彩色多普勒与超声弹性成像对甲状腺良恶性结节的诊断价值分析

目的探讨彩色多普勒血流显像（ColorDopplerFlowImaging,CDFI）与超声弹性成像（UltrasoundElastogra—phy,UE）对甲状腺良恶性结节的诊断价值。方法选取甲状腺结节患者67例,共90个病灶,行CDFI、UE检查,所有结节均经手术病理证实,计算CDFI、UE评分法诊断甲状腺良恶性结节的敏感性、特异性、准确性。结果CDFI鉴别甲状腺良恶性结节的敏感性、特异性、准确性分别是61．9％、75．4％、72．2％;UE分别为71．4％、88．4％、84．4％。两者之间的准确性比较,差异有统计学意义（P〈0．05）。结论UE对甲状腺良恶性结节的鉴别诊断价值高于CD—FI     

超声造影对颈部肿大淋巴结良恶性的鉴别诊断

目的探讨超声造影在颈部肿大淋巴结良、恶性鉴别诊断中的应用价值。方法对就诊于我院60例92枚颈部肿大淋巴结进行常规超声与超声造影检查,观察淋巴结的灌注分布类型并对其时间-强度曲线进行分析,并与手术病理诊断结果对照,比较造影前后超声诊断的准确性。结果超声造影显示,良性淋巴结造影以均匀强化为主（34/42）;恶性淋巴结以不均匀强化为主（38/50）。良性淋巴结时间-强度曲线形态以快退为主,恶性淋巴结以慢退为主。92枚淋巴结穿刺或术后病理证实,良性淋巴结42枚,恶性淋巴结50枚。常规超声诊断的敏感性为76%,特异性为80%,准确性为78%;超声造影敏感性为92%,特异性为95%,准确性为93%。结论超声造影可以对颈部肿大淋巴结进行良恶性鉴别的定性诊断提供有价值的依据。     

~(99)TC~m-MIBI核素显像对鉴别诊断乳腺肿物良恶性及乳癌腋下淋巴结转移的评价

目的：评价(99m)锝-甲氧基异丁基异腈（(99)TCm－MIBI）核素闪烁显像对诊断及鉴别诊断乳腺良、恶性包块和腋下淋巴结转移癌的临床价值．方法：对67例临床拟诊的乳腺包块患者进行了99TCm－MIBI乳腺核素前位及侧位闪烁显像（SMM）诊断．全部影像结果均与病理组织检查对照．结果：99TCm－MIBI显像诊断与鉴别诊断乳腺良、恶性肿物的灵敏度、特异性和总诊断符合率分别为92．0％，85．7％及88．1％．对25例病理学证实为乳腺癌患者腋下淋巴结转移瘤的诊断灵敏度、特异性和正确诊断率分别是71．4％，90．9％及80．0％．结论：99TCm－MIBI核素乳腺显像对诊断及鉴别诊断乳腺良、恶性包块及腋下淋巴结转移癌具有较好的临床应用价值，是一个灵敏、特异、安全、无创的好方法．     

血清CA125、CA199联合多普勒超声血流显像对卵巢上皮性肿瘤的诊断价值

目的：探讨血清CA125、CA199联合多普勒超声血流显像在早期卵巢上皮性恶性肿瘤诊断中的价值。方法：对2006年1月～2008年12月我院的102例卵巢上皮性肿瘤患者及42例对照组妇女分别进行血清CA125、CA199及多普勒超声检测,并分别以血清CA125〉35kU／L、CA125〉100kU／L,CA199〉37kU／L、CA199〉70kU几,阻力指数（RI）〈0．5、RI〈0．6作为阳性结果．比较各种指标对卵巢上皮性恶性肿瘤预测的敏感性、特异性、阳性预测值和阴性预测值。结果：卵巢上皮性恶性肿瘤患者血清CA125、CA199水平明显高于对照组和良性肿瘤组,而良性肿瘤组和对照组间无显著性差异（P〉0．05）。多普勒血流显像：恶性肿瘤组RI显著低于良性肿瘤组。单独应用CA125〉100kU／L敏感性为78．4％,特异性为88．4％,单独应用CA199〉70kU／L敏感性为49．0％,特异性为86．0％。多普勒超声（RI〈0．5）联合上述两种血清学指标,敏感性为94．2％,特异性为95.3％。结论：血清CA125、CA199联合多普勒超声血流显像可明显提高卵巢上皮性恶性肿瘤诊断的敏感性和特异性。     

良恶性胆道梗阻的CT、MRI诊断(附65例病例分析)简

目的对65例良、恶性胆道梗阻患者的CT、MRI影像资料进行分析,探讨CT、MRI成像各自在良、恶性胆道梗阻诊断方面的优缺点,提高对良、恶性胆道梗阻的诊断率。方法收集65例临床诊断为梗阻性黄疸的病人,行上腹部CT检查,同时行MRI、MRCP检查,所有病例均经手术及病理确诊。对其影像学征象进行统计分析,分别计算出各征象对胆道梗阻诊断的敏感性、特异性及准确性。结果以病理结果为标准,各征象的诊断敏感性、特异性及准确性如下：在CT上,结石的敏感性91．3％、特异性100％、准确性96．9％;管壁毛糙的敏感性90．6％、特异性100％、准确性95．4％;胆管壁不均匀增厚的敏感性82．8％、特异性100％、准确性93．8％;管壁强化的敏感性94．7％、特异性100％、准确性96．9％;实质性肿瘤及肿大淋巴结的敏感性100％、特异性97．5％、准确性98．5％;胆管扩张的敏感性100％、特异性100％、准确性98．5％;杯口征的敏感性87．0％、特异性100％、准确性95．4％;乌嘴征的敏感性92．6％、特异性100％、准确性96．9％;双管征的敏感性、特异性、准确性均为100％;在MRI上,结石的敏感性82．6％、特异性100％、准确性93．8％;管壁毛糙的敏感性84．4％、特异性100％、准确性92．3％：胆管壁不均匀增厚的敏感性65．5％、特异性100％、准确性84．6％;管壁强化的敏感性97．4％、特异性100％、准确性98．5％;实质性肿瘤及肿大淋巴结的敏感性、特异性、准确性均为100％;胆管扩张的敏感性、特异性、准确性均为100％;杯口征的敏感性95．7％、特异性100％、准确性98．5％;鸟嘴征的敏感性、特异性、准确性均为100％;双管征的敏感性、特异性、准确性均为100％;结论CT、MRI在显示胆道梗阻的直接、间接征象方面各有优缺点,两种检查方法相结合有助于明确良、恶性胆道梗阻诊断。     

超声弹性成像在乳腺BI-RADS4级病变中的应用价值

目的探讨超声弹性成像对乳腺BI-RADS4级病变良恶性鉴别的应用价值。方法对乳腺65个常规超声BI—RADS4级评分病灶,以术后病理结果为金标准,分析超声弹性图评分、弹性指数及病灶与同深度腺体组织的弹性比值对其良恶性鉴别诊断的应用价值,并构建弹性比值受试者工作特征曲线。结果65个病灶（良性17个,恶性48个）中超声弹性图评分对BI—RADS4级病变良恶性鉴别诊断的敏感性、特异性和准确性分别为81．3％、70．6％和78．5％。良恶性病灶弹性比值差异有统计学意义（P〈0．05）。应用弹性比值鉴别BI．RADS4级乳腺病灶良恶性的曲线下面积为0．753,当弹性比值诊断界值取2．7时,其敏感性66．7％,特异性77．8％。结论超声弹性成像对BI—RADS4级病变良恶性鉴别有较高应用价值。     

SUV小于2．5的孤立性肺结节18F—FDGPET／CT诊断价值初探

目的正电子断层显像（PET）通常以标准摄取值（SUV）≥2．5为肺癌诊断标准,但仍有部分SUV〈2．5的孤立性肺结节（SPN〈2.5）为肺癌。本研究旨在分析SPN〈2.5,氟代脱氧葡萄糖（18F—FDG）PET／CT表现及其诊断价值。方法51例18F—FDGPET／CT早期显像SUV平均值（SUVavg）〈2．5的孤立性肺结节病人纳入研究。对SPN放射性摄取测量采用两种方法：视觉分析及半定量分析。测量SPN的早期及延迟显像的SUVavg、SUVmax及其早期一延迟变化率（△SUVavg、△SUVmax）。37例以病理诊断及14例以2年以上临床随诊结果为最终诊断标准。统计学分析采用SPSS16．0软件。结果51例SPN〈2.5患者中,良性11例,恶性40例。虽然良恶性SPN〈2.5患者各项SUV值间均无统计学差异（P〉0．05）,但恶性SPN〈2.5,患者各项SUV值均有高于良性的趋势,特别是ASUVavg、ASUVmax。以ASUVmax〉0为诊断阈值,18F—FDGPET／CT诊断恶性SPN的敏感性68．4％、特异性60．0％、准确性66．7％、阳性预测值86．7％及阴性预测值33．3％。视觉分析：无FDG摄取的SPN〈2.5 9例中,5例为良性,4例为恶性;有FDG摄取的SPN〈2.5 42例中,6例良性,36例恶性,两组之间有显著的统计学差异,P=0．02。良恶性SPN〈2.5的CT密度及大小之间均无统计学差异（P〉0．05）。综合PET和CT信息分析SPN〈2.5,18F—FDGPET／CT诊断恶性SPN〈2.5的敏感性97．5％、特异性54．5％、准确性88．2％、阳性预测值88．6％、阴性预测值85．7％。结论单纯以SUV≥2．5为标准鉴别诊断SPN会导致肺癌的漏诊。对于此类结节,ASUV有较高的肺癌阳性预测值;FDG摄取视觉分析能提高结节的良恶性鉴别准确率;综合FDGPET和cT分析的PET／CT能显著提高诊断肺癌的敏感性和准确性,但特异性较低。     

彩超诊断良恶性浅表肿大淋巴结的应用价值

目的 探讨浅表淋巴结良恶性病变中彩色多普勒超声诊断的价值.方法 观察50例浅表淋巴结肿大患者的150个浅表淋巴结的纵径/横径(L/S)值.内部回声,CDFI和PW频谱特征.结果 良.恶性肿大淋巴结的L/S值分别为(2.07±0.2),(1.6±0.25).四项指标中L/S值及RI差异有非常显著性(P＜0.001).结论 通过分析淋巴结超声测量的L/S值,结合淋巴结内部回声,CDFI和频谱分折,对淋巴结的良恶性鉴别具有临床实用价值,可作为淋巴结诊断的首选方法.     

^18F-FDG PET延迟显像技术在肺良恶性病变鉴别诊断中的应用

目的探讨^18F-脱氧葡萄糖（FDG）PET延迟显像对肺良恶性病变的鉴别诊断价值。方法对36例肺癌患者和20例肺良性病变患者分别进行^18F-FDGPET早期头部至盆腔显像和注射后3h胸部延迟显像,测定两次显像病灶的标准摄取值（SUV）,并计算^18F-FDG的储留指数（RI）。结果肺癌组延迟显像SUV明显高于肺良性病变组（P〈0．01）,肺癌组的砌也明显高于肺良性病变组（P〈0．01）;对于早期显像SUV〉2．5的肺部结节,以RI〉20％为阈值,延迟显像对肺良恶性病变鉴别诊断的灵敏度、特异性和准确性分别为90．0％、80．0％和86．7％。结论^18F-FDGPET延迟显像有助于肺良恶性病变的鉴别诊断,结合应用SUV及RI两项指标可提高诊断准确率。     

淋巴结肿大的超声诊断与手术病理的对比研究

目的对比手术病理结果,分析超声在淋巴结性质诊断中的临床应用价值。方法回顾性分析2011年10月～2013年10月江西省玉山县中医院就诊并发现淋巴结肿大的患者共110例,应用彩色多普勒超声诊断仪并高频探头,二维超声观察肿大淋巴结声像图特征,彩色多普勒血流显像观察肿大淋巴结血流特征。结果良性肿大淋巴结长短径之比〉2,门部回声规则且强,内部血流多呈条状规则分布;恶性肿大淋巴结长短径之比〈2．门部强回声消失或偏移,内部血流信号多呈网状或沿周边分布。恶性肿大淋巴结皮质部回声、最大血流速度【淋巴结炎（9．3±3．4）cm／s、反应性肿大淋巴结（82士21）cm／s、恶性淋巴瘤（17．5士6．7）cm／s、淋巴结转移癌（15．4±5．5）】和阻力指数（淋巴结炎、反应性肿大淋巴结〉0．65,恶性淋巴瘤、淋巴结转移癌〈o．60）均明显低于良性肿大淋巴结（P〈O05）。结论在肿大淋巴结性质的初步判断中,超声检查特异性显著,对临床治疗具有非常重要的指导价值,值得广大临床推广应用。     

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.