肝胆显像、肝功各酶及胆红素对婴儿黄疸的鉴别

目的研究放射性核素肝胆显像、肝功各酶及胆红素的测定对临床难以鉴别的婴儿肝炎综合征（IHS）和先天性胆道闭锁（EHBA）婴儿持续性黄疸的价值。方法采用速率生化分析法检测36例临床难以鉴别IHS和EHBA的婴儿持续性黄疸空腹血清谷草转氨酶（AST）,血清谷丙转氨酶（ALT）,血清乳酸脱氢酶（LDH）,血清谷氨酰转肽酶（GGT）,血清碱性磷酸酶（ALP）,血清总胆红素（TBILI）,血清直接胆红素（DBILI）及血清间接胆红素（IBILI）。并于当天对患儿行肝胆显像。结果肝胆显像诊断IHS灵敏度为85%（17/20）,特异度为100%（16/16） 诊断EHBA灵敏度为100%（16/16）,特异度为85%（17/20）。患儿血清AST、ALT、LDH、GGT、ALP、TBILI、DBILI及IBILI含量高于参考值范围 TBILI及DBILI的含量在EHBA组高于IHS组（P〈0.05）。AST、LDH、ALT、GGT、ALP及IBILI含量在IHS与EHBA组差别无统计学意义（P〉0.05）。结论婴儿持续性黄疸均有肝损害。肝胆显像、血清肝功各酶及胆红素测定能无创、安全、较准确地鉴别IHS与EHBA,提高IHS和EHBA患者的诊断,对于婴儿持续性黄疸治疗的选择有重要意义。     

婴儿肝炎综合征与胆道闭锁鉴别诊断方法的比较

回顾性评价了经手术或尸检诊断的１１例胆道闭锁和随访了２６例黄疸消失的婴儿肝炎综合征患儿十二指肠液的颜色，放射性核素肝胆显像，Ｂ超肝胆检查结果，以十二指肠液透明无色诊断胆产闭锁，十二指肠黄色诊断婴儿肝炎综合征，正确率为９４．６％，以肠道有无效放射性示踪剂来鉴别胆道闭锁与婴儿肝炎综合征，正确率为８１．１％，Ｂ超声波肝胆检查有无胆囊鉴别胆道闭锁与婴儿肝炎综合征，正确率为７８．０％，结果表明，观察十二指肠     

婴儿肝炎综合征与胆道闭锁鉴别诊断方法的比较

回顾性评价了经手术或尸检诊断的１１例胆道闭锁和随访了２６例黄疸消失的婴儿肝炎综合征患儿十二指肠液的颜色、放射性核素肝胆显像、Ｂ超肝胆检查结果．以十二指肠液透明无色诊断胆道闭锁，十二指肠液黄色诊断婴儿肝炎综合征，正确率为９４．６％．以肠道有无放射性示踪剂来鉴别胆道闭锁与婴儿肝炎综合征，正确率为８１．１％．Ｂ型超声波肝胆检查有无胆囊鉴别胆道闭锁与婴儿肝炎综合征，正确率为７８．０％．结果表明，观察十二指肠液颜色是简单、快速、可靠的鉴别方法．     

胆汁淤积型肝炎~(99m)Tc-EHIDA与~(99m)Tc-MIBI肝胆显像对比研究

目的探讨~(99m)Tc-MIBI肝胆动态显像是否可用于婴儿肝炎综合征和先天性胆道闭锁的鉴别诊断,为临床诊治提供依据。方法随机抽取34例~(99m)Tc-EHIDA SPECT肝胆动态延迟显像肠道不显影而最终临床诊断为胆道闭锁的患儿作为观察组,10例同期临床诊断为肝炎综合征的患儿作为对照组,在行~(99m)Tc-EHIDA肝胆显像后次日行~(99m)Tc-MIBI肝胆显像;对比分析~(99m)Tc-EHIDA与~(99m)Tc-MIBI肝胆显像在婴儿先天性胆道闭锁及婴儿肝炎综合征的影像特征。结果 34例观察组和10例对照组~(99m)Tc-MIBI肝胆显像均出现肠道显影,且肠道放射性分布出现时间较早,提示肠道放射性并非来自肝胆排泄而是肠道自身的摄取。结论对于~(99m)Tc-EHIDA SPECT肝胆显像肠道未出现放射性核素影像的黄疸患儿,~(99m)Tc-MIBI肝胆显像对于婴儿肝炎综合征和先天性胆道闭锁的鉴别诊断价值有限。     

99~m Tc-EHIDA肝胆显像鉴别婴儿持续性黄疸

放射性核素的研究进展,使99~mTC标记的乙酰苯胺亚氨二醋酸(IDA)衍生物肝胆显像成为鉴别婴儿持续黄疸的可靠方法。本文报告26例婴儿持续性黄疸99~mTc-EHIDA(邻位二乙基IDA)肝胆动态显像结果。资料与方法一、1右床资料:一987年6月~1958年9 月,我科收治婴儿持续性高胆红素血症26 例,其冲男19例,女7例.年龄33~335天。起病日龄2~290天。显像前血清总胆红素均值121。07拼mol/L;一分钟胆红素均值 77。8林     

十二指肠引流液胆汁检测鉴别诊断婴儿肝炎与胆道闭锁的研究

十二指肠引流液胆红素定量及胆酸定性，鉴别婴儿肝炎（ＩＨ）或胆道闭锁（ＢＡ）。５６例日龄平均６３天的梗阻性黄疸婴儿共作十二指肠引流液检查７０次。十二指肠引流液最终胆汁阳性３０例，黄疸均消退，均符合ＩＨ；最终胆汁阴性２５例，手术均证实为ＢＡ；仅１例胆汁阴性者术中发现肝外胆管通畅但穿刺无胆汁，肝活检提示为毛细胆管性肝炎。十二指肠引流液胆汁检查与最后诊断的符合率为９８．２１％（５５／５６）。十二指肠引流液胆汁检测鉴别ＩＨ或ＢＡ简便、快速、安全、准确，是早期鉴别ＩＨ或ＢＡ具有特异性的诊断方法。     

超声检测胆囊和十二指肠液引流检查对婴儿黄疸的鉴别诊断意义

目的　探讨超声胆囊和十二指肠液引流检查对婴儿持续性黄疸的鉴别诊断意义。方法　应用实时超声仪观察哺乳前后婴儿胆囊大小变化 ,应用婴儿十二指肠引流术收集胆汁。结果　经随访黄疸消退的 30例婴儿肝炎综合征哺乳前胆囊最大断面积为 (2 .0 7± 0 .96 )cm2 ,哺乳后 30min为 (0 .92± 0 .12 )cm2 ,胆囊收缩率为 (5 4 .5± 16 .6 ) % ;十二指肠液胆红素≥12 .5 μmol/L ,胆汁酸阳性。经手术证实的 32例胆道闭锁哺乳前胆囊最大断面积为 (0 .81± 0 .14 )cm2 ,哺乳后 30min为(0 .6 7± 0 .11)cm2 ,胆囊收缩率为 (17.1± 11.5 ) % ,十二指肠液无胆汁。两组胆囊收缩率对比具有极显著性差异 (P <0 .0 1)。结论　超声检测哺乳前后胆囊大小变化及胆囊收缩率结合十二指肠液检查 ,能准确鉴别婴儿肝炎综合征与胆道闭锁。     

婴幼儿禁食时间对肝胆动态显像诊断的影响

<正>新生儿病理性黄疸主要由胆道闭锁(Biliary atresia, BA)和婴儿肝炎综合征 (Infant hepatitis syndrome, IHS)引起。因为BA与IHS都有相同的临床症状和体征,相同的生化检查结果和相同的组织学改变[1],鉴别比较困难。目前,对这两种疾病的主要鉴别手段仍为核素肝胆显像[2-3]。核素肝胆显像是将可经过胆道系统排泄的显像剂引入患儿体内,通过观察胆囊与肠道是否显像来判断患儿的黄疸原因。     

99mTc—EHIDA肝胆显像鉴别诊断婴儿黄疸15例

目的：评价99mTc—EHIDA肝胆显像鉴别诊断先天性胆道闭锁与婴儿肝炎综合征的临床价值。方法：15例持续性黄疸患儿行99mTe—EHIDA肝胆显像,显像结果与手术病理或临床随访结果对比,判断诊断效能。结果：99mTc—EHIDA肝胆显像诊断先天性胆道闭锁的灵敏度、特异性、准确性分别为100％、81．8％、89．4％。结论：99mTc—EHIDA肝胆显像对于CBA的鉴别诊断有较高的临床价值。     

新生儿黄疸的SPECT脑血流灌注显像和预后评估的关系

目的：探讨处不同水平血清总胆红素的新生儿SPECT脑血流灌注显像的影像特点和预后评估的关系。方法用99Tcm-乙撑双半胱氨酸二乙脂（ECD）对28例不同水平TSB的新生儿进行SPECT脑血流灌注显像，并同时进行新生儿20项行为神经测定（NBNA）、脑干听觉诱发电位检查（BAER）；对其中25例患儿的智力、听力及神经系统检查进行了1．3年随访。结果随着TSB的升高与脑血流灌注显像异常率为：220．5μmol／L组，11％（1／9）；42．0μmaol／L组，43％（3／7）；427．5μmnol／L组，83％（5／6）。显像异常9例中，无后遗症者2例；有轻度后遗症者2例；有严重后遗症者2例；死亡3例。结论脑血流SPECT断层显像能对胆红素脑病做出早期诊断；并对病灶定位、病情评估及预后判断有较大帮助，为早期干预治疗提供客观依据。     

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.