多层螺旋CT层厚和螺距选择对多平面重建图像质量的影响

目的探讨多层螺旋CT层厚和螺距的选择对多平面重建图像质量的影响。材料与方法选择1mm．3mm探测器线宽及3．5及5．5螺距四种组合对一幅完整人类头颅骨标本行多层螺旋CT扫描。重建采用1mm及3mm有效层厚及0．5和1．5mm的50％重叠重建。多平面重建选择垂直于听眶线的冠状面重建。结果四组图像均获得高质量冠状位多平面重建图像,以1mm层厚,3．5螺距组图像质量最佳,对细微结构的显示1mm有效层厚获得MPR高于3mm层厚,而螺距影响不大：结论多层螺旋CT层厚影响MPR图像质量的决定因素,而螺距对图像质量影响不大．     

16层螺旋CT三维重建及仿真内窥镜在喉部应用的探讨

目的：初步探讨16层螺旋CT三维重建(3D)及仿真内窥镜(VE)在喉部的临床应用，并与单层螺旋CT对比分析其优越性。方法：对46例患者(其中正常组8例，病变组38例)进行喉部16层CT常规扫描和多平面(MPR)重建，并分别行CTVE检查。每例患者均采用多方位多角度观察。正常组重点观察其正常解剖结构，病变组重点观察病变的位置、大小、形态及周围结构受侵犯情况。所有病变组的观察结果均经病理和临床综合检查证实。并通过对不同重建层厚图像的比较，分析不同层厚对图像质量的影响。结果：运用16层螺旋CT进行薄层容积扫描，MPR重建及CTVE的Auto Navigator和任意方位、任意角度旋转的成像技术可更清晰地显示喉腔内的正常解剖结构及病变的部位和形态，图像质量高，三维立体关系明确。结论：16层螺旋CT的3D及CTVE成像技术较单层螺旋CT在技术上有重大进步，能够更清晰显示喉腔内结构，大大提高了重建图像的质量，在喉部的应用前景将更加广阔。     

16层CT门静脉成像扫描参数及后处理方式的研究

目的：探讨16层CT门静脉成像扫描时间、层厚及后处理方式。方珐：比较延迟时间为55s、65s两组的门静脉与肝实质CT值的差异;55s组分别以0．75、1．0、3．0mm层厚重建,获取最大密度投影(MIP)、多平面重建(MPR)两种方法的重建图像,根据评分比较成像质量。结果：55s组的门静脉与肝实质CT差值高于65s组,1．0mm层厚重建图像质量高于3．0mm组,但与0．75mm组比较差异无统计学意义,MIP法重建图像质量明显好于MPR法。结论：延迟时间55s,以1．0mm层厚用MIP方法重建即可获得高质量的门静脉图像。     

CT仿真内窥镜技术的临床应用

目的:探讨CT仿真内窥镜技术（computed tomography virtual endoscopy,CTVE)的成像方法及临床应用价值。方法：对96例不同部位的病变行CTVE检查，层厚3－5mm，螺距1.3-1.5，重建重叠率50％，利用Navigatgor软件生成仿真内窥镜图像并与纤维内窥镜及手术对照。结果：所有病例均获得了满意的CTVE图像，准确率为95％。结论：适当的检查前准备、扫描参数、阈值和观察方法是CTVE检查的关键，CTVE提供了一种无创性的诊断方法。     

自动管电流调制技术结合量子降噪技术在MSCT肝脏多期增强扫描中的应用

目的评价肝脏MSCT多期增强扫描采用自动管电流调制技术并应用多种量子降噪技术(Q01、Q02、USO)降低图像噪声、提高图像质量的价值。方法连续58例行肝脏MSCT平扫和增强扫描的患者纳入本研究。使用Toshiba Aquilion 16层CT,管电压120k Vp、机架旋转0.5秒/圈、螺距0.938、准直层厚1mm*16层、图像重建层厚7mm,采用自动管电流调制技术,目标噪声为10.0HU,CT机根据定位像扫描时获取的信息设置扫描时的管电流,范围100-400m A。标准软组织算法分别在不使用、使用Q01、Q02和USO降噪技术时重建层厚为1、3、5、7、10mm的图像共20组。测量肝门层面肝右叶、腹主动脉、脾脏和前腹壁皮下脂肪的图像噪声并计算平均值。根据图像噪声、病变显示、诊断可接受度将图像质量分3级,1mm图像增加三维后处理图像比较,由CT副主任技师和副主任医师各1名进行双盲法评价。结果图像噪声随着层厚的变薄而增加,使用Q01、Q02、USO可不同程度的降低噪声,提高图像质量,层厚越薄噪声越大时降噪幅度越大。使用Q01、Q02和USO可使噪声分别下降3.1-5.8HU、4.5-8.3HU和5.5-12.6HU。层厚10mm不使用QD、7mm使用Q01、5mm和3mm使用Q02、层厚1mm使用USO可获得最佳的图像质量。结论肝脏MSCT增强扫描采用自动管电流调制技术并根据层厚选择不同的量子降噪技术即可降低图像噪声又能提高图像质量。     

颌面部CT三维成像的运用

目的探讨不同扫描参数的CT三维成像图像的质量.方法对40例颌面部病变患者选择不同的管电流、层厚、螺距、重建间距及扫描角度等,扫描后再进行图像后处理,对所得三维成像图像质量进行对比.结果不同层厚,相同螺距(1.2)时,层厚为3 mm所得图像质量佳.相同层厚(3 mm),不同螺距时,螺距为1.2所得图像质量佳.结论选择3 mm扫描层厚和1.2螺距,重建间距为50%,能得到最佳质量的图像,同时能减少对病人的辐射量,延长机器的使用寿命.     

结肠模拟息肉CT结肠成像的实验研究

目的：研究扫描参数、图像重建参数和后处理方法对CT结肠成像（CTC）图像质量和模拟息肉检出率的影响,以期获得良好图像质量和较高息肉检出率的成像参数及后处理方法的最佳组合。方法：用猪结肠制成大小不等的模拟息肉共计60枚。充气后应用16层螺旋CT进行容积扫描,分别比较不同螺距、不同层厚、不同重叠重建率、不同算法及不同后处理方法对图像质量的影响及息肉的检出率,确定最佳参数组合。结果：准直1．25mm,螺距1．375：1、重建层厚1．25mm、O％重叠重建率和标准算法重建是扫描和重建参数的最佳组合。各种后处理方法中：CTVE、VR＋Raysum、MPR＋轴位和VD对10～12mm组息肉的检出率分别为100％、95％、95％、100％;对5-9．9mm组息肉的检出率分别为95％、75％、80％和95％;对2～4．9mm组息肉的栓出率分别为85％、30％、50％和80％。综合应用以上各种方法对10～12mm组、5～9．9mm组和2-4．9mm组的检出率分别为100％、100％和90％。结论：16层螺旋CT的CTC最佳成像参数应为：准直1．25mm,螺距1．375：1,1．25mm重建层厚,0％重叠重建率和标准算法重建。CTVE和VD对息肉的检出率高于其他后处理方法,CTVE结合其他后处理方法可提高息肉的检出率。     

颌面部CT三维成像的运用

目的 探讨不同扫描参数的CT三维成像的质量。方法对40例颌面部病变患者选择不同的管电流、层厚、螺距、重建间距及扫描角度等,扫描后再进行图像后处理,对所得三维成像图像质量进行对比。结果 不同层厚、相同螺距（1．2）时,层厚为3mm所得图像质量佳。相同层厚（3mm),不同螺距时,螺距为1．2所得图像质量佳。结论 选择3mm扫描层厚和1．2螺距,重建间距为50％,能得到最佳质量的图像,同时能减少对病人的辐射量,延长机器的使用寿命。     

16层螺旋CT肺动脉成像智能触发阈值的合理选择

目的研究不同智能触发监测点阈值条件下的CTA扫描效果,以期提高肺动脉CTA图像质量.方法 120例接受肺动脉CTA患者随机均分成Ⅰ、Ⅱ、Ⅲ、Ⅳ4组,分别以40、60、80、100HU作为监测阈值进行追踪触发扫描,比较肺动脉、肺静脉、主动脉强化CT值及肺动脉与主动脉强化CT值差值的组间差异,同时比较不同监测阈值下等级图像差异.结果肺动脉、肺静脉、主动脉强化CT值及肺动脉与主动脉强化CT值差值在4组间有显著性差异,不同监测阈值下等级图像有显著性差异(P<0.001).40HU与其它3组有显著性差异(P<0.001);60HU与80、100HU有显著性差异(P<0.001);80、100HU两组相比差异无统计学意义(P>0.05),图像质量较差.结论以主肺动脉干为监测点,40HU监测触发阈值时肺动脉强化CT值最大,可获得理想的肺动脉CTA图像.     

螺旋CT仿真内窥镜评价膀胱结节的动物实验研究

目的:评价螺旋CT横断面和仿真内窥镜图像显示膀胱结节的能力和膀胱螺旋CT仿真内窥镜的最佳扫描参数。方法:于狗膀胱的不同位置造成6个5mm直径结节,膀胱充气后应用4组不同的扫描参数对其进行扫描,盲法评价图像质量、比较CT横断面和仿真内窥镜图像显示膀胱结节的异同。并统计处理其结果。结果:横断面和螺旋CT仿真内窥镜(CTVE)均显示出6个结节;层厚5mm,进床速度9mm/s,重叠率50%,标准重建可获得满意的图像质量,同时具有较低的X线剂量。结论:螺旋CT横轴位和CTVE图像相结合将成为显示膀胱肿瘤的有效方法之一。     

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.