44例裂孔性视网膜脱离的暗适应视网膜电图及振荡电位的观察

目的：检测裂孔性视网膜脱离患者的视网膜电图（FERG）及振荡电位（OPs),总结FERG及OPs在视网膜脱离中的变化规律。方法：随机选择1眼为裂孔性视网膜脱离,另1眼除屈光不正外无其他眼疾中44例、44眼,进行暗适应FERG及OPs的检测。与对侧眼作比较研究,主要观察指标有：FERG中的a波振幅（aA);b波振幅（bA);a波峰时（aT);b波峰时（bT),OPs中的∑O,O1,O2,O3,O4及其峰时值的变化。结果：全部病例均有病理改变,视网膜脱离眼上述指标与对侧眼差异有显著性（P＜0．05）,降低幅度与视网膜脱离面积有关。视网膜脱离眼FERG的a波振幅、b波振幅与手术效果相关,异常程度轻者手术成功率高。结论：视网膜电图检查是了解视网膜机能的有效方法之一,术前检查视网膜脱离患者的FERG及OPs,有助于了解病变严重程度及视功能损害的情况,能对手术预后做出较适合的估计。     

术前闪光视网膜电图振荡电位对2型糖尿病患者眼底病变和白内障术后视力的评价

目的: 评价2型糖尿病白内障患者术前闪光视网膜电图振荡电位波幅和潜伏期与眼底病变和术后视力恢复程度的关系.方法: 选择75例2型糖尿病白内障患者,在白内障囊外摘除人工晶体植入术前行闪光视网膜电图振荡电位总波振幅及其子波的波幅和潜伏期测定,术后行眼底检查、矫正视力测定,比较患者术前OPs各子波振幅、潜伏期、OPs总波振幅与术后眼底所见、视力恢复之间的关系,并与对照组比较.结果: 术前OPs各子波、OPs总波振幅与眼底病变和白内障术后视力恢复程度明显相关.结论: 术前振荡电位中OPs总波,子波OPs1～4的波幅的降低程度可以在一定程度上预测2型糖尿病白内障患者眼底视网膜病变的程度和视力恢复程度,潜伏期的检测意义不如振幅.     

糖尿病视网膜病变中视网膜电图振荡电位及尿微量白蛋白水平的分析

目的 研究视网膜电图振荡电位(OPs)总振幅及尿微量白蛋白(U-mAlb)水平在糖尿病视网膜病变(DR)各期中的变化情况,探讨将这些指标应用于临床筛查的可能性. 方法 测定健康对照组、临床前期组及轻、中、重度非增生性DR组和增生性DR组等6组的闪光视网膜电图(FERG)的OPs总振幅及U-mAlb排出量,并行统计学比较. 结果 OPs总振幅及U-mAlb排出量与DR各组间有显著相关性.OPs总振幅随着DR程度的加重而减小,6组间差别均有统计学意义(P<0.01).U-mAlb排出量在健康对照组、临床前期组及轻度非增生性DR组中差别无统计学意义,但在中度非增生性 DR组、重度非增生性 DR组及增生性 DR组中差别有统计学意义(P<0.01),且病变越严重,U-mAlb排出量上升越快. 结论 OPs总振幅可作为DR的定量指标,对诊断有重要价值,尤其是早期DR,敏感性较高;U-mAlb排出量与DR的严重程度相关.     

应用F-ERG监测无眼底病变早产儿视功能发育

目的:探讨F-ERG(闪光视网膜电图)对无眼底病变早产儿视功能发育的影响。方法:随机选取眼底筛查无眼底病变的早产儿56例和正常足月产婴儿40例在矫正胎龄40周(0个月)、52周(3个月)、64周(6个月)行F-ERG检查,记录F-ERG对不同月龄视杆反应b波、最大混合反应a和b波、视锥反应a、b波潜伏期和振幅以及OPs波总振幅。结果:0个月,两组视杆反应b波、最大混合反应a、b波、视锥反应a、b波潜伏期和振幅以及OPs波总振幅均具有统计学差异(P<0.05);3个月,各反应潜伏期逐渐变短,振幅逐渐增加,两组间差异较明显;6个月,两组视锥反应a、b波潜伏期和振幅无统计学差异(P>0.05),其他反应波形仍存在差异(P<0.05)。结论:早产能显著影响低月龄早产儿视功能,而随着视网膜结构和功能的发育,6个月后视功能逐渐成熟。     

重组人促红细胞生成素治疗大鼠视网膜光损伤的效果观察

目的:观察重组人促红细胞生成素治疗大鼠视网膜光损伤的效果。方法:选取4周龄雄性SD大鼠48只,随机分成正常组、模型组、治疗1、2、3组。正常组大鼠8只,其余各组均为10只。用手术显微镜(光照强度为22 000±1 000 lux)造模。治疗1、2、3组大鼠分别在光照前4 h、光照后立即、光照后3d按照5 000 IU/Kg腹腔注射r HEPO 1次。各组大鼠造模后立即和造模后7 d行闪光视网膜电图(FERG)检查,观察并比较各组大鼠a、b波振幅的变化情况。结果:1光照后,立即FERG检查,模型组和治疗1、2、3组大鼠的a波、b波的振幅均低于正常组,差异有统计学意义(P<0.05);治疗1组大鼠的a波、b波的振幅高于治疗2、3组和模型组,差异有统计学意义(P<0.05)。2光照后7 d FERG检查,治疗1、2、3组和模型组7 d后大鼠的a波、b波的振幅均有所恢复,仍均低于正常组,差异有统计学意义(P<0.05);治疗1、2、3组大鼠的a波、b波的振幅呈依次降低,组间比较差异有统计学意义(P<0.05);治疗1、2组大鼠的a波、b波的振幅高于模型组(P<0.05)。结论:r HEPO对实验性大鼠视网膜光损伤具有保护作用,尤以光照前4 h和光照后立即给药效果明显。     

高脂血症人群闪光视网膜电图的特征描述

目的 描述高脂血症人群闪光视网膜电图（F ERG）特征，探讨高脂血症对视网膜功能的影响。方法 收集2011年2—6月于上海交通大学附属第一人民医院体检中心确诊为高脂血症的124例患者为高脂血症组，以同期常规体检的60名健康者为正常对照组。对两组受试者进行F-ERG检查，记录视杆细胞反应的a波（Rod-a）和b波（Rod-b）、最大综合反应的a波（Max-a）和b波（Max-b）、振荡电位（Ops）、视锥细胞反应的a波（Cone-a）和b波（Cone-b）以及30 Hz闪烁光反应的b波（Flicker-b）。比较两组间F-ERG 5项标准反应各子波的波幅、潜伏期以及Max-b与Max-a波幅比值（b/a）的差异。结果 高脂血症组F-ERG 5项标准反应各子波的波幅均显著低于正常对照组，差异有统计学意义（P<0.01）；除Max-b波潜伏期略延长外（P<0.05），高脂血症组其余各子波潜伏期均较正常对照组显著延长，差异有统计学意义（P<0.01）。高脂血症组Max-b与Max-a波幅比值（b/a）显著高于正常对照组，差异有统计学意义（P<0.01）。结论 高脂血症患者的视网膜功能明显受损，且视网膜外层功能较内层受损严重。     

藏红花提取液对慢性高眼压兔眼视网膜电图的保护作用

目的: 探讨藏红花提取液在慢性持续性高眼压条件下对兔眼视网膜功能的保护作用.方法: 将新西兰白兔30只随机分为对照组、高眼压组和治疗Ⅰ、Ⅱ、Ⅲ组;高眼压组和治疗Ⅰ、Ⅱ、Ⅲ组的兔眼前房注入3 g/L复方卡波姆溶液制作成慢性高眼压模型,治疗Ⅰ,Ⅱ,Ⅲ组的兔每日耳缘iv藏红花提取液,对照组仅作前房穿刺.在升高眼压前和高眼压持续1,2,4 wk共4个时间点,检测ERG的b波、Ops波的振幅. 结果: 高眼压组的b波、Ops波振幅在高眼压持续1,2,4 wk时比对照组和治疗组非常显著性降低(P＜0.01),对照组和治疗Ⅱ、Ⅲ组间差异无显著性意义(P＜0.05).结论: 慢性高眼压可导致兔眼视网膜功能损害,表现为ERG的b波、Ops波振幅进行性下降;藏红花提取液对这种视网膜功能损害有保护作用.     

视网膜电图振荡电位在糖尿病性视网膜病变早期诊断的价值

目的：探讨视网膜电图振荡电位（oscillatory potentials,OPs)在糖尿病性视网膜病变早期诊断中的价值，以及与糖尿病病程、血糖和血压的关系。方法：测定102例2型糖尿病患者的视网膜电图振荡电位，分析暗适应OPs的波幅及潜时，并将OPs、眼底荧光血管造影和检眼镜检查三者对糖尿病性视网膜病变的异常检出率进行比较；同时测定患者的血压、空腹血糖及糖化血红蛋白，与OPs进行相关分析。结果：在糖尿病性视网膜病变前期组，暗适应OPs总波幅、OPs各子波波幅（OP1－OP4）降低及OP1、OP2潜时延长，均与对照组有显著性差异（P＜0．01），且与糖尿病性视网膜病变各期有明显的相关性，其中以OPs总波幅的相关性最好；OPs、眼底荧光血管造影及检眼镜检查三者对糖尿病性视网膜病变的异常检出率依次为67．6％、52．9％和45．1％；OPs总波幅与血糖、病程、血压（包括收缩压和舒张压）均呈负相关。结论：暗适应OPs总波幅是目前诊断早期糖尿病性视网膜病变最敏感的指标，它不仅能早期发现病变，还能反映视网膜的进行性损害；及早发现和控制高血糖、高血压，对减少和延缓糖尿病性视网膜病变的发生发展有重要意义。     

视网膜电图在视网膜脱离术前后的应用研究

目的：探讨视网膜脱离术前后的视网膜电图（ERG）变化规律。方法：对30例单眼单纯性视网膜脱离的病人术前术后行ERG检查。结果：ERG振幅下降与视网膜脱离的面积正相关，与脱离时间正相关；术前ERG振幅越高，手术的成功率越高，术后机功能恢复越好；网脱手术成功者对侧眼ERG振幅与正常对照组间差异无显著性（P≥0.05），而手术未成功组与正常对照组间差异有显著性（P＜0．01），未成功组与手术成功组间ERG振幅的差异有显著性（P＜0．05）。结论:ERG检查对视网膜脱离手术治疗有重要指导意义。     

暗适应最大电反应和30Hz闪烁光ERG对视网膜脱离的视网膜功能评价

目的了解暗适应最大电反应和30Hz闪烁光ERG联合检测对视网膜脱离的视网膜功能评价。方法比较各组暗适应最大电反应a、b波振幅和30Hz闪烁光ERG平均振幅。结果视网膜脱离后暗适应最大电反应可表现a、b波振幅降低,与对照组比较差异有显著性意义(P<0.05)。脱离面积愈大,a、b波振幅下降愈明显。波及黄斑区组的视网膜脱离,30Hz闪烁光ERG平均振幅降低与对照组比较差异有显著性意义(P<0.05);未波及黄斑区组与对照组比较差异无显著性意义(P>0.05)。结论联合检测暗适应最大电反应和30Hz闪烁光ERG可对视网膜脱离的视网膜功能进行全面、客观、准确的评价。     

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.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

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.