100例国人蝶腭孔及其邻近结构的解剖

观察100例蝶腭孔的位置、形态,大小及经鼻腔蝶腭孔行翼发神经电灼术有关的数据,为临床提供形态学基础.蝶腭孔孔79%位于上鼻道后部,中鼻甲根部后端的上方,呈卵圆形(52%)或圆形(34%),蝶腭孔径前后径平均为6.63±2.09mm,上下径平均为5.69±1.49mm;蝶腭孔至鼻前棘和鼻后孔的距离分别平均为51.48±3.68mm 和13.98±1.74mm;孔棘连线与硬腭间的夹角平均为26.73±3.35(?),并对术中确认蝶腭孔的方法进行了探讨.     

鼻内镜下经蝶窦蝶鞍区手术中蝶窦前壁的应用解剖

目的:为鼻内镜下经蝶窦蝶鞍区手术准确寻找蝶窦口,避免损伤蝶腭动脉提供解剖学资料.方法:在15例国人头颅标本上,用游标卡尺和角规对30侧蝶窦前壁进行解剖学(走行、位置、外径以及与相关结构的距离)观察和测量.结果:鼻小柱根部至蝶窦口下极及蝶腭孔的距离分别为(60.40±3.21,58.10～72.76) mm和(62.14±1.93,59.50～73.40) mm;蝶腭孔至蝶窦口下极的距离为(12.20±1.10,8.10～16.35) mm,在蝶腭孔处蝶腭动脉的外径为(1.99±0.13,1.50～2.80) mm;蝶窦口下极至鼻中隔后上动脉及鼻中隔后下动脉的距离分别为(3.49±0.24,2.78～5.20) mm和(6.42±1.08,4.30～8.50) mm.结论:蝶窦口是经蝶窦蝶鞍区手术的重要标志;开放蝶窦时宜从蝶窦口内下方开放,以免损伤蝶腭动脉.     

鼻内镜下经上颌窦蝶腭动脉结扎术的应用解剖学

【目的】为鼻内镜下经上颌窦蝶腭动脉结扎提供解剖学资料。【方法】对固定的成人尸体上颌动脉翼腭部进行显微外科解剖,观察腭降动脉与蝶腭动脉的关系,并测量腭降动脉和蝶腭动脉的外径及长度。【结果】蝶腭动脉为上颌动脉的直接延续,蝶腭动脉外径平均为(1.79±0.34)mm,腭降动脉的外径平均为(1.48±0.27)mm,长度平均为(8.28±2.49)mm。【结论】腭降动脉是经上颌窦鼻内镜下定位蝶腭动脉重要解剖标志。     

鼻内窥镜下翼管神经切断术对血管运动性鼻炎的治疗作用

目的:探讨鼻内窥镜下翼管神经切断术对血管运动性鼻炎的治疗作用,方法:对14个尸头进行细致的解剖测量研究,并对51例血管运动性鼻炎患者实施了鼻内窥镜下切除中鼻甲后端进路的翼管神经切断术,术后随访5年.结果:解剖测量显示,翼管位于蝶腭孔的后方,外口呈漏斗型,垂直径为(3.5±0.9)mm,横径为(2.9±0.5)mm,距离圆孔为(6.1±1.2)mm,距离鼻中隔(10.5±5.9)mm.翼管的纵轴与水平面成角(27±9.6)度,与矢状平面成角(7.8±2.5)度.51例病人的随访结果显示,术后5年内显效病例为41例(80.4%),有效病例3例(5.9%).结论:鼻内窥镜下切除中鼻甲后端进路的翼管神经切断术,是治疗血管运动性鼻炎的有效方法.     

翼腭窝骨性结构的解剖学观测及其临床意义

目的　通过对翼腭窝及其通道骨性结构的测量为临床鼻颅底外科手术提供解剖学依据。方法　观察 30例 (6 0侧 )成人干性颅骨标本的翼腭窝及其通道的形态、大小 ,以及与毗邻结构的关系 ,并进行相关数据的测量。结果　翼管前口的宽度为 (3 5 3± 0 6 4 )mm ,后口的宽度为 (1 72± 0 5 0 )mm ,翼管的长度为 (14 74± 1 6 4 )mm。圆孔、蝶腭孔与前鼻棘的距离分别为 (6 2 90± 3 81)mm、(5 2 99± 4 95 )mm。2 2侧 (36 6 7% )位于蝶窦侧壁的外下方 ,11侧 (18 33% )位于蝶窦侧壁的外侧 ,9侧 (15 0 0 % )位于蝶窦底的下方 ,18侧(30 0 0 % )凸入窦内 ,翼管的顶壁与窦底壁的骨质融为一体 ,3侧 (5 0 0 % )翼管上壁缺如 ,与蝶窦相通。结论　本研究的测量数据可作为经鼻内窥镜翼腭窝手术和蝶窦手术入路的重要解剖学参数     

鼻内镜下翼管区应用解剖及临床意义

目的:通过鼻内镜下经鼻腔入路对翼管周围区域的解剖学研究,为临床内镜下翼管区域手术提供解剖学基础. 方法: 对10具新鲜尸头鼻内镜下鼻腔外侧壁入路对翼管区域进行解剖学观测,观测翼管区域恒定的解剖学标志及穿经血管神经结构. 结果: (1)翼管区位于翼腭窝后壁内侧、蝶窦下外侧壁,有颌内动脉、翼腭神经节、翼管神经穿行.(2)蝶腭孔、翼管嵴、圆孔是术中辨认翼管的重要骨性标志.(3)翼管前口至翼管后口距离(13.80±1.99)mm,经翼管沿翼管隆突可至破裂孔. 结论: 熟知翼管及其周围区域的解剖可降低翼管区手术的并发症,提高手术安全性.     

蝶腭动脉应用解剖学研究

目的：通过对蝶腭动脉以及相关解剖结构的观测,探讨治疗鼻腔后部出血时蝶腭动脉结扎术的影响因素,为减少术中出血以获得满意的手术视野、选择合适的术式、减少手术并发症提供相关的理论指导。方法：干性半侧颅骨标本30侧,观察蝶腭孔的位置,测量蝶腭孔的相关数据,测量筛前孔至前鼻棘的距离、筛骨嵴至下鼻甲水平部的垂直距离及筛骨嵴至腭骨水平板的垂直距离。手术显微镜下对15具（30侧）外观无异常、经10%福尔马林固定的成人尸头（未区分性别）的鼻腔外侧壁、上颌窦及翼腭窝进行详细解剖,观测蝶腭动脉及其相关解剖结构。结果：筛骨嵴和蝶腭孔是经鼻腔定位蝶腭动脉的重要的标志;上颌动脉在翼腭窝内走行,分支类型有个体差异,其翼腭窝部分为Y型、中间型、M型3型。上颌窦后壁入路可以对蝶腭动脉进行主干结扎,不会损伤上颌动脉下颌段和翼肌段分支。结论：蝶腭动脉的相关解剖对于蝶腭动脉结扎术具有重要意义,手术前必须熟悉与其定位有关的解剖结构。经中鼻道上颌窦后壁进路进行蝶腭动脉主干结扎术是一种可供选择的方法,经鼻腔可结扎蝶腭动脉的分支。上颌动脉翼腭段在翼腭窝内变化较大,手术时需要注意,避免损伤引起并发症。     

鼻内镜下处理翼腭窝病变的应用解剖

目的:为鼻内镜下行翼腭窝区手术防止伤及窝内结构提供解剖学资料.方法:用手术显微镜对15具成人头颅标本按照鼻内镜下中鼻道经腭进路,中鼻道经上颌窦进路和中鼻甲切除进路要求进行显微解剖,观察不同手术进路暴露翼腭窝的范围.解剖20例(40侧)干性颅骨标本并测量相关解剖学数据.结果:3种手术进路对翼腭窝内结构都有不同的暴露.圆孔距前鼻棘的距离平均为(61.86±3.67) mm,圆孔上缘距眶上裂内下端的距离平均为(3.56±0.75) mm,圆孔上缘距视神经管下端的距离平均为(11.23±1.24) mm.结论:3种手术进路能有效地处理不同的翼腭窝病变;圆孔可以作为手术中安全范围标志.     

针刺蝶腭神经节治疗变应性鼻炎综述

1 解剖应用 1．1 局部解剖:蝶腭(翼腭)神经节为颅部的副交感神经节,位于翼腭窝的上部,此窝为宽3～4 mm, 深约10 mm的裂隙,呈漏斗状且尖端朝下。翼腭窝主要内容物为蝶腭神经节、上颌动脉翼腭段及其     

鼻内窥镜下筛泡的应用解剖研究

目的 :对筛泡行应用解剖学研究 ,以冀为鼻内窥镜筛泡切除术确定安全的手术界限 ,减少并发症的发生。方法 :30例、6 0侧外观无异常经 10 %福尔马林固定的成人尸头 (男 2 3例 ,女 7例 ) ,用MJ3435型带锯机 ,沿眉弓上缘及枕骨粗隆上 1cm连线水平锯开颅盖骨 ,去除脑组织 ;沿正中线矢状锯开头颅 ,去除鼻中隔 ;经眶下孔与正中剖面平行矢状锯开 ,用解剖刀、筛泡钳和剥离器等按鼻内窥镜下筛窦手术的体位和路径 ,逐层解剖并测量各解剖结构的径线 ,观测其变异。结果 :筛泡内外径 8.91± 2 .82mm ,筛泡垂直径 13.92± 7.0 8mm ,筛泡骨壁厚 0 .2 3± 0 .10mm ,筛泡中心到下鼻甲附着缘的最小平均距离 11.96± 2 .31mm。钩突与筛泡之间平均距离 :上 0 .6 8± 0 .36mm ,中 1.71± 0 .78mm ,下 2 .81± 0 .5 8mm。结论 :由于筛泡变异大 ,了解其解剖结构的径线 ,对鼻内窥镜手术有重要作用。     

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.