动态增强三维血管成像MR技术在腹部肿瘤诊断中的作用

目的探讨动态增强三维血管成像技术(3D CE-MRA)在诊断腹部肿瘤中的价值.方法 26例腹部良恶性肿瘤患者行常规MRI与3D CE-MRA,对3D CE-MRA病灶检出率、对比噪声比(CNR)进行比较,统计其肿瘤的动静脉显示率,并观察肿瘤不同增强时相的表现.结果共41个病灶,在实质脏器37个病灶中,T2WI检出29个,B超检出30个,3D CE-MRA动脉期检出34个,其病灶检出率高于T2WI和B超.肝内肿瘤CNR,T2WI为21±3.8,3D CE-MRA动脉期为13±4.6(P＜0.05),静脉期为19±3.3(P＞0.05),延迟期为23±2.5(P＜0.05).肝外肿瘤CNR, T2WI为15±5.8,3D CE-MRA动脉期为18±4.3(P＜0.05),静脉期为20±6.1(P＜0.05),延迟期CNR为21±4.8(P＜0.05),3D CE-MRA CNR等于或高于T2WI,其肿瘤动脉显示率为80.4%,静脉显示率为26.8%,能显示肿瘤不同时相的强化特点.结论 3D CE-MRA对腹部肿瘤检出率高,能显示肿瘤血管与组织强化特点,为诊断腹部肿瘤有价值的方法.     

左室特发性室速误诊为室上性心动过速5例分析

目的 :分析起源于左室后间隔特发性室速的临床及电生理特点 ,探讨其误诊为室上性心动过速的原因及两者的鉴别要点。方法 :回顾分析 1999～ 2 0 0 2年住院的左室特发性室速 5例 ,平均年龄 2 7岁 ,男 4例 ,女 1例 ,心动过速均有突发突止 ,不伴血流动力学障碍 ,且对异搏定敏感的特点 ,均在外院误诊为室上性心动过速伴差异性传导 ,射频消融未成功。结果 :本组 5例电生理检查心室程控刺激诱发心动过速 ,伴有室房分离 ,ECG显示右束支传导阻滞 ,有时合并左前分支阻滞 ,电轴不偏或左偏 ,在左后间隔最提前的 P电位处消融后心动过速不能被诱发。结论 :起源于左后间隔的特发性室速临床表现与室上速相似 ,但 ECG V1 和 V6 导联的形态有助于和室上性心动过速伴差异性传导相鉴别     

肺炎证候诊断标准的初步建立

目的:初步建立肺炎证候诊断标准。方法:采用病证结合研究模式,通过32篇文献分析、1059份临床调查和27份专家咨询,运用医学统计和计算智能技术,揭示肺炎证候要素及其组合、变化规律,揭示肺炎基础证候的诊断指标及其相互关系,构建肺炎证候诊断指标体系,初步建立肺炎证候诊断标准。结果:在总结不同分析方法和不同研究阶段结果基础上,根据拟定的肺炎常见证型及变证的确立、证型主次症的划分或判定方法及依据、肺炎证候诊断标准的建立形式和依据,初步建立了包括风热袭肺、外寒内热、痰热壅肺、痰湿壅肺、肺脾气虚、气阴两虚等6个常见证,和热入心包、邪陷正脱等2个变证的肺炎证候诊断标准。结论:初步建立的肺炎证候诊断标准有待在临床中进一步考核与验证。     

Application of metabolomics in establishing primary nephrotic syndrome diagnosis model

Objective To establish diagnosis model and explore related metabolic pathways by analyzing the serum metabolic profile of patients with primary nephrotic syndrome (PNS) through metabolomics. Methods Thirty PNS patients hospitalized in Huai'an First People's Hospital between December 2010 and April 2012 were enrolled. High performance liquid chromatography-mass spectrometry (LC-MS) was employed to detect metabolites in the serum of 30 PNS patients and 30 healthy controls. Metabolic fingerprint profiling and multivariate pattern recognition analysis were combined to establish disease-specific metabolic diagnosis model, and metabolic pathway analysis was performed. Results PNS group and control group could be well separated by principal component analysis (PCA) model as well as partial least-squares discriminant analysis (PLS-DA) model with Q2 of 0.300. There was well interpretation in PLA-DA model (R2X=0.581,R2Y=0.452). Compared with healthy controls,PNS patients had decreased cholestane 3, 7, 12, 15 alcohol, acyl glycerine, phytosphingosine and tryptophan, and increased sphingomyelin, arginine and glutamic acid (all VIP＞1, P＜0.05). The metabolic disorders pathways of PNS patients included sphingolipid metabolism, arginine and proline metabolism, linoleic acid metabolism and pyrimidine metabolism (all impact＞0.10 and P＜0.05). Conclusions Metabolomics combined with multivariate pattern recognition analysis may be a new tool for diagnosis and monitoring of PNS.     

The current status of heart failure diagnostic biomarkers

Heart failure (HF) affects approximately 23 million individuals worldwide and this number is increasing, due to an aging and growing population. Early detection of HF is crucial in the management of this debilitating disease. Current diagnostic methods for HF rely heavily on clinical imaging techniques and blood analysis, which makes them less than ideal for population-based screening purposes. Studies focusing on developing novel biomarkers for HF have utilized various techniques and biological fluids, including urine and saliva. Promising results from these studies imply that these body fluids can be used in evaluating the clinical manifestation of HF and will one day be integrated into a clinical workflow and facilitate HF management.     

孤立性心室肌致密化不全的磁共振诊断

目的探讨磁共振对于孤立性心肌致密化不全的临床诊断价值.方法利用西门子1.5T磁共振机检查9例有不同临床症状的心脏病患者以进一步观察心内结构.结果在9例患者中,磁共振清晰辨别出不同部位和程度的心肌致密化不全病变,其特征性表现为显著的小梁化心肌及深入到室壁内的小梁间隙;尤其是对于累及左室前侧壁和心尖部的病变,磁共振能较超声心动图提供更明确的形态显示和更高的空间分辨率.结论磁共振提高了心肌致密化不全的诊断率,是超声心动图检查的有效补充和替代方法.