PPH联合外剥内扎术及皮桥整形术治疗环状混合痔疗效分析

目的：探讨吻合器痔上黏膜环切术（PPH）联合外剥内扎术及皮桥整形术治疗重度环状混合痔的近远期临床疗效。方法选取92例重度环状混合痔患者,随机分为观察组和对照组,各46例。观察组患者给予PPH联合外剥内扎术及皮桥整形术治疗,对照组给予传统PPH外剥内扎术及皮桥整形术治疗。对比分析2组患者手术中出血量、手术时间及手术预后的相关指标等。结果观察组患者手术时间（45.2±6.4）min、术后住院时间（9.5±2.4） d短于对照组;观察组术后疼痛感（VAS评分）：术后24 h（3.7±1.4）分、第一次排便（5.6±2.1）分、术后1周（1.3±0.7）分,观察组疼痛感明显低于对照组（P﹤0.05）;观察组黏膜外翻及肛门潮湿症状2例,发生率低于对照组（P<0.05）,近期（﹤1个月）肛门坠涨及不适感18例明显多于于对照组患者,差异有统计学意义（P<0.05）。观察组患者远期肛门坠胀及不适感2例,与对照组患者比较差异无统计学意义。结论 PPH联合外剥内扎术及皮桥整形术治疗重度环状混合痔较传统治疗方法患者痛苦小、创伤程度低、住院时间短,可在临床治疗上被考虑以及推广使用,但术后近期肛门坠肿及不适感明显。     

痔上粘膜环切钉合术的远期疗效及并发症分析

目的观察痔上粘膜环切钉合术（PPH）治疗痔病的远期疗效及并发症。方法回顾性分析2003年~2008年123例PPH及外剥内扎术（MMH）患者的临床资料,比较两组的远期疗效及并发症。结果平均随访时间为（61.71±17.50）个月。PPH组术后脱出率（41.27%）及出血率（30.16%）明显高于MMH组（P〈0.05）;术后疼痛、排便不畅、肛门失禁、肛门坠胀、残留皮赘、再手术及不满意率两组间差异均无统计学意义（P〉0.05）。结论 PPH术后远期脱出及出血率较高,远期疗效有待进一步评价。     

PPH术与外剥内扎硬注术治疗重度脱垂性痔的疗效对比研究

目的对重度脱垂性痔的外剥内扎术与痔上直肠粘膜环切钉合术(PPH)的疗效进行比较研究。方法将确诊的162例重度脱垂性痔患者,采用单盲设计和简单随机法分为PPH组和外剥内扎组,每组81例,比较两组病例的手术疗效以及术后7天情况。结果术后两组患者在便血、外痔突出、肛门或下腹疼痛、肛缘水肿、肛门坠胀等方面比较,PPH组疗效优于外剥内扎组,差异有统计学意义(P<0.05或P<0.01)。结论 PPH术治疗重度脱垂性痔疗效明确,与外剥内扎硬注术比较,在改善患者便血、外痔突出、肛缘水肿等症状体征方面更有优势。     

消痔灵注射结合外剥内扎术治疗混合痔的临床观察

目的观察消痔灵注射结合外剥内扎术治疗混合痔的临床疗效。方法将480例混合痔患者随机分为两组,治疗组360例,对照组120例,治疗组采用消痔灵注射结合外剥内扎术,对照组采用外剥内扎术,对比观察两组患者疗效,疼痛、创缘水肿、出血、肛门坠胀等常见并发症,痔核扎线脱落时间、创面愈合时间及复发率情况。结果治疗组和对照组总有效率,术后肛门坠胀,随访3个月、6个月和1年复发率,两组之间比较差异无统计学意义（P〉0．05）。治疗组和对照组术后疼痛积分、创缘水肿、出血等并发症,术后痔核扎线脱落时间,创面愈合时间,随访3年和5年复发率两组之间比较差异有统计学意义（P〈0．05）。结论消痔灵注射结合外剥内扎术治疗状混合痔优于传统的外剥内扎术。     

环状混合痔行吻合器痔上黏膜环切钉合术患者的近期及远期并发症分析

目的：探讨吻合器痔上黏膜环切钉合术（PPH）对环状混合痔患者的临床治疗效果,并对其近期及远期并发症发生情况进行分析。方法选取该院2011年1月至2013年1月收治的环状混合痔患者139例为研究对象,分为PPH组（72例）以及外剥内扎术组（67例）,对比分析两组患者临床治疗效果及近远期并发症发生情况。结果PPH组患者手术时间、术后出血量、术后肛门视觉模拟评分（VAS）疼痛评分、伤口愈合时间、平均住院时间低于外剥内扎术组,总体满意度高于外剥内扎术组,差异有统计学意义（P＜0．05）。PPH组术后便血、疼痛、瘙痒、脱垂、肛周不适、排便困难等症状缓解率显著高于对照组,差异有统计学意义（P＜0．05）。PPH组近期并发症、远期并发症发生率均低于外剥内扎组,差异有统计学意义（P＜0．05）。结论PPH治疗环状混合痔的近期效果优于外剥内扎术,其近远期并发症发生率较低,大多数并发症可通过提高手术操作技巧及规范手术操作来控制。     

痔上黏膜环切钉合术与传统外剥内扎术治疗重度痔的临床研究

目的：比较痔上黏膜环切钉合术（ PPH）与传统外剥内扎术（ Milligan-Morgan,M-M）治疗重度痔的近远期疗效。方法：收集因重度痔（Ⅲ°～Ⅳ°痔）行PPH术的80例患者和因重度痔（Ⅲ°～Ⅳ°痔）行MM术的93例患者的临床资料及术后随访资料,系统的比较两组患者的手术时间、住院时间、住院费用、创面愈合时间、术后疗效和并发症及复发等情况。结果：两组在手术时间、住院时间、住院费用、创面愈合时间、术后肛周疼痛及排便困难的缓解及术后疼痛、出血、肛缘水肿、肛门狭窄发生间的差异均具有统计学意义 P＜0．05～P＜0．01）;两组在术后便血、肿物脱垂的缓解、术后肛门坠胀和肛门控便能力下降的发生及复发间的差异均无统计学意义（ P＞0．05）。结论：PPH治疗重度痔的近期疗效明显优于M-M手术,但长期疗效尚需进一步随访。     

外剥内扎术与PPH结合外痔血栓剥除术治疗嵌顿痔疗效观察

目的：比较外剥内扎术与PPH结合外痔血栓剥除术治疗嵌顿痔的临床疗效。方法选取2012年7月至2013年7月在我院住院治疗的84例嵌顿痔患者,应用随机数字表法将其分成两组,每组42例。其中对照组患者采用外剥内扎术;观察组患者采用PPH结合外痔血栓剥除术,对两组患者的手术结果进行对比分析。结果观察组在治疗中的手术时间、住院时间、愈合时间以及术后出血、肛门坠痛、复发概率小等方面明显优于对照组,差异均有统计学意义（P〈0.05）。结论相比于外剥内扎术,PPH结合外痔血栓剥除术对于嵌顿痔患者是一种更加安全有效的方法,值得临床上推广应用。     

PPH术与外剥内扎术治疗混合痔临床疗效对比

目的 对比评价吻合器痔上黏膜环形切除术（PPH）与外剥内扎术的临床疗效。方法 79例环形混合痔患者随机分成A组和B组，A组行PPH术，B组行外剥内扎术，并对两组病人的多项指标进行统计比较分析研究。结果 PPH手术组与外剥内扎术组的比较，PPH术组在手术时间、术后疼痛持续时间、住院天数、康复时间、肛门括约肌功能状况、术后复发情况等多个方面均优于外剥内扎术组。结论 PPH术是一种治疗重度混合痔相对简单、安全而可靠的新术式，其疗效优于外剥内扎术。     

PPH 术与外剥内扎术治疗环状混合痔的临床疗效及安全性比较

目的：分析研究对环状混合痔使用PPH手术与外剥内扎手术治疗的效果及安全性。方法：选择2011年7月至2013年3月我院收治的环状混合痔88例为临床研究对象,随机分为两组。PPH组患者使用吻合器痔上黏膜环形切除术治疗,外剥内扎术患者使用外剥内扎的方法,保留肛垫。对比观察两组患者治疗效果、疼痛感、手术后并发症。结果：PPH组患者手术后痊愈率更高,愈合时间更快,与外剥内扎组比较差异明显,P＜0．05,差异有统计学意义;PPH 组患者尿潴留发生率低、肛缘水肿发生率低,肛门不全失禁发生率低,疼痛感轻,肛门坠胀发生率高,与外剥内扎组比较差异明显,P＜0．05;PPH组患者肛管舒张压低于对照组,P＜0．05,差异有统计学意义。结论：对环状混合痔使用PPH与外剥内扎术治疗均有较好的效果,其中PPH方法手术后并发症更少,但是适应症较窄,需要医生合理选择手术方式。     

PPH与外剥内扎术治疗重度混合痔160例

目的对比痔上黏膜环切吻合术（PPH）与外剥内扎术（M—M）治疗重度混合痔的临床疗效。方法将320例患者分两组,吻合器组160例,外剥内扎组（对照组）160例,对两组手术时间、疼痛持续时间等指标进行比较。结果两组总的症状改善满意度分别为96％（吻合器组）、90％（对照组）,在手术时间、疼痛持续时间、术后住院时间、恢复正常工作时间、创面愈合时间及术后并发症（出血、尿潴留、肛门坠胀、肛缘水肿、肛门狭窄）发生率方面,吻合组明显优于对照组（P〈0．05）。结论痔上黏膜环切吻合术是一种安全、有效、痛苦小、并发症少、创面愈合快、患者满意度高的治疗重度痔的新技术,具有临床推广价值。     

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.