下颌骨外旋人路切除Shamblin Ⅲ型巨大颈动脉体瘤

目的:探讨Shamblin Ⅲ巨大颈动脉体瘤切除术的最佳入路.方法采用下颌骨截断外旋入路切除Shamblin Ⅲ型巨大颈动脉体瘤3例.结果经下颌骨截断外旋,手术视野暴露充分,肿瘤得到根治,疗效满意,无明显神经功能障碍及其他并发症.结论下颌骨截断外旋入路具有暴露充分、提供良好操作空间的特点,可以避免或显著减少严重并发症的发生.     

下颌骨外旋入路切除ShamblinⅢ型巨大颈动脉体瘤

目的:探讨Shamblin Ⅲ巨大颈动脉体瘤切除术的最佳入路。方法采用下颌骨截断外旋入路切除Shamblin Ⅲ型巨大颈动脉体瘤3例。结果经下颌骨截断外旋,手术视野暴露充分,肿瘤得到根治,疗效满意,无明显神经功能障碍及其他并发症。结论下颌骨截断外旋入路具有暴露充分、提供良好操作空间的特点,可以避免或显著减少严重并发症的发生。     

下颌骨外旋入路切除咽及咽旁间隙肿瘤

目的：探讨咽及咽旁间隙肿瘤切除的最佳入路。方法：采用下颌骨外旋入路切除咽及咽旁间隙肿瘤12例，其中鼻咽部肿瘤2例，口咽，喉咽部肿瘤5例，咽旁间隙肿瘤5例。对其中的3例恶性肿瘤同期行颈淋巴结清扫术，对咽部缺损明显的3例行前臂游离皮瓣修复2例，胸大肌皮瓣修复1例。结果：12例病变均获得彻底的切除。疗效满意，未见明显的功能受损及严重的并发症。结论：下颌骨外旋入路切除咽及咽旁间隙肿瘤，具有视野开阔，操作安全方便，便于修复缺损，后遗畸形轻微等特点。特别适用于咽及咽旁间隙特殊病变如血管瘤的切除。     

切除咽旁间隙肿瘤临床术式之探讨（附30例报告）

目的：探讨切除咽旁间隙肿瘤的良好手术途径。方法：酌情采用六种不同术式：(1)口腔进路；(2)下颌角后方切开进路；(3)颈侧高位切开下颌骨外旋；(4)经颈侧腮腺入路；(5)经鼻侧上唇正中切开行上颌骨翻揭；(6)颞部切口行颧弓拆装入路。结果：本组30例术中视野暴露充分，肿瘤均能完整大块切除，手术经过顺利。结论：为安全完整切除咽旁间隙肿瘤，酌情采用不同的术式是合理的。     

首先识辨二腹肌支神经的离心法腮腺肿瘤切除术41例临床分析

目的 探讨腮腺肿瘤手术的合理方法.方法 根据CT、术前病史及面神经电图(ENoG)评估,以首先识辨二腹肌支神经的离心法面神经解剖+多种方式的腮腺及肿瘤切除,必要时扩大切除并颈廓清术等4种方案治疗腮腺肿瘤患者41例43侧.结果 术后失访1例,6个月内死于远隔转移1例,死于其他疾病1例.38例(40侧)经6个月～6年随访,暂时性面瘫发生率为7.5%(3侧),永久性面神经功能H-B Ⅲ级发生率为5.0%(2侧),H-B Ⅳ级发生率为2.5%(1侧).术后肿瘤局部复发率为2.5%(1侧).术后无涎漏、出血、Frey综合征等并发症的发生.结论 离心法腮腺肿瘤切除以首先识辨二腹肌支神经的离心法面神经解剖为关键,经4个方案切除腮腺及其肿瘤,适合于绝大部分腮腺肿瘤,在保全面神经功能、减少肿瘤复发等方面有明显优势.     

经下颌孔后升支垂直截骨入路外科治疗颞下窝肿瘤

目的探讨经下颌孔后升支垂直截骨的下颌骨外旋入路切除颞下窝肿瘤的效果。方法对2014年4月至2017年8月7例经下颌孔后升支垂直截骨的下颌骨外旋入路切除的颞下窝肿瘤患者的临床资料进行回顾性分析。结果 7例患者手术均顺利完成,未出现术后并发症,随访2～24个月,无1例复发。结论下颌孔后升支垂直截骨的下颌骨外旋入路可充分暴露颞下窝肿瘤,且手术创伤小、术后并发症少,是切除颞下窝肿瘤安全有效的术式。     

腮腺肿瘤81例临床分析

目的 探讨腮腺区肿瘤的诊断及治疗。方法 回顾性分析81例腮腺区肿瘤的CT检查、病理检查、治疗方法及随访结果。结果 良性肿瘤70例，其中14例行肿瘤切除加腮腺区域切除，56例行肿瘤及腮腺浅叶或全腮腺切除。恶性肿瘤11例，全部行肿瘤加全腮腺切除，同时有7例行同侧颈淋巴结清扫，切除面神经者2例。结论 腮腺区良性肿瘤视瘤体大小及肿瘤类型可选用腮腺区域性切除或浅叶及全腮腺切除，而恶性肿瘤则需全腮腺切除，必要时切除面神经及颈淋巴清扫。     

亚甲蓝染色在腮腺肿瘤及腺体切除术中的运用

目的：用亚甲蓝将腮腺染成蓝色，提高识别腮腺导管与面神经的能力，避免在腮腺肿瘤及腺体切除术中因识别错误或操作不慎而损伤或切断面神经。方法：将0．5％亚甲蓝2毫升从腮腺主导管注入腮腺内，然后，用酸性物质(维生素C片)含于舌背前1／3区，刺激涎腺分泌，将染料排空，最后，手术切除腮腺肿瘤及腺体。结果：切除腮腺肿瘤及腺体后，无一例因识别错误或操作不慎而将面神经损伤，造成面神经瘫痪。结论：使用亚甲蓝对腮腺进行染色，手术切除肿瘤及腺体时的安全性要比未经染色时的手术高。     

两种腮腺肿瘤切除术式的临床分析

目的：比较两种腮腺肿瘤切除术的疗效及并发症发生率，探讨保留腮腺功能、减少手术并发症及术后面部畸形的最佳方法。方法：将我科收治确诊的41例腮腺肿瘤患者分为两组，传统腮腺浅叶切除术23例（浅叶组），肿瘤包膜外0．5cm部分腺体与肿瘤切除术18例（部分切除组）。部分切除术组给予全麻，肿瘤附近长5．0cm切口，翻瓣，沿肿瘤外0．5cm处，借助剪刀、双极电凝、神经探测监测仪逐步分离，保护面神经分支。完整切除肿瘤连同肿瘤外0．5cm腮腺组织一并切除，分层缝合，负压引流。结果：随访1～3年。浅叶组口干3例，部分切除术组无口干；两组各有一过性额支支配区麻木症状2例；浅叶组均不同程度出现面部凹陷畸形，部分切除组面部畸形不明显；两组随访期内均无复发。结论：肿瘤外0．5cm肿瘤与部分腺体切除术治疗腮腺良性肿瘤安全可行，面部畸形不明显，腮腺功能保留良好。     

下颌骨切开外旋入路切除放疗后复发的扁桃体癌

目的：探讨切除放疗后复发的扁桃体癌的最佳手术入路。方法：采用下颌骨切开外旋入路切除放疗后复发的扁桃体癌10例,同期行颈淋巴结清扫术以及胸大肌皮瓣修复。结果：放疗后复发的扁桃体癌10例,经下颌骨切开外旋入路获得彻底的切除,其中1例胸大肌皮瓣部分坏死,遗留咽部缺损,其余病例未见明显的功能受损及严重的并发症。结论：下颌骨切开外旋入路切除放疗后复发的扁桃体癌,具有视野开阔、操作安全、便于修复缺损及后遗畸形轻微等优点。     

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.