指掌侧固有动脉的断层观测

目的观察国人手指掌侧固有动脉的管径和截面积,以期为临床提供数据。方法用27例成人手指作组织切片后,取近侧、中间和远侧指横纹及相邻指横纹中点处的横断面切片,对指掌侧固有动脉管径和截面积进行了观测。结果指掌桡侧固有动脉多出现在断面中的4、5区,指掌尺侧固有动脉多位于8、9区内;拇指在Ⅰ、Ⅱ断层上,动脉的外径、截面积桡侧大干尺侧,在Ⅲ断层两者相仿;示指、中指管径、截面积皆为尺侧大干桡侧;环指、小指管径、截面积平均值桡侧大干尺侧。结论在临床指掌侧固有动脉吻合时,应注意先吻合优势动脉。     

掌浅弓的应用解剖研究

目的:研究掌浅弓的形态学特征,为临床手部血管修复,吻合或断掌再植时修复掌浅弓提供解剖学基础。方法:对28具成人尸体的56例手进行层次解剖,充分暴露掌浅弓,观察其类型、形状、对称性及分支。结果:掌浅弓分4型即尺动脉型、桡尺动脉型、正中尺动脉型、尺动脉掌深弓分支型;桡尺动脉型最为多见。掌浅弓有4种形状,即弧线形、单弓形、不完全形、鞍形。弧线形与单弓形多见,不完全型、鞍型较少见。掌浅弓左右两侧对称性多见,占59.3%。掌浅弓的分支有3~6条,45例发出小指尺掌侧固有动脉,占80.5%。21例小指尺掌侧固有动脉与第3指掌侧总动脉共干,占37.5%。30例发出3条指掌侧总动脉,占53.6%。22例发出4条指掌侧总动脉,占39.3%。结论:临床手外科手掌损伤修复重建掌浅弓时应充分注意掌浅弓的分型、形状、对称性和分支。     

掌浅弓的应用解剖

目的 为手掌血管损伤时,修复掌浅弓提供解剖学基础。方法 对60例成人掌浅弓的类型、形状、对称性和分支进行解剖观察。结果 掌浅弓分4型即尺动脉型、桡尺动脉型、正中尺动脉型、桡正中尺动脉型;以尺动脉型和桡尺动脉型为多见。掌浅弓有5种形状,即弧线形、单弓形、不完全形、鞍形和双弓形。弧线形与单弓形多见,不完全型、鞍型与双弓形少见。掌浅弓左右两侧对称性多见,占55．6％。掌浅弓的分支有3-6条,48例发出小指尺掌侧固有动脉,占80．0％。11例小指尺掌侧固有动脉与第3指掌侧总动脉共干,占18．3％。28例发出3条指掌侧总动脉,占46．7％。27例发出4条指掌侧总动脉,占45．0％。结论 手掌损伤修复重建掌浅弓时应充分注意掌浅弓的分型、形状、对称性和分支。     

断掌再植的神经解剖学基础

目的：为断掌再植的神经修复提供解剖学依据。方法：对30侧成人手标本掌部浅、深两层的主要神经分支进行解剖。以远侧腕横纹为横坐标，以掌中线为纵坐标对掌部主要神经分支的起、止点进行坐标测量。将手掌部划分为64个正方形小区，按照掌部主要神经分支起、止坐标对各神经进行小区定位，确定各神经分支的体表投影。模拟不同平面断掌，确定各断掌平面应修复的神经。结果：R1T3、R1T4、R2T2、R2T3、R2T45个小区集中了正中神经返支、正中神经分叉处及尺神经深支的大鱼际肌段，此区域神经分支较多，是断掌时神经修复的重要区域。U2T1、U2T2、U1T33个小区有尺神经深支通过，通过此三小区的断掌应仔细修复尺神经深支。结论：应用本方法可以对断掌及其他手掌外伤的神经损伤作出较为准确的估计预测，并根据预测结果对掌部损伤神经进行有目的的修复。     

正中神经返支的临床应用解剖

目的:研究正中神经返支的起始部位、体表投影及其相关数据,为腕管综合征手术治疗提供相关解剖资料。方法:常规解剖60侧经福尔马林固定后的成人手标本,肉眼观察正中神经返支的起点部位、行程和分布情况。测量正中神经返支的起点及止点坐标。以中指掌指横纹中点至腕远侧横纹中点的连线作纵坐标,以纵轴的中点作一与纵坐标相垂直的横坐标,将手掌分成四个象限,确定返支起始部位在象限中的体表投影。结果:正中神经返支的起点均在近侧桡侧象限,起点横纵坐标分别为6.73±1.84mm、26.20±5.57mm。结论:左、右侧正中神经返支的全长皆位于近侧桡侧象限内,因此设计腕管综合征的手术切口时,在中指掌指横纹中点至腕远侧横纹中点的连线尺侧切开皮肤或屈肌支持带,可避免损伤正中神经返支。     

人尺侧腕屈肌亚部化研究

目的 拟用Sihler‘s肌内神经染色法证实人尺侧腕屈肌的肌亚部分。方法 用改良Sihler’s染色法对10侧人尺侧腕屈肌进行肌内神经染色，以观察肌内神经分支分布。结果 尺神经干发出2支神经分别进入尺侧腕屈肌尺侧半和桡侧半，尺侧半神经和桡侧半神经在各自半侧肌内发出数级神经分支，各级神经分支间有丰富的吻合。结论 尺侧腕屈肌可分为尺侧亚部和桡侧亚部，两亚部各有一独立神经支配。     

掌浅弓变异1例

在供学生实验解剖操作的61具成人尸体中,笔者发现1例尸体左侧掌浅弓变异,由尺动脉终支与骨间前动脉吻合而成,较为罕见.为积累国人体质调查资料,并为临床提供形态学依据,报告如下. 老年男性尸体,身高169cm,左侧掌浅弓变异. 尺动脉终支越过腕横韧带浅面至手掌.骨间前动脉于骨间膜上缘发自骨间总动脉,伴随骨间前神经下行,经旋前方肌浅面,穿腕横韧带深面至手掌.在掌腱膜深面,尺动脉终支与骨间前动脉吻合,形成掌浅弓.弓的凸缘平掌骨中部,发出3条指掌侧总动脉和1条小指尺掌侧动脉,并从弓的桡侧发1分支分布于拇短屈肌和拇收肌.     

手掌神经血管、腕横韧带和腕远纹关系的研究

目的:为腕管松解术及掌中间隙引流术提供解剖学基础.方法:在50例(男34、女16)福尔马林固定成人尸体100侧手掌上,对其血管神经、腕横韧带及其位置关系进行解剖学观测.结果:正中神经及其腕掌部分支均位于掌长肌腱尺侧与第3指蹼连线的桡侧,尺动脉位于尺神经桡侧,尺动脉终末支与正中神经平行,间距为11.2±2.3mm.有尺/正中神经交通支者占94%,有掌浅弓者占78%,在掌长肌腱尺侧缘与环指中轴的连线上,腕远纹至交通支的距离为35.5±3.5mm,至掌浅弓的距离为37.4±3.6mm,腕横韧带下缘至交通支的距离为6.5±3.2mm,至掌浅弓的距离为8.4±3.7mm.结论:在掌长肌腱尺侧缘至环指中轴的连线上,腕远纹远侧35.5mm内以及37.4mm-以下无主要血管、神经,此区域是手术相对安全区.     

手太阳小肠经主要穴位的局部解剖学研究

我们在五具尸体上针刺手太阳小肠经六个主要穴位(每穴10例共60例),然后以局部解剖学的方法调查了穴位周围浅筋膜内,及深筋膜下的神经。并探讨了神经支在“穴区”内的局部解剖位置关系、分布状态和神经支的来源。一、“穴区”的划分是以穴中心点10mm 以内的区域为“穴区”,并将此以1mm、5mm 和10mm 为半径形成三个同心环,由内向外将“穴区”再分别划分为第一区、第二区和第三,区三个分区。“穴区”内的神经,在60例穴位中分布于第一区内者33例占55.0%,分布于第二区内者21例占35.0%,分布于第三区内者6例占10.0%。二、我们观察了小肠经六个主要穴位的神经分布。少泽:除个别例由尺神经指掌侧固有神经或指背神经单独分布外,主要由二者双重神经分布。前谷:主要由尺神经指背神经分布,只有少数(2例)尚有尺神经指掌侧固有神经二重神经分布。后溪:由尺神经指背神经分布。腕骨:主要由尺神经指掌侧总神经或尺神经指背神经分布,只有个别例由上二支双重神经分布,或由尺神经手背支单独分布。阳谷:皆由尺神经手背支分布。小海:主要由前臂内侧皮神经分布,只有一例由臂内侧皮神经分布。三、手太阳小肠经主要穴位(60例)的神经支数,其一穴一支者50例占83.3%,一穴二支者10例占16.7%。四、神经支在“穴区”内的走行,呈单干单独走行者56例占93.3%,其余4例占6.7%呈网状。五、神经支在“穴区”内配布的位置,主要集中配布在第一区内,只有少数配布在第二区和第三区内的桡、尺两侧。在第一区内者多数可被刺中,在第二区和第三区内者,如行针进行提插时针尖可偏向桡、尺两侧,这样便可增加针刺的命中率。本经六个主要穴位的神经来源,主要来自尺神经、臂内侧皮神经和前臂内侧皮神经。各穴位间乃沿着属于同一脊髓节段神经的分支区域循行。这可能构成经络实质的物质基础。     

左上肢掌长肌缺如伴有尺动脉变异一例报告

1、掌长肌及其肌腱缺如,掌腱膜近侧端附着在腕横韧带的浅面。2、尺侧浅动脉由腋动脉第三段分出,位置表浅,形成高位尺浅动脉。 3、骨间总动脉由肱动脉分出,肌支丰富,与正常的尺动脉在前臂的分支分布基本相同。4、在手背桡动脉除发一穿支,穿第一掌骨间隙与尺侧浅动脉的掌深支构成掌深弓外,还发一异常分支,继续下行,到达拇收肌下缘,在此处发出拇指尺侧动脉和食指桡侧动脉,然后绕过拇收肌下缘达手掌,与尺侧浅动脉的掌浅支吻合成掌浅弓。     

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.     

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.