Extreme liver resections with preservation of segment 4 only

AIM To evaluate safety and outcomes of a new technique for extreme hepatic resections with preservation of segment 4 only.METHODS The new method of extreme liver resection consists of a two-stage hepatectomy. The first stage involves a right hepatectomy with middle hepatic vein preservation and induction of left lobe congestion; the second stage involves a left lobectomy. Thus, the remnant liver is represented by the segment 4 only(with or without segment 1, ± S1). Five patients underwent the new two-stage hepatectomy(congestion group). Data from volumetric assessment made before the second stage was compared with that of 10 matched patients(comparison group) that underwent a single-stage right hepatectomy with middle hepatic vein preservation.RESULTS The two stages of the procedure were successfully carried out on all 5 patients. For the congestion group, the overall volume of the left hemiliver had increased 103%(mean increase from 438 m L to 890 m L) at 4 wk after the first stage of the procedure. Hypertrophy of the future liver remnant(i.e., segment 4 ± S1) was higher than that of segments 2 and 3(144% vs 54%, respectively, P 0.05). The median remnant liver volume-to-body weight ratio was 0.3(range, 0.28-0.40)before the first stage and 0.8(range, 0.45-0.97) before the second stage. For the comparison group, the rate of hypertrophy of the left liver after right hepatectomy with middle hepatic vein preservation was 116% ± 34%. Hypertrophy rates of segments 2 and 3(123% ± 47%) and of segment 4(108% ± 60%, P 0.05) were proportional. The mean preoperative volume of segments 2 and 3 was 256 ± 64 cc and increased to 572 ± 257 cc after right hepatectomy. Mean preoperative volume of segment 4 increased from 211 ± 75 cc to 439 ± 180 cc after surgery. CONCLUSION The proposed method for extreme hepatectomy with preservation of segment 4 only represents a technique that could allow complete resection of multiple bilateral liver metastases.     

Middle segmental pancreatectomy: A safe and organ-preserving option for benign and low-grade malignant lesions

AIM: To study the feasibility and safety of middle segmental pancreatectomy (MSP) compared with pancreaticoduodenectomy (PD) and extended distal pancreatectomy (EDP). METHODS: We studied retrospectively 36 cases that underwent MSP, 44 patients who underwent PD, and 26 who underwent EDP with benign or low-grade malignant lesions in the mid-portion of the pancreas, between April 2003 and December 2009 in Ruijin Hospital. The perioperative outcomes and long-term outcomes of MSP were compared with those of EDP and PD. Periop-erative outcomes included operative time, intraoperative hemorrhage, transfusion, pancreatic fistula, intraabdominal abscess/infection, postoperative bleeding, reoperation, mortality, and postoperative hospital time. Long-term outcomes, including tumor recurrence, newonset diabetes mellitus (DM), and pancreatic exocrine insufficiency, were evaluated. RESULTS: Intraoperative hemorrhage was 316.1 ± 309.6, 852.2 ± 877.8 and 526.9 ± 414.5 mL for the MSP, PD and EDP groups, respectively (P < 0.05). The mean postoperative daily fasting blood glucose level was significantly lower in the MSP group than in the EDP group (6.3 ± 1.5 mmol/L vs 7.3 ± 1.5 mmol/L, P < 0.05). The rate of pancreatic fistula was higher in the MSP group than in the PD group (42% vs 20.5%, P = 0.039), all of the fistulas after MSP corresponded to grade A (9/15) or B (6/15) and were sealed following conservative treatment. There was no significant difference in the mean postoperative hospital stay between the MSP group and the other two groups. After a mean follow-up of 44 mo, no tumor recurrences were found, only one patient (2.8%) in the MSP group vs five (21.7%) in the EDP group developed new-onset insulin-dependent DM postoperatively (P = 0.029). Moreover, significantly fewer patients in the MSP group than in the PD (0% vs 33.3%, P < 0.001) and EDP (0% vs 21.7%, P = 0.007) required enzyme substitution. CONCLUSION: MSP is a safe and organ-preserving option for benign or low-grade malignant lesions in the neck and pr     

Current surgical treatment for bile duct cancer

Since extrahepatic bile duct cancer is difficult to diagnose and to cure,a safe and radical surgical strategy is needed.In this review,the modes of infiltration and spread of extrahepatic bile duct cancer and surgical strategy are discussed.Extended hemihepatectomy,with or without pancreatoduodenectomy(PD),plus extrahepatic bile duct resection and regional lymphadenectomy has recently been recognized as the standard curative treatment for hilar bile duct cancer.On the other hand,PD is the choice of treatment for middle and distal bile duct cancer.Major hepatectomy concomitant with PD(hepatopancreatoduodenectomy)has been applied to selected patients with widespread tumors.Preoperative biliary drainage(BD)followed by portal vein embolization(PVE)enables major hepatectomy in patients with hilar bile duct cancer without mortality.BD should be performed considering the surgical procedure,especially,in patients with separated intrahepatic bile ducts caused by hilar bile duct cancer.Right or left trisectoriectomy are indicated according to the tumor spread and biliary anatomy.As a result,extended radical resection offers a chance for cure of hilar bile duct cancer with improved resectability,curability,and a 5-year survival rate of 40%.A 5-year survival rate has ranged from 24% to 39% after PD for middle and distal bile duct cancer.     

Polydatin attenuated food allergy via store-operated calcium channels in mast cell

AIM: To investigate the effect of polydatin (PD), a resveratrol glucoside, on mast cell degranulation and antiallergic activity. METHODS: After the rats were orally sensitized with ovalbumin (OVA) for 48 d and underwent PD treatment for 4 d, all the rats were stimulated by 100 mg/mL OVA for24 h and then sacrificed for the following experiments. The small intestines from all the groups were prepared for morphology examination by hematoxylin and eosin staining. We also used a smooth muscle organ bath to evaluate the motility of the small intestines. The OVA-specific immunoglobulin E (IgE) production and interleu-kin-4 (IL-4) levels in serum or supernatant of intestinal mucosa homogenates were analyzed by enzyme-linked immunosorbent assay (ELISA). Using toluidine blue stain, the activation and degranulation of isolated rat peritoneal mast cells (RPMCs) were analyzed. Release of histamine from RPMCs was measured by ELISA, and regulation of PD on intracellular Ca 2+ mobilization was investigated by probing intracellular Ca 2+ with fluo-4 fluo-rescent dye, with the signal recorded and analyzed. RESULTS: We found that intragastric treatment with PD significantly reduced loss of mucosal barrier integrity in the small intestine. However, OVA-sensitization caused significant hyperactivity in the small intestine of allergic rats, which was attenuated by PD administration by 42% (1.26 ± 0.13 g vs OVA 2.18 ± 0.21 g, P < 0.01). PD therapy also inhibited IgE production (3.95 ± 0.53 ng/mL vs OVA 4.53 ± 0.52 ng/mL, P < 0.05) by suppressing the secretion of Th2-type cytokine, IL-4, by 34% (38.58 ± 4.41 pg/mLvs OVA 58.15 ± 6.24 pg/mL, P < 0.01). The ratio of degranulated mast cells, as indicated by vehicles (at least five) around the cells, dramatically increased in the OVA group by 5.5 fold (63.50% ± 15.51% vs phosphate-buffered saline 11.15% ± 8.26%, P < 0.001) and fell by 65% after PD treatment (21.95% ± 4.37% vs OVA 63.50% ± 15.51%, P < 0.001). PD mediated attenuation of mast cell degranulation was fur     

Transrectal ultrasound and magnetic resonance imaging measurement of extramural tumor spread in rectal cancer

AIM:To evaluate the agreement between transrectal ultrasound(TRUS) and magnetic resonance imaging(MRI) in classification of ≥ T3 rectal tumors.METHODS:From January 2010 to January 2012,86 consecutive patients with ≥ T3 tumors were included in this study.The mean age of the patients was 66.4 years(range:26-91 years).The tumors were all ≥ T3 on TRUS.The sub-classification was defined by the penetration of the rectal wall:a:0 to 1 mm;b:1-5 mm;c:6-15;d: 15 mm.Early tumors as ab(≤ 5 mm) and advanced tumors as cd( 5 mm).All patients underwent TRUS using a 6.5 MHz transrectal transducer.The MRI was performed with a 1.5 T Philips unit.The TRUS findings were blinded to the radiologist performing the interpretation of the MRI images and measuring the depth of extramural tumor spread.RESULTS:TRUS found 51 patients to have an early ≥ T3 tumors and 35 to have an advanced tumor,whereas MRI categorized 48 as early ≥ T3 tumors and 38 as advanced tumors.No patients with tumors classified as advanced by TRUS were found to be early on MRI.The kappa value in classifying early versus advanced T3 rectal tumors was 0.93(95% CI:0.85-1.00).We found a kappa value of 0.74(95% CI:0.63-0.86) for the total sub-classification between the two methods.The mean maximal tumor outgrowth measured by TRUS,5.5 mm ± 5.63 mm and on MRI,6.3 mm ± 6.18 mm,P = 0.004.In 19 of the 86 patients the following CT scan or surgery revealed distant metastases;of the 51 patients in the ultrasound ab group three(5.9%) had metastases,whereas 16(45.7%) of 35 in the cd group harbored distant metastases,P = 0.00002.The odds ratio of having distant metastases in the ultrasound cd group compared to the ab group was 13.5(95% CI:3.5-51.6),P = 0.00002.The mean maximal ultrasound measured outgrowth was 4.3 mm(95% CI:3.2-5.5 mm) in patients without distant metastases,while the mean maximal outgrowth was 9.5 mm(95% CI:6.2-12.8 mm) in the patients with metastases,P = 0.00004.Using the MRI classification three(6.3%) of 48 in the MRI ab group had distant metastases,while 16(42.1%) of the 38 in the MRI cd group,P = 0.00004.The MRI odds ratio was 10.9(95% CI:2.9-41.4),P = 0.00008.The mean maximal MRI measured outgrowth was 4.9 mm(95% CI:3.7-6.1 mm) in patients without distant metastases,while the mean maximal outgrowth was 11.5 mm(95% CI:7.8-15.2 mm) in the patients with metastases,P = 0.000006.CONCLUSION:There is good agreement between TRUS and MRI in the pretreatment sub-classification of ≥ T3 tumors.Distant metastases are more frequent in the advanced group.     

Effect of atrovastatin therapy on borderline vulnerable lesions in patients with acute coronary syndrome

To evaluate the effect of atrovastatin therapy on borderline vulnerable lesions in patients with acute coronary syndrome (ACS) .Methods Patients with ACS underwent coronary angiography (CAG) and intravascular ultrasound (IVUS) investigation.Patients with culprit vulnerable borderline lesions were enrolled.No coronary inter-vention was performed on these lesions.All the patients received atrovastatin therapy for 12 months and underwent clin-ical follow-up along with IVUS follow-up.Cross section area (CSA) of the targeted lesion,CSA of the reference arter-ies (extra elastic membrane) ,minimal lumen CSA,and plaque area were measured at baseline and follow-ups.Ad-verse events included recurrent angina,recurrent myocardial infarction,revascularization and death.Results No ad-verse events was reported during follow-up period.Compared with baseline data,the level of ApoB decreased signifi-cantly at the end of the study (0.589 ± 0.136 g /L vs 0.681 ± 0.132 g /L,P = 0.03) .Both the percent diameter steno-sis and the percent area stenosis detected by CAG displayed minimal change ((62.50 ± 10.21) % vs (54.79 ± 12.35) % ,P = 0.48 and (58.61 ± 8.36) % vs (48.18 + 10.56) % ,P = 0.78) .Detected by IVUS,the minimal lu-minal CSA of the targeted lesion increased significantly (6.32 ± 2.42 mm2 vs 5.63 ± 2.51 mm2,P 0.01) ,the plaque area and CSA stenosis decreased (7.70 ± 2.19 mm2 vs 8.17 ± 2.55 mm2,P 0.05 and 56.94 ± 8.47% vs 61.4 ± 110.34% ,P 0.01) .A total of 25 soft plaques (50% ) transformed into fibrous plaque.Conclusions Atro-vastatin therapy stabilizes borderline vulnerable plaque and reverses atherosclerosis progression in patients with ACS.     

Magnetic resonance imaging: Is there a role in clinical management for acute ischemic colitis?

AIM:To validate the utility of magnetic resonance imaging(MRI) for the clinical management of acute ischemic colitis(IC).METHODS:This is a magnetic resonance(MR) prospective evaluation of 7 patients who were proved to have acute IC on the basis of clinical,endoscopic and computed tomography(CT) findings and who were imaged in our institution between February 2011 and July 2012.The mean age of the patients was 72.28 years.Abdominal CTs were obtained using a 64-detector row configuration for all patients with un-enhanced and contrast-enhanced scans,in the late arterial phase(start delay 45-50 s) and in the portal venous phase(start delay 70-80 s).The MR examinations were performed using a 1.5T superconducting magnet,using Fast Imaging Employing Steady State Acquisition and T2-weighted fast-recovery fast-spin echo sequences in axial and coronal plane.CT and MRI examinations were analysed for the presence of colonic abnormalities and associated findings.RESULTS:Segmental involvement was seen in 6 patients(85.71%),with a mean length of involvement of 412 mm(range 145.5-1000 mm).Wall thickness varied between 6 mm and 17.5 mm(mean 10.52 mm) upon CT examinations and from 5 to 15 mm(mean 8.8 mm) upon MR examinations.The MRI appearance of the colonic wall varied over the time:TypeⅠappearance with a 3 layer sandwich sign was seen in 5 out of 12 examinations(41.66%),patients underwent MR within a mean of 36 h(ranging from 1 to 54 h) after the CT examination.Type Ⅱ and Ⅲ appearance with a 2 layer sign,was seen in 4 examinations(33.33%),patients underwent MR within a mean of 420.5 h(ranging from 121 to 720 h) after the CT examination.In the remaining three MRI examinations,performed within a mean of 410 h(ranging from 99.5 to 720 h) the colonic wall appeared normal.CONCLUSION:MRI,only using precontrast images,may be used as a substitute for invasive procedures in diagnosis and follow-up of acute IC.     

会讯

Objective To study the quadrigeminal cistern obliteration on CT scans as a prognostic index for spontaneous cerebellar hematomas. Methods A series of 75 patients with spontaneous cerebellar hematoma diagnosed by CT scanning was treated. Sixteen patients had hematoma of less than 20 mm in diameter on CT scan,35 patients with 20～40 mm,and 24 patients with >40 mm hematoma in size. Obliteration of the quadrigeminal cisterns was classified on CT scans into three grade normal (n=29), compressed (n=31), or absent (n=15). Evacuation of hematoma by suboccipital craniotomy were performed in 32 patients and CT-guided stereotactic aspiration were performed in 3 cases, Seven cases were underwent ventricular drainage alone for hydrocephalus. Both suboccipital craniotomy and ventricular drainage were performed in 9 cases. Results Nineteen patients (25.3%) died and fifty-six patients was survived. Among the 75 patients, 14 of 15 patients with an absent cistern died and only one survived with vegetative state, 4 of 31 patients with an compressed cistern died, only one of 29 patients with normal cistern died. Conclusion The quadrigeminal cistern obliteration on CT scans is an accurate indicator of outcome and is useful in selecting appropriate treatment for patients with cerebellar hematomas.     

Benefits and limitations of middle bile duct segmental resection for extrahepatic cholangiocarcinoma

Background:Pancreaticoduodenectomy(PD)is a standardized strategy for patients with middle and distal bile duct cancers.The aim of this study was to compare clinicopathological features of bile duct segmen-tal resection(BDR)with PD in patients with extrahepatic cholangiocarcinoma.Methods:Consecutive cases with extrahepatic cholangiocarcinoma who underwent BDR(n=21)or PD(n=84)with achievement of R0 or R1 resection in Kobe University Hospital between January 2000 and December 2016 were enrolled in the present study.Results:Patients who underwent PD were significantly younger than those receiving BDR.The frequency of preoperative jaundice,biliary drainage and cholangitis was not significantly different between the two groups.The duration of surgery was longer and there was more intraoperative bleeding in the PD than in the BDR group(553 vs.421 min,and 770 vs.402 mL;both P<0.01).More major complications(>Clavien-DindoⅢa)were observed in the PD group(46%vs.10%,P<0.01).Postoperative hospital stay was also longer in that group(30 vs.19 days,P=0.02).Pathological assessment revealed that tumors were less advanced in the BDR group but the rate of lymph node metastasis was similar in both groups(33%in BDR and 48%in PD,P=0.24).The rate of R0 resection was significantly higher in the PD group(80%vs.38%,P<0.01).Adjuvant chemotherapy was more frequently administered to patients in the BDR group(62%vs.38%,P=0.04).Although 5-year overall survival rates were similar in both groups(44%for BDR and 51%for PD,P=0.72),in patients with T1 and T2,the BDR group tended to have poorer prognosis(44%vs.68%at 5-year,P=0.09).Conclusions:BDR was comparable in prognosis to PD in middle bile duct cancer.Less invasiveness and lower morbidity of BDR justified this technique for selected patients in a poor general condition.     

Gd-EOB-DTPA-enhanced magnetic resonance imaging features of hepatic hemangioma compared with enhanced computed tomography

AIM:To clarify features of hepatic hemangiomas on gadolinium-ethoxybenzyl-diethylenetriaminpentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) compared with enhanced computed tomography (CT). METHODS:Twenty-six patients with 61 hepatic hem- angiomas who underwent both Gd-EOB-DTPA-enhanced MRI and enhanced CT were retrospectively reviewed. Hemangioma appearances (presence of peripheral nodular enhancement, central nodular enhancement, diffuse homogenous enhancement, and arterioportal shunt during the arterial phase, fill-in enhancement during the portal venous phase, and prolonged enhancement during the equilibrium phase) on Gd-EOB-DTPA-enhanced MRI and enhanced CT were evaluated.The degree of contrast enhancement at the enhancing portion within the hemangioma was visually assessed using a five-point scale during each phase. For quantitative analysis, the tumor-muscle signal intensity ratio (SIR), the liver-muscle SIR, and the attenuation value of the tumor and liver parenchyma were calculated. The McNemar test and the Wilcoxon's signed rank test were used to assess the significance of differences in the appearances of hemangiomas and in the visual grade of tumor contrast enhancement between Gd-EOB-DTPA-enhanced MRI and enhanced CT. RESULTS:There was no significant difference between Gd-EOB-DTPA-enhanced MRI and enhanced CT in the presence of peripheral nodular enhancement (85% vs 82%), central nodular enhancement (3% vs 3%), diffuse enhancement (11% vs 16%), or arterioportal shunt (23% vs 34%) during arterial phase, or fill-in enhancement (79% vs 80%) during portal venous phase. Prolonged enhancement during equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than on enhanced CT (52% vs 100%, P 0.001). On visual inspection, there was significantly less contrast enhancement of the enhancing portion on Gd-EOB-DTPA-enhanced MRI than on enhanced CT during the arterial (3.94 ± 0.98 vs 4.57 ± 0.64, respectively, P 0.001), portal venous (3.72 ± 0.82 vs 4.36 ± 0.53, respectively, P 0.001), and equilibrium phases (2.01 ± 0.95 vs 4.04 ± 0.51, respectively, P 0.001). In the quantitative analysis, the tumor-muscle SIR and the liver-muscle SIR observed with Gd-EOB-DTPA-enhanced MRI were 0.80 ± 0.24 and 1.28 ± 0.33 precontrast, 1.92 ± 0.58 and 1.57 ± 0.55 during the arterial phase, 1.87 ± 0.44 and 1.73 ± 0.39 during the portal venous phase, 1.63 ± 0.41 and 1.78 ± 0.39 during the equilibrium phase, and 1.10 ± 0.43 and 1.92 ± 0.50 during the hepatobiliary phase, respectively. The attenuation values in the tumor and liver parenchyma observed with enhanced CT were 40.60 ± 8.78 and 53.78 ± 7.37 precontrast, 172.66 ± 73.89 and 92.76 ± 17.92 during the arterial phase, 152.76 ± 35.73 and 120.12 ± 18.02 during the portal venous phase, and 108.74 ± 18.70 and 89.04 ± 7.25 during the equilibrium phase, respectively. Hemangiomas demonstrated peak enhancement during the arterial phase, and both the SIR with Gd-EOB-DTPA-enhanced MRI and the attenuation value with enhanced CT decreased with time. The SIR of hemangiomas was lower than that of liver parenchyma during the equilibrium and hepatobiliary phases on Gd-EOB-DTPA-enhanced MRI. However, the attenuation of hemangiomas after contrast injection was higher than that of liver parenchyma during all phases of enhanced CT. CONCLUSION:Prolonged enhancement during the equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than enhanced CT, which may exacerbate differentiating between hemangiomas and malignant tumors.     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

目的 以血管内超声评价雷帕霉素洗脱支架置人术后发生支架内再狭窄及血栓形成的机械性危险因素.方法 对雷帕霉素洗脱支架置入术后发生支架内再狭窄或早期(≤30 d)血栓形成的60例患者(事件组)及无支架内再狭窄和早期血栓形成的34例患者(无事件组)的血管内超声资料进行分析比较.结果 事件组发生支架内再狭窄43例,早期血栓形成17例.与无事件组比较,事件组的最小支架面积(MSA)[(4.6±1.6)mm2比(5.8±1.6)mm2,P＜0.01]、最小支架直径[(2.2±0.5)mm比(2.5±0.4)mm,P＜0.01]和支架扩张率[(69.2±20.7)%比(80.6±17.2)%,P＜0.01]较小、纵向支架对称性较差(2.0±0.6比1.7±0.6,P＜0.05).MSA＜4 mm2(43.3%比14.7%,P＜0.01)和支架扩张率＜60%(40.7%比11.8%,P＜0.01)在事件组较常见.与无事件组比较,事件组的近段残余斑块负倚较大[(49.0±15.5)%比(38.4±17.6)%,P＜0.01].Logistic回归分析显示,MSA(OR:0.7,95%CI:0.5～0.8,P＜0.01)和近段残余斑块负荷(OR:280.7,95%CI:17.2～40 583.6,P＜0.01)是药物洗脱支架发生再狭窄或早期血栓形成的独立预测因素.结论 较小的MSA和较重的近段残余病变易导致雷帕霉素洗脱支架发生支架内冉狭窄及早期血栓形成.     

An adult-onset case of argininosuccinate synthetase deficiency presenting with atypical citrullinemia.

A 52-year-old heavy drinker presented with repeated episodes of disturbance of consciousness and an increase in serum ammonia level, triggered by excessive alcohol intake. He was diagnosed as having adult-onset citrullinemia with deficiency of hepatic argininosuccinate synthetase (ASS) activity. Cranial magnetic resonance imaging (MRI) showed high-intensity lesions in the central pons and the bilateral middle cerebellar peduncles on T2-weighted images. Although almost all cases of adult-onset citrullinemia have been reported to be enzymologically classified as type II, the serum amino acid pattern and serum level of human pancreatic secretory trypsin inhibitor (hPSTI) were atypical for type II in the present case.     

Effectiveness of Levodopa in Patients with Multiple System Atrophy and Associated Clinicopathological Features

Objective To determine the clinicopathological features of levodopa or dopamine agonist (DA) responders with multiple system atrophy (MSA), an autopsy-confirmed diagnosis is vital due to concomitant cases of MSA and Parkinson''s disease (PD). We therefore aimed to investigate the effectiveness of levodopa and DA in autopsy cases of MSA without PD and thereby clarify the clinical course, magnetic resonance imaging (MRI) findings, and pathological features of levodopa-responsive MSA cases. Methods The medical records (clinical data, MRI findings, and pathological findings) of 12 patients with MSA were obtained, and the patients were pathologically confirmed to not have PD. The clinical diagnoses of the patients were MSA with predominant parkinsonism (MSA-P) (n=7), MSA with predominant cerebellar ataxia (MSA-C) (n=4), and progressive supranuclear palsy (PSP) with a concomitant pathology of MSA (n=1). Results Nine patients received a maximum dose of 300-900 mg of levodopa as treatment, which was effective in two MSA-P patients and mildly effective in another two MSA-P patients. DA was mildly effective in one MSA-C patient. The levodopa responders showed marked autonomic dysfunction relatively late and became bedridden after 10 years. Additionally, they exhibited bilateral hyperintense putaminal rims in MRIs after six and nine years, respectively, after disease onset. One levodopa responder and one DA mild responder showed relatively mild neurodegeneration of the putamen. Conclusion Levodopa responders, despite having MSA-P, may show a relatively slow progression in putaminal neurodegeneration, and might maintain prolonged daily life activities in cases without an early occurrence of autonomic dysfunction.     

穿支动脉区梗死扩散加权成像影像学滴水征与进展性运动缺损的关系

目的对比分析急性期进展性：和无进展性穿支动脉区梗死的临床特征,并探讨穿支动脉区梗死扩散加权成像（DWI）影像学模式与进展性运动缺损（PMD）的关系。方法回顾性分析经头磁共振及头颈部CT或MR血管造影成像证实的新发穿支动脉区梗死（脑桥或大脑中动脉深穿支供血区）患者75例,根据卒中发生后5d内动态的美国国立卫生研究院卒中评分（NIHSS）情况,分为PMD组30例,NPMD组45例。采用t或,检验比较两组的危险因素、神经功能缺损程度、临床表现、梗死灶影像学模式、基底动脉、颈内动脉及大脑中动脉病变情况。结果PMD组中病灶呈滴水征的比例[20／30（66．7％）]高于NPMD组[10／45（22．2％）,X2=14．8,P〈0．01]。PMD组患者平均人院时NIHSS评分（4．60±1．40）高于NPMD（3．75±1．20,t=2．81,P〈0．01）。经Logistic回归分析发现,穿支动脉区梗死DWI影像学滴水征与PMD呈正相关（OR3．0,95％CI1．25—7．17,P〈0．05）。结论DWI影像学滴水征是穿支动脉区梗死影像学模式特征之一,影像学滴水征或可作为进展性卒中或早期神经功能恶化的预测指标。     

多系统萎缩与帕金森病患者肺及呼吸肌功能检测意义

目的 评估多系统萎缩(MSA)和帕金森病(PD)患者的呼吸功能.方法 对临床诊断的16例MSA、20例PD患者及17例年龄、性别匹配的正常对照者行肺及呼吸肌功能测定.结果 MSA组较PD组肺一氧化碳弥散量(DLCO)占预测值百分比降低[(62.86±15.66)％比(76.67±18.98)％,P＜0.05].两组最大吸气压(MIP)占预测值百分比[MSA组(39.08±22.99)％、PD组(39.83±24.83)％比对照组(57.44±19.90)％,P＜0.05]、最大呼气压(MEP)占预测值百分比均较对照组均降低[MSA组(49.59±22.97)％、PD组(49.26±22.86)％比对照组(77.10±21.46)％,P＜0.001].结论 临床相对常见神经系统变性病MSA和PD均存在呼吸功能受累,以呼吸力学功能障碍为著;MSA患者可能还存在肺换气功能障碍.应重视神经变性病患者呼吸功能.     

Probable sporadic Creutzfeldt-Jakob disease with valine homozygosity at codon 129 and bilateral middle cerebellar peduncle lesions

We describe a 67-year-old Japanese man with probable sporadic Creutzfeldt-Jakob disease (CJD) who had valine homozygosity at codon 129, a rarity in the Japanese. T2-weighted magnetic resonance imaging (MRI) detected high-intensity lesions in the bilateral middle cerebellar peduncles and basal ganglia as well as cerebellar and cortical atrophy. He developed cerebellar ataxia and subsequent mental deterioration, myoclonus, and periodic synchronous discharge as shown in an electroencephalogram. Cerebrospinal fluid examination showed a high level of neuron-specific enolase and a positive immunoassay for the 14-3-3 protein. He died of pneumonia 10 months after the initial symptoms appeared. Whether or not the genetic polymorphism increased his susceptibility to sporadic CJD is not clear because valine homozygosity at codon 129 is less than 1% in the normal Japanese population. Although there is no convincing evidence in the present case, the MRI findings of cerebellar peduncle changes, which are rare in CJD, suggest a kind of degeneration, demyelination, or both.     

牙周基础治疗对老年牙周疾病患者血清炎性标记物的影响

目的 观察患有牙周病的老年人经过牙周基础治疗后,其冠心病相关血清炎性标记物的变化.方法 选择老年牙周病患者52例,记录其探诊深度(probing depth,PD)、附着水平(attachment level AL)、C-反应蛋白(C-reactive protein,CRP)和白细胞介素-6(interleukin-6 IL-6)水平.牙周基础治疗后3个月、6个月再次检查牙周临床指标,测定CRP和IL-6水平,比较治疗前后各项指标的变化.结果 治疗后6个月,PD和AL值分别为(5.9±1.1)mm和(6.8±1.0)mm,与治疗前[分别为(7.5±1.2)mm和(8.4±1.1)mm]比较,差异有统计学意义(均P＜0.05).CRP和IL-6分别为(1.5±0.2)mg/L和(1.6±0.5)ng/L,与治疗前[分别为(2.0±0.3)mg/L和(1.9±0.4)mg/L]比较,差异有统计学意义(分别为P＜0.01,P＜0.05).结论 牙周基础治疗能降低老年牙周疾病患者冠心病相关血清炎性标记物CRP和IL-6的水平.

Abstract：

Objective To ascertain serum inflammatory markers could be modified following treatment of periodontal disease in elderly patients. Methods The probing depth (PD), clinical attachment level (AL), C-reactive protein (CRP), interleukin-6 (IL-6) were determined. And then fifty-two elderly periodontitis patients underwent a standard phase of non-surgical periodontitis treatment (consisting of oral hygiene instructions and subgingival scaling and root planning). After three and six months, PD, AL, CRP and IL-6 were determined again and compared to the baseline. Results Six months after treatment, significant reductions in PD [(5.9±1.1) mm vs. (6.8±1.0) mm, P＜0.05], AL [(1.3±0.9) mm vs.(8.4±1.1) mm, P＜0.05], CRP [(1.5±0.2) mg/L vs. (2.0±0.3) mg/L, P＜0.01] and IL-6 [(1.6±0.5) ng/L vs. (1.9±0.4) ng/L, P＜0.05] were observed. Conclusions Treatment of chronic periodontitis can decrease the levels of serum inflammatory markers in elderly patients.     

自MR-T2图像勾画肝细胞癌患者放疗靶区精度研究

目的 研究MRI-T2加权像扫描(MR-T2)图像对肝细胞癌(HCC)患者放疗靶区勾画精度的影响。方法 2019年5月～2020年5月我院诊治的36例HCC患者,在接受放疗前行CT和MRI检查,勾画大体肿瘤体积(GTV),经形变配准后获得大体内靶区(IGTV)和计划靶区(PTV)。应用Reg Refine图像形变配准。记录2%、50%、95%和98%PTV体积的受照剂量(分别记为D2、D50、D95和D98)。结果 经Reg Refine配准后,门静脉x、y和z轴向位移分别为(0.5±0.2)mm、(0.8±0.3)mm和(0.7±0.3)mm,显著小于自动形变配准【分别为(2.9±0.4)mm、(4.8±0.5)mm和(3.9±0.6)mm,P<0.05】,腹腔干x、y和z轴向位移分别为(0.8±0.4)mm、(0.7±0.3)mm和(0.6±0.3)mm,显著小于自动形变配准【分别为(3.2±0.5)mm、(3.0±0.7)mm和(2.4±0.4)mm,P<0.05】;形变配准后GTV和IGTV分别为(379.8±103.9)cm³和(430.1±120.6)cm³,显著大于形变配准前【分别为(330.4±92.8)cm³和(375.2±95.5)cm³,P<0.05】, PTV为(542.7±130.2)cm³,显著小于形变配准前【(690.2±150.3)cm³,P<0.05】;形变配准后D2、D50、D95和D98靶区剂量分别为(56.0±12.9)Gy、(53.0±6.8)Gy、(49.8±5.3)Gy和(52.9±8.1)Gy,与形变配准前【(55.7±13.2)Gy、(52.8±7.3)Gy、(50.1±4.6)Gy和(53.3±7.7)Gy】比,差异均无统计学意义(P>0.05);形变配准后肝脏V5、V10、V20、V30和V40受照剂量分别为(52.7±9.4)%、(32.0±5.6)%、(20.1±4.6)%、(13.5±5.2)%和(7.4±3.8)%,显著低于配准前【分别为(58.2±10.1)%、(39.3±7.5)%、(24.8±5.8)%、(17.2±4.4)%和(10.1±3.9)%,P<0.05】。结论 应用MR-T2图像勾画HCC放疗靶区有助于扩大靶区范围和运动轨迹,提高肝癌靶区勾画精度。     

Diffusion Tensor Imaging (DTI) and its clinical correlates in drug naïve Wilson’s disease

The purpose is to evaluate white matter (WM) abnormalities in Wilson’s disease (WD) using the technique of diffusion tensor imaging (DTI). The prospective case–control study comprised of 15 drug-naïve patients with WD and 15 controls. The phenotype of subjects was evaluated. The DTI/conventional MRI was acquired (3T MRI): Fractional anisotropy (FA) and mean diffusivity (MD) values were extracted from regions of interest placed in pons, midbrain, bilateral frontal and occipital cerebral white matter, bilateral internal capsules (IC), middle cerebellar peduncles (MCP) and corpus callosum (CC). Six patients showed lobar WM signal changes on T₂-Weighted (T2W)/Fluid attenuation inversion recovery (FLAIR) images while remaining had normal appearing WM. MD was significantly increased in the lobar WM, bilateral IC and midbrain of WD patients. FA was decreased in the frontal and occipital WM, bilateral IC, midbrain and pons. Normal-appearing white matter on FLAIR images showed significantly increased MD and decreased FA values in both frontal and occipital lobar WM and IC compared with those in controls. Correlation of clinical scores and DTI metrics revealed positive correlation between neurological symptom score (NSS) and MD of anterior limb of right internal capsule, Chu stage and MD of frontal and occipital WM. Negative correlation was observed between the Modified Schwab and England Activities of Daily Living (MSEADL) score and MD of bilateral frontal and occipital WM and IC. This is the probably the first study to reveal widespread alterations in WM by DTI metrics in drug naïve WD. DTI analysis revealed lobar WM abnormalities which is less frequently noted on conventional MRI and suggests widespread WM abnormalities in WD. It may be valuable in assessing the true extent of involvement and therefore the severity of the illness.     

血管内超声对急性冠状动脉综合征临界病变治疗决策的影响

目的 在血管内超声指导下评价急性冠状动脉综合征(ACS)患者易损斑块介入治疗和单纯药物治疗的疗效和安全性.方法 入选ACS经冠状动脉造影显示狭窄程度在50%-70%的临界狭窄病变患者100例,采用完全随机方法分为介入治疗组和药物治疗组,每组各50例.其中男78例,女22例,年龄在43～74(60.4±14.1)岁.每组再根据血管内超声(IVUS)测定的罪犯病变最小血管腔面积(MLA)分为2个亚组,即MLA≥4 mm2组和MLA＜4 mm2组.对比分析在IVUS指导下临界病变易损斑块介入治疗和单纯药物治疗两组患者住院期间和随访10～12个月的疗效.结果 介入治疗组50例中40例在术后10～12个月进行了冠状动脉造影和IVUS复查,IVUS味发现局部支架内血栓征象,支架内增生内膜负荷量与术后即刻比较差异无统计学意义.随访时最小支架内管腔面积与术后即刻相比差异亦无统计学意义[(8.98±2.12)mm2比(10.12±1.15)mm2,P＞0.05].药物治疗组50例中有9例在随访期间行经皮冠状动脉介入治疗,35例在术后10～12个月进行了冠状动脉造影和IVUS复查,IVUS结果与治疗前比较,狭窄处的MLA较大[(7.32±1. 42)mm2比(4.98±0.89)mm2,P＜0.01],斑块面积较小[(7.70±2.09)mm2比(10.01±2.55)mm2,P＜0.05],斑块负荷较低[(55.94±8.36)%比(67.97±9.36)%,P＜0.01],斑块内低回声区面积较小[(2.27±0.79)mm2比(4.08±0.80)mm2,P＜0.01].介入治疗组MLA≥4 mm2亚组中1例术后第2天前降支支架急性血栓形成.药物治疗组MLA＜4 mm2亚组中9例[37.5%(9/24)]患者在临床随访期间仍反复发作心绞痛,行介入治疗后未再发心绞痛.结论 IVUS测定MLA≥4.0 mm2的ACS 临界病变患者经严格药物治疗可延缓易损斑块进展,使斑块趋于稳定.

Abstract：

Objective To compare the efficacy and safety between the interventional and conservative treatment options for borderline vulnerable plaque lesion in acute coronary syndrome (ACS)patients by intravascular ultrasound(IVUS). Methods A total of 100 ACS patients [78 male, age 43 -74 (60. 4 ± 14. 1 ) years] undergoing coronary angiography (CAG) with borderline lesion ( coronary artery stenosis between 50% - 70% ) were enrolled in May 2007 to February 2009, who were randomly divided into PCI group (50 patients) and conservative therapy group (50 patients). According to minimal lumen area (MLA) detected by IVUS, patients were further divided into MLA ≥4. 0 mm2 sub-group and MLA ＜4.0 mm2 sub-groups. Outcomes during hospitalization and after 10- 12 month follow-up were compared. Results IVUS was performed in 40 patients at 10 - 12 months post PCI, there was no in-stent thrombosis and the extent of stent neointimal hyperplasia was comparable as at the time of immediately post PCI. IVUS was performed in 35 patients at 10 - 12 months post conservative therapy, IVUS results showed that MLA increased signilicantly [(7.32 ± 1.42 ) mm2 vs. (4. 98 ± 0. 89 ) mm2, P ＜ 0. 01], while plaque area [(7.70 ±2.09)mm2 vs. (10.01 ±2.55)mm2,P＜0.05], plaque burden [(55.94 ±8.36)% vs. (67.97 ±9. 36) %] and low echo area [(4. 08 ± 0. 80) mm2 vs. (2. 27 ± 0. 79) mm2] were significantly decreased at follow up compared to those as baseline ( all P ＜0. 01 ). There was one patient in PCI group with MLA ≥4. 0 mm2 developed acute in-stent thrombosis in left anterior descending artery two days after the procedure and 9 patients in conservative therapy and MLA ＜ 4. 0 mm2 group received PCI due to recurrent angina pectoris during follow-up. Conclusions For the borderline lesion with MLA≥4.0 mm2 detected by IVUS, adequate medication could effectively attenuate and or reverse the plaque progression and stabilize plaque.