MR在剥脱性骨软骨炎中的应用

目的:探讨MRI在剥脱脱性骨软骨炎影像诊断中的价值。方法:收集经临床手术病理或关节镜证实的剥脱性骨软骨炎的MRI资料17例,分析其MRI表现特点。结果:17例中膝关节内外侧髁14例,距骨滑车3例,其不同病程的MRI表现与关节镜或手术病理所见一致。结论:剥脱性骨软骨炎的MRI表现具有特征性,MR是诊断该病的理想检查方法。     

手术治疗髌骨骨软骨骨折的体会

髌骨骨软骨骨折是髌骨骨折的一种特殊类型,指髌骨关节面骨软骨剥脱性骨折,临床少见。由于骨折块不带或仅带少量骨质,X光片有时难以显示,极易漏诊而延误治疗,导致预后不佳。2005年2月～2007年12月,我院采用关节镜检及镜下手术或切开复位内固定手术治疗髌骨骨软骨骨折28例,取得了良好疗效,现报道如下。     

关节镜下自体软骨移植修复中青年软骨缺损疗效观察

目的：探讨关节镜下取非负重区软骨替代负重区病变软骨自体软骨镶嵌式移植修复软骨缺损的方法。方法：2004年3月-2008年4月共30例中青年关节面软骨缺损患者，在关节镜下采用镶嵌式骨软骨移植术，将膝关节非负重关节面骨软骨条，移植修复膝关节负重面的病灶性软骨缺损。结果：术后随访9个月-32个月，平均17个月，患者关节活动度良好，疼痛症状基本消失，复查MRI结果显示软骨缺损区表面光滑，移植的骨软骨柱位置良好。结论：关节镜下自体软骨移植具有疗效好，创伤小，且避免异体移植产生的排斥反应及疾病传播，是修复软骨缺损的好方法。     

原发性膝关节骨关节病的磁共振成像与关节镜对照研究

目的 通过与关节镜对照,探讨磁共振成像(M砒)对原发性膝关节骨关节病的诊断价值.方法 观察38例原发性膝关节骨关节病患者MRI上关节软骨、软骨下骨质的异常信号特点及骨质增生情况;分析关节软骨的关节镜与MRl分级之间的相关性.结果 共35例患者有髌骨骨质增生,以50岁以下为多见.MRI上关节软骨Ⅰ、Ⅳ级信号少(7、10处),Ⅱ～Ⅲ级信号最多(95处),MRI分级与关节镜分级之间有相关性(r=0.658～0.785;P均<0.0001),但关节镜下Ⅳ级病灶易被MRI判为Ⅱ～Ⅲ级信号.23例患者出现软骨下骨质异常信号,多发生于髌骨和股骨内髁.结论 MRI能清楚显示膝关节骨关节病的病变特点和严重程度.     

股骨头骨骺剥脱性骨软骨炎的X线、CT诊断分析

目的探讨股骨头骨骺剥脱性骨软骨炎的影像诊断要点。方法分析6例经手术病理证实的股骨头骨骺剥脱性骨软骨炎患者的临床表现、X线及CT征象。结果 X线、CT表现为股骨头骨质局限凹陷,边缘不规则硬化2例,薄层硬化4例。术后半年随访复查股骨头骨骺均恢复正常形态。结论剥脱性骨软骨炎早期X线多无发现。发生在股骨头骨骺的应与股骨头无菌坏死和早期边缘性骨结核鉴别。该病因关节软骨和软骨下骨缺血坏死,骨质破坏仅侵犯骨骺的靠关节面边缘,病灶较局限,呈浅勺状,而骨骺的其他部位骨质无破坏,无死骨存在,临床髋部疼痛病史长、无低热,这些均是该病的诊断要点。     

MRI 诊断髌骨软化症

目的：观察 MRI 对髌骨软化症的诊断意义。方法对86例膝关节 MRI 扫描图像进行认真分析,观察了解髌骨的软骨信号变化,有无厚薄、高低,有无缺损及中断以及软骨下骨质信号的改变情况;除了观察髌骨软骨的变化情况以外,同时观察股骨髁面关节软骨变化状况,了解有无软骨下骨质异常变化。结果 MRI 检查具有无创性,并且可以显示关节各处的微小细节构造,如韧带及关节软骨。髌骨软化症晚期可以利用X 线及 CT 诊断发现,但是 MRI 相比于 X 线和 CT 检查更利于该病症的早期发现,使得其在临床上更具有诊断价值。结论MRI 诊断髌骨软化症具有重要意义。     

0.5T磁共振诊断膝关节软骨损伤的评价

目的 探讨低场强磁共振对膝关节软骨损伤的诊断价值及其临床意义。方法 分析31例有膝关节外伤病史，且经关节镜和／或手术证实为关节软骨损伤患者的MRI表现，并与关节镜和／或手术结果对照。结果 31例膝关节软骨损伤患者中有29例在MRI上表现异常，其中显示软骨信号异常14例，软骨信号异常伴局限性缺损13例，软骨缺损伴软骨下骨损伤14例。MRI还发现关节镜无法观察到的骨挫伤、隐匿性骨折等改变。结论 磁共振对膝关节软骨损伤的显示较准确，结合临床及关节镜检查可准确评价膝关节损伤的范围，程度。     

低场强磁共振成像诊断髌骨软化症42例

目的分析髌骨软化症低场强MRI及影像学分期表现。方法对60例疑似髌骨软化症病人髌股关节MRI扫描,其中42例诊断为髌骨软化症,均与关节镜作对比。结果Ⅰ期（4例）为软骨内点状低信号,Ⅱ期（6例）为软骨凹凸不平,有局限性变薄,Ⅲ期（14例）为软骨明显不光整,局部有软骨的缺损,Ⅳ期（18例）软骨缺损同时有骨性关节面侵蚀,与关节镜下分期基本吻合。结论低场强MRI诊断髌骨软化症很有价值,采用梯度回波扫描,尤其是GET1WI在诊断有独特的优势。     

踝关节损伤致距骨剥脱性骨软骨炎漏诊原因分析

目的分析踝关节损伤致距骨剥脱性骨软骨炎的漏诊原因.方法 通过总结分析2007年3月~2011年2月我院就诊的踝关节损伤患者共176人病例资料及关节镜手术所见,寻找存在距骨剥脱性骨软骨炎漏诊的患者.结果 就诊的176人中存在距骨剥脱性骨软骨炎的27人,伤后即行MRI检查明确诊断的15人,后期MRI检查诊断的12人,我院此期间的漏诊率为44.4%.结论 医生的经验不足、医院无MRI检查设备或检查费用昂贵患者不能承担及患者对自身疾病的认识不足是导致距骨剥脱性骨软骨炎的漏诊原因.     

强直性脊柱炎骶髂关节病变的早期影像学诊断

目的 探讨强直性脊柱炎骶髂关节病变早期的影像学诊断价值.方法 收集经临床确诊的21个强直性脊柱炎早期病例,回顾分析其骶髂关节DR、CT及MRI表现.结果 DR仅发现5例骶髂关节可疑异常.CT显示19例骶髂关节病变,主要表现有关节面皮质白线中断(17例),局部骨质硬化(14例),骨皮质下小囊样改变(8例).MRI显示21例关节均为异常,主要表现有关节面下骨髓水肿(21例),关节软骨破坏(20例);9例行增强扫描,关节面下骨髓(9例)、滑膜(6例)、关节软骨(8例)及关节韧带(5例)呈现不同程度强化.结论 强直性脊柱炎的早期影像学诊断,X线检查最为基本,但诊断意义有限;CT对分级较为客观,且能较好地显示骨质病变情况;MRI具有明显优势,结合临床,可做出早期诊断.     

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.