同层动态CT增强对肺孤立性结节的诊断意义

目的 评价同层动态CT增强扫描对肺孤立性结节的诊断意义。方法 先对87例直径≤40mm的肺孤立性结节病灶中心行薄层扫描，再静脉注射非离子型造影剂（100ml）行系列同层动态增强扫描，测量其增强前后的CT值，绘制其时间一密度曲线。结果 肺癌性结节（平均54．6HU，范围6．28-91．2HU）和肺炎性结节（平均61．6HU，范围8．65～116HU）增强后CT值显著高于肺良性结节（平均31．2HU，范围-28．1-84．1HU）（P〈0．05）；以净增值20HU作为肺恶性结节的阳性指标，其敏感性为91．53％，特异性为51．85％，准确率为79．07％。结论 同层动态增强技术对肺癌和结核瘤的鉴别诊断极具价值。     

高分辨率CT在轻微支气管扩张诊断中的应用

目的评价高分辨率CT（以下简称HRCT）在轻微支气管扩张诊断中的价值。方法对48例临床怀疑为支气管扩张、28例有慢性支气管炎及哮喘病史的患者以及20例健康检查者分别进行常规螺旋CT扫描和深吸气及深呼气相HRCT扫描。将螺旋CT与HRCT扫描结果进行对照分析，找出HRCT在轻微支气管扩张诊断中的优势及深吸气与深呼气相HRCT的特点。结果48倒可疑支气管扩张患者中，螺旋CT发现支气管扩张38例，HRCT发现支气管扩张43例：在28例有慢性支气管炎或哮喘病史的患者中，呼气相HRCT发现支气管壁增厚18例；显示病变肺叶的空气潴留征11例。结论深吸气相HRCT对显示肺小气道病变尤其是小支气管扩张比常规CT有更大的优越性；深呼气相HRCT在发现支气管壁增厚方面明显优于常规CT并能清晰的显示病变肺叶的空气潴留征。对临床怀疑支气管扩张的患者。应首选HRCT检查。     

慢阻肺患者HRCT肺气肿定量分析与疾病严重程度的相关性研究

目的 探讨高分辨CT(HRCT)肺气肿定量分析对慢性阻塞性肺疾病(慢阻肺,COPD)患者疾病严重程度的预测价值.方法 选取我院随访的稳定期慢阻肺患者,行HRCT检查及肺功能检查,应用相关软件处理全肺容积、肺气肿体积,并计算既定阈值下(-950 HU、-910 HU)低衰减区域比例(LAA％),完成CAT评分表、SGRQ...     

慢性阻塞性肺疾病稳定期患者胸部定量CT变化分析

目的探讨慢性阻塞性肺疾病稳定期患者胸部定量CT变化。方法统计分析2011年至2013年我院收治的100例慢性阻塞性肺疾病稳定期患者的临床资料。结果 VC、DLCO、FEF750、FEV1%pred在四组患者之间的差异均显著（P〈0.05）;CT为-1 024--970,-960,-950,-940,-930,-920,-910HU下LAA%结果均一致,四组患者的LAA%之间的差异均显著（P〈0.05）;CT为-1 024-910HU时LAA%、症状评分和DLCO、FEF750、F E V 1%p r e d均呈显著的负相关关系（P〈0.05）;LAA%和MMRC呈显著的正相关关系（P〈0.05）。结论胸部定量CT变化可以作为评估慢性阻塞性肺疾病稳定期患者病情严重程度的重要指标。     

64层螺旋CT低剂量双相扫描像素指数在慢性阻塞性肺疾病肺功能评估中的应用价值

目的探讨64层螺旋CT低剂量双向扫描像素指数(PI)在慢性阻塞性肺疾病(COPD)肺功能评价中的应用价值。方法选择首都医科大学附属北京天坛医院临床确诊的COPD患者40例为研究组,同期健康体检者40例为对照组,两组患者均在深吸气末和深呼气末行64层螺旋CT双肺低剂量扫描,按照CT密度值将全肺扫描像素指数分为5个区域(分别为-400~-700 HU、-700~-800 HU、-800~-910 HU、-910~-960 HU、-960~-1024 HU),计算不同区域深吸气末扫描像素指数(PI in)及深呼气末扫描像素指数(PI out),双相扫描全肺及上、中、下肺小于-910 HU的吸气末及呼气末像素指数(PI in-910、PIout-910)。CT扫描完成后2 d内患者均行肺功能检测,测定第一秒用力肺活量(FEV1),FEV1占预计值的百分比(FEV1%)、FEV1与用力肺活量比值(FEV1/FVC),并进行组间PI以及PI与肺功能指标间的相关性分析。结果两组不同CT阈值分区呼气相、吸气相PI值比较,在-800~-910 HU、-910~-960 HU、-960~-1024 HU区域,两组PI in差异有统计学意义(P<0.05),全部分区中,两组PIout差异均有统计学意义(P<0.05)。在-910~-1024 HU范围内PI均与FEV1%、FEV1/FVC有显著相关性(P<0.01)。研究组全肺及上、中、下肺双相扫描指数PI in-910、PIout-910均较对照组显著增加,差异有统计学意义(P<0.05)。PI in-910、PIout-910均与FEV1%、FEV1/FVC均有良好相关性(P<0.01)。结论 64层螺旋CT低剂量双向扫描像素指数与肺组织气体潴留及通气指标有良好的相关性,可以有效评估慢性阻塞性肺疾病患者肺功能。     

CT定量联合肺功能鉴别肺气肿型和支气管炎型慢性阻塞性肺疾病的价值研究

目的 分析计算机断层成像(CT)定量联合肺功能鉴别肺气肿型和支气管炎型慢性阻塞性肺疾病(COPD)的价值。方法 选取2019年1月—2022年1月苏州大学附属第一医院收治的132例COPD患者作为研究对象(COPD组),其中肺气肿型COPD患者58例、支气管炎型COPD患者74例,另选取同期该院100例健康成年人作为对照组。对所有研究对象进行深吸气末、深呼气末双相CT扫描,收集肺体积、肺血管体积、平均肺密度、低衰减区域(<-950 HU)占肺总体积百分比(LAA%_-950)等指标,并进行肺功能检查,收集第1秒用力呼气容积实际测量值占预测值百分比(FEV₁%pred)、用力肺活量实际测量值占预测值百分比(FVC%pred)、第1秒用力呼气容积与用力肺活量的比值(FEV₁/FVC)、一氧化碳弥散量(DLCO)等指标。比较COPD组与对照组基线资料、CT定量和肺功能检查结果;比较2种类型COPD患者CT定量和肺功能指标的差异;绘制受试者工作特征(ROC)曲线分析CT定量和肺功能鉴别2种类型COPD的效能;一致性分析CT定...     

慢性阻塞性肺病的CT肺功能研究

目的：研究平静呼吸状态下定量CT肺功能对慢性阻塞性肺病（COPD）的诊断价值。方法：COPD组48例和健康对照组28例，行平静呼吸下定量CT检查。利用CT肺功能定量分析软件分析图像数据并得出相应CT肺功能参数值：CT值（包括两肺平均CT值，左、右两肺CT值，上、中、下肺野CT值），像素指数（PI，分为-1024～-960，-960～-910，-910～-800，-800～-700，〉-700五区），容积（两肺总容积，左右两肺各自容积），比较各组参数的差异。结果：轻中度组、重度组与正常组相比，肺总容积、PI-960～-910均显著增加，平均CT值、PI-800～-700、PI〉-700均显著减低（P〈0.01），PI-1024～-960、PI-910～-800在正常组、轻中度组及重度组之间均存在差异（P〈0.05）。轻中度组及重度COPD组的CT值、各PI指数在左右两肺及上中下肺野之间比较差异均无显著性（P〉0.05）。结论：定量CT肺功能可对不同程度COPD的肺功能进行评估，是对COPD患者尤其是不能耐受肺功能检查者了解其肺功能情况的另一种途径。     

胸部高分辨率CT结合肺功能最大中期呼气流量/用力肺活量比值、呼出气一氧化氮水平对慢性阻塞性肺疾病风险人群的预测价值

目的 探索胸部高分辨率CT气道壁厚度、肺气肿容积结合肺功能最大中期呼气流量（MMEF）/用力肺活量（FVC）比值（MMEF/FVC）、呼出气一氧化氮（FeNO）水平在慢性阻塞性肺疾病（COPD）风险人群中的早期诊断价值。方法 纳入2018年1月至2022年12月在首都医科大学附属北京朝阳医院呼吸与危重症医学科就诊的320例患者作为研究对象,根据病史、症状及肺功能情况分为COPD稳定期组（100例）、COPD风险组（102例）和对照组（118例）,比较三组患者的胸部高分辨率CT气道壁厚度、肺气肿容积、MMEF/FVC和FeNO水平并探讨其对COPD高风险人群的早期诊断价值。结果 对照组、COPD风险组、COPD稳定期组气道壁厚度、FeNO水平、胸部高分辨率CT全肺CT值低于-950HU的肺容积百分比依次增高,MMEF/FVC依次降低,组间比较差异均有统计学意义（P<0.001）。FeNO水平对COPD风险人群的早期诊断价值较高（AUC=0.657,95%CI 0.583～0.731）,气道壁厚度及全肺CT值低于-950HU的肺容积百分比对COPD风险人群的早期诊断也具有一定价值。结...     

螺旋CT高分辨力扫描对轻微支气管扩张的诊断应用

目的:评价螺旋CT高分辨力扫描(以下简称HRCT)在轻微支气管扩张诊断中的价值。方法:对21例临床怀疑为支气管扩张、26例有慢性支气管炎病史的患者分别进行常规螺旋CT扫描和HRCT扫描。将扫描结果进行对照分析,找出HRCT在轻微支气管扩张诊断中的优势。结果:21例可疑支气管扩张患者中,螺旋常规CT扫描发现支气管扩张8例,HRCT发现支气管扩张19例;在26例有慢性支气管炎病史的患者中,HRCT发现支气管扩张9例。结论:HRCT对显示肺小气道病变尤其是小支气管扩张比常规CT有更大的优越性。对临床怀疑支气管扩张的患者,应首选HRCT检查。     

慢性阻塞性肺疾病患者血清和诱导痰中白细胞介素-13的水平相关性研究

目的：观察急性加重期和稳定期慢性阻塞性肺疾病（COPD）患者诱导痰及血浆中白细胞介素-13（IL-13）水平的变化。方法：检测并分析30例COPD急性加重期患者,30例COPD稳定期患者及25例健康体检者诱导痰及血浆中IL-13水平及其肺功能。结果：COPD急性加重期及稳定期患者诱导痰及血浆中IL-13的水平均高于健康组（P〈0．05）,急性加重期患者的诱导痰及血浆中IL-13的水平又高于稳定期组（P〈0．05）;血中IL—13浓度水平与肺功能无相关性（P〉0．05）,诱导痰中IL-13浓度水平与肺功能呈负相关性（P〈0．05）。结论：COPD组诱导痰及血浆中IL-13的水平增高,与COPD的发生及加重密切相关。全身炎症反应与气流受限关系不大,而局部炎症反应与气流受限密切相关。     

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.