下腔静脉造影在肾癌伴发下腔静脉癌栓切除术前评估中的应用价值

【摘要】 目的 评价下腔静脉DSA造影检查在肾癌伴发下腔静脉癌栓切除术前评估中的应用价值。方法 回顾性分析2017年5月至2019年1月在解放军总医院接受下腔静脉造影检查的连续97例患者,最终纳入共37例肾癌伴发下腔静脉癌栓手术治疗患者。2名具有5年以上临床经验的主治医师分别对下腔静脉造影图像及术前影像进行评价,根据评价标准,下腔静脉完全阻塞且主要侧支循环通路完善、主要侧支循环直径≥10 mm为侧支循环完善组,否则为侧支循环不完善组。分别记录两组患者手术方案选择。两组临床资料作差异性分析,计量指标根据正态分布与否用t检验或Mann-Whitney秩和检验,计数指标用Fisher确切概率检验。采用Kappa系数分析2名观察者间评价一致性。 结果 CT、MR显示肾癌伴发下腔静脉瘤栓阻塞程度、侧支循环均有一定限度,下腔静脉造影能清晰显示下腔静脉瘤栓阻塞程度和侧支循环开放情况。37例患者中侧支循环完善组26例,其中14例（53.8%）行机器人辅助腹腔镜肾根治性切除+下腔静脉瘤栓离断术,12例（46.2%）行机器人辅助腹腔镜肾根治性切除+下腔静脉取栓术;侧支循环不完善组11例,全部（100%）行机器人辅助腹腔镜肾根治性切除+下腔静脉取栓术。2名观察者间评价具高度一致性（Kappa=0.871）。两组间患者性别、Mayo分级、术中出血量差异有统计学意义,其余变量差异无统计学意义。结论 下腔静脉造影能准确判定肾癌伴发下腔静脉癌栓患者下腔静脉癌栓阻塞程度和侧支循环建立情况,对下腔静脉离断术或取栓术术式选择具有重要指导意义。     

Identification of microRNA biomarkers in serum of patients at different stages of atrial fibrillation

BackgroundAtrial fibrillation (AF) is a type of cardiac arrhythmia which is caused by irregular electrical activities in the atria.ObjectiveTo identify serum microRNA (miRNA) biomarkers at three durations (duration since diagnosis of AF) of AF.MethodsThis study included 14 patients with AF and 8 healthy subjects. The blood sample was collected from each patient at baseline (time of diagnosis) and 12-month and 24-month follow-up periods. The serum was used for miRNA sequencing. The differentially expressed miRNAs (DEMs) between the 3 AF and control groups were independently compared. The predicted target genes of DEMs were subjected to functional enrichment and protein-protein interaction network analyses. Additionally, the miRNA-target gene networks were constructed for the 3 AF groups and miRNA time series analysis was performed. The expression of several key miRNAs was verified by real-time quantitative polymerase chain reaction (qRT-PCR).ResultsIn total, 28, 22, and 24 DEMs were identified in the baseline, 12-month, and 24-month groups, respectively. miR-483-5p was the common DEM in the 3 AF groups. In the baseline and 12-month groups, the miR-200b-3p and miR-125b-5p target genes were significantly enriched in the Wnt signaling and several cancer-related pathways, respectively. In the 12-month group, the miR-34a-5p target genes were enriched in the cancer-related pathways. In the miRNA-target gene network, miR-34a-5p regulated the highest number of target genes. The time series analysis revealed that 7 miRNAs, which were downregulated in the control group, were upregulated in the AF groups. The qRT-PCR analysis revealed that the 24-month group exhibited a significant upregulation of miR-483-5p (p < 0.05), whereas the baseline group exhibited significant a downregulation of miR-125b-5p (p < 0.05).ConclusionIn patients with AF, miR-125b-5p and miR-483-5p can be potential biomarkers of the baseline and 24-month periods, respectively.     

Diffusion tensor imaging MR Neurography detects polyneuropathy in type 2 diabetes

AimTo evaluate if diffusion-tensor-imaging MR-Neurography (DTI-MRN) can detect lesions of peripheral nerves due to polyneuropathy in patients with type 2 diabetes.MethodsTen patients with type 2 diabetes with polyneuropathy (DPN), 10 patients with type 2 diabetes without polyneuropathy (nDPN) as well as 20 healthy controls (HC) were included. DTI-MRN covered proximal (sciatic nerve) and distal regions (tibial nerve) of the lower extremity. Fractional-anisotropy (FA) and diffusivity (mean (MD), axial (AD) and radial (RD)) were calculated and compared to neuropathy severity. Conventional T2-relaxation-time and proton-spin-density data were obtained from a multi-echo SE sequence. Furthermore, we evaluated sensitivity and specificity of DTI-MRN from receiver operating characteristics (ROC).ResultsThe proximal and distal FA was lowest in patients with DPN compared with nDPN and HC (p < 0.01). Likewise, proximal and distal RD was highest in patients with DPN (p < 0.01). MD and AD were also significantly different though less pronounced. ROC curve analyses of DTI separated nDPN and DPN with area-under-the-curve values ranging from 0.65 to 0.98. T2-relaxation-time and proton-spin-density could not differentiate between nDPN and DPN.ConclusionDTI-MRN accurately detects DPN by lower nerve FA and higher RD. These alterations are likely to reflect both proximal and distal nerve fiber pathology in patients with type 2 diabetes.     

肝-胰动脉的DSA研究及其在肝癌经导管动脉内化疗栓塞术中的意义

目的　研究肝 胰动脉的DSA解剖学特征 ,探讨其在肝癌经导管动脉内化疗栓塞术中的意义。方法　回顾分析 10 0 0例肝动脉DSA造影片。将发自肝固有动脉以远的各级肝动脉分支的供应胰腺的变异血管命名为肝 胰动脉 ,分析其起源、走行、分支、分布等解剖学特征 ,并统计其发生率。结果　共发现 16例存在肝 胰动脉 ,占 1.6 % ,其中 1例可见 2支 ,共显示 17支肝 胰动脉。其中起源于肝固有动脉 7支 ,占 41.2 % (7/ 17) ;起源于肝右动脉 6支 ,占 35 .3 % (6 / 17) ;起源于肝左动脉 4支 ,占 2 3.5 %(4/ 17)。结论　肝 胰动脉是一种少见的血管变异 ,TACE时避免将其误栓对有效地预防术后胰腺受损等并发症的发生具有重要的临床意义。     

肺原发黏液表皮样癌的影像表现与临床病理分析

目的 通过对肺黏液表皮样癌(PMEC)的影像表现与临床病理分析,提高对该病的认识及诊断准确率。方法 回顾性总结2016年1月至2020年12月解放军总医院第一医学中心连续收集的经组织病理学证实的27例PMEC患者的临床及CT影像资料,包括病变的部位、大小、边缘、密度、强化特征、伴随征象以及病理分级等。结果 27例PMEC患者中6例(6/27,22.2%)为大气道型,14例(14/27,51.9%)为肺门型,7例(7/27,26.9%)为周围型。20例大气道及肺门型PMEC的CT表现为气管及主支气管腔内的软组织结节或肿块,边界清晰,其中6例轻度强化,4例中度强化,5例重度强化,5例不均匀强化,且有3例出现钙化;7例周围型PMEC的CT表现为肺内软组织结节或肿块,3例实性部分重度强化,1例中度强化,3例轻度强化。16例(16/27,59.3%)伴阻塞性肺炎或肺不张、支气管扩张黏液栓形成。9例(9/27,33.3%)淋巴结转移,8例(8/27,29.6%)远处多脏器转移。年龄(t=-3.132,P=0.005)、淋巴结肿大(χ²=9.281,P=0.003)及远处转移(χ²=7.816,P=0.008)在低级别和高级别组中差异有统计学意义。结论 PMEC的CT影像表现具有一定特征性,认识这些征象有助于鉴别诊断并提高诊断的准确率。     

单次激发快速自旋回波序列在肾上腺疾病诊断中的应用

目的:探讨单次激发快速自旋回波(single shot fast spin echo,SSFSE)序列在肾上腺疾病诊断中的应用价值.方法:50例患者MR扫描序列包括横轴位FSE T2WI并抑脂、化学位移同反相位、横轴位SSFSE T2WI、冠状位SSFSE T2WI.所有SSFSE不加脂肪抑制.结果:SSFSE T2WI可清楚显示肾上腺病变的侧别、数目、大小、范围及可能的性质.结论:SSFSE序列的应用有助于显示肾上腺病变解剖结构及病变的定性诊断,在肾上腺疾病诊断中有重要的应用价值.     

非典型囊性脑膜瘤一例

非典型囊性脑膜瘤因MRI表现不典型,诊断有时较为困难。本研究报道1例非典型囊性脑膜瘤,并详细描述其MRI表现,为诊断囊性脑膜瘤的定位及分型提供有价值的影像学证据。