新生儿胆红素脑病的MRI影像特征

目的探讨磁共振成像（MRI）对新生儿胆红素脑病（NBE）诊断的价值。方法回顾性分析20例临床诊断为新生儿胆红素脑病的MRI表现。结果 20例患儿中18例表现为苍白球,呈对称性T1WI高信号。16例患儿底丘脑T1WI呈高信号,T2WI呈等或稍高信号,5例患儿桥脑背侧、中脑呈T1WI高信号,桥脑腹侧T1WI呈等信号;扩散加权成像（DWI）示所有新生儿胆红素脑病核团信号未见明确异常。结论新生儿胆红素脑病的MRI表现有一定的特征性,MRI具有较好的诊断价值。     

新生儿缺氧缺血性脑病的影像诊断价值

目的:探讨新生儿缺氧缺血性脑病的CT和MRI表现及诊断价值。方法:回顾性分析38例有围产期窒息史患儿的CT和MRI表现及追踪其复查CT和MRI的表现。结果:38例中,初诊头部CT和MRI均有不同程度HIE征象。CT表现为脑实质内范围大小不一的低密度灶,灰、白质分界模糊,甚至消失。表现为:灰、白质信号差别消失或一个或多个脑叶白质区呈片状T1低信号及T2高信号灶,或伴有基底节区可见点状异常T2低信号灶。追踪复查CT和MRI,20例CT和MRI表现正常,4例放弃治疗死亡,余14例中,CT表现为低密度灶无明显改善,甚至遗留脑软化灶。MRI表现为脑萎缩伴随基底节区异常T2信号或脑水肿征象。结论:CT和MRI相结合,对HIE有客观反映,能弥补超声诊断空白,对HIE早诊断和预后评估、脑损伤监测有一定实用价值。     

新生儿缺氧缺血性脑病早期MRI表现

目的 探讨新生儿缺氧缺血性脑病（HIE）早期的MRI表现.方法 回顾性分析146例新生儿缺氧缺血性脑病患儿早期的MRI表现.结果 头颅MRI提示HIE患儿的早期异常征象主要有：脑水肿94例,88例为局限性脑水肿,表现为额顶叶皮层高信号,灰白质分界不清;基底节、丘脑、内囊后肢异常信号31例,表现为基底节、丘脑背侧斑片状T1信号增高,T2为低信号,内囊后肢正常高信号消失;脑实质出血10例,脑室内出血17例,蛛网膜下隙出血85例;1例重度窒息表现为大面积脑梗死.结论 MRI可以反映新生儿HIE早期脑损伤的多种表现,能反映出新生儿缺氧缺血性脑病的脑损害程度,对新生儿缺氧缺血性脑病诊断有较高的参考价值.     

血清NSE联合颅脑MRI在预测新生儿高胆红素血症脑损伤中的应用价值

目的:分析血清神经元特异性烯醇化酶(neuron specific enolase,NSE)联合颅脑MRI在预测新生儿高胆红素血症脑损伤中的应用价值。方法:将225例高胆红素血症新生儿纳入研究范围,均有完整颅脑MRI影像资料及血清NSE检查结果,以临床最终诊断为结局,分析血清NSE联合颅脑MRI对新生儿高胆红素血症脑病的预测价值。结果:225例高胆红素血症新生儿中,30例在病理性黄疸基础上脑干听觉诱发电位异常,并伴神经系统症状,临床综合诊断为新生儿高胆红素血症脑损伤;高胆红素血症新生儿血清NSE、MRI检查所得苍白球与壳核T1WI信号强度比值(G/P比值)显著低于高胆红素血症脑损伤新生儿,差异有统计学意义(P<0.05);以G/P比值、血清NSE水平、G/P比值联合血清NSE为检验变量,结局(是否发生新生儿高胆红素血症脑病)为状态变量,绘制ROC曲线,结果显示,G/P比值、血清NSE水平、G/P比值联合血清NSE曲线下面积依次为0.806、0.635、0.814,提示G/P比值联合血清NSE预测新生儿高胆红素血症脑损伤效能最佳;其中,G/P比值、血清NSE的Cut-off分别为1.894、63.7924,单一诊断的灵敏度依次为66.70%、36.70%;特异度依次为87.70%、86.20%,联合诊断时灵敏度、特异度分别为70.00%、88.70%。结论:血清NSE联合颅脑MRI对新生儿高胆红素血症脑损伤具优势预测价值,可进一步提升单一指标或辅助检查手段预测的灵敏度及特异度,值得临床重视。     

MRI征像分析在新生儿缺氧缺血性脑损伤诊断中的临床价值

目的探讨MRI征像分析在新生儿缺氧缺血性脑损伤诊断中的临床价值。方法回顾性分析2013年2月至2015年5月在我院新生儿科住院的711例缺氧缺血性脑损伤新生儿MRI资料。结果新生儿缺氧缺血性脑损伤主要发生于产前、产时及产后不同时期,本组711例新生儿中,产前及产时窒息有583例,产后为128例;682例患儿头颅MRI证实脑损伤(95.92%,682/711),最常见的类型为白质损伤(590/711,82.98%),其次为灰质损伤,包括皮层损伤(369/711,51.89%),基底节-丘脑损伤(298/711,41.91%)及脑干损伤(263/711,36.99%);不同程度损伤的轻度组、中度组、重度组之间间1 min、5min Apgar评分差异均有统计学意义(P0.05)。结论新生儿缺氧缺血性脑损伤最常见的类型为白质损伤,中、重度脑病患儿的MRI影像学损伤程度较重,且以基底节-丘脑损伤为主。MRI影像分析对新生儿缺氧缺血性脑损伤诊断尤为重要。     

足月新生儿窒息后脑损伤的MRI表现及DWI技术的诊断价值分析

目的探究足月新生儿窒息后脑损伤的磁共振成像(MRI)表现及磁共振弥散加权成像(DWI)技术的诊断价值。方法选取洛阳市第三人民医院2013年2月至2016年1月收治的66例窒息后脑损伤的足月新生儿,均实施MRI检查,由2位临床经验丰富,且对患儿临床表现尚不清楚的影像科医师通过双盲法对66例患儿MRI检查结果进行分析。结果对66例患儿MRI常规诊断(FLAIR、T_2WI、T_1WI)与DWI序列扫描图像进行综合分析,脑损伤组共39例,无脑损伤组共27例。其中脑损伤组中出现30例新生儿缺氧缺血脑病(HIE),9例出血性脑损伤;39例脑损伤患儿MRI检查显示,常规序列(FLAIR、T_2WI、T_1WI)8例表现正常,31例表现异常;DWI序列扫描图像显示16例表现正常,23例表现异常。结论 DWI技术可有效检测早期病变,常规MRI检查适用于病变慢性期及随访中,两者可互相补充,为足月新生儿窒息后脑损伤诊断提供有力依据,在临床治疗中具有重要意义。     

MRI在新生儿脑损伤中的诊断及预后应用价值

目的：探讨MRI在新生儿脑损伤中的临床诊断及预后评估中的应用价值。方法：对本院2012年5月至2013年5月收治的28例新生儿低血糖脑损伤患儿分别行CT及头部MRI诊断，采用格拉斯哥昏迷评分（ GCS）对患儿脑损伤严重程度进行评估，并于患儿脑损伤后6个月对其进行格拉斯哥预后评分（ GOS）。结果：CT检查中存在与真实情况存在一定的误差，共有7例患儿（25．00％）未发现异常，脑损伤检出率为23处。 MRI检查中有2例（7．14％）未发现异常，脑损伤检测率为48处，CT检测脑损伤的位置主要在额叶，而MRI检测的脑损伤主要在额颞叶。 MRI脑损伤检出率是CT的2．08倍，差异具有统计学意义（P＜0．05）。患者脑损伤程度与预后呈正相关（P＜0．05）。结论：MRI对低血糖脑损伤诊断及预后具有一定的应用价值，通过MRI检查能有效了解低血糖脑损伤脑损伤的区域、损伤的程度、数量及其与预后的相关性，为低血糖脑损伤临床诊治提供指导。     

新生儿缺氧缺血性脑病的CT、MRI探讨

目的总结CT及MRI对新生儿缺氧缺血性脑病的各期病理改变与影像诊断特点。方法收集90例经临床治疗证实进行分析。结果新生儿缺氧缺血性脑病的病理改变为脑水肿、脑组织坏死、颅内出血。CT表现为不同程度低密度。MRI表现为长T1长T2。结论上述征象虽有一定特征性,但有些病例不典型,择期作MRI很有必要。     

磁共振扩散加权成像技术在新生儿缺血缺氧性脑病与急性胆红素脑病鉴别诊断中应用的价值

目的探讨磁共振扩散加权成像技术在新生儿缺血缺氧性脑病与急性胆红素脑病鉴别诊断中的应用价值。方法回顾性分析我院收治的20例新生儿缺血缺氧性脑病和25例急性胆红素脑病临床资料,所有新生儿均行磁共振成像(MRI)常规扫描检查和磁共振扩散加权成像(DWI)技术扫描,观察对比缺血缺氧性脑病和急性胆红素脑病临床表现,并确定DWI技术在新生儿缺血缺氧性脑病和急性胆红素脑病鉴别诊断中应用价值。结果缺血缺氧性脑病患儿壳核高信号、其他部位异常信号检出人数高于急性胆红素脑病患儿(P0.05),而苍白球高信号、底丘脑高信号检出人数低于急性胆红素脑病患儿(P0.05);20例缺血缺氧性脑病患儿中18例出现基底节区异常信号;而急性胆红素血症患儿DWI检查均没有基底节异常信号,两组相比差异显著(P0.05)。结论磁共振扩散加权成像技术在新生儿缺血缺氧性脑病与急性胆红素脑病鉴别诊断中有较高的应用价值。     

住院足月儿获得性脑损伤相关问题分析

目的 探讨住院足月儿获得性腩损伤的种类、程度、构成比以及转归情况.方法 对象为2006年6月～2008年6月,新生儿病区确诊为获得性脑损伤的所有足月儿.结果 2年间新生儿病区诊断为获得性脑损伤的足月儿共301例,其中男性194例,女性107例,缺血缺氧性脑病(HIE)150例(49.83%)、颅内出血123例(40.86%)、胆红素脑病15例(4.98%)、低血糖脑病9例(3.0%),其余4例(1.33%);在脑损伤患儿中,男婴占64.45%,严重不良预后占7.64%.结论 HIE、颅内出血、胆红素脑病是足月儿获得性脑损伤的主要原因,加强围生保健,减少窒息发生,动态监测高危儿血清胆红素可以达到减少足月儿获得性脑损伤的目的.     

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.