CIN2/3患者子宫颈锥切前后病理一致性分析

目的:比较CIN2/3患者阴道镜指引下多点活检与子宫颈锥切术后病理结果的差异,评价阴道镜指引下子宫颈活检在高级别子宫颈上皮内瘤变(CIN2,3)诊断中的作用.方法:840例阴道镜指引下多点活检病理诊断为CIN2/3的患者行子宫颈锥切术,对比锥切术前后的病理结果.结果:子宫颈锥切术前后CIN2,3病理的符合率为72.9％,CIN2及CIN3的符合率分别为62.1％、81.8％,阴道镜指引下子宫颈点活检子宫颈浸润癌遗漏几率分别为0.2％及6.6％.结论:阴道镜指引下子宫颈多点活检是诊断CIN2,3的一种简单而有效的方法,与子宫颈锥切术后的病理的符合率较高,但有遗漏子宫颈浸润癌的可能,进一步处理的选择应综合评估.     

宫颈锥切术在宫颈上皮内瘤样病变Ⅱ级Ⅲ级诊断和治疗中的价值

目的:探讨宫颈锥切术在宫颈上皮内瘤样病变Ⅱ级、Ⅲ级(CINⅡ、Ⅲ)诊断和治疗中的价值.方法:回顾分析70例CINⅡ、Ⅲ级患者,采用自身对照法,对比研究宫颈锥切术和阴道镜下多点活检的病理结果的差异.结果:宫颈锥切术与阴道镜下多点活检的病理结果符合率为72.86%,有6例(8.57%)早期浸润癌,1例(2.86%)浸润癌.宫颈锥切术后密切随访3年内有3例复发.结论:宫颈锥切术在CINⅡ、Ⅲ的诊断和治疗中具有重要的价值,不能被阴道镜多点活检所取代,对于有生育要求的年轻CINⅡ、Ⅲ级患者,是首选的治疗方法,术后需密切随访.     

阴道镜下宫颈活检和宫颈环形电切术后病理检查对宫颈病变的诊断价值

目的 探讨阴道镜下宫颈活检、宫颈环形电切术(LEEP)后组织病理检查及两者联合对宫颈癌前病变及宫颈癌的早期诊断价值.方法 对554例经宫颈细胞学检查和(或)人乳头状瘤病毒检测异常,或筛查正常而肉眼观察宫颈柱状上皮中重度外翻者,行阴道镜下宫颈活检及LEEP,比较LEEP手术前后病理诊断的变化.结果 阴道镜下宫颈活检诊断结果与LEEP术后病理诊断结果的总符合率为49.82％.宫颈活检诊断为子宫颈上皮内瘤变(CIN)Ⅰ级的病例中,LEEP术后诊断为CINⅡ/Ⅲ级的占14.36％;宫颈活检诊断为CINⅡ/Ⅲ级(含原位癌)的病例中,LEEP术后诊断为浸润癌的占3.89％.两种方法诊断CINⅡ/Ⅲ级的一致性比较,Kappa值为0.62;阴道镜下宫颈活检、LEEP术后组织病理诊断CINⅡ/Ⅲ级与两者联合后的最终诊断比较,Kappa值分别为0.80和0.84,均有很高的一致性;阴道镜下宫颈活检诊断的总准确率为81.77％,对CINⅡ/Ⅲ级的漏诊率为20.64％.结论 阴道镜下宫颈活检、LEEP术后组织病理检查是诊断CIN及宫颈微小浸润癌的有效方法,阴道镜宫颈活检可能漏诊高级别CIN及宫颈微小浸润癌,两者联合可提高诊断的准确性.     

宫颈冷刀锥切术在诊断CINⅢ及早期宫颈癌中的价值

目的 对比观察阴道镜多点活检和宫颈冷刀锥切术两种方法对宫颈上皮内瘤样病变Ⅲ级(CINⅢ)和宫颈癌的诊断价值.方法 回顾性分析2014年1月至2014年12月我院妇瘤科收治的CINⅢ和可疑早侵癌患者233例,所有患者阴道镜下多点活检诊断为CINⅢ和可疑早侵癌并同时接受宫颈冷刀锥切术以进一步明确诊断,对比观察两种方法的诊断结果,总结宫颈冷刀锥切术的主要并发症.结果 术前诊断CINⅢ的患者中宫颈冷刀锥切术后病理结果与阴道镜活检诊断结果完全符合140例(70.7％);不符合者58例(29.3％),其中病理降级38例(19.2％),病理升级20例(10.1％);术前阴道镜诊断可疑早侵癌的患者中,宫颈锥切术后病理结果与阴道镜完全符合31例(88.6％),不符合者4例(11.4％).所有患者均顺利完成宫颈冷刀锥切术,术中出血15 ～400 mL,其中大部分为50 mL以下出血;宫颈冷刀锥切术主要并发症为术后出血和宫颈管粘连.结论 阴道镜多点活检诊断CIN和宫颈癌存在一定的漏诊和误诊,宫颈锥切术可以很好的弥补,在早期宫颈癌的诊断中具有重要的价值.     

子宫颈锥切术在诊治宫颈上皮内瘤变中的应用价值

目的 明确宫颈锥切术能否被阴道镜下多点活组织检查(活检)代替,以及探讨宫颈锥切术在宫颈上皮内瘤变(CIN) 诊治中的价值.方法 回顾性分析因宫颈病变同时行阴道镜下多点活检和宫颈锥切术的患者76例,采用自身对照法,对比研究宫颈锥切术和阴道镜下多点活检的病理检查结果.结果 宫颈锥切术与阴道镜下多点活检的病理检查结果完全符合者48例(63.16%);宫颈锥切术后,因发现宫颈浸润癌,行广泛子宫切除术者4例;因原位癌行全子宫切除术者6例.8例CINⅢ级患者宫颈锥切术后密切随诊,保留了生育功能.结论 宫颈锥切术在CIN治疗中具有重要价值,它不能被阴道镜下多点活检所取代.     

子宫颈冷刀锥切及成形术在宫颈上皮内瘤变诊治中的应用价值研究

目的研究子宫颈冷刀锥切及成形术在宫颈上皮内瘤变诊治中的应用价值。方法选择我院2011年3月-2012年3月92例宫颈上皮内瘤变行子宫颈冷刀锥切及成形术的患者资料进行回顾性分析,采用自体对照研究,将宫颈锥形切除术后的病理结果与阴道镜下宫颈多点活检的组织学结果进行比较。结果两种检查方法病理检查显示结果有较大差异,阴道镜下CINⅢ29例,宫颈锥切术结果分别为浸润癌2例,CINⅢ23例,CINⅡ3例,CINⅠ1例,符合率79.31%,CINⅡ41例,宫颈锥切术结果 27例,符合率65.85%;CINⅠ22例,宫颈锥切术结果 13例,符合率61.9%。结论子宫颈冷刀锥切术具有操作简单、实用及经济的特点,对阴道镜下活检的不足起到弥补作用,冷刀锥切及成形术可使术中、术后出血量明显减少。     

阴道镜指引下宫颈活检与宫颈锥切术后病理结果的对比研究

目的研究阴道镜指引下宫颈活检与宫颈锥切术后病理结果的对比。方法所选研究病例均选取自2017年6月至2018年6月我院诊治的宫颈病变患者中,共71例;术前均行阴道镜指引下宫颈活检;并行宫颈锥切术;对切除的组织进行术后病理检查,对比两种检查的结果。结果 (1)阴道镜引导下宫颈活检检出宫颈炎症15例(21.13%),术后病理检查显示宫颈炎症9例(12.68%),阴道镜下宫颈活检的宫颈炎症符合率为60.00%。(2)阴道镜引导下CIN1的符合率为45.45%、CIN2的符合率为54.55%、CIN3的符合率为91.66%,其中,阴道镜引导下宫颈活检CIN1、CIN2的符合率对比(P 0.05),但阴道镜下宫颈活检CIN3的符合率明显高于CIN1、CIN2(P 0.05)。结论阴道镜指引下宫颈活检可作为宫颈病变的初步诊断方案,但仍无法替代宫颈锥切术后病理检查,但仍存临床应价值。     

宫颈锥型切除术在高级别宫颈上皮内瘤变治疗中的诊断价值

目的：探讨宫颈锥型切除术在高级别宫颈上皮内瘤变(HG CIN, CIN3)治疗中的诊断价值。方法：回顾我院妇科因阴道镜下多点活检病理诊断为CIN3的76例患者,采用前后对照法,对术前阴道镜下多点活检、术后组织学结果进行对比分析。结果：76例CIN3患者中40例入院后拟行全子宫切除术,全子宫切除术前均行诊断性宫颈锥型切除术,36例直接行宫颈锥型切除术治疗,76例患者锥切术后石蜡切片病理与阴道镜下多点活检病理结果对照,一致者49例,占64.47％,不一致者27例,占35.53％,锥切术后有5例组织病理较术前活检组织病理升级,占6.58％,5例术后病理结果为早期浸润癌。其中3例Ia1期,1例Ia2期,1例Ib1期。结论：阴道镜下多点活检具有一定的局限性,拟行全子宫切除术前行宫颈锥型切除术进一步明确诊断是必要的。     

宫颈锥切术在诊断宫颈上皮内瘤变和早期宫颈浸润癌中的价值研究

目的：探讨宫颈锥切术在诊断宫颈上皮内瘤样病变和镜下早期宫颈癌浸润中的诊断价值,提高宫颈癌的确诊率,为疾病进一步治疗提供参考依据。方法对赣南医学院第一附属医院2011年6月～2013年6月120例经阴道镜活检病理诊断CIN（cervical intraepithelial neoplasia,CIN）或镜下早期宫颈癌浸润的患者在LEEP刀下行宫颈锥切术再行病理检查病理诊断资料作回顾性分析。结果以宫颈锥切病理为准,CINⅠ25例,CINⅡ40例, CINⅢ36例,原位癌（carcinoma in situ,CIS）13例,浸润癌6例,对比阴道镜多点活检病理结果相符合有71例,不符合49例,其中诊断不足有23例,诊断过度26例。120例LEEP诊断为宫颈浸润癌的有13例,阴道镜下活检漏诊率为10.8％。结论阴道镜下多点宫颈活检对CIN的诊治有局限性,联合宫颈锥切可提高宫颈癌诊断准确率,并减少隐匿性宫颈癌的漏诊率,可以对宫颈癌的进一步诊断提供重要参考依据。     

宫颈锥切术在诊治宫颈上皮内瘤变的临床分析

目的：探讨宫颈锥切术后病理检查对于阴道镜活检病理示宫颈上皮内瘤变（CIN） Ⅲ级（包括原位癌）的诊断和治疗的临床价值.方法：回顾性分析阴道镜下多点活检为CIN Ⅲ级及原位癌的患者99例,采用自身对照法,对比阴道镜下多点活检、宫颈锥切术、全子宫切除术的病理结果.结果：68例宫颈锥切术病理后与阴道镜多点活检病理结果符合,符合率为68.7％,17例宫颈锥切术后病理分级降级：炎症10例,CIN Ⅱ4例,CIN Ⅰ3例,14例宫颈锥切术后病理分级升级为宫颈癌：IA1 11例,IA2 1例,IB1 2例.对锥切切缘阳性无法随诊、无生育要求或伴有子宫附件疾患、原位癌、宫颈癌等38例患者行子宫切术或根治性子宫切除术,子宫切除术病理符合率为71.05％,两组比较,差异无统计学意义（P＞0.05）.结论：宫锥切术具有诊断治疗的双重作用,而且对于阴道镜下活检为CINⅢ级（包括原位癌）的患者,能进一步明确病变程度,是确定下一步治疗方案的不可逾越的过程.     

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.