结核性腹膜炎的CT表现及其病理学基础

目的 探讨结核性腹膜炎的CT表现特点及其病理基础。方法 21例经病理和临床证实的结核性腹膜炎病历，主要观察1)腹水性质及解剖分析；2)系膜、网膜、腹膜改变的CT表现形式；3)淋巴结肿大及其增强情况。结果 1)腹水18例，高密度腹水15例(＞20HU)，3例低密度腹水(＜20HU)，6例为包裹性积液。2)系膜改变为增尽、结节状、污秽状，共21例。3)饼状网膜肿块5例，网膜点条状改变8例。4)腹膜增尽15例(腹膜光滑13例，腹膜结节2例))。5)淋巴结肿大9例，7例并见环状强化。结论 腹膜、网膜、系膜的改变伴高密度腹水，环状强化的肿大淋巴结，常可作出结核性腹膜炎的诊断。     

胰腺结核和胰周淋巴结结核的CT表现

目的探讨胰腺结核和胰周淋巴结结核的CT表现和诊断要点。方法3例胰腺结核和胰周淋巴结结核,1例经手术病理证实,2例经抗结核治疗后3～4个月后复查CT后明确诊断。结果CT常规平扫加增强扫描,2例为胰头部结核伴胰周淋巴结结核。1例为胰头、体部结核伴胰周淋巴结结核。CT表现为胰头部增大。胰头、体区见多发结节状混杂密度灶或囊实性包块,壁较薄,有轻-中度强化,并伴有胰周淋巴结肿大,淋巴结多呈环状强化。结论胰头、体区多发结节状混杂密度灶囊实性包块并伴有胰周淋巴结肿大,尤其是淋巴结呈环状强化,结合病史,可提示胰腺和胰周淋巴结结核。     

多层螺旋CT在肠系膜脂膜炎诊断中的应用

目的探讨多层螺旋CT(MSCT)对肠系膜脂膜炎的诊断价值。方法回顾性分析11例肠系膜脂膜炎患者的CT表现与诊断,其中6例经病理学证实,其他按照CT诊断标准做出判断。应用MSCT进行腹部平扫和双期增强扫描,同时采用1mm层厚和1mm间隔重组,形成最大密度投影(MIP)和多平面重组(MPR)图像,评价肠系膜脂肪组织、系膜淋巴结、系膜血管及邻近肠道改变。结果所有诊断为肠系膜脂膜炎均起自小肠系膜且仅累及系膜根部,包绕系膜血管、淋巴结,3例可见肠系膜血管变细;9例病变可以看到脂肪环征、肿瘤样假包膜征;肠系膜脂膜炎的强化变化差异无统计学意义(均>0.05),平扫时肠系膜脂膜炎病变密度明显增高,有统计学意义(<0.01)。9例肠系膜脂膜炎病变在系膜根部可见多发小淋巴结,增强示明显强化,2例病变肠系膜所血管支配的肠道壁肿胀。结论多层螺旋CT是诊断肠系膜脂膜炎首选的非常有用的无创影像手段。     

结核性腹膜炎的CT表现

目的 分析结核性腹膜炎的CT表现特点，以提高其诊断水平。方法 回顾性分析26例经临床病理证实结核性腹膜炎的CT表现．结果 （1）腹水21例，其中17例表现为高密度腹水（CT值〉20HU），4例表现为低密度腹水，少量11例，中量7例，大量3例；（2）壁腹膜光滑增厚15例，3例轻微不规则增厚，增强扫描有强化：（3）肠系膜改变26例，表现为系膜增厚成团，呈结节状．片状或“污点”状改变；（4）大网膜改变19例，表现为饼状增厚、结节状或“污点”状改变；（5）伴腹腔淋巴结肿大8例，5例环形强化，3例无明显强化。结论 污迹腹膜增厚及少，中量高密度腹水，为结核性腹膜炎常见CT表现：鉴别诊断主要与癌性腹膜炎鉴别。     

结核性腹膜炎螺旋CT诊断价值探讨

目的探讨结核性腹膜炎的螺旋CT表现特征。方法回顾性分析经证实的结核性腹膜炎36例,分析其螺旋CT表现。结果腹腔积液33例,腹膜增厚32例;大网膜增厚26例,表现为污迹样、结节样“饼状”或“星芒状”增厚;肠系膜受累30例;肠曲粘连7例;淋巴结增大18例。结论腹膜、网膜、系膜的改变伴高密度腹水,肿大淋巴结,肠曲粘连并结合临床有可能作出结核性腹膜炎的正确诊断。     

继发性肺淋巴瘤43例CT分析

目的探讨继发性肺淋巴瘤(SPL)的CT表现。方法回顾性分析经穿刺活检、手术病理证实诊断为SPL的43例患者的临床和CT资料。结果 43例病理类型中31例非霍奇金淋巴瘤(NHL),12例霍奇金淋巴瘤(HL);胸部CT示肺内结节影8例,其中多发实性结节影4例,单发实性结节影2例,多发浅淡磨玻璃样结节1例;大片实变19例,单发实变9例,其余10例均为多发片状实变影;团块影16例,单发团块4例,多发团块影12例,其中2例伴不规则空洞性团块。43例中7例接受增强检查,大部病灶呈不均匀轻中度强化,3例病灶内见坏死无强化区,1例伴不规则空洞,1例病灶内可见穿行血管。伴随其它CT表现包括10例伴有单侧胸腔大量积液,3例伴有单侧少量积液,1例伴有肋骨破坏及胸壁肿块影,7例纵隔、腋下淋巴结肿大,4例病例发现肺以外器官的侵犯。结论 SPL可表现为结节影、实变影及团块影,可单发、多发,掌握其CT影像特点,能够为临床诊疗提供帮助。     

结核性腹膜炎的64层螺旋CT诊断

目的探讨64层螺旋CT对结核性腹膜炎的诊断价值,方法回顾分析经手术、穿刺、病理及临床综合指标且经抗结核治疗、随访症状及影像学检查明显改善者9例,CT检查主要观察：（1）网膜、系膜的增厚形式,（2）腹水的分布及密度,（3）腹腔淋巴结及增强表现。结果结核性腹膜炎的64层螺旋CT表现有：（1）大网膜增厚8例,污迹样增厚7例,饼状大网膜4例,腹膜结节2例;（2）肠系膜受累5例,磨玻璃样改变3例,条索3例;（3）壁层腹膜增厚5例,以均匀增厚为主。上述3种表现可单独存在也可并存。病变腹膜增强扫描均有不同程度的增强;（4）淋巴结肿大4例,其中一例环状强化;（5）小肠改变3例;（6）腹腔积液4例。结论腹部64层CT平扫加增强对发现和诊断渗出性结核腹膜炎具有重要的临床价值。     

胰腺结核和胰周淋巴结结核的影像学表现

目的 探讨胰腺结核及胰周淋巴结结核的影像学表现及诊断要点,评价影像学检查对其的诊断价值.方法 选取胰腺结核和胰周淋巴结结核患者5例,2例为手术病理学证实,3例为经抗结核治疗追踪临床证实;其中2例为胰头部结核伴胰周淋巴结结核,3例为胰头周围淋巴结结核(伴脾脏结核1例).5例均行多层螺旋CT(MSCT)平扫+三期动态增强扫描,其中1例行MRI平扫,1例行MRI平扫+三期动态增强扫描.回顾性分析患者的MSCT和MRI表现.结果 2例胰头部结核伴胰周淋巴结核,1例伴钙化,CT表现为多发结节状混杂密度灶,轻度-中度蜂窝样强化,并伴有胰周淋巴结肿大,部分融合,呈环形强化.3例胰头周围淋巴结结核CT表现为淋巴结肿大,向上延伸至肝门部,部分融合,1例合并脾脏粟粒样结核灶,增强扫描显示肿大淋巴结呈环状强化.2例胰头周围淋巴结结核MRI表现T1WI为等或略低信号,T2WI为稍高信号,扩散加权成像(DWI)呈高信号,增强扫描显示边缘环形强化.结论 胰腺结核和胰周淋巴结结核的CT表现为胰腺局灶蜂窝状轻中度强化,肿块及胰周淋巴结肿大伴边缘环状强化,可合并脾脏等腹腔结核灶,影像学表现有一定的特异性.     

多层螺旋CT对肠系膜脂膜炎的影像学特征及临床意义

目的探究多层螺旋CT对肠系膜脂膜炎的影像学特征及临床意义。方法以2016年4月至2017年5月北京市和平里医院放射科收治的75例疑似肠系膜脂膜炎患者作为研究对象。患者均进行256层螺旋CT平面重建检查确诊,观察患者CT图像,根据其特征判断假肿瘤征、纤维组织结节、淋巴结增大、假包膜征、脂肪环征、囊变、钙化。门诊随访16个月,观察疾病发展情况。结果 75例患者中有55例患者行腹部CT平扫,10例进行CT平扫联合增强扫描,10例进行增强扫描。病变部位均在肠系膜。患者均为假肿瘤征:呈片状或包块影,肠系膜脂肪密度变大,其CT值超过正常腹膜后脂肪组织,未见强化,肠系膜血管被包绕。70例患者病变内出现纤维组织结节、淋巴结增大。患者均为假包膜征:病变周围存在不同厚度软组织密度带,边界清晰。51例患者可见脂肪环征,环状低密度影包绕于肠系膜血管及纤维组织结节、淋巴结周围;出现1例囊变、1例钙化;22例患者周围肠管被推移。随访39例,其中18例患者病变无明显变化,3例病变全吸收,13例病变部分吸收,5例病变进展。CT临床诊断灵敏度100%(5/5),特异性7.1%(5/70)。结论 256层螺旋CT能够准确诊断肠系膜脂膜炎存在假肿瘤征、假包膜征、脂肪环征,可作为首选无创影像学检查。     

结核性腹膜炎的CT影像表现及病理基础

目的:分析结核性腹膜炎的CT表现特点,以提高对其诊断及鉴别诊断的能力.方法:回顾性分析本院自2007年11月-2011年5月经临床及病理证实的20例结核性腹膜炎的CT表现.结果:(1)腹水18例,少量15例,中量3例,低密度腹水5例,高密度腹水13例.(2)腹膜增厚15例,其中壁层腹膜光滑增厚15例,肝脏脏层腹膜增厚6例,腹膜结节7例.(3)肠系膜改变20例,表现为系膜密度增高,并呈条索、结节状改变.(4)大网膜的改变14例,表现为饼状增厚,结节状或污迹状改变.(5)肠管改变20例,肠管管壁增厚18例,聚集成团10例.(6)腹腔淋巴结肿大10例.(7)盆腔脓肿2例.结论:高密度腹水、系膜及网膜改变为结核性腹膜炎的CT表现特征.     

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.