Scanning Electron Microscopic Characterization of Healing and Normal Rat Ligament Microstructure Under Slack and Loaded Conditions

The objective of this study was to observe and compare behavior of the collagen fiber microstructure in normal and healing ligaments, both in situ and ex vivo, in order to add insight into the structure-function relationship in normal and healing ligaments. Fifty-two ligaments from 26 male rats were investigated. Eleven animals underwent surgical transection of both medial collateral ligaments (MCLs) (22 ligaments), which were allowed to heal for a period of 2 weeks. An additional 15 animals (30 ligaments) were used as normals. Ligaments were placed into six groups: Slack ( n = 6 control, n = 6 healing), Reference ( n = 4 control, n = 4 healing), Loaded ( n = 4 control, n = 4 healing), 15° Flexion ( n = 4 control, n = 4 healing), 120° Flexion ( n = 4 control, n = 4 healing), and Tissue Strain vs. Flexion Angle ( n = 8 normals). All ligaments, except those in the Tissue Strain vs. Flexion Angle group, were prepared for scanning electron microscopy. Tissues were harvested, mounted in a load frame, and chemically fixed in one of five states: (1) slack, (2) reference (onset of loading), (3) loaded, (4) 15° knee flexion, or (5) 120° knee flexion. After fixation the tissues were prepared for electron microscopy (SEM). The micrographs from the slack, reference, and loaded groups show fiber straightening with loading in normal ligaments as well as in both scar and "retracted" regions of healing ligaments. Collagen fibers' diameter and crimp patterns were dramatically changed in the scar region of healing ligaments: Width decreased from 19.4 &#45 1.7 &#119 m to 6.5 &#45 2.1 &#119 m ( p < .000001), period from 51.4 &#45 15.1 &#119 m to 11.0 &#45 2.4 &#119 m ( p < .000001), and amplitude from 9.8 &#45 0.8 &#119 m to 3.9 &#45 0.8 &#119 m ( p < .000001). Normal ligaments fixed in situ show wavy regions at 120° but less so at 15° flexion. Healing ligaments fixed in situ show regions of fiber waviness in the scar region at 120° and also at 15° flexion, indicating ligament laxity persists toward both extremes of the range of motion. The data suggest that straightening of crimped fibers is a functionally relevant phenomenon, not only in normal but also in healing ligaments.     

多模式CT预测评估缺血性卒中患者血脑屏障完整性和侧支循环的价值分析

目的探讨多模式CT对评估缺血性卒中患者血脑屏障完整性和侧支循环的价值。方法选取我院收治的确诊为缺血性卒中的患者76例,行多模式CT检查,包括CT平扫(NCCT)、CT灌注成像(CTP)及CT血管成像(CTA)等模式。分析灌注范围的分布并绘制感兴趣区(ROI),测定脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)及表面通透性(PS)等灌注指标。结果1)依据侧支循环分组,良好组患者的CBV、CBF、MTT明显高于不良组(P<0.05)。良好组患者末次随访时的梗死范围、mRS评分明显低于不良组(P<0.05);2)依据出血性转化分组,HT组的PS明显高于未HT组,而MTT明显低于未HT组,两组比较差异有统计学意义(P<0.05)。结论对于脑血管狭窄及侧支循环的建立,多模式CT可观察侧支循环的建立或开放状况,预测缺血性卒中预后水平,可评估血脑屏障(blood brain barrier,BBB)的完整性及HT的发生风险,对临床治疗有指导意义。     

动态CT心肌灌注成像评估冠状动脉慢性完全性闭塞患者心肌灌注功能及冠状动脉侧支循环的初探

目的:探讨动态CT心肌灌注成像(CT-MPI)对冠状动脉慢性完全性闭塞(CTO)患者心肌灌注功能及冠状动脉侧支循环(CCC)的意义。方法:自2019年4月至12月前瞻性收集郑州大学华中阜外医院冠状动脉造影证实为CTO的患者进行动态CT-MPI扫描,获得每个心肌节段的灌注参数,包括心肌血流量(MBF)、心肌血流量比值(rMBF)、心肌血容量(MBV)、开始时间(TTS)、达峰时间(TTP)、血管外细胞外容积(EEV)、流量提取乘积(FE)及灌注毛细血管血容量(PCBV)。以SPECT为参考标准,比较大致正常和异常、不同缺血程度、存活与梗死心肌节段参数间差异,采用ROC曲线下面积(AUC)比较其诊断效能。以冠状动脉造影Rentrop分级为标准,比较CCC良好组和不良组心肌节段参数间差异及其与Rentrop分级间的相关性。结果:最终纳入21例患者。灌注异常组的MBF、rMBF、MBV、FE、PCBV及EEV均低于灌注大致正常组,而TTS及TTP高于大致正常组(P<0.05)。其中MBF的AUC最大,为0.809,最佳截断值为71.75 ml·100 ml^-1·min^-1,灵敏度和特异度分别为0.71和0.80。MBF及rMBF随着心肌缺血程度加重而降低,但中、重度组间差异无统计学意义(P值分别为0.811和0.696)。当鉴别梗死及存活心肌时,rMBF的AUC最大为0.896,最佳截断值为69.17%,灵敏度和特异度分别为0.75和0.92。CCC良好组MBF、MBV、FE及EEV明显高于不良组(P均<0.05),但与Rentrop分级间无明显相关性(|r|均<0.3)。结论:动态CT-MPI定量参数对CTO患者心肌灌注功能及CCC状态具有良好的诊断价值,但与CCC Rentrop分级之间相关性较差,其意义有待进一步研究。     

基于CT灌注成像评估侧支循环在急性缺血性脑卒中取栓前后脑梗死进展及预后评估中的应用

目的探讨基于CT灌注成像(CTP)评估的侧支循环对急性前循环大动脉闭塞患者取栓前后脑梗死进展及临床预后的影响。方法回顾性分析浙江省人民医院神经内科自2018年5月至2019年9月收治的110例发病24 h以内的急性前循大动脉闭塞患者的资料。所有患者均完成取栓手术,采用区域性软脑膜侧支(rLMC)评分对四维CT血管造影(4D-CTA)上的全时相融合像(tMIP)进行侧支循环评估;根据CTP的核心脑梗死体积和术后1周内头颅MR的DWI影像结果,计算进展梗死体积;采用改良Rankin量表(mRS)评分评估患者术后3个月时预后情况。结果(1)侧支循环好组患者56例,侧支循环差组患者54例。年龄(OR=0.951,95%CI:0.910~0.993,P=0.023)、心功能不全(OR=0.116,95%CI:0.018~0.731,P=0.022)、基线空腹血糖(OR=0.788,95%CI:0.646~0.961,P=0.019)、觉醒性卒中(OR=0.093,95%CI:0.023~0.380,P=0.001)及颈内动脉段闭塞(OR=7.604,95%CI:2.650~21.821,P=0.000)是侧支循环的独立影响因素。(2)侧支循环评分(95%CI:-2.947~-1.474,P=0.000)、缺血半暗带体积(95%CI:0.065~0.126,P=0.000)、脑组织水肿评分(95%CI:2.952~7.600,P=0.000)、出血转化(95%CI:8.966~23.114,P=0.000)及24 h美国国立卫生研究院卒中量表(NIHSS)评分(95%CI:0.606~1.248,P=0.000)是进展梗死体积的独立影响因素。(3)预后良好组患者共59例,预后不良组患者共51例。出血转化(OR=0.019,95%CI:0.001~0.275,P=0.004)及进展梗死体积(OR=0.824,95%CI:0.756~0.897,P=0.000)是急性前循环大动脉闭塞取栓患者远期预后的独立影响因素。结论基于4D-CTA的rLMC侧支循环评分对发病24 h内急性前循环大动脉闭塞取栓患者的进展梗死体积有良好的预测作用,并可通过进展梗死体积进一步预测患者预后。     

阿托伐他汀对高胆固醇血症大鼠侧支血管生长的影响

目的　探讨阿托伐他汀对高胆固醇血症大鼠侧支血管生长的影响。 方法　28只成年SD大鼠,给予高脂饮食8周,建立结扎股动脉诱导的高胆固醇血症大鼠侧支血管生长模型。随机将动物分为单纯股动脉结扎组（L组）、高胆固醇血症+股动脉结扎组（HL组）和阿托伐他汀（0.3 mg·kg-1·14 d-1,腹腔注射）+高胆固醇血症+股动脉结扎组（AL组）。存活7 d后,采用血管造影,HE染色和共聚焦免疫荧光术,观察高胆固醇血症情况下,阿托伐他汀应用对侧支血管生长的作用以及重要的促侧支血管生长分子在侧支血管表达模式的变化。 结果　与L组比较,HL组的侧支血管数目减少,侧支血管生长受到损害,表现为血管内膜过度增生,中膜明显增厚,导致血管腔狭窄,且血管壁细胞增殖和外膜炎症细胞减少;AL组应用了阿托伐他汀,侧支血管的生长较HL组明显改善,发育为管腔较大的侧支血管,血管壁细胞的增殖和外膜炎症细胞增多,侧支血管数目增加。其侧支血管数目,血管横截面积和免疫荧光强度差异具有统计学意义（P<0.05）。 结论　高胆固醇血症损害大鼠后肢侧支血管的生长;阿托伐他汀可促进血管壁细胞的增殖和外膜巨噬细胞的增多,从而改善和恢复侧支血管的生长。     

多时相CT血管造影对急性缺血性脑卒中患者侧支循环评估价值及溶栓治疗指导作用

目的探讨多时相CT血管造影(CTA)对急性缺血性脑卒中(AIS)患者侧支循环评估价值及溶栓治疗指导作用。方法我院收治的AIS患者,选取其中接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的120例患者为研究对象。治疗前均给予多时相CTA检查,根据影像学检查结果及Alberta卒中项目早期CT评分(ASPECTS)分为侧支循环良好组及侧支循环不良组。收集两组基线资料,并比较入院时、溶栓治疗24 h及2周后的神经功能美国国立卫生院神经功能缺损评分(NIHSS)量表、28 d内死亡率及随访3个月后的预后情况改良Rankin评分量表(mRS)。分析AIS患者侧支循环血流总体评分(ASPECTS)与预后(mRS)之间的相关性。结果两组性别、年龄、体质指数(BMI)、合并症、栓塞部位比较差异无统计学意义(P>0.05),侧支循环不良组介入干预率高于侧支循环良好组(P<0.05);入院时,两组NIHSS量表评分比较差异无统计学意义(P>0.05),溶栓治疗24 h及2周后,两组NIHSS量表评分均较入院时下降,且组间比较差异有统计学意义(P<0.05);两组28 d内死亡率比较差异无统计学意义(P>0.05),随访3个月后侧支循环良好组的mRS评分更低(P<0.05);AIS患者ASPECTS与mRS之间呈负相关(r=-0.396,P<0.05)。结论多时相CTA对于静脉溶栓治疗的AIS患者可为其提供理想的参考价值,通过判断其侧支代偿,有利于早期制定治疗方案,以改善预后。     

针刺夹脊穴结合温针灸治疗原发性面肌痉挛临床疗效观察

目的:比较针刺夹脊穴结合温针灸与常规针刺治疗原发性面肌痉挛的疗效差异。方法:选择60例符合纳入标准的原发性面肌痉挛病人随机分成两组,每组各30例。对照组用常规针刺治疗,治疗组在对照组的针刺选穴基础上取颈部夹脊穴(C3-C6棘突下旁开0.5寸,左右各4穴)和温针灸养老穴。结果:两组患者的面肌痉挛强度和频率均降低(P<0.05)。总有效率比较,治疗组(90%)>对照组(63.3%),(Z=-2.815,P=0.005<0.01)。结论:针刺夹脊穴结合温针灸与常规针刺均可改善患者面肌痉挛症状,且夹脊穴结合温针灸治疗疗效更佳。     

电针深刺夹脊穴治疗腰椎间盘突出症163例疗效观察及对血浆β-内啡肽的影响

目的观察电针深刺夹脊穴治疗腰椎间盘突出症的疗效及血浆β-内啡肽的影响。方法将163例腰椎间盘突出症患者随机分为治疗组85例和对照组78例,2组均采用电针并配合牵引治疗,其中治疗组选取深刺腰部夹脊穴,对照组常规取穴,分别于治疗前、后测定患者血浆β-内啡肽的含量,采用模糊视觉疼痛量表(VAS)及JOA腰痛评分标准对疼痛进行评定。结果治疗后2组模糊视觉疼痛(VAS)评分及JOA腰痛评分均明显改善,与治疗前比较差异均有统计学意义(P0.01),与对照组相应时间点比较,差异有统计学意义(P0.01)。治疗后2组β-内啡肽含量均明显增高,与治疗前比较,差异有统计学意义(P0.01);其中治疗组β-内啡肽含量增高更为明显,与对照组相应时间点比较,差异有统计学意义(P0.01)。结论电针深刺夹脊穴治疗腰椎间盘突出症具有显著的临床疗效,并可提高患者血浆β-内啡肽活性,这可能是电针镇痛作用机制之一。     

Characteristics and Impact of Life Turning Points for Older Adults

This research examines the characteristics of turning points, events considered as being significant in one’s life. One hundred and forty-nine turning points, as reported by 53 older adults were investigated. They were characterized according to: age at occurrence of turning point, domain, specific or thematic nature, and areas of functioning on which the turning point had an impact. Compared to men, women reported significantly more turning points related to the health domain. Turning points were distributed through the life span, with some concentration at midlife. Family was the sphere most influenced by turning points. The different domains of turning points corresponded to the specific spheres of impact. Turning points were more often related to discrete events than to a series of events clustered under a theme. Identity and social role processes appear most influential in leading older adults to identify particular life circumstances as turning points in their lives.

全脑CTP联合CTA分析烟雾病症状与侧枝循环的相关性

目的 利用全脑CT灌注(CTP)联合CT血管成像(CTA)分析烟雾病(MMD)患者的临床症状与侧支循环的关系.方法 回顾性分析30例烟雾病患者的临床症状、CTP、CTA资料.以5名正常人灌注值作为参考值.将30例烟雾病患者分为无症状组、症状轻微及TIA组、卒中组,分析各组临床症状,灌注参数值及侧枝循环情况.结果 (1)临床症状:无症状者5例;头痛、TIA者8例;脑梗塞12例;脑出血5例;(2)侧枝血管:无症状组、症状轻微及TIA组侧枝循环良好.卒中组侧支循环代偿不良;(3)灌注参数值:无症状组:CBF、CBV、MTT、TTP与正常组比较无明显变化;症状轻微及TIA组:CBF、CBV与正常组比较无明显改变,MTT、TTP延长(P＜0.05);卒中组:CBF、CBV明显下降,MTT、TTP明显延长(P＜0.05).结论 CTP联合CTA能很好评估烟雾病患者的脑血流动力学变化及侧支循环情况,其临床症状与侧枝循环密切相关.