The evaluation of therapeutic efficiency in glaucoma treated by trabeculectomy with mitomycin C(MMC)and glaucoma shunting device implantation

目的 评价小梁切除术联合丝裂霉素C及青光眼引流器植入治疗青光眼的近期疗效.方法 25眼(20例)青光眼患者行小梁切除术联合丝裂霉素C及青光眼引流器植入术,随访6个月,观察术后最佳矫正视力、眼压、滤过泡形态、眼底、视野、术后前房深度及并发症情况.结果 25眼(20例)术后平均眼压(11.42±2.14)mmHg,眼压在6~ 21 mmHg 者23眼,眼压控制成功率为92.0%;最佳矫正视力提高15眼(60.0%),术后功能性滤过泡24眼(96.0%),6眼(24.0%)发生浅前房,1眼出现(4.0%)前房出血,2眼(8.0%)脉络膜脱离,眼底及视野未出现明显变化.结论 小梁切除术联合丝裂霉素C及青光眼引流器植入能有效降低青光眼患者眼压,促进功能性滤过泡形成,从而提高青光眼的手术成功率.     

小梁切除术联合丝裂霉素C及青光眼引流器植入治疗青光眼的疗效评价

目的评价小梁切除术联合丝裂霉素C及青光眼引流器植入治疗青光眼的近期疗效。方法 25眼(20例)青光眼患者行小梁切除术联合丝裂霉素C及青光眼引流器植入术,随访6个月,观察术后最佳矫正视力、眼压、滤过泡形态、眼底、视野、术后前房深度及并发症情况。结果 25眼(20例)术后平均眼压(11.42±2.14)mmHg,眼压在6～21 mmHg者23眼,眼压控制成功率为92.0%;最佳矫正视力提高15眼(60.0%),术后功能性滤过泡24眼(96.0%),6眼(24.0%)发生浅前房,1眼出现(4.0%)前房出血,2眼(8.0%)脉络膜脱离,眼底及视野未出现明显变化。结论小梁切除术联合丝裂霉素C及青光眼引流器植入能有效降低青光眼患者眼压,促进功能性滤过泡形成,从而提高青光眼的手术成功率。     

青光眼滤过术后睫状体脉络膜脱离的临床分析

浅前房是青光眼滤过术后常见的并发症之一,睫状体脉络膜脱离(CCD)是青光眼滤光术的浅前房的主要原因。如果处理不当,会引起角膜损伤、虹膜前后粘连、瞳孔膜及白内障、继发性青光眼等。现将我院1390例行青光眼滤过术患者1456只眼术后发生睫状体脉络膜脱离情况进行临床分析。1　资料与方法1.1　对象　连续收集1985年以来我院施行青光眼滤过手术患者1390例1456只眼,术后发生睫状体脉络膜脱离67例69只眼,男36例,女31例,年龄7～78岁,平均56.6岁。1.2　临床表现　急性闭角型青光眼41眼,慢性闭角型青光眼11眼,原发性开角型青光眼5眼,继发性青光眼…     

急性闭角型青光眼持续高眼压的手术治疗

目的:探讨持续高眼压状态下急性闭角型青光眼手术治疗的方法和疗效。方法:对使用多种药物3天不能控制眼压(≥40 mmHg)的56例(56眼)患者施行小梁切除术。术前尽量降低眼压,术中少量、缓慢、多次释放房水,使用可调整缝线,术后恢复前房防止眼压过低。结果:未出现脉络膜上腔爆发性出血和恶性青光眼。术后患眼视力0.01～0.1 16眼,0.1～0.8 40眼,均好于术前高眼压状态下视力(P0.01)。术后眼压≤21 mmHg 48眼。较术前明显降低(P0.01)。术后3例脉络膜脱离,2例滤过过强致前房迟缓形成,2例滤过不畅致高眼压,均经过治疗后恢复。结论:持续高眼压急诊行小梁切除术是可行而且必要的。     

青光眼滤过术后浅前房的原因及处理

目的 探讨青光眼滤过术后出现浅前房的原因及处理方法.方法 对148例(163眼)行滤过手术,术后观察前房、眼压、滤过泡等,对出现浅前房者进行原因分析及治疗.结果 术后31眼出现浅前房,占19.02%.其中结膜瓣渗漏6眼(3.68%),滤过旺盛11眼(6.75%),脉络膜脱离10眼(6.13%),恶性青光眼4眼(2.45%).结论 术后浅前房发生的常见原因是滤过旺盛及脉络膜脱离,应及时发现和处理,以维护视功能.     

小梁切除术后脉络膜脱离原因分析及防治

目的探讨小梁切除术后发生脉络膜脱离的原因及防治措施，以提高青光眼手术的成功率，减少并发症，保护视功能。方法对5年内6例7眼青光眼小梁切除术后发生脉络膜脱离的患者进行临床分析。结果6例患者全部合并有慢性病，特别是高血压病史。急性闭角型青光眼4例，慢性闭角型青光眼2例，l例双眼经保守治疗15d后前房形成。5例患者经手术处理后前房虽形成，但有3例出现并发症。结论对合并有慢性病的急性闭角型青光眼患者应视为小梁切除术后发生脉络膜脱离的高危人群，术前应控制慢性病，稳定眼压，选好手术时机，一旦发生脉络膜脱离，不要急于手术处理，可延长观察时间，视前房情况而定。     

滤过术后浅前房相关因素分析

目的 探讨青光眼滤过术后浅前房与术前眼压及术后并发症的关系。方法 回顾性总结各类型青光眼行抗青光眼手术183例，228眼术后发生浅前房49眼的情况。结果①spaeth分类：发生浅前房49眼（21．49％）。②术前眼压：≤21mmHg者160眼，浅前房26眼；眼压22-35mmHg者45眼，浅前房13眼；眼压〉35mmHg者23眼，浅前房10眼。③术后并发症有结膜渗漏、滤过过强和脉络膜脱离。结论 青光眼滤过术后浅前房与多种因素有关。①与术前眼压密切相关。控制正常者，发生率低。②与术后并发症密切相关，而且以滤过过强性和原因不明者多见。     

急性闭角型青光眼急性发作后继发睫状体脉络膜脱离的临床观察

目的观察急性闭角型青光眼急性发作缓解后继发睫状体脉络膜脱离的眼压和前房深度的变化,探讨继发性睫状体脉络膜脱离发生的原因。方法对2007年1月-2008年4月在我院住院的160例（160眼）急性闭角型青光眼的临床资料进行回顾性分析,超声生物显微镜（UBM）检查发现,40例（40眼）急性闭角型青光眼急性发作缓解后继发睫状体或脉络膜脱离,5例（5眼）临床前期眼检出睫状体脉络膜脱离;测量急性发作前后和睫状体脉络膜脱离时的眼压和前房深度,并进行统计学分析。结果发作缓解后无睫状体脉络膜脱离组的眼压为（12±5.2）mmHg（1mmHg=0.133kPa）,中央前房深度为（1.662±0.235）mm,发作缓解继发睫状体脉络膜脱离组眼压为（8.3±3.5）mmHg,中央前房深度为（1.373±0.180）mm。睫状体脉络膜脱离组眼压比无脱离组低,睫状体脉络膜脱离组的前房深度比无脱离组浅,差异均有显著性。结论急性发作眼及临床前期眼在降眼压过程中皆可能发生睫状体脉络膜脱离。急性闭角型青光眼急性发作缓解后眼压过低或前房深度变浅,高度怀疑睫状体脉络膜脱离的可能,其主要原因可能与眼压大幅度快速下降有关。     

现代小梁切除术的疗效观察

目的观察现代小梁切除术治疗难治性青光眼及原发性青光眼的疗效.方法对2001年8月～2003年3月5日收治的难治的青光眼、晚期原发性开角型青光眼、前房极浅式疑有恶性青光眼倾向的原发性闭角型青光眼(40只眼)进行现代小梁切除术,术后根据眼压水平,滤过泡形成及前房情况适时拆除可调眼压线,定期随诊患者12个月,内容包括:眼压、视力、滤过泡、前房、晶状体及眼底.结果 40只眼分别于术后3～16 d拆除可调眼压线,拆线时间平均12±2 d,拆线后眼压平均下降1.20 kPa,患者术后1周平均眼压0.16 kPa,与术前相比差异有显著性(P<0.01),术后12个月末眼压≤0.27 kPa者30只眼(90%),其中32只眼眼压≤0.2 kPa,12个月末时功能性滤过泡的累积存活率为85%±5%.术后36只眼呈中度式浅前房,4只眼术后第1天前房浅Ⅰ°,经药物治疗前房逐渐加深.结论现代小梁切除术既可避免术后早期滤过过强,眼压过低引起的并发症,又可安全改善滤过,减少滤过区瘢痕,提高手术成功率.     

青光眼滤过术后浅前房的临床分析

目的:探讨青光眼滤过术后浅前房形成的常见原因及相应预防、处理方法.方法:总结2000年6月～2007年6月我院316例青光眼常规小梁切除术,术后观察低眼压性浅前房的发生原因、类型及相应处理.结果:348眼中,术后发生低眼压性浅前房41眼,发生率11.8%.其中,滤过过畅28眼(68.3%),结膜瓣渗漏6眼(14.6%),睫状体脉络膜脱离4眼(9.7%),恶性青光眼3眼(7.3%).结论:引流过畅是青光眼手术后浅前房发牛的主要原因;青光眼滤过术术前有效地控制眼压、减轻眼部炎症反应,术中注意保持前房深度,术后观察眼压及前房的变化、及时对症处理,是预防浅前房形成的关键.     

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.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.