Duane眼球后退综合征(附13例临床分析)

0　引言　 Duane眼球后退综合征 (Duane′s retractionsyndrome,DRS)是一种先天性眼球运动异常疾病 ,属特殊类型的斜视 .我科在 1990 /1997年间共收治 DRS 13例 ,现报道如下 :1　临床资料1.1　一般情况　就诊年龄 :3～ <7岁 1例 ;7～ <16岁 5例 ;16～ <2 4岁 3例 ;≥ 2 4岁 4例 .单眼 12例 ,双眼 1例 .性别 :男 8例 ,女 5例 .代偿性头位明显者 3例 .1.2　类型　按 Huber(1974)分类法 : 型 9例 , 型 1例 , 型 3例 .1.3　眼位偏斜　第一眼位 :正位 1例 ,内斜视 7例 ,外斜视 4例 ,上斜视 1例 .1.4　屈光不正与弱视　屈光不正 (近视 ) 10例 …     

人子宫内膜异位症在位内膜间质细胞原代培养方法探讨

目的 探讨子宫内膜异位症在位内膜间质细胞原代培养的最优方法.方法 40例子宫内膜异位症患者(增殖期和分泌期内膜各20例)的在位内膜组织随机分为4组,分别采用胰蛋白酶、Ⅰ型胶原酶、Ⅱ型胶原酶、Ⅳ型胶原酶消化,随机选择离心分离或筛网分离间质细胞,行细胞免疫组织化学染色(SP法)鉴定.结果 增殖期与分泌期内膜间质细胞培养成功率差异无统计学意义(χ2=3.68,P＞0.05).胰蛋白酶组的细胞培养成功率与其他3种胶原酶组的细胞培养成功率间差异有统计学意义(P＜0.05),3种胶原酶细胞培养成功率间差异无统计学意义(P＞ 0.05);I型胶原酶酶解所得间质细胞的单层汇聚时间[(5.0±0.8)d] 最短(P＜0.05);I型胶原酶和胰蛋白酶的细胞消化时间差异无统计学意义(P＞0.05),但短于Ⅱ型和Ⅳ型胶原酶(P＜0.05);筛网分离法与离心分离法在细胞培养成功率和细胞纯度上差异无统计学意义(P＞0.05),但前者的细胞单层汇聚时间[(6.0±0.3)d]短于后者[(6.5±0.4)d](P＜0.05).结论 月经周期不影响细胞培养成功率;采用I型胶原酶消化子宫内膜、筛网分离间质细胞是子宫内膜异位症在位内膜间质细胞培养的最好方法.     

深圳市社区老年2型糖尿病患者生存质量和心理及社会支持调查研究

目的 调查社区老年2型糖尿病(diabetes meuitus,DM)患者生存质量及抑郁、社会支持现状,为有针对性地进行社区干预提供依据.方法 用方便抽样的方法抽取深圳市梅林社区老年2型DM患者,按照1:1的比例选取人口学资料类似的无DM者作为对照组.两组患者均采用问卷调查,问卷包括一般资料、世界卫生组织生存质量?测定量表简表(WHOQOL-BREF)中文版、抑郁自评量表(SDS)、社会支持评定量表.结果两组被调查者的性别、年龄、婚姻状况、学历、退休前职业、家庭人均月收入、最近3个月内重大生活事件的发生率间差异均无统计学意义(P＞0.05).两组被调查者的生存质量间差异有统计学意义(P＜0.01);生理领域、心理领域、总的生存质量状况评分及健康状况和生存质量综合评分问差异均有统计学意义(P＜0.05).两组被调查者抑郁发生率间差异有统计学意义(P=0.029);抑郁程度间差异有统计学意义(P=0.002);抑郁总分、抑郁指数间差异均有统计学意义(P＜0.05).糖尿病组抑郁患者与非抑郁患者的生存质量评分间差异有统计学意义(P＜0.01);抑郁患者与非抑郁患者的生理领域、心理领域、社会领域、环境领域、总的生存质量状况评分及健康状况和生存质量综合评分间差异均有统计学意义(P＜0.05).两组被调查者的客观支持得分间差异有统计学意义(P=0.037).结论 老年2型DM患者生存质量下降,特别是生理、心理领域;DM患者抑郁发生率高于老年非DM者,且DM抑郁评分患者生存质量低于非抑郁者;老年2型DM患者获得的客观支持低于老年非DM者.     

冠心病合并2型糖尿病80例冠状动脉造影的特点分析

目的 观察冠心病合并2型糖尿病患者冠状动脉病变特点.方法 冠心病患者162例,其中合并2型糖尿病患者80例(观察组),单纯冠心病患者82例(对照组),两组均采用Judkins法行选择性冠状动脉造影,比较两组患者不同受累血管支数及狭窄程度等.结果 观察组单支病变发生率为21.3%,明显低于对照组的40.2%,差异有统计学意义(P＜0.05),3支病变发生率为48.9%,明显高于对照组的30.5%,差异有统计学意义(P＜0.05),两组双支病变发生率比较,差异无统计学意义(P＞0.05);观察组弥漫性病变发生率为40.0%、右冠状动脉(RCA)病变发生率为77.5%,均明显高于对照组的22.0%及39.0%(P＜0.05);观察组冠状动脉病变更为严重(P＜0.05).结论 冠心病合并2型糖尿病患者常可累及多支冠状动脉,病变程度严重,多呈弥漫性.     

左室射血分数正常心力衰竭患者6 min步行试验的临床研究

目的 通过6 min步行试验评价左室射血分数正常的心力衰竭（HFNEF）患者心肺功能变化.方法 选取慢性心功能衰竭患者71例,按左室射血分数分为HFNEF组及射血分数降低的心力衰竭（HFREF）组,并另选32名健康体检者作为对照组,对所有入选者进行6 min步行试验并测定肺通气功能及心脏彩超.结果 3组间步行距离、左心室内径及短轴缩短率差异均无统计学意义（P＞0.05）;3组间6 min步行试验前后肺功能指标变化差异有统计学意义（P＜0.05）,HFNEF组与对照组和HFREF组比较差异有统计学意义（P＜0.05）,而HFREF组与对照组比较差异无统计学意义（P＞0.05）.结论 6 min步行试验可用于HFNEF的心力衰竭患者心功能的评估,并且相对安全;HFNEF患者较HFREF患者肺功能损害更明显.     

普伐他汀对早期中老年急性冠脉综合征的疗效研究

目的 观察中老年急性冠脉综合征(ACS)患者早期应用中等剂量普伐他汀的临床意义.方法 选择中老年ACS患者107例,随机分为3组.在常规治疗的基础上A组采用普伐他汀40 mg治疗;B组采用阿托伐他汀40 mg治疗;C组采用阿托伐他汀80 mg治疗.3组疗程均为3个月,比较3组患者的外周血脂浓度、凝血功能、肝功能和药物不良反应,随访1年,观察心血管事件发生率.结果 3组患者治疗后血总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、纤溶酶原激活物抑制剂(PAI-1)水平、组织型纤溶酶原激活剂(t-PA)活性比较,差异均有统计学意义(P＜0.05).其中治疗后A组与B组TC、LDL-C、PAI-1、HDL-C、t-PA比较,差异均有统计学意义(P＜0.05);A组与C组t-PA比较,差异有统计学意义(P＜0.05).随访1年3组心血管事件发生率比较,差异有统计学意义(P＜0.05).3组不良反应发生率比较,差异有统计学意义(P＜0.05),其中C组高于A组,差异有统计学意义(P＜0.05).结论 中等剂量普伐他汀应用于中老年早期ACS的疗效优于常规剂量阿托伐他汀,不良反应和1年内心血管事件发生率较低.     

射血分数降低的心衰与射血分数保留的心衰临床特征分析

目的分析射血分数降低的心衰(HFREF)与射血分数保留的心衰(HFPEF)临床特征。方法对60例心衰患者的临床资料进行回顾性分析,按照LVEF的不同,将全部患者分成射血分数降低的心衰(LVEF50%)和射血分数保留的心衰(LVEF≥50%);分析观察两组患者的临床特征。结果 60例患者中,HFREF患者共36例,HFPEF患者共24例。在年龄、性别方面,两组患者比较差异有统计学意义(P0.05);另外两组患者的EF值、LVD值、合并心律失常、合并心肌病以及NTpro BNP水平比较差异有统计学意义(P0.05)。结论射血分数保留的心衰的年龄更高;患者的性别不同,NHYA分级和分布也存在差异;射血分数降低的心衰患者LVD值、NTpro BNP水平更高;合并症对射血分数降低的心衰患者的总体影响更严重。     

达格列净治疗2型糖尿病伴射血分数正常心力衰竭患者的效果

目的:观察达格列净治疗2型糖尿病(T2DM)伴射血分数正常心力衰竭(HFNEF)患者的效果。方法:选取64例T2DM伴HEpEF患者为研究对象,采用随机数字表法分为对照组和观察组各32例。对照组给予常规降糖及标准抗心力衰竭药物治疗,观察组在对照组基础上给予达格列净治疗,比较两组治疗前后血清学指标[氨基末端B型钠尿肽原(NT-proBNP)、超敏C反应蛋白(hs-CRP)、血清可溶性ST2(sST2)、糖化血红蛋白(HbA1c)]水平、心功能指标[左心室射血分数、左心室舒张末期内径]水平、6 min步行距离和治疗期间不良反应发生率。结果:治疗后,观察组血清HbA1c、hs-CRP、NT-proBNP和sST2水平均低于对照组,6 min步行距离长于对照组,差异有统计学意义(P<0.05);治疗后,两组左心室舒张末期内径均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);两组治疗前后及组间左心室射血分数比较,差异均无统计学意义(P>0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:在常规降糖及标准抗心力衰竭药物治疗基础上给予达格列净治疗T2DM伴HFNEF患者可降低血清学指标水平,延长6 min步行距离,改善心功能指标水平,效果优于单纯常规降糖及标准抗心力衰竭药物治疗。     

The exploration of the Radiographic Characteristics of Pulmonary Tuberculosis Combined with Diabetes Mellitus

目的 探讨肺结核合并糖尿病的影像学特点.方法 对肺结核合并糖尿病和单纯肺结核患者各80例进行影像学对比分析.结果 肺结核合并糖尿病发生率为12.97%,2组结核病变好发部位比较差异无统计学意义(P＞0.05);急性血播仅发生在肺结核合并糖尿病患者,肺结核合并糖尿病患者病变累计多个肺段占70%、多个肺叶占65%,2组比较差异有统计学意义(P＜0.05);单纯肺结核患者多累计单一肺段、肺叶,2组比较差异有统计学意义(P＜0.05);肺结核合并糖尿病患者在病灶形态上以空洞、肿块、干酪性肺炎(浸润病灶)发生率高,分别占62.5%、13.75%、28.75%,2组比较差异有统计学意义(P＜0.05);单纯性肺结核以斑片、腺泡结节发生率高,分别占88.3%、55.00%,2组比较差异亦有统计学意义(P＜0.05).结论 肺结核合并糖尿病患者组病变相对广泛,呈多个肺叶肺段分布,空洞、肿块及浸润病灶发生率高.     

急性心肌梗死合并新发心房颤动患者住院期间临床特点及预后分析

目的 探讨急性心肌梗死合并新发心房颤动(新发房颤)患者的临床特点和预后.方法 选取2014年1月至2017年1月北京市海淀医院收治的急性心肌梗死住院患者368例,分为研究组(合并新发房颤,82例)和对照组(无新发房颤,286例),收集患者基本情况、冠心病危险因素、心脏彩超等资料,分析2组患者的临床特点、心脏彩超结果及预后情况.结果 2组的年龄、术前心功能Killip分级＞1、再灌注时间＞6h、前壁心肌梗死、二尖瓣反流及糖尿病发生率比较,差异有统计学意义(P＜0.05).2组吸烟、高血压和脑梗死发生率比较,差异无统计学意义(P＞0.05).研究组左房内径、左室舒张末径及左室收缩末径高于对照组,射血分数低于对照组,差异均有统计学意义(P＜0.05).2组室间隔厚度、左室后壁厚度差异无统计学意义(P＞0.05).研究组病死率及心力衰竭发生率与对照组比较,均显著较高,差异有统计学意义(P＜0.05).结论 临床应对急性心肌梗死合并新发房颤患者的各项危险因素进行有针对性的预防,加强新发房颤监测,改善患者预后.     

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.