CT灌注成像对急性脑梗死患者静脉溶栓治疗的指导作用

目的 探讨CT灌注成像对急性脑梗死患者静脉溶栓治疗的指导作用.方法 选取发病6h内的急性脑梗死患者30例,行颅脑CT灌注成像检查,观察静脉应用尿激酶溶栓前后病变区相对脑血流量(rCBF)、相对脑血容量(rCBV)、相对平均通过时间(rMTT)的变化,于溶栓前、后进行NIHSS评分.结果 急性脑梗死发病6h内CT灌注成像均发现与临床症状相对于的脑灌注异常区,表现为脑血流量(CBF)、脑血容量(CBV)降低,平均通过时间(MTT)延迟,表明存在缺血半暗带.溶栓后大部分患者脑灌注情况明显改善,梗死核心区rCBF,rCBV与溶栓前比较无统计学差异(P>0.05);缺血半暗带区rCBF显著增加(P＜0.01),rMTT减小(P＜0.01).溶栓后NIHSS评分显著降低(P＜0.05).结论 急性脑梗死患者超早期行CT灌注成像能显示缺血半暗带,溶栓后缺血半暗带区脑灌注异常明显改善,对静脉溶栓治疗具有临床指导意义.     

急性脑梗死的CT脑灌注成像分析

目的：对CT 脑灌注成像技术诊断急性脑梗死的价值进行探讨。方法选择该院于2014年1月—2014年8月期间收治的急性脑梗死患者60例作为研究对象,该组患者均在1周内经CT平扫并复查确诊为脑梗死;患者入院后均在6 h内进行接受16层螺旋CT脑灌注成像,比较分析健侧正常区、半暗带区及脑梗死区的影像。结果通过统计、计算CT脑灌注成像数据可知,在 CBF、CBV及MTT的平均值方面,脑梗死区与健侧区相比,差异有统计学意义(P<0.05);脑梗死区域、半暗带区及健侧区的CBV和MTT平均值呈逐渐下降趋势,而CBF成上升趋势。结论急性脑梗死可利用16层螺旋 CT进行诊断,早期诊断效果良好,可为治疗提高准确的影像依据。     

多层螺旋CT灌注成像在急性缺血性脑病早期诊断中的应用价值

目的:分析多层螺旋CT灌注成像在急性缺血性脑病早期诊断中的应用价值。方法:选取76例拟诊为急性缺血性脑病患者,先对其运用CT平扫进行疾病的诊断,再对其运用多层螺旋CT灌注成像进行疾病的诊断。记录CT平扫和多层螺旋CT灌注成像的诊断结果及多层螺旋CT灌注成像各项参数测量的结果并比较。结果:经多层螺旋CT灌注成像确诊为急性缺血性脑病的有72例,有4例未发现异常;经CT平扫确诊为急性缺血性脑病的有34例,未发现异常的有42例;多层螺旋CT灌注成像对急性缺血性脑病的敏感度明显高于CT平扫,差异具有统计学意义(P<0.05);多层螺旋CT灌注图像上健侧、病灶周边及病灶中心的脑血流量(CBF)、平均通过时间(MTT)、对比剂峰值时间(TTP)均存在着明显的差异,差异具有统计学意义(P<0.05)。结论:多层螺旋CT灌注成像的鉴别诊断有助于急性缺血性脑病的临床治疗。     

64层螺旋CT脑灌注联合CT血管造影诊断颈内动脉狭窄或闭塞的应用价值

目的 探讨64层螺旋CT脑灌注联合CT血管造影诊断颈内动脉狭窄或闭塞的应用价值.方法 选取颈内动脉狭窄或闭塞所致的急性缺血性脑血管病患者90例,均行64层螺旋CT脑灌注联合CT血管造影检查.观察64层螺旋CT脑灌注参数及CT血管造影扫描后颈内动脉狭窄程度.结果 急性脑梗死及短暂性脑缺血发作患者患侧对比剂平均通过时间、峰值时间均长于健侧(P<0.05),急性脑梗死患者患侧脑血流量、脑血容量均少于健侧(P<0.05).急性脑梗死患者颈内动脉狭窄程度与64层螺旋CT脑灌注MTT值有明显相关性(P<0.05),而短暂性脑缺血发作患者则无明显相关性.结论 64层螺旋CT脑灌注联合CT血管造影扫描能同时诊断脑组织局部血流灌注改变情况和颈内动脉狭窄程度.     

CT脑灌注成像技术在超早期脑梗死诊断中的意义

目的探讨螺旋CT脑灌注成像技术在超早期脑梗死诊断中的意义。方法对55例短暂性脑缺血发作患者行头部CT平扫,选择基底核区或感兴趣区行CT脑灌注成像,获取脑血流量(CBF)、脑血容量(CBV)和对比剂平均通过时间(MTF)图。结果与对侧相比CBF、CBV下降,MTF延长。对于CT平扫未见病灶的患者,可预示有无梗死灶的存在、位置及范围;对于已有梗死灶的患者可预示病灶的发展趋势。结论CT脑灌注成像技术可超早期预示脑梗死病灶及其发展趋势,有重要的临床应用价值。     

CT灌注成像对急性缺血性脑病的诊断研究

目的应用多层螺旋CT灌注成像（CTP）I对急性缺血性脑病的早期诊断价值进行研究.方法 50例临床拟诊为急性缺血性脑病患者,均在症状发生后1～12 h内,首先行常规CT平扫,接着进行CT灌注成像检查;所有病人在首次检查后3～7 d内再行CT和临床随诊.结果首次常规CT平扫上,21例显示脑梗死灶,未发现异常病灶者29例.此29例患者经复查CT和临床随诊证实大面积脑梗死者24例,腔隙性脑梗塞3例,另2例诊断为短暂缺血性发作（TIA）.CTPI检查显示脑灌注异常者48例,2例未发现灌注异常.在CTPI图像上,测量感兴趣区（RO）I局部脑血流量（rCBF）、对比剂峰值时间（TTP）、平均通过时间（MTT）的改变明显,病灶侧与健侧、病灶中心与周边区比较差异有统计学意义（P〈0.05）.结论 CTPI能早期发现急性脑缺血病灶,定量分析还可区分脑梗死区和半暗带区,有助于临床选择治疗方案,尤其是早期溶栓治疗的实施.     

超急性期脑梗死CT扫描及临床诊断分析

目的：对超急性期脑梗死16排螺旋CT扫描结果与临床诊断进行分析。方法选取疑似超急性期脑梗死患者38例,均于发病后6 h内展开CT扫描与灌注成像,对CT扫描结果进行分析。结果经CT平扫30例未见明确病灶,8例为可疑脑缺血区;38例患者经CT灌注检查,发现灌注图中均有对应于临床症状的脑缺血区域。30例在头部CT复查中发现程度不同的脑梗死,脑梗死区域中rCBF、rCBV明显低于对照区域,MTT、TTP相有明显延后;缺血性暗带区rCBF明显低于对照区域,rCBV有轻度升高或正常,MTT、TTP有明显延后。结论16排螺旋CT扫描与灌注成像在超急性期脑梗死诊断中具有重要价值,对临床治疗有重要的指导作用。     

CT灌注成像在急性缺血性脑血管病中的应用

目的探讨多层螺旋CT(MSCT)平扫、CT灌注成像(CTPI)在急性缺血性脑血管病中的应用价值。方法对52例急性缺血性脑血管病患者于急性发作6 h内依次行MSCT平扫、CTPI,并根据随访CT或MRI检查结果分为脑梗死(CI)组34例和短暂性脑缺血发作(TIA)组18例,综合分析比较两组发病情况及CTPI参数结果。结果 CI组患侧与健侧CT灌注参数差异有统计学意义(P<0.05);TIA组患侧与健侧平均通过时间(MTT)、峰值时间(TTP)差异有统计学意义(P<0.05);两组间CT灌注参数:脑血流量(CBF)、脑血容量(CBV)、TTP差异有统计学意义(P<0.05);临床神经功能缺损程度评分(NIHSS)≥5分CI的阳性率明显高于NIHSS评分<5分(P<0.05)。结论 CTPI能够早期诊断急性缺血性脑血管病并可以从形态和功能学上综合分析急性缺血性脑血管病的病因和程度,获得更详细的影像学信息,为临床医师早期、合理治疗急性缺血性脑血管病提供更多的客观影像学依据。     

螺旋CT灌注成像对脑胶质瘤血流灌注的定量研究

目的:探讨螺旋CT灌注成像对脑胶质瘤血流灌注的定量诊断的价值。方法:有病理或追踪结果的39例脑病变患者,其中胶质瘤2 5例,非胶质瘤1 4例,应用SomatomPlus 4螺旋CT扫描机对所有患者进行CT灌注成像扫描。经灌注软件处理,使用2 5 6彩色直观地显示脑组织中血流灌注图,并计算出局部脑血流量(rCBF)、局部脑血容量(rCBV)、对比剂平均通过时间(MTT) ,并与对侧脑组织灌注参数进行统计分析比较。结果:脑胶质瘤的rCBF、rCBV值明显高于对侧脑组织rCBF分别为( 78.62±5 2 .1 9)mL/( 1 0 0g·min) ,( 2 6.48±8.2 1 )mL/( 1 0 0g·min) ,P <0 .0 1 ,rCBV分别为( 1 4.1 3±8.1 6)mL/1 0 0g ,( 2 .1 4±1 .34)mL/1 0 0g ,MTT值明显高于对侧脑组织( 8.2 0±3.42 )s ,( 3.82±2 .2 6)s ,P <0 .0 1 ,以上均有程度不同的瘤周水肿,其rCBF、rCBV均低于对侧脑组织,脑膜瘤、转移瘤、血管母细胞瘤、淋巴瘤均显示局部高灌注。结论:灌注成像能定量脑胶质瘤的血供状态,显示特征性动态曲线,估计病理类型,检出脑胶质瘤瘤周水肿低灌注区和术后复发灶。     

CT脑灌注成像在超早期脑梗死诊断中的临床应用

目的探讨螺旋CT脑灌注成像技术在超早期脑梗死诊断中的价值。方法分析总结12例发病在6h内临床可疑脑梗死,对其进行了CT平扫、CT脑灌注检查和CT复查住院患者资料,并对灌注资料做统计学分析。结果CT平扫2例脑实质密度轻微减低、脑沟变浅（17％）,CT脑灌注10例显示与临床症状对应区域血流灌注异常（83％）,与对侧比较CBF、CBV下降,MTT延长。24～72hCT复查血流灌注异常区域全部出现大小不等低密度脑梗塞灶。2例对于CT平扫、CT灌注及复查均未见异常（17％）。结论常规CT平扫对超早期脑梗死诊断有限,不能满足临床的要求。CT脑灌注成像技术对超早期脑梗死诊断有重要的临床应用价值。     

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.