肘关节斜位投照的临床运用

目的:探讨肘关节斜位投照在肘关节外伤的临床价值。方法:回顾性分析肘关节外伤26例,常规正侧位片可疑骨折或有明显症状而未见骨折者均加照肘关节侧斜位,部分同时加照正斜位。结果:26例肘关节外伤患者,均得到了明确的肯定或否定性诊断。结论:肘关节斜位投照,是对临床高度怀疑肘关节骨折而常规体位投照未能确诊的病人加照时首选的投照体位,明显提高了肘关节骨折的检出率,是肘关节标准正侧位和被动体位投照的重要补充。     

肘关节X线摄片斜投照30例分析

目的探讨肘关节斜位投照在肘关节外伤的临床价值。方法回顾性分析肘关节外伤30例,常规正侧位片可疑骨折或有明显症状而未见骨折者均加照肘关节侧斜位,部分同时加照正斜位。结果30例肘关节外伤患者,均得到了明确的肯定或否定性诊断。结论肘关节斜位投照,是对临床高度怀疑肘关节骨折而常规体位投照未能确诊的病人加照时首选的投照体位,明显提高了肘关节骨折的检出率,是肘关节标准正侧位和被动体位投照的重要补充。     

肋骨腋中线骨折X线投照方法的改进

胸部外伤特别是肋骨腋中线骨折,采用传统的胸部正侧位投照方法容易漏诊。笔者在传统的正侧位投照方法的基础上,把侧位片改为左前斜30°-45°角或右前斜30°-45°角的体位投照,并经80例胸部外伤病人的240张胸片的观察,降低了肋骨腋中线骨折的漏诊率,介绍如下。1投照方法1.1投照体位患者直立于摄影架前,先面向暗     

一种新的肘关节斜位投照法的临床应用

肘关节内骨折是比较常见的损伤。在标准的肘关节正侧位片上,由于其关节面相互重叠,因而有一部份无移位的轻微骨折往往不易发现,以致造成漏诊。我们参照Greenspan氏介绍的桡骨头、肱骨小头斜位投照法,在一年多的时间内对97例肘创伤患者除进行常规肘正侧位摄片外,均附加这种斜位投照。通过临床应用,我们体会到,本法确能发现一些常规位置上不能发现的肘部不明显骨折,因而提高了诊断准确性。现介绍如下:     

肘关节侧位非规范体位摄片对细微骨折诊断的影响--附856例肘关节侧位X线片分析

目的探讨肘关节侧位非规范体位摄片对肘关节细微骨折诊断的影响因素，加强其投照体位的规范化，减少和避免肘关节细微骨折的漏诊。方法对我院856例肘关节侧位X线片进行观察分析。结果肘关节侧位非规范体位593例（69．28％）；其分类情况，曲肘角度不规范341例（58．49％），上臂体位不规范共252例；肘关节侧住非规范体位593例中由于肘关节侧住上臂体位不规范，未发现骨折而进一步重新摄标准侧位片发现有细微骨折共11例，其漏诊比例约占细微骨折病例总数的13．41％。结论肘关节侧位非规范体位摄片是影响肘关节细微骨折诊断的重要因素。     

切线位加侧斜位对肋骨骨折的诊断价值 (附46例报告)

由于肋骨的解剖呈"C"形弯曲以及胸腔内脏器重叠,一般投照体位投照难以发现骨折征象.笔者总结46例肋骨骨折病例,介绍一种新的投照体位:切线位加侧斜位.     

124例胫骨平台骨折的X线分析

目的：进一步明确X线平片在诊断胫骨平台骨折中的作用。方法：对124例胫骨平台骨折的X线检查资料进行了回顾性分析（其中18例又进行了CT的对照检查）。结果：124例中首次正侧位X线平片检查发现骨折113例；加摄左、右斜位发现骨折6例；轴位发现骨折1例；另4例CT扫描证实骨折后再次平片检查，2例显示骨折线，2例石膏固定骨折线观察不清。结论：常规X线平片检查仍然是诊断胫骨平台骨折的首选方法；对于外伤后临床症状明显，在常规正侧位平片的基础上加摄特殊体位一般可确立诊断；CT检查除可发现隐匿性骨折外，还可了解有无关节软骨及周边肌腱的损伤。     

儿童肘关节损伤的X线诊断漏诊原因分析

目的:探讨儿童肘关节损伤的X线诊断漏诊原因。方法:随机抽取近4年DR、CR的100例1~6岁儿童因外伤而漏诊的常规肘关节正侧位平片进行分析。结果:投照位置标准20例,占20%;投照位置倾斜40例,占40%;有双侧比对40例,占40%。其中髁上骨折骨折63例(伸直型56例,屈曲型7例),占63%;外上髁骨折10例,占10%内上髁骨折(合并髁分离)10例,占10%;鹰嘴骨折2例;桡骨颈骨折1例,肱骨小头骨骺分离3例,肘关节脱位2例,上尺桡关节脱位(包括半脱位)6例,占6%;全髁分离2例,肘关节单纯性脱位并撕脱骨折1例。其中复查发现,髁上肱骨下端及尺骨近端骨膜反应并关节囊内肿胀各2例;发生畸形愈合共计5例,合并屈伸功能障碍3例;肘内翻及外翻各1例,总计肘关节临床表现伤残9例,达9%。本组因投照体位不规范,致髁上不完全性骨折、肱骨小头骨骺分离、上尺桡关节脱位以及不明显的撕脱骨折漏诊7例,诊断技术原因漏诊5例,共计漏诊12例(占12%)。结论:规范的儿童肘关节X线投照体位,熟悉的儿童肘关节X线解剖、加上健侧比对的方法,是减少儿童肘关节损伤漏诊的最好方法。     

锁骨骨折多体位投照的应用价值

目的:探讨锁骨外伤骨折漏诊的原因,增加锁骨多体位摄片,减少锁骨骨折的漏诊发生。方法:对65例锁骨部有外伤患者先行锁骨正位摄片,后加照锁骨前弓位和锁骨左右斜位与正位比对。结果:先行正位摄片确诊骨折7例,约占11%,加照锁骨前弓位及左右斜位新增加2例,约占14%,漏诊2例,约占3%。结论:锁骨外伤,常规锁骨正位不能完全反映骨折情况,增加锁骨多体位摄片,能减少锁骨漏诊,明确诊断。     

使用多体位投照X线平片对肋骨骨折进行诊断的效果观察

目的：探讨使用多体位投照X线平片对肋骨骨折进行诊断的临床效果。方法：对2010年1月～2014年1月期间我院收治的73例肋骨骨折患者的临床资料进行回顾性分析。我们为这73例患者均进行了多体位投照X线平片检查,并对检查结果进行分析。结果：经过多体位投照X线平片检查,在这73例肋骨骨折患者中共检查出骨折189处,其中54例患者的122处骨折是通过使用正位胸片检出,占骨折总数的64.5%,有14例患者的43处骨折是通过使用斜位胸片检出,占骨折总数的22.8％;有3例患者的14处骨折是使用局部切线片检出,占骨折总数的7.4％。结论：使用多体位投照X线平片检查对肋骨骨折患者进行诊断可以有效地提高患者骨折的检出率,此方法值得在临床上推广应用。     

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.