糖尿病性白内障术中前房注射曲安奈德的临床研究

目的：探讨糖尿病性白内障术中前房注射曲安奈德的临床效果。方法：采用随机对照的方法,将80例糖尿病性白内障随机分为两组,实验组41例,采用小切口白内障摘除人工晶体植入术,术毕前房注入曲安奈德2 mg;对照组39例,术式同实验组,术毕前房不注入曲安奈德。观察术后角膜水肿、角膜内皮细胞密度、前房渗出、后囊混浊,眼压并发症等情况。结果：两组角膜水肿、前房渗出、房水闪辉、后囊混浊与对照组相比较有统计学意义（P〈0.05）,眼压、角膜内皮细胞密度、瞳孔黏连无统计学意义（P〉0.05）。结论：术中前房注射曲安奈德可以有效地减少糖尿病性白内障患者术后并发症的发生,临床效果稳定可靠。     

术中前房注射曲安奈德在糖尿病性白内障中的应用

目的探讨术中前房注射曲安奈德在糖尿病性白内障中的应用。方法选取2012年1月～2018年2月眼科住院治疗的糖尿病性白内障患者72例(72眼),知情同意后采用抛硬币法分成曲安奈德组(n=36)和对照组(n=36)。两组均在在表面麻醉下行超声乳化白内障联合人工晶状体植入术,曲安奈德组术中侧切口注入1 mg曲安奈德和复方平衡盐溶液以维持前房。对照组按常规方法注入复方平衡盐溶液以形成维持前房。观察并比较两组术后角膜水肿、瞳孔粘连、前房纤维蛋白渗出及后囊浑浊的发生率。结果曲安奈德组术后角膜水肿发生率低于对照组(χ~2=4.50,P0.05)。两组术后瞳孔粘连发生率相接近(χ~2=0.26,P0.05)。曲安奈德组术后前房轻、中、重度渗出总发生率低于对照组(χ~2=6.77,P0.01)。曲安奈德组术后后囊浑浊的发生率低于对照组(χ~2=4.13,P0.05)。结论术中前房注射曲安奈德在糖尿病性白内障中的应用效果较确切,能显著减轻术后角膜水肿和前房纤维蛋白渗出,降低后囊浑浊的发生率。     

曲安奈德在初学小切口白内障手术中的应用体会

目的：观察曲安奈德在初学小切口白内障手术中的作用。方法对45例（45眼）白内障患者行白内障囊外摘除+人工晶状体植入术,截囊前向前房内注入曲安奈德,娩核后观察：后囊完整的36例36眼行常规小切口白内障囊外摘除术+人工晶状体植入术;伴有后囊破裂并玻璃体脱入前房的9例9眼,在曲安奈德染色辅助下彻底清除前房内的玻璃体后行前段玻璃体切割术+人工晶状体植入术。术后观察角膜情况、前房内炎症反应、眼压变化、黄斑水肿情况、视力等。结果45例患者术后有9例角膜水肿,所有患者前房清亮,无炎症反应,无不可耐受的眼压升高,检眼镜下未见明显的黄斑水肿。结论初学小切口白内障手术中使用曲安奈德,可以提高手术的可视性和安全性,抑制术后炎症反应,减少近期及远期并发症,视力预后较好。     

并发性白内障术中前房注射曲安奈德的应用

目的报道并发性白内障术中前房注射曲安奈德的效果及安全性。方法对45例葡萄膜炎并发性白内障行白内障摘除人工晶体植入术在术中于前房内注射曲安奈德2mg,观察术后前房渗出情况、角膜水肿情况、眼压等。结果全部病人无高眼压,无重度前房渗出,曲安奈德在前房平均存留4天,术后1个月44.44%的病人视力≥0.5。结论前房注射曲安奈德可减轻葡萄膜炎并发性白内障人工晶体植入术后前房渗出,是一种安全有效的方法。     

糖尿病患者白内障术后的临床观察

目的 观察糖尿痛患者行小切口白内障摘除加人工晶状体植入术后的手术效果和并发症,探讨糖尿病患者白内障术后视力的影响因素.方法 对38例50眼糖尿病患者行小切口白内障摘除加人工晶状体植入术,同时随机抽取同期行此术式的常规老年性白内障患者(对照组)35例50眼.随访3个月,观察两组患者术后1周及3个月时的最佳矫正视力及眼前段并发症的发生情况,包括角膜内皮水肿、前房纤维蛋白渗出、前房少量出血、虹膜后粘连、眼压升高、晶状体后囊浑浊.结果 无论是术后1周还是术后3个月,糖尿病组的总体最佳矫正视力均低于对照组,且差异有统计学意义(术后1周χ2=8.579,P=0.0034;术后3个月χ2=5.915,P=0.015).术后眼前段并发症中,角膜水肿及眼压升高的发生率高于对照组,但两者比较差异无统计学意义(角膜水肿χ2=1.515,P＝0.2184;高眼压χ2=1.7778,P=0.1824).糖尿病组前房纤维素渗出及虹膜后粘连的发生率均明显高于对照组,两者比较差异有统计学意义(前房纤维素渗出χ2=4.332,P=0.0374;虹膜后粘连χ2=4.000,P=0.0455).两组术后3个月内晶状体后囊膜浑浊的发生率差异无统计学意义(χ2=0.3788,P=0.5383).结论 糖尿病患者术后1周及3个月视力均低于对照组.糖尿病患者,行白内障术后眼前段并发症的发生率高于老年性白内障,糖尿病视网膜病变的严重程度是影响糖尿病患者术后视力的主要原因.     

糖尿病患者白内障摘除联合人工晶体植入术的临床观察

目的 探讨糖尿病患者白内障摘除联合后房型人工晶体植入术的疗效及并发症。方法 对90例（112只眼）糖尿病白内障患者施行ECCE＋IOL植入术。结果 术后视力≥O．3者占7％。并发症包括：角膜内皮水肿45眼（40％），前房纤维索性渗出膜13眼（11．7％），晶体表面色素沉着8眼（7．1％），前房出血2眼（1．9％），后囊浑浊6眼（5．4％）。晶状体后囊破裂5眼（4．5％）。结论 对糖尿病患者血糖控制稳定的情况下施行ECCE＋IOL植入术，疗效满意，术后并发症少。     

糖尿病患者白内障超声乳化吸除术临床分析

目的分析糖尿病患者白内障超声乳化吸除术的疗效和安全性。方法对28例（34眼）合并糖尿病的白内障表麻下行超声乳化吸除联合人工晶体植入术。结果术后视力≥0．3者28眼,占82．3％,其中≥0．8者6眼,≥0．1者4眼,占11．8％,〈0．1者2眼,占5．9％;术后确诊糖尿病视网膜病变24眼,占70．6％,其中单纯型18眼,增殖型4眼;行激光光凝者6眼,占17．6％。主要并发症：角膜内皮水肿12眼,占35．3％;后囊破裂4眼,占11．8％;前房纤维素性渗出膜形成2眼,占5．9％;前房出血1眼,占2．9％。无1例出现感染性眼内炎。结论糖尿病患者行白内障超声乳化吸除术疗效满意,并发症少,术后视力恢复情况与眼底病变相关联。     

超声乳化摘除联合人工晶状体植入术中前房注射曲安奈德对复杂性白内障疗效的影响

目的 观察复杂性白内障超声乳化摘除联合人工晶状体植入术中前房注射曲安奈德的有效性及安全性.方法 选取2013年6月至2015年6月安徽省第二人民医院收治的复杂白内障患者79例(79只眼),按随机数字表法分为观察组(40例)和对照组(39例),观察组40例(40眼)在植入人工晶体置换前房玻璃酸钠后,前房内注入曲安奈德2 mg/0.1 mL,对照组39例(39眼)前房注入平衡液0.1 mL.观察两组患者前房炎症反应及渗出、眼压、角膜内皮计数情况,随访至术后3个月观察各组是否出现虹膜后粘连及人工晶体前膜等并发症.结果 观察组术后3天、7天、2周前房反应低于对照组,差异均有统计学意义(x23d=18.89,x27d=23.75,x22w=16.08,P＜0.05).术后角膜内皮计数,两组比较差异无统计学意义(F=0.32,P＞0.05),术后两组眼压升高,但差异无统计学意义(F=3.23,P＞0.05),随访至术后3个月,对照组出现人工晶体前膜及虹膜后粘连5例,观察组未出现此类并发症.结论超声乳化摘除联合人工晶状体植入术中,前房注射曲安奈德(2 mg/0.1 mL)可抑制复杂性白内障术后前房炎症及渗出,减少术后并发症的发生,疗效稳定,对眼压及角膜内皮无明显影响,给药简单,安全有效.     

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。     

后Tenon’s注射曲安奈德治疗视网膜静脉阻塞黄斑水肿

目的评价后Tenon’s注射曲安奈德治疗视网膜静脉阻塞（retinl vein occlusion,BVO）黄斑水肿（macular edema,ME）的疗效和安全性。方法对23例（28眼）BVO所致ME患者行后注射曲安奈德40mg,于术前和术后不同时间检查视力、眼压、眼底、眼底荧光血管造影（funds fluorescein angiography,FFA）等检查。结果术后5只眼（1786％）视力改善,14只眼（50％）视力无变化,和术前相比差异有显著性。治疗后19只眼（82．1％）患者黄斑水肿明显减轻。术后2月平均眼压升高,和术前相比差异有显著性。所有患者除眼压升高外,无其他并发症发生。结论后Tenon’s注射曲安奈德是一种治疗视网膜静脉阻塞所致黄斑水肿的有效、安全手段。     

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.