急性脑缺血再灌注DWI及PWI的实验研究

目的:评价DWI及PWI判定急性脑梗死诊断及缺血半暗带的作用。材料和方法:40只SD大鼠随机均分4组,A组作假手术对照;B、D组分别栓塞2h、6h,均再灌注2h、24h;C组栓塞2h再灌注24h、7d。B、C、D组于各自栓塞及再灌注时间点行DWI、PWI及常规序列扫描;后处理获得表观扩散系数(ADC)、脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)形态图。并将结果与四氮唑红(TTC)染色和病理作比较。结果:A组DWI、PWI、TTC染色及病理观察均无异常;B、C、D组栓塞时均可见右大脑中动脉供血区DWI呈高信号,D组异常信号区面积明显大于B组,病理电镜表现为细胞内水肿。B、D组再灌注24hDWI异常信号区面积与灌注前相比,B组无明显变化,D组较前增大;C组再灌注7d6只大鼠DWI见高信号,但ADC图均正常。B、D组栓塞时右大脑中动脉供血区PWI灌注缺损区面积相似。B组PWI异常信号面积大于DWI异常信号区;D组PWI与DWI异常信号面积无明显差别。结论:DWI能灵敏反映急性期缺血脑组织损伤情况,PWI能灵敏反映组织血流灌注情况。DWI、PWI联合应用有可能判定缺血半暗带。     

The Effect of Erythropoietin on Focal Cerebral Ischemia Reperfusion in Rats by Observing STAT1, STAT3 Protein and MRI Expression

目的 探讨促红细胞生成素(EPO)对大鼠局灶性脑缺血再灌注后脑梗死面积变化及信号转导与转录激活子-1( STAT1)、磷酸化STAT1( P-STAT1)、信号转导与转录激活子-3(STAT3)、磷酸化STAT3( P-STAT3)蛋白表达的影响.方法 雄性健康SD大鼠40只,随机分为假手术组(A)、脑缺血再灌注组(B)、生理盐水治疗组(C)、EPO治疗组(D),采用线栓法阻断大鼠一侧大脑中动脉血流2h,再灌注24h,建成局灶性脑缺血再灌注损伤模型.治疗组于脑缺血刚开始时腹腔注射EPO或等量生理盐水,于24h时行MRI检查观察脑梗死面积,采用Western blotting检测STAT1、P-STAT1、STAT3、P-STAT3蛋白表达水平的变化.结果 与B、C组相比,D组脑梗死面积减小(P＜0.05),STAT3磷酸化水平增加(P＜0.05),STAT1磷酸化水平有所减少.结论 EPO可能通过影响JAK/STAT信号转导通路减小脑梗死面积.     

大鼠急性脑缺血再灌注的MRI研究

目的:研究弥散加权成像(DWI)及血流灌注成像(PWI)在大鼠大脑中动脉阻塞及再灌注过程中的动态变化以及病理学基础.材料和方法:35只SD大白鼠随机分4组,A组(5只)假手术对照组,B、C、D组(各10只)行线栓法右大脑中动脉缺血(MCAO)模型制作后,再灌注前、再灌注后不同时间点行DWI、PWI、T1WI、T2WI扫描,将检查结果与TTC染色及病理检查比较.结果:B组再灌注后DWI异常信号相对面积无明显变化(P>0.05),再灌注前后ADC值无明显改变(P>0.05).C组再灌注7d时6只大鼠DWI见高信号,但ADC图未见异常.D组再灌注后24hDWI异常信号面积较前增大(P<0.05),再灌注前后ADC值无明显改变(P>0.05).D组感兴趣区ADC值明显低于B组(P<0.05).再灌注后B、C组CBF、CBV图基本恢复正常,MTT图显示局部血流时间延长,D组较B、C组血流恢复更不均匀、不完全,局部存在灌注缺损.结论:DWI能反映急性脑缺血再灌注后脑损伤的变化,PWI能反映再灌注后脑组织血流灌注情况.     

大鼠急性脑缺血再灌注的磁共振灌注扩散成像与病理对照研究

目的探讨急性脑缺血再灌注的磁共振灌注成像(PWI)及扩散成像(DWI)的表现以及其病理改变。方法取70只Wistar大鼠,用线栓法建立右侧大脑中动脉栓塞(MCAO)模型,分为假手术(A组)、栓塞30min及再灌注30min、60min(B、B1、B2组)、栓塞60min及再灌注30min、60min(C、C1、C2组),每组各10只。对各组分别行头部MRI扫描,计算缺血区的DWI异常信号相对面积(rSD)、相对表观扩散系数(rADC)、PWI异常信号相对面积(rSP)、相对平均通过时间(rMTT),将所测值进行比较。对缺血区脑组织进行病理观察。结果实验各组在T1WI、T2WI像上均未见异常信号。A组的DWI和PWI亦未见异常信号。在DWI像上,B、C、B1、B2、C2、C1组在右侧基底节区高信号的范围由小扩大,随后逐渐缩小。在PWI像上,B、C组在右侧基底节区出现明显低灌注信号,在B1、C2组则出现高灌注信号,C1组呈现稍低灌注信号,B2组的信号基本正常。在B、C2组间存在MTT/DWI异常信号不匹配区。病理观察:DWI异常信号区及MTT/DWI异常信号不匹配区均可见细胞器肿胀,提示为半暗带,B1、C1组可见轻度血管源性水肿,B2、C2组未见明显病理改变。结论细胞内水肿是半暗带的病理改变之一,在早期脑梗塞DWI高信号仍提示为半暗带组织,再灌注早期可出现血管源性水肿,再灌注越早脑细胞越容易恢复正常。     

促红细胞生成素对大鼠脑缺血再灌注后STAT1和STAT3表达的影响及MRI表现

目的探讨促红细胞生成素(EPO)对大鼠局灶性脑缺血再灌注后脑梗死面积变化及信号转导与转录激活子-1(STAT1)、磷酸化STAT1(P-STAT1)、信号转导与转录激活子-3(STAT3)、磷酸化STAT3(P-STAT3)蛋白表达的影响。方法雄性健康SD大鼠40只,随机分为假手术组(A)、脑缺血再灌注组(B)、生理盐水治疗组(C)、EPO治疗组(D),采用线栓法阻断大鼠一侧大脑中动脉血流2 h,再灌注24 h,建成局灶性脑缺血再灌注损伤模型。治疗组于脑缺血刚开始时腹腔注射EPO或等量生理盐水,于24 h时行MRI检查观察脑梗死面积,采用Western blotting检测STAT1、P-STAT1、STAT3、P-STAT3蛋白表达水平的变化。结果与B、C组相比,D组脑梗死面积减小(P<0.05),STAT3磷酸化水平增加(P<0.05),STAT1磷酸化水平有所减少。结论 EPO可能通过影响JAK/STAT信号转导通路减小脑梗死面积。     

依达拉奉治疗短暂脑缺血再灌注损伤的MR评价和病理对照研究

目的 探讨依达拉奉对兔短暂脑缺血再灌注损伤后缺血半暗带(IP)区线粒体细胞色素C(CytC)向胞浆释放和Bcl-2蛋白表达的影响,并进行MR评价. 材料与方法健康新西兰白兔15只,随机分为假手术组、对照组和依达拉奉组,每组5只.分别在脑缺血再灌注后2 h和24 h行扩散加权成像(DWI)和灌注加权成像(PWI)以确定IP是否存在,于再灌注后24 h免疫组织化学染色测定3组IP区神经元CytC和Bcl-2蛋白的表达. 结果 假手术组可见少量CytC蛋白释放和Bcl-2蛋白表达;对照组CytC蛋白的表达量显著多于依达拉奉组(P＜0.01),依达拉奉组Bcl-2蛋白的表达量高于对照组(P＜0.05). 结论 依达拉奉能够抑制CytC的释放和上调Bcl-2蛋白表达,对病灶周边的IP区有极好的神经保护作用;DWI和PWI结合IP图能灵敏地确定IP的存在,有利于对诊断、治疗方案的调整及疗效评估.     

磁共振3D-pcASL灌注成像结合DWI鉴别超急性与急性缺血性脑梗死

目的探讨磁共振三维伪连续动脉自旋标记(3D-pcASL)灌注成像联合DWI序列鉴别超急性与急性缺血性脑梗死的临床应用价值。方法回顾分析我院20例超急性期(A组)和36例急性期(B组)缺血性脑梗死患者的MRI图像。在梗死最大层面测量3D-pcASL序列脑血流(CBF)的异常灌注面积(SCBF)和DWI图上异常高信号面积(SDWI),并计算理论缺血半暗带(IP)。比较梗死核心(IC)、IP区CBF和ADC与对侧的差异,分析病灶-对侧相对值(rCBF、rADC)在两组间的差异。结果 IC区高灌注3例(A组0例,B组3例),IC区等灌注9例(A组1例,B组8例),IC区低灌注44例(A组19例,B组25例)。SCBFSDWI 41例(A组19例,B组22例),SCBF≈SDWI 15例(A组1例,B组14例)。IC区的CBF和ADC值在两组中均较对侧降低(P0.05)。两组理论IP区的CBF值和A组理论IP区的ADC值均低于对侧(P0.05)。A组IC区的rADC高于B组,相反,A组理论IP区的rCBF、rADC低于B组(P0.05)。结论临床可联合应用3D-pcASL和DWI序列对发病时间不具体的急性缺血性脑梗死进行鉴别诊断,从而有助于及时合理的选择个体化治疗方案。     

磁共振DWI、PWI和MRS量化评定超早期脑梗死缺血半暗带

目的:应用扩散加权成像(DWI)、灌注成像(PWI)以及磁共振波谱(MRS)技术界定超早期脑梗死缺血半暗带,力求提出量化评定标准。方法:13例发病时间在2～6h的超急性脑梗死患者行MRI检查,包括DWI、PWI及1HMRS技术,并在2～28d复查T2WI确定最终梗死范围。对梗死中心区、缺血半暗带及对侧镜像区,测量其扩散变化,血流灌注以及代谢改变。结果:①梗死中心区与缺血半暗带表观弥散系数(ADC)平均值分别为7.01×10-4mm2/s及9.36×10-4mm2/s,rADC平均值分别为0.63及0.87,梗死中心区ADC及rADC均明显降低,缺血半暗带ADC及rADC轻度下降,二者之间差异有显著性意义。②PWI显示11例超急性脑梗死存在灌注缺损区或灌注减低区,2例腔隙性脑梗死未见明显灌注异常。③MRS改变为乳酸(Lac)浓度升高和N乙酰天门冬氨酸盐(NAA)水平降低。④对于PWI>DWI者,ADC值轻度降低(<22%)Lac升高且NAA正常或轻度下降(<14%)的区域可能为缺血半暗带;而ADC值明显降低(25%～53%)Lac升高且NAA明显下降的区域(16%～34%)可能为不可逆损伤区。结论:综合应用DWI、PWI和MRS可发现超早期脑梗死,并预测缺血半暗带。     

脑缺血再灌注大鼠模型FAIR-PWI研究

目的:探讨流动敏感交替反转恢复序列灌注成像(FAIR- PWI)对大鼠脑缺血后再灌注的评价.方法:使用GE 3.0T MRI成像仪,在完成T1WI、T2WI、弥散加权成像(DWI)和FAIR - PWI序列后,对SD大鼠行暂时性右侧大脑中动脉闭塞(TMCAO)手术,分别在脑缺血3h和再灌注3h及21h行重复上述MRI检查;最后进行病理学TTC染色观察梗死区域及范围.结果:TMCAO后3h时,患侧大脑半球DWI信号升高、FAIR - PWI灌注增加、且皮质相对脑血流量(rCBF)大于基底节区;再灌注3h及21h后,患侧大脑半球DWI信号面积(0.63±0.1.2cm2、0.48±0.23cm2)仍高于FAIR - PWI高灌注面积(0.51±0.26cm2、0.34±0.44cm2,P=0.01),皮质及基底节区rCBF较缺血时增加.TTC染色示梗死面积(0.42±0.78cm2)小于DWI异常信号面积,而大于FAIR - PWI高灌注面积,且梗死区以基底节为主.结论: FAIR- PWI结合DWI能对早期缺血再灌注进行动态观察及半定量测量,可能为临床溶栓治疗方案的预后判断和随访提供重要参考.     

促红细胞生成素对大鼠脑缺血再灌注后STATl和STAT3表达的影响

目的探讨促红细胞生成素（EPO）对大鼠局灶性脑缺血再灌注后信号转导与转录激活因子（STAT）1、磷酸化STATl（P．STATl）、STAT3、P—STAT3蛋白表达及细胞凋亡的影响。方法将雄性sD大鼠80只完全随机分为假手术（A）组、单纯脑缺血再灌注（B）组、脑缺血再灌注＋生理盐水（c）组和脑缺血再灌注＋EPO（D）组,每组20只,采用线栓法制作局灶性脑缺血再灌注损伤模型。各组大鼠均于缺血2h后再灌注24h时,行MRI检查并计算缺血区异常信号相对面积值,Westernblot检测STATl、P—STATl、STAT3、P—STAT3蛋白表达水平的变化并计算相对灰度（rOD）值,原位末端标记法（TUNEL）检测细胞凋亡情况并计算细胞凋亡指数。应用单因素方差分析和q检验分析数据。结果MRIT,WI示B、C组在左侧大脑半球皮质及皮质下均可见大片脑缺血异常高信号影,D组仅皮质下脑实质内或仅皮质处可见斑片状脑缺血高信号影;与B、C组比较,D组异常高信号区相对面积明显减小[（28．00±4．60）％、（29．70±4．80）％和（21．10±2．40）％;F=11．285,P〈0．01]。STATl、STAT3蛋白在正常脑组织中表达,缺血再灌注及EPO干预对二者表达水平均无明显影响（F=0．806和1．558,均P〉0．05）。P—STATl在A组表达较低,rOD值为0．75±0．13,缺血再灌注后表达显著增加;与B、C组相比,D组P—STATl表达水平有所减少（B～D：2．08±0．15、2．05±0．16、1．92＋0．05;F=3．274,P〉0．05）。P—STAT3在A组表达也较低,rOD值为1．02±0．09,缺血再灌注后表达显著增加;与B、c组相比,D组P—STAT3表达明显增加（B—D：2．22±0．13、2．04±0．14、4．21±0．21;F=40．719,P〈0．01）。B、C组细胞凋亡指数分别为（42．00±1．30）％和（41．20±2．50）％,高于D组[（20．90±1．46）％;F=378．704,JP〈0．01]。结论EPO可增加脑缺血区域P—STAT3表达水平、降低P—STATl表达水平,从而减少脑细胞凋亡的数目、减小脑梗死面积。     

Mistakes in the diagnosis and treatment of the complete dislocation and fractures of the acromial end of the clavicle

The analysis of the mistakes in the operative treatment of the sick with such a trauma was conducted. Two typical examples were given. The mistakes were stipulated non-diagnosis of the simultaneous break of the coracoclavicular ligament and not taking measures for its recovery. The radiodiagnosis based on N. Z. Shmidt's method is considered to be inevitable for this category of the sick. After the confirmation of the diagnosis the operation of choice can be the operation of Yotkins-Leochuk for the sick with the complete dislocation of the acromial end of the clavicle, and the operation of Yotkins for the sick with fractures of the acromial end of the clavicle with the break of the coracoclavicular ligament. By means of these methods 43 sick men with the dislocation and 7 sick men with fractures of the acromial end of the clavicle have been operated since 1973. No cases had complications, relapses or unsatisfactory results.     

Quantitative evaluation of the echo intensity of the median nerve and flexor muscles of the forearm in the young and the elderly

Objectives

Musculoskeletal structures often appear brighter on imaging in the elderly, which makes it difficult to accurately delineate a peripheral nerve during ultrasound-guided regional anaesthetic procedures. The echo intensity of skeletal muscles is significantly increased in the elderly. However, there are no data comparing the echo intensity of peripheral nerves in the young and the elderly, which this study was designed to evaluate.

Methods

13 healthy, young volunteers (aged <30 years) and 11 elderly patients (aged >60 years) who were scheduled to undergo orthopaedic lower limb surgery were recruited. The settings of the ultrasound system were standardised and a high-frequency linear array transducer was used for the scan. A transverse scan of the median nerve (MN) and the flexor muscles (FMs) at the left mid-forearm was performed and three video loops of the ultrasound scan were recorded for each subject. Still images were captured from the video loops and normalised. Computer-assisted greyscale analysis was then performed on these images to determine the echo intensity of the MN and the FMs of the forearm.

Results

The echo intensity of the MN and FMs of the mid-forearm was significantly increased in the elderly (p<0.005). There was also a reduction in contrast between the MN and the adjoining FM in the elderly (p=0.04).

Conclusion

Under the conditions of this study, the MN and the FMs in the forearm appeared significantly brighter than those in the young, and there was a loss of contrast between these structures in sonograms of the elderly.Recently, there has been an increase in interest in the use of ultrasound to guide peripheral nerve blocks [1-3]. We have observed during such procedures that musculoskeletal structures often appear significantly brighter and that there is loss of contrast between the nerve and its adjoining muscles in the elderly, which often makes it difficult to accurately delineate a peripheral nerve using ultrasound in this age group. There are published data showing that the echo intensity (EI) of skeletal muscles is significantly increased in the elderly [4]. However, there are no data comparing the EI of a peripheral nerve in the young and the elderly, which this study was designed to evaluate.     

Sonography of the wrist and the hand

Sonographic examination of the hand requires high-frequency linear transducers. As the relevant structures are located very close to the surface, water stand-off pads are mandatory. Owing to the high sensitivity of sonography in the detection of fluid, exudative synovitis, tenosynovitis and ganglia can be easily diagnosed. Sonographic information on muscle atrophy and alterations of the shape and echogenicity of the median nerve in patients with carpal tunnel syndrome may be useful in evaluating the extent of disease. Further indications for the sonographic examination of the hand include suspected tumors, foreign bodies and synovial proliferation. Osseous destruction can be visualized in patients with rheumatoid disease, but the precise extent is hard to determine.     

Aspects of the venous drainage of the pons and the mesencephalon

Summary After a brief resumé of the morphology of the pontomesencephalic veins, the authors demonstrate the drainage dynamics of these veins in normal and pathlogical vertebral angio-seriograms. The repercussions of drainage impairment are illustrated.

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Untersuchungen über die Venen-Drainage von Pons und Mesencephalon

Zusammenfassung Nach kurzer Beschreibung der Morphologie der pontomesencephalen Venen wird die Drainagedynamik dieser Venen anhand normaler und pathologischer Vertebralisangiogramme demonstriert. Die unterschiedlichen Mechanismen einer Drainagebehinderung werden erläutert.

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A propos du drainage veineux du pont et du mésencéphale

Résumé Après un bref résumé de la morphologie des veines ponto-mésencéphalques, les auteurs décrivent les modalités de drainage de ces veines en sérioangiographie vertébrale normale et pathologique. Ils illustrent les répercussions de drainage défectueux.

     

高原彝汉成年人血红蛋白、红细胞值调查分析

目的了解高原地区彝汉成年人血红蛋白、红细胞及相关指标的基础水平，探讨其与国家参考值指标是否存在差异。方法选择健康成人规范采集静脉血，用美国COULTERAC·Tdiff2血球分析仪检测，对数据进行统计学处理。结果川西南高原彝汉成人的血红蛋白、红细胞水平及相关指标与国家参考值比较差异有非常显著的意义，P〈0．001；当地彝汉民族比较差异无显著意义，P〉0．05。结论有必要制定高原地区成人血红蛋白、红细胞及相关指标的正常参考值，为临床提供更科学实际的参考依据。     

MR imaging of the major nerves about the elbow: cadaveric study examining the effect of flexion and extension of the elbow and pronation and supination of the forearm

Magnetic resonance (MR) imaging provides useful information in the evaluation of peripheral nerves. Recent advances in MR imaging allow for detailed depiction of the soft tissue structures of the elbow joint. Three major nerves are present about the elbow. Six cadaveric elbows were imaged to depict the normal anatomy of these nerves and to determine the best plane and position of the elbow for optimal visualization of each nerve. Axial images of the elbow in full extension with the forearm in supination allow identification of all major nerves. Axial images with the elbow in full flexion allow accurate assessment of the cubital tunnel and the ulner nerve. Axial images of the elbow in full extension with the forearm in pronation are helpful for assessment of the median and radial nerves in the forearm.