复杂性视网膜脱离的玻璃体视网膜手术治疗

目的　探讨玻璃体切除 ( parsplanavitrectomy ,PPV)联合硅油填充治疗复杂性视网膜脱离 (retinaldetach ment ,RD)的方法、疗效及并发症。方法　 41例 41眼复杂性RD ,行三切口经睫状体平坦部玻璃体切除术联合硅油填充。术中 9眼行裂孔边缘光凝 ,直视下冷疑者 11眼 ,2例晶体切除。结果　术后出院视力均优于术前 ,视网膜全部复位 3 7眼 ,下方局限性脱离 2眼 ,失败 2眼。结论　PPV联合硅油填充治疗复杂性RD有较好的疗效 ,提高了复明率     

重硅油填充治疗下方视网膜脱离的疗效

目的观察重硅油填充治疗下方视网膜脱离的临床效果。方法回顾性分析收治的24例24眼下方视网膜脱离患者,有裂孔者位于3～11点。均采用玻璃体切除和重硅油填充术,术中依病情需要联合膜剥离、视网膜切开、重水应用、眼内激光、白内障超声乳化及人工晶体植入、普通硅油取出术等。观察术后视网膜复位、视力、眼压及并发症情况。结果随访2～13个月,平均(6.3±3.28)个月。手术后2周视网膜均复位(100%),末次随访初次手术复位21眼(87.5%),二次手术复位22眼(91.7%)。术后最佳矫正视力与术前比较差异有统计学意义(t=3.07,P<0.05)。其中17眼(70.8%)最佳矫正视力提高,13眼(54.2%)在0.05以上。并发白内障100%(除3眼无后囊外);11眼(45.8%)术后高眼压;9眼(37.5%)术后并发增殖膜;重硅油乳化和角膜变性率较低,分别为3眼(12.5%)和1眼(4.2%)。结论重硅油作为眼内填充物治疗合并下方视网膜脱离者效果较好,主要并发症有白内障、高眼压和增殖膜。     

孔源性视网膜脱离玻璃体切割术后脉络膜厚度的相关研究

目的 应用光学相干断层扫描成像(optical coherence tomography,OCT)观察孔源性视网膜脱离(rhegmatogenous retinal detachments,RRD)玻璃体切割(pars plana vitrectomy,PPV)术后黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SCT)的变化及其对视力预后的影响。方法 回顾性病例分析,收纳2016年至2019年就诊于保定市第一中心医院RRD行PPV术后成功复位者,共63例63只眼纳入研究,同时取对侧健眼为正常对照组。所有受检者行23 G PPV联合硅油眼内填充;均于PPV术后3个月行硅油取出术。分别于PPV术前和硅油取出术后3 d、3个月行logMAR最佳矫正视力(best corrected visual acuity,BCVA)、裂隙灯显微镜、间接检眼镜、彩色眼底照相、OCT检查,观察BCVA、SCT和黄斑区微结构改变,同时分析SCT变化与术后BCVA的相关性。结果 RRD组硅油取出术后3 d、3个月,患眼logMAR BCVA分别为0.56±0.20、0.39±0.18;较手术前(0.81±0.39)明显改善,差异有统计学意义(F=42.663,P<0.05)。术前BCVA与术后3个月BCVA呈正相关(r=0.732,P<0.05)。硅油取出术后3 d RRD组SCT(303.32±25.68)μm,与术前及硅油取出术后3个月比较,差异有统计学意义(t=3.658、4.027,P<0.05)。 硅油取出术后3个月SCT(272.02±17.11)μm,与术前比较,差异无统计学意义(t=2.071,P=0.093)。相关性分析结果显示,RRD患者SCT与BCVA无关(r=-0.023、-0.31,P=0.569、0.784)。结论 孔源性视网膜脱离复位术后早期SCT增加,后期逐渐下降,且变化与术后BCVA无相关性。     

影响硅油取出结果诸因素的临床分析

目的 阐明硅油取出后与视网膜脱离和视力下降有关的各种危险因素。方法 对行硅油取出术的94眼进行回顾性研究。结果 有19眼(20％)术后出现视网膜脱离，30眼(32％)视力减退。术前及术后低眼压、术后视网膜前膜、初发病变为视网膜巨大裂孔及复发性视网膜脱离、初始视力低于0.02等因素是对视网膜解剖复位及视力有影响的危险因素。结论 在用硅油填充等手段治疗视网膜巨大裂孔或复发性视网膜脱离时，特别是当初始视力低于0.02时，医生和患者都应清楚治疗结果不理想的可能性很大。     

玻璃体切除术联合硅油充填治疗高度近视黄斑裂孔性视网膜脱离25例分析

目的探讨玻璃体切除手术联合硅油填充治疗高度近视性黄斑裂孔的疗效和经验。方法25例(25眼)高度近视黄斑裂孔性视网膜脱离患者,行玻璃体切除术联合硅油充填治疗,观察黄斑裂孔闭合情况。结果23眼黄斑裂孔闭合,视网膜脱离达到解剖复位,成功率为92%,成功病例视力均有不同程度提高。术后并发高眼压3例,白内障6例,硅油乳化1例。结论玻璃体切除术联合硅油充填是治疗高度近视性黄斑裂孔的有效方法。     

硅油眼内填充治疗复杂性视网膜脱离

目的 观察硅油眼内填充治疗复杂性视网膜脱离的临床效果。方法 回顾性研究45例(46眼)复杂性视网膜脱离病例，视网膜脱离伴严重增殖性玻璃体视网膜病变23眼(D1级5眼，D2级6眼，D3级12眼)．其中6眼单纯巩膜扣带术后未复位，巨大裂孔4眼，伴巩膜后葡萄肿的黄斑裂孔4眼，糖尿病视网膜病变Ⅵ期6眼。眼外伤增殖性玻璃体视网膜病变致牵拉性视网膜脱离9眼。行闭合式玻璃体手术硅油眼内填充，联合巩膜扣带术治疗。结果 术后随访3～24个月，43眼获解剖复位，成功率93．5％。成功病例视力均有不同程度提高。术后并发症高眼压6眼，白内障5眼，硅油乳化1眼。结论 玻璃体手术眼内硅油填充治疗复杂性视网膜脱离可明显提高手术成功率，用5000cps以上的硅油可减少并发症发生。     

玻璃体视网膜手术联合硅油填充治疗复杂性玻璃体视网膜病变

目的探讨玻璃体视网膜手术(VR术)联合硅油填充治疗复杂性玻璃体视网膜病变的临床效果.方法对采用VR术联合硅油填充治疗102例(102只眼)复杂性玻璃体视网膜病变患者进行临床分析.结果术后近期视网膜复位97眼(95.1%);91眼随访3～23月,平均13.3月,最终视网膜复位81眼(88.9%).术后最终视力提高78眼(85.7%);0.05以上视力43眼(47.3%).术中主要并发症是医源性裂孔(8眼,7.8%);术后主要并发症分别是白内障(41眼,45.1%)、继发性青光眼(13眼,14.3%)和视网膜脱离(10眼,11%).结论 VR术联合硅油填充是治疗复杂性玻璃体视网膜病变的有效方法.     

玻璃体视网膜手术治疗复杂性外伤性视网膜脱离113例分析

目的探讨玻璃体视网膜手术(vitreoretinal surgery,VRS)治疗复杂性外伤性视网膜脱离的疗效。方法回顾性分析2002年2月~2005年5月行VRS联合过氟化碳液体、视网膜切开和硅油填充术等技术治疗的复杂性外伤性视网膜脱离(retinal detachment,RD)113例(113只眼)。结果视网膜完全解剖复位102只眼,部分复位5只眼,失败6只眼,总有效率94.7%。术后视力提高者81只眼(70.8%);0.01以上视力69只眼(61.6%);≥0.1视力16只眼(14.3%)。结论通过VRS联合过氟化碳液体、视网膜切开和硅油填充术等技术能重建外伤眼球,复位视网膜,并可恢复视力。     

先天性脉络膜缺损合并视网膜脱离的玻璃体视网膜手术6例分析

目的　评价玻璃体视网膜手术在治疗先天性脉络膜缺损合并视网膜脱离中的效果。方法　 6例 ( 6只眼 )先天性脉络膜缺损合并视网膜脱离患者均采用经睫状体平坦部的三切口闭合式玻璃体手术 ,其中 3只眼填充硅油 ,3只眼填充C3F8。结果　所有 6只眼视网膜均解剖复位 ,术后 4只眼视力提高 ,2只眼同术前视力 ,平均随访时间 3 .6个月 ( 1月— 12月 )。结论　玻璃体视网膜手术联合硅油或C3F8填充术是目前治疗先天性脉络膜缺损合并视网膜脱离的有效方法     

松弛性视网膜切开术治疗复杂性视网膜脱离21例的体会

目的探讨松弛性视网膜切开治疗复杂性视网膜脱离的疗效。方法对21例（21眼）复杂性视网膜脱离患者行松弛性视网膜切开联合眼内光凝和硅油填充术治疗：观察术后视网膜解剖复位、视功能改善情况。结果出院时21例患者均视网膜解剖复位。随访3～18个月,平均8个月;随访期间解剖复位16例占76．2％,视力提高17例占80．9％,其中视力恢复〉0．02者8例占38％,最好视力0．08。结论松弛性视网膜切开术治疗复杂性视网膜脱离可提高其解剖复位率,是治疗复杂性视网膜脱离的有效方法之一。     

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.