鼻内窥镜加柯——陆手术联合进路治疗上颌窦内息肉和囊肿

目的 探讨鼻内窥镜加柯--陆手术联合进路治疗上颌窦内息肉和囊肿的手术切除方法.方法 对42例伴有上颌窦病变的慢性鼻窦炎患者行鼻内窥镜加柯--陆手术联合进路鼻窦手术.结果 术后随访6个月,治愈31例,好转10例,1例无效.结论 该方法可彻底清除上颌窦病变又克服了鼻内窥镜手术处理上颌窦病变时的局限性,保持了完整解剖结构和生理性引流通道,把破坏性手术改变为功能性手术.     

鼻内镜下利用自制多角度刮匙经上颌窦自然口切除上颌窦囊肿

目的:探讨鼻内镜下利用自制多角度刮匙经上颌窦自然口切除上颌窦囊肿的优点。方法:0°鼻内镜下扩大上颌窦自然口约至1.5cm×1.2cm。70°内镜自上颌窦自然口观察上颌窦内病变,将带孔鼻窦刮匙根据需要折弯成各种角度,自扩大的上颌窦自然口进入窦腔,刮除囊壁,利用折弯成各种角度的吸引管吸除囊液及囊壁。结果:20侧上颌窦囊肿均一次手术成功,无并发症发生,经半年以上随访均无复发。结论:鼻内镜下利用自制多角度刮匙经上颌窦自然口切除上颌窦囊肿手术损伤小,术后恢复快,是一种较为理想的上颌窦囊肿手术方法。     

泪前隐窝入路上颌窦良性病变切除36例体会

目的探讨鼻内镜下泪前隐窝入路治疗上颌窦良性病变的临床效果。方法回顾2010年9月至2012年9月,行鼻内镜下泪前隐窝入路上颌窦良性病变切除36例,上颌窦息肉4例,上颌窦囊肿24例,鼻及鼻窦内翻性乳头状瘤2例,鼻腔及上颌窦真菌病6例。术前均行鼻窦CT扫描,上颌窦囊肿24例均位于上颌窦内壁、底壁、前下壁,怀疑内翻性乳头状瘤行MRI扫描,观察术后治疗效果。结果 36例患者鼻内镜下经上颌窦自然开口无法清除病变,改用泪前隐窝入路能良好地暴露上颌窦各壁,彻底清除病变,随访5个月～2年,头昏、头痛、鼻出血、闷胀、鼻涕倒流、臭味、流鼻涕等症状逐渐消失,其中,有1例内翻性乳头状瘤术后复发,在随访过程中经鼻内镜下鼻道开窗口发现上颌窦有新生物,清除并行病理证实为复发,其根用电凝吸引器电凝,随访至今无复发,其余35例经鼻内镜随访下鼻甲形态良好,上颌窦黏膜光滑,下鼻道开窗口形态良好。结论鼻内镜下泪前隐窝入路上颌窦良性病变切除能良好地暴露上颌窦各壁,视野宽、创伤小,便于上颌窦内病变的观察和清除,不留死角,疗效满意,维护了鼻腔正常形态和功能。     

微波热凝术在内窥镜上颌窦手术中的应用研究

目的：探讨微波在鼻内窥镜上颌窦手术中的应用价值。方法：在鼻内窥镜上颌窦手术中，应用微波技术处理上颌窦内各壁增生肥厚黏膜、息肉、囊肿、霉菌团块、内翻性乳头状瘤、浆细胞瘤、小血管瘤等良性病变。结果：随诊观察105例144侧，发现在鼻内窥镜手术中，经扩大的上颌窦自然开口，采用微波热凝术能彻底清除病变组织，减少术中的出血，增加了Ess的疗效。结论：微波热凝术是在内窥镜下经扩大的上颌窦自然开口，彻底、有效地清理窦腔内病变，防止扩大手术和再手术的合理技术。     

微波热凝术在内窥镜上颌窦手术中的应用

为探讨微波在内窥镜上颌窦手术中的应用价值,在内窥镜鼻窦手术（ESS）中,应用微波热凝技术清除上颌窦腔各壁增生肥厚粘膜、囊肿、息肉等不可逆炎性粘膜病变和良性肿瘤,随访观察163例202侧。发现采用微波热凝术经扩大自然开口能顺利地清除上颌窦腔内、底壁及后外侧壁等部位的病变,避免了病变组织的残留和经唇龈沟径路手术的创伤,提高了ESS的疗效。结果表明微波热凝术是在内窥镜下经扩大后的上颌窦自然开口彻底、有效地清理窦腔各壁病变、防止扩大手术和再次手术的合理技术。     

微波热凝术在内窥镜上颌窦手术中的应用

为探讨微波在内窥镜上颌窦手术中的应用价值,在内窥镜鼻窦手术（ESS）中,应用微波热凝技术清除上颌窦腔各壁增生肥厚粘膜、囊肿、息肉等不可逆炎性粘膜病变和良性肿瘤,随访观察163例202侧。发现采用微波热凝术经扩大自然开口能顺利地清除上颌窦腔内、底壁及后外侧壁等部位的病变,避免了病变组织的残留和经唇龈沟径路手术的创伤,提高了ESS的疗效。结果表明：微波热凝术是在内窥镜下经扩大后的上颌窦自然开口彻底、有效地清理窦腔各壁病变、防止扩大手术和再次手术的合理技术。     

鼻内窥镜引导下经鼻腔、口腔径路上颌窦根治术

慢性上颌窦炎合并上颌窦息肉、上颌窦囊肿是鼻部常见疾病.以往手术方式是经口腔尖牙窝行上颌窦根治,后发展为鼻内窥镜经鼻腔功能性上颌窦根治.前术式对组织创伤较大,后术式微创,但对上颌窦内病变的清除受限.我科自2003年12月以来,引进动力系统在鼻内窥镜引导下经鼻腔、口腔联合径路行上颌窦根治取得满意效果,报告如下.     

鼻内窥镜中下鼻道联合开窗术治疗上颌窦息肉及囊肿

目的：探讨治疗上颌窦息肉及囊肿的有效方法。方法：对30例行鼻内窥镜中、下鼻道联合开窗术治疗上颌窦息肉或囊肿的临床资料进行总结。结果：术后随访1年，全部治愈，无1例复发。结论：该方法可彻底清除上颌窦内病变，防止复发，术后便于术腔清洁处理，提高手术治愈率。     

鼻内窥镜加柯-陆手术联合进路治疗上颌窦良性病变

目的 探讨彻底清除上颌窦病变并防止复发的治疗方法。方法 对96例上颌窦病变患者行鼻内窥镜和柯－陆手术联合进路鼻窦手术，彻底清除病变。结果 术后随访1－6年（平均3年），治愈85例（88.5%)，好转11例（11.5%)，总有效率100％。结论 该方法可彻底清除上颌窦病变，防止复发，弥补了经鼻内窥镜鼻窦手术在处理上颌窦病变时的局限性。     

鼻内镜下中、下鼻道径路治疗上颌窦良性病变疗效观察

目的探讨分析鼻内镜下中、下鼻道径路治疗上颌窦良性病变疗效。方法共对40例上颌窦良性病变采取鼻内镜不同手术径路进行手术后疗效分析,上颌窦炎12例,上颌窦囊肿16例,上颌窦息肉7例,上颌窦霉菌病5例。结果术后6～12个月随访,其中上颌窦炎12例,有1例复发;上颌窦囊肿16例,有1例复发;上颌窦息肉7例,无复发;上颌窦霉菌病5例,有1例复发。结论功能性鼻内镜手术具有手术创伤小,手术中术区可视性好,术后局部反应轻,鼻窦生理功能恢复好,术后复发率低等优点,鼻内镜下采取合理的手术径路,对手术的成败及术后上颌窦生理功能的恢复起着至关重要的作用。     

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.