复杂开放性眼外伤Ⅰ期修复的临床意义

目的 探讨复杂开放性眼外伤显微手术Ⅰ期修复的重要性.方法 2004年1月～2006年12月收治复杂开放性眼外伤患者89例(均为单眼受伤).89眼均行Ⅰ期显微手术修复,其中43眼行Ⅱ期手术.回顾Ⅰ期手术修复的效果,并就伤眼Ⅰ期手术修复质量与Ⅱ期手术术后视力恢复状况进行相关性分析.结果 复杂开放性眼外伤Ⅰ期手术修复或行Ⅱ期手术后,伤眼视力均较手术前明显提高(P＜0.01),分别为0.43±0.39 vs 0.21±0.32和0.36±0.25 vs 0.03±0.03;伤眼Ⅰ期修复质量与其Ⅱ期手术术后视力恢复显著相关(r=0.274,P＜0.05).结论 对于复杂开放性眼外伤,Ⅰ期显微手术的修复质量及Ⅱ期手术时机的准确把握,对伤眼的预后至关重要.     

41例眼球开放性外伤的手术治疗

目的探讨开放性眼球外伤手术治疗的方法及临床效果。方法41例复杂性眼外伤Ⅰ期均行角巩膜创口清创缝合术,同时Ⅰ期或Ⅱ期联合白内障摘除、眼内异物摘除、玻璃体切割手术。结果术后矫正视力提高者31眼(75.61%),视力无提高者6眼(14.63%)。术中眼内异物取出成功率达100%。结论严重眼球外伤治疗中,Ⅰ期手术修复是提高伤眼视力和决定后续治疗的关键,Ⅱ期手术治疗是提高临床效果的手段。     

穿通性眼外伤合并外伤性白内障行Ⅰ期和Ⅱ期白内障手术的临床疗效比较

目的：比较穿通性眼外伤合并外伤性白内障行Ⅰ期和Ⅱ期白内障手术的临床疗效。方法选取重庆市第九人民医院眼科2012年8月~2014年3月进行手术的穿通性眼外伤合并外伤性白内障患者80例（80眼）,将其分为Ⅰ期组和Ⅱ期组,其中I期组40例（40眼）,予以角巩膜伤清创缝合+伤后2 d内Ⅰ期外伤性白内障摘除+人工晶状体植入术;Ⅱ期组40例（40眼）,予以角巩膜伤清创缝合+术后1~2个月Ⅱ期外伤性白内障摘除+人工晶状体植入术。随访并记录Ⅰ期白内障和Ⅱ期白内障摘除不同干预下的视力、眼压、术后反应等,比较两者的远期疗效。结果两组组内治疗前、后比较,伤眼视力>0.6的比例均明显上升（Ⅰ期组治疗前、后为5.0%、37.5%,Ⅱ期组治疗前、后为7.5%、42.5%）,伤眼视力<0.3的比例均明显下降（Ⅰ期组治疗前、后为67.5%、30.0%,Ⅱ期组治疗前、后为67.5%、22.5%）,眼压改善也较为明显[Ⅰ期组治疗前、后为（32.9±3.4）、（25.7±3.1）mmHg,Ⅱ期组治疗前、后为（33.7±2.9）、（21.5±1.4）mmHg],差异均有统计学意义（P<0.05）;两组组间治疗前、后比较,差异均无统计学意义（P>0.05）。Ⅱ期组继发性青光眼（10.0%）、脉络膜脱离（7.5%）、角膜及虹膜炎性反应（12.5%）、后囊混浊（42.5%）、睫状体脱离（22.5%）的发生率明显低于Ⅰ期组（37.5%、17.5%、25.0%、42.5%、22.5%）,差异有统计学意义（P<0.05）。Ⅱ期组患者较Ⅰ期组患者前房深度增加[（3.40±0.20）比（1.75±0.11）mm],泪膜破裂时间（BUT）评分升高[（8.77±0.23）比（5.92±0.17）分],角膜荧光染色评分降低[（0.76±0.04）比（1.98±0.17）分],差异均有统计学意义（P<0.05）。结论穿通性眼外伤合并外伤性白内障行Ⅰ期和Ⅱ期白内障手术均能有效提高视力、预防眼压升高（继发于外伤的青光眼）;若角巩膜伤清创缝合术后1~2个月行外伤性白内障摘除+人工晶状体植入术（即Ⅱ期行外伤性白内障手术）,更能有效恢复患者的视力,降低眼内压,术后并发症少,安全性高,较伤后2d内行白内障摘除（即Ⅰ期手术）远期效果好。     

开放性眼外伤在基层医院的处理体会

目的 探讨基层医院处理开放性眼外伤的方法及意义.方法 对65例(65只眼)开放性眼外伤住院患者的处理方法进行回顾分析.结果 4只眼非手术治疗;61只眼手术治疗,其中4只眼修复伤口后及时转院,1只眼行眼球摘除术.所有病例中视力提高51只眼,无提高9只眼,最终无光感2只眼.结论 基层医院是开放性眼外伤主要首诊场所,首次处理是否得当对伤眼的预后有直接关系.基层眼科医生掌握显微手术技术及具备扎实的专业知识是做好开放性眼外伤首诊处理的关键.     

二级医院开放性眼外伤的急诊诊治体会

目的 探讨在二级医院急诊处置开放性眼外伤的方法及意义.方法 对73例(73眼)开放性眼外伤的急诊住院诊治进行回顾性分析.结果 6眼非手术治疗,67眼手术治疗,其中18眼修复伤口后及时转院,1眼行眼球摘除术.所有病例随访半年后视力提高66眼,无提高5眼,最终无光感1眼.结论 二级医院眼科是开放性眼外伤主要首诊场所,首次处理是否得当与伤眼的预后有直接关系.二级医院眼科医生掌握显微手术技术及具备扎实的专业知识是做好开放性眼外伤急诊诊治的关键.     

开放性眼外伤急诊手术临床分析

目的:分析开放性眼外伤急诊手术过程。方法:对我院2004年1月～2011年6月在我院住院治疗31例(31眼)开放性眼外伤患者的临床资料进行回顾性分析。结果:31例开放性眼外伤患者急诊进行清创缝合手术,其中3例行眼内容物剜除术,2例行球内磁性异物取出术,2例行前段玻璃体切割术,31例伤口达1期愈合。结论:开放性眼外伤,在伤后尽快进行正确的伤口处理,早期应用抗生素预防感染,能够使伤眼获得一定的视力。因此开放性眼外伤1期处理水平直接决定伤眼的预后。     

复杂眼外伤合并球内异物的玻璃体手术治疗体会

目的探讨玻璃体手术在复杂眼外伤合并球内异物中的临床效果。方法 33例33眼,经术前CT和（或）B超定位,行玻璃体切除、角巩膜裂伤缝合、晶状体切除、复杂视网膜脱离复位、激光光凝、巩膜外冷凝、球内注药、硅油或C3F8球内注入等手术方法,治疗复杂眼外伤所致球内异物。观察伤眼视力和外伤恢复情况。结果 33例33眼均一次手术成功取出异物。术后视力提高25眼（占76%）,视力无改变6眼（占18%）,视力下降2眼（占6%）。结论玻璃体手术在治疗复杂眼外伤所致球内异物中具有临床优越性。伤眼的视力恢复取决于损伤部位、手术时机、有无严重并发症等。     

角巩膜破裂修复联合白内障摘出人工晶状体植入术

目的 探讨角巩膜破裂修复联合外伤性白内障或眼内异物摘出术及人工晶状体植入术三联或四联手术治疗复杂性眼外伤的手术方法及其疗效。方法 回顾性分析35例复杂性眼外伤施行此联合手术的效果及并发症。结果 35例伤眼术后伤口均愈合良好，无严重并发症，术后视力恢复满意。结论 联合手术能及时、有效地修复角巩膜破裂及恢复伤眼视力，缩短病程，是治疗复杂性眼外伤的有效方法。     

基层医院治疗开放性眼外伤20年回顾分析

目的探讨开放性眼外伤在基层医院的治疗。方法收集我院1989年1月～2009年12月收治的开放性眼外伤429例(432眼)的临床资料,分为开展显微手术前和开展显微手术后两阶段,进行回顾性分析。结果本组病例429例(435眼),第一阶段(1988年～1998年开展显微手术前)156眼,治疗后视力0.05者107眼(68.59%);第二阶段(1999年～2009年开展显微手术后)276眼,治疗后视力0.05者82眼(29.71%)。结论开放性眼外伤因伤情复杂易致盲,而手术器械设备以及手术技术的限制,也曾经是眼外伤的致盲率高居不下的因素。基层医院开展眼科显微技术,对于开放性眼外伤的治疗,最终降低致盲率,有重要意义。     

玻璃体切除术治疗眼内异物的临床应用

目的探讨玻璃体切除手术治疗眼内异物的临床应用。方法对我院2008年3月～2011年3月收治的22例22眼眼内异物经术前CT和(或)B超定位,行玻璃体切除、角巩膜裂伤缝合、晶状体切除、复杂视网膜脱离复位、激光光凝、巩膜外冷凝、球内注药、硅油或C3F8球内注入等手术方法治疗眼外伤所致球内异物。观察伤眼视力和外伤恢复情况。结果 20例20眼均一次手术成功取出异物,2例2眼手术未能取出异物转上级医院治疗。术后视力提高14眼(占63.6%),视力无改变6眼(占27.3%),视力下降2眼(占9.1%)。结论玻璃体切除手术是治疗眼球内异物最好方法之一,伤后及时诊断手术,可有效恢复伤眼的视力,治疗并发症。     

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.