膈疝致胸片误诊的X线影像分析

目的：了解膈疝的X线影像学特征，并深入探究膈疝致胸片误诊的原因。方法：回顾性分析我院2012年3月至2014年3月收治的接受X线检查并因发生膈疝而诱发胸片误诊的60例患者的临床资料。结果：膈疝影像特征多表现为肺部疾病型、液气胸型、横膈病变型及肿瘤型，经由CT检查、胃肠造影等检查手段可进行确诊，术前X线胸片检查误诊诱因主要包括经验、检查手段缺乏及诊断方向偏离等。结论：临床上必须要采用多种影像技术对膈疝进行诊断，有助于减少误诊率，指导临床早期治疗。     

严重钝性胸伤肺挫裂伤的诊治体会(附140例分析)

目的：总结近30年来140例严重钝性胸伤伴肺挫裂伤的临床诊治经验。方法：回顾性分析肺挫裂伤致伤原因及特点、X线胸片的影像学特征和血气分析情况。结果：本组治愈135例，治愈率96．7％，死亡12例，死亡率7．87％。结论：早期、及时地胸片X线检查，配合动态血气分析指标，结合伤情病史，对肺挫裂伤的伤性判断、诊断和治疗有重要临床价值。X线胸片和血气分析不失为简便且行之有效的监测手段，对调整救治方案和评价治疗猓颇为有效，值得推广应用。     

50例新生儿呼吸窘迫综合征的X线胸片表现

目的 探讨新生儿呼吸窘迫综合征(NRDS)的X线胸片表现及不同时间段的演变.方法 回顾性分析临床符合NRDS诊断的50例患儿的X线胸片表现并将其首次及复查X线胸片的表现进行对比分析.结果 50例患儿出生12 h内首次X胸片检查中,2例表现为肺纹理增多,边缘模糊不清;24例表现为肺野透过度减低,肺野内可见粗细不等的颗粒影;13例见弥漫性斑片状阴影;6例肺野磨玻璃样变,心界、膈肌模糊;5例白肺改变.24～48 h内复查X线胸片,25例病情加重.全部经呼吸机给氧及药物治疗,41例痊愈,7例好转,2例出现肺出血或气胸等并发症死亡.其中可见支气管充气征者共28例(占56.0%).结论 X线胸片检查是诊断NRDS的最客观的方法,其影像表现有特征性,可根据演变的过程指导临床治疗.     

膈疝致胸片误诊的X线影像分析

目的:了解膈疝的X线影像学特征,并深入探究膈疝致胸片误诊的原因。方法:回顾性分析我院2012年3月至2014年3月收治的接受X线检查并因发生膈疝而诱发胸片误诊的60例患者的临床资料。结果:膈疝影像特征多表现为肺部疾病型、液气胸型、横膈病变型及肿瘤型,经由CT检查、胃肠造影等检查手段可进行确诊,术前X线胸片检查误诊诱因主要包括经验、检查手段缺乏及诊断方向偏离等。结论:临床上必须要采用多种影像技术对膈疝进行诊断,有助于减少误诊率,指导临床早期治疗。     

成人呼吸窘迫综合征的X线表现及演变过程

目的：分析成人呼吸窘迫综合征（ARDS）的X线表现及X线影像演变过程。方法：32例临床诊断符合ARDS住院病人,均行X线检查,其中17例行2次以上检查,最多者共行7次胸部X线检查。结果：初步检查胸片结果,无明显异常6例,仅肺纹理增强、呈间质性肺水肿样改变（网格状肺纹理）12例,毛玻璃状样改变13例,合并胸腔积液7例,复查显示随检查时间不同,上述肺内表现逐渐演变,数周后可以转归为网格状肺纹理甚至正常肺部改变。结论：胸部X线片对ARDS的诊断有重要价值,复查胸片对ARDS的诊断与病程的跟踪很有必要。     

急性胸部外伤卧位胸片X线征象及意义

目的分析急性胸外伤后常规胸部X线征象及卧位胸片意义。方法回顾性分析145例急性胸外伤者的卧位胸片表现，探讨其产生的病理基础。结果创伤性湿肺32例，伴不同量胸腔积液，肺撕裂伤12例，挫伤合并肺出血18例，气管断裂7例，张力性气胸15例，中少量胸腔积液24例，大量胸腔积液19例，液气胸18例。结论重视、认识和掌握胸外伤的各种X线征象，卧位X线胸片在本病是有价值的，应列为主要的检查方法之一。     

甲状腺机能亢进性心脏病中X线表现意义的分析与探讨

目的：分析与探讨甲状腺机能亢进性心脏病中X线表现与对诊断的意义。材料与方法：按俞氏诊断标准排队其它疾患的40例甲状腺机能亢进性心脏病，均在治疗前摄X线胸片，其中有28例治疗后即症状缓解与病情痊愈并摄胸片，分析X线表现并对数据做统计学处理。结果：X线胸片表现为肺血多、肺淤血、肺动脉段膨出、右下肺动脉增粗；心脏大和心型变化即右室、左室大，特别是左房大；两下肺纹理增粗增多，呈网格样改变内见斑点影、似融合样；膈肌低平，胸廓呈桶状，两肺呈轻度肺气肿样改变与甲心病病理改变有直接关系。结论：甲亢患者心肺X线表现与甲心病病理改变关系密切，正确认识X线表现对临床治疗特别对肺循环紊乱评价有意义。     

X线检查无特征性改变的肺泡癌被误诊1例报告

1病例简介 陆某某，男，45岁。因反复咳嗽咳痰、左胸痛1年余于2006年1月16日入院。患者表现为阵发性轻咳，痰少、白粘痰偶带血丝。左胸痛，无气紧。偶伴发热、盗汗。于2005年9月19日在柳州市人民医院查X线胸片及胸CT片均示：左下肺片状外高内低致密阴影，其余肺野未见异常，诊断“左肺炎、左胸腔积液”治疗无好转。2005年12月14日到蒙山县医院查X线胸片示：左中下肺野中外带呈片状高密度阴影，其余肺野未见异常，诊断“结核性胸膜炎”予异烟肼、利福平、乙胺丁醇、吡嗪酰胺治疗1个多月无好转。该患者成年后吸烟每天3-4包，每天饮白酒1～2斤。入院后查X线胸片及胸CT片均提示左侧胸塌陷，左侧肺野呈大片状阴影，左中下肺野密度较高。入院后拟诊“左肺结核、左侧结核性胸膜炎”予抗结核、抗感染治疗无好转，     

系统性红斑狼疮胸部病变的X线分析

目的探讨系统性红斑狼疮（SLE）胸部病变的X线表现特征。方法对112例临床诊断明确、有完整资料的SLE患者的胸部x线表现征象进行分析,并提出鉴别诊断要点。结果在112例SLE患者,胸部病变X线表现阳性者58例,占51．8％,常在肺、心脏、胸膜、膈中有三者以上同时受累。结论SLE患者胸部病变X线表现具有一定特征性,可作为SLE临床诊断的重要依据之一。     

20例外伤性膈疝的诊治分析

目的：进一步提高外伤性膈疝的诊疗水平。方法：对20例外伤性膈疝患者资料进行回顾性分析总结。结果：全组患者经手术治疗痊愈,无死亡,2例合并肺感染,2例合并不全性肠梗阻。结论：外伤性膈疝多有合并伤,应早期诊断和治疗,X线胸片、CT、B超是有效诊断方法。正确手术入路是提高疗效,减少漏诊和术后并发症的有力保证。     

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.