动力系统与半导体激光下鼻甲部分切除术的比较

目的:比较动力系统与半导体激光下鼻甲部分切除术的优缺点。方法:比较4 6例动力系统下鼻甲部分切除术与37例半导体激光下鼻甲部分切除术术中出血量,手术时间,早、中期疗效,术后痂皮情况,术后并发症等。结果:动力系统下手术出血量多,手术时间短,近期疗效好(术后2周总有效率为73.9% ) ;半导体激光下手术出血少,患者痛苦轻,但术后痂皮多,近期效果不好(术后2周总有效率只有18.9% ) ,两者比较差异有高度显著性(χ2 =2 9.5 2 ,P <0 .0 1) ,中期效果两者相仿(术后半年动力系统组总有效率为93.5 % ,半导体激光组总有效率为94 .6 % ,差异无显著性(χ2 =0 .0 6 ,P >0 .0 5 ) ,动力系统组与激光组术后并发症发生率分别为2 .7%和8.7% ,差异亦无显著性(χ2 =0 .85 ,P >0 .0 5 )。结论:两种手术方法各有优缺点,中期疗效两者相仿,术后并发症发生率无明显差别。     

动力系统两种刀头行下鼻甲部分切除术的比较

目的:比较动力系统下用下鼻甲刀头行下鼻甲黏膜下切除术与用筛房刀头行下鼻甲部分切除术的优缺点。方法:91例用筛房刀头行下鼻甲部分切除术(筛房刀头组) ,4 5例用下鼻甲刀头行下鼻甲黏膜下切除术(下鼻甲刀头组) ,比较2组术中出血量,手术时间,早、中期疗效,术后痂皮量及去除快慢、术后并发症等。结果:筛房刀头组手术出血量多,手术时间短,中期疗效好,术后并发症稍多;下鼻甲刀头组手术出血少,患者痛苦轻,术后痂皮少,很快改善了鼻塞症状(术后1周总有效率6 4.4 % ) ,无并发症。但中期疗效(术后半年总有效率为77.8% )不及筛房刀头组(术后半年总有效率为94 .5 % ) ,两者差异有显著性(χ2 =10 .39,P <0 .0 1)。结论:两种手术方法各有优缺点,筛房刀头组中期疗效好于下鼻甲刀头组。     

不同下鼻甲手术方式疗效的比较

目的:比较下鼻甲切除术与半导体激光术治疗慢性肥厚性鼻炎的效果。方法:对53例行下鼻甲部分切除术和62例行半导体激光术治疗的慢性肥厚性鼻炎患者进行回顾性分析。结果:半导体激光治疗组的总有效率为87.1%,下鼻甲部分切除术组总有效率90.4%,两组比较无显著性差异(χ2=0.34,P<0.05);半导体激光治疗组术后并发症明显少于下鼻甲部分切除术组(χ2=19.32,P<0.01);下鼻甲部分切除术组的术后鼻塞天数[(3.9±0.6)d]明显长于半导体激光治疗组[(1.9±0.4)d](t=3193,P<0101)。结论:半导体激光术与下鼻甲切除术均是治疗慢性肥厚性鼻炎的有效方法,但半导体激光术具有更为简单,并发症少,术后反应轻等特点。     

黏膜下微型电动切削器下鼻甲部分切除加骨折外移术治疗慢性肥厚性鼻炎的疗效观察

目的观察黏膜下微型电动切削器下鼻甲部分切除加骨折外移术治疗慢性肥厚性鼻炎的疗效。方法随机选择130例慢性肥厚性鼻炎患者,65例行下鼻甲黏膜下微型电动切削器部分切除加骨折外移术(A组),45例行鼻内镜下鼻甲部分切除术(B组),20例行下鼻甲射频治疗(C组),术后随访6个月~1年。结果A组治愈46例,好转19例,B组治愈30例,好转15例,C组治愈15例,好转4例,无效1例,3组患者疗效间差别无统计学意义(P=0.892)。结论黏膜下微型电动切削器下鼻甲部分切除术加下鼻甲骨折外移术对慢性肥厚性鼻炎,因下鼻甲黏膜下纤毛结构保存好,有良好的治疗效果。     

鼻内镜下鼻甲黏膜下成形术治疗慢性肥厚性鼻炎的临床体会

目的:总结鼻内镜下鼻甲黏膜下成形术治疗慢性肥厚性鼻炎的经验。方法:采用XPS-3000手术综合动力系统配备专用下鼻甲切削刀头对25例慢性肥厚性鼻炎患者行内镜下鼻甲黏膜下成形术(A组),同时将选择行常规下鼻甲部分切除术的22例患者(B组)作为对照,比较两组的术中出血量、手术时间、鼻腔通气时间和黏膜恢复时间。结果:下鼻甲黏膜下成形术的术中出血量、手术时间、鼻腔通气时间和黏膜恢复时间比传统下鼻甲切除术要少和短,两组比较差异有统计学意义(P<0.05)。术后随访3个月,A、B两组的有效率分别为92%及86%,下鼻甲黏膜下成形术疗效更好。结论:内镜下鼻甲黏膜下成形术比传统的下鼻甲部分切除术创伤更小,术后疗效更好,值得临床进一步推广应用。     

鼻内窥镜下下鼻甲部分切除术的疗效

目的探讨鼻内窥镜下下鼻甲部分切除术的疗效,为临床制订手术方案提供借鉴。方法回顾性分析2011年1月~2012年6月辽宁阜新矿业集团有限责任公司总医院耳鼻喉科收治的150例慢性肥厚性鼻炎患者临床资料,按手术方式分为鼻内窥镜下下鼻甲黏膜下部分切除术组(A组)、鼻内窥镜下下鼻甲骨折外移术组(B组)、传统下鼻甲骨部分切除术组(C组),每组各50例。观察三组患者手术时间、术中出血量、住院时间及术后并发症,并比较分析三组患者术后近期疗效、远期疗效及总有效率。结果 B组的手术时间明显短于A、C组,差异均有统计学意义(P<0.05),而A、C两组手术时间比较,差异无统计学意义(P>0.05)。三组患者术中出血量、住院时间比较,C组明显高于A、B两组,组间差异有统计学意义(P<0.05)。术后两个月观察A、B、C三组患者的近期疗效,分别为92.0%、92.0%、90.0%,组间差异无统计学意义(P>0.05)。术后两年复查,A、B、C三组患者远期总有效率分别为94.0%、92.0%、80.0%,C组远期疗效明显低于A组、B组,差异有统计学意义(P<0.05)。A、B两组组患者远期总有效率差异无统计学意义(P>0.05)。A、B、C组三组的术后并发症发生率分别为2.0%、4.0%、20.0%,A、B组明显低于C组,组间差异有统计学意义(P<0.05)。结论鼻内窥镜下下鼻甲黏膜下部分切除术、鼻内窥镜下下鼻甲骨折外移术与传统下鼻甲骨部分切除术3种方法治疗慢性肥厚性鼻炎均有疗效,但鼻内窥镜下下鼻甲黏膜下切除术治疗慢性肥厚性鼻炎远期疗效优于传统下鼻甲骨部分切除术,安全可靠,值得临床推广。     

鼻内窥镜引导半导体激光下鼻甲部分切除术的临床探讨

目的:探讨鼻内窥镜引导下行半导体激光下鼻甲部分切除术的应用价值。方法:回顾分析56例慢性肥厚性鼻炎患者在鼻内窥镜引导下行半导体激光下鼻甲部分切除术的临床资料。结果:术后半年复查,总有效率94.64%,术中无出血,术后无并发症。结论:半导体引导下激光下鼻甲部分切除术方法简便、快捷、有效,是治疗慢性肥厚性鼻炎的有效方法。     

支撑喉镜联合鼻内镜下微型电动切削声带良性肿物

目的观察支撑喉镜联合鼻内镜下微型电动切削器切削声带良性肿物的疗效。方法选择108例临床可确诊为声带良性肿物患者,随机分为支撑喉镜联合鼻内镜下微型电动切削器切除声带良性肿物(观察组56例)与支撑喉联合镜鼻内镜下显微喉器械切除声带良性肿物(对照组52例),术后随访并观察6个月评定比较两组疗效。结果两组治愈率分别为92.86%和50%,有效率分别为98.21%和92.31%,临床治愈率差异有统计学意义(P<0.05)。结论两种术式疗效前者较好,且手术容易操作、时间短。     

电动微型切割器功能性下鼻甲成形术疗效分析

目的:探讨在鼻内镜下应用电动微型切割器行下鼻甲成形术治疗肥厚性鼻炎的疗效分析。方法:回顾性分析36例慢性肥厚性鼻炎,均在鼻内镜下行下鼻甲黏膜下吸切减容术。结果:36例患者应用电动微型切割器行下鼻甲成形术,术后随访6个月,治愈24例,显效8例,有效4例,总有效率100%。结论:应用电动微型切割器行下鼻甲成形术治疗肥厚性鼻炎疗效好,术后并发症少,符合功能性手术的原则,值得推广。     

鼻内镜下下鼻甲电动切吸成形术与微波治疗肥厚性鼻炎疗效比较

目的 比较和评价鼻内镜下下鼻甲电动切吸成形术和微波热凝术治疗肥厚性鼻炎的效果.方法 对96例接受鼻内镜下下鼻甲电动切吸成形术和微波热凝术患者的资料进行回顾性分析,其中46例行下鼻甲电动切吸成形术,50例行微波热凝术.结果 术后1个月下鼻甲电动切吸成形术的有效率为100%,微波热凝术为95.27%,二者无显著性差异 (P＞0.05);术后6个月前者为100%,后者为92.17%,二者无显著性差异 (P＞0.05);术后1年前者为100%,后者为84.25%,二者有显著性差异 (P＜0.01).鼻腔粘连并发症两组均无,术后反应各不相同.结论 鼻内镜下下鼻甲电动切吸成形术和微波热凝术治疗肥厚性鼻炎早期效果相近,但微波热凝术中远期疗效差,仅适用于下鼻甲黏膜增厚为主的慢性肥厚性鼻炎,而鼻内镜下下鼻甲电动切吸成形术中远期疗效稳定,适用范围广.     

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.     

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.     

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.