64层螺旋CT冠状动脉成像评价冠状动脉支架通畅性

目的探讨64层螺旋CT冠状动脉成像评价冠状动脉支架通畅性的临床应用价值。方法对29例冠状动脉支架植入术后患者的59枚支架行64层螺旋CT回顾性心电门控增强扫描,扫描与支架植入术的平均间隔是(28.4±21.2)个月。采用5分制计分法评价支架的轴位多平面重建(MPR)图像及通过支架内腔中心的曲面重建(CPR)图像质量,同时测量支架内管腔直径。计算支架内管腔直径与支架近端的管腔直径比值以评价支架内腔可见度。其中5位患者有常规冠状动脉造影对照,共9个支架的通畅性得到评价。结果图像平均质量达到优良水平[(1.94±0.84)分]。图像质量与心率、呼吸运动及支架位置有关。所有59枚支架内腔均为可见,平均支架内腔可见直径比率为(76.1±11.1)%。有常规冠状动脉造影对照的9个支架均诊断为通畅,与常规冠状动脉造影结果吻合。结论64层螺旋CT冠状动脉成像可有效评价冠状动脉支架的通畅性。     

64层螺旋CT在评价冠状动脉支架通畅性中的临床应用价值

目的：研究64层螺旋CT（MSCT）评价冠状动脉支架通畅性的临床应用价值。方法：使用MSCT对52例患者的76个支架进行评价,并以常规冠状动脉造影作为＂金标准＂进行对照。结果：使用MSCT时,平均只有40%的支架内腔能被显示,另有4个支架内腔不能用于狭窄评价。MSCT显示,57个支架通畅,与常规冠状动脉造影相符合者55个;14支架再狭窄和1个支架闭塞,均得到常规冠状动脉造影证实。结论：虽然MSCT只能显示部分支架管腔,但在评价支架通畅性方面能提供有用信息,可用于支架术后患者的随访。     

多层螺旋CT冠状动脉成像的临床应用现状

多层螺旋CT(MSCT)以亚秒级的扫描速度和使用回顾性心电门控技术来实现冠状动脉的CT成像。其重要应用是显示冠状动脉狭窄、评价冠状动脉斑块钙化及稳定性以诊断和排除冠状动脉粥样硬化性心脏病。MSCT对冠状动脉中重度狭窄和完全闭塞的阴性预测值较高,与有创冠状动脉造影高度相关。MSCT能进行冠状动脉搭桥和支架植入术后的无创性追踪,也可用于其他冠状动脉疾病的评价。主要介绍MSCT冠状动脉血管成像的技术和临床应用现状。     

十六层螺旋CT冠状动脉造影的初步探讨

目的 探讨十六层螺旋CT冠状动脉造影的技术操作要点和临床应用价值。方法 对64例临床可疑冠心病及5例置入冠状动脉支架的患者进行十六层螺旋CT心电门控平扫及增强扫描。对所有患者行冠状动脉钙化积分扫描,用增强扫描重建像行多曲面重建(MPR)、最大密度投影(MIP)重建及容积再现技术(VRT)重建,其中10例可疑冠心病患者有常规冠状动脉造影作对照。总结CT冠状动脉造影的评价方法和显示情况,分析影响冠状动脉成像的原因。对5例患者置入的7个冠状动脉支架另行垂直切面MPR及MIP重建,并行仿真血管内窥镜重建,观察支架通畅情况。结果 拟订出四步扫描步骤。十六层螺旋CT平扫可测定钙化积分,增强扫描MPR、MIP及VRT重建像能多角度各向同性地显示冠状动脉的所有1级、绝大部分2、3级以及部分4级分支。MPR及MIP图像对冠状动脉分支的显示优于VRT图像。用VRT重建像评价图像质量79．7％(55例)为1级,10．1％(7例)为2级,10．1％为3级。图像质量的影响因素有主动脉根部造影剂浓度、心率、有无心律不齐和患者屏气情况等。评价10例冠状动脉狭窄情况,与常规冠状动脉造影结果基本相符。7个支架均显示良好,6个支架通畅,1个不通畅。结论 十六层螺旋CT冠状动脉造影可一次检查完成冠状动脉钙化积分和狭窄评价,也可评价支架通畅情况,是一种无创、简便、优良的冠状动脉成像方法。     

多层螺旋CT冠状动脉成像随访冠状动脉支架的应用价值

冠状动脉支架植入术目前已是治疗冠状动脉粥样硬化性心脏病的重要手段,经皮冠状动脉内支架置人术后随访是临床跟踪判断疗效的关键.目前,评价冠状动脉内支架通畅性及再狭窄的主要依据为有创性导管法行冠状动脉造影(SCAG)检查.本文分析32例冠状动脉支架植入术后的CT冠状动脉造影成像资料,初步探讨16层螺旋CT冠状动脉成像在评价冠状动脉支架通畅性的临床应用价值.     

多层螺旋CT评价冠状动脉支架再狭窄的临床价值

目的 探讨多层螺旋CT(MSCT)冠脉成像在评价冠状动脉支架中的价值.方法 对46例冠状动脉支架术后患者行导管法选择性冠状动脉造影检查及MSCT冠脉成像检查,利用MSCT的各种先进的图像后处理功能对各支冠状动脉进行重建,以显示冠状动脉支架的形态、位置并观察有无再狭窄.结果 在46例行MSCT冠脉成像的患者均成功显示冠状动脉各主支(左主干、前降支、回旋支及右冠状动脉)及部分3、4级分支,且可显示所有冠状动脉支架的形态、位置.与导管法选择性冠脉造影法比较,CT冠脉成像诊断46例121个支架内不同程度程度狭窄的敏感性90.5%,特异性94.3%.阳性预测价值和阴性预测价值分别为73.1%和97.1%.所有行MSCT冠脉成像检查的患者无1例出现并发症.结论 MSCT冠脉成像是评价冠状动脉支架的一种安全可靠具有一定诊断价值的检查方法.     

8层螺旋CT冠状动脉成像诊断冠心病价值与误诊分析

目的评价我院8层螺旋cT（MscT）冠状动脉成像诊断冠心病的价值及误诊分析。方法对临床急性冠脉综合征（不稳定性心绞痛、非sT段抬高的心肌梗死及sT段抬高的心肌梗死）的非选择性连续54例患者进行8层螺旋CT冠状动脉成像,其中有2例患者既往置入冠状动脉支架。以选择性冠状动脉造影结果作为评价标准,探讨我院8层MSCT在诊断冠状动脉疾病中的价值及误诊原因分析。结果基于冠状动脉血管节段分析,598个冠状动脉节段中有592个节段（96．7％）进入统计学分析,8层螺旋CT诊断冠状动脉病变的敏感性81％,假阳性率13％,假阴性率13％,误诊率19％。结论我院8层螺旋CT冠状动脉成像对冠状动脉疾病的诊断和支架再狭窄的评价有较高价值,但不能完全取代冠状动脉造影。     

64层螺旋CT冠状动脉成像对冠脉支架置入术后支架内血管的评价

目的初步探讨64层螺旋CT不同成像方法对评价冠状动脉支架置入术后支架内血管的应用价值。方法回顾分析经DSA证实的61例冠脉支架置入术后患者冠脉血管造影资料,应用64层螺旋CT二种不同成像方法即标准算法及高分辨锐利算法对冠脉血管进行造影及血管后处理,分别分析二种不同成像方法对冠状动脉支架置入术后支架内血管及血管钙化的显示情况。结果61例患者共行冠状动脉支架置入80支,冠状动脉多层螺旋CT血管标准算法成像显示血管通畅55支,血管内钙化22支,再狭窄25支,敏感度为95．1％,特异性为96．2％;高分辨锐利算法成像显示血管通畅59支,血管内钙化18支,再狭窄21支,敏感度为97．1％,特异度为98．2％,二者比较差异具有统计学意义（P〈0．05）。结论应用64层冠状动脉多层螺旋CT血管造影成像对冠脉支架置入术后支架内血管的评价具有较好的可信性和可行性,其中高分辨锐利算法成像对钙化的显示敏感性、特异性更高。     

64层螺旋CT冠状动脉造影在冠心病中的应用价值

目的评价多层螺旋CT冠状动脉造影（MSCTA）在冠心病中的应用价值。方法对58例患者行64层MSCT冠状动脉造影检查,经肘前静脉注射对比剂,平静吸气后屏气进行扫描,采用回顾性心电门控技术,并将图像传送到工作站进行容积再现、多平面重建、曲面重建和最大密度投影进行图像后处理重建,对其中24例患者行选择性冠状动脉造影检查,分析MSCT图像质量,并与选择性冠状动脉造影相比较。结果58例64层MSCT冠状动脉造影均清楚显示冠脉各主支及其分支,38例患者的115支冠脉上见有粥样硬化斑块,并可显示斑块的类型和狭窄的程度。5例冠状动脉支架置入和1例冠状动脉搭桥术后均清楚显示支架和血管桥的位置及远端血流情况。结论64层MSCT是有效可靠冠心病诊断方法,是冠状动脉疾病筛选和诊断中很有潜力的非侵袭性检查方法。     

64层螺旋CT冠状动脉造影扫描技术临床应用效果评价及影响图像质量的因素分析

目的 评价64层螺旋CT冠状动脉造影（MSCTA）成像技术的临床应用效果并分析影响血管图像质量的因素.方法 选择100例（其中13例冠状动脉支架植入术后复查,3例冠状动脉搭桥术后复查）进行64层螺旋CT冠状动脉造影检查,并分析影响图像质量的因素.结果 100例被检者中35例CT未见异常,65例见冠状动脉各段各分支血管有不同程度的钙化斑块和狭窄（其中10例因心率＆gt;80次/min,或因吸气,屏气不好,致使部分三维冠状动脉血管图像显示欠佳,出现阶梯样伪影;11例可疑为心肌桥;3例冠状动脉搭桥术后复查,见搭桥血管形成;13例冠状动脉支架植入术后复查,见支架管腔通畅,无明显再狭窄现象）.结论 64层螺旋CT冠状动脉造影对冠状动脉成像质量好,诊断准确率高,可做为冠状动脉疾病的筛选手段及冠状动脉术后复查首选方法,图像质量受心率、呼吸和对比剂等多方面因素的影响.     

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.