颅内静脉窦血栓形成21例临床分析

目的探讨颅内静脉窦血栓形成(CVST)的临床特征、影像特点及治疗.方法分析21例CVST患者的发病年龄、发病形式、临床表现、影像特点及治疗.结果①CVST以青年女性多见;②多为急性、亚急性起病;③危险因素有分娩、妊娠、炎症、口服避孕药、高黏血症、高脂血症等;④早期表现为头痛、视乳头水肿、癫痫发作,伴或不伴局灶性神经功能缺损;⑤影像学表现为静脉窦闭塞及局限性梗死灶,可伴渗血或出血;⑥应用脱水、抗凝、局部溶栓及对症治疗,痊愈15例,好转6例.随访6个月～2年,所有患者腰穿压力均恢复正常,未出现脑静脉系统血栓再发和新的神经功能受损症状.结论对临床急性、亚急性起病的头痛、呕吐、伴或不伴局灶性神经功能缺损及癫痫发作的年轻患者,应高度警惕CVST,及时行CT、MRI、MRV或DSA检查,早期规范抗凝、血管内溶栓等治疗.     

颅内静脉窦血栓形成21例临床分析

目的：探讨颅内静脉窦血栓形成（CVST）的临床特征、影像特点及治疗。方法：分析21例CVST患者的发病年龄、发病形式、临床表现、影像特点及治疗。结果：①CVST以青年女性多见;②多为急性、亚急性起病;③危险因素有分娩、妊娠、炎症、口服避孕药、高黏血症、高脂血症等;④早期表现为：头痛、视乳头水肿、癫痫发作,伴或不伴局灶性神经功能缺损;⑤影像学表现为静脉窦闭塞及局限性梗死灶,可伴渗血或出血;⑥应用脱水、抗凝、局部溶栓及对症治疗,痊愈15例,好转6例。随访6个月~2年,所有患者腰穿压力均恢复正常,未出现脑静脉系统血栓再发和新的神经功能受损症状。结论：对临床急性、亚急性起病的头痛、呕吐、伴或不伴局灶性神经功能缺损及癫痫发作的年轻患者,应高度警惕CVST,及时行CT、MRI、MRV或DSA检查,早期规范抗凝、血管内溶栓等治疗。     

颅内静脉窦血栓形成16例临床分析

目的:探讨颅内静脉窦血栓形成(CVST)的临床表现。方法:回顾性分析16例CVST患者临床表现、影像学特征、脑脊液检查结果及预后情况。结果:CVST多数为急性或亚急性发病;早期表现以头痛为主15例(93.75%)、伴呕吐10例(62.5%),伴局灶性神经功能缺损或癫痫发作8例(50%);影像学表现为静脉窦闭塞伴局限性脑梗死10例,其中伴出血4例;脑脊液压力增高15例(93.75%),蛋白增高6例,白细胞计数增高4例。16例中痊愈6例(37.5%),其中4例应用尿激酶局部静脉窦溶栓治疗,2例抗凝治疗,其余10例均给予抗凝等治疗后好转出院,有效率100%。结论:对于急性发病的头痛、呕吐,伴有局灶性神经功能缺损或癫痫发作的青壮年患者,应高度怀疑CVST,及时行CT、MRI、磁共振静脉成像(MRV)等检查,必要时行数字减影血管成像(DSA)检查。一旦诊断明确,应给予尿激酶局部静脉窦溶栓或尽早选用抗凝药物治疗。     

29例脑静脉窦血栓形成的早期诊断及临床分析

目的探讨脑静脉窦血栓形成(CVST)的早期诊断及预后。方法回顾性分析29例(男11例、女18例)CVST患者的发病年龄、发病形式、首发症状、临床表现、影像学特征、脑脊液检查结果及预后情况。结果CVST发病年龄多在20~40岁;多数为急性或亚急性发病;早期表现以头痛为主26例(89.66%)、以呕吐为主16例(55.17%),伴或不伴有局灶性神经功能缺损或癫痫发作;影像学表现为静脉窦闭塞伴局限性脑梗死15例(52%),其中伴有渗血或血肿7例(24%);脑脊液压力明显增高者22例,蛋白正常17例(65.4%),增高9例(34.6%),白细胞正常20例,轻度增高6例;同型半胱氨酸增高5例(17%),均为男性患者;29例患者中,22例好转出院(75.86%),痊愈2例(6.95%),均为应用尿激酶局部静脉窦溶栓治疗患者。有4例因病情危重家属放弃治疗自动出院,有效率为82.81%,死亡1例(3.4%)。其中10例好转患者随访半年,6例仍有不同程度的颅内高压症状。结论对于急性发病的头痛、呕吐、伴或不伴有局灶性神经功能缺损或癫痫发作的青壮年患者,应高度怀疑CVST,及时行CT、MRI、磁共振动脉成像(MRA)、磁共振静脉成像(MRV)等检查,必要时行数控减影血管成像(DSA)检查。一旦诊断明确,应尽早选用肝素类抗凝药物治疗,并且要长时间足疗程。     

颅内静脉窦血栓形成46例临床分析

目的 探讨颅内静脉窦血栓形成(CVST)的临床表现及影像学改变.方法 回顾性分析46例CVST患者的发病年龄、临床表现及影像学改变.结果 CVST发病年龄多为20-45岁,常发生于围产期妇女,多数为急性或亚急性起病,临床症状以头痛、癫痫发作及肢体瘫痪为主;多伴有脑脊液压力升高;核磁共振成像静脉造影(MRV)及螺旋CT静脉成像(CTV)均可发现静脉窦不同程度的静脉闭塞、回流障碍.如能及时确诊并干预,预后较好.结论 对于急性或亚急性起病的以颅内高压为突出表现,而无明显中枢感染迹象的中青年患者,尤其是围产期或长期口服避孕药的育龄女性,应考虑CVST的可能.CTV和MRV的确诊率高,安全无创,检查方便、快捷,是目前诊断CVST的首选方法 .     

脑静脉窦血栓22例诊治分析

目的:分析脑静脉窦血栓形成(CVST)的早期诊断及治疗。方法:回顾性分析22例CVST患者临床资料。结果:平均发病年龄34岁,病因多样。临床突出表现为头痛、呕吐伴或不伴意识障碍、视乳头水肿、局灶性神经功能缺损或癫痫发作;影像学表现为静脉窦闭塞,约50%患者可见静脉性梗死,出血性梗死常见。对因脱水基础上积极抗凝治疗。结论:以头痛起病,伴或不伴意识障碍、局灶神经功能缺损或癫痫发作的青壮年,应高度怀疑CVST,检查首选MRI和MRV,应尽早积极抗凝治疗。     

颅内静脉窦血栓形成的早期诊断及分析

目的：探讨静脉窦血栓（CVST）形成的早期诊断及影像学的特点和治疗。方法：回顾性分析我科2006～2008年6例患者的发病年龄,发病形式,首发症状,影像学特征及脑脊液检查和治疗情况。结果：CVST发病年龄30—60岁,多为急性发病。6例患者中。男4例．女2例。结论：对急性发病的头痛、呕吐伴或不伴有局灶性神经功能缺损或癫痫发作的青壮年患者应高度怀疑CVST,尤其是有鼻面部感染、中耳炎、产后或服避孕药、全身消耗等诱因的,应及时做CT、MRA、MRV检查。明确诊断后尽早选用抗凝药物。     

静脉窦血栓的临床分析

目的:探讨静脉窦血栓(CVST)的临床诊断和治疗。方法:回顾性分析30例静脉窦血栓患者的临床资料,包括患者的临床表现及检查项目和治疗方法、疗效进行临床分析。结果:CVST患者多为青年患者,急性或亚急性起病,早期表现多为头痛,恶心呕吐,伴或不伴神经功能的缺损及癫痫发作。腰穿检查可以发现患者脑脊液压力增高,影像学检查可以发现患者静脉窦及脑实质的异常信号。临床主要采取脱水、抗凝、溶栓为主要治疗方法。多数患者疗效满意。结论:对于中青年头痛,呕吐患者,需注意行MRI+MRV检查排除是否有CVST,必要时进行DSA检查,一旦确诊,立即给予抗凝,溶栓等治疗。     

颅内静脉窦血栓形成32例临床分析

目的:探讨脑静脉窦血栓形成(CVST)的早期诊断及治疗.方法:分析5年来收治32例CVST患者的临床诊治及转归资料.结果:32例均经头颅CT、磁共振成像(MRI)早期诊断,有5例经数字减影血管造影(DSA)确诊,经溶栓、抗凝治疗后1例死亡,余均好转.结论:CVST临床表现各异,首发症状多为头痛、癫痫、精神障碍、肢体活动障碍,误诊率高,对于急性、亚急性或慢性发病的头痛、呕吐、伴或不伴有局灶性神经功能缺损或癫痫发作的青壮年患者,应高度怀疑CVST,及时行CT、MRI、磁共振静脉成像(MRV)等检查,必要时行DSA检查.DSA是确诊的金标准.一旦确诊,应尽早选用抗凝药物治疗,并且要长时间足疗程.     

磁共振影像在脑静脉和静脉窦血栓诊断中的价值

目的探讨MRI和MRV对脑静脉和静脉窦血栓（CVST）形成的诊断价值。方法回顾性分析16例CVST患者的临床和影像学资料。结朵多为中青年,急性或亚急性起病,临床表现为头痛、呕吐、伴或不伴局灶神经功能缺损症状或癫痫发作,影像学表现为静脉窦闭塞及静脉性梗死及脑出血灶,MRV表现为受累静脉窦部分或广泛高血流信号的缺失、狭窄。应用脱水、抗凝、溶栓治疗。16例中13例完全恢复正常,3例死亡。结论MRI和MRV是诊断和随访CVST形成的最佳检查方法,对脑静脉、静脉窦血栓的诊断优于cT,可替代创伤性的DSA检查。     

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.