分化型甲状腺癌骨转移的临床特点及影像学诊断分析

目的探讨分化型甲状腺癌（DTC）骨转移的临床特征和影像学诊断。方法回顾性分析106例经131I治疗的DTC骨转移患者的发生率、发病年龄、临床症状、体征、病理类型、转移部位及合并其他转移的情况,并对131I全身扫描、99mTc-MDP骨扫描、MRI、X线和CT诊断DTC骨转移敏感性进行比较,总结其临床特征。结果骨转移发生率约占DTC患者的8.43%（106/1258）,好发部位以肋骨、髂骨和胸椎居多,以溶骨性骨转移为主;以骨转移为首发症状的DTC患者占19.81%;多发性骨转移多见。MRI、131I扫描、CT、X线、和99mTc-MDP骨扫描诊断甲状腺癌骨转移的敏感性依次为96.59%、93.84%、66.49%47.46%和38.19%,其中131I全身扫描与X线、CT和99mTc-MDP检查比较差异有统计学意义（P〈0.05）;131I全身扫描与MRI检查比较差异无统计学意义（P〉0.05）。结论骨转移以多发性溶骨性病变为主,MRI和131I全身扫描的敏感性较高,CT次之,全身骨扫描和X线的敏感性较低。     

核素骨显像诊断分化型甲状腺癌转移灶的应用价值

目的探讨核素骨显像对分化型甲状腺癌骨转移的临床诊断价值。方法对35例分化型甲状腺癌骨转移癌患者99mTc-MDP全身骨显像结果进行回顾性分析。结果多发骨转移（82.86%）明显多于单发骨转移(17.14%);转移灶的分布规律是躯干骨多于四肢骨和颅骨;多数病人有骨痛症状。结论核素骨显像对甲状腺癌骨转移诊断具有较高的敏感性,联合MRI、PET-CT及X射线平片检查更能提高诊断准确率。     

99mTc-MDP骨显像对多发性骨髓瘤骨病的诊断价值

目的:探讨99mTc-MDP骨显像对多发性骨髓瘤(multiple myeloma,MM)骨病的诊断价值?方法:回顾分析了83例初诊的MM患者,均行全身99mTc-MDP骨显像,以X线检查部位为限定范围,与相应部位的骨显像结果进行比较分析?结果:99mTc-MDP骨显像阳性率为88.0%(73/83例),X线检查阳性率为73.3%(55/75例),低于骨显像的阳性率,但同时行头颅?胸片?腰椎及骨盆X线检查患者的X线检查阳性率与骨显像检查无显著差异(P=0.726)?99mTc-MDP骨显像对肋骨病变的阳性率高于X 线(P < 0.01),X线对头颅?骨盆病灶阳性率高于骨显像(P < 0.01)?结论:99mTc-MDP骨显像与多部位的X线检查总的敏感性相似,但骨显像对肋骨病灶的敏感性优于X线,而X线则对检测头颅?骨盆病变更敏感,故两种检查方法相互结合,对不相符部位进一步行CT/MRI 验证是提高MM骨病检出率的重要途径?     

99mTc-MDP骨显像结合CT诊断鼻咽癌骨转移的临床价值

目的探讨99mTc-MDP全身骨显像结合CT诊断鼻咽癌骨转移的临床价值.方法对120例鼻咽癌患者行核素99mTc-MDP全身骨显像和CT检查.结果 120例鼻咽癌患者99mTc-MDP全身骨显像结合CT诊断骨转移的阳性率为60%(72/120),全身骨显像阳性率67.5%(81/120),假阳性率为7.5%(9/120);CT诊断阳性率为44.2%(53/120).骨转移的部位以脊柱最多,其次为胸部、骨盆、四肢及颅骨.结论 99mTc-MDP全身骨显像结合CT检查对于鼻咽癌临床诊断分期及治疗有重要意义,可作为鼻咽癌治疗前的常规检查.     

全身骨扫描与MR弥散加权成像技术在转移性骨肿瘤诊断中的应用价值比较

[背景]比较99mTc标记的亚甲基二磷酸盐(99mTc-MDP)全身骨扫描(BS)与MR弥散加权成像技术(WB-DWI)在转移性骨肿瘤诊断中的应用价值.[病例报告]选择2014年1月至2016年12月间经临床诊断确诊为恶性肿瘤且分别行BS和WB-DWI检查的患者共112例进行对比研究.在混合型和成骨型骨转移瘤的诊断中BS的敏感度和准确度明显高于WB-DWI(P<0.05),而在溶骨型骨转移瘤的诊断中WB-DWI敏感度及准确度明显高于BS(P<0.01).[讨论]BS在多数转移性骨肿瘤的诊断中具有优势,但在溶骨型骨转移瘤的诊断中具有一定的缺陷和局限性,因此有必要结合X线平片、CT和MRI等影像学技术提高诊断的准确度.     

SPECT/CT99mTc-MDP全身骨显像在骨转移瘤与多发性骨髓瘤鉴别诊断中的应用价值

目的:探讨骨转移瘤与多发性骨髓瘤(MM)99mTc-MDP骨显像特征,评估SPECT/CT在骨转移瘤与多发性骨髓瘤鉴别诊断中的价值。方法:21例骨转移瘤患者和11例MM患者进行99mTc-MDP全身骨显像对比分析,35例患者均进行了SPECT/CT断层融合显像。结果:(1)21例骨转移瘤患者骨显像发现122个病灶均表现为放射性浓聚,同机CT显示其中109个病灶骨质呈溶骨性改变,13个病灶骨质呈成骨性改变。(2)11例MM患者骨显像发现67个病灶表现为放射性浓聚,7个病灶为浓聚合并缺损,同机CT显示所有病灶骨质均表现为溶骨性改变。结论:SPECT/CT99mTc-MDP骨显像对骨转移瘤与多发性骨髓瘤鉴别诊断的具有较高的价值。     

99mm Tc-MIBI全身显像在分化型甲状腺癌随访中的价值

目的探讨^99mTc—MIBI全身显像（MIBIWBI）用于首次去除治疗后的分化型甲状腺癌（DTC）随访的应用价值。方法78例经首次去除治疗的DTC患者6个月后,停用甲状腺激素或左甲状腺素3～4周,行^99mTc—MIBI全身显像及5m Ci-^131全身显像及其他常规检查。结果在颈部淋巴结和纵隔淋巴结的检测中,^99mTc—MIBI全身显像优于^131I全身扫描,对甲状腺残留组织的显示及肺部转移和骨骼转移的检测中,^99mTc—MIBI全身显像与^131I全身扫描间差异无统计学意义。结论^99mTc—MIBI显像与Tg结合可以提高复发和转移灶诊断的灵敏度和准确性,起到确定转移部位和数量的作用。     

99mTc-MIBI显像与99mTc-MDP骨显像诊断转移性骨肿瘤的对比研究

①目的 探讨99mTc-MIBI显像与99mTc-MDP骨显像在转移性骨肿瘤诊断价值上的差异.②方法 对68例经病理证实为恶性肿瘤并怀疑有骨转移的患者均进行99mTc-MIBI显像与99mTc-MDP全身骨显像(两项检查时间不超过1周),对比分析两种显像结果.③结果 68例患者中经临床证实骨转移32例,则99mTc-MIBI显像诊断转移性骨肿瘤总的灵敏度为80.2%,特异性为85.0%,准确性为82.4%;99mTc-MDP骨显像诊断转移性骨肿瘤总的灵敏度为70.8%,特异性为63.3%,准确性为67.6%.对于原发灶为乳腺癌、多发性骨髓瘤的患者所发生的骨转移,99mTc-MIBI显像比99mTc-MDP骨显像有优势;而对于原发灶为前列腺癌的患者所发生的骨转移,99mTc-MIBI显像探测能力则不及99mTc-MDP骨显像.④结论 99mTc-MIBI显像在评价肿瘤骨转移方面比传统的骨显像具有更好的敏感性、特异性和准确性.     

131I治疗术后分化型甲状腺癌的疗效及其影响因素

目的 分析大剂量131I治疗术后分化型甲状腺癌(DTC)患者疗效及其影响因素.方法 对216例DTC患者术后接受131I治疗的临床资料进行回顾性分析.对每次服131I后第4天131I全身显像进行对比观察作为判断疗效的依据,根据患者病理类型、转移部位、服131I次数分别观察其总体疗效.结果 大剂量131I治疗术后DTC患者总有效率86.57%,对于颈部淋巴结转移的疗效明显优于纵膈转移、肺转移及骨转移,无明显不良反应,安全可靠.结论 术后联合大剂量131I治疗对于分化型甲状腺癌是一种有效而又安全的方法,癌灶转移部位对131I治疗的疗效有一定的影响.     

多发性骨髓瘤的临床与影像诊断

目的 探讨多发性骨髓瘤的X线、CT及MRI表现,提高对多发性骨髓瘤的影像诊断水平.方法 回顾分析60例经病理证实和临床确诊的多发性骨髓瘤患者的影像学检查资料.结果 60例发性骨髓瘤骨病累及部位以脊柱骨、肋骨、骨盆、颅骨最多见.影像学表现为骨质疏松、骨质破坏、病理性骨折、软组织肿块,少数见骨质硬化.X线诊断敏感性65.4%(34/52),准确度82.4%,CT诊断敏感性98.1%(51/52),准确性94.1%,MRI诊断敏感性100%(20/20),准确性95%,X线诊断敏感性和准确性与CT和MRI存在显著差异(P<0.05),CT和MRI无显著差异(P>0.05).X线、CT和MRI联合诊断敏感性和准确性100%(12/12).结论 多发性骨髓瘤骨质损害的影像表现具有一定特征性,X线平片空间分辨率高,可对全身骨骼进行全面评估,CT和MRJ对早期病变和小的骨质破坏及软组织肿块敏感性高,可作为X线平片的补充.X线、CT和MRI三者联合应用,可提高多发性骨髓瘤影像学诊断准确性.     

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.