圆锥角膜行非机械性全层角膜移植术后拆除连续缝线导致的角膜功能和屈光度的改变情况

目的：评价全层角膜移植术后由于连续缝线拆除引起的角膜功能和屈光度的改变情况。设计：回顾性连续病例研究。机构：临床试验。研究人群：此纵向调查共纳入67例有晶状体眼圆锥角膜患者（行中央准分子激光环钻术、初步角膜移植术、供／受体角膜直径为8．1／8．0mm，采用双向连续缝合法）。主要观察指标：分别在缝线在位时（时相1）、单向缝线拆除时（时相2）和所有缝线拆除时（时相3）这3个时相点进行Zeiss角膜散光计检查[等值屈光力（KEQ）、散光（KAST）、角膜地形图检查（等值屈光力TEQ）和散光（TAST）、主观屈光检查（球镜当量度SEQ）和柱镜度（RAST）]。     

角膜地形图对穿透性角膜移植术后角膜散光的评价作用

目的 :探讨穿透性角膜移植术 (PKP)后角膜地形图对角膜散光的评价作用。方法 :对 37例 39只眼行穿透性角膜移植术后眼进行角膜地形图检查和检影验光 ,对所得散光度数、散光轴位及视力进行统计分析。结果 :两种方法所得散光度数差别≤ 0 .2 5 DS和≤ 0 .5 0 D分别占 12 .5 %和 5 2 .33% ;轴位差别≤ 5 o 和≤ 10 o者分别为 2 8.2 1% ,35 .90 % ;有 2 7眼 (6 9.2 3% )潜视力值 (PRA )与最佳矫正视力 (BCRA)相符。结论 :角膜地形图可对穿透性角膜移植术后眼的散光度数、轴位及视力做出大致评估。有助于提高验光的速度和准确度 ,提高患者的视觉质量     

穿透性角膜移植术后角膜表面构型的长期变化

目的:通过对角膜地形图成像数据、视力和屈光的傅里叶级数谐波分析,调查穿透性角膜移植术(PK)后角膜表面构型的长期纵向变化情况。设计:干预性病例研究。方法:搜集130例(130只眼)预约接受PK术的连续患者,均采用10-0尼龙缝线16位间断缝合角膜。分别测定PK术后1周、1、3、6、9、1     

术后拆线控制人工晶体植入术后角膜激光

目的：通过拆线法减少人工晶体植入后角膜散光，从而进一步提高术后视力。方法：对人工晶体植入术术后6周顺规性散光大于或等于3.0D的40只眼用无菌针头选择性拆断角巩缘缝线。结果：拆断缝线前后比较，角膜散光度拆线前为4.87±0.61D，拆线后一个月消退至1．53±0．39D。视力由4．20±0．17提高至4．92±0．12。每拆断一根缝线，角膜散光度平均消退1．25D。结论：无菌针头拆断角巩缘缝线法是一种有效、安全、简单、花费少的控制人工晶体植入术后角膜散光的方法。     

外伤和手术后散光的控制

内眼手术或角膜外伤后的散光都是由于伤口不正确的愈合所致。近年来许多学者试图借助角膜弯度计,注意手术细节来预防散光,不成功时,再用其他手术矫正,包括削除,移植或角膜放射状切开等方法。但不管怎样努力,最终还是不同于好眼,仍有明显散光。作者报告,在术后头几周,用调整角巩缘连续缝合的张力,或对间断缝合选择张力过紧的缝线拆除一针或几针,使伤口愈合张力平衡,能精确地控制散光。这些调整是在     

电脑验光仪引导下拆除角膜缝线改善白内障术后散光

目的 分析电脑验光仪引导下的角膜缝线拆除改善白内障术后散光的临床效果。方法 对102例大切口和小切口白内障囊外摘除手术后的患者，进行半年至一年的随访观察，并经电脑验光仪检测发现存在明显散光，根据其散光程度及散光轴向作散光调整，即拆除相应的角膜缝线。缝线拆除在显微镜下，采用手术刀或激光断线法进行。结果 不管大小切口ECCE，术后角膜散光较术前均有显著增加（P＜0．05），并随时间增加逐步减小。在拆线后一周，角膜散光均值较术前相比均有明显减小（P＜0．05）。结论 电脑验光仪引导下的角膜缝线拆除，能较好地改善白内障术后引起的角膜散光。     

人工晶体术后角膜散光的拆线调整

目的:本文就27例30只眼的12～14mm角巩膜缘切口白内障囊外摘除术(Extracapsular cataract extraction简称ECCE)联合光学直径6.5mm人工晶体(Intraocular lens简称IOL)植入术后6周的角膜散光(Postoperative astigmatism简称POA)≥2.5D.方法:应用一次注射器5#针头拆断角巩膜间断缝合缝线进行调整.结果:拆线后两周,POA由4.83±1.42D退至1.59±0.86D,平均减退:3.13D,平均每拆一根缝线,角膜散光可减少1.62D,30只眼平均需拆线数量1.93根,拆断缝线后,POA轴位由顺规性散光向逆规性散光漂移.结论:证明一次性注射器拆断缝线法是一种简单有效的术后调整角膜散光方法.     

穿透性角膜移植术后植片神经再生的共焦显微镜观察

目的 应用共焦显微镜观察穿透性角膜移植术后植片神经再生的特征。方法 角膜激光共焦显微镜(heidelberg retina laser tomography, HRT3)对71例穿透性角膜移植患者于术后1、3、6和12个月行连续系列观察,分析角膜植片上皮下和基质中神经再生的生长规律及不同因素对其再生的影响。结果 穿透性角膜移植术后1个月角膜植片中未观察到任何神经存在。术后3、6、12个月,角膜植片上皮下神经和基质神经的再生率分别为3个月26眼/71眼(36.62%)和11眼/71眼(15.49%)、6个月44眼/71眼(61.97%)和30眼/71眼(42.25%)、12个月46眼/71眼(64.79%)和36眼/71眼(50.74%);术后12个月,角膜植片再生的上皮下及基质神经纤维与正常角膜神经明显不同,表现为直径小、长度短、密度低。不同病因患者行穿透性角膜移植术后12个月时角膜神经再生的比例分别为机械外伤性角膜白斑9眼/10眼(90.00%)、圆锥角膜10眼/12眼(83.33%)、角膜营养不良3眼/4眼(75.00%)、大疱性角膜病变7眼/11眼(63.63%)、病毒性角膜炎6眼/12眼(50.00%)、穿透性角膜移植术(penetrating keratoplasty,PKP)/板层角膜移植术(lamellar keratoplasty,LKP)术后8眼/18眼(44.44%)、先天性角膜白斑1眼/4眼(25.00%)。发生角膜移植排斥反应导致再生的角膜神经不同程度减少或消失。另有5眼再生的上皮下神经发生不明原因的消退或消失。结论 穿透性角膜移植术后神经再生受多种因素的影响而差异较大,激光共焦显微镜可以对术后的角膜神经再生进行连续随访观察。     

白内障术后角膜散光

白内障术后角膜散光影响视力的恢复。本对角膜散光的分析方法、不同白内障术式术后屈光变化、影响术后角膜散光的因素、术中运用角膜计、Placido盘调整缝线及角巩膜松解切口、术后选择性拆除缝线、散光性角膜切开术控制术后角膜散光进行了综述。     

不同长度小切口人工晶体植入术后角膜散光的临床观察

目的为了解缝合与不缝合的不同长度小切口白内障囊外摘除及人工晶体植入术后角膜散光的改变。方法用角膜曲率计测量角膜散光，同时进行检影验光，观察了127只眼术后6个月内角膜散光的变化。结果巩膜隧道式小切口加垂直缝线多造成循规性散光，小切口无缝线多造成逆规性散光，术后早期近规性散光有逐渐增大的趋势；8mm切口的手术性散光显著大于6．5mm切口的手术性散光（P＜0．05）。结论巩膜隧道式小切口宜缝合，尤其是切口大于6．5mm时，以免造成较大的逆规性角膜散光。     

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.