带蒂睾丸鞘膜瓣覆盖在尿道下裂术后尿道裂开手术中的应用

目的 探讨应用带蒂睾丸鞘膜瓣覆盖尿道治疗尿道下裂术后尿道裂开的临床疗效.方法 回顾性分析2013年5月至2016年5月海南省人民医院治疗30例尿道下裂术后尿道裂开患儿的病历资料,年龄1.5～14岁,平均3.6岁,均采用TIP术式完成尿道成形术后,根据新建尿道的大小和长度,游离合适大小的带蒂睾丸鞘膜瓣,转移覆盖新建尿道.结果 30例患儿一期治愈率为93％,均无并发症发生,术后尿瘘2例(发生率6％),6个月后经尿道瘘修补治愈.其余患儿拔尿管后排尿通畅,所有患儿均获随访,随访时间1～3年,阴茎外观满意,勃起正常,无疼痛,未发生尿道瘘、尿道狭窄和尿道憩室样扩张.结论 TIP术式+带蒂睾丸鞘膜瓣覆盖治疗尿道下裂术后尿道裂开疗效满意,明显减少术后尿道瘘的发生.     

多层肉膜血管蒂覆盖尿道板切开卷管术式治疗尿道下裂

目的 探讨多层肉膜血管蒂覆盖尿道板切开卷管尿道成型术治疗尿道下裂的疗效.方法 2006年1月～2009年1月,56例尿道下裂采用尿道板皮下层、阴茎体两侧的筋膜、阴茎体及阴囊的跟斗皮瓣及左右两层背侧包皮血管蒂覆盖成形尿道的方法治疗尿道下裂,观察尿道下裂术前尿道口位置、手术年龄、术后并发症等情况.结果 术后随访6月～3年,术后尿瘘5例,无明显尿道狭窄及尿道憩室病例.结论 改良Snodgrass术式是治疗尿道下裂较好的术式,该术式成功率高,外形美观,值得推广应用.     

成人先天性尿道下裂术后尿瘘的治疗

目的探讨25例成人先天性尿道下裂术后尿瘘的治疗方法及其效果,以期提高治疗水平。方法从1997年1月至2006年12月收治的25例成人先天性尿道下裂术后尿瘘患者,瘘口位于阴茎阴囊交界处10例,阴茎体部7例,冠状沟下8例;1个瘘口者7例,2个以上者18例。简单尿瘘（9例）采用Y-V成形或TIP术治疗,复杂尿瘘（16例）采用Mathieu法或TIP术或阴囊中隔尿道成形及肉膜蒂加盖术。结果术后随访6个月至2年,22例患者1次手术成功。结论充分的术前准备、选择正确的手术方法及尿道成形材料、充分有效的尿转流及术后细致的护理,是尿瘘修补成功的重要要素。阴茎无下曲、阴茎皮肤充裕、远端尿道尚可应用的尿瘘患者,采用Y-V成形或TIP术;远端尿道闭锁/狭窄或阴茎皮肤瘢痕多、皮肤不充裕伴阴茎下曲的患者,采用Mathieu法、TIP术或阴囊中隔尿道成形术,肉膜蒂加盖：均是行之有效的方法。     

去表皮皮下组织瓣交叉覆盖技术在尿道瘘修补术中的应用

目的 评价去表皮皮下组织瓣交叉覆盖技术应用于尿道瘘修补术中的效果.方法 病例分两组,实验组为从2010年2月～2011年1月共40例尿道下裂术后尿道瘘患者,在尿道瘘修补手术中采用去表皮皮下组织瓣交叉覆盖尿瘘修补后关闭瘘口;对照组为从2009年1月～2010年1月共50例患者,行常规三层缝合法尿道瘘修补术.结果 随访3～12个月,实验组40例术后1例出现尿瘘,对照组50例术后8例出现尿瘘.结论 在尿瘘修补手术中,采用去表皮皮下组织瓣交叉覆盖技术,提高了手术成功率,降低了术后尿道瘘复发率.     

阴茎背侧翼状肉膜瓣双重覆盖联合尿道海绵体缝合技术在TIP术修复尿道下裂中的应用

目的评估阴茎背侧翼状肉膜瓣双重覆盖联合尿道海绵体缝合技术在尿道板纵切卷管法尿道成形(TIP)术修复尿道下裂中减少尿瘘发生的临床价值。方法回顾性分析TIP术修复的尿道下裂病例126例。其中冠状沟型57例、阴茎体型43例、阴茎阴囊型26例。分成3组,Ⅰ组(18例),新建尿道无肉膜瓣覆盖;Ⅱ组(32例)阴茎背侧翼状肉膜瓣双重覆新建尿道;Ⅲ组(76例)阴茎背侧翼状肉膜瓣联合尿道海绵体双重覆新建尿道。结果术后Ⅰ、Ⅱ、Ⅲ组分别出现尿瘘3例(16.7%)、4例(12.5%)、2例(2.63%);Ⅱ、Ⅲ组分别出现阴茎扭转3例(9.37%)、5例(6.58%),Ⅲ组出现伤口裂开2例(2.63%);Ⅰ、Ⅱ、Ⅲ组分别出现尿道口狭窄1例(5.56%)、2例(6.25%)、5例(6.58%)。Ⅰ、Ⅱ组尿瘘发生率比较差异无统计学意义,但Ⅲ组和Ⅰ、Ⅱ组比较差异有统计学意义(P<0.01)。结论 TIP术修复尿道下裂,采用阴茎背侧翼状肉膜瓣双重覆盖联合尿道海绵体缝合技术是一种减少尿瘘发生的可靠方法,操作简便,易于实施。     

不同手术方式治疗尿道下裂术后尿道狭窄

目的探讨尿道下裂术后尿道狭窄的手术治疗效果及术式选择。方法对16例尿道下裂术后尿道狭窄病例的临床资料进行回顾性分析。结果尿道外口狭窄或闭锁8例行尿道外口成形术,6例治愈,2例再发狭窄,予行定期尿道扩张后治愈;单纯吻合口狭窄行狭窄段切除吻合3例,3例治愈;新尿道全段疤痕狭窄3例行全段切除一期尿道重建2例,2例治愈,尿道造瘘二期尿道重建1例,1例治愈;新尿道尿囊形成伴尿道外口狭窄2例行狭窄段切除及尿囊大部分切除成形,2例治愈。结论尿道狭窄是尿道下裂术后严重的并发症,应根据不同的情况选择合理的手术治疗方法。     

40例“前型”尿道下裂治疗研究

目的：探讨“前型”尿道下裂手术在“口腔粘膜”重建尿道、去皮肤的肉膜覆盖成形尿道等各操作步骤的要点．方法将40例“前型”尿道下裂患者中有阴茎下弯的纠正后,然后所有患者用口腔粘膜移植于阴茎腹侧前三分之一处白膜表面,固定,增加尿道的宽度,选择适宜大小的尿管后成形尿道．阴茎背侧皮肤转移至阴茎腹侧,将带蒂皮瓣去皮肤后,保留皮下肉膜层,完整的加盖于尿道卷管成形处（包括阴茎龟头海绵体切开两冀下方）,再成形龟头．结果40例“前型”尿道下裂成形术中,无1例出现尿道狭窄,术后2月行输尿管镜检示：“移植的口腔粘膜均存活”,且位于阴茎龟头海绵体切开两冀下方加盖的皮下肉膜层粘连满意,未见龟头切口处裂开．有2例发生尿瘘,均术后半年行尿瘘修补术成功．1例转移皮瓣坏死,换药后愈合．术后40例患者阴茎外观均满意．结论遵循“前型”尿道下裂各步骤操作的要点,手术成功率明显提高,整形效果好,术后并发症明显减少．     

睾丸精索鞘膜在治疗尿道下裂及尿瘘修补术中的应用

目的：探讨睾丸精索鞘膜在治疗尿道下裂及尿瘘修补术中的应用和优势,总结手术经验,提高手术成功率。方法：本文总结了2002年12月～2010年12月共35例背侧包皮肉膜组织缺乏、不足够覆盖成形尿道的患儿,采用Snodgrass手术加转睾丸鞘膜及精索鞘膜瓣治疗尿道下裂;26例瘘口直径小于5mill,位置在阴茎体部或阴茎阴囊交界处或阴囊部26例的尿瘘患儿,采用转移睾丸精索鞘膜修补术。结果：35例一次手术成功30例。成功率85．7％（30／35）。连续内翻缝合加用转移睾丸精索鞘膜修补一次成功率为84．6％（22／26）。结论：在新成形尿道或尿瘘修补口处加盖转移睾丸精索鞘膜更高的成功率。     

组织瓣转移覆盖技术与复合术式在尿道下裂治疗中的应用

目的评价带蒂背侧皮下组织瓣转移覆盖技术应用于尿道下裂手术中的疗效。方法病例分2组,实验组为从2003年2月至2009年5月共38例尿道下裂患者,在尿道下裂手术中采用带蒂背侧皮下组织瓣转移覆盖新尿道及尿瘘修补后关闭瘘口;对照组为从2000年1月至2007年2月共59例患者,行常规尿道成形术。结果随访3～12个月,实验组38例术后1例出现尿瘘,对照组50例术后8例出现尿瘘。结论在尿道下裂手术中,采用带蒂背侧皮下组织瓣转移覆盖技术和复合式术,提高了手术成功率,降低了术后尿瘘发生率。     

真皮脂肪瓣修补尿道下裂术后尿瘘

目的探讨提高尿道下裂术后尿瘘修补术的疗效.方法用真皮脂肪瓣修补阴茎体部尿瘘11例,2例合并有瘘口远端尿道狭窄者,在术中同时处理.结果11例均获成功.结论阴茎部尿瘘由于皮肤及皮下组织薄弱,局部血运差,手术较易失败.本手术用真皮脂肪瓣覆盖瘘口,通过内(瘘口内层)、中(真皮脂肪瓣)、外(皮肤)三层交叉缝合,既修补严密、又减少了尿道和切口的张力,有利于切口的愈合.     

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.