中国家猫中耳结构的观察

藉助手术显微镜,本文经鼓泡外上壁进路,对10只家猫(20耳)的中耳结构作显微镜观察和测量。锤柄下端向下延伸至鼓膜的下4/5,锤柄长与鼓膜接触面大,砧长脚较短,锤骨柄与砧长脚杠杆之比为3倍,其鼓膜有效振动面积与镫骨底板面积之比为23.6倍,声压将被提高70.8倍。因此,猫的鼓室扩音功能远比人耳为大。     

上鼓室胆脂瘤与听骨链重建术

目的 :探讨上鼓室胆脂瘤患者在凿开上鼓室 ,清除胆脂瘤组织后重建上鼓室壁并一期听骨链恢复传音功能的方法和效果。方法 :对上鼓室胆脂瘤 2 3例行上鼓室凿开术 ,清除胆脂瘤上皮组织 ;酌情剪除锤骨头 ,取出砧骨体 ,然后行镫骨头上加高或锤骨长柄、镫骨头连接术。观察术后鼓膜愈合及听力恢复情况。结果 :随访 2 3例 4～ 1 2年 ,2 0例鼓膜愈合良好 ,2例鼓膜后上方外移 ,1例鼓膜发生 2mm穿孔并且胆脂瘤复发。术后气骨导差值 <1 0dB 8例 ,<2 0dB 6例 ,<3 0dB 6例 ,3 0dB以上 3例。以镫骨头上加高听力恢复最好。结论 :上鼓室胆脂瘤患者应以清除胆脂瘤上皮为前提 ,清除病变后根据情况重建上鼓室壁和听骨链 ,有助于恢复听力     

乳突根治术中自体残余听小骨行听力重建的临床应用

目的 探讨乳突根治中利用自体残余听小骨在听骨链重建中的临床应用效果.方法 回顾分析2007～2010年25例利用自体听小骨合理连接听骨链重建患者,随访时间3～36个月.方法 利用锤骨柄直接与活动的镫骨头连接或利用自体砧骨修整后接于完整的锤骨和活动的镫骨之间,观察术后有无并发症并行听力学疗效分析.结果 3～36个月回访,除4例鼓膜留有穿孔,其余鼓膜完整,术后平均纯音听力(500、1000、2000HZ)的气导较术前提高20～30 dB.结论 在乳突根治术中当听小骨破坏及部分缺失时,可利用残余听小骨合理重建以达到听骨链的连接,提高听力,此方法操作便利,费用低廉,效果稳定,并发症少,听力恢复理想.     

118例鼓室硬化临床资料分析

目的通过临床资料分析,探讨鼓室硬化的发病情况及影响听力的主要因素。方法回顾性总结2004年1月至2009年5月我科收治的118例(137耳)鼓室硬化病例,265例(311耳)慢性化脓性中耳炎的病例列为对照组,比较患病年龄、病程长短、性别构成的差别。进一步分析鼓室硬化的病变部位和听力改变的特点。结果(1)鼓室硬化女性患病年龄较大,患病率较高。(2)不同部位病变的发生率由高到低是:鼓膜、锤骨、砧骨、锤砧关节、其它部位、砧镫关节、镫骨。(3)纯音听阈检查听骨链有硬化或破坏的听力较差(P<0.05);女性较男性听力差(P<0.05)。Carhart切迹和气导听力倒V形曲线出现率接近。听力损失影响因素按比重,从大到小顺序为:砧骨、锤骨、锤砧关节、砧镫关节、镫骨、伴发病变、其它部位病变、鼓膜、性别。结论性别可能是鼓室硬化发病的影响因素之一。骨导carhart切迹与气导听力倒V形曲线可能是鼓膜和听骨链钙化的标志。听骨链病变对听力影响严重,处理好听骨链的重建是手术成败的关键。     

多层螺旋CT仿真内镜技术在显示正常中耳结构中的应用

目的　研究多层螺旋CT(MSCT)成像对正常中耳结构的影像学表现及临床意义。方法　利用MSCT对 2 1例正常耳进行扫描及中耳结构的立体重建。结果　MSCT的仿真内镜技术 (CTVE)可显示整个中耳结构。CTVE成像对锤骨、砧骨、镫骨头显示率均为 10 0 % ;对镫骨前后角显示率为 90 5 % ;对镫骨底板显示率仅为 38 1%。结论　应用MSCT的仿真内镜成像可明确显示鼓室及听小骨细胞结构 ,为临床诊断和治疗提供重要信息。     

胎儿鼓膜听骨链移植在鼓室成形术中的应用

利用7～9个月的胎儿鼓膜听骨链移植,为鼓室成形术提供新的材料来源。我院自1989年2月开始,用胎儿鼓膜听骨链移植应用于鼓室成形术,14例(15耳),近期效果满意报道如下。 1 移植材料的采取和保存我们用7个月以上的死亡婴儿,于出生后24小时,摘取鼓膜听骨链,方法是将耳廓严密消毒,在手术显微镜下进行,在乳突后上方切口,凿开上鼓室,暴露锤砧关节,沿鼓膜后部分离鼓膜,凿除外耳道后壁,暴露砧镫关节,剪断各韧带及肌腱,挑出镫骨,分离鼓环,将     

鼓室硬化症鼓室成型术25例临床分析

目的:总结手术治疗鼓室硬化症的临床经验。方法:回顾性总结2001年11月至2005年2月我科经治的25例鼓室硬化症临床资料。手术均在全麻显微镜下采用剥除硬化灶,修补鼓膜或加听骨链重建行Ⅰ期鼓室成型术。采用颞肌筋膜修补鼓膜,以自体乳突骨皮质或陶瓷人工听骨重建听骨链。结果:病灶侵及鼓膜、鼓岬、砧锤骨、镫骨及周围,均呈板障型乳突,无并发胆脂瘤。听力提高15 dB以上24例(96%),术后4例有眩晕。结论:尽量清除硬化灶,形成宽大的鼓室,并重建鼓膜和听骨链,手术疗效与病灶影响听骨链程度有关,精确、熟练的耳显微外科技术是成功的关键。     

盘—锤韧带、锤前韧带、蝶下颌韧带的解剖学研究

对26具胎儿、新生儿新鲜尸颅的(52侧)中耳、颞下颌关节(TMJ)及盘—锤韧带(DML)、锤前韧带(AML)、蝶下颌韧带(SML)进行了解剖学研究,模拟实验发现:下颌前伸移动,DML紧张明显,牵拉锤骨使其沿长轴转动,表现为鼓膜前下象限内陷、后下象限外凸;下颌前下移动,DML、AML均紧张,以AML明显,牵拉锤骨使其沿长轴方向翘动,表现为鼓膜下象限内陷,上象限外凸.通过模拟实验认为,DML、AML可能是间接外伤性鼓膜破裂的解剖学基础.     

人工耳蜗植入术鼓阶入口定位的相关解剖研究

目的通过对人工耳蜗植入手术相关的后鼓室及上鼓室解剖结构进行观察、测量,为人工耳蜗植入手术中顺利找到并准确定位鼓阶入口提供理论参考。方法对20侧成人颞骨标本进行解剖,模拟人工耳蜗植入术,在手术显微镜下观察、测量与人工耳蜗植入手术相关的解剖数据。结果砧骨短脚至圆窗龛之间的距离为(5.91±0.29)mm;镫骨头至圆窗龛之间的距离为(2.11±0.18)mm;面神经垂直段至圆窗龛之间的距离为(6.70±0.19)mm;锥隆起至圆窗膜前缘之间的距离为(2.22±0.21)mm;镫骨头至圆窗膜下缘之间的距离为(2.16±0.14)mm;鼓阶入口与卵圆窗最近距离为(2.12±0.19)mm;匙状突至圆窗龛之间的距离为(3.79±0.17)mm;镫骨头至耳蜗第二回切开点之间距离为(2.25±0.13)mm;锥隆起至耳蜗第二回转切开点之间距离为(2.28±0.20)mm。结论人工耳蜗植入手术中切开耳蜗底回的位置位于锥隆起前下方约2.22 mm处;切开耳蜗第二回的位置位于锥隆起前上方约2.28 mm处;根据病人不同情况,为术中选择不同的鼓阶切开点提供了参考。     

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.     

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.     

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.