大前庭导水管综合征的诊断与治疗

目的：探讨大前庭导水管综合征的诊断与治疗。方法：对39例经高分辨率CT证实为双侧大前庭导水管综合征的导水管管径和听阈改变进行分析。结果：同一患者中，管径大的较管径小的听力损失重；不同患者管径大小与听力损失程度无关。声发射测定时波动大。7例突发听力障碍加重期，按突聋治疗后4例基本上恢复到原听力，3例好转。结论：有波动性进行性听力下降、轻微的头颅外伤引起严重的听力下降的患者，或声发射测定发现波动大的感音神经性聋患者，要常规进行颞骨高分辨率CT扫描，一经证实就积极进行预防与治疗，这对保存患者的残余听力有重要意义。     

儿童大前庭导水管综合征早期综合诊断模式探讨

目的:通过对我院18例儿童大前庭导水管综合征病例临床结果分析,了解其发病特点,探索小儿大前庭导水管综合征早期综合诊断的模式。方法:对所有病例行病史询问及常规耳科检查;采用瞬态耳声发射(TEOAE)、听性脑干反应(ABR)、多频稳态反应(ASSR)检查畸变产物耳声发射(DPOAE)检查、声导抗等多种客观听力测试相结合的方法进行听力评估;应用0.5～0.8 mm薄层CT进行颞骨扫描;部分病例运用直接测序对突变热点SLC26A4 IVS7-2A>G进行筛查。结果:18例中男13例,女5例,其中单侧发病3例,双侧发病15例;平均确诊年龄为25.4月;听力结果显示:轻度听力损伤1耳,占总数的2.78%(1/36),中度听力损伤1耳,占总数的2.78%(1/36),中重度听力损伤9耳,占总数的25%(9/34),重度听力损伤7耳,占总数的19.44%(7/36),极重度力损伤18耳,占总数的50.0%(18/36);听性脑干反应(ABR)特征性的声诱发短潜伏期负反应出现8耳,占总数的22.22%(8/36);CT结果显示:符合前庭导水管扩大CT诊断标准33耳,异常率高达91.67%(33/36);热点突变SLC26A4 IVS7-2A>G基因筛查7例,发现热点突变6例,阳性率85.71%(6/7)。结论:应用常规病史调查及CT检查大前庭导水管确诊年龄为25.4月龄,而应用儿童早期听力与热点突变SLC26A4 IVS7-2A>G联合筛查、高分辨率颞骨薄层CT扫描相结合的方法,可将确诊年龄提前至1个月,两者具有显著差异,对小儿大前庭导水管综合征早期发现、早诊断、早预防具有重要意义。     

大前庭导水管畸形的CT表现及多平面重组的价值

目的探讨大前庭导水管的CT表现及多平面重组在诊断该病中的价值。方法18例大前庭导水管患者均经多层螺旋CT扫描的轴位扫描,经后处理获得MPR图像。结果在18位患者中17例为双侧和1例单侧扩大,扩大的导水管呈三种形态：裂隙状（6耳）、三角形（27耳）及囊袋状（2耳）,其内缘均显示与前庭（19耳）或总脚（16耳）相通,导水管中段平均管径3．15mm;结合MPR图像可全面地显示导水管。结论CT能准确地判定前庭导水管扩大的存在,MPR图像能更好的显示和诊断大前庭导水管畸形。     

大前庭导水管综合征的临床特点

目的进一步认识前庭导水管综合征的临床特点,减少误诊,及时治疗。方法13例患者分别作了听力学检查和高分辨率颞骨横断位CT扫描,其中6例作了內听道MRI扫描,具体测量相关数据。结果13例全部有严重的听力损失,4例听力有波动性,3例有头颅外伤史。在CT图像上,12例双侧和1例单侧有前庭导水管扩大。MRI图像上,5例双侧、1例单侧内淋巴管和内淋巴囊均有扩大。结论该病的诊断应综合分析临床资料及影像学图像,才能做到早期诊断和及时治疗。     

前庭导水管扩大的CT诊断及临床价值

目的:分析CT前庭导水管扩大的CT表现,评价其临床价值。方法:25例患者作了高分辨的颞骨颅底横断位扫描,具体测量相关数据。结果:在CT图像上,在25位患者共40耳,15例双侧和10例单侧扩大的前庭导水管外口均大于1.5mm,38耳内侧缘与总脚直接相通。结论:CT能准确地显示前庭导水管扩大,对指导治疗有帮助。     

高压氧疗治疗大前庭导水管综合征患儿急性听力丧失九例

目的目的探讨高压氧疗治疗大前庭导水管综合征患儿急性听力丧失的临床效果。方法对急性听力丧失的大前庭导水管综合征患者9例11耳,进行为期2周共10次高压氧治疗。结果患儿均耐受良好,治疗后复查纯音听阈测试,提示患耳听阈均有明显改善。结论 9例患儿对高压氧疗耐受良好,治疗效果显著,高压氧疗可以成为大前庭导水管综合征急性听力丧失患者的治疗方法之一。     

前庭导水管扩大的CT诊断及临床价值

目的：分析CT前庭导水管扩大的CT表现，评价其临床价值。方法：25例患者作了高分辨的颞骨颅底横断位扫描，具体测量相关数据。结果：在CT图像上，在25位患者共40耳，15例双侧和10例单侧扩大的前庭导水管外口均大于1．5mm，38耳内侧缘与总脚直接相通。结论：CT能准确地显示前庭导水管扩大，对指导治疗有帮助。     

儿童大前庭导水管综合征听力特点分析(附6例报告)

目的探讨儿童大前庭导水管综合征的听力学特点。方法对6例2.5~8.5岁患有大前庭导水管综合征的病儿在初次发病时进行听性脑干诱发反应(ABR)、40 Hz诱发反应、多频稳态诱发反应(ASSR)检查,并在初次发病及最近一次发病时行瞬态诱发性耳声发射(TEOAE)、声导抗及纯音听阈(或行为测听)检查。结果 6例12耳初诊及最近一次的声导抗检查均为A型鼓室图,镫骨肌反射均未引出。TEOAE检查均未通过。ABR、40 Hz诱发反应、ASSR、纯音听阈检查结果均为中度、重度甚至极重度听力损失,且98 dBnHL click刺激声时ABR检查结果示在潜伏期2.77 ms左右均有显著负反应波(ASNR)出现。纯音听阈结果示在250、500、1 000 Hz时均有气骨导差且均大于15 dBnHL。结论大前庭导水管综合征病儿初次发病时一般为双侧中重度以上感音神经性听力损失,随后波动性听力逐渐下降直至全聋。ASNR的出现可以作为大前庭导水管综合征听力学诊断的参考指标,但确诊仍依靠影像学检查。大前庭导水管综合征纯音听阈可以有低范围的气骨导差,但原因不明。本病目前没有有效的治疗方法,但及时助听语训,对病儿的言语语言发育是有效的。重视日常防护及发病时尽早治疗,大前庭导水管综合征是可以有效预防或延迟发作的。     

小儿大前庭导水管综合征的临床治疗

目的:探讨小儿大前庭导水管综合征的临床治疗方法。方法:选择2015年1月~2016年1月收治的小儿大前庭导水管综合征患儿14例,对其进行临床检查并使用血管扩张剂、神经营养剂等治疗。结果:(1)所有患儿均存在不同程度的听力损失和不同听力曲线;(2)经治疗,14例患儿有9例听力恢复到下降前水平,有5例需要佩戴助听器并继续进行听觉恢复训练。结论:小儿大前庭导水管综合征临床治疗效果不够理想,仍有必要继续寻求更为有效的治疗方案,预防和控制这类疾病的发生。     

大前庭水管综合征患者的MRI图像相关测量与听力损失程度的关系

目的 探讨MRI在诊断大前庭水管综合征(LVAS)中的价值以及LVAS患者的听力损失程度与内淋巴管及内淋巴囊的形态和大小的关系.方法 收集15例(26耳)大前庭水管综合征患者,对其进行听力学评估,并利用3D T2加权快速自旋回波序列(FSE)对所有患者进行颞骨薄层轴位MRI扫描,由两位影像学医师分别测量内淋巴管和内淋巴囊的体积及内淋巴囊骨内部分中点最大宽径值,采用直线相关分析对这些测量值与平均听力值进行统计学处理.结果 15例(26耳)LVAS患者中,极重度聋9耳,重度聋10耳,中度聋6耳,轻度聋1耳,平均听力水平为(79.9±19.1)aB.MRI显示,26耳内淋巴管及内淋巴囊均呈不同程度的扩大,内淋巴囊骨内部分中点最大宽径值为(2.84±0.60)mm,内淋巴囊体积为(356.6±171.1)mm3.统计学分析显示,这两个测量值与听力损失程度的直线相关关系无统计学意义(P>0.01).结论 MRI能直观、准确地判定大前庭导水管的存在,有利于LVAS的诊断;LVAS患者的听力损失程度与内淋巴管和内淋巴囊的体积及内淋巴囊骨内部分中点的最大宽径值均无明显的相关性.     

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.