高血压性视网膜病变的视觉电生理改变探讨

目的：探讨高血压性视网膜病变的闪光视网膜电网（FERG）,振荡电位（OPs)改变,方法：比较正常对照组15例30只眼和不同眼底分毋组的原发性高血压病患者,共49例98只眼的FERG,OPs的变化。结果：1．FERG：a波潜伏期：对照组与I级组相比差异无显著性,与Ⅱ,Ⅲ级组相比差异均有显著性;I级组与Ⅱ级组间差异无显著性,但I级与Ⅲ级,Ⅱ级与Ⅲ级组间差异均有显著性;a波振幅：对照组与I级组间差异无显著性,与其他各组间差异均有显著性;各级患者组间差异均有显著性;b波潜伏期,除I级与II级组间差异无显著性外,其余各组间差异均显著;b波振幅;除对照组与I级组间差异无显著性外,其余各组间差异均有显著性,2．OPs潜伏期：对照组各子波与I级组以及OP1,OP4及Ⅱ级组间差异无显著性,与其他各组间差异均有显著性,I级各子波与II级组间差异无显著性,与Ⅲ级组间差异显著,Ⅱ级与Ⅲ级组间差异显著。OPs振幅：对照组OP3与I级组间差异无显著性,其余比较差异均有显著性,除I级与Ⅱ级组间的OP4振幅差异无显著性外,各级患者组间的各子波振幅以及总振幅差异均有显著性。结论：FERG,OPs可作为高血压性视网膜病变及其严重程度的客观定量指标。     

正常猕猴与人的视网膜电图比较

目的比较正常猕猴与人视网膜电图异同,为进一步利用猕猴建立动物模型研究视网膜疾病打下基础。方法健康成年猕猴7只(14只眼)与8例(16只眼)正常人进行视网膜电图检测,对两者Rod-ERG中的b波,Max-ERG的a、b波,Cone-ERG的b波峰时值及波幅和OPs的O2值,Flicker-ERG的P值进行统计学检验。结果猕猴与人的视网膜电图波形结果较为相似,各指标与人的结果相比,潜伏期短,幅值低,但Cone-ERG和Flicker-ERG两者幅值差异不具有统计学意义。结论视网膜电图检测从功能上证明猕猴较其他常用实验动物更接近人,尤其表现在视锥细胞及黄斑区功能,可用作人类视网膜疾病尤其是黄斑区病变的良好动物模型。     

正常猕猴与人的视网膜电图及视觉诱发电位对比研究

目的 研究正常猕猴与人视网膜电图(FERG,PERG)及视觉诱发电位(FVEP,PVEP)的异同.方法 选取通过眼底照相及光学相干断层扫描(OCT)等眼科相关检查确定眼部没有明显异常的正常成年猕猴3只(6眼)及健康成年人8例(16眼),对其FERG、PERG、FVEP、PVEP进行检测和记录,导出数据后运用SPSS 13.0软件行统计学分析.结果 暗适应0.01ERG的b波及暗适应3.0ERG的a波,b波猕猴与人相比峰时明显较短,振幅明显较低(P＜0.05).暗适应Ops的OS2波猕猴与人相比振幅明显较低(P＜0.05).明适应3.0ERG的a波,b波峰时和振幅,明适应30 Hz震荡电位振幅两者差异无统计学意义.FVEP的P2波猕猴与人相比峰时明显较短,振幅明显较高(P＜0.05).PERG猕猴与人相比P50及N95波振幅明显较低(P＜0.05).PVEP的P100波峰时猕猴与人差异无统计学意义,P100波振幅猕猴与人相比较低(P＜0.05).结论 视网膜电图及视觉诱发电位可对猕猴行视功能评价,作为评估人视网膜功能的参照.     

多焦视网膜电图评价视网膜脱离手术后的黄斑功能

目的:探讨多焦视网膜电图(MERG)对视网膜脱离(RD)术前、术后的黄斑区客观评价意义。方法:应用Retiscan图像系统对12例RD患者的12只患眼及未网脱眼术前和术后黄斑区进行MERG检测。结果:视网膜脱离术前黄斑区域第1环MERG值与对侧眼对应区域比较P1波振幅密度和N1波振幅较对侧眼相应值均明显降低(P<0.05);术后黄斑区域第1环P1波振幅密度和N1波振幅较术前有明显提高(P<0.05);与对侧眼对应区域比较P1波振幅密度和N1波振幅明显降低(P<0.01)。结论:多焦ERG能客观定量评价RD术前、术后黄斑区的视功能;视网膜解剖复位后黄斑区视功能不能完全恢复;P1波和N1波潜伏期无明显改变。     

多焦视网膜电图评价视网膜脱离手术术前、术后视网膜功能

目的:探讨多焦视网膜电图(multifocal electroretinography,MERG)对视网膜脱离(retina detachment,RD)术前、术后的视功能客观评价意义。方法:应用Retiscan图像系统对101例RD患者的101只患眼及未网脱眼术前和术后的视功能进行MERG检测。测试野水平视角为±30°,垂直视角为±30°,采用ERG-jet电极,在8min(分8段)记录64个视网膜部位的反应。结果:视网膜脱离区域P1波振幅密度和N1波振幅较对侧眼相应值均明显降低(P<0.001),P1波和N1波潜伏期较对侧眼相应区域的潜伏期明显延迟(P<0.001):视网膜脱离区域术后P1波振幅密度和N1波振幅较术前同一区域均有明显提高(P<0.001),P1波和N1波潜伏期较术前同一区域的潜伏期明显缩短(P<0.001);视网膜脱离区域术后P1波振幅密度和N1波振幅较对侧眼对应区域均有明显降低(P<0.001),P1波和N1波潜伏期较对侧眼相应区域的潜伏期明显延迟(P<0.001)。结论:多焦ERG能客观定量评价RD 术前、术后的视功能;视网膜脱离手术虽然能达到解剖复位,却不能完全达到功能复位。     

视网膜电图在视网膜脱离术前后的应用研究

目的：探讨视网膜脱离术前后的视网膜电图（ERG）变化规律。方法：对30例单眼单纯性视网膜脱离的病人术前术后行ERG检查。结果：ERG振幅下降与视网膜脱离的面积正相关，与脱离时间正相关；术前ERG振幅越高，手术的成功率越高，术后机功能恢复越好；网脱手术成功者对侧眼ERG振幅与正常对照组间差异无显著性（P≥0.05），而手术未成功组与正常对照组间差异有显著性（P＜0．01），未成功组与手术成功组间ERG振幅的差异有显著性（P＜0．05）。结论:ERG检查对视网膜脱离手术治疗有重要指导意义。     

视网膜颞上分支静脉阻塞光学相干断层扫描与多焦视网膜电图的观察

目的：观察视网膜颞上分支静脉阻塞的光学相干断层扫描和多焦视网膜电图各参数的特征及相关性。方法：随机选择视网膜颞上支静脉阻塞患者30例（30只眼）,对侧眼作为正常对照组,分别行光学相干断层扫描（OCT）及多焦视网膜电图（mfERG）检查,OCT用来观察黄斑区视网膜厚度,mfERG分析其一阶反应的P1、N1波各成分特征。结果：OCT显示患眼各个分区的视网膜厚度与对侧眼比较差异有统计学意义（P〈0．05）;mfERG显示患眼1环、颞上象限、上半侧区域P1波振幅密度,颞上象限、上半侧区域N1波潜伏期与对侧眼比较差异有统计学意义（P〈0．05）;患眼CSF视网膜厚度与2环的P1波振幅密度呈显著负相关关系（r=-0．691,P=-0．02）;直径5mm中心凹周围视网膜平均厚度与3环P1波振幅密度呈显著负相关关系（r=-0．636,P=0．03）。结论：OCT与mfERG相结合能更全面反映视网膜分支静脉阻塞眼功能、厚度及微结构变化。     

重组人促红细胞生成素治疗大鼠视网膜光损伤的效果观察

目的:观察重组人促红细胞生成素治疗大鼠视网膜光损伤的效果。方法:选取4周龄雄性SD大鼠48只,随机分成正常组、模型组、治疗1、2、3组。正常组大鼠8只,其余各组均为10只。用手术显微镜(光照强度为22 000±1 000 lux)造模。治疗1、2、3组大鼠分别在光照前4 h、光照后立即、光照后3d按照5 000 IU/Kg腹腔注射r HEPO 1次。各组大鼠造模后立即和造模后7 d行闪光视网膜电图(FERG)检查,观察并比较各组大鼠a、b波振幅的变化情况。结果:1光照后,立即FERG检查,模型组和治疗1、2、3组大鼠的a波、b波的振幅均低于正常组,差异有统计学意义(P<0.05);治疗1组大鼠的a波、b波的振幅高于治疗2、3组和模型组,差异有统计学意义(P<0.05)。2光照后7 d FERG检查,治疗1、2、3组和模型组7 d后大鼠的a波、b波的振幅均有所恢复,仍均低于正常组,差异有统计学意义(P<0.05);治疗1、2、3组大鼠的a波、b波的振幅呈依次降低,组间比较差异有统计学意义(P<0.05);治疗1、2组大鼠的a波、b波的振幅高于模型组(P<0.05)。结论:r HEPO对实验性大鼠视网膜光损伤具有保护作用,尤以光照前4 h和光照后立即给药效果明显。     

裂孔性视网膜脱离与眼屈光度的相关性研究

目的探讨眼屈光度与裂孔性视网膜脱离(RRD)、视网膜变性和视网膜干孔发生之间的关系。方法对260例RRD患者的患眼和对侧眼散瞳后进行电脑验光仪验光及眼底三面镜检查。用χ2检验分析眼屈光度与RRD的关系及与视网膜变性、裂孔形态部位的关系。结果随着近视度数的加深,双眼RRD的发生、RRD中视网膜圆孔及对侧眼视网膜变性的发生均升高(均P<0.001);对侧眼干孔发生也升高(P<0.05);伴有近视眼的RRD下方象限视网膜裂孔的发生率高于非近视眼(P<0.05)。结论高度近视是导致视网膜脱离的主要危险因素。单眼RRD的对侧眼,尤其是伴有高度近视RRD的对侧眼是视网膜脱离的高危眼,需注意检查,发现病变要及时处理以防止视网膜脱离的发生。     

光谱视网膜电图对单纯型糖尿病性视网膜病变的分析

目的观察单纯型糖尿病性视网膜病变(DR)的光谱视网膜电图(ERG)改变特点。方法采用自然瞳孔和相同刺激光强度,在暗适应和明适应两种条件下,DR 组和对照组分别依次给予蓝光、绿光和红光刺激。皮肤电极记录,t 检验分析。结果 DR 组红光 ERG 暗适应 a 波振幅P=0.05,b 波振幅暗适应和明适应 P<0.01;绿光 ERG 暗适应 a 波振幅 P<0.01,b 波振幅暗适应和明适应 P<0.01,明适应 b 波峰潜时 P<0.01,暗适应 b 波峰潜时 P<0.05;蓝光 ERG 暗适应 a 波振幅 P<0.05,b 波振幅 P<0.05,结论光谱 ERG 可以作为不同时期 DR 的不同波长锥细胞损害情况的评价指标。     

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.