磁共振成像与计算机断层扫描影像学检查对中老年强直性脊柱炎髋关节病变的诊断价值

目的分析磁共振成像(MR)与计算机断层扫描(CT)影像学检查对中老年强直性脊柱炎(AS)髋关节病变的诊断价值。方法对46例中老年AS疑似髋关节病变患者进行CT及MRI检查,对比分析两种检查方式影像学表现特点,并对比两种检查方式检出敏感性及骨质异常检出率。结果 CT检查AS髋关节病变主要表现包括髋臼囊变、髋臼关节面破坏、股骨近端骨质硬化、髋臼骨质硬化、关节间隙均匀狭窄及硬结节; MRI检查AS髋关节病变主要表现包括髋臼囊变、髋臼脂肪沉积、股骨头脂肪沉积、髋臼坏死骨髓水肿、股骨近端坏死骨髓水肿及关节囊积液。在各髋关节病变分级患者中,两种检查方式诊断符合率差异无统计学意义(P>0. 05),而在总体患者诊断方面,MRI检查符合率明显高于CT检查(P<0. 05)。两种检查方式在骨质硬化及骨质侵蚀检出率差异无统计学意义(P>0. 05)。结论 CT及MRI检查诊断中老年AS髋关节病变均具有良好的价值,其中MRI检查能够准确反映髋关节早期炎性病变,从而有助于早期诊断率的提高。     

骨盆正位像评价强直性脊柱炎髋关节病变临床意义研究

目的总结强直性脊柱炎(ankylosing spondylitis,AS)患者骨盆正位像中髋关节病变的特点,以及骨盆正位像在评价AS患者髋关节病变中的意义。方法对2010-01-01—2015-12-31期间中国医科大学附属第一医院风湿免疫科门诊就诊或住院的79例AS患者进行骨盆正位像检查,详细分析髋关节病变的特征,比较髋关节有无异常患者的临床特点,并借助统计学方法对数据和研究结果进行分析。结果 48例(60.8%)患者骨盆正位像提示髋关节出现异常改变,其中最具特征的表现为继发于肌腱端炎的慢性改变和髋关节间隙变窄。与髋关节正常组患者比较,异常组患者疾病病程更长[(9.1±6.2)年对(5.5±6.3)年,P=0.02],血清C-反应蛋白(C-reactive protein,CRP)水平更高[(34.8±34.4)mg/L对(19.1±16.5)mg/L,P=0.02];异常组患者中40例患者伴有臀部疼痛,而正常组中仅有13例患者主述臀部疼痛,两组比较差异有统计学意义(40/48对13/31,P0.01)。另外,64例患者出现典型的骶髂关节的改变,包括局限性或弥漫的骶骨和髂骨硬化、侵蚀;伴或不伴关节间隙的改变、甚至间隙消失。结论骨盆正位像作为最基本的影像学手段,反映了AS患者髋关节病变的特征,对理解AS的髋关节病变具有重要意义。建议将骨盆正位像作为筛查髋关节疾病的常规检查方法。     

髋关节结核的CT表现

目的 探讨髋关节结核的CT表现。方法 收集在我院检查确诊的髋关节结核的患者41例。分析其CT表现并比较儿童和成人的影像差别。结果 髋关节结核的主要CT表现为骨质破坏（90．3％），臀肌及下肢肌肉萎缩（87．7％），软组织肿胀及脓肿（75．6％），关节间隙增宽或狭窄（73．1％），关节腔积液（63．5％），关节周围骨质疏松（46．3％）。儿童出现关节积液的比例明显高于成人。结论 CT对髋关节结核的诊断具有重要的价值。     

儿童型强直性脊柱炎的早期诊断--24例前瞻性分析

目的：探讨儿童型强直性脊柱炎(JAS)的临床表现及早期诊断方法。方法：对24例JAS进行前瞻性分析及随访研究，结果：24例患者中，男性22例，女性2例，发病年龄8～15岁，平均12．5岁，63%为12～15岁，63%以外周关节病为首发症状，25％以关节受累发病，仪2例(9％)以腰痛为首发症状就诊时11例(46%)符合修订的AS纽约标准，21例(88％)符合汕头AS诊断标准。另3例(13％)经2年随访满足汕头AS诊断标准。结论：90％左右JAS以外周关节或髋关节受累为首发症状2001年汕头AS诊断标准对JAS诊的敏感性较修订的纽约标准高。     

髋骨关节结核的CT表现

目的探讨髋骨关节结核的CT表现。方法收集确诊的髋骨关节结核的患者41例，分析其CT表现并比较儿童和成人的影像差别。结果髋骨关节结核的主要CT表现为骨质破坏（90．3％），患侧臀肌及下肢肌肉萎缩（87．7％），软组织肿胀及脓肿（75．6％），关节间隙增宽或狭窄（73．1％），关节腔积液（63．5％），关节周围骨质疏松（46．3％）。儿童出现关节腔积液的比例明显高于成人。结论CT对髋关节结核的诊断具有重要的价值。     

强直性脊柱炎胸腰椎后凸畸形与髋关节病变的相关性分析

目的 探讨强直性脊柱炎(AS)胸腰椎后凸畸形患者髋关节病变的危险因素.方法 本组66例AS患者,男性57例,女性9例,年龄17～53岁,平均(33±10)岁,其中50例为AS伴胸腰椎后凸畸形患者(A组),16例为无胸腰椎后凸畸形AS患者(B组).收集患者的临床资料、实验室检查、影像学资料及生活质量评估量表.临床资料包括年龄和病程;实验室检查包括:红细胞沉降率(ESR)、C反应蛋白(CRP)和人类白细胞抗原(HLA)-B27;影像学资料包括:胸腰椎后凸Cobb角(GK)、髋关节病变评分(BASRI-hip);生活质量评估量表包括:AS疾病活动性量表(BASDAI)、AS功能量表(BASFI)和Oswestry功能障碍量表(ODI).运用BASRI-hip对髋关节病变进行评分,并定义评分大于2分为有髋关节病变,定义有髋关节病变组为C组,无髋关节病变组为D组.统计学处理采用独立样本t检验和Spearman相关性分析以及多元回归分析.结果 A组50例胸腰椎后凸畸形AS患者中,27例(54％)发生髋关节影像学病变,B组16例无胸腰椎后凸畸形AS患者,3例(19％)发生髋关节影像学病变(OR=5.08).多元回归分析显示GK和病程是AS胸腰椎后凸畸形患者的髋关节病变的高危因素.相关性分析显示BASFI评分与AS患者的髋关节病变显著相关(r=0.345,P=0.014).结论 较大GK和较长病程是AS胸腰椎后凸畸形患者髓关节病变的高危因素,AS患者的髋关节病变显著降低其生活质量.     

重视强直性脊柱炎关节外表现的诊治

强直性脊柱炎( ankylosing spondylitis,AS)是一种慢性炎症性疾病,主要侵犯骶髂关节、脊柱等中轴关节,也可出现外周关节受累和关节外表现.长期以来,诊断AS主要依据脊柱关节表现,治疗上也大都关注脊柱关节病变而忽视了关节外表现.事实上,AS关节外表现非常常见,42％的AS患者有1个或多个关节外表现[1].眼、消化道、皮肤、心血管、肾脏、肺脏等系统均可累及.从近几年欧美指南的演变不难看出,AS关节外表现逐步受到关注和重视.1984年AS纽约标准中只包括中轴关节表现,而2009年血清阴性脊柱关节病(SPA)新标准则将部分关节外表现,即眼葡萄膜炎、炎性肠病(IBD)和银屑病纳入了AS早期诊断的分类标准.     

强直性脊柱炎骶髂关节病变的X线CT磁共振成像比较分析

强直性脊柱炎 (ankylosingspondylitis ,AS)为一种原因未明的以中轴骨、关节慢性炎症为主的全身性病变 ,属于风湿性疾病的范畴。在AS的骨关节病变中 ,骶髂关节是较早且几乎必受累及的部位 ,全面认识AS骶髂关节病变的影像学改变 ,对于AS的早期诊断具有重要意义。本文就 91例AS骶髂关节病变的X线平片、CT和磁共振成像 (MRI)影像学表现进行了分析和比较 ,同时初步探讨了AS骶髂关节病变的MRI早期影像诊断。1　资料与方法1 1　临床资料 :本组AS病例共 91例 ,男性 6 2例 ,女性 2 9例 ,年龄 17～ 37岁 ,平均 2 1 7岁 ;病程 5个月～ 9年 ,…     

儿童结核性脑膜炎CT影像临床研究

目的 探讨CT扫描对儿童结核性脑膜炎的诊断价值。方法 210例儿童结核性脑膜炎，CT平扫210例，增强126例，130例患儿复查2～4次。结果 CT正常22例，异常188例，显示有7种病变类型分别是渗出性病变99例(47．1％)，脑积水115例(54．8％)，结核球51例(24．3％)，脑萎缩40例(19．0％)，脑血管炎及脑梗死26例(12．3％)，硬膜下积液12例(5．7％)，钙化11例(5．2％)，其中一种病变者82例(43．5％)，以渗出病变、脑积水、结核球占多数，两种病变同时存在者75例(40．3％)，3种病变同时存在者31例(16．2％)，以渗出性病变合并脑积水、结核球或脑积水合并脑萎缩、脑梗死居多。结论 CT在诊断儿童结核性脑膜炎病变部位范围和程度提供准确的诊断依据及对预后估计治疗效果判断具有非常重要价值。渗出性病变是儿童结脑最主要及特征性表现，脑积水及局灶状脑梗死为其典型表现，脑沟增宽可作为脑萎缩早期的唯一征象，增强CT显示脑膜血管异常强化及结核球敏感性明显高于CT平扫。结脑所致脑积水的程度与病程成正比，与患儿的年龄成反比。     

超声评估附着点病变的研究现状及进展

脊柱关节炎(SPA)是以中轴、外周关节以及关节周围组织慢性进展性炎症为主要表现的一组疾病,该组疾病以强直性脊柱炎(ankylosing spondylitis,AS)为原型,还包括反应性关节炎、银屑病关节炎(PsA)、炎性肠病相关性关节炎等.附着点炎是指肌腱、韧带、关节囊插入骨部位的炎症,是SpA的特征性改变.SpA患者附着点部位的炎症渐发展为骨破坏及新骨形成,后者导致韧带及关节强直.研究附着点病变的发展规律,对于了解SpA的发病及转归有重要意义.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.