支气管动脉的血管解剖及其在大咯血介入治疗中的价值

目的探讨支气管动脉的血管解剖及其在大咯血介入治疗中的价值。方法回顾性总结2004年1月～2011年12月107例大咯血患者行支气管动脉造影(bronchial arteriography,BAG)的DSA造影及胸部多层螺旋CT血管成像(multrslice computed tomographic angiography,MSCTA)资料。结果①支气管动脉大多开口在胸主动脉平T5～T6椎体之间水平(81.3%,87/107)。②10例(9.3%)支气管动脉开口于T5～T6椎体区间以外,称为迷走支气管动脉。③右侧支气管动脉大多与右侧肋间动脉共干,称为肋间-支气管动脉干(intercostobronchial trunk,ICBT)。④起源于胸主动脉的右侧支气管动脉开口于右侧壁及前壁的最多,起源于胸主动脉的左侧支气管动脉开口于前壁的居多。起自胸主动脉的支气管动脉与胸主动脉的下夹角多为锐角。⑤行MSCTA患者中100%可显示双肺内确切病灶,96.3%(52/54)可显示粗大迂曲的支气管动脉。结论支气管动脉栓塞(bronchial artery embolization,BAE)是大咯血安全、有效的治疗手段,已作为内科治疗无效后的首选。了解熟悉支气管动脉的解剖,为介入手术提供可视化解剖基础,从而为介入手术的成功提供重要保证。     

兔肝门静脉阻断的MSCT血管成像评价

目的探讨MSCT的肝动脉与门静脉血管成像价值,评价MSCT血管成像(multi-slice CT angiograph,MSCTA)在显示兔肝门静脉阻断效果中的作用.方法20只新西兰大白兔行门静脉左外支结扎,另20只仅行假手术对照.3周后行MSCTA检查,对每只实验兔的动脉期和门静脉期图像进行容积再现(volume rendering,VR)、最大密度投影(maximumintensity projection,MIP)及多平面重建(multiplanar reformation,MPR).并统计其肝动脉与门静脉的I、Ⅱ级分支及≥Ⅲ级分支的显示情况,尤其是门静脉的阻断情况.结果肝左外叶门静脉分支结扎者均能被MSCTA检查证实.Ⅲ级以上肝动脉分支的MSCTA显示率(40%)明显低于Ⅰ、Ⅱ级肝动脉分支的显示(分别为100%和70%)(P＜0.05).对于门静脉分支的MSCTA显示方面,各级分支的显示率无显著性差异(P＞0.05).结论MSCTA可无创直观地显示免肝动脉与门静脉的空间解剖细节,在兔肝门静脉阻断效果的评价中起着重要作用.     

支气管动脉解剖变异的数字减影血管造影表现及临床意义

目的：统计支气管动脉解剖变异的类型，探讨支气管动脉解剖变异对肺部疾病介入诊断和介入治疗的临床意义。方法：对1995年～1999年期间所做的选择性支气管动脉造影、灌注化疗及栓塞的47例患者的临床资料进行回顾性分析，统计支气管动脉起源、开口水平、分支类型、共干情况及开口距脊柱中轴线的距离。结果：47例患者中，46例支气管动脉都开口于胸主动脉；1例患者的右支气管动脉起源于右锁骨下动脉。开口于T5-T6水平右侧占86．6％，左侧占86．0％。支气管动脉干为1～3支，两侧支气管动脉为1～2支。支气管动脉开口位置在脊柱中轴线的左侧，距脊柱中轴线的距离左侧为3～4cm，右侧为1～2cm。结论：熟悉支气管动脉解剖变异的类型，有利于提高支气管动脉插管的成功率和肺部疾病介入治疗的治愈率，减少并发症的发生。     

128层螺旋CT血管造影(MSCTA)对子宫动脉的研究简

目的研究128层螺旋CT血管造影（MSCTA）对子宫动脉显示,观察与同侧输尿管解剖关系。方法搜集我院2012年10月-2013年1O月行全腹三期增强扫描,且无盆腔手术病例50例。采用最大密度投影（MIP）、容积再现（VR）、多平面重组（MPR）等后处理技术重建出子宫动脉的二维、三维图像,显示双侧子宫动脉及其分支情况,及与邻近输尿管解剖关系。结朵5O例（100％）CT血管造影（CTA）均能显示子宫动脉起源、分支及分布情况。CTA与CT尿路造影（CTU）融合图像,可清晰显示子宫动脉与同侧输尿管解剖关系。结论MSCTA能清晰地显示子宫动脉主干及分支情况,结合CTA与CTU融合图像,能清晰显示其与邻近输尿管的解剖关系,为外科及介入科提供解剖学依据。     

高对比剂注射速率下320排CT对支气管动脉的解剖学研究

目的：探讨高对比剂注射速率下,采用320排CT分析咯血患者支气管动脉（BA）的正常解剖和异位起源情况。方法：对于173例在我院行BA-CT血管造影（CTA）检查的患者,通过观察其轴位、最大密度投影（MIP）及容积重建（VR）图来分析其分支类型、开口起源位置和异位起源。结果：本研究中,最常见的BA分支类型是II型（1R1L）,占37.0%,在右侧BA中,有45.6%是以与肋间动脉共干形式存在;在左侧BA中,61.5%是单独起源的。本组占45.1%的患者含有至少1支异位BA。最常见的异位起源位置是降主动脉起始部,其次是主动脉弓。结论：尽管BA管径细小,解剖变异较大,但是在高对比剂注射速率下,320排CTA能很好地显示BA的正常解剖及异位起源,可为咯血临床治疗方案的制定提供有价值的信息。     

64排螺旋CT对支气管动脉的影像解剖学分型研究及临床意义

目的利用64排螺旋CT对支气管动脉(Bronchial Artery BA)进行影像解剖分型,探讨其在临床应用价值。方法收集2013年7月-2014年7月行64排螺旋CT血管造影和动脉期CT增强扫描患者146例。使用轴位与多平面重组(MPR)、最大密度投影(MIP)、容积再现(VR)等技术对BA进行分析。结果 146例中,共发现BA 360支,大多起于胸5-6水平,总变异58支(16.11%,58/360)。右侧BA185支,左侧BA175支,显示9种类型,最为常见的是R1L1(50.00%,73/146),其次是R1L2(18.49%,27/146)、R2L1(16.44%,24/146)两种类型。结论 64排螺旋CT血管造影与动脉期增强扫描技术可清晰显示BA,对临床诊断及治疗提供帮助,特别对介入放射医师快速准确的实施BA介入术提供准确、清晰的影像学资料。     

胃十二指肠动脉解剖变异的多层螺旋CT血管造影研究

目的探讨胃十二指肠动脉(GDA)变异的分型、发生率及表现。方法回顾性分析行上腹部多层螺旋CT血管造影(MSCTA)检查且GDA显示完整者1810例,采容积再现(VR)血管生长技术(AV)对GDA进行重建,以GDA起源和分支的解剖学描述为标准,将变异分为3型:Ⅰ型为起源变异,Ⅱ型为分支变异(IIa型为正常起源于GDA的分支发自其他动脉,Ⅱb型为正常起自其他动脉的分支发自GDA,Ⅱc型为上述2型分支变异的混合表现),Ⅲ型为同时存在GDA起源及分支变异,分析各型的表现及发生率。结果 1810例患者中,GDA变异62例,总的发生率3.43%(62/1810),Ⅰ型10例,发生率0.55%(10/1810);Ⅱ型49例,发生率2.71%(49/1810),其中,Ⅱa型8例,发生率0.44%(8/1810),Ⅱb型28例,发生率1.55%(28/1810);Ⅱc型13例,发生率0.72%(13/1810)。胰横动脉起自GDA的发生率0.44%(8/1810),替代和(或)副右肝动脉起自GDA的发生率1.5%(27/1810),胰十二指肠上动脉起自肝固有动脉、肝右动脉、替代或副肝右动脉的发生率1.0%(18/1810)。结论 MSCTA能清楚显示GDA解剖及变异,准确进行分型。     

64排螺旋CT支气管动脉成像对支气管扩张症患者的DSA介入治疗价值分析

目的 探讨支气管扩张的支气管动脉64排螺旋CT三维成像,并与该患者的DSA表现对照分析,旨在提高支扩患者的综合影像诊断,同时提高支气管扩张症患者的介入治疗的远期疗效.方法 对2010年6月至2011年10月本院37例因为支气管扩张大咯血的患者的支气管动脉行64排螺旋CT薄层扫描,用容积再现(VR)、多平面重建(MPR)、最大密度投影(MIP)进行三维重建,通过不同的角度观察支气管动脉的空间解剖细节,之后对照相应的支气管动脉造影(DSA)的影像表现资料予以回顾性对照分析、总结.结果 37例支气管扩张患者支气管动脉的螺旋三维图像均能够清晰显示支气管动脉的起源、走行的路径和血管直径.支气管扩张患者DSA造影表现支气管动脉的主干部位均呈现出不同程度的较为明显的扩张以及迂曲.结论 支气管动脉 64排螺旋CT的三维成像技术可以较为精确清晰地显示支气管扩张患者支气管动脉的起源及空间解剖特征,以及变异情况;能够准确、直观地显示支气管动脉[1],从而指导支气管扩张患者有关支气管动脉方面的综合全面介入治疗,值得在临床上推广使用.     

腰动脉CT血管成像的影像解剖学研究

目的探讨多层螺旋CT血管成像（MSCT-CTA）对腰动脉的显示情况,分析腰动脉的影像学解剖特点。方法采用64层螺旋CT扫描仪和静脉注射碘对比剂,对100例患者进行腹主动脉CT血管成像,使用容积再现（VRT）、最大密度投影（MIP）进行血管三维重建,观察腰动脉起源、与腹主动脉的交角、腰动脉间距以及追踪腰动脉的细小分支Adamkiewicz动脉（AKA）、第5对腰动脉的显影率及起源与走行。结果100例患者CTA共检出778支腰动脉,其中,752支腰动脉起源于腹主动脉背侧,26支腰动脉共干;腰动脉与腹主动脉夹角：374支腰动脉以直角发出,再向上向后行走于腰椎两侧缘（<20o）;194支呈正常型;210支例呈垂直型。相邻腰动脉的间距分别为：（30.88±5.76） mm、（28.74±5.65） mm、（24.42±3.88） mm。结论 MSCTA能够准确地、非损伤地显示腰动脉的解剖特点。     

MSCTA三维重建技术对肾动脉的解剖学研究及临床应用价值

目的:通过多排螺旋CT血管造影（multislice spiral CT angiography,MSCTA）三维重建成像技术,找寻肾动脉的解剖及变异规律,为肾脏手术提供有意义的解剖学参考资料。方法:回顾性分析行肾动脉MSCTA检查且泌尿系统无重大病变50例病人的影像学资料,观察肾动脉起源位置与椎体的位置关系,对比左右肾动脉与腹主动脉夹角的大小及肾动脉变异情况。结果:97%的肾动脉开口于第一腰椎椎体上1/3至第二腰椎椎体下1/3。伴有副肾动脉的主肾动脉直径测量值明显小于单支肾动脉的测量值（P<0.01）。左侧θ夹角明显大于右侧θ夹角（P<0.01）。50例中有24例（48%）出现肾动脉变异情况,左右侧出现肾动脉变异例数相当。变异肾动脉32支,起源于腹主动脉23支,肾动脉门前分支9支。结论:MSCTA检查能立体直观地显示肾动脉解剖及其变异情况,根据其影像检查结果能为肾脏相关手术提供解剖学参考。     

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.