肝豆状核变性患者^99mTc-TRODAT-1脑多巴胺转运体SPECT显像

 [目的]研究肝豆状核变性（WD）患者^99mTc-TRODAT-1脑多巴胺转运体（DAT）SPECT显像特点.[方法]WD患者31例,分为脑型组（18例）及非脑型组（13例）.所有WD患者及性别、年龄匹配正常对照者12例均行^99mTc-TRODAT-1脑DAT SPECT显像,勾画出三组受检者脑内纹状体及小脑感兴趣区,计算机自动给出各区放射性计数,计算各组受检者纹状体区特异性放射性摄取比值（ST/CB,纹状体/小脑）并加以比较.[结果]脑型WD组、非脑型WD组及正常对照组ST/CB值分别为1.71±0.17、1.86±0.16、1.97±0.11;ST/CB值的组间比较均存在显著性差异（P脑与正常＜0.001,P非脑与正常=0.036＜0.05,P脑与非脑=0.004＜0.01）;脑型WD患者及部分非脑型WD患者（5/13）图像显示一侧或双侧纹状体的缩小及放射性摄取减少以后部为主,即相当于壳核区.[结论]^99mTc-TRODAT-1 SPECT脑DAT显像可敏感地反映脑型WD患者及部分非脑型WD患者黑质-纹状体多巴胺能神经元突触前DAT的功能状态,DAT功能降低以纹状体后部（即相当于壳核区）为主.     

美多巴对帕金森病大鼠模型脑多巴胺转运体影响的自显影

【目的】研究美多巴对帕金森病大鼠模型脑多巴胺转运体的影响。【方法】立体定位右侧纹状体注射6-羟多巴胺制备偏侧帕金森病大鼠模型,模型成功后给予美多巴灌胃治疗5周。分4组(正常组、帕金森病模型大鼠组、帕金森病模型大鼠经美多巴治疗组、帕金森病模型大鼠未治疗组)行脑多巴胺转运体99mTc-TRODAT-1放射自显影,每组4只。图像分析得到左、右侧纹状体及小脑的光密度值,计算左、右侧脑多巴胺转运体的特异性放射性摄取比值(纹状体/小脑-1),比较各时间点(正常、术后4周、术后9周)多巴胺转运体比值的变化。【结果】正常大鼠脑多巴胺转运体对99mTc-TRODAT-1的特异性摄取比值左、右两侧无显著性差异;术后4周大鼠成为帕金森病模型后,大鼠两侧脑多巴胺转运体的比值较正常均降低,右侧(损毁侧)降低明显。术后9周未治疗组帕金森病模型大鼠双侧脑多巴胺转运体的比值均较4周刚成为模型时明显升高;经美多巴治疗后,双侧的比值均较未服药组明显降低,右侧(损毁侧)降低幅度更大。【结论】长期美多巴治疗可能会使帕金森病模型大鼠脑多巴胺转运体的数量减少。     

帕金森病猴模型脑多巴胺转运体SPECT显像

【目的】探讨脑多巴胺转运体SPECT显像在帕金森病诊断中的应用价值及吡贝地尔治疗对脑多巴胺转运体的影响。【方法】正常恒河猴经右侧颈总动脉注射 (一次或多次 ) 1 甲基 4 苯基 1,2 ,3,6 四氢吡啶 (MPTP)制备成偏侧帕金森病猴模型 ,术后 5～ 6周给于吡贝地尔 (泰舒达 )治疗。定期行脑多巴胺转运体99mTc TRODAT 1SPECT显像 ,测量两侧纹状体及小脑的放射性摄取计数 ,计算两侧纹状体的特异性放射性摄取比值 (r)和不对称指数 (AI)。【结果】正常猴两侧纹状体的 r接近 ,AI- 5 2 8～ 6 11;右侧颈总动脉注射MPTP后的模型猴右侧纹状体的 r降低及 AI增大比非模型猴更明显。治疗组和非治疗组双侧纹状体的r同向变化 ,右侧改变更明显 ;治疗组的AI大部分升高 ;非治疗组的AI均降低。【结论】脑多巴胺转运体99mTc TRODAT 1SPECT显像有助于帕金森病的早期诊断 ,吡贝地尔可能会引起猴脑多巴胺能神经元数量的改变     

帕金森病猴模型脑多巴胺转运体SPECT显像

目的 探讨脑多巴胺转运体SPECT显像在帕金森病诊断中的应用价值及吡贝地尔治疗对脑多巴胺转运体的影响。方法 正常恒河猴经右侧颈总动脉注射（一次或多次）1－甲基－4－苯基1，2，3，6－四氢吡啶（MPTP）制备成偏侧帕金森病猴模型，术后5－6周给于吡贝地尔（泰舒达）治疗。定期行脑多巴胺转运体^99mTc-TRODAT-1 SPECT显像，测量两侧纹状体及小脑的放射性摄取计数，计算两侧纹状体的特异性放射性摄取比值（r) 和不对称指娄（AI）。结果 正常猴两侧纹状体的r接近，AI－5．28－6．11；右侧颈总动脉注射MPTP后的模型猴右侧纹状体的r AI增大比非模型猴更明显。治疗组和非治疗侧纹状体的r同向变化，右侧改变更明显；治疗组的AI大部分升高；非治疗组的AI均降低。结论 脑多巴胺转运体^99mTc-TRODAT-1 SPECT显像有助于帕金森病的早期诊断，吡贝地尔可能会引起猴脑多巴胺能神经元数量的变化。     

~(99)Tc~m-TRODAT-1 SPECT脑多巴胺转运体显像在帕金森病和原发性震颤中的应用研究

目的探讨^（99）Tc^m-TRODAT-1 SPECT脑多巴胺转运体（DAT）显像在帕金森病（PD）和原发性震颤（ET）中的应用价值。方法对经我院确诊的51例PD患者,19例确诊为ET患者及11例正常人进行^（99）Tc^m-TRODAT-1 SPECT脑DAT显像。利用感兴趣区技术（ROI）计算PD患者、ET患者和正常人DAT对^（99）Tc^m-TRODAT-1的特异性摄取比值及两侧特异性放射性摄取比值的不对称指数（AIPD、AICON）。结果 1）正常对照组左右侧脑多巴胺转运体的特异性放射性摄取比值分别为1.633±0.088、1.623±0.0691,双侧对称,双侧比较无统计学意义（t=0.655,P=0.527）,不对称指数为2.074±1.793。正常人双侧ST/CB均值的95%可信区间为1.577-1.678。2）ET患者左右侧脑多巴胺转运体的特异性放射性摄取比值分别为1.561±0.117、1.546±0.115,两侧基本对称,双侧比较无统计学意义（t=1.396,P=0.180）,双侧ST/CB均值及不对称指数同正常人比较无统计学意义（t=1.934,P=0.063;t=-0.795,P=0.433）。ET患者双侧ST/CB均值的95%的可信区间为1.498-1.608。3）PD患者双侧ST/CB比值低于正常人ST/CB比值,具有统计学意义（t=-3.625,P=0.001,t=-4.968,P=0.000）。PD患者左右双侧ST/CB值的95%的可信区间分别为1.386-1.463、1.447-1.534。结论^（99）Tc^m-TRODAT-1 SPECT脑多巴胺转运体显像可鉴别帕金森病与原发性震颤,弥补CT、MRI等检查的不足,为临床治疗提供重要信息。     

帕金森病 99mTc-TRODAT-1 SPECT显像的临床研究

目的探讨99mTc-TRODAT-1 SPECT脑显像对帕金森病(PD)患者诊断和病情监测的临床应用价值.方法选择29例PD患者(病例组)和17例非PD患者(对照组),行99mTc-TRODAT-1 SPECT检查;选纹状体显像较为清晰的层面进行半定量分析,利用ROI技术分别计算纹状体/枕叶(ST/OC)和纹状体/额叶(ST/FC)放射性计数比值代表DAT功能水平;以SPSS 10.0软件包行t检验和回归分析.结果病例组放射性计数比值显著低于对照组(P<0.01),H-Y I 期患者症状同侧放射性计数比值显著低于对照组(P<0.05),症状对侧(右侧)ST/OC比值与UPDRS成负相关(r=-0.0118,P=0.04).结论99mTc-TRODAT-1 SPECT显像可作为临床诊断PD的一种比较客观的检查方法,以便早期诊断和监测PD.     

Single photon emission computer tomography of dopamine transporters in monkeys and humans with 99mTc-TRODAT-1

Background The diagnosis of Parkinson’s disease is presently based on non-specific symptoms. However, radionuclide dopamine transporters imaging can provide specific diagnostic tool for Parkinson’s disease. This study was designed to investigate the effects of imaging of dopamine transporters with 99mTc-TRODAT-1 in early diagnosis or differential diagnosis of Parkinson’s disease.Methods Nine normal monkeys were used to establish N-methyl-4-phenyl-1, 2, 3, 6-tetra-hydropyridine (MPTP) hemi-Parkinsonian animal models, and they were subjected to imaging. Twenty-nine patients with Parkinson’s disease, 12 age-matched healthy volunteers, and 18 age-matched patients with Parkinson’s syndrome were investigated. Single photon emission computer tomography (SPECT) was performed 3 hours after intravenous injection of 740 MBq 99mTc-TRODAT-1. Striatum specific uptake of 99mTc-TRODAT-1 was calculated according to the ratio of striatum (ST) to cerebellum (CB)in dopamine transporters uptake.Results In normal monkeys, bilateral ratio of ST/CB was 2.34±0.41. After the injection of MPTP, uptake rate of 99mTc-TRODAT-1 at damaged region was much lower than that at the contralateral region, resulting in a significant difference in the ratio of ST/CB (right: ST/CB=1.73±0.35; left: ST/CB=1.90±0.30), especially in hemi-Parkinsonian model monkeys (right: ST/CB=1.29±0.17; left: ST/CB=1.80±0.33). The ratios of ST/CB were 1.57±0.17 and 1.61±0.14 for the right and left respectively in the healthy volunteers, 1.04±0.29 and 1.06±0.30 in the age-matched patients with Parkinson’s disease, and 1.56±0.17 and 1.59±0.18 in the age-matched patients with Parkinson’s disease syndrome. A significant difference was noted between group of Parkinson’s disease, normal controls and Parkinson’s disease syndrome. Conclusion The results suggest that 99mTc-TRODAT-1 dopamine transporters SPECT has clinical application value in early diagnosis or differential diagnosis of Parkinson’s disease.     

脑多巴胺转运蛋白SPECT显像在鉴别帕金森病与血管性帕金森综合征中的价值

目的探讨脑99mTc-TRODAT-1多巴胺转运蛋白(DAT)SPECT显像对鉴别帕金森病(PD)和血管性帕金森综合征(VP)的临床应用价值。方法对30例PD组患者、24例VP组患者及16例健康对照(组)者分别进行99mTc-TRODAT-1 SPECT脑显像,剂量为740MBq。应用计算机感兴趣区技术及2个数学模型分别计算PD患者、VP患者及健康对照者双侧纹状体体积(V,cm3)、质量(W,g),代表相应部位DAT的功能水平。结果PD组双侧纹状体体积和质量均低于健康对照组及VP组,差异有统计学意义(P<0.01或P<0.05);PD患者症状对侧纹状体体积和质量均显著低于症状同侧(P<0.01)。VP组双侧纹状体体积和质量与健康对照组比较差异无统计学意义(P>0.05),其症状对侧与症状同侧纹状体体积和质量比较差异亦无统计学意义(P>0.05)。结论99mTc-TRODAT-1 DAT SPECT脑显像有助于PD与VP的鉴别诊断。     

监测帕金森病严重程度的有效方法——^99mTc-TRODAT-1 SPECTDAT显像

目的：探讨^99mTc-TRODAT-1 SPECT DAT显像对帕金森病严重程度的监测价值。方法：对15例正常对照和51例按Hoehn-Yahr分期的早、中和晚期不同严重程度的帕金森病患者进行^99mTc-TRODAT-1 SPECT DAT显像，并在双侧纹状体及枕叶勾画感兴趣区，选择枕叶为参考区，计算双侧纹状体的特异性结合率及非对称指数进行比较分析。结果：帕金森病患者病程的不同时期蜘Tc-TRODAT-1 SPECT DAT显像显示脑双侧纹状体的进行性改变，早期帕金森病表现为纹状体放射性摄取的降低和轮廓缩小，以症状对侧更明显，随着病情发展到中晚期，其放射性摄取进一步降低，轮廓缩小更显著，图像显影不清，甚至不显影。双侧纹状体的特异性结合率及非对称指数在正常对照组及不同分期帕金森病组中存在显著差异（P〈0．05）。结论：^99mTc-TRODAT-1 SPECT DAT显像是监测帕金森病严重程度的有效方法。     

美多巴对帕金森病大鼠模型脑多巴胺转运体影响的自显影

[目的]研究美多巴对帕金森病大鼠模型脑多巴胺转运体的影响。[方法]立体定位右侧纹状体注射6—羟多巴胺制备偏侧帕金森病大鼠模型，模型成功后给予美多巴灌胃治疗5周。分4组(正常组、帕金森病模型大鼠组、帕金森病模型大鼠经美多巴治疗组、帕金森病模型大鼠未治疗组)行脑多巴胺转运体^99mTc-TRODAT—1放射自显影，每组4只。图像分析得到左、右侧纹状体及小脑的光密度值，计算左、右侧脑多巴胺转运体的特异性放射性摄取比值(纹状体／小脑—1)，比较各时间点(正常、术后4周、术后9周)多巴胺转运体比值的变化。[结果]正常大鼠脑多巴胺转运体对^99mTc—TRODAT—1的特异性摄取比值左、右两侧无显著性差异；术后4周大鼠成为帕金森病模型后，大鼠两侧脑多巴胺转运体的比值较正常均降低，右侧(损毁侧)降低明显。术后9周未治疗组帕金森病模型大鼠双侧脑多巴胺转运体的比值均较4周刚成为模型时明显升高；经美多巴治疗后，双侧的比值均较未服药组明显降低，右侧(损毁侧)降低幅度更大。[结论]长期美多巴治疗可能会使帕金森病模型大鼠脑多巴胺转运体的数量减少。     

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.