T1 mapping技术检测心肌弥漫性纤维化的临床应用进展

心肌弥漫性纤维化是众多心肌疾病共同的病理表现,是组织特性评价中可通过心脏磁共振定量化评估的重要内容。T1 mapping技术通过不同的方法测量心肌的T1值,得到平扫T1值、增强后的T1值及细胞外容积,可定量评价心肌弥漫性纤维化及水肿程度。本文将对T1 mapping技术扫描序列、技术方法及其临床应用进行综述。     

肺动脉高压心肌纤维化磁共振评价及临床意义

右心室重塑是肺动脉高压的重要病理生理改变过程,而心肌纤维化是右心室重塑的主要改变之一,在右心功能不全中发挥重要作用。心脏大血管磁共振成像是评价心肌纤维化的主要手段之一,借助心肌延迟强化、T1 mapping等技术实现对心肌纤维化定性及定量评估。现就肺动脉高压心肌纤维化的磁共振评价及其在肺动脉高压临床诊断、严重度评估及预后中的价值做一综述。     

缺血性心肌病(文献综述)

自1912年Herrick发现阻塞性冠状动脉病可引起急性心肌梗塞的临床表现以来,建立起血管疾病是继发性心肌损伤和心肌衰竭的重要原因之一的概念。1969年Raftery首次提出继发于冠状动脉疾病的心肌病,观察到心肌缺血能引起弥漫性纤维化和产生不能与原发性扩张型心肌病相区别的临床综合征。1970年Burchr命名这种临床综合征为“缺血性心肌病”,后来用它描述心肌缺血所致各种各样的心脏异常。John son虽曾提出应当用“来自冠状动脉病的心肌病”来命名,本文仍依多数学者意见采用缺血性心肌病(ICM)一词,现就有关问题综述如下。定义、病因及诊断标准 Raftery和Burch提出ICM的定义是心肌缺血引起弥漫性心肌纤维化和产生不能与原发性扩张型心肌病相区别的临床综     

超声评价高血压左心室肥厚心肌密度特征的价值

<正> 高血压左心室肥厚独立于高血压的危险因素,现有研究表明,高血压患者左心室心肌纤维化的发生是其最重要的病理基础.本文旨在通过采用计算机辅助的灰阶分析声学组织密度定量新技术,对高血压患者的心肌组织进行研究,以评价超声诊断高血压左心室肥厚心肌纤维化的可行性.     

缺血性心肌病诊断分析

缺血性心肌病诊断分析南京军区福州总医院老年病科（３５０００１）曾玉卿，祝梅华缺血性心肌病是由于冠状动脉粥样硬化所致长期心肌缺血引起的心肌弥漫性纤维化，产生与扩张型心肌病相类似的临床综合征。我院从１９７５年以来收治１０例最初诊断为“扩张型心肌病”，后修...     

心内膜心肌活检对心内膜心肌纤维化的诊断

对经右心造影确诊的１０例心内膜心肌纤维化病人进行右室心内膜心肌活检，结果９例发现不同程度的心内膜增厚及纤维化而获病理诊断，１例漏诊。提示该方法对心内膜心肌纤维化有较高的诊断价值，同时讨论了漏诊的原因。     

超声组织定征在心血管疾病诊断中的应用

超声组织定征(Ultrasonic Tissue Characterization,UTC)技术是通过检测组织的声学参数来定量描述正常和病理组织的物理(声学)特性。研究表明,背向散射积分作为组织定征的参数,可以识别缺血心肌、顿抑心肌、梗死心肌、左心室心肌肥厚及心脏移植排斥反应,评价和分析系统性疾病如糖尿病等引起的弥漫性心肌受累的状态、心腔内血栓和动脉斑块的成份等。因而UTC技术具有很大的临床价值和发展潜力,将成为常规超声心动图诊断的辅助手段。本文就超声组织定征技术在心血管疾病诊断中的应用及进展作一综述。     

成年甲减性心脏病23例误诊临床分析

甲减性心脏病是由于甲状腺激素分泌减少,心肌间质蛋白性水肿和心肌弥漫性小灶性变性及纤维化导致心脏形态结构、功能及传导出现异常。本病起病隐匿,发病缓慢。甲减在老年人多见,且症状多不典型,多见于女性,有些病人以心血管系统症状为主,而掩盖     

缺血性心肌病诊断问题（附10例分析及文献复习）

缺血性心肌病是由于冠状动脉粥样硬化所致长期心肌缺血引起的心肌弥漫性纤维化，产生与扩张型心肌病相类似的临床综合征。我院从75年以来共收治10例，最初诊断为“扩张型心肌病”，后修正诊断为“缺血性心肌病”的患，为了提高对此病认识，将资料     

3.0T心脏磁共振技术在扩张型心肌病中的临床价值

目的:探讨在高场强3.0T磁共振中扩张型心肌病(扩心病)的影像学表现及临床诊断价值。方法:选择扩心病患者20例,正常对照组15例,均行心脏磁共振(CMR)、心脏超声、冠状动脉造影检查。CMR主要技术包括心脏形态平扫、心脏功能、心肌活性、心肌灌注成像技术。应用Argus心脏功能软件对所得图像进行分析,测定左心室射血分数(LVEF),其结果与超声测得LVEF对比分析。结果:正常对照组分别运用心脏超声与CMR测左室LVEF,结果差异无统计学意义(P0.05)。扩心病中19例出现室壁运动异常,表现为左室壁弥漫性运动减弱,心脏超声测20例扩心病患者LVEF为(37.7±16.7)%,CMR测LVEF为(30±11.2)%,结果差异有统计学意义(P0.05)。扩心病中20例(100.0%)出现心肌延迟强化,表现为左心室心外膜下和(或)中层心肌片状强化,共计136个节段扩心病纤维化多表现为肌壁间弥漫性分布,其中发生部位以基底部及中间部间隔壁最为显著;心肌纤维化程度与心肌灌注呈正比。结论:3.0T的CMR检查可以显示扩心病的病变部位、形态、范围、程度、心功能及心肌灌注情况。综合分析CMR各个序列的结果,可以为心肌病的诊断与鉴别诊断提供影像学依据。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Results of treatment of fistula-in-ano

To evaluate the application of Parks' classification in the management of patients with fistula-in-ano, a study was undertaken to assess the outcome of surgery, especially with respect to the recurrence rate and alteration of continence. A retrospective analysis of 160 consecutive patients who were classified at the time of operation was conducted. The distribution of fistulas was as follows: intersphincteric, 41.9 percent, transsphincteric, 52.1 percent, suprasphincteric, 1.3 percent, extrasphincteric, 0. A horseshoe extension occurred in 8.8 percent of the fistulas and 3.8 percent did not exactly conform to the classification as they were either complex or combinations of more than one type of fistula. The sole immediate postoperative complication was bleeding, which occurred one week postoperatively and ceased spontaneously (0.7 percent). Alteration in continence occurred in 6 percent of patients with 2.6 percent experiencing temporary incontinence to flatus, 1.3 percent to liquid stool, and 0.7 percent to solid stool. Permanent loss of control for flatus occurred in one patient (0.7 percent) and for liquid stool in one patient (0.7 percent). No patients suffered loss of control for solid stool. Recurrence developed in 6.3 percent of patients, all between five and 25 months postoperatively. Classifcation was found to be a useful guide in the operative management of patients with fistula-in-ano. Read at the joint meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.