不同程度近视眼眼轴长度及黄斑区视网膜厚度的观察

目的 通过对不同程度的近视眼进行黄斑区视网膜厚度及眼轴长度测量,分别与正常对照组比较,评价其差异.方法 收集不同程度近视患者55例(90眼),分为低、中、高度近视3组,同时选择正常对照组20例(30眼),分别进行眼轴长度测量及黄斑区视网膜厚度测量,进行光相干断层扫描(optical coherence tomography,OCT)时将黄斑区分为9个区域.结果 低度近视组与正常对照组之间各个区域视网膜厚度比较,差异无统计学意义(P＞0.05).中度近视组视网膜厚度出现区域性变薄(P＜0.05),高度近视组的视网膜厚度明显变薄(P＜0.01).高度近视的黄斑中心凹及鼻侧内圈的视网膜厚度较低、中度组未见明显变薄,差异无统计学意义(P＞0.05).低度近视组的眼轴较正常对照组变长,差异有统计学意义(P＜0.05);中度近视组及高度近视组的眼轴较正常对照组明显延长,差异有统计学意义(P＜0.01).结论 近视眼眼轴随近视程度的加深逐渐延长.黄斑区视网膜厚度分布存在区域特异性,随屈光度的增加出现区域选择性变薄,高度近视眼视网膜变薄是确实存在的,主要在旁中心凹区,而不是在中心凹.     

单纯性近视眼鼻侧视网膜神经纤维层厚度变化与等效球镜和眼轴长度的相关性研究

目的探讨单纯性近视眼鼻侧视网膜神经纤维层厚度变化与等效球镜和眼轴长度的相关性。方法选择2013年2月至2015年2月在复旦大学附属中山医院青浦分院眼科接受检查的近视眼患者122例(236眼)为研究对象,根据患者等效球镜度数分为低度近视眼组(-3.0 D<等效球镜≤-0.5 D)36眼、中度近视眼组(-6.0 D≤等效球镜≤-3.0 D)142眼和高度近视眼组(-13.0D≤等效球镜<-6.0 D)58眼。进行眼科常规检查,以及等效球镜、眼压、眼轴长度和视野检查,并进行相关性分析。结果中度近视眼组和高度近视眼组眼轴长度[(25.2±0.7)mm、(26.9±0.7)mm]和等效球镜[(-4.7±0.7)D、(-8.2±1.5)D]高于低度近视眼组[(24.2±0.6)mm、(-2.0±0.5)],高度近视眼组高于中度近视眼组,差异均有统计学意义(P<0.05)。低度近视眼组上象限、下象限和鼻侧象限的视网膜神经纤维层厚度分别为(138±14)μm、(146±11)μm、(68±6)μm,中度近视眼组分别为(126±14)μm、(130±10)μm、(62±6)μm,高度近视眼组分别为(113±11)μm、(118±10)μm、(50±4)μm,中度近视眼组和高度近视眼组上象限、下象限和鼻侧象限的视网膜神经纤维层厚度小于低度近视眼组,高度近视眼组小于中度近视眼组,差异均有统计学意义(P<0.05)。低度近视眼组、中度近视眼组和高度近视眼组鼻侧象限视网膜神经纤维层厚度与等效球镜和眼轴长度呈负相关(r=-0.553,-0.672,-0.681;r=-0.616,-0.539,-0.882,均P<0.05)。结论单纯性近视眼患者鼻侧象限视网膜神经纤维层厚度与等效球镜和眼轴长度呈负相关。     

光学相干断层扫描仪检测正视眼与高度近视眼中央角膜厚度差异的研究

目的 探讨光学相干断层扫描仪OCT测量正视眼与高度近视眼中央角膜厚度(CCT)是否存在差异.方法 高度近视患者等效球镜SE≥-6.00D,散光≤-3.00D,共82例164眼,正视眼组裸眼视力≥1.0,屈光度为+1.00D～-0.25D,散光≤-0.50D,共48例96眼.用光学相干断层扫描仪(OCT-3)测量中央角膜厚度(CCT).结果 高度近视组164眼CCT为470.67～630.47(534.03±40.66)μm,正视组96眼CCT446.00～653.28(538.44±40.75)μm,两者差异无统计学意义(t=0.842,P= 0.401).双眼CCT比较右眼CCT为(534.64±40.52)μm,左眼CCT为(535.68±40.98)μm,两者无统计学差异(P ＞0.05).高度近视组CCT与屈光度两者无明显相关(P ＞0.05).结论 高度近视眼CCT较正视眼无明显变化,近视形成发展的过程对角膜中央未形成明显影响.     

原发性视神经萎缩的视网膜电图明视负向反应研究

目的:研究原发性视神经萎缩的视网膜电图(ERG)明视负向反应(PhNR)变化特点,并进行PhNR与视网膜神经纤维层厚度(RNFLT)、视野平均缺损值(MD)、杯盘比(C/D)的相关性研究,探索PhNR在原发性视神经萎缩的诊断及视神经节细胞功能评价中的作用。方法:选取正常健康者20例20只眼和原发性视神经萎缩的患者18例20只眼。分别对两组进行ERG、视野、眼底照相和OCT检查,比较两组视网膜电图PhNR振幅,并将原发性视神经萎缩组的PhNR振幅分别与MD、C/D和RNFLT进行相关性分析。结果:原发性视神经萎缩组和对照组的ERG中暗视反应、最大反应、30Hz震荡电位的振幅差异无显著性意义,视神经萎缩组明视反应a波和b波振幅差异也没有显著性意义,但原发性视神经萎缩组的PhNR振幅比对照组明显下降(P<0.01),而且PhNR的振幅与视神经损伤情况如RNFLT(r=0.665)、MD(r=0.564)、杯盘比(r=0.686)等相关(均为P<0.01)。结论:原发性视神经萎缩眼视网膜电图PhNR振幅明显下降甚至消失,PhNR可用于原发性视神经萎缩的诊断和神经节细胞及其轴突功能的评价。     

丝裂霉素C防止高度近视LASEK术后角膜雾状混浊的临床研究

目的 探讨高度近视准分子激光上皮瓣下角膜磨镶术(LASEK)术中应用丝裂霉紊C(MMC)抑制术后角膜上皮下雾状混浊(Haze)的疗效.方法 218例436眼行LASEK术的高度近视患者随机分为两组:MMC组112例224眼及对照组106例212眼.MMC组在激光切削完毕后用浸有0.02%MMC的棉片覆于角膜切削区40～60s;对照组采用常规LASEK手术.术后早期观察眼部刺激症状及角膜上皮愈合情况;1、3、6、12个月复查视力、屈光度、角膜Haze及角膜地形图.结果 两组上皮愈合时间差异无统计学意义(P＞0.05);术后1、3、12个月,两组Haze分级≥0.5级以上发生率比较,MMC组明显低于对照组(P＜0.01),未出现2级及2级以上的Haze;术后1年两组达最佳矫正视力者差异无统计学意义(P＞0.05),但MMC组中高于及低于最佳矫正视力1行的眼数与对照组相比.差异有统计学意义(P＜0.05);MMC组术后1个月与1年的角膜曲率差异无统计学意义,而对照组差异有统计学意义(P＜0.05).结论 LASEK术中应用低浓度MMC能有效抑制高度近视LASEK术后角膜Haze的产生,防止屈光状态回退,有助于视力的提高.     

近视眼视网膜神经纤维层厚度与屈光因素关系的研究

目的 测定不同程度近视眼患者的视网膜神经纤维层厚度(retinal nerve fiber layer thickness,RNFLT),探讨其屈光度数、矫正视力和中央角膜厚度(central cornea thickness,CCT)对RNFLT可能的影响及相关性,以了解近视眼RNFLT的变化规律.方法 随机抽取2003年7月-2005年5月在我院就诊的近视眼患者90例(90眼),根据屈光度数分为3组:低度近视组:≤-3.00 D(14眼),中度近视组:-6.00～-3.00 D(47眼),高度近视组:＞-6.00 D(29眼,其中5眼＞-9.00 D).采用光学相干断层成像仪(OCT 3000,RNFLT 3.4)测定RNFLT,Pachymeter-SP-3000角膜测厚仪测定CCT,同时进行散瞳验光.结果 3个研究组的年龄、性别、矫正视力、CCT、上下方及鼻侧RNFLT经单因素方差分析无显著性差异(P＞0.05);低度近视组与高度近视组的颞侧RNFLT有显著性差异(P=0.012).各组RNFLT规律:下方＞上方＞颞侧＞鼻侧.参数法和非参数法相关性分析结果显示:高度近视组的总体平均RNFLT与等效球镜值显著正相关(r=0.372,P=0.047),其余参数的相关性不显著(P＞0.05).结论 近视眼RNFLT存在独特的变化规律,高度近视的RNFLT受等效球镜值影响.     

高度近视眼不同空间频率P—ERG的改变

目的：对高度近视眼患者进行不同空间频率图形视网膜电图（P－ERG）检测，并与眼轴及屈光度之间的相互关系进行分析，以助高度近视眼的临床诊断和全面评价其视功能。方法：将近视眼患者分为低中度近视和高度近视组，分别检测其不同空间频率b波振幅，并与正常组比较。结果：高度近视组P－ERGb波振幅与正常组相比明显降低，潜时也延长（P＜0．05），而这些改变以高空间频率明显。低中度近视P－ERGb波振幅与潜时间正常组相比差异无统计学意义。结论：图形视网膜电图（P-ERG)有助于高度近视的临床诊断，而作为评价其视功能的一项措施，可为判断预后、预防和治疗提供依据。     

近视眼角膜厚度的OrbscanⅡ检测

目的:采用OrbscanⅡ角膜地形图分析系统研究近视眼不同屈光度的角膜厚度改变.方法:利用OrbseanⅡ角膜地形图分析仪检查353眼不同屈光状态的近视眼患者(低度近视组Gl:-1.00～-3.00 D 85眼,中度近视组G2:-3.25～-6.00 D 95眼,高度近视组G3:-6.25～-10.00 D 90眼,超高度近视组G4:-10.25～-15.00 D83眼)的角膜厚度分布,并与381眼正视眼(对照组)进行对比分析.结果:对照组中央角膜厚度为(556.1 4±33.7)μm,G1、G2、G3、G4组近视眼的中央角膜厚度分别为:(554.2±33.9)μm、(551.6±32.7)μm、(549.1±30.2)μm和(548.5±31.6)μm,5组问相比,差异无统计学意义(P>0.05);对照组最薄点角膜厚度为(533.6±32.7)μm,G1、G2、G3、G4组角膜最薄点厚度分别为(534.6±33.9)μm、(532.6±34.7)μm、(530.1±29.2)μm和(535.5±27.6)μm,5组间相比,差异无统计学意义(P>0.05).结论:近视患者的角膜中央厚度和最薄点厚度与正视眼无明显差异,角膜中央厚度和最薄点厚度可能与屈光度数无关.     

阿托品治疗近视儿童的多焦视网膜电图

目的:应用多焦视网膜电图(m fER G)评估阿托品滴眼液治疗近视儿童的视网膜功能。方法:治疗组(n=48)阿托品滴眼1次/d、持续2年,记录m fERG,对照组(n=57)相同时间安慰剂滴眼,记录m fERG。所有记录都从停用阿托品(安慰剂)第2至第3个月之间盲法开始。应用m fER G的一次核(k1)和二次核第一部分(k21)反应的振幅和暗示时间分别研究内层和外层视网膜功能。结果:阿托品组与安慰剂组相比,k1反应振幅无显著降低(阿托品组P=0.181,安慰剂组P=0.150)。两组间k1反应时间无明显差异(阿托品组P=0.767,安慰剂组P=0.849)。两组间k21振幅和暗示时间差异无…     

合并糖尿病白内障患者术后黄斑厚度变化的临床研究

目的 通过光学相干断层扫描仪测量黄斑区视网膜厚度,观察合并糖尿病的白内障患者术后黄斑区视网膜厚度的变化.方法 选择2012年6-12月我科白内障手术患者59例96眼,其中无糖尿病的患者为A组(18例33眼),有糖尿病但无糖尿病视网膜病变的患者为B组(19例31眼),有糖尿病视网膜病变的患者为C组(22例32眼).比较3组手术前后最佳矫正视力及术前,术后1d、1周、1个月黄斑区视网膜厚度.结果 术前3组最佳矫正视力无统计学差异,术后1个月A组患者31眼(94％)最佳矫正视力≥0.5;B组患者最佳矫正视力28眼(90％)≥0.5,2组比较差异无统计学意义(P＞0.05);C组患者22眼(69％)最佳矫正视力≥0.5,与A、B两组相比,差异均有统计学意义(P＜0.05).中心凹区:A、B两组术后1d、1周、1个月黄斑区视网膜厚度与术前比较,差异均无统计学意义(P＞0.05);C组术后1d、1周黄斑区视网膜厚度与术前比较,差异无统计学意义(P＞0.05),C组术后1个月视网膜厚度较术前明显增加(P＜0.05).内环区和外环区:3组术后1d、1周、1个月外环区视网膜厚度与术前比较,差异均无统计学意义(P＞0.05).结论 糖尿病视网膜病变患者在术后,虽然经过一定的抗感染治疗,但视网膜厚度仍明显增加,并且黄斑中心凹区改变明显,提示糖尿病视网膜病变是引起白内障术后黄斑水肿的高危因素.     

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.