侧型腰椎间盘突出症的椎间盘镜治疗

目的探讨椎间盘镜微创治疗极外侧型腰椎间盘突出症的临床疗效。方法2001年4月～2007年9月我院采用椎间盘镜行髓核摘除术治疗极外侧型腰椎间盘突出症12例，均为单间隙突出。其中男性9例，女性3例；年龄42～58岁，平均47岁；病程6个月。3年，平均10.8个月。突出类型：椎间孔内突出型7例，椎间孔外突出型5例。结果12例术后随访10～34个月，平均17个月。疗效按改良Macnab标准评定，优8例，良3例，可1例，优良率91．6％。结论应用椎间盘镜治疗极外侧型腰椎间盘突出症，具有切口小、出血少、组织创伤轻和术后恢复快等特点，是一种治疗极外侧型腰椎间盘突出症的新方法。     

METRX显微椎间盘镜髓核摘除术治疗中央型腰椎间盘突出症

目的　总结采用METRX椎间盘镜手术系统治疗中央型腰椎间盘突出症的临床疗效。方法　采用METRX显微椎间盘镜髓核摘除术治疗中央型腰椎间盘突出症 6 3例、74个椎间隙。结果　所有病例均获得随访 ,随访时间 8～ 4 8个月 ,平均 2 6 5个月。疗效 :优 4 1例 ,良 17例 ,可 3例 ,差 2例 ,优良率 92 1%。术后同间隙椎间盘突出复发 1例 ,神经根损伤 1例 ,无椎间盘炎、硬膜囊撕裂病例。结论　显微椎间盘镜髓核摘除术具有手术创伤小、神经根减压彻底、术后恢复快的特点 ,适用于中央型腰椎间盘突出症的治疗 ,选择正确的手术入路和术中熟练的操作是手术成功的关键     

后路椎间盘镜治疗腰椎间盘突出症

目的：探讨后路椎间盘镜手术系统治疗腰椎间盘突出症的适应证，技术要求以及优点，方法：采用后路显微内窥镜椎间盘切除术（Microendoscopic Discectomy,MED)对椎间盘突出症患行髓核除和神经根管扩大术。结果：本组54例男性38例，女性16例，年龄22-59岁，随访2-18个月，按Nakai分级；优46例，良7例，可1例。结论：MED可直接切除髓核，钙化后纵韧带，增生骨，具有创伤小，恢复快，手术效果好的优点，适用于多数腰椎间盘突出症或合并侧隐窝狭窄患。     

METRX椎间盘镜髓核摘除神经根管扩大治疗椎间盘突出症

目的：采用METRX（Micro.Endoscopic,Discetomy)椎间盘镜手术系统治疗腰椎间盘突出症。方法：2001年9月－2002年2月采用此手术治疗方式治疗32例，34个间隙腰椎间盘突出症，男20例，女12例，年龄21－73岁，平均37．5岁，合并侧隐窝狭窄7例，突出间隙L4－5间隙22例，L5－S1间隙12例，双间隙2例，椎间盘突出钙化2例，结果：随访1－6个月，疗效优26例，良3例，差3例，优良率96％。1例硬囊破裂，复发一例，无神经根损伤、无感染，血肿及腹腔血管损伤。结论：METRX椎间盘镜手术系统采用后正椎板间隙入路电视辅助佐内窥镜下行髓核摘除及神经根管扩大术，此手术具有效果可靠，损伤小，出血少，恢复快的优点，是目前较理想的手术方式之一。     

后路椎间盘镜技术治疗高位腰椎间盘突出症16例

目的探讨后路椎间盘镜技术治疗高位腰椎间盘突出症的手术技巧及疗效。方法2000年3月至2010年10月应用后路椎间盘镜技术治疗高位腰椎间盘突出症患者16例。手术节段：第12胸椎一第1腰椎4例，第1—2腰椎5例，第2～3腰椎7例；单侧开窗14例，双侧开窗2例。采用Maenab评分标准评定疗效。结果术后随访15d～24个月，平均12个月。单侧手术时间平均40min，出血量平均75ml；术后1～3d下床活动；无神经损伤及感染等并发症发生。疗效：优12例，良3例，可1例。结论后路椎间盘镜技术治疗高位腰椎间盘突出症创伤小、恢复快、疗效优良。     

椎间盘镜治疗腰椎间盘突出症

目的：探讨椎间盘镜治疗腰椎间盘突出症的临床疗效和安全性。方法：采用椎间盘镜髓核摘除术治疗腰椎间盘突出症患者65例,男38例,女27例。年龄30-65岁,平均年龄36．4岁。膨隆型5例,突出型45例,脱垂游离型15例。L3～4病变者6例,L4～5病变者35例,L5S1病变者15例,L3～4和L4～5同时病变者5例,L4～5和L5S1同时病变者4例。治疗结束后观察患者临床疗效和并发症情况。结果：所有患者均获得6～24个月的随访,平均随访时间14个月。65例患者的切口均甲级愈合,随访期间未发生感染、硬膜外血肿及神经损伤等并发症。术后6个月随访时按照日本整形外科学会腰痛疾患疗效标准评定,治愈22例,显效38例,有效5例。结论：椎间盘镜治疗腰椎间盘突出症创伤小、疗效好、安全性高,值得临床推广应用。     

显微椎间盘镜髓核摘除术治疗青少年腰椎间盘突出症疗效观察

目的探讨显微椎间盘镜髓核摘除术治疗青少年腰椎间盘突出症的疗效。方法对21例青少年腰椎间盘突出症患者采用显微椎间盘镜髓核摘除术治疗,并随访48～96个月,观察其效果。结果按照Nakai标准评定,21例患者优17例,良3例,可1例,优良率为95.2%。结论显微椎间盘镜髓核摘除术治疗青少年腰椎间盘突出症术后恢复快、疗效肯定,应特别重视预防粘连及术后康复锻炼。     

椎间盘镜治疗复杂型腰椎间盘突出症65例

目的：报告椎间盘镜治疗复杂型腰椎间盘突出症的治疗体会。方法：复杂型腰椎间盘突出症65例，在椎间盘镜下行突出椎间盘摘除，切除增生的小关节突，扩大侧隐窝及神经根管。结果：获得3～12个月随访60例，平均9个月，并按Nakai标准评定：优良56例(93．3％)。结论：椎间盘镜适用于复杂型腰椎间盘突出症的手术治疗，效果好，创伤小，患者术后恢复快。     

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.