艾滋病合并肺部真菌感染的CT表现分析

目的探讨艾滋病合并肺部真菌感染的CT表现特点,提高影像诊断水平.方法回顾性分子92例经确诊的艾滋病合并肺部真菌感染的CT表现,进行分类分析讨论.结果艾滋病合并肺部真菌感染的菌株种类有:肺孢子菌62例(占67.40%)、曲霉菌16例(占17.40%)、白色念珠菌8例(8.70%)、隐球菌6例(占6.53%)、混合性感染17例(占18.48%).其主要CT表现为:⑴肺孢子真菌感染:表现为双肺对称性分布的云雾状、毛玻璃阴影及斑片状实变影;⑵曲霉菌感染:①表现为厚薄不同的空洞,内常见半球形的附壁结节及游动性球节、团块影,周围可见磨玻璃样的晕影环绕,即“晕征”;⑶白色念珠菌感染:为延支气管分布的斑片影及实变影,部分伴有树芽征或结节伴有晕征及胸水;⑷隐球菌感染:多态、多样、多病灶为特征;⑸混合性感染:更为多态多样,与合并的感染菌株类型不同而不同.结论 AIDS并合肺部真菌感染,不同菌株的感染其CT表现各不相同,各具有特征性,但不特异性,影像学结合病原学不难做出诊断.     

艾滋病合并肺部真菌感染的CT表现分析

目的 探讨艾滋病合并肺部真菌感染的CT表现特点,提高影像诊断水平.方法 回顾性分析92例经确诊的艾滋病合并肺部真菌感染病例的CT表现,进行分类分析讨论.结果 艾滋病合并肺部真菌感染的菌株种类有:肺孢子菌62例、曲霉菌16例、白色念珠菌8例、隐球菌6例、混合性感染17例.其主要CT表现为:⑴肺孢子菌感染:表现为双肺对称性分布的云雾状、毛玻璃阴影及斑片状实变影;⑵曲霉菌感染:①表现为厚薄不同的空洞,内常见半球形的附壁结节及游动性球形灶,即形成所谓的"空气新月征"及"滚珠征".②大片致密影以及沿支气管分布的小斑片影.③单个或多个结节、团块影,周围可见磨玻璃样的晕影环绕,即"晕征";⑶白色念珠菌感染:为沿支气管分布的斑片影及实变影,部分伴有树芽征或结节周围伴有晕征及胸水;⑷隐球菌感染:多态、多样、多病灶为特征;⑸混合性感染:更为多态多样,与合并的感染菌株因类型不同而不同.结论 AIDS合并肺部真菌感染,不同菌株的感染其CT表现各不相同,各具有特征性,但不具特异性,影像学结合病原学不难做出诊断.     

艾滋病合并肺结核与合并肺孢子虫肺炎的影像学比较研究

目的 分析艾滋病病人合并肺结核（TB）与合并卡氏肺孢子虫肺炎（PCP）的影像学特征差异，探讨其鉴别诊断。方法 回顾性分析32例CD4细胞低200个/μL的艾滋病病人，19例感染肺结核，13例PCP，分别比较病变的影像学特征与病变的分布范围。结果 PCP与TB比较，影像学上毛玻璃密度影、斑片状渗出、大小不等结节两组间差别无显著性（P〉0．05）。两组病变均可能出现病变多于3个肺野（84．62％，63．16％，P〉0．05）。感染TB时，粟粒结节、增殖病变、空洞、肺外感染、胸水，虽然发生率稍高，但两组间差别仍无显著性（P〉0．05）。肺门及纵隔淋巴结肿大时多为TB（P〈0．05），PCP更多出现肺大片实变与肺气囊（P〈0．05）。TB病变多位于上肺尖段或下叶背段（42．11％，7．69％，P〈0．05），病变的发展多由上肺往下肺进行（31．58％，P〈0．05）。患PCP时，病变主要位于下肺（53．85％，15．79％，P〈0．05），其发展主要由下肺往上肺（38．46％，5．26％，P〈0．05），由肺门向外带（30．77％，P〈0．05）。结论 在艾滋病期，当CD4细胞计数〈200个/μL时，感染TB与PcP均可能出现毛玻璃影、大小不等结节影，双肺弥漫性改变。TB更多出现肺门及纵隔淋巴结肿大，病变多在上肺尖段及下叶背段，由上向下蔓延。出现大片实变，肺气囊，病变由下肺向上蔓延，由肺门为中心向外扩展，则诊断为PCP。     

艾滋病合并肺结核患者普通胸片影像分析

目的探讨艾滋病（AIDS）合并肺结核患者普通胸片的影像学特征,以提高其诊断水平。方法收集2007～2009年73例艾滋病合并肺结核患者的普通胸片影像资料,与98例单纯性肺结核患者的影像表现进行对比分析。结果AIDS合并肺结核与单纯性肺结核患者相比,病变累及部位及范围均有统计学意义（P〈0．05）;AIDS合并肺结核患者斑片和（或）大片实变影、多发空洞、多发结节影、纵隔（或）腋下淋巴结肿大、胸腔积液影出现几率明显高于单纯性肺结核患者。结论AIDS患者胸部影像学征象表现呈多肺叶、大片状、多发空洞、纵隔淋巴结肿大时,应首先考虑肺结核的可能。     

艾滋病合并肺结核的影像学研究

目的 探讨艾滋病合并肺结核的CT特点.方法 回顾性分析经病理证实的32例艾滋病合并肺结核的CT表现.结果 病变好发部位及累及范围对比：病变弥漫性累及双肺、病变累及双肺上叶尖后段和（或）下叶背段、病变仅累及肺基底部或（和）舌叶、中叶、上叶前段组间的出现率之间的差异有统计学意义（P值分别为＜0.01,0.001,0.029）.病变性质特点对比：局限性斑片状或部分融合成大片阴影、多发结节影、胸内结核性淋巴结肿大、结核性胸膜炎出现率组间的差异有统计学意义（P值分别为0.040,＜0.01,＜0.01,0.018）.大片实变影液化坏死经引流支气管排出形成多发小空洞出现率两者差异有统计学意义（x2=4.222,P=0.040）.结论 由于AIDS患者CD4T细胞数减少,免疫抑制的严重缺陷,AIDS合并肺结核CT表现以多叶或弥漫性粟粒样分布为主,渗出伴实变,伴淋巴结肿大,胸腔积液或胸膜增厚常见,且常常是多种不典型征象并存、大片实变影内液化会死形成多发小空洞发生率明显增高.     

老年右肺中叶病变纤维支气管镜检价值的探讨

为探讨老年人右肺中叶病变的病因及纤支镜检的价值，我们对36例老年人右肺中叶病变患者进行了纤支镜检查。结果肺癌占58．3％（21／36）、肺炎占33．3％（12／36）、肺结核占8．3％（3／36）。总确诊率为86．1％，肺癌为85．7％，肺炎为91．7％。提示老年人中叶病变的原因以肺部恶性肿瘤为常见。表明纤支镜检对右肺中叶病变的诊断可靠、快速，结果较为满意。     

综合性医院艾滋病患者肺部病变26例临床分析

目的探讨艾滋病患者肺部病变的临床和诊断要点。方法回顾分析我院（综合性医院）2005年1月-2006年12月期间收治26例艾滋病合并肺部疾病的临床资料。结果26例艾滋病合并肺部疾病的发生率为70．27％（26／37）,以发热（84．62％）及呼吸系症状为主诉者（76．92％）是常见的首发症状,本组患者首诊入院及拟诊科室多为呼吸内科,且多为医师主动筛查;艾滋病的肺部表现主要为胸部CT呈肺部毛玻璃样改变（GGO）,占38．46％,及／或肺炎（23．08％）．以及肺结核（38．46％）。以呼吸道症状入院17例,其中咳嗽咳（黄）痰13例,气促、喘气、呼吸困难11例;以发热消瘦皮疹淋巴结肿大等入院5例;以意识障碍入院2例;以浮肿、腰部不适入院2例。有颅内病变3例,肝硬化1例,淋巴瘤1例,剥脱性皮炎2例,急性肾衰竭1例,败血症及感染2例。口腔霉菌感染2例,猪霍乱沙门菌败血症1例,严重手部感染不愈1例,合并呼吸衰竭6例。结论我国艾滋病患者的肺部病变主要为以胸部CT改变以CGO为特征的肺部弥漫性病变、肺结核及肺部炎症,及时识别艾滋病的肺并发症是延长患者生命的重要手段之一。     

46例小儿支原体肺炎胸部CT比较分析

目的分析46例小儿支原体肺炎的胸部CT,提高本病的影像学诊断水平。方法采用回顾资料方法,选择2011年6月-2011年12月入住我院儿科治疗支原体肺炎的46例患儿的CT资料进行比较分析。结果单侧肺叶病变者34例占73.9%(其中右侧者20例,占58.8%,左侧者14例,占41.2%),双侧病变者12例占26.1%;单叶段病变者20例占43.5%,多叶段病变者26例,占56.5%。病变累及分布右侧肺上叶14例、中叶6例、下叶21例;左侧肺上叶16例、中叶6例、下叶18例。其中,肺段实质浸润性病变(大片实变影)共32例;肺小叶实质浸润性病变(斑点状或斑片状实变影)30例;肺间质浸润性病变(散在斑点或斑片状影)10例,磨玻璃影4例,多数多叶片病变中大片实变影和斑点或斑片状实变影共同存在。此外,其他病变还包括肺门淋巴结肿大3例,胸腔积液11例,肺不张2例。经系统治疗后,肺间质浸润性病变10例治疗后7天内复查CT发现病灶全部吸收;肺实质浸润性病变36例中,7天内病灶吸收11例,14天内13例,21天内7例,5例超过21天病灶吸收者均合并有其他脏器受累情况。结论支原体肺炎患儿胸部CT表现有一定特点,单侧多于双侧,右肺多于左肺,大片实变影最常见,其次是斑点状或斑片状实变影,最少是散在斑点或斑片状影,根据这些特点可以立于本病早期诊断和治疗,并可以确定治疗效果。     

小儿支原体肺炎54例胸部CT影像分析

目的分析总结小儿肺炎支原体肺炎（MPP）胸部CT影像学特点。方法回顾性分析本院儿科2010年9月—2011年2月间明确诊断的54例MPP患儿的临床资料及胸部CT。结果胸部CT显示病变部位：单侧者39例（72.22%）,双侧者15例（27.78%）;单侧中右侧者20例（51.28%）,左侧者19例（48.72%）;多个叶段受累30例（55.56%）多于单个叶段受累24例（44.44%）,各受累叶段分布情况为：右下叶18例（33.33%）,左下叶15例（27.78%）,左上叶11例（20.37%）,右上叶7例（12.96%）,右中叶7例（12.96%）,左中叶2例（3.70%）;病变性质显示为大片实变影31例（57.41%）,斑点状及斑片状实变影22例（40.74%）,云絮状或磨玻璃样或网格样密度增高影各1例（1.85%）,双肺散在斑片影7例（12.96%）,其中非单个叶段受累者大片实变与斑点状及斑片状实变多同时存在。其他病变还有胸腔积液14例（25.93%）,肺门淋巴结肿大7例（12.96%）,肺不张7例（12.96%）,心包积液1例（1.85%）。婴幼儿MMP胸部CT以散在斑片影为主,年幼儿以斑点状及斑片状实变影为主,年长儿则多表现为大片实变影。结论小儿MPP单侧病变多于双侧,右肺病变多于左肺,大片实变影最多,其次为斑点及斑片状实变影,也可见双肺散在斑片影。其影像学特点与年龄有关。胸部CT影像学特点有助于婴幼儿及年幼儿MPP的诊断及儿童MPP的早期诊断。     

侵袭性肺部真菌感染CT表现

目的 探讨侵袭性肺部真菌感染（IPFI） CT表现特点.方法 回顾性分析71例IPFI患者的CT检查资料和病历资料.观察三种主要CT表现在肺野内分布情况,比较不同免疫状态IPFI患者CT表现.结果 IPFI主要CT表现为结节或肿块、肺内实变影及磨玻璃影,病变以两肺分布为主（P＜0.05）,结节或肿块、肺内实变影下肺野分布率高于上肺野（P＜0.05）,肺野外周区域分布率高于肺野中央区域（P＜0.05）.免疫抑制患者多发肺实变率高于免疫正常患者,而单发肺实变率低于免疫正常患者,胸腔积液发生率高于免疫正常患者,差异均有统计学意义（P＜0.05）.结论 IPFI主要CT表现为结节或肿块、肺内实变影及磨玻璃影,而结节或肿块影以两肺下野及外周区域分布为主,不同免疫状态IPFI患者CT表现有所不同,多发肺内实变影常多见于免疫功能低下患者,而单发实变影则多见于免疫功能正常患者.     

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.