Assessment of myocardial viability in rats: Evaluation of a new method using superparamagnetic iron oxide nanoparticles and Gd-DOTA at high magnetic field.

The aim of this study was to detect salvageable peri-infarction myocardium by MRI in rats after infarction, using with a double contrast agent (CA) protocol at 7 Tesla. Intravascular superparamagnetic iron oxide (SPIO) nanoparticles and an extracellular paramagnetic CA (Gd-DOTA) were used to characterize the peri-infarction zone, which may recover function after reperfusion occurs. Infarcted areas measured from T1-weighted (T1-w) images post Gd-DOTA administration were overestimated compared to histological TTC staining (52% +/- 3% of LV surface area vs. 40% +/- 3%, P=0.03) or to T2-w images post SPIO administration (41% +/- 4%, P=0.04), whereas areas measured from T2-w images post SPIO administration were not significantly different from those measured histologically (P=0.7). Viable and nonviable myocardium portions of ischemically injured myocardium were enhanced after diffusive Gd-DOTA injection. The subsequent injection of vascular SPIO nanoparticles enables the discrimination of viable peri-infarction regions by specifically altering the signal of the still-vascularized myocardium.     

一氧化碳中毒迟发性脑病的临床预防

目的　探讨临床治疗措施对一氧化碳中毒迟发性脑病的预防。方法　将 130例一氧化碳中毒患者随机分为A、B、C 3组 ,A组采用纳络酮、低分子肝素、高压氧治疗 ;B组采用胞二磷胆碱、醒脑注射液、高压氧治疗 ;C组采用胞二磷胆碱、醒脑注射液治疗。结果　A组昏迷时间与B、C组对比 ,B组与C组对比 ,明显缩短 ,有显著性差异 (P <0 .0 5或P <0 .0 1) ;本组 130例患者中 ,共发生迟发性脑病15例 ,发生率为 11.5 % ,迟发性脑病发生率A组与B、C组对比 ,B组与C组对比 ,明显降低 ,有显著性差异 (P <0 .0 5或P <0 .0 1)。结论　选择有效的药物 ,及早应用高压氧和充足的疗程是迟发性脑病临床预防的关键。     

腹腔镜辅助下大隐静脉隔绝术治疗大隐静脉曲张60例

目的探讨腹腔镜辅助下大隐静脉隔绝术的疗效。方法2000年1月～2004年1月对60例66条大隐静脉曲张腹腔镜辅助下行大隐静脉隔绝术,腹腔镜辅助下高位结扎、电灼大腿段大隐静脉,阻断其小腿段所有属支及交通支,使大隐静脉与体循环隔绝。结果手术时间30～60min,(50±9)min;术后住院时间3～5d,(3.5±0.6)d。60例随访1～36个月,平均28个月,无复发。结论腹腔镜辅助下大隐静脉隔绝术创伤小,疗效好,复发率低,是治疗大隐静脉曲张的理想术式。     

冠心病患者血清对氧磷酶活性的测定

目的探讨冠心病患者血清对氧磷酶1活性及其与冠心病之间的关系。方法选择冠状动脉造影确诊的冠心病患者106例和非冠心病组62例,用乙酸苯酯法和比色法分别测定两组血脂、血清对氧磷酶1活性、超氧化物歧化酶及丙二醛含量,并进行对比分析。结果冠心病组血清中对氧磷酶1活性和超氧化物歧化酶水平分别为113±64μkat/L和43.8±8.2 kU/L,均较对照组降低(134±72μkat/L和63.4±5.7 kU/L)(P<0.05);而丙二醛含量较对照组升高(9.4±1.8μmol/L比4.1±0.5μmol/L,P<0.01)。对氧磷酶1活性与高密度脂蛋白和超氧化物歧化酶水平呈正相关,与丙二醛水平呈负相关。冠状动脉狭窄者对氧磷酶1活性较无狭窄者明显减低(P<0.001),2、3支血管病变者较1支血管病变者对氧磷酶1活性降低(P<0.05)。结论冠心病患者血清对氧磷酶1活性降低,低对氧磷酶1活性与冠心病严重程度有关。     

The patella and tibial condyle position after combined and after closing wedge high tibial osteotomy

High tibial osteotomy changes the patella and tibial condyle position, which makes the subsequent total knee replacement technically demanding. From 1 January 1993 to 31 December 2000, combined osteotomy [After the first osteotomy made 2 cm distally to the joint line, a bone wedge is removed based laterally. Its tip ends at the center of the tibial condyle (half bone wedge). The distal part of the tibia is placed into the valgus position and the half bone wedge is placed into the gap opened medially.] was performed on 103 knees and closing wedge osteotomy was performed on 47 consecutive knees. Eighty combined (group A) and 41 closing wedge (group B) osteotomy were studied. All knees were assessed radiologically before surgery, in the 10th postoperative week, in the 12th postoperative month and at the time of the final follow-up (in group A—66.15 months, in group B—66.61 months). We examined the change of the femorotibial angle, of the patellar height according to the method of Insall and Salvati, of the tibial slope angle according to the method of Bonnin, of the tibial condylar offset according to the method of Yoshida and of the distance between the lateral tibial plateau and the top of the fibular head. In group A and B, the recurrence of the varus deformity was not noted and valgus alignment did not increase in any case. In group-A, the Insall–Salvati ratio remained unchanged in 65% of knees. The tibial slope angle decreased in both groups. There was correlation between the change of the tibial condylar offset and the angle of the correction in both groups. There was correlation between the change of the distance between the lateral tibial plateau and the top of the fibular head. After combined osteotomy, the transposition of the tibial condyle and the decrease of the distance between the lateral tibial plateau and the top of the fibular head was less than after closing wedge osteotomy, although the average angle of correction was more after combined osteotomy (11.835°), than after closing wedge osteotomy (9.465°). Theoretically, the recurrence of the varus deformity, the increase of the valgus alignment and (in majority of cases) the shortening of the patellar tendon do not compromise the likelihood of successful conversion to the subsequent total knee replacement, either after combined or after closing wedge osteotomy. The combined osteotomy does not lead to considerable transposition of the tibial condyle and to considerable lateral tibial bone loss; therefore, theoretically, the combined osteotomy does not impair the subsequent total knee replacement.     

胫骨高位截骨手术并发症23例次分析

[目的] 探讨胫骨高位截骨手术并发症的发生情况，并提出预防和治疗措施。[方法]2000年1月～2004年10月采用胫骨高位截骨术治疗膝骨关节炎合并内翻畸形患者126人，21人发生手术并发症，男4例，女17例；年龄48～64岁，平均61岁。术前拍摄站立膝关节正位X线片，测量股骨一胫骨角，计算截骨角度，采用外侧闭合胫骨高位截骨术矫正膝内翻畸形。[结果] 术后随访6～12个月，平均7．5个月。共21名患者发生各类并发症23例次．发生率为16．7％。其中发生胫骨骨折4例，腓总神经麻痹3例，出现深静脉血栓形成5例，膝内翻复发病例6例，内固定失败4例（其中2例合并膝内翻复发），感染1例。[结论] 降低胫骨高位截骨手术并发症需要术者熟悉局部解剖和精确的术前设计，提高手术技巧及完善的围手术期护理。     

超敏C反应蛋白及血脂水平与急性冠状动脉综合征患者6个月内预后的关系

目的:探讨超敏C-反应蛋白(hs-CRP)、血脂水平与急性冠状动脉综合征(ACS)患者6个月内预后的关系。方法:分别测定201例非ST段抬高的ACS患者入院时的hs-CRP和血脂水平,随访6个月,终点为冠状动脉事件(冠心病性死亡、非致死性急性心肌梗死、急诊再血管化、因不稳定型心绞痛引起的再住院)。hs-CRP≥3mg/L、总胆固醇(TC)/高密度脂蛋白胆固醇(HDL-C)≥4.7mmol/L为异常。结果:201例患者中发生冠心病猝死5例,非致死性心肌梗死16例,急诊再血管化4例,不稳定型心绞痛所致再住院27例。hs-CRP异常组较hs-CRP正常组冠状动脉事件发生率显著增高(RR1.90,95%CI1.09~3.32,P<0.05)。血脂异常组较正常组冠状动脉事件发生率亦显著增高(RR1.70,95%CI1.02~2.83,P<0.05)。血脂及hs-CRP均异常组较均正常组冠状动脉事件发生率显著升高(RR3.43,95%CI1.35~8.73,P<0.01)。结论:hs-CRP或(和)血脂水平异常的ACS患者6个月内冠状动脉事件发生率显著升高,并以二者均异常者为著,因此联合检测可能有助于识别冠心病二级预防中的高危个体。     

乳腺癌99mTc-MIBI影像与P-糖蛋白表达的相关性

为了探讨活体乳腺恶性肿瘤对99mTc-甲氧基异丁基异腈(99mTc-MIBI)的摄取和肿瘤细胞P-糖蛋白(P-glyco-protein,P-gp)表达间的关系。2003年10月~2005年12月对40例未经治疗的乳腺癌患者进行99mTc-MIBI早期(10min)与延迟(120min)平面显像,计算其外排率(WOR)。显像后1周内进行手术治疗或化疗,术后应用免疫组化方法检测肿瘤标本P-gp表达,结果进行统计学计算。结果:WOR在P-gp阳性者为(12.8±8.2)%,高于P-gp阴性者(1.2±6.2)%,差异有统计学意义,t=3.42,P=0.01;WOR与肿瘤大小成正相关。初步研究结果显示,乳腺恶性肿瘤对99mTc-MIBI的摄取与P-gp表达呈明显负相关,即肿瘤细胞高度表达P-gp时,99mTc-MIBI摄取较低,99mTc-MIBI显像和肿瘤细胞P-gp表达相关性好,可成为体内无创检测肿瘤组织P-gp表达及耐药性的重要手段。     

In vivo detection of single cells by MRI.

The use of high-relaxivity, intracellular contrast agents has enabled MRI monitoring of cell migration through and homing to various tissues, such as brain, spinal cord, heart, and muscle. Here it is shown that MRI can detect single cells in vivo, homing to tissue, following cell labeling and transplantation. Primary mouse hepatocytes were double-labeled with green fluorescent 1.63-microm iron oxide particles and red fluorescent endosomal labeling dye, and injected into the spleens of recipient mice. This is a common hepatocyte transplantation paradigm in rodents whereby hepatocytes migrate from the spleen to the liver as single cells. One month later the animals underwent in vivo MRI and punctuated, dark contrast regions were detected scattered through the livers. MRI of perfused, fixed samples and labeled hepatocyte phantoms in combination with histological evaluation confirmed the presence of dispersed single hepatocytes grafted into the livers. Appropriate controls were used to determine whether the observed contrast could have been due to dead cells or free particles, and the results confirmed that the contrast was due to disperse, single cells. Detecting single cells in vivo opens the door to a number of experiments, such as monitoring rare cellular events, assessing the kinetics of stem cell homing, and achieving early detection of metastases.     

Complete disappearance of lung abnormalities on high-resolution computed tomography: A case of histiocytosis X

A case of pulmonary Langerhans cell histiocytosis, proved by both lung high-resolution computed tomography and lung biopsy, is described. Following smoking cessation, lung nodules and cysts gradually disappeared on serial computed tomography scans, with complete clearance of the lesions after 12 months. The role of tobacco smoking is discussed, in detail, against the background of the literature.