白内障术后1 d发生恶性青光眼1例报道

恶性青光眼(Malignant glaucoma,MG)是一类发作迅速、症状重、治疗难度大的继发性青光眼,多发生于青光眼滤过术后[1],目前已有许多相关病案报道。然而白内障超乳晶体植入术后发生恶性青光眼的报道却并不多见。短眼轴是MG的独立危险因素[2],前房浅、房角狭窄、晶状体较厚并且前移的特点[3-5],与原发性闭角型青光眼(Primary angle-closure glaucoma,PACG)眼前节形态的高度相似性,使得合并短眼轴的PACG的术后风险性更大。该文记录了1例慢性闭角型青光眼患者行白内障术后1 d发生MG的相关情况。     

Pairwise ANFIS Approach to Determining the Disorder Degree of Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) is an important disease that affects both the right and the left cardiac ventricle. This paper presents a novel classification method called pairwise ANFIS based on Adaptive Neuro-Fuzzy Inference System (ANFIS) and one against all method for detecting the obstructive sleep apnea syndrome. In order to extract the features related with OSAS, we have used the clinical features obtained from Polysomnography device as a diagnostic tool for obstructive sleep apnea (OSA) in patients clinically suspected of suffering from this disease. The clinical features obtained from Polysomnography Reports are Arousals Index (ARI), Apnea and Hypoapnea Index (AHI), SaO₂ minimum value in stage of REM, and Percent Sleep Time (PST) in stage of SaO₂ intervals bigger than 89%. Since ANFIS has output with one class, we have extended the output of ANFIS to multi class by means of one against all method to diagnose the OSAS that has four classes consisting of normal (25 subjects), mild OSAS (AHI = 5–15 and 14 subjects), middle OSAS (AHI < 15–30 and 18 subjects), and heavy OSAS (AHI > 30 and 26 subjects). The classification accuracy, sensitivity and specifity analysis, mean square error, and confusion matrix have been used to test the performance of proposed method. The obtained classification accuracies are 82.92%, 82.92%, 85.36%, and 87.80% for each class including normal, mild OSAS, middle OSAS, and heavy OSAS using ANFIS with one against all method with 50–50% train-test split, respectively. Combining ANFIS and one against all method that is firstly proposed by us was firstly applied for diagnosing the OSAS. The proposed method has produced very promising results in the detecting the obstructive sleep apnea syndrome.     

矮小症31例临床分析

目的分析矮小症的临床特征。方法对2010年7月—2012年8月收治的31例矮小症患者的临床资料进行回顾性分析。结果 31例矮小症患者中,甲状腺功能减低症10例(32.26%),包括原发性甲状腺功能减退6例和继发性甲状腺功能减退4例;特发性生长激素缺乏症(IGHD)8例(25.81%);特发性矮小(ISS)3例(9.68%);先天性卵巢发育不全(TS)3例(9.68%);软骨发育不全(ACH)2例(6.45%);体质性青春期发育延迟3例(9.68%);先天愚型1例(3.23%);Silver-Russell综合征1例(3.23%)。结论矮小症病因复杂,临床表现各异,确诊困难。故对于矮小患者应详细询问病史,完善各项检查,以便早诊断、早治疗。     

Turner综合征患者的听力学特点分析

Turner综合征(Turner syndrome,TS)由X染色体异常所导致。其临床特点主要不仅是由于卵巢发育异常和雌激素分泌减少或缺如导致的不孕不育、身材矮小,而且常常存在听力异常。在不同基因型的患者中听力损失形式差异有统计学意义。本文就Turner综合征患者的耳部和听力学特点及相关因素进行综述。     

晶状体溶解性青光眼临床分析

目的：探讨晶状体溶解性青光眼的病因、临床特征、诊断和处理方法。方法：对我院11例（11只眼）住院治疗的晶状体溶解性青光眼病例进行分析。11例患者均系老年人，均有长期白内障病史．其中2例曾做过针拨术．无青光眼病史。起病突然，眼压升高．降眼压药物治疗眼压均不能控制。其中5例行白内障囊内摘除加前房冲洗术：4例行白内障囊外摘除加前房冲洗术：2例白内障针拨术后患者行晶状体捞出加前房冲洗术。结果：11例患者术后眼压均控制在1．2～1．94kPa（9-14．55mmHg），视力恢复情况：指数／20cm者4例，矫正视力在0．1～0．4者7例。结论：该病为目前临床上独立存在的继发性、急性开角型青光眼，尽早摘除混浊晶状体是本病治疗及预防的唯一方法。     

小梁切除术联合丝裂霉素C及青光眼引流器植入治疗青光眼的疗效评价

目的评价小梁切除术联合丝裂霉素C及青光眼引流器植入治疗青光眼的近期疗效。方法 25眼(20例)青光眼患者行小梁切除术联合丝裂霉素C及青光眼引流器植入术,随访6个月,观察术后最佳矫正视力、眼压、滤过泡形态、眼底、视野、术后前房深度及并发症情况。结果 25眼(20例)术后平均眼压(11.42±2.14)mmHg,眼压在6～21 mmHg者23眼,眼压控制成功率为92.0%;最佳矫正视力提高15眼(60.0%),术后功能性滤过泡24眼(96.0%),6眼(24.0%)发生浅前房,1眼出现(4.0%)前房出血,2眼(8.0%)脉络膜脱离,眼底及视野未出现明显变化。结论小梁切除术联合丝裂霉素C及青光眼引流器植入能有效降低青光眼患者眼压,促进功能性滤过泡形成,从而提高青光眼的手术成功率。     

Comparison of Different Classifier Algorithms on the Automated Detection of Obstructive Sleep Apnea Syndrome

In this paper, we have compared the classifier algorithms including C4.5 decision tree, le artificial neural network (ANN), artificial immune recognition system (AIRS), and adaptive neuro-fuzzy inference system (ANFIS) in the diagnosis of obstructive sleep apnea syndrome (OSAS), which is an important disease that affects both the right and the left cardiac ventricle. The goal of this study was to find the best classifier model on the diagnosis of OSAS. The clinical features were obtained from Polysomnography device as a diagnostic tool for obstructive sleep apnea in patients clinically suspected of suffering this disease in this study. The clinical features are arousals index, apnea–hypopnea index (AHI), SaO₂ minimum value in stage of rapid eye movement, and percent sleep time in stage of SaO₂ intervals bigger than 89%. In our experiments, a total of 83 patients (58 with a positive OSAS (AHI > 5) and 25 with a negative OSAS such that normal subjects) were examined. The decision support systems can help to physicians in the diagnosing of any disorder or disease using clues obtained from signal or images taken from subject having any disorder. In order to compare the used classifier algorithms, the mean square error, classification accuracy, area under the receiver operating characteristics curve (AUC), and sensitivity and specificity analysis have been used. The obtained AUC values of C4.5 decision tree, ANN, AIRS, and ANFIS classifiers are 0.971, 0.96, 0.96, and 0.922, respectively. These results have shown that the best classifier system is C4.5 decision tree classifier on the diagnosis of obstructive sleep apnea syndrome.     

Screening for Turner syndrome: how useful is the buccal smear test?

The buccal smear test was used to screen for Turner syndrome in a sample of girls with severe short stature who did not have any other clinical features of that condition. The majority of the girls did not show X chromatin bodies in the buccal mucosal cells. None of those who qualified for chromosomal analysis showed an XO chromosomal pattern either. We conclude that reliability of the buccal smear test as a screening method for Turner syndrome remains doubtful.     

应用超声生物显微镜观察高褶虹膜综合征患者的房角变化

目的 在光照和暗室条件下,通过超声生物显微镜(UBM)观察高褶虹膜综合征患者房角的变化情况.方法 对诊断为高褶虹膜综合征的20例患者(24眼),在光照和暗室条件下分别行UBM检查.结果 暗室条件下,24眼房角均关闭.在光照条件下,房角关闭16眼,开放8眼,房角开放眼均为周边虹膜肥厚型.结论 由于周边虹膜肥厚所致的高褶虹膜综合征患者,其房角的状态随光照条件的改变呈动态变化,在暗室条件下,房角关闭,在光照条件下,房角开放.临床中可行UBM检查鉴别窄角慢性单纯型青光眼.     

脊髓血管母细胞瘤的MRI诊断与鉴别诊断

目的：分析脊髓血管母细胞瘤MRI影像学特征及鉴别诊断。方法：回顾性分析11例脊髓血管母细胞瘤MRI平扫及增强表现,探讨MRI特征,并分析Von Hippel—Lindau综合征（VHL综合征）及非VHL综合征血管母细胞瘤MRI表现的差异。结果：11例中8例为单发肿瘤（72．7％）,3例VHL综合征均为多发肿瘤（27个）。MRI表现多与肿瘤大小相关。除体积较小（上下径≤1cm）者多位于颈髓外,以胸髓多见,邻近背侧软脊膜。肿瘤边界清楚,强化明显。≤1cm的肿瘤呈点状或结节状,为均匀等T1、稍长T2信号,强化均匀;〉1cm的肿瘤多呈香肠状、葫芦形或不规则形,多以稍长T1、稍短T2为主的混杂信号,不均匀强化。肿瘤常继发大范围脊髓囊性改变（77．8%）及水肿,与肿瘤大小无相关性。〉1cm的肿瘤内部及周围常见流空血管影（100％）。除VHL综合征患者常发生多发、体积小的肿瘤,VHL综合征与非VHL综合征患者在MRI表现中无明显差异。结论：脊髓血管母细胞瘤的MRI影像学表现具有特征性,MR检查是首选方法。     

内源性硫化氢和基于中医气血理论的血瘀证之间的关系

“Qi” and “blood” are two essential concepts in Chinese medicine (CM). As qi is intangible, the concept of qi is still controversial between CM and Western medicine. However, the endogenous hydrogen sulfide (H₂S) and other gaseous signaling molecules provides a new approach for understanding the essence of qi in CM. Blood stasis syndrome is a common syndrome in CM. According to the CM theory, the incidence of blood stasis syndrome is closely correlated to the reckless movement of qi, as qi and blood are inseparable in regulating physiological functions. In recent years, more and more evidences suggest a close correlation between blood stasis syndrome and microcirculation dysfunction. In this paper, we discuss the relationship between endogenous H₂S and blood stasis syndrome based on qi-blood theory of CM. We found that endogenous H₂S maybe a material basis in concept of qi in CM, while dysfunctional microcirculation is the pathological basis of the blood stasis syndrome. As qi is closely associated with incidence and progression of blood stasis syndrome, endogenous H₂S may play an important role in preventing and treating the blood stasis syndrome by improving the function of microcirculation.     

玻璃体腔注射雷珠单抗和康柏西普联合青光眼引流阀植入治疗新生血管性青光眼的疗效

目的：观察玻璃体腔注射雷珠单抗和康柏西普联合青光眼引流阀（AGV）植入治疗新生血管性青光眼（NVG）的疗效。方法：将68例NVG患者根据AGV植入术前是否进行玻璃体腔注药以及药物的不同分为雷珠单抗组（n=26）、康柏西普组（n=21）和对照组（n=21）,分别于AGV植入术前3~7 d行玻璃体腔注射雷珠单抗（10 g·L^-1）或者康柏西普（10 g·L^-1）,待虹膜新生血管消退后行AGV植入术;对照组患者给予药物或前房穿刺后待眼压（IOP）平稳行AGV植入术;对屈光介质清晰的患者,玻璃体腔注药和AGV术前行全视网膜光凝术（PRP）,如果屈光介质不清晰,先应用抗血管内皮生长因子（VEGF）药物治疗,待能窥清眼底时再行PRP。结果：雷珠单抗组、康柏西普组和对照组患者术后平均眼压均较术前降低（P<0.01）;3组患者术后平均抗青光眼药物数目均较术前明显减少（P<0.01）;3组患者术后不同时间点手术成功率比较差异无统计学意义（P>0.05）;术后1个月、3个月雷珠单抗组和康柏西普组患者最佳矫正视力（BCVA）均明显优于对照组（P<0.05）;雷珠单抗组和康柏西普组患者术后不同时间点各项并发症发生率比较差异均无统计学意义（P>0.05）。结论：玻璃体腔注射抗VEGF药物联合AGV植入术可以有效、安全地治疗NVG,短期内提高患者视力,快速减轻患者疼痛、减少手术并发症。     

原发性青光眼古今中医文献整理研究

目的：了解历代医家有关原发性青光眼的治疗经验和对病因病机的认识,总结青光眼的主要病因、病机及最佳治疗方案。方法：采用手工检索、光盘检索、联机检索相结合的方法进行文献检索,再根据青光眼文献登记表,逐项进行记录,进行调查表调查,最后对证候类型、中医治法、方药、护理方法等进行频数和排序统计分析。结果：原发性青光眼主要由风、火、痰、郁、虚及肝之阴阳失调,引起气血失常,经脉不利,目中玄府闭塞,珠内气血津液不行而致。其证型以肝火上炎证、肝郁气滞证、肝肾阴虚证、阴虚阳亢证、阴虚火旺证、肝经风热证最为常见。其中急性闭角型青光眼以肝经风热证、肝火上炎证居多;慢性闭角型青光眼以肝郁气滞证、阴虚阳亢证、肝经风热证居多;原发性开角型青光眼以肝肾阴虚证、肝经风热证居多。治疗青光眼最常用药有：茯苓、生地、当归、车前子、决明子、甘草、川芎、菊花等。结论：通过对原发性青光眼的文献整理研究,运用科学的分析方法,明确了原发性青光眼的发病机理、病机特点、演变规律、辨证要点、主要证型及常用药物等,为规范原发性青光眼的诊疗奠定了基础。     

慢性青光眼血流动力学及其影响因素分析

目的:探讨慢性青光眼眼部血流情况及其影响因素和青光眼的可能发病机制.方法:采用彩色多普勒成像检测中、晚期原发性开角型青光眼(POAG)54例(65眼)、原发性慢性闭角型青光眼(PCACG)32例(53眼)和正常组30例(30眼)的眼动脉、睫状后短动脉、视网膜中央动脉的收缩期峰值血流速度、舒张末期血流速度及阻力指数.应用计算机进行多因素Logistic回归分析.结果:POAG、PCACG的阻力指数显著增高,与正常对照组比较差异均有统计学意义(均P＜0.01).两组青光眼舒张末期的血流速度明显减慢,与正常对照组比较差异均有统计学意义(均P＜0.05).多因素Logistic回归分析,筛选出影响青光眼的3个显著因素.眼动脉的舒张末期血流速度是影响PCACG的显著因素(P=0.000);眼动脉、睫状后短动脉的舒张末期血流速度是影响POAG的显著因素(P＜0.01).结论:慢性青光眼的视功能损害与眼部血流速度尤其舒张末期血流速度及阻力指数密切相关.眼动脉的舒张末期血流速度减慢可能是PCACG前房角关闭的诱发因素.眼动脉、睫状后短动脉的舒张末期血流速度减慢可能是POAG视神经缺血的主要原因.     

马凡氏综合征心脏大血管病变的影像诊断

目的探讨马凡氏综合征大血管病变的影像表现,评价影像对其主动脉病变及继发病变的诊断价值。方法告马凡氏综合征5例,行升主动脉瘤切除Bentall术2例,结合文献进行回顾性分析心脏大血管的MRI表现。结果马凡氏综合征心脏大血管MRI主要表现为:①主动脉窦部瘤样扩张;②左房受压;③左室扩大,室壁增厚;④主动脉瓣关闭不全及升主动脉扩张;⑤二尖瓣脱垂、二尖瓣关闭不全;⑥可合并主动脉夹层。结论 MRI在显示马凡氏综合征心脏大血管病变的部位,形态特点,继发性改变或并发症以及鉴别诊断上具有显著的优越性。     

Malignant Phenotype of PC3 Cell Line Was Inhibited by siRNA Targeting PAR Gene

To investigate the effects of down-regulation of prostate androgen regulated （PAR） expression on proliferation of PC3 cells by using RNA interference （RNAi）, suppression of PAR expression was achieved by transfection of PC3 cells with short hairpin RNA （shRNA） expression vectors against PAR, designated as psiRNA-PAR1, psiRNA-PAR2 and psiRNA-PAR3. The inhibitory effects were confirmed by RT-PCR. The growth features of PC3 transfectants were analyzed by cell counts, colon formation in soft agar and flow cytometry. The expression of PAR was suppressed by the three shRNA expression vectors, psiRNA-PAR1 was shown to inhibit the PAR expression most efficiently, with the inhibitory rate reaching a peak at （81.18±1.68）% 48 h after the transfection. PC3 transfectants exhibited a decreased proliferation in cell culture and a low efficiency of colon formation in soft agar. Flow cytometry revealed a G2/M arrest and induced apoptosis. Down-regulated PAR expression inhibited the growth of PC3 cells by inducing G2/M arrest and activating apoptotic pathway. As a potential proto-oncogene that triggers and/or has persistent malignant proliferation, PAR may serves as a very target for the gene therapy.     

不同剩余小肠长度的短肠综合征患儿远期营养状况分析

目的探讨不同剩余小肠长度的短肠综合征患儿远期营养状况。方法通过查阅短肠综合征患儿医疗文书及长期随访,获取17例新生儿期短肠综合征患儿的一般资料和营养状况资料,按小肠剩余长度分为小肠≤40 cm组和小肠长度>40 cm组,对其营养状况进行对比分析。结果小肠≤40 cm组患儿年龄别身高、体质量百分位偏低比率显著高于小肠>40 cm组患儿(P<0.05);小肠≤40 cm组患儿平均红细胞体积异常比率高于小肠>40 cm组(P<0.05)。结论小肠剩余长度较长患儿的营养状况较好,提示小肠剩余长度是短肠综合征患儿预后的关键影响因素。     

Exploration on significance of platelet cd62p, cdp63 determination in type 2 diabetes mellitus patients with blood stasis syndrome

Objective: To study the relationship between blood stasis syndrome (BSS) and platelet activation and its influencing factors in type 2 diabetic mellitus (DM).Methods: Platelet CD_62p, CD₆₃ expressions were determined in 30 type 2 DM patients with BSS, 27 type 2 DM patients without BSS and 20 normal controls by flow cytometry.Results: CD_62p, CD₆₃ levels were significantly higher in type 2 DM group with BSS than those in the type 2 DM group without BSS and in the normal controls. CD_62p was positively correlated with CD₆₃, while positive correlation existed between HbA₁c, LDL-C and CD_62p in DM patients with BSS.Conclusions: The increased level of platelet activation was the primary molecular basis of BSS in type 2 DM. It was important to perform the syndrome differentiation of BSS and treatment of activating blood flow to remove BSS in type 2 DM.     

儿童矮小症67例病因和治疗分析

目的探讨儿童矮小症的病因与治疗特点,为临床诊断治疗提供参考依据。方法对67例儿童矮小症患儿的临床资料进行分析,并使用重组人生长激素（rh—GH）和其他相关治疗。结果67例矮小症儿童中,生长激素（GH）缺乏性矮小23例,特发性矮小21例,家族性矮小9例,体质性青春发育延迟4例,宫内发育迟缓3例,Turner综合征、甲状腺功能减退、21-三体综合征各2例,先天性软骨发育不良1例。rh—GH对生长激素缺乏症（GHD）疗效显著,对特发性矮小、家族性矮小、宫内发育迟缓效果满意,非GH缺乏甲状腺功能低下者予以甲状腺素片治疗,生长增速。结论矮小原因很多,及时发现病因,寻求最佳治疗手段非常重要。     

持续气道正压呼吸联合珂立苏治疗新生儿呼吸窘迫综合征的疗效观察

目的 分析研究持续气道正压(CPAP)呼吸和珂立苏防治新生儿呼吸窘迫综合征的临床效果。方法选取新生儿呼吸窘迫综合征患儿92例,随机分成观察组和对照组,各46例,对照组仅采用常规疗法+CPAP,观察组在常规治疗基础上给予CPAP+珂立苏治疗,比较分析两组患者的血氧饱和度(SpO₂)、自主呼吸改善情况、血气变化、临床疗效及并发症发生情况。结果与对照组比较,治疗12h后观察组患儿的SpO₂指标、自主呼吸改善成功率、PaO₂均明显升高,PaCO₂降低显著;各组间治疗前后变化及组内治疗前后的比较差异具有显著性;观察组治疗总有效率(95.66%)明显高于对照组(69.57%)(P=0.0094),且并发症较低。结论采用CPAP联合珂立苏的方法治疗早产新生儿呼吸窘迫疗效显著,未见明显并发症,值得临床推广。