3.0磁共振磁敏感加权成像对轻型脑外伤评估价值探讨

目的分析探讨3.0磁共振磁敏感加权成像(SWI)对轻型脑外伤评估价值。方法选择轻型颅脑外伤患者49例,受伤7 d内进行头部CT及SWI检查,分析并简要评价检查效果。根据症状是否昏迷,分为昏迷组30例,非昏迷组19例。结果昏迷组中经SWI检查检出病灶28例,比非昏迷组(检出病灶者11例)要高;阳性出血灶患者中脑损伤后综合征发病率(63.16%,24/38)高于阴性出血灶患者(27.28%,3/11),P<0.05。结论 SWI检查对于脑外伤后综合征患者而言,其敏感性明显高于CT,尤其是头部存在实质性出血灶患者;轻型脑外伤患者脑内存在微小出血灶,与脑外伤综合征联系比较密切。     

磁敏感加权成像(SWI)对中枢神经系统疾病的诊断价值

目的对磁敏感加权成像技术(SWI)在中枢神经系统疾病的诊断中的应用价值进行探讨,推广磁敏感加权成像技术在诊断中的应用。方法回顾性分析我院在2013年1月至2014年1月收治的96例中枢神经系统疾病患者的SWI图像与常规MRI图像,全部患者均经临床或病理证实所患为中枢神经系统疾病。结果 15例脑外伤患者SWI图像均可显示出合并出血及损伤范围,常规MRI15例中有5例病变显示不全,共有10处病变未显示;50例脑血管病变患者(包括31例脑血管畸形及19例脑血管病合并出血),SWI均可显示清晰的形态异常血管及病变边界,对海绵状血管瘤有敏感的成像,常规MRI仅可清楚显示50例中的38例,未能显示其余12例陈旧性出血病变;31例脑肿瘤患者SWI图像比常规MRI图像对瘤内出血及病变边界显像更清晰。结论磁敏感加权成像技术在中枢神经系统疾病的诊断上具有重要价值,显像更清晰,比常规MRI更好地显示出病变部位情况,尤其在显示脑创伤、脑血管畸形、脑血管病,颅脑肿瘤内出血方面更敏感,为疾病的诊断和治疗提供更好的参考依据,值得在临床推广。     

鼻咽癌放疗后放射性脑病早期阶段磁共振成像及磁敏感加权成像表现及其临床意义

目的进一步了解鼻咽癌放射性脑病早期阶段患者脑常规磁共振成像(MRI)及磁敏感加权成像(SWI)表现,并初步探讨与其相关的病理机制。方法选择2010年7月至2012年12月,在浙江省肿瘤医院首次诊断为放射性脑病患者132例,分析首次确诊放射性脑病的常规MRI和SWI图像,评价病变发生部位、常规MRI和SWI图像特点。结果本组病例首程放疗后发生放射性脑病的中位时间为36个月,病灶均位于颞叶,以白质区为主,左侧48例,右侧36例,双侧48例。放射性脑病早期MRI可表现为:Ⅰ型(单纯水肿)58例,表现为均匀的颞叶白质水肿。Ⅱ型水肿(水肿伴微出血灶)74例,表现为信号不均匀的颞叶白质水肿,内见点状T2WI低信号影,SWI上点状低信号,且较T2WI所示范围更大。结论在鼻咽癌放射性脑病早期阶段病变主要发生于颞叶白质,可表现为单纯水肿或水肿伴微出血灶两种不同征象。放射性脑病早期阶段的MRI及SWI表现可能与微血管损伤的程度不同有关。     

SWI检查对颅脑外伤患者诊断符合率的影响

目的探讨磁敏感加权成像(SWI)对颅脑外伤患者诊断符合率的影响。方法选取2017年6月~2019年7月某院颅脑外伤患者80例作为研究对象。均行CT平扫、SWI检查,以手术结果作为“金标准”,对比两种检查方案病灶检出数量、病灶部位,分析SWI检查对颅脑外伤诊断符合率的影响。结果CT示脑挫裂伤低密度影伴高密度影、脑出血类圆形高密度影、急性期硬膜下血肿新月形高密度影;SWI示颅内出血低信号,附近水肿带示高信号,脑室及蛛网膜下腔出血呈点样、线状低信号,弥漫性轴索损伤微小出血灶低信号;SWI检查脑挫裂伤并血肿、复合外伤符合率及颅脑外伤总符合较CT高(P<0.05)。结论SWI检查在颅脑外伤中有特异性影像学表现,且能显示弥漫性轴索损伤微小出血灶,进一步提高诊断符合率,可为临床诊断、制定治疗方案提供数据支持。     

磁敏感加权成像对脑弥漫性轴索损伤的诊断价值

目的探讨磁敏感加权成像(SWI)序列在脑弥漫性轴索损伤(DAI)中的诊断价值。方法 25例临床高度怀疑或已经确诊为DAI的脑外伤患者,CT检查未发现明显异常或者损伤灶不位于典型部位,继而进行MRI检查。先行SWI检查后再行常规MR(T2WI、T1WI、DWI或FLAIRT2WI)检查。分析SWI图像特点,比较SWI与常规MR序列对弥漫性轴索损伤病变的显示情况。结果 SWI对于病灶数目的检出率明显高于常规MR序列。结论 SWI序列的应用大大提高了DAI病灶的检出率,为临床早期诊断提供更加可靠的影像学依据。     

磁共振多序列组合在早期新生儿缺氧缺血性脑病的诊断价值

目的探讨磁共振(MRI)多序列组合在早期新生儿缺氧缺血性脑病(HIE)的诊断价值。方法选择2019年4月至2020年8月茂名市妇幼保健院收治的76例HIE患儿与76例非HIE新生儿,均给予MRI检查。比较常规MRI、常规MRI+磁共振扩散加权成像(DWI)、常规MRI+磁敏感加权成像(SWI)、常规MRI+DWI+SWI序列的HIE病灶检出个数、对病灶的检出率及诊断HIE灵敏度、特异度及准确度。结果常规MRI+DWI+SWI检出162个病灶,多于常规MRI+SWI检出137个、常规MRI+DWI检出132个、常规MRI检出104个。常规MRI+DWI+SWI检查诊断的HIE灵敏度、准确度(96.05%、97.37%)均高于常规MRI(61.84%、78.95%)、常规MRI+DWI(81.58%、90.13%)、常规MRI+SWI(82.89%、90.13%),差异有统计学意义(P 0.05)。结论在早期新生儿HIE诊断中MRI多序列组合的应用,可提高HIE检出率。     

3.0T磁敏感加权成像在颅脑疾病中的临床应用

目的探讨3.0T磁敏感加权成像(SWI)在颅脑疾病临床诊断中的应用价值。方法回顾性分析86例患者临床检测结果,统计MRI检出病变数量及加用SWI检出数量,并总结各类颅脑疾病的SWI成像特征与共性。结果 SWI扫描总检出率明显高于MRI单扫,且SWI检出脑血管畸形率明显高于MRI单扫,差异有统计学意义(P<0.01)。结论 SWI扫描对脑内血管分布、结构、出血、以及铁沉积的敏感性较常规MRI更高,尤其在对脑血管畸形、脑出血、脑梗塞合并出血、神经变性性疾病有更高的检出率和检测效果。     

磁敏感加权成像在急性大脑中动脉闭塞机械取栓术后的临床应用

目的 探讨磁敏感加权成像(SWI)技术在急性大脑中动脉(MCA)闭塞机械取栓术后的临床应用价值.方法 采用Solitaire AB支架机械取栓术治疗急性MCA闭塞的患者21例.患者发病到治疗时间4-7 h.均成功取栓,脑血管造影显示MCA开通；取栓结束术中即刻行DynaCT示颅内无出血灶；取栓术后1、3、7d行CT、MRI及SWI检查,分析常规CT、MRI与SWI检查在显示病变微出血中的差异.结果 21例患者中,术后第3天SWI检出脑微出血16例,表现为点状、条状、类圆形或环形的低信号影；而术后第1天行头颅CT检出脑微出血3例,术后第3天MRI检出脑微出血8例.结论 SWI技术在诊断脑微出血灶方面优于常规序列,可以指导急性MCA闭塞机械取栓术后的用药治疗,评价取栓术后的预后和治疗效果.     

磁敏感加权成像在脑微出血诊断中的应用

目的 探讨磁敏感加权成像(SWI)在脑微出血中的诊断价值.方法 收集经MRI证实的脑微出血60例,行T1WI、T2WI序列与SWI序列扫描,评价SWI序列对脑微出血检出的优越性.结果 60例患者中单发17例,多发43例,共发现病灶591个,主要分布于皮层和皮层下、基底节区.T1WI发现病灶242个,T2WI发现病灶318个,SWI发现病灶591个,检出率分别为40.95％,53.81％和100％.SWI表现为点状、圆形低信号灶.病变范围的显示较常规序列范围大.结论 SWI序列对颅内微小出血的敏感性明显高于常规MRI序列.     

磁敏感加权成像(SWI)在颅脑损伤中的临床应用

目的探讨SWI在颅脑损伤的临床应用中与CT、T1WI、T2WI及FLAIR序列的优势。方法对来我院就诊的58例颅脑外伤患进行T1WI、T2WI、FLAIR、SWI及CT常规扫描,并对其影像进行分析,对比各方法显示颅内出血灶的数目、范围的效果。结果 58例患者中SWI成像显示病灶54例,检出率为93%(54/58);T1WI序列显示病灶19例、T2WI显示病灶43例、FLAIR序列显示病灶48例,CT扫描显示病灶29例,总检出率为82.8%(48/58)。结论 SWI可以充分的显示组织之间的磁敏感特性的差别,在诊断颅内出血方面,特别是微小出血病灶与CT及MR常规序列相比有显著优势。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.