脑梗死患者的脑血管造影分析

目的探讨脑梗死患者脑血管造影(DSA)的特点。方法经CT、MR I确诊为脑梗死并行DSA检查的70例患者的临床资料,分析脑动脉狭窄或闭塞情况。结果70例患者中,17例患者造影阴性,53例存在脑动脉狭窄或闭塞。53例造影阳性患者中,44例存在责任血管,其中单纯颅外动脉狭窄12例,单纯颅内动脉狭窄24例,颅内、外动脉联合狭窄8例;轻-中度狭窄11例,重度狭窄-闭塞33例,两者之间侧支循环的发生率有统计学意义(P<0.01)。结论脑梗死患者所有脑动脉狭窄和责任血管中,颅内病变明显多于颅外病变,最常累及的病变部位是大脑中动脉(MCA)、颈内动脉(ICA)起始部和椎动脉(VA)开口,最常见的侧支循环是W illis环和软膜血管,严重的脑动脉狭窄更易引起侧支循环。     

颅内大动脉狭窄和闭塞的血管内介入诊断与治疗

目的 探讨颅内大动脉狭窄和闭塞的临床诊断方法,评价颅内大动脉狭窄和闭塞血管内介入治疗的临床应用价值.方法 对我院神经内科2003年6月至2007年3月46例症状性颅内大动脉狭窄和闭塞患者的临床表现、经颅多普勒超声(transcranial doppler,TCD)、全脑血管造影和血管内支架成形治疗等相关资料进行系统回顾.结果 ①TCD诊断颅内大血管狭窄的阳性预测值为84.8%;②对46例患者的50支狭窄血管进行血管内支架成形术,其中大脑中动脉(MCA)狭窄26支,颈内动脉颅内段狭窄19支,颈内动脉颅内段闭塞1支,大脑前动脉狭窄2支,椎动脉颅内段狭窄2支;③46例患者支架成形术成功44例(95.7%),术后即刻DSA显示狭窄程度0%～5%,围手术期严重并发症3例(6.8%);40例患者术后6～12个月随访,无短暂性缺血发作及新发脑梗死.结论 TCD在颅内动脉狭窄的诊治中有重要价值;血管内介入治疗是治疗症状性颅内大动脉狭窄安全、有效的方法,手术成功率较高,其长期疗效有待于进一步观察.     

CT血管造影、经颅多普勒和彩超联合应用于TIA患者血管病变的相关性研究

目的 探讨短暂性脑缺血发作(TIA)患者颅内外血管病变.方法 对45例患者进行头颈64排CT血管造影(CTA)及经颅多普勒(TCD)和颈动脉彩超检查,观察其异常情况.结果 CTA检查45例TIA患者中40.例颅内外共116支动脉狭窄或闭塞,总异常率为88.9%,颅内动脉狭窄或闭塞61.1%高于颅外动脉38.9%,颅外动脉狭窄中以颈内动脉(ICA)颅外段狭窄最多44.4%,颅内动脉狭窄中以ICA颅内段狭窄最多32.3%,频发(发作频率≥2/d)及短时程(发作持续时间在1h以内)患者重度狭窄及闭塞发生率(74.2%)高于非频发组及长时程(发作持续时间≥1 h),均P<0.05.有统计学意义;TCD异常75.6%,占CTA异常的94.4%,TCD血流速度增快85支,较CTA65支多;颈动脉超声检查结果16例颈部动脉狭窄或闭塞,共35支动脉狭窄或闭塞,其中椎动脉狭窄或闭塞7支.彩色多普勒超声检查对颈动脉狭窄或闭塞检出率低于CTA,对椎动脉的狭窄或闭塞检出率远低于CTA.结论 TIA患者颅内外动脉狭窄或闭塞及斑块发生率高,CTA检查显示动脉狭窄或闭塞异常率为88.9%,颅内动脉狭窄或闭塞高于颅外动脉,频发及短时程患者重度狭窄及闭塞发生率高于非频发组,有统计学意义.     

DSA在脑血管病的临床应用

目的：通过数字减影脑血管造影检查,分析脑血管病病因及脑血管的形态变化,指导该病的临床诊断和治疗。方法：对2011-2012年神经内科84例病例,行数字减影选择性全脑血管造影。结果：84例脑梗死患者其中动脉粥样硬化最多（77例,占91.7%）,烟雾病为（3例,占3.6%）,血管未见异常（4例,占4.7%）。其中84例患者中有脑血管病变80例共256支血管狭窄。颅外段狭窄占41.4%,颅内段占58.6%;颅外段狭窄动脉中以颈内动脉颅外段最常见,占27.8%,而颅内段狭窄则以大脑中动脉最常见,占20.8%。其中闭塞血管41支,占16.0%,重度狭窄血管42支,占16.4%,中度狭窄血管61支,占23.8%,轻度狭窄血管112支,占43.8%。结论：颅内外脑动脉粥样硬化及斑块形成伴狭窄是脑血管病的主要发病原因。DSA可以确定脑血管病患者颅内外脑动脉粥样硬斑块形成及狭窄情况,对脑血管病的临床诊断和治疗方案的选择起非常重要作用。     

短暂性脑缺血发作与狭窄脑动脉供血关系

目的通过数字减影血管造影检查,探讨短暂性脑缺血发作（TIA）的临床特点及其与脑供血动脉狭窄的相关性。方法采用数字减影血管造影（DSA）对43例TIA患者进行全脑血管造影检查,观察患者颈总动脉,颈内动脉和椎基底动脉颅内颅外段血管有无粥样硬化斑快、性质及狭窄程度。结果43例中有动脉硬化斑块存在的31例,血管狭窄27例,血管迂曲3例,单侧颈内动脉颅内或颅外段闭塞4例,双侧颈内动脉末端闭塞1例一烟雾病。1例伴有梭形动脉瘤。颅内动脉狭窄16例,颅外动脉狭窄11例,至少存在2处血管狭窄14例,其中8例行血管内支架成型术治疗。结论DSA可明确TIA患者是否存在血管狭窄及严重程度,脑供血动狭窄可能是TIA的主要原因。     

64排螺旋CT颈动脉造影扫描技术临床应用及影响图像质量因素分析

目的:探讨临床颈内动脉粥样硬化性狭窄患者采用64排螺旋CT血管造影(64-MSCTA)扫描技术诊断应用价值,并对影响图像质量的因素进行分析总结。方法:对35例行颅颈64-MSCTA检查的缺血性脑血管疾病患者临床资料进行回顾性的分析总结,35例患者均行颅颈64-MSCTA检查,评价患者颈动脉的成像质量。结果:35例缺血性脑血管疾病患者经检查发现颅颈部动脉存在不同程度狭窄及闭塞的患者25例,病变患者中发现病变血管共43支:轻度狭窄12支,占27.9%;中度狭窄15支,占34.9%;重度狭窄9支,占20.9%;闭塞7支,占16.3%。59支可评价颈动脉,不同血管分段可评价血管的显示率分别为:颈动脉起始段为94.9%;颈动脉颅外段为98.3%;颈动脉颅内段为86.4%;总体的可评价血管的显示率为93.2%。结论:临床64-MSCTA对于颈动脉成像的质量比较高,而对于颅外段成像的质量相对比较好。64-MSCTA对于临床颈内动脉粥样硬化狭窄性疾病的诊断有较好的应用价值,值得临床推广应用。     

64-MSCTA成像技术在颈内动脉粥样硬化狭窄性病变诊断中的应用研究

目的探讨64层螺旋CT血管造影(64-MSCTA)成像技术在颈内动脉粥样硬化狭窄性病变诊断中的应用价值。方法回顾性分析行颅颈部64-MSCTA检查的30例缺血性脑血管病患者的临床资料,患者全部行颅颈部64-MSCTA检查,对其颈动脉成像质量进行评价。结果本组30例缺血性脑血管病患者检查共发现26例患者颅颈部动脉有不同程度的狭窄和闭塞,病变患者共发现病变血管44支,其中轻度狭窄13支(29.5%),中度狭窄14支(31.8%)、重度狭窄10支(22.7%),闭塞7支(15.9%)。可评价颈动脉共计60支,其中起始段可评价血管显示率为93.3%,颅外段为98.3%,颅内段为85.0%,总体可评价血管显示率为92.2%。结论 64-MSCTA对颈动脉成像质量较高,对于颅外段的成像质量相对较好。64-MSCTA可用于颈内动脉粥样硬化狭窄性病变的诊断。     

脑分水岭梗死与颅内外血管狭窄的相关性分析

目的　探讨脑分水岭梗死 (CWI)与颅内外血管狭窄的相关性。方法　对 6 88例脑梗死患者行常规头颅CT和 (或 )MRI检查以明确梗死部位 ,其中分水岭梗死 139例 ,非分水岭梗死 5 49例。应用经颅多普勒(TCD)检测颅内血管 ,双功能彩色多普勒检测颅外血管 ,如有重度血管狭窄 (狭窄 80 %以上 )作脑血管造影检查(DSA)进一步证实。结果　 139例脑分水岭梗死患者中 ,有 5 1例颈内动脉闭塞 ,44例重度颈内动脉狭窄 ,6 0例合并颅内血管多发狭窄 ;非脑分水岭区梗死患者 5 49例中 ,2 0例颈内动脉闭塞 ,17例颈内动脉重度狭窄 ,134例颅内血管多发狭窄。将两组资料进行卡方检验 ,有显著性差异。结论　颈内动脉严重狭窄、闭塞、颅内血管的多发狭窄是脑分水岭梗死的主要发病原因     

磁共振血管成像和血管造影对急性脑梗死患者颅外段颈动脉狭窄的对比研究

目的研究磁共振血管成像技术对急性脑梗死患者颅外段颈动脉狭窄的诊断价值。方法对32例临床怀疑颈动脉狭窄的急性脑梗死患者行磁共振血管成像(magnetic resonance angiography MRA)及数字减影血管造影(digital subtraction angiography,DSA)检查,DSA以NASCET法计算狭窄率,MRA分别以NASCET法和截面积法计算狭窄率。结果以DSA诊断为金标准,32例128条颅外段颈动脉狭窄,MRA以NASCET法诊断的敏感性63%,特异性100%,准确性78.1%,Kappa=0.593;MRA截面积法诊断的敏感性63%,特异性100%,准确性79.7%,Kappa=0.622。结论MRA在诊断急性脑梗死颅外段颈动脉狭窄病变时,具有较高的敏感性、准确性和特异性,可用于筛选可疑颅外段颈动脉狭窄或闭塞的患者,使大部分患者免除DSA检查,但MRA尚不能代替DSA。     

缺血性脑卒中患者全脑血管造影的特点分析

目的：探讨缺血性脑卒中患者全脑血管造影的临床特点。方法选择100例缺血性脑卒中患者为研究对象,对所有患者进行全脑血管造影检查,对全脑血管造影的特点进行分析。结果100例患者经全脑血管造影检查后显示,75例患者（75.00%）有脑动脉狭窄或闭塞,有44例患者（44.00%）存在前循环动脉狭窄或闭塞,有28例患者（28.00%）存在后循环动脉狭窄或闭塞;前后循环均狭窄或闭塞28例（28.00%）;前循环动脉狭窄显著高于后循环脉动狭窄,差异有统计学意义(P＜0.05)。颅内动脉狭窄或闭塞25例（25.00%）;颅外动脉狭窄47例（47.00%）;颅内外均有狭窄或闭塞28例（28.00%）。颅外动脉狭窄主要为颈内动脉颅外段,颅内动脉狭窄主要为椎动脉颅内段与大脑中动脉。结论全脑血管造影可对缺血性脑卒中患者的动脉狭窄情况进行观察,并判断狭窄或闭塞程度,为临床治疗提供准确依据。     

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.