多排CT灌注成像对大鼠超急性期脑梗死的诊断价值

目的:探讨多排CT灌注成像(CTPI)技术对大鼠超急性期脑梗死的诊断价值。方法:雄性SD大鼠50 只,随机分为对照组10只,实验组40只。实验组按大脑中动脉栓塞(MCAO)后0.5h、1h、2h、3h、6h均分为5个 时点,每个时点8只;对照组也分为5个时点,每个时点2只。2组采用GELightSpeed16排CT机于MCAO后各时 点行灌注扫描,分别计算脑血流量(CBF)图、脑血容量(CBV)图、平均通过时间(MTT)图。在三色的功能图像上画 取双侧对称性兴趣区(ROI),获得病灶侧与对侧脑组织的血流动力学参数值,计算CBF的绝对值和相对值。比较 CBF、CBV、MTT成像结果与TTC染色结果并分析2者间的相关性。结果:对照组各参数图均未见异常灌注区,TTC 染色显示双侧大脑半球对称性红染。实验组各参数图均可见缺血梗死区域。MACO后各时点CBV图中的低灌注 体积与CBF图核心区体积之间差异无统计学意义(P>0.05)。TTC染色梗死体积与CBF核心区、CBV异常灌注区 体积均呈正相关较低(r=0.960,P<0.01;r=0.911,P<0.01);TTC染色梗死体积与MTT异常灌注区体积相关性 较低(r=0.800,P<0.01)。结论:16排CTPI可早期发现梗死病变,能全面显示并可量化梗死和缺血半暗带的部 位、范围和程度,为临床诊断和治疗提供个性化信息。     

64排CTP观察米诺环素在兔脑缺血再灌注中价值评价

目的应用64排CTP技术观察米诺环素在活体兔脑缺血再灌注效果对比分析研究。方法选取雄性新西兰白兔50只,随机分为实验组及对照组,实验组缺血再灌注前后分别给予米诺环素治疗,分析米诺环素治疗活体兔脑缺血再灌注组与对照组CTP的脑血流灌注图、脑血容积图、血流灌注峰值时间图及功能图像差异性及TTC染色结果对比分析。结果脑缺血模型CTP与病理对照:在缺血不同时间段,CBF图与MTT图的缺损面积间比较无显著差异(P0.05);CVB图缺损面积与TTB染色缺损面积在缺血不同时间段之间比较无明显差异(P0.05);在缺血2h组,CBF、MTT图与CBV图缺损面积、TTC染色缺损面积组之间比较有显著差异(P0.05);在缺血6h组无显著差异(P0.05)。活体兔脑缺血再灌注用米诺环素治疗后脑缺血容积减少且具有统计学意义(P0.05)。结论米诺环素能够改善由缺血再灌注引起的损伤,同时使用CTP成像评估活体兔血流改变准确、可靠,因此,应用64排CTP观察米诺环素对活体兔脑缺血再灌注效果良好、准确,值得临床实践应用。     

兔脑微栓塞模型脑血流动力学的CT灌注动态变化

目的探讨兔脑微栓塞模型CT灌注成像(CT perfusion imaging, CTPI)脑血流动力学的动态变化规律。方法30只新西兰兔,随机分成两组,A组:假手术对照组5只,B组:微栓塞组25只。经颈外动脉向颈内动脉注入直径约0.5 mm的SiO₂颗粒10枚,分别于栓塞后30 min、3 h、6 h、12 h及24 h行CTPI,24 h 处死动物取脑组织行HE染色。根据HE染色结果将模型分为缺血组和梗死组,分别观察其脑血流量(cerebral blood flow, CBF)、脑血容积(cerebral blood volume, CBV) 和平均通过时间(mean transit time, MTT)的动态变化规律。结果A组CTPI及HE染色均未见明显异常。B组3只因实验意外死亡,1只因下肢静脉穿刺失败导致CTPI失败,21只行CTPI,其中18只灌注异常,3只未见明显异常。18只灌注异常的兔中,HE染色10只脑梗死,7只脑缺血,1只未见明显异常。30 min时7只缺血兔脑不同程度低灌注,表现为CBF降低,MTT延长,CBV无显著变化,3～6 h 低灌注进一步加重,CBV值略降低,12 h低灌注不同程度恢复,24 h进一步恢复。30 min 时10只梗死兔脑明显低灌注,表现为CBF及CBV显著降低,MTT显著延长,3只兔低灌注分别在3 h、6 h及12 h不同程度恢复,然后下一时间又迅速降低并随着时间延长进一步加剧,其余7只兔低灌注程度随时间延长逐渐加剧或在一定水平上波动。结论脑缺血3～6 h低灌注最明显,12～24 h低灌注不同程度恢复,而脑梗死随时间延长低灌注程度不断加重或一过性恢复后再次加重。脑缺血的特征是CBF和CBV的不匹配,缺血组织CBF显著降低,CBV无显著变化,而脑梗死则表现为这两个参数的一致性下降。     

应用颅脑CT血管成像联合CT灌注成像诊断后循环缺血的临床价值分析

目的 :采用CT血管成像(CTA)与CT灌注成像(CTPI)相结合的技术,观察后循环缺血患者的椎基底动脉情况及局部脑血流灌注情况,探讨二者结合在后循环缺血诊断中的价值。方法:收集30例后循环缺血患者及30例健康人的临床资料,同时应用64排128层螺旋CT给予CTA与CTPI检查。结果 :30例PCI患者CTP上发现与临床症状相对应的异常灌注区共27例,其中MTT图上27例,CBF图上22例,而CBV图上仅14例,另外3例在所有灌注参数图上均未发现异常。病例组中,患侧及健侧的平均MTT及平均CBF差异具有统计学意义(P<0.05),患侧及健侧的平均CBV差异无统计学意义(P>0.05)。PCI组中椎基底动脉狭窄的比例均显著增加(P<0.01),椎基底动脉走行迂曲及椎动脉发育不良的例数也明显增多(P<0.05)。结论 :CTA联合CTPI能够清晰的显示后循环系统及脑供血情况,是判断后循环缺血病因及脑缺血严重程度的一项较实用的客观可靠的检查手段。     

磁共振灌注成像与CT灌注成像在老年缺血性脑血管病患者中的应用

目的分析磁共振灌注成像(PWI)与CT灌注成像(CTPI)在老年缺血性脑血管病(CVD)患者中的应用价值。方法选取2016年5月至2018年5月我院收治的老年缺血性脑血管病90例,均接受PWI与CTPI检查,分析其脑血流量(CBF)、脑血容量(CBV)、达峰时间(TTP)、对比剂平均通过时间(MTT),比较两种方法对脑梗死灶(CI)与短暂性脑缺血(TIA)检出率及诊断效能。结果 90例患者阳性病灶共498个,PWI检出率72.69%(362/498)与CTPI91.57%(456/498)比较差异有统计学意义(P0.05);PWI中,CI患侧、TIA患侧CBF较健侧低(P0.05);CTPI中,CI患侧CBF、CBV低于健侧,而TTP、MTT较健侧延长,TIA患侧仅TTP与MTT较健侧延长(P0.05);CTPI诊断灵敏度、准确度高于PWI(P0.05)。结论与PWI相比,CTPI检查中若灌注参数变化较大可提示CI病变,对CVD有较高灵敏度、准确度,整体诊断效能更好。     

CT灌注成像在急性缺血性脑血管病中的诊断价值

目的 探讨临床应用CT灌注成像(CTPI)在急性缺血性脑血管病中的诊断价值.方法 选取2014年4月至2017年11月在六安市人民医院神经内科进行诊治的42例急性缺血性脑血管病患者,根据头颅MRI平扫检查结果 将其分为短暂性脑缺血发作(TIA)组(18例)和脑梗死(CI)组(24例),所有患者均行CTPI检查,对脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)及达峰时间(TTP)等CTPI参数进行分析,并结合CT血管造影检查(CTA)、全脑血管造影术(DSA)或磁共振血管成像(MRA)等数据,对责任血管不同狭窄程度CTPI阳性率进行比较.结果TIA组中,与健侧相比,患侧MTT及TTP延长(P<0.05),CBV和CBF无明显变化(P>0.05);CI组CBV和CBF水平患侧低于健侧(P<0.05),MTT和TTP水平患侧长于健侧(P<0.05);CI和TIA两组病例健侧CBV、CBF、MTT及TTP水平差异均无统计学意义(P>0.05);CI组患侧CBV、CBF水平低于TIA组,而MTT及TTP长于TIA组(P<0.05).CTPI阳性的患者中责任血管闭塞及重度狭窄的发生率高于轻中度及无狭窄的患者,差异有统计学意义(P<0.05).绪论CTPI检查对早期缺血性脑血管病发病部位、范围、病情及鉴别诊断具有参考价值,并能结合血管成像检查为临床工作者选择治疗方案和判断预后提供重要的依据.     

64排动态CT脑灌注成像在脑梗死缺血半暗带中的临床应用

目的应用64排动态CT脑灌注成像技术探讨脑梗死缺血半暗带情况。方法观察测量43例存在缺血半暗带脑梗死患者的梗死核心区、缺血半暗带区及其镜像对侧各灌注参数值。结果 43例缺血半暗带区表现为平均通过时间(MTT)、达峰时间(TTP)均延长,脑血流量(CBF)下降,而脑血容量(CBV)表现为轻度升高、正常或轻度降低。缺血半暗带区与梗死核心区比较,CBV、CBF、MTT及TTP值差异均有统计学意义(P<0.05)。缺血半暗带与健侧对应区比较,CBF、MTT、TTP值差异有统计学意义,CBV差异无统计学意义。结论应用64排动态CT脑灌注成像,对脑梗死患者可明确病变部位、范围以及有无缺血半暗带的存在。     

320排容积CT全脑灌注成像对良性脑缺血的研究

目的探讨320排容积CT全脑灌注成像(CTPI)对发现良性脑缺血的作用。方法 30例急性缺血性脑卒中患者进行全脑CTPI检查,分别重建灌注参数图,包括脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)、达峰时间(TTP)、延迟(Delay)图像。根据TTP与CBF图上异常范围的不相匹配区域定为良性脑缺血区,并分别测量各灌注参数图参数绝对值。本组全部病人治疗后48 h内均进行CTPI复查。结果 30例首次接受CTPI检查患者中,27例显示TTP延长,其中24例可见CBV/CBF减低,20例可见TTP/CBF不相匹配区存在;治疗后复查CTPI病例中,8例良性缺血区有不同程度的改善,14例未见明显变化。结论 CTPI除能发现脑梗死区、半暗带外,还可诊断出良性脑缺血区,为临床提供早期诊断、及时干预治疗的依据。     

7.O T磁共振灌注和弥散加权成像的缺血半暗带实验研究

目的 探讨高场强磁共振(7.0T)灌注和弥散加权成像在大鼠急性脑梗死缺血半暗带研究中的价值.方法 利用线栓法建立大鼠急性脑梗死模型.60只SD大鼠随机分成6组,即假手术对照组,栓塞0.5、1.5、3、6和24 h组,每组10只.各组大鼠于相应时间点行头颅MRI扫描:PWI、DWI、T1WI、T2WI及MRA.后处理获得脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)形态图,并分别计算rCBV、rCBF、rMTT相对值.测量DWI异常信号区相对体积(rVD)及PWI异常灌注区相对体积(rVP).将结果与四氮唑红(TTC)染色和病理对比.结果 假手术组各序列扫描、TTC染色及病理均未见异常.各栓塞组栓塞侧大脑中动脉供血区rCBV、rCBF明显降低,rMTT明显延长,梗死核心严重,梗死边缘较轻.各栓塞组栓塞侧大脑中动脉供血区于DWI和PWI均可见异常信号区;DWI异常信号区体积随栓塞时间延长而增大,PWI异常信号区体积随时间延长变化不明显,栓塞6 h前PWI异常信号区大于DWI异常信号区(P<0.05),6 h以后PWI、DWI梗死体积大小差异无统计学意义(P>0.05).3 h以后DWI梗死体积与24 hTTC梗死体积差异无统计学意义(P>0.05).结论 高场强磁共振灌注和弥散加权成像动态显示急性脑梗塞缺血半暗带的时间、空间变化,为进一步研究提供基础.     

CT灌注成像在诊断急性脑缺血中的运用和研究

目的研究C T灌注成像(C T perfusion imaging,CTPI)在诊断急性脑缺血中的运用效果,为急性脑缺血的诊断提供有效依据。方法运用随机抽样的方法选取我院放射科2012年1月至2014年9月收治的80例急性脑缺血患者,运用GE Lightspeed 128层螺旋CT扫描机对患者进行检查,然后对CT灌注成像各个参数及CTPI各个参数图异常灌注区面积相关性进行统计分析。结果 80例急性缺血性脑卒中患者中,72例患者CTPI异常,急性脑缺血诊断的敏感性为90.00%(72/80);CTPI的CBF、CBV、MTT、TTP、PE异常率均显著高于单层CPCI(P0.05);CBF、CBV、MTT呈线性正相关且具有较好的相关性,差异具有统计学意义(P0.05)。结论 CTPI在诊断急性脑缺血中具有较高的敏感性和异常率,运用效果良好,值得在临床推广。     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.