先天性白内障晶状体植入术后视功能恢复的因素分析

目的探讨对先天性白内障患儿手术后视功能恢复的影响，手术时间、人工晶体植入年龄、单双眼患病以及手术后屈光改变等。方法回顾性分析41例（71只眼）手术治疗经过和手术后3个月以上的随访结果，按白内障摘除和人工晶状体植入年龄，单眼和双眼患病，有无眼球震颤等进行分组。观察指标：对比手术后1个月和末期随访屈光检查，并与手术时预留的屈光度数进行对比；各组间进行手术后视力、屈光变化对比。结果先天性白内障人工晶状体植入术后都有不同程度的近视漂移，与第1次手术的年龄有关，年龄越小近视漂移越严重，所需要为术后矫正成正视眼的人工晶状体度数越大（即患儿的白内障为高度远视状）越容易发生较大度数的近视趋向，视功能恢复好坏更与有无眼球震颤及是否单眼发病有关。结论实施儿童白内障手术时，选择人工晶状体要考虑年龄和眼轴长度。     

超声乳化透明晶状体吸除术治疗高度近视临床观察

目的:探讨超声乳化透明晶状体吸除联合人工晶状体植入术治疗高度近视的有效性和安全性。方法:对2013年1-7月在本院选取的29例(43只眼)高度近视患者行超声乳化透明晶状体吸除联合人工晶状体植入术,观察其临床效果。所有患者平均(51.93±6.89)岁,术前矫正视力(0.46±0.18)D,平均近视度数(-10.94±6.14)D,平均角膜散光度数(-1.04±0.67)D,平均眼轴长度(27.73±2.12)mm。结果:术后所有患者裸眼视力均提高,术后矫正视力(0.69±0.17)D,与术前比较差异有统计学意义(t=5.9987,P0.001),术后平均近视度数(-1.73±0.77)D,与术前预留屈光度基本吻合;术后平均角膜散光度数(-1.23±0.66)D,与术前比较差异无统计学意义(t=1.2963,P0.05)。术后随访3个月,未发生晶状体后囊膜混浊,未见视网膜裂孔、视网膜脱离及黄斑囊样水肿。结论:超声乳化透明晶状体吸除联合人工晶状体植入术是矫治高度近视安全、有效的方法,具有术后视力好、并发症少、预测屈光状态准确性及稳定性好等优点。     

儿童人工晶体植入术后屈光状态的观察

目的观察儿童人工晶体植入术后近视漂移程度,指导儿童人工晶体屈光度的选择。方法对2～8岁先天性白内障患儿行Ⅰ期或Ⅱ期人工晶体植入术,由SRK—Ⅱ公式计算人工晶体屈光度后,植入低于计算度10%的人工晶体,术后配镜,弱视训练。随诊1～4年,观察视力、眼轴、屈光度变化及术眼并发症。结果矫正视力：中、轻度弱视者93眼,占91.18%;重度弱视者9眼,占8.82%。术后眼轴平均增长（0.52±0.84）mm,与术前比较,有统计学意义（P〈0.05）。术后屈光度变化：平均为（-1.53±1.00）D,与术前相比,有统计学意义（P〈0.05）。术后并发症：以葡萄膜反应为主,占11.76%,无严重的角膜及视网膜并发症。结论 2岁以上儿童行人工晶体植入术,安全可靠,但由于儿童人工晶体眼仍存在视觉发育近视化趋势,为弥补这种发育带来的屈光问题,术中植入低度欠矫的人工晶体较为合理。     

儿童眼轴与角膜曲率在单纯性近视初期的变化

目的探讨青春期前儿童的正视眼与初期单纯性近视眼之间,眼轴长度、角膜曲率及其相关关系的变化.方法随机选取我科屈光门诊的轻度近视患儿30例(60眼),散瞳验光,测量眼轴长度、角膜曲率与角膜屈光力,并与同期随机选取的30例(60眼)健康正视眼儿童相比较.结果近视眼组平均眼轴长度为(24.02±0.77)mm,正视眼组为(22.99±0.72)mm,两组眼轴差异非常显著(P<0.01).两组角膜曲率、角膜屈光力之间差异无显著性.以水平向角膜曲率测得眼轴长度与角膜曲率的比值(AL/CR),近视眼组为3.032±0.058,正视眼组为2.899±0.095,差异非常显著(P<0.01).结论青春期前,儿童在由正视眼转化为轻度近视眼的过程中,以眼轴增长为主,表现为轴性近视.AL/CR超过3是近视发生的高危指标.     

先天性白内障摘除人工晶状体植入术后视功能及屈光状态的变化

目的 评价先天性白内障摘除人工晶状体(IOL)植入术后视功能和屈光状态的变化.方法 选取行先天性白内障摘除IOL植入的45例(62眼)患者,其中单眼28例,双眼17例(34眼);＜2岁者16例,2～5岁者17例,＞5岁者12例.随访3年,分别观察单双眼及不同年龄段患者术后最佳矫正LogMAR远视力(BCDVA)、立体视和屈光度的变化.结果 术后1、3年BCDVA明显优于术后1周(P＜0.05),术后1、3年的差异无统计学意义(P ＞0.05).术后3年立体视良好者9例(20%),其中单眼患儿4例(14.3%),双眼患儿5例(29.4%),差异无统计学意义(P ＞0.05).＜2岁患儿术后各时期及2～5岁与＞5岁患儿术后1、3年屈光状态与术中预留IOL屈光度的差异均有统计学意义(均P＜0.05).各年龄段患儿术后3年与术后1年屈光状态的差异均有统计学意义(均P＜0.05);术后1、3年均发生近视漂移,＜2岁患儿术后3年近视漂移-3.50D,2～5岁患儿近视漂移-2.11D,＞5岁患儿近视漂移-1.86D.结论 先天性白内障摘除人IOL植入术可获得较好的视力,术后1年是视力提高的关键期.随着患儿手术时年龄的增大,近视漂移的幅度呈下降趋势.     

负度数人工晶体植入的临床分析

目的分析超高度近视合并白内障患者超声乳化后负度数人工晶状体植入的临床疗效。方法回顾性分析34例（43眼）行白内障超声乳化联合负度数人工晶体植入术的患者。记录术前眼轴长度、术前视力,观察术中、术后并发症及术后视力,随访6个月。结果术后屈光度数与预留屈光值接近,平均绝对屈光误差≤±1D;裸眼视力≥0．3者占72．09％,有46．51％术眼裸眼视力≥O．5。随访中无视网膜脱离等致盲性并发症。结论通过术前精确测量眼轴长度和角膜屈率,超声乳化＋负度数人工晶体植入治疗超高度近视合并白内障安全性高,预测性较好,能使患者获得良好的视力。     

儿童屈光状态及眼生物参数研究

目的 对咸宁市咸安区6～12岁儿童眼球屈光状态及眼生物参数进行初步研究,为咸宁市儿童视力低下防控工作提供参考性意见。方法 对咸宁市咸安区的10 969名6～12岁儿童进行眼健康筛查,并建立屈光发育档案,检查裸眼视力、扩瞳前屈光度、眼轴长度、前房深度、角膜曲率。比较不同性别和年龄儿童的屈光状态及眼生物参数差异。结果 咸宁市咸安区6～12岁儿童筛查性近视的检出率分别为10.3%、13.3%、17.0%、22.7%、28.1%、35.7%、45.6%,总体检出率为24.8%。随着年龄的增长,眼轴长度由(22.85±0.73)mm增至(23.78±0.98)mm,前房深度由(3.51±0.22)mm增至(3.70±0.26)mm,扩瞳前屈光度由(+0.22±0.78)D增至(-0.86±1.54)D,差异均具有统计学意义(P均<0.05)。角膜曲率由(43.03±1.41)D降至(42.95±1.43)D,差异无统计学意义(P>0.05)。不同屈光状态儿童的眼轴长度差异具有统计学意义(P<0.05)。不同屈光状态儿童的性别差异均无统计学意义(P>0.05)。结论 咸安区...     

眼屈光要素对青少年屈光度的影响

目的 :通过对青少年及儿童眼球的屈光要素 (角膜曲率、眼轴、前房深度、晶体厚度 )的测定 ,了解其对青少年屈光度的影响。方法 :以 3～ 19岁作为研究对象用散瞳验光、A超测量仪及角膜曲率计检测出 395例远视、近视屈光程度和屈光各要素的测量值进行分析。结果 :12岁前远视 2 74眼 (6 4 .0 % ) ;角膜水平径线的总平均值为 (4 2 .80± 1.5 0 )D,垂直径线总平均值为 (4 3.75± 1.6 7) D,顺规性散光 4 33眼 (91.2 % ) ,逆规性散光 1眼 (0 .2 % ) ,斜散光 4 1眼 (8.6 % )。近视程度与眼轴长度呈正相关 ,远视程度与眼轴长度呈负相关 ,前房深度、晶体厚度与度数无明显相关。中低度近视、远视与平均眼轴长度之间差异无显著性 (P>0 .0 5 )。高度近视、远视与平均眼轴长度差异有极显著性 (P<0 .0 1)。结论 :儿童青少年屈光变化是由远视到正视 ,再由正视转变为近视 ,在屈光程度上起主要作用的屈光要素是眼轴和角膜曲率     

白内障合并高度近视人工晶状体计算公式的选择

目的以临床资料验证SRK-T公式和SRK-Ⅱ公式的准确性。方法收集43例(43眼)高度近视(眼轴长度≥26.0 mm)白内障接受超声乳化联合人工晶状体植入术患者的临床资料。43眼按眼轴长度分为两组:A组(25眼)眼轴长度<29.0 mm,B组(18眼)眼轴长度≥29.0 mm。分组比较采用SRK-T和SRK-Ⅱ公式分别计算的平均绝对预测屈光误差值及应植入人工晶状体度数间的相差幅度及分布。结果分别以SRK-T和SRK-Ⅱ公式计算预测眼屈光度数,平均绝对预测屈光误差值在A组分别为(1.33±0.67)D和(1.40±0.59)D,差异无统计学意义(P>0.05);在B组分别为(0.84±0.65)D和(1.42±0.87)D,差异有统计学意义(P<0.05)。A组采用SRK-T和SRK-Ⅱ公式分别计算的应植入人工晶状体度数相差≤±0.5 D者为84%;B组经SRK-T和SRK-Ⅱ公式分别计算的应植入人工晶状体度数相差≥±2.0 D者为61.11%。结论对于眼轴长度≥29.0 mm的高度近视白内障眼,SRK-T公式更适用,其结果的准确性优于SRK-Ⅱ公式。     

放射状角膜切开术术后白内障手术及人工晶状体度数选择

目的探讨放射状角膜切开术（RK）术后白内障手术的诊治特点及人工晶状体度数选择的可靠性。方法回顾性分析我院2010
年3月~2013年6月RK术后的白内障患者8例（12只眼）,术前对白内障患者的视力、角膜曲率及眼轴长度进行检查,比较患者用
TOPCON-KR8800型自动角膜曲率计测量的3组角膜中央2.6 mm的角膜曲率值,选择较为低的K数值,选用经SRK T三元回归公
式自动计算的近正视化（-1.00D~-2.00D）的人工晶状体（后房型折叠人工晶状体）,行白内障超声乳化摘除联合人工晶状体植入术,
术后3月随访患者的视力、屈光状态。结果RK术后白内障患者行人工晶状体植入的12只眼术后视力均较术前提高：其中6只眼裸
眼视力达到0.8~1.0,另外6只眼裸眼视力达到0.4~0.6+,矫正视力0.6~1.0;术后屈光状态：6只眼接近正视（+0.75D~-1.00D）,另外6
只眼的屈光度为-1.00D~-2.50D,通过术后配镜,患者均能接受。结论对RK术后的白内障患者,施行白内障超声乳化吸出术+人工
晶状体植入术是可行的;比较患者的3组自动角膜曲率计测量的角膜中央2.6 mm的角膜曲率值,选择较为低的K数值,使用SRK T
公式计算人工晶状体的度数,预留-1.00~-2.00D的近视较为安全,避免>+3.00D的远视出现,也较为患者接受。
     

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.