准分子激光原位角膜磨镶术前后角膜非球面分析

 【目的】探讨准分子激光原位角膜磨镶术（LASIK）前后角膜非球面特点及其对术后视觉质量的影响。【方法】前瞻性对本中心接受LASIK患者26例50眼进行随访研究,检测指标包括OrbscanⅡz角膜地形图（提供角膜非球面因子Q值）、波前像差、对比敏感度（contrast-sensitivity function,CSF）、裸眼视力、最佳矫正视力、最佳矫正球镜度;分析时段为术前及术后3月,分析手术前后角膜非球面因子Q值分布,Q值与高阶像差以及高阶像差与对比敏感度的关系。【结果】术前Q值为-0.17±0.11;术后Q值为0.84±0.41,两者存在统计学差异（P=0.01）。术前Q值与术前球差成负相关（P=0.000,r=-0.578）,与高阶像差成正相关（P=0.047,r=-0.333）。手术前后Q值改变与球差改变成负相关（P=0.000,r=-0.588）,与高阶像差改变成正相关（P=0.001,r=0.566）。术后3月无眩光、低、中、高度眩光对比敏感度均较术前降低,但无统计学差异（P〉0.05）。高阶像差改变与术后无眩光各空间频率对比敏感度6.3,4.0,2.5,1.6,1.0,0.7（cycles per degree,cpd）成负相关（P〈0.05）；高阶像差改变 与低、中、高度眩光对比敏感度中高频空间频率6．3，4．0，2．5，1．6cpd成负相关（P〈0.05），与低频空间频率（1．0，0.cpd）无相关关系（P〉0.05）。【结论】近视性LASIK使角膜由伸长型（长椭球体）椭球体演变为扁平型椭球体（扁椭球体），并影响术后视觉质量。     

过渡区切削与Q值引导准分子激光原位角膜磨镶术后视觉质量的比较

目的研究角膜前表面非球面形状,观察过渡区准分子激光原位角膜磨镶术（TA～LASIK）手术组与非球面准分子激光原位角膜磨镶术（Q—LASIK）手术组视觉质量的差异,为个性化屈光手术的改进提供依据。方法收集2008年11月到2009年11月期间近视眼患者100例（100眼）,均为左眼,分为TA—LASIK手术组50眼,Q值调整组50眼,对术前、术后3个月6项指标做对照观察（视力、角膜非球面性、对比敏感度,波前像差变化和视觉相关生活质量调查表）;采用SPSS12．0统计学软件对资料进行分析。结果Q值引导手术组术后和TA引导手术组术后3个月视力〉5．0相比较,差异无统计学意义（x^2=0．195,P〉0．05）;两组术后角膜非球面性Q值均向正值方向发展,两组的球差和两组的Q值比较差异无统计学意义（t=0．849,t=0．792,P均〉0．05）。在球差与对比敏感度方面,术后3个月Q值组与TA组比较差异无统计学意义（P〉0．05）。在白昼视力、眩光、光晕、重影、夜晚驾驶方面两组比较差异无统计学意义（P〉0．05）。结论TA—LASIK手术后与Q—LASIK术后Q值改变相对少,能保持角膜相对的长椭圆形,即角膜非球面性。提示过渡区切削能改善视觉质量。     

虹膜定位波前像差引导的LASIK与传统LASIK治疗高度近视像差的变化与对比敏感度、眩光敏感度关系

目的：比较虹膜定位波前像差引导的准分子激光原位角膜磨镶术（LASIK）和传统LASIK矫正高度近视术后3个月时波前像差的变化与对比敏感度、眩光敏感度的关系,探讨像差对视觉质量的影响。方法：将行虹膜定位波前像差引导的LASIK的高度近视患者9例（17眼）作为试验组,行传统LASIK的近视患者8例（14眼）作为对照组。对试验组和对照组术后3个月的视力、波前像差、对比敏感度和眩光敏感度进行统计学分析。结果：（1）试验组、对照组术后3个月的视力无统计学意义（P〉0．05）,波前像差Zernike函数c4（离焦）、C7（垂直彗差）、C8（水平彗差）、三叶草差（C6、C9）、C12（球差）、RMSg（总体像差均方根值）、RMSh（高阶像差均方根值）无统计学意义（P〉0．05）。（2）术后3个月比较对比敏感度,白天在低频区3．0c／d、中频区6．0c／d空间频率下,有统计学意义（P〈0．05）;晚上在低频区3．0c／d空间频率下,有统计学意义（P〈0．05）。白天＋眩光在低频区3．0c／d空间频率下,有统计学意义（P〈0．05）。结论：虹膜定位波前像差引导的LASIK较传统LASIK矫正高度近视无更好的视觉质量。     

准分子激光原位角膜磨镶术术后视觉质量下降的分析

评价准分子激光原位角膜磨镶术（LASIK）临床疗效的标准是不但要达到预期的矫正视力,还要获得良好的视觉质量。LASIK术后视觉质量的下降与众多因素有关,文中从视力、屈光度、对比敏感度、眼波前像差、角膜非球面Q值、双眼视功能、优势眼的改变等7个方面综述LASIK手术对视觉质量的影响,并探讨其对LASIK手术的指导意义。     

波前像差与角膜地形图联合分析非球面人工晶体对术眼视觉质量的影响

目的白内障术后的视觉质量因人工晶状体的设计改进而显著改善。文中研究非球面人工晶状体植入术后患眼高阶像差及对比敏感度的特点,评价非球面人工晶状体对术眼视觉质量的影响。方法患者共80只眼分为2组,一组植入非球面人工晶状体Acrysoft SN60WF,一组植入球面人工晶状体Acrysoft SA60AT。术后进行角膜地形图波前像差及对比敏感度的测量。结果术后的最佳矫正视力及角膜高阶像差比较组间差异无统计学意义(P>0.05)。术后的高阶像差测量显示球面像差Zernike C12、4阶高阶像差及总体像差比较中SA60AT组大于SN60WF组,组间差异均具有统计学意义。眩光对比敏感度,在空间频率6、12、18c/d时,SN60WF组大于SA60AT组(P<0.05)。结论非球面人工晶状体可以减少球面像差,增加对比敏感度。     

准分子激光原位角膜磨镶术后视觉质量下降的分析

评价准分子激光原位角膜磨镶术(LASIK)临床疗效的标准是不但要达到预期的矫正视力,还要获得良好的视觉质量.LASIK术后视觉质量的下降与众多因素有关,文中从视力、屈光度、对比敏感度、眼波前像差、角膜非球面Q值、双眼视功能、优势眼的改变等7个方面综述LASIK手术对视觉质量的影响,并探讨其对LASIK手术的指导意义.     

LASIK手术对角膜前后表面Q值的影响及相关性研究

目的研究LASIK手术对角膜前、后表面Q值的变化以及与近视等效球镜相关性。方法 2009年6月-9月行准分子激光近视矫治手术病人96例192眼,按近视屈光度分为低度近视组（-3.00D--6.00D）和高度近视组（〉-6.00D）,分别在术前和术后1周行Pentacam眼前节分析系统检查,测量角膜前后表面Q20、Q25、Q30、Q35值并进行统计学分析。结果手术前中度和高度近视角膜前后表面Q20、Q25、Q30、Q35差别无统计学意义（P〉0.05）。手术后角膜前后表面的Q20、Q25、Q30、Q35值均向正值方向改变,且前表面的变化明显,等效屈光度数越大,术后Q值向正值变化越大。中度近视和高度近视等效屈光度与角膜前表面ΔQ20（r=0.29,P=0.004）、ΔQ25（r=0.30,P=0.003）、ΔQ30（r=0.31,P=0.002）显著相关,与ΔQ35相关（r=0.23,P=0.021）;与角膜后表面ΔQ值无相关（r分别-0.115,-0.12,-0.135,-0.152,P〉0.05）。结论 LASIK手术后角膜前后表面Q20、Q25、Q30、Q35值均有变化。并且角膜前表面Q值与等效屈光度相关。     

弱视患者自适应光学系统矫正高阶像差前后视觉行为变化的研究

目的 探讨单眼弱视眼通过自适应光学系统矫正高阶像差（higher order aberrations, HOAs）前后视觉行为的变化。 方法 分别测量10名单眼弱视患者通过自适应光学系统矫正弱视眼高阶像差前后的视力(visual acuity, VA)及对比敏感度(contrast sensitivity, CS)阈值,并分析视力和对比敏感度阈值的变化。 结果 弱视眼矫正高阶像差后视力提高（P=0.005）;弱视眼矫正高阶像差后对比敏感度阈值降低(P<0.001),这一进步主要发生于24 cpd的空间频率（spatial frequency, SF）上（P=0.018）。 结论 弱视眼在矫正高阶像差后视觉功能提升,高阶像差的存在对弱视患者高空间频率上对比敏感度功能的下降具有一定的作用。     

非球面调整的LASIK手术后早期对比敏感度、眩光敏感度及波前像差的变化

目的比较非球面调整的LASIK手术(Fine Adjustded customized Alation Treatment,F-CAT)与标准LASIK手术(Standard Excimer Laserin Keratomileusis Lasik,S-LASIK)后对比敏感度、眩光敏感度及波前像差的变化,评价非球面调整后的近视手术对视觉质量的影响。方法回顾性分析同期接受F-CAT手术近视患者12例(24只眼)和接受S-LASIK手术患者12例(24只眼),分别观察术前和术后视力、屈光度、对比敏感度、球差,对数据进行统计学分析。结果术后两组裸眼视力均达到术前最佳矫正视力,无显著性差异(P>0.05),术后3月F-CAT组对比敏感度和眩光敏感度与术前相比无下降,术后F-CAT组对比敏感度和眩光好于S-LASIK组,在6c/d,12c/d,18c/d有显著性差异(Wilcoxon,P<0.05);两组术后3月球面像差、高阶像差的均方根值RMS均有所增加,和术前比较均有显著性差异(Wilcoxon,P<0.05),但术后F-CAT组的球面像差、高阶像差的均方根值RMS均低于S-LASIK组,两组之间有显著性差异(W...     

低度近视眼准分子激光角膜屈光手术后视觉及相关角膜参数与飞行员正视眼的对比分析

目的检测中国歼击机飞行员视觉及相关角膜参数,并与低度近视眼行准分子激光角膜屈光手术后的数据进行对比分析,评估准分子激光角膜屈光手术在我空军应用的前景。方法选取进行准分子激光原位角膜磨镶术（LASIK）或角膜表面切削手术（PRK）的低度近视眼,分别观察裸眼视力、屈光状态、Astramax角膜地形图获得的波阵面像差,即总高/低阶像差、垂直彗差、水平彗差和球差,以及角膜前表面Q值、角膜曲率等角膜参数,与歼击机飞行员正视眼数据进行对比分析。结果PRK和LASIK治疗≤-3.00D轻度近视眼,术后裸眼视力达到飞行员的标准;屈光状态,即球镜度数、柱镜度数、等效球镜三组差异无统计学意义;手术组角膜的Q值没有改变;中央角膜曲率显著下降;术后总高/低阶像差和球差与飞行员组差异有统计学意义。LASIK术后球差的增加显著高于PRK。结论 低度近视眼行PRK或LASIK术后裸眼视力、屈光状态、角膜的Q值可以达到飞行员的标准。但总高阶像差、彗差和球差的增加可能严重影响视觉质量,LASIK较PRK对球差的影响更大。在选拔飞行员时,对做过角膜屈光手术的患者应该慎重。同时在屈光手术中如何减少和避免波阵面像差的改变,如何通过手术保持和提高视觉质量也是我们今后的课题。     

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.