恶性梗阻性黄疸的ERC写CT对照分析

本文对比分析了８２例恶性梗阻性黄疸（包括胆管癌４５例，转移性癌２６例，胰头癌６例及壶腹周围癌５例）的ＥＲＣＰ与ＣＴ表现，主要发现：恶怀胆管梗阻部位多位于肝外胆管近侧段；肝外胆管近侧段梗阻所致的肝内胆管重度扩张的发生率，远多于远侧段阻塞，在反映肝内胆管扩张程度、扩张范围方面ＣＴ优于ＥＲＣＰ，而显示病灶肿块直接征象方面ＥＲＣＰ优于ＣＴ。     

恶性梗阻性黄疸的ERCP与CT对照分析

本文对比分析了８２例恶性梗阻性黄疸（包括胆管癌４５例，转移性癌２６例，胰头癌６例及壶腹周围癌５例）的ＥＲＣＰ与ＣＴ表现，主要发现：恶性胆管梗阻部位多位于肝外胆管近侧段；肝外胆管近侧段梗阻所致的肝内胆管重度扩张的发生率，远多于远侧段阻塞，在反映肝内胆管扩张程度、扩张范围方面ＣＴ优于ＥＲＣＰ，而显示病灶肿块直接征象方面ＥＲＣＰ优于ＣＴ。     

磁共振胆道造影在胆道梗阻定位和定性诊断中的价值

目的：通过ＭＲＩ胆道造影（ＭＲｃｈｏｌａｎｇｉｏｇｒａｐｈｙ，ＭＲＣ）与ＣＴ、ＵＳ、经皮穿刺胆道造影术（ＰＴＣ）或内窥镜逆行胰胆管造影术（ＥＲＣＰ）及手术、病理的对照研究，评价ＭＲＣ显示胆道梗阻部位，确定梗阻原因的能力。材料与方法：３０例梗阻性黄疸的患者在ＧＥＳｉｇｎａ１．５Ｔ超导系统上进行了ＭＲＣ检查，并与ＰＴＣ或ＥＲＣＰ、ＣＴ、ＵＳ、手术及病理对照。结果：本组资料中，ＭＲＣ显示胆道梗阻的部位准确性达１００％，优于有损伤性的ＰＴＣ或ＥＲＣＰ。ＭＲＣ确定梗阻原因的准确性达７０％，类似于ＰＴＣ或ＥＲＣＰ、ＣＴ、ＵＳ。结论：初步研究结果表明，无损伤性的ＭＲ胆道造影在梗阻性黄疸的定位和定性上具有很高的敏感性、准确性，对于梗阻性黄疸，特别是行ＥＲＣＰ失败和不宜行ＰＴＣ或ＥＲＣＰ的病人是最有效的替代方法。     

MRCP在胆胰疾病中的应用

目的：评价ＭＲＣＰ技术在胆胰疾病中的应用价值。材料和方法：２２例胆胰疾病患者采用快速自旋回波和重Ｔ２加权技术进行ＭＲＣＰ扫描,获得原始图像经最大信号强度投影（ＭＩＰ）及三维表面重建（３Ｄ－ＳＳＤ）后处理。结果：２２例患者ＭＲＣＰ成功率为１００％,１８例梗阻性黄疸均能显示梗阻部位及扩张胆管,４例非梗阻性黄疸患者可满意显示正常胆总管及左右肝管主干。结论：ＭＲＣＰ能较好显示胆系解剖及病变部位与性质,创伤小,且成像技术简单,检查时间短,目前已成为胆胰系统疾病诊断的重要检查方法。     

磁共振胆管胰管成像的临床应用研究

目的：探讨快速自旋回波（ＦＳＥ）及单次激发快速自旋回波（ＳＳＦＳＥ）对磁共振胆胰管成像（ＭＲＣＰ）的临床应用价值。材料与方法：分析应用ＦＳＥ对３５例胆道系统病变及正常志愿者的ＭＲＣＰ检查，其中２１例行ＳＳＦＳＥ并与ＦＳＥ行对照观察：结果：仅用ＦＳＥ行ＭＲＣＰ的１４例中，９例扩张的胆管经后处理显示清楚，３例显示胰管，５例无扩张的胆道显示不满意。同时用ＦＳＥ和ＳＳＦＳＥ扫描２１例，对胆管梗阻部位和扩张胆管的显示无显著差异；ＳＳＦＳＥ对无扩张胆、胰管的显示分别是７４．４％、５２．４％，显著高于ＦＳＥ的１６．６％、０．９％，对胆囊显示二者相似。结论：梗阻性胆胰管扩张者，ＦＳＥ和ＳＳＦＳＥ均可得到满意结果，而正常无扩张胆胰管的显示，ＳＳＦＳＥ较ＦＳＥ好     

原发性硬化性胆管炎的诊断:磁共振胆道成像与内镜逆行性胆道造影的比较

目的　检验磁共振胆道成像作为诊断原发性硬化性胆管炎的可选择性方法的价值。病例和方法　20例原发性硬化性胆管炎行内镜逆行性胆道造影和磁共振胆道成像。评价肝内外胆道显示率和病理性改变。结果　胆管和肝管壁不规则(6/7),所有病例均存在胆道狭长或扩张,磁共振胆道成像(ＭＲＣＰ)显示肝外胆管多段狭长和扩张较好,而ＥＲＣＰ因受图像分辨率的限制,仅可显示胆管周围分支的中断。ＭＲＣＰ显示早期原发性硬化性胆管炎的胆道系统壁不规则改变亦较ＥＲＣＰ稍好。结论　原发性硬化性胆管炎早期诊断,ＭＲＣＰ可以作为ＥＲＣＰ的补充,而就晚期原…     

螺旋CT胆系造影诊断胆管阻塞

目的用螺旋ＣＴ胆系造影（ＳＣＴＣ）显示胆管狭窄部位和程度，以及扩张胆管的范围。方法阻塞性黄疸患者３７例。用３０％胆影葡胺４０～６０ｍｌ静脉缓注，延迟２５分钟后行螺旋ＣＴ扫描并作三维成像。结果胆管显影率为８１％，３０例显影患者均能显示阻塞部位及扩张胆管，定性诊断正确率为９３％。结论ＳＣＴＣ能显示胆管狭窄部位、程度及胆管扩张范围，安全、简单、可靠。能观察肝分泌功能，估价胆汁流通畅程度，是显示胆系阻塞的有效方法     

MR T_1WI抑脂及MR胰胆管造影术用于梗阻性黄疸的诊断

目的：探讨Ｔ１ＷＩ抑脂技术（ＦＴ１ＷＩ）和ＭＲ胰胆管造影术（ＭＲＣＰ）对梗阻性黄疸的诊断价值。方法：回顾４７例不同病因所致梗阻性黄疸的ＭＲＩ征象。应用ＧＥＳｉｇｎａ１．５Ｔ超导ＭＲ机,除常规的Ｔ１ＷＩ、Ｔ２ＷＩ序列外,还采用ＦＴ１ＷＩ和ＦＭＰＳＰＧＲ造影增强及ＭＲＣＰ技术。结果：恶性病变均可见大小不等的肿块,ＦＴ１ＷＩ序列对肿块的显示最清楚,为明显的低信号。良性病变均无肿块。ＭＲＣＰ可以明确梗阻的部位及阻塞端的形态。结论：根据ＭＲＣＰ所示胆道梗阻的部位和形态,结合轴位各序列,尤其是ＦＴ１ＷＩ显示的病灶特点,能更加准确地诊断梗阻性黄疸的病因。     

磁共振胆胰管成像(附45例报告)

目的：评价磁共振胆胰管成像（ＭＲＣＰ）技术的临床价值。方法：对２０名志愿者和２５例胆胰病变的患者采用快速自旋回波和重Ｔ２－加权技术进行ＭＲＣＰ检查。结果：正常志愿者ＭＲＣＰ能显示胆囊和胆总管以及多数左右肝管和胆囊管，胰管多数能在原始冠状位像上显示，扩张的胆胰管显示满意，各种胆胰病变的诊断符合率高，梗阻性黄疸的定位和定性准确率较高。结论：ＭＲＣＰ能作为非创伤性胆胰病变的检查方法，尤其适用于梗阻性黄疸。     

磁共振胰胆管成像的临床应用价值

目的：研究磁共振胰胆管成像（ＭＲＣＰ）的临床应用价值。材料与方法：前瞻与回顾性分析了８例正常志愿者、６例慢性胰腺炎和３３例梗阻性黄疸的ＭＲＣＰ检查。结果：ＭＲＣＰ清楚显示１４例正常左、右肝管，肝总管，胆总管和胆囊；冠状位、横轴位分别清楚显示５３９％和８６７％的正常胰管；ＭＲＣＰ结合ＭＲＩ常规平扫前瞻性诊断梗阻性黄疸的准确率为９３３％。结论：ＭＲＣＰ具有重要的临床应用价值     

肝细胞癌边缘部的CT与病理对照研究

目的：探讨肝细胞癌边缘部的ＣＴ征象与病理基础。材料和方法：搜集４５例经手术、病理证实的肝细胞癌，观察其术前边缘部的ＣＴ表现及各种病理改变。结果：（１）找出了肿瘤边缘部三种不同形态的病理学基础；（２）ＣＴ增强扫描后，肿瘤呈边缘不清者，病灶大多有缩小；（３）发现了瘤旁小门静脉癌栓的ＣＴ征象，并得到病理检查证实，其发生率的高低与ＣＴ的肿瘤边缘形态分类及癌细胞的分级有关。结论：（１）肝细胞癌边缘部的ＣＴ形态分类，能较好地反映肿瘤包膜的完整程度；（２）肝细胞癌边缘部的ＣＴ形态分类，对于术前评估肿瘤的浸润程度和范围、预测瘤旁小门静脉癌栓的发生率及评价癌细胞的分级均有一定的帮助     

蛋白激酶C在肢体缺血预处置中的作用

目的：探讨缺血预处置（ＰＣ）减轻骨骼肌组织缺血再灌注（Ｉ／Ｒ）损伤的作用机制．方法：采用大鼠后肢原位灌流方法观察ＰＣ和ＰＣ加用蛋白激酶Ｃ抑制剂ｐｏｌｙｍｙｘｉｎＢ或Ｈ７对Ｉ／Ｒ的影响．实验动物分为５组：Ｉ／Ｒ组，ＰＣ组，ＰＣ＋ＰＢ组，ＰＣ＋Ｈ７组，对照组．比较各组灌流液中和肌组织中的损伤性指标变化．结果：ＰＣ可以明显减轻肢体的Ｉ／Ｒ损伤，使用ｐｏｌｙｍｙｘｉｎＢ或Ｈ７则阻断ＰＣ对Ｉ／Ｒ骨骼肌细胞内酶漏出、丙二醛产生及钙超载等损伤性指标的改善作用．结论：ＰＣ对Ｉ／Ｒ肢体具有保护作用，其保护机制与蛋白激酶Ｃ的激活有关     

肝动脉注入羟基喜树碱明胶微球对大鼠移植性肝癌的疗效研究

目的：为了观察羟基喜树碱明胶微球（ＯＰＴ－ｍｓ）的疗效，我们建立了大鼠移植性肝癌模型。材料与方法：以肝动脉注射生理盐水作对照，比较了肝动脉注射常规型ＯＰＴ（１ｍｇ／ｋｇ），空白明胶微球（１０ｍｇ／ｋｇ）和ＯＰＴ－ｍｓ［１０ｍｇ（含药１ｍｇ）／ｋｇ］治疗大鼠肝癌的作用。结果：接受常规ＯＰＴ、空白明胶微球治疗的大鼠，其肿瘤生长受到显著抑制（Ｐ＜０．０５），肿瘤组织发生不同程度的坏死，但与对照组相比动物的生存期未显著延长（Ｐ＞０．０５），而接受ＯＰＴ－ｍｓ治疗的大鼠，其肿瘤的坏死更彻底、更广泛，且动物的生存期明显延长（Ｐ＜０．０１）。结论：ＯＰＴ－ｍｓ疗效明显优于常规型ＯＰＴ单纯肝动脉化疗和空白明胶微球的单纯肝动脉栓塞。     

The effects of supplemental carbohydrate ingestion on intermittent isokinetic leg exercise.

BACKGROUND: The purpose of this investigation was to examine the effects of carbohydrate (CHO) supplementation on isokinetic leg extension/flexion exercise performance, blood glucose responses, blood free fatty acid (FFA) responses, and blood lactate (La) responses. METHODS: Eight resistance trained males (mean+/-SEM, age: 23.7+/-1.3 yrs, height: 180.0+/-3.5 cm, bodymass: 94.9+/-4.9 kg) participated in a randomized, double blind protocol with testing sessions separated by 7-d. Subjects were given CHO or placebo (P) while performing 16 sets of 10 repetitions at 120 degrees x s(-1) on a Cybex isokinetic dynamometer. Performance variables measured were; total work (TW), average work (AW), peak torque (PT) and average torque (AT). Plasma glucose (PG), FFA, and La were measured prior to testing (PRE), after set 8 (MID), and 16 (POST). RESULTS: Results indicated that the CHO treatment elicited significantly (p<0.05) more TW (CHO: 41.1+/-3.9 kJ; P: 38.1+/-3.9 kJ) and AW (CHO: 2.6+/-0.2 kJ; P: 2.4+/-0.2 kJ). There were no differences (p<0.05) between treatments for PT of the hamstrings (CHO: 91.6+/-6.5 Nm; P: 87.4+/-8.5 Nm) and quadriceps (CHO: 129.7+/-9.5 Nm; P: 123.0+/-10.6 Nm). The AT of the hamstrings (CHO: 77.8+/-5.2 Nm; P: 75.7+/-8.7 Nm) and quadriceps (CHO: 116.9+/-8.9 Nm; P: 110.0+/-8.5 Nm) were not statistically different (p>0.05) between the treatments. PG was significantly higher at the POST blood draw in the CHO treatment. No significant differences (p>0.05) were observed between the treatments for FFA and La concentrations. CONCLUSIONS: The data from this investigation indicate that the use of CHO supplementation during isokinetic leg exercise allows for the performance of more work.     

腹腔和腹膜后间隙结核的CT表现及其病理基础

目的：明确腹腔、腹膜后间隙结核的ＣＴ表现与病理基础的相关性。材料和方法：对１３例淋巴结结核、２例结核性腹膜炎以及２例淋巴结结核合并结核性腹膜炎采用ＣＴ增强扫描，观察其病变的形态、密度及解剖分布。结果：淋巴结结核表现为淋巴结增大，增强扫描呈环状强化，可融合成多房样肿块，主要分布于系膜、网膜及Ｌ２平面以上的腹膜后间隙；而结核性腹膜炎ＣＴ表现为腹水密度较高，网膜、系膜上斑片和结节影，网膜增厚，卷缩成不规则肿块，受累的系膜、网膜与肠曲粘连、固定。结论：淋巴结结核病理改变决定其ＣＴ增强扫描特征以及优势解剖分布；ＣＴ扫描可揭示结核性腹膜炎解剖病理特点。     

睡眠剥夺对工作绩效的影响

目的 探讨睡眠剥夺情况下人的工作绩效的变化规律。方法 8名健康青年作为被试,采用单因素区组化的实验设计方法。在实验日6：00至次日8：00的26h的持续觉醒过程中,每隔特定时间间隔重复一组相同的试验项目。测试项目：（1）听觉Oddball单任务反应时（RT1）和正确率（CR1）;（2）听觉Oddball 手控跟踪双任务的跟踪误差（ER）及反应时（RT2）和正确率（CR2）;（3）主观任务难度评价（SR）;（4）斯坦福困倦度量表（SSS）;结果RT1,RT2,ER 3项指标的9个时间点间整体比较均具有显著差异（分别为P＝0．0001,P＝0．0001,P＝0．0004）,3项指标在睡眠剥夺过程中均显著升高;睡眠剥夺对SR,SSS得分均具有显著影响（P＝0．0001,P＝0．0000）,在夜间这2项指标得分升高;由于反应策略的调整,被试的反应正确率在睡眠剥夺过程中无显著变化。结论 睡眠剥夺对认知反应任务反应时和跟踪任务的跟踪误差,主观任务难度评价及困倦程度均具有显著影响。     

胸部疾病诊断中多种影像互补作用

目的：通过分析胸部较疑难的病例，总结胸部疾病诊断中多种影像互补作用。材料与方法：分析５０例经不同医院未确诊的较疑难病例。均有Ｘ线和ＣＴ材料，１７例有磁共振照片。常见病（肺炎、肺结核、肺癌）影像表现较特殊的２９例（５８％），余２１例（４２％）为少见病。这些病例作者均亲自做临床检查并全面分析影像材料。结果：胸片对于胸部较疑难病例正确诊断１１例（２２％）。ＣＴ诊断正确３２例（６４％）。磁共振有定性诊断价值者７例（占磁共振检查的４１％）。结论：（１）胸部正侧位片是胸部较疑难病例影像诊断的基础检查方法。（２）胸部ＣＴ是胸片常用而且主要的补充检查方法，在普通ＣＴ检查基础上有目的地采用增强扫描、高分辨ＣＴ扫描、螺旋ＣＴ扫描可提高ＣＴ诊断水平。（３）在ＣＴ基础上有目的地采用磁共振检查可发挥磁共振对于胸部疾病的诊断作用。     

Nicorandil administration shows cardioprotective effects in patients with poor TIMI and collateral flow as well as good flow after AMI

BACKGROUND: Nicorandil (NCR) has been reported to have cardioprotective effects in patients with AMI. And collateral flow and TIMI flow are also important determinants of final salvaged myocardium in patients with AMI. There is no evidence as to whether TIMI or collateral flow modifies the cardioprotective effects of NCR in patients with AMI. Methods and Results: We studied 68 initial AMI patients without restenosis which was defined as 50% diameter reduction of the intervention site in the chronic period. On initial CAG, 41 patients with poor flow (collateral: Rentrop 0 or 1 and TIMI 0 or 1) were NCR/Non-NCR = 20/21. Twenty-seven patients with good flow (collateral: Rentrop 2 or 3 or TIMI 2 or 3) were NCR/Non-NCR = 13/14. NCR was administered intravenously (4 mg) via intracoronary injection (2 mg) or continuously (4 mg/h). 99mTc-tetrofosmin (TF) and 123I-BMIPP SPECT were performed in the subacute and chronic (6 Mo) periods. In 20 SPECT segments, summed defect scores (TDS) and regional wall motion (WMS: -1=dyskinesis -4 = normal) of AMI segments using TF-QGS were estimated. In poor flow patients, the following values for NCR patients were higher (p < 0.05) than for Non-NCR patients in the improvement degree of TDS (BMIPP) (NCR: 6.5 +/- 3.9 vs. Non-NCR: 4.0 +/- 3.4), the improvement degree of TDS (TF) (NCR: 5.7 +/- 4.6 vs. Non-NCR: 2.2 +/- 4.6), and delta WMS (NCR: 1.4 +/- 1.1 vs. Non-NCR: 0.9 +/- 1.0). In good flow patients, the following values for NCR patients were better (p < 0.05) than for Non-NCR patients in TDS (BMIPP) (subacute) (NCR: 9.9 +/- 5.2 vs. Non-NCR: 16.5 +/- 10.4) and (chronic) (NCR: 5.1 +/- 5.2 vs. Non-NCR: 12.4 +/- 8.5), WMS (subacute) (NCR: 1.7 +/- 1.3 vs. Non-NCR: 1.0 +/- 1.0), and WMS (chronic) (NCR: 3.0 +/- 1.5 vs. Non-NCR: 2.1 +/- 1.3). Conclusion: We conclude that the cardioprotective effects of nicorandil administration are observable in both AMI patients with poor collateral and TIMI flow and good flow before reperfusion therapy.     

体外产气法对苏丹草与棉秆间组合效应的研究

为了探讨苏丹草(Sudan Grass,SG)与棉秆(Cotton Straw,CS)在瘤胃发酵中的组合效应,本研究将苏丹草与棉秆以100∶0、75∶25、50∶50、25∶75、0∶100比例进行组合,每个组合3个重复,利用瘤胃液体外发酵技术,分析GP(产气量)、pH值、瘤胃液NH3-N(氨态氮)和VFA(挥发性脂肪酸)含量,评价产气量组合效应以及综合组合效应。结果表明:(1)苏丹草和棉秆比例为50∶50和25∶75时,产气量与产气速率较高。(2)24~72h阶段50∶50和25∶75组的组合效应均为正值,且25∶75组的组合效应值最高。(3)苏丹草与棉秆不同比例的组合中,25∶75的组合产生的组合效应最高。     

Multidetector-row helical CT: analysis of time management and workflow

The purpose of this study was to evaluate time management and workflow for multidetector-row helical CT (MDCT). Time for patient and data handling of at total of 580 patients were evaluated at two different time periods (December 1999, August 2000), each for the following baseline measurements: (a) change of clothes/instruction; (b) patient placement on the CT table/i.v. catheter; (c) CT planning and programming; (d) CT data acquisition; (e) CT data reconstruction; (f) CT data storage/printing. All imaging was performed on a Somatom Volume Zoom (Siemens, Erlangen, Germany). Time measurements summarized for different CT protocols revealed the following: (a) 5:01 min (+/- 2.06 min); (b) 4:36 min (+/- 2.43 min); (c) 4:11 min (+/- 2.55 min); (d) 0:43 min (+/- 0.15 min); (e) 6:59 min (+/- 2.39 min); (f) 09:51 min (+/- 3.51 min). Planning and programming was most time-consuming for CT angiography, whereas chest and abdominal CT needed only 3:26 and 3:30 min, respectively. Reconstruction time was highest for HRCT (9:22 min) and CTA (9:03 min). Data storage/printing was most time-consuming for HRCT (13:02 min), followed by combined neck-chest-abdomen examinations (12:19 min). Comparing the two time periods, during which a software update was performed, a mean time reduction of 4:31 min per patient (15%, p<0.001) was achieved. Whereas CT data acquisition time is no longer a problem with MDCT, patient management, data reconstruction, and data storage are the most time-consuming parts. Well-trained technicians, state-of-the-art workstations, and fast networking are the most important factors to improve workflow.