多层螺旋CT血管成像在主动脉夹层动脉瘤诊断中的应用

目的:研究多层螺旋CT血管成像在主动脉夹层动脉瘤诊断中的应用。方法:对2010年9月至2012年1月12例主动脉夹层动脉瘤患者行多层螺旋CT,并进行回顾性分析,使用lightspeedTM16层及BrightspeedTM8层CT机进行扫描,再将得到的数据传输进工作站,在工作站采用曲面重建、多层面重建、表面阴影重建等对主动脉夹层动脉瘤采用三维重建。结果:在12例观察者中,有5例为DeBakeyⅠ型,3例为DeBakeyⅡ型,剩下的4例为DeBakeyⅢ型。有2例合并马方综合征的三维重建图像中有特征表现,1例主动脉重要分支受累。所有病例均能清楚显示出主动脉的全程和分支,真假腔内膜病变以及夹层动脉瘤位置和范围、管壁钙化情况,附壁血栓与病变的空间位置关系亦可以满意显示。仿真内镜能表现出内膜片和血管的关系及夹层动脉瘤内膜破口情况。结论:多层螺旋CT血管成像可以准确、迅速地诊断出夹层动脉瘤和其分型,协助临床制定相应治疗方案,为手术提供精准的解剖信息,对于评价血管的畅通性及明确有无血管内膜增生及有无支架变形有非常重要的临床意义,临床应广泛推广应用。     

夹层动脉瘤的多层螺旋CT成像技术

目的：探讨多层螺旋CT成像技术在诊断夹层动脉瘤方面的应用价值,并对各种处理技术进行比较研究。方法：回顾性总结12例夹层动脉瘤的MSCT技术,通过对比剂至主动脉最大对比增强期扫描获得大量数据,输入ADW4．0工作站后,应用多层面重建（Muhiplanar reconstruction,MPR）,曲面重建（Curved planar reconstruction,CPR）,容积重建（Vdume reconstruction,VR）,表面重建（Surface shaded display,SSD）,最大密度投影（Maximum intensity projection,MIP）及MSCT仿真内窥镜成像技术（MSCT virtual endoscopy,MSCTVE）等对夹层动脉瘤进行图像重建,所有图像由三位有经验的影像学医师进行评估。结果：夹层动脉瘤的特异征象主要是分离移位的内膜,真假腔的存在;非特异征象是主动脉增厚钙化,主动脉不规则扩张,附壁血栓。二维图像（多平面重建及曲面重建）能较好显示病变范围、大小及病变细节,而三维重建（最大密度投影、表面遮盖显示和容积重建）能良好地显示管壁钙化情况和病变空间关系,仿真内窥镜可显示夹层动脉瘤的内膜破口情况、内膜片与血管关系。结论：MSCT成像技术已成为诊断夹层动脉瘤的有效影像学检查方法,其中MSCT血管造影由于其迅速,非侵入性,高敏感性及特异性且能显示夹层动脉瘤受累程度而逐渐取代传统CT。扫描在主动脉及分支增强最佳时进行。MSCT的二维及三维重建技术能提供夹层动脉瘤的大量信息,在夹层动脉瘤的诊断中具有重要价值,可有助于临床及外科治疗。     

16层螺旋CT血管成像技术在主动脉夹层中的诊断价值

目的探讨16层螺旋CT血管造影及后处理技术对主动脉夹层患者的诊断价值。方法 14例主动脉夹层患者临床初诊被误诊或漏诊,最后经16层螺旋CT血管造影检查及三维重建技术确诊。三维重建方法包括多平面重建(MPR)、最大密度投影(MIP)、容积再现(VR)、仿真内窥镜(CTVE)、表面遮盖成像(SSD)、曲面重建(CPR)。结果多种重建图像与轴位图像相结合,能清晰显示主动脉夹层的病变范围、类型、真假腔、内膜片、破口部位等解剖细节及其与主要分支血管的空间解剖关系。结论 16层螺旋CT血管造影及后处理技术可以全面显示主动脉夹层的病变和解剖细节,在主动脉夹层的诊断和临床治疗中具有重要的应用价值。     

16层螺旋CT血管成像对主动脉夹层的诊断与评价

目的评价16层螺旋CT血管成像对主动脉夹层的临床应用价值。方法41例主动脉夹层行16层螺旋CT血管造影检查及三维重建，三维重建方法包括多平面投影（MPR）、最大密度投影（MIP）、容积再现（VR）、曲面重建（CPR）、表面覆盖成像（SSD）、仿真内窥镜（CTVE）。结果多种重建图像与轴位图像相结合，能清晰显示主动脉夹层的病变范围、类型、真假腔、内膜片、破口等解剖细节及其与主要分支血管的空间解剖关系。结论16层螺旋CT血管造影是诊断与评价主动脉夹层最有效的无创性检查方法之一。     

多层螺旋CT在主动脉夹层的临床应用

目的:探讨多层螺旋CT血管造影(MSCTA)技术在主动脉夹层的临床应用价值.方法:对53例主动脉夹层患者进行MSCTA检查,图像经工作站行后处理,运用多平面重建(MPR)、曲面重建(CPR)、最大密度投影(MIP)和容积显示(VR)等技术重建显示图像.结果:53例主动脉夹层中,I型夹层15例,Ⅱ型夹层2例,Ⅲ型夹层36例,其中不典型夹层12(Ⅰ型3,Ⅲ型9)例.所有轴位图像均清晰地显示内膜片、破口、分支动脉起源.三维重建图像可立体显示主动脉全貌、内膜片走行及与周围器官的空间解剖关系.结论:多层螺旋CT血管造影可以全面显示主动脉夹层的病变和解剖细节,在病变的诊断、术式选择及术后随访中有重要应用价值.     

MSCTA在急诊主动脉夹层动脉瘤诊断中的应用

目的 评价多层螺旋CT血管造影(MSCTA)在急诊主动脉夹层动脉瘤诊断中的临床价值.方法 对21例主动脉夹层动脉瘤患者进行多层螺旋CT血管造影检查,并利用原始数据在AW4.2工作站进行MPR重建,Curved重建以及VR图像显示.结果 21例患者均很好地显示了主动脉全程及其分支,真、假腔,内膜片以及夹层动脉瘤的部位、范围、分型等.按Debakey分型,21例中I型12例,Ⅱ型2例,Ⅲ型7例.结论 MSCTA检查对急诊主动脉夹层动脉瘤的诊断及治疗方案选择具有重要的临床价值.     

16层螺旋CT血管造影对主动脉夹层的临床应用价值

目的探讨16排CT血管造影三维重建在主动脉夹层动脉瘤中的应用价值。方法对43例主动脉夹层患者行16排螺旋CT平扫和血管造影,采用多平面重建、最大密度投影、容积再现等后处理技术进行图像重建。结果不同重建方式从不同方面显示了主动脉夹层的范围、真假腔、内膜片、破口、分支受累情况以及支架置入情况,综合运用可全面显示主动脉夹层的结构和特点。结论 16层螺旋CT血管造影三维重建是一种快速、安全、可靠、无创的检查手段,对主动脉夹层的术前诊断,治疗方式的选择及术后随访观察有极其重要价值。     

螺旋CT对主动脉夹层动脉瘤的诊断价值

目的探讨螺旋CT对主动脉夹层动脉瘤的诊断价值。方法对12例主动脉夹层动脉瘤患者进行CT平扫,对其中10例进行CT增强扫描,原始图像在工作站进行多平面重建(MPR)及表面遮盖显示法(SSD)三维重建。结果CT平扫可显示主动脉增宽,主动壁钙化。CT增强扫描及重建可清晰地显示真假腔及内膜片、破口位置及内膜瓣钙化和移位、内膜剥离范围炎性动脉瘤的影像特征。结论螺旋CT完全能满足临床对主动脉夹层动脉瘤诊断和治疗需要,为外科手术提供更详尽信息,是诊断主动脉夹层动脉瘤较好的影像检查方法。     

多排螺旋CT在胸主动脉夹层动脉瘤诊断中的价值

目的 探讨多层螺旋CT血管成像技术在胸主动脉夹层动脉瘤诊断中的应用价值.方法 对20例怀疑为胸主动脉夹层动脉瘤患者采用多层螺旋C T血管扫描,利用三维重建技术对扫描的图像进行容积重组(VR),多排平面重建(MPR),最大密度投影(MIP),曲面重建(CPR)等技术进行后处理,重建与分析血管图像,辅助诊断是否为胸主动脉夹层动脉瘤.结果 本组20例均确诊为主动脉夹层动脉瘤.所有图像均很好地显示了主动脉全程及其分支,以及真腔、假腔、内膜片、内膜破裂口等,动脉夹层动脉瘤的部位和范围得到真实直观的显示.根据Debakey分型:Ⅰ型3例,Ⅱ型2例,Ⅲ型15例.结论 多层螺旋CT血管成像技术对胸主动脉夹层动脉瘤的血管成像分辨率高、诊断检出率高,通过结合三维后处理技术,可清晰地显示夹层动脉瘤的部位和范围,以及破裂口的所在位置,在胸主动脉夹层动脉瘤的诊断中具有较高的临床应用价值.     

多层螺旋CT血管成像在不典型主动脉夹层中的诊断价值

目的探讨CT血管成像技术在不典型主动脉夹层(AAD)中的表现。方法对12例不典型主动脉夹层病例行多层螺旋CT血管造影检查,结合二维和三维重建技术进行图像分析。结果采用Stanford分类法分型:8例为A型,4例B型。AAD CT表现为:(1)均未见撕裂内膜片和双腔影像;(2)主动脉壁新月形或环状增厚(假腔)达5.0～30 mm;(3)平扫假腔密度高于、等于或低于主动脉真腔者,分别为6例、4例和2例;(4)增强扫描假腔均无强化;(5)83%(10例)病变主动脉无明显受压改变;(6)随诊假腔有变化。二维图像(多平面重建及曲面重建)能较好地显示病变范围、大小及细节,而三维重建(最大密度投影、表面遮盖成像和容积重建)良好显示管壁钙化情况和病变空间关系,模拟内镜可以显示动脉内膜情况。结论多层螺旋CT血管造影结合图像后处理技术,是一种准确、有效诊断不典型主动脉夹层的检查方法。     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.