痛风的影像学研究进展

影像学检查可以帮助临床医师评价痛风.X线成像只能显示慢性痛风进展期的典型变化.CT可能是评价痛风骨改变和痛风石的最好方法,双源CT可以评估全身周围关节的尿酸盐总沉积量.MRI适合评估软组织、滑膜厚度和炎性反应,对痛风的早期病变敏感性很高,也能够较好的显示痛风石.超声检查可以评价软骨、软组织、尿酸盐沉积和滑膜炎性反应.核医学有助于在细胞和分子层面理解痛风性关节炎的发病机制.     

影像学检查在痛风关节炎中的应用

［摘要］　高尿酸血症和痛风关节炎的发病率逐年增高,在我国年轻化的趋势明显。近年来,包括超声、CT和MRI等影像学技术越来越多地应用于痛风关节炎的诊断和鉴别,这些技术的普及不仅提高了诊断的敏感性和特异性,还可以有效评估疾病的严重程度、尿酸盐沉积的范围以及监测患者降尿酸治疗的情况。多年来,除了血尿酸水平的测定以外,关节X线检查一直是诊断痛风关节炎的主要辅助手段,但是由于敏感性差,不利于早期诊断。近年来随着双能CT、超声和MRI技术在临床上的不断推广,大大提高了痛风关节炎诊断的敏感性和特异性,同时也使得痛风关节炎的早期规范化诊治水平明显改善。     

肝纤维化的影像学诊断现状

肝纤维化是临床各类慢性肝病进行性发展的结果,可进一步发展为致死率较高的肝硬化及肝癌。早期诊断肝纤维化对疾病的逆转有着重要意义。目前,肝穿刺活组织检查是诊断肝纤维化的"金标准",但由于其有诸多缺点而无法作为常规筛查手段。近年来,各种无创影像学检查技术取得了一定的进展,就CT、MRI、核医学、超声等对肝纤维化诊断的研究现状作一综述。     

新型影像学技术在痛风诊治中的应用进展

痛风诊断的金标准依赖于典型的临床表现以及关节滑液或痛风石中发现尿酸盐结晶。新型影像学技术如超 声、双能CT 正逐渐取代有创性的滑液检查,成为辅助诊断的有力工具,也期待未来这些新技术能在痛风的治疗随访 中发挥更大的作用。     

肝纤维化的影像学研究进展

长期以来,临床多以肝活检组织病理学检查作为诊断肝纤维化的金标准,但其有一定的创伤性及盲目性。超声、CT、MRI及核医学等多种影像学检查在肝纤维化、肝硬化的诊断、治疗及预后的评价方面发挥着重要的作用,它们各有其优缺点,应进行合理的选用及相互对照验证。     

骨关节炎影像学研究进展

骨关节炎(osteoarthritis,OA)是最常见的一种关节疾病,以关节软骨损害为主,还可累及软骨下骨、滑膜、韧带、肌腱、关节囊等,甚至影响到整个关节,导致关节软骨发生退变、纤维化、断裂、溃疡等病变。0A主要影响老年人,是老年人肢体残疾和生活水平下降的主要原因。随着世界人口老龄化和肥胖率的增加,0A的患病率越来越高。     

痛风研究进展

痛风是嘌呤代谢紊乱、尿酸排泄障碍所致血尿酸增高的一组疾病。随着人们生活水平的提高和饮食结构的改变,高尿酸血症和痛风的发病率逐年上升。近年来国内外对本病研究日益增多,现将有关进展综述如下。流行病学     

肝纤维化的影像学研究进展

肝纤维化如能作出早期诊断、及时评估其病情的进展情况,对于慢性肝病的治疗和预后有重要意义. 影像学检查已开始从过去单纯的形态学检测向功能形态学检测方面和分子影像学检测方面转变,使其在肝纤维化检测和评估中发挥了更多的作用.     

防治痛风的药物研究进展

秋水仙碱、非甾体类抗炎药(NSAIDs)、促肾上腺皮质激素、糖皮质激素仍为治疗痛风急性发作的有效药物。小剂量秋水仙碱预防给药,能明显降低急性痛风的发生率。环氧化酶-2抑制剂胃肠道副反应降低,疗效与传统的NSAIDs相近。冰敷、黑皮质素3型受体激动剂也能缓解急性痛风的症状。别嘌呤醇f、ebuxostat、奥昔嘌醇通过抑制黄嘌呤氧化酶(XOD)减少尿酸生成,对别嘌呤醇过敏者可以采用脱敏疗法。非诺贝特可以增强别嘌呤醇的降尿酸作用,重组尿酸氧化酶降尿酸的作用强于别嘌呤醇。传统中药黄柏及二妙丸等能抑制XOD,有较强的降尿酸作用。     

原发性高尿酸血症及痛风易感基因研究进展

原发性高尿酸血症及痛风为多基因遗传性疾病.近期对该病进行的全基因组关联分析(GWAS)发现了多个与尿酸排泄及痛风发病相关的基因,为该病的病因学研究、疾病风险预测及防治提供了新思路.本文就此作一综述.

Abstract：

Primary hyperuricemia and gout are multifactorial conditions with strong genetic components. recently genome-wide association studies (GWAS) have revealed that several genes are related to primary hyperuricemia and gout which offers a thought for the research into the etiology, disease risk prediction, and prevention and treatment of this disease.     

Recent progress in abdominal CT imaging]

In this pictorial review, we introduce recent technical development of CT scanning in the imaging of the abdominal organs, namely, the gastrointestinal tract, colon, liver, biliary tract, and pancreas. With multidetector- row CT scanner, we can depict the abdominal organs by doing thin-section volumetric images and displaying the images in transverse axial, coronal, and sagittal plane reconstruction with isotropic images. We can see the interior of the abdomen directly as in the operating theatre. In addition, we can see the interior of the gastrointestinal tract as if we are flying through a tunnel.     

Magnetic resonance imaging for lung cancer screen

Lung cancer is the leading cause of cancer related death throughout the world. Lung cancer is an example of a disease for which a large percentage of the high-risk population can be easily identified via a smoking history. This has led to the investigation of lung cancer screening with low-dose helical/multi-detector CT. Evidences suggest that early detection of lung cancer allow more timely therapeutic intervention and thus a more favorable prognosis for the patient. The positive relationship of lesion size to likelihood of malignancy has been demonstrated previously, at least 99% of all nodules 4 mm or smaller are benign, while noncalcified nodules larger than 8 mm diameter bear a substantial risk of malignancy. In the recent years, the availability of high-performance gradient systems, in conjunction with phased-array receiver coils and optimized imaging sequences, has made MR imaging of the lung feasible. It can now be assumed a threshold size of 3-4 mm for detection of lung nodules with MRI under the optimal conditions of successful breath-holds with reliable gating or triggering. In these conditions, 90% of all 3-mm nodules can be correctly diagnosed and that nodules 5 mm and larger are detected with 100% sensitivity. Parallel imaging can significantly shorten the imaging acquisition time by utilizing the diversity of sensitivity profile of individual coil elements in multi-channel radiofrequency receive coil arrays or transmit/receive coil arrays to reduce the number of phase encoding steps required in imaging procedure. Compressed sensing technique accelerates imaging acquisition from dramatically undersampled data set by exploiting the sparsity of the images in an appropriate transform domain. With the combined imaging algorithm of parallel imaging and compressed sensing and advanced 32-channel or 64-channel RF hardware, overall imaging acceleration of 20 folds or higher can then be expected, ultimately achieve free-breathing and no ECG gating acquisitions in lung cancer MRI screening. Further development of protocols, more clinical trials and the use of advanced analysis tools will further evaluate the real significance of lung MRI.     

The role of imaging in osteoarthritis

Osteoarthritis (OA) is the most prevalent joint disorder with no approved disease-modifying treatment available. The importance of imaging in assessing all joint structures involved in the disease process, including articular cartilage, meniscus, subarticular bone marrow, and synovium for diagnosis, prognostication, and follow-up, has been well recognized. In daily clinical practice, conventional radiography is still the most commonly used imaging technique for the evaluation of a patient with known or suspected OA and radiographic outcome measures are still the only approved end point by regulatory authorities in clinical trials.The ability of magnetic resonance imaging (MRI) to visualize all joint structures in three-dimensional fashion including tissue ultrastructure has markedly deepened our understanding of the natural history of the disease. This article describes the roles and limitations of different imaging modalities for clinical practice and research in OA, with a focus on radiography and MRI and an emphasis on the knee joint.     

Sirt1 功能的研究进展

Sirt1是迄今为止在哺乳动物细胞中发现的与沉默调控基因Sir2同源性最高的同系物,是一个NAD依赖的去乙酰化酶。它参与了众多基因转录、能量代谢以及细胞衰老过程的调节。Sirt1不仅可以促进脂质动员与肝脏糖异生,还能调控胰岛β细胞的胰岛素分泌功能。此外,Sirt1还是一个内源性的凋亡抑制因子。     

艾塞那肽临床研究新进展

肠促胰素是肠道在进餐后分泌的激素,能促进胰岛素的分泌.胰高糖素样肽1(GLP-1)是主要的肠促胰素,通过葡萄糖依赖的方式促进胰岛素分泌、抑制胰高糖素分泌以及延缓胃排空、增加饱腹感等作用维持体内血糖的稳定.另外,在2型糖尿病患者中,它还可改善β细胞功能.但是天然的GLP-1半寿期很短,无法用于临床治疗.艾塞那肽是从希拉巨蜥唾液中分离得到的一种多肽,它可与GLP-1受体结合,产生与GLP-1相似的生理效应,但它的半寿期远比GLP-1长,因此每天两次皮下注射即可产生满意的疗效.临床研究显示艾塞那肽可显著降低2型糖尿病患者HbA_(1C)、空腹血糖及餐后血糖,并降低体重.动物研究表明艾塞那肽还可改善β细胞功能、增加β细胞量.由于GLP-1受体激动剂的独特疗效,新近的糖尿病治疗指南已将其列入2型糖尿病的治疗药物.     

颅内静脉畸形的CT和MR诊断

目的　评价CT、MR在诊断颅内静脉畸形中的价值与限度。方法 :5例经DSA证实的颅内静脉畸形病例 ,全部行CT平扫加增强和MR平扫检查。结果　CT和MR显示 2例幕下出血病例 ,表现为高密度或T1及T2W高信号 ,CT增强和MR显示了其余所有病灶 ,表现为条状或放射状高密度或低信号即“海蛇头”引流静脉影像特征。结论　CT增强和MR平扫是诊断和随访颅内静脉畸形的有效方法 ,对于无症状病例的筛选 ,MR平扫是首选。     

Recent advances in thoracic x-ray computed tomography for pulmonary imaging

The present article reviews recent advances in pulmonary computed tomography (CT) imaging, focusing on the application of dual-energy CT and the use of iterative reconstruction. Dual-energy CT has proven to be useful in the characterization of pulmonary blood pool in the setting of pulmonary embolism, characterization of diffuse lung parenchymal diseases, evaluation of thoracic malignancies and in imaging of lung ventilation using inhaled xenon. The benefits of iterative reconstruction have been largely derived from reduction of image noise compared with filtered backprojection reconstructions which, in turn, enables the use of lower radiation dose CT acquisition protocols without sacrificing image quality. Potential clinical applications of iterative reconstruction include imaging for pulmonary nodules and high-resolution pulmonary CT.     

Recent developments in diet and gout

PURPOSE OF REVIEW: Gout is the most common inflammatory arthritis in men, affecting approximately 1-2% of adult men in Western countries. United States gout prevalence has approximately doubled over the past two decades. In recent years, key prospective epidemiological and open-labeled dietary studies, coupled with recent advances in molecular biology elucidating proximal tubular urate transport, have provided novel insights into roles of diet and alcohol in hyperuricemia and gout. This review focuses on recent developments and their implications for clinical practice, including how we advise patients on appropriate diets and alcoholic beverage consumption. RECENT FINDINGS: Studies have observed an increased risk of gout among those who consumed the highest quintile of meat, seafood and alcohol. Although limited by confounding variables, low-fat dairy products, ascorbic acid and wine consumption appeared to be protective for the development of gout. SUMMARY: The most effective forms of dietary regimen for both hyperuricemia and gout flares remains to be unidentified. Until confirmed by a large, controlled study, it is prudent to advise patients to consume meat, seafood and alcoholic beverages in moderation, with special attention to food portion size and content of non-complex carbohydrates which are essential for weight loss and improved insulin sensitivity.