实时剪切波弹性成像技术对正常卵巢组织的定量研究#br#

目的 探讨卵巢弹性的影响因素,获取正常卵巢杨氏模量的参考值范围,评估及预测实时剪切波弹性成像（shear wave elastography, SWE）技术在卵巢储备功能方面的可行性。 方法 应用SWE超声诊断仪对常规经阴道超声检查的671例体检者的卵巢组织进行弹性测定,获得正常卵巢组织的杨氏模量值。 结果 围绝经期和绝经期卵巢杨氏模量值大于育龄期（P＜0.01）。育龄期中月经增生期与分泌期卵巢杨氏模量值差异无统计学意义（P＞0.05）。育龄期中不同年龄阶段组间卵巢杨氏模量值差异无统计学意义（P＞0.05）。育龄期卵巢杨氏模量最小值为（12.8±4.08） kPa、最大值为（16.9±4.86）kPa、平均值为（14.63±4.31） kPa。 结论 生理阶段影响正常卵巢组织的杨氏模量,月经周期对卵巢杨氏模量无影响,正常卵巢组织的硬度随着年龄的增长逐渐变硬。     

Assessment of left ventricular radial deformation by speckle tracking imaging

The left ventricular radial strain in the inner and outer layers was evaluated by using two-dimensional speckle tracking imaging （2DS）. Twenty-five piglets were studied. The short axis views were acquired. Peak systolic radial strain was measured from 6 circumferential points related to 6 standard segments in the inner and outer layers respectively using 2DS methods. The peak positive first derivative （dp/dt） of left ventricular pressure was compared to the radial strain from 2DS. The inner band showed higher peak radial strain values as compared to the outer band at all of the segments （P〈0.0001）, but the differences had significance just in anteroseptal, posterior, inferior and septal segments （P〈0.05）. Good correlation could be found between radial strain of inner and outer layers and peak dp/dt （P〈0.001）. These preliminary results showed that the degree of local deformation or wall thickening of the ventricular wall in its inner layer was more obvious than its outer layer. It is suggested that the 2DS technique is useful and sensitive for better understanding the regional and global myocar- dial motion and its relationship to the complex architecture of myocardium.     

高频超声结合剪切波弹性成像在诊断糖尿病周围神经病变中的应用价值

目的探讨高频超声和剪切波弹性成像技术（SWE）对糖尿病周围神经病（DPN）的诊断价值,并分析其影响因素。方法选取我院2型糖尿病患者100例,包括糖尿病伴周围神经病患者50例,糖尿病不伴周围神经病患者50例,并纳入同期健康志愿者50例。应用高频超声及剪切波弹性成像测量比较三组患者胫神经超声特征、横截面积（CSA）及杨氏模量值。分析2型糖尿病患者胫神经运动神经传导速度（MCV）及DPN组患者多伦多临床评分（TCSS）与胫神经CSA、杨氏模量值的相关性,探讨胫神经杨氏模量值的影响因素。绘制ROC曲线分析CSA及杨氏模量值对胫神经病变的诊断价值。结果 DPN组胫神经较NDPN组及健康对照组神经束回声减低,神经外膜增厚,"筛网状"结构模糊。三组组内左右侧胫神经CSA、杨氏模量值差异无统计学意义（P>0.05）。三组间胫神经CSA、杨氏模量值差异有统计学意义（P<0.05）,两两比较差异均有统计学意义（P <0.05）。2型糖尿病患者胫神经CSA与杨氏模量值呈正相关（r=0.67,P <0.01）,胫神经MCV分别与胫神经CSA和杨氏模量值呈负相关（r=-0.54,P<0.01; r=-0.62,P<0.01）。DPN组TCSS分别与CSA和杨氏模量值呈正相关（r=0.29,P<0.01; r=0.30,P<0.01）。糖尿病病程、糖化血红蛋白水平影响胫神经杨氏模量值。胫神经杨氏模量值诊断DPN最佳截点值为46.7 k Pa,敏感度为84%,特异度为88%。结论高频超声结合SWE可通过神经形态和硬度的改变评估2型糖尿病胫神经病变,是诊断DPN的有效手段。     

剪切波弹性成像评价健康成年人跟腱硬度的研究

目的 探讨应用剪切波弹性成像评价健康成年人跟腱硬度的临床价值。方法 选取2021年12月至2022年6月在温州医科大学附属第二医院进行检查的90名健康志愿者，根据年龄分为青年组（18～44周岁，n=30）、中年组（45～59周岁，n=30）和老年组（60周岁以上，n=30），应用剪切波弹性成像（shear wave elastography，SWE）技术测量所有受试对象双侧跟腱近段、中段、远段的杨氏模量值，同时测量跟腱厚度。结果 老年组及中年组两侧跟腱均显著厚于青年组（P<0.05），老年组与中年组两侧跟腱厚度比较，差异无统计学意义（P>0.05）。老年组两侧跟腱近段杨氏模量值显著小于青年组（P<0.05）；3组的两侧跟腱中段和远段杨氏模量值比较，差异均无统计学意义（P>0.05）。年龄与双侧侧跟腱厚度均呈显著正相关（P<0.05），双侧跟腱中段、远段杨氏模量值年龄均与无显著相关性（P>0.05），跟腱近段杨氏模量值与年龄呈显著负相关（P<0.05）。结论 健康成年人的跟腱厚度随着年龄增长而增加，跟腱近段的硬度随着年龄的增长而降低，并可以通过SWE进行评价。     

An anatomical and histological study of human meniscal horn bony insertions and peri-meniscal attachments as a basis for meniscal transplantation

Background AIIograft meniscal transplantation is an increasingly popular treatment option for the symptomatic young patients with meniscus deficiency. However, many questions still surround it. In this research, we studied the anatomical location and histological structure of human meniscal horn bony insertions and to observe the anatomical morphology and histomorphology of peri-meniscal attachments based on meniscal allograft transplantation. Methods Twenty-two fresh-frozen adult cadaver knees were dissected. The locations of meniscal anterior and posterior horn bony insertions to tibia were measured. The anatomical morphology of peri-meniscal attachments was observed and the histological structure of meniscal horn bony insertions and peri-meniscal attachment were studied by HE staining. Results The anterior horn bony insertion of medial meniscus was （9.19±1.83） mm inferior to the corresponding anterior border of tibial plateau, and （7.81±2.25） mm lateral to the axial line of the medial intercondylar eminence. The posterior horn bony insertion of medial meniscus was in the posterior intercondylar fossa of tibia, located between the anterior fibers of the posterior cruciate ligament （PCL） tibial insertion and anterior border of the tibial posterior intercondylar fossa, and was （5.05±1.18） mm lateral to the axial line of the medial intercondylar eminence. The distance between anterior and posterior horn bony insertions of the lateral meniscus was （13.68±2.19） mm. Anterior horn bony insertion of the lateral meniscus was （3.99±1.27） mm medial to the axial line of the lateral intercondylar eminence, and the posterior horn bony insertion of the lateral meniscus was （5.80±1.36） mm medial to the axial line of the lateral intercondylar eminence. Except for the meniscal horn bony insertions, which is the typical enthesis, we call the attachment of the other parts of menisci as ‘peri-meniscal attachment＇. The morphological and histological study showed that the main peri-meniscal attachment was the meniscotibial ligament, through which the meniscus attached to the tibia with enthesis structure, and there was only loose connective tissue between menisci and capsule. Conclusions In meniscal allograft transplantation, the traditional meniscal size-matching method which take medial and lateral intercondylar eminences as references is not as accurate as expected. Attention should be taken to locate both anterior and posterior horn tunnels of medial meniscal allograft inferior to the tibia plateau, and to locate anterior and posterior horn tunnels of lateral meniscus close enough （mean 13.68 mm）. The best way to reconstruct the peri-meniscal attachment is to suture the allograft to the preserved outer remnant of the original meniscus.     

经阴道超声评估宫颈成熟度对临产时间的预测价值研究

目的 探讨经阴道超声评估宫颈成熟度对临产时间的预测价值。方法 选取2020年9月至2021年11月在河北省秦皇岛市第一医院建档并分娩的孕妇46例，根据距离临产时间（time to onset of labor,TOL）分为TOL≤2周组15例、TOL>2周组31例，分别记录孕妇的一般资料、宫颈Bishop评分，经阴道超声宫颈内外口前后唇的弹性值、宫颈长度、宫颈宽度、胎头距会阴的距离。采用多因素logistic回归分析临产时间的影响因素，采用受试者工作特征曲线分析宫颈长度、宫颈内口前唇弹性值对临产时间的预测价值。结果 两组孕妇年龄、孕周、宫颈Bishop评分、宫颈宽度、胎头距会阴的距离、宫颈内口后唇弹性值、宫颈外口前唇弹性值、宫颈外口后唇弹性值比较差异均无显著性（P>0.05）。TOL≤2周组宫颈长度、宫颈内口前唇弹性值显著低于TOL>2周组，差异有显著性（P<0.05）。多因素logistic回归分析结果显示，宫颈内口前唇弹性值及宫颈长度是临产时间的独立影响因素（P<0.05）。受试者工作特征曲线分析显示，宫颈长度、宫颈内口前唇弹性值预测2周内临产的最佳截...     

An anatomical comparison of two minimally invasive pelvic reconstructive surgeries using fresh female cadavers

Background During the past decade, graft materials have been widespread used in the vagina in order to correct pelvic organ prolapse. The aim of this study was to describe and compare the exact anatomical position of the puncture devices and their relations to the relevant anatomical structures in the ProliftTM and a modified pelvic reconstructive surgery with mesh. Methods Twelve fresh cadavers were allocated randomly to either the ProliftTM or the modified pelvic reconstructive surgery group. Each group had six fresh cadavers. Relevant distances between the puncture devices and anatomical structures were recorded in both minimally invasive puncture surgeries. Results The mean distances from the posterior puncture points of the obturator membrane to the posterior branch of obturator arteries were shorter （（0.60＋0.36） cm and （0.78＋0.10） cm） when compared with the distances to the anterior branch of obturator arteries （（1.53＋0.46） cm and （1.86＋0.51） cm） for the reconstruction of the anterior compartment in both surgeries （all P 〈0.05）. The distance from the puncture points of the pelvic floor through the ischiorectal fossa to the coccygeal and inferior gluteal arteries in the ProliftTM technique （（0.88＋0.10） cm） and （（1.59＋0.36） cm））were much shorter than that in the modified pelvic reconstructive surgery （（2.95＋0.09） cm） and （（3.40＋0,36） cm）） for the reconstruction of the middle and posterior compartments （all P 〈0.05）. Conclusions Compared with the ProliftTM technique, the modified pelvic reconstructive surgery with mesh would be safer not to cause great damage to the inferior gluteal arteries and the coccygeal arteries, The posterior branch of obturator arteries would be easier to be injured than the anterior branch of obturator arteries during anterior compartment reconstruction in both surgeries.     

SELECTION OF SURGICAL APPROACH TO TREAT TRAUMATIC INSTABILITY OF SUBAXIAL CERVICAL SPINE

Objective To evaluate the clinical outcomes of surgical therapy in treating traumatic instability of subaxial cervical spine through either anterior or posterior approach. Methods According to the A llen-Fergurson＇s classification, we retrospectively studied 42 cases of traumatic instability of subaxial cervical spine through either anterior or posterior surgical reconstruction. Patients requiring approach for either reduction or decompression were not included. Results The average follow-up interval was 3 years and 2 months. The anterior and posterior reconstructions were 24 and 18 cases, respectively. Before operation, the average scores of JOA and VAS were： 12.1 and 6. 9 for anterior group, and 12.3 and 7. 2 for posterior group. At the final assement, the scores of JOA and VAS improved to 16. 0 and 2.2 for anterior group, and 15. 7 and 2.6 for posterior group. The average ASIA motor scores of anterior and posterior group improved to 68. 2 and 65. 5 at the final follow-up from 58.4 and 59. 7 before operation, respectively. The ASIA grade （A-E） was converted to a numeric score. The average scores before operation in the anterior and posterior group were 3.3 and 3.4, and increased to 3.8 and 3. 7 at the final follow-up. After operation, there were different extent improvements of average radiological parameter, such as Cobb angle, vertebral body translation and disc height ratio. The average operation time and blood losing were 122 min and 125 mL for anterior group, and 153 min and 287 mL for posterior group. Fusion was achieved in all patients and 4 and 2 complications occurred at the anterior or posterior group. Conclusion The results showed that there were no obvious difference in parameters, such as neurological assements, functional grades, fusion rate, operation time and blood losing, between anterior and posterior group, except the virtues of anterior group in reconstruction and maintaining physiologic cervical lordosis and intervertrbal disc height occurred.     

A MRI quantitative study of corpus callosum in normal adults

Objective： To investigate the possible age- and sex-related differences in the various dimensions of corpus callosum among Chinese normal adults. Methods： Magnetic resonance images of 286 healthy adults, including 127 males and 159 females, and ranging in age from 20 to 81 years, were investigated. They were classified into 5 age groups （ 20-29, 30-39, 40-49, 50-59, and 60-81 years old）. Corresponding to the age group sequence above, the male/female ratio of each group respectively was： 25/26, 26/33, 33/50, 32/36, and 11/14. The following dimensions of corpus callosum were systematically measured on the midsagittal Tl-weighted images： frontal to occipital pole （represented as line segment AB）, total longitudinal dimension of the corpus callosum （CD）, the maximum height （EF）, the widths of the genu （CX）, anterior one third （GH）, central region （EZ）, posterior one third （MN） and splenium （YD）. After that, the obtained data was analyzed statistically. Results： （1） The total longitudinal dimension, maximum height, widths of the genu, central region and splenium were proved to be larger in females. But the widths of the anterior one third and posterior one third were similar in-between. In spite of that, a conspicuous sex-related difference was not found. （2） The total longitudinal dimension and the maximum height of the corpus callosum remained stable in all age subgroups. Yet the widths of the genu, anterior one third, central region, posterior one third and splenium had a tendency of decreasing gradually with aging. Statistical difference was seen in the anterior one third, central region, posterior one third （P〈0.05）. Conclusion： There is no sex-related difference in all dimensions of corpus callosum. But, with aging, a significant difference is found in the widths of the anterior one third, central region and posterior one third.     

A dissection of the right coronary artery with ST segment elevation in lead V1 to V5

To the editor： A 60-year-old male was admitted with complaints of chest distress occurring over four months. His ECG displayed QS in leads V1 and V2 （Figure IA）. A diagnosis of old anteroseptal wall and anterior wall myocardial inthrction was made. Coronary angiography （CAG） revealed that the middle portion of the left anterior descending artery （LAD） was completely occluded （Figure 1C）,     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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.