高频超声联合声触诊弹性超声在冻结肩治疗效果评估中的作用

目的 探讨超声测量盂肱关节囊厚度及硬度在冻结肩（FS）治疗效果评估中的价值。方法 收集2021年6月—2022年8月自贡市第四人民医院收治的68例FS患者,根据临床特征分为三期,所有患者进行超声引导下注射联合液压松解关节囊治疗,治疗前1天和治疗后2周进行肩关节评估,临床评估使用肩关节功能Constant-Murley(CMS)评分及肩关节活动度,超声评估采用测量盂肱关节囊厚度和硬度,然后对两类评估方法进行相关性分析。结果 不同分期冻结肩患者治疗后较治疗前,关节囊厚度及硬度均降低（P＜0.05）,CMS评分及肩关节活动度均升高（P＜0.05）。治疗前、治疗后及治疗前后改善值的关节囊厚度、硬度与CMS评分和肩关节活动度均呈负相关（P<0.05）。结论 利用超声测量盂肱关节囊厚度及硬度评估冻结肩治疗效果,其测值与临床评分具有相关性,评估结果一致,评估方式更加客观,具有临床诊断价值     

高频超声在肩关节及周围软组织病变诊断中的应用价值

目的探讨高频超声在肩关节及周围软组织病变诊断中的应用价值。方法选择2012年1月~2015年6月在我院诊断的肩关节及周围软组织病变患者78例的临床资料进行回顾性分析。所有患者均经高频超声检查,分析肩关节及周围软组织病变高频超声影像学特征。结果 78例患者中8例肩袖撕裂,4例肱二头肌长头肌腱断裂,6例肱二头肌长头肌腱炎,7例肱二头肌长头腱鞘炎,2例肱二头肌长头腱脱位,18例肩袖肌腱病,17例肩袖钙化,7例肩关节周围滑囊炎,5例肩关节囊炎,3例关节盂唇损伤,1例冈上肌肌腱炎性病变。结论正规的超声检查在检查肩关节周围软组织损伤方面具有较高的准确性,能提供定位及定性诊断,且具有无创、经济、可重复等优势。     

高频超声对肩关节病变的诊断及其疗效评估

目的 探讨高频超声对肩关节病变的诊断及在疗效评估中的应用价值.方法 应用高频超声对43例肩关节疼痛患者43个肩关节扫查,观察肱二头肌长头腱、冈上肌肌腱、冈下肌肌腱、肩胛下肌肌腱、盂肱关节、肩锁关节、滑囊的情况,并对最大积液深度、肌腱厚度进行治疗前后对比.结果 43例患者其中肱二头肌长头腱病变39例占90.7%,冈上肌肌腱19例占44.2%,冈下肌肌腱14例32.6%,滑囊10例占23.3%,盂肱关节9例占20.9%,肩胛下肌肌腱9例占20.9%,肩锁关节7例占16.3%.治疗前后超声检查在积液最大深度与肌腱厚度上比较,差异有统计学意义(P＜0.05).结论 高频超声可以观察肌腱、关节,同时可以进行疗效评估.     

超声在冻结肩关节囊液压扩张治疗近期疗效预测中的价值

目的 探讨超声在冻结肩(frozen shoulder,FS)关节囊液压扩张治疗近期疗效预测中的价值.方法 选取单侧FS患者100例,采用高频超声评估患肩喙肱韧带(coraco-humeral ligament,CHL)、腋囊厚度等,用组内相关系数(intraclass correla-tion coefficient...     

喙肱韧带高频超声显像对粘连性关节囊炎的诊断价值

目的通过观察粘连性关节囊炎患者喙肱韧带（CHL）高频超声声像图表现并测量其厚度,探讨对粘连性关节囊炎的诊断价值。方法采用高频超声检查分别测量52例单侧粘连性关节囊炎患者的双侧CHL厚度及盂肱关节腋下囊（IC）的厚度及30例健康志愿者的双侧CHL厚度;对结果进行差异性比较及相关性分析。结果粘连性关节囊炎患者患侧CHL及IC厚度均大于健侧的厚度及健康志愿者的厚度（均P＜0.05）,粘连性关节囊炎患侧CHL与IC厚度呈正相关（r=0.613,P＜0.05）。结论高频超声观察并测量CHL厚度对粘连性关节囊炎有重要的诊断价值,且与IC厚度呈正相关,与MRI的表现一致。     

高频超声对肩关节疼痛性疾病的诊断价值

目的:探讨高频超声对肩关节疼痛性疾病的诊断价值。方法:使用高频超声对172例患者肱二头肌长头腱、冈上肌肌腱、冈下肌肌腱、滑囊、盂肱关节、肩胛下肌肌腱及肩锁关节均行横断面和纵截面扫描,探查病变解剖结构。结果:172例患者肱二头肌长头腱156例,冈上肌肌腱76例,冈下肌肌腱56例,滑囊40例,盂肱关节36例,肩胛下肌肌腱36例,肩锁关节28例,回声改变指肌纤维的回声和边缘发生变化132例,积液116例,肌腱增厚88例,所有肌腱钙化32例,关节骨侵蚀24例,撕裂20例,肌腱变薄8例。结论:高频超声能够准确显示患者肌腱和关节病变情况,同时也能够为治疗和疗效评价提供可靠依据,临床应用价值较高。     

螺旋CT引导下肩关节气碘双向对比造影对僵冻肩诊断的价值探讨

目的探讨螺旋CT空气碘水双对比造影对诊断冻结肩的临床意义。方法11例患者做螺旋CT介入引导肩关节囊穿刺,分别注入76%泛影葡胺2ml 生理盐水8 ml进行造影后注入过滤空气10ml,行肩关节扫描。结果9例患者气碘双对比造影CT表现均与关节镜中所见一致。主要特征:(1)腋隐窝消失或盂唇增厚;(2)肱二头肌腱腱鞘不显影或充盈不良;(3)肩关节囊内关节囊间隙减小,关节轮廓不规则缘显影粗糙出现网格状。(4)关节内的黏连导致气体注入后关节第三间隙被动扩大关节囊和滑膜厚度>4mm;(5)发现冈上肌破裂三型肩峰,所有患者造影术后症状都不同程度的缓解。结论CT空气碘水双对比造影可以明确冻结肩诊断,并对症状的缓解起到了一定的治疗作用,并能为关节镜下治疗该病提供重要的影像学信息。     

肩关节前方不稳的研究进展

据报道[1]肩关节不稳的易患率为1.7％,其中肩关节前方不稳是最常见的肩关节不稳,约占肩关节不稳的90％ ～98％[2]. 1 肩关节的稳定结构 盂肱关节的解剖特点决定了肩关节是人体最不稳定关节,维持肩关节稳定的因素分为静力性因素和动力性因素,前者包括匹配的肱骨头和关节盂、关节囊盂唇复合体、盂肱韧带、喙肱韧带等,后者主要包括肩关节周围的肌肉和肩袖,盂唇及盂肱韧带韧带是维持肩关节稳定的关键性因素,在正常情况下,肱骨头仅有25％与关节盂接触,由于关节盂唇的存在使二者的接触面积增加到75％,并且与关节囊、盂肱韧带、肱二头肌长头腱止点紧密融合在一起.     

肩关节成形术临床应用

盂肱关节形成术适用于肩盂、肱骨头发育不良或韧带、关节囊过度松弛引起的盂肱关节不稳定和复发性肩关节脱位,或因创伤和病变所致盂肱关节结构破坏、功能丧失的重建.     

肌骨超声检查对不同临床分期冻结肩的诊断价值

目的分析不同临床分期冻结肩的腋下关节囊厚度和肩袖间隙血流信号情况,探讨应用肌骨超声检查对不同临床分期冻结肩的诊断价值。方法收集2018年6月至2021年12月温州医科大学附属第三医院就诊的患者,其中冻结肩患者87例（冻结肩组）和非冻结肩患者30例（非冻结肩组）,冻结肩组患者参照临床表现进一步分为冻结肩Ⅰ期组35例、冻结肩Ⅱ期组29例和冻结肩Ⅲ期组23例。检查各组患者肩关节的肌骨超声表现,比较各组患者腋下关节囊厚度和肩袖血流阳性率。结果冻结肩患者患侧腋下关节囊厚度为（3.46±1.04）mm,明显高于非冻结肩组的（1.89±0.36）mm,差异有统计学意义（P＜0.05）。腋下关节囊厚度冻结肩Ⅰ期组为（2.87±0.95）mm,冻结肩Ⅱ期组为（4.44±0.72）mm,冻结肩Ⅲ期组为（3.08±0.46）mm,3组间比较差异有统计学意义（P＜0.05）,且冻结肩Ⅱ期组患者肩关节囊厚度最厚,分别与Ⅰ期、Ⅲ期组患者比较差异均有统计学意义（均P＜0.05）;冻结肩组肩袖间隙血流阳性率高于非冻结肩组,差异有统计学意义（P＜0.05）。进一步分析发现,肩袖间隙血流阳性冻结肩Ⅰ期组35例、Ⅱ期组3例、Ⅲ期组1例、非冻结肩组2例,4组间比较差异有统计学意义（P＜0.05）。冻结肩Ⅰ期组肩袖间隙血流阳性率远高于其他组（P＜0.05）。相关性分析显示,冻结肩患者腋下关节囊厚度与疾病病程之间无相关性（r=-0.037,P＞0.05）。结论应用超声检查检测腋下关节囊厚度和肩袖间隙血流情况有助于临床早期诊断冻结肩及早期治疗,缩短患者病程,具有重要的临床应用价值。     

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.