彩色多普勒超声诊断糖尿病患者颈动脉粥样硬化斑块的价值

目的探讨彩色多普勒超声诊断糖尿病患者颈动脉粥样硬化斑块的价值。方法对124例糖尿病患者（研究组）及100例健康人群（对照组）行颈动脉超声检查,测量颈动脉内-中膜厚度（IMT）和斑块指标,进行对比分析。结果研究组颈动脉IMT、斑块发生率均高于对照组（均P〈0．05）。两组斑块发生部位差异无统计学意义（P〉0．05）,均主要出现在颈动脉分叉处。结论2型糖尿病患者颈动脉粥样硬化的发病率较高,颈动脉彩色多普勒超声是动脉粥样硬化性病变筛选和诊断的理想方法。     

Age-dependent decline of blood-brain barrier P-glycoprotein expression in the canine brain

The efflux transporter P-glycoprotein serves as a major molecular gatekeeper at the blood-brain barrier. It has been suggested that a reduction of P-glycoprotein activity with aging might enhance exposure of brain tissue to exogenous and endogenous compounds thereby contributing to the development of neurodegenerative diseases.Brain tissue from owner-kept dogs renders an excellent tool to study the impact of aging on the background of variable environmental and genetic influencing factors. Therefore, we determined expression rates of P-glycoprotein in canine post-mortem tissue from 23 non-laboratory dogs. P-glycoprotein expression in the parahippocampal cortex exhibited a negative correlation with age. Analysis of the area labeled for P-glycoprotein in dogs aged >100 months revealed a 72% drop in P-glycoprotein expression as compared to young adults aged 23-36 months. Respective data from the dentate hilus and dentate gyrus indicated an earlier drop with a reduction by 77 and 80% in dogs aged 37-99 months in comparison with younger individuals. In contrast to the decline observed with aging in dogs without plaques, P-glycoprotein expression rates rather tended to increase with further aging in dogs with plaque formation.In conclusion, the thorough analysis of P-glycoprotein expression rates in non-laboratory dogs revealed a significant decline with aging. The data strongly support the concept that age-dependent changes might predispose to neurodegenerative diseases. In the early pathogenesis of Alzheimer's disease which is modelled by diffuse plaques in the canine brain, an up-regulation of P-glycoprotein might act as a compensatory mechanism to enhance Abeta efflux from the brain. Future studies are necessary to further evaluate the correlation between Abeta deposits and P-glycoprotein expression in different phases of the disease.     

Benign asbestos-related pleuropulmonary diseases

Among the non malignant diseases related to asbestos exposure, pleural plaques are the most frequent. Pleural effusion and diffuse pleural thickening, as well as asbestosis, are uncommon nowadays in asbestos-exposed screened populations. Despite the absence of any useful treatment, accurate diagnoses of these diseases are needed for two reasons: on the one hand in order to save patients from anxiety related to diagnostic and prognostic discrepancies, and on the other hand in order to ensure a proper attribution of the high social and financial compensations which are provided in France for asbestos affected patients. CT scan of the thorax is the most sensitive and specific tool for a precise diagnosis of these lesions, but it often displays minute abnormalities which may give rise to major diagnostic discordances, owing to the absence of any tomodensitometric reference in populations proved to be free from any asbestos exposure. There is a need to seek for a suitable standardization of imaging technique and interpretation, for a consensus in the characterization of CTscan abnormalities that warrant compensation, and for a careful medico-psychologic assistance for patients affected by asbestos-related benign diseases.     

Levels of dietary sodium intake: diverging associations with arterial stiffness and atheromatosis

BackgroundRecent epidemiological evidence suggests a J-shaped, rather than the classical linear, association between dietary sodium (Na) intake and cardiovascular (CV) disease. Numerous animal studies have shown the acceleration of atheromatosis in a low-salt diet but data in humans are scarce. Our aim was to test the hypothesis that in a cohort of patients who are CV-free, yet at increased CV risk, moderate Na intake is associated with lower prevalence of atheromatosis and arterial stiffening than those at very low Na intake.MethodsTwo 24-h dietary recalls were conducted to estimate Na intake. Atheromatosis (carotid and femoral plaques) was assessed by B-mode ultrasonography and arterial stiffness through tonometry (carotid-to-femoral pulse wave velocity, cf-PWV).ResultsIn 901 individuals (age: 52.4 ± 13.8 years, 45.2% males), only females at 3rd and 4th quartile of total Na intake (derived from food and discretionary salt) had significantly lower probability to present femoral plaques than those at 1st quartile (751.0 ± 215.5 mg/day), even in the full-adjusted model [0.462(0.229-0.935) and p = 0.032 3rd quartile; 0.274(0.118-0.638) and p = 0.003 4th quartile]. On the contrary, male and female individuals at 3rd quartile had significantly higher probability to present arterial stiffness (PWV >10 m/s) than those at 1st quartile [1.991(1.047-3.785) and p = 0.036].ConclusionsOverall, the present data suggest that very low Na intake is associated with: a) accelerated atheromatosis, verifying findings from animal models, and providing a possible explanation of the modern epidemiology and b) lower arterial stiffness, which is in line with previous human findings, therefore suggesting a diverging effect of Na in the two major arterial pathologies.     

Follow-up of subjects occupationally exposed to asbestos: MRI and PET scans

MRI and PET scans are not normally used for screening and follow-up of patients following occupational exposure to asbestos. These examinations usually complement the investigation of a parenchymal mass, an effusion or pleural thickening. PET and MRI have an excellent ability to define a parenchymal lesion as malignant (cancer versus rounded atelectasis) or a pleural lesion (mesothelioma versus plaque). MRI distinguishes perfectly the involvement of sub-pleural fat by bronchial carcinoma or mesothelioma. MRI, taking account of its lack of irradiation, could be regarded as suitable for potentially repeated examinations following initial screeing by CT scan. A comparative study of multidetector scanner versus MRI, including diffusion MRI could be, nevertheless, interesting. PET cannot be proposed for the follow up or for screening on account of the irradiation induced and the difficulty of access. Pleural plaques do not take up FDG. There is no specific study of asbestos related fibrosis and there is discordance between studies of other types of pulmonary fibrosis.     

微量元素锶对实验性兔动脉粥样硬化斑块形成的影响

目的研究微量元素锶对高脂喂养实验性兔动脉粥样硬化进程中斑块形成的影响。方法71只新西兰兔适应性饲养1周后,随机分为A～E五组,分别是纯水对照组15只,锶水浓度3 mg/L组14只,锶水浓度9 mg/L组16只,锶水浓度18 mg/L组12只,锶水浓度36 mg/L组14只。各组均给予高脂饲料,120 g/（只.d）喂养12周。实验开始及结束时,检测血脂四项总胆固醇（total cholesterol,TC）、三酰甘油（triglyceride,TG）、高密度脂蛋白胆固醇（high-densitylipoprotein cholesterol,HDL-C）及低密度脂蛋白胆固醇（low-density lipoprotein cholesterol,LDL-C）,Elisa法检测血清炎性因子高敏C反应蛋白（high sensitive C reactive protein,hs-CRP）、内皮素-1（endothelin-1,ET-1）、白细胞介素-2（interleukin-2,IL-2）及白细胞介素-6（interleukin-6,IL-6）。图像处理软件计算动脉粥样硬化斑块面积百分比。普通光镜观察主动脉HE染色切片,根据动脉粥样硬化四级分类标准将其分为轻、中、重度及无明显变化者,比较各组差异。结果①高脂喂养12周（第13周）后,A～E组血脂四项升高幅度呈大致递减趋势,D、E组血脂四项升高幅度明显小于A组;②锶水喂养后各组hs-CRP、ET-1、IL-2、IL-6均较喂养前显著升高（P〈0.01）,但各组间比较差异无统计学意义（P〉0.05）;③随锶水浓度增高,A～E组动脉粥样硬化斑块面积逐渐减小（P〈0.05,P〈0.01）;④病理结果示：各组实验性兔主动脉均有轻、中、重度动脉粥样硬化及无明显变化者,A组以重度者最多,E组以轻度及无明显变化者居多,总体趋势A～E组逐渐减轻。结论微量元素锶可延缓动脉粥样硬化进程中斑块形成,且锶水浓度越高,效果越显著,其作用与改善脂质代谢有关。     

强化序贯阿托伐他汀钙治疗急性脑梗死临床研究

目的观察强化、序贯阿托伐他汀钙治疗急性脑梗死的临床疗效。方法选择2012年6月～2013年6月来自本院神经内科就诊的100例脑梗死患者入组,患者均在发病后24小时内入院并符合急性缺血性脑卒中的临床诊断,随机分为治疗组与对照组,治疗组50例,对照组50例,治疗组加用阿托伐他汀钙40mg,口服,每天一次,强化治疗14天后,改20mg,口服,序贯治疗21天。对照组不使用阿托伐他汀钙。两组患者的活血化瘀、抗血小板聚集、脑细胞代谢等神经科治疗药物、康复方案相同,分别在治疗前和治疗后5周进行NIHSS（美国国立卫生院脑卒中量表）神经功能缺损评分、日常生活活动能力（activitiesofdailylivingADL）量表评分以及改良Rankinj量表（ModifiedRankinScale,MRS）评分,进行效疗评定。结果治疗后,治疗组的NIHSS评分、ADL评分、改良Rankinj量表评分均有明显降低,较对照组有显著差异（P〈0．05）。治疗组临床治疗效果优于对照组（P〈0．05）。结论强化、序贯阿托伐他汀钙治疗脑梗死有显著临床效果。     

颈动脉超声对脑梗死的筛查及应用价值分析

目的 探讨颈动脉超声在脑梗死筛查中的应用价值。方法 选取2019年3月1日-2021年3月1日于我 院行颈动脉超声检查的110例脑梗死患者纳入脑梗死组,另选取同期90例健康体检者纳入健康体检组,均行 颈动脉超声检查,比较两组颈动脉内膜中层厚度（IMT）、检出的斑块总数、斑块回声情况、软硬斑块 及溃疡斑块的情况。结果 脑梗死组IMT为（2.11±0.19）mm,高于健康体检组的（0.86±0.14）mm, 差异有统计学意义（P ＜0.05）;脑梗死组多发斑块检出率高于健康体检者,差异有统计学意义 （P＜0.05）;脑梗死组低回声或混合性回声斑块比率高于健康体检组,高回声斑块比率低于健康体检者, 差异有统计学意义（P＜0.05）;脑梗死组硬化斑块、溃疡斑块比例均高于健康体检组,差异有统计学意义 （P＜0.05）。结论 颈动脉超声可作为脑梗死筛查的有效方法,通过检查颈动脉内膜斑块比率、斑块回声 情况及斑块性质对脑梗死进行筛查,有利于为后续治疗方案的制定与实施提供准确可靠的参考依据。