内镜超声微探头对隆起性大肠病变的鉴别价值

目的探讨内镜超声微探头对隆起性大肠病变的鉴别价值。方法选择2014年1月~2015年10月收治的100例经病理证实的隆起性大肠病变患者为研究对象,分别行常规肠镜、微探头超声内镜检查,观察微探头超声内镜图像特征。并以病理诊断为对照,比较常规肠镜、微探头超声内镜对隆起性大肠病变的诊断准确率。结果超声内镜对隆起性大肠病变诊断总准确率为95.0%,常规肠镜的诊断总准确率为76.0%,比较差异有统计学意义(P<0.01)。其中,超声内镜对黏膜下肿瘤的诊断准确率明显高于常规肠镜(P<0.01)。内镜超声微探头诊断图像特征:息肉显示黏膜层回声低,黏膜下层以下结构正常;肠癌内部低回声,管壁层次结构不同程度破损。结论内镜超声微探头诊断隆起性大肠病变图像特征典型,其诊断准确率相比常规肠镜有明显优势。     

超声内镜对食管平滑肌瘤诊断价值

目的探讨超声内镜对食管平肌瘤的诊断价值.方法通过对52例食道粘膜下隆起进行超声内镜检查,并与手术病理进行比较.结果 44例食管平滑肌瘤声像图特征为粘膜肌层或固有肌层低回声结构;44例病检提示平滑肌瘤43例,超声内镜检查准确率为97.7%.结论超声内镜在食道平滑肌瘤的诊断和鉴别诊断中有重要的价值.     

小探头内镜超声对食管隆起病变的诊断价值探讨

目的探究小探头内镜超声对食管隆起病变的诊断价值探讨。方法选取食管病变患者72例,在我院于2018年进行诊断治疗,均选择超声内镜(EUS)检查,对照分析术前超声及术后病理情况,记录患者的超声结果,观察病变位置、大小及对EUS准确性的影响。结果在诊断72例食管病变患者中,血管瘤2例(3%);息肉3例(4%);囊肿1例(1%);食管壁压迫9例(12%);间质细胞10例(14%)及平滑肌源性肿瘤39例(54%);脂肪瘤3例(4%);炎性增生5例(7%)。小探头超声内径检查评估黏膜下层癌诊断的特异性是89%,灵敏性是68%,准确性是84%;评估食管黏膜隆起性病变的特异性是72%、灵敏性是90%、准确性是92%。2组诊断结果对比差异有统计学意义(P<0.05)。结论针对食管病变患者,采用超声内镜EUS检查,可对患者的病变作出定位诊断,对比超声图像有助于准确推出病理性质,对食管病变有极佳的诊断价值,改善患者的生活质量,具有临床应用价值。     

微探头超声结合ESD技术对消化道黏膜隆起性病变的诊疗价值

目的:评价内镜微探头超声(miniprobe ultrasonography,MPS)对消化道黏膜及黏膜下隆起性病变的诊断价值;探讨内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)在治疗消化道黏膜隆起性病变中的价值.方法:对我院内镜中心2008-01～2009-08间普通胃肠镜检查发现的消化道黏膜局限性隆起病变,进行MPS检查,对位于黏膜下层以上的隆起性病变借助于ESD技术行内镜治疗.比较术前MPS诊断与内镜治疗术后病理结果的一致性;评价应用ESD技术治疗黏膜下层以上的隆起性病的可行性及疗效;1mo后复查胃肠镜及MPS.结果:MPS诊断消化道黏膜及黏膜下隆起性病变34例,其中食管21例,胃11例,大肠2例.诊断平滑肌瘤20例,间质瘤8例,脂肪瘤1例,纤维瘤1例,早期癌1例,中重度不典型增生3例.分别来源于黏膜层、黏膜肌层和黏膜下层.选择ESD治疗,均完整切除病变,成功率100%,术中穿孔1例,经保守治疗痊愈,未发生大出血及其他并发症,并发症发生率2.94%.ESD术后病理诊断与ESD术前MPS诊断符合31例,诊断准确率91.18%.1mo后复查内镜及MPS,原病变处溃疡愈合,瘢痕形成,病变切除完全.结论:MPS对消化道粘膜及黏膜下隆起性病变诊断准确率高,应用ESD技术对于消化道黏膜及黏膜下隆起性病变治疗彻底、安全、可靠、创伤小、费用低、并发症少,具有广泛的临床应用价值.MPS和ESD联合应用,可提高病变诊断准确性及治疗安全性.     

超声内镜诊断胃内隆起性病变的价值

目的:评估超声内镜在胃内隆起性病变诊断中的应用价值。方法:186例经胃镜检查发现的胃内隆起性病变,行超声内镜及超声小探头检查,除45例为正常脏器外压、5例黏膜下血管瘤、7例静脉曲张而进行随访观察外,其余均经手术或活检获取病理确诊,将2种方法诊断结果与病理结果进行比较。结果:胃黏膜下肿瘤104例,以间质瘤居多;胃非肿瘤性病变82例,以壁外压迫居多;对胃黏膜下隆起性病变的总诊断符合率超声内镜为93.0%,明显高于胃镜的74.2%(P0.01)。结论:超声内镜可显示消化道管壁的层次结构和壁外情况,有利于胃内隆起性病变的诊断和鉴别诊断。     

微探头超声内镜在胃平滑肌瘤诊断中的应用价值

目的探讨微探头超声内镜（miniprobe endoscopic ultrasonography MEUS）在胃平滑肌瘤诊断中的应用价值。方法对125例胃黏膜下隆起性病变行微探头超声内镜检查,在MEUS检查前均经胃镜检查并发现胃内有隆起性病变,但诊断未能确定。对76例MEUS诊断为胃平滑肌瘤的病例均行内镜下治疗,术后标本送病理检查。将胃镜、MEUS及病理结果进行比较。结果超声内镜诊断胃平滑肌瘤76例,其中病变起源于黏膜肌层62例,给予内镜下黏膜下切除术治疗;起源于固有肌层14例,给予内镜下黏膜下剥离术治疗。病变位于胃底部14例,胃体部28例,胃窦部34例;直径〈2cm 64例,〉2cm 12例。76例患者均成功切除病变,7.5MHZ适合于显示病灶内部回声,12MHZ显示病灶起源较清楚。病理均提示为胃平滑肌瘤,其起源层次与超声内镜诊断结果一致,超声内镜检查准确率为100%。结论微探头超声内镜可清晰显示胃平滑肌瘤的病变层次结构,根据其诊断结果对胃平滑肌瘤行内镜下治疗是一种安全、有效、创伤小的治疗方法。     

EMPS在大肠黏膜隆起性病变中鉴别诊断中的应用研究

目的:研究小探头超声内镜在诊断大肠粘膜隆起性病变中的应用价值。方法:对132例大肠粘膜病灶予以小探头超声内镜检查。结果:超声内镜检查对大肠粘膜隆起性病变的总诊断符合率为96.97%,高于肠镜(71.21%);超声内镜检查对肠外压性隆起与粘膜下肿瘤的诊断率均是100%,显著较肠镜高(33.33%和40.63%);但超声内镜检查对肠癌与息肉的诊断率与肠镜的检查结果相近。结论:超声内镜检查在大肠粘膜隆起性病变中的诊断与鉴别诊断中有一定的价值,可为采取进一步的治疗提供良好依据。     

超声小探头对上消化道腔内隆起性病变的诊断价值

目的探讨超声小探头对上消化道腔内隆起性病变的诊断价值及优越性。方法对49例电子胃镜检查示上消化道腔内隆起性病变患者进行超声小探头检查,分析病变的起源、性质、浸润的范围,并与部分术后病理结果对比。结果息肉样病变13例,并均予内镜下切除,黏膜下病变17例,外压病变6例,肿瘤5例,十二指肠Brunner’s腺增生2例,黏膜炎性增厚2例,溃疡1例,未见异常3例,其中30例术后病理证实。结论超声小探头检查能更清楚显示消化道管壁各层结构,更易于寻找病变,提高内镜活检的安全性,并能同时进行内镜下治疗,对癌的T分期准确。     

卢戈液-美蓝双重染色联合超声小探头诊断食管早期癌及癌前病变的临床研究

目的 探讨内镜下卢戈液-美蓝双重染色联合超声小探头诊断食管早期癌及癌前病变的临床价值. 方法 对食管可疑病变先后用3%卢戈液和0.5%美蓝喷洒病变黏膜,观察病变染色程度及范围.对卢戈液不染或淡染-美监染色病变行活组织病理学检查,并用超声小探头探查病变浸润深度.结果卢戈液不染或淡染-美蓝染色217例,病理为食管早期癌89例,不典型增生128例(轻度34例,中度68例,重度26例),卢戈液小染或淡染-美监染色诊断食管早期癌及不典型增生准确率为100%.超声小探头显示116例浸润至黏膜上皮层,37例浸润至黏膜肌层,30例浸润至黏膜下层,6例出现淋巴结转移.术后病理:上皮内癌18例,黏膜肌层痛32例,黏膜下癌39例.与其对照,超声小探头鉴别黏膜内癌和黏膜下癌的准确性为89.9%(80/89). 结论 卢戈液-美蓝双重染色联合超声小探头有助于提高食管早期癌及癌前病变的检出率和诊断率,对合理选择治疗方法有指导意义.     

微探头超声内镜对上消化道隆起性病变的诊断价值探讨

目的探讨微探头超声内镜对上消化道隆起性病变的诊断价值。方法对98例上消化道隆起性病变患者进行内镜及超声微探头检查,记录病变的部位、大小、边界情况、来源层次、回声特征及治疗情况,总结其内镜及超声图像特征。结果 98例上消化道隆起性病变中,病变位于食管21例(21.4%),贲门部5例(5.1%),胃底25例(25.5%),胃体9例(9.2%),胃角3例(3.1%),胃窦21例(21.4%),十二指肠14例(14.3%)。病变性质最多见的是平滑肌瘤或间质瘤,共41例,其次为息肉29例,异位胰腺13例,囊肿6例,脂肪瘤4例,布氏腺增生3例,类癌1例,食管黏膜下鳞状上皮异位1例。其中86例的EUS结果与病理一致(87.8%)。结论超声微探头检查上消化道隆起性病变具有简便易操作、分辨率高、准确、安全、无创伤等优点,提供了更准确的诊断上消化道隆起性病变的途径,可指导选择相应的治疗措施。     

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.