丘脑的薄层断面定位解剖和三维重建

目的　对丘脑的神经核团进行薄层断面定位解剖和计算机三维重建 ,为功能和立体定向神经外科在丘脑区域的手术提供解剖资料。方法　采用大体标本冰冻薄层断面切片技术 ,将人脑从冠状位、矢状位和轴位 3个方位进行0 43mm的薄层连续切片 ,以连合间径线的中点为原点建立空间坐标 ,对丘脑内部神经核团进行定位测量 ;在SGI工作站 ,对首例中国数字化可视人体数据集中丘脑的内部核团进行计算机三维重建。结果　丘脑内侧核分别出现在冠状位的Y0～Y -3 0层面 ,矢状位的X +6～X +2 4层面 ,轴位的Z0～Z +4 0层面 ;丘脑外侧核分别出现在冠状位的Y +10～Y -3 6层面 ,矢状位的X +14～X +3 8层面 ,轴位的Z0～Z +4 0层面 ;测得的丘脑内侧核靶心坐标 (X ,Y ,Z)为 5 12± 1 13、-6 68±1 5 7、7 5 8± 1 2 7,丘脑外侧核的靶心坐标为 12 47± 1 2 1、-5 43± 1 19、10 64± 1 78;丘脑内部神经核团的三维重建清晰显示出丘脑内部神经核团的立体形态、空间位置和毗邻关系。结论　丘脑的薄层断面定位解剖和三维重建 ,便于手术者掌握丘脑的空间形态 ,对于功能和立体定向神经外科在丘脑区域的手术具有重要的参考价值     

CT导向术中电生理刺激治疗震颤型帕金森病41例

1　临床资料　震颤型帕金森病 4 1(男 2 3,女 18)例 ,年龄 (5 1±5 )岁 ,病程 (6± 3)a ,服药史 (5± 2 )a.分为 2组 ,一组 (2 1例 )将CT扫描的光盘或胶片输入计算机工作站 ,大脑前后联合的显示可以在三维重建的矢状面上获得 ,从而自动得到丘脑腹外侧核的坐标 ;另一组 (2 0例 )在显示大脑前后联合的CT定位片上 ,利用丘脑、尾状核、苍白球、内囊、三脑室的形态、位置特点 ,先将丘脑、苍白球的大体形态在CT片上画出 ,参考姚家庆解剖图谱 ,直接确定丘脑腹外侧核的位置坐标 .根据计算机得到的有关三维坐标值安装机械臂 ,连接射频仪后进行电生…     

基底神经节的书写功能

目的通过葡萄糖代谢率比值的测定评价基底神经节在汉语书写中的作用,探讨其神经心理学机制。方法10名大学本科一年级学生,以正电子发射计算机断层显像为检测手段,观察和比较受试者在假写状态及文字书写状态下基底神经节的葡萄糖代谢情况。结果10名受试者在文字书写状态较假写状态,左侧豆状核差值(0.0435±0.0396),右侧豆状核差值(0.0634±0.0301),左侧尾状核差值(0.0463±0.0384),右侧尾状核差值(0.0566±0.0396),差异具有显著性(均P<0.05);双侧豆状核、尾状核的激活值差异无显著性(均P>0.05)。结论双侧基底神经节均参与了汉语文字书写的过程。     

人脑深部核团三维模型的构建与数据测量

目的 构建大脑深部核团三维可视化模型,以对其立体形态和空间位置进行研究.方法 选取可视人体数据集头部连续横断位图像,将其重采样到平行前后连合平面方向后,逐张分割出其中的脑深部核团及前后连合等结构的二维轮廓;采用面绘制和体绘制对各分割结构进行三维重建和虚拟显示,并根据重建模型测量计算各核团在大脑空间坐标系中的位置范围、重心点坐标和体积.结果 获得了平行于前后连合平面的头部连续断面真彩色图像集和附有解剖学标识的脑深部核团二维轮廓分割图像集,重构了各核团的面绘制和体绘制三维模型,并获得其在前后连合中点为原点的大脑空间坐标系中的核团重心点坐标,核团在X、Y、Z轴上的投影范围和核团体积等解剖数值.结论 基于可视人体数据集所构建的脑深部核团三维可视化模型充分显示了各核团在大脑中的立体形态和空间位置关系,并提供了核团重心点坐标、范围、体积等解剖数值.     

肾上腺形态及其毗邻关系的薄层断层与CT断层解剖学研究

目的 阐明肾上腺在薄层断面和CT断面的周围结构毗邻关系，为肾上腺细小病变提供影像学诊断依据。方法 对中国首例可视化人体肾上腺部分的数据集进行总结和分析，观察肾上腺的形态及其周围毗邻结构。选择50例经螺旋CT扫描无肾上腺病变的断面图像与薄层断面对照分析。结果 首例中国可视化人体肾上腺部分从共计48层，每层厚度为1．0mm．每层断面所显示的肾上腺及其周围结构清晰，CT清晰显示肾上腺大小、形态及周围结构。结论 本文报道的首例中国可视化人体肾上腺部分为连续、完整的薄层断面标本，无节段性数据缺损，层厚1．0mm，厚度均匀，连续的薄层断面解剖学基础，肾上腺形态变化较大，肾上腺于前方结构毗邻变化较大．决定肾上腺病变向前生长时有不同的优势途径。     

成年大鼠纹状体、边缘区和苍白球的计算机三维重建

目的　建立和了解成年大鼠纹状体、边缘区和苍白球在脑中的立体形态和相互关系 .方法　在大鼠脑的连续冠状切片 Nissl染色的基础上通过 Onyx2超级图形工作站应用计算机图形技术进行了三维重建 .结果　边缘区位于尾壳核和苍白球之间 ;尾壳核的立体形态呈近似的内凹半球形 ,从嘴侧到尾侧随着脑平面的增宽尾壳核逐渐向外侧 (即靠近外轮廓的方向 )移位 ,体积为 (37.77± 9) m m3,最大嘴尾径为 6 .2mm;最大背腹径为 4.9m m;最大内外径为 3.5 2 9mm.苍白球呈块形 ,位于尾壳核的内侧 ,除内侧外其他三个方向均被尾壳核包绕 ,体积为 (4.0 5± 0 .0 6 ) mm3,最大嘴尾径为 4.41mm,最大背腹径为 2 .6 45 mm ,最大内外径为 1.5 44 m m.边缘区呈现一个片状扇形结构 ,体积为 (0 .48± 0 .0 2 ) mm3,最大嘴尾径为 1.6 m m,最大背腹径为 2 .15 8m m,最大内外径为0 .17mm;同尾壳核和苍白球一样从嘴侧到尾侧随着脑平面的增宽边缘区亦逐渐向外侧 (即靠近外轮廓的方向 )移位 ,其移位的幅度亦明显大于脑平面增宽的幅度 ;整个边缘区从嘴侧到尾侧呈均匀变化 ,其片状逐渐变宽 ,长度 (背腹径 )逐渐变小 ,从而形成一个盘状结构 .结论　建立了大鼠脑纹状体、边缘区和苍白球的三维立体结构     

右侧基底神经节区病变致汉语失写症临床特征分析

失写症（Agraphia）是由于获得性脑损害而导致书写功能受损或丧失。基底神经节性失写是指病灶部位主要位于基底神经节区,包括壳核、尾状核、苍白球、内囊区,引起失写综合征。对于基底神经节性失写、基底神经节性汉语失写的相关研究报道较少,现对我科收治的50例右侧基底神经节区病变致7例汉语失写症的失写特征报道如下。     

三叉神经脑池段MRI与塑化薄层切片对照研究

目的　对三叉神经脑池段进行MRI与塑化切片对照研究 ,获得正常影像和断层解剖资料。方法　采用生物塑化技术制作三叉神经横断位 8例、矢状位和冠状位各 1例薄层切片 ,同时采用FLASH 3D序列完成头颅标本及 60例正常人脑干MR扫描 ,对三叉神经脑池段的形态、走行进行对比观察。结果　标本及活体MR扫描 ,三叉神经脑池段的行程、解剖结构能够准确显示 ,塑化切片与MRI有良好的对应关系。多平面重建 (Multiplanarreconstruction ,MPR)横断位上三叉神经脑池段长度 (12 .78± 2 .0 3 )mm ,向前上外侧走行 ,与脑干背侧连线成角 (10 3 .0 4± 5 .14 )° ,随着年龄的增大 ,三叉神经脑池段与脑干背侧连线的夹角逐渐变小 ,其中小于3 0岁年龄组与 5 0岁以上年龄组之间有显著性差异 (P <0 .0 5 ) ;左右侧三叉神经与脑正中矢状面的夹角分别为 (9.2 8± 4.80 )° ,(9.44± 4.2 0 )° ,(P >0 .0 5 ) ,无显著性差异。结论　薄层MRI能够准确显示神经脑池段的解剖结构和走行规律 ,是评价三叉神经及相关结构的准确的影像学技术。     

利用Amira进行脑基底核的三维重建

目的 利用Amira软件对人脑基底核团进行三维重建.方法 采用中国数字化可视人体数据集的头部薄层连续横断面图像,利用Photoshop软件中的自动阈值分割和人工分割相结合的方法 对基底核进行分割,并利用Amira软件进行三维重建.结果 重建结构真实、逼真,再现了各核团的自然形态及毗邻,可在三维空间以任意速度旋转并可对重建部分进行缩放和透明显示.结论 三维重建实现了对基底核的重建,对影像诊断和立体定向手术具有重要意义,而且可用于解剖学教学.     

左侧基底神经节区病变致汉语失写书写障碍临床分析

失写症（Agraphia）是指由于获得性脑损害而导致书写功能受损或丧失。基底神经节性失写是指病灶部位主要在基底神经节区（包括壳核、尾状核、苍白球、内囊区）,引起的失写综合征。现对我科收治的50例左侧基底神经节区病变致42例汉语失写症的失写特征报告如下。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.