壳多糖眼内应用的实验研究

将壳多糖与进口透明质酸钠作对比研究，探讨其作为粘弹剂在内眼手术中的应用可能性。方法：新西兰兔２０只，右眼前房内注入壳多糖为实验组，左眼前房内注入透明质酸钠为对照组。结果：观察球结膜充血，角膜混浊，前房渗出，眼压变化，角膜内皮活细胞染色并计数，发现实验组与对照组均无显著性差异。光镜，透射电镜观察细胞形态无明显异常。     

实验性家兔持续性高眼压对角膜内皮细胞损伤的观察

目的观察实验性家兔持续性高眼压对角膜内皮细胞的损伤,探讨临床上青光眼持续性高眼压对角膜内皮细胞的损伤机制。方法选择26只健康成年家兔随机分成3个实验组(高眼压持续3 d组、2周组、4周组)各7只(14眼)共42只眼,及正常对照组5只(10眼)。实验组前房注入1%甲基纤维素建立持续性高眼压家兔模型,用角膜内皮显微镜和透射电镜观察持续性高眼压兔眼角膜内皮细胞密度及超微结构的变化。结果3个实验组兔眼角膜内皮细胞平均密度较正常对照组均有不同程度下降,差异有显著性,内皮细胞超微结构出现不同程度变化。结论持续性高眼压对角膜内皮细胞造成损伤,随高眼压持续时间越长程度越重。提示临床上诊治青光眼时应早期控制眼压,减少角膜内皮细胞损伤。     

表面麻醉联合前房内注射0.5%利多卡因麻醉在青光眼术中有效性及安全性的观察

目的研究表面麻醉联合前房内注射0.5%利多卡因在小梁切除术中的麻醉有效性及安全性。方法42例患者随机分成2组,每组各21例。试验组术中采取表面麻醉,行前房穿刺后前房内注射浓度为0.5%利多卡因。对照组术中采取表面麻醉联合球后麻醉的方式。2组均行小梁切除术。观察术中患者的疼痛耐受程度,术中、术后并发症及术后眼压、角膜等情况。结果试验组及对照组患者均可配合完成手术,2组各有3例患者悬吊上直肌时诉疼痛,对照组中有8例行虹膜周切时诉疼痛。对照组有2例术中出现术眼瞳孔散大,2例眶压增高导致手术操作难度加大。术后对照组有1例出现下睑淤血,1例术后出现轻度上睑下垂,持续2周后消退。2组术后1、3、6d和3、6个月时角膜内皮无异常改变,术后3及6个月眼压经统计学处理差异无统计学意义。结论在小梁切除术中使用表面麻醉联合前房内注射0.5%利多卡因的麻醉方式,麻醉效果好,患者疼痛耐受佳,术中术后相关并发症少,且术后眼压控制效果良好,对角膜内皮细胞无影响,不失为一种安全有效、简便的眼前段手术麻醉方式。     

羧甲基壳聚糖载姜黄素缓释药膜抑制兔后发性白内障的实验研究

目的:探讨羧甲基壳聚糖载姜黄素缓释药膜防治后发性白内障的有效性和安全性。方法:将16只(32只眼)新西兰白兔分别行超声乳化透明晶状体吸除术,并随机均分为4组:A组植入人工晶体襻上固定有载药量为50μg羧甲基壳聚糖载姜黄素缓释药膜,B组植入人工晶体襻上固定有不含姜黄素的空白缓释药膜,C组植入人工晶体术毕后前房内注入20 mg/L姜黄素溶液,D组植入不含药膜的人工晶体;术后行裂隙灯显微镜检查,评价结膜充血、角膜水肿、前房闪辉、后发性白内障等,术后12 w对术眼行组织病理学检查。结果:术后C组炎症反应最重,A组和B组相当,但均较D组稍严重;术后12 w A、B、C、D组后发性白内障的发生率分别为25%(2/8)、75%(6/8)、62.5%(5/8)、100%(8/8);光镜下各组角膜、虹膜、视网膜结构无明显差异。结论:羧甲基壳聚糖载姜黄素缓释药膜植入兔眼能明显减少后发性白内障的发生,且对眼内角膜、虹膜、视网膜等组织无明显毒副作用,能安全、有效地防治后发性白内障。     

子宫切除术椎管内两种麻醉方法麻醉效果的比较

目的 比较子宫肌瘤行子宫切除术中椎管内两种麻醉方法的效果.方法 60例子宫肌瘤患者,随机分成A、B 2组,每组30例.2组均用16号穿刺针硬膜外腔侧入穿刺成功后,A组经穿刺针注入0.75%布比卡因4 ml+肾上腺素20μg,然后向头端置人硬膜外导管4 cm固定,即刻平卧,经导管注入局部麻醉混合液(1.6%利多卡因+0.2%丁卡因+肾上腺素20μg)2～3次作为初量,每次3～6ml,间隔1～2 min;B组注入1%利多卡因4 ml+肾上腺素20μg,如无脊麻征和入血管征,用25GⅡ型腰穿针顺硬膜外穿刺针进入蛛网膜下腔,见有脑脊液回流,8～10 s内注入等比重药液0.5%布比卡因3 ml(配制:0.75%布比卡因2 ml+0.9%氯化钠溶液至3 ml),然后向头端置入硬膜外导管4 cm固定,即刻平卧.2组阻滞平面均达T8以上.2组术中均按需追加局麻混合液以维持麻醉阻滞平面.观察和比较2组血压、心率、感觉和运动阻滞情况,肌松效果和不良反应.结果 2组感觉和运动阻滞皆较完善,肌松满意;与B组比较,A组血液动力学变化小,不良反应轻.结论 置管前先注入0.75%布比卡因硬膜外阻滞用于子宫切除术麻醉效果满意,且较腰-硬联合麻醉的血液动力学稳定,副作用轻,因而更安全.     

医用几丁糖注入家兔眼前房的实验研究

目的 实验观察医用几丁糖注入家兔前房可能引起的损害,探讨这种高分子物质在眼科的应用前景。方法 将４０只兔右眼前房注入０．１ｍｌ医用几丁糖,左眼前房注入平衡盐溶液作对照,术后观察角膜及前房的反应。结果 实验组与对照组的眼内反应,包括结膜充血,眼压变化,前房渗出,角膜内皮活细胞计数,差异均无显著性（Ｐ〉０．０５）。光镜、透射电镜观察细胞形态无明显异常。结论 医用几丁糖与平衡盐溶液在眼内反应相似,认为医     

2%利多卡因表面麻醉取角膜异物临床观察

目的 观察2%利多卡因表面麻醉取角膜异物的效果和安全性.方法 95例患者均滴2%利多卡因溶液表面麻醉.结果 取角膜异物安全有效率100%.结论 2%利多卡因表面麻醉下取角膜异物效果良好,且安全.     

化学处理多孔硅胶人工角膜支架在动物体内的生物学反应

目的：观察多孔硅胶支架材料经不同化学处理后植入免眼角膜内的生物学反应。方法：选用20只新西兰大白兔，平均分为4组，将多孔硅胶支架材料制成直径4mm的圆盘状，化学处理后植入兔角膜板层囊袋内。材料经酸溶液处理10min为Ⅰ组；酸溶液处理15min为Ⅱ组；H2O2溶液处理15min为Ⅲ组；未处理即对照组。术后每天裂隙灯观察，持续84d后取角膜行光镜、扫描电镜及免疫组织化学分析。结果：材料经化学处理后，眼睑充血减轻、分泌物减少，新生血管出现延迟，范围较小。光镜HE染色及扫描电镜观察见化学处理组多孔硅胶支架内角膜成纤维细胞和胶原蛋白较未处理组多。免疫组化染色见处理组Ⅰ型胶原沉积明显多于对照组。结论：化学溶液对多孔硅胶的表面处理可明显减轻兔角膜炎症反应，增加材料的组织相容性。     

医用几丁糖注入家兔眼前房的实验研究

目的　实验观察医用几丁糖注入家兔前房可能引起的损害 ,探讨这种高分子物质在眼科的应用前景。方法　将 40只兔右眼前房注入 0 .1ml医用几丁糖 ,左眼前房注入平衡盐溶液作对照 ,术后观察角膜及前房的反应。结果　实验组与对照组的眼内反应 ,包括结膜充血、眼压变化、前房渗出、角膜内皮活细胞计数 ,差异均无显著性 (P >0 .0 5 )。光镜、透射电镜观察细胞形态无明显异常。结论　医用几丁糖与平衡盐溶液在眼内反应相似 ,认为医用几丁糖作眼内注射是安全的。     

硅油对兔眼角膜内皮结构的影响

目的：制备前房内硅油注入和硅油注入取出的动物模型,以探讨实验动物眼中硅油对角膜内皮的影响,同时观察、分析硅油取出后角膜的病理变化。方法：将40只健康成年白兔随机分成3组：前房硅油注入组（SIG）、前房硅油注入取出组(SIOG)、空白对照组(CG)。将SIG及和SIOG制成动物模型后进行裂隙灯、角膜厚度、角膜内皮细胞密度、角膜组织学及透射电镜检查,分析硅油在前房内允许停留的最长时间及前房硅油注入取出后角膜发生的病理变化。结果：角膜内皮细胞密度检查结果中,SIG和SIOG 8～16周时角膜内皮细胞密度比相应时限CG下降明显（P<0.01）;组织学及透射电镜下可见12周角膜内皮细胞核固缩,损伤区出现多层角膜内皮细胞。SIOG组在裂隙灯下角膜呈水肿状,SIOG组角膜厚度与SIG组比较明显增加（P<0.01）,组织学及透射电镜结果显示角膜基质的纤维束排列疏.松、紊乱,角膜基质厚度明显增加。CG组角膜内皮细胞无显著改变。结论：兔眼前房内硅油停留8周可引起角膜内皮细胞发生不可逆的损伤,时间越长,损伤越严重。     

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.