针刺治疗青光眼研究进展

针刺降眼压有即刻效应和后效应,其机制可能不仅与改善房水排出、影响房水生成率有关,还与增加房水排出和血浆β-内啡肽浓度关。针刺保护视神经的机制可能与减少视网膜丙二醛的产生、增加超氧化物歧化酶和谷胱甘肽过氧化物酶、活化视网膜琥珀酸脱氢酶、提高视网膜三磷酸腺苷酶的活性、减轻视网膜超微结构的损害,降低高眼压状态后视网膜NO、葡萄糖含量、减轻视网膜超微结构损伤、增加视神经轴突的存活率、减少视网膜神经节细胞的凋亡、上调Bcl-xl、脑源性神经营养因子(brain derived neurotrophic factor,BDNF)表达有关。针刺能改善视网膜血流量、眼血流图波幅、灌注和排放指数,调节眼底的微循环。针灸治疗青光眼的效应主要体现在降低眼压、保护视神经、改善血流,其机制与影响相关机能调节和化学分子、神经递质表达有关。     

青光眼患者的护理

青光眼(glaucoma)是病理性眼球内压力(Intraocularpressure,IOP,眼压)升高导致特征性视神经损害和视野缺损的一组眼病或临床症候群.眼压是指眼球内容物作用于眼球壁的压力.正常眼压值是11～21mmHg.临床上绝大部分青光眼是因房水外流阻力增加所致.房水循环途径中任何一个环节发生障碍,都会影响到房水生成与排出之间的平衡,表现为眼压的波动.各种抗青光眼治疗手段都围绕着两点,即减少房水产生和促进房水排出,以重新恢复房水循环平衡.     

眼压波动对青光眼视网膜微循环的影响

目的 观察眼压波动对青光眼患者视网膜微循环的影响.方法 用海德堡视网膜血流仪(heidberg retinal flowmetry, HRF)检查30例青光眼患者视神经乳头和视盘旁视网膜各4个点血流,比较20例青光眼患者24h眼压波动大于8mmHg状态下及24h眼压波动小于8mmHg状态下视神经乳头和视盘旁视网膜血流的变化.结果 24h眼压波动小于8mmHg状态下视神经乳头和视盘旁视网膜血流较24h眼压波动大于8mmHg状态下明显改善.结论 降低青光眼患者眼压波动能够明显改善青光眼患者视网膜微循环.     

低剂量的硝苯地平逆转内皮素—1对眼部血液动力学作用

据报道钙通道阻滞剂可用于具有正常眼压的青光眼,作用机制不完全清楚。很多研究表明,应用钙通道阻滞剂后,可使眼部血流增加。因为在开角型青光眼和正常眼压的青光眼患者,眼部动脉和视神经头微循环血流速度减慢,所以,钙通道阻滞剂增加眼部血流的作用可能是其治疗青光眼的机制。另外,更新的研究表明内皮素—1(ET—1)与正常眼压青光眼的发病有关,ET—1可使病人眼部血     

疏风解压明目汤联合西药治疗青光眼的临床研究

目的:探讨中药联合西药治疗青光眼的临床研究。方法:作者将多年临床中应用中药联合西药治疗青光眼的资料进行总结。结果:此疗法具有:改善神经供血,增强视网膜血管及视神经的耐氧能力,降低血液粘稠度,改善轴浆流,清除缺血后再灌注产生的氧自由基等功效。结论:a、降低眼压,减轻或防止因眼内压力的升高对眼组织造成的损害;b、保护视神经,通过药物治疗,起到对视网膜神经节细胞的保护作用,减少青光眼对视神经的损害。     

青光眼临床治疗的研究进展

青光眼的药物治疗 抗青光眼的药物主要通过以下两种机制降低眼压：减少房水生成；促进房水排出，各种降眼压药物巾，既有通过单一机制降低眼压，也有通过以上2种机制联合作用以降低跟压。近几年，多种抗青光眼新药研发成功，并逐步在临床应用     

青光眼病人忌用的药

青光眼是一种严重危害视力的常见病。其原因很复杂，一般认为由于眼球内的房水产生过多，或排出发生困难，以致眼压升高，而酿成青光眼。若眼压持续升高，压迫眼球壁，可造成视网膜和视神经乳头萎缩而变形，影响视力，严重者还会致盲，故不能掉以轻心。     

青光眼眼部彩色多普勒血流显像分析

利用彩色多普勒血流显像对比分析了２０例正常人（４０只眼），２３例青光眼（３２只眼）的眼部超声结构参数和彩色多普勒血流显像参数，发现前房变浅，晶状体增厚，视神经变窄及视网膜中央动脉阻力指数升高，视网膜中央动、静脉血流量减少及睫状动脉血流速度增高和血流量增加是诊断青光眼的重要指标，尤其对低眼压性青光眼有重要的临床意义。     

急性闭角型青光眼病药物治疗11例

青光眼病是致盲的主要疾病之一,是病理性高眼压或正常眼压并发视乳头,视网膜神经纤维层损害和青光眼性视野改变,原发急性闭角型青光眼系房角关闭,房水排出受阻引起眼压急骤升高所产生的一系列病理改变,是眼科急症之一.     

青光眼眼部彩色多普勒血流显像分析

利用彩色多普血流显像对比分析了２０例正常人（４０只眼），２３例青光眼（３２只眼）的眼部超声结构参娄和彩色多普勒血流显像参数，发现前房变浅，晶状体增厚，视神经变窄及视网膜中央动脉阻力指数升高，视网膜中央动、静脉血流量减少及睫状动脉血流速率增高和血流量增加是诊断青光眼的重要指标，尤其对低眼压性青光眼有重要的临床意义。     

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.