医用超声技术在临床的应用

介绍了医用超声技术在眼科学、神经学、血管学、心脏病学、消化系统、泌尿科学、产科学和妇科学、外科（手术）学的主要应用,并论述了经颅二维及彩色多普勒技术、组织谐波成像技术、三维成像技术和扩展视野成像技术在临床上的价值．     

Machine learning in cardiac CT: Basic concepts and contemporary data

Propelled by the synergy of the groundbreaking advancements in the ability to analyze high-dimensional datasets and the increasing availability of imaging and clinical data, machine learning (ML) is poised to transform the practice of cardiovascular medicine. Owing to the growing body of literature validating both the diagnostic performance as well as the prognostic implications of anatomic and physiologic findings, coronary computed tomography angiography (CCTA) is now a well-established non-invasive modality for the assessment of cardiovascular disease. ML has been increasingly utilized to optimize performance as well as extract data from CCTA as well as non-contrast enhanced cardiac CT scans. The purpose of this review is to describe the contemporary state of ML based algorithms applied to cardiac CT, as well as to provide clinicians with an understanding of its benefits and associated limitations.     

Role of MDCT in evaluation of epicardial fat volume as an independent risk factor for coronary atherosclerosis

Objective

The aim of this study was to clarify the association between epicardial fat volume and coronary atherosclerosis.

Cushing syndrome with secondary adrenal insufficiency from concomitant therapy with ritonavir and fluticasone

We present 2 cases of Cushing syndrome with secondary adrenal insufficiency from concomitant use of ritonavir and inhaled corticosteroids in children with human immunodeficiency virus infection. These cases highlight the need for special consideration when treatment with an inhaled/intranasal corticosteroid is indicated in children receiving antiretroviral therapy.     

Increase in epicardial fat volume is associated with greater coronary artery calcification progression in subjects at intermediate risk by coronary calcium score: a serial study using non-contrast cardiac CT

Objective

Epicardial fat volume (EFV) is related to calcified coronary plaques. However, it is unknown whether baseline EFV or changes in EFV affect the progression of coronary artery calcification over time.

Methods

We identified 375 consecutive asymptomatic subjects with an intermediate risk of developing coronary artery disease, who underwent serial non-contrast CT at least 3–5 years apart. Subjects were divided into tertiles of CCS progression (% increase) between the 2 scans. Subjects from the upper tertile (High Progressors) were matched by age and gender to 81 subjects from the lower tertile (Low Progressors). All subjects underwent serial measurements of CCS and EFV. Relationships between EFV and CCS progression, and change in plaque number were examined.

Results

At baseline, there was no difference in EFV, and EFV indexed to body surface area (EFVi) between the groups. At follow-up, EFV, EFVi and percent increase in EFVi-change were higher in High Progressors than Low Progressors (EFV, 102 ± 38 cm³ vs. 90 ± 35 cm³, p = 0.03; EFVi, 50 ± 16 cm³/m² vs. 46 ± 15 cm³/m², p = 0.03; percent increase in EFVi-change, 15 ± 22% vs. 7 ± 20%, p = 0.02). On multivariate analysis, after adjusting for conventional risk factors, EFVi increase ≥ 15% [odds ratio (OR) 2.3, p < 0.05], log (baseline CCS) [OR 0.3, p < 0.0001] and scan interval time [p = 0.003, OR 1.0] were predictive of being a High Progressor. EFVi increase ≥ 15% (β = 3.0, p = 0.02) and hypertension (β = 3.1, p = 0.01) were independent predictors of number of new calcified plaques on follow-up.

Conclusion

Increase in EFV is associated with greater progression of coronary artery calcification in intermediate-risk subjects.     

Efavirenz and 8-hydroxyefavirenz induce cell death via a JNK- and BimEL-dependent mechanism in primary human hepatocytes

Chronic use of efavirenz (EFV) has been linked to incidences of hepatotoxicity in patients receiving EFV to treat HIV-1. While recent studies have demonstrated that EFV stimulates hepatic cell death a role for the metabolites of efavirenz in this process has yet to be examined. In the present study, incubation of primary human hepatocytes with synthetic 8-hydroxyEFV (8-OHEFV), which is the primary metabolite of EFV, resulted in cell death, caspase-3 activation and reactive oxygen species formation. The metabolite exerted these effects at earlier time points and using lower concentrations than were required for the parent compound. In addition, pharmacological inhibition of cytochrome P450-dependent metabolism of EFV using 1-aminobenzotriazole markedly decreased reactive oxygen species formation and cell death. Treatment of primary human hepatocytes with EFV and 8-OHEFV also stimulated phosphorylation of c-Jun N-terminal kinase (JNK) as well as phosphorylation of the JNK substrate c-Jun. Further, the mRNA and protein expression of an isoform of Bim (Bcl-2 interacting mediator of cell death) denoted as BimEL, which is proapoptotic and has been shown to be modulated by JNK, was increased. Inhibition of JNK using SP600125 prevented the EFV- and 8-OHEFV-mediated cell death. Silencing of Bim using siRNA transfected into hepatocytes also prevented cell death resulting from 8-OHEFV-treatment. These data suggest that the oxidative metabolite 8-OHEFV is a more potent inducer of hepatic cell death than the parent compound EFV. Further, activation of the JNK signaling pathway and BimEL mRNA expression appear to be required for EFV- and 8-OHEFV-mediated hepatocyte death.     

CYP2B6基因多态性与艾滋病患者HAART中依非韦仑血浆浓度的关联研究

目的研究依非韦仑（EFV）的血浆浓度与细胞色素P4502B6（CYP2B6）基因多态性的关系。方法用高效液相色谱仪（HPLC系统）测定深圳市东湖医院艾滋病专科门诊68例患者,服用EFV后8-12小时的EFV血浆浓度,用逆转录-聚合酶链反应检测所有患者的CYP2B6 516位点的G〉T基因频率。结果CYP2B6 516位点的基因型39例是GG型,26例是GT型,3例是TT型。各组EFV的血浆浓度分别是（3.3±1.2）μg/ml、（4.7±2.3）μg/ml、（9.0±0.8）μg/ml,其差异有显著的统计学意义（P〈0.01）。结论GT基因型频率在中国人相当常见,该基因型可出现较高的EFV血浆浓度;TT基因型虽然少见,但EFV血浆浓度异常升高。检测CYP2B6基因多态性可帮助临床个性化EFV用量。