进行性核上性麻痹12例临床及核磁共振分析

目的：探讨进行性核上性麻痹（PSP）的临床和影像学特点。方法回顾性分析12例临床诊断的PSP患者的临床和影像学资料。结果12例患者主要症状为运动迟缓、姿势不稳、假性球麻痹和垂直性眼肌麻痹,部分患者有认知功能障碍、小便障碍等。多数患者首发症状为运动迟缓。患者头颅MRI均可见不同程度脑萎缩,以额叶及中脑为著,部分患者出现“蜂鸟征”和“喇叭花征”改变。结论 PSP患者以运动迟缓为最常见首发症状,姿势不稳、易跌倒为常见的临床表现,垂直性眼肌麻痹最具诊断意义,头颅MRI检查有助于PSP诊断。     

进行性核上性麻痹和多系统萎缩的纵向MRI检查：萎缩率和部位

进行性核上性麻痹(PSP)和多系统萎缩(M SA)患者的脑萎缩率及其与临床疾病进展之间的关系尚不清楚。24例PSP患者、11例M SA-P(帕金森变异型)患者、12例帕金森病患者和18例健康对照者纳入本项连续M RI扫描研究。为评估生存期内的脑萎缩及其与PSP和M SA-P疾病进展的关系,对患者进行临床和正规神经心理学评估。对连续扫描进行登记并根据脑边界位移积分计算患者的全脑萎缩率。通过登记局部感兴趣区以获得局部边界位移积分(BSI),计算脑干(中脑和脑桥)、小脑、侧脑室和第3脑室以及前额和后下脑区的局部萎缩率。82%的受试者完成了连续M …     

齿状核红核苍白球路易体萎缩一家系患者的临床、影像和基因分析

目的 探讨齿状核红核苍白球路易体萎缩(dentatorubral-pallidoluysian atrophy,DRPLA)一家系患者的临床、影像及基因改变特点.方法 对1例早发成年型DRPLA患者的临床、影像及基因资料进行分析,并对其家族成员行详细的病史询问.结果 先证者,男性,42岁,病程5年.首发症状为言语含糊,后续的主要症状为走路不稳、言语不清(吟诗样语言伴构音障碍)、全身不自主运动、认知功能下降及性功能障碍.头颅MRI(2009年)示双侧脑室旁、桥脑长T2信号,小脑轻度萎缩,外院初诊为“多发性硬化”,应用激素冲击治疗无明显疗效;4年后复查头颅MRI(2013年)示上述部位异常信号增多,脑干和小脑明显萎缩.外周血DNA检查发现ATN-1基因中CAG重复序列数异常增多.先证者之父,39岁发病,首发症状为走路不稳,逐渐出现言语欠流利及行走缓慢,病情进行性加重;70岁出现言语含糊不清、饮水呛咳伴吞咽困难;头颅MRI示“脑白质病”;最后至不能进食后病故.结论 早发成年型DRPLA临床主要表现为痴呆、共济失调、舞蹈手足徐动;头颅MRI可见双侧弥漫性白质病变,脑干和小脑进行性萎缩;ATN-1基因中CAG重复序列数测定可明确诊断.     

浅谈多系统萎缩的临床症状、CT显像和MRI显像

目的:观察多系统萎缩(MSA)患者的临床表现、CT显像和MRI显像,为临床早期诊断MSA提供临床信息.方法:回顾分析12例多系统萎缩患者的临床资料,9例为MSA-C,3例为MSA-P,分析统计患者的临床症状磁共振成像表现、螺旋CT表现.结果:多系统萎缩临床表现主要包括自主神经功能障碍、尿便功能症状、小脑性共济失调、帕金森综合征;12例均行CT、MRI扫描,CT扫描4例(33.3%)显示轻度小脑、脑干部分有萎缩,其余无异常表现; MRI扫描3例(25.0%)表现正常,9例(75.0%)异常,图像表现为小脑半球、全小脑萎缩、中脑萎缩、大脑脚变细,桥脑、桥脑臂及延髓萎缩、额叶和(或)顶叶萎缩、外侧裂增宽等.结论:MSA临床表现无特异性,易误诊为其他疾病,MRI头颅扫描相比CT头颅扫描更具有敏感性,临床诊断MSA时综合患者的详细病史、全面的神经系统检测、辅助MRI影像学检测结果,可提高MSA临床诊断率.     

18例肝豆状核变性临床与CT

报告18例肝豆状核变性(HLD),临床以进行性肢体震颤、肌强直、精神症状、流涎、肝硬化及角膜色素环为主要症状。HLD头颅CT的阳性率为83.3％,CT改变以脑萎缩最常见,其次为豆状核低密度灶,脑干萎缩,再次为脑室扩大,小脑萎缩,丘脑低密度灶等,但以双侧基本对称的豆状核区低密度灶最具特征性。     

不同类型多系统萎缩临床表现与磁共振成像特征分析

目的 探讨不同类型多系统萎缩(MSA)患者的临床表现及磁共振成像(MRI)特征之间的差别.方法 回顾性分析经临床诊断为MSA的41例患者的临床资料及MRI资料,其中帕金森型(MSA-parkinsonian,MSA-P)17例,小脑萎缩型(MSA-cerebellar,MSA-C)24例.比较MSA-P及MSA-C患者的临床表现及MRI资料.结果 临床表现:MSA-P与MSA-C患者在构音障碍、共济失调步态、跟膝胫试验阳性、指鼻轮替试验障碍、步态异常、肌张力增高6个方面比较,差异有统计学意义(P<0.05).MRI特征:MSA-P与MSA-C患者在侧脑室扩大、第四脑室扩大、壳核外侧缘高信号、壳核后外侧低信号、小脑萎缩、脑桥及小脑中脚萎缩、延髓萎缩、中脑萎缩、壳核萎缩9项MRI表现比较,差异有统计学意义(P<0.05).结论 常规MRI及临床表现有助于MSA的诊断及其分型的鉴别.     

进行性核上性麻痹2例临床分析

目的通过对进行性核上性麻痹的临床特点、病因病理、诊断及治疗的了解,提高进行性核上性麻痹诊断的准确性。方法分析我院近3年的2例进行性核上性麻痹患者的临床资料,并复习相关文献。结果2例患者均于60岁后缓慢起病,临床表现为姿势不稳、帕金森综合征、垂直性核上性眼肌麻痹、假性球麻痹和痴呆等症状。2例头颅MRI未见异常。结论进行性核上性麻痹是一种误诊率很高的疾病,临床医生应予重视。     

多系统萎缩临床亚型诊断的研究

目的:探讨多系统萎缩(MSA)的临床表现与MRI特征及其临床亚型诊断的价值。方法:回顾性总结30例MSA患者的临床及MRI资料。结果:橄榄脑桥小脑萎缩(OPCA),以小脑体征为主要表现;MRI检查为脑桥和小脑部萎缩,第四脑室扩大;T2W1出现脑桥小脑对称性高信号及脑桥十字征。纹状体黑质变性(SND),以锥体外系症状明显,MRI改变多位于基底核团,呈现壳核萎缩,T2W1显示壳核外侧缘缝隙样高信号。Shy-Drager综合征(SDS),以自主神经症状明显,出现早而且重;MRI未见特异性改变。结论:MSA诊断主要依据临床症状及神经系统异常体征和MRI特征,临床亚型诊断使MSA诊断细化,体现了系统病征特点,具有应用价值。     

尸检确认的进行性核上性麻痹患者大脑萎缩的发生率

目的:生前反复M RI脑容量扫描确定6例经尸检确诊为进行性核上性麻痹(PSP)的患者大脑萎缩及脑室扩张的发生率。方法:该研究使用boundary shife in-tegrat技术确认6例经病理检查证实的PSP患者脑萎缩及脑室扩张发生率。并与6例年龄及性别配对的对照组比较。结果:PSP患者脑萎缩及脑     

与进行性核上性麻痹患者区域性脑萎缩相关的临床异常

尽管脑萎缩与进展性核上性麻痹(PSP)临床表现的关系并不明显,影像学检查发现大多数PSP患者均存在轻度脑萎缩。但本研究对21例PSP患者、17例Parkinson病患者及23例对照组患者分别进行M R I脑部扫描,采用逐像素形态学分析法测量灰质、白质及脑脊液以判定局部组织萎缩的概率。选择大约处于病程中期的PSP和Parkinson病患者作为研究对象。以对照组为参照,标记出疾病组的组织显著萎缩区域,分析这些区域内组织萎缩的概率与相应疾病组的运动障碍、行为与认知异常的国际标准指数间的相关性。Parkin-son病组仅有轻微的区域性萎缩。根据额叶皮…     

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.