常规超声与超声弹性成像对乳头溢液的诊断价值分析

目的探讨常规超声与超声弹性成像对乳头溢液的诊断价值,分析其效果。方法选择2010年9月～2012年3月50例经手术病理证实为乳头溢液的患者作为研究对象,患者在术前进行常规超声及实时超声弹性成像检查,采用平行于乳腺导管的放射状方法对其进行扫描检查,要针对患者的乳晕区域的扩张导管以及占位的常规超声声像图的表现而为患者诊断,诊断结果有BI-RADS1～5级,实时弹性的成像要依据病灶的成像特征进行分析,分为1～5级,此次所有患者的全部病变均或者手术的病理。结果笔者所在医院此次研究的50例患者,其中良性病变为40个,恶性病变为10个,在常规超声的基础上加强使用弹性成像,对病变诊断的敏感度达到100%。结论常规超声如果发现导管扩张伴有内部局限性回声病变,则应为患者使用超声弹性成像检查,可有效提高诊断的特异性。     

归脾汤加减在冠心病心绞痛患者中的应用价值研究

目的探讨归脾汤加减在冠心病心绞痛患者中的应用价值。方法选取2009年12月～2012年2月于笔者所在医院进行治疗的66例冠心病心绞痛患者为研究对象,将其随机分为对照组(常规西药组)和观察组(归脾汤加减组)各33例,将两组患者的心绞痛及心电图治疗总有效率、显效时间及治疗前后的心功能检测指标进行比较。结果观察组的心绞痛及心电图治疗总有效率高于对照组,显效时间短于对照组,治疗后心功能指标优于对照组,差异均有统计学意义(P<0.05)。结论归脾汤加减在冠心病心绞痛患者中的应用价值较高,可有效改善患者的心功能指标。     

心电图ST段压低临床价值

目的探讨心电图ST段低压的临床价值。方法选取笔者所在医院2009年1月～2010年12月行24 h动态心电图监测显示ST段压低患者114例作为研究对象,结合其伴随症状、临床诊断、其他心电图改变等情况进行综合分析。结果本组114例患者中以伴发胸痛(闷)者最多,占76.3%;临床诊断为心脏病患者72例,占63.2%。结论 ST段压低对冠心病,尤其对心肌缺血等心肌损伤的程度及部位的诊断具有极其重要的价值,但缺乏特异性,需要结合临床及心电图其他表现综合判断。     

Posterior pelvic pain provocation test is negative in patients with lumbar herniated discs

The classification of pelvic girdle pain can only be reached after lumbar causes have been excluded by a clinical examination. During clinical examination, the posterior pelvic pain provocation test is a well-established method for verifying pelvic girdle pain. However, a criticism of pelvic pain provocation tests is that they may have an effect on lumbar structures, thus yielding false-positive results. The posterior pelvic pain provocation test was performed with four groups of patients: patients with computed tomography-verified disc herniations (1) on the waiting list for surgery (14 women; 9 men); (2) 6 weeks after disc surgery (18 women, 12 men); (3) pregnant women seeking care for pelvic girdle pain (n = 25); and (4) women with persistent pelvic girdle pain after delivery (n = 32). The sensitivity of the posterior pelvic pain provocation test was 0.88 and the specificity was 0.89. The positive predictive value was 0.89 and the negative predictive value was 0.87. Analysis of only women showed similar results. In our study, the posterior pelvic pain provocation test was negative in patients with a well-defined lumbar diagnosis of lumbar disc herniation, both before and after disc surgery. Our results are an important step toward the more accurate classification of lumbopelvic pain.     

Incorporating a class of constraints into the dynamics of optimal control problems

A method is proposed to systematically transform a constrained optimal control problem (OCP) into an unconstrained OCP, which can be treated in the standard calculus of variations. The considered class of constraints comprises up to m input constraints and m state constraints with well‐defined relative degree, where m denotes the number of inputs of the given nonlinear system. Starting from an equivalent normal form representation, the constraints are incorporated into a new system dynamics by means of saturation functions and differentiation along the normal form cascade. This procedure leads to a new unconstrained OCP, where an additional penalty term is introduced to avoid the unboundedness of the saturation function arguments if the original constraints are touched. The penalty parameter has to be successively reduced to converge to the original optimal solution. The approach is independent of the method used to solve the new unconstrained OCP. In particular, the constraints cannot be violated during the numerical solution and a successive reduction of the constraints is possible, e.g. to start from an unconstrained solution. Two examples in the single and multiple input case illustrate the potential of the approach. For these examples, a collocation method is used to solve the boundary value problems stemming from the optimality conditions. Copyright © 2009 John Wiley & Sons, Ltd.     

快速床旁检测NT-前端B型钠尿肽对左室射血分数正常心力衰竭的诊断价值

目的探讨快速床旁前检测INT-前端B型钠尿肽（NT-pro BNP）对左室射血分数正常的心力衰竭（HFNEF）的诊断价值。方法本研究入选了2007年10月-2008年10月本院门诊及住院左室射血分数正常的心力衰竭（HFNEF）患者118例,按美国纽约心脏病协会（NYHA）心功能分级标准分为I II III IV级,另选取健康人30例为对照组,利用荧光标记法进行检测NT-前端B型钠尿肽（NT-pro BNP）。结果左室射血分数正常的心力表竭（HFNEF）患者全血NT-pro BNP浓度明显高于对照组,差异有统计学意义（P〈0．01）,各组全血NT-proBNP浓度随着NYHA分级级别增加而增高,差异有统计学意义（P〈0．01）。结论快速床旁检测NT-pro BNP对左室射血分数正常的心力表竭（HFNEF）的诊断具有较高的敏感性,为HFNEF的早期诊断提供试验依据。     

不同营养支持治疗对老龄重症脑血管病患者营养状况的影响及疗效观察

目的:观察不同营养支持方式对老龄重症脑血管疾病患者的营养状况影响及临床疗效。方法:老年重症脑血管病患者66例,随机分为肠内营养组(EN)与肠外营养组(PN),各33例,两组常规治疗相同,按照等氮、等热量的营养支持原则,EN组逐步实施肠内营养,PN组给予肠外营养。2周后观察体重变化百分比(IBW%)、肱三头肌皮褶厚度(TSF)、血清白蛋白、血红蛋白变化,记录治疗期间并发症发生情况及3个月后临床疗效。结果:两组病例治疗后TSF、血清白蛋白、血红蛋白与治疗前明显下降,差异有统计学意义;治疗后EN组IBW%、TSF、血清白蛋白、血红蛋白优于PN组,差异有统计学意义。EN组上消化道出血及肺部感染发生率均少于对照组,差异有统计学意义。PN组总有效率为66.7%,EN组总有效率为42.4%,PN组病死率为18.2%,EN组病死率为42.4%,差异有统计学意义。结论:肠内营养在改善老龄重症脑血管病患者营养状况、减少并发症及远期的病死率方面优于肠外营养,值得临床推广。     

Diagnostic utility of skin biopsy in dystrophinopathies

Aims

Muscle biopsy is an important diagnostic modality and screening test for the diagnosis of dystrophinopathies. Sometimes muscle biopsies are needed for the diagnosis when genetic tests are inconclusive and are also useful for immunoblotting assay of the dystrophin protein. However, the procedure is painful, requires anesthesia and sometimes needs to be repeated. This study was undertaken to elucidate the role of skin biopsy in the diagnosis of dystrophinopathies and to validate if it can be utilized as a useful adjunct/replacement for the muscle biopsy.

Methods

Paired skin and muscle biopsies were studied from 39 patients with Duchenne muscular dystrophy (DMD), 4 patients with Becker's muscular dystrophy (BMD) and 37 controls. Immunostaining for dystrophin and utrophin was done on frozen sections of the test group and controls and their staining pattern in skin biopsies was compared with corresponding muscle biopsies.

Results

Immunostaining for dystrophin was negative in the skin biopsies of all patients (39/39, 100%) with DMD and was only weakly expressed in skin of BMD patients (4/4, 100%). Dystrophin was strongly expressed on arrector pili muscle cells of all control patients (94.6%) except two cases in whom it was weakly expressed. Utrophin was expressed on the arrector pili muscle cells of DMD patients (39/39, 100%) as well as controls (30/37, 81.1%).

Conclusion

Our study suggests that skin biopsy is very useful for the diagnosis of dystrophinopathies and their differentiation from other muscle diseases. It has high degrees of sensitivity, specificity, and positive and negative predictive values. It can be a useful adjunct/replacement for the muscle biopsy especially when repeated biopsies are required for monitoring therapy or in patients with advanced DMD where extreme fibrosis, adipose tissue infiltration and inflammation make interpretation of the muscle biopsy difficult. Skin biopsy is a simple, cost effective, less invasive and less traumatic diagnostic procedure when compared with muscle biopsy. This is even more pertinent because patients with muscular dystrophies have a higher risk for any form of general anesthesia. A smaller scar and fewer chances of infection at the site of biopsy are other additional advantages of skin biopsy over muscle biopsy.     

肝门部胆管癌超声诊断的临床价值

目的 探讨肝门部胆管癌(HCCA)超声诊断的临床价值.方法 将59例肝门部胆管癌病人二维声像表现按团块型、结节型、狭窄型和栓塞型进行超声图像分型;超声显示病变侵犯范围采用Bismuth-Corlette Ⅰ～Ⅳ分型法进行分型;手术方式分为病损切除术与胆道内或外引流术.将声像表现分型与Bismuth-Corlette分型进行比较;观察Bismuth Corlette各型与手术方式的关系;对比不同手术方式与肿瘤最大径的关系.结果 59例HCCA的超声诊断准确率为96.61%(57/59).其中42.37%(25/59)行病损切除术,57.63%(34/59)行胆道内或外引流术.59例中团块型与Bismuth Corlette Ⅳ型所占比例最大,分别达64.41%(38/59)和50.85%(30/59).团块型中以Bismuth-CorletteⅣ型所占比例最大(60.53%,23/38);而结节型均为Bismuth-CorletteⅡ型(100.00%,9/9).Bismuth Corlette Ⅱ型的病损切除率最高,达62.50%(10/16).病损切除术组中肿瘤最大径<4 cm的占68.00%(17/25),而胆肠内或外引流术组中肿瘤最大径>4 cm的占76.47%(26/34),二者比较有统计学意义(P<0.01).结论 超声诊断HCCA具有重要的临床价值,声像表现为结节型、Bismuth-Corlette Ⅱ型及肿瘤最大径<4cm可作为HCCA病损切除的重要指标.     

单纤维肌电图中多电位对颤抖值的影响

目的：确定单纤维肌电图（SFEMG）中最佳的颤抖（jitter）值数目。方法：选择39例重症肌无力患者进行眼轮匝肌SFEMG检测,重新计算多电位的颤抖值并比较差异性。结果：来自异常终板的多电位可以增大颤抖值,该值在不同的Ossermann分型之间无差异。结论：在SFEMG操作中,应采用一个颤抖值的描记,以防止假阳性的结果。