骶髂关节斜冠状位高分辨率CT的临床应用

<正>骶髂关节解剖结构复杂、涉及病变较多,传统X线检查诊断的价值不大。常规CT轴位扫描仍存在诸多不足。本文探讨了骶髂关节斜冠状位高分辨率CT(HRCT)扫描方法及临床应用,旨在提高对骶髂关节病变诊断的准确率。1资料与方法1.1一般资料:选取临床资料较完整、临床拟诊骶髂关节病变患者53例行骶髂关节斜冠状位HRCT扫描。其中男性32例,女性21例,年龄17⁷4岁,平均(56±7)岁。     

利用MRI对10岁～20岁正常人骶髂关节软骨厚度的研究

目的探讨利用MRI测量10岁～20岁健康志愿者骶髂关节软骨厚度,更确切了解正常骶髂软骨,为骶髂关节病变早期诊断和动态观察提供依据。方法随机选择30例10岁～20岁健康志愿者及一具20岁女性尸体,行MRI3D-WATS斜冠状面扫描,测量骶髂关节软骨的总厚度及骶侧、髂侧软骨的厚度;尸体标本选择与MRI图象相对应的骶髂关节层面切开,取骶髂关节滑膜部一块,光镜观察。结果3D-WATS序列可分辨骶侧软骨、髂侧软骨及两者之间的间隙。相关分析表明,年龄与骶髂关节软骨厚度呈负相关,骶侧软骨厚度较髂侧软骨厚。结论10岁～20岁健康志愿者的骶髂关节软骨厚度随年龄增长,有逐渐变薄的趋势。     

强直性脊柱炎临床及骶髂关节HRCT表现

目的:总结强直性脊柱炎骶髂关节的HRCT表现。方法:分析50例临床确诊强直性脊柱炎病例的骶髂关节HRCT资料。结果:50例中42例有骶髂关节异常表现。包括:Ⅰ级14例;Ⅱ级18例;Ⅲ级6例;Ⅳ级4例。结论:骶髂关节CT检查有助于强直性脊柱炎的早期诊断,高分辨率CT(HRCT)扫描能提高诊断的准确率。     

强直性脊柱炎骶髂病变的HRCT及曲面重建诊断价值分析

目的分析HRCT结合曲面重建在诊断强直性脊柱炎(AS)骶髂关节病变的诊断价值。方法对96例临床明确诊断AS患者的骶髂关节行高分辨CT扫描及曲面重建,分析其影像表现。结果骶髂关节炎可以双侧或单侧。早期(CTⅠ～Ⅱ级)48例,多累及髂骨侧,表现为骶髂关节髂骨面下小虫蚀样破坏或微小囊变,关节面下轻微硬化,关节面皮质白线中断,略毛糙。中期(CTⅢ级)34例,双侧受累,关节面及关节面下骨侵蚀破坏,呈锯齿样或毛刷样改变,周围骨增生硬化明显,关节面模糊毛糙,可见软骨或韧带钙化,关节间隙不规则狭窄,少数可见真空现象。晚期(CTⅣ级)14例,多双侧受累,关节间隙消失,关节强直,周围骨质疏松。结论 HRCT可显示骶髂关节的细微结构,结合曲面重建在影像表现上提供更全面的范围,因此HRCT具有较高的敏感性和特异性,可做出更早期诊断及明确的分级及分期,为临床治疗提供客观依据。     

肾性骨营养不良骶髂关节病变CT表现

目的分析肾性骨营养不良(ROD)患者骶髂关节改变的CT特征,以提高对其的认识水平。方法回顾分析25例ROD患者的骶髂关节病变CT特点及临床资料。其中男14例,女11例,年龄29-69岁,平均49岁。分析ROD骶髂关节骨质病变的部位、骶髂关节间隙、密度、边界、周围骨质及软组织情况。结果所有ROD患者均为双侧骶髂关节髂骨侧骨质受累,并伴有其它多种ROD影像表现,包括骨质疏松23例、骨质软化21例、骨质硬化9例、棕色瘤10例、软组织异常钙化15例及病理性骨折5例,35个骶髂关节间隙正常,15个间隙增宽,17个骶髂关节见双边征。结论 ROD骶髂关节受累表现为双侧髂骨侧骨质破坏,多伴发多种ROD影像表现,双边征及关节间隙增宽具有特征性,结合ROD其它影像征象及临床病史可提高对骶髂关节病变的诊断率。CT对其诊断具有一定的价值。     

幼年脊柱关节病伴骶髂关节内积气1例报告

幼年脊柱关节病（Juvenile SpondyloarthropathiesJSpA）是指16岁以前发病的一组以关节滑膜、肌腱端、腱鞘和滑囊症状为主的综合征。表现为慢性脊柱炎和骶髂关节炎,最终致残。由于临床表现不典型,早期诊断困难。骶髂关节炎初期由于关节炎症病变可出现关节积气现象,故骶髂关节CT有积气时应注意此病。本病在成人已有报道,但幼年脊柱关节病出现骶髂关节真空征尚报道很少。现将1例幼年脊柱关节病出现骶髂关节积气报告如下：     

3D T1-VIBE序列用于评价强直性脊柱炎骶髂关节软骨的初步研究

目的采用三维容积内插体部扫描序列(3D T1-VIBE)对强直性脊柱炎(AS)患者骶髂关节(SIJ)软骨进行扫描,分析其MRI表现,探讨3D T1-VIBE序列显示SIJ软骨的可行性。方法利用3D T1-VIBE序列对10名AS患者共20侧SIJ软骨进行MR扫描,着重观察SIJ软骨。结果 10例中3例髂侧关节软骨边缘模糊,部分层面可见SIJ软骨二者间隙;7例显示关节面模糊,不能区分出骶侧与髂侧关节软骨及其二者间隙,关节软骨侵蚀破坏、连续性中断。结论 3D T1-VIBE序列能较X线和CT更好显示AS患者SIJ软骨的侵蚀破坏,髂侧关节软骨的模糊、微侵蚀和关节软骨间隙消失是诊断早期骶髂关节炎(SIS)的重要征象。     

强直性脊柱炎骶髂关节和髋关节的CT表现

目的:探讨强直性脊柱炎(AS)患者骶髂关节和髋关节的CT表现及其诊断价值.方法:回顾性分析40例经临床诊断及治疗的强直性脊柱炎患者的骶髂关节和髋关节CT资料.结果:骶髂关节和髋关节CT表现均未见异常者2例;骶髂关节受累,髋关节未受累及17例.骶髂、髋关节改变表现为关节面模糊,骨质疏松,密度不均匀10例;关节面下囊性变,虫蚀样骨质破坏17例;关节面边缘明显硬化,骨赘形成7例;关节强直,关节间隙部分或完全消失12例.结论:CT扫描可以清晰显示骶髂关节和髋关节病变的表现,对于强直性脊柱炎的早期诊断有重要意义.     

骶髂关节MRI扫描技术在早期强直性脊柱炎疾病中的应用价值

目的评价骶髂关节扫描技术在早期强直性脊柱炎疾病中的应用价值。方法对120例疑为骶髂关节炎患者采用斜横断面、斜冠状面薄层扫描进行综合分析。结果共发现双侧骶髂关节炎70例,单侧骶髂关节炎45例,5例骶髂关节未见明显改变。其中70例双侧骶髂关节炎病例中,50例双侧骶髂关节间隙不同程度变窄,关节面毛糙模糊,关节软骨水肿明显,呈不规则中断、增粗,关节面下骨质内见片状异常信号影,部分炎症累及髂骨,15例双侧骶髂关节的软骨下局部骨硬化,软骨下骨板边界不清,5例双侧骶髂关节炎病例累及双侧坐骨、双侧髋臼,关节软骨面明显模糊,骨髓水肿;45例单侧骶髂关节炎中:40例单侧骶髂关节的间隙呈线样高信号,患侧关节面毛糙、关节面下骨质见异常高信号影,5例单侧骶髂关节炎合并累及髂内、外肌伴脓肿形成。结论骶髂关节斜横断面、斜冠状面的扫描技术对早期强直性脊柱炎的诊断有重要意义,值得临床推广。     

骶髂关节炎的临床特点及诊断方法

目的通过回顾性分析骶髂关节炎患者的影像学资料,探讨骶髂关节炎的临床特点与诊断方法。方法收集我院诊治的60例骶髂关节炎患者的临床资料,并根据CT扫描与X线检查结果探讨骶髂关节炎的临床特点与诊断方法。结果 CT扫描提示,60例骶髂关节炎患者中,双侧骶髂关节炎53例,单侧骶髂关节炎7例;而X线检查显示,双侧骶髂关节炎45例,单侧骶髂关节炎9例,疑似异常5例,正常1例。骶髂关节炎CT特点为:髂骨侧关节面下出现侵蚀、硬化而变模糊,皮质部分近乎消失,骨质糜烂成融雪状,骨小梁模糊,关节骨性强直,关节间隙缩窄或消失,关节周围骨质疏松;X线特点为:关节面毛糙,骨质侵蚀、硬化,关节腔隙增宽或狭窄,关节出现强直。结论相对X线检查,CT扫描对于骶髂关节炎的鉴别诊断具有更重要的应用价值,值得在临床推广使用。     

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.