儿童先天性白内障手术治疗的临床观察

目的探讨先天性白内障的手术时机、术后弱视治疗与术后视力康复等问题。方法对52例（67眼）先天性白内障进行手术治疗，〈3岁为白内障超声乳化摘除联合后囊膜环形撕开，均行Ⅱ期人工晶状体植入术；1〉3岁采用超声乳化摘除、后囊膜环形撕囊或合并前段玻璃体切割联合Ⅰ期人工晶体植人。结果52例（67眼）术后视力均有明显提高。经弱视治疗后：矫正视力〈0．05者3眼（4．48％）；0．05-0．25者11眼（16．42％）；0．3～0．5者25眼（37．31％）；0．6～1．0者21眼（31．34％）；其余7眼（10．45％）因年龄小不能配合视力表检查，但有视力改善征象，表现为明显追光或注视目标较术前有提高。木后未见黄斑囊样水肿、视网膜脱离及眼内炎等严重并发症。结论儿童先天性白内障宜早发现、早诊断、早治疗，以便把握手术时机，并强调随访。术后采取积极的光学矫正措施和弱视训练是恢复和巩固远期视力的关键。     

羊膜移植应用于青光眼术后滤过泡瘢痕化疗效分析

目的：探究羊膜移植应用于青光眼术后滤过泡瘢痕化的疗效。方法：资料选自2011年8月至2013年8月在本院诊治的青光眼患者68例（120眼），按照随机数字表方法分成两组，对照组30例（52眼）行小梁切除术，研究组38例（68眼）行小梁切除术联合羊膜移植，分析两组手术疗效、视力恢复、眼压和滤过泡情况。结果：研究组手术有效率94．12％，比对照组71．12％高（ P＜0．05）；且视力恢复有效率91．18％，比对照组65．38％高差异显著（ P＜0．05）；同时研究组眼压恢复≤21 mmHg 为85．29％，比对照组55．77％高；滤过泡形成88．24％，比对照组61．54％高，比较具有统计学上的意义（ P＜0．05）。结论：青光眼应用小梁切除术联合羊膜移植，能够提高手术疗效，具有一定研究和应用价值。     

玻璃体手术治疗眼外伤的预后因素分析

目的：探讨影玻璃体手术治疗眼外伤的预后因素，方法：对1998年7月至2000年8月，经玻璃体手术治疗的严重眼外伤病例随访资料齐全的85例，85眼临床资料进行分析。结果：术后功能修复63眼（74．1％），解剖修复14眼（16．4％），失败8眼（9．4％），术前视力与预后：（1）术前视力≥0．02者的功能修复率（100．0％）较术前视力＜0．02者（68．5％）高，二者间差异非常显著（P＜0．01），（2）伤型与预后：功能修复率分别为：穿通伤：73．3％，异物伤：75．0％，钝挫伤：75．9％；破裂伤66．7％，相互比较无显著性差异（P＞0．05），（3）手术时机与邓在后；功能修复率14d内为71．4％（10／14），15－30d为69．6％（16／23），大于30d为77．1％（37／48），三者比较无明显差异（P＞0．05），但修复失败主要发生在外伤后超过30d手术者（6／8），（4）术前外伤性增殖性玻璃体视网膜病变（TRVR）与预后：合并有TPVR者的功能修复率（64．3％）较术前无TPVR者的手术后功能修复率（83．7％）低，其差异有统计学意义（P＜0．05），（5）术前有玻璃体积血，外伤性白内障者功能修复率与不伴有玻璃体积血和无外伤性白内障者无显著差异（P＞0．05），结论：玻璃体手术是治疗眼外伤的有效手段，影响伤眼手术预后的因素是：术前视力，手术时机和术前是否合并有TPVR。本组资料末显示伤型，玻璃体积血，外伤性白内障与预后有关，术中，术后应注意PVR等并发症的防治。     

糖尿病患者白内障囊外摘除联合人工晶体植入术临床分析

目的：探讨患有糖尿病的老年性白内障患者行白内障囊外摘除联合人工晶体植入术（ECCE＋IOL）的治疗效果。方法：采用ECCE＋IOL治疗合并糖尿病的老年性白内障48例48眼，同时随机选择48眼同期手术的单纯性老年性白内障病例作为对照。结果：术后视力≥0．3，糖尿病组42眼（88％），对照组46眼（96％），差异无显著性（P＞0．05），视力≥0．6者，糖尿病组31眼（64％），对照组42眼（88％），两组比较差异有高度显著性（P＜0．01），术后糖尿病组并发症较重，特别是纤维蛋白渗出，与对照组比较差异有显著性（P＜0．05），结论：糖尿病患者行ECCE＋IOL术后并发症均能得到控制。大多数获得满意视力，影响术后视力的主要原因是视网膜病变。     

白内障合并糖尿病和爿乍糖尿病白内障超声乳化人工晶体植入术的疗效观察

目的观察合并糖尿病的白内障与非糖尿病的白内障患者行白内障超声乳化（PHACO）联合人工晶体植入术的治疗效果。方法将85例（91眼）白内障患者分为两组，A组为白内障合并糖尿病组，共14例（16眼）。男6例（8眼），女8例（8眼）；年龄60一83yr。术前视力：光感-0．25。B组为白内障无糖尿病组，共71例（75眼），男24例（24眼），女47例（51眼）；年龄55．93yr。术前视力：光感～0．3。两组均采用PHACO联合人工晶体植入术治疗，A组术前控制血糖。结果①术后d1视力〈0．3，A组9眼（56．3％），B组26眼（34．7％）；0．3〈视力〈0．8，A组4眼（25．0％）。B组41眼（54．7％）；视力〉0．8，A组3眼（18.8％），B组8眼（10．7％）；术后1wk视力〈0．3，A组4眼（25．0％），B组13眼（17．3％）；0．3〈视力〈0．8，A组8眼（50．0％），B组47眼（62．7％）；视力〉0．8，A组4眼（25．0％），B组15眼（20．0％）。②术后d1角膜水肿A组11眼（68．8％），术后4—7d恢复透明，B组29眼（38．7％），术后2～4d恢复透明，术后除A组1眼患者出现前房渗出外，两组患者均无术后感染、前房出血、切口愈合不良、虹膜后粘连、后囊膜破裂、人工晶体脱位、视网膜脱离等并发症发生。结论白内障超声乳化术效果肯定，术后视力恢复良好。合并糖尿病的白内障患者在严格控制血糖的情况下，也可取得良好的手术治疗效果。     

352例老年人健康体检视力状况分析

目的：探讨影响局部区域性老年人视力的主要致病因素。方法：对2004年11月-2005年11月期间，到我院健康体检的352例新乡市东郊65岁以上老年人行眼科常规检查，对视力低于1．0者作裂隙灯、眼底检查。结果：年龄相关性白内障患者为576眼（81．81％），年龄相关性黄斑变性36眼（5．11％），糖尿病性视网膜病变（ORP）39眼（5．54％），青光眼27眼（3．83％），后发性白内障6眼（0．85％）单纯性视神经萎缩5眼（0．71％）等。结论：随着社会的老龄化，老年人眼部疾患发病率明显增高，年龄相关性白内障、年龄相关性黄斑变性、DRP等是影响视力的主要因素。     

高龄老年人白内障手术的临床观察

目的：观察高龄老年人（80岁以上）白内障超声乳化除及人工晶体植入术的临床疗效及手术技巧。方法：对81例（101眼）高龄老年人行白内障超声乳化除及人工晶体植入术。乳化时间平均175s，超声能量平均32．59％。结果：术后1周，1月，3月视力≥0．5分别为56眼，66眼，76眼；≥0．3为81眼，86眼，91眼。主要并发症为；角膜水肿（26．73％），后囊破裂（6．93％），未见全身性并发症发生。结论：该手术对高龄白内障为安全，可靠的复明手术，但必须重视此类患的某些特殊性。     

20G 玻璃体切割术临床效果分析

目的：探讨20G玻璃体切割手术的安全性和有效性。方法：选取2013年2月至2013年4月在我院行20G玻璃体切割术的患者44例（44眼）。结果：术后视网膜完全解剖复位44眼（100％）;玻璃体切割手术前与手术后1、2、3d眼压的差异具有统计学意义（P〈0．05）,与手术后1月眼压之间的差异无统计学意义（P〉0．05）;手术前与手术后1、2、3d、1月最佳矫正视力的差异具有统计学意义（P〈0．05）,术后1d视力较术前提高21眼（47．7％）;术后2d视力较术前提高25眼（56．8％）;术后3d视力较术前提高27眼（61．4％）;术后1月视力较术前提高32眼（72．7％）;对术后视力〈0．1与≥0．1的病例分析发现,视力的好坏与手术时间的长短存在关系（t=2．959,P=0．005）;高度近视眼与非近视眼术后1月最佳矫正视力之间的差异有统计学意义（x2=4．528,P=0．（133）,且非近视眼较高度近视眼手术效果好。结论：20G玻璃体切割术仍然是一种治疗玻璃体视网膜疾病安全有效的技术,手术成功率高、术后视力恢复理想、术后眼压控制理想。     

表面麻醉联合结膜下浸润麻醉在青光眼滤过手术中的疗效分析

目的 观察评估表面麻醉联合结膜下浸润麻醉在青光眼滤过手术中的临床疗效及安全性。方法 对109例（132眼）各型青光眼患者在0．4％ Benoxil滴眼液和2％利多卡因0．2～0．3ml结膜下浸润麻醉行青光眼滤过手术，观察麻醉效果及术中、术后并发症。结果 124眼（93．93％）术中无疼痛，顺利完成手术：6眼（4．55％）有轻微疼痛及眨眼动作，追加表面麻醉剂1～2次，手术顺利完成；2眼（1．52％）疼痛明显，追加球周或球后麻醉，完成手术。术后视力及视野有所改善，或维持术前状况，眼部炎症反应轻。结论 表面麻醉联合结膜下浸润麻醉行青光眼滤过手术是安全可靠的，在临床上值得推广。     

囊外摘除人工晶体植入术治疗白内障104例

目的探讨白内障现代囊外摘除人工晶状体植入术的疗效。方法对白内障囊外摘除与人工晶状体植入术患者104例104眼回顾性分析。结果术后视力明显提高，≥0．05者103眼，脱盲率99．0％；〉10．3者95眼，脱残率91．3％。术中、术后并发症：后囊膜破裂1眼（0．96％）；术后角膜水肿25眼（24．0％）；虹膜损伤1眼（0．96％）；术后暂时性高眼压1眼（0．96％）；瞳孔轻度变形者2眼（1．92％）；人工晶状体夹持1眼（0．96％）；术后葡萄膜炎4眼（3．8％）；1周后角膜平均散光1．53±1．32，经处理未见严重并发症发生。结论白内障小切口囊外摘除人工晶状体植入术，疗效显著、并发症少，安全易行，是基层医院防盲复明手术的首选术式。     

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.