经鼻内鼻窦手术的手术经验与并发症

文献调查表明 ,在经鼻内鼻窦手术中使用助视镜仍未达到降低术中严重并发症发生率的预期目的。该研究回顾性地分析了不同医生连续手术病例的主要并发症发生情况 ,包括眼眶并发症 (眶周损伤、眶内脂肪脱出至筛窦、眼肌或神经损伤 )、硬脑膜损伤、颅内并发症 (脑膜炎、脑损害、脑出血 )和颈内动脉损伤等 ,并将其逐年分布情况引入到个人学习曲线中 ,亦即把造成严重并发症的 5位手术者的手术经历与各自的个人学习曲线进行对照分析。这 5位医生从开始接受此种手术训练起 ,每人统计分析前 30 0例次手术 ,共 150 0例次 ,其中发生硬脑膜损伤 8例次 (0…     

实时剪切波技术评价急性缺血性脑卒中患者颈动脉纵向弹性模量

目的 探讨采用实时剪切波弹性成像(SWE)检测急性缺血性脑卒中患者颈动脉纵向弹性模量的可行性。方法 选取急性缺血性脑卒中(AIS)患者179例(脑卒中组),其中大动脉粥样硬化性脑梗死(LAA)103例,腔隙性脑梗死(LAC)患者76例。另选取年龄、性别匹配的正常对照组168例。采用超声射频技术测量双侧颈动脉脉搏波传导速度(PWV)。SWE检测双侧颈动脉浅壁20个ROI纵向平均弹性模量的平均值(ME_mean)、最大弹性模量的平均值(ME_max)和最小弹性模量的平均值(ME_min)。分析影响动脉僵硬度的相关因素。结果 ①与对照组相比,脑卒中患者颈动脉僵硬度参数PWV增大、颈动脉浅壁纵向弹性模量参数ME_mean和ME_max增大(P均<0.05)。②所有受试者ME_mean和ME_max与年龄、收缩压、颈动脉管径、PWV和低密度脂蛋白胆固醇呈正相关,与总胆固醇呈负相关(P均<0.05)。结论 采用SWE可通过检测颈动脉纵向弹性模量评价动脉僵硬度。     

应用超声检查评价高血压患者血管僵硬度与心功能的关系

Objective To assess the relationship between arterial stiffness and heart function in patients with hypertension using ultrasonography. Methods A total of 167 patients with hypertension and 165 controls were enrolled, and the parameters of arterial stiffness and heart function were measured and calculated. The results were analyzed and compared. Results The ratio of peak early-diastolic mitral orifice flow velocity and peak early-diastolic mitral annular velocity in left ventricular posterior wall (E/e), and Tei index were significantly higher in hypertension group than in controls(E/e: 10.92±3.14 vs. 7.70 ±1.56, Teiindex: 0.58±0.13 vs. 0.45±0.09, both P＜0.05), but there was no significant difference in ejection fraction (EF) between the two groups. In hypertension group, the parameters of arterial stiffness including β value, pressure-strain elastic modulus (Ep), pulse wave velocity (PWVβ) and arterial compliance were 11.0±5.2, (172.6±83.8)kPa, (7.8±1.6) m/s and (0.6±0.2) mm2/ kPa. In control group, the corresponding data were 7.5±3.0, (97.1±45.4) kPa, (5.9±1.3) m/s and (0.8±0.3) mm2/kPa. There were significant differences between the two groups (all P＜0.05). The E/e was positively correlated with Ep and PWVβ(γ=0.316 and 0.296, both P＜0.05). The Tei index was positively correlated with Ep,augmentation index (AI) and PWVβ(γ=0.278, 0.300 and 0.323, P＜0.05-0.01). There was no significant correlation between EF and arterial stiffness. Conclusions The arterial stiffness and damage of heart function can result from hypertension. The arterial stiffness can be one of monitoring indexes for the heart function damage in early time.     

鼻内镜术后鼻腔粘连的临床分析

目的 探讨鼻内镜术后鼻腔粘连发生的相关因素,并结合临床体会提出预防和处理措施.方法 分析403例(718侧)鼻内镜术后发生鼻腔粘连的19例(27侧)的临床资料.对粘连类型、病变性质、病变程度、变态反应及术后反复感染、鼻腔结构异常、手术因素和随访处理情况诸因素进行分析.结果 (1)本组病例粘连的发生率为4.71%;(2)各粘连类型按发生率高低依次是中鼻甲与鼻腔外侧壁粘连、筛窦腔粘连闭塞、中鼻甲与鼻中隔粘连、下鼻甲与鼻中隔粘连,未见中鼻甲与下鼻甲粘连及上颌窦自然开口粘连封闭;(3)感染性病变、病变严重、变态反应及术后反复感染、鼻腔结构异常、手术技巧不够熟练和随访处理经验不成熟以及不按时随访的粘连发生率较高.结论 术前充分认识上述相关因素,加强围手术期治疗,提高手术技巧,正确处理中、下鼻甲及鼻中隔,术后定期随访和及时解除粘连是减少鼻腔粘连发生的关键.     

激光与放射治疗T1声门型喉癌的系统评价及Meta分析

目的采用Meta分析方法对激光与放射治疗T1声门型喉癌的疗效进行评价。方法检索Medline/Pub Med、Web of knowledge、EMBASE、the Cochrane Library、the Wiley online library、Springer、Google及CNKI等数据库。通过制定纳入及排除标准,对文献进行筛选、质量评估,并提取相关数据。采用REevM Aan5.0软件对所纳入文献进行数据处理和综合分析。以早期喉癌患者的局部控制率、总体生存率、保喉率为观察指标,对比两种治疗的疗效。结果经筛选,最终对11篇符合要求的文献数据进行Meta分析。激光治疗与放射治疗相比可明显提高T1声门型喉癌患者的的保喉率(P<0.00);激光治疗组的总体生存率明显高于放射治疗组(P=0.04);激光治疗组的局部控制率与放疗组比较,差异无统计学意义(P=0.91)。通过偏差分析,总体5年生存率和保喉率的Meta分析均不存在明显的发表偏倚。结论激光治疗T1声门型喉癌的5年生存率及保喉率明显优于放射治疗组,但两者局部控制率无明显差异。     

应用超声检查评价高血压患者血管僵硬度与心功能的关系

Objective To assess the relationship between arterial stiffness and heart function in patients with hypertension using ultrasonography. Methods A total of 167 patients with hypertension and 165 controls were enrolled, and the parameters of arterial stiffness and heart function were measured and calculated. The results were analyzed and compared. Results The ratio of peak early-diastolic mitral orifice flow velocity and peak early-diastolic mitral annular velocity in left ventricular posterior wall (E/e), and Tei index were significantly higher in hypertension group than in controls(E/e: 10.92±3.14 vs. 7.70 ±1.56, Teiindex: 0.58±0.13 vs. 0.45±0.09, both P＜0.05), but there was no significant difference in ejection fraction (EF) between the two groups. In hypertension group, the parameters of arterial stiffness including β value, pressure-strain elastic modulus (Ep), pulse wave velocity (PWVβ) and arterial compliance were 11.0±5.2, (172.6±83.8)kPa, (7.8±1.6) m/s and (0.6±0.2) mm2/ kPa. In control group, the corresponding data were 7.5±3.0, (97.1±45.4) kPa, (5.9±1.3) m/s and (0.8±0.3) mm2/kPa. There were significant differences between the two groups (all P＜0.05). The E/e was positively correlated with Ep and PWVβ(γ=0.316 and 0.296, both P＜0.05). The Tei index was positively correlated with Ep,augmentation index (AI) and PWVβ(γ=0.278, 0.300 and 0.323, P＜0.05-0.01). There was no significant correlation between EF and arterial stiffness. Conclusions The arterial stiffness and damage of heart function can result from hypertension. The arterial stiffness can be one of monitoring indexes for the heart function damage in early time.     

针刺对肥胖大鼠神经肽Y及其基因表达的影响

目的 :探讨针刺减肥相关的细胞分子机制。方法 :采用RT PCR和NorthernBlot技术测定下丘脑神经肽Y(NPY)基因表达水平 ,放射免疫分析测定血浆和下丘脑NPY的含量 ,观察针刺治疗前后肥胖大鼠体重、Lee’s指数、体脂、血浆和下丘脑NPY的含量以及下丘脑NPY基因表达的变化。结果 :肥胖的大鼠体重、Lee’s指数、体脂、血浆和下丘脑NPY的含量以及下丘脑NPY基因表达均显著高于正常大鼠。针刺治疗取得良好减肥疗效的同时 ,肥胖大鼠血浆和下丘脑NPY含量以及下丘脑NPY基因表达水平明显回降。结论 :针刺对肥胖机体中枢和外周NPY水平的良性调整作用以及抑制下丘脑NPY基因过度表达可能是针刺减肥的细胞分子机制之一。     

小鼠卵母细胞体外成熟的形态变化

生发泡期小鼠卵母细胞与卵细胞间以及卵丘细胞之间存在细胞连接，卵丘细胞的突起伸入卵母细胞内，细胞突起存在类似于鞭毛的９＋２结构，这使卵母细胞和卵丘细胞成为结构和功能上的整体。生发泡破裂后卵细胞出现吞噬现象，其意义不清。排出极体处的细胞膜微绒毛消失，其下方是中期纺锤体，此区域可能为第二极体的释放部位。