电子自旋共振技术观察急性声损伤后耳蜗自由基改变

目的:应用电子顺磁自旋共振(ESR)技术观察急性声损伤后豚鼠耳蜗自由基的变化规律.方法:将正常白毛红目豚鼠48只分为3组:A组(对照组)取6只豚鼠不给予噪声刺激,分别在检测听功能后测定自由基和硝酸银染色.B组21只豚鼠在(125±1)dB SPL稳态噪声暴露2h后分别于即刻、2h、6h,12h、24h、48h、72h施行ABR测试和ESR检测耳蜗自由基,检测方法为断头后快速取出耳蜗,液氮速冻.样品处理后放入ESR系统谐振腔中检测自由基含量.C组21只豚鼠在噪声暴露后于上述时间点检测听觉功能并取基膜行硝酸银染色观察Corti器毛细胞形态改变.结果:①正常豚鼠耳蜗中有少量自由基存在,其相对自由基值为(21.68±1.27).噪声暴露后即刻取样组自由基值明显升高,在暴露后2h达峰值(147.01±4.95)dB SPL,此后逐渐下降,至72h恢复至接近正常水平(53.12±2.57)dB SPL;②在125dB SPL的急性噪声暴露后,豚鼠的听阈明显提高,至6h达到峰值(73.89±2.41)dB SPL,直至72h仍未恢复到暴露前正常水平(50.28±1.48)dB SPL;③急性声损伤后形态学改变表现为外毛细胞纤毛紊乱、排列不规则,部分区域可见毛细胞缺失.结论:①急性噪声暴露后,豚鼠耳蜗内自由基水平明显增高,并在2h达峰值;②应用ESR技术检测耳蜗组织中自由基含量的方法具有直接、客观和灵敏的特点,ESR技术可用于某些内耳急性损伤动物模型的实验观察.     

小儿类听神经病的临床表现

目的:报道1组小儿类听神经病(ANSD)的临床特征,以加深对该病的认识。方法:回顾性分析84例(151耳)ANSD患儿病史、影像学、听力学表现及人工耳蜗植入效果。结果:①高胆红素血症11例,家族史2例,缺氧3例,早产1例,基底核病变1例,先天性脑发育落后2例,脑瘫1例,蜗神经发育不全13例;②79.8%(67/84)为双侧发病,20.2%(17/84)为单侧发病;③短声ABR:70.2%(106/151)在最大输出(100dB nHL)无反应波形引出,29.8%(45/151)在非常高的刺激强度仅有分化不良的Ⅴ波;④行为听力测试:23例有测试结果者中,1例为轻度感音神经性聋,2例重度,20例为极重度;⑤影像学:29例有内耳MRI者中,外、中、内耳结构正常者16例,蜗神经发育不良12例,蜗神经发育不良伴双脑室周围白质髓鞘形成不良1例;⑥人工耳蜗植入效果:5例患耳植入人工耳蜗,其中3例术后1年婴幼儿有意义听觉整合量表得分与蜗性聋儿相当,1例稍差于蜗性聋儿,另1例无效。结论:ANSD是听力学表现相同的一大类疾病,在病史、听力学、影像学及人工耳蜗植入效果方面存在多样性,因此对此类患儿应进行全面、详细的临床检查,以便制...     

人工耳蜗使用者噪声环境下言语识别能力研究

目的:评估人工耳蜗(CI)植入者在噪声环境下的言语识别能力。方法:利用普通话版噪声下言语测试(MHINT)为言语测试工具,选取22例CI受试者,按照MHINT适应性得分规则,首先确定受试者在噪声下识别50%～74%的句子内容(评分规则3),达到该水平则继续进行75%以上难度内容(评分规则2或规则1),否则停止。获得受试个体在噪声下言语识别能力的语句接受阈、言语识别率和PI function曲线。结果:22例受试者中,5例在噪声下识别能力达80%～90%,3例可达60%～70%,7例达到50%,7例未能达到MHINT评分规则3测试。获得15例受试者的PI function并与听力正常人进行比较。结论:MHINT适应性得分规则测试法,可有效地获得CI植入者在噪声下的言语识别能力。与听力正常者相比,CI植入者的PI function显示右移10dB以上,在噪声环境下仍需要更好的信噪比。     

骨髓细胞学检查在视网膜母细胞瘤中的应用价值

目的探讨骨髓细胞学检查在视网膜母细胞瘤转移中的应用价值。方法选取2008年1月至2009年4月临床确诊为视网膜母细胞瘤的211例患儿,在治疗前常规进行骨髓穿刺,并行骨髓细胞学检查,观察早期有无骨髓转移。结果在211例患儿中210例为正常骨髓象,1例骨髓中发现有肿瘤细胞,但不能确定是视网膜母细胞瘤肿瘤细胞。结论视网膜母细胞瘤早期骨髓转移发生率极低,入院患者是否应当常规做骨髓细胞学检查值得商榷。但骨髓细胞学检查仍然是早期发现转移的重要手段之一,对于存在高风险转移因素的患儿仍应积极进行此项检查。     

Repeatability and Reproducibility of Quantitative Assessment of the Retinal Microvasculature Using Optical Coherence Tomography Angiography Based on Optical Microangiography

Objective The aim of this study was to determine the repeatability and reproducibility of optical coherence tomography angiography(OCTA) based on optical microangiography(OMAG) measurements of macular vessels in normal eyes. Methods In this prospective cohort study, 40 eyes of 40 healthy volunteers underwent repeated OCTA(Cirrus HD-OCT 5000 angiography system, Carl Zeiss Meditec, Inc.) scans on two separate visit days. On each visit day, the eyes were scanned three times. The following parameters were used to quantitatively describe the OCTA images of the superficial vascular network: vessel area density(VAD), vessel skeleton density(VSD), vessel diameter index(VDI), vessel perimeter index(VPI), vessel complexity index(VCI), flux, and foveal avascular zone(FAZ). Coefficient of variation(CV) and intraclass correlation coefficient(ICC) were calculated for evaluating intravisit and intervisit repeatability, as well as interobserver reproducibility. Results The measurements showed high repeatability [CVs ≤ 4.2%(intravisit) and ≤ 4.6%(intervisit)] and interobserver reproducibility(ICCs ≥ 0.923) for all parameters. Conclusion This study demonstrated good repeatability and reproducibility of OCTA based on OMAG for the measurement of superficial vessel parameters in normal eyes.     

整合医学理念在妇科临床实习教学中的应用

在妇科教学中适时转变观念,建立整合医学教学理念和方法,能培养学生主动思考、分析和解决临床实际问题的能力。为建立学生“依人治病”的理念,本研究将整合医学理念引入妇科临床教学实践中,从教学、临床和资源等方面进行整合,从课程内容设计、教学形式方面进行改进。结果显示,学生对教师授课满意度高,有效调动了学生积极性,初步培养了学生的临床思维,取得较好的实践效果。     

两种C反应蛋白试剂盒在急性冠脉综合征患者中的应用比较

目的 探讨国产德赛C反应蛋白（CRP）试剂盒在贝克曼全自动生化仪上应用的可行性,以及在急性冠脉综合征（ACS）患者中的应用评估。方法 选择笔者医院冠心病重症监护治疗病房（CCU）30例ACS患者以及体检中心25例健康对照者,收集临床资料,用贝克曼库尔特（Beckman Coulter）公司的试剂盒与上海德赛试剂盒同时对上述55份临床血液标本在贝克曼仪器上进行检测,通过精密度试验、正确度试验、低值检测限、线性试验、生物参考区间验证试验以及干扰试验对德赛CRP试剂盒进行性能验证;同时比较分析两种试剂盒在30例ACS患者中的检测应用。结果 德赛CRP检测值的批内变异系数小于1/4CLIA''88,偏差小于1/2CLIA''88;德赛CRP的低值检测限为0.257mg/L;德赛与Beckman原装试剂盒的相关性良好（r=0.996）,检测结果比较,差异无统计学意义（P>0.05）;德赛CRP试剂盒在0.0~340.0mg/L范围内,线性良好;生物参考区间验证合格;一定程度的溶血、黄疸及脂血对检测结果无明显干扰;两种试剂盒在ACS患者中的检测结果比较,差异无统计学意义（P>0.05）。结论 德赛CRP试剂盒在贝克曼仪器上的性能验证结果准确可靠,该试剂盒能安全可靠的应用于临床,尤其适用于ACS患者的疾病监测。     

电动牙刷加速正畸牙齿移动的临床研究

目的探讨电动牙刷加速正畸牙齿移动的临床效果。方法选择30例需要拔除两侧上颌第一双尖牙的患者．进行配对实验。患者均采用MBT直丝弓矫正器,以150g拉力将尖牙向远中移动。左侧（实验侧）每日使用电动牙刷刷洗左侧上颌牙列2次,每次10min。而右侧（正常侧）则不采用电动牙刷刷洗。观察28d,分别测定记录尖牙移动距离．牙周状况和牙体长度。结果实验第7、14、21及28天使用电动牙刷侧尖牙移动距离分别为0．470、0．923、1．128及1．375mm,正常侧为0．361、0．784、0．944、1．149mm,两侧的差异有统计学意义（P〈0．05）。两侧尖牙牙周状况和牙体长度的差异无统计学意义（P〉0．05）。结论使用电动牙刷能够有效加速正畸牙齿的移动,对正畸移动牙齿牙周和牙体长度没有影响。     

Predictors and outcomes of photodynamic therapy on circumscribed choroidal hemangiomas in Chinese patients

Choroidal hemangiomas （CHs） are relatively rare,benign,vascular,hamartomatous tumors.They are categorized to circumscribed choroidal hemangiomas （CCHs） or diffuse choroidal hemangiomas （DCHs） clinically and histologically.Although circumscribed CHs （CCHs） are often asymptomatic,they can affect visual acuity （VA） if they are situated beneath the fovea,where they can cause accumulation of secondary subretinal fluid and/or cystic retinal degeneration.Due to its minimal invasiveness and negligible toxicity to the normal retina,photodynamic therapy （PDT） with verteporfin has been applied widely in the treatment of CCH.1 Treatment strategies for CCHs should take into account tumor size,anatomic location,VA,and presence/absence of complications.The present study was conducted to identify potential predictors of successful PDT treatment other than those previously reported.We also present alternative treatment modalities for larger,more complicated CCHs.Keywords：circumscribed choroidalhemangiomas; photodynamic therapy; tumor height; predictors and outcomes;success rate;fluorescence angiography; indocyanine green angiography     

Visual function and morphological changes in the macular area of patients with type 2 diabetes mellitus after intensive insulin therapy

Background Intensive insulin therapy has been found to lessen the progress of diabetic retinopathy （DR） to some extent,while it has also been implicated to be responsible for decrease of DR.We investigated visual function and morphological changes in the macular area in short-term follow-up of patients with type 2 diabetes mellitus after intensive insulin therapy.Methods This was a prospective clinical study of nonproliferative DR patients （102 eyes,120 patients） undergoing intensive insulin therapy.The Contrast Glare Tester （Takagi CGT-1000） was used to examine contrast sensitivity （CS） and Heidelberg Retina Tomograph （HRT） Ⅱ and Stratus Model 3000 OCT were used to observe the changes of morphology in the macular area.Follow-up times were pre-intensive therapy,3 and 6 months post-intensive therapy.Results CS at low and middle frequencies was higher at 3 and 6 months post-therapy compared with pre-therapy （P 〈0.05）.Significant differences in CS at low frequency were found between 6 and 3 months post-therapy （P 〈0.05）.Macular edema index was lower in the first,second,and third rings of the macular area after intensive therapy compared with pre-therapy （P 〈0.05）.Compared with 3 months post-therapy,the macular edema index was lower in the first,second,and third rings of the macular area at 6 months post-therapy （P 〉0.05）.No significant differences in the thickness of the first,second,and third rings of the macular area were detected between 3 and 6 months post-therapy and pre-therapy （P〉0.05）.Conclusion CS and macular edema indexes were significantly improved in nonproliferative diabetic retinopathy patients after intensive insulin therapy,but thickness of the macular area was unchanged.