X线平片、螺旋CT、MRI检查在脊柱骨折临床诊断中的应用价值

目的:分析X线平片、螺旋CT、MRI检查在脊柱骨折临床诊断中的应用价值。方法:回顾性分析2013年8月-2018年8月本院确诊的60例脊柱骨折患者,患者均行X线平片、螺旋CT、MRI检查。以手术结果为"金标准",比较三种检查方法的准确率、诊断脊柱骨折患者椎体压缩损伤、脊髓损伤、椎间盘损伤以及神经根损伤的检出率及三种检查方法的检出时间和检查费用。结果:三种检查方法的准确率比较,差异均有统计学意义(P0.01);MRI与螺旋CT的准确率均高于X线平片,差异均有统计学意义(P0.05);MRI的准确率为96.67%,虽高于螺旋CT的88.33%,但差异无统计学意义(P0.05)。三种检查方法的椎体压缩损伤、脊髓损伤、椎间盘损伤以及神经根损伤检出率比较,差异均有统计学意义(P0.01);MRI检查椎体压缩损伤的检出率高于螺旋CT和X线平片(P0.05);MRI检查的脊髓损伤检出率显著高于X线平片(P0.05);MRI和螺旋CT椎间盘损伤、神经根损伤检出率均高于X线平片(P0.05)。MRI的检出时间均显著长于螺旋CT和X线平片,螺旋CT长于X线平片,差异均有统计学意义(P0.05);MRI的检查费用均显著高于螺旋CT和X线平片,螺旋CT高于X线平片,差异均有统计学意义(P0.05)。结论:螺旋CT和MRI检查诊断脊柱骨折各具优势,与螺旋CT检查相比,MRI检查的准确率更高,可更加清晰地显示患者的各部位损伤。     

强直性脊柱炎并发脊柱骨折的影像学表现

目的：分析强直性脊柱炎并发脊柱骨折的影像学表现，探究对患者进行诊断的最佳影像学检查方法。方法对2011年10月至2013年10月在我院进行治疗的强直性脊柱炎并发脊柱骨折的患者共计20例进行临床资料的回顾性分析。结果对所有患者进行X线、多层螺旋CT以及磁共振成像检查，其中X线检查出脊柱损伤症状47处、多层螺旋CT检查出97处，磁共振检测出105处。结论强直性脊柱炎并发脊柱骨折患者出现前中后脊柱同时损伤的概率较高，X线检测对韧带和软组织损伤的敏感度较低，CT可以显示韧带骨折并能够发现比较细小的附件骨折，磁共振能够明确诊断出韧带、脊髓、软组织等各部位的损伤，是对骨折进行早期诊断的重要方法，临床上常用的方法是X线检测，应该对磁共振成像检测方法进行推广。     

多层面螺旋CT三维重建对脊椎骨折的临床诊断价值研究

目的 探讨多层螺旋CT三维重建在脊椎骨折临床诊断中的价值。方法 选取60例外伤性脊柱骨折患者为研究对象,均接受脊椎X线平片、磁共振成像及多层螺旋CT的多平面重建、三维表面重建、容积重建检查。记录并分析各种检查方式对脊椎骨折检出率与骨折位置、骨折类型及合并椎管狭窄诊断准确率的差异。结果60例受试者多层螺旋CT三维重建检查检出全部骨折椎节(100.0%),且骨折位置及合并椎管狭窄诊断准确率均为100.0%,稳定性骨折、爆裂骨折诊断准确率分别为97.2%和95.8%;均显著高于X线平片检查结果(P0.05),略高于磁共振成像检查结果(P0.05)。结论 多层螺旋CT三维重建技术能有效提高脊椎骨折的检出率及诊断准确性,于患者针对性治疗措施的顺利开展有利。     

数字化重建技术在复杂颌骨骨折中的应用120例临床分析

目的:探讨数字化CT重建成像技术在复杂颌骨骨折诊断中的应用价值. 方法:对近3年来我院120例复杂颌骨骨折患者行X线摄片、二维CT及三维数字化CT重建成像检查,与手术中所见进行对照判断各种检查方法对复杂颌骨骨折的诊断准确率. 结果:X线摄片、二维CT和三维数字化CT重建成像检查对120例复杂颌骨骨折的诊断准确率分别为60%( 72/120 )、70%(84/120)、95%(114/120),X线摄片、二维CT分别与三维数字化CT重建成像相比,差异有统计学意义(P <0.05). 结论:三维数字化CT重建成像对于复杂颌骨骨折的术前诊断具有良好的准确率.     

膝关节外伤在磁共振和64排螺旋CT的诊断对比研究

目的：探讨磁共振和64排螺旋CT对膝关节外伤的诊断价值对比。方法选取65例于2014年10月—2015年10月期间该院接收的膝关节外伤患者,均行磁共振和64排螺旋CT扫描,观察两者的检查结果。结果磁共振膝关节外伤检出率为98.5%高于64排螺旋CT的90.8%(P<0.05),且磁共振在半月板损伤、骨质损伤、韧带损伤、关节积液上的诊断准确率分别为100%、96.0%、100.0%、100.0%,64排螺旋CT分别为95.5%、92.0%、75.0%、90.0%,但除半月板损伤外,组间比较差异无统计学意义(P>0.05)。结论膝关节外伤采用磁共振和64排螺旋CT检查,均可有效诊断,但磁共振的诊断效能更佳。     

浅析低剂量胸部CT扫描在诊断肺癌中的临床应用

目的 探究低剂量胸部CT扫描在诊断肺癌中的临床应用价值.方法 选取本院2018年5月至2020年5月接收的100例疑似肺癌患者作为研究对象,分别进行胸部数字化X线摄影术(DR)、低剂量胸部CT扫描检查,以病理学结果为金标准,比较两种检查方法诊断效能.结果 病理学结果显示,100例疑似肺癌患者中,确诊为肺癌患者48例,CT检出40例,胸部数字化X线摄影检出25例.低剂量胸部CT扫描对结节大小为≤5 mm和6～10 mm的检出率高于胸部数字化X线摄影术,且总检出率高于胸部数字化X线摄影术,差异有统计学意义(P<0.05);两种检查方法对结节大小为11～20 mm、≥20 mm的检出率比较差异无统计学意义.低剂量胸部CT诊断灵敏度、特异度和符合率分别为81.25％、98.08％、90.00％,高于胸部数字化X线摄影术的27.08％、76.92％、53.00％,差异有统计学意义(P<0.05).结论 与胸部数字化X线摄影术检查比较,低剂量胸部CT扫描对结节大小为≤5 mm和6～10 mm的检出率高,且诊断灵敏度、特异度和符合率也高,值得临床推广应用.     

CT磁共振成像与X线诊断脊椎骨折的影像学对比

目的:探讨CT、磁共振成像(MRI)与X线对于脊椎骨折影像学对比及其诊断价值分析.方法:选取我院在2018年1月-2019年1月期间所收治的100例脊柱骨折患者为此次研究的对象,回顾性分析患者的临床资料,并对所有患者均施以CT、MRI及X线检查,并以病理检查的结果作为对照的金标准,对3种检测方法其诊断的准确率与特异度进行对比分析.结果:对于脊柱骨折良恶性检出方面,CT、MRI相应检出率比X线明显偏高,对比差异显著,P<0. 05,具有统计学意义;同时在检测的敏感性、特异度及准确率方面,CT、MRI均比X线明显优越,P<0. 05,具有统计学意义;而CT与MRI检测结果方面对比差异不具有统计学意义(P>0. 05).结论:X线属于脊柱骨折的临床基础检查方式,针对外伤而引起的脊柱骨折表现出较高的检查和诊断价 值,而CT与MRI在良恶性脊柱骨折鉴别及其病因诊断方面均表现出优越的价值.     

螺旋CT三维重建成像在骨关节外伤中的临床应用观察

目的探讨螺旋CT三维重建成像对骨关节外伤患者的诊断价值。方法选取我院2016年3月至2016年9月收治的156例骨关节外伤患者,对其进行分别进行X线检查以及螺旋CT三维重建成像,并将检查结果分别作为对照组与研究组,分析两组检查诊断效果。结果实验组诊断准确率100%,对照组诊断准确率81.41%,具有统计学意义(P0.05)。结论骨关节外伤通过螺旋CT三维重建成像检查检验结果更加清晰,值得推广。     

原发性腹膜后脂肪瘤的影像学诊断

目的探讨X线平片、超声成像(USG)、计算机体层摄影术(CT)及磁共振成像(MR I)对原发性腹膜后脂肪瘤的诊断价值,并比较其优点及局限性。方法对29例经手术病理证实的腹膜后脂肪瘤患者的临床资料进行回顾性分析,评价其诊断准确率。结果X线平片无一例诊断正确;USG、CT、MR I的诊断准确率分别为72.4%、96.6%、100%。结论X线平片对原发性腹膜后脂肪瘤的诊断有较大的局限性;USG、CT、MR I对原发性腹膜后脂肪瘤的诊断敏感性高,CT、MR I明显优于USG,MR I优于CT。     

胸部低剂量CT在肺癌诊断中的应用分析

目的在肺癌诊断的过程中,探究胸部低剂量CT在诊断中的应用价值。方法在2017年间,对我院需要进行肺癌筛查的患者进行研究,共146例,对患者进行两组检查,即低剂量胸部CT检查与胸部数字化X线摄影术(DR),对比两种方法的检出率、灵敏度等。结果在肺癌检出率、灵敏度、阴阳性预测值、诊断符合率的对比上,低剂量胸部CT检查方法的相对较好,同时在检查可疑肺癌时,低剂量胸部CT检查的检出率、诊断符合率等也相对较高。结论在肺癌诊断采用低剂量胸部CT检查方法与胸部数字化X线摄影术方法的效果比较,前者有着相对较高的诊断符合率、灵敏度、阴阳性预测值等,因此诊断患者是否患肺癌的准确率更高,应用价值更高。     

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.     

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.     

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.