彩色多普勒超声在早期糖尿病肾病诊断中的价值

目的探讨彩色多普勒超声在早期糖尿病肾病诊断中的价值。方法选择30例早期糖尿病肾病为实验组．30例正常人为对照组,采用彩色多普勒超声二维及CDFI模式检查所有受检者肾脏大小、主肾动脉（MRA）、肾锥体叶间动脉（IRA）及。肾窦部段动脉（SRA）的收缩期最大流速（Vmax）、舒张期最低流速（Vmin）及血流阻力指数（RI）。结果实验组肾脏长径、宽径、厚径及体积均小于对照组（P〈0．05）;实验组患者两肾主肾动脉、叶问动脉、段动脉的Vmax、Vmin明显低于对照组（P〈0．05）,且实验组患者RI高于对照组（P〈0．05）。结论早期糖尿病肾病患者肾动脉血流呈现高速低阻,采用彩色多普勒超声检测肾动脉血流参数对于诊断早期糖尿病肾病具有重要的价值。     

精神分裂症患者颅底动脉血流观察文

目的观测精神分裂症患者的颅底动脉血流的特点。方法应用经颅多普勒仪对300例符合CCMD-3诊断标准的患者进行颅底各动脉平均血流速度（Vm）的测定,与匹配的100例正常人作对照,并对临床表现为阳性症状突出与阴性症状突出者作组内对照。结果精神分裂症组的经颅多普勒（TCD）异常,各动脉Vm减慢,与对照组比较差异有显著统计学意义（P〈0.01）;阴性症状组Vm比阳性症状组低（P〈0.01）。结论精神分裂症存在脑部血管自动调节机制障碍。     

经颅多普勒检测对糖尿病患者脑血管事件预测价值的探讨

目的：评价经颅多普勒超声（TCD）检测糖尿病患颅内动脉血流异常的预后价值。方法：对105例48－85岁2型糖尿病患进行TCD检测并前瞻性随访67个月。结果：本组糖尿病患血流速度异常率较高占57．1％，且以流速异常增高为主：随访期间，7例发生非脑血管病死亡，19例发生非致死性脑硬塞，1例发生非致死性脑出血，3例发生一过性脑缺血发作（TIA），所有23例发生脑血管事件的患进入研究时颅内动脉血流速度异常脑血管事件发生率显高于颅内动脉血压血流速度正常（P＜0．05）。结论：经颅多普勒超声检测颅内动脉血流速度异常对糖尿病患随后脑血管事件的发生有预测价值。     

经颅多普勒超声在颈内动脉海绵窦瘘诊断中的临床意义

①目的探讨经颅多普勒超声（TCD）在颈内动脉海绵窦瘘诊断中的临床意义。②方法对29例临床疑诊为颈内动脉海绵窦瘘的患者进行TCD检测颅底主要动脉的平均流速（Vm）、频谱形态、声频、搏动指数（PI）。③结果26例TCD均有异常改变，患侧颈内动脉颅外段、颈内动脉虹吸段血流速度增高，搏动指数降低，与健侧比较，差异有统计学意义（P〈0．01）；患侧颈内动脉终末段、大脑中动脉Vm与健侧比较，无显著差异（P〉0．01）；而PI比较，差异有统计学意义（P〈0．01）。其中24例患者有频谱形态异常；3例TCD血流速度及频谱形态未见明显改变。与DSA比较，诊断符合率为90％。④结论TCD在颈内动脉海绵窦瘘的临床诊断中具有重要的临床意义，值得推广。     

CDFI和TCD联合应用对单侧颈内动脉重度狭窄或闭塞患者颅内外动脉血流改变的综合评价（附53例报告）

目的联合应用颈动脉超声（CDFI）和经颅多普勒超声（TCD）对单侧颈内动脉重度狭窄或闭塞患者的颅内外动脉血流改变的综合评价。方法回顾性分析53例经DSA证实的单侧颈内动脉狭窄〉70％或闭塞患者的CDFI和TCD联合检测结果。结果（1）CDFI显示：颈内动脉重度狭窄或闭塞段以及其近段、远段的血流速度、阻力指数均异常,部分患者对侧颈内动脉、同侧颈外动脉以及双侧椎动脉血流速度代偿性增高;（2）TCD显示：患侧与对侧的sPvMcA值分别为（55．42±28．06）cm／s和（99．35±38．25）cm／s,PI值分别为0．62±0．17和0．96±0．21,患侧与对侧的SPVMCA值和P1值均有统计学意义（均P〈0．05）。前交通动脉（ACoA）开放占50．94％（27／53）,后交通动脉（PCOA）开放占41．51％（22／53）,颈内一外动脉侧支开放占37．74％（20／53）。结论联合应用CDFI与TCD可以全面地观察颈内动脉重度狭窄或闭塞后整个颈动脉系统和后循环系统的血流动力学改变,为单侧颈内动脉重度狭窄或闭塞患者的临床治疗和预后提供可靠依据。     

脑梗死患者颈动脉与颅内动脉血流的临床研究

目的:探讨脑梗死患者颈动脉内中膜厚度、粥样硬化斑块的形成及颅内动脉血流动力学改变与糖尿病之间的关系.方法:116例大脑中动脉供血区脑梗死患者根据有无合并糖尿病分为脑梗死无糖尿病组(74例)及脑梗死合并糖尿病组(42例),并以40例健康者作为对照组,所有观察对象分别进行颈动脉彩色多普勒(CDFI)及经颅多普勒(TCD)检查,测量颈动脉内中膜厚度(IMT),观察管壁有无斑块及斑块的性质,记录颅内动脉血流参数.结果:糖尿病组颈动脉内-中膜厚度及颈动脉斑块发生率分别与非糖尿病组和对照组比较,有显著性差异(P<0.05),大脑中动脉血流情况3组间也存在差异(P<0.05).结论:糖尿病是造成脑梗死患者颈动脉内中膜增厚及粥样硬化斑块形成的主要危险因素,同时影响颅内血流情况,彩色多普勒及经颅多普勒联合检测对预防脑梗死的发生、判断预后、指导早期治疗具有重要作用.     

精神分裂症患者颅内动脉血流动力学的超声研究

目的：应用经颅彩色多普勒超声（TCD）研究精神分裂症患者颅内动脉血流动力学的状况。方法：用TCD检测40例精神分裂症患者（病例组）颅内动脉大脑中动脉（MCA）、大脑前动脉（ACA）、大脑后动脉（PCA）的血流动力学指标。结果：病例组的MCA、ACA、PCA的收缩期峰值速度（Vs）、舒张期峰值速度（Vd）和峰值平均血流速度（Vm）明显低于对照组（P〈0．01或P〈0．05）。结论：精神分裂症患者的颅内动脉血流动力学发生改变,表现为血流速度降低。     

彩色多普勒血流显像预测2型糖尿病视网膜早期病变的应用价值

目的探讨彩色多普勒血流显像（CDFI）对眼底尚无改变糖尿病患者视网膜中央动脉（CRA）血流动力学变化的诊断价值。方法利用CDFI对42例（84只眼）糖尿病人和18例（36只眼）正常对照者的视网膜中央动脉血流进行检测。结果糖尿病患者视网膜中央动脉收缩期峰值流速（Ps）、舒张期峰值流速（ED）均低于正常对照组（P〈0．05）；搏动指数（PI）、阻力指数（RI）均高于对照组（P〈0．01）。结论彩色多普勒血流显像是检测无眼底改变糖尿病患者CRA血流动力学变化的有效诊断方法。     

经颅多普勒超声联合颈动脉彩超对糖尿病脑血管病诊断的应用

目的探讨将经颅多普勒（TCD）和颈动脉彩超（CDFI）两种检测手段联合用于糖尿病脑血管病诊断的临床应用价值。方法选取该院2010年6月—2013年12月期间治疗的180例确诊糖尿病的患者随机分成3组,A组（观察组）全部同时进行TCD和CDFI的联合检测。B组（对照组一）在同期仅进行TCD检测。C组（对照组二）在同期仅行CDFI检测。对3组患者在异常情况的阳性检出率、检测异常率与糖尿病病程的关系、有并发症的情况下阳性率的检出三个方面进行比较。结果A组（观察组）异常情况阳性检出率为88%,明显高于B组（对照组一）的65%和C组（对照组二）的70%,差异有统计学意义（P〈0.05）。对于病程〈3年和3~5年者,观察组异常率分别为87%和89%,明显高于对照组〈3年和3~5年病程者（P〈0.05）;而5~10年及〉10年病程者（P〈0.05）。有合并症的情况下,3组患者的阳性率均有明显增高,观察组阳性检出率增高尤为明显。结论 TCD和CDFI联合应用于糖尿病脑血管病的诊断,能明显提高阳性检出率和早期诊断的准确性,对临床诊断具有重要价值。     

彩色多普勒超声对2型糖尿病患者下肢动脉血流动力学及血管内皮功能的测定分析

目的应用彩色多普勒超声对2型糖尿病（T2DM）患者下肢动脉血流动力学及血管内皮功能的变化进行观察。方法2型糖尿病患者（T2DM）206例（T2DM组）,健康体检者129例（正常对照组）,采用彩色多普勒超声对其下肢动脉基础状态、反应性充血和含服硝酸甘油后血管内径、峰值流速及血流量进行测定。结果T2DM组患者股动脉和足背动脉内一中膜（IMT）均较正常对照组增厚（P〈0．05）;T2DM组患者足背动脉血流量明显低于对照组（P〈0．01）;反应性充血时,T2DM组与正常对照组比较,足背动脉的内径和内皮依赖性舒张功能（EDD）明显减低（P〈0．01）;硝酸甘油介导的足背动脉内径和内皮非依赖性舒张功能（EIDD）T2DM组较正常对照组降低（P〈0．01）。结论彩色多普勒超声检查可发现T2DM患者下肢动脉形态学、血流动力学及血管内皮功能变化,并可将其作为检查T2DM患者下肢动脉病变的优先考虑方法。     

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.     

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.     

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.