磁共振成像扩散加权成像技术在鉴别原发性胆囊癌和肝细胞癌中的价值

Objective To investigate the value of diffusion-weighted magnetic resonance imaging in the differential diagnosis of primary gallbladder cancer with liver invasion and primary hepatocellular carcinoma (HCC) with gallbladder invasion. Methods From January 2009 to October 2010, 11 patients with primary gallbladder cancer and 19 patients with primary HCC were admitted to the PLA General Hospital. The clinical data of the 30 patients were retrospectively analyzed. All patients underwent diffusion-weighted magnetic resonance imaging with b value of 800 s/mm2, and the receiver operating curve (ROC) was drawn. The apparent diffusion coefficient (ADC) values of the patients with gallbladder cancer and HCC were compared by independent sample t test. Results Thirty tumors were detected in the 30 patients. All tumors showed high signal on DWI, slightly low signal on T1 WI and slightly high signal on T2 WI. The foci of 11 patients with primary gallbladder cancer were at the gallbladder fossa, and 10 of them had liver involvement. The mean ADC value of the 11 patients was (0.89 ±0. 14)mm2/s. Of the 19 patients with primary HCC, the foci of 15 patients were at the right lobe of liver, and 4were at the left lobe. The mean ADC value of the 19 patients was (1.04 ±0.18)mm2/s. There was a significant difference in the ADC value between patients with primary gallbladder cancer and those with primary HCC ( t =2.425, P＜0. 05). The area under the ROC was 0. 756 (95% confidence interval: 0.577-0. 935), and the sensitivity and specificity were 68.4% and 81.8%, respectively, when the threshold value was 0.96 mm2/s.Conclusion The ADC value of patients with primary gallbladder cancer is lower than those with primary HCC when the b value is 800 s/mm2, which is helpful in the differential diagnosis of primary gallbladder cancer and primary HCC.     

112例混合痔患者行PPH术加外痔切除术的围术期护理体会

目的探讨混合痔患者行PPH术加外痔切除术的围术期护理体会。方法回顾性分析112例混合痔患者行PPH术加外痔切除术的术前、术中、术后护理体会。结果患者术中肠道清洁,术后无感染、无明显的吻合口出血,术后8h下床活动,按期痊愈出院。结论做好混合痔患者行PPH术加外痔切除术的围术期护理,可有效减轻患者痛苦,减少术后并发症,缩短住院天数,提高手术成功率。     

溃疡性结肠炎患者肺损害与血清ET-1水平相关性探讨

目的观察溃疡性结肠炎(ulcerative colitis,UC)患者血清内皮素-1(endothelin-1,ET-1)水平与肺损害的相关性,探讨UC肺损害的机制。方法选择90例2009年11月-2011年3月就诊于北京中医药大学东直门医院消化科门诊UC患者,观察并比较不同病程、病变范围、活动度的UC患者血清ET-1水平,探讨UC患者血清ET-1水平与肺功能各指标的相关性,包括肺活量(vital capacity,VC),用力肺活量(forcedvital capacity,FVC),一秒钟用力呼气容积(forced expiratory volume in one second,FEV1),一秒率(FEV1/FVC),峰流速(peak expiratory flow,PEF),最大中期呼气流速(maximal mid expiratory flow,MMEF),25%、50%、75%肺活量时的最大呼气流速(maximal expiratory flow in25%,50%,75%vital capacity,FEF25%,50%,75%),肺一氧化碳弥散量(diffusion capacity of the lungs for carbon monoxide,DLCO),肺泡通气量(alve-olar ventilation,VA),弥散常数(diffusion constant,KCO),肺总量(total lung capacity,TLC),残气量(residualvolume,RV),功能残气量(function residual volume,FRV),残气量/肺总量(RV/TLC)。另选择30名健康志愿者作为对照组,比较UC组与对照组肺部症状、胸部X线摄片、肺功能、血清ET-1水平及肝肾功能[丙氨酸转氨酶(alanine aminotransferase,ALT),天冬氨酸转氨酶(aspartate aminotransferase,AST),血尿素氮(blood u-rea nitrogen,BUN),血肌酐(serum creatinine,SCr)]。结果 UC组伴有咳嗽、胸闷等肺部症状10例(11.1%),胸部X线摄片异常25例(27.8%),肺功能异常54例(60.0%);UC组ALT升高2例(2.2%),AST升高2例,对照组ALT、AST均正常。UC组与对照组BUN及SCr均正常。与对照组比较,UC组血清ET-1水平升高,差异有统计学意义(P<0.05);各病变范围及活动度组患者血清ET-1水平比较,差异均无统计学意义(P>0.05);病程≥5年UC患者血清ET-1水平较病程<5年者升高,差异有统计学意义(P<0.05)。UC患者血清ET-1水平与FEF25%及KCO呈负相关,差异均有统计学意义(P<0.05)。结论血清ET-1水平可以更早地反映UC患者肺损害情况,血清ET-1可能是反应UC肺损害的敏感指标。UC患者肺损害可能与肺小气道阻塞,肺弹性功能减退以及弥散膜受损有关。     

丹参酮微乳制备工艺的初选及优化

目的寻找丹参酮微乳最佳的处方和制备工艺。方法选择大豆磷酯与F-68为乳化剂,甘油和山梨醇为辅助乳化剂。通过单因素实验初选,均匀设计优化处方和制备工艺。结果优化条件下,制备的丹参酮微乳为淡红色透明胶体溶液,平均粒径为42.1 nm,包封率为98.47%,载药量为0.468%。结论该优化条件可作为丹参酮微乳最佳的处方和制备工艺。     

支持HCV 1b亚基因组复制的细胞模型的建立

目的 建立一个稳定支持中国人群HCV 1b亚基因组高效复制的体外细胞模型。方法 构建中国人群HCV 1b亚型亚基因组复制子质粒，通过体外转录的方法获得亚基因组复制子RNA，采用电穿孔技术把RNA转染到Huh-7.5.1细胞中，经过G418筛选含有HCV 1b亚基因组的细胞集落。RT-PCR检测细胞集落中的HCV亚基因组以及Western blot检测细胞集落中的HCV蛋白的表达。用干扰素（IFN）处理含有HCV亚基因组的细胞，观察细胞中HCV RNA的变化。结果 G418药物筛选得到了支持HCV1b亚基因组复制的细胞集落。RT-PCR 检测有HCV RNA NS4B的表达，Western blot检测有HCV的非结构蛋白NS5B的表达。IFN处理含有HCV复制子的细胞，HCV RNA水平明显降低。结论 成功建立了支持中国人群HCV 1b亚基因组高效复制的体外细胞模型，为进一步研究HCV致病机制、治疗药物筛选及疫苗方面的研究打下了基础。     

男女性生殖道炎性疾病者阴道加德纳菌及其他病原菌感染研究

目的了解男女性生殖道炎性疾病者阴道加德纳菌及其他病原菌的感染状况.方法收集2003年10月～2004年8月,无锡地区682例(男459例,女223例)男女性生殖道炎性疾病患者的尿道和宫颈分泌物标本及115例前列腺炎患者的前列腺液标本,进行阴道加德纳菌(GV)、解脲脲支原体(Uu)、人支原体(MH)、生殖道支原体(MG)、肺炎支原体(MP)、淋病奈瑟球菌(NG)、沙眼衣原体(CT)检测,女性同时进行念珠菌和滴虫检测.结果男性生殖道患者GV阳性率为8.1%,居NG(37.3%)、Uu(22.7%)之后列第3位;女性Gv为28.3%,居念珠菌(42.6%)、Uu(38.6%)之后也列第3位.结论男女性生殖道炎性疾病患者GV阳性率较高,在检出的病原菌中居第3位,对STD患者应注重GV的检测及治疗.     

复发性与初发性脑梗死患者颈动脉粥样硬化斑块的比较

目的 研究复发性脑梗死患者颈动脉粥样硬化斑块的特征及其在脑梗死复发中的预测价值.方法 采用彩色多普勒超声仪对65例复发性脑梗死患者(复发组)、63例初发性脑梗死患者(初发组)和66例健康体检者(对照组)进行颈动脉探查,观察颈动脉粥样硬化斑块的数目及部位.并测量血管壁的厚度、斑块的大小及厚度,计算粥样硬化斑块积分.结果 复发组患者颈动脉粥样硬化斑块发生率73.8%(48,65),高于初发组的57.1%(36/63)和对照组的24.2%(16/66)(P<0.05),软斑及溃疡斑数目明显增高.复发组颈动脉粥样硬化斑块积分(1.83±0.57)分,高于初发组的(1.34±0.29)分(P<0.05).结论 颈动脉不稳定性粥样硬化斑块的存在是复发性脑梗死的危险因素.颈动脉超声检查对复发性脑梗死有极好的预测价值.     

β2-BKR基因和AGT基因多态性与原发性高血压的相关性研究

目的调查缓激肽β 2 受体(β 2 -bradykinin receptor, β 2 -BKR)基因和血管紧张素原(angiotensinogen, AGT)基因多态性与原发性高血压(essential hypertension, EH)的关系. 方法采用病例-对照研究.用MS-PCR和PCR-SSCP方法检测深圳地区EH 97例(EH组)和血压正常者87例(NT组)的β 2 -BKR基因-58T/C多态性和AGT基因M235T多态性.结果 EH组β 2 -BKR CC基因型(0.36)和C等位基因频率(0.60)显著高于NT组(0.14,P=0.000;0.43,P=0.001).EH组CC MT(0.19)、TC MM(0.18)基因型显著高于NT组(0.06,P=0.009;0.05,P=0.006).β 2 -BKR CC基因型者EH的相对危险度增加(OR＝1.913,95%CI:1.913-3.049,P＝0.006).EH组AGT基因型分布与NT组相比无显著性差异(P=0.091),但M等位基因频率(0.55)显著高于NT组(0.44,P=0.037).结论β 2 -BKR-58T/C多态性与深圳地区人群的EH相关,CC基因型可能与EH危险增加有关,C等位基因可能与AGT M235T多态性存在基因-基因间的协同作用.     

“一站式”MRI在活体肝移植术前评估中的价值

目的：探讨“一站式”MRI在活体肝移植供肝术前影像评估中的价值。方法：61例行活体半肝移植的供体术前行“一站式”MRI检查,后处理重建肝血管及胆道系统,并与手术所见对照。结果：61例活体供肝中,MichelⅠ型肝动脉48例,Ⅲ型7例,Ⅷ型2例,Ⅸ型1例,2例Ⅳ段肝动脉起自肝右动脉（RHA）,1例RHA起自腹腔干（CT）。58例正常门静脉解剖,3例“三分叉”型门静脉。41例正常肝静脉解剖,18例肝左静脉（LHV）和肝中静脉（MHV）形成共干后汇入IVC;2例肝右下静脉（IRHV）汇入下腔静脉（IVC）。58例正常肝管解剖,2例“三分叉＇型胆管,1例肝右后叶胆管（RPHD）起自左肝管（LHD）。术前MR对供体肝动脉、门静脉和肝静脉解剖的诊断正确率分别为96.7%,100%,95.1%。MRCP结合增强MR胆管造影联合显示胆道系统解剖的准确率为93.4%。结论：“一站式”MRI检查方案能够显示活体肝动脉、门静脉、肝静脉及胆道系统的解剖及变异,可以作为活体肝移植的术前评估方式。     

颅脑损伤后预防应用抗癫痫药物疗效Meta分析

目的 探讨颅脑损伤后应用抗癫痫药(AEDs)预防创伤后癫痫的疗效.方法 广泛检索PubMed、Ovid、Springer、维普、CNKI等数据库,对相关文献进行严格评价,最终纳入的21篇文献通过Meta分析,研究预防应用AEDs对创伤后早期、晚期癫痫是否有作用,研究颅脑损伤类型(外伤、颅脑手术)对预防用药效果的影响及预防用药后患者死亡率等情况.结果 在对预防用药是否有意义评价中,差异有统计学意义(OR=0.66,Z=4.310,P=0.000),故支持给药;在对早期癫痫预防用药效果评价中,差异有统计学意义(OR=0.48,Z=3.980,P=0.000),苯妥英钠组(OR=0.53)比卡马西平组(OR=0.40)对早期癫痫的预防效果更优;在对晚期癫痫预防用药效果评价中,差异没有统计学意义(OR=1.05,Z=0.310,P=0.760);在对不同类型颅脑损伤预防用药效果评价中,都具有应用意义(脑外伤OR=0.48,颅脑手术OR=0.69);在预防用药对死亡率影响比较分析中,对患者的死亡率都没有影响(OR=0.82,Z=0.920,P=0.360).结论 在已研究的药物范围内,颅脑损伤后预防性应用AEDs可使癫痫发病率明显降低;苯妥英钠对早期癫痫的预防效果较好;各类AEDs对晚期癫痫的预防效果差异无统计学意义;在外伤后癫痫和颅脑手术后癫痫患者中预防应用AEDs效果无明显差异;预防应用AEDs后对患者死亡率没有明显影响.

Abstract：

Objective To determine the efficacy ofantiepileptic drugs (AEDs) on prevention of epilepsy after craniocerebral injury. Methods Related articles searched from the databases such as PubMed, Ovid, Springer, VP and CNKI were collected and strictly evaluated; 21 articles were finally selected. Whether pretreatment with AEDs played its role in epilepsy appeared in the early/late stages was discussed with Meta-analysis; the influences of different craniocerebral injury types (resulting from trauma or surgery) on the efficacy of anti-epilepsy prophylaxis, and the mortality rate of the patients performed pretreatment were analyzed with Meta-analysis. Results Pretreatment withAEDs could significantly improve the results (OR=0.66, Z=4.31, P=0.000); pretreatment with AEDs obviously decreased the rate of epilepsy appeared in the early stage (OR=0.48, Z=3.980, P=0.000), but did not statistically decrease the rate of epilepsy appeared in the late stage (OR=1.05, Z=0.310, P=0.760);pretreatment with diphenylhydantoin (OR=0.53) was more effective on epilepsy appeared in the early stage than pretreatment with carbamazepine (OR=0.40). Pretreatment with AEDs was all-effective considering different craniocerebral injury types resulting from trauma (OR=0.48) and surgery (OR=0.69). No significant differences were noted on the mortality rate of patients performed pretreatment and without pretreatment (OR=0.82, Z=0.920, P=0.360). Conclusion The inception rate of epilepsy can be decreased remarkably after anti-epilepsy prophylaxis with AEDs in patients after craniocerebral injury,and diphenylhydantoin has a better effect for epilepsy appeared in the early stage. No reasonable differences between various kinds of AEDs on epilepsy appeared in the late stage are noted. Pretreatment with AEDs enjoys a good result in both post-traumatic brain injury and craniotomy. Pretreatment can not affect the mortality rate of the patients.