脑血管周围间隙扩大的研究进展

脑血管周围间隙(PVS)是包绕在脑小动脉、毛细血管和小静脉周围的微小组织间隙,血管周围间隙扩大(EPVS)可引起脑内类淋巴系统功能障碍,与脑血管疾病、认知功能障碍等多种神经系统疾病密切相关.作者对PVS的解剖结构、功能以及EPVS的磁共振影像学表现和评估方法、发生机制、危险因素及其临床意义等方面的研究进展进行了综述.     

MRI在脑梗死后软化灶和V-R腔鉴别诊断中的应用

目的探讨MRI在脑梗死后软化灶和血管周围间隙（V-R腔）鉴别诊断中的价值。方法对经临床随访证实的43例（共108个）脑软化灶患者与32例（共51个）V-R腔患者行常规磁共振T1WI、T2WI和FLAIR扫描,观察两种病灶的数量、位置、大小、形态、信号征象。结果脑梗死后软化灶和V-R腔在MRI常规序列上均表现为小点状或小片状病灶,直径约1 cm;病灶均呈长T1长T2信号改变,内部信号均匀,边界清楚;前者多位于基底节、放射冠和半卵圆中心,而后者多位于前联合、大脑半球皮髓质交界区和中脑;前者多形态不规则、边界不光滑,而后者多呈类圆形或椭圆形、边界光滑规则;前者在FLAIR序列上可见病灶周围呈环状高信号表现,后者无此特征。结论 MRI可通过观察病灶部位、形态和是否具有FLAIR周边高信号等对脑梗死后软化灶和V-R腔进行鉴别诊断。     

血管周围间隙的MRI表现（附210例分析）

目的分析血管周围间隙（PVS）的发生部位、形态等影像学表现。方法选择210例经颅脑磁共振成像（MRI）检查显示有PVS的患者,其中行磁共振增强扫描75例,弥散加权成像37例,CT扫描39例,CT增强扫描26例。结果PVS均为双侧多发,呈圆形或椭圆形、点状、条状或线状,边界清晰锐利;多发生于前连合两侧、近大脑凸面半卵圆中心、脑干大脑脚、极外囊,小脑齿状核旁白质少见。MRI显示PVS信号与脑脊液信号一致,增强扫描无强化征象。结论PVS见于任何年龄,好发于前连合两侧、近大脑凸面半卵圆中心、脑干大脑脚;呈条形或线形、圆形或卵圆形,绝大多数无占位效应,MRI信号显示与脑脊液信号一致。     

小动脉闭塞型卒中患者血清25-(OH)D3、Hcy水平与脑血管周围间隙扩大程度的关系

目的 探讨小动脉闭塞型卒中患者血清25-羟维生素D[25-(OH)D₃]、同型半胱氨酸(Hcy)水平与血管周围间隙扩大(EPVS)严重程度的关系。方法 选择200例小动脉闭塞型卒中患者，入院后均完成血清25-(OH)D₃、Hcy水平检测和颅脑MRI检查。在基底节区及半卵圆中心层面上分别按照视觉量化评估法进行评估分级，根据分级将患者分为无/轻度EPVS组、中/重度EPVS组。在按部位比较时，基底节区及半卵圆中心区EPVS依据EPVS严重程度分为无/轻度组(EPVS分级0～1级)和中重度组(EPVS分级2～4级)。比较不同等级及不同部位EPVS患者血清25-(OH)D₃、Hcy水平；采用Spearman相关分析25-(OH)D₃、Hcy与EPVS严重程度的相关性；采用二元Logistic回归模型分析血清25-(OH)D₃、Hcy水平与小动脉闭塞型卒中患者EPVS严重程度的相关性。结果 200例患者的血清25-(OH)D₃为(20.79±8.83)nmoL,Hc...     

血浆纤维蛋白原水平与急性腔隙性脑梗死患者血管周围间隙扩大的关联性研究

目的 探讨血浆纤维蛋白原水平与急性腔隙性脑梗死患者血管周围间隙扩大(EPVS)的关联性。方法 回顾性分析2021年1月至2022年6月连云港市第二人民医院收治的伴EPVS的172例急性腔隙性脑梗死患者的临床资料。经头颅MRI评估EPVS数目及严重程度,分为基底节区血管周围间隙扩大(BG-EPVS)、半卵圆中心区血管周围间隙扩大(CSO-EPVS),轻度组(0～1级,≤10个EPVS)及中重度组(2～4级,>10个EPVS)。比较两组患者的一般临床资料,采用多因素logistic回归分析血浆纤维蛋白原水平与EPVS进展的关联性。采用ROC曲线分析血浆纤维蛋白原水平鉴别轻度、中重度EPVS的效能。结果 172例患者中,判定为轻度BG-EPVS 57例(33.14%),中重度BG-EPVS 115例(66.86%);判定为轻度CSO-EPVS 100例(58.14%),中重度CSO-EPVS 72例(41.86%)。与轻度BG-EPVS组相比,中重度BG-EPVS组年龄更大,合并高血压病者更多,总胆固醇(TC)、高密度脂蛋白(HDL)、纤维蛋白原水平更高,差异均有统计学意义(P<...     

血管周围间隙扩大与脑微血管病变及其他血管危险因素的相关性

目的评估扩大的血管周围间隙(EPVS)与脑微血管病变及其他血管危险因素的相关性。方法采用医学影像信息系统(华海PACS)系统搜集2014年5月至2015年6月间主因头晕入住神经内科并经影像学检查确诊为EPVS的患者100例。记录患者的临床与影像学资料,包括年龄、性别、EPVS的发生部位及分级、脑白质高信号(WMH)程度分级、脑萎缩程度分级及有无腔隙性脑梗死、高血压、糖尿病和高脂血症。采用单因素和多因素分析法确定EPVS与其他临床及影像学资料的相关性。结果 EPVS常见于老年人,男性稍多于女性。半卵圆中心和基底节区为EPVS最常见好发区,且以轻度为主。与轻度EPVS组相比,重度EPVS组发生重度WMH的比例更高。多因素分析显示,WMH为半卵圆中心和基底节区EPVS的独立预测因子,而年龄、高血压仅为基底节区EPVS的独立预测因子。结论 EPVS可提示造成小血管壁通透性改变的诸多潜在病理变化,应作为一个重要的脑微血管病变的标志物。     

磁共振成像对老年人脑内腔隙灶、脱髓鞘和血管周围间隙的鉴别诊断

目的：探讨磁共振成像（MRI）对老年人脑内腔隙灶、脱髓鞘和血管周围间隙的鉴别诊断能力。方法：回顾性分析100例无痴呆病状的老年人在GE1．5T扫描机上完成的T1加权像（T1WI）和T2加权像（T2WI），其中6例包括有弥散成像（DWI）。结果：同一患者脑内病灶可多处分布，100例中，61例有腔隙性脑梗死，共110个腔隙灶，分别位于桥脑（17个），小脑（14个），豆状核（14个），内囊（10个），丘脑（12个），室旁和尾状核（26个），半卵圆中心（7个），这些病灶呈圆形，卵圆形，三角形，弧线形和不规则形；71例有脱髓鞘改变，累及室旁和半卵圆中心，但有7例位于桥脑；95例有血管周围间隙，可数可的共125个，分布在基底节（84个），室旁和半卵圆中心（41个），结论：腔隙灶，脱髓鞘和血管周围间隙需要从信号变化，病灶形态，部位和扫描序列4个方面进行鉴别诊断。     

老年人血管间隙的MRI表现

目的探讨老年脑人血管间隙的ＭＲＩ特征。方法分析６５例老年人头部ＭＲＩ资料，按照Ｈｅｉｅｒ的诊断标准对血管间隙进行分级。结果６５例在基底节下１／３显示血管间隙，Ⅰ级１８例，Ⅱ～Ⅲ级４７例；４４例在中央白质近边缘区显示血管间隙，Ⅰ级１６例，Ⅱ～Ⅲ级２８例。结论高分辨的ＭＲＩ能清晰显示血管间隙。基底节下１／３的Ⅰ级血管间隙是正常解剖，Ⅱ～Ⅲ级血管间隙及中央白质近边缘区血管间隙是脑的退行性改变。     

中枢神经细胞瘤1例报告

患者男，39岁。因阵发性头晕，视力下降伴嗜睡1a，发作1d于2003年5月6日人院。人院时查体：视力、视野未见明显异常，双侧视盘边界模糊，A：V=1：2。双侧瞳孔等大等圆，光反射灵敏。额纹，鼻唇沟对称，仲舌居中。四肢肌张力正常，肌力正常，腱反射正常，双侧巴氏征阴性。颅脑CT检查示左侧额顶脑实质内不规则低密度影，密度不均；左顶部可见囊状类圆形低密度影，周边可见钙化，双侧脑室扩大，其前角和底部受压。术中见肿瘤位于侧脑室额角脑室壁，累及左侧额部、额上回纵裂并突人右侧额叶脑内，肿瘤质韧，呈灰黄色，内含网状血管，血运较丰富，肿瘤部分呈囊性，囊液黄色，量约50ml，与周围脑组织无明显边界，呈浸润性生长，术中分块全部切除。肿瘤组织切片，HE染色，光镜观察，见瘤区血管呈枝芽状，血管周围可见神经纤维区，     

糖尿病下肢动脉病变的磁共振血管造影诊断

下肢动脉病变是糖尿病患者的一种高发病率的并发症。血管性病变及其所导致的糖尿病足既往需要有创的X线血管造影来明确血管狭窄及闭塞的部位、程度以及范围,新近的增强磁共振血管造影(CE MRA)扫描有望取代X线血管造影检查,用于对下肢动脉狭阻性病变的诊断,其对血管移植术前足部动脉弓的显示能力甚至可超过X线血管造影。全面的磁共振成像技术对于糖尿病足血管及神经病变的预测、诊断,明确动脉移植术前血管情况,判断截肢范围等具有重要的意义。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.