颈动脉粥样硬化斑块性质与颅内血流动力学变化的相关性

目的利用16排螺旋CT血管成像及灌注成像探讨颈动脉粥样硬化斑块性质与颅内血流动力学的相关性。方法对42例颈动脉超声证实的颈动脉斑块患者行16排螺旋CT灌注成像-血管成像检查,根据CT值的不同分析斑块成分,并将脂肪斑块和纤维斑块定义为不稳定性斑块,钙化斑块定义为稳定性斑块;利用灌注成像分析颅内脑血流灌注情况。结果42例颈动脉斑块患者中不稳定性斑块25例,其中脂肪斑块10例,纤维斑块15例;稳定性斑块17例。14例表现为症状相应区域低灌注,其中脂肪斑块颅内低灌注的发生率为70%,纤维斑块颅内低灌注的发生率为47%,而钙化斑块无颅内低灌注表现。结论不稳定性斑块的存在比较稳定性斑块易于引起颅内血流动力学变化。     

Effect of high ovarian response on the expression of endocrine gland-derived vascular endothelial growth factor (EG-VEGF) in peri-implantation endometrium in IVF women

Objective: To investigate the effect of ovarian stimulation on the expression of EG-VEGF mRNA and protein in peri-implantation endometrium in women undergoing IVF and its relation with endometrial receptivity (ER). Design: Prospective laboratory study. Setting: University hospital. Patients: Eighteen women in stimulated cycles (SC) as study subjects and 18 women in natural cycles (NC) as controls. Women in SC group were classified with two subgroups, high ovarian response (SC1, n=9) with peak serum E₂>5,000 pg/mL and moderate ovarian response (SC2, n=9) with peak serum E₂ 1,000-5,000 pg/mL. Intervention(s): Endometrial biopsies were collected 6 days after ovulation in NC or after oocyte retrieval in SC. Main outcome measure(s): Endometrium histological dating was observed with HE staining. EG-VEGF mRNA expression levels determined by real-time polymerase chain reaction analysis, and protein levels by immunohistochemistry. Results: All endometrial samples were in the secretory phase. The endometrial development in SC1 was 1 to 2 days advanced to NC, and with dyssynchrony between glandular and stromal tissue. Immunohistochemistry analysis showed that EG-VEGF protein was predominantly expressed in the glandular epithelial cells and endothelial cells of vessels, and also presented in the stroma. The image analysis confirmed that both the gland and stroma of endometrium in SC1 had a significantly lower EG-VEGF protein expression than that in SC2 and NC endometrium. Moreover, EG-VEGF mRNA levels were significantly lower in SC1 than in NC. Both EG-VEGF protein and mRNA levels had no significant difference between SC2 and NC. Conclusion: Decreased expression of EG-VEGF in the peri-implantation is associated with high ovarian response, which may account for the impaired ER and lower implantation rate in IVF cycles.     

B超引导降低经皮肾取石术中胸膜损伤的探讨（附1424例报告）

目的：总结B超引导下微造瘘经皮肾取石术（mini-percutaneous nephrolithotomy,mPCNL）中行肋间穿刺所致胸膜损伤的发生率,探讨其手术的安全性.方法：回顾性分析2003年11月～2009年4月间施行的1424例B超引导下mPCNL,其中第11肋间穿刺组598例,第12肋下穿刺组826例.B超引导过程中避开肺内气体反射区域.实时监视下用18GPTC针穿刺进入目标肾盏,经针鞘置入0.965 mm导丝,沿导丝分别引入F6～16同轴扩张鞘进行扩张,建立F14～18手术通道,置入F8 Storz输尿管镜或F9.8 Wolf输尿管镜,采用钬激光和（或）双频激光进行碎石.结果：第11肋间穿刺组中,1例（0.17%）发生胸膜穿孔伴液胸,第12肋下穿刺组中无胸膜损伤,2例（0.24 %）发生液胸,两组间比较,差异无统计学意义（P＞0.05）.结论：mPCNL时,B超引导能明确辨析肺内气体回声.实时监视下穿刺扩张可直接避免因肺损伤而造成的气胸,同时可显著降低术中11肋间穿刺胸膜损伤的发生率,减少液/气胸发生率.     

健脾为基础中医药治疗对中晚期胰腺癌生存期影响的研究

[目的]探讨健脾为基础中药治疗在中晚期胰腺癌综合治疗中对生存期的影响。[方法]运用巢式病例对照研究,采用Cox多因素回归分析方法,研究影响中晚期胰腺癌总生存期(OS)的独立性相关因素,在基线平衡的条件下,进一步运用病例对照的方法对暴露因素(健脾为基础中药复方辨证治疗)对两组生存期的影响进行研究。[结果]KPS(P=0.000)和健脾为基础中医药治疗(P=0.000)是影响中晚期胰腺癌OS的独立性相关因素。中药治疗组与非中药治疗组相比OS延长(P=0.000),服用中药的相对危险度为0.082(95%CI:0.050～0.135)。中药治疗组1、2、3年生存率分别为83%、54%、45%,非中药治疗组为23%、7%、7%。[结论]KPS、健脾为基础的中医药治疗分别是影响中晚期胰腺癌OS的独立性相关因素;健脾为基础中医药治疗组较非中药治疗组显著改善患者的生存。     

慢性肾脏病与外周动脉疾病研究进展

慢性肾脏病患者外周动脉疾病发生率远高于普通人群,且和患者的心血管事件的危险性及病死率相关。现简述近年来有关慢性肾脏病患者中外周动脉疾病的流行病学、危险因素、临床表现的特点,并提出适合其特点的诊断和治疗方法。     

模糊神经网络预测电针镇痛过程中生化指标变化的应用研究

目的针对电针镇痛过程中生化指标检验的时滞性、费用高等不足，本文提出基于模糊神经网络预测电针镇痛过程中生化指标变化的方法。方法模糊神经网络的性能通过调整隶属函数的类型和隶属函数的个数进行优化。模糊神经网络的训练数据来源于电针镇痛患者的ECG、EEG等生理电信号以及检测的生化指标。我们从中选取45个样本为训练样本，剩余的15个样本作为测试样本。结果从模型训练结果的变化来看，训练数据预测的结果比较接近实际检测的结果。结论模糊神经网络预测的结果与实际检测的结果非常吻合，这为电针镇痛过程中生化指标变化预测提供了一种新的方法和思路。     

重视与附着点炎症相关的关节炎的诊治

与附着点炎症相关的关节炎(ERA)为幼年特发性关节炎的一个亚型,以男性年长儿多见,以非对称性累及下肢关节、骶髂关节和多数患儿有附着点炎症、HLA-B27阳性为特点。CT、MRI有助于早期发现骶髂关节炎。本病的药物治疗包括非甾体抗炎药、糖皮质激素、改善病情用药和生物制剂。TNF-α拮抗剂可有效缓解病情。加强对ERA的认识,及时诊断治疗能明显改善患儿关节炎症,避免残疾发生。     

蛋白激酶B参与门静脉高压症高动力循环的研究

目的 探讨蛋白激酶B （AKT）与肝硬化门静脉高压症（portal hypertension,PHT）高动力循环的关系,特别是AKT与肝门静脉高压症内脏血管收缩反应性降低的关系.方法 将SD大鼠随机分为4组：正常对照组（N组,n=7）、四氯化碳诱导的肝硬化门静脉高压组（PHT组,n=7）,经AKT特异性阻滞剂LY294002处理的门静脉高压组（LY组,n=7）和注射二甲基亚枫（DMOS）的门静脉高压组（DMOS组,n=7）,分别测量门静脉压力（portal vein pressure,PP）,离体肠系膜分支动脉对缩血管物质去甲肾上腺素（norepinephrine,NE）的反应性,应用LY294002对离体微动脉收缩反应性的影响以及肠系膜动脉内皮细胞内AKT、内皮一氧化氮合酶（eNOS）的蛋白表达变化.结果 ①与N组相比,PHT组PP明显增高（P＜0.01）,应用LY294002后,PP无明显降低（P＞0.05）;②PHT组肠系膜微动脉对NE的反应性较N组明显降低（P＜0.01）,LY294002可改善这种低反应性（P＜ 0.01）;③AKT在PHT肠系膜动脉内皮中的表达明显上调（P＜0.05）,eNOS的表达PHT组和N组无明显差别（P＞ 0.05）,但p-eNOS的表达在PHT组动脉内皮中明显增高（P＜ 0.05）.结论 肝硬化门静脉高压症的内脏动脉中,AKT的表达上调,通过促进eNOS的活化和降低血管收缩反应性,参与内脏高动力循环的形成.     

Plasma creatinine levels,estimated glomerular filtration rate and carotid intima media thickness in middle-aged women: A population based cohort study

Background and aimThe relationships between high Creatinine (Cr) levels or low estimated Glomerular Filtration Rate (eGFR) and common carotid Intima Media thickness (IMT) have been evaluated in a population-based cohort study in women, aged 30–69 (Progetto ATENA).Methods and resultsSerum Cr and eGFR were measured in 310 women, as a part of 5.062. In this group carotid ultrasound examination (B-Mode imaging) was performed and mean max IMT was calculated. Women were classified by Cr levels >1 mg/dL or eGFR < 56 ml/min.Women with Cr > 1 mg/dL (90th percentile of creatinine distribution) or eGFR less than 56 ml/min (5th percentile of eGFR distribution) had relatively more carotid plaques as compared to the rest of the cohort.Multivariate logistic analysis, after adjustment for age, demonstrated a significant association between Cr (>1 mg/dL) and IMT (≥1.2 mm): OR 4.12 (C.I 1.22–13.86), p = 0.022; or eGFR (<56 ml/min) and IMT (≥1.2 mm): OR 4.31 (C.I 1.27–14.66), p = 0.019.ConclusionsThese findings on an independent relationship between Cr and common carotid plaques in this population of middle aged women, independently of age, suggest the value of screening for early carotid disease in asymptomatic middle aged-women with mild renal insufficiency, in order to predict those at relatively higher risk for future cardiovascular events.