人丘脑断面解剖及磁共振图像三维重建

目的建立人丘脑的可视化三维模型,为大脑立体定向手术提供解剖学基础。方法以6例成年男性头颅标本为研究对象,选取其中1例进行磁共振扫描,将获得的图像导入计算机,利用交互式医学影像控制系统医学三维重建软件重建丘脑三维模型。然后制备6例研究对象的大脑标本,分为矢状位组、冠状位组、水平位组,每组2例,在-20℃低温下冷冻,分别制备矢状位、冠状位、水平位层厚0. 5 mm连续切片并拍摄照片,将图片导入计算机,利用photoshopCS6软件对图像中丘脑轮廓边界进行识别、提取并测量断面上丘脑前后径、左右径、上下径及体积。结果丘脑的前后径、左右经、上下径分别为(29. 52±0. 47)、(14. 51±0. 18)、(18. 66±0. 35) mm,左、右侧丘脑体积分别为(6 218. 56±563. 60)、(5 764. 37±485. 48) mm~3,丘脑的三维重建清晰显示了丘脑的空间位置、立体形态。结论通过丘脑的薄层断面定位解剖和三维重建,得到丘脑的空间结构及形态,为立体定向手术提供了数据及形态学参考依据。     

三叉神经脑池段MRI与塑化薄层切片对照研究

目的　对三叉神经脑池段进行MRI与塑化切片对照研究 ,获得正常影像和断层解剖资料。方法　采用生物塑化技术制作三叉神经横断位 8例、矢状位和冠状位各 1例薄层切片 ,同时采用FLASH 3D序列完成头颅标本及 60例正常人脑干MR扫描 ,对三叉神经脑池段的形态、走行进行对比观察。结果　标本及活体MR扫描 ,三叉神经脑池段的行程、解剖结构能够准确显示 ,塑化切片与MRI有良好的对应关系。多平面重建 (Multiplanarreconstruction ,MPR)横断位上三叉神经脑池段长度 (12 .78± 2 .0 3 )mm ,向前上外侧走行 ,与脑干背侧连线成角 (10 3 .0 4± 5 .14 )° ,随着年龄的增大 ,三叉神经脑池段与脑干背侧连线的夹角逐渐变小 ,其中小于3 0岁年龄组与 5 0岁以上年龄组之间有显著性差异 (P <0 .0 5 ) ;左右侧三叉神经与脑正中矢状面的夹角分别为 (9.2 8± 4.80 )° ,(9.44± 4.2 0 )° ,(P >0 .0 5 ) ,无显著性差异。结论　薄层MRI能够准确显示神经脑池段的解剖结构和走行规律 ,是评价三叉神经及相关结构的准确的影像学技术。     

颞骨及其邻近区塑化薄层断面解剖学研究

目的：明确颞骨及相关结构的薄层断面形态，为该区病变的影像学诊断提供解剖学依据。方法：用生物塑化技术将颞骨制成横断、冠状及矢状位3个方位的薄层断面（片厚1．2mm），对颞骨内听小骨、骨半规管、前庭、耳蜗、面神经等结构进行观测。结果：塑化薄层断面可良好显示颞骨内结构。颞骨横断面有11个层面，冠状断面有12个层面，矢状断面有13个层面，对各关键层面的结构进行了描述。结论：颞骨塑化薄层断面良好显示颞骨及内部结构的解剖结构及毗邻关系，可直接与高分辨率CT（Highresolution computed tomography,HRCT)、MRI扫描图像进行对照研究，对颞骨病变的影像诊断及手术方式的选择具有重要参考价值。     

Meckel腔的应用显微解剖研究

目的研究Meckel腔及其比邻结构的显微解剖,为涉及Meckel腔相关疾病的显微手术治疗和影像学检查提供解剖学资料。方法成年尸体头颅标本10例,开颅切除大脑,手术显微镜观察和测量Meckel腔及其比邻结构。结果Meckel腔是由颅后窝向颅中窝后内侧部分突入的硬脑膜陷凹,腔内容纳三叉神经半月节和三叉池。Meckel腔由上下、前后和内外侧壁构成,其中内侧壁与海绵窦外侧壁相贴,并有重要的神经血管比邻。Meckel腔上腔深(14.39±1.37)mm、下腔深(14.95±1.18)mm、宽(12.14±0.64)mm、厚(5.45±0.53)mm;三叉神经节长(11.90±1.16)mm、宽(10.04±1.24)mm、厚(3.44±0.74)mm。结论Meckel腔及相邻结构的显微解剖研究,对显微神经外科手术和影像诊断具有重要意义。     

颞下颌关节生物塑化薄片与MRI对照研究

目的　为临床颞下颌关节病变的影像学诊断及关节内镜手术提供正常解剖学依据。方法　利用生物塑化技术 ,将 9例颞下颌关节及相邻结构制成三个方位 (横断、冠状位及矢状位 )的塑化薄层断面标本 ,与MRI图像进行对照研究。结果　颞下颌关节生物塑化薄片及MRI图像可清楚显示颞下颌关节解剖结构 ,两者之间有良好的对应关系。外耳道的前倾角为 (1 0 8± 3 6°) ,关节结节后斜面与眦耳线夹角为 (58 8± 4 2 )°。结论　生物塑化薄片与MRI图像进行对照研究可为颞下颌关节的影像诊断、关节内窥镜手术提供有价值的形态学资料 ,有助于避免在TMJ关节镜手术中损伤中耳或颅中窝结构等并发症的发生     

三叉神经断面解剖及肿瘤侵犯的影像表现

目的 探讨三叉神经薄层断面解剖和肿瘤侵犯的影像学表现。方法 应用首例中国数字化可视人体数据集，并对照CT、MRI观察三叉神经形态及其毗邻。同时观察了11例三叉神经肿瘤侵犯三叉神经的表现。结果 首例可视化人体数据集能清楚地显示三叉神经全程。对应的CT和MRI检查能清楚显示三叉神经脑池段，对Meckel腔内三叉神经节则显示不够清楚。CT和MRI能准确显示三叉神经肿瘤侵犯三叉神经情况。结论 首例可视化人体数据集能提供准确的三叉神经断面数据，对CT和MRI显示三叉神经和评价肿瘤侵犯提供了形态学依据。     

膝关节磁共振成像及其临床应用的系列研究

磁共振成像(Magnetic Resonance Imaging,MRI)由于具有软组织分辨力高,可任意断面成像、无创伤等特点,在国外早已广泛用于膝关节病变的诊断。1992年以来,我们在膝关节MRI方面做了一些工作,现摘要报告如下。 1.膝关节正常MRI解剖学研究应用直接和/或间接对照方法,对新鲜尸体的正常膝关节标本的MBI和大切片、并和正常活体膝关节相对应的MRI进行了矢状断面和冠状断面的解剖学对照研究,建立了对国人膝关节解剖结构正常     

眶下管的应用解剖及其临床意义

目的:探讨眶下管的形态结构,为临床应用提供有关解剖学资料。方法:取成人头颅骨72例(144侧),对眶下管的位置、口径大小、毗邻关系进行观察和测量,并比较左右眶下管有无显著性差异。结果:眶下管长度左侧为(13.97±2.15)mm、右侧为(13.63±1.75)mm;与冠状面的夹角左侧为(42.15±8.46)度、右侧为(45.77±6.08)度;上壁厚左侧为(0.39±0.29)mm、右侧为(0.26±0.14)mm;下壁厚左侧为(0.61±0.20)mm、右侧为(0.55±0.26)mm;左右均无显著性差异(P>0.05)。结论:眶下管解剖结构复杂,在临床诊疗中应加以注意。     

头颅MRI在女童中枢性性早熟诊断中的价值

目的 通过头颅MRI观察中枢性性早熟女童在不同年龄段垂体的大小、形态及信号变化,探讨MRI在女童中枢性性早熟诊断中的价值。方法 收集2013年10月~2014年8月在昆明医科大学附属儿童医院(以下简称“我院”)确诊为中枢性性早熟的102例女童为病例组,同时在我院选取92例同时期入院的无内分泌疾病的同龄女童为对照组。按年龄分成<6岁、6~8岁、>8~10岁3个亚组,将鞍区MRI SE序列T1WI冠状位、正中矢状位平扫,同时用垂体形态、大小及信号等指标与对照组进行对比分析。结果 垂体MRI影像学分析显示,病例组有10例垂体结构异常(垂体微腺瘤2例,Rathke囊肿2例,Rathke裂6例)。病例组与对照组相同年龄段比较,矢状高径、矢状前后径、冠状高径、冠状宽径测量值差异均有统计学意义(P<0.05或P<0.01)。病例组垂体上缘83.7%为隆凸型,对照组79.3%为平坦型,差异有统计学意义(P=0.039);垂体后叶形态各异,但均为高信号(100%)。结论中枢性性早熟女童上缘隆凸型垂体出现率高于正常儿童,垂体高径增加可反映下丘脑-垂体-性腺轴提前启动,对临床诊断有重要的价值。     

眼眶MRI在不同分期弥漫性甲状腺肿伴甲亢眼病患者检测中的影像学特征及意义

目的:探讨眼眶MRI在不同分期弥漫性甲状腺肿伴甲亢眼病患者检测中的影像学特征及意义。方法:选取32例弥漫性甲状腺肿伴甲亢眼病(Graves)患者作为观察组,另选取同期在本院体检的无任何眼科疾病的32例健康志愿者作为对照组。两组均接受眼眶MRI检查,比较两组Graves眼病活动期与非活动期泪腺横断位短径、横断位长径、横断位截面积、冠状位短径、冠状位长径、冠状位截面积、泪腺与同侧颞肌的信号强度比(SIR)、体积等各定量参数,并分析泪腺/颞肌SIR与临床活动性评分(CAS)相关性分析、Graves眼病眼眶MRI影像学特征,统计MRI诊断Graves眼病不同分期符合率。结果:观察组泪腺横断位短径、横断位长径、横断位截面积、冠状位短径、冠状位长径、冠状位截面积、体积、泪腺/颞肌SIR值较对照组大,差异有统计学意义(P<0.05);Graves眼病活动期泪腺横断位短径、横断位长径、横断位截面积、冠状位短径、冠状位长径、冠状位截面积值与非活动期相比,差异无统计学意义(P>0.05);但活动期泪腺/颞肌SIR值较非活动期高,差异有统计学意义(P<0.05);经Spearman检验可知,泪腺/颞肌SIR与CAS评分之间呈正相关,差异有统计学意义(P<0.05);Graves眼病患者多数表现为双侧眼球突出,肌锥内外脂肪组织增多,纺锤样增粗,其中以肌腹增粗为主;眶尖部视神经受到压迫;MRI诊断Graves眼病不同分期符合率为84.38%。结论:活动期与非活动期弥漫性甲状腺肿伴甲亢眼病患者眼眶MRI检测的泪腺定量参数不等,使用脂肪抑制T2加权序列可提高活动期患者眼外肌内水肿和炎性成分辨别敏感度,有助于指导临床治疗及预后评估。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.