立体定向手术治疗难治性精神分裂症(附256例报告)

目的:探讨立体定向技术和多靶点组合对难治性精神病的治疗意义,综合评估临床疗效。方法:在立体定向基础上,应用CT、电阻值和微电极电生理进行核团定位,对256例难治性精神病患者,采用杏仁核、内侧隔区、扣带回等多靶点组合射频热凝治疗。应用临床疗效总评量表(clinical grobal impressions scale,CGI)、简明精神病评定量表(brief psychiatric rating scale,BPRS)、阴性和阳性综合量表(the postitve and negative syndrome,PNSS)精神病评定量表在术后6个月对治疗效果进行评定。结果:依据减分率标准,256例患者中,显著进步140例,进步108,无变化8例。手术前后量表评分有显著差异(P<0.05=无严重并发症和后遗症发生。结论:多靶点组合的立体定向技术是难治性精神病的有效治疗方法之一,靶点组合设计和亚核团的准确定位,对提高疗效,降低并发症有较大意义。     

立体定向亚核团定位手术治疗难治性精神病384例

目的：探讨立体定向技术和亚核团定位对难治性精神病的治疗意义,综合评估临床疗效。方法：在立体定向基础上,应用CT、电阻值和微电极电生理进行核团定位,对384例难治性精神病患者,采用杏仁核、内侧隔区、扣带回等多核团组合射频热凝治疗。应用临床疗效总评量表（clinical grobal impressions scale,CGI）、简明精神病评定量表（brief psychiatric rating scale,BPRS）、阴性和阳性综合量表（the postitve and negative syndrome,PNSS）精神病评定量表在术后6个月对治疗效果进行评定。结果：依据减分率标准,384例患者中,显著进步210饲,进步162,无变化12例。手术前后量表评分有显著差异（P〈0．05=无严重并发症和后遗症发生。结论：亚核团定位的立体定向技术是难治性精神病的有效治疗方法之一,核团组合设计和亚核团的准确定位,对提高疗效,降低并发症有较大意义。     

立体定向核团组合多靶点毁损治疗难治性精神病

目的研究采用立体定向方法脑内核团组合多靶点毁损对难治性精神病的治疗作用。方法根据病人诊断分类、主要症状，采用不同核团组合多靶点射频热凝治疗难治性精神病69例，于手术前及术后3个月、1年进行评估。结果本组69例患者经脑内核团组合多靶点毁损治疗后，显效17例，有效44例，无效8例，总有效率88．4％。结论立体定向下脑内核团组合多靶点毁损对难治性精神病有明显的治疗作用。     

立体定向多靶点联合毁损术治疗难治性精神病

目的 探讨立体定向多靶点联合毁损术治疗难治性精神病的临床疗效、并发症及其防治.方法 对42例难治性精神病患者,根据各自不同的临床症状,采用MRI定位立体定向手术行双侧扣带回、杏仁核和内囊前肢等多靶点联合毁损,术后复查MRI验证毁损靶点的准确性,并由精神科医生进行密切随访,观察其疗效和并发症.结果 随访时间6～24个月,平均(11.62±4.85)个月,42例均得到随访,恢复5例,显著进步32例,进步4例,无效1例,加重0例;除手术后早期有暂时性并发症外,无远期严重并发症的发生.结论 立体定向多靶点联合毁损术治疗难治性精神病是安全有效的治疗方法 之一.     

立体定向双侧多靶点射频毁损治疗难治性精神分裂症

目的 探讨立体定向双侧多靶点射频毁损治疗难治性精神分裂症的疗效和安全性.方法 采用颅脑MR与CT图像融合定位,对115例难治性精神分裂症患者实施立体定向脑内核团射频热凝毁损手术治疗.结果 115例患者术后2周,显著进步31例(26.96％),进步84例(73.04％),有效率100％,无严重并发症发生.6个月以上随访恢复14例(12.61％),显著进步66例(59.46％),进步27例(24.32％),无效3例(2.70％),有效率97.30％.结论 立体定向脑内核团毁损治疗难治性精神分裂症安全、有效.     

计算机辅助立体定向颅内多靶点毁损治疗难治性精神分裂症临床研究

目的:探讨计算机辅助立体定向技术和颅内多靶点组合毁损对难治性精神分裂症的临床疗效及安全性。方法:选择80例难治性精神分裂症病患者作为研究对象,每例患者均在CT和MRI图像融合技术指导及计算机辅助下,采用杏仁核、伏隔核、内囊前肢、扣带回等多靶点组合射频热凝治疗。按全国精神外科协作组1990年制定的疗效评定方法进行疗效评定。结果:80例患者中,术后2周显著进步36例,进步41例,无效3例,加重0例,总有效率96.25%;术后6个月显著进步43例,进步33例,无效4例,加重0例,总有效率95%;术后无严重并发症和后遗症发生。结论:计算机辅助立体定向颅内多靶点毁损治疗难治性精神病安全有效。     

脑立体定向多靶点联合毁损术治疗难治性癫痫

目的:探讨立体定向多靶点联合毁损术治疗难治性癫痫的靶点组合及疗效。方法:2006年～2011年对32例难治性癫痫患者,采用脑电图、CT、MRI检查等术前综合评估,选择性多靶点组合:双侧杏仁核、胼胝体、扣带束、内囊前肢、海马、F0rel-H、前联合等。立体定向手术后对患者进行随访、疗效评定。结果:癫痫疗效依照谭启富疗效分级标准,本组癫痫发作控制显效率80%。结论:立体定向手术是治疗难治性癫痫一种有效方法,手术可以显著控制癫痫症状,有利于患者恢复社会功能;立体定向多靶点联合毁损术微创、定位准确,可以明显提高手术安全,减少并发症。     

立体定向多靶点治疗难治性精神病术后问题分析

目的：讨论多靶点组合手术治疗难治性精神病术后问题。方法：应用多元化的定位方法和不同组合的多靶点治疗技术治疗难治性精神病86例，对术后发生和应注意的问题进行综合分析。结果：难治性精神病经手术治疗后，显效46例，有效36例，无效4例。术后高热、小便失禁等并发症均为暂时性，术后应配合药物、心理支持等综合手段治疗。结论：多靶点组合的立体定向技术针对难治性精神病是一种有效的治疗方法，但应注意并发症的发生，并结合药物、心理治疗等综合手段进行康复。     

立体定向边缘系统射频消融治疗难治性精神病

目的:探讨CT、MRI图像融合技术引导下立体定向边缘系统内多靶点射频消融治疗难治性精神病的意义。方法:对35例难治性精神病患者在MRI和CT引导下进行图像融合定位处理,于边缘系统内确定手术靶点,行立体定向多靶点射频消融手术。结果:术后随访1～36个月,有效率为91.4%;无严重并发症和后遗症发生。结论:立体定向边缘系统射频消融手术治疗难治性精神病是一种安全、有效的方法,CT、MRI图像融合引导有利于靶点的精确定位,对提高疗效有较大意义。     

立体定位多靶点联合损毁治疗难治性精神分裂症83例分析

目的:探讨选择性双侧多靶点毁损术治疗难治性精神分裂症的疗效。方法:应用脑立体定向技术对83例难治性精神分裂症进行颅内选择性双侧多靶点毁损治疗。结果:83例患者术后随访恢复20例,占24.1%;显著进步41例,占49.4%;进步14例,占16.9%;无变化8例,占9.6%;总有效率为90.4%。BPRS评分术前明显高于术后(P<0.05)。MMSE评定手术前后无显著性差异(P>0.05)。术后无严重并发症和后遗症。结论:立体定位多靶点联合损毁治疗可安全、有效治疗难治性精神分裂症。根据患者个体症状决定相应的多靶点组合,对提高疗效、降低并发症有较大意义。     

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.