泌尿系上尿路肿瘤临床诊断方法的评价

①目的:总结泌尿系上尿路肿瘤的诊断情况。②方法:回顾性分析47例上尿路肿瘤病人的临床资料。③结果:62％的病人由静脉肾盂造影首先确诊肾盂肿瘤，19％病人由B超首先确诊占位，13％病人由CT首先确诊占位，2例病人由腔内B超诊断占位，2例病人由输尿管镜诊断占位，3例病人由磁共振水成像(MRU)检查发现占位。④结论:静脉肾盂造影仍为上尿路肿瘤的主要检查方法，其与逆行肾盂造影相结合，可基本完成对上尿路肿瘤的诊断。CT检查对肾盂占位的定性和定位诊断有良好的优越性。MRU、腔内B超和输尿管镜检查对疑难病例诊断有重要作用。     

上尿路移行细胞癌的临床诊治体会

目的研究治疗上尿路移行细胞癌的最佳方法。方法对我院自2008年10月到2010年10月收治的36例上尿路移行细胞癌病人的临床资料进行回顾性分析。结果上尿路逆行造影顺利的病人,通过CT、静脉肾盂造影或B超检查,对输尿管癌和肾盂癌的病灶处都能准确定位。CT、静脉肾盂造影(简称IVP)、B超对输尿管癌的诊断率分别是88.9%,16.7%,61.1%。B超和静脉肾盂造影相互结合,定性诊断率为72.2%。结论临床上IVP结合B超检查可以作为治疗上尿路移行细胞癌的常规检查方法。对IVP检查不显影的患者,上尿路逆行造影可以进行辅助检查,进一步的检查措施可选择CT。治疗本病的最佳方法是进行肾输尿管全切+膀胱袖套状切除术。     

上尿路浸润性尿路上皮癌的诊断分析

目的 上尿路浸润性尿路上皮癌少见,术前诊断较为困难.文中通过探讨上尿路浸润性尿路上皮癌的诊断方法,提高其诊断水平.方法 分析27例上尿路浸润性尿路上皮癌的临床资料,所有患者均进行B超、CT尿路成像(computed tomography urography,CTU)、静脉尿路造影(intravenous urography,IVU)、尿脱落细胞学、膀胱镜、输尿管镜等检查.结果 B超发现肾盂占位11例,阳性率为73.3%;输尿管占位3例,阳性率为25%.CTU检查发现肾盂占位14例,阳性率为93.3%;输尿管占位10例,阳性率为83.3%.IVU发现肾盂充盈缺损10例,阳性率为66.7%;输尿管充盈缺损或狭窄6例,阳性率为50.0%.尿脱落细胞学检查发现癌细胞6例,阳性率为22.2%.膀胱镜检查发现患侧输尿管口喷血8例,阳性率为29.6%,膀胱肿瘤2例.输尿管镜成功检查并发现病变24例,阳性率为88.9%.所有患者均行根治性手术.结论 CTU、输尿管镜是上尿路浸润性尿路上皮癌重要的检查手段.上尿路浸润性尿路上皮癌因无典型的乳头状改变,输尿管镜下易于误诊,应提高对其认识.     

输尿管癌的影像学分析(附2例报告)

目的：探讨各种影像学检查方法在诊断和鉴别诊断输尿管癌的价值与应用。方法：回顾性分析经手术及病理证实的输尿管癌2例,均行静脉肾盂造影、逆行尿路造影、B超、CT、MRI检查。结果：输尿管癌2例在静脉肾盂造影、逆行尿路造影显示输尿管内充盈缺损和管腔变窄,梗阻近端输尿管及肾盂轻度积水扩张;B超显示肾盂轻度积水扩张;CT扫描显示软组织密度肿瘤影,梗阻处以上输尿管及肾盂积水扩张;MRI检查显示肿瘤在Tl加权为等信号,12加权为略高信号或等信号。结论：静脉肾盂造影、逆行尿路造影、B超、CT、MRI检查在显示输尿管癌病变各有特点,CT和MRI对诊断输尿管癌具有很高的敏感性,并能对其准确分期,B超可行初步筛查,静脉肾盂造影、逆行尿路造影为常规方法。     

影像学检查诊断上尿路移行细胞癌的比较及临床意义（附234例分析）

目的：比较各种影像学检查对输尿管肿瘤的检出情况,探讨多层螺旋CT泌尿系统成像(MSCTU)在输尿管肿瘤诊断中的优越性。方法：2004年6月至2006年9月手术病理诊断的上尿路移行上皮癌患者234例,其中肾盂癌82例、输尿管癌152例,多数患者行泌尿系B超、静脉尿路造影（IVU）、逆行造影及MSCTU。各项检查的阳性率和符合诊断率的比较采用多重卡方检验。结果：行B超检查者215例,发现异常152例,检查阳性率70.7%,明确诊断58例,符合诊断率为27.0%;行IVU检查者193例,发现异常132例,检查阳性率68.4%,明确诊断65例,符合诊断率33.7%;行逆行造影者132例,发现异常115例,检查阳性率87.1%,明确诊断93例,符合诊断率70.5%;行MSCTU检查者226例,发现异常220例,检查阳性率97.3%,明确诊断214例,符合诊断率94.7%。逆行造影对输尿管肿瘤的符合诊断率显著优于B超和IVU检查(P<0.001),MSCTU的符合诊断率显著优于逆行造影(P<0.001)。结论：血尿患者行B超检查后怀疑为上尿路移行细胞癌患者,宜首先考虑行MSCTU检查,以缩短诊断时间并减轻患者痛苦。     

CT尿路造影在肾盂输尿管癌诊断和分期中的价值

目的 探讨CT尿路造影在肾孟输尿管癌诊断和分期中的价值.方法 对89例可疑肾盂输尿管肿瘤患者进行CT尿路造影检查,将其结果 与术后病理检查结果 进行比较.结果 根据CT尿路造影诊断为肾盂癌62例、榆尿管癌26例、输尿管狭窄1例,其中9例为多中心尿路上皮癌.病理检查显示CT尿路造影对肾盂输尿管癌诊断和分期的准确率分别为96.6%(86/89)和90.7%(78/86).对邻近组织浸润检测的敏感度和特异度分别为85.2%(23/27)和93.2%(55/59).结论 CT尿路造影可以准确地对肾盂输尿管癌进行诊断和分期,可能成为上尿路上皮肿瘤的首选检查方法 .     

两种64层CT尿路成像方法对输尿管结石诊断价值的比较

目的比较两种64层CT尿路成像（CTU）方法对输尿管结石的诊断价值。方法本文包含两组资料。一组为阳性法组，收集B超提示输尿管结石，行静脉肾孟造影（IVP）的患者共36例，患者行IVP检查后接受64层CT平扫；另一组为阴性法组，收集23例急性肾绞痛疑为输尿管结石直接行64层CT平扫。将上述两组原始资料传送至工作站，用多平面重建，（MPR）及曲面重建（CPR）进行图像后处理，比较KUB＋IVP与CTU的诊断输尿管结石阳性率、阴性法CTU与超声的诊断输尿管结石阳性率以及阳性法CTU与阴性法CTU的诊断输尿管结石阳性率，用SPSS12．0软件进行χ^2检验。结果（1）阳性法组36例输尿管结石中，KUB＋IVP诊断正确者20例，阳性法CTU诊断正确者31例，两者差异有统计学意义（χ^2=8．13，P〈0．05）；（2）阴性法组23例输尿管结石中，阴性法CTU诊断正确者22例，B超诊断正确者15例，两者差异有统计学意义（χ^2=4．97，P〈0.05）；阳性法CTU与阴性法CTU诊断输尿管结石正确率无明显差异（χ^2=0．55，P〉0.05）。结论阴性法CTU与阳性法CTU对输尿管结石诊断率优于B超，KUB＋IVP；阴性法方便快捷、不需使用对比剂，尤其适用于肾绞痛患者的检查。     

25例原发性输尿管癌的诊断与治疗

目的：探讨提高原发性输尿管癌的诊治。方法：回顾性分析25例原发性输尿管癌的临床资料,比较各种检查方法,总结诊治经验。结果：25例均有血尿和腰痛表现,术后均经病理证实为输尿管癌。术前经B超、静脉尿路造影术、膀胱镜检及逆行肾盂输尿管造影、CT、磁共振成像等方法检查确诊23例。结论：血尿和腰痛是原发性输尿管癌的典型表现。术前联合B超、静脉尿路造影（IVU）、膀胱镜检及逆行肾盂输尿管造影、CT、MRU等方法诊断,可提高原发性输尿管癌的诊治符合率。患侧肾、输尿管和膀胱袖套状切除仍是原发性输尿管癌治疗金标准。预后取决于输尿管癌的分期和分级。     

原发性输尿管癌33例临床分析

目的　提高原发性输尿管癌的诊治水平。方法　分析 33例病例通过超声、静脉尿路造影、膀胱镜和逆行造影进行诊断 ,部分病人接受CT和磁共振水成像检查。结果　所有病例均行手术 ,2 7例获得术前确诊。结论　静脉尿路造影、膀胱镜和逆行造影仍是基本检查手段 ,对于部分病例 ,CT和磁共振水成像有重要诊断价值。肾、输尿管全长及膀胱部分切除术仍是主要术式。     

肾盂移行细胞癌的诊断方法评价

目的评价肾盂移行细胞癌术前诊断的方法。方法回顾性分析24例肾盂移行细胞癌（TCC）患者的临床资料。肿瘤位于右侧16例,左侧8例。对B超或彩超、超声造影（CEUS）、静脉尿路造影（IVU）、逆行肾盂造影（RP）、CT、磁共振成像（MRI）或磁共振尿路造影（MRU）、尿液脱落细胞学检查的敏感性进行比较。结果B超或彩超、CEUS、IVU、RP、CT、MRI或MRU、尿液脱落细胞学检查对肾盂移行细胞癌的诊断敏感度分别为52.2%、100%、21.4%、85.7%、88.9%、66.7%、46.2%。结论B超或彩超、IVU可作为肾盂癌的初步检查方法,CT在术前诊断及分期中起重要作用,CEUS等新技术的应用为肾盂癌的术前诊断提供了新的方法。     

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.