3例平山病临床表现、肌电图及肌活检分析

目的：分析平山病临床、电生理及病理等特征,为该病诊断与鉴别诊断提供依据。方法：回顾性分析3例平山病患者的临床、电生理和骨骼肌活检病理资料。结果：3例患者均为男性,上肢远端无力伴肌萎缩,均无感觉障碍和锥体束征。多次神经传导速度检测共22条,运动传导中远端运动潜伏期（DML）延长2条（9.1%）,正常高限2条（9.1%）;CMAP波幅下降4条（18.2%）;感觉神经传导速度及波幅均在正常范围;F波检测共15次,其中,F波未引出2次（9.1%）,F波出现率低于80%者6次（40.0%）,F波潜伏期及速度均在正常范围。多次肌电图所检肌肉共31块,异常率为67.7%,均提示神经源性损害,异常肌肉主要分布于C5～T1支配区。病程中随访肌电图可见异常自发电位、多相波均减少。肱二头肌活检2例,均提示神经源性损害。结论：平山病的肌电图、肌活检对诊断具有重要意义,肌电图结果的改善提示预后良好。     

神经电生理及核磁共振检查对平山病的诊断价值

目的：探讨神经电生理及核磁共振检查对平山病的诊断价值。方法：对14例确诊的平山病患者的临床特点、神经电生理特征及影像学表现进行回顾性分析。结果：所有患者有症状侧上肢正中神经和尺神经感觉运动传导速度及正中神经复合肌肉动作电位（compound motor active potentials,CMAPs）均正常,8条尺神经CMAPs降低超过正常值20%。14例患者有症状侧下颈段脊髓前角细胞支配肌肉均出现神经源性损害（C7~8、T1水平）;其中4例呈有症状侧上肢肌肉神经源性损害;7例呈双侧上肢肌肉神经源性损害（其中2例仅有单侧上肢肌肉无力萎缩表现）;3例呈广泛神经源性损害（1例为单侧上肢2例为双上肢肌肉无力萎缩）。常规颈椎生理位MRI平扫10例未见异常或略变细;4例提示颈胸段脊髓萎缩变细。颈椎前屈位MRI扫描提示14例患者均有颈胸段椎管后方硬膜前移,脊髓呈明显受压变形、变细改变。结论：大多数平山病患者肌电图检查呈节段性下颈段脊髓前角损害的特征性异常,因而神经电生理检查在平山病的诊断中有重要作用。平山病患者肌电图检查亦可能出现广泛神经源性损害,因而疑诊平山病患者均应行颈段脊髓生理位及前屈位MRI扫描。     

平山病的神经电生理特点

目的 分析平山病的神经电生理特点,以提高对该病的诊断水平.方法 方便选取2009年2月—2014年1月在该院中就诊的20例平山病患者为研究对象,进行神经传导及针极肌电图检测,观察感觉神经传导、运动神经传导情况,针极肌电图表现,对比单侧发病患者患肢、健肢正中神经与尺神经的CAMP波幅、DML、ADM/APB.结果 20例患者中,均具正常SCV、SNAP波幅.8例尺神经DML延长,4例正中神经DML延长,1例桡神经DML延长;18例尺神经CMAP波幅降低,11例正中神经CMAP波幅降低,5例桡神经CMAP波幅降低.20例均患侧颈7,8~胸1节段支配肌异常,2例同时累及颈7节段支配肌;17例对侧上肢颈8~胸1节段支配肌异常,11例同时累及颈7节段支配肌.11例单侧发病患者中,患肢正中神经CMAP波幅(7.75±1.86)mV、DML(4.07±0.54)ms,尺神经CMAP波幅(3.75±2.45)mV、DML(3.45±0.38)ms,ADM/APB(0.48±0.32);健肢正中神经CMAP波幅(10.27±1.17)mV、DML(3.72±0.23)ms,尺神经CMAP波幅(10.46±1.99)mV、DML(2.80±0.29)ms,ADM/APB(1.04±0.24).患肢正中神经、尺神经CMAP波幅,ADM/APB低于健肢,正中神经、尺神经DML高于健肢,差异有统计学意义(P<0.05).结论 平山病的神经电生理学特点可为该病提供有助于定位诊断和鉴别诊断的依据.     

POEMS综合征的神经肌电图特征分析

目的:探讨POEMS综合征的神经肌电图特征,为疾病的早期识别提供参考依据。方法:回顾性分析8例POEMS综合征患者(观察组)的神经肌电图特征,对比患者上、下肢的神经传导及F波出现率差异,并与对照组(同时期内进行肌电图检查的8例健康体检者)的神经传导和针肌电图指标进行对比。结果:观察组感觉神经动作电位(sensory nerve action potential, SNAP)引出率(41.7%)低于复合肌肉动作电位(compound muscle action potential, CMAP)(81.3%)(P<0.05),下肢CMAP引出率(62.5%)低于上肢(100%)(P<0.05),下肢SNAP引出率(0.0%)低于上肢(62.5%),胫神经F波引出率(0.0%)低于正中神经(100%)。与对照组相比,观察组运动传导末端潜伏期(distal motor latency, DML)延长、运动神经传导速度(motor nerve conduction velocity, MCV)减慢、波幅(amplitude, AMP)降低(P<0.05),感觉传导AMP降低、感...     

电生理检测对格林-巴利综合征的临床意义

目的 了解格林-巴利综合征(GBS)电生理异常和受损程度的分布情况,评估其临床意义.方法 对54例GBS患者进行电生理检测,记录肢体两侧、上下肢及远近端运动神经末端潜伏期(DML)、运动传导速度(MCV)、肌肉复合动作电位(CMAP)和感觉传导速度(SCV).结果 MCV异常率(77.0%)高于SCV异常率(59.4%)(x2=5.115,P<0.05).四肢近端与远端,上肢与下肢DML异常分布率基本一致.远端运动神经重度受损率(75.6%)较近端神经(47.4%)高(x2=14.62,P<0.01),说明远端运动神经较近端受损程度重.结论 :GBS在电生理上改变为广泛的、多灶、远近端神经、上下肢均受累,运动神经较感觉神经易受累,远端神经较近端神经受损程度重.     

POEMS综合征患者神经电生理特点研究

目的研究POEMS综合征的神经电生理特点。方法分析16例POEMS综合征患者医疗及神经传导记录,共检测92根运动神经和58根感觉神经。结果复合肌肉动作电位(CMAP)和感觉神经动作电位(SNAP)在下肢比上肢更不易被引出(包括运动和感觉神经,P<0.05)。CMAP波幅下肢比上肢降低更明显(P<0.05)。运动神经(94%)和感觉神经(78%)传导速度减慢较常见。70%的运动神经远端运动潜伏期(DML)延长,患者的远端潜伏期指数(TLI)较正常值明显升高(P<0.05)。结论 POEMS综合征患者的神经电生理结果存在特征性表现,传导异常较常见,下肢受累更严重,在神经的中间部分比远端部分表现更突出,可以对早期诊断POEMS综合征提供帮助。     

平山病的临床和电生理分析

目的探讨平山病（HD）的临床表现和电生理改变。方法观察8例HD患者的临床表现,并应用Keypoint肌电图仪进行神经电生理检查。结果神经传导速度检查：8例患者正中神经及尺神经有轻度异常表现,感觉传导速度均在正常范围,未发现神经传导阻滞。肌电图检查：8例颈区肌肉均有神经源性损害,脑区、胸区及腰骶区肌肉均未发现异常。4例上肢F波出现率降低,潜伏期延长。结论 HD的主要诊断依据为临床特征,一侧上肢前臂以下肌无力、肌萎缩,病情在一段时间内呈进展性,但多自限。电生理检查肌电图是其重要的诊断手段。     

神经肌电图对腕管综合征的诊断意义

目的:探讨神经肌电图对腕管综合征(CTS)的诊断价值。方法:用常规方法对206例CTS患者行肌电图(EMG)和神经电图检查。结果:共检502块肌肉,其中64例(31.1%)CTS患者EMG呈神经原性损害,表现为拇短展肌可见自发电位57例,运动单位平均时限延长62例,多相波增多59例,单纯相72例,混合相113例,干扰相21例。共检测神经1 338条,正中神经神经电图检查异常率为100%。其中正中神经远端潜伏时(DML)延长214条(55.9%),运动神经传导速度(MCV)异常141条(36.8%),感觉神经传导速度(SCV)异常325条(94.5%),诱发电位波幅降低265条(77.1%)。结论:CTS患者以中年以上女性多见,常为双侧病变,以右侧为重。神经肌电图检测诊断CTS较为敏感,表现为正中神经SCV轻度减慢或诱发电位波幅降低,正中神经DML延长,MCV异常,拇短展肌EMG呈神经原性损害。     

急性运动轴索性神经病与急性炎性脱髓鞘性多神经病的比较研究

目的 分析急性运动轴索性神经病(acute motor axonal neuropathy,AMAN)患者临床和神经电生理学特点,并与急性炎性脱髓鞘性多神经病(acute inflammatory demyelinating polyneuropathies,AIDP)进行比较.方法 回顾性分析2012年1月至2016年3月内蒙古医科大学附属医院收治的25例AMAN患者,Hughes评分3～6分,选择同期住院的Hughes评分3～6分的AIDP患者30例,对2组进行比较研究.结果 AMAN患者年龄＜50岁,病前腹泻多见.AMAN电生理特点为,感觉神经动作电位(sensory nerve action potential,SNAP)波幅及感觉神经传导速度(sensorynerve conduction velocity,SCV)均正常,下肢腓总神经远端运动神经末端潜伏期(distal motor latency,DML)延长,运动神经传导速度(motor nerve conduction velocity,MCV)轻度减慢,余神经DML及MCV均正常;复合肌肉动作电位(compound muscle action potential,CMAP)波幅明显降低,F波潜伏期正常,F波未引出比率高.AIDP患者电生理特点为,SNAP波幅及SCV均降低,运动神经DML延长,MCV减慢,下肢胫神经F波潜伏期延长.结论 AMAN为单纯运动神经受累,感觉神经正常,运动神经以轴索损害为主,电生理表现为CMAP波幅明显降低,可伴有传导阻滞,F波未引出比例高.AIDP既有运动神经的受累,又有感觉神经的受累,电生理表现为SCV和MCV减慢,DML延长,F波出现率降低,F波潜伏期延长.     

多发性肌炎肌电图分析

多发性肌炎是以骨骼肌炎性受损为特点 ,肌电图主要表现为肌源性损害 ,同时静息电位出现大量纤颤正尖波以及肌强直样电位 ,所以肌电图检查需与神经源性损害区别 ,以免误诊。1　资料本组 2 6例 ,男 10例 ,女 16例 ,年龄 36～ 5 8岁 ,病程 1个月～ 2 a。临床表现 :本组 2 6例均出现对称性近端肌无力、自发性肌痛、血清 CK升高。2　方法采用上海海神 NDI- 4 0 0 F肌电图诱发电位仪观察 :1神经传导速度 :上肢尺神经运动神经传导速度 (MCV) ,感觉神经传导速度 (SCV ) ;下肢腓总神经 MCV,腓浅神经 SCV以排除神经源性损害。 2肌电图 :双侧上…     

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.