准分子激光角膜上皮下磨镶术中运用丝裂霉素C对角膜内皮细胞的影响

目的探讨准分子激光角膜上皮下磨镶术（LASEK）中应用丝裂霉素c（MMC）对角膜内皮细胞的影响。方法近视患者40例77眼随机分为两组行LASEK治疗,激光切削后术中应用质量浓度为0.02%的MMC滤纸片覆盖在角膜基质床上,分别持续15s和1min,分别于术前和术后3、6、12个月观察角膜内皮细胞密度和形态。结果术前与术后的内皮细胞密度、变异系数和六角形细胞百分比差异无统计学意义（P〉0.05）。结论小样本的研究表明,LASEK术中应用MMC是一种防止haze发生的较安全的方法,但对屈光手术的安全性尚需大样本的长期临床观察。     

准分子激光皮下角膜磨镶术后雾状混浊形成的影响因素

目的:通过准分子激光上皮下角膜磨镶术(LASEK)术后角膜上皮下雾状混浊(haze)形成等级的分析,探讨haze形成的主要影响因素。方法:于2005年10月至2006年6月接受LASEK手术的92例(179只眼)连续病例中,选取随访超过3个月的病例83例(162眼,占总眼数的90.50%),其中男性23例(45只眼),女性60例(117只眼);年龄为18-48岁,平均(26.81±7.23)岁;术前屈光度(等效球镜度数)为-15.75--4.00D,平均(-9.24±2.48)D;术前角膜中央厚度为440-533μm,平均(489.83±18.00)μm。应用SPSS12.0软件中的Spearman等级相关分析方法和逻辑回归分析方法,分析术后角膜上皮下雾状混浊(haze)与手术前后各项检测指标,包括患者年龄、术前屈光度、术前角膜中央厚度、术中角膜切削深度、术中角膜切削率(术中角膜切削深度/术前角膜中央厚度)、术后角膜上皮愈合时间等因素的关系。结果:83例患者术中角膜切削深度为67.90-143.30μm,平均(117.60±14.55)μm;术中角膜切削率为0.135-0.295,平均(0.240±0.028);角膜上皮愈合时间,3 d为127眼(78.40%),4 d为27眼(16.67%),5 d为6眼(3.70%),6 d为2眼(1.23%);术后最后一次复查时的角膜haze,0级为130眼(80.25%),0.5级为13眼(8.02%),1级为11眼(6.79%),2级为5眼(3.09%),3级为3眼(1.85%)。等级相关分析显示,haze与年龄呈负相关(r=-0.173,P<0.05),与术中角膜切削深度呈正相关(r=0.155,P<0.05),逻辑回归分析显示,年龄与术中角膜切削深度不能预测haze的发生。结论:LASEK术后haze形成等级与术中角膜切削深度呈正相关,与患者年龄呈负相关,但相关性较小,主要的影响因素尚待进一步研究。     

准分子激光角膜原位磨镶术对角膜内皮的影响

目的　探讨准分子激光角膜原位磨镶术(LASIK)对角膜内皮的影响。方法　将行LASIK术患者60例116眼,分为A组38例73眼(未配戴角膜接触镜组),B组22例43眼(戴角膜接触镜组)。两组激光切削深15~150μm,平均激光切削深度 86.23±22.31μm, 术前及术后3个月进行角膜内皮显微镜检查,观察角膜内皮细胞密度、形态。分析切削深度与角膜内皮密度的相关性。结果　①A组术前角膜内皮密度与术后3个月角膜内皮密度无显著性差异(t=0.329,P>0.05)。②B组术后 3个月平均角膜内皮密度明显高于术前,有显著性差异(t=3.859,P<0.01)。术后角膜内皮形态无明显改变。③A组角膜切削深度与角膜内皮细胞密度无显著相关性(r=0.0321,P>0.05)。结论　LASIK术后早期不引起中央部角膜内皮细胞密度和形态改变。     

糖尿病病人白内障手术后中央角膜内皮及厚度的变化

目的 观察糖尿病病人白内障术后中央角膜内皮细胞的数目、形态及中央角膜厚度的变化,同时观察角膜厚度与角膜内皮细胞密度的关系。方法 选择并发糖尿病的老年性白内障病人26例（28眼）,在行小切口白内障囊外摘除联合后房型人工晶体植入术前及术后3 d、1周、1月、3月时,应用带有角膜测厚仪的非接触式角膜内皮显微镜观察其中央角膜的内皮细胞密度、内皮细胞变异系数及厚度的变化,并与34例无糖尿病的老年性白内障病人进行对照。分析组间及组内不同时间各变量的变化,同时进行角膜厚度与角膜内皮细胞密度相关性分析。结果 两组中央角膜内皮细胞密度、内皮细胞变异系数及厚度手术前后各时间比较差异均无显著性（P〉0.05）。角膜厚度与角膜内皮细胞数无相关性（r=0.095、0.084,P〉0.05）。但是在组内观察各个变量随时间的变化时显示,糖尿病病人的内皮细胞对损伤的反应及修复能力较无糖尿病病人差。结论 糖尿病病人白内障术后角膜内皮细胞的改变主要表现为对损伤的反应及修复能力减弱。     

高血压患者角膜内皮细胞形态学的研究分析

目的:探讨原发性高血压病对角膜内皮的影响。方法:应用全自动角膜内皮细胞分析仪对296例348眼进行角膜厚度及内皮细胞形态检测。原发性高血压患者148例173眼,其中A组(Ⅰ、Ⅱ期)87例104眼,B组(Ⅲ、Ⅳ期)61例69眼;正常对照组148例175眼。各组之间年龄、性别差异无统计学意义,且均排除其他全身疾病史。对各组角膜内皮细胞的平均密度、六边形细胞比例、变异系数及中央角膜厚度进行统计学分析。结果:高血压组患者较正常对照组角膜内皮细胞变异系数和中央角膜厚度增加,六边形细胞比例以及中央角膜内皮细胞密度减少,差异具有统计学意义(P<0.05或P<0.01);高血压B组与高血压A组相比较4项指标之间差异均有统计学意义(P<0.05或P<0.01)。结论:原发性高血压患者角膜内皮细胞形态结构存在异常,且随病变程度的加重而加重。对合并患有高血压的患者在进行内眼手术时应特别注意保护角膜内皮,防止角膜内皮功能失代偿。     

准分子激光角膜上皮瓣下磨镶术对兔角膜基质细胞凋亡的影响

目的 观察兔行不同切削深度的准分子激光角膜上皮瓣下磨镶术(LASEK)后角膜基质细胞凋亡的变化.方法 健康新西兰白兔随机分为3组,随机选择一只眼行LSEK术,分别按近视-3.00、-9.00和-15.00D设计切削,另一只眼为对照眼.24 h和7 d后常规取角膜制成石蜡切片,采用核苷酸末端转移酶介导的dUTP缺口标记(TUNEL)法检测基质细胞凋亡,计数凋亡细胞,计算凋亡指数进行分析.结果 凋亡细胞呈棕黄色,体积缩小,核固缩成团.术后24h-3.00、-9.00和-15.00D三组激光切削眼凋亡指数分别为0.39±0.10、0.55±0.08和0.54±0.12,均分别高于对照眼;-9.00D的切削较-3.00D组凋亡细胞增多,-15.00D组凋亡指数与-9.00D无显著性差异;术后7 d激光切削组的凋亡指数与对照眼无显著性差异,且较24 h减轻.结论 LASEK术可导致兔角膜基质细胞凋亡,且随切削深度的增加,细胞凋亡呈增加趋势.     

轴性高度近视合并白内障超声乳化摘除术前后角膜内皮细胞的变化

目的: 分析轴性高度近视病人角膜内皮细胞形态学,并评估超声乳化术对轴性高度近视合并白内障
病人角膜内皮细胞的影响。方法: 随机选取行超声乳化术的轴性高度近视合并白内障病人42 例( 46 眼) 为实验
组,单纯老年性白内障病人45 例( 50 眼) 为对照组,随访观察比较两组术前、术后1wk、1mo 以及3mo 中央区的角
膜内皮细胞密度、六角形细胞百分比、平均角膜内皮细胞面积以及变异系数。结果: 实验组和对照组术前角膜内
皮细胞密度比较,差异无统计学意义( P ＞ 0． 05) ,但六角形细胞百分比较对照组小,平均角膜内皮细胞面积以及
变异系数较对照组大,差异均有统计学意义( P ＜ 0． 05) 。两组术后1wk、1mo 以及3mo 角膜内皮细胞各项指标与
术前相比,差异均有统计学意义( P ＜ 0． 05) 。而在术后1wk、1mo、3mo 两组间比较,实验组角膜内皮细胞密度以
及六角形细胞百分比进一步下降,平均角膜内皮细胞面积以及变异系数进一步增大,两组间各项指标比较,差异
均有统计学意义( P ＜ 0． 05) 。结论: 轴性高度近视病人角膜内皮细胞功能减退,超声乳化术对角膜内皮细胞有
一定的损伤,轴性高度近视合并白内障病人比单纯老年性白内障病人角膜内皮更易受损。     

角膜中央厚度与眼压测量值的相关性分析

目的:探讨角膜中央厚度与眼压测量值的相关关系. 方法:选择行准分子激光屈光性角膜切削术(Excimer laser photorefractive keratectomy,PRK)的患者307只眼和行准分子激光原位角膜磨镶术(Excimer laser in situ keratomileusis,LASIK)的患者257只眼,术前屈光度-2.50～-15.00 D,术后1年屈光度-1.00～+1.00 D.采用非接触式眼压计测量眼压,超声角膜测厚仪测量角膜中央厚度.采用Pearson相关分析和偏相关分析研究变量间的相关关系.结果:术前角膜中央厚度与眼压测量值明显相关(r=0.376,P<0.01);术后角膜中央厚度与眼压测量值也明显相关(行PRK手术者,r=0.510,P<0.01;行LASIK手术者,r=0.410,P<0.01);控制切削等值球镜度,对术前、术后角膜中央厚度差值、眼压测量差值进行偏相关分析,结果二者明显相关(行PRK手术者,偏相关系数r=0.233,P<0.01;行LASIK手术者,偏相关系数r=0.211,P<0.01).结论:角膜中央厚度与眼压测量值存在明显的相关关系.     

同轴微切口超声乳化术联合小梁切除术治疗青光眼合并白内障的疗效

目的观察同轴微切口与小切口超声乳化术联合小梁切除术治疗青光眼合并白内障的疗效。方法选择2010年1月~2016年12月在我院青光眼合并白内障的患者90例(90眼),随机将患者分为观察组和对照组,每组均为45例。对照组采用传统的3 mm切口超声乳化联合小梁切除术,观察组采用1.8 mm的切口超声乳化联合小梁切除术。观察两组治疗后的手术成功率和并发症发生率及治疗前后两组的裸眼视力、散光、眼压、角膜内皮细胞密度、六角细胞比例、角膜内皮细胞变异系数和中央角膜厚度的变化。结果观察组的手术成功率为97.78%,对照组的成功率为91.11%,两组的手术成功率差异无统计学意义(χ2=0.847,P0.05)。治疗前的裸眼视力、散光、眼压、角膜内皮细胞密度、六角细胞比例、角膜内皮细胞变异系数和中央角膜厚度差异无统计学意义(P0.05)。治疗后两组的裸眼视力、角膜内皮细胞变异系数和中央角膜厚度较治疗前明显升高(P0.01),裸眼视力和中央角膜厚度观察组升高更为明显(P0.01),对照组的角膜内皮细胞变异系数升高水平更为明显(P0.01)。治疗后对照组的散光水平较治疗前和观察组明显升高(P0.01)。治疗后两组的眼压,角膜内皮细胞密度和六角细胞比例较治疗前明显降低(P0.01),而对照的角膜内皮细胞密度和六角细胞比例降低水平更为明显(P0.01),两组的眼压差异无统计学意义(P0.05)。对照组的术后并发症发生率为31.11%,明显高于观察组的8.89%(χ~2=5.625,P0.05)。结论同轴微切口超声乳化术联合小梁切除术治疗青光眼合并白内障的疗效优于传统手术方式,在减少术后散光和角膜内皮细胞的损伤和降低并发症方面具有明显的优势。     

超声乳化白内障摘除术与小切口白内障摘除术对角膜内皮细胞影响的对比研究

目的 通过观察超声乳化白内障摘除手术和小切口白内障摘除术对角膜内皮细胞的数量和形态学(变异系数、六角形细胞比例)以及中央角膜厚度的变化,分析两种手术方式对角膜内皮细胞的安全性。 方法 分析2015年1—12月就诊于蚌埠医学院第一附属医院的共200例白内障患者,分为2组,所有患者均接受6周的随访。超声乳化组患者100例,接受超声乳化白内障手术;小切口组患者100例,接受小切口白内障摘除术。对比2组患者术前、术后各时期中央角膜厚度、内皮细胞密度、变异系数及六角形细胞比例变化情况。 结果 术前、术后6周2组患者中央角膜厚度变化比较差异无统计学意义(P>0.05),术后1周,小切口组患者中央角膜厚度变化与超声乳化组比较差异有统计学意义(P<0.05)。术前、术后各时期,2组患者内皮细胞密度变化比较差异无统计学意义(P>0.05)。2组患者各时期角膜内皮细胞面积变异系数及六角形细胞比例变化差异无统计学意义(P>0.05)。 结论 2种手术方式均会造成不同程度的角膜内皮细胞丢失,但两者对角膜内皮细胞功能和形态学的影响无显著差异。而术前详细的检查,术中精细、熟练的操作以及术后精心的观察治疗,是减少白内障患者角膜内皮细胞丢失的关键。      

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.     

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.     

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.     

Notes for contributors to Journal of Nanjing Medical University

Journal of Nanjing Medical University (English Edition) JNMU, sponsored by Nanjing Medical University, was established in 1987. It is a bimonthly comprehensive English medical journal published locally and abroad.Since 2007, Journal of Nanjing Medical University (English Edition )was granted Elsevier the full publishing and distribution rights worldwide for the Electronic Edition, excluding the People's Republic of China.     

ANTI-PROLIFERATION EFFECT OF ORIDONIN ON HL-60 CELLS AND ITS MECHANISM

Objcetive To investigate the anti-proliferation effect of oridonin on leukemic HL-60 cells and its mechanism. Methods HL-60 cells in vitro in culture medium were given different concentrations of oridonin. The inhibitory rate of cells were measured by microculture tetrazolium (MTT) assay, cell apoptotic rate was detected by flow cytometry (FCM), morphology of cell apoptosis was observed by hoechst 33258 fluorescence staining, and the activity of telomerase was detected using telomere repeat amplification protocol (TRAP) PCR-ELISA before and after apoptosis occurred. Results Oridonin could decrease telomerase activity, inhibit growth of HL-60 cells, and cause apoptosis significantly. The suppression was both in time- and dose-dependent manner. Marked morphological changes of cell apoptosis including condensation of chromatin and nuclear fragmentation were observed clearly by hoechst 33258 fluorescence staining especially after cells were treated 48-60 hours by oridonin. Conclusions Oridonin has apparent anti-proliferation and apoptotic effects on HL-60 cells in vitro, decreasing telomerase activity of HL-60 cells may be one of its most important mechanisms. These results will provide strong laboratory evidence of oridonin for clinical treatment of acute leukemia.     

HOUSE DUST MITE ALLERGEN （Derp1 AND Blot5） LEVELS IN ASTHMATICS＇ HOME IN HONGKONG

Objective To measure Derpl and Blot5 allergen levels in asthmatics' homes in Hongkong.Methods Seventy houses were enrolled for a mite indoor environment study. Dust samples were obtained from two sites of each patients' house: bed and floor. Derpl and Blot5 levels were quantified by a two-site monoclonal antibody-based ELISA technique.Results The levels of Derpl allergens found in bed (geometric mean (GM) 3.43 μg/g of dust; 95%CI, 1.89-4.96 μg/g)and on the floor (GM 1.12 μg/g of dust; 95%CI, 0.71-1.53 μg/g) indicated significant differences (P=0.005). However, the levels of Blot5 allergens found in bed (GM 19.00 μg/g of dust; 95%CI, 0.89-38.90 μg/g) and on the floor (GM 6.14 μg/g of dust; 95%CI, 0.40-11.90 μg/g) showed no statistically significant difference. In addition, in regards to the exposure index for Derpl and Blot5 allergens found in bed and on the floor, 17.6% in bed and 8.6% on the floor had levels of Blot5 ≥ 10 μg/g of dust, higher than those obtained for Derp1 (7.2% and 0% in bed and on the floor respectively, P＜ 0.05); higher percentages in bed and on the floor (25.0% and 35.7%) were observed for levels of Blot5 =0 μg/g of dust as compared with Derpl in bed and on the floor (4.3% and 14.5% respectively, P＜ 0.05).Conclusions Derpl and Blot5 are the major allergens found in this regional study, Blot5 is a more potent allergen in Hongkong, probably reflecting the high level of exposure to Blomia tropicalis (Bt). Bt and Dermatophagoides pteronyssinus (Dp) allergens should be included for precise diagnosis and effective immuno-therapeutic treatment of mite allergy in Hongkong.     

Acute and mid-term results of pecutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy

Objective: To assess the acute and mid-term results of cardiac function improvements and left ventricular outflow tract gradient (LVOTG)changes in 30 patients displaying hypertrophic obstructive cardiomyopathy (HOCM) treated with percutaneous transluminal septal myocardial ablation (PTSMA). Methods: PTSMA was intended for 32 patients comprising of 13 women and 19men (average years being 54.1 ± 15.5) to be treated in accordance with the following inclusion criteria: The New York Heart As-sociation(NYHA) definition for cardiac functional class Ⅲ or Ⅳ , or class Ⅱ but for whom medical therapies were not tolerated or with syncope; intraventricular septal (IVS) and left ventricular posterior wall (LVPW) hypertrophy asymmetrically associated with ratio of IVS to LVPW≥1.3 and LVOTG≥50 mm Hg at rest or ≥100 mm Hg at provocation (Valsalva maneuver). The target vessels were determined by coronary arteriography that demonstrated more than one septal branch and probatory balloon occlusion produced greater than 50% decrease of LVOTG. Once the target vessel established, the alcohol was administrated into septal ventricular via over-the-wire balloon. LVOTG was assessed by means of echocardiography measurements immediately after procedure and 3 months. Simultaneously, cardiac function class was also evaluated. Results: Two patients were abandoned prior to intervention due to inappropriate septal target vessels and DDD Pacemakers were chosed. Immediately after the procedure, resting LVOTG was reduced from 73.8 ± 35.5 to 16.6 ± 7.8 mmHg, at provocation LVOTG from 149.3 ± 42.5 to 61.9 ± 43.0 mmHg(P ＜0.0001 each) by echocardiography measurements. After 3 months, the mean New York Heart Association class was reduced from 2.8 ± 0.6 to 1.1 ± 1.0(P ＜ 0.0001) and the LVOTG also remained decrease(28.5 ± 6.4 mmHg at rest and 75.3 ± 11.6 mmHg at provocation). Conclusion: PTSMA is a promising nonsurgical technique for relief of symptoms and reduction of LVOTG in hypertrophic obstructive cardiomyopathy.     

IMAGING DIAGNOSIS OF THORACOLUMBAR BURST FRACTURES

Objective To review imaging use in the diagnosis of thoracolumbar burst fractures and to determine the diagnostic value of different imaging methods. Methods One hundred and fourteen patients with 120 thoracolumbar burst fractures were retrospectively reviewed. Plain radiographs were available in all cases; CT scans and MRI were obtained in 96 and 74 cases, respectively. Results A total of 27 burst fractures were misdiagnosed as other types of fractures on radiographs alone, and accounted for 22.5% of all fractures. The results indicated that plain radiographs often fail to delineate the pathological features of thoracolumbar burst fractures, leading to delay in diagnosis. Conclusion In regard to thoracolumbar injury diagnosis, burst fractures should be differentiated from compression fractures. CT should be routinely indicated and MRI examination, when necessary, may be simultaneously considered.