弥散加权和弥散张量成像在脑梗死诊断中的应用

目的： 分析脑梗死的弥散张量成像(DTI)和弥散加权成像(DWI)的影像表现,评价其临床应用价值。方法：对84例不同时期（超急性期６例,急性期30例,亚急性期26例,慢性期22例）脑梗死患者行常规磁共振成像（MRI）、DWI及DTI扫描,比较患侧和健侧弥散信号的改变及表观弥散系数（ADC）、各项异性指数（FA）值的变化,分析不同时期脑梗死DWI信号改变、ADC值及FA值的关系。 结果： 超急性期、急性期和亚急性期病灶在DWI呈高信号,慢性期表现为低信号;亚急性期和慢性期平均相对表观弥散系数（rADC）值明显高于超急性期和急性期脑梗死病灶的平均rADC值（P<0.05）。45例不同时期（超急性期４例,急性期16例,亚急性期14例,慢性期11例）患者脑梗死区平均FA值明显低于健侧对应区的平均FA值（P<0.05）。结论：DWI和DTI可以快速检出超急性和急性期脑梗死,DWI和MRI的联合应用可以对脑梗死进行分期。     

DWI在宫颈癌新辅助化疗中的应用价值

目的探讨扩散加权成像（DWI）在宫颈癌的新辅助化疗疗效中的评价作用。方法收集我院经病理检查证实的25例宫颈癌患者,在新辅助化疗前及化疗后行常规MRI及DWI检查,评价化疗前后肿瘤及转移性淋巴结在DWI图像及其ADC值的变化。结果（1）25例宫颈癌化疗后肿瘤实性成分ADC值较化疗前明显升高,且肿块体积的变化差异有统计学意义（P〈0．01）。（2）DWI序列对转移胜淋巴结的检出敏感性高于T2WT序列,差异有统计学意义（P〈0．05）。化疗有效的淋巴结DWI信号减低,ADC值增高。（3）宫颈癌病理分型平均ADC值差异有统计学意义（P〈0．05）。结论DWI序列评价宫颈癌化疗前后疗效早于肿瘤体积变化,检测转移性淋巴结的敏感性高于常规MRI。     

高血压脑病的MRI表现

目的分析高血压脑病的MRI表现。方法搜集8例经临床诊断高血压脑病患者，行MR T1WI和T2M检查，其中4例加行扩散加权成像（DWI），分析血压变化、MRI表现及ADC值变化。结果发病时平均血压199／123mmHg，平均升高25．73％／28．71％；MRI上病变主要呈T1稍低、T2稍高信号，以顶枕叶、小脑半球多见。DWI病变呈等及稍高信号，ADC值较正常平均升高58％。仅1个病灶DWI出现明显高信号，表现扩散系数（ADC）值减低。结论MRI有助于高血压脑病的诊断及鉴别诊断，预后及疗效观察，DWI是将其与急性脑梗死区分开的最佳影像学检查方法。     

DWI及ADC值在脑低级星形细胞瘤的应用研究

目的:探讨扩散加权成像(DWI)和表观扩散系数(ADC)值对脑低级星形细胞瘤的鉴别诊断应用价值。方法:对27例脑低级星形细胞瘤病例进行MRI平扫加DWI检查。在病灶部位及对侧相应正常脑组织分别进行ADC值测量,比较两侧部位的ADC值大小,探讨脑低级星形细胞瘤病灶部位的与对侧正常脑组织ADC值的差异。结果:脑低级星形细胞瘤病灶ADC值较对侧相应正常区域明显升高。结论:DWI能为常规MRI检查提供补充信息,对脑星形细胞瘤其临床诊疗和评估也有一定的价值。     

DWI在多发性脑原发恶性淋巴瘤与脑转移瘤中的鉴别诊断价值

目的：探讨多发性脑原发恶性淋巴瘤与脑转移瘤的磁共振弥散加权成像（diffusion weighted imaging, DWI）影像学特征,分析ADC值、rADC值对两者的鉴别诊断价值。方法：回顾性分析经病理证实的多发性脑原发恶性淋巴瘤14例和脑转移瘤17例,观察其常规MRI表现和DWI表现,同时测量肿瘤实质部分的ADC值和rADC值,进行统计学分析。结果：多发性脑原发恶性淋巴瘤14例35个病灶中,DWI图像上25个病灶呈高信号,8个病灶表现为稍高信号,2个病灶呈等信号,ADC平均值为（0.60±0.13）×10-3 mm2/s,rADC值为0.95±0.14。脑转移瘤17例选取的52个病灶中,DWI图像上27个病灶呈低信号,14个病灶呈等信号,7个病灶呈稍高信号,4个病灶呈高信号,ADC平均值为（0.80±0.17）×10-3 mm2/s,rADC值为1.15±0.24。两者ADC值（P=0.001）和rADC值（P=0.008）差异均具有统计学意义。结论：弥散加权成像通过观察DWI图像以及ADC值及rADC值的测定,为多发性脑原发恶性淋巴瘤与脑多发性转移瘤的鉴别诊断提供重要的参考依据,可减少诊断误差。     

磁共振动脉自旋标记(ASL)技术对颞叶癫痫患者海马灌注情况的研究

目的 研究磁共振动脉自旋标记技术对海马脑血流量（CBF）的定量测量方法,评估颞叶癫痫的发生与海马灌注量的关系及探求预测颞叶癫痫的海马CBF的临界值。方法 通过视频脑电（VEEG）及磁共振常规序列将筛选出的42例受试者均分成3组,即健康对照组、常规海马MRI未见异常,一侧颞叶异常放电的颞叶癫痫患者组及常规海马MRI证实为一侧海马硬化的颞叶癫痫患者组,然后行海马3D ASL检查。在海马头、体、尾显示最好的层面分别设置6个相同大小的感兴趣区（ROI）,测量并记录每位受试者双侧海马的CBF值,探讨海马的脑血流量值与颞叶癫痫的关系。结果 分别计算出每个受试者单侧海马的平均脑血流量值,得出健康对照组海马的平均CBF值为53.82±0.98ml/（100g·min）。癫痫单侧异常放电组患侧与健侧海马的平均CBF值分别为49.12±5.31、55.99±1.65ml/（100g·min）;癫痫单侧海马硬化组患侧与健侧海马的平均CBF值分别为39.57±2.08、48.06±1.74ml/（100g·min）。然后对这3组实验者不同组别之间单侧海马的平均CBF值进行两两比较,即比较癫痫单侧异常放电组患侧与健侧、癫痫单侧海马硬化组患侧与健侧、健康对照组与癫痫单侧异常放电组患侧、健康对照组与癫痫单侧海马硬化组患侧、癫痫单侧异常放电组患侧与癫痫单侧海马硬化组患侧、健康对照组与癫痫单侧海马硬化组健侧、健康对照组与癫痫单侧异常放电组健侧、癫痫单侧异常放电组健侧与癫痫单侧海马硬化组健侧之间海马的平均脑血流量值,发现这8次比较中前6次的差异有统计学意义。对健康对照组与癫痫单侧颞叶异常放电组的患侧进行比较,运用ROC曲线对最佳临界点进行计算,得出cut-off值是46.76。结论 磁共振动脉自旋标记（ASL）技术可以通过定量测量海马CBF值的方法对颞叶癫痫患者海马的脑血流量进行评价。颞叶癫痫患者海马灌注量的变化要先于影像学的改变。ASL定量测量海马CBF值有助于颞叶癫痫的早期诊断与治疗。     

脑梗死MR表观弥散系数演变规律及其应用价值

目的：探讨脑梗死病灶弥散加权成像表观弥散系数（ADC）值在时间和空间上的演变规律，为脑梗死分期、指导治疗、判断转归提供一定的依据。方法：应用自旋回波-回波平面（SE-EPI）成像序列对69例脑梗死患者共进行88次DWI和常规MRI检查。其中超急性8例次，急性期35例次，亚急性期20例次，慢性期25例次，测量各期梗死病灶平均ADC值及平均相对ADC（rADC）值，并分别测量梗死灶中心至病灶边缘的ADC值及rADC值。结果：超急性期与急性脑梗死平均ADC值及平均rADC值明显下降，亚急性期病灶平均ADC值及平均rADC值高于超急性期及急性脑梗死病灶（P〈0．05），部分亚急性晚期（10～14d）病灶平均ADC值接近于甚至稍高于健侧相对应区，出现假正常化现象。慢性期脑梗死病灶平均ADC值高于健侧相对应区，其平均ADC值、平均rADC值明显高于超急性期、急性期及亚急性期脑梗死病灶（P〈0．05）。7例超急性脑梗死及26例急性期脑梗死灶内的ADC值、rADC值不均匀的，病灶中心区ADC值和rADC值最低，从中心往外逐渐升高呈“梯度征”，15例亚急性期脑梗死ADC值、rADC值呈现与超急性期及急性期相反的“梯度征”，即病灶中心区ADC值和rADC值最高，从中心往外逐渐降低。结论：脑梗死病灶ADC值，rADC值在时间及空间上均有一定的演变规律及相应的病理生理学基础，将脑梗死病灶ADC值、rADC值在时间及空间上的变化规律结合起来并加以应用，有助于及时准确地判断脑梗死病灶期龄和病理生理改变，为临床治疗及预后判断提供依据。     

前列腺癌的MRI、DWI及MRS的影像分析

目的：以病理结果为参照,探讨MRI、DWI及MRS3种成像方法对前列腺癌的定性诊断价值。方法：收集经穿刺活检,手术病理证实的83例前列腺疾病患者,其中前列腺癌患者35例,BPH患者48例,所有患者均进行MRI常规扫描、DWI及MRS扫描,分析测量PCa癌区的ADC值,以ADC值≤1.24x10~（-3）mm2/s作为诊断前列腺癌的阳性诊断标准。MRS观察枸橼酸盐（Cit）、胆碱（Cho）、肌酸（Cr）的化学位移以及（Cho＋Cr）/Cit比值,以CC/C≥0.86为阳性体素标准。结果：早期前列腺癌的MRI诊断很难与前列腺的其它病变鉴别,早期病变需要借助于DWI及MRS检查可进一步确诊;前列腺癌的MRI主要表现在T2WI上病灶呈局灶性结节状或片状低信号,前列腺外围发生破坏、中断,肿瘤囊外侵在T1WI及T2WI前列腺周围见簇状、结节状或不规则形高信号或低信号,精囊腺肿大或精囊角消失;前列腺癌病灶在DWI上呈高信号,ADC图呈低信号,受累的精囊,淋巴结转移和骨转移病灶DWI上呈高信号,ADC图上呈低信号;癌区的ADC值平均为（1.165±0.201）x10~（-3）mm2/s。MRS谱线前列腺癌表现为Cit明显下降,Cho明显升高,（Cho＋Cre）/Cit比值为0.86为分界线,癌区（CC/C）值明显升高,平均值为2.54±1.78。结论：综合应用MRI、DWI和MRS技术,特异性和准确率都比单独使用其中一种有明显的提高。其中MRS诊断价值较高。     

磁共振常规和弥散加权成像技术对多发性硬化的诊断价值分析

目的比较常规磁共振（MRI）检查和弥散加权磁共振（DWI）检查技术对多发性硬化（MS）的诊断价值。方法采用美国GE公司生产的Signa 1.5T TWin Speed磁共振机对58例经临床与实验室检查明确的MS病例（男34例、女24例，平均年龄35．95岁），例行T1FLAIR、T2加权扫描（T2W1）及弥散加权成（DWI）像检查。将3种序列所见进行比较，同时使用软件进行DWI的弥散系数（ADC）值及影像分析。结果（1）MS，病灶在MRI扫描中，T2WI像共发现病灶798个，T1FLAIR检见病灶673个，T1FLAIR显示的病灶数为T2WI的84％。采用DWI检查，可见病灶537个，检见病灶数为T2WI的67％。（2）T1FLAIR所检MS病灶的信号多为低或略低信号，T2WI的病灶显示为高信号，DWI在急性期病灶显示为略高信号影，在慢性期可表现为等信号或低信号。（3）MS急性期病灶平均ADC值与急性脑梗死相比无显著性差异（P〉0.05）。亚急性和慢性期平均A13（2值（0.00105）高于脑缺血的ADC值（0.000495）（P〈0.001），但低于脑肿瘤的ADC值（0.00174）（P〈0.05）。结论常规磁共振的阳性检出率T2WI优于T1WI；DWI可以明确判定脑内白质区的MS病灶是否急性期，同时应用DWI、ADC图检查对判别病灶的性质，尤其对脑缺血性或肿瘤性病灶有较大帮助，是诊断MS等脱髓鞘疾病的有效影像学方法。     

MR DWI成像在低级别胶质瘤及脑梗死鉴别诊断中的应用

目的探讨弥散加权成像（DWI）与表观扩散系数（ADC）值在低级别胶质瘤及脑梗死鉴别诊断中的应用价值。方法回顾性分析20例低级别胶质瘤及55例脑梗死患者（均处于急性或亚急性阶段）的DWI表现,并分别测量低级别胶质瘤实性部分、脑梗死病灶中心部分及对侧正常的脑组织的ADC值、相对表观扩散系数（rADC）值、指数表观扩散系数（EADC）值、相对指数表观扩散系数（rEADC）值,并进行统计学分析。结果 20例低级别胶质瘤患者,13例DWI表现为稍高信号,7例呈等或稍低信号;52例脑梗死患者DWI序列均呈较均匀高信号,3例信号欠均匀;低级别胶质瘤与脑梗死患者病灶之间平均ADC值、rADC值、EADC值及rEADC值的差异均有统计学意义（P〈0.01）。结论 DWI ADC值、rADC值、EADC值及rEA DC值均能较好的鉴别低级别胶质瘤及脑梗死。     

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.