晚期肌萎缩侧索硬化症呼吸机辅助通气患者周围神经传导功能的观察

目的探讨晚期肌萎缩侧索硬化症(amyotrophic lateral sclerosis,ALS)呼吸机辅助通气患者周围神经传导的特点。方法分析3例呼吸机辅助通气晚期ALS患者临床资料,测定感觉神经传导速度(SCV)、运动神经传导速度(MCV)、运动末端潜伏期(DML)和复合肌肉动作电位(CMAP)波幅。结果 3例患者(12条运动神经)周围神经运动传导功能测定均为异常,其中66.7%(8/12)未引出波形,33.3%(4/12)CMAP波幅减低,16.7%(2/12)DML延长,16.7%(2/12)MCV减慢;且随着病程延长,患者CMAP波幅逐渐下降,直至最终引不出反应。所有患者SCV及感觉神经动作电位(SNAP)波幅均正常。结论晚期ALS呼吸机辅助通气患者可出现严重的周围神经运动传导异常,而对感觉传导影响不大,具体机制有待进一步探讨。     

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.     

面神经传导检测对早期判断急性面神经炎神经损害程度及预后的分析

目的分析急性面神经炎患者前3天面神经传导肌肉复合动作电位(CMAP)波幅下降的速度,探讨其在面神经炎早期判断神经受损程度及预后评估的价值。方法检测计算55例面神经炎患者发病前3天患侧面神经CMAP波幅对比健侧的下降速度(%/d)。结果 55例面神经炎患者前3天患侧面神经CMAP波幅下降平均速度与面神经损害程度及预后评估比较有统计学意义。结论通过对面神经炎患者患侧面神经CMAP波幅下降速度的检测,可以对面神经损害程度及预后作出早期诊断,并能指导临床早期选择合适治疗方案,避免耽误最佳治疗时机。     

神经肌电图检测对格林-巴利综合征的诊断价值

目的 :探讨格林 -巴利综合征的电生理改变特点。方法 :对 30例格林 -巴利综合征患者进行神经传导速度、肌电图和F波检测。结果 :30例格林 -巴利综合征患者检测均以周围神经脱髓鞘为主的特点。神经传导速度表现为 :周围神经运动和感觉传导速度减慢 ,末端潜伏期延长 ,异常率为 10 0 % ;肌电图表现为 :神经源性改变 ,异常率 93% ;F波出现率降低 ,潜伏期延长或消失 ,异常率 10 0 %。结论 :神经肌电图电生理检测在格林-巴利综合征诊断中起着重要的作用 ,对于格林 -巴利综合征的诊断及预后具有重要价值。     

神经肌电图在腕管综合征中的诊断价值

目的探讨神经肌电图检查在腕管综合征中的诊断价值。方法回顾性分析56例腕管综合征的神经肌电图。结果52.8%的腕管综合征的病例正中神经在腕以下段感觉神经传导波幅降低或消失,90.3%的感觉传导速度减慢;84.7%的正中神经运动电位潜伏期延长,33.3%的CMAP波幅降低;54.2%的病例拇展短肌神经源性损害表现。对8例针肌电图及神经传导速度均正常的患者,进行了刺激环指,比较相同距离正中神经与尺神经的潜伏期之差值,有6例差值大于0.4ms。结论不同神经支配的相应肌肉、正中神经支配的拇展短肌肌电图、同侧正中、尺神经传导对比的神经电图检查,对腕管综合征的诊断具有重要意义。刺激环指比较同等距离正中神经与尺神经潜伏期的差值是早期诊断腕管综合征的敏感指标。     

小儿格林巴利综合征27例肌电图及神经传导速度检测

目的探讨小儿格林巴利综合征(GBS)肌电图及神经传导速度检测的特征及临床意义。方法对27例GBS患儿的临床资料及实验室资料进行分析,并作针极肌电图(EMG)及神经传导速度(NCV)检测和分析,观察静息状态时自发电位,测定轻收缩时运动单位电位(MUP)的时限、波幅,大力收缩时的幕集相。测定运动、感觉神经的传导速度(MCV、SCV)及动作电位的末端潜伏期(ML)、波幅(AMP)、F波等。结果共检测73条肌肉、156条运动神经、81条感觉神经。EMG提示神经原性改变占74.1%;运动神经远端潜伏期(ML)延长占64.7%,MCV减慢占59.6%,AMP降低81.4%,F波异常占91.9%;SCV减慢占37.0%,伴波幅下降34.6%。结论小儿GBS存在广泛的周围神经损害,肌电图及神经传导速度检测对GBS的诊断、鉴别诊断、分型、随访及预后的评估有重要意义。     

腕管综合征91例电生理诊断

目的:探讨神经电生理检测对腕管综合征的诊断价值。方法:对91例(131侧)腕管综合征患者作神经传导速度(NCV)和肌电图检测分析,并与正常值对比。结果:131侧正中神经中6侧运动神经动作电位、7侧感觉神经动作电位消失;95侧正中神经运动传导速度腕部潜伏期(DML)延长;114侧正中神经感觉传导速度减慢、波幅降低。47块拇短展肌见有失神经电位。其中,拇指～腕段感觉神经传导速度减慢是最敏感的指标。结论:神经电生理检查在腕管综合征诊断中有重要意义。     

腕管综合征的电生理诊断

目的:探讨神经电生理检测对腕管综合征的诊断价值。方法:对91例(131侧)腕管综合征患者作神经传导速度(NCV)和肌电图检测分析,并与正常值对比。结果:131侧正中神经中6侧运动神经动作电位、7侧感觉神经动作电位消失;95侧正中神经运动传导速度腕部潜伏期(DML)延长;114侧正中神经感觉传导速度减慢、波幅降低。47块拇短展肌见有失神经电位。其中,拇指至腕段感觉神经传导速度减慢是最敏感的指标。结论:神经电生理检查在腕管综合征诊断中有重要意义。     

小儿吉兰-巴雷综合征神经电生理分析

目的探讨小儿吉兰-巴雷综合征（GBS）神经电生理特征和临床意义。方法对41例GBS患儿动态神经传导和肌电图进行检测。结果运动神经异常率79％，其中神经传导速度（NCV）69％下降，波幅（AMP）15％下降，末端潜伏期（DL）41％延长。感觉神经异常率29％，其中感觉神经传导速度（SCV）25％下降，波幅17％下降。F波异常占90％。肌电图（EMG）检查87块肌肉中表现神经源性损害的占48％。结论小儿GBS存在广泛的周围神经损害，神经电生理检查在小儿GBS诊断等方面有重要临床意义。     

30例糖尿病患者神经电生理研究

目的 探讨糖尿病性周围神经病变的电生理改变特征。方法 测定30例2型糖尿病患者及30例正常人的正中神经及排总神经运动传导速度（MCV）,感觉传导速度（SCV）,远端潜伏期（DPL）,复合肌肉动作电位（CMAP）的波幅,检测数据进行t检验。结果 糖尿病组神经传导速度（NCV）较正常组减慢,异常率为36.6%-83.3%,下肢异常率高于上肢。SCV异常率高于MCV,尤以腓肠神经最敏感。DPL延长,CMAP波幅减低,两组对比差异均有显著性（P＜0.001)。糖尿病组NCV,DPL与年龄及空腹血糖无明显关系,与病程呈正相关。结论 NCV的检测能提高糖尿病性周围神经病变的诊断阳性率,对早期诊断糖尿病性周围神经病变及其预防有重要意义。     

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.