泡状视网膜脱离的临床特征分析

目的:通过分析大泡状视网膜脱离(RD)的临床、眼底血管造影及光学相干断层扫描特征,进一步明确病因,减少误诊,指导临床诊断与治疗。方法:回顾性研究5例(7只眼)泡状视网膜脱离的眼底荧光血管造影(FFA)、吲哚青绿血管造影(ICGA)及光学相干断层扫描(OCT)等特征,分析其改变。结果:①FFA:5例(7只眼)均发现后极部多处色素上皮脱离(PEDS)病灶所致的荧光渗漏点,晚期该渗漏部分融合,并向神经上皮下渗漏。②ICGA早期可见脉络膜动脉充盈不良,其邻近的脉络膜静脉及毛细血管扩张成强荧光,中晚期可见多发性色素上皮脱离及渗漏点。③OCT:视网膜神经上皮呈穹窿状隆起,下方为低反射暗区,其中可见色素上皮脱离腔。结论:大泡状视网膜脱离存在脉络膜循环障碍,脉络膜血管的高渗透性可能是本病的基本病理改变,而视网膜色素上皮病变是继发性改变,该病可能是一种重型中心性浆液性脉络膜视网膜病变,临床可参考相应的治疗。     

光学相干断层扫描对照眼底荧光造影在中心性浆液性视网膜病变中的应用

目的:探讨光学相干断层扫描(OCT)和眼底荧光血管造影(FFA)在中心浆液性视网膜脉络膜病变(CSC)诊治和疗效观察方面的作用。方法:对28例(36眼)的CSC患者进行OCT及FFA检查。结果:28例(36眼)经FFA确诊的CSC患者渗漏点45个,其中6眼(13个渗漏点)在OCT图像上显示为神经上皮浆液脱离,2眼(2个渗漏点)为色素上皮脱离,20眼(35个渗漏点)表现为神经上皮层伴色素上皮层脱离。结论:利用OCT并FFA检查不但能定量、定性检查CSC患者,还能准确定位渗漏点,两者互为补充,准确有效指导激光治疗和随诊。     

光相干断层扫描检查在中心性浆液性脉络膜视网膜病变中的应用

目的探讨光相干断层扫描（OCT）在检测中心性浆液性脉络膜视网膜病变（CSC）中的应用价值。方法对60例（60眼）经眼底荧光血管造影（FFA）诊断为单眼初发的CSC患者进行时域OCT检查,观察其形态学特征,并对病变图像进行定量测量和分析。其中34例（34眼）在恢复期行OCT复查,对比分析发作期与恢复期视力及黄斑中心凹视网膜厚度的定量测量结果。采用直线相关法对视网膜浆液性脱离区各参数与视力进行相关性分析。结果（1）FFA检查结果：单纯视网膜神经上皮脱离51眼（2眼经OCT检查证实为视网膜神经上皮合并色素上皮脱离）,单纯视网膜色素上皮脱离4眼,视网膜神经上皮合并色素上皮脱离3眼．其他2眼（经OCT检查证实为单纯视网膜色素上皮脱离）。（2）OCT检查结果：单纯视网膜神经上皮脱离49眼,单纯视网膜色素上皮脱离6眼,神经上皮合并色素上皮脱离5眼。（3）恢复期患者视力较发作期患者有所提高,但并无统计学意义（P〉0.05）;而恢复期黄斑中心凹视网膜厚度显著薄于发作期（P〈0．01）。（4）视力与神经上皮浆液性脱离水平横径、垂直纵径、高度及中心凹6mm范围内容积均显著相关fP〈0．01）,与黄斑中心凹视网膜厚度、色素上皮脱离范围无明显相关性（P〉0.05）。结论OCT能够无创伤性地在活体上观察CSC视网膜组织形态学改变,可明确应用于CSC的临床分型及视力的预后评估。     

中心性浆液性脉络膜视网膜病变频域光学相干断层扫描

目的:探讨中心性浆液性脉络膜视网膜病变(CSC)形态学改变及其发病机制。方法:回顾性横断面观察研究,对43例(49眼)CSC患者进行FFA和频域光学相干断层扫描(SD-OCT)检查,并将两者结果对比观察。结果:呈典型FFA表现21只眼,OCT扫描均发现神经上皮脱离或色素上皮脱离或两者皆有。其中FFA中未发现任何异常荧光部位5只眼,在OCT中却可见局部色素上皮光带粗糙和小隆起。FFA中呈不典型的渗漏表现23只眼中,OCT扫描也发现神经上皮脱离或色素上皮脱离或两者皆有,其中局部视网膜色素上皮光带粗糙和小隆起表现8只眼。FFA中未见任何异常荧光的5只眼,其中OCT扫描却发现有只眼呈局限性浆液性神经上皮浅脱离,即视网膜的隐性渗漏。结论:CSC的发病机制可能为脉络膜循环障碍继发RPE损害。SD-OCT对FFA诊断和研究CSC有很好的补充甚至是替代作用。     

中心性浆液性脉络膜视网膜病变诊治研究

中心性浆液性脉络膜视网膜病变(CSC)是一种自限性疾病,部分患者易复发,病程迁延,对视力影响显著。眼底照相、眼底荧光血管造影(FFA)、光学相干断层扫描(OCT)、吲哚青绿脉络膜造影(IGGA)、眼电生理等先进的检查手段的应用,对CSC的诊断与治疗提供了理论依据。中医谓"视瞻昏渺",多认为与肝脾肾功能失调有关。中医药及针灸治疗可调和阴阳,气血调和,机体功能恢复,通络开窍,进而改善大脑的缺血缺氧状况,增加脑血流量,提高脑部血液循环功能。     

中心性浆液性脉络膜视网膜病变的吲哚青绿和荧光素血管造影图像对比分析

中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy，CSC)常见于20～40岁的男性患者，典型症状表现为后极部视网膜神经上皮层的局限性浆液性脱离，眼底荧光血管造影(fundus fluorescein angiography，FFA)证实这种视网膜脱离起源于视网膜色素上皮(retinal pig—     

经瞳孔温热疗法治疗中心性浆液性脉络膜视网膜病变临床观察

目的:评价经瞳孔温热疗法(TTT)对于中心性浆液性脉络膜视网膜病变(CSC)的治疗效果.方法:将40例经眼底血管荧光造影确诊为CSC患者中的20例20只眼采用TTT作为治疗组,20例20只眼中药治疗作为对照组.观察两组治疗后在视物变形、视力、中心视野、光学相干断层扫描(OCT)、荧光素眼底血管造影(FFA)等变化及与疗程的关系,并进行统计分析.结果:TTT治疗后能够全面改善CSC引起的各项主、客观指标,大多数病例在治疗后2周时已有明显改善,在8周的观察期内各项指标基本恢复正常,最为重要的视网膜荧光素渗漏和视网膜神经上皮脱离两项指标恢复尤其理想.未发现视力、视野损害、继发性新生血管等可能的并发症.而且TTT在进一步缩短病程方面明显优于口服健脾利水中药.结论:结果证明了TTT治疗CSC的有效性和安全性,完全可以替代传统的视网膜激光光凝术用于CSC的治疗.     

中心性浆液性脉络膜视网膜病变同步造影中眼底血管充盈状态的探讨

目的观察和分析中心性浆液性脉络膜视网膜病变（centeral serous chorioretinopathy,CSC）患者荧光素钠和吲哚青绿眼底血管同步造影中脉络膜、视网膜血管的早期充盈特点。方法用海德堡眼底血管造影仪对23例CSCR患者行荧光素眼底血管造影（FFA）和吲哚青绿眼底血管造影（ICGA）,并分别观察FFA和ICGA中视网膜、脉络膜动脉的充盈时间。结果23例患者（23眼）眼底血管的早期充盈状态有两种形式：12例患者脉络膜动脉的充盈在ICGA中早于视网膜中央动脉,在FFA中却晚于视网膜中央动脉;11例患者脉络膜动脉的充盈在ICGA和FFA中均晚于视网膜中央动脉。两种充盈状态下ICGA和FFA中脉络膜动脉充盈时间、视网膜动脉充盈时间差异均有统计学意义（P〈0．05）。结论CSC患者眼底血管的早期充盈状态中充盈倒置现象的发生与脉络膜及视网膜血流动力学异常有关。     

810-nm激光治疗孤立性脉络膜血管瘤的临床研究

目的：回顾性分析810-nm眼底激光治疗孤立性脉络膜血管瘤伴黄斑区视网膜脱离患者的临床效果。方法：收集27例27眼孤立性脉络膜血管瘤伴黄斑区视网膜脱离患者使用810-nm半导体激光治疗的临床资料,治疗后第1、3、6、12月复诊,包括视力、眼底照相、B超、眼底荧光血管造影（FFA）、吲哚菁绿血管造影（ICGA）及黄斑光学相干断层扫描（OCT）等检查,根据瘤体萎缩及黄斑积液情况决定是否再次激光治疗。结果：经多次激光治疗后疗效显著18例（66.67%）,好转9例（33.33%）,所有病例眼底照相瘤体萎缩,B超显示瘤体高度下降,黄斑OCT示网膜下液吸收。结论：810-nm激光光凝可显著改善孤立性脉络膜血管瘤患者的临床症状,方法简易、费用低廉、疗效好。     

经瞳孔温热疗法治疗中心性浆液性脉络膜视网膜病变

目的 初步观察经瞳孔温热疗法(TTT)治疗中心性浆液性脉络膜视网膜病变(CSC)的疗效.方法 28例28眼CSC行TTT治疗,并定期随访,观察治疗前后视力、眼底、眼底荧光造影(FFA)及光学相干断层扫描(OCT)的变化.结果 28眼CSC经TTT治疗后,患者黄斑水肿减轻或吸收,FFA显示渗漏停止或减少,视力明显提高.结论 TTT治疗CSC有效,但还需要更多的病例来评价治疗效果.     

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.