脑白质疏松的研究进展

脑白质疏松（leukoaraiosis,LA）由加拿大神经病学专家Hachinski等在1987年提出的一个影像学诊断术语,用以描述脑室周围及半卵圆中心区脑白质的斑片状或斑点状改变。CT表现为低密度灶,MRI表现为T1W1为等、低信号,T2W1高信号。随着CT和MRI的广泛应用,LA越来越多地在中、老年患者中发现。其病理改变主要是白质广泛脱髓鞘,而弓状纤维保留。近年来有关LA的临床、影像学、病理、发病机制等的研究受到广泛的关注。现将近几年有关脑白质疏松的研究综述如下。     

白质损害的进展

白质损害在1987年由加拿大神经病学家Hachniski用“白质疏松”来定义。脑白质疏松症（Leukoaraiosis,LA）是一个影像学诊断术语,用于描述头颅CT扫描时发现的脑室周围白质异常低密度或磁共振（MRI）检查时T2加权图像上见到的双侧性、弥漫性大脑自质高信号即白质高信号灶。     

白质损害的进展

白质损害在1987年由加拿大神经病学家Hachniski用“白质疏松”来定义。脑白质疏松症（Leukoaraiosis，LA）是一个影像学诊断术语，用于描述头颅CT扫描时发现的脑室周围白质异常低密度或磁共振（MRI）检查时T2加权图像上见到的双侧性、弥漫性大脑自质高信号即白质高信号灶。     

脑白质疏松症的临床研究进展

1987年，Hachinski应用脑白质疏松症（LA）一词来描述皮质下脑白质的异常CT表现，表现为边界不清的双侧斑片或弥漫性密度减低区，仅限于脑室周围或扩展至半卵圆中心。而在MRI T2加强像和液体衰减翻转恢复系列上，表现为脑室周围的高信号环或皮质下多发性的点状或斑片状，部分融合或融合性区域。在一些文献上，这种与脑梗死不同的影像学改变也称作白质高信号或白质损害。     

脑白质疏松与多发性硬化关系研究进展

<正>脑白质疏松症(leukoaraiosis,LA)首先是作为一个影像学诊断术语于1987年由Hachinsk等~([1])提出,表现脑室周围以及半卵圆中心区呈脑白质弥漫性斑点状或连续斑片状改变。随着CT和MRI对脑白质疏松检出率增加,该病受到广泛关注。LA的主要病理表现有胶质细胞增生、血管周围间腔增大,少胶质细胞、髓鞘和轴突的丢失。多发性硬化(multiple sclerosis,MS)是以中枢神经系统白质脱髓鞘病变为     

白质损害的进展

白质损害在1987年由加拿大神经病学家 Haehniski用"白质疏松"来定义.脑白质疏松症(Leukoaraiosis,LA)是一个影像学诊断术语,用于描述头颅CT扫描时发现的脑室周围白质异常低密度或磁共振(MRI)检查时T2加权图像上见到的双侧性、弥漫性大脑白质高信号即白质高信号灶[1].     

新生儿轻、中度缺血缺氧性脑病终期的MRI表现

目的：探讨新生儿轻、中度缺血缺氧性脑病终期的MRI表现及其诊断价值。方法：对51例围产期有轻、中度缺血缺氧病史,临床上表现为脑瘫的早产或足月产忠儿进行MRI研究。结果：51例中的19例早产儿MRI表现为脑室周围脑白质软化症;32例足月儿中25例MRI表现为分水岭区脑损伤,7例表现为脑室周围脑白质软化症。结论：早产及足月新生儿轻、中度缺血缺氧性脑病的终期均具有典型的MRI表现,MRI可作为显示其病理改变的首选影像学检查方法。     

儿童脑白质病MRI诊断价值

目的探讨儿童脑白质病MR影像学特征,为临床诊断及治疗提供依据。方法对80例具有完整临床及颅脑MRI影像资料,进行分析研究。结果 80例儿童脑白质异常分为4类：（1）儿童脱髓鞘病变43例;（2）髓鞘形成不良性疾病12例;（3）髓鞘发育延迟10例;（4）不明原因的脑白质异常15例。MRI表现为脑深部白质片状长T2信号改变。结论 MRI能清晰显示脑白质的异常,有助于提高儿童脑白质病的诊断水平。     

早产儿脑白质损伤的临床、病理及磁共振成像表现

目的探讨早产儿脑白质损伤的临床、病理及磁共振成像（MRI）表现。方法回顾分析商丘市第四人民医院1997年12月至2010年11月60例脑白质损伤早产儿的临床、病理及MRI资料。结果MR／不同成像序列所显示脑白质损伤病灶数目分别为：DWI显示727个,F1AIR显示126个,T1WI显示96个,T2WI显示58个。侧脑室周围不同部位脑白质区病灶形态分布：簇状病灶分布于侧脑室后脚附近脑白质最多（18例）;线状病灶主要分布于侧脑室旁及室管膜下区域;分别显示为10例,7例;斑片状病灶以半卵圆中心、侧脑室后角分布相对较多,分别为22例,19例。不同胎龄早产儿脑损伤在脑内的表现形式有脑室周围一脑出血（IVH）8例,蛛网膜下隙出血（SAH）11例,SAH＋IVH3例,以〈32周居多;有侧脑室周围脑白质损伤和软化囊变等形式占51例（51／66）。结论早产儿脑白质损伤的是一个动态病理过程,病理基础决定MRI表现,MRI表现可作为损伤程度及临床,病理转归的一项重要评价指标。     

慢性酒精中毒与脑白质疏松

<正>白质疏松（LA）是通过影像学检查（CT或MRI）呈现白质变化而确诊。CT显示白质或半卵圆区弥散性或斑片状低密度改变。临床主要表现智能障碍,其发生率老年人为9％～19％;在脑卒中患者中占30％～44％;在Alzhimer病患者中可高达30％～60％。LA的发生与年龄、性别、吸烟、饮酒、糖尿病、高血压、冠心病等因素有关。慢性酒精中毒对神经系统的损害,如Wernicke- korsakoff综合征,酒精中毒性小脑变性和酒精中毒性周围病等已多见诸报道。但它所致LA报道不多。本文从以下几方面综述慢性酒精中毒与脑白质疏松的相关性。     

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.     

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.