结直肠息肉患者的临床和内镜特征研究

观察结直肠息肉患者的临床症状表现以及内镜下的息肉分布情况,比较临床症状与息肉大小分布的差异性。方法：选取2011年1月至2013年6月期间在我院诊断治疗的结直肠息肉患者412例作为研究对象。结肠镜下诊断患者的临床症状、内镜下息肉发生部位以及息肉大小。结果：412例结直肠息肉患者临床症状腹痛腹胀的发生率为36．7％,大便性状改变的发生率为17．2％,便血的发生率为22．6％,腹泻的发生率为9．2％,便秘的发生率为8．5％,贫血消瘦的发生率为5．8％。息肉分布在直肠和乙状结肠的比例较高,分布在回盲肠的比例最低。息肉直径不超过0．5cm的占43．54％,直径在0．6-1．0cm的占35．24％,直径大于1．1cm的占21．22％。消瘦与不消瘦患者的息肉大小比较差异具有统计学意义（P＜0．05）,便血与不便血患者的息肉大小比较差异具有统计学意义（P＜0．05）。584枚息肉有359枚发生病变,均病变成腺瘤,病变率为61．6％。息肉发生腺瘤病变与息肉直径、数目与粘膜表面有关,与息肉分布位置无关。结论：结直肠息肉临床表现主要是便血、消瘦、便秘腹泻以及腹痛腹胀等,主要分布在直肠和乙状结肠,不同症状的患者息肉大小比例不同。     

结直肠锯齿状腺瘤临床病理探讨(附36例分析)

目的：探讨结直肠锯齿状腺瘤(serrated adenoma，SA)的临床病理特点和鉴别诊断。方法：运用形态学方法对2570例结直肠腺瘤性息肉和2230例结直肠增生性息肉进行观察。结果：共检出锯齿状腺瘤36例，占同期结直肠息肉的0．75％，其中25例原诊断为腺瘤性息肉，11例原诊断为增生性息肉，36例锯齿状腺瘤中，13例(36％)伴有增生性息肉病灶，5例(14％)伴有传统腺瘤灶。锯齿状腺瘤主要发生在直肠和乙状结肠，大多数(29／36，80．6％)为息肉样型，28例(77．8％)例为单发，肿瘤直径3～20mm，平均11mm，3例(8．3％)恶变。结论：锯齿状腺瘤为一种具有独立的临床病理特点的高恶变率的病变，应注意与增生性息肉以及传统腺瘤进行鉴别诊断。     

窄带成像结肠镜在结直肠息肉样病变诊断中的应用价值

目的 探讨窄带成像(NBI)结肠镜在结直肠息肉样病变诊断中的应用价值.方法 81例结直肠息肉样病变患者(97个病变)行结肠镜检查,分别在普通内镜模式、NBI模式及染色模式下进行检查,对病变进行腺管开口分型及微血管形态分型,将内镜诊断结果与病理诊断结果进行对比分析.结果 普通内镜、NBI内镜、染色内镜分别检出病变88个(90.72％)、96个(98.97％)、97个(100.00％),NBI内镜病变检出率优于普通内镜(P＜0.05),但与染色内镜比较,差异无统计学意义(P＞0.05).NBI内镜诊断结直肠肿瘤性病变的符合率、敏感度、特异度分别为92.78％、93.50％、90.00％,染色内镜分别为90.72％、90.91％、90.00％,普通内镜分别为80.41％、80.52％、80.00％,NBI内镜诊断结直肠肿瘤性病变的符合率、敏感度均高于染色内镜、普通内镜;NBI内镜、染色内镜特异度相似,均明显高于普通内镜.结论 NBI内镜操作简单易行,有利于平坦型结直肠息肉样病变的发现,可区别肿瘤性病变和非肿瘤性病变,且优于普通内镜.     

门诊结肠镜检查诊断大肠肿瘤效果评价

目的：探讨有下消化道症状的门诊患者行结肠镜检查对诊断大肠肿瘤的临床意义。方法：1997年1月至2003年7月对2024例具有下消化道症状而就诊的患者行结肠镜检查。结果：结肠镜为息肉的患者中常见的消化道症状分别为腹泻(24．2％)、便血(31．4％)和腹痛(11．8％)。结肠镜诊断为癌肿患者中常见的消化道症状占分别为便血(51．7％)和脓血便(15．6％)。癌肿和息肉多发于直肠和乙状结肠，癌肿病灶在直肠和乙状结肠的比例分别为32．9％及30．5％，息肉病灶在直肠和乙状结肠的比例分别为27．0％及30，9％。结论：对有下消化道症状的患者中结肠镜检查是一安全、简便且经济省时的方法，对于提高早期结肠癌的的诊断率及治疗都具有重要的意义。     

结直肠息肉的治疗及癌变因素分析

目的探讨结直肠息肉癌变的相关因素和治疗策略。方法回顾性分析1324例电子结肠镜检查以及治疗的结直肠息肉患者的临床、内镜及病理资料，分析影响结直肠息肉病变的相关因素。结果1324例结直肠息肉中，338例有临床症状，110例存在癌变或同时伴有肠癌，有症状息肉的癌变或伴有肠癌发生率为25．5％(338／1324)。经电子结肠镜电灼法切除868例(共1674粒息肉)，开腹息肉切除术164例(共630粒息肉)，行包括息肉的肠段切除8例，行结肠癌根治切除术97例，8例姑息性癌肿切除术。结论年龄≥61岁、直径≥2．0cm、多发息肉、广基分叶状、伴有下消化道症状的左半结肠腺瘤性息肉的癌变和伴发结直肠痛的发生率明显增高。单发的带蒂小息肉、分化良好以及明确良性者，经电子结肠镜切除是安全的，局部多发、直径较大、广基无蒂息肉应开腹手术，伴肠癌息肉、有癌变的较大息肉则应当按结直肠癌行肠切除术。     

16排螺旋CT结肠仿真结肠镜检查与电子结肠镜诊断结肠肿瘤对照研究

目的 探讨16排螺旋CT结肠仿真结肠镜(CTVC)与电子结肠镜检查在结肠肿瘤诊断中的应用价值.方法 22例患者均先行电子结肠镜检查,再行螺旋CT容积扫描,将结肠仿真结肠镜成像与电子结肠镜检查结果进行比较.结果 22例患者中结肠癌(16例)以手术病理确诊为标准,电子结肠镜与仿真结肠镜对肿瘤的诊断符合率为100%,但CTVC检查同时还发现肠道外转移灶4例.电子结肠镜下检出结肠息肉(6例)11个病灶,CT仿真结肠镜检出(5例)8个病灶,诊断符合率83%,病灶检出率为73%.结论 CT结肠仿真结肠镜检查是一种无创、安全、可靠的技术,对肿瘤的诊断与电子结肠镜有同样高度敏感性,并能发现结肠以外病灶,但对结肠小息肉检查敏感性不高.     

经阴道、会阴超声诊断直肠肿瘤的临床价值

目的：探讨经阴道、会阴超声诊断直肠肿瘤的临床价值。方法：直肠灌水后经阴道、会阴超声检查直肠肿瘤病人28例，并与正常人20例，直肠腔内超声16例对照，同时5例肿瘤作了标本超声检查。结果：28例患者中，26例检出直肠肿瘤28个，其部位在距肛门口2．5－15cm范围内，2例经阴道、会阴超声未发现肿瘤。直肠灌水后经阴道会阴超声检查可直观显示肿瘤的形态，与标本超声显示一致；其病理分期的符合率分别为80．8％。发现淋巴结肿大5例。尤其对高位直肠肿瘤或肿瘤致直肠严重狭窄的病例或Miles手术后，更具有价值。结论：经阴道、会阴超声可作为直肠肿瘤检查的补充方法。     

经阴道超声诊断输卵管妊娠

目的：探讨经阴道超声诊断输卵管妊娠的价值。方法：回顾性分析临床诊断的异位妊娠97例，其中经阴道超声检查62例，腹部超声检查35例，与术后结果对比。结果：经阴道超声检查排除8例异位妊娠，确诊为子宫内早孕，并行人工流产术，与手术后结果对比，行阴道超声检查的54例患者中未破裂的异位妊娠36例中确定35例，占64．8％；破裂型和流产型符合的占33．3％；总符合率98．1％；腹部B超诊断的35例符合率为74．3％。而且未破裂型符合率仅占28．5％。破裂型和流产型占符合率的45．8％。阴道超声诊断输卵管妊娠根据附件区图像的特点分为三型：未破裂型附件区表现为Donut征，其包块直径大小为（2．77±0．58）cm，流产型附件区包块为一低回声，其中可见面包圈征，包块直径大小为（5．26±0．68）cm，破裂型附件区包块为囊实混合型包块，包块直径大小（5．81±0．61）cm。前者与后两者包块大小比较差别有统计学意义（P〈0．01），后两者之间比较差异有统计学意义（P〈0．05）。结论：阴道超声频率高，检查途径近，图像清晰，简便，快捷，诊断输卵管妊娠早而且符合率高，是临床诊断输卵管妊娠不可缺少的方法之一。     

大肠息肉内镜漏诊及其相关因素分析

目的：了解电子结肠镜检查的息肉漏诊情况,分析漏诊息肉的内镜和病理特点,并探讨息肉漏诊的影响因素。方法回顾近两年来接受2次或以上电子肠镜检查（间隔时间不超过180d）的患者资料,分析息肉漏诊率,漏诊息肉的内镜和病理学特点及其影响因素。结果178例符合条件的患者中,基础息肉314颗,漏诊息肉87颗,息肉漏诊率为27.7％。漏诊息肉中直径＜5、5～＜10、≥10mm者分别为55.2%,32.2%,12.6%;Ip型、Isp型、Is型、II型息肉分别为：4.6％、17.2％、75.9％、2.3％;漏诊息肉的部位：直肠21.8％,乙状结肠41.4％,降结肠5.7％,脾曲0%,横结肠17.2％,肝曲1.1％,升结肠11.5％,回盲部1.1％;漏诊息肉中,肿瘤性息肉占64.0%,直径≥1cm、含有绒毛状成分或有高度异型增生3者之一的腺瘤占所有漏诊息肉的11.5％。息肉漏诊率与结肠镜的操作方法（单人法和双人法）、操作者的年资和结肠镜操作熟练程度,都不存在统计学相关。漏诊息肉数和基础息肉数明显相关（r=0.694, P＜0.01）。结论大肠息肉的漏诊在电子结肠镜检查中非常普遍。直径＜5 mm、Is型的大肠息肉漏诊率最高。息肉漏诊最常见发生于直肠、乙状结肠和横结肠。漏诊息肉数和基础息肉数明显相关。     

多排螺旋CT仿真结肠镜对结直肠占位性病变诊断价值的研究

目的 探讨多排螺旋CT仿真结肠镜(CT virtual colonoscopy,CTVC)对结直肠占位诊断的临床价值.方法 41例经结肠镜诊断为结肠占位的患者,经肛门注气后行16排螺旋CT腹盆腔连续薄层扫描,应用多排螺旋CT仿真结肠镜软件对获取的数据进行三维仿真结肠镜图像重建,与结肠镜和临床病理结果进行对照分析.结果 结肠镜诊断结肠息肉12例共21枚息肉,仿真结肠镜发现10例共15枚息肉;结肠镜诊断结肠癌29例,仿真结肠镜诊断结肠癌27例,并发现2例肝转移,1例腹膜后淋巴结转移.结论 CTVC对结肠占位性病变是一种无创、有效的检查方法,它不仅可以显示结肠占位的部位、大小,而且还可以显示结肠壁及结肠外的转移情况,对结肠癌的临床分期和手术方案的选择具有重要意义.     

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.