神经导航引导下切除幕上胶质瘤的体会

目的:应用神经导航系统对成人幕上胶质瘤实施手术,研究肿瘤全切除与神经功能保护。方法:回顾性分析郑州大学附属肿瘤医院神经外科于2009年9月至2011年11月应用神经导航系引导进行幕上胶质瘤切除术的74例病例资料。病灶最大直径7.4 cm,最小1.9 cm,平均5.4 cm。结果:用神经导航系统进行幕上胶质瘤及其周围解剖结构定位准确,平均注册误差(2.12+0.51)mm。术后近期复查,CT或MRI证实肿瘤全切60例(81%),次全切除8例(10.8%),大部切除6例(8.2%)。结论:神经导航定位精确,有助于手术计划的精确实施。神经导航下切除幕上胶质瘤显微手术,有助于达到微侵袭效果和提高肿瘤全切除率。     

神经导航在垂体瘤显微手术中的应用

目的 评价神经导航系统在垂体瘤显微手术中的应用价值.方法 在19例垂体瘤经蝶手术中应用神经导航系统指导手术操作,神经导航术中定位中线结构、蝶窦前壁、鞍底以及海绵窦、颈内动脉等,并用以判断肿瘤切除程度.结果 19例神经导航各例的平均坐标误差为1.14～3.62 mm(总平均1.53 mm).19例垂体瘤全切14例,次全切除4例,大部切除1例.术后11例出现一过性尿量增多,无脑脊液漏和颅内感染,无手术死亡.结论 对一些巨大或解剖定位结构不清的垂体瘤进行手术时,神经导航提供实时三维定位,有助于提高肿瘤全切除率,减少手术并发症.     

神经导航辅助显微手术切除脑转移瘤

目的 探讨神经导航在脑转移瘤显微手术中的应用.方法 应用神经导航系统辅助显微手术切除脑转移瘤31例.结果 所有病人术后近期复查CT或MR证实肿瘤全切除率为100%,病人临床症状得到改善,无重要神经功能受损表现,无手术并发症及死亡.结论 脑转移瘤显微手术中应用神经导航技术,具有准确定位、动态示踪、保护神经功能等特点,有助于提高肿瘤切除率和降低手术并发症的发生.     

神经导航辅助显微手术切除颅内微小占位病变

目的 探讨神经导航系统在颅内微小占位病变手术中的应用价值.方法 应用SteahhStation神经导航系统辅助显微手术切除颅内微小占位病变23例,并对神经导航系统的术中准确性和术后治疗效果进行评价.结果 应用SteahhStation神经导航系统辅助显微手术切除颅内微小占位病变的过程中寻找病变成功率为100%,导航手术的病变总全切率达到100%.术后患者无明显神经功能障碍.结论 神经外科手术中应StealthStafion神经导航系统可靠、准确,提高了颅内微小占位病变的手术全切率,同时可减少手术的并发症.     

神经导航引导下的显微手术治疗颅内病灶

目的 :探讨神经导航在颅内病变微创显微手术中的应用价值 ,以最小的手术创伤来达到最好的手术疗效。方法 :对 2 8例颅内病灶患者进行 3mm层厚的CT或磁共振 (MR)扫描 ,利用导航工作站进行术前计划、切口设计、术中指示病灶部位及重要颅内结构。结果 :所有病灶定位准确 ,全切 2 3例 ,次全切除 2例 ,大部切除 3例。术后神经功能保留良好。结论 :神经导航辅助下的微创显微神经外科手术可以达到准确定位及切除病灶 ,减少功能损害的目的。     

神经导航引导下的显微手术治疗颅内病灶

目的：探讨神经导航在颅内病变微创显微手术中的应用价值，以最小的手术创伤来达到最好的手术疗效。方法：对28例颅内病灶患者进行3mm层厚的CT或磁共振(MR)扫描，利用导航工作站进行术前计划、切口设计、术中指示病灶部位及重要颅内结构。结果：所有病灶定位准确，全切23例，次全切除2例，大部切除3例。术后神经功能保留良好。结论：神经导航辅助下的微创显微神经外科手术可以达到准确定位及切除病灶，减少功能损害的目的。     

CT神经导航在经鼻蝶内镜下垂体瘤切除术中的应用

目的探讨CT神经导航在经鼻蝶内镜下垂体瘤切除术的应用。方法在35例经鼻蝶内镜下垂体瘤切除术中应用神经导航技术,术前行CT扫描,在导航系统工作站中进行图像三维重建及制定手术计划,术中应角导航指导手术操作。结果35例导航手术均能精确定位,术中导航误差在1．5mm以内,术后1—3个月复查MRI扫描示肿瘤全切24例、次全切10例、部分切3例。术中无正常组织损伤,术后无严重并发症。结论神经导航在经蝶窭入路内镜下垂体腺瘤切除术中起有效的辅助作用,定位准确、安全性高,有利于提高肿瘤切除率,减少并发症。     

立体定向显微手术切除颅内小病灶

目的：探讨立体定向显微手术切除颅内小病灶的方法和效果。方法：采用CRW—FN脑立体定向仪或Vector Vision神经导航系统定位,显微手术切除颅内小病灶。结果：49例患者中,21例行有框架立体定向手术,28例行神经导航手术。全切病灶39例,次全切10例。仅4例患者出现暂时神经功能障碍,且均在术后3-6个月恢复,未遗留永久性功能障碍。结论：立体定向显微手术具有定位准确、创伤小、并发症少等优点。     

神经导航辅助下中央区胶质瘤切除的应用研究

目的:研究神经导航技术在中央区胶质瘤显微手术中的应用价值.方法:对术前MRI诊断为中央区胶质瘤的20例患者行神经导航辅助下显微手术切除,对肿瘤的切除程度、患者术后的功能状态进行分析评价.结果:肿瘤全切15例,次全切3例,大部切除2例,未出现手术死亡,无新发神经功能障碍.结论:神经导航辅助下手术切除中央区胶质瘤时定位精确,能有效的提高肿瘤切除率,降低术后功能障碍的出现.     

神经导航在脑膜瘤显微手术中的应用

目的探讨神经导航在脑膜瘤显微手术中的应用。方法应用神经导航系统完成52例脑膜瘤显微手术并对其平均注册误差、术中病灶的精确定位,正常结构的保护及手术疗效进行回顾分析。结果52例平均注册误差为(1.2±0.5)mm,术中病灶定位准确,全切除44例,次全切除6例,大部分切除2例,无手术死亡,术后神经功能保留良好。结论脑膜瘤显微手术治疗应用神经导航技术,可以准确定位和切除病灶,保护神经功能和降低手术并发症的发生。     

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.     

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.     

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.