目的 探讨扩散张量成像(DTI)评估髌股关节表面软骨早期损伤的临床应用价值.方法 对临床预行膝关节镜检查的患者行膝关节DTI及T2* mapping扫描;依据膝关节镜结果,搜集30例Outerbridge分级为Ⅰ、Ⅱ级的髌股关节表面软骨损伤患者纳入早期损伤组,30例无髌股关节软骨损伤患者纳入正常对照组;对比分析早期损伤组及正常组的DTI、T2* mapping表现.结果 30例髌股关节早期损伤患者关节镜下共发现48处软骨表面软骨损伤.DTI的各向异性分数(FA)、表观扩散性系数(ADC)伪彩图分别能显示39处(81.2％,39/48)、36处(75.0％,36/48),DTI共显示41处,敏感度为85.4％,特异度为83.3％.T2* mapping伪彩图显示35处(72.9％,35/48),敏感度为72.9％,特异度为91.7％.DTI与T2*mapping在发现损伤数目上差异没有统计学意义(x2=2.274,P=0.132).早期损伤组FA均值0.29±0.05较正常组0.39±0.08降低,ADC均值(1.71 ±0.20) ×10-3mm2/s较正常组(1.39±0.06)×10-3mm2/s升高,T2*均值(57.66±12.99) ms较正常组(31.16±5.48) ms升高,各组间差异均有统计学意义.结论 DTI可定量评估髌股关节早期软骨损伤,且较T2*mapping敏感,有较大临床应用潜力.

Objective To evaluate the value of DTI in mild articular cartilage injury in patellofemoral joint.Methods The DTI and arthroscopy data of 82 patients wih routine MRI diagnosed as mild articular cartilage injury were analyzed retrospectively.According to the results of arthroscopy,40 cases of mild articular cartilage injury with Outerbridge classification Ⅰ or Ⅱ were divided into experimental group,and 33 cases with normal patellofemoral articular cartilage were divided into control group.There were 8 articular cartilage injury patients with Outerbridge classification Ⅲ or Ⅳ in patello-femoral join were excluded.The DTI data were analyzed compared with arthroscopy.Results Arthroscopy detected 62 lesions of cartilage injury in experimental group.Totally 49 lesions (49/62,79.03 ％) were detected by ADC pseudocolor image and 51 lesions (51/62,82.25 ％) were detected by FA pseudocolor image.The DTI pseudocolor images of articular cartilage injury showed uneven levels.The red or pink levels can been observed.Compared with the control group,ADC value increased and FA value decreased significantly in experimental group (both P＜0.05).Conclusion DTI can clearly display and detect mild articular cartilage injury in patellofemoral joint,which provide valuable information for early cartilaginous injury.

目的:探讨3.0T磁共振扩散张量成像(DTI)定量测量正常髌软骨的可行性.方法:对40例健康青年志愿者的右膝关节髌软骨进行DTI扫描,利用Matlab 7.1及Mricron应用软件对图像进行后处理,观察髌软骨的DTI表现,并测量其表现扩散系数(ADC)及各项异性分数(FA)值.结果:40例中仅4例图像质量较差.髌软骨的ADC及FA图表现均表现为沿髌骨表面走行的稍高信号,其ADC值为(1.428±0.087)×103mm-2/s,FA值为0.207±0.018.结论:3.0T磁共振能进行髌软骨DTI,其定量测量参数能反映髌软骨的水分子扩散特征.

OBJECTIVE:To develop and evaluate the short version of patient reported outcomes (PROs) questionnaire for gastric stuffiness (Wei Pi) patients with modern test theory and technologies, hoping to provide testing tools for related clinical practice and scientific researches with higher quality and less administrative and response burdens.METHODS:Using descriptive study design, clinical data were collected with sociological questionnaire and previous developed full items version of PROs instrument for gastric stuffiness (Wei Pi) patients via field and online surveys between Sep 2011 and Mar 2012. The statistical analysis group identified the termination parameters firstly, and then selected items with discrimination, fitting residual, item information curve (IIC) , item characteristic curve (ICC), and the rank of computerized adaptive testing (CAT) select proportion, etc. After assumption evaluation of item response theory (IRT), IIC, ICC, difficulty coefficient distribution, items-response relation and thresholds, etc. were used for psychometric evaluation of instrument.RESULTS:A total of 331 patients [Ages: 31.99 +/- 10.29 yrs; Male: 186 (56.3%)] were enrolled in statistical analysis. The test termination criterion was Max SE = 0.2 or Max items number =16. After items selection, a 15-item short version of instrument, which contains symptoms facet (8 items) and impact facet (7 items) was generated. With good unidimensionality, local independence, and monotonicity, the IC and ICC in IRT analysis showed good working capability of the questionnaire. The difficulty coefficient distribution and items-response relation were also rational, as well as response thresholds.CONCLUSIONS:The short version of PROs instrument for adult gastric stuffiness (Wei Pi) patients was successfully developed and assessed. The instrument with good methodological and reporting quality could be used in clinical and scientific evaluating their symptoms and impact.

为探讨喉痹之病因病机及其论治,本文就《素问·阴阳别论》中"一阴一阳结,谓之喉痹"展开论述。笔者认为咽喉与五脏六腑、十二经脉均有联系,其中与脾胃二脏的生理关系最密切。咽通六腑而胃主之,浊阴由咽而下达,主地气,喉通五脏而脾主之,清阳自喉而上腾,主天气,故阴阳升降之枢在脾胃,而阴阳升降之要道在咽喉。喉痹之为病,总为阴阳升降失常所致,其治关键在于调理阴阳升降复常,而从脾胃立论是治疗喉痹的一个重要辩治方法。

随着生活方式、环境的改变,糖尿病的"三多一少"症状逐渐不典型化,患者表现出体形肥胖,神疲乏力,少气懒言等脾虚症状越来越明显,因此从脾虚探讨糖尿病的病机,从脾虚立论,以健脾为中心,辨证论治糖尿病,具有实际意义。