气管侧切扩大气管造瘘口预防喉全切除后颈部造瘘口狭窄(附33例报告)

目的：研究预防喉全切除术后气管造瘘口狭窄的方法。方法：33例患者喉全切除后采用改良的造瘘口方法，即将气管残端双侧纵行剪开，长约2cm，于气管造瘘口下方皮肤设计三角形皮瓣，嵌入缝合。结果：所有患者术后3个月均不再带管，亦无造瘘口狭窄，无呼吸困难，生活质量显著改善。结论：这种经改良的气管侧切式造瘘口方法可以很好地预防喉全切除术后气管造瘘口狭窄。     

全喉切除"X"型气管造口成形术

目的 介绍一种新的全喉切除气管造口成形术。方法 ll例患全喉切除后在造口区皮肤做“X”型切口，再在气管环断端另切四个小纵切口．将气管断端与皮肤交错缝合完成造口成形术．结果 所有患均不带管，无呼吸困难．生活质量显改善．结论“X”型气管造口成形完全能避免造口狭窄的发生。     

镍钛合金支架在全喉切除气管造口术应用的临床观察

【目的】观察环行镍钛合金支架在全喉切除术后预防气管造口狭窄的临床疗效。【方法】全喉切除术后，在气管残端放置直径为20mm、高分别为10mm、5mm的环形镍钛合金支架，使支架与气管残端及皮肤融合生长，起到环状软骨样的支撑作用。【结果】Ⅰ期气管造口成形放置支架24例，Ⅱ期放置支架1例；术后随访6～30个月，气管造口成椭圆形，面积均数为190mm^2，变异系数为16．29％，无狭窄发生。【结论】环形镍钛合金支架在气管造口成形中起到了环状软骨样的支撑作用，有效地防止全喉切除术后气管造口狭窄的发生。     

喉全切除术后气管造瘘口狭窄

喉癌是耳鼻咽喉头颈外科常见的恶性肿瘤,喉全切除是治疗中晚期喉癌的最有效办法。喉全切除后要在颈部进行气管造瘘,气管造瘘口狭窄是术后常见的并发症之一,本文就喉全切除术后气管造瘘口狭窄的诊断、病因学及治疗学研究进展作一综述。     

发音钮术后并发气管食管瘘致误咽2例报告

全喉切除是治疗晚期喉癌的方式之一,患者因术后丧失发音能力,给生活带来诸多不便,经气食管安装发音钮是全喉切除术后发音重建的方法之一。１９９１至１９９７年我们对晚期喉癌７２例施行了全喉切除术,其中１２例安装了发音钮０例１年内发音良好,２例并发气管食管瘘口扩大致严重误咽。现报道如下。１　临床资料　　１２例均为男性,４３～６７岁,平均５２岁,术后随访５个月至２年,２例形成气管食管瘘并致误咽,行手术修补。　　例１,男,６４岁。于１９９１年８月行全喉切除术后安装发音钮重建发音,术后１年发音功能丧失,因故患者…     

全喉切除气管食管组织瓣发音功能重建术18例

目的 探讨全喉切除术后发音功能重建的方法。方法采用全喉切除后在气管后壁食管切一下向性组织瓣的方法，形成气管食管瘘口，组织瓣的下端保留3～5mm宽不切断，皮肤造口处采用气管环减张切口皮瓣植入缝合的方法。结果18例中17例发音成功，成功率为94．4％。18例中有13例术后不戴气管套管。结论操作简便，发音成功率高，全部病例无一例出现气管食管瘘。不足之处是患需用手堵住气管造口处进行发音。     

镍钛合金支架在全喉切除气管造口术应用的临床观察

[目的] 观察环行镍钛合金支架在全喉切除术后预防气管造口狭窄的临床疗效.[方法] 全喉切除术后,在气管残端放置直径为 20 mm、高分别为 10 mm、 5 mm的环形镍钛合金支架,使支架与气管残端及皮肤融合生长,起到环状软骨样的支撑作用.[结果] Ⅰ期气管造口成形放置支架 24例,Ⅱ期放置支架 1例;术后随访 6～ 30个月,气管造口成椭圆形,面积均数为 190 mm2,变异系数为 16.29%,无狭窄发生.[结论] 环形镍钛合金支架在气管造口成形中起到了环状软骨样的支撑作用,有效地防止全喉切除术后气管造口狭窄的发生.     

镍钛合金支架在预防和治疗全喉切除气管造口狭窄中的应用

目的：探索一种预防和治疗全喉切除后气管造口狭窄的方法。方法：在全喉切除气管造口成型或术后造口狭窄再成型时安放环形网状气管造口支架。结果：喉癌术时安放支架气管造口成型（I期）5例；喉癌术后发生造口狭窄，再行气管造口成型（Ⅱ期）1例，全部治愈，造口呈椭圆形，满足呼吸需要。随访6个月，造口形态稳定，无狭窄发生。结论：环形网状气管造口支架时造口有明显的支撑作用，可以预防或治疗全喉切除气管造口狭窄。     

镍钛合金支架在预防和治疗全喉切除气管造口狭窄中的应用

[目的]探索一种预防和治疗全喉切除后气管造口狭窄的方法.[方法]在全喉切除气管造口成型或术后造口狭窄者再成型时安放环形网状气管造口支架.[结果]喉癌术时安放支架气管造口成型(Ⅰ期)5例;喉癌术后发生造口狭窄,再行气管造口成型(Ⅱ期)1例,全部治愈,造口呈椭圆形,满足呼吸需要.随访6个月,造口形态稳定,无狭窄发生.[结论]环形网状气管造口支架对气管造口有明显支撑作用,可以预防或治疗全喉切除气管造口狭窄.     

全喉切除术的气管造口改良48例

目的：为简化全喉切除术，减少戴管时间，对全喉切除气管造口进行改良。方法：①不切断甲状腺峡部，②气管旁不作游离，③切口皮肤直接与气管缝合。结果：经统计学处理，秩和检验，保留环状软骨者，μ＝４．６１，Ｐ〈０．０１，戴管时间两组有显著性差异。切除环状软骨者，μ＝７．６７，Ｐ〈０．０１，两组有显著性差异。结论：改良后手术简单，戴管时间缩短。     

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.     

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.     

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.