天幕脑膜瘤的分型和手术入路选择

目的：探讨天幕脑膜瘤的分型和手术入路的选择。方法：对1996年1月2005年4月间收治的天幕脑膜瘤进行回顾性分析，并按分型选择不同的手术入路。本组26例，其中内侧型10例；外侧型12例；镰幕型4例。对主要向幕上发展者，根据肿瘤的部位，采用扩大翼点入路、颞下入路、颞枕部入路和枕部入路；肿瘤全部或主体在颅后窝者，采用枕下或枕部-枕下联合开颅术；跨幕者采用颞下-乙状窦前入路；镰幕型均采用枕部入路。结果：本组肿瘤全切除23例，次全切除3例，全组元死亡，术后出现新增神经功能障碍2例，复发5例。结论：天幕脑膜瘤手术入路的选择必须根据患者的解剖分型进行个体化设计；熟悉局部显微解剖并熟练运用显微外科技术是取得手术成功的关键。     

小脑幕脑膜瘤的显微手术治疗

目的探讨小脑幕脑膜瘤的手术入路和手术技巧。方法对近5年来收治的16例小脑幕脑膜瘤进行回顾性分析。本组16例。对主要向幕上发展的采用颞枕及其幕上下联合入路，对幕镰型后方者采用Poptmn入路，肿瘤全部或主体在后颅窝者采用乙状窦后及其幕上下联合入路。结果本组全切肿瘤15例，部分切除1例，术后死亡1例，新增神经功能障碍3例，偏瘫1例。结论小脑幕脑膜瘤手术入路的选择必须个体化设计，尽可能采用简便适用的手术入路。正确的手术入路和对局部解剖的熟悉是手术取得成功的关键。     

小脑幕脑膜瘤的显微手术治疗

目的：总结小脑幕脑膜瘤显微手术的经验和教训，以利提高手术的疗效。方法：采用经颞枕硬膜内入路，枕部经小脑幕与枕下联合入路，枕下内侧入路、旁正中入路，均采用显微神经外科技术切除肿瘤。结果：肿瘤全切除6例，次全切除2例，术后死亡1例，共济失调1例，构音障碍和饮水咳呛1例，5例痊愈。结论：小脑幕脑膜瘤切除应选择合适的手术入路。手术时必须切除窦内肿瘤，在切除肿瘤侵入的横窦前、必须有血管造影完全闭塞的证据。脑干随近的肿瘤先行包膜内切除，后切除肿瘤包膜。     

改良枕下经天幕入路显微外科处理松果体区及幕镰区肿瘤15例报告

目的:探讨应用改良枕下经天幕入路显微外科处理松果体区及幕镰区肿瘤的方法及其疗效。方法:对15例松果体区及幕镰区肿瘤,采用改良枕下经天幕入路显微手术治疗,并对手术方法及疗效进行分析。结果:本组15例中,肿瘤全切9例,占73.33%,次全切除2例,占13.33%,死亡1例,占6.67%,术后新增神经功能障碍2例,随访13例,复发3例。结论:改良枕下经天幕入路显微外科处理松果体区及幕镰区肿瘤,对病变显露良好,术后反应小,损伤小。     

桥小脑角胆脂瘤的显微外科治疗

目的：总结桥小脑角(CPA)胆脂瘤的显微外科手术入路和神经内镜辅助手术。方法：28例桥小脑角胆脂瘤，采用枕下开颅乙状窦后入路16例、颞枕开颅颠下小脑幕入路10例、颞枕开颅幕上下联合入路2例。其中5例手术应用神经内镜辅助。结果：肿瘤全切除21例，近全切除7例，无手术死亡。结论：枕下开颅乙状窦后入路适用于胆脂瘤位于CPA以及由CPA向斜坡生长者；颞枕开颅颞下小脑慕入路适用于CPA胆脂瘤向岩骨尖斜坡及幕上鞍区发展者；巨大胆脂瘤同时累及CPA、鞍区和下斜坡时采用颞枕开颅幕上下联合入路。神经内镜辅助有助于减小手术创伤，提高肿瘤全切率。     

岩斜区肿瘤显微外科治疗手术入路选择（附17例报告）

目的：探讨岩斜区肿瘤外科治疗手术入路选择。方法：回顾性分析我院自1997年至2000年6月显微外科手术治疗的17例岩斜区肿瘤。12例肿瘤直径大于4cm。采用6种手术入路：颞下-小脑幕;天幕上下联合;颞下-乙状窦前;枕下乳突后;枕下远外侧;额眶颧入路。结果：肿瘤全切除12例（71%）,术后恢复良好者11例（65%）,术后新增颅神经损害6例（35%）。结论：选择和掌握适合的颅底手术入路,采用显微外科技术入路,采用显微外科技术切除岩斜区肿瘤可取得满意效果。     

岩尖斜坡区脑膜瘤的显微外科治疗

目的：探索岩尖斜坡区脑膜瘤手术入路和手术效果。方法：通过显微外科手术治疗21例岩尖斜坡区脑膜瘤,根据肿瘤的生长方式和MRI的表现分为三种类型：Ⅰ型5例,主要向中颅窝生长(包括海绵窦);Ⅱ型4例,主要向后颅窝生长;Ⅲ型12例,骑跨岩骨分别向中、后颅窝生长。额颞开颅断颧弓颞下入路切除肿瘤5例。颞枕开颅颞下小脑幕入路切除肿瘤4例,乙状窦前入路10例和乙状窦后入路切除肿瘤2例。结果：肿瘤全切除9例,近全切除11例,部分切除1例;无手术死亡。Ⅰ型岩斜坡肿瘤全切除2例,次全切除3例;Ⅱ型岩斜坡肿瘤全切除3例,次全切除1例;Ⅲ型全切除4例,次全切除7例,部分切除1例。结论：Ⅰ、Ⅱ型多数能全切除,术后效果良好;若Ⅰ型岩斜坡脑膜瘤侵犯海绵窦则难以全切除,术后容易并发动眼神经损伤。Ⅲ型岩斜坡脑膜瘤全切除非常困难,乙状窦前入路是Ⅲ型岩斜坡脑膜瘤最佳的的手术入路。     

岩斜区表皮样囊肿的显微外科治疗

目的：探讨颅底岩骨斜坡区表皮样囊肿显微外科治疗的手术入路、切除技巧及神经保护方法等。方法：21例岩斜区表皮样囊肿患者中，11例采用枕下乙状窦后入路，7例采用颞枕经小脑幕入路，4例采用颞枕枕下乙状窦后幕上下联合入路手术。结果：肿瘤全切8例．肿瘤次全切13例。术后临床症状及体征完全消失者8例，较术前明显好转者4例，基本同术前者8例，死亡1例。结论：手术入路的选择应取决于肿瘤的起源和累及部位；保护神经功能的关键是应用显微技术囊内切除肿瘤后锐性分离包膜，在与神经血管粘连紧密处留部分包膜，不强行剥离。     

镰旁脑膜瘤分型及显微手术治疗方法探讨

目的：探讨镰旁脑膜瘤分型及据此采用的显微手术治疗方法。方法：选取2005年1月至2012年12月接受治疗的镰旁脑膜瘤患者40例,由冠状位MRI成像诊断法将镰旁脑膜瘤分为3种类型,其中Ⅰ型指肿瘤位于大脑镰的一侧,而大脑镰无移位情况或肿瘤近于上矢状窦,选择同侧入路显微手术治疗法。Ⅱ型指肿瘤位于大脑镰的一侧,大脑镰出现局部移位,选择对侧入路显微手术治疗法;Ⅲ型是指肿瘤向大脑镰两侧生长,两侧等大或不等大,采用瘤体较小侧或非优势半球侧纵裂入路显微手术法。结果：术后对患者行CT检查,患者未出现明显脑挫裂伤或血肿。所有患者肿瘤全部切除,无严重并发症发生。结论：对镰旁脑膜瘤分型并采取适宜的显微手术入路,效果显著,安全性高。     

显微切除小脑幕脑膜瘤25例临床研究

目的:小脑幕脑膜瘤手术入路、显微切除方法以及如何最大限度切除肿瘤和减少术后并发症的方法.方法:1999年3月至2006年8月间25例小脑幕脑膜瘤的病例资料经临床、磁共振成像、数字减影血管造影诊断并根据肿瘤部位,采用颞枕入路、枕部入路、枕-枕下联合入路显微切除肿瘤.结果:SimpsonⅠ级切除11例(44%),SimpsonⅡ级切除8例(32%),大部分切除6例(24%),术中无死亡病例.结论:利用现代影像技术,规范分类,选择合适的手术入路,应用显微神经外科技术,可以明显提高本病的治疗效果,减少并发症的发生.     

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.