肝血管瘤的螺旋CT三期扫描表现分析

目的 描述肝血管瘤在螺旋CT肝动脉期、门静脉期扫描（双期扫描）和延迟5min扫描的增强表现特点，探讨延迟扫描对肝血管瘤的诊断价值。方法 回顾性分析经螺旋CT双期扫描和延迟5min扫描的58例共79个病灶的资料，记录病灶在各个时相的增强形态特点，比较病灶大小与双期扫描表现的关系。结果 69.6%（55/79）的病灶在动脉期边缘结节状强化，门静脉期强化结节扩大，向中央扩展，其中18.2%（10/55）完全充填呈均匀高密度；11.4%（9/79）动脉期病灶无强化；8.9%（7/79）动脉期和门静脉期病灶呈均匀高密度；2.5%（2/79）动脉期病灶呈均匀高密度，门静期呈等密度病灶均呈低密度，大于2cm病灶在双期扫描中的表现以边缘结节强化为主，小于或等于2cm病灶除表现为边缘结节强化外，还较易完全充填呈高密度。延迟5min扫描79.7%（63/79）的病灶完全充填呈等或高密度，20.3%（16/79）部分充填，中央仍为低密度。结论 肝血管瘤在螺旋CT双期扫描和延迟5min扫描中有多种表现，多数病变在双期扫描中表现典型，延迟扫描对诊断无更多帮助，少数病变在双期扫描中表现不典型，延迟扫描仍有必要。     

脾脏肿瘤 CT 诊断及鉴别诊断

目的：探讨脾肿瘤 CT 表现和鉴别诊断价值。方法30例脾肿瘤（良性13例,恶性17例）均行CT 平扫＋增强检查,其中手术及穿刺活检病理证实18例,征象典型及病史明确16例。结果良性肿瘤表现为脾脏内单发或多发,多数大小不等低密度结节病变,1例血管瘤为等密度。血管瘤及淋巴管瘤可显示点状或小片状钙化。增强扫描,血管瘤显示延迟均匀强化特点,淋巴管瘤内间隔可轻度强化,脾囊肿无强化。脾错构瘤的钙化和脂肪组织肿块为其特征性表现。脾脏恶性肿瘤多较大,密度不均匀。增强扫描不均匀强化,脾淋巴瘤表现为脾肿大或多发结节样低密度病变,增强扫描强化不明显。结论 CT 是诊断脾肿瘤的主要检查方法,结合临床及 B 超检查,CT 多可作出病因学诊断。     

肝血管瘤的增强CT诊断

目的：探讨利用螺旋CT增强扫描诊断肝血管瘤的要点。方法回顾性分析在我院行上腹部螺旋CT平扫及增强扫描的肝血管瘤患者18例。结果18例患者均经彩色多普勒超声证实或考虑肝血管瘤,CT平扫表现为肝内单发或多发圆形、椭圆形低密度影,边界清楚,密度均匀;增强扫描：动脉期均呈结节及环形强化,门静脉期造影剂逐渐向内填充,延迟期见大多数病灶完全填充为等密度,个别较大病灶部分填充,中心可见低密度区。结论“二快一慢”的CT增强扫描与肝血管瘤的诊断正确率密切相关,而病灶渐进性强化特点在肝血管瘤的诊断和鉴别诊断中具有重要价值,CT增强扫描对诊断肝血管瘤是一种有效而准确的方法。     

肝血管瘤的CT表现与临床分析

目的总结68例肝脏血管瘤的CT与临床表现,探讨多层螺旋CT三期增强扫描在肝血管瘤中的影像特点及诊断价值。方法搜集68例肝血管瘤的CT平扫及增强扫描资料。回顾性分析经手术病理证实为肝血管瘤的CT表现特点。结果大多数肝血管瘤CT平扫表现为肝内单发或多发圆形、椭圆形的低密度影,边界较清楚。增强扫描动脉期呈结节样、环形或斑片状强化,门脉期对比剂逐渐向病灶中心充填。延迟期扫描造影剂进一步向病灶中心充填,部分病灶完全充填为等密度或部分充填。结论结节样强化是CT诊断肝血管瘤的特征性表现,CT三期增强扫描是诊断肝血管瘤的一种有效而准确的方法,具有定性诊断的价值。     

脾脏良性肿瘤多层螺旋CT诊断（附13例报告）

目的 探讨碑脏艮性肿瘤CT表现及诊断价值，以提高诊断水平。方法 回顾性分析13例经病理证买脾脏良性肿瘤CT资料，其中海绵状血管瘤5例，脾囊肿6例，淋巴管瘤2例。结果 海绵状血管瘤增强扫描呈边缘强化并向中心充填，延期扫描痛灶可完全弥合与睥成等密度；脾囊肿呈圆形或椭圆形囊状占位，水样密度，边缘光滑，不强化为其特点：淋巴管瘤的典型表现是多发低密度灶，可有间隔状强化。结论 脾脏良性肿瘤具有比较特征性的螺旋CT表现，可作出较准确的定位．定性诊断。     

螺旋CT对肝局灶性结节增生的诊断价值

为比较肝局灶性结节增生（FNH）在常规CT和螺旋CT中的不同表现,探讨螺旋CT对FNH的诊断价值。分析6例经手术病理证实的FNH,其中2例行常规CT,4例行螺旋CT检查。结果：平扫两种方法表现相似,均呈边缘模糊的略低密度灶,增强扫描后常规CT2例均呈略高密度灶,延迟4min后呈略低密度,其中1例病灶中央低密度疤痕区有延迟强化,螺旋CT增强后4例动脉期病灶均有明显强化;门脉期2例呈略高密度,2例呈等密度,延迟期3例呈等密度,1例呈略低密度;2例动脉期扫描可见平扫低密度疤痕区有明显强化的放射状血管影,1例有延迟强化,表明常规CT对FNH定性困难。螺旋CT多期扫描在FNH的诊断和鉴别诊断中价值较大。     

螺旋CT对肝局灶性结节增生的诊断价值

为比较肝局灶性结节增生(FNH)在常规CT和螺旋CT中的不同表现,探讨螺旋CT对FNH的诊断价值,分析6例经手术病理证实的FNH,其中2例行常规CT,4例行螺旋CT检查。结果平扫两种方法表现相似,均呈边缘模糊的略低密度灶。增强扫描后常规CT2例均呈略高密度灶,延迟4min后呈略低密度,其中1例病灶中央低密度疤痕区有延迟强化。螺旋CT增强后4例动脉期病灶均有明显强化;门脉期2例呈略高密度,2例呈等密度;延迟期3例呈等密度,1例呈略低密度;2例动脉期扫描可见平扫低密度疤痕区有明显强化的放射状血管影,1例有延迟强化。表明常规CT对FNH定性困难,螺旋CT多期扫描在FNH的诊断和鉴别诊断中价值较大。     

多发性脾肿瘤的CT和MR诊断

目的探讨多发性脾脏肿瘤的影像学表现，提高多发脾占位病变良恶性的鉴别诊断水平。方法回顾性分析经临床、手术病理证实的32例多发性脾肿瘤的CT和MR表现，原发性肿瘤13例，转移瘤19例。结果恶性肿瘤CT常表现为实质性或囊实性低密度肿块，增强后原发性肿瘤呈实质部分明显或中度以上强化，转移瘤以边缘强化为主；MR表现：淋巴瘤结节于T1、T2大多均呈等信号，有时可表现为他低信号；增强后早期为低信号结节，延迟呈等信号。转移瘤T2WI极少数呈低信号。良性肿瘤以血管瘤和脉管瘤常见，CT多表现为低密度或囊性病变，增强后均匀强化或边缘呈晕状强化，血管瘤具特征性延迟强化。MR明显优于CT和动态增强CT，增强T2WI具有典型的“白炽灯”征。脉管瘤MR显示病变内含低信号分隔影，T1、他均呈高信号，增强无强化或部分边缘强化。结论认识多发性脾肿瘤的CT和MR表现，有助于临床鉴别诊断良恶性肿瘤或非肿瘤性病变。     

CT检查在彩超引导下肝血管瘤介入术中的临床应用价值

目的分析肝血管瘤CT影像学征象及在介入术中的临床应用价值。方法选取本院2017年2月至2018年5月收治的33例肝血管瘤患者,患者均进行彩超引导下肝血管瘤介入术,分析CT图像中肝血管瘤位置、大小、形态及增强扫描等特征及对病变的检出率。结果33例患者共发现45.个病灶,单发病灶23例,多发病灶10例。病灶直径133cm~10cm;病灶位置:肝左叶30个,肝右叶8个,肝尾状叶7个。病灶.形态:圆形21例,类圆形12例。CT平扫检出率为9111%,扫描可见境界清楚的低密度肿块。4例患者病灶中央有裂隙状的更低密度影,2例瘤内可见钙化,呈圆形.;3例呈高密度肿块影。CT增强扫描检出率为10000%。其动脉期可见病灶边缘明显强化;门静脉期增强区域进行性向心性扩展;延迟扫描整个病灶变成均匀等密度,增强扫描呈典型“快进慢出”特征。结论CT检查可有效显示肝血管瘤的典型影像学特征,在彩超引导下肝血管瘤介入术中具有指导作用。     

肝脏血管瘤的螺旋CT临床诊断分析

目的探讨肝血管瘤螺旋CT平扫及动态增强扫描的CT表现及其诊断价值。方法收集60例CT诊断为肝脏血管瘤患者的临床有关资料,分析肝脏血管瘤CT特征和临床价值。结果 60例患者共93枚肝血管瘤病灶,其中单发病灶36例(60.0%),多发病灶24例(40.0%)。表现为平扫门、腔静脉样低密度灶,动态增强扫描早期呈边缘结节状强化,延迟扫描趋于与肝实质呈等密度。结论动态增强扫描早期边缘结节状强化,晚期持续等密度充填是肝脏血管瘤的特征性表现,具有定性诊断的价值。     

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.     

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.     

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.