目的 分析大脑皮层层状坏死(cortical laminar necrosis,CLN)的磁共振磁敏感加权成像(suscepti-bility-weighted imaging,SWI)影像学表现,并评估CLN是否含有出血成分.方法 收集作者医院2016年9月至2021年9月符合CLN诊断标准的患者18例,其中男10例,女8例,年龄1～86岁.分析患者临床病因以及影像学资料.结果 18例CLN患者中,病因为脑梗死8例,脑外伤4例,脑肿瘤术后损伤4例,缺血缺氧脑病1例,病毒性脑炎1例.CLN区SWI像未见出血10例(55.6％),表现为斑点出血4例(22.2％),层状出血4例(22.2％).结论 大部分CLN患者层状坏死区域SWI像未见出血,SWI是鉴别CLN是否合并出血的重要序列.

目的 比较干化学法、尿总蛋白/尿肌酐比值(PCR)和尿清蛋白/尿肌酐比值(ACR)3种尿蛋白筛查方法的一致性,并分析其在健康体检中的应用价值.方法 选取2020年8月11-30日解放军总医院第六医学中心健康管理科936例健康体检者晨尿标本,同时进行干化学法尿蛋白定性/半定量测定,比色法或比浊法尿总蛋白、尿清蛋白和尿肌酐定量测定,研究干化学法、PCR和ACR 3种检测方法阴阳性符合率,干化学法少量蛋白尿与ACR微量清蛋白尿测定的一致性,以及尿蛋白阳性体检者标本情况等.结果 当ACR<30 mg/g时,PCR符合率97.6％,干化学法符合率98.9％,阴性符合率高;当ACR在30～300 mg/g时,PCR假阴性率为28.7％,干化学法假阴性率为78.3％,阳性符合率低;当ACR>300 mg/g时,PCR符合率为100.0％,干化学法符合率84.6％,其中2例干化学法假阴性均因高尿酸血症口服碳酸氢钠所致,阳性符合率高.36例干化学法1+(半定量250～<750 mg/L)体检者标本中,对应尿清蛋白水平仅10例在此区间内,符合率为27.8％,这与研究人群年龄和代谢状态相关.118例3种检测方法结果不一致体检者标本中,8例干化学法阳性、PCR和ACR均阴性,临床特征包括3例糖尿病和4例高血压/高血脂患者.155例尿蛋白阳性标本中,干化学法尿蛋白假阴性率68.1％,假阳性率0.1％;ACR假阴性率16.2％,假阳性率1.8％;PCR假阴性率20.6％,假阳性率0.8％.结论 尿蛋白检测应针对不同对象选择不同检测和评价方法,尿蛋白结果的解读应纳入患者近期饮食、口服药物和代谢状态.

目的:观察瑞舒伐他汀改善冠心病患者血管内皮功能及血脂的效果.方法:选取2017年8月-2019年7月在某军队医院就诊的120例冠心病患者,随机分为对照组和观察组各60例,两组均参照相关指南行冠心病常规治疗,在此基础上对照组服用阿托伐他汀,观察组服用瑞舒伐他汀,治疗时间均为12周.测定比较两组治疗前后血脂[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]水平和血管内皮功能[内皮素-1(ET-1)、一氧化氮(NO)、血管性血友病因子(vWF)]水平,以及超敏C反应蛋白(hs-CRP)炎症因子的改变,并观察比较两组治疗效果.结果:(1)观察组治疗后总有效率为91.7％,显著高于对照组的76.7％(P＜0.05).(2)两组治疗后,TC、TG和LDL-C均非常显著低于同组治疗前(P＜0.01),HDL-C非常显著高于同组治疗前(P＜0.01);且治疗后观察组TC、TG显著低于对照组(P＜0.05).(3)两组治疗后,vWF、ET-1和hs-CRP均非常显著低于同组治疗前(P＜0.01),NO非常显著高于同组治疗前(P＜0.01);且治疗后观察组vWF、ET-1和hs-CRP非常显著低于对照组(P＜0.01),NO非常显著高于对照组(P＜0.01).(4)治疗期间,两组均未发生药物相关不良反应.结论:瑞舒伐他汀与阿托伐他汀均可改善冠心病患者血管内皮功能及血脂水平,有效抑制机体炎症反应,且治疗期间无不良心血管事件发生;瑞舒伐他汀上述效果优于阿托伐他汀.

目的:观察α-硫辛酸联合红光照射治疗糖尿病足溃疡的疗效.方法:选取在某医院就诊的糖尿病足伴溃疡98例,随机分为对照组和观察组各49例,两组在糖尿病常规治疗控制血糖基础上,对照组使用α-硫辛酸治疗糖尿病足溃疡,观察组使用α-硫辛酸+红光周期照射患区治疗,疗程均为4周.对比两组疗程内溃疡有效愈合率及溃疡愈合时间、踝肱指数、足背动脉血流速度等指标.结果:两组治疗后症状、体征均有显著改善,观察组总有效率为95.9％,显著高于对照组的83.7％(P＜0.05);观察组Wagner分级Ⅰ、Ⅱ、Ⅲ级溃疡创面愈合时间均显著或非常显著短于对照组(P＜0.05,P＜0.01);观察组踝肱指数、足背动脉血流速度等指标显著或非常显著优于对照组(P＜0.05,P＜0.01).治疗期间,两组均未发生明显不良反应.结论:采用α-硫辛酸联合红光照射治疗糖尿病足伴溃疡疗效优于单独应用α-硫辛酸治疗,且安全性好.

目的 分析隆胸术后假体及并发症的MRI表现,探讨扩散加权成像(DWI)结合动态增强MRI应用于隆胸术后评估的价值.资料与方法 收集54例隆胸术后患者,包括水凝胶注射隆胸术17例34个假体,硅胶假体植入隆胸术19例34个假体,自体脂肪移植隆胸术18例36个乳腺,分析假体有无破裂、破裂分型及周围腺体病变的MRI表现.结果 水凝胶注射隆胸术组17例34个水凝胶注射假体中,30个假体破裂(聚集型破裂14个,离散型破裂16个),并发乳腺癌1例、脓肿1例;硅胶假体植入隆胸术组19例34个硅胶假体中,未破裂23个(其中包膜挛缩15个),假体破裂11个,其中囊内破裂8个,表现为"包膜下线"征、"索套"征等;囊外破裂3个,表现为假体突破纤维包膜,进入腺体后方或腺体内;并发乳腺癌1例;自体脂肪移植隆胸术18例,表现为乳腺周围脂肪间隙多个环形强化结节.结论 不同隆胸术及隆胸材料具有特征性MRI表现,DWI结合动态增强MRI能够准确评估假体有无破裂及破裂类型,并能发现腺体病变.

目的 研究分析晚期前列腺癌患者应用戈舍瑞林与比卡鲁胺治疗的效果与安全性,为临床治疗晚期前列腺癌患者提供可靠的参考依据.方法 选取2015年3月 ～2016年1月解放军总医院第六医学中心收治的晚期前列腺癌患者112例,按照随机数表法分为两组,每组56例.观察组患者联合应用戈舍瑞林与比卡鲁胺间歇性治疗,对照组患者则联合应用戈舍瑞林与比卡鲁胺持续治疗,比较分析两组晚期前列腺癌患者的治疗效果.结果 两组患者治疗1、3个月的疼痛缓解率比较差异无统计学意义(P>0.05).治疗6、12个月后,观察组的疼痛缓解率较对照组高,差异有统计学意义(P<0.05).两组患者治疗后的血清PSA值、不良反应发生率、骨转移情况、血清睾酮比较,差异无统计学意义(P>0.05).结论 联合应用戈舍瑞林与比卡鲁胺间歇性治疗与持续治疗均有显著疗效,间歇性治疗能够更好的缓解患者疼痛.

Objective To explore the efficacy of Getong Tongluo capsule combined with defibrase injection in the elderly patients with acute cerebral infarction. Methods A total of 128 elderly patients with acute cerebral infarction in our hospital from June 2016 to April 2018 were enrolled. The control group was treated with defibrase injection on the basis of routine treatment,and experimental group was treated with Tongluo capsule on the treatment of control group,the course of treatment was 15 days.The efficacy,the levels of angiopoietin-1 (Ang-1), endothelin-1, vascular endothelial growth factor (VEGF),and the incidence rate of adverse reactions in two groups were observed and compared. Results The total effective rate of experimental group was significantly higher than that of control group (95.31％ vs 78.13％,P＜0.05). There were no significant differences in levels of ANG-1,endothelin-1,VEGF,and neurological deficit score between the two groups before treatment.After treatment,the levels of ANG-1 and endothelin-1,and the neurological deficit score in the experimental group were significantly lower, the level of VEGF was higher than those in the control group (P＜0.05). The incidence rate of total adverse reactions was 6.25％ in both experimental group and the control group (P＞0.05). Conclusions Getong Tongluo capsule combined with defibrase injection can regulate the cytokine levels and promote the recovery of neurological function in the elderly patients with acute cerebral infarction.

Objective: To study the effecof leflunomide combined with losartan potassium therapy on renal function and glomerulapodocyte injury in patientwith diabetinephropathy.Methods: total of 82 patientwith diabetinephropathy (CKDIIIa, IIIstage) who were treated in ouhospital between June 2013 and May 2016 were selected athe research subjects, random numbetable waused to divide them into leflunomide (LEF) group and control group who received leflunomide combined with losartan potassium therapy and losartan potassium monotherapy respectively.Before treatmenand 8 weekaftetreatment, serum contentof renal function indexes, RAAmoleculeand inflammatory factorawell aurine contentof podocyte damage proteinwere determined.Results: Eighweekaftetreatment, serum Scr, BUN, CysC, PRA, AT-II, ALD, IL-1β, IL-6 and TNF-α contents, urine AClevelawell apodocalyxin, nephrin, CA2AP and podocin contentof both groupof patientwere significantly lowethan those before treatment, and serum Scr, BUN, CysC, IL-1β, IL-6 and TNF-α contents, urine AClevel awell apodocalyxin, nephrin, CA2AP and podocin contentof LEF group were significantly lowethan those of control group, serum PRA, AT-II, ALD contenthad no significandifference with control group.Conclusions: Leflunomide combined with losartan potassium therapy can improve the renal function of patientwith diabetinephropathy, and inhibithe inflammatory response injury to glomerulapodocyte.

Objective To compare the preparation time,cleaning effect,satisfaction degree,and adverse re-action among the three kinds of enemas in bowel preparation for colonoscopy in the elderly,and explore the effective-nessandsafetyenemasofbowelpreparationforcolonoscopyinelderly.Methods 279patientsundergoingconven-tional colonoscopy were randomly divided into 3 groups.Group A received 50%magnesium sulfate,group B received Sodium Phosphates Oral Solution,group C received Sulfate-free Polyethylene Glycol Electrolyte Powder.The cleaning effect,satisfaction degree,and the incidence of adverse reaction werecompared among the three groups.Results The preparation time in Group A and group B was less than that in group C (P<0.05),and the intestinal cleaning effect was better than that in group C (group A,group C (P<0.05),group B,group C (P<0.01),and the satisfaction de-gree of group C was higher than that of A,B groups (P<0.05),and the incidence of adverse reactions was lower than that in A,B groups (P<0.05).Conclusion The cleaning effect of three kinds of enemas for bowel preparation be-fore colonoscopy in the elderly was satisfactory.

Objective To investigate the influence of different types of morning blood pressure surge(MBPS) on the cerebral infarction h(CI),left ventricular hypertrophy (LVH)and carotid intima-media thickness(IMT)in elder-ly patients with essential hypertension.Methods A total of 320 elderly hypertension patients underwent 24-hour ambula-tory blood pressure monitoring (ABPM),brain CT or MRI or cerebral digital subtraction angiography (DSA)and echocar-diography and carotid arteries ultrasound examination.According to the value of MBPS(MBPS≥35 mm Hg),119 patients were selected as the MBPS group,and the blood pressure types were dertermined.The patients were divided into 2 groups:dipper MBPS group (76 patients:7 patients with extreme-dipper and 69 patients with dipper)and non-dipper MBPS group (43 patients:3 patients with reverse-dipper and 40 patients with non-dipper).The level of blood lipid,blood sugar and oth-er biochemical indicators,as well as single and double side carotid intima-media thickness,left ventricular hypertrophy were tested and analyzed.Results (1 )There were no significant differences in clinical manifestations between non-dip-per MBPS group and non-dipper MBPS group(P >0.05).(2)In non-dipper MBPS group,the level of cerebral infarction, LVH and IMT were higher than those in dipper MBPS(P <0.05).Conclusion Non-dipper MBPS is related to the CI, LVH and IMT in the elderly hypertensive patients.

Objective To investigate the effect of Donepezil combined with Cerebrolysin(CL)and Ginkgo biloba(Egb76 1 )in the treatment of aged patients with Alzheimer's disease on cognitive function and behavioral disor-ders.Methods A total of 132 patients with Alzheimer's disease were collected and randomly divided into 2 groups:Donepezil combined with Cerebrolysin(CL)and Ginkgo biloba(Egb761)group (combined treatment group,n=66), Donepezil group(n=66).MMSE Scale and ADL Scale of 2 groups were assessed and compared before treatment and 3 months,6 months and 12 months after treatment.Results The cognitive function and behavioral abilities in aged patients with Alzheimer's disease improved markedly (P<0.01 )in the combined group 3 months,6months and 12 months after treatment.Conclusion Combination of Donepezil with Cerebrolysin(CL)and Ginkgo biloba(Egb761 ) can markedly ameliorate the cognitive function and behavioral abilities in patients with Alzheimer's disease with no ob-vious side effects.

Objective To observe the efficacy of autologus cytokine-induced killer(CIK)cells in the treatment of renal cell carcinoma(RCC).Methods Twenty patients diagnosed as RCC in stage ⅠandⅡ of TNM from Januarary to december 2009 were divided into 2 groups,CIK cells therapy group and the control group.The phenotypes were identified before and after CIK cells cultured.We detected the levels of CD3+,CD4+,cell ratio of CD4+/ CD8+ before and after treatment.The efficiency and the clinical symptoms of the treated patients were observed.Results The levels of CD3+,CD3+ CD8+,and CD3+ CD56+ were increased after culturing(P0.01).The immunity function of therapy group significantly increased after being treated with CIK cells(P0.01).The quality of life was improved.In therapy group there were 19 patients with complete remission,1 patient with disease progression,the rate of disease control is 95%.In control group there were 13 patients with complete remission,7 patients with disease progression.The rate of disease control is 65%(P0.05).No adverse event happened during or after the CIK cells treatment.Conclusion Autologous CIK cells in treating RCC patients had a acceptable curative effect that can enhance cellular immune function and prolong disease progression.

Objective To study the relationship between GRACE(global registry of acute coronary events) risk stratification and carotid intima-media thickness(IMT) in elderly patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS).Methods A total of 83 elderly NSTE-ACS patients admitted to our hospital,including 49 patients with UA(unstable angina) and 34 ones with non-ST-segment elevation myocardial infarction(NSTEMI),were enrolled in the study.GRACE risk score was used for risk assessment.The IMT of carotid arteries was determined with B-mode ultrasound.The relationship between GRACE risk stratification and IMT was analyzed.Results The patients were divided into three groups,i.e.high-risk group,mid-risk group and low-risk group according to the GRACE risk stratification.The IMT of the high-risk group was higher than that of the mid-risk group [(1.15 ±0.29) mm vs(0.94 ±0.14) mm,P < 0.01]and the IMT of the mid-risk group was higher than that of the low-risk group [(0.94 ± 0.14) mm vs(0.82 ± 0.13) mm,P < 0.05].Conclusion Measurement of IMT is of predictive value for risk stratification in elderly patients with NSTE-ACS.

Objective To study the causes and countermeasures of adverse reactions in patients with malignant tumor after treatment with cytokine-induced killer(CIK) cells.Methods Clinical manifestations,laboratory findings,treatment measures and causes of adverse reactions in 730 patients with malignant tumor after treated with CIK cells from March 2008 to October 2012 were retrospectively analyzed.Results The main adverse reactions after infusion of CIK cells were fever(6.85%),rash(1.64%),digestive discomfort(0.96%),arthralgia(0.41%),anaphylactoid reaction(0.14%),tumor lysis syndrome(0.14%),and systemic inflammatory response syndrome reaction(0.68%).All the side effects were not specifically treated except for hypotension,severe anaphylactoid reaction and tumor lysis syndrome.The adverse reactions were related with the homing characteristics of CIK cells and individual difference.Conclusion CIK cells therapy is a safe and effective adoptive immunotherapy for malignant tumor and its adverse reactions can be treated expectantly.

Objective To evaluate effect of pulmonary artery perfusion for treatment of congenital heart disease with pulmonary hypertension during cardiopulmonary hypass (CPB). Methods 11 patients with severe pulmonary hypertension (pulmonary pressure 110～133/60～78 mm Hg, mean pressure 82～100 mm Hg) underwent cardiac surgery by the general anesthesia and CPB. Lung protection was performed by pulmonary artery perfusion with hypothermic solution containing aprotinin. Results There was one operative death with a mortality rate of 9%. 10 patients recovered eventually and were discharged. Conclusion Pulmonary artery perfusion is a simple and effective method for lung protection during open heart surgery. It could decrease pulmonary vascular resistance, reduce the right ventricle after load, shorten the time of assistant ventilation, decrease the morbidity of pulmonary hypertention crisis and right heart failure.\;