结核性脑膜炎的临床特点观察与治疗分析

目的分析结核性脑膜炎的临床特点及治疗方法,以提高结核性脑膜炎的诊治水平。方法回顾性分析本院于2017年1月至2018年3月收治的63例结核性脑膜炎患者的临床资料,对患者临床特点进行观察,包括入院时体征与表现、实验室检查、影像学检查,同时给予患者实施抗结核治疗,统计患者的临床特点及治疗情况。结果 63例患者入院后体征以头痛、发热、恶心呕吐等症状为主;实验室检查显示脑脊液改变,具体以脑脊液压力、蛋白升高等有关;影像学检查显示50例患者影像表现异常,以低密度病灶、脑梗死、脑积水为主;实施抗结核治疗后,63例患者治愈48例,好转12例,无效3例。结论针对结核性脑膜炎,结合临床症状、脑脊液检查及影像学检查可诊断,诊断后早期予以患者抗结核治疗,可改善患者预后。     

原发性结核性脊髓神经根炎4例临床特征分析

目的 探讨原发性结核性脊髓神经根炎(TBRM)的临床和影像学特点,并强调脑脊液结核分枝杆菌DNA检测的重要性.方法 回顾性分析收治的4例原发性结核性脊髓神经根炎患者,4例患者脑脊液常规检测均为不典型结核感染改变,临床诊断主要建立在临床表现、影像学检查、脑脊液阳性巢式PCR检测和抗结核治疗反应.结果 经过抗结核治疗后,3例患者均恢复良好,1例治疗有效,但仍然留下残疾.结论 原发性TBRM少见,脑脊液常规检查多不典型,临床诊断极为困难.因早期诊断和患者的预后有关,对可疑病例及时进行脑脊液巢式PCR检测对快速诊断有重要意义.     

48例结核性脑膜炎临床分析

目的分析结核性脑膜炎及脑结核瘤的临床及检查特点。方法回顾分析10年来住我科初治结核性脑膜炎（TBM）患者48例的临床及实验室资料。并报道1例脑结核瘤合并结核性脑膜炎。结果多有脑脊液压力升高、白细胞计数升高、糖及氯化物降低、蛋白升高、头颅CT呈现脑积水及基底池炎性渗出物,脑膜可有强化。多合并胸部X线肺结核表现,易误诊和复发;均使用异烟肼、利福平、乙胺丁醇、吡嗪酰胺四联治疗,部分病例加用对氨基水杨酸钠治疗,大部分患者使用糖皮质激素治疗。脑结核瘤治疗同结核性脑膜炎。结论结核性脑膜炎临床表现复杂,症状多不典型,呈亚急性或慢性病程,早期不易确诊,神经系统并发症发生率高;患者的临床表现、脑脊液检查和颅外结核感染及影像学为诊断结核性脑膜炎提供了依据;早期正规抗结核治疗和激素治疗是提高治愈率、降低死亡率的关键。注意将脑结核瘤与脑脓肿、颅内转移瘤、胶质瘤及脑囊虫病相鉴别。     

幼儿脑脓肿的CT影像学诊断临床分析

目的 提高对脑脓肿CT影像学表现的认识和诊断水平.方法 对30例临床怀疑或确诊为脑脓肿的4～8岁幼儿患者行CT检查,临床表现为头痛、呕吐、视神经乳头水肿等颅内压增高征象.结果 CT典型表现为边界清楚的低密度灶,增强后脓肿显示完整壁和厚度均一的明显环状高密度强化;脓肿中央密度不变,略高于脑脊液,不被强化;所有脓肿壁周围均有低密度"暗带".结论 脑脓肿CT表现具有一定特征性,是敏感、准确、快捷的检查方法,适用于各部位脑脓肿的诊断.     

肝硬化合并结核性腹膜炎诊治探讨

目的:研究肝硬化合并结核性腹膜炎的临床诊治方法和结果。方法:将我院收治的肝硬化合并结核性腹膜炎患者21例作为研究对象,分析临床症状表现,行血常规、腹水常规、影像学辅助检查,合理选择抗结核药物治疗,观察患者的临床治疗效果和肝功能恢复情况。结果:21例患者中治疗有效20例(95.2%),患者症状消失或减轻,腹水现象消退;因食管静脉曲张破裂出血死亡1例(4.8%)。患者治疗前肝功能Child-Pugh评分为(11.5±2.4)分,治疗后为(6.1±1.2)分,差异具有显著统计学意义(P0.05)。结论:肝硬化合并结核性腹膜炎患者临床诊治困难,及时的临床诊断和合理的抗结核治疗方案(OFHES),可取得满意的治疗效果,具有安全高效的特点。     

39例脑脓肿的临床分析

目的阐述脑脓肿的临床特征,探讨脑脓肿的治疗方法,以提高其治疗效果.方法回顾性分析37例脑脓肿的发病,病因,影像学表现和治疗方法.结果脑脓肿好发于青壮年,血源性和隐源性脑脓肿发病率趋增高,CT检查是脑脓肿主要的诊断方法.结论脑脓肿的绝大多数病例若及时诊断治疗可获满意效果.     

结核性胸膜炎患者CT诊断结果的临床分析

目的:探讨结核性胸膜炎患者CT诊断结果。方法:随机选取结核性胸膜炎患者42例,分析患者的CT影像学资料。结果:分析结果显示,其中4例患者表现为慢性胸膜病变,6例患者表现为渗出及局限胸膜病变并存,11例患者表现为单纯性局限性胸膜炎,21例患者表现为单纯渗出性胸膜炎。使用CT对结核性胸膜炎进行检查,符合率明显优于X线,差异显著,具有统计学意义,即P<0.05。结论:对于结核性胸膜炎患者实施CT诊断,诊断的符合率较高,由于CT检查的费用较高,临床上CT检查并没有列入常规检查,在具体治疗过程中,根据临床实际情况,对CT检查进行合理选用,有利于提高诊断的符合率,值得在临床推广和应用。     

结核性脑炎18例临床分析

目的 探讨结核性脑膜炎的预后、早期诊断与治疗.方法 对18例结核性脑膜炎患者的临床资料和辅助性检查进行回顾性分析.结果 11例患者好转并继续院外抗结核治疗,3例患者转院进一步进行治疗,3例患者放弃继续治疗,1例患者由于治疗无效死亡.结论 在综合治疗结核性脑膜炎基础上,早期诊断和有效地抗结核药物联合激素应用是其预后的关键.     

肝硬化合并结核性腹膜炎诊治探讨

目的：研究肝硬化合并结核性腹膜炎的临床诊治方法和结果。方法：将我院收治的肝硬化合并结核性腹膜炎患者21例作为研究对象,分析临床症状表现,行血常规、腹水常规、影像学辅助检查,合理选择抗结核药物治疗,观察患者的临床治疗效果和肝功能恢复情况。结果：21例患者中治疗有效20例（95．2％）,患者症状消失或减轻,腹水现象消退;因食管静脉曲张破裂出血死亡1例（4．8％）。患者治疗前肝功能 Child －Pugh 评分为（11．5±2．4）分,治疗后为（6．1±1．2）分,差异具有显著统计学意义（P ＜0．05）。结论：肝硬化合并结核性腹膜炎患者临床诊治困难,及时的临床诊断和合理的抗结核治疗方案（OFHES）,可取得满意的治疗效果,具有安全高效的特点。     

结核性脑膜炎临床表现及脑脊液细胞学结果分析

目的:探讨结核性脑膜炎的临床表现和脑脊液细胞学检查对结核性脑膜炎及时诊治的指导意义。方法:回顾性分析38例结核性脑膜炎患者的临床病历资料,尤其是细胞学动态变化资料。结果:38例结核性脑膜炎患者多亚急性起病,以颅高压和脑膜刺激征为主要表现,脑脊液白细胞数、蛋白中度升高,葡萄糖、氯化物中度减低,脑脊液细胞学细胞数多中度升高,早期为混合细胞反应,嗜中性粒细胞比例下降较慢,可稳定在1个月以上,正规抗结核治疗后多数好转,发病2周内接受抗结核治疗的患者预后明显优于其他患者。结论:对于病原学检查阳性率低、早期确诊困难的结核性脑膜炎,脑脊液细胞学检查结合临床症状和其他检查对于其鉴别诊断和治疗评估有重要意义。     

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.