口服法低剂量多层螺旋CT小肠造影的应用价值

目的探讨口服等渗甘露醇法低剂量多层螺旋CT小肠造影(Multislice computed tomography enterography,MSCTE)对小肠疾病的诊断价值。方法对62例临床怀疑小肠疾病患者口服2.5%等渗甘露醇溶液及肌注山莨菪碱后随机分组分别行常规剂量和低剂量MSCTE检查,将诊断结果与手术病理、内镜病理或临床随访结果进行对照,评估常规剂量和低剂量MSCTE对小肠疾病的诊断价值并比较二者诊断准确率有无差异。结果经病理及随访结果证实小肠疾病57例,常规剂量MSCTE诊断敏感性89.28%、特异性80.00%、准确率87.87%,低剂量MSCTE诊断敏感性88.46%、特异性100.00%、准确率89.65%。两种检查方法诊断准确率有无统计学差异(χ~2=3.27,P=0.574)。结论口服等渗甘露醇法低剂量MSCTE在多种小肠疾病有较高的诊断价值。     

多层螺旋CT肠道造影在小肠病变中的临床应用

目的:探讨多层螺旋CT肠道造影(multislice spiral CT enterography,MSCTE)在小肠病变检查中的临床应用价值。方法:选取本院2015年1月-2016年10月收治的76例疑似小肠疾病患者,所有患者于45 min内分3~4次口服20%的甘露醇溶液+碘佛醇注射液+温开水共2 000 m L;约75 min行全腹部CT平扫和增强扫描,将MSCTE检查结果与CT平扫、手术病理或内窥镜检查进行对比分析,评估MSCTE在小肠肿瘤性病变、小肠炎症性病变等小肠病变中的诊断符合率、敏感性、特异性、阳性预测值和阴性预测值。结果:所有患者均顺利完成CT平扫和MSCTE检查,MSCTE的诊断符合率为94.74%,明显高于CT平扫的47.37%,差异有统计学意义(X~2=41.455,P0.01);MSCTE的敏感性、特异性、阳性预测值和阴性预测值分别为96.43%、90.00%、90.00%和96.43%均明显高于CT平扫法的65.63%、34.09%、57.69%和42.00%,差异均有统计学意义(P0.05)。结论:与常规CT平扫相比,MSCTE检查应用于小肠病变诊断中具有更高的诊断符合率、敏感性和特异性,明显提高小肠疾病的诊断能力,在小肠病变检查中值得推荐应用。     

多层螺旋CT小肠造影在小肠梗阻诊断中的价值

目的 探讨多层螺旋CT(MSCT)小肠造影(MSCTE)在小肠梗阻的部位、程度及病因诊断中的价值.方法 回顾性分析52例经手术、组织病理学或临床治疗证实病因为小肠梗阻的患者MSCT平扫及MSCTE资料,计算MSCTE及MSCT平扫判断小肠梗阻部位、程度的准确性和MSCTE在小肠梗阻病因诊断中的准确率、假阳性率、假阴性率、敏感性.结果 52例患者中机械性小肠梗阻46例,血运性肠梗阻5例,麻痹性肠梗阻1例,其中37例有MSCT平扫资料.机械性小肠梗阻中32例有MSCT平扫资料,MSCTE与MSCT平扫判断机械性小肠梗阻部位、梗阻程度的准确性比较,差异无统计学意义(P＞0.05);MSCTE对小肠梗阻病因的诊断正确率高于MSCT平扫(P＜0.01);MSCTE对小肠梗阻病因诊断的假阳性率和假阴性率均为9.62％,敏感性为90.38％.结论 MSCTE在小肠充分扩张的基础上,联合运用多种图像后处理技术,可以明显提高对小肠梗阻病因的诊断准确性,具有较高的临床应用价值.     

MSCTE和MSCTA联合运用在小肠梗阻病因诊断中的价值

目的探讨多层CT小肠造影(MSCTE)和多层CT血管造影(MSCTA)联合运用在小肠梗阻病因诊断中的价值。方法回顾性分析57例行MSCTE和MSCTA检查,并经过手术和病理检查证实为小肠梗阻患者的影像学资料。使用Siemens Somatom Sensation 64层螺旋CT进行检查,经过后处理方法[多平面重建(MPR)、最大密度投影(MIP)、容积再现技术(VRT)、曲面重建法(CPR)],分析其图像在小肠梗阻病因诊断中的作用。结果所有病例中,肿瘤15例,粘连14例,腹外疝8例,炎症6例,内疝或扭转5例,肠套叠3例,胆石或粪石4例,血管性2例。组Ⅰ:常规横断位结合MPR、CPR对病因诊断的准确性为89.5%(51/57);组Ⅱ:常规横断位结合MPR、CPR和CTA技术(VRT、MIP)对病因诊断的准确性为94.7%(54/57);组Ⅱ的诊断准确性明显高于组Ⅰ(P<0.05)。结论 MSCTA和MSCTE的联合运用可以明显提高小肠梗阻病因诊断的准确性,具有较高的临床应用价值。     

MSCT CTA与DSA诊断肾癌的应用对照研究

目的 探讨多层螺旋CT血管成像法MSCT(CTA)与选择性肾动脉数字减影血管造影法(DSA)对诊断肾癌的应用价值. 方法 对26例病理证实的肾癌患者的多层螺旋CT血管成像MS(2T(CTA)与选择性肾动脉数字减影血管造影(DSA)的影像特征进行对照分析. 结果 多层螺旋CT血管成像法MSCT(CTA)对肾癌的肿瘤血供类型、肿瘤供血动脉来源的诊断符合率和肾动脉解剖显示正确率达到96.15%.选择性肾动脉数字减影血管造影法(DSA)对肾癌的肿瘤血供类型、肿瘤供血动脉来源的诊断合率和肾动脉解剖显示正确率达到92.31%. 结论 多层螺旋CT血管成像法MSCT(CTA)与选择性肾动脉数字减影血管造影法(DSA)对诊断肾癌都具有较高的临床诊断价值,两组正确率的比较,没有显著性差异.多层螺旋CT血管成像法MS(3T(CTA)比选择性肾动脉数字减影血管造影法(DSA)对指导肾癌的介入与外科手术治疗具有较大的使用价值.     

MSCT CTA与DSA诊断肾癌的应用对照研究

目的 探讨多层螺旋CT血管成像法MSCT(CTA)与选择性肾动脉数字减影血管造影法(DSA)对诊断肾癌的应用价值. 方法 对26例病理证实的肾癌患者的多层螺旋CT血管成像MSCT(CTA)与选择性肾动脉数字减影血管造影(DSA)的影像特征进行对照分析. 结果 多层螺旋CT血管成像法MSCT(CTA)对肾癌的肿瘤血供类型,肿瘤供血动脉来源的诊断符合率和肾动脉解剖显示正确率达到96.15%.选择性肾动脉数字减影血管造影法(DSA)对肾癌的肿瘤血供类型,肿瘤供血动脉来源的诊断合率和肾动脉解剖显示正确率达到92.31%. 结论 多层螺旋CT血管成像法MSCT(GTA)与选择性肾动脉数字减影血管造影法(DSA)对诊断肾癌都具有较高的临床诊断价值,两组正确率的比较,没有显著性差异.多层螺旋CT血管成像法MSCT(CTA)比选择性肾动脉数字减影血管造影法(DSA)对指导肾癌的介入与外科手术治疗具有较大的使用价值.     

MSCT CTA与DSA诊断肾癌的应用对照研究

目的 探讨多层螺旋CT血管成像法MSCT(CTA)与选择性肾动脉数字减影血管造影法(DSA)对诊断肾癌的应用价值. 方法 对26例病理证实的肾癌患者的多层螺旋CT血管成像MSCT(CTA)与选择性肾动脉数字减影血管造影(DSA)的影像特征进行对照分析. 结果 多层螺旋CT血管成像法MSCT(CTA)对肾癌的肿瘤血供类型,肿瘤供血动脉来源的诊断符合率和肾动脉解剖显示正确率达到96.15%.选择性肾动脉数字减影血管造影法(DSA)对肾癌的肿瘤血供类型,肿瘤供血动脉来源的诊断合率和肾动脉解剖显示正确率达到92.31%. 结论 多层螺旋CT血管成像法MSCT(GTA)与选择性肾动脉数字减影血管造影法(DSA)对诊断肾癌都具有较高的临床诊断价值,两组正确率的比较,没有显著性差异.多层螺旋CT血管成像法MSCT(CTA)比选择性肾动脉数字减影血管造影法(DSA)对指导肾癌的介入与外科手术治疗具有较大的使用价值.     

小肠出血的诊断方法及病因分析

目的探讨小肠出血的诊断方法及病因分析。方法回顾性分析郑州市第一人民医院2011年7月至2017年12月收治的37例小肠出血患者的临床资料。结果各检查方法在小肠出血的检查中阳性率分别为:术中内镜100%,结肠镜11.8%,多层螺旋CT扫描(MSCT)8.8%,数字减影血管造影(DSA)69.2%.胶囊内镜71.4%,气钡双重造影21.4%,小肠镜46.7%。37例小肠出血患者中33例检查结果阳性,其中小肠肿瘤10例(27.0%),血管病变10例(27.0%),炎症性肠病5例(13.5%),憩室7例(18.9%),小肠钩虫1例(2.7%);原因不明4例(10.8%)。结论小肠出血病因多样,检查缺乏特异性,根据出血的缓急可选择合适的检查方法,胶囊内镜、DSA、小肠镜检查的检出率较高。小肠出血肿瘤、血管畸形最为多见。     

口服CT小肠造影的临床应用

目的探寻口服CT小肠造影的可行性和临床应用价值。方法疑似小肠病变的患者在45～60min内分3～4次口服完等渗甘露醇溶液1500～2000mL;评估小肠肠管充盈满意度与扩张度,对肠管病变进行分析（肠壁病理改变、肠腔狭窄和肠系膜淋巴及血管病理性征象）;计算小肠CT造影检查检出病变的敏感性、特异性、阳性预测值及阴性预测值。结果等渗甘露醇溶液得到所有病人接受、认可;肠道充盈满意度：5例欠佳,10例较满意,45例满意;无小肠梗阻的各段小肠扩张度分别：十二指肠（23.2±3.2）mm,空肠（25.7±3.9）mm,回肠（21.7±2.2）mm;小肠梗阻的各段小肠扩张度分别：十二指肠（22.2±2.5）mm,空肠（41.4±9.7）mm,回肠（43.6±11.6）mm。多种小肠疾患的肠内、肠壁、肠系膜及腹内脏器情况MSCTE都显示清楚。口服CT小肠造影检出小肠病变的灵敏性、特异性、正确率、阳性预测值及阴性预测值分别为97.9%、91.7%、96.7%、97.9%、91.7%。结论口服小肠造影是检测小肠病变的简洁、安全可靠并能全景展示小肠管的方法,同时是小肠与腹腔内其他脏器疾病鉴别的较为可靠手段。     

小肠原发性肿瘤31例临床分析

目的 探讨原发性小肠肿瘤的临床特点及诊断.方法 回顾性分析近5年来我们所收治的31例原发性小肠肿瘤的临床和病理特征.结果 小肠肿瘤大多位于十二指肠,占21/31(67.74%).全组术前确诊率为17/31(54.84%).其中,十二指肠肿瘤较高66.67%(14/21);空回肠肿瘤术前诊断率较低,仅3例30%(3/10).本组患者以恶性病变28例,以腺癌占绝大多数24/31(77.42%),其次为恶性淋巴瘤4/31(12.90%).良性肿瘤仅3例.小肠肿瘤可表现为腹痛、腹块、消化道出血、肠梗阻和黄疸、发热等.X线钡餐,特别是低张小肠气钡造影和内镜对诊断小肠肿瘤有较大帮助.选择性肠系膜上动脉血管造影对小肠肿瘤,特别是诊断困难的小肠出血有诊断价值.CT对判断肿瘤有一定帮助.结论 小肠肿瘤以恶性者和腺癌多见,又以十二指肠为主.十二指肠水平都以上肿瘤以消化道内镜检查加活检为首选.低张小肠造影是有效的诊断和定位方法.肠系膜上动脉造影对血管瘤和平滑肌瘤是较好的方法.CT也有一定帮助.     

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.     

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.     

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.