显微镜直视下视网膜脱离复位手术的临床研究

目的 探讨显微镜直视下视网膜脱离复位手术的疗效及临床应用的可能性.方法 孔源性视网膜脱离56例,全部为显微镜直视下巩膜外硅胶垫压及冷凝(或联合环扎)进行手术.术前根据三面镜检查裂孔位置、大小及脱离范围,计算垫压和/或环扎缝置位置,术中先预置巩膜外垫压和/或环扎带缝线,根据术前检查网膜下液的低点,放液针穿破巩膜、脉络膜引流视网膜下液,显微镜直视下用冷凝头顶压巩膜确定裂孔及变性区并冷凝,固定硅胶带和/或环扎带,如术中检查眼压低,予玻璃体内注入消毒空气.术中观察裂孔封闭、网膜复位确实后结束手术.术后观察视力、眼压、葡萄膜反应、冷凝区反应、视网膜复位等情况.结果 56例病例,视网膜一次复位54例,原位再次脱离2例,其中1例为裂孔位于垫压嵴后坡,再次网膜下液出现;另外1例为多发裂孔术前术中未全部查及;其中矫正视力提高的有45例,无改变的有6例,下降的5例;术后葡萄膜及冷凝区视网膜均无过度炎性反应.结论 显微镜直视下视网膜脱离复位手术操作简单、快捷,疗效可靠.     

不放液的节段性外垫压治疗单纯型孔源性视网膜脱离

目的探讨不放液的节段性外垫压治疗单纯型孔源性视网膜脱离的疗效。方法对19例(19眼)视网膜脱离病人行巩膜外垫压结合巩膜冷凝术封闭视网膜裂孔治疗。结果术后随访中17例视网膜复位,2例视网膜脱离复发,1次手术成功率89.47%。术后随访两个月以上,视力≥0.3的有13眼,其中≥1.0的有2眼。结论不放液的节段性外垫压结合巩膜冷凝术治疗单纯型孔源性视网膜脱离效果满意。本手术应用于早期手术的视网膜脱离,或者视网膜裂孔不复杂的病例,术后视力恢复好。     

上方马蹄形裂孔伴球形视网膜脱离巩膜外显微手术方法探讨

目的 探讨上方马蹄形裂孔伴球形视网膜脱离巩膜外显微手术方法及其手术效果。方法 对2001年1月～2003年1月本院的17例上方马蹄形裂孔伴球形视网膜脱离患者作回顾性分析，手术方法：巩膜电凝针排出视网膜下液，在手术显微镜直视下，巩膜标记器精确定位视网膜裂孔位置，巩膜外冷凝，放射状或平行角膜缘硅胶垫压，联合玻璃体腔内空气注入。术后随访6～15个月。结果 出院时视网膜均解剖复位，术后1个月1例因玻璃体积血机化发生牵引性视网膜脱离，行玻切、硅油填充后视网膜复位。13只眼视力有不同程度提高，提高2行以上者占9例，提高1～2行者占4例，3只眼视力无改变。结论 对于上方马蹄形裂孔伴球形视网膜脱离患者，手术显微镜直视下精确定位视网膜裂孔，巩膜外硅胶垫压联合玻璃体腔内注气是安全有效的手术方法。     

巩膜扣带术中联合气体填充固定和放视网膜下液的比较

目的比较巩膜扣带术中联合气体填充固定与放视网膜下液治疗原发性孔源性视网膜脱离的临床效果.方法巩膜扣带术中裂孔定位良好但裂孔周围视网膜下液较多时联合气体填充固定或放视网膜下液治疗.结果 38例38眼行巩膜扣带术,其中26眼术中联合行玻璃体腔C3F8气体填充治疗,术后23眼(88.5%)经1次手术后脱离的视网膜完全复位,12眼术中采用放视网膜下液治疗, 术后11眼(91.7%)脱离的视网膜经1次手术完全复位.结论巩膜扣带术中可联合气体填充固定代替术中放视网膜下液.巩膜扣带术联合气体填充固定的主要并发症为术后新裂孔形成.     

巩膜外垫压术治疗单纯型孔源性视网膜脱离

目的探讨巩膜外垫压术治疗单纯型孔源性视网膜脱离的疗效.方法对2000年至2004年住院的28例（28眼）视网膜脱离病人行巩膜外垫压结合巩膜冷凝术,封闭视网膜裂孔治疗.结果术后随访中27例视网膜复位,1例视网膜脱离复发.1次手术成功率96.43%.术后随访两个月以上,视力≥0.3的有20眼,其中≥1.0的有7眼.结论巩膜外垫压结合巩膜冷凝术治疗单纯型孔源性视网膜脱离效果满意.本手术应用于早期手术的视网膜脱离,或者视网膜裂孔不复杂的病例,术后视力恢复好.     

玻璃体手术治疗视网膜脱离合并脉络膜脱离

为了探讨玻璃体手术在视网膜脱离合并脉络膜脱离治疗中的应用,回顾性分析了12例12只眼视网膜脱离合并脉络膜脱离的病例,应用闭合式玻璃体手术,玻璃体腔内应用6mm长灌注针头,切除玻璃体,剥离视网膜前膜,气液交换,周边部下方裂孔置巩膜外填压,调整环扎带,玻璃体注气C3Fe15％。一例患者注入硅油。术前、术后常规全身激素用药。结果12例12只眼术中眼内压迅速重建,脉络膜下腔的液体经三个巩膜切口自行引流,脉络膜复位,无需另外的巩膜切口引流脉络膜下腔的液体,术后随访2～16个月,12只眼全部获得视网膜解剖复位,未诱发术后玻璃体视网膜增殖病变(PVR)。提示玻璃体手术在治疗视网膜脱离合并脉络膜脱离时是优先考虑的术式。     

显微镜直视下外路视网膜脱离手术疗效观察

目的 探讨显微镜直视下外路视网膜脱离手术的可行性.方法 孔源性视网膜脱离17例,在手术显微镜下定位裂孔并对裂孔及变性区进行冷凝,行巩膜外硅胶垫压术.结果 术后随访1～6个月,裂孔封闭,视网膜完全复位17眼,视力提高17眼.矫正视力<0.3 5眼.≥0.3 12眼.结论 显微镜直视下外路视网膜手术冷凝及巩膜外硅胶垫压术手术视野清晰,放大倍数大,简单易行,术后疗效理想.     

黄斑裂孔性视网膜脱离的手术治疗

目的探讨黄斑裂孔性视网膜脱离手术治疗及其效果。方法对36只眼黄斑裂孔性视网膜脱离采用单纯玻璃体腔注气（C2F66、C3F8）或联合巩膜外环扎、巩膜外垫压、玻璃体切割术,术后随访1～6个月（平均3．2个月）。结果经平均3．2个月的随访,33只眼治愈,治愈率为91．67％,视力提高27只眼,减退4只眼,无变化5只眼;视网膜解剖复位33只眼;术后短暂高眼压6只眼,玻璃体腔少量积血1只眼,晶状体混浊加重2只眼。结论黄斑裂孔性视网膜脱离手术的关键在于术前根据玻璃体视网膜情况,设计正确的手术方案,提高手术成功率。     

巩膜外垫压联合玻璃体腔注气术治疗玻璃体切除术后视网膜脱离的临床效果

目的观察巩膜外垫压联合玻璃体腔注气术治疗玻璃体切除术后视网膜脱离患者的临床效果。方法选取2008-03/2012-04月在作者医院接受治疗的玻璃体切除术后视网膜脱离患者30例(总共30眼),所有患者均给予巩膜外垫压联合玻璃体腔注气术治疗,随访至2013-12月,观察这30例患者的总体治疗情况及术后相应并发症的发生情况。结果 30例患者总共30只病眼均治愈,其中有3只病眼因为初次手术后的眼裂口周围的冷冻瘢形成较差而再次进行眼底激光治疗;另有2只病眼于手术完成46d后发现其他象限周围视网膜再次出现小裂孔,经再次巩膜外垫压联合玻璃体腔注气术治疗后将视网膜完全复位。所有患者术后视力均未出现下降且无严重并发症发生。患者手术前后的视力比较,患者术后视力在0.02以上所占的比例显著高于术前(P<0.05),患者手术后第30天的前房深度、晶状体厚度、眼轴长度均较手术前显著改善(P<0.05)。结论巩膜外垫压联合玻璃体腔注气术治疗玻璃体切除术后视网膜脱离患者的临床效果显著,安全性高。     

巩膜外填压治疗硅油眼复发性视网膜脱离的临床疗效

目的探讨硅油眼复发性视网膜脱离进行巩膜外填压的治疗效果。方法对43例（43眼）因各种原因行玻璃体切割术联合硅油注入术后视网膜脱离复发的患者进行巩膜外填压,术中引流或不引流视网膜下液,对患者进行随访,分析巩膜外填压的疗效及视功能恢复情况。结果43眼中,39眼视网膜脱离在下方,4眼为颞上或颞侧脱离。手术后视网膜复位41眼,2眼因PVR严重术中视网膜不能复位而改行玻璃体手术联合硅油注入术。术后视力手动2眼,指数4眼,0.01为3眼,0.02-0.05为19眼,0.05-0.1为7眼,0.1-0.5为10眼。平均随访10个月,3眼视网膜脱离再次复发而行玻璃体手术。结论巩膜外填压对硅油眼复发性视网膜脱离具有较好的疗效,但对于PVR严重的复发眼宜行玻璃体手术。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.     

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.