133Ba非均匀性衰减校正在心肌断层显像中的应用价值

对14例正常对照者和42例经冠状动脉造影证实的冠心病患者行^99Tc^m-MIBI心肌断层显像，分别采用常规无非均匀性衰减校正（NC）和^133Ba非均匀性衰减校正（AC）技术，比较NC和AC处理后的心肌断层图像。结果：在正常对照组中。NC图像显示左心室心肌各节段之间放射性呈不均匀分布；AC图像显示左心室心肌各节段之间放射性分布均匀性明显改善，更能反映真实情况。在冠心病组中，AC图像显示诊断病变冠状动脉的准确性比NC图像明显提高。认为^133Ba非均匀性衰减校正系统对心肌断层显像的组织放射性非均匀衰减和散射效应有良好的校正作用。有利于提高^99Tc^m-MIBI心肌断层显像诊断的准确性。     

99Tcm-MIBI门控心肌断层显像与心血池显像测定左室射血分数的比较

[目的 ]利用ECToolbox软件 ,比较99Tcm -MIBI门控心肌断层显像测定左室射血分数(LVEF)与门控心血池显像测定结果的相关性 ,并探讨其影响因素。 [方法 ]4 2例受检者 ,两周内行门控心肌断层显像和门控心血池显像。受检者分两组 ,A组 :心尖或前壁基底部严重缺血组 ,共 7例 ;B组 :包括其余所有受检者 ,共 35例。 [结果 ]4 2例门控心肌断层显像测定LVEF值 (6 1 .95±1 5 .1 3) % ,略高于门控心血池显像的测定结果 (5 8.83± 1 2 .79) % ,t值 2 .2 6 ,P <0 .0 5 ;两者相关系数r =0 .81。A组病例门控心肌断层显像测定LVEF(5 7.2 9± 1 7.1 6 ) % ,明显高于门控心血池显像 (4 9.0 0± 1 6 .85 ) % ,t值 4 .6 1 ,P <0 .0 1 ;B组病例门控心肌断层显像测定LVEF (6 2 .4 8±1 4 .1 8) % ,与门控心血池显像 (6 0 .80± 1 1 .1 0 ) %无明显差异 ,t值 1 .1 3,P >0 .0 5。 [结论 ]利用ECToolbox软件测定门控心肌断层显像的LVEF与门控心血池显像的测定结果有较好的相关性 ;对于心尖或前壁基底部严重缺血的病人 ,结果误差较大。     

激光心肌血运重建联合大网膜移植的研究

目的采用激光心肌血运重建术(TMLR)联合大网膜移植作用于犬的缺血心脏,观察缺血心肌血供的变化和新生毛细血管的增生情况。方法将24条实验犬随机分为缺血组(I组)、激光打孔组(L组)、大网膜移植组(O组)、激光打孔联合大网膜移植组(L O组)。3个月后再行99~m锝(Tc)心肌同位素灌注显像。然后处死,取心肌组织,观察各组新生毛细血管的增生情况。结果L O组干预后同位素图像上感兴趣区(region of interest,ROI)比值(ROI比值=干预区ROI同位素计数/正常区ROI同位素计数)明显提高(P＜0．01),其增幅明显高于其他3组(P值均＜0．05)。L组干预后ROI比值明显高于干预前(P＜0．001),但其增幅与I组、O组的差异无显著性(P值均＞0．05)。I组、O组干预前、后ROI比值的差异无显著性(P值均＞0．05)。高倍镜下,L O组和L组孔道区(孔道为中心0．5mm范围)的新生毛细血管数明显多于孔道周围区(离开孔道1个低倍视野以上,P＜0．01、0．05)。L O组与L组孔道区的差异无显著性(P＞0．05)。结论以TMLR联合大网膜移植较单一使用这两种方法能够更明显改善缺血心肌的灌注。     

组织追踪显像对房间隔缺损患者右室壁局部心肌运动的定量分析

目的 探讨组织追踪显像技术评价房间隔缺损患者右室壁局部心肌运动的价值.方法 测量32例房间隔缺损右心扩大者(房间隔缺损组)及30例健康者(对照组)的右室侧壁、前壁及下壁的基底段、中段、心尖段心内膜下心肌层的位移曲线,然后测定每一曲线上的收缩期峰值位移( PDs),比较两组的PDs值,并将各节段PDs值与右室射血分数(RVEF)进行相关性分析,测量并比较两组右房收缩期、右室腔舒张期面积及肺动脉内径.结果 (1)房间隔缺损组右室侧、前、下壁的基底段PDs值均明显小于正常组(P＜0.01);(2)房间隔缺损组右室侧壁、前壁及下壁基底段PDs与RVEF呈显著正相关(r=0.38、0.41、0.34,均P＜ 0.01).房间隔缺损组右房、右室腔面积明显大于正常组(P＜0.01),主肺动脉内径明显宽于正常组(P＜0.01).结论 组织追踪技术能够评价房间隔缺损患者右室壁局部心肌收缩功能,其中基底段是组织追踪显像检测房间隔缺损患者右室壁局部心肌运动时的最重要节段.     

153Gd衰减校正对门控心肌断层显像测定左室心功能参数的影响

目的:探讨153Gd衰减校正(AC)处理对99mTc-甲氧基异丁基异腈(MIBI)门控心肌断层显像(G-SPECT)测定左室心功能参数的影响?方法:69例疑为冠心病患者,均行99mTc-MIBI静息G-SPECT,分别用AC和非衰减校正(NC)处理,测得舒张末期容量(EDV)?收缩末期容量(ESV)?左室射血分数(LVEF),所有患者在1~4周内行二维超声心动图(2-DE)检查测定LVEF,比较AC?NC和2-DE测得LVEF的相关性?结果:①NC和AC测得EDV?ESV分别为(79.6 ± 33.4)ml?(33.8 ± 29.9)ml和(87.4 ± 34.8)ml?(36.7 ± 31.9)ml,它们之间的相关性良好(rEDV=0.99,y = 1.04x + 4.73;rESV=0.99,y = 1.06x + 0.79;P均 < 0.01),但AC测得的EDV?ESV均> NC(P均 < 0.01);②NC和AC测得LVEF分别为(60.3 ± 9.2)%?(60.8 ± 9.9)%,它们之间的相关性良好(r = 0.98,y = 1.02x-1.04,P < 0.01),且两者间没有统计学差异(P > 0.05);③2-DE测得的LVEF为(54.6 ± 8.9)%,< NC?AC测得的LVEF(P均 < 0.01),但它们之间的相关性良好(rNC = 0.88,y = 0.91x + 10.81;rESV = 0.81,y = 0.87x + 13.10;P均 < 0.01)?结论:AC处理99mTc-MIBI G-SPECT测得的LVEF准确?可靠,和NC?2-DE测得的LVEF相关性良好?     

透射式组织衰减校正技术在诊断冠心病的应用研究

目的：应用透射式组织衰减校正技术，以提高核素心肌显像诊断冠心病的特异性。方法：在心肌灌注断层显像的同时，利用１５３Ｇｄ附加线源对受检对象作透射扫描，实时获取其组织衰减分布图，据此对心肌显像组织衰减进行补偿校正，并作校正前后的对比研究。结果：模型试验表明，本技术能有效补偿由于组织衰减所致“下壁”、“后侧壁”等的放射性减低；３例正常人见１个节段（后壁）放射性稀疏，经校正后消失；１１例心肌梗死和９例冠心病患者显像见异常节段４７个，经校正后为３２个，经校正后转为正常的节段为下壁５个、后壁６个、后侧壁４个；但其中４例心肌梗死患者的４个下壁节段仍为阳性。以心肌节段计算，透射式衰减校正技术的应用避免了８．７％（１６／１８４个节段）的心肌缺血假阳性诊断。结论：本法可降低心肌显像诊断冠心病假阳性，提高特异性。     

心肌灌注断层显像对急性心肌梗塞的定位和定量分析──与心电图定位和定量分析对比

本文对３０例ＡＭＩ患者进行心肌灌注断层显像的定位和定量分析，并与ＥＣＧ的定位和定量分析进行比较，对靶心图存在的缩小和扩大病灶因素用左室模型进行校正。结果表明：心肌灌注断层显像在后侧壁、后间壁、后壁和心尖部梗塞的定位上明显优于ＥＣＧ，经模型校正后靶心图所测梗塞面积百分比与ＱＲＳ记分所测梗塞面积百分比相关良好（ｒ＝０．７０６，Ｐ＜０．１）。预后不良组无论靶心图或ＱＲＳ记分所测梗塞面积均明显高于预后较好组。     

Ultrasound speckle tracking imaging in the evaluation of left ventricular function after stent implantation in patients with acute coronary syndrome

目的 探讨超声斑点追踪技术(STI)对急性冠脉综合征支架植入后左室心肌功能的定量作用.方法 选择40例急性冠脉综合征患者,应用STI检测术前、术后1个月左室基底水平、乳头肌水平及心尖部水平18个室壁节段收缩期峰值径向应变(SR)和周向应变(Cs),并进行比较.结果 与PCI前相比,PCI后心尖水平的室间隔CR值,基底水平前间隔、前壁CR值,乳头肌水平前间隔、前壁CR值均较PCI前明显提高,两者比较差异有统计学意义(P＜0.05).心尖水平的前间隔CR值,基底水平前间隔、前壁CR值,乳头肌水平前间隔、前壁CR值与PCI前比较差异有统计学意义(P＜0.05).结论 STI是评价急性冠脉综合征患者支架植入术后左室心肌功能的有效方法.     

123Ⅰ-MIBG心肌显像评价扩张型心肌病心力衰竭的严重程度及预后

目的探讨 123 Ⅰ-MIBG心肌显像在评价扩张型心肌病心力衰竭(DCM-HF)的严重程度及其预后中的应用价值.方法对24例DCM-HF患者(DCM-HF组)和10例正常者(NC组),行早期(20 min)及延迟(3 h) 123 Ⅰ-MIBG心肌显像,采用心/上纵隔(H/M)和心脏放射性洗脱率(WR%)作为相对半定量计数分析,与超声心功能指标及血浆去甲肾上腺素(NE)浓度进行对比.结果 DCM-HF组的早期及延迟H/M均低于NC组,WR均高于NC组.NYHA心功能Ⅳ级患者延迟H/M低于Ⅱ级患者.DCM-HF组的H/M与左室射血分数呈正相关(早期相r=0.581,P＜0.01;延迟相r=0.699,P＜0.01),而WR与左室射血分数呈负相关(r＝-0.628,P＜0.05).延迟H/M与血浆NE浓度呈负相关(r=-0.507,P＜0.05),而WR与血浆NE浓度呈正相关(r＝0.479,P＜0.05).结论 123Ⅰ-MIBG心肌显像可用于评价DCM-HF的严重程度及其预后.     

心尖肥厚性心肌病14例临床诊断分析

目的 了解心尖肥厚型心肌病(AHCM)的临床表现和心电图诊断特点.方法 分析14例心尖肥厚型心肌病的临床表现和心电图,核素心肌断层显像及心脏超声心动图特征,确定心尖肥厚型心肌病的诊断方法.结果 心电图显示以胸导为主的导联R波振幅呈V4≥V5＞V3规律增高,同时伴有T波对称性深倒置,超声心动图和核素心肌断层显像显示心尖部心肌肥厚.结论 标准12导心电图显示胸导联V3～V5R波振幅关系增高伴对称性T波深倒置,应该考虑心尖肥厚型心肌病的可能,心电图改变特点是心尖肥厚型心肌病的首要诊断依据.     

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.