七叶洋地黄双苷滴眼液治疗LASIK术后视疲劳的临床研究

目的 观察七叶洋地黄双苷滴眼液治疗准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)术后视疲劳的疗效.方法 运用七叶洋地黄双苷滴眼液治疗LASIK术后患者150例300只眼,以视疲劳的自觉症状及眼调节幅度为观察指标,与对照组进行对比.结果 术后1周及2周时七叶洋地黄双苷滴眼液治疗组较对照组主观症状及眼调节幅度有明显改善.结论 七叶洋地黄双苷滴眼液治疗LASIK术后视疲劳安全有效.     

维生素B12滴眼液对青少年近视眼调节的影响

目的探讨维生素B12滴眼液对青少年近视眼调节功能的影响.方法对48例低度近视患者滴用维生素B12滴眼液1月后对调节灵敏度、正相对调节量、负相对调节量进行测量,与用药前进行比较.结果用药1月后调节灵敏度,右眼:(8.42±1.27)vs(10.96±1.22),t=12.20,P<0.01,左眼:(8.40±1.14)vs(10.73±1.28),t=10.54,P<0.01,正相对调节量(-2.45±0.32)vs(-3.09±0.51),t=8.77,P<0.01,均较用药前改善,差异有统计学意义;负相对调节量(1.96±0.25)vs(1.99±0.17),t=1.14,P=0.26,用药前后比较,差异无统计学意义.结论维生素B12滴眼液能有效改善青少年近视眼的调节功能.     

白内障术后非甾类抗炎药物单独抗炎作用的有效性与安全性研究

目的 探讨白内障超声乳化术后单独局部应用非甾类抗炎药物0.1％溴芬酸钠的有效性、安全性和耐受性.方法 选取年龄相关性白内障患者64例(64眼)行常规超声乳化白内障摘除联合后房型人工晶体植入术,分为溴芬酸钠组32例(32眼)和激素组(对照组)32例(32眼).溴芬酸钠组术后第1天起予0.1％溴芬酸钠水合物滴眼液2次/d,持续4周;对照组术后第1天起予典必殊滴眼液4次/d,使用1周后改为0.1％氟美瞳滴眼液4次/d续用至4周.观察并记录两组患者术前及术后第1天、1周、2周、1个月的视力、眼压、炎症症状评分、眼部体征评分及安全性评价评分.结果 溴芬酸钠组术后视力恢复情况与对照组比较无统计学差异.术后第1周时溴芬酸钠组眼压明显低于对照组(P＜0.05),第2、4周眼压值仍低于对照组,但无统计学差异(P＞0.05).在炎症症状、眼部体征评分与安全性评价评分上,溴芬酸钠组与对照组均无统计学差异(P＞0 05).结论 非甾类抗炎药物溴芬酸钠用于白内障术后抗炎有效、安全,无明显不耐受,能一定程度上代替激素作为围手术期用药.     

0.3%玻璃酸钠滴眼液对微创白内障超声乳化术后泪膜的影响

目的 探讨0.3%玻璃酸钠滴眼液对微创白内障超声乳化吸出联合人工晶体植入术后泪膜的影响。方法 将单纯性老年性白内障患者52例(60只眼),随机分为A组27例(31只眼)和B组25例(29只眼)。两组均行白内障超声乳化吸出联合人工晶体植入。A组术后除常规用药外还给予0.3%玻璃酸钠滴眼液治疗;B组术后仅给予常规用药。记录患者术前及术后1天、1周、2周、1个月的角膜荧光素染色(FL)、泪液分泌试验(SⅠt)、泪膜破裂时间(BUT)等,同时进行干眼主观症状评分。结果 术后1d、1周、2周,A组干眼症状评分均低于B组,两组比较,差异有统计学意义(P0.05)。术后1个月,两组干眼症状评分比较,差异无统计学意义(P0.05)。术后1d、1周、2周、1个月,A组与B组相比,BUT明显延长(P0.05),FL着色密集度明显减少(P0.05),SⅠt浸湿滤纸长度明显增加,两组比较,差异均有统计学意义(P0.05)。结论 白内障术后常规应用玻璃酸钠滴眼液很有必要,可有效改善干眼症状,值得临床推广。     

噻托溴胺治疗稳定期慢性阻塞性肺疾病临床研究

目的 观察噻托溴胺粉雾剂吸入治疗稳定期慢性阻塞性肺疾病(COPD)的临床疗效.方法 52例COPD稳定期患者,随机分为噻托溴胺组(T组)和异丙托溴胺组(I组)各26例.2组均采用常规避免吸烟、预防呼吸道感染、祛痰、止咳及按需吸人短效沙丁胺醇气雾剂等治疗.T组在上述综合性治疗的基础上,加用噻托溴胺粉雾剂吸入治疗,Ⅰ组加用异丙托溴胺气雾剂吸入治疗.测定患者基线肺功能及首次用药后2 h与治疗后2、3、4周的肺功能第1秒用力呼气容积(FEV1)和用力肺活量(FVC)值,观察圣·乔治呼吸评分变化及药物不良反应.结果 T组及Ⅰ组患者首次用药后2 h的FEV1均较用药前升高[(1 397±205) vs (1 273±187)ml,P＜0.01;(1 387±217) vs (1 270±204) ml,P＜0.01],2组FVC也明显升高[(2 978±296) vs (2 696±297)ml,P＜0.01;(2 939±353) vs (2 668±332) ml,P＜0.01];用药2、3及4周后T组FEVI较治疗前明显增高[(1 383±200)、(1 372±194)、(1 368±190) ml vs (1 273±187) ml,P均＜0.05],FVC也明显增高[(2 929±319)、(2 880±323)、(2 848±384) ml vs (2 696±297) ml,P均＜0.05],而Ⅰ组较治疗前无明显变化.FEV1及FVC较用药前升高值,在首次用药后2 h,T组与Ⅰ组比较差异无统计学意义(P均＞0.05);在用药2、3及4周后,T组均明显高于Ⅰ组(P均＜0.01).试验结束时,T组圣·乔治呼吸评分有明显改善(P＜0.05),Ⅰ组无改善(P＞0.05).结论 规律吸入噻托溴胺4周可显著改善COPD患者的症状和肺功能及圣·乔治呼吸评分.     

短期联合应用糖皮质激素和非甾体类抗炎药在白内障术后的应用研究

目的观察白内障超乳术后进行妥布霉素地塞米松滴眼液联合普拉洛芬滴眼液治疗的临床疗效。方法将在本院行超声乳化白内障吸除术的100例白内障患者按随机数字表分为研究组50例和对照组50例,对照组给予单纯糖皮质激素妥布霉素地塞米松滴眼液治疗,第1周6次/日,第2周期4次/日,连续4周,研究组给予糖皮质激素妥布霉素地塞米松滴眼液联合非甾体类抗炎药0.1%普拉洛芬滴眼液治疗,妥布霉素地塞米松滴眼液第1周3次/日,0.1%普拉洛芬滴眼液第1周3次/日,轮流使用,每两小时滴眼一次,第2周单独使用0.1%普拉洛芬滴眼液,4次/日,连续4周,比较两组患者干预前后症状综合评分、房水闪辉及眼压差异。结果研究组术后1周症状和体征综合评分明显低于对照组,差异具有统计学意义(P0.05),术后4周症状和体征综合评分差异无统计学意义(P0.05);研究组术后1周和术后4周的房水闪辉明显低于对照组,差异具有统计学意义(P0.05);研究组和对照组术后1周的眼压差异无统计学意义(P0.05),研究组术后4周的眼压明显低于对照组,差异具有统计学意义(P0.05);研究组发生黄斑囊样水肿1例(2%),对照组发生黄斑囊样水肿6例(12%),差异有统计学意义(P0.05)。结论短期联合应用糖皮质激素和非甾体类抗炎药在白内障术后的应用具有积极临床意义,有效地减少术后炎症反应,预防了黄斑囊样水肿的发生,减少了糖皮质激素用量,避免眼压升高。     

LASIK 术后干眼与非干眼症状患者的影响因素比较研究

目的:评价LASIK术后6个月干眼症状相关的影响因素。方法:随访LASIK手术后6个月,360例患者根据是否有干眼症状分成干眼症状组和非干眼症状组。比较两组间干眼症状和SPEED评分,χ2检验和t检验用于统计分析。结果:干眼症状组与非干眼症状组比较:长时间用眼阅读、睡眠差、紧张、认为干眼与手术有关的比例分别为(30.5%vs.12.5%,P=0.000)、(18.3%vs.9.6%,P=0.025)、(24.4%vs.9.9%,P=0.002)、(35.4%vs.1.5%,P=0.000);干眼症状组有、无相关影响因素SPEED评分分别为(3.22±1.72)vs.(1.92±1.57),P=0.001;(2.62±1.52)vs.(1.82±1.45),P=0.045;(2.72±1.57)vs.(1.98±1.39),P=0.043;(3.02±1.66)vs.(1.88±1.47),P=0.032。两组间饮酒和吸烟无统计学意义。结论:干眼症状组患者更容易发生长时间用眼阅读、睡眠差、紧张及认为干眼与手术有关等情况。本研究利于合理解释LASIK术后远期干眼的症状和提高相关治疗。     

维生素B12滴眼液对青少年近视眼调节的影响

［摘要］目的　探讨维生素B12滴眼液对青少年近视眼调节功能的影响．方法　对48例低度近视患者滴用维生素B12滴眼液1月后对调节灵敏度、正相对调节量、负相对调节量进行测量,与用药前进行比较．结果　用药1月后调节灵敏度,右眼:（8.42±1.27）vs（10.96±1.22）,t＝12.20,P＜0.01,左眼:（8.40±1.14）vs （10.73±1.28）, t＝10.54,P＜0.01,正相对调节量（-2.45±0.32）vs（-3.09±0.51）,t＝8.77,P＜0.01,均较用药前改善,差异有统计学意义;负相对调节量（1.96±0.25）vs（1.99±0.17）,t＝1.14,P＝0.26,用药前后比较,差异无统计学意义．结论　维生素B12滴眼液能有效改善青少年近视眼的调节功能．     

经口内镜下肌切开术不同方式治疗贲门失弛缓症对比研究

目的 比较经口内镜下环形肌切开术与全层肌切开术及切开长度≤5 cm与切开长度＞5 cm治疗贲门失弛缓症的临床疗效.方法 回顾性分析本院2013年2月至2014年8月诊断贲门失弛缓症并行经口内镜下肌切开术(peroral endoscopic myotomy,POEM)56例患者的临床资料.其中24例患者行环形肌切开为环形肌切开组,32例患者行全层切开为全层切开组;28例患者切开长度≤5 cm为短切组,28例患者切开长度＞5 cm为长切组.分别比较4组治疗贲门失弛缓症临床症状缓解情况,术前、术后食管最大直径变化情况,术中、术后并发症发生情况.结果 4组术前一般资料,包括性别、年龄、体质量指数(BMI)、术前食管最大直径、术前Eckardt评分、病程等比较差异无统计学意义(P＞0.05).环形肌切开、全层切开、长切、短切4组术前Eckardt评分分别与术后1、6、12个月比较,差异均有统计学意义(P＜0.01).全层切开组与环形肌切开组相比,术后Eckardt评分1个月[(0.50±1.07)vs(0.71±1.04)]、6个月[(0.53±1.10)vs(0.50±0.78)]、12个月[(0.37 ±0.75) vs(0.42±0.82)],术后6个月食管最大直径[(26.44 ±7.88)vs(24.00 ±5.82) mm]以及气体并发症[(5/24)vs(13/32)]差异均无统计学意义(P＞0.05);短切组与长切组相比,术后Eckardt评分1个月[(0.46±0.83)vs(0.71±1.42)]、6个月[(0.39 ±0.68) vs(0.64 ±1.19)]、12个月[(0.32±0.72)vs(0.46±0.84)],术后6个月食管最大直径[(24.81 ±7.87) vs(25.98 ±6.37)mm]以及气体并发症[(9/28)vs(9/28)]差异均无统计学意义(P＞0.05).结论 治疗贲门失弛缓症建议采用经口内镜下食管环行肌切开术,且以切开长度≤5 cm为宜.     

盐酸坦洛新联合阿米替林治疗慢性非细菌性前列腺炎

目的 回顾性分析盐酸坦洛新缓释胶囊联合阿米替林治疗慢性非细菌性前列腺炎的作用机制和临床疗效.方法 对94例慢性非细菌性前列腺炎患者随机分组,治疗组50例,口服盐酸坦洛新缓释胶囊(0.2 mg,每晚1次)和阿米替林(25 mg,每天2次);对照组44例,仅口服盐酸坦洛新缓释胶囊(0.2 mg,每晚1次).疗程均为6～8周.采用美国国立卫生研究院慢性前列腺炎症状指数评分(NIH-CPSI)对2组治疗前、后分别评分.结果 94例患者均获得随访,随访时间2～12个月.治疗后患者症状明显改善,NIH-CPSI总分治疗组及对照组均明显下降[(14.8 ±4.1)vs (29.2 ±3.5),(17.1±3.8)vs(28.5±4.7),P均＜0.05)],且治疗组低于对照组[(14.8±4.1) vs(17.1±3.8),P＜0.05)].治疗组总有效率92.0％,对照组总有效率68.2％.治疗组仅2例嗜睡,l例头晕,能继续用药,对照组无明显不良反应.结论 盐酸坦洛新缓释胶囊联合阿米替林治疗慢性非细菌性前列腺炎效果良好.     

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.