多普勒组织成像评价正常人心肌舒缩运动速度

目的　探讨心肌舒缩运动变化的相关因素。方法　标准切面 (左心室长轴、短轴 )用脉冲多普勒组织成像(DTI)测定室间隔、前壁、下后壁的内膜下心肌及外膜下心肌运动峰值速度。结果　各个室壁及各层心肌收缩期 s峰值速度不相同。内膜下心肌的 s峰值速度大于外膜下心肌的 s峰值速度 ,室间隔左心室面 s峰值速度大于右心室面 s峰值速度 ,两者间存在速度阶差。长轴左心室后壁 s峰值速度大于室间隔 s峰值速度 ,短轴后壁 s峰值速度大于前壁 s峰值速度。 s峰值速度与年龄无相关 ,舒张期 a峰值速度与年龄呈中度相关 ,e/ a比与年龄呈中度负相关 ,室壁运动的 e/ a比与二尖瓣血流 E/ A比呈中度相关。结论　脉冲 DTI可用于评价心肌的舒缩功能     

The Occurrence of Increased Intraperitoneal Volume Events in Automated Peritoneal Dialysis in the US: Role of Programming,Patient/User Actions and Ultrafiltration

♦ Background, objectives and methods: Increased intraperitoneal volume (IIPV) can occur during automated peritoneal dialysis (APD). The contribution of factors such as cycler programming and patient/user actions to IIPV has not been previously explored. The relationship between IIPV and cycler programming, patient/user actions, and ultrafiltration over a two-year period was investigated using US data from Baxter cyclers. Drain/fill volume ratios of > 1.6 to ≤ 2.0 and > 2.0 were defined as Level I and Level II IIPV events, respectively.♦ Results: Level I IIPV events occurred in 2.39% of standard and 4.73% of small fill volume therapies, while Level II IIPV events occurred in 0.26% and 1.33% of therapies, respectively. IIPV events occurred significantly more often in association with tidal peritoneal dialysis (PD) compared to non-tidal PD therapies. In tidal therapies, IIPV events were primarily related to suboptimal programming of total ultrafiltration volume. Factors that increased the odds of IIPV events during standard therapies included programming the initial drain volume target to < 70% of the last fill, and setting minimum drain volumes to < 85% of the fill volume. Bypass of initial drain by patients/users was also associated with a significant increase in the odds of IIPV events in non-tidal, but not tidal PD. An increase in the odds for IIPV was also seen for standard therapies within the highest (> 1,245 mL) versus the lowest (< 427 mL) quartile of ultrafiltration. Similar trends were seen in small fill volume therapies. Clinical presentations associated with IIPV events were not assessed.♦ Conclusions: IIPV events are more frequent in tidal and small fill volume therapies. The greatest potential for IIPV occurred when the total ultrafiltration was set too low for the patient’s UF requirements during tidal therapy. Patient/user bypass of drains without reaching the target drain volume contributes significantly to IIPV events in non-tidal PD therapies. Poorly functioning PD catheters may be central to the cycler programming and patient/user actions that lead to IIPV.     

脑膜病理检查在疑似脑膜转移癌患者中的应用研究

目的探讨脑膜病理检查在疑似脑膜转移癌患者中的价值。方法回顾性分析该院2019年3月—2020年07月收治的20例初诊为脑膜转移癌的患者,在为其行脑室腹腔分流(VP)、Ommaya囊植入和脑室外引流术时取脑膜组织行病理检查。结果该组20例患者中共有15例患者的脑膜病理活检为异常,阳性率为75%,其中13例为脑膜转移瘤,另2例分别为胶质母细胞瘤和结核性脑膜炎。所有患者均无取标本带来的相关并发症。结论脑膜病理检查能提高脑膜转移癌的确诊率,为实施精准放疗和个性化化疗提供依据,是一种简单、安全并且能够确诊脑膜转移癌的重要方法。[国际神经病学神经外科学杂志, 2021, 48(2):154-158]     

真性红细胞增多症转急性髓系白血病1例

真性红细胞增多症是一种以红细胞异常增殖为主的克隆性慢性骨髓增生性疾病。其外周血总容量绝对增多,血液黏滞度增高,常伴白细胞和血小板升高,脾大,病程中可有出血、血栓形成等并发症。多转归为骨髓纤维化,少部分直接转化为急性白血病。我院2011年1月收治1例真性红细胞增多症治疗     

Analysis of results related to the percent free prostate specific antigen among men without prostate diseases in Xi’an area

To measure the percent of free prostate specific antigen （fPSA） among men without prostate diseases in Xi＇an area, and to study the relationship of percent fPSA with age and pathological grade, clinical stage of prostate cancer （PCa） with percent fPSA, and to analyze the difference between the data in China and the.overseas data to determine appropriate reference range for Chinese male. Methods： A total of 713 participants were enrolled into the study, with PSA, fPSA in serum measured and the percent fPSA calculated. Out of 713 cases, 679 without prostate diseases were divided into 5 groups by age, and then the relationships of PSA, fPSA and percent fPSA with age were studied, respectively. The relationship of pathological grade and clinical stage with percent fPSA of the 34 participants with PCa was also studied. With the help of the related data of men without prostate disease, the appropriate reference range for Chinese male was established. Results： The increases in PSA or fPSA were correlated with age, while there was no significant correlation between age and percent fPSA. The percent fPSA was also correlated with pathological grade and clinical stage of PCa. The percent fPSA of men without prostate disease in Xi＇an area was significandy lower than that in the related overseas data. The reference range of percent fPSA for Chinese male was≥ 15%. Conclusion： Percent fPSA might be more useful than PSA in the detection of prostate cancer. As the percent fPSA is decreased, the pathological grade is decreased, and the clinical stage is increased, the malignant degree is increased. The reference range of ≥15% is more appropriate for Chinese male.     

Migraine,a result of increased CSF pressure: A new pathophysiological concept (preliminary report)

Summary Clinical and neuroradiological evaluation of 40 adult patients, suffering from migraine-type headache, produced evidence of a relationship between migraine, increased CSF pressure in the posterior fossa and cerebellar herniation. These findings have led to an alternative pathophysiological concept of migraine. A disturbance of CSF circulation is thought to be the underlying factor, which causes increased pressure in the basal cisterns and posterior fossa. This results in headache, acquired cerebellar herniation and, in severe cases, spasm of the vertebral arteries with subsequent cerebral ischemia. There seems to be no essential difference in pathophysiology between common and classic migraine.