异丙酚靶控输注系统研究不同麻醉深度下兔海马c-fos mRNA水平的改变

目的 :研究异丙酚不同麻醉深度对兔脑海马c fosmRNA水平的影响。方法 :30只日本大耳兔 ,随机分为 3组 ,即对照组 ,浅麻醉组 ,深麻醉组。浅麻醉组 ,深麻醉组予以异丙酚靶控输注 (TCI)达到所需麻醉状态 30min后断头处死 ,0～ 4℃分离取脑 ,采用原位杂交法测定海马各区c fosmRNA表达水平。结果 :与对照组比较 ,海马CA1区 ,齿状回(DG)区c fosmRNA表达水平随着麻醉深度的增加而显著升高 (P <0 .0 5 )。海马CA3区未见明显变化。结论 :异丙酚可能通过影响c fosmRNA的表达 ,从而影响随后反应基因的转录而发挥抑制中枢的作用且此作用存在区域性差异。     

浅谈针刺深浅

灵活的掌握针刺深浅对临床治疗疾病很重要,要整体把握患者的病情,结合患者自身形质等因素,综合考虑,做到因人施针,深浅适宜.针刺应注意辨证论治,根据疾病的阴阳、表里、寒热、虚实选择针刺的深浅;针刺应根据针法选择针刺的深浅;针刺应根据个体、形体和部位的差异选择针刺的深浅;针刺应根据四时差异选择针刺的深浅.     

医学类专科学生英语词汇学习现状实证研究

目的调查、分析医学专科学生英语词汇学习现状,为探索词汇教学的有效途径提供参考。方法以200名2010级医学专业专科学生为研究对象,按英语词汇测试成绩从高到低排列,成绩前30％和后30％分为“高分组”和“低分组”,通过自制量表调查2组学生的词汇学习现状,采用PASWStatistics统计工具进行探索性因子分析,独立样本t检验以比较2组学生词汇学习的异同。结果在析出的4个因子中,2组学生在词汇学习“态度”“方法策略”（P=-0．000）,“词汇深度”（P=0．010）3个因子上呈现的差异均有统计学意义,在词汇“重要性”认识（P=0．099）上差异无统计学意义。结论词汇学习态度、方法策略、深度是影响词汇学习的重要因素。在教学过程中应引导学生转变词汇学习态度,激发兴趣,倡导自主学习,同时改善词汇学习方法,重视词汇深度。     

Defect Detection and Characterization in Concrete Based on FEM and Ultrasonic Techniques

In order to estimate the crack depth in concrete using time-of-flight, finite element analysis and experiments were performed on non-cracked concrete blocks and 45 mm and 70 mm vertical cracks. As a result of measuring the time-of-flight change by changing the positions of the transmitter and receiver, it was confirmed that the finite element analysis results agreed with the experimental results, and high accuracy was confirmed by various formulas for calculating the depth of defects using the obtained experimental measurements for comparison. In addition to the verification of the simulation and experimental theory, research was conducted through actual field cases, and methodologies for crack detection and depth evaluation for concrete structures were presented, and furthermore, the expected effects of improving the soundness and safety of structures were shown.     

运用定性研究方法制定北京市社会心理咨询标准服务评价指标

目的 构建北京市社会心理咨询标准服务评价指标。方法 利用文献检索初步提炼评价指标,通过个人深度访谈收集心理卫生相关领域专家对指标的意见和建议,利用Nvivo 12.0软件对访谈文字稿进行整理、编码、节点分析和整合,初步形成三级标准服务评价指标体系;而后以线上问卷的方式邀请79名专家参加两轮德尔菲专家咨询,对指标进行统计分析、筛选和修改。结果 通过文献检索和个人深度访谈初步形成包括3个一级指标,13个二级指标以及80个三级指标的指标体系。经专家现场预评价和讨论后,保留3个一级指标、10个二级指标和42个三级指标纳入第一轮德尔菲专家咨询问卷。第一轮德尔菲法专家咨询问卷回收率为96.2%,专家权威系数为0.80±0.03,专家协调系数为0.124;第二轮咨询问卷回收率为83.3%,专家权威系数为0.83±0.02,专家协调系数为0.095,最终通过指标的筛选、增补、合并,形成包括3个一级指标、17个二级指标及45个三级指标的北京市社会心理咨询标准服务评价指标定体系。结论 本研究初步构建的北京市社会心理咨询标准服务评价指标体系符合当前北京市心理咨询服务的基本要求,其效果还需要在后续实际使用中进行评价和不断完善。     

应用IOL-Master对大学生近视眼屈光成分的生物学测量研究

目的:应用IOL-Master测量大学生近视眼的眼轴长度(AL),水平、垂直角膜屈光力(K1,K2),前房深度(ACD)及角膜直径,探讨大学生近视眼各屈光成分值与屈光度的关系以及大学生近视眼的主要成因。方法:大学生近视患者1059例2118眼,经电脑验光按等效屈光度分为三组:A组低度近视<-3.00D(738眼),B组中度近视-3.00～-6.00D(989眼),C组高度近视>-6.00D(391眼)。采用光学相干生物测量仪(Zeiss,IOL-Master)测量其AL,K1,K2,ACD及角膜直径,计算眼轴长度与角膜曲率的比值AL/CR,数据采用SPSS18.0统计分析。结果:随着近视屈光度的增加,眼轴长度明显增加,两者之间存在显著相关性(P<0.01),且各组间具有显著差异性(P<0.01);K1在A组与B组间差异无显著性(P>0.05),K2在各组间具有差异性(P<0.05),但K1和K2仅与中度近视的屈光度存在相关性(P<0.05);各组AL与K1、K2呈负相关,且有显著统计学意义(P<0.01);ACD在B组与C组间差异无显著性(P>0.05),低度近视的屈光度与ACD存在显著相关性(P<0.01);角膜直径在各组间无显著性差异(P>0.05),且与屈光度无相关性(P>0.05);AL/CR比值3.183±0.132,近视屈光度与AL/CR比值呈负相关(r=-0.761,P=0.000)。结论:轴性近视是大学生近视的主要类型。大学生中度近视是眼轴与角膜屈光力共同作用所致;ACD对大学生近视屈光度影响较小;角膜直径对大学生近视屈光度无影响。     

[In Press] Optical coherence tomography with or without enhanced depth imaging for peripapillary retinal nerve fiber layer and choroidal thickness

AIM: To assess peripapillary retinal nerve fiber layer (RNFL) and choroidal thickness obtained with enhanced depth imaging (EDI) mode compared with those obtained without EDI mode using Heidelberg Spectralis optical coherence tomography (OCT). METHODS: Fifty eyes of 25 normal healthy subjects and 32 eyes of 20 patients with different eye diseases were included in the study. All subjects underwent 3.4 mm diameter peripapillary circular OCT scan centered on the optic disc using both the conventional and the EDI OCT protocols. The visualization of RNFL and choroidoscleral junction was assessed using an ordinal scoring scale. The paired t-test, intraclass correlation coefficient (ICC), 95% limits of agreement (LoA), and Bland and Altman plots were used to test the agreement of measurements. RESULTS: The visibility score of RNFL obtained with and without EDI was of no significant difference(P=0.532), the visualization of choroidoscleral junction was better using EDI protocol than conventional protocol (P＜0.001). Peripapillary RNFL thickness obtained with EDI was slightly thicker than that obtained without EDI (103.25±9.42 μm vs 101.87±8.78 μm, P=0.010). The ICC of the two protocols was excellent with the value of 0.867 to 0.924, the 95% LoA of global RNFL thickness was between -10.0 to 7.4 μm. Peripapillary choroidal thickness obtained with EDI was slightly thinner than that obtained without EDI (147.23±51.04 μm vs 150.90±51.84 μm, P＜0.001). The ICC was also excellent with the value of 0.960 to 0.987, the 95% LoA of global choroidal thickness was between -12.5 to 19.8 μm. CONCLUSION: Peripapillary circular OCT scan with or without EDI mode shows comparable results in the measurement of peripapillary RNFL and choroidal thickness.     

特发性黄斑裂孔术中填充物的探讨

目的:探讨如何选择特发性黄斑裂孔术中的填充物.方法:回顾性分析特发性黄斑裂孔手术患者46例46眼的临床资料.A组(23眼)行经睫状体平坦部的三切口玻璃体切除+内界膜剥除+硅油注入术,B组(23眼)行经睫状体平坦部的三切口玻璃体切除+内界膜剥除+C2F6(20％)注入术,术前应用频域光学相干断层扫描及其深度增强成像技术(EDI-OCT)测量黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)以明确分组.对手术前后最佳矫正视力(best corrected visual acuity,BCVA)、裂孔闭合率、IS/OS破坏直径及手术并发症等进行临床观察.结果:术后随访至少12mo.随访期末A组术后BCVA与术前相比,差异有统计学意义(t=7.659,P＜0.05).B组术后BCVA与术前相比,差异有统计学意义(t=11.648,P＜0.05).A组裂孔闭合率100％,B组裂孔闭合率为95.2％.A组术后IS/OS破坏直径与术前相比差异有统计学意义(t=12.252,P＜0.05),B组术后IS/OS破坏直径与术前相比差异有统计学意义(t=13.257,P＜0.05).并发症:A组术后4眼发生高眼压,B组术后1眼裂孔未闭合继发视网膜脱离,再次行硅油注入术后裂孔闭合.B组术后2眼出现玻璃体积血,1眼吸收,1眼再次行玻璃体腔灌洗术.结论:两种手术方式均可有效治疗特发性黄斑裂孔.A组手术方式可以更持久顶压黄斑区视网膜,利于黄斑裂孔闭合,但是需俯卧较长时间及再次手术取出硅油,增加患者身心和经济负担.B组手术方式无需再次手术取出填充物,但是存在黄斑裂孔不闭合需再次手术的风险.我们将黄斑中心凹下脉络膜厚度作为术前合理选择手术方案的标准,为患者提供个性化的治疗方案.     

应用EDI-OCT 检测NAION患者脉络膜厚度的研究

目的：评价利用光学相干断层扫描增强深部成像(enhanced depth imaging optical coherence tomography,EDI-OCT)测量非动脉炎性前部缺血性视神经病变(nonarteritic anterior ischemic optic neuropathy, NAION)脉络膜厚度的临床意义。

方法：选取2014-12/2016-10门诊就诊的NAION患者(对侧眼未受累)共30例30眼,选取与病例组性别、年龄、屈光度相匹配的正常对照组60例60眼,应用EDI-OCT分别测量患病眼、对侧眼及对照组右眼的脉络膜厚度。

结果：患病组与对照组相比,年龄、性别、屈光度无统计学差异(P>0.05)。经统计学检验,患病眼、对侧眼中心凹附近及视盘盘周各部位脉络膜厚度均小于对照组,差异有统计学意义(P<0.01),而患病眼与对侧眼脉络膜厚度比较差异无统计学意义(P>0.05)。

结论：NAION患者患病眼、对侧眼脉络膜厚度较正常对照组明显减低,提示睫状后短动脉小血管的阻塞可能影响脉络膜的血供,进而影响脉络膜厚度。     

Optical coherence tomography enhanced depth imaging of chorioretinal folds in patients with orbital tumors

AIM: To characterize spectral-domain optical coherence tomography (SD-OCT) features of chorioretinal folds in orbital mass imaged using enhanced depth imaging (EDI). METHODS: Prospective observational case-control study was conducted in 20 eyes of 20 patients, the uninvolved eye served as a control. All the patients underwent clinical fundus photography, computed tomography, EDI SD-OCT imaging before and after surgery. Two patients with cavernous hemangiomas underwent intratumoral injection of bleomycin A5; the remaining patients underwent tumor excision. Patients were followed 1 to 14mo following surgery (average follow up, 5.8mo). RESULTS: Visual acuity prior to surgery ranged from 20/20 to 20/200. Following surgery, 5 patients’ visual acuity remained unchanged while the remaining 15 patients had a mean letter improvement of 10 (range 4 to 26 letters). Photoreceptor inner/outer segment defects were found in 10 of 15 patients prior to surgery. Following surgical excision, photoreceptor inner/outer segment defects fully resolved in 8 of these 10 patients. CONCLUSION: Persistence of photoreceptor inner/outer segment defects caused by compression of the globe by an orbital mass can be associated with reduced visual prognosis. Our findings suggest that photoreceptor inner/outer segment defects on EDI SD-OCT could be an indicator for immediate surgical excision of an orbital mass causing choroidal compression.