64MDCT冠状动脉成像不同心率下的最佳重建时相分析

目的探讨64排螺旋CT（64MDCT）冠状动脉成像不同心率下冠状动脉各节段血管的最佳重建相位。方法对61例病例行64MDCT冠状动脉成像,扫描后原始数据分别按R—R间期30％,35％,40％,45％,50％,60％,70％,75％的相位进行后处理重组。记录扫描期间平均心率,心率〈70次/min为Ⅰ组,≥70次／分为Ⅱ组,分析不同心率组不同R-R时相对各支冠状动脉血管的显示情况。结果Ⅰ组的所有的冠状动脉节段可以在单一的75％相位上获得最佳图像质量;Ⅱ组的所有冠状动脉可以在单一的45％或加％的相位上获得最佳图像质量,多时相重建并不能显著提高图像质量。结论随着64MDCT的时间分辨率的充分发展,所有有关冠状动脉节段能在一个重建间隔得到有诊断价值的图像。     

心率及重建时相对64层CT冠状动脉成像图像质量的影响

目的探讨不同重建时相对64层CT冠状动脉成像质量的影响。方法64例患者采用64层CT回顾性心电门控冠状动脉成像,扫描原始数据不同时相重建,用横断面、曲面重建、容积再现等方法对图像质量综合评分。患者心率<65次/min为Ⅰ组(n=36),65～79次/min为Ⅱ组(n=18),≥80次/min为Ⅲ组(n=10),患者冠状动脉血管分为12段,4条冠状动脉分支(左冠状动脉主干、左前降支、左回旋支、右冠状动脉)用于图像质量分析。结果Ⅰ和Ⅱ组60%、65%相位图像质量最优,Ⅲ组右冠状动脉(right coronary artery,RCA)最优的相位窗为40%相位,左回旋支(left circumflex coronary artery,LCX)、左前降支(left anterior descending coronary artery,LAD)、左主干(left main,LM)最优的相位窗为60%。结论心率低于80次/min的患者冠状动脉重建时相首选舒张中期60%或65%时相;心率高于80次/min患者,按左、右冠状动脉分支分别进行重建有利于提高冠状动脉的成像质量。     

心率对64层螺旋CT冠状动脉成像影响

目的探讨64层螺旋CT冠状动脉成像的临床应用价值及心率对图像质量的影响。方法对66例患者行64层螺旋CT冠状动脉成像,记录扫描时间、心率、心率变化,后处理重建冠状动脉各分支的显示情况、冠状动脉病变的显示情况;将66例患者按心率≤60次为Ⅰ组,心率61～70次为Ⅱ组,心率71～80次为Ⅲ组,心率〉80次为Ⅳ组,比较各组间图像质量评分。结果64层螺旋CT冠状动脉成像扫描时间短,心率变化小,对冠状动脉三四级分支的显示优,对病变显示清晰;比较不同心率组冠状动脉图像质量评分,Ⅳ组（心率〉80次）明显低于Ⅰ、Ⅱ、Ⅲ组（P〈0．05）,Ⅰ、Ⅱ、Ⅲ各组间差异无统计学意义。结论64层螺旋CT冠状动脉成像扫描时间短,图像清晰,但心率〉80次对图像质量仍有很大的影响。     

64排螺旋CT冠状动脉成像的质量控制技术

目的探讨64排螺旋CT冠状动脉成像质量的影响因素。方法搜集500例患者64排螺旋CT冠状动脉成像（64DCTCA）完整资料,将图像进行多相期重建后传至工作站处理,以显示冠状动脉主干和分支进行分析,评价不同心率、心动周期内不同R-R时相重建图像、不同注射方式的冠脉成像质量。结果64排螺旋CT冠状动脉成像图像质量与患者心率、呼吸运动及冠状动脉钙化积分等因素成负相关。结论检查前控制好患者心率（〈65次/分）、选择最佳的重建时相窗（60%R-R间期）、患者屏气配合及双相注射对比剂有利于提高冠脉的成像质量。     

16层螺旋CT冠状动脉成像技术因素与图像质量相关性研究

目的 探讨16层螺旋CT冠状动脉血管成像技术因素与图像质量的相关性.方法 436例受检者行16层螺旋CT冠状动脉血管成像检查,将图像行后处理重建显示冠状动脉主干及其主要分支.结果 心率对图像质量影响较大,理想心率在55次/分～75次/分,MSCT对冠状动脉主干及其主要分支显示率为80.3%达到诊断要求;选择重建相位窗为75%可提高工作效率;使用注射速率为3.5ml/s,显示冠状动脉清晰且受腔静脉伪影少.     

64 层CT在心率较快患者冠状动脉成像中的技术应用

 【目的】 探讨64层螺旋CT在心率较快患者冠状动脉成像中的技术应用。【方法】 收集临床拟诊冠心病而行64层CT冠状动脉造影检查的患者107例。平均心率低于80 min-1的患者55例,作为正常心率对照组。平均心率超过80 min-1(80 ~ 98 min-1)的患者52例。扫描后对已采集数据进行个性化重建,利用后处理工作站进行图像质量分析。 【结果】 对冠状动脉近段/中段和远段成像质量进行统计分析,和心率正常组相比,心率80 ~ 90 min-1和平均心率超过90 min-1者CTA图像质量评价没有显著统计学差异。【结论】 对于64层CT冠状动脉成像心率较快的患者,选择合适的图像重建时相,使用回顾性心电门控配合个性化重建能明显改善患者的冠状动脉CT造影图像质量。     

冠状动脉64层螺旋CT成像质量与心率关系

目的探讨冠状动脉螺旋CT成像质量与心率的关系。方法随机抽取冠状动脉64层螺旋CT成像250例,排除呼吸运动影响及心律失常者,按照平均心率(次/min)分5组(≤60,～65,～70,～75,>75),分析各支冠状动脉各段显示情况。结果心率≤70次/min共812支血管,图像质量3级以上3支;～75次/min共140支血管,图像质量3级以上8支;>75次/min共47支血管,图像质量3级以上10支。心率>70次/min图像质量开始受到影响(<0.05),心率>75次/min明显受到影响(<0.01)。结论64层螺旋CT冠状动脉成像时心率快慢及心率稳定与否影响成像质量,有效心率控制并维持心率稳定能保证良好的冠脉图像质量。     

心率对64排CT冠状动脉造影成像质量影响的评估与讨论

目的 评估与讨论心率对64排CT冠状动脉造影成像质量的影响.方法 选择我院2011年3月～2012年12月300例不同心率接受64排CT冠状动脉造影成像检查的患者,按平均心率分为五组,A组患者60例平均心率≤60次/min,B组60例患者平均心率在61～65次/min,C组60例患者平均心率为66～70次/min,D组患者60例患者平均心率为71～75次/min,E组60例患者平均心率＞75次/min,比较五组患者64排CT冠状动脉造影成像质量.结果 300例患者共921支血管,从图像质量分级情况显示,图像质量与平均心率呈负相关,心率越快,则图像质量越差,A组图像均为1级,B组、C组图像质量略低于A组,组间比较差异无显著性,无统计学意义P＞0.05.D组、E组图像质量与前三组比较差异具有显著性,有统计学意义P<0.05.结论 61排CT冠状动脉造影成像质量会受到心率变化的影响,心率越快,对质量的影响越大,因此,为保证64排CT冠状动脉造影成像质量,应维持患者心率稳定,对心率过快的患者进行有效控制.     

64排螺旋CT冠状动脉成像技术的临床应用

目的探讨64排螺旋CT冠状动脉成像技术及影响图像质量的因素。方法采用回顾性心电门控,对306例患者用64排CT进行心脏扫描,以R-R间期的不同时相75%、70%、45%、40%进行预览,利用Comp cardiac后处理软件三维重建分析冠状动脉。结果 306例患者,有16例显示不良。其中心率≤65次/min的占3例,心率≥75次/mim的占9例,心率65-75次/min的占4例。其余290例患者能顺利完成检查,冠状动脉显示清楚,二三级分支也能显示,达到诊断要求。结论选择合适的扫描技术,控制患者的心率,加强患者屏气配合,正确的图像后处理技术均可提高冠状动脉的质量。     

16排螺旋CT冠脉成像最佳重建时相窗探讨

目的 讨论16排螺旋CT冠状动脉成像重建相位窗的选择对图像质量的影响.方法 100例临床拟诊冠心病的患者行MSCT冠脉成像.利用回顾性ECG门控技术,重建出20%～80%R-R间期轴位图像,分别进行三维VRT重建.比较图像质量并进行评分.结果 左前降支(LAD)、左回旋支(CX)、右冠状动脉(RCA)在心动周期时相的60%～70%成像效果较好.左主干(LM)除40%R-R间期外,其余时相成像效果均较好.结论 当扫描时患者平均心率小于60次/min时,60%、70%R-R间期是最佳重建相位窗.     

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.