肺动脉球囊扩张成形术治疗慢性血栓栓塞性肺动脉高压的安全性和有效性

目的评估肺动脉球囊扩张成形术(BPA)治疗慢性血栓栓塞性肺动脉高压(CTEPH)的安全性及有效性。方法2017年2月至2018年5月,前瞻性收集首都医科大学附属北京朝阳医院25例CTEPH患者,均接受BPA治疗,其中男10例、女15例。分析患者的临床资料,比较BPA治疗前后患者脑尿钠肽(BNP)、平均肺动脉压(mPAP)、三尖瓣环收缩期位移(TAPSE)、6 min步行实验(6WMD)、右心室基底内径、WHO心功能分级的变化。采用配对t检验比较治疗前后各指标的差异。结果25例患者共接受50次BPA治疗,12例治疗次数≥2次,其mPAP由术前的(50.4±9.9)mmHg(1 mmHg=0.133 kPa)下降到(39.9±10.6)mmHg,差异有统计学意义(t=9.7,P<0.001);BNP由术前的(513.5±357.3)pg/ml下降至(106.3±137.5)pg/ml,差异有统计学意义(t=3.2,P=0.006);TAPSE由术前的(16.2±2.8)mm增加至(18.0±2.4)mm,差异有统计学意义(t=-5.7,P=0.002,);右心室基底内径由(45.9±6.9)mm减小至(41.2±7.3)mm,差异有统计学意义(t=5.6,P<0.001,);6WMD由术前的(371.1±86.8)m增加至(467.7±76.1)m,差异有统计学意义(t=-6.4,P<0.001);WHO心功能分级由(2.4±0.7)级改善为(1.2±0.4)级,差异有统计学意义(t=2.8,P=0.021)。3例患者出现肺动脉损伤,其中2例表现为咯血,行动脉栓塞后咯血停止;本组患者未出现肺水肿等其他并发症。结论BPA能改善CTEPH患者临床症状,提高肺动脉的血流动力学指标,可作为不能手术切除的CTEPH患者的选择治疗方法。     

实性肺结节低剂量CT影像组学图像质量控制的体模研究

目的探讨影像组学在低剂量CT扫描条件下实性肺结节CT图像质量控制中的应用价值。方法使用CT750 HD CT分别在不同管电压及不同管电流下对胸部肺结节人体仿真模型进行扫描,记录不同扫描条件下的容积CT剂量指数(CTDIvol),测量并计算图像中结节的信噪比(SNR)和对比噪声比(CNR),分析辐射剂量、噪声与管电压管电流变化的规律,将所有扫描数据通过影像组学分析软件对实性结节的全部特征进行提取,使用R语言统计学软件对提取的特征参数进行主成分分析,选取主成分中对图像质量贡献较大的特征进行分析。对确定的重要特征参数进行单因素方差分析,揭示不同管电压下特征参数的差异,再进一步通过事后检验对不同管电压组之间进行两两比较,找出组间差异。结果辐射剂量在研究的范围内随管电压、管电流的增加而线性增加。肺结节的SNR和CNR总体变化趋势虽然与管电压及管电流的变化呈线性关系,但在低剂量下没有明确的变化趋势阈值存在,无法准确评价低辐射下图像质量。影像组学提取的所有特征参数中均质性、体素值总和及Haralick相关性是3个主要成分,其方差累计的贡献率为89.2%,且特征值均>1。特征参数均质性曲线显示出其变化趋势与管电压及管电流变化成相关性,且稳定性和一致性较好。均质性单因素方差分析结果显示在管电压140及120 kVp时,两组间的均质性值的变化差异无统计学意义(P=0.117),而在其他管电压间均质性值变化差异均有统计学意义(P<0.001)。当管电压在100 kVp、管电流≥60 mA时或管电压在80 kVp、管电流≥90 mA时,均质性无明显变化,可以得到满意的图像质量。结论影像组学分析方法可以有效定量化地评价和控制低辐射剂量下实性肺结节CT图像质量。     

扩散峰度成像在肝脏疾病中的应用进展

扩散峰度成像(DKI)序列作为扩散加权成像(DWI)的衍生序列能够显示复杂组织中水分子扩散受限程度,反映组织微观结构信息。其在肝脏主要应用于肝功能储备和肝脏纤维化程度评估、肝内良恶性肿块病变鉴别、及对肝癌经动脉化学栓塞术后复发评估等。就DKI的基本原理、主要技术参数及在肝脏疾病诊断和疗效评估中的研究进展予以综述。     

Multimodality imaging in COVID-19 patients: A key role from diagnosis to prognosis

The integrated clinical, laboratory and ultrasound approach is essential for the diagnosis, evaluation and monitoring of the patient's therapy in coronavirus disease 2019 pneumonia. The ideal imaging approach in this context is not yet well defined. Chest X-ray is characterized by low sensitivity in identifying earlier lung changes. The "bedside" pulmonary ultrasound has an undeniable series of advantages in the patient at high infectious risk and can provide incremental data in the respiratory intensive care for the serial control of the individual patient as well as for the home delivery of the stabilized subjects. Pulmonary computed tomography shows high sensitivity but should not be routinely performed in all patients, because in the first 48 h it can be absolutely negative and in the late phase the imaging findings may not change the therapeutic approach. Echocardiography should be limited to patients with hemodynamic instability to assess ventricular function and pulmonary pressures.     

L’hypo-albuminémie contribue-t-elle à l’aggravation de l’insuffisance cardiaque ?

BackgroundHypoalbuminemia has now emerged as a powerful prognosticator in heart failure regardless of age, clinical presentation, left ventricular ejection fraction and usual prognostic markers. Growing evidence is that this prognostic value persists after adjusting for causative factors for hypoalbuminemia such as malnutrition, inflammation and liver dysfunction.ObjectiveTo address the prognostic relevance of hypoalbuminemia in frail elderly patients with well-characterized cardiogenic pulmonary edema at high risk for adverse outcome, beyond causative factors for low serum albumin levels. Serum albumin was measured after clinical stabilization to avoid hypervolemia.ResultsIn all, 67 patients with a mean age of 86 years were included. Hospital mortality was 30%. Patients who died and who survived were similar in age, ejection fraction, BNP concentration, serum creatinine, serum hemoglobin, total bilirubin and prealbumin. Patients who died had lower serum albumin levels (P < 0.001), higher blood urea nitrogen (P = 0.03) and higher C-reactive protein (P = 0.02). In multivariate analysis, serum albumin was the sole independent predictor of hospital death (P < 0.01), after adjusting for malnutrition (prealbumin P = ns), inflammation (C-reactive protein P = ns) and liver dysfunction (total bilirubin P = ns).ConclusionSerum albumin is a powerful prognosticator in frail elderly patients with acute cardiogenic pulmonary edema even after adjusting for main causative factors. These results suggest that hypoalbuminemia may contribute to the worsening of heart failure given the physiological properties of serum albumin that includes antioxidant activity and plasma colloid osmotic pressure action. Further studies are critically needed to address the relevance of prevention and correction of hypoalbuminemia in heart failure.     

Clinical significance of serum human epididymis protein 4 in liver fibrosis: An experimental study

Background:Human epididymis protein 4 (HE4) has been identified as marker for renal fibrosis. Present study aimed to investigate the clinical significance of serum HE4 in liver fibrosis.Methods:Serum from 65 liver fibrosis patients, 68 hepatic patients without fibrosis, and 50 controls was collected respectively. Serum HE4 levels were measured by chemiluminescence immunoassay and compared among the groups. The relationships between serum HE4 levels and the clinical characteristics of liver fibrosis were also analyzed. A receiver operator characteristic curve was plotted to investigate the diagnostic efficacy of serum HE4 for liver fibrosis. Child–Pugh (C–P) score and liver fibrosis score were also evaluated. Data were analyzed by statistical software 13.0.Results:Serum HE4 levels were significantly higher in liver fibrosis than that of controls [105.35 (82.64, 164.18) vs 46.2 (39.9, 58.9) pmol L⁻¹, P = .00] and hepatic patients without liver fibrosis [105.35 (82.64, 164.18) vs 51.00 (44.02, 65.65) pmol L⁻¹, P < .01]; Serum HE4 levels in liver fibrosis patients with C–P class C were significantly higher than those with C–P class A [143.75 (106.50, 186.08) vs 81.42 (69.73, 99.26) pmol L⁻¹, P = .005] and C–P class B [143.75 (106.50, 186.08) vs 113.10 (88.92, 169.50) pmol L⁻¹, P = .01]; the diagnostic sensitivity and specificity of serum HE4 levels for liver fibrosis detection were 87.5% and 81.1%, at a cutoff value of 69 pmol L⁻¹; Serum HE4 levels in alcoholic liver fibrosis were higher than that of liver fibrosis with hepatitis B virus infection [131.30 (100.67, 228.35) vs 89.46 (73.74, 116.45) pmol L⁻¹, P < .01].Conclusion:Serum HE4 was closely correlated with C–P class and might be a potential marker for liver fibrosis.     

18F-FDG符合线路代谢显像在肺部病变影像诊断中的应用价值

目的 探讨¹⁸F-FDG符合线路代谢显像在肺部病变影像诊断中的价值。方法 选择2015年3月至2018年1月在铜陵市人民医院核医学科行¹⁸F-FDG符合线路代谢显像检查的48例肺部病变患者,对其代谢图像分别采用目测法及半定量法进行分析判断,比较2种方法的诊断价值。结果 48例患者在¹⁸F-FDG符合线路代谢显像中以目测法等级3级作为恶性病变的诊断标准,其诊断价值较高,阴性预测值、阳性预测值、敏感性、特异性、准确性分别为70.00%、86.84%、91.67%、58.33%和83.33%。良恶性病变半定量参数靶区与非靶区比值（T/NT值）的差异有统计学意义（P<0.05）,以T/NT值为诊断标准作非参数法拟合受试者工作特征曲线（ROC曲线）,曲线下面积约为0.50,其诊断效能较低。依据ROC曲线得出T/NT值诊断肺部恶性病变的阈值为13.25,其诊断价值的敏感性、特异性、准确性分别为50.00%、80.00%和50.00%。结论 ¹⁸F-FDG符合线路代谢显像在肺部病变的诊断与鉴别诊断中目测法较半定量参数T/NT值诊断价值高,应用简便。     

2013～2018年安徽省老年肺结核疫情特征分析

目的 分析2013～2018年安徽省老年肺结核疫情特征,为制定老年肺结核防治策略提供参考依据。方法 采用描述性流行病学研究方法,分析2013～2018年安徽省老年肺结核患者疫情特征。结果 2013～2018年,安徽省活动性肺结核年平均登记率老年人高于全人群（χ²=55.061,P<0.001）;涂阳肺结核年平均登记率老年人高于全人群（χ²=21.840,P<0.001）,老年复治涂阳占全省复治涂阳的42.42%（3 379/7 965）;老年肺结核男女性别比为3.32∶1;安徽省所辖16个市以亳州、铜陵、池州老年肺结核年平均登记率最高。结论 安徽省老年肺结核疫情高于全人群,男性高于女性,亳州、铜陵、池州老年肺结核疫情重,需加强重点人群和重点地区的结核病防治工作。     

S-allyl-l-cysteine attenuates bleomycin-induced pulmonary fibrosis and inflammation via AKT/NF-κB signaling pathway in mice

Idiopathic pulmonary fibrosis (IPF) is a progressive and lethal lung disease characterized by inflammation, multifocal fibrotic lesions and excessive collagen deposition with limited therapies. As a major bioactive compound in garlic, S-allyl-l-cysteine (SAC) is a neuroprotective drug candidate to prevent cognitive decline, however, its anti-pulmonary fibrotic activity remains unknown. Here, we investigated whether SAC could attenuate bleomycin (BLM)-induced pulmonary fibrosis and inflammation in mice. Our results showed that SAC dose-dependently reduced the infiltration of inflammatory cells, pulmonary lesions and collagen deposition in BLM treated mice with downregulated mRNA expression levels of fibrotic genes including alpha smooth muscle actin (α-SMA), fibronectin, collagen I and collagen III as well as the protein level of α-SMA. In addition, SAC could also reduce the mRNA expression of inflammatory mediators such as TNF-α and iNOS. Furthermore, higher phosphorylation of AKT and NF-κB p65 in IPF patient samples and murine samples was verified by immunohistochemistry while SAC could decrease the phosphorylation level of AKT and NF-κB p65 in mice stimulated with BLM. These findings, for the first time, indicate that SAC might mediate AKT/NF-κB signaling pathway to inhibit BLM-induced pulmonary fibrosis and support the potential role of SAC as an anti-pulmonary fibrosis agent.