MSCT多时相薄层扫描诊断微小肝癌的临床应用研究

目的探讨微小肝癌(MHCC)的检查方法及诊断价值。方法27例微小肝癌患者分别行多层螺旋CT(MSCT)多时相薄层扫描,扫描时间分别为动脉期20-25s、门脉期50-55s、平衡期2-3min、延迟期5-7min,多时相薄层3-5mm,用高压注射器经肘静脉注射,速率为3ml/s,剂量为1.5-2.0ml/kg。结果共发现36个病灶,动脉期、门脉期、平衡期和延迟期的检出率分别为91.7%、72.2%、77.8%、83.3%,综合多时相薄层扫描检出率为94.4%;DSA检出MHCC的敏感性为33.3%。结论多层螺旋CT(MSCT)多时相薄层扫描,检出MHCC以动脉期和延迟期为最佳,综合多时相薄层扫描可以提高MHCC的检出率和诊断准确性。     

多层螺旋CT对微小肝癌的诊断研究

目的 研究多层螺旋CT(MSCT)多时相薄层扫描对微小肝癌(MHCC)的诊断价值,提高MH-CC的检出率.方法 选择临床上已确诊为肝功能失代偿期的肝硬化患者300例,先行常规螺旋CT增强扫描后,然后行MSCT多时相薄层扪描,即动脉期(20～25 s)、门静脉期(50～55 s)、平衡期(2～3min),高压注射器灌注非...     

多层螺旋CT多时相薄层扫描对微小肝癌的诊断价值

目的 研究多层螺旋CT(multi-slice helical CT,MSCT)多时相薄层扫描对微小肝癌(microhepatic cellular carcinoma,MHCC)的诊断价值.方法 临床已确诊为肝功能失代偿期肝硬化患者338例定期行MSCT多时相薄层扫描,扫描时间分别为动脉期20~25s,门静脉期50~...     

多层螺旋CT对微小肝癌的诊断价值分析

目的 探讨多层螺旋CT对微小肝癌的诊断价值.方法 回顾性分析320例临床确诊的肝功能失代偿期肝硬化患者的临床资料,均行先行常规螺旋CT增强扫描后进行多层螺旋CT扫描,对检查出的阳性病例在DSA上行选择性肝动脉造影检查.结果 320例患者中检查出微小肝癌29例,共50个癌灶,多层螺旋CT的表现特点是平扫呈等密度或略低密度,三期敏感性分别为:动脉期93.1％,门静脉期79.3％,平衡期86.2％,综合三期敏感性为96.6％均显著高于常规螺旋CT(P＜0.05).结论 多层螺旋CT显示微小细胞肝癌以动脉期和延迟期最佳,是临床上必须选择的最佳检查方法.     

原发性肝癌合并肝动脉-门静脉瘘的多层螺旋CT诊断

目的探讨原发性肝细胞癌(HCC)患者合并肝动脉-门静脉瘘(APFs)的多层螺旋CT(MSCT)动态增强的影像学表现,并与肝动脉血管造影的影像学表现相比较。方法对38例HCC合并APFs的患者进行肝脏MSCT动态增强及DSA检查。以DSA诊断APFs为金标准,对照分析MSCT诊断APFs的准确率及APFs的CT的影像学特征。结果 38例HCC在MSCT增强动脉期均发现与APFs相关的阳性影像学征象。MSCT增强影像学表现可分为:中央型(29例)和周围型(9例)。中央型表现为:①肝动脉期门静脉主干和/或左右一级分支提早显影,显影段门静脉密度接近主动脉增强密度。②动脉期低密度门静脉癌栓内及其周围见网状滋养动脉显影。周围型表现为:①肝动脉期肿瘤所在的肝叶瘤周肝实质出现片状强化区,门静脉期该区域密度与其他部位正常肝组织密度一致;②肝动脉期肿瘤内门静脉提前显影呈线条状、圆点状强化,密度较高,边缘较清晰。结论 MSCT诊断APFs可作为无创检查的首选,并对指导肝癌的化疗栓塞术(TACE)具有重要意义。     

胰腺内分泌肿瘤的术前螺旋CT多期扫描

目的评估薄层CT多期扫描在胰腺内分泌肿瘤(PET)术前定位中的价值.方法对63例经手术及病理证实的PET的CT检查资料进行回顾性分析,对肿瘤的强化特征和各期相的检出情况进行比较和分析.结果术前CT定位准确性81%(51/63),大多数肿瘤(n=59)在至少一个期相上呈高密度,1例肿瘤呈低密度,5例呈等密度.PET在动脉期和胰腺实质期显示明显,8例假阴性中呈等密度4例,蒂状突出2例,肿瘤邻近血管2例.结论薄层螺旋CT多期扫描对PET的检出敏感性高,多数肿瘤在增强早期显示明显,肿瘤邻近血管、蒂状突出及非高密度病灶是造成假阴性的潜在因素.     

血清miR-122-5p水平联合MSCT对肝癌的诊断价值

目的探讨血清miR-122-5p水平联合多层螺旋电子计算机断层扫描(MSCT)对肝癌的诊断价值。方法选取2016年1月至2019年1月我院80例肝癌患者纳入观察组,收集同期进行肝癌筛查的健康人群100例作为正常对照组,均进行MSCT检查,并检测血清miR-122-5p水平,绘制受试者工作特征曲线(ROC)分析血清miR-122-5p水平联合MSCT对肝癌的诊断价值。结果80例肝癌患者进行MSCT多期扫描共发现107个病灶,病灶大小为5~10mm;单个癌结节58例,2个癌结节17例,3个癌结节5例;病灶位于肝右叶50例,左叶27例,左、右叶3例;92个强化病灶中68个病灶呈明显或轻度较均匀强化,24个病灶呈不均匀强化,表现为肿瘤边缘环形强化、部分性强化、中心点状强化;MSCT检出率分别为动脉期88.79%(95/107)、门静脉期71.96%(77/107)、平衡期77.57%(83/107)、延迟期83.18%(89/107),综合多时相薄层扫描检出率为93.46%(100/107);肝癌患者血清中miR-122-5p水平低于正常对照组(P<0.05);ROC曲线分析显示,血清miR-122-5p、MSCT联合检查与肝癌诊断相关的AUC为0.884,高于miR-122-5p、MSCT单独检测的0.766、0.795(P<0.05)。结论血清miR-122-5p水平联合MSCT可有效提高肝癌的诊断价值。     

胰腺内分泌肿瘤的术前螺旋CT多期扫描

目的评估薄层CT多期扫描在胰腺内分泌肿瘤(PET)术前定位中的价值.方法对63例经手术及病理证实的PET的CT检查资料进行回顾性分析,对肿瘤的强化特征和各期相的检出情况进行比较和分析.结果术前CT定位准确性81%(51/63),大多数肿瘤(n=59)在至少一个期相上呈高密度,1例肿瘤呈低密度,5例呈等密度.PET在动脉期和胰腺实质期显示明显,8例假阴性中呈等密度4例,蒂状突出2例,肿瘤邻近血管2例.结论薄层螺旋CT多期扫描对PET的检出敏感性高,多数肿瘤在增强早期显示明显,肿瘤邻近血管、蒂状突出及非高密度病灶是造成假阴性的潜在因素.     

MSCT三期增强扫描对小肝癌的临床诊断价值

目的：研究多层螺旋CT (MSCT)三期增强扫描对小肝癌(SHCC)的诊断价值。方法收集2015年1月至2016年5月期间我院收治的SHCC患者34例,均采用MSCT平扫以及三期(动脉期、门脉期、延迟期)增强扫描,观察并比较病灶的表现。结果34例患者中共检出40个病灶,平扫检出率为65.00%(26/40),动脉期为92.50%(37/40),门静脉期为70.00%(28/40),延迟期为90.00%(36/40);动脉期以高密度影为主(92.50%),静脉期以低密度影为主(67.60%),延迟期以低密度影为主(80.00%),动脉期与延迟期的检出率明显高于门静脉期,差异均有统计学意义(P<0.05);三期联合增强扫描对小肝癌病灶的检出率为92.50%(37/40)。结论 MSCT三期增强扫描联合能够准确反映SHCC病灶强化的特征,对SHCC的早期定位及定性诊断具有重要价值。     

多层螺旋CT三期增强扫描对小肝癌的诊断价值

目的:探讨小肝癌的多层螺旋CT动脉期、门静脉期及延迟期增强表现特征及其诊断价值,进一步提高小细胞肝癌的诊断能力。方法:对30例小肝癌行螺旋CT动脉晚期、门静脉期和延迟期增强扫描,分别于造影剂注射后25～30s、60～70s、3～5min开始扫描,碘海醇注射速率为2.5～3.0ml/s,用量80～100ml。结果:30例小肝癌共发现35个结节病灶。平扫、动脉期、门静脉期及延迟期的检出率分别为65.7%(23/35)、91.4%(32/35)、68.5%(24/35)、88.5%(31/35)。82%(29/35)的小肝癌动脉期呈高密度,静脉期68.5%(24/35)呈低密度,延迟期80%(28/35)呈低密度。动脉期和延迟期敏感性高于门静脉期。三期增强联合检出率为91.4%。结论:多层螺旋CT三期增强扫描可充分反映小肝癌的强化特征,对小肝癌的检出和定性准确率的提高有重要价值。     

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.     

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.     

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…     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.