高频超声检查对皮脂腺囊肿的诊断价值

目的：通过探讨分析皮脂腺囊肿的声像图特征,提高对本病的诊断水平。方法：对手术病理证实的22例皮脂腺囊肿的声像图特征进行回顾性分析。结果：22例皮脂腺囊肿声像图均表现为圆形或椭圆形低回声肿物,质软,探头加压可变形,边界清晰光滑,有完整的包膜回声,肿物后方回声有增强,内部回声不均匀,呈密集点状或粗颗粒状,大体病理呈豆腐渣样。彩色多普勒血流（CDFI）显示：肿物周边及内部无明显血流信号。结论：彩色多普勒超声在皮脂腺囊肿的诊断中具有较高的价值。     

超声内镜对上消化道黏膜下肿瘤诊断与鉴别诊断的价值

目的:评价超声内镜(endoscopic ultrasonography, EUS)对上消化道黏膜下肿瘤诊断与鉴别诊断的价值.方法:通过对97例上消化道黏膜下肿瘤及51例其他隆起性病变进行EUS检查,并与内镜活检、切除和手术病理进行比较.结果:上消化道黏膜下肿瘤种类的分布有一定规律,其中间质细胞瘤最为常见,本组占35.81％(53/148);EUS 对本组的总诊断符合率达91.22％(135/148);各种黏膜下肿瘤的声像图具有一定的特征.间质细胞瘤的声像图特征为低回声,呈梭形或椭圆形,病灶边界清楚、包膜光滑、回声均匀.恶性间质细胞瘤边界不清,包膜完整性差,回声不均,常有断裂征;与间质细胞瘤难以鉴别的神经源性肿瘤与颗粒细胞瘤的声像图呈低回声.与胃镜、钡餐造影、CT等相比,EUS更易确定病变的性质.结论:EUS对上消化道黏膜下肿瘤的诊断与鉴别诊断具有更高的价值.     

甲状旁腺腺瘤的超声表现

目的:探讨甲状旁腺腺瘤的声像图特征。方法:总结14例甲状旁腺瘤的声像图特点,包括大小、形状、回声、边界、血流等。结果:甲状旁腺腺瘤声像图特征是:①外形呈圆形、卵圆形、泪滴状或长条状,边界清楚,形态规则。②多数瘤体有完整包膜,内部多为均匀低回声。③彩色多普勒可显示一动脉血流信号进入瘤体,后直接终止于瘤体内。结论:甲状旁腺腺瘤的声像图有一定的特点,超声对甲状旁腺瘤的诊断有一定的临床应用价值。     

体表表皮样囊肿的超声诊断分析

目的探讨超声对体表表皮样囊肿的诊断价值。方法回顾性分析经手术和病理证实的75例表皮样囊肿患者的超声声像图特征。结果超声诊断符合率80%(65/81)。超声明确所有肿物的位置;肿物均呈低或中等回声,大部分肿物内部回声分布不均匀,可见不规则的无回声区或小等号样偏强回声或点状偏强回声或强回声光斑,3个位于睾丸内肿物呈高低回声相间改变;肿物后方回声增强改变;加压探头可见肿物形态发生改变,内部回声可有"漂浮"感;CDFI无明显血流信号。结论表皮样囊肿的超声声像图具有一定的特征性,可为临床诊疗提供可靠的信息。     

腮腺占位性病变声像图特征及超声诊断价值

目的 探讨腮腺常见占位性病变的超声影像学特征,提高对腮腺占位性病变的鉴别诊断能力.方法 回顾性分析2013年5月至2017年9月六安市第二人民医院经病理证实的腮腺占位性病变的19例患者临床资料,分析良恶性腮腺占位性病变在彩色多普勒超声下的不同声像图特征,并将超声鉴别良恶性结果 与病理结果进行对比分析,计算超声诊断的灵敏度、特异度和准确性等指标.结果1例恶性腮腺占位性病变,其超声声像图特征为形态不规则、边界不清晰、包膜不完整.超声诊断腮腺恶性病变的灵敏度、特异度和准确性分别为100％、88.9％、89.5％.绪论超声在腮腺占位性病变中的良恶性鉴别诊断中价值高,病灶形态不规则、边界不清晰和包膜不完整是恶性腮腺肿瘤超声诊断的重要参考指标.     

以腹腔巨大包块为表现的肾错构瘤1例报告

患者 女,53岁,因体检发现肝内及腹腔占位性病变1个月,于2006年6月27日入院.患者无不适,查体右中腹可扪及约10 cm×9 cm的包块,质硬,活动,与周围脏器无明显粘连,无压痛,肝脾未触及.双肾区无叩痛.腹部B超示肝内可见0.5 cm×3.3 cm实性占位,边界清楚,内部回声不均匀,呈花朵样,中央为强回声,肿物周边可见强回声环,无晕征,内部可引出少许静脉血;肿物旁可见1.3 cm×0.9 cm强回声占位,均匀,内部回声呈网状;右侧腹腔内可见巨大实性占位,占据整个右半腹腔,边界清楚,内部回声强弱不均匀,可引出少量动静脉血;肾脏位于肿物后方,向内上方移位;下腔静脉受压;肝脏与肿物之间可见小片液性暗区;腹腔未见明确肿大淋巴结.     

超声诊断肾上腺转移癌的临床价值

目的探讨超声诊断肾上腺转移癌的临床价值。方法对我院20例经手术后病理证实的肾上腺转移癌声像表现进行回顾性分析,重点观察肾上腺肿块的大小、形态、内部回声、有无包膜等,总结其声像特征。结果肾上腺转移癌声像图表现：①患侧肾上腺轮廓均有不同程度的增大;②形态多为不规则形,其次为椭圆形;大小在1.9-10.6 cm之间;③内部回声多呈低回声,少数呈弱回声、高回声,伴有液化坏死时可伴有无回声。结论超声显像诊断肾上腺转移癌时,应结合临床病史、体征及其他影像学检查结果,相互印证,互为补充,可提高本病的确诊率。     

彩色多普勒超声对脾实质性占位性病变的诊断价值

目的：探讨脾实质性占位性病变的二维及彩色多普勒超声声像图特征。方法：综合分析经病理证实的27例（良性病灶18例,恶性病灶9例）脾局灶性实质性声像图和血流信号特征。结果：良性病变常规二维超声以边界清晰、形态规则、内部回声均匀的高回声病灶为多见,且结节多为单发;恶性病变常规二维超声以边界清晰的结节,形态规则,内部回声均匀的低回声病灶为多见,结节多为多发。良、恶性病灶大小比较差异有统计学意义（P〈0.05）。结论：脾实质性占位性病变的二维及彩色多普勒超声声像图表现有一定特征性,具有诊断及鉴别诊断价值。     

胰腺实性假乳头状瘤超声表现1例

患者,女性,19岁.因间断性上腹痛1年,查体发现胰腺肿物3 d入院.二维声像图表现,胰腺体、尾部回声均匀,胰腺头部显示不清,相当于胰腺头部区域可探及大小约 7.4cm× 5.9cm团状低回声(图1),外形尚规整,向胰腺外突出,与周围组织分界清晰,其内回声不均匀,可探及片状不规则无回声区及团状稍高回声,主胰管直径约 0.3cm.彩色多普勒血流显像:肿物内部及周边未探及彩色血流信号.超声提示,胰腺头部混合性占位性病变(胰头部肿瘤可能性大).2 d后行手术切除,术中所见,胰头部见直径约8 cm肿瘤,切面囊性,囊壁厚 1.0～1.5cm,灰白色,囊内壁附咖啡样物质(图2).术后病理诊断:胰腺实性假乳头状瘤.     

甲状腺腺瘤声像图特征与其病理组织结构对照分析

目的:探讨甲状腺腺瘤声像图特征与甲状腺腺瘤病理组织结构的关联,提高彩超对甲状腺腺瘤的诊断准确率。方法:回顾46例甲状腺腺瘤的声像图表现,与该46例甲状腺腺瘤病理组织结构做对比。结果:甲状腺腺瘤的声像图表现为甲状腺局限性肿大,内可见圆形或椭圆形低回声结节,囊实,混合回声结节,边界清,包膜完整光滑,周边有晕环;彩色多普勒显示为结节周边见环状血流信号。病理组织结构的差异导致声像图表现不同,在39例滤泡性腺瘤中,27例表现为较均匀低回声结节,8例低回声结节中见囊性变,4例表现为甲状腺内囊性无回声、囊壁内侧见乳头状块附着,3例表现为囊性无回声且壁较厚、均匀整齐、内有少量絮状强回声,7例不典型腺瘤中5例为均匀中低回声。结论:甲状腺腺瘤病理组织结构的差异是构成甲状腺腺瘤声像图不同表现的基础,了解其关系可提高超声诊断甲状腺腺瘤的准确性。     

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.