脑肿瘤患者认知异常的静息态脑功能成像研究

目的探讨脑肿瘤患者认知异常的静息态脑功能成像。方法选择19例脑肿瘤患者为脑肿瘤组,23例健康体检的志愿者为对照组。所有受试者在静息状态下完成血氧水平依赖功能磁共振成像（BOLD-fMRI）检查,采用静息态脑功能成像方法对静息态功能磁共振成像（rs-fMRI）数据进行局部一致性影像（ReHo）、低频振幅影像（ALFF）处理,通过RESTPLUS软件分析脑肿瘤组与对照组ReHo值、ALFF值的差异。结果与对照组比较,脑肿瘤组双侧额下回、双侧颞中回、双侧海马旁回、右侧前扣带回ALFF值均明显升高（均P＜0.01）;中脑、左侧颞中回、双侧颞上回、双侧海马旁回、双侧前扣带回、双侧顶上回、双侧额下回、双侧辅助运动区ReHo值均明显升高（均P＜0.01）。结论脑肿瘤患者在额叶、颞叶、边缘系统及辅助运动区存在着一系列脑部自发神经活动的变化,激活的区域与目前对该脑区认知功能的研究基本符合,且以双侧大脑半球改变为多。     

高血压对阿尔茨海默病患者脑结构和功能影响的MRI研究

目的 探讨高血压对阿尔茨海默病(AD)患者脑结构和功能的影响.方法 收集高血压和正常血压AD患者各20例,均行常规MRI、3DT1WI和静息态功能磁共振(rs-fMRI)扫描,采用基于体素的形态学分析(VBM)、低频振幅(ALFF)和局部一致性(ReHo)对两组数据进行对比分析.结果 与正常血压组患者比较,高血压组灰质体积(GM V)显著减少的脑区位于双侧背外侧前额叶、后扣带回/楔前叶、顶下小叶和眶回(P<0.05);高血压组ALFF显著减低的脑区位于双侧背外侧前额叶、后扣带回/楔前叶、顶下小叶和右侧颞上回、岛叶,增高的脑区位于右侧海马、海马旁回、岛叶和双侧前扣带回(P<0.05);高血压组ReHo显著减低的脑区位于左侧背外侧前额叶、内侧前额叶、顶下小叶、双侧后扣带回/楔前叶和右侧岛叶,增高的脑区位于左侧颞上回、右侧海马、双侧海马旁回和前扣带回(P<0.05).结论 高血压对 AD脑结构和功能影响主要表现在背外侧前额叶、后扣带回/楔前叶和顶下小叶脑质萎缩和自发神经元活动异常.     

基于局部一致性的重度抑郁症患者脑静息态功能磁共振成像研究

目的 采用脑静息态功能磁共振成像(rs-fMRI)局部一致性(ReHo)方法探讨重度抑郁症(MDD)患者脑区自发性活动特征,评价其与抑郁严重程度的相关性.方法 对24例MDD患者和26例相匹配的康对照组(HC)进行rs-fMRI扫描,分析两组ReHo值,将差异显著的脑区内平均ReHo值与HAMD-17评分进行相关性分析.结果 MDD患者较HC组左侧直回、左侧海马、右侧楔前叶、右侧顶上回、左侧顶下缘角回、右侧楔叶ReHo值显著升高;右背外侧前额叶、右侧后扣带回、左侧枕下回、双侧颞下回、右侧颞上回ReHo值降低(P<0.05,Alphasim矫正).Pearson相关分析显示两组差异脑区左侧海马ReHo值与HAMD-17评分呈正相关(r=0.593,P=0.002),右侧后扣带回ReHo值与HAMD-17评分呈负相关(r=-0.431,P=0.035).结论 MDD患者静息态下脑功能损害主要集中于边缘系统及默认网络等多个脑区,且左侧海马与右侧后扣带回局部脑区自发活动的时间同步性与抑郁严重程度存在相关性.ReHo分析可作为抑郁症严重程度评价的潜在生物学标记.     

交替性霍纳氏综合征患者的脑部功能连接变化:附1例报告

目的探讨交替性霍纳氏综合征(AHS)患者脑部度中心性功能连通性变化。方法对1例AHS患者及8名健康受试者进行脑部结构像及静息态脑功能成像扫描。采用度中心性(DC)方法评价AHS患者脑部静息态默认网络结点的中心性度量变化。统计学采用单样本t检验及双样本t检验,采用假阳性率(FDR)校正,P<0.05有统计学意义。结果 AHS患者左眼发病时DC主要为双侧额中回前部及额盖和岛盖,高于全脑均值的脑区主要为双侧枕叶、颞叶及扣带回,低于正常被试的脑区主要位于左侧颞下回、中央后回,右侧颞上回,枕外侧回及双侧旁中央小叶。右眼发病时DC主要为双侧额上回及额中回前部、顶叶、中扣带回及枕内侧回,高于全脑均值的脑区主要位于双侧枕叶、颞叶及扣带回及双侧额叶眶回、直回,低于正常被试的脑区主要位于左侧缘上回、右侧枕外侧回、旁中央小叶及双侧颞上回。结论 AHS患者脑部改变可表现为多个脑区度中心性功能连接减低。     

阿尔茨海默病的静息态fMRI低频振幅研究

  目的 应用静息态功能磁共振成像(fMRI)低频振幅（(ALFF)方法对阿尔茨海默病(AD) 基线脑活动变化进行研究。 方法　利用GE Signa 3.0T MRI对AD患者组和正常对照组（各18例）分别进行静息态fMRI扫描。应用低频振幅(ALFF)统计方法计算并对比2组ALFF改变的脑区。 结果　静息状态下,AD组患者右侧海马(BA28)及海马旁回(BA36)、左额下回(BA47) 、双侧小脑后叶脑区ALFF值较正常对照组增高,差异有统计学意义( P < 0.001, 未校正);AD组患者楔前叶(BA 7)、后扣带回(BA31) 、左侧丘脑ALFF值较正常对照组减少,差异有统计学意义( P < 0 .001, 未校正)。 结论 AD患者静息态下脑功能区ALFF值产生显著变化。     

浅针山根穴治疗原发性失眠静息态功能磁共振研究

目的探讨浅针山根穴治疗原发性失眠(PI)的中枢作用机制。方法对10例PI患者(治疗组)在浅针治疗前后及10例健康者(对照组)进行静息态功能磁共振技术(fMRI)扫描,比较2组之间及治疗组治疗前后脑区功能连接差异情况。结果治疗组与对照组比较,功能连接增强的脑区主要有双侧额中回、右侧中央前回、双侧中央后回、左侧楔前叶、右侧顶上小叶;功能连接减低的脑区主要有左侧脑岛、左侧前扣带回、右豆状核、左侧尾状核。治疗组治疗后与治疗前比较,功能连接增强的脑区主要有双侧脑岛、双侧脑干、左侧尾状核、双侧扣带回;功能连接减低的脑区主要有双侧额中回、右侧楔前叶。结论 PI患者存在情绪回路功能的异常;浅针刺激山根穴能改善情绪回路的功能,可能是浅针治疗PI的中枢机制之一。     

阿尔茨海默病不同频段低频振幅静息态功能磁共振成像研究

目的：探讨阿尔茨海默病（AD）患者静息状态下不同频段低频振幅（ALFF）脑功能活动特点。方法使用3.0T磁共振对20例AD患者及20名正常对照者进行脑静息态功能磁共振检查。采用静息态功能磁共振数据处理助手（DPARSF）和静息态功能磁共振数据分析工具包(REST)进行处理及检验统计分析,主要观察Slow-4和Slow-5频率段AD组的脑功能活动特点,用REST软件呈现结果,确定有统计学意义的脑区解剖位置。结果与正常对照组相比,AD患者组ALFF值减低的脑区包括：后扣带回、楔前叶、双侧额叶及双侧顶下小叶（P<0.05）;双侧海马旁回和梭状回、右侧额顶叶、右侧小脑后叶和双侧基底节区的ALFF值则明显升高（P<0.05）;双侧基底节区的自发神经活动对Slow-5频率段更敏感,而较高频率的Slow-4频率段更适合检测出双侧海马旁回及梭状回等脑区自发神经活动的异常。结论 AD患者多个脑区自发神经元活动存在异常,且部分脑区的自发神经元活动存在频率依赖性。     

基于低频振幅算法的难治性癫痫发作间期静息态功能磁共振成像研究

目的 采用功能磁共振成像(functional magnetic resonance imaging,fMRI)探讨难治性癫痫患者发作间期脑功能的改变.方法 对难治性癫痫患者和健康对照的功能磁共振数据均采用低频振荡振幅(amplitude of low frequency fluctuation,ALFF)算法分别进行处理,计算并对比难治性癫痫组相比健康对照组ALFF改变的脑区,分析ALFF改变脑区与病程的相关性.结果 静息状态下难治性癫痫组与对照组相比ALFF值增强的脑区主要有中脑、桥脑、尾状核、额下回及双侧海马旁回、海马等部位;ALFF值减弱的脑区主要有双侧额叶、右侧颞上回、扣带回后部及相邻的楔前叶,且右侧颞中回的ALFF值与病程呈负相关(r=-0.71,P＜0.05).结论 难治性癫痫患者发作间期存在广泛的脑功能异常,且与癫痫病程相关.     

抑郁症脑网络的静息态功能磁共振分析

目的 分析抑郁症患者脑网络的静息态功能磁共振(rs-fMRI)特征,并评价其与抑郁严重程度的相关性。方法 选取在我院心理门诊治疗的抑郁症患者25例作为研究组,同期健康志愿者25例作为对照组,均进行rs-fMRI扫描。并采用Pearson分析有统计学意义的脑区内平均ReHo值与汉密尔顿抑郁量表(HAMD-17)评分的相关性。结果 研究组左侧海马、左侧直回、左侧顶下缘角回、右侧楔前叶、右侧顶上回、右侧楔叶的ReHo值明显高于对照组的ReHo值(P0.05);研究组左侧枕下回、左侧颞下回、右侧颞上回、右侧颞下回、右侧背外侧前额叶、右侧后扣带回的ReHo值明显低于对照组的ReHo值(P0.05)。经相关性分析,抑郁症患者的HAMD-17评分与左侧海马的ReHo值呈正相关(P0.001),抑郁症患者的HAMD-17评分与右侧后扣带回的ReHo值呈负相关(P0.05)。结论 抑郁症患者静息态下脑功能损伤主要集中在默认网络和边缘系统等,且左侧海马、右侧后扣带回局部脑区连接强度变化与抑郁症严重程度具有相关性,Re Ho可辅助评价抑郁症严重程度。     

轻度认知障碍静息态功能磁共振研究低频振幅分析

目的 基于静息态功能磁共振成像（functional magnetic resonance imaging,fMRI）技术,应用低频振荡幅度（amplitude of low-frequency fluctuation,ALFF）观察轻度认知障碍（mild cognitive impairment,MCI）的静息态脑功能改变。方法 选取50例MCI患者作为研究对象,以50例年龄匹配的正常健康老年人作为对照组。所有被试均进行fMRI检查,采取ALFF后处理方法,比较MCI与正常对照组静息态脑功能的差异。结果 与正常对照组比较,MCI组患者双侧海马旁回、双侧尾状核、左侧壳核和左侧岛叶ALFF减弱。未检测出ALFF增强的区域。结论 MCI患者静息态fMRI显示海马旁回等脑区活动强度减弱。     

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.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.