超声速度向量成像技术评价急性心肌缺血犬左心室心内膜下心肌力学状态

目的采用超声速度向量成像技术评价急性心肌缺血犬左心室收缩期心内膜下心肌力学变化规律。方法对12只健康比格犬结扎冠状动脉左前降支制作急性心肌缺血模型，采集缺血前后左心室二尖瓣口水平、乳头肌水平、心尖水平动态二维灰阶动态图像；获取左心室不同水平各节段缺血前后心内膜下心肌周向应变、径向应变、旋转角度与径向位移；分析同一节段心肌周向和径向应变与旋转角度的相关性，及两个相邻节段心肌周向应变差值（Acs）与相应节段心肌旋转角度和径向位移的相关性。结果缺血前左心室心内膜下心肌同一室壁周向应变、旋转角度从基底段到心尖段依次增大，缺血后这一力学状态发生改变，其中前间隔基底段周向应变大于心尖节段（P〈0．05），后间隔中段周向应变大于心尖节段（P〈0．05）；后壁基底段旋转角度大于中段（P〈0．01）、下壁中段旋转角度小于心尖节段（P〈0．05）、前间隔中段旋转角度小于心尖节段（P〈0．05）。缺血前心尖水平切面相邻两个节段心肌ACS与其相应节段心肌的旋转角度呈线性相关（r=0．609～0．739，P〈0．05或P〈0．01）；缺血前左心室心内膜下心肌同一室壁乳头肌水平节段与基底水平节段心肌△CS与其乳头肌节段心肌的径向位移呈线性相关（r=0．657～0．852，P〈0．05或P〈0．01），缺血后相关性消失。结论缺血前左心室心内膜下心肌相邻两个节段间的△CS与对应节段心肌旋转角度、径向位移的线性相关提示，相邻丽个节段心肌间的△CS与心尖节段旋转运动以及左心室心腔向心性收缩密切相关。急性心肌缺血状态下，左心室心内膜下心肌应变状态异常改变是左心室重构的重要力学基础。     

二维斑点追踪成像评价舒张性心功能衰竭患者左心室局部收缩功能

目的 探讨二维斑点追踪成像(speckle tissue imaging,STI)评价射血分数正常的舒张性心功能衰竭(diastolic heart failure,DHF)患者的左心室心肌局部收缩功能.方法 临床确诊的DHF患者与正常对照组各32例.分别存储胸骨旁左心室短轴基底水平、乳头肌水平及心尖水平连续3个心动周期的二维灰阶图像,使用Qlab7.0工作站进行脱机分析,记录上述三个短轴切面共18个节段径向收缩期峰值应变率;记录基底水平、心尖水平旋转角度峰值,计算左心室扭转峰值(Twist).结果 DHF组的各节段径向应变率曲线形态与正常对照组相似,两组内同一水平不同节段间的径向应变率峰值差异均无统计学意义(P>0.05).与正常对照组相比,DHF组左心室心尖水平前间隔、侧壁、后壁、下壁,乳头肌水平后壁、后间隔,基底水平后壁、下壁及后间壁的收缩期峰值应变率低于正常对照组(P<0.05).DHF组左心室心尖、基底水平旋转角度峰值及左心室整体扭转角度峰值均较正常组减低,但差异无统计学意义(P>0.05).结论 二维斑点追踪成像显示左心室射血分数正常的DHF患者早期存在局部心肌收缩功能异常.     

斑点追踪成像技术对扩张型心肌病左心室扭转运动的初步研究

目的 应用超声斑点追踪显像技术(speckle tracking imaging,STI)评价扩张型心肌病(dilated cardiomyopathy,DCM)左心室短轴方向收缩期扭转运动的变化.方法 应用STI技术对16例DCM患者和18例健康成人胸骨旁左心室心尖、乳头肌和基底短轴观的心肌收缩期扭转运动进行定量分析.结果 DCM组左心室各节段心肌最大旋转角度较正常组明显减低(P＜0.05),基底与心尖水平最大旋转角度差值(扭转角度)较正常组明显减小(P＜0.05).DCM组左心室短轴基底水平各节段呈顺时针扭转的比例为100%(同正常组),乳头肌水平各节段呈顺时针扭转的比例为82%(正常组为50%),心尖水平各节段呈顺时针扭转的比例为47%(正常组为0).结论 STI技术是有效评价左室扭转运动的超声心动图新方法,DCM左室扭转运动减低,扭转模式异常.     

比格犬心室起搏状态左心室心肌三维位移的超声研究

目的 观察比格犬心室起搏状态左心室心肌三维峰值位移,量化评价心室不同起搏状态心肌力学状态特征,为优化心室起搏方式提供力学依据.方法 10只健康比格犬开胸模型,随机进行右心室心尖起搏(RVA-P)、左心室侧壁起搏(LVL-P)、左心室心尖起搏(LVA-P),分别采集各种起搏状态一个完整心动周期的全容积实时灰阶图像.分析评价基础状态(BASE)及心室不同起搏状态左心室心肌三维峰值位移(3D-D)及其达峰时间(3D-DTC)和达峰时间标准差(3D-DTSD).结果 ①LVL-P和LVA-P状态与BASE和RVA-P状态比较左心室的3D-D均有减低趋势,LVL-P与BASE、RVA-P状态比较左心室中前壁、中前间隔、中下壁、中后壁、中侧壁的3D-D差异有统计学意义(P＜0.05);LVA-P与RVA-P状态比较左心室中前壁、中侧壁、中后壁的3D-D差异有统计学意义(P ＜0.05);LVL-P和LVA-P状态与BASE和RVA-P状态比较左心室心尖水平各节段的3D-D差异有统计学意义(P＜0.05).②LVL-P与BASE状态比较左心室底下壁、中下壁、尖下壁的3D-DTC差异有统计学意义(P＜0.05);RVA-P、LVA-P状态与BASE状态比较左心室中侧壁的3D-DTC差异有统计学意义(P＜005);心室不同起搏状态与BASE状态比较左心室3D-DTC均发生前移.③BASE与心室不同起搏状态比较左心窒3D-DTSD均无显著性差异,RVA-P和LVA-P状态比较左心室3D-DTSD差异有统计学意义(P＜0.05).结论 RVA-P状态能够维持左心室心肌运动有效性和同步性;LVL-P和LVB-P状态均减低了正常左心室心肌三维运动的同步性,同时降低了左心室心尖和乳头肌水平节段心肌运动的有效性.通过对BASE及心室不同起搏状态左心室心肌三维状态的力学超声评价,有助于深入揭示更为真实的心室不同起搏状态左心室心肌力学异常.     

超声技术对肥厚型心肌病左心室节段心肌跨壁位移特征的评价

目的应用超声定量组织多普勒(TDI-Q)技术评价肥厚型心肌病患者左心室壁节段心肌,探讨其早期节段心肌收缩功能是否发生改变,并明确相关心肌力学参数变化特征。方法选取健康志愿者32名和肥厚型心肌病患者21例,分别采集3个连续心动周期二尖瓣、乳头肌以及心尖标准短轴切面动态二维组织多普勒左心室心肌速度图像。分析左心室不同水平和节段的心内膜下心肌、中层及心外膜下心肌收缩期跨壁径向峰值位移、达峰时间等力学参数变化规律和特征。结果健康对照组左心室基底、心尖和乳头肌水平各节段整体收缩期径向峰值位移达峰时间的差异无统计学意义(F=0.74、1.28、1.79,P均0.05);肥厚型心肌病组患者左心室不同水平收缩期峰值位移达峰时间不同步,乳头肌水平间隔壁、心尖水平侧壁达峰时间大于其余各节段。健康对照组受检者除尖下壁和尖侧壁外,其余各节段心内膜下心肌径向峰值位移明显大于心外膜下心肌径向峰值位移,差异均有统计学意义(t=-1.903、4.574、-3.552、-2.614、-1.728、-1.790、-1.836、-2.794、-2.733,P均0.05);肥厚型心肌病组患者基底水平后壁、间隔壁及乳头肌水平下壁、后壁、侧壁心内膜下心肌径向峰值位移大于心外膜下心肌径向峰值位移,差异均有统计学意义(t=-2.305、-2.148、3.550、-1.182、-3.602,P均0.05)。健康对照组受检者同一节段心内膜下心肌、心外膜下心肌间跨壁径向峰值位移均大于肥厚型心肌病组患者,基底水平下壁、后壁、侧壁、间隔壁,乳头肌水平下壁、后壁、间隔壁和心尖水平侧壁、间隔壁比较,差异均有统计学意义(t=-3.787、-2.983、-4.325、-6.972、-2.352、2.823、-3.274、-1.338、-2.857,P均0.05)。结论肥厚型心肌病左心室不同水平心肌运动同步性异常、心内膜下与心外膜下心肌间跨壁峰值位移差减小,提示局部心肌收缩功能受损。左心室节段跨壁超声力学评价能够深入揭示早期肥厚型心肌病患者左心室不同节段整体和节段跨壁心肌的力学特征。     

斑点追踪成像对冠状动脉心脏病患者左室心肌应变功能的早期评价

目的应用斑点追踪成像(STI)定量分析冠状动脉心脏病(简称冠心病)患者左室长轴及短轴应变,探讨STI早期诊断心肌缺血的临床价值。方法 59例临床确诊为冠心病患者(冠心病组),33例体检健康者为对照组,于左室心尖二腔、长轴、四腔切面和胸骨旁左室短轴二尖瓣水平、乳头肌水平、心尖水平切面,应用STI定量分析左室长轴纵向应变峰值、短轴径向应变峰值和圆周应变峰值。结果与对照组比较,冠心病组各节段纵向、径向、圆周应变值均减低,其中纵向应变基底段的前间隔,中间段的间隔和前间隔,心尖段的前壁和侧壁均减低(P<0.05)。径向应变二尖瓣水平的后壁、下壁、前间隔,乳头肌水平的下壁、间隔、前间隔、侧壁,心尖水平的间隔减低(P<0.05);圆周应变二尖瓣水平的后壁、间隔、前间隔,乳头肌水平的前壁、侧壁、前间隔,心尖水平除侧壁以外节段均减低(P<0.05)。结论冠心病患者在超声心动图检查尚未见节段性室壁运动异常时,应用STI可显示左室心肌收缩功能明显减低。     

斑点追踪成像技术评价非心肌梗死性冠心病患者左室应变及扭转运动的价值研究

目的应用二维斑点追踪成像(STI)技术评价非心肌梗死性冠心病患者左室应变及扭转运动的特点和规律。方法选取未发生心肌梗死的冠心病患者30例(冠心病组)和正常成人30例(正常组),应用STI技术分析左室二维应变、二尖瓣水平旋转角度及旋转率、心尖水平的旋转角度及旋转率、左室整体扭转角度及扭转率。结果冠心病组与正常组比较,基底水平及乳头肌水平的前室间隔、前壁,心尖水平的前室间隔、前壁、后室间隔收缩期纵向峰值应变降低(P0.05);心尖水平前间隔、前壁的收缩期圆周峰值应变降低(P0.05);基底水平前室间隔、前壁,乳头肌水平前壁的收缩期径向峰值应变降低(P0.05);左室整体扭转角度及扭转率,心尖及瓣环水平的旋转角度及旋转率绝对值均较正常组降低,其中左室整体扭转率组间比较差异有统计学意义(P0.05)。结论非心肌梗死性冠心病患者相应节段心肌的应变及扭转运动已受到影响,应用二维STI技术可以准确评价非心肌梗死性冠心病患者的左室应变及扭转运动,为临床诊断冠心病提供有价值的参考。     

右心室心尖不同部位起搏时左心室收缩时序的超声研究

目的探讨右心室心尖不同部位起搏时左心节段性室壁的收缩特征及时序。方法利用实时三维超声心动图技术确定右心室心尖起搏电极顶端在右心室心尖部的准确空间附着位点。运用应变显像技术，测定左心室壁各节段收缩期应力的达峰时间，即自心电图Q波起点至收缩期峰值应变时限（interval between Q wave of surface ECG and peak strain，QPSI），反映左心室各室壁的收缩时序；并计算QPSI的离散度，即最大QPSI减去最小QPSI的时限差，代表左心室内收缩延迟时间。观察正常对照组、右心室心尖不同部位起搏组左心室壁的节段性运动，评价各组左心室壁的收缩（或应变）时序及收缩协调性。结果右心室心尖起搏组的左心室壁收缩时序较正常对照组发生改变。右心室心尖侧壁起搏与右心室心尖间隔起搏组的左心室壁收缩时序不同，左室间隔心尖段、后壁基底段差异存在统计学意义（P〈0．05）。右心室心尖起搏时左室壁整体的收缩发生延迟，并且右心室心尖侧壁起搏组左室壁的收缩延迟时间明显大于右心室心尖间隔起搏组（P〈0．05）。结论右心室心尖不同部位起搏可以导致左心室不同的收缩模式改变，提示右心室心尖不同部位起搏所引起的电激动顺序及对心脏血流动力学的影响也存在差异。     

斑点追踪显像对急性冠状动脉闭塞早期左室节段旋转的评价

目的：应用斑点追踪显像（STI）评价兔急性冠状动脉闭塞早期左室节段旋转角度,探讨该方法对左室节段功能评估的敏感性。方法：健康新西兰兔46只,开胸行左冠状动脉前支结扎术建立急性冠状动脉闭塞模型,在术前及术后10 min两次采集胸骨旁左室长轴、心尖四腔及两腔切面、左室短轴二尖瓣、乳头肌、心尖水平切面动态二维图像;测量常规参数：左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）、左室短轴缩短率（LVFS）、左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、左室射血分数（LVEF）;应用STI技术分析左室三水平共18个节段的旋转角度。结果：①LVEDD、LVESD、LVFS、LVEDV、LVESV、LVEF术后较术前差异均无统计学意义（P＞0.05）。②左室二尖瓣水平术前下壁及后间隔旋转角度最大,前壁及侧壁旋转角度最小,术后各节段间旋转角度差异无统计学意义（P>0.05）;心尖水平及乳头肌水平术前及术后各节段间旋转角度差异均无统计学意义（P>0.05）。③左室二尖瓣水平前间隔、后间隔、下壁及后壁的旋转角度术后较术前明显减小（P<0.05）,前壁及侧壁旋转角度术后较术前无明显变化（P>0.05）;心尖水平及乳头肌水平各节段旋转角度术后较术前均无明显变化（P>0.05）。结论：急性冠状动脉闭塞早期用STI评价左室节段旋转角度可以敏感的反映左室节段功能的改变。     

超声斑点成像技术评价左心室长轴心肌节段应变与位移

目的 评价生理和病理状态下左心室壁长轴方向心肌节段应变、位移和内径改变及三者之间的相关性。方法 获取心脏起搏组（12例）、右束支传导阻滞组（13例）、对照组（14例）标准心尖四腔观；分别测量计算室间隔、侧壁的心尖和基底四个节段长轴峰值应变和位移以及舒张末和收缩末内径差值；比较各组问测值差异并分别进行各参数间的相关分析。结果 心脏起搏组室间隔基底段峰值应变大于心尖段（P〈0．05）；对照组侧壁基底段峰值位移及相对心尖段峰值位移大于右束支阻滞组和起搏器组（P〈0．05）；右束支阻滞组侧壁应变差与相对位移显著相关（r=-0．607，P=0．037）。结论 起搏导致的拳川隔基底段应变异常增高和右束支传导阻滞导致的心尖和基底节段峰值位移及相对位移降低将会减低左心室射I衄能力。未能在多数节段建立长轴应变、位移和内径的相关关系，表明心尖与基底相对扭转对心室收缩功能更为重要。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

甲状旁腺功能减退性心肌病的系统综述

目的 甲状旁腺功能减退（甲旁减）性心肌病是一种罕见的心脏疾病,为扩张型心肌病中少数可逆转的一种,常被误诊为不明原因或难治性心力衰竭。本文旨在探寻甲旁减性心肌病的规律性特征。方法 检索Pubmed、SinoMed、万方数据库中符合标准的甲旁减性心肌病病例,采用统计分组法对纳入研究的文献进行分析,依据系统综述和meta分析优先报告条目（PRISMA声明）进行报告。结果 在我们筛查出的41例患者中,女性居多（68.29%）,平均年龄为45.5岁,各年龄段均有发病。甲旁减性心肌病最常见的病因为特发性甲旁减（78.05%）,颈部手术导致的甲旁减性心肌病次之（17.07%）。患者均以心力衰竭就诊,伴不同程度的低钙血症。51%的患者有神经肌肉兴奋性增加的病史,90%的患者左心室射血分数降低。该病误诊漏诊率较高,仅36%的患者于入院后即明确诊断为甲旁减性心肌病。低血钙的纠正是治疗的关键,90%的患者心脏功能在血钙浓度正常化后恢复至正常。结论 对所有不明原因或难治性心力衰竭患者都应警惕甲旁减性心肌病的可能。     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.     

Effects of intravenous anesthetic agents on middle cerebral artery blood flow velocity during induction of general anesthesia

Objective. Our objective was to quantify the effects of intravenous anesthetics on values measured by or derived from transcranial Doppler sonography (TCD) during induction of general anesthesia.Methods. We recorded blood flow velocity in the middle cerebral artery (V-MCA) before, during, and after induction of general anesthesia in six groups of young patients without intracranial pathology (n=10 each) using TCD. Patients were randomized to receive either 2 mg/kg propofol, 1.5 mg/kg methohexital, 5 mg/kg thiopental, 0.3 mg/kg etomidate, 2 µg/kg fentanyl and 0.15 mg/kg midazolam, or 1.5 mg/kg ketamine and 0.15 mg/kg midazolam intravenously. At 2 min after injection, each patient was intubated and given isoflurane 0.8% and nitrous oxide 66% in oxygen. Ventilation was set to achieve an end-tidalPco ₂ of 40 mm Hg. V-MCA, arterial blood pressure, heart rate, hematocrit, andPco ₂ (venous samples) were measured before and 1, 3, 5, 10, and 30 min after induction of anesthesia.Results. The preinduction data were not different between groups. At 1 min after injection, propofol, thiopental, methohexital, and etomidate significantly decreased V-MCA. TCD values were only slightly affected following fentanyl/midazolam. Ketamine/midazolam induced a modest rise in V-MCA. After endotracheal intubation, V-MCA increased in all groups, and slowly declined thereafter.Conclusions. Under the circumstances of our study, values derived from TCD measurements responded differently to the agents used to induce general anesthesia in nonneurosurgical patients.     

单核细胞/高密度脂蛋白胆固醇比值不能预测PCI术后对比剂肾病的发生

目的 探讨术前单核细胞与高密度脂蛋白比值(monocyte to high density lipoprotein cholesterol ratio, MHR)与经皮冠状动脉介入（percutaneous coronary intervention , PCI）治疗后发生造影剂肾病（contrast induced nephropathy, CIN）的相关性，为CIN的发生寻找其他可能的危险因素，为及早筛选CIN高危人群提供新的方向。方法 回顾性分析5P试验入选的我院心内一科行经皮冠状动脉介入治疗术的冠心病患者1 087例，根据在PCI术后是否发生造影剂肾病分为CIN组和非CIN组，研究CIN的相关危险因素，分析MHR与造影剂肾病的相关性，应用Logistic回归分析查看MHR是否为CIN发病的高危因素。结果 CIN组共57例，非CIN组1 030例。两组在高脂血症、BMI、左心室射血分数（LVEF）、术前尿酸及术前C 反应蛋白水平等方面比较差异有统计学意义（P＜0.05）。 Logistic回归分析显示LVEF及糖尿病与造影剂肾病的发生相关。结论 同以往研究结果不同，MHR并不能作为CIN的危险因素，但LVEF对于CIN可能具有更高的预测价值。     

Calcified primary tumors of the gastrointestinal tract

The dominant pattern and location of calcifications occurring within 23 primary gastrointestinal tumors have been analysed and correlated with the data from the literature. The provided guidelines for radiologic diagnosis of such calcified tumors include: (1) a retrocardiac mass containing amorphous calcifications is typical of leiomyoma of the esophagus; (2) calcific deposits similar to that in uterine fibroids may be the feature of gastric leiomyoma or intestinal leiomyosarcoma; (3) sand-like deposits within the wall of the stomach or colon are characteristic of a mucinous adenocarcinoma; (4) clusters of phleboliths in the gastrointestinal wall suggest a hemangioma particularly if recurrent intestinal bleeding and cutaneous hemangiomas are associated; (5) sunburst type of calcification in the pancreas indicates a cystadenoma or cystadenocarcinoma of that organ; and (6) aggregates of granular calcifications in the liver are diagnostic for metastatic adenocarcinoma of the colon but may rarely be seen in a primary malignancy of the liver.     

小肠克罗恩病的经腹超声图像特征分析

目的分析总结小肠克罗恩病肠道及肠周病变的超声图像特征。 方法回顾性选取2009年6月至2019年6月南京医科大学附属苏州医院收治的临床已确诊小肠克罗恩病的患者25例,共计进行42人次经腹肠道超声检查。对其病变肠壁、肠壁外腹部并发症的超声图像及小肠克罗恩病的活动度评估结果进行分析总结。 结果病变肠壁表现：主要表现为肠壁增厚（41/42）,多为全周性及全层性增厚,最厚段36人次位于下腹部,其中以右下腹最多（30/36,83.3%）;活动期及严重者肠壁层次消失（16/42）,僵硬,蠕动消失;26人次病变肠壁发现深达肠壁各层的溃疡。并发症表现：15人次出现狭窄,图像特征为肠壁增厚、肠腔变窄及近端肠管扩张;8人次出现瘘,图像特征为肠壁与其他器官之间的条状或分支状低回声带,含有或不含有气体强回声;爬行脂肪征30人次,图像特征为高回声脂肪团块包绕肠壁;肠系膜淋巴结炎20人次,其中18人次病灶长径<20 mm,为多发;腹腔积液16人次;腹部包块9人次,其中脓肿5人次,图像特征为炎性肿块内或肠系膜区局限性液区,透声差,无血流信号;穿孔1人次,超声图像表现为肠壁增厚,连续性中断,局部肠壁外见低回声区,腹腔内见游离液区,液区透声差;炎性息肉8人次,单发或多发,超声图像特征为凸入肠腔内的低回声或等回声凸起;憩室形成3人次,图像表现为局部肠壁变薄膨出,多位于系膜缘。活动期（超声评估）狭窄、爬行脂肪征、肠系膜淋巴结炎、腹腔积液等的发生率均明显高于缓解期（超声评估）,差异均有统计学意义（P=0.002、0.000、0.024、0.025）;活动期（超声评估）肠壁和爬行脂肪的最大厚度平均值明显大于缓解期（超声评估）,差异均有统计学意义（P均=0.000）。超声与Harvey-Bradshaw指数对小肠克罗恩病活动性评估的一致性较好（Kappa=0.897,P<0.05）。 结论经腹肠道超声能够清晰显示小肠克罗恩病的肠道病变及肠外并发症的改变,可以较准确地评估病变的活动度,且操作灵活,患者依从性好,可以作为小肠克罗恩病的常规影像学评估工具。