白内障超声乳化术近角膜缘切口的设计及评价

目的 设计并总结白内障超声乳化术近角膜缘切口人工晶体植入术的方法和经验。方法 施行近角膜缘切口白内障患者１８０只眼。刻度钻石刀作近角膜级切口,改良原位超声乳化碎核,能量设定为５０－７０％,有效时间１０ｓ至１ｍｉｎ２８ｓ,植入５．５ｍｍＰＭＭＡ人工晶体。结果 术后第一天的视力≥０．５为９５％,术后１个月视力≥１．０者为９７％。全部病例均无任何严重并发症。结论 近角膜缘切口白内障超声乳化人工晶体植入要     

白内障超声乳化术近角膜缘切口的设计及评价

目的设计并总结白内障超声乳化术近角膜缘切口人工晶体植入术的方法和经验。方法施行近角膜缘切口白内障患者１８０只眼。刻度钻石刀作近角膜缘切口,改良原位超声乳化碎核,能量设定为５０％～７０％,有效时间１０ｓ至１ｍｉｎ２８ｓ（平均４８ｓ）,植入５．５ｍｍＰＭＭＡ人工晶体。结果术后第一天的视力≥０．５为９５％,术后１个月视力≥１．０者为９７％。全部病例均无任何严重并发症。结论近角膜缘切口白内障超声乳化人工晶体植入术,具有手术时间短,术后散光小,视力恢复快等优点。     

白内障超声乳化折叠式人工晶体植入与硬性人工晶体植入结果分析

目的：探讨白内障超声乳化折叠式人工晶体植入的优越性。方法：对５０例（５０只眼）老年性白内障行怕乳化吸出,通过３．２ｍｍ隧道切口植入硅胶折叠式人工晶体及４４例３．２ｍｍ切口基础上扩大至６．０－６．５ｍｍ,植入后房型ＰＭＭＡ硬性人工晶体。结果：术后１周裸眼视力≥０．５者占７８％。随访１－３个月视力≥０．８者占８６％,与后房型硬性人工晶体植入比较术后１和１个月平均散光分别为（０．９２±０．８４）ＤＴ （     

白内障超声乳化吸出及囊袋内人工晶体植入术

为观察和评价超声乳化白内障吸出术的临床效果、特点、并发病及防治措施，对４１　眼白内障施行超声乳化吸出术及小切口（６ｍｍ）囊袋内人工晶体植入术，并以同期的白内障患者４１眼行现代囊外摘除及后房型人工晶体植入做对照。结果：术后６个月，视力≥１．０者占４３．９％＞０．８者占７０．７≥０．５者占９２．７％，均明显高于对照组（Ｐ＜０．００１），术后平均散光为１．０４±０．８１，１，低于对照组（Ｐ＜０．０１）。白内障超声乳化吸出并囊袋内人工晶体植入术的复明效果优于囊外摘除并后房型人工晶体植入术。     

100眼超声乳化白内障吸除及人工晶体植入术

本文报道了９８例１００眼老年性白内障超声乳化吸除及人工晶体植入术，结果表明此项手术具有切口小、安全、术后视力恢复快及手术致角膜散光少等优点。本组８６眼原位超声乳化成功，出院时视力≥０．５和≥１．０者分别为４２％和６０％。手术主要并发症为角膜水肿混浊。结论认为原位超声乳化白内障吸除及人工晶体植入术后散光小和视力恢复快，值得在临床上推广应用。     

白内障成熟期超声乳化手术

将１９４ 例（２００ 眼）成熟期白内障分为白核组４６ 眼,棕核组１５４ 眼,应用改良的乳化劈核技术行超声乳化手术。结果表明,白核组平均乳化能量为１７．１９％ ,平均乳化时间为３６．５ｓ;棕核组为２６．９５％ 和７５ｓ。术后裸眼视力≥０．５ 的１８９ 眼（９４．５％ ）,≥１．０ 的９１ 眼（４５．５％ ）。并发症主要为术中后囊膜破坏２０ 眼,术后角膜水肿４ 眼,前房渗出３ 眼。提示采用改良的高负压低能量乳化劈核技术能对各种硬度的核进行分割且所用能量低、时间短,是成熟期白内障超声乳化手术的有效方法     

青光眼滤过术后透明角膜切口白内障超声乳化摘除人工晶体植入术

介绍经透明角膜切口的青光眼滤过术后白内障超声乳化摘除人工晶体植入的方法及疗效。方法：对１８例１８眼施行手术,上方透明角膜内１ｍｍ处做３．２ｍｍ切口,。超声乳化白内障摘除后扩大切口中至５．５－６ｍｍ,植入人工晶体。结果１８眼术后视力全部提高,术中术后无严重并发症。     

不同白内障术式对术后角膜屈光状态和视力的影响

目的探讨超声乳化白内障吸除及可折叠晶体植入、超声乳化及非折叠晶体和白内障囊外摘除（ＥＣＣＥ）三种不同术式对术后角膜屈光状态和视力功能恢复的影响。方法对三组１６９例老年性白内障分别采用３．５ｍｍ、６．５ｍｍ巩膜隧道和１０ｍｍ角巩缘切口，施行白内障超声乳化摘除及折叠式人工晶体植入术、超声乳化摘除及一体型人工晶体植入术、囊外摘除及一体型人工晶体植入术。结果术后第３天的平均裸眼视力分别为１．０２、０．５２和０．４６。达到正常视力的比例分别为６６．２５％、１２．３０％和８．６６％，超声乳化和囊外摘除术相比较，差异均有显著性（ｔ检验，Ｐ＜０．０５）。结论手术切口小，操作轻，术后早期获得良好的裸眼视力，角膜散光轻微，减少了缝合所需时间及消除缝线的不良反应。     

三种隧道式切口用于白内障超声乳化吸除术的比较

目的 评价３种隧道工切口在白内障超声乳化吸除术中的应用效果。方法 采用透明角膜（Ⅰ组）、角膜缘（Ⅱ组）、反弧形巩膜（Ⅲ组）隧道式切口,对５６８例（５８８眼）老年性、并发性、外伤性白内障行超声乳化吸除,并植入Ａｃｒｙｓｏｆ折叠式人工晶状体或直径５．５ｍｍ的人工晶状体。结果 ３组在术后１周、２周、１个月视力≥０．５者分别占７４．６％、７９．５％、７７．４％、８３．５％、８６．４％、８４．６％、８８．６％、８９．７％、８７．４％;角膜散光以角膜切口组为高,差异有显著性（Ｐ〈０．０５）。术后３个月时３组的角膜散光已经基本接近（Ｐ〉０．０５）。结论 ３种隧道式切口均是白内障手术较佳的切口。     

白内障超声乳化吸除术的配合

１　临床资料我科自１９９７年１１月起，成功地配合了白内障超声乳化吸除及小切口人工晶体植入术３７例，其中男性患者１６例，女性患者２１例，最小年龄５岁，最大年龄９３岁，平均年龄６７岁，右眼１７眼，左眼２０眼，术前视力均为光感，术后平均视力≥０．５占９５％，＞１．０占１１％。２　器械物品的准备美国爱尔康公司推出的ｕｎｉｖｅｒｓａｌⅡ型晶体超声乳化仪，苏州产ｓｏｍｓ－２０００型显微镜，以及常规显微器械。高温高压消毒的器械　白内障超声乳化手柄、３０°、５０°超声乳化头、注／吸手柄、注／吸头、保护套管、扳手…     

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.