副鼻窦颅底CT扫描及应用

为了更好地显示副鼻窦的解剖结构．我们将常规的横断面扫描改为颅底位冠状面扫描，它能更清晰的显示上颌窦、额窦、筛窦及蝶窦的冠状面结构，使多数窦腔影像显示在同一层面上，为临床诊断和鉴别诊断提供方便。材料和方法自1999年5月至2002年12月，本院行副鼻窦CT扫描共42例，其中20例病人行颅底位冠状面扫     

牛奶留住我的青春

几年前去浴室洗澡，看到有人用牛奶洗浴护肤。我很惊讶：怎么牛奶也能用来洗浴？ 带着疑惑我请教了一位正在用牛奶洗浴的大姐，这名大姐热情地向我介绍：牛奶营养丰富，含有各种蛋白质、维生素、矿物质，特别是含有较多的维生素B族，它们能滋润肌肤，保护表皮、防裂、防皱，使皮肤光滑柔软白嫩，使头发乌黑减少脱落．从而起副护肤美容作用；牛奶中所含的铁、铜和维生素A，有美容养颜作用，可使皮肤保持光滑滋润；牛奶中的乳清对面部皱纹有消除作用；同时牛奶还能为皮肤提供封闭性油脂，形成薄膜以防皮肤水分蒸发，     

正交试验法优选克咳炎颗粒的提取工艺

目的:利用正交试验法优选克咳炎颗粒处方中有效成分的提取工艺.方法:以浸膏得率和苦杏仁苷含量为指标,选择用水量,煎煮时间,沉淀剂为考察因素,利用正交试验L9(34)确定水提取中药的工艺,采用HPLC测定该处方中有效成分苦杏仁苷的含量.结果:最佳工艺条件为6倍用水量,提取时间为120 min,以甲壳素为沉淀荆.结论:该制备工艺合理可行,其质量稳定,为克咳炎颗粒的最佳提取工艺.     

国产复方布洛芬药效学实验研究

布洛芬是非甾体类抗炎药,常用于各种炎症治疗.扑热息痛为常用的解热镇痛药物,其抗炎作用很弱.在布洛芬的局部消炎作用基础上,结合扑热息痛的快速镇痛,加强疗效,能使病人更快解除痛苦.临床上布洛芬加扑热息痛的复方,用于关节炎的治疗,证明比单方布洛芬治疗有较好的效果[1],已有多个国家生产.本实验以国外复方布洛芬为对照,对国产复方布洛芬的解热、镇痛和抗炎作用进行了药效对比研究.     

乳腺MRI检查中检出乳腺外病变的价值

目的探讨乳腺MRI检查中发现乳腺外病变的检出率、发生部位及性质。方法选取721例乳腺磁共振检查的患者,其中初诊乳腺癌患者163例,乳腺癌治疗后随访患者322例,无乳腺癌病史(如常规体检、乳腺良性病变或其它病变原因进行乳腺MRI检查)患者236例,观察乳腺MRI是否存在乳腺外的其它部位病变及其发生率、分布类型。结果721例乳腺MRI检查患者中,发现乳腺外病变196例(27.18%,196/721),恶性病变124例(17.20%,124/721),良性病变72例(9.99%,72/721)。最常见的乳腺外病变是淋巴结115例(15.95%,115/721),其次是肝脏65例(9.01%,65/721)、胸部63例(8.74%,63/721)、骨质病变21例(2.91%,21/721)及其它(包括皮肤、胆囊、脾脏等)5例(0.69%,5/721)。163例初诊乳腺癌患者中发现乳腺外恶性病变61例(37.42%,61/163),322例乳腺癌治疗后随访中发现乳腺外恶性病变60例(18.63%,60/322),236例无乳腺癌病史患者发现乳腺外恶性病变3例(1.27%,3/236)。结论在进行乳腺MRI检查时不仅要注意乳腺本身是否存在病变,还要注意扫描范围内乳腺以外的其它区域,特别是对于初诊乳腺癌或乳腺癌治疗后随访的患者。     

MR扩散加权成像评价膀胱癌经动脉灌注化疗及栓塞术后疗效的价值

目的探讨MR扩散加权成像(DWI)在膀胱癌经髂内动脉灌注化疗及栓塞术后疗效评价中的作用。资料与方法对经病理证实的28例膀胱移行上皮细胞癌患者于介入术前后行MR DWI。在GE Signa Excite HD 1.5TMR扫描仪上,先取多个扩散敏感梯度因子(b值)分别为300 s/mm2、500 s/mm2、800 s/mm2、1000 s/mm2、1200 s/mm2、1500 s/mm2,利用固定参数组合的自旋回波-回波平面成像(SE-EPI)序列对28例经动脉灌注化疗及栓塞术的膀胱癌肿块分别于术前24～48 h、术后7～10天各进行一次多b值的DWI。经分析比较后选取合适的b值为1200s/mm2,测量出每例膀胱癌不同监测时间点的肿瘤平均表观扩散系数(ADC)值,对两组结果进行比较。结果 28例膀胱肿瘤治疗前平均ADC值(1.15±0.12)×10-3mm2/s,介入治疗后肿瘤平均ADC值(1.36±0.15)×10-3mm2/s,治疗后肿瘤平均ADC值升高,P值<0.05,差异具有统计学意义。结论初步研究表明,对膀胱肿瘤的ADC值进行动态测定,可以评价膀胱癌介入治疗后早期病理学反应。     

亚低温对兔心肺复苏后凝血及脑微循环的影响

目的 探讨亚低温治疗对兔心肺复苏后凝血异常及脑微循环血流变化的干预作用.方法 本实验在中山大学卫生部辅助循环重点实验室进行.24只成年新西兰大白兔随机(随机数字法)分为常温(normothermic,NT)治疗组和亚低温治疗(therapeutic hypothermia,TH)组,每组12只,采用交流电致颤的方式建立心肺复苏(CPR)模型,自主循环恢复后(ROSC)NT组动物置于室温下观察12 h,TH组动物采用体表降温的方法诱导亚低温,达到目标温度后维持12 h.所有动物CPR前及ROSC后4,8,12 h分别测定PT,APTT,INR,D-D,血小板计数(BPC);测定抗凝血酶Ⅲ活性(AT-Ⅲ)和血浆蛋白C活性(PC);用PERIMED Multichannel Laser Doppler系统监测大脑皮层微循环血流.各组数据依据正态检验结果用单因素方差分析或秩和检验,多重比较用LSD-t检验,两样本均数的比较用成组t检验,相关性采用Pearson相关性分析,以P＜0.05为差异具有统计学意义.结果 NT组动物ROSC后PT,APTT,INR逐渐缩短的趋势,ROSC后12 h APTT明显短于基础值(P=0.025),而AT-Ⅲ和PC活性显著下降.和NT组相比,TH组PT,APTT,INR值显著增大,差异具有统计学意义;但AT-Ⅲ,PC活性、D-D浓度,两组差异无统计学意义.CPR前、ROSC后4,8和12 h NT组大脑皮层血流分别(401.60±11.76),(258.86±34.58),(317.59±23.36)和(371.98±5.79)mL/min,TH组为398.18±12.91.336.19±19.27,347.76±13.80和383.78±3.29 mL/min.ROSC后各时间点TH组大脑皮层血流量明显高于NT组(4 h:t=-6.025,df=16,P=0.000;8 h:t=-2.942,df=12,P=0.012;12 h:t=-3.959,df=8,P=0.004).Pearson相关分析显示ROSC后大脑皮层血流和APTT正相关(4 h:R=0.503,P=0.033;8 h:R=0.565,P=0.035;12 h:R=0.774,P=0.009),与其他凝血指标无关.结论 ROSC后亚低温治疗使凝血功能下降的同时伴随脑微循环血流的增加,CPR后亚低温治疗对ROSC后凝血失衡的影响可能是其发挥脑保护作用的机制之一.

Abstract：

Objective To study the effects of mild hypothermia (MH) on blood coagulation and cerebral microcirculation in rabbits after cardiopulmonary resuscitation (CPR). Method A total of 24 New Zealand rabbits were randomly (random number) divided equally into normothermic group (NT) and MH group. CPR model was established by ventricular fibrillation induced by using alternating current. The rabbits of NT group were observed for 12 h in room temperature after restoration of spontaneous circulation (ROSC). The mild hypothermia was induced in the rabbits of group MH by surface cooling after ROSC, and maintained for 12 h after the aimed low temperature reached. The PT (prothrombin time), APTT (activated partial thromboplastin time), INR (international normalized ratio of prothrombin), D-dimmer (DD) , blood platelet count (BPC) , anti-thrombin Ⅲ activity (AT-Ⅲ) and protein C activity (PC) were measured before CPR and 4 h, 8 h and 12 h after ROSC, and at the same time the cerebral microcirculation was measured by using PERIMED Multichannel Laser Doppler system. One-way ANOVA or Mann-Whitney rank was used to determine the statistical significance between two groups. LSD-t test was used for multiple comparisons,t test for comparisons of means between two independent samples, and Pearson correlation test for correlation analysis. Results The PT, APTT and INR showed a trend of gradually shortening during the course. The APTT in 12 h after ROSC was significantly shorter than that before CPR (23.32 ±5.19 vs. 29.53 ±5.10,P = 0.025), and the activity of AT- Ⅲ and PC were decreased significantly. Compared with the group NT,the PT, APTT and INR in group MH were increased significantly, while there were no differences in the activity of AT- Ⅲ, PC and D-D between two groups. The rates of cerebral microcirculation in group NT before CPR and 4 h, 8 h and 12 h after ROSC were 401.60 ± 11.76 mL/min, 258.86 ± 34. 58 mL/min,317.59 ± 23.36 mL/min and 371.98 ± 5.79 mL/min, respectively, and those in group MT were 398.18 ±12.91 mL/min, 336.19 ± 19.27 mL/min, 347.76 ± 13.80 mL/min and 383.78 ± 3.29 mL/min, respectively. There were significant differences between two groups at each interval after ROSC (4 h: t = - 6.025,df=16, P=0.000;8 h: t= -2.942, df=12, P=0.012;12 h: t= -3.959, df=8, P=0.004). The Pearson correlation test showed that the rate of cerebral microcirculation was positive correlated with APTT after ROSC (4 h:R =0.503,P=0.033;8 h:R=0. 565,P=0. 035;12 h:R=0. 774,P=0. 009), and was not correlated with the other blood coagulants. Conclusions The mild hypothermia led to the inhibition of blood coagulation and improved the cerebral microcirculation concomitantly, which may be one of the mechanism of cerebral protection.