超声刀与传统电刀甲状腺手术临床效果比较

目的比较超声刀与传统电刀在甲状腺手术中对患者喉返神经的保护作用。方法 104例患者采用超声刀行甲状腺手术（超声刀组）,108例采用传统电刀行甲状腺手术（传统电刀组）,对比两组患者的手术时间、术中出血量、术后引流量、住院时间和喉返神经损伤并发症发生率。结果与传统电刀组相比,超声刀组手术时间、术中出血量均明显降低（P〈0.05）,其他方面均无明显差异（P〉0.05）。结论超声刀行甲状腺手术可明显缩短患者手术时间,减少术中出血量,利于术者对喉返神经的辨认。     

超声刀在开放性甲状腺手术中的应用

目的:探讨超声刀在开放性甲状腺手术中的应用价值。方法:回顾分析160例甲状腺手术患者的临床资料,其中80例采用超声刀开放性甲状腺手术(超声刀组),另外80例采用传统方法进行甲状腺手术(对照组)。比较两组手术时间、切口长度、术中出血量、术后引流量和并发症。结果:超声刀组手术时间平均58.2 min,比对照组平均缩短23.9 min(P0.01),超声刀组切口长度平均4.9cm,比对照组平均缩短2.5 cm(P0.01),超声刀组术中出血量平均25.6ml,比对照组平均减少21.7ml(P0.01)。超声刀组术后引流量平均56.8ml略多于对照组,差异无统计学意义(P0.05),超声刀组和对照组各有1例发生暂时性喉返神经麻痹。结论:超声刀在开放性甲状腺手术中的应用,能明显缩短手术时间、切口长度及减少术中出血,并不增加手术并发症,值得推荐。     

经前胸壁路径内镜下甲状腺手术31例分析

目的 探讨内镜下甲状腺手术的方法,总结临床应用经验.方法 选择2008年8月～2009年6月新疆医科大学附属中医医院普外科完成经前胸壁路径内镜下甲状腺手术患者31例,其中甲状腺腺瘤26例,结节性甲状腺肿4例,1例甲状腺乳头状癌患者改开放手术行甲状腺患侧全部切除,对侧大部切除.结果 31例手术全部成功,30例良性病变患者的手术时间为(116±17)min,术中出血量为(85±6)ml,伤口引流量(术后总量)为(105±35)ml,术后住院时间为(4.0±0.8)d.全部病例均未发生切口感染、术中术后大出血、喉返神经损伤、喉上神经损伤和甲状腺功能低下等并发症.结论 内镜甲状腺手术是安全可靠的,具有很好的美容效果.采用前胸壁路径及合适长度的皮下隧道,极大的简化了手术操作,值得推广.     

超声刀在甲状腺手术中的应用研究

目的探讨采用超声刀进行甲状腺手术的临床效果。方法选择在我院进行手术治疗的甲状腺疾病患者186例．随机分为研究组和对照组各93例,研究组采用超声刀进行手术治疗,对照组采用传统方法进行治疗。结果研究组切口长度、平均手术时间、术中出血量、术后引流量、术后住院时间、术后VAS评分结果与对照组比较,差异有显著统计学意义（P〈0．01）。研究组术后并发症少于对照组（P〈0．05）。随访3个月,研究组切口粘连、颈部麻木、颈部疼痛、吞咽不适及皮下结节例数少于对照组（P〈0．05或P〈0．01）。两组不同手术方式喉返神经损伤的例数差异无统计学意义（P〉0．05）。结论超声刀用于开放性甲状腺切除手术,可以减少手术对患者的创伤,且不增加喉返神经损伤情况,值得临床推广。     

超声刀在开放性甲状腺手术中的应用

目的：探讨超声刀在开放性甲状腺手术中的应用价值。方法：回顾分析160例甲状腺手术患者的临床资料,其中80例采用超声刀开放性甲状腺手术（超声刀组）,另外80例采用传统方法进行甲状腺手术（对照组）。比较两组手术时间、切口长度、术中出血量、术后引流量和并发症。结果：超声刀组手术时间平均58．2 min,比对照组平均缩短23．9 min（P＜0．01）,超声刀组切口长度平均4．9cm,比对照组平均缩短2．5 cm（P＜0．01）,超声刀组术中出血量平均25．6ml,比对照组平均减少21．7ml（P＜0．01）。超声刀组术后引流量平均56．8ml略多于对照组,差异无统计学意义（P＞0．05）,超声刀组和对照组各有1例发生暂时性喉返神经麻痹。结论：超声刀在开放性甲状腺手术中的应用,能明显缩短手术时间、切口长度及减少术中出血,并不增加手术并发症,值得推荐。     

腔镜下甲状腺切除术8例分析

目的：探讨内镜下甲状腺切除技术的临床疗效。方法：对8例甲状腺腺瘤及结节性甲状腺肿采用腔镜下甲状腺腺瘤切除、甲状腺大部切除术。结果：均完成手术，无中转开放手术，手术时间100-200min，平均130min，出血量少，无喉上神经及喉返神经损伤，无甲状旁腺损伤。住院4-7d，平均5.5d。结论：腔镜下甲状腺手术切口隐蔽，美观；且由于内镜的放大作用喉上及喉返神经和甲状旁腺显露清晰减少副损伤的机会。     

内镜下甲状腺切除术9例分析

目的:应用内镜技术探讨创伤小、美观的甲状腺切除技术。方法:对9例甲状腺腺瘤采用内镜行甲状腺腺瘤、甲状腺腺叶切除及甲状腺腺叶次全切除。结果:均完成手术,无中转开放手术,手术时间90~200分钟,平均119分钟,出血量极少。无喉返及喉上神经损伤表现。住院5~9天,平均6.8天。结论:由于内窥镜的放大作用,术野结构清晰,可避免喉返神经及甲状旁腺的损伤。且手术创口小而隐蔽,具有美容效果。     

显露喉返神经技术在困难甲状腺手术患者中的应用观察

目的探究显露喉返神经技术对困难甲状腺手术患者的应用价值。方法按照术中是否显露喉返神经将2014年12月~2016年10月诊治的124例困难甲状腺手术患者分为显露组(73例)和非显露组(51例),比较两组患者手术时间、术中出血量、术后引流量和引流时间等手术一般情况及是否产生术后喉返神经损伤。结果显露组手术时间长于非显露组(P<0.001),两组患者术中出血量、术后引流量以及术后引流时间比较差异无统计学意义(P>0.05);显露组喉返神经损伤发生率为2.74%(2/73),低于非显露组的17.65%(9/51),比较差异有统计学意义(P<0.05)。结论显露喉返神经技术可明显减少困难甲状腺手术患者喉返神经损伤,值得推广。     

小切口甲状腺手术联合新法暴露喉返神经的临床研究

目的研究小切口甲状腺手术的技术要点及从气管食管沟寻找解剖喉返神经在术中防止喉返神经损伤的意义。方法回顾性分析在甲状腺手术中采取小切口切除方式和甲状腺腺体下方气管食管沟寻找解剖喉返神经54例,对手术结果以及技术要点进行分析总结,并观察喉返神经损伤情况。结果采用小切口甲状腺手术,能够清楚显示甲状腺,未出现术中术后出血及喉返神经损伤,平均出血量为15mL,平均手术时间为50min,术后切口一期愈合,5d左右出院,切口隐蔽美观。结论小切口甲状腺手术方式可以缩小创面,术中清楚显露提高安全性,术后恢复快,不影响美观。从腺体下方气管食管沟寻找解剖喉返神经是更安全、简便的方法。     

低领小切口甲状腺切除术115例

目的 探讨超声刀辅助下低领小弧形切口行甲状腺腺叶切除术在手术安全、手术时间、术中出血量、术后并发症及术后切口美容方面是否具有更好的效果.方法 对115例符合手术适应症的患者实施超声刀辅助下甲状腺低领小弧形切口微创手术,患者均行一侧甲状腺腺叶切除术.结果 115例患者手术均顺利完成,术野、喉返神经及甲状旁腺显露清晰.切口长2～4cm(平均2.6 cm);肿物平均直径3.82 cm (2.7 ～ 4.8 cm);手术时间24～80 min(平均32 min);术中出血量3～20 mL(平均6 mL);所有患者对手术的美容效果满意.结论 采用超声刀辅助下低领小弧形切口施行甲状腺单侧腺叶切除具有术野显露充分、手术时间短、手术安全、术后并发症少、且有明显的美容效果,值得应用推广.     

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.