合成磁共振技术联合T1-MPRAGE序列在帕金森病患者尾状核改变中的探讨

目的 应用合成磁共振技术联合T₁-MPRAGE序列分析帕金森病(PD)尾状核体积及弛豫值的改变并探讨其在PD诊断中的价值。方法 对30例PD患者及20例健康对照组(HC)均行合成MRI及T1-MPRAGE序列检查,使用FreeSurfer软件自动分割并提取尾状核体积,勾画感兴趣区(ROI)得到双侧尾状核的T₁、T₂弛豫值及质子密度(proton density PrD)值,比较PD组与HC组间的差异;分别绘制双侧尾状核T₁弛豫值、左侧尾状核PrD值及体积与弛豫值联合的受试者工作特征(ROC)曲线并计算曲线下面积(AUC)。结果 PD组与对照组相比,右侧尾状核体积缩小(P<0.05),双侧尾状核T₁弛豫值增高(P<0.05),左侧尾状核PrD值减低(P<0.05);左侧尾状核T1值在PD组与HC组中的诊断效能最高,AUC为0.902,敏感度为0.933,特异度为0.850%。结论 通过合成MRI技术联合T₁-MPRAGE序列能观察到PD患者...     

轻度认知功能障碍患者海马区的磁共振弥散张量成像分析

目的探讨轻度认知功能障碍(MCI)患者与认知功能正常的老年人海马的平均弥散系数(ADC)及部分各向异性(FA)值的差异,评估海马磁共振弥散张量成像(MR-DTI)在MCI患者诊断中的应用价值。方法采用MR-DTI对18例MCI患者(MCI组)和18例性别、年龄、文化程度匹配的对照组(NC组)DTI参数进行分析,比较两组间海马ADC和FA值的差别,并将MCI患者的简易智能精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)、日常生活能力量表(ADL)评分与其海马ADC、FA各自进行相关性分析。结果 MCI组与NC组比较:①双侧海马总ADC值及左侧海马ADC值明显增高(P<0.01),右侧海马ADC值略增高,差异不明显(P>0.05),左、右侧及双侧海马FA值无统计学差异(P>0.05);②MMSE、MoCA评分明显降低,ADL评分明显增高(P<0.01);③MMSE评分与左侧及双侧海马总ADC值呈明显负相关(P<0.01),MMSE评分与FA值及右侧海马ADC值无相关性(P>0.05),MoCA和ADL评分与ADC、FA值均无明显相关性(P>0.05)。结论磁共振弥散张量成像对轻度认知功能障碍患者有一定的诊断价值。     

电点燃法建立癫痫模型的实验研究

目的:观察用电点燃海马和杏仁核方法建立癫痫动物模型的成功率.方法:通过电点燃海马和杏仁核建立癫痫动物模型.结果:单侧海马点燃和双侧海马点燃成功率有显著性差异(P<0.01),而双侧海马点燃、单侧杏仁核点燃与双侧杏仁核点燃成功率无显著性差异(P>0.05).结论:多个癫痫病灶的存在促发癫痫的形成,且通过电点燃杏仁核建立癫痫模型是一种比较好的方法.     

中国癫痫患者定量3T MRI海马体积研究

背景 本研究的目的在于对中国癫痫患者各分部海马体积进行MRI定量研究。 方法 于2007年7月~2008年3月间收集46例中国癫痫患者,其中难治性癫痫（IE）21例,非难治性癫痫（NIE）25例,并入选25例正常成人作为对照。所有受试者接受了斜冠状面垂直于海马长轴的3T高分辨率MRI薄层扫描。通过图片存档和通信系统（PACS）对海马的结构进行视觉评估并对各分部海马体积进行定量研究。 结果 研究结果显示,正常对照组中,各部分海马体积没有显著的性别差异(P>0.05)。右侧海马头(HHV)和海马体体积(HBV)及整个海马体积(HCV)较左侧大(P<0.05),但双侧海马尾体积(HTV)差异无显著意义(P>0.05). 双侧/弥漫性(63.6%/21.4%)及单侧/局灶性(85.7%/20.0%)海马萎缩分别见于IE患者和NIE患者。前部海马,尤其HHV (见于26.2%的IE患者和20.0%的NIE 患者)和HBV(见于28.6%的IE患者和12.0%的NIE患者),其萎缩要较HTV(见于4.8%的IE患者和0.0%的NIE患者)显著。 结论 通过对局灶海马体积进行评估,我们可以更好地界定海马硬化的范围和分布,由于3T MRI的优越性,其能使得我们及早发现海马体积的局灶或细微结构的变化。     

基于静息态 fMRI 的难治性癫痫患者丘脑功能连接研究

目的：利用静息态功能磁共振成像（fMRI）中的功能连接方法,探讨难治性癫痫患者丘脑的功能连接改变及意义。方法难治性癫痫患者19例,多模态神经影像学检查中颅内均未发现明显致痫病灶,发作间期及发作期长程视频脑电图提示双侧大脑半球棘波及棘慢波;同期招募19例健康对照者。采集静息态 fMRI 数据,分别以左、右丘脑为感兴趣区（ROI）与全脑进行功能连接分析,了解难治性癫痫患者相对于正常对照组功能连接增高和减弱的区域。结果以左侧丘脑为 ROI 做功能连接分析,难治性癫痫组与双侧梭状回、右侧舌叶、双侧楔叶及双侧楔前叶的功能连接强度增强,而与双侧尾状核、左侧壳核及左侧杏仁核的功能连接强度减弱;以右侧丘脑为 ROI 做功能连接分析,难治性癫痫组与双侧距状回、双侧楔前叶及左侧直回的功能连接强度增强,而与双侧壳核、双侧尾状核、双侧杏仁核及右侧脑岛的功能连接强度减弱。结论难治性癫痫患者静息状态下丘脑功能连接异常,丘脑可能参与了“癫痫网络”的构成。     

创伤后应激障碍大鼠海马和杏仁核中神经元凋亡及Caspase-9的表达及其意义

目的:探讨创伤后应激障碍(PTSD)大鼠海马和杏仁核神经元凋亡及Caspase-9表达水平的变化,阐明PTSD大鼠海马与杏仁核体积异常的原因。方法:将100只雄性Wistar大鼠随机分为对照组(20只)和PTSD组(80只),利用改良的单一连续应激(SPS&S)制作PTSD大鼠模型。采用Morris水迷宫实验和僵立行为实验检测大鼠行为学表现;TUNEL方法检测大鼠海马和杏仁核神经元凋亡阳性细胞率;流式细胞术(FCM)检测大鼠海马和杏仁核神经元凋亡率;Western blotting法检测大鼠海马和杏仁核中Caspase-9表达水平。结果:PTSD组大鼠逃避潜伏期(EL)和僵立行为百分比显著高于对照组(P<0.05);PTSD后1、4、7和14d大鼠海马和杏仁核TUNEL阳性细胞和凋亡率高于对照组(P<0.05),28d与对照组比较差异无统计学意义(P>0.05);PTSD后1、4、7和14d大鼠海马和杏仁核Caspase-9表达水平高于对照组(P<0.05),28d与对照组比较差异无统计学意义(P>0.05)。结论:PTSD大鼠海马和杏仁核神经元凋亡增加,Caspase-9表达水平上调,提示其凋亡可能是引起海马与杏仁核体积异常的原因之一。     

基于1H-MRS探究终末期肾病患者海马代谢异常的研究

目的 应用氢质子磁共振波谱成像技术(¹H-MRS)探究终末期肾病(ESRD)患者的海马代谢异常与认知损伤的关系。方法 选择37例ESRD患者(ESRD组)及27名年龄、受教育程度相匹配的健康志愿者(HC组),所有受试者进行一系列神经心理学量表评估及双侧海马单体素¹H-MRS波谱扫描。使用SPSS 18.0软件包对波谱数据及量表评分进行统计学分析。结果 两组受试者听觉词语学习测试(AVLT-H)中的瞬时记忆得分、颜色连线测试(CTT)、蒙特利尔认知评估量表(MoCA)、数字符号转换测验、数字记忆广度测试评分均有明显统计学差异(P<0.05);ESRD组的左侧海马N-乙酰基天门冬氨酸/肌酸(NAA/Cr)值较HC组减低(P<0.05);ESRD组右侧海马NAA/Cr值及双侧海马NAA、胆碱(Cho)、Cr、Cho/Cr值均较HC组无明显统计学差异(P>0.05)。Pearson相关性分析结果显示:左侧海马NAA/Cr值与MoCA中的记忆子项呈显著正相关(r=0.665,P<0.001),与CTT 2呈显著负相关(r=-0....     

基于体素的形态测量学方法分析颞叶癫痫患者脑灰质体积变化

目的采用基于体素的形态测量学方法比较颞叶癫痫患者和正常人脑灰质的体积,探讨颞叶癫痫患者脑灰质体积的变化。方法收集22例经手术病例证实的颞叶癫痫患者及15例性别、年龄相匹配的健康志愿者,分别行全脑三维结构像扫描,采用基于体素的形态学测量学(VBM)方法分析病例组及对照组的数据,计算和比较两组脑灰质的体积。结果与对照组相比,左侧颞叶癫痫患者的右侧小脑前叶、左侧颞中回、左侧颞下回、左侧枕中回、左侧额下回、右侧额下回、右侧颞中回、左侧海马、左侧额上回、右侧尾状叶、右侧额中回、左侧中央后回、右侧中央前回灰质体积减小(P均0.05);右侧颞叶癫痫患者的右侧颞下回、右侧颞中回、左侧舌回、左侧枕下回、左侧颞下回、左侧海马旁回、右侧丘脑、左侧枕上回、左侧颞中回、右侧额上回、左侧中央前回、左侧中央后回、右侧中央前回灰质体积减小(P均0.05)。结论颞叶癫痫患者多个脑区脑灰质体积降低,通过采用基于体素的形态测量学技术可以反映脑灰质体积的变化。     

维持性血液透析伴认知功能障碍患者脑MRI影像学特点分析

目的研究维持性血液透析(MHD伴认知功能障碍患者脑磁共振(MRI)影像学特点。方法将我院2016年1月-2018年1月间收治的31例MHD伴认知障碍患者纳为观察组,同时纳入50例健康体检者为对照组,分析两组脑MRI弥散张量成像(DTI)扫描影像学特点。结果观察组双侧额叶、双侧颞叶、双侧叶顶、双侧枕叶、双侧海马、双侧内囊前肢、双侧内囊后肢等感兴趣区域FA值均低于对照组,其中双侧额叶及双侧海马FA值差异显著(P0.05);观察组左侧额叶FA值显著低于对照组(P0.05)、右侧海马FA值显著低于对照组(P0.05)。结论 MHD认知障碍者左侧额叶及右海马FA值显著低于常模,其左侧额叶及右侧海马易受到损坏,脑白质神经纤维束完整性差。     

COPD大鼠模型海马组织代谢研究

目的:探讨慢性阻塞性肺疾病(COPD)并发慢性脑损害的可能分子机制。方法:将24只大鼠随机分为正常对照组、单纯脂多糖组、单纯吸烟组、COPD模型组。采用被动吸烟联合气管内注射脂多糖方法建立COPD大鼠模型,在活体状态下进行高磁场Micro-MRI成像及双侧海马波谱采集,分析大鼠双侧海马氮-乙酰天门冬氨酸复合物(NAA)/肌酸(Cr)、胆碱复合物(Cho)/Cr之值的变化。结果:与正常对照组相比,COPD模型组双侧海马Cho/Cr值显著降低(P<0.05);单纯吸烟组、单纯脂多糖组左侧海马Cho/Cr值也较正常对照组明显低(P<0.05),右侧海马Cho/Cr值无明显差异(P>0.05)。单纯吸烟组、单纯脂多糖组、COPD模型3组间双侧海马Cho/Cr值无明显差异(P>0.05);各组间双侧海马NAA/Cr值无明显差异(P>0.05);各组内左右两侧NAA/Cr、Cho/Cr值无明显差异(P>0.05)。结论:COPD大鼠模型双侧海马Cho/Cr值明显降低,海马组织代谢异常可能是COPD并发慢性脑损害早期病理基础之一。     

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.