环孢素滴眼液联合聚乙二醇滴眼液治疗干眼症患者的效果

目的：观察环孢素滴眼液联合聚乙二醇滴眼液治疗干眼症患者的效果。方法：选取2020年2月至2021年12月该院收治的73例干眼症患者进行前瞻性研究,按照随机数字表法将其分为观察组37例与对照组36例。对照组给予聚乙二醇滴眼液治疗,观察组在对照组基础上联合环孢素滴眼液治疗,比较两组临床疗效、治疗前后干眼症状评分、泪河高度、眼表疾病指数（OSDI）评分、眼表功能指标[泪膜破裂时间（BUT）、泪液分泌试验（SIT）、角结膜荧光素染色（FL）]水平和泪液炎性因子[基质金属蛋白酶-9(MMP-9)、白细胞介素-1β(IL-1β)、胸腺基质淋巴细胞生成素（TSLP）]水平。结果：观察组治疗总有效率为94.59%,明显高于对照组的75.00%,差异有统计学意义（P<0.05）;治疗后,观察组泪河高度、BUT、SIT水平高于对照组,干眼症状评分、OSDI评分、FL评分以及TSLP、MMP-9、IL-1β水平低于对照组,差异均有统计学意义（P<0.05）。结论：环孢素滴眼液联合聚乙二醇滴眼液治疗干眼症可提高治疗总有效率、泪河高度、BUT、SIT水平,降低干眼症状评分、OSDI评分、FL评分和炎...     

原发性干燥综合征干眼患者临床指标与泪液中 IL-1β、IL-6、MMP-9的相关性研究

目的 研究原发性干燥综合征(primary Sjgren′s syndrome,PSS)干眼患者泪液中白介素-1β(interleukin-1β,IL-1β)、白介素-6(interleukin-6,IL-6)、基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)的表达水平与临床干眼指标之间的相关性。方法 选取2020年8月~2021年1月在徐州医科大学附属医院确诊为PSS伴干眼的患者30例为研究组,同期30例健康人为对照组,分别完成眼表疾病指数量表(ocular surface disease index,OSDI)、基础泪液分泌试验(schirmerⅠtest,St)、非接触式泪河高度(non-invasive tear meniscus height,NITMH)、非接触式泪膜破裂时间(non-invasive breakup time,NIBUT)、脂质层厚度分级、眼红分析、睑板腺缺失评分、角膜荧光素钠染色(fluorescent,FL)评分及泪液采集。检测两组泪液中IL-1β、IL-6、MMP-9的表达水平,并分析与临床干眼指标的相关性。结果 研究组OSDI、FL、睑板腺缺失评分、IL-1β、IL-6、MMP-9的表达水平均高于对照组(P＜0.05),St、NITMH、NIBUT、脂质层厚度分级均低于对照组(P＜0.05)。相关性分析结果显示,研究组IL-1β、IL-6、MMP-9表达水平与OSDI、FL呈正相关(P＜0.05),与St、NITMH、NIBUT、脂质层厚度分级呈负相关(P＜0.05),与眼红分析和睑板腺缺失评分无相关性(P＞0.05)。结论 PSS干眼患者泪液中IL-1β、IL-6、MMP-9的表达水平与OSDI、FL、St、NITMH、NIBUT、脂质层厚度分级具有相关性。     

六味地黄丸对肝肾阴虚干眼患者治疗效果及性激素水平的影响

目的:探讨六味地黄丸对肝肾阴虚干眼患者的治疗效果及其对性激素水平的影响。方法:选取2020年9月至2021年1月在浙江中医药大学附属第一医院眼科门诊被诊断为干眼的肝肾阴虚患者72例,随机分为对照组(n=37)和治疗组(n=35),对照组采用常规人工泪液治疗,治疗组在人工泪液的基础上加服六味地黄丸,对比两组患者治疗前后干眼主观症状评分(ocular surface disease index,OSDI)、泪膜破裂时间(tear breakup time,TBUT)、泪河高度(tear meniscus height,TMH)、泪液分泌试验(Schirmer I test,SIT)、角膜荧光素染色评分(cornea fluorescein staining,CFS)、雌二醇(estradiol,E_(2))浓度、睾酮(testosterone,T)浓度等变化情况。结果:治疗前,对照组和两组OSDI、TBUT、TMH、SIT、CFS、E_(2)、T等比较,差异无统计学意义(P>0.05);治疗3个月后,对照组和治疗组的干眼主观症状评分、泪膜破裂时间、泪河高度、泪液分泌试验、角膜荧光素染色评分均显著优于治疗前(P<0.05);治疗组的干眼主观症状评分、泪膜破裂时间显著优于对照组(P<0.05)。对照组治疗前后雌二醇浓度、睾酮浓度变化比较,差异无统计学意义(P>0.05);治疗组治疗后雌二醇浓度明显提高(P<0.05),睾酮浓度变化比较,差异无统计学意义(P>0.05)。结论:六味地黄丸能显著改善肝肾阴虚干眼患者的眼部症状评分和泪膜破裂时间,改善泪膜稳定性,并提高患者雌二醇水平,提高治疗效果。     

小梁切除术对泪膜功能影响的研究

目的观察小梁切除术对泪膜功能的影响,并结合眼表疾病指数（OSDI）问卷评估术后主观干眼症状,以指导对干眼的防治。方法选取行小梁切除术的青光眼患者25例33眼,分别于术前1d及术后1、3、6个月采用OSDI问卷评估眼部症状,采用Keratograph眼表综合分析仪测量中央泪河高度（TMH）、泪膜首发破裂点位置、首次和平均非侵入式泪膜破裂时间（NITBUT）,并对OSDI评分和泪膜参数进行相关性分析。结果术前和术后不同时点OSDI评分比较差异有统计学意义（P＜0.01）。术后1和3个月OSDI评分较术前明显增加,差异均有统计学意义（均P＜0.01）;术后6个月和术前比较差异无统计学意义（P＞0.05）。术前和术后1个月泪膜首发破裂点位置最常见于鼻下象限,术后3和6个月泪膜首发破裂点位置最常见于鼻上象限。术前和术后不同时点首次NITBUT和平均NITBUT比较差异均有统计学意义（均P＜0.05）。术后1、3、6个月首次NITBUT及术后1、3个月平均NITBUT较术前缩短,差异均有统计学意义（均P＜0.05）;但术后6个月平均NITBUT和术前比较差异无统计学意义（P＞0.05）。术前和术后不同时点TMH比较差异无统计学意义（P＞0.05）。术前和术后不同时点OSDI评分和首次NITBUT及平均NITBUT均呈负相关（均P＜0.05）,但OSDI评分和TMH无明显相关性（均P＞0.05）。结论小梁切除术影响眼表泪膜的功能从而产生干眼症状,术后半年时,虽然主观干眼评分已经恢复到术前水平,但泪膜的稳定性仍未恢复,泪膜首发破裂点位置最常见于和滤过泡邻近的鼻上和颞上象限。     

功能性溢泪糖尿病患者下睑松弛矫正术后泪膜和泪液蛋白的特点

目的 探讨糖尿病功能性溢泪患者下睑松弛矫正术后眼表症状、泪膜和泪液蛋白的特点.方法 下眼睑松弛导致的糖尿病功能性溢泪患者60例(右眼),随机分为两组:A组行外侧睑板条悬吊术;B组行常规Kuhnt睑板三角切除术,分别于术前、术后1周、1个月及3个月对患者行眼表症状评分、泪膜4项检查和泪液各蛋白测定.结果 A组总有效率为90.0％;B组总有效率为66.7％,两组比较差异有统计学意义(P＜0.05);术前两组干眼各亚症状评分、眼表指数(OSDI)、泪膜破裂时间(BUT)、基础泪液分泌试验(ST)、泪河高度、角膜荧光素染色(FL)、泪液蛋白(TP)、乳铁蛋白(LF)、溶菌酶(LZM)和分泌型免疫球蛋白A(sIgA)比较,差异无统计学意义(P＞0.05);术后1周,两组患者ST、泪河高度、FL比较,差异均有统计学意义(P＜0.05),但两组眼表各症状、OSDI、BUT、泪液总蛋白量、LF、LZM及sIgA比较,差异无统计学意义(P＜0.05);术后3个月,两组患者OSDI、BUT、ST、泪河高度、FL比较,差异有统计学意义(P＜0.05),但两组眼表各症状、泪液总蛋白量、LF、LZM及sIgA比较,差异无统计学意义.结论 对于下眼睑松弛导致的糖尿病功能性溢泪患者,外侧睑板条悬吊术可以明显改善患者眼表症状和泪膜稳定性,升高泪液蛋白,提高患者的视觉质量.     

增生性糖尿病视网膜病变微创玻璃体手术中角膜保护剂与平衡盐溶液对眼表保护效果对比

目的 研究增生性糖尿病视网膜病变（proliferative diabetic retinopathy, PDR）微创玻璃体手术中角膜保护剂与平衡盐溶液对眼表的保护效果。方法 方便选择2020年1月—2021年11月于大庆油田总医院接受微创玻璃体手术治疗的92例PDR患者作为观察对象,采用随机数表法将其分为2组,各46例。对照组微创玻璃体术中滴加平衡盐溶液,研究组术中滴加角膜保护剂。对比两组术前和术后7 d泪膜功能、眼部不适症状及术毕角膜上皮水肿分级。结果 与术前相比,术后7 d两组泪膜破裂时间、泪液浸湿长度均更短,术后7 d两组角膜荧光素钠染色评分均更高,差异有统计学意义（P<0.05）;术后7 d研究组泪膜破裂时间（5.62±1.60）s、泪液浸湿长度（11.25±2.19）mm/5 min均长于对照组（4.83±1.52）s、（9.87±1.2）mm/5 min,角膜荧光素钠染色评分（5.38±1.06）分低于对照组（6.16±1.23）分,差异有统计学意义（t=2.428、3.436、3.258,P<0.05）;与术前相比,术后7 d两组患者OSDI评分均更高,差异...     

泪小点栓塞治疗水液缺乏性干眼症疗效分析

干眼是由于泪液的质或量异常及动力学异常引起的泪膜稳定性下降及眼表面损害,从而导致眼部不适等症状的一类疾病,是目前全球最为常见的眼表疾病.大部分轻度患者经滴用人工泪液后症状可得到改善.对于经频繁滴用人工泪液及全身治疗效果不明显的中重度患者,笔者采用SmartPLUG泪小点栓塞术进行治疗,取得了较好的疗效,现报道如下.     

氯替泼诺治疗中重度干眼抗炎作用的临床分析

目的观察0．5％氯替泼诺滴眼液治疗中重度干眼病的临床疗效。方法按标准纳入中重度千眼患者40例,回顾性分两组：联合用药组予0．5％氯替泼诺滴眼液和新泪然滴眼液联合用药;单用药组用新泪然滴眼液。在治疗前及治疗后2、4、6周观察眼表疾病指数（OSDI）、泪膜破裂时间（BUT）、泪液分泌实验（SchirmerI试验）、眼表染色评分（OSS评分）、眼压;ELISA测泪液中炎症介质白介素-6（IL-6）的表达。结果治疗2周后,联合用药组OSDI评分均值明显降低,较治疗前差异有显著性（P〈0．05）;治疗2周联合用药组眼表炎症体征减轻;联合用药组BUT均较治疗前延长;两组各时间点的SehirmerI及眼压值无明显变化。结论0．5％氯替泼诺滴眼液通过下降IL-6表达,减轻中重度干眼眼表炎症,安全有效。     

鱼腥草滴眼液联合玻璃酸钠滴眼液在干眼患者白内障术后中的应用效果

目的:探讨鱼腥草滴眼液联合玻璃酸钠滴眼液在干眼患者白内障超声乳化术后中的应用效果。方法:选取术前存在干眼症状接受白内障超声乳化术的患者90例(90只眼),按照随机数字表法将其分为观察组和对照组,各45例。两组术后均常规给予妥布霉素地塞米松滴眼液,在此基础上,观察组接受鱼腥草滴眼液联合玻璃酸钠滴眼液治疗,对照组仅接受玻璃酸钠滴眼液治疗,8周为一疗程。对比两组治疗前后眼表疾病指数(OSDI)评分、泪膜破裂时间(TBUT)、角膜荧光素染色评分和泪液分泌(SehirmerⅠ)试验,观察治疗8周后两组干眼患病率、泪液中炎症细胞因子(IL-1β、TNF-α)水平,记录两组治疗期间不良反应发生情况。结果:治疗8周,观察组OSDI评分、TBUT、荧光素染色评分和SehirmerⅠ试验均优于对照组(P0.05);治疗8周时,观察组干眼患病率低于对照组(P0.05),观察组泪液中IL-1β、TNF-α水平均低于对照组(P0.05);两组治疗期间,均未见明显不良反应发生。结论:对于术前存在干眼症状的白内障患者,鱼腥草滴眼液联合玻璃酸钠滴眼液可以进一步改善白内障超声乳化术后干眼症状和体征,可能与减轻炎症反应有关。     

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.     

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.     

Notes for contributors to Journal of Nanjing Medical University

Journal of Nanjing Medical University (English Edition) JNMU, sponsored by Nanjing Medical University, was established in 1987. It is a bimonthly comprehensive English medical journal published locally and abroad.Since 2007, Journal of Nanjing Medical University (English Edition )was granted Elsevier the full publishing and distribution rights worldwide for the Electronic Edition, excluding the People's Republic of China.