循证医学分析超声造影和增强磁共振诊断肝脏局灶性病变价值

目的 通过循证医学分析超声造影(CEUS)和增强磁共振(CEMRI)对肝脏局灶性病变的诊断价值.方法 检索Pubmed、Cochrane library、中国生物医学文献数据库以及CNKI数字图书馆关于CEUS及CEMRI诊断肝脏局灶性病变的中英文文献,并对文献进行评价和筛选.应用Metadisc软件对纳入的试验结果进行分析,比较CEUS和CEMRI对肝脏局灶性病变的诊断价值.结果 符合条件的文献共43篇,CEUS诊断肝脏局灶性病变合并敏感度为89%,合并特异度为90%,加权SROC曲线下面积(AUC)为0.9656.CEMRI诊断肝脏局灶性病变合并敏感度为79%,合并特异度为84%,加权SROC AUC为0.8956.结论 CEUS与CEMRI时肝脏局灶性病变诊断准确性无统计学差异.     

超声弹性应变率与常规超声对甲状腺结节的鉴别诊断价值

目的：研究超声弹性应变率与常规超声对甲状腺结节的鉴别诊断价值。方法纳入研究共126例择期手术甲状腺结节患者,共有146个结节。行术前常规超声及超声弹性成像扫描。根据常规超声结果及Stacul半定量评分法判断结节良恶性。根据超声弹性成像结果构建ROC曲线,确定诊断最佳临界点。以术后病理结果作为标准,比较超声弹性应变率、常规超声及联合诊断在甲状腺结节鉴别诊断价值。结果超声弹性应变率ROC曲线下面积(AUC)为0.827,最佳诊断界值为2.53;弹性应变率诊断灵敏度、特异度及诊断准确率分别为78.38%、72.48%及73.97%;常规超声诊断灵敏度、特异度及诊断准确率分别为75.68%、74.31%及74.68%;联合诊断灵敏度、特异度及诊断准确率分别为86.49%、88.07%及87.67%;超声弹性应变率与常规超声在灵敏度及特异度上差异无统计学意义;联合诊断特异度及诊断准确率明显高于超声弹性应变率及常规超声(P<0.05)。结论超声弹性应变率在鉴别诊断甲状腺结节具有中等价值。超声弹性应变率与常规超声联合诊断可提高甲状腺结节特异度及诊断准确率。     

超声与针吸细胞学检查对甲状腺结节诊断的Meta分析

目的评价超声和针吸细胞学检查（FNAC）对甲状腺结节的诊断价值。方法对Pubmed、Embase、中国知网、中国生物医学文献数据库（CBM）和维普数据库进行检索,根据诊断性试验研究纳入标准纳入和排除文献,采用QUADAS条目对纳入文献进行质量评价,应用Meta-Disc 1.4软件对纳入的研究结果进行Meta分析并绘制汇总受试者工作特征曲线（SROC曲线）,计算曲线下面积。结果共纳入10篇文献,甲状腺FNAC诊断共纳入3595例,超声诊断共纳入4694例,FNAC与超声诊断的敏感度分别0.88[95%CI（0.86-0.90）]和0.80[95%CI（0.76-0.83）];特异度分别为0.94[95%CI（0.93-0.95）]、0.87[95%CI（0.85-0.88）];SROC曲线下面积分别为0.9504、0.8859。结论甲状腺结节FNAC的准确性较超声高,但两者对甲状腺结节的诊断都具有重要的意义,使甲状腺疾病患者避免不必要的手术治疗,对临床具有重大的诊断价值。     

常规超声联合US-FNAB对甲状腺良恶性结节的诊断价值

目的 :探讨常规超声联合超声引导下甲状腺细针穿刺活检(ultrasound guided fine-needle aspiration biopsy,US-FNAB)对甲状腺良恶性结节的诊断价值。方法 :对70例经手术后病理证实为甲状腺恶性结节患者的临床资料进行回顾性分析,评估常规超声,US-FNAB及两者相联合在甲状腺良恶性结节诊断中的价值。结果:常规超声诊断甲状腺良恶性结节的敏感度、特异度、准确度分别为79.1%、63.6%和74.2%,US-FNAB的敏感度、特异度、准确度分别为87.5%、77.3%和84.3%,超声联合US-FNAB的敏感度、特异度、准确度分别为91.6%、90.9%和91.4%,三种方法比较差异均具有统计学意义(P<0.05)。结论:常规超声与US-FNAB联合检查能提高甲状腺良恶性结节诊断的准确性,具有一定的临床实用价值。     

超声弹性成像技术在甲状腺恶性结节诊断中的应用

目的:评价超声弹性成像技术在甲状腺恶性结节诊断中的价值。方法:以病理诊断为金标准,判断超声弹性诊断的敏感度、特异度及准确度。结果:124例患者共检出148个甲状腺结节,以病理诊断为金标准,超声弹性成像技术诊断的敏感度为88.14%、特异度为87.64%、准确度为87.84%。结论:超声弹性成像诊断甲状腺结节性质有较高的准确性,为甲状腺结节的良、恶性鉴别诊断提供了一种新的方法。     

超声造影对甲状腺肿瘤诊断价值的Meta分析

目的用Meta分析方法评价超声造影(CEUS)对甲状腺肿瘤诊断的价值。方法搜索Cochranelibrary、Pubmed数据库、Embase数据库、CBM以及万方数据库,检索所有用超声造影对甲状腺肿瘤进行诊断的文献,提取相关文献数据。根据Cochrane协作网筛选与诊断试验方法组推荐的诊断试验纳入标准筛选文献,对文献进行质量评价,并提取纳入研究的特征信息,进行Meta分析,绘制受试者工作特征曲线(SROC)。结果共纳入的5篇文献具有同质性,利用双变量固定效应模型,合并诊断敏感度和特异度分别为89%(CI:0.81～0.94)、89%(CI:0.81～0.94),合并阳性和阴性似然比分别为7.98(CI:4.71～13.51)、0.12(CI:0.07～0.21),SROC曲线下面积为0.89,SE=0.02。结论 Meta分析及SROC曲线提示,CEUS对甲状腺肿瘤具有较高临床诊断价值。     

PCR-SSCP检测结核分枝杆菌耐利福平诊断的系统评价

目的 用Meta-分析的方法评价PCR-SSCP检测结核分枝杆菌耐利福平的准确性.方法 通过检索PUBMED、EMBASE、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库等数据库和其他方式广泛收集文献.用QUADAS标准评价文献质量.用Meta-disc软件计算合并敏感度、合并特异度和SROC曲线下面积等.结果 最终纳入4篇外文文献(5个研究),Meta-分析显示PCR-SSCP用于结核分枝杆菌耐利福平的诊断均显示了较高的敏感度和特异度,有较高的诊断价值.其合并敏感度为97%,[95%CI(95%,99%)];合并特异度为84%,[95%CI(78%,89%)];合并阳性似然比为8.14,[95%CI(1.77,37.42)];合并阴性似然比为0.05,[95%CI(0.02,0.14)1;SROC曲线下面积:AUC=0.989 0,SE(AUC)=0.012 0.结论 目前PCR-SSCP法检测结核分枝杆菌耐利福平诊断有一定诊断价值,可作为诊断结核分枝杆菌耐利福平的确诊方法.     

超声新技术在甲状腺良恶性结节诊断中的价值

摘 要: 【目的】 探讨常规超声?超声造影?剪切波弹性成像超声在甲状腺结节良恶性鉴别诊断中的应用价值? 【方法】 对本院内分泌科门诊的45例甲状腺结节患者行常规超声?超声造影及剪切波弹性成像超声检查,以病理结果为诊断良恶性的金标准,绘制受试者工作曲线,分析3种不同超声检查方法单独或联合应用对甲状腺结节良恶性的诊断价值? 【结果】 常规超声?超声造影及剪切波弹性成像3种超声学检查方法在甲状腺结节良恶性鉴别中均具有应用价值?单独应用时,剪切波弹性成像超声的诊断效能最高,最大曲线下面积(AUC)=0.850?敏感性=90.0%?特异性=80.0%?准确性=82.2%?常规超声次之,AUC=0.721?敏感性=70.0%?特异性=74.3%?准确性=73.3%?超声造影的诊断效能最低,AUC=0.708?敏感性=66.7%?特异性=75.0%?准确性=73.2%?常规超声联合剪切波弹性成像?超声造影联合剪切波弹性成像都可以将敏感性提升至100%,其中以“常规超声联合剪切波弹性成像”诊断的特异性最高,达85.7%?【结论】 剪切波弹性成像超声鉴别甲状腺良恶性结节的敏感性和特异性均较高;常规超声与剪切波弹性成像联合应用可能进一步提高诊断价值?     

超声引导下粗针穿刺活检诊断甲状腺结节的Meta分析

目的 通过Meta分析的方法评价超声引导下粗针穿刺活检(US-CNB)诊断甲状腺良恶性结节的价值.方法 计算机检索PubMed、The Cochrane Library(2016年第5期)、Embase、中国生物医学文献数据库、中国知网、维普、万方数据库中关于US-CNB诊断甲状腺结节的诊断准确性试验,检索时限为各数据库建库至2016年6月8日.采用诊断性试验准确性质量评价工具(QUADAS)评价纳入文献的质量,以穿刺成功率、诊断灵敏度(Sen)、特异度(Spe)、阳性似然比(+LR)、阴性似然比(-LR)、诊断优势比(DOR)及汇总受试者工作特征(SROC)曲线下面积(AUC)为结局指标,运用STATA12.0和Meta-DiSc1.4软件对纳入研究数据进行统计分析.结果 最终29篇诊断准确性试验,共4 213例甲状腺结节患者4 391个结节被纳入分析.Meta分析结果显示,US-CNB穿刺成功率为98.7％[95％CI(98.3％,99.0％)];US-CNB诊断甲状腺结节的Sen=0.94[95％CI(0.93,0.95)],Spe=0.98[95％CI(0.98,0.99)],+LR=33.96[95％CI(20.31,56.78)],-LR=0.06[95％CI(0.04,0.10)],DOR=581.14[95％CI(335.08,1007.87)],AUC为0.99.结论 当前的证据显示,US-CNB对甲状腺良、恶性结节的诊断准确性较高,值得临床推广运用.     

甲状腺影像报告和数据系统与细胞学检查鉴别诊断甲状腺结节的临床研究

目的 评价甲状腺影像报告和数据系统与甲状腺细针穿刺(FNA)细胞学检查对甲状腺结节良.恶性的诊断价值。方法 回顾性分析2016年1月~2017年8月在首都医科大学宣武医院诊断为甲状腺结节患者286例 (共311个结节)的临床资料。所有患者均于超声检查后接受外科手术或FNA细胞学检查。根据甲状腺影像报告和数据系统对超声图像进行分类评估,并与术后病理结果对照,评价甲状腺影像报告和数据系统超声分类及FNA细胞学检查的诊断效能。结果 311个甲状腺结节中,经术后病理确诊,包括273个恶性结节及38个良性结节。对照病理结果,甲状腺影像报告和数据系统诊断甲状腺恶性结节的准确度为88.4%(275/311),敏感度为90.1%(246/273),特异性为76.3%(29/38);FNA细胞学检查诊断甲状腺恶性结节的准确度为97.7%(304/311),敏感度为99.3%(271/273),特异性为86.8%,(33/38)。ROC曲线分析显示,两种方法诊断恶性甲状腺结节的曲线下面积(AUC)分别为0.753.0.944 (Z=5.246,P=O.013)。结论 甲状腺影像报告和数据系统对鉴别甲状腺结节良.恶性具有较高的诊断价值,FNA细胞学检查能更加有效地判断甲状腺结节性质。     

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.