超声诊断腹壁及会阴瘢痕内子宫内膜异位症45例

目的探讨超声诊断腹壁及会阴瘢痕内子宫内膜异位症和临床应用价值。方法对瘢痕内子宫内膜异位病灶切除术后经病理证实的患者总结其声图像特征。结果 45例患者均在切口处软组织内探及肿块,肿块位于腹壁各层,深者侵及腹腔大网膜;肿块形态不规则,边界欠清晰,未见包膜回声,内部呈不均匀低回声区,部分内见少量散在分布的液性无回声区;8例显示腹壁下肿块内点状或线状血流信号,脉冲多普勒显示血流信号以动脉血流频谱为主,动脉频谱呈低速高阻型,PSV 7-20 cm/s,RI 0.7-0.8,37例未见明显血流信号。结论超声检查有助于腹壁及会阴瘢痕内子宫内膜异位症的术前诊断,从而对手术中病灶的彻底清除具有指导意义。     

彩色多普勒超声在肾母细胞瘤中的诊断价值

目的:探讨彩色多普勒超声对肾母细胞瘤的诊断价值。方法:应用本阿洛卡-6500彩色多普勒超声诊断仪,分析17例经病理诊断确定为肾母细胞瘤患儿的术前超声表现,包括肿瘤大小、形态、部位、数量、内部回声及血流情况,对检查结果进行整理分析。结果:17例肾母细胞瘤,位于右侧8例,位于左侧9例,均为单侧单发,肿瘤呈圆形及类圆形,声像图表现为中低不均混合回声。彩色多普勒显示肿块血流丰富,血流频谱显示瘤体内不规则高阻低速血流信号。结论:彩色多普勒超声不仅价格低廉,无X线辐射,更能够多方位,多切面的实时动态观察肿瘤与周围脏器的关系,对临床诊治具有非常重要的价值。     

剖宫产术后腹壁切口子宫内膜异位症的超声诊断分析

目的 探讨剖宫产术后腹壁切口子宫内膜异位症的超声诊断.方法 对自2006年8月～2011年12月收治的31例经手术及病理证实为继发于剖宫产术后腹壁切口子宫内膜异位症的超声检查结果进行回顾性分析.结果 二维声像图显示腹壁切口瘢痕处探及不均匀低回声肿块,肿块位于腹壁各层,形态不规则,边界欠清晰,未见明显包膜回声,部分低回声肿块内可见单个或多个小无回声区.大部分与月经周期有关,经前及经期肿块增大,经后肿块缩小.彩色多普勒血流显示部分肿块内部无明显血流信号,部分肿块内可见星点状或短线状血流信号,多普勒频谱显示为动脉血流,呈低速高阻型的特点.结论 超声检查是诊断剖宫产术后腹壁切口子宫内膜异位症的有效手段,具有方便、快捷、可靠、无痛苦、可重复性强等优点,并能动态观察病情变化,是目前诊断内膜异位症的最佳检查方法.     

子宫内膜异位症在手术后腹壁瘢痕处的彩超表现

目的探讨高频超声与彩色多普勒血流显像对腹壁切口瘢痕处子宫内膜异位症的超声表现。方法对66例经手术病理证实的腹壁瘢痕子宫内膜异位症的声像图特征进行分析。结果腹壁瘢痕处探及边界不清、形态不规则、无包膜、内部回声不均质的中低回声团块,团块内呈斑片状液性暗区间杂弱回声光点及条带状低回声;彩色多普勒血流显像(CDFI)显示肿块周边及内部有点状、短棒状和条状血流信号。脉冲多普勒(PW)表现为低速高阻的特点,Vs 5.0～20 cm/s、RI 0.65～0.82。结论高频超声结合CDFI和PW能对剖宫产术后腹壁瘢痕子宫内膜异位症进行明确诊断,为临床提供可靠的诊断价值。     

睾丸表皮样囊肿超声1例

临床资料 患者,男,27岁,发现右阴囊肿大3年余而就诊,查体：右睾丸肿大,无明显触痛,附睾未见异常,腹股沟区未触及肿大淋巴结。左侧睾丸正常。超声所见：于右侧睾丸实质内探及肿块,大小1．41cm×1．11cm,边界清,其内可见“洋葱皮”样改变,CDFI示肿块内未见血流信号（图1）,右侧睾丸后方可见多处管状回声,内探及静脉频谱血流信号。左侧附睾未见异常。     

小肾癌的超声诊断价值

目的 探讨小肾癌的二维及彩色多普勒超声诊断及鉴别诊断价值.方法 对我院经手术病理诊断为小肾癌的22例病人的二维及彩色多普勒超声检查结果作回顾性分析.结果 22例小肾癌回声类型为:实性均匀高回声型8例,等回声型2例,低回声型6例,实性不均匀回声型2例;囊实混合回声型4例,其中3例为囊性肾癌.17例小肾癌瘤周肾门侧显示半环状血流信号,3例瘤周显示环状血流信号;上述20例中,7例瘤内探及1～2条线状血流信号,5例肾门侧近肿瘤肾血管粗细不均、走行扭曲.2例瘤周和内部未探及明显血流信号.结论 依据小肾癌的超声表现,并结合其他影像学检查方法,可对小肾癌做出可靠的诊断.     

超声诊断肿块型胰腺炎分析与探讨

目的探讨肿块型胰腺炎的声像图特点,以提高对本病的认识及与胰腺癌的鉴别诊断能力。方法回顾性总结分析8例术前影像诊断为胰腺占位性病变而手术病理证实为肿块型胰腺炎的声像图表现、临床资料及CT影像结果。结果8例肿块型胰腺炎均表现为孤立性实性肿块。肿块位于胰头4例,钩突1例,胰体3例。肿块边界均模糊(8/8),但形态规则者占75%(6/8);肿块内部回声均呈低回声(8/8),其中回声不均匀者5例(5/8),均匀者3例(3/8);4例位于胰头及1例位于钩突部的肿块可见主胰管扩张(5/8),其中2例伴有胆总管扩张(2/8);7例肿块周边及内部未探及多普勒血流信号(7/8),仅1例肿块内探及血流(1/8)。8例肿块均未见浸润性生长(8/8)征象,7例未见周围或腹腔肿大淋巴结(7/8)。结论肿块型胰肠炎声像图有一定特点,超声检查仍可作为诊断肿块型胰腺炎的首选影像方法。     

高频超声诊断儿童异位胸腺的临床价值

目的探讨儿童异位胸腺的高频超声表现,评价高频超声诊断儿童异位胸腺的临床价值。方法回顾性分析10例儿童异位胸腺的超声表现,患儿年龄3~13岁,临床均以局部肿物就诊。结果所有肿块均呈中等偏低回声团块,边界清晰,包膜完整,形态多为中央厚、周边逐渐变薄,内部回声不均匀,可见散在点状、线状高回声,患儿年龄越大,点状、线状高回声则越密集,CDFI示肿块内可见稀疏的点、线状血流信号,探头加压时肿块变形明显。所有肿块病理诊断与超声诊断结果相一致。结论儿童异位胸腺具有较特征的超声表现,可指导临床对其的诊断及治疗。更多还原     

Value of high frequency ultrasound in the diagnosis of colonic polyps in children

目的 探讨高频超声在儿童结肠息肉中的诊断价值.方法 回顾性分析经结肠镜及病理证实的34例结肠息肉患儿的高频超声声像图特征.结果 34例患儿中,病理显示幼年性息肉33例,腺瘤性息肉1例.共42枚息肉,其中单发息肉31例,多发息肉3例共11枚;超声诊断结肠息肉31例,漏诊3例.结肠息肉声像图表现为肠腔内中等回声或稍低回声肿块,34个肿块内可探及散在的小囊腔,33个肿块通过蒂与肠壁相连,CDFI示息肉内血流信号丰富,表现为以蒂部条束状血流信号为主干进入肿块,肿块内部血流分布由中心向外部辐射.4例患儿超声检出合并继发肠套叠.结论 儿童结肠息肉超声声像图具有特异性;超声检查具有无创、安全、方便及检出率高等特点,对儿童结肠息肉具有重要的诊断价值,可作为儿童结肠息肉首选的检查方法.     

高频超声在儿童结肠息肉中的诊断价值

目的探讨高频超声在儿童结肠息肉中的诊断价值。方法回顾性分析经结肠镜及病理证实的34例结肠息肉患儿的高频超声声像图特征。结果 34例患儿中,病理显示幼年性息肉33例,腺瘤性息肉1例。共42枚息肉,其中单发息肉31例,多发息肉3例共11枚;超声诊断结肠息肉31例,漏诊3例。结肠息肉声像图表现为肠腔内中等回声或稍低回声肿块,34个肿块内可探及散在的小囊腔,33个肿块通过蒂与肠壁相连,CDFI示息肉内血流信号丰富,表现为以蒂部条束状血流信号为主干进入肿块,肿块内部血流分布由中心向外部辐射。4例患儿超声检出合并继发肠套叠。结论儿童结肠息肉超声声像图具有特异性;超声检查具有无创、安全、方便及检出率高等特点,对儿童结肠息肉具有重要的诊断价值,可作为儿童结肠息肉首选的检查方法。     

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.     

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.