超声弹性成像评估2型糖尿病患者胫神经病变的应用价值

目的 探讨超声弹性成像评估2型糖尿病患者胫神经病变的应用价值。方法 对2型糖尿病伴周围神经病变患者33例、不伴周围神经病变患者32例及29例健康志愿者胫神经应用常规高频超声测量前后径及横截面积（cross-sectional area,CSA）,应用声触诊组织定量（virtual touch tissue quantification,VTQ）技术及声触诊组织成像和定量（virtual touch tissue imaging quantification,VTIQ）技术测量剪切波速度（sheer wave velocity,SWV）,对比分析VTQ及VTIQ两种弹性成像技术对2型糖尿病患者胫神经病变的应用价值。结果 2型糖尿病伴周围神经病变者胫神经前后径、CSA、SWV值均大于不伴周围神经病变者,且大于健康志愿者（P<0.05）。VTIQ技术诊断2型糖尿病周围神经病变的敏感度及特异性高于VTQ技术（P<0.05）。结论 2型糖尿病患者出现周围神经病变之前,胫神经硬度已发生变化,VTQ及VTIQ技术均可较早发现这一变化。VTIQ技术对2型糖尿病患者胫神经病变诊断价值优于VTQ技术。     

高频超声结合剪切波弹性成像在诊断糖尿病周围神经病变中的应用价值

目的探讨高频超声和剪切波弹性成像技术（SWE）对糖尿病周围神经病（DPN）的诊断价值,并分析其影响因素。方法选取我院2型糖尿病患者100例,包括糖尿病伴周围神经病患者50例,糖尿病不伴周围神经病患者50例,并纳入同期健康志愿者50例。应用高频超声及剪切波弹性成像测量比较三组患者胫神经超声特征、横截面积（CSA）及杨氏模量值。分析2型糖尿病患者胫神经运动神经传导速度（MCV）及DPN组患者多伦多临床评分（TCSS）与胫神经CSA、杨氏模量值的相关性,探讨胫神经杨氏模量值的影响因素。绘制ROC曲线分析CSA及杨氏模量值对胫神经病变的诊断价值。结果 DPN组胫神经较NDPN组及健康对照组神经束回声减低,神经外膜增厚,"筛网状"结构模糊。三组组内左右侧胫神经CSA、杨氏模量值差异无统计学意义（P>0.05）。三组间胫神经CSA、杨氏模量值差异有统计学意义（P<0.05）,两两比较差异均有统计学意义（P <0.05）。2型糖尿病患者胫神经CSA与杨氏模量值呈正相关（r=0.67,P <0.01）,胫神经MCV分别与胫神经CSA和杨氏模量值呈负相关（r=-0.54,P<0.01; r=-0.62,P<0.01）。DPN组TCSS分别与CSA和杨氏模量值呈正相关（r=0.29,P<0.01; r=0.30,P<0.01）。糖尿病病程、糖化血红蛋白水平影响胫神经杨氏模量值。胫神经杨氏模量值诊断DPN最佳截点值为46.7 k Pa,敏感度为84%,特异度为88%。结论高频超声结合SWE可通过神经形态和硬度的改变评估2型糖尿病胫神经病变,是诊断DPN的有效手段。     

2型糖尿病下肢神经损伤的剪切波弹性成像评估

目的 评估2型糖尿病患者(diabetes mellitus,DM)下肢神经损伤,为DM患者的病情进展判断及治疗干预提供影像学依据。方法 连续收集2020年1-6月于空军军医大学第一附属医院确诊收治的44例2型糖尿病周围神经病变患者(diabetic peripheral neuropathy,DPN),同期纳入门诊体检中心健康体检者32例为对照组。联合应用高频超声及剪切波弹性成像技术(shear wave elastic maging technology,SWE)对所有研究对象双侧下肢神经(胫、腓总及腓肠神经)进行成像及参数分析。结果 高频超声参数中胫神经直径及横截面积(cross-sectional area,CAS)、腓总神经CAS具有较好的诊断效能;剪切波弹性参数中,腓总神经杨氏模量平均值Mean(kPa)、最大值Max(kPa)、腓总神经平均速度Mean(m/s)及最大速度Max(m/s)具有较好诊断效能(0.70＜AUC＜0.90,P均＜0.001)。下肢感觉及运动神经中腓总神经最为敏感,可作为DPN的重点观察指标。结论 超声剪切波弹性成像可检出2型糖尿病周围神经损害,为临床干预提供早期诊断依据。     

剪切波杨氏模量值在甲状腺结节良恶性诊断中的应用价值

目的应用剪切波弹性成像测定甲状腺结节的杨氏模量值,探讨其在甲状腺结节良恶性鉴别诊断中的价值。方法选取2016年8月—2017年8月在河北省人民医院超声科检查的甲状腺结节患者142例(152个结节)进行实时剪切波弹性成像。以手术病理学检查为"金标准"、甲状腺细针抽吸活检(FNA)细胞学检查+超声随访为参考标准,绘制ROC曲线,分析鉴别良、恶性病灶的参考界值。结果甲状腺良、恶性结节杨氏模量的最大值、平均值比较差异均有统计学意义(t=-5.690、-5.439、-4.363、-4.804,P<0.05)。弹性模量最大值、平均值诊断甲状腺恶性结节的诊断截断值分别为42.86 kPa、23.22 kPa,ROC曲线下面积分别为0.768、0.743,诊断甲状腺良、恶性结节的敏感度分别为80.0%、75.4%,特异度分别为70.2%、71.4%,准确率分别为74.5%、73.1%。结论剪切波弹性成像测得的甲状腺结节杨氏模量最大值及平均值可以定量评价病灶的硬度,有助于甲状腺结节良恶性的鉴别诊断,其中最大值具有更好的诊断价值。     

2型糖尿病胫神经病变超声特征的ROC曲线分析

目的 比较2型糖尿病胫神经病变超声形态学各项指标,寻找2型糖尿病胫神经病变的高诊断价值指标。 方法 回顾性分析进行下肢血管及胫神经超声检查的2型糖尿病患者60例,以性别、年龄、病程等因素选择纳入标准及排除标准选择病例,以密歇根神经筛查量表（Michigan Neuropathy Screening Instrument,MNSI）体格检查2分作为诊断截断值分为两组（有神经病变组和无神经病变组）。比较两组胫神经宽度、厚度、横截面积、“筛孔样”结构以及是否有能量多普勒信号。 结果 两组胫神经宽度、“筛孔样”结构是否清晰显示及能量多普勒信号是否显示差异无统计学意义（P＞0.05）。胫神经的厚度、横截面积差异有统计学意义（P＜0.05）。胫神经厚度（AUC=0.826）的敏感度84.21%,特异度73.81%,阳性预测值69.60%,阴性预测值82.40%;横截面积(AUC=0.921)的敏感度94.74%,特异度85.71%,阳性预测值81.80%,阴性预测值94.40%;胫神经厚度与横截面积ROC的AUC差异有统计学意义（P=0.047）。 结论 2型糖尿病胫神经病变的超声各特征中胫神经厚度诊断价值中等,选择cut-off值为3.62 mm可得到较为理想的诊断效能;横截面积诊断价值较高,选择cut-off值为21.0 mm2可得到较为理想的诊断效能。     

实时剪切波超声弹性成像鉴别诊断肝血管瘤、肝细胞性肝癌的临床价值

目的:分析实时剪切波超声弹性成像鉴别诊断肝血管瘤、肝细胞性肝癌的临床价值。方法:选取90例(90个病变)接受实时剪切波超声弹性成像检查的患者作为观察对象,其中45例肝血管瘤患者和45例肝细胞性肝癌患者。比较肝血管瘤和肝细胞性肝癌患者的病变直径、病变杨氏模量平均值、病变与邻近肝组织杨氏模量平均值的比值,通过绘制ROC曲线,确定病变杨氏模量平均值对肝血管瘤和肝细胞性肝癌的诊断临界点。结果:肝血管瘤和肝细胞性肝癌患者的病变直径比较,差异无统计学意义(P>0.05);肝血管瘤患者的病变杨氏模量平均值、病变与邻近肝组织杨氏模量平均值的比值均明显高于肝细胞性肝癌患者,差异具有统计学意义(P<0.05);病变杨氏模量平均值对肝血管瘤和肝细胞性肝癌的诊断临界点为13.15 kPa,其特异度为56.0%,敏感度为87.6%,AUC为81.5%(95%CI=73.9%～89.2%);病变与邻近肝组织杨氏模量平均值的比值对肝血管瘤和肝细胞性肝癌进行诊断的临界点为1.32 kPa,其特异度为78.5%,敏感度为98.1%,AUC为97.0%(95%CI=94.4%～99.5%)。结论:实时剪切波超声弹性成像鉴别诊断肝血管瘤、肝细胞性肝癌的临床效果较为理想,可作为鉴别诊断两种疾病的有效参考依据。     

高频超声在糖尿病四肢神经病变诊断中的应用价值分析

目的分析高频超声在糖尿病四肢神经病变诊断中的应用价值。方法选取漯河医学高等专科学校第二附属医院糖尿病周围神经病变(DPN)患者68例作为观察组。另选取同期健康体检者68例作为对照组。两组受试者均采用高频超声诊断,比较两组上肢正中神经、尺神经横截面长径(D1)、横截面宽径(D2)、横截面积(CSA)及下肢股神经和隐神经宽径、厚径、横截面积。结果观察组上肢正中神经、尺神经各节段神经D1、D2、CSA值均高于对照组,差异有统计学意义(P<0.05);观察组股神经及隐神经宽径、厚径、横截面积均高于对照组,差异有统计学意义(P<0.05)。结论高频超声可准确评估糖尿病四肢神经病变径线及横截面积等情况,具有较高临床应用价值。     

2型糖尿病下肢周围神经病变的超声形态参数与密歇根神经病变筛查评分系统的关系研究

目的研究2型糖尿病下肢周围神经病变的超声形态参数,并分析其与密歇根神经病变筛查评分系统(MNSI)评分的相关性。方法选择2016年1月‐2017年12月于该院进行治疗的71例2型糖尿病患者作为研究对象,按照患者有无下肢周围神经病变分为糖尿病下肢周围神经病变(DPN)组(n=37)和无糖尿病下肢周围神经病变(NDPN)组(n=34),同时选择同期非糖尿病健康者为对照组(n=38),分析3组之间超声形态参数的差异,并比较2型糖尿病下肢周围神经病变的超声形态参数与MNSI评分的相关性。结果 DPN组与NDPN组患者腓总神经和胫神经的超声形态参数均明显大于正常对照组,比较差异有统计学意义(P 0.05);且DPN组均明显大于NDPN组,比较差异有统计学意义(P 0.05);MNSI评分越高,糖尿病患者腓总神经、胫神经超声形态参数越大,二者显著相关(P 0.05)。结论 2型糖尿病下肢周围神经病变超声与MNSI评分具有一定的相关性,MNSI评分越高,2型糖尿病下肢周围神经病变的超声形态参数越大。     

实时剪切波超声弹性成像对甲状腺弥漫性病变的诊断价值

目的：应用实时剪切波超声弹性成像测定弥漫性甲状腺疾病的杨氏模量值,探讨其在甲状腺弥漫性病变中的诊断价值。方法该院临床确诊的甲状腺弥漫性病变患者120例,其中甲状腺功能亢进53例、亚急性甲状腺炎34例、桥本甲状腺炎33例。另选取甲状腺正常的120例体检者为对照组。所有受检者均常规超声检查排除甲状腺结节。进行实时剪切波超声弹性成像检查,测得甲状腺弥漫性病变组织的定量弹性平均值（Mean）、最大值（Max）、最小值（Min）和弥散度（SD）。结果对照组杨氏模量值与甲状腺功能亢进组杨氏模量值的M ean差异无统计学意义（ P＞0．05）,除此项外对照组杨氏模量值与各疾病组杨氏模量值的M ax、M ean、SD差异均有统计学意义（ P＜0．05）。结论实时剪切波超声弹性成像通过分析弹性图及测量杨氏模量的绝对数值,可以反映甲状腺组织的硬度,为甲状腺弥漫性病变提供了一个新的诊断信息。     

高频超声在糖尿病下肢周围神经、血管病变诊断的应用研究

目的 使用高频超声来评估糖尿病足患者的下肢周围神经、血管病变程度,为临床糖尿病下肢周围神经、血管病变的诊断提供依据,为临床选择恰当的治疗方案提供指导.方法 对46例糖尿病足患者（共59侧,A组）和健康志愿者89例（共178侧,B组）进行高频超声检查,测量踝管处胫后动脉内径、胫后动脉血流速度、胫神经横截面积.结果 胫后动脉内径A组为（1.56±0.31）mm,B组为（2.21±0.49）mm,两组比较差异有统计学意义（P＜0.01）;胫后动脉血流速度A组为（33.53±13.33） cm/s,B组为（47.6±9.44）cm/s,两组比较差异有统计学意义（P＜0.01）;胫神经横截面积A组为（3.55±0.58）mm2,B组为（2.85±0.28）mm2,两组比较差异有统计学意义（P＜0.01）.高频超声检查提示：A组胫后动脉内径明显缩小、胫后动脉血流速度明显减低,胫神经水肿明显.结论 糖尿病足患者高频超声检查有明显胫后动脉内径缩小、胫后动脉血流速度减低、胫神经水肿者,内科治疗控制血糖后应及时手术治疗.     

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.