视盘三维参数对青光眼视神经损害评价的应用研究

目的通过对海德堡视网膜断层扫描仪Ⅱ型（HRT-Ⅱ）视盘参数与激光扫描偏振仪（GDX）视网膜神经纤维层（RNFL）厚度的相关性分析,探讨HRT-Ⅱ盘沿参数对青光眼视神经损害的评价。方法使用HRT-Ⅱ和GDX仪器对原发性慢性闭角型青光眼患者51例（73眼）,进行视盘参数和RNFL厚度测量,并进行视盘参数与RNFL厚度的相关分析。结果 RNFL厚度与盘沿面积（RA）、盘沿体积（RV）无相关性;RNFL厚度全周平均值与盘沿面积/视盘面积（RA/DA）、盘沿体积/视盘体积（RV/DV）呈正相关（=0.430、0.444,〈0.05）;视神经纤维指数（NFI）与盘沿面积/视盘面积（RA/DA）、盘沿体积/视盘体积（RV/DV）呈负相关（=-0.564、-0.545,〈0.01）;RNFL厚度上方平均值与上方盘沿体积/上方视盘体积（SRV/SDV）呈正相关（=0.472,〈0.05）;RNFL厚度下方平均值与下方盘沿体积/下方视盘体积（IRV/IDV）呈正相关（=0.426,〈0.05）。结论 HRT-Ⅱ视盘参数中,应用盘沿/视盘参数优于直接应用RA、RV参数,应用RV/DV三维参数优于RA/DA参数。     

海德堡视网膜断层扫描仪在青光眼诊断中的价值

目的评价海德堡视网膜断层扫描仪Ⅱ型（HRT-Ⅱ）在青光眼诊断中的应用价值。方法对正常组98例（98只眼）和闭角型青光眼（PACG）组59例（59只眼）、开角型青光眼（POAG）组36例（36只眼）分别行HRT-Ⅱ检查,比较各组间视盘结构参数的差异,并用ROC曲线下面积分析不同参数的诊断灵敏度和特异度。结果正常组与开角型青光眼组间杯盘面积比、视杯容积、盘沿容积、杯型测量及平均神经纤维层厚均有显著性差异。正常组与闭角型青光眼组只有杯形测量及平均神经纤维层厚有显著性差异。结论 HRT-Ⅱ对青光眼的诊断有很大帮助。     

原发性开角型青光眼与正常眼HRT-Ⅱ视盘形态结构的对比研究

目的探讨Heidelberg视网膜断层扫描仪(HRT-Ⅱ)在原发性开角型青光眼(POAG)早期诊断中的意义。方法用HRT-Ⅱ对早期、进展期POAG30例(48眼)及正常人25例(50眼)的视盘进行断层扫描,获得视盘平均地形图像和视盘结构诸参数,将POAG视盘参数与视野平均缺损(MD)行相关性分析。结果POAG与正常人视盘结构各参数中视盘面积、视杯面积、盘沿面积、杯盘面积比、视杯容积、盘沿容积、平均视杯深度、最大视杯深度、轮廓线高度变化值、视杯形态测量、平均神经纤维层厚度存在明显差异,检测的视野平均缺损与HRT-Ⅱ视盘检测参数具有一致性。结论HRT-Ⅱ能够反映POAG视盘改变,与视野相关性好,为临床早期诊断POAG提供了依据。     

海德堡视网膜断层扫描仪在青光眼诊断中的价值

目的：评价海德堡视网膜断层扫描仪Ⅱ型（Heidelberg retina tomograph-Ⅱ,HRT-Ⅱ）在青光眼诊断中的应用价值。方法：对对照组98例（98只眼）和闭角型青光眼（Primary angle closure glaucoma,PACG）59例（59眼）,开角型青光眼（primaryopen angle glaucoma,POAG）36例（36眼）分别行HRT-Ⅱ检查,比较各组间视盘结构参数的差异,并用Roc曲线下面积分析不同参数的诊断灵敏度和特异度。结果：正常组与开角型青光眼组间杯盘面积比、视杯容积、盘沿容积、杯型测量及平均神经纤维层厚均有显著性差异。正常组与闭角型青光眼间只有杯形测量及平均神经纤维层厚有显著性差异。结论：HRT-Ⅱ对青光眼的诊断有很大帮助。     

视网膜断层扫描仪测量广西汉族正常人群视盘参数的研究

目的了解本地区汉族正常人群视盘参数的正常值。方法将三代居住广西隆林县无血缘关系的120例正常汉族成年人纳入研究对象,运用海德堡视网膜断层扫描仪（Heidelberg retina tomograph-Ⅱ,HRT-Ⅱ）分别检测不同年龄段汉族人群视乳头地形图总体参数。结果正常汉族人视盘参数正常值：视盘面积（DA）为（2．2165±0．4266）mm^2,视杯面积（CA）为（0．4816±0．2979）mm^2,盘沿面积（RA）为（1．7311±0．3217）mm^2,视杯／视盘面积比值（C／DAR）为（0．2074±0．1092）,盘沿／视盘面积比值（R／DAR）为（0．7923±0．1091）,视杯容积（CV）为（0．1076）mm^3,盘沿容积（RV）为（0．5196±0．1519）mm^3,平均视杯深度（MCD）为（0．2055±0．0798）mm,最大视杯深度（MxCD）为（0．6039±0．1949）mm,视乳头轮廓线高度变化值（HVC）为（0．4513±0．1639）mm,视杯形态测量（CSM）为（-0．2155±0．0617）mm,平均视网膜神经纤维层厚度（mRN-FLT）为（0．3059±0．0845）mm,视网膜神经纤维层截面面积（RNFLA）为（1．5785±0．3830）mm^2。按年龄分成4组,正常汉族人mRNFLT、RNFLA在49岁以下与50岁以上比较差异有统计学极显著意义（P〈0．01）,而49岁以下各组之间比较差异无统计学意义（P〉0．05）。性别间各参数比较差异无统计学意义（P〉0．05）。眼别间比较差异元统计学意义（P〉0．05）。汉族C／DAR比值双眼差值范围为0．048～0．112。RV和HVC两个参数不受视盘大小影响。结论HRT-Ⅱ可定量检测广西汉族正常人视盘参数,且不同年龄视盘参数的均值与性别及眼别无关,RV和HVC可做为一个评价指标。     

FD-OCT测量视盘周围视网膜神经纤维层和视神经乳头参数在青光眼早期诊断中的意义

目的:探讨RTVue傅里叶域光学相干断层扫描成像仪(fourier-domain optical coherence tomography, FD-OCT)测量视盘周围视网膜神经纤维层(retinal nerve fiber layer, RNFL)及视神经乳头(optic nerve head,ONH)各项参数在青光眼早期诊断中的作用?方法:应用RTVue FD-OCT测量青光眼患者50例76只眼及正常人45例80只眼的视盘周围RNFL厚度及ONH各项参数,比较正常眼与各期青光眼的差异,用受试者工作特征曲线下面积(area under the receive operating characteristic curve, AUROC)评价其在青光眼早期诊断中的作用?结果:不同阶段青光眼患者各象限及平均RNFL厚度均比正常人减少,差异有统计学意义(P < 0.001)?除视盘面积,其余ONH参数(视杯面积?盘沿面积?盘沿容积?视神经容积?视杯容积?杯盘比?水平杯盘比?垂直杯盘比)在正常组与青光眼组之间差异均有统计学意义(P < 0.001)?正常组与青光眼组之间平均RNFL?垂直杯盘比?杯盘比和视杯面积的AUROC最大?正常组与早期组之间平均RNFL?杯盘比?视杯面积AUROC最大?结论: RTVue FD-OCT测量视盘周围RNFL厚度及ONH参数有助于青光眼早期诊断?     

海德堡视网膜断层扫描仪在开角型青光眼诊断中的价值

目的 评价海德堡视网膜断层扫描仪 (Heidelberg retina tomograph,HRT)在开角型青光眼(primary open angl glaucom,POAG)诊断中的应用价值.方法 对照组98例(98眼)和POAG组36例(36眼)分别行HRT检查,比较各组间视盘结构参数的差异,并用ROC曲线下面积分析不同参数的诊断灵敏度和特异度.结果 对照组与POAG组间杯盘面积比、视杯容积、盘沿容积、视杯形态测量指数及平均视网膜神经纤维层厚度差异均有统计学意义(P＜0.05).ROC曲线下面积分析特异度最高的为视杯形态测量指数,灵敏度最高的为平均视网膜神经纤维层厚度.结论 HRT检查对开角型青光眼的诊断有很大帮助.     

视盘参数分析在大视杯青光眼诊断中的应用研究

目的探讨海得堡视网膜断层扫描仪(HRT-Ⅱ)在区分非青光眼大视杯与青光眼大视杯的意义。方法将大视杯患者40例(80眼)分为非青光眼大视杯组21例(42眼)和青光眼大视杯组19例(38眼),并设正常视杯对照组24例(48眼),使用HRT-Ⅱ测量视盘参数并比较其差异。结果通过对各组检查图形进行分析得出14项目的视盘参数,3组间差异有统计学意义(<0.05)。非青光眼大视杯组与青光眼大视杯组除视盘面积、平均视杯深度值、大视杯深度值外差异均有统计学意义(均>0.05);非青光眼大视杯组与对照组除视乳头轮廓线高度变化值、平均视网膜神经纤维厚度、视网膜神经纤维层截面面积外,差异均有统计学意义(均<0.05);青光眼大视杯组与对照组各项指标差异均有统计学意义(均<0.05)。结论 HRT-Ⅱ为区分非青光眼大视杯与青光眼大视杯提供了一种客观检查方法。     

原发性开角型青光眼HRT-Ⅱ视盘参数与视野缺损的相关性研究

目的 通过对原发性开角型青光眼视盘参数与视野平均缺损(Mean defect,MD)之间的相关性研究,探讨原发性开角型青光眼的早期诊断方法 .方法 用海德堡激光眼底扫描仪(HRT-Ⅱ)和自动视野计测定110例(147眼)原发性开角型青光眼,采用直线相关分析和多元线性回归分析视盘参数与视野平均缺损的相关性.结果 原发性开角型青光眼盘沿面积与MD显著相关,盘沿面积每减少1 mm~2,MD的绝对值将增加7.933dB.各象限盘沿面积异常情况中,以颞下区盘沿面积变窄最为明显.结论 在HRT-Ⅱ的各项视盘参数中,盘沿面积最能反映青光眼的视野平均缺损程度.各象限盘沿面积异常情况中,以颞下区盘沿面积变窄最为明显.     

免散瞳立体眼底照相检测正常人视盘参数的可重复性

目的:评价立体眼底照相检测正常人视盘参数的可重复性。方法:同一操作者对30例(60眼)正常受试者进行视盘Nonmyd WX立体眼底照相,每眼扫描3次(隔日),测垂直杯盘比、上方盘沿宽度、下方盘沿宽度、视杯面积、视盘面积、盘沿面积、杯盘面积比、盘缘视盘面积比、视杯容积、视盘容积、盘沿容积、平均视杯深度、最大视杯深度13个视盘参数,组内相关系数(ICC)评价可重复性。结果:13个视盘参数ICC值均较高,为0.773-0.985。结论:免散瞳立体眼底照相检测视盘参数具有较好的可重复性。     

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.     

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.     

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.