21例白肾征的影像学表现分析

目的 探讨白肾的X线及CT表现。方法 对21例静脉肾盂造影（IVP ）检查显示白肾征象（其中13例泌尿系CT增强后行IVP检查）的患者，结合临床对其X线及CT征象进行分析。结果 21例中阳性结石17例，阴性结石4例。IVP表现为随着时间延长，肾实质密度持续增高（即“白肾”）；CT表现为皮质期、髓质期，肾皮质及髓质强化减轻，并逐渐强化，排泄期及延迟期肾实质持续均匀强化，肾盂及肾盏内可见造影剂浅淡充盈。结论 白肾在IVP上具有特征性的影像学表现，白肾的意义为输尿管发生急性或亚急性完全性梗阻，但肾功能尚未明显受损，提示临床医生应及时解除梗阻，避免肾功能进一步受到损害。     

多层螺旋CT泌尿系成像在肾盂癌诊断中的价值

目的探讨多层螺旋CT泌尿系成像(MSCTU)在肾盂癌诊断中的价值.材料和方法 回顾性分析58例MSCTU检查肾盂癌病例,所有病例均行MSCT平扫、增强动、静脉期、分泌期多期扫描,及1.25mm层厚后重建,分别经MPR、CPR、VR、MIP重组.结果 原始轴位平扫,与增强动、静脉期、排泄期扫描能够清楚显示病变,及病变特点,经MPR、CPR重组能够更清楚显示病变与周围组织的关系,以及肾实质的侵润范围.结论 MSCTU能够多平面、多方位、立体显示肾盂癌的形态与密度,显示肾盂癌的影像特征,有利于肾盂癌的诊断,并能同时客观评价双侧肾脏排泄功能,为临床提供全面有价值的资料.     

髓质海绵肾的CT影像分析

目的 总结CT扫描对髓质海绵肾的早期诊断.方法 本文搜集近几年来5例髓质海绵肾的病例,均做螺旋CT扫描,分析其CT表现.结果 髓质海绵肾的CT平扫显示环绕诸肾小盏的钙化灶,可单发或呈簇状,一般钙化较小,呈砂粒状,无肾盂肾盏的积水征.增强扫描可见钙化,周围扩张的收集管内有造成影剂聚集,有时可见集合管的囊状扩张.结论 CT对海绵肾中细小结石及远端集合管扩张的发现较敏感,有利于对本病的早期诊断.     

16层螺旋CT肾集合系统及肾动脉联合成像技术初步研究

目的探讨16层螺旋CT肾集合系统及肾动脉联合成像技术方法。材料与方法14例肾结石、1例外伤肾破裂、5例正常人行16层螺旋CT肾集合系统及肾动脉联合成像检查。采用MIP和VR进行肾集合系统及肾动脉三维成像。结票19例MIP、VR图像能同时清晰显示肾动脉1～3级分支及肾盂、肾盏形态,其中图像质量优秀6例,占30％,良好13例,占65％,差1例,占5％。同层面腹主动脉平均CT值332±58Hu,肾动脉主干CT值289±46Hu,肾盂CT值1116±309Hu,肾皮质CT值167±23Hu,肾髓质CT值87±12Hu,肾集合系、肾动脉及肾实质三者之间的密度差异能形成对比度较高的清晰图像。结论采取2次对比剂团注后1次增强扫描,16层螺旋CT肾集合系统及肾动脉联合成像技术方法可行。     

MSCTU在泌尿系统结石和肿瘤诊断中的应用价值

目的探讨MSCTU在泌尿系统结石和肿瘤诊断中的应用价值。方法 78例患者均行泌尿系常规CT平扫、双期增强扫描及排泄期尿路造影;原始数据采用最大密度投影（MIP）、多平面重建（MPR）及曲面重建（CPR）等处理技术。结果 78例患者中有46例输尿管结石、12例肾盏结石、11例肾癌、5例肾盂癌、4例膀胱癌侵犯输尿管下段。结论 MSCTU扫描速度快、范围广、病变检出率高、图像清晰,为泌尿系病变定位、定性诊断提供重要信息。     

多层螺旋CT尿路成像研究现状及进展

多层螺旋CT尿路成像（Multi-slice SpiralComputed Tomography Urography,MSCTU）是近年来泌尿系影像诊断领域的一项新技术,它是经静脉注入对比剂后,利用对比剂经肾脏分泌排泄的原理,对比剂在肾盏、肾盂、输尿管及膀胱内充盈,通过螺旋CT对泌尿系统进行快速连续容积扫描,将获得的原始图像经计算机后处理三维重组,从而获得整个泌尿系立体图像的成像技术。随着多层螺旋CT的普及应用,MSCTU日益为临床工作者所认识和青睐,本文将对MSCTU技术应用现状及进展做一综述。     

肾窦常见恶性肿瘤的CT诊断

目的 探讨各种肾窦常见恶性肿瘤的多层CT影像表现.方法 回顾分析31例不同种类肾窦恶性肿瘤的多层CT影像资料.结果 31例肾盂恶性肿瘤中肾盂癌15例,多层CT表现为肾窦中心性肿块,有轻至中度强化,增强分泌期显示肾盂内充盈缺损和不同程度肾积水.肾癌侵犯肾窦10例,CT多平面重建显示癌肿以肾实质内为主,肾盂受侵犯表现肾盂局限性受压、肾盂肾盏偏侧性破坏,增强CT肿块多呈不均匀性明显强化.肾窦平滑肌肉瘤2例,瘤体较大,边界清楚,增强后呈不均一性明显强化.淋巴结转移瘤3例,CT表现为肾窦内或肾门处强化性结节病灶,肾盂出口受压则引起肾积水.腹膜后淋巴瘤累及肾窦l例,CT多平面重建示腹膜后肿块直接侵入肾窦,有轻至中度强化,分泌期CT显示肾盂肾盏变形.讨论多层螺旋CT具有图像分辨率优良、快速扫描和强大的图像后处理功能,有利于肾窦恶性肿瘤定位、定性诊断.     

MSCT在活体肾移植术前评估及筛选供肾者中的应用价值

目的 探讨多层螺旋CT在活体肾移植术前评估及筛选供肾者中的应用价值.方法 13例亲属活体供肾者在取肾前行多排螺旋CT肾皮质期、实质期、排泄期扫描,成像方法包括容积再现技术(VR)、最大密度投影(MIP)、血管分析(GVA)、多平面重建(MPR)等.结果 7例显示双侧肾动脉均为单支肾动脉,3例显示左肾双支动脉,2例显示右肾双支动脉,1例左肾为三支肾动脉;12例显示双肾均为单支静脉引流,1例右侧双支肾静脉;肾盂结构及输尿管显示清晰.MSCT结论与术中所见完全一致.结论 MSCT能清晰显示供体肾动、静脉及肾盂结构,输尿管解剖、变异及与下腔静脉关系,可为临床评估及筛选供肾提供可靠依据.     

多层螺旋CT尿路造影诊断肾盂输尿管交界部狭窄

目的 通过多层螺旋CT尿路造影的良好分辨率和多样成像方式对肾孟输尿管交界部狭窄进行诊断。方法 使用64排螺旋CT对5例肾孟输尿管交界部狭窄患者进行检查;在膀胱充盈状态下行平扫、皮质期、排泄期及延迟扫描;选用VR、MIP、CPR和MPR等后处理技术。结果 5例均发生在左侧肾脏,表现出中度或重度肾积水,1例伴同侧肾动脉狭窄,1例同侧出现副肾动脉、2例伴有结石存左。结论 多层螺旋CT尿路造影比静脉肾孟造影有更高的显影率,MSCTU可以通过VR、MIP、CPR及MPR后处处理技术全面、立体,直观地显示病变与周围结构的关系。     

多层螺旋CT多期增强扫描对小肾癌的诊断价值

目的探讨64层螺旋CT多期增强扫描对小肾癌的诊断价值。方法回顾性分析23例经手术或活检证实的小肾癌的螺旋CT资料及病理结果。结果 CT平扫中8例为等密度,14例为略低密度,1例为囊实性混杂密度。增强扫描皮质期18例强化程度高于或相当于正常肾皮质,3例强化低于肾皮质但高于肾髓质,1例强化程度等于肾髓质,1例囊实性病例囊壁明显强化。肾实质期扫描23例均显示肿瘤强化迅速减退,肾盂期扫描肿瘤密度进一步减退。结论多层螺旋CT多期增强扫描对小肾癌的诊断是可靠有价值的诊断方法,特别是小肾癌皮质期强化明显,实质期强化迅速减退,呈＂快进快出＂表现,有重要的定性意义。     

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.