99m TcO4-核素显像联合超声检查对甲状腺结节的鉴别诊断价值

目的 探讨99mTcO4-核素显像联合超声检查对甲状腺结节的诊断价值.方法 以术后病理结果为金标准,对苏州大学附属第二医院2006年4月至2010年8月114例患者的125个甲状腺结节的99mTcO4-核素显像及超声检查结果进行对比研究.结果(1)125个结节中,甲状腺腺瘤所占比例为51.2％,甲状腺癌仪占24.0％,其他甲状腺病变占24.8％;核素显像中“冷”结节占73.6％,其中甲状腺癌占25.0％;超声检查中以实性结节和囊实性结节为主且实性结节的恶性率最高.(2)实性“凉”、“冷”结节与囊实性“凉”、“冷”结节的恶性率差异有统计学意义(P＜0.05).(3)在直径＞2.0 cm的实性“凉”、“冷”结节中,甲状腺癌占62.5％.结论 99mTcO4-核素显像联合超声检查有助于评价甲状腺结节的摄取能力,对鉴别诊断甲状腺结节良恶性起着重要作用.     

CT结合核素显像对甲状腺肿瘤的鉴别诊断价值

目的　探讨CT扫描结合核素显像在甲状腺肿瘤鉴别诊断中的价值。方法　回顾性分析经手术及病理证实的 5 4例甲状腺肿瘤的CT表现及核素显像结果 ,其中甲状腺腺瘤 4 0例 ,甲状腺癌 14例。结果　CT扫描 4 8个腺瘤病灶中有 4 0个包膜完整 ,其中 37个囊腺瘤病灶均有完整性强化环。 15个甲状腺癌病灶中有 12个边界模糊 ,7个呈“强化残圈”征 ,5个有强化瘤壁结节 ,4个乳头状癌病灶侵犯周围组织。核素显像甲状腺腺瘤 4 5个结节中 ,热结节 4个 ,温结节 8个 ,凉冷结节 33个。甲状腺癌 15个甲状腺结节中均为凉冷结节。结论　CT扫描结合核素显像可以使我们对于甲状腺肿瘤的性质有更进一步的认识 ,从而有利于鉴别诊断。对于核素显像为热结节、温结节者 ,首先应考虑为良性病变 ,为凉冷结节者应密切结合CT征象。     

15例肾上腺骨髓脂肪瘤影像诊断

目的：探讨MRI、CT影像对诊断肾上腺骨髓脂肪瘤的临床应用价值。方法：分析15例肾上腺骨髓脂肪瘤CT及MRI表现，15例作CT平扫加增强三期扫描，3例行MRI平扫增强扫描，并作三期T1WI横断及冠状位扫描。将手术证实的15例病理与CT及MRI诊断对照，进行鉴别诊断。结论：在肾上腺骨髓脂肪瘤的影像诊断中，应合理应用CT及MRI的各种扫描技术及其综合诊断并注意与肾上腺瘤，肾错构瘤，腹膜后脂肪瘤等相鉴别。CT及MRI为肾上腺骨髓脂肪瘤诊断的重要影像学检查技术。     

~(99m)Tc-MIBI双时相法诊断甲状旁腺功能亢进症的临床价值

目的探讨核素99mTc-甲氧基异丁基异腈(99mTc-MIBI)双时相法显像在诊断甲状旁腺功能亢进症(hyper-parathyroidism,HPT)中的作用,并与其他影像检查方法进行比较。方法65例临床考虑为HPT的患者均分别进行了核素显像及超声检查,20例做了CT检查,11例做了MRI检查。核素显像采用99mTc-MIBI双时相法。比较几种影像检查的灵敏度、特异性,分析其对HPT的诊断价值。结果65例患者中,甲状旁腺激素(PTH)增高36例,以PTH结果为诊断标准。核素检查阳性34例,阴性2例,灵敏度94.4%,特异性100%,准确性96.9%;超声检出32例,阴性4例,假阳性2例,其灵敏度88.9%,特异性93.1%,准确性90.8%;CT阳性17例,MRI阳性8例。结论核素99mTc-MIBI双时相法甲状旁腺显像是一种简便有效的检查方法,可提高甲状旁腺瘤术前定位诊断的准确率。临床高度怀疑原发性甲状旁腺功能亢进症的病人,若超声检查阴性应进一步行核素检查除外甲状旁腺瘤。     

MRI、SPECT骨显像对脊柱良恶性病变的鉴别诊断价值

目的探讨磁共振成像（MRI）联合^99Tcm-亚甲基二膦酸盐（MDP）骨显像（BS）（BS/MRI）对恶性肿瘤患者脊柱病变的鉴别诊断价值。方法对69例恶性肿瘤患者进行BS与脊柱MRI检查,获得全身BS及MRI图像并进行分析。结果在相同扫描野内,BS/MRI对69例脊柱病灶的诊断符合率明显高于BS和MRI,差异均有统计学意义（P〈0.01）。结论MRI联合BS对恶性肿瘤患者脊柱病变的鉴别诊断具有重要的临床价值。     

甲状腺结节CT及MRI诊断分析

目的分析与探讨甲状腺结节的CT与MRI诊断方法与要点。方法选取2010年5月～2012年5月广东省顺德区第一人民医院收治的甲状腺结节患者106例,对其CT及MRI资料进行回顾性分析。重点分析CT与MRI的表现特点,并对比两种方法的准确率。结果 106例患者CT扫描显示多为良性结节,其中提示为恶性肿瘤者8例,MRI扫描显示结节多为良性结节,其中提示为恶性肿瘤者10例。通过病理学检查,106例患者中发现癌细胞者12例,疑为恶性者1例。MRI的诊断准确率高于CT检查,差异有统计学意义(P<0.05)。结论 MRI对于甲状腺结节能够清晰地分辨良恶性,且对较小病灶能够清晰显示,但由于MRI敏感度不如CT,因此临床上进行诊断时可结合两种方法,以提高检测准确度。     

甲状腺弥漫性病变的CT诊断及鉴别诊断

目的：分析甲状腺弥漫性痛变的CT影像表现,探讨甲状腺弥漫性病变的良、恶性诊断及鉴别诊断要点。方法：回顾性分析经手术病理、穿刺活检或临床及实验室检查证实的36例甲状腺弥漫性病变的CT表现;所有病例均行CT平扫和增强扫描。结果：甲状腺腺瘤16例,甲状腺癌5例,结节状甲状腺肿ll例,其中单结节型5例,多结节型6例,桥本氏甲状腺炎l例,Crave病3例。结论：CT对甲状腺弥漫性病变的良、恶性鉴别诊断,应从病变大小、边缘、密度、有无颈淋巴结肿大,周围组织是否受侵及瘤内颗粒状钙化等方面进行综合分析,对病变的定性诊断及鉴别诊断具有重要价值。     

胆管错构瘤的影像诊断与鉴别诊断

目的:探讨胆管错构瘤的CT、MRI及超声表现,以提高对本病的认识,并与肝内其它弥漫性病变鉴别,减少误诊。方法:回顾性分析13例胆管错构瘤的CT、MRI及超声表现,并结合文献,对本病的病理、临床及影像特点进行讨论。结果:CT显示病灶呈多发低密度,大小不等,形态各异,边缘部分清楚,部分模糊,增强扫描无强化;MRI显示病灶呈长T1长T2信号,形态各异,增强扫描无强化;超声显示肝内多发低至无回声异常信号,彩色多普勒未见异常血流信号。结论:正确认识胆管错构瘤的影像特点,对本病的诊断及鉴别诊断有较大帮助。     

甲状腺结节良恶性鉴别的研究进展

甲状腺结节(TN)是常见的疾病,5%的TN为恶性肿瘤。关于甲状腺良恶性结节的鉴别诊断日益受到学术界的关注,结合TN的病史及临床表现,并通过在超声、CT、磁共振状态下甲状腺良恶性结节的不同表现可鉴别。如今,最有诊断价值的当属甲状腺细针穿刺,通过病理检查可确诊TN的良恶性。同时,放射性核素检查鉴别冷、热、凉结节和肿瘤标志物的检测如半乳糖凝集素、血管内皮生长因子、降钙素、血清甲状腺球蛋白、抗人白细胞抗原单克隆抗体系统、端粒酶反转录酶等对TN良恶性的鉴别也有一定的作用。     

99Tcm-MDP骨显像与磁共振成像诊断骨转移灶的对比分析

^99Tc^m-MDP骨显像与磁共振成像（MRI）能早期检测恶性肿瘤患者有无骨转移灶，为临床进行疾病分期、治疗方案的选择及预后判断提供了宝贵资料。本研究对25例同时进行^99Tc^m-MDP骨显像与MRI的恶性肿瘤患者不一致的影像特点进行分析，以探讨其各自的诊断价值，现报道如下。     

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.