鼻内窥镜下筛泡的应用解剖研究

目的 :对筛泡行应用解剖学研究 ,以冀为鼻内窥镜筛泡切除术确定安全的手术界限 ,减少并发症的发生。方法 :30例、6 0侧外观无异常经 10 %福尔马林固定的成人尸头 (男 2 3例 ,女 7例 ) ,用MJ3435型带锯机 ,沿眉弓上缘及枕骨粗隆上 1cm连线水平锯开颅盖骨 ,去除脑组织 ;沿正中线矢状锯开头颅 ,去除鼻中隔 ;经眶下孔与正中剖面平行矢状锯开 ,用解剖刀、筛泡钳和剥离器等按鼻内窥镜下筛窦手术的体位和路径 ,逐层解剖并测量各解剖结构的径线 ,观测其变异。结果 :筛泡内外径 8.91± 2 .82mm ,筛泡垂直径 13.92± 7.0 8mm ,筛泡骨壁厚 0 .2 3± 0 .10mm ,筛泡中心到下鼻甲附着缘的最小平均距离 11.96± 2 .31mm。钩突与筛泡之间平均距离 :上 0 .6 8± 0 .36mm ,中 1.71± 0 .78mm ,下 2 .81± 0 .5 8mm。结论 :由于筛泡变异大 ,了解其解剖结构的径线 ,对鼻内窥镜手术有重要作用。     

颈椎横突孔和椎动脉的观测及其临床意义

本文观察150个正常成人离体颈椎（C3－C6）的横突孔和30具成人尸体（男18、女12）的椎动脉，测量两侧横突孔的内径、横突孔-钩突间距和椎动脉在第六颈椎横突孔下方的外径。观察结果，横突孔的横径左侧为6．82±0.75mm，右侧为6．71±0．86mm；横突孔的失状径左侧为5．68±0．82mm，右侧为5．45±0．76mm。椎动脉的外径左侧为3．80±0．65mm，右侧为3．20±0．45mm。结果表明，正常横突孔的内径明显大于椎动脉的外径，但横突孔内壁骨质增生或钩突增生突入孔内，并压迫椎动脉时，会引起椎动脉型颈椎病。     

视交叉及其周围结构的测量

目的 :为视交叉及其周围区病损机制和手术治疗提供解剖学依据。方法 :在 37例成人颅脑视交叉及其周围区 ,对具有临床意义的数据进行解剖学测量。结果 :视神经颅内段长度为 :左 ( 9.5± 0 .2 )mm ,右 ( 9.6± 0 .3)mm ;垂直径 :左 ( 3.5± 0 .1 )mm ,右 ( 3.6± 0 .1 )mm ;横径 :左 ( 5 .3± 0 .2 )mm ,右 ( 5 .5± 0 .3)mm。视交叉后缘至鞍背的距离 :前置位 ( 3.5± 1 .1 )mm ;后置位 ( 3.0± 1 .5 )mm。视交叉的前后径、垂直径、横径分别为 ( 8.5± 0 .9)mm ,( 3.2± 0 .1 2 )mm ,( 1 1 .9± 0 .5 )mm。视神经管间距为 ( 1 1± 1 .2 )mm。视交叉的前角角度为 ( 65 .5± 5 .6)度。结论 :①视交叉与垂体的位置关系的不同 ,垂体瘤压迫视交叉的部位就不同。②视交叉前角的角度一般小于直角 ,其大小与视神经管间距及视神经颅内段长度有关。③视交叉并不与鞍隔接连 ,故垂体肿瘤增大向上穿破鞍隔后 ,在一定时间内 ,尚不致压迫视交叉。④鞍隔的厚度 ,鞍隔孔的类型和大小与肿瘤扩散的难易和扩展方向有重要关系。     

寰椎椎弓的解剖学测量及其临床意义

目的 :为临床行椎弓切除减压术提供解剖学依据。方法 :对 10 3例寰椎前、后弓进行了解剖学观测。结果 :前结节与横突孔间距 :左 :2 4 .83± 3.4 6 0mm ,右 :2 5 .4 2± 3.346mm ;后弓 :外侧半距 :左 :19.6 0± 3.5 81mm ,右 19.35± 3.135mm ;内侧半距 :左 :11.5 7± 2 .997mm ,右 11.4 2±2 .6 34mm。结论 :前路手术显露前弓范围在 2 1～ 2 8mm内 ,但不能切除前弓。后路手术显露后弓范围在 15～ 2 3mm内 ,切除后弓范围在 10～ 11mm内。     

外鼻的解剖学观测及意义

目的 :为外鼻整形和美容提供形态学资料。方法 :选择健康成人 30例 ,成人颅骨 30例 ,用游标卡尺 (精确度0 .0 2 mm)对外鼻进行解剖学测量。结果 :活体鼻额角为 148.4°± 7.6°,鼻深 15 .6± 5 .3mm,鼻宽 2 3.2± 2 .9mm,鼻背高10 .3± 2 .8mm,鼻长 2 1.4± 3.6 mm,两侧鼻背间夹角 141.3°± 8.1°。颅骨鼻背起始点不一定是鼻背的最低点 ,鼻额角为143.5°± 7.1°,鼻宽 10 .4± 3.9mm,鼻背高 12 .5± 3.1mm,梨状孔顶间距 7.6± 1.6 mm,两侧鼻骨间夹角为 10 1.3°±7.4°,鼻上颌角为 144 .4°± 9.6°,鼻骨长 2 3.3± 4.8mm,鼻骨中心厚 1.5± 0 .6 mm。。结论 :为外鼻的解剖学和外鼻再造提供了有益的数据。     

肝内门静脉螺旋CT成像诊断肝炎肝硬化

目的　探讨螺旋 CT肝内门静脉血管成像对肝炎肝硬化 (L C)的诊断价值 .方法　对 2 6例 L C患者和 30例正常人进行螺旋 CT门静脉系统血管成像 ,采用造影剂量 1.5m L· kg- 1 ,注射速率 3m L· s- 1 ,层厚 3mm,床速 5 mm·s- 1 ,重建层厚 2 mm,并进行最大密度投影血管重建 .在重建横断面图像上 ,于门静脉主干及其 1,2级分支、肝右前叶上段、肝左外下段门静脉分支分叉处总干近心端测量其血管短径 ,并计算各分级间比值 ,于脾门处测量脾静脉血管短径 .结果　 5 6例均清楚显示门静脉主干及其右前上段、左外下段门静脉分支 .2 6例 L C螺旋 CT肝内门静脉血管成像 (spiralCT portography,SCTP)显示门静脉分支级数减少 ,多为 3,4级 ,正常对照组多为 4～ 7级 ,平均等级分分别为 2 .9± 0 .5 ,3.3± 0 .5 (P<0 .0 1) .门静脉主干及右 1,2级分支增粗 ,其短径分别为 (14 .6± 2 .3) mm ,(13.3± 2 .2 ) mm和 (9.8± 1.0 )mm,右前上段 3级以下分支变细、扭曲、僵直 ,呈“枯树枝”状 ,3级分支管径为 (6 .1± 1.2 ) mm,正常组门静脉主干、右 1,2级分支及右前上 3级分支管径分别为 (12 .3± 1.0 ) mm ,(10 .6± 1.6 ) mm,(8.7± 1.4 ) mm和 (6 .8± 1.3) mm,两组对比差异显著 (P<0 .0 5 ) ;L C组门静脉左支角部、矢状部、     

成人四肢常用骨牵引部位骨的形态及其毗邻关系

目的 :为创伤骨科提供四肢常用骨牵引部位的形态学依据。方法 :对 10 0例成人尸体四肢骨标本 ,3 0例成人尸体四肢标本进行解剖 ,观察骨的不同方位毗邻的血管和神经。结果 :股骨下端内上髁上方 2 0mm处 ,矢状径为 ( 2 0 0 6± 2 5 2 )mm ,冠状径 ( 4 2 96± 2 66)mm ;股骨粗隆最突部矢状径为 ( 3 4 4 6± 2 91)mm ,冠状径 ( 5 4 4 3± 3 82 )mm ;胫骨粗隆最突部矢状径为 ( 4 1 3 6± 3 5 4 )mm ;冠状径 ( 3 5 90± 3 66)mm ;尺骨冠突部矢状径为 ( 3 1 69± 2 3 1)mm ;冠状径为 ( 2 1 18± 2 2 7)mm ;跟骨距后下缘的前上方 2 0mm处 ,冠状径为 ( 2 1 18± 2 2 7)mm。这些部位骨剖面的结构表层均为薄层骨皮质 ,内为较密骨松质 ,在骨的不同方位毗邻重要的血管和神经。结论 :临床上可根据牵引部位的形态特点注意选择适当的骨牵引器具、牵引穿针部位和方向 ,以防止骨牵引术所致的并发症     

腰椎峡部的应用解剖学研究及其临床意义

目的 :提供腰椎峡部的应用解剖学资料 ,定量评价腰椎峡部的结构特点及其与毗邻结构的解剖关系 ,探讨腰 5椎弓峡部易患病性的解剖基础。方法 :直接测量 2 0具成人脊柱干燥骨腰段 (L1 ～ L5 )标本的腰椎峡部及其相关结构。结果 :腰椎峡部上缘长度自 L2 (6 .34± 1.2 6 mm)～ L5 (8.6 3± 1.6 0 mm)逐渐增加 ,其下缘长度自 L2 (6 .82± 1.5 4mm)～ L5 (4 .83± 1.5 0 mm)逐渐减小 ;峡部纵径自 L3(11.92± 1.6 2 mm )～ L5 (11.46± 2 .0 3mm)逐渐减小 ;峡部上缘在 L4最薄 (1.5 0± 0 .43mm) ;峡部下缘厚度自 L1 (5 .82± 1.2 6 mm )～ L5 (6 .89± 0 .97mm )逐渐增加。峡部相对于椎弓根的内倾角 L1 ～ L5 (10 3.6± 10 .7度～ 110 .8± 9.6度、尾倾角 L2 ～ L5 (12 5 .3± 7.4度～ 130 .2± 11.0度 )逐渐增加。腰椎峡部的解剖参数与脊柱水平相关 ,并与椎小关节面的方向以及椎弓根的大小密切相关。结论 :该研究结果为临床上第 5腰椎的易患病性提供了解剖学资料 ,有助于临床更好地掌握腰椎峡部螺钉内固定术     

成人脊髓圆锥水平的脊髓和硬膜囊径线MRI研究

目的 :评价正常成人脊髓圆锥水平脊髓和硬膜囊矢径、横径的正常值范围及在临床实践中的应用价值。方法 :对 1 5 6例正常成人行脊髓圆锥最大矢径横截面水平T1 WI横断面扫描 ,测量该处脊髓与硬膜囊的矢径、横径 ,计算其平均值、标准差及矢径与横径比、近似面积。结果 :脊髓圆锥最大矢径横截面多位于T1 2 椎体 (82例 ,5 2 5 7% ) ,脊髓矢径 (6 86± 0 75 )mm ,横径 (8 4 1± 0 88)mm ,矢横比 0 75～ 0 85 ,硬膜囊矢径 (1 3 2 6± 1 6 1 )mm ,横径 (1 7 5 8± 2 6 8)mm ,矢横比 0 6 5～ 0 80 ,各径线大小无性别、年龄和身高差异 ,脊髓与硬膜囊矢径成正相关。结论 :熟悉脊髓和硬膜囊径线的正常值范围对临床诊断髓内肿瘤与硬膜囊等病变有较大帮助     

交感神经对细纤维反应特性的影响

目的 :研究大鼠皮肤细纤维的反应特性及交感神经对其的影响。方法 :采用电生理学方法 ,分析细纤维的反应特性及交感神经对诱发放电数的影响。结果 :Aδ纤维的感受野为3 0 0～ 19 0 0mm2 (10 70± 0 95 ) ,传导速度 3 5 0～ 2 3 5 0m/s (11 90± 6 75 ) ,机械阈值 1 45～17 2 0 g (3 83± 1 5 5 )。C多型伤害性纤维的感受野为 1 5 0～ 5 0 0mm2 (2 71± 0 83) ,传导速度为 0 35～ 2 0 0mm/s (0 79± 0 0 9) ,机械阈值 1 45～ 17 2 0 g (5 6 4± 4 0 6 )。C机械伤害性纤维的感受野在 2 0 0～ 6 0 0mm2 (4 0 0± 2 0 0 )之间 ,传导速度 0 5 0～ 1 70m /s (0 80± 0 12 ) ,机械阈值在 3 80～ 17 2 0 g (6 85± 3 0 1)之间。C机械纤维的感受野在 2 0 0～ 8 0 0mm2 (4 0 5±1 40 )之间 ,传导速度 0 45～ 1 80m/s (1 15± 0 6 8) ,机械阈值 0 0 1～ 0 0 3g (0 0 2± 0 0 1)。C冷纤维的感受野 2 0 0～ 15 0 0mm2 (7 2 0± 1 5 0 ) ,传导速度 0 5 0～ 1 90m/s (0 70± 0 0 5 )。刺激交感神经后 ,Aδ纤维和C多型伤害性纤维的诱发放电数均明显减少 (各P <0 0 1) ,抑制率分别为 2 2 6 2 %和 2 9 49%。结论 :交感神经能抑制Aδ和C多型伤害性纤维的传入活动     

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.