从内生伏毒谈内疫病机与治法

伏毒学说认为：内生伏毒是导致诸多内科疑难病的重要病因;内疫病机是根据杂气病因学提出的假说,这两个理论均源于中医温病学。针对内生伏毒的辨证原则和治法方药可以用于内疫病机导致疾病,以实现促邪归正治疗宗旨。通过对内疫病机的认识可以加深对伏毒学说的理解,有利于掌握伏毒的辨证原则和治法方药,而伏毒学说则为内疫病机提供了从理论假说走向临床实践的桥梁。     

Nanomaterials for Inner Ear Diseases: Challenges,Limitations and Opportunities

The inner ear is located deep in the temporal bone and has a complex anatomy. It is difficult to observe and obtain pathological tissues directly. Therefore, the diagnosis and treatment of inner ear diseases have always been a major clinical problem. The onset of inner ear disease can be accompanied by symptoms such as hearing loss, dizziness and tinnitus, which seriously affect people’s lives. Nanoparticles have the characteristics of small size, high bioavailability and strong plasticity. With the development of related research on nanoparticles in inner ear diseases, nanoparticles have gradually become a research hotspot in inner ear diseases. This review briefly summarizes the research progress, opportunities and challenges of the application of nanoparticles in inner ear diseases.     

Auricular skin-cartilage sandwich graft technique for full-thickness eyelid reconstruction

Full-thickness deficiency of eyelid tissues can result in coloboma or retraction or both. Here we report our initial experience on the use of auricular skin-cartilage sandwich graft technique for full-thickness eyelid deformities. Five patients (4–32 years) underwent the procedure. Patients with full-thickness eyelid deformity were included. Three patients were operated for large-sized coloboma and two for eyelid retraction. One patient had congenital, and four patients had acquired etiology. The following parameters were specifically assessed: correction of deformity, ocular surface problems, graft status, and epithelization of skin-cartilage graft. All the patients had a good correction of eyelid position, except one patient who had severe eyelid retraction (8 mm) at presentation. None of our patients had corneal erosion/defect, persistent ocular surface redness, or graft loss. The auricular skin-cartilage sandwich graft technique produces optimal results with no graft loss. Advancement of orbicularis muscle in between the auricular skin and cartilage grafts (sandwich technique) is an imperative step that leads to the survival of both grafts.     

多媒体教学对大学生视、听功能影响的调查分析

目的从医学生理角度探讨多媒体教学对大学生视、听功能的影响。方法依据眼疲劳及耳疲劳的主要症状自行设计调查表,对2004级、2005级临床医学专业应用多媒体教学的班级进行调查分析。结果2004级、2005级均有部分学生报告有眼疲劳及耳疲劳症状。2004级2个班眼疲劳及耳疲劳发生情况对比各项指标差异无显著性;2005级2个班眼疲劳及耳疲劳发生情况对比各项指标差异也无显著性;2004级与2005级眼疲劳及耳疲劳发生情况对比,5项指标差异具有显著性,5项指标差异不具有显著性。结论多媒体教学对大学生视、听功能的影响不容忽视,要采取积极的预防措施。     

耳穴贴压复合表面麻醉用于鼻内镜手术的效果观察

目的：评价耳穴贴压复合表面麻醉用于鼻内镜手术的麻醉效果。方法选择80例表面麻醉下择期鼻内镜手术患者,随机数字法分为两组：耳穴贴压复合表面麻醉组（A组,n=40）和单纯表面麻醉组（B组,n=40）。 A组患者取耳神门（TF4）、交感（AH6a）和外鼻（TG1.2i）3处穴位粘贴王不留行籽,于术前30分钟进行按压治疗,B组仅穴位处粘贴胶布作为对照且不行按压治疗。患者均采用1%的丁卡因进行表面麻醉,术中根据患者情况给予小剂量的艾司洛尔、硝酸异山梨酯或芬太尼。术中观察麻醉优良率;艾司洛尔、硝酸异山梨酯与芬太尼使用率及不良反应。结果与B组比较,A组麻醉优良率明显升高（P〈0.01）,艾司洛尔、硝酸异山梨酯与芬太尼使用率降低（P均〈0.01）,两组均未出现不良反应。结论耳穴贴压复合表面麻醉用于鼻内镜手术具有良好的麻醉效果。     

持续灌流与非灌流切换结合模式的耳内镜下中耳胆脂瘤手术

目的 本文旨在探索持续灌流模式在耳内镜手术中应用的最佳方式,以及尝试建立持续灌流与非灌流模式切换结合的耳内镜中耳胆脂瘤手术流程.方法 回顾性分析在2019年1月至2020年12月间收治的73名单侧的中耳胆脂瘤患者,术中确定为中上鼓室胆脂瘤患者,年龄为10-68岁,其中女性患者34名,男性患者39名.其中33名患者采用持...     

MRI of enlarged endolymphatic sacs in the large vestibular aqueduct syndrome

We studied ten inner ears of five patients with a bilateral large vestibular aqueduct syndrome, using CT and MRI. Although the large vestibular aqueduct varied in size, a markedly dilated endolymphatic sac extending to the sigmoid sinus was demonstrated bilaterally on MRI in all patients. The cause of hearing loss in this syndrome is unclear. However, it is suggested that reflux of the protein-rich, hyperosmolar endolymph from the enlarged endolymphatic sac (EES) into the cochlea through a widely patent endolymphatic duct may damage the neuroepithelium. CT density and spin-echo MRI signal intensity of the endolymph in EES were markedly higher than those of CSF in eight inner ears of four patients. Increased density and high signal may indicate protein-rich, hyperosmolar endolymph. In some patients with sensorineural hearing loss and EES, the vestibular aqueduct may not appear dilated on CT. MRI is therefore necessary for correct diagnosis of this syndrome, which should more correctly be termed “large endolymphatic duct and sac syndrome”. Prominent EES may predict poor prognosis in this syndrome. Received: 28 March 1997 Accepted: 18 July 1997     

耳软骨在二次隆鼻术及鼻尖成形术中的应用

目的：探索二次隆鼻术及鼻尖成形术的方法。方法：采用鼻小柱“飞鸟”形切口加鼻翼软骨缘切口,切开分离皮肤、皮下组织,显露假体并取出,分离两侧鼻翼软骨及侧鼻软骨等,将取下的耳软骨缝合固定于新雕刻假体的顶部及短壁上,插入鼻背固定,缝合双侧穹窿部鼻翼软骨,缝合切口。结果：自2010年6月～2013年6月对46例不满意隆鼻术行二次隆鼻及鼻尖成形术,获得满意的手术效果。术后鼻尖形态自然、鼻长度延长、高度增加、歪鼻也得到矫正等。结论：用自体耳软骨及硅胶假体行二次隆鼻术及鼻尖整形术,能解决鼻尖不良形态,矫正鼻偏斜、鼻孔外露、增加鼻长度,获得鼻部整体形态自然协调的效果,是一种理想的手术方法。     

瘢痕切除即刻局部注射曲安奈德联合放疗治疗耳廓瘢痕疙瘩疗效观察

目的:探讨手术切除,术中曲安奈德局部注射,术后放疗联合治疗耳廓瘢痕疙瘩的效果。方法:将病例分为三组:第一组:12例,24个瘢痕疙瘩(手术+曲安奈德注射+放疗),手术切除瘢痕疙瘩,术中注射醋酸曲安奈德,注射剂量依切缘大小而异,每次注射量不大于40mg,术后每周1次,连续4～8次,术后24h内行局部浅层放疗3天;第二组:11例,22个瘢痕疙瘩(手术+放疗),手术切除瘢痕疙瘩,术后24h内行放疗3天;第三组:17例,23个瘢痕疙瘩(手术+曲安奈德注射),手术切除瘢痕疙瘩,术中即刻注射曲安奈德,术后每周1次,连续4～8次。结果:第一组、第二组、第三组有效率分别为95.83%、77.27%、52.17%。第一组与第二组、第三组比较有显著差异(P<0.05)。结论:手术切除,术中曲安奈德局部注射联合术后放疗治疗耳廓瘢痕疙瘩副作用小、复发率低,值得临床应用。     

三种全耳再造手术方式支架外露情况的比较研究

目的:通过比较三种不同全耳再造手术方式术后支架外露的发生情况,为耳再造手术方式的选择提供依据。方法:对369例全耳再造术分别采用耳后乳突区皮肤扩张后肋软骨支架耳再造(软骨组)、颞浅筋膜瓣翻转Medpor材料耳再造(Medpor组)及颞浅筋膜瓣翻转肋软骨耳轮联合Medpor耳基耳再造手术(复合组),比较不同全耳再造术后支架外露的发生率、发生部位、出现时间及与患者年龄、手术时期等方面的差异。结果:软骨组、Medpor组及复合组支架外露发生率分别为7.1%、12.9%及6.7%,三者比较差异无统计学意义(P>0.05)。三组中,耳轮外上缘均为外露比例最高部位,出现时间均多在术后3月内发生。软骨组支架外露发生率在18岁以上者最高,Medpor组支架外露发生率则在18岁以上者最低(P<0.05)。近5年来手术者支架外露比例较前5年降低。结论:不论选择何种手术方式,均不能完全杜绝支架外露的发生,采用何种方法要依患者的情况及术者对手术方式的掌握情况来综合考虑。但对于6～12岁少儿,采用肋软骨法再造为宜;而对于大于18岁的成人,则采用Medpor法再造为宜。