LVC程序视野检查在青光眼合并白内障患者的应用

目的探讨中央低视力(low vision center, LVC)程序视野检查在术前评估青光眼合并白内障低视力患者视功能的价值.方法接受青光眼-白内障联合术的低视力患者共14例(14只眼),术前1d及术后3月内行LVC程序视野检查.术前同时行视网膜潜视力测定.结果所有患者在联合术后总的平均阈值敏感度(mean sensitivity, MS)均有显著提高(P＜0.01),而颞侧的MS值较鼻侧改善更为明显.术前视野已有绝对暗点形成的区域,术后仍存在.与视网膜潜视力测定相比,LVC程序视野检查的MS值与术后最佳矫正视力间存在对应关系.结论术前LVC程序视野检查对于青光眼合并白内障低视力患者有特殊价值,有助于术者判断该类患者术后的视力、视野的情况,可作为术前估计其潜在视功能的新方法之一.     

三维频域光学相干断层扫描、彩色中心视野对诊治脉络膜新生血管疾病的意义

目的分析三维频域光学相干断层扫描(3D-OCT)在脉络膜新生血管疾病(CNV)治疗中的形态学图像及彩色中心视野对黄斑功能检测的临床意义。方法前瞻性分析51例62眼确诊为CNV且行光动力疗法(PDT)治疗的患者3D-OCT图像及10°、30°彩色中心视野,比较治疗前后患者黄斑中心凹厚度、视野平均敏感度(mean sen-sitivity,MS)平均值及视力的改变。结果 CNV患者PDT治疗后3、6个月黄斑中心凹厚度与治疗前比较差异有统计学意义(P<0.05)。治疗后1、3、6个月10°及30°视野的MS较治疗前均明显提高,差异有统计学意义(P<0.05)。治疗后6个月有54.8%的患眼视力提高超过2行。结论 3D-OCT可诊断CNV,并进行PDT治疗前后视网膜形态结构的观察;彩色中心视野能定量评估CNV患者PDT治疗后黄斑功能的恢复。     

儿童病理性近视后巩膜加固术临床观察

目的:测量儿童后巩膜加固术前及术后眼轴及视力,评估后巩膜加固术对儿童病理性近视的疗效.方法:随访门诊高度近视儿童,应用异体巩膜做后巩膜加固术的加固材料,将其中的13例(25只眼)行后巩膜加固术,术前术后均行散瞳检影验光进行屈光度检查,IOL-Master测量眼轴,分别观察术前术后屈光度的增长速度以及眼轴的增长情况.结果:后巩膜加固术前随访8～43个月,平均23.56±11.79个月,屈光度平均每年增长-1.33±1.08D,术后随访6～30个月,平均17.08±9.22个月,屈光度平均每年增长-0.36±1.19D.术前术后屈光度增长有显著统计学意义(P=0.007＜0.01).结论:后巩膜加固术对阻止儿童病理性近视的发展有确切的疗效,且安全.     

不伴黄斑水肿的重度非增生性糖尿病视网膜病变的激光治疗

目的观察不伴黄斑水肿的重度非增生性糖尿病视网膜病变患者在行全视网膜光凝治疗前后黄斑中心厚度及视力的变化,探讨治疗的安全性。方法收集我院26例(52眼)不伴黄斑水肿的重度非增生性糖尿病视网膜病变(Non-proliferative diabetic retinopathy,NPDR)的2型糖尿病患者(视力≥0.8),行每周1次的全视网膜光凝(Panretinal pho-tocoagulation,PRP)治疗,分四期完成。记录术前、术后3、6个月视力(visual acuity,VA),并使用光学相干断层扫描(opticalcoherence tomography,OCT)检测黄斑中心厚度。结果 26例重度NPDR患者(52眼)中,行PRP术后3个月、6个月VA与术前比较无统计学意义(P>0.05),术后3、6个月黄斑中心凹厚度与术前比较,差异有统计学意义(P<0.05),PRP治疗后黄斑中心厚度较治疗前轻度增加。结论对不伴黄斑水肿的重度NPDR行PRP治疗安全有效,术后黄斑中心厚度轻度增加。     

标准化A/B超在海绵血管瘤和神经鞘瘤鉴别诊断中的价值

目的:观察视网膜內界膜(ILM)剥离对糖尿病黄斑水肿的疗效,视力和黄斑中心凹厚度的变化以及对眼压的影响。探讨曲安奈德(TA)在玻璃体切割及ILM剥离术中的作用。方法:选取糖尿病视网膜病变(IV,V期)引起的黄斑水肿患者60例(60眼)。分成观察组和对照组各30眼。观察组行玻璃体切割手术,术中应用TA标记残留玻璃体后皮质、机化膜及ILM,剥离后极部ILM;对照组行单纯玻璃体切割手术,术中应用TA标记玻璃体后皮质及机化膜。观察:2组术前视力与术后(4个月)视力的变化以及2组之间视力的变化;2组术前、术后2周内、术后4个月眼压的变化,以及2组之间眼压的对照;术后4个月黄斑中心凹OCT值与术前对照及两组之间黄斑中心凹OCT值对照。结果:(1)视力:观察组术后4个月时视力与术前对照P0.01,具有统计学意义;对照组术后视力与术前对照P0.05具有统计学意义;观察组30眼中有25眼(84.6%)视力有提高,对照组30眼中有17眼(56.7%)有提高,2组之间对照P0.05具有统计学意义。(2)黄斑中心凹OCT值:观察组术后4个月黄斑中心凹OCT值与术前对照P0.01具有统计学意义;对照组术后黄斑中心凹OCT值与术前对照P0.01具有统计学意义;观察组30眼中黄斑水肿消退28眼,有效率92.3%,对照组30眼中有20眼明显消退,有效率66.7%,2组之间对照P0.05,具有统计学意义。(3)眼压:观察组术后14天内眼压与术前眼相对照P0.05,具有统计学意义,术后4个月时眼压P0.05,无统计学意义;对照组,术后14天内眼压与术前对照P0.05,具有统计学意义,术后4个月眼压P0.05,无统计学意义;术后14天内,观察组有8例眼压超过21mmHg,对照组有7例眼压超过21mmHg,2组之间对照,P0.05无统计学意义。结论:单纯玻璃体切割手术对黄斑水肿有效,ILM剥离能明显提高手术疗效;TA的标记作用使玻璃体切割及ILM剥离更加安全确切。     

视网膜內界膜剥离治疗糖尿病黄斑水肿的研究

目的:观察视网膜內界膜(ILM)剥离对糖尿病黄斑水肿的疗效,视力和黄斑中心凹厚度的变化以及对眼压的影响。探讨曲安奈德(TA)在玻璃体切割及ILM剥离术中的作用。方法:选取糖尿病视网膜病变(IV,V期)引起的黄斑水肿患者60例(60眼)。分成观察组和对照组各30眼。观察组行玻璃体切割手术,术中应用TA标记残留玻璃体后皮质、机化膜及ILM,剥离后极部ILM;对照组行单纯玻璃体切割手术,术中应用TA标记玻璃体后皮质及机化膜。观察:2组术前视力与术后(4个月)视力的变化以及2组之间视力的变化;2组术前、术后2周内、术后4个月眼压的变化,以及2组之间眼压的对照;术后4个月黄斑中心凹OCT值与术前对照及两组之间黄斑中心凹OCT值对照。结果:(1)视力:观察组术后4个月时视力与术前对照P0.01,具有统计学意义;对照组术后视力与术前对照P0.05具有统计学意义;观察组30眼中有25眼(84.6%)视力有提高,对照组30眼中有17眼(56.7%)有提高,2组之间对照P0.05具有统计学意义。(2)黄斑中心凹OCT值:观察组术后4个月黄斑中心凹OCT值与术前对照P0.01具有统计学意义;对照组术后黄斑中心凹OCT值与术前对照P0.01具有统计学意义;观察组30眼中黄斑水肿消退28眼,有效率92.3%,对照组30眼中有20眼明显消退,有效率66.7%,2组之间对照P0.05,具有统计学意义。(3)眼压:观察组术后14天内眼压与术前眼相对照P0.05,具有统计学意义,术后4个月时眼压P0.05,无统计学意义;对照组,术后14天内眼压与术前对照P0.05,具有统计学意义,术后4个月眼压P0.05,无统计学意义;术后14天内,观察组有8例眼压超过21mmHg,对照组有7例眼压超过21mmHg,2组之间对照,P0.05无统计学意义。结论:单纯玻璃体切割手术对黄斑水肿有效,ILM剥离能明显提高手术疗效;TA的标记作用使玻璃体切割及ILM剥离更加安全确切。     

Bevacizumab治疗湿性型年龄相关性黄斑变性疗效观察

目的 探讨Bevacizumab治疗湿性型年龄相关性黄斑变性的效果.方法 我院20例(20眼)湿性型年龄相关性黄斑变性患者给予玻璃体腔内注射Bevacizumab治疗,观察术前、术后1周及术后1个月矫正视力,术前及术后1个月视网膜中心厚度.结果 术后1周及术后1个月矫正视力较术前明显升高,差异有统计学意义(P＜0.05);术后1个月视网膜中心厚度较术前明显降低,差异有统计学意义(P＜0.05).术后1个月18眼染料渗漏减少,2眼渗漏无减少.所有注射眼均未发生眼内炎、青光眼、视网膜脱离及血管阻塞等严重并发症.结论 玻璃体腔内注射Bevacizumab治疗湿性型年龄相关性黄斑变性可以显著提高视力,减轻黄斑水肿.     

糖尿病白内障巩膜隧道小切口摘除加人工晶体植入临床分析

目的探讨糖尿病白内障巩膜隧道小切口摘除联合人工晶体植入术后的疗效.方法对40例糖尿病白内障64眼施行巩膜隧道小切口摘除加人工晶体植入术,并随机抽取同期此类手术40例非糖尿病白内障68眼为对照组,对术后视力及并发症进行比较.结果糖尿病组术后视力提高,但视力比非糖尿病组差(P＜0.05),并发症比非糖尿病组高(P＜0.05).影响视力提高的主要原因是糖尿病性视网膜病变.结论巩膜隧道小切口摘除加人工晶体植入治疗糖尿病白内障可改善视力,同时便于对糖尿病视网膜病变进行光凝处理.     

特发性黄斑裂孔手术前后注视性质和视敏度变化

目的 观察特发性黄斑裂孔手术前后注视性质和视敏度的变化,并探讨其与手术前后黄斑视功能变化的关系,为特发性黄斑裂孔手术提供更为有效的视功能观察指标.方法 本实验采用回顾性分析,选取2018年12月至2019年12月于我院就诊,行玻璃体切除术(pars plana vitrectorny,PPV)联合内界膜撕除术的特发性黄斑裂孔(idiopathic macular hole,IMH)患者28例30只眼纳入研究.于术前、术后1个月、术后3个月、术后6个月分别行最佳矫正视力(best cor-rected visual acuity,BCVA)、光学相干断层成像(optical coherence tomography,OCT)、微视野查.采用OCT记录术前IMH的孔径及术后的愈合情况.采用微视野计行微视野检查,记录内容包括:(1)黄斑区视网膜平均敏感度(average thresh-old,AT);(2)2°固视率(P1)、4°固视率(P2);(3)优选的视网膜注视位点(preferred retinal location,PRL)移动距离.比较AT,BCVA术前术后的变化特点,并研究PRL的移动距离与视力变化及注视性质之间的关系.结果 OCT显示术后黄斑裂孔全部闭合.术前与术后6个月的注视性质存在差异(两独立样本秩和检验,Z=-4.273,P<0.01).术前至术后1个月(r=0.5276,P<0.01)、术前至术后3个月(r=0.802,P<0.01)、术前至术后6个月(r=0.5995,P<0.01)的PRL的移动距离均与相应阶段的BCVA改变量呈正相关.BCVA从基线时的(1.09±0.23)明显改善至术后6个月的(0.48±0.15)(P<0.01),但术后1个月与术前相比无显著改善(P=0.177),术后3个月(P<0.01)、术后6个月(P<0.01)均有显著改善.AT也有显著的提高,从基线时的(20.55±2.47)dB提高至术后6个月的(23.07±2.18)dB(P<0.01).结论 特发性黄斑裂孔术后裂孔闭合,注视性质向稳定中心注视转变.特发性黄斑裂孔术后黄斑区视网膜平均敏感度显著增加,在第1个月时尤为明显.可作为比最佳矫正视力更为敏感的视功能观测指标.     

巩膜后注射曲安奈德治疗视网膜色素变性黄斑水肿的短期疗效分析

目的 观察巩膜后注射曲安奈德(triamcinolone acetonide,TA)在视网膜色素变性(retinitis pigmentosa,RP)黄斑水肿患者治疗中的安全性和临床疗效.方法 纳入2013-2014年西南医院眼科门诊确诊为RP黄斑水肿患者10例,其中男性5例,女性5例;年龄(34.9±13.6)岁,均为双眼发病.手术前行视力、眼压、眼底彩色照相、眼底自发荧光(fundus autofluorescence,FAF)、眼底荧光造影(fundus fluorescein angiography,FFA)、光学相干断层扫描(optical coherence tomography,OCT)、闪光视网膜电图(fash electroretinogram,FERG)及多焦视网膜电图(muhifocal electroretinogram,mfERG)等检查.单眼行巩膜后注射TA 20 mg,观察治疗眼术后视力、眼压、黄斑1～9区OCT等变化以及相关并发症情况.结果 10例患者术后1周黄斑中心凹(1区)厚度较术前下降[(298.7±146.2) vs(358.4±152.2) μm,P=0.073],术后1个月1区厚度较术前显著下降[(279.6±130.5) vs (358.4±152.2)μm,P=0.023].与术前相比,10例患者黄斑1～9区平均厚度在术后1周[(284.3±76.8) vs (301.9±83.3)μm,P =0.047]及术后1个月[(271.9±68.7) vs (301.9±83.3)μm,P=0.011]均明显下降.患者术后1周、1个月视力较术前分别提高2个和6个字母数.无术后高眼压、结膜出血、感染等并发症.结论 巩膜后注射TA可用于治疗RP黄斑水肿,未出现并发症,并能有效减轻黄斑水肿.     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.