血行播散型肺结核头颅核磁共振(MRI)的影像学改变特征分析

目的探讨血行播散型肺结核头颅核磁共振(MRI)的影像学改变特征。方法将2015年5月至2017年5月我院收治的73例血行播散型肺结核患者为研究对象,对患者实施常规增强扫描、头颅核磁共振平扫和脑脊液检查,观察其影响学改变特征。结果 MRI平扫和增强检查结果中发现异常征象并诊断为结核性脑膜炎的有64例(87.67%),异常征象表现为颅内多发性结核瘤51例(79.69%)和脑膜强化13例(20.31%);脑脊液检查结果显示,53例出现异常改变(72.60%)。结论经MRI平扫发现血行播散型肺结核中有87.67%的患者出现异常,提高了对结核性脑膜炎的诊断准确性。     

螺旋CT对颅内低密度病变诊断的应用

目的：评价螺旋CT扫描对颅内低密度病变的诊断价值。方法：应用螺旋CT对颅内低密度病变患者进行头颅平扫,发现占位病灶后再行多期增强扫描,并用增强扫描后的原始数据进行三维重建,对颅内低密度（占位）病变行定性、定量、定位诊断,与临床诊断及术后病理结果进行对比。结果：螺旋CT平扫＋多期增强扫描结合头颅三维重建定位诊断90％,定性诊断85％。结论：螺旋CT对颅内低密度病变的定位、定量及定性诊断率高,某些病变甚至为特异性检查,是诊断颅内病变的重要方法之一。     

179例血行播散型肺结核头颅MRI的影像学改变

目的:观察血行播散型肺结核头颅核磁共振(MRI)的影像学改变.方法:对179例血行播散型肺结核患者常规行头颅MRI平扫+增强扫描检查及脑脊液检查.结果:179例中有20例MRI影像学无异常改变,占11.2%.有MRI影像学异常改变者159例,占88.8%,其中109例显示颅内多发性结核瘤,占60.9%,50例显示脑膜强...     

结核性脑膜炎的增强CT表现及其诊断价值

目的探讨增强CT对结核性脑膜炎的诊断价值。方法回顾分析临床确诊为结核性脑膜炎的125例患者的头颅CT平扫及增强扫描的影像学表现。结果平扫发现异常40例,增强检查发现异常115例。CT平扫表现为基底池透光度降低、边界模糊、狭窄,脑实质单发或多发结节,结节周围可见低密度水肿区,基底节区腔隙性梗死,脑积水;增强后显示基底池明显强化,脑实质结节灶均匀或环状强化。结论增强CT扫描较CT平扫能更有效显示结核性脑膜炎的各种病理改变,为结核性脑膜炎的临床诊治及疗效观察提供可靠的证据。     

癫痫的CT诊断及其评价

目的评价CT检查对癫痫诊治的临床应用价值。方法对临床诊断癫痫的168例患者行头颅CT平扫，部分做增强扫描。结果头颅CT阴性102例，阳性66例，阳性率393％，其中包括先天性颅脑发育12异常8例，脑寄生虫病2例，颅内肿瘤12例，颅骨骨瘤1例．脑血管病38例，脑萎缩57例，脑软化灶33例，颅内钙化灶5例。结论CT检查提高了癫痫病因的检出率，有助于指导临床治疗。     

37例肺结核婴幼患儿临床分析

目的总结婴幼儿肺结核的临床特点。方法对37例婴幼儿肺结核的结核接触史、临床表现、卡介苗接种情况、PPD试验结果、实验室检查、影像学特点进行回顾性分析。结果37例患儿有结核接触史者22例（59．4％）,高原常住儿童37例（100％）,卡介苗接种者3例（8．1％）;发热34例（91．9％）,有呼吸道症状者31例（83．8％）,有神经系统症状者7例（18．9％）,CRP升高者23例（62．1％）,血常规检查白细胞升高28例（75．7％）,胸部CT检查异常者37例（100％）,头部CT异常者5例（13．5％）,头部MRI异常者6例（16．2％）,PPD（＋）者25例（67．5％）。最后诊断为原发性肺结核4例（10．8％）,血行播散型肺结核11例（29．7％）,继发性肺结核22例（59．5％）,并发结核性胸膜炎者5例（13．5％）,并发结核性脑膜炎者9例（24．3％）。结论婴幼儿结核有一定的临床特点,临床医生应高度重视,作出早期诊断;同时应加强高原常住儿童的结核病防治工作,提高高原常住儿童的卡介苗接种率。     

高分辨CT扫描对肺结核的诊断价值

目的提高高分辨CT（HRCT）对扫描肺结核的临床诊断价值。方法对248例经临床确诊,部分病例经查痰检验的肺结核HRCT影像表现进行探讨,确定有价值的影像综合分析。结果肺门淋巴结结核24例中结核性肺泡炎8例（33．3％）,肺内结节3例（12．5％）,均有肺门淋巴结肿大。浸润型肺结核125例中伴有支气管管壁增厚26例（20．8％）,支气管狭窄23例（16．4％）,支气管扩张46例（36．8％）,出现间质纤维化6例（4．5％）,并出现〈1cm的空洞。发现结核瘤（〉2cm）6例（4．8％）,结核结节（2cm）9例（7．2％）。血行播散型肺结核32例中发现支气管扩张3例（9．3％）,结核性肺泡炎3例（9．3％）,支气管狭窄2例（6．25％）。慢性纤维空洞型肺结核43例中发现支气管管壁增厚9例（20．9％）,支气管扩张41例（95．3％）,支气管狭窄30例（69．7％）。结核性胸膜炎24例中肺门淋巴结肿大8例（33．3％）,结核性肺泡炎5例（20．8％）,支气管扩张3例（12．5％）,肺内结节3例（12．5％）。结论HRCT扫描对各型肺结有着独特的诊断价值,能为临床早期的正确诊断与治疗提供有力的影像学依据。     

7例乳腺结核 CT 影像学表现

目的：回顾性分析乳腺结核CT增强检查表现特点,以提高其诊断准确性。方法对重庆市公共卫生医疗救治中心经病理学证实的7例乳腺结核患者的 CT 增强检查结果进行回顾性分析,对重要 CT 表现进行统计学处理。结果7例乳腺结核临床表现为结节型、弥散播散型、硬化型各3、2、2例,7例均为多发病变,形态不规则者6例,单纯类圆形者1例;CT 平扫为等密度7例,钙化1例,边界均与正常组织分界不清,邻近组织受累7例,伴有肺结核及其他肺外结核4例;7例 CT 增强均出现环形强化。结论乳腺结核 CT 平扫影像学改变信息量有限,增强扫描特征性改变显著,均为环形强化,强化明显。胸部 CT 平扫加增强扫描对乳腺结核影像学诊断值得推广。     

CT扫描在马红球菌肺脓肿与肺内空洞性病变中的鉴别诊断价值

目的：探讨CT扫描鉴别诊断马红球菌肺脓肿与肺部空洞病变的价值。方法马红球肺脓肿患者16例,肺结核性厚壁空洞患者12例,肺癌性空洞患者7例,行胸部CT常规平扫及增强扫描,对平扫、增强30 s、60 s CT值进行比较分析。结果16例马红球菌肺脓肿患者中,多发空洞11例,单发空洞5例;增强CT扫描空洞壁造影剂浓度呈速升速降变化。12例结核性厚壁空洞患者,多发空洞5例,单发空洞7例;增强CT扫描空洞壁造影剂浓度呈速升速缓降变化。7例癌性空洞患者均为单发空洞,增强CT扫描空洞壁造影剂浓度呈速升缓降变化。结核空洞组的平扫CT值、增强30 s CT值、增强60 s CT值均高于马红球菌肺脓肿组、癌性空洞组（P＜0．05）;而马红球菌肺脓肿组与肺癌性空洞壁组的平扫CT值、增强30 s CT值、增强60 s CT值比较,差异无统计学意义（ P＞0．05）。结论 CT平扫、动态增强扫描对马红球菌肺脓肿、肺结核空洞、空洞型肺癌的鉴别诊断有一定临床价值。     

结核性脑膜炎CT，MRI诊断

目的 总结结核性脑膜炎的CT、MRI表现。方法 应用西门子somatonARC型CT与O．5T Philips MRI检查，35例结核性脑膜炎中，25例做过头颅CT检查，10例行MRI检查。结果 CT平扫对脑结核的检出率为80％，CT增强扫描与MRI检查对脑结核的检出率均为100％。结核性脑膜炎的CT，MRI表现呈多样件，其病损类型主要为基底池、环池、侧裂池、脑沟的渗出物；脑积水；脑梗塞；脑白质水肿；结核瘤；结核性脓肿。结论 CT，MRI均可显示结核性脑膜炎的病变部位，范围，病损类型，在继发脑梗塞及脑积水改变，MRI较CT显示更明确。     

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.