肝细胞特异性MR对比剂在肝脏功能评价中的初步研究

目的分析不同功能级别肝功能患者注射肝细胞特异性对比剂钆塞酸二钠（Gd·EOB-DTPA）后肝脏信号强度的变化规律,探讨Gd．EOB．DTPA在肝功能评价中的应用。方法28例患者使用Gd-EOB-DTPA作为对比剂行肝脏MR增强扫描,均按照Child．Pugh分级法行肝脏功能分级,其中Child-PughA级15例,B级9例,C级4例。每例分别于轴位片上同一层面的肝脏及竖脊肌各确定一感兴趣区域,测量感兴趣区域对比增强前反相位信号强度（s1、s2）及注射对比剂后肝细胞期（静脉注射20min后）的信号强度（s3、S4）,分别计算两个时期肝脏与竖脊肌信号强度的比值（Rati01=S1／s2,Rati02=$3／$4）。再用Ratiol及Rati02计算信号比增加百分率[IncreasedSignal％=（Rati02-Rati01）／Rati02×100％]表示肝脏增强程度。统计分析不同功能级别肝脏IS％的差异是否具有统计学意义。结果Child．Pugh肝功能A级的IS％较B级和C级的高,A级与B级（P=0．ooo）、A级与C级（P=0．000）之间IS％的差异有统计学意义。Child-Pugh肝功能B级与C级之间IS％的差异无统计学意义（P=0．318）。结论Gd．EOB．DTPAMR增强扫描可在一定程度上反应肝脏细胞功能,可作为肝脏功能评价的一种新方法。     

获得性免疫缺陷综合征并发肝脾结核的CT和MRI表现特征

目的探讨获得性免疫缺陷综合征（AIDS）并发肝脾结核患者的CT和MRI表现特征,为临床诊断提供参考。方法回顾性分析经穿刺或临床确诊为AIDS并发肝脾结核的26例患者（观察组）,以及无免疫相关疾病的其他患者并发肝脾结核者41例（对照组）,所有患者均行腹部CT和MR增强扫描。观察CT和MR增强扫描的表现特征,如病灶部位、范围（单发或多发）、形态、强化方式、并发其他脏器结核情况等。应用SPSS19．0软件对两组数据进行统计学分析,计数资料的比较采用7。检验,以P〈0．05为差异有统计学意义。结果观察组患者在肝脾病灶的分布上（34．62％,9／26）与对照组（12．20％,5／41）比较,差异有统计学意义（X^2=6．06,P=0．035）。观察组粟粒型肝脾结核、粟粒-结节型肝脾结核、并发其他器官结核、淋巴结结核发生率分别为34．62％（9／26）、23．08％（6／26）、84．62％（22／26）、76．92％（20／26）,均高于对照组的7．32％（3／41）、4．88％（2／41）、58．54％（24／41）、12．20％（5／41）,仅脓肿型肝脾结核E19．23％（5／26）]低于对照组[43．90％（18／41）],差异均有统计学意义（X^2=8．06,P=0．005;X^2=5．01,P=0．025;X^2=5．03,P=0．025;X^2=19．60,P〈O．01;X^2=4．30,P=0．038）。对照组粟粒及小结节型MR扫描T2WI呈稍高信号,弥散加权成像（DWI）呈高信号,部分结节延迟强化。结论观察组中肝脾结核病灶更易累及脾脏,并且病灶形态以粟粒型、粟粒结节型多见,而且并发淋巴结结核者明显多于对照组。对AIDS并发肝脾结核患者CT或MRI表现特征的认识,有利于临床早期明确诊断。     

慢性肝炎

连续CT检查对病毒性慢性肝病的诊断价值——杜忆兵等（河南郑州解放军第153中心医院放射科450004）．《医学影像学杂志》，2005，15（7）：575．577【目的：评价连续CT检查对病毒性慢性肝病的临床应用价值。方法：回顾性分析42例病毒性慢肝患连续螺旋CT检查〉2年的系列图像，测量肝（左、右叶）及脾体积。以及侧支循环的范围及程度。所有病例的CT表现与肝功能（按Child．Phgh分级）和肝组织学结果进行对照。结果：13例Child分级积分增加（积分增加组），其余积分无改变（积分不变组）。在积分增加组初次检查与末次检查相比肝体积比率明显变小（P〈0．05），右叶体积比率也明显变小（P〈0．01）。左叶及脾体积比率在初末次检查均无明显变化（P〉0．05）。     

肝脏局灶性结节性增生和甲胎蛋白阴性肝细胞癌患者的影像学特点分析

目的：探讨肝脏局灶性结节性增生（FNH）和甲胎蛋白（AFP）阴性肝细胞癌（HCC）患者的 MRI 和 CT 平扫及动态增强表现。方法回顾性分析2012年4月－2014年4月北京市密云县医院收治的124例肝脏肿瘤患者的临床资料。结果74例 FNH患者中,54例患者接受 CT 检查,其中38例患者接受三期动态增强扫描,16例患者仅接受平扫;62例患者接受 MRI 检查,均接受平扫及增强扫描,其中应用钆贝葡胺（Gd －BOPTA）造影剂42例。50例 AFP 阴性 HCC 患者中,40例患者接受 CT 检查,其中10例患者只接受平扫;46例患者接受 MRI 平扫及增强扫描,其中采用 Gd －BOPTA 造影剂30例,30例30个病灶中延迟1～2 h 扫描均呈低信号。结论FNH 和 AFP 阴性 HCC 患者的 MRI 和 CT 平扫及动态增强表现各具特点,多种检查方法联合应用能够促进二者诊断率的显著提升。     

慢性肝病患者血清25－羟维生素D水平及临床意义

目的：探讨慢性肝病患者血清25－羟维生素 D[25（OH）D]水平及其临床意义。方法收集2012年6月－2013年9月吉林大学第一医院肝胆胰内科153例慢性肝病住院患者的血清作为试验组,应用液相色谱串联质谱检测技术检测患者的25（OH）D水平,以同院体检中心300例健康人作对照组。试验组分为非肝硬化组、肝硬化组（Child －Pugh A、B、C 级）及原发性胆汁性肝硬化（PBC）组,分析比较各组间的差异,计量资料采用 t 检验和方差分析,计数资料采用χ2检验,各变量间相关性采用 Pearson 直线相关分析。结果153例慢性肝病患者正常（≥30 ng／ml）、不足（20～30 ng／ml）、缺乏（10～20 ng／ml）及严重缺乏（＜10 ng／ml）的比例分别为20．3％、22．9％、35．9％、20．9％。肝硬化组25（OH）D 缺乏及严重缺乏的比例（41．7％、25．0％）明显多于非肝硬化组（27．5％、12．5％）及 PBC 组（23．5％、17．6％）,差异均有统计学意义（χ2＝6．261～18．474,P ＝0．001～0．012）。肝硬化组25（OH）D 水平为（18．58±12．48）ng／ml,低于非肝硬化组（23．78±11．81）ng／ml 及健康对照组（25．69±12．39）ng／ml,差异均有统计学意义（P值分别为0．029、0．001）。肝硬化组以 Child －Pugh 分级分组,C 级25（OH）D 水平明显低于 A 级,差异有统计学意义（P ＝0．009）。结论慢性肝病患者血清25（OH）D 水平普遍降低,其中肝硬化患者降低明显重于非肝硬化患者,尤其以 Child －Pugh 分级 C 级降低最为严重。     

肝硬化患者肠黏膜通透性与Child—Pugh分级的相关性研究

目的探讨肝硬化患者肠黏膜通透性（IP）与Child—Pugh分级的相关性及肠道去污剂对肝硬化患者肠道屏障功能及肝功能状态的影响。方法按Child—Pugh分级标准将76例肝硬化患者分为A、B、C3组,并选择30例体检者作为对照组,采用高压液相色谱法检测各组患者尿液乳果糖／甘露醇排出比（L／M）;给予76例肝硬化患者选择性肠道去污剂,比较用药前后各组患者肝功能Child—Pugh分级和肠黏膜通透性。结果肝硬化患者尿乳果N／甘露醇排出比明显高于对照组（0．208±0．025vs0．057±0．019）,肝硬化患者按Child。Pugh分级各组尿乳果糖／甘露醇排出比也均明显高于对照组,差异有显著性（P〈0．01）;采用Spearman等级相关分析发现,肝功能Child—Pu巾评分与乳果糖／甘露醇排出比呈正相关（r=0．658,P〈0．05）;给予肠道去污药物2周后肝硬化Child-Pugh分级各组患者尿液乳果糖／甘露醇排出比与治疗前比较均明显下降（P〈0．05）,各组Child—Pugh评分均有改善。结论肝硬化患者的肠黏膜通透性与肝功能Child—Pugh评分呈正相关,即肠道通透性随肝功能下降而升高,肠黏膜通透性对于肝硬化患者的诊断和治疗有临床意义。     

MR化学位移成像脑代谢物改变与肝硬化的临床相关性

目的 利用磁共振波谱分析（MRS）评价肝硬化患者脑代谢物的异常变化及其与Child-Pugh分级和肝功能指标的相关性。方法 应用3．0T磁共振对52例乙型肝炎肝硬化患者（Child A级20例、Child B级14例、Child C级18例）及15例慢性乙型肝炎患者进行磁共振波谱分析,计算脑代谢物Cho（胆碱）、mI（肌醇）、NAA（N-乙酰天门冬氨酸）、Cr（肌酸）和GLX6（谷氨酰胺复合物）峰下面积、脑代谢物峰下面积与Cr比值（NAA／Cr、Cho／Cr、ml／Cr、Glx6／ml）。结果 Child-Pugh A级患者与对照组mI、GLX6比较,差异有统计学意义,Child-Pugh B级与Child-Pugh A级Cho、mI、GLX6比较,差异有统计学意义（P〈0．01）,Child-Pugh C级与Child-Pugh B级Cho、mI比较,差异有统计学意义（P〈0．01或P〈0．05）;Child-Pugh A级与对照组ml／Cr、Glx6/Cr比较,差异有统计学意义（P〈0．01）,Child-Pugh B级与Child-Pugh A级Cho／Cr、ml／Cr、Glx6/Cr比较,差异有统计学意义（P〈0．01或P〈0．05）,Child-Pugh C级与Child-Pugh B级Cho／Cr、ml／Cr比较,差异有统计学意义（P〈0．05）;肝陛脑病与无肝性脑病患者脑代谢物峰下面积比值（Cho／Cr、ml／Cr、G1x6/Cr）比较,差异有统计学意义（P〈0．01）;Child-Pugh分级与Glx6/Cr呈正相关,与Cho／Cr、ml／Cr呈负相关;肝硬化患者TBIL、PT与Cho／Cr、ml／Cr呈负相关,与Glx6/Cr呈正相关。ALB与Cho／Cr、ml／Cr呈正相关,与Glx6/Cr呈负相关。AIJT与NAMCr、Cho／Cr、ml／Cr、Glx6/Cr无明显相关性。结论 肝硬化及肝性脑病患者存在脑代谢物浓度异常改变,它可作为肝硬化和肝性脑病早期诊断及程度评价的一项指标。     

造影剂致过敏反应1例报告

2007年7月,我院对患者行CT增强扫描时突发造影剂过敏反应1例。现报告如下。患者男,46岁,因双季肋部疼痛10d来院就诊。触诊肝区压痛,CT平扫发现肝右叶点状多发低密度影,为使诊断更加明确,予CT增强扫描。患者一般情况良好,心、肝、肾功能正常;自诉无海产品及药物过敏史,碘过敏试验阴性,给予高压下快速静脉注入造影剂（泛影葡胺3．0ml／s）。     

超声检查和血清肝纤维化相关标志与肝纤维化病理分级的相关性

目的：探讨慢性肝病患者超声检查指标和血清肝纤维化相关标志与肝纤维化病理分级的相关性。方法：经肝穿刺活检的181例慢性肝病患者按纤维化和蔼分为S0－S1组76例,S2－S4组105例。比较两组患者的4项超声检查指标和4项血清肝纤维化相关标志浓度。结果：超声检查指标中,两组患者的门静脉主干内径、脾长径和脾静脉内径有显著差异（P＜0．01）,而门静脉血流量参数无显著差异（P＞0．05）;血清肝纤维化相关标志中,透明质酸浓度的组间差异最为显著（P＜0．001）,7SⅣ胶原和基质金属蛋白酶抑制剂浓度也有差异（P＜0．02）,但Ⅲ型前胶原浓度无显著差异（P＞0．5）。脾长径和脾静脉内径与血清透明质酸浓度有较好的相关性（P＜0．001）。结论：门静脉主干内径、脾长径和脾静脉内径这3项常用超声检查指标结合血清肝纤维化相关标志与肝纤维化病理分级有一定相关性。     

CT薄层增强扫描对良恶性肺结节鉴别诊断

目的 探讨CT增强扫描对鉴别良恶性肺结节的价值。方法 89例肺结节中,恶性63例（均为肺癌）,良性26例。分别于注射100ml造影剂前及注射开始后的35s、2min及5min对病灶进行薄层平扫及增强扫描。观察病灶的强化程度及强化特征,并进行CT－病理以对照研究。结果 肺癌的强化程度显著高于良性肺结节（P＜0．02）。在强化特征方面27例肺癌出现高密度点条征;51例肺癌和4例良性结节强化不均匀;3例肺癌和4例良性结节强化均匀;5例结核球和1例炎性假瘤呈环状强化;12例结核球无强化。结论 CT增强扫描对良恶性肺结节的鉴别诊断有较重要的价值。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

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.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

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.     

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.     

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.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.