双源CT血管成像评价冠状动脉钙化性斑块血管腔狭窄程度准确性的研究

目的 探讨双源CT冠状动脉成像(DSCTA)评价钙化斑块引起血管腔狭窄的准确性.方法 62例患者DSCTA显示冠状动脉一处或多处钙化斑块,并行冠状动脉造影(CAG)检查.钙化斑块大小分为小、中和大.使用各种后处理技术,以确定钙化斑块引起血管阻塞(狭窄管腔直径≥50%),无血管阻塞(狭窄管腔直径＜50%),并与CAG比较.结果 DSCTA显示小钙化斑块122处,中钙化斑块44处,大钙化斑块86处.122处小钙化斑块,5%CAG显示有梗阻.44处中钙化斑块,14%梗阻,86处大钙化斑块,42%有梗阻.DSCTA与CAG一致95%(116/122)小钙化斑块、91%(40/44)中钙化斑块、67%(58/86)大钙化斑块.DSCTA低估2例小钙化斑块血管腔狭窄,高估4例小钙化斑块、4例中钙化斑块、28例大钙化斑块血管腔狭窄.86处大钙化斑块引起的血管腔梗阻,DSCTA敏感性100%,特异性44%,阳性预测值56%,阴性预测值100%,准确性67%.结论 DSCTA准确显示90%以上小和中等大小钙化斑块血管阻塞病变,正确诊断约2/3大钙化斑块血管阻塞病变.判断错误通常是高估狭窄程度.     

双源CT冠状动脉成像联合腺苷负荷CT心肌灌注在诊断冠心病心肌缺血中的应用分析

目的 探讨双源CT冠状动脉定量分析联合腺苷负荷CT心肌灌注(CTP)扫描在诊断冠心病心肌缺血中的应用分析。方法 选择冠状动脉狭窄50%的冠心病患者68例(共计126支病变血管),行双源CT冠状动脉成像及腺苷负荷CTP,按照是否出现CTP异常分为CTP-组(70支)及CTP+组(56支),分析2组各个病变分支在最小管腔面积狭窄度、最小管腔直径狭窄度、斑块负荷、斑块体积、斑块最大厚度、病变长度、斑块性质及钙化积分方面的差异。结果 CTP-组与CTP+组脂质斑块体积和纤维-脂质斑块体积比较,差异无统计学意义(P0.05)。CTP+组最小管腔面积狭窄度、最小管腔直径狭窄度、斑块负荷、斑块体积、斑块最大厚度、病变长度及钙化积分明显高于CTP-组,差异有统计学意义[(69.3±15.2)%vs(59.5±9.2)%,(63.3±10.5)%vs(55.8±5.5)%,(69.9±8.2)%vs(57.5±6.5)%,67.3mm3 vs 43.2mm3,11.5mmvs 6.2mm,2.5mmvs 2.0mm,(281.1±242.4)分vs(107.2±63.8)分,P0.05,P0.01)]。结论 双源CT冠状动脉成像联合腺苷负荷CTP不仅可以对冠状动脉进行解剖学分析,同样也可以对其进行功能学分析。     

冠状动脉钙化性中重度狭窄的MSCT与DSA对比研究

目的探讨钙化斑块所致管腔≥50%狭窄评价的准确程度。方法回顾性分析97例患者冠状动脉成像和冠状动脉造影检查,比较钙化斑块所致冠状动脉狭窄≥50%的64排螺旋CT冠状动脉成像(CTCA)与冠状动脉造影(CAG)评价的差异性。结果64层螺旋CT冠状动脉成像评价冠状动脉管腔狭窄≥50%的病变中,钙化斑块所致的管腔狭窄≥50%有统计学意义(P0.01)。结论 64层螺旋CT冠脉成像分析钙化斑块所致冠状动脉管腔≥50%狭窄误差比较大,对混合斑块、非钙化斑块所致冠状动脉管腔≥50%狭窄的评价可信度比较高。     

老年冠状动脉疾病患者血清Wnt-1水平对冠状动脉病变性质的预测价值

目的检测老年冠状动脉疾病(CAD)患者血清Wnt(wingless type protein)-1水平,探讨Wnt-1与炫速双源CT造影冠状动脉病变严重程度和形态的相关性。方法选取2016年10月至2018年5月就诊于郑州大学第一附属医院心血管内科且年龄大于60岁的疑似冠心病患者371例,行炫速双源CT冠状动脉造影术,按管腔狭窄程度分组,≤50%为非严重冠状动脉病变,50%为严重狭窄病变,根据冠状动脉斑块钙化情况分为非钙化斑块,钙化斑块和混合斑块。采用酶联免疫吸附试验(ELISA)法测定血清Wnt-1水平。结果严重冠状动脉病变组血清Wnt-1水平明显高于非严重冠状动脉病变组(132.52±40.48)vs.(98.39±28.23)ng/ml,P0.001。logistic回归分析发现血清Wnt-1水平是预测严重冠状动脉病变的独立预测因子(OR=1.56,95%CI:1.24～2.03,P=0.003)。并且冠状动脉钙化组血清Wnt-1水平(135.56±38.82)ng/ml显著高于非冠状动脉钙化组(96.75±29.13)ng/ml和混合斑块组(102.62±34.64)ng/ml(P0.001)。logistic回归分析显示血清Wnt-1水平是预测冠状动脉钙化的独立预测因子(OR=2.07,95%CI:1.53～2.85,P0.001)。结论血清Wnt-1水平显著与冠状动脉CT造影老年血管斑块严重程度和钙化密切相关。Wnt在老年冠状动脉疾病中的病理生理机制需要进一步的前瞻性临床研究。     

双源CT冠脉造影诊断准确性的影响因素

目的 以选择性冠脉造影(SCA)为标准判断双源CT(dual-source computed tomography,DSCT)冠脉造影的结果,分析影响DSCT冠脉造影诊断准确性的因素。方法 回顾性分析DSCT冠脉造影诊断为冠心病,后行选择性冠脉造影的患者156例,共分析1 369个节段,其中751个病变节段。绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC)值。比较病变不同钙化程度、病变血管直径、病变长度和病变血管分布对DSCT冠脉造影诊断准确性的影响。结果 重度钙化的AUC值明显低于中度钙化（0.571 vs. 0.718,P<0.05）和轻度钙化（0.571 vs. 0.843,P<0.01）。血管直径较小病变的AUC值明显低于血管直径较大病变（0.699 vs. 0.861,P<0.01）。回旋支病变的AUC值明显低于前降支病变（0.724 vs. 0.836,P<0.05）和右冠病变（0.724 vs. 0.853,P<0.05）。结论 重度钙化、血管直径较小和回旋支病变都是降低DSCT冠脉造影诊断准确性的因素。     

冠状动脉钙化斑块性质对CTCA、CAG评价冠状动脉狭窄程度的影响

目的探讨冠状动脉钙化患者钙化斑块与年龄的关系,分析不同性质斑块对冠状动脉CT血管成像（CTCA）及冠状动脉造影（CAG）对患者冠状动脉管腔狭窄程度评价效果的影响。方法对行CTCA检查的冠状动脉钙化患者1 021例行年龄相关分析,对56例均行CTCA和CAG的患者进行冠状动脉钙化节段统计,比较不同性质斑块所致冠状动脉狭窄≥50%的CTCA与CAG评价效果的差异性。结果冠状动脉钙化与年龄呈正相关（P=0.000）;837个冠状动脉节段中307段存在≥50%的管腔狭窄,有钙化斑块67段,钙化为主斑块30段,混合斑块77段。CTCA在观察斑块的性质方面优于CAG,在对冠状动脉混合斑块和钙化为主斑块的CTCA评价与CAG评价在95%的可信区间内差异性较小,对钙化斑块所致冠状动脉管腔≥50%的狭窄程度评价有统计学差异（P均〈0.05）。结论冠状动脉钙化程度随着年龄增长而增加。与CAG比较,CTCA评价钙化斑块所致冠状动脉管腔狭窄≥50%的灵敏度高,在评价斑块性质方面优。     

增龄性冠状动脉斑块钙化特征分析在男性冠心病防治中的应用价值

目的利用血管内超声(IUVS)评价增龄性冠状动脉钙化斑块的形态学特征并分析其在冠心病防治中的应用价值。方法选取行冠状动脉造影(CAG)及IVUS检查的青年组、中年组、老年组三组不同年龄段男性冠心病患者103例,在介入治疗前对钙化病变血管进行IVUS检查,获取血管外弹力膜面积、斑块狭窄面积、管腔钙化斑块狭窄率,测量病变钙化弧度、钙化长度比与钙化指数,并进行年龄因素相关分析。结果①随着年龄的增长,各组靶血管病变的血管外弹力膜面积和斑块面积均有逐步减少与升高的变化趋势,差异有统计学意义(P<0.05)。②钙化弧度、重度钙化率、钙化长度比随着年龄增长而呈现显著增加趋势,在老年组变化程度最明显(P<0.05)。③相关性分析发现钙化相关指标与增龄后的管腔斑块狭窄等指标有显著正相关(P<0.05)。结论随着年龄的增长,斑块钙化的程度逐渐加重,且呈现向心性演变趋势。在IVUS辅助下进行钙化特征相关指标的测定对指导男性冠心病患者复杂钙化病变的介入治疗有重要意义。     

稳定型心绞痛冠状动脉斑块结构与重构关系的研究

目的:探讨血管内超声对稳定型心绞痛(SAP)患者冠状动脉(冠脉)病变斑块结构与血管重构关系的评估价值。方法:在冠脉介入治疗前应用血管内超声对SAP患者的冠脉病变进行研究。根据测定的重构指数(RI)将患者分为A组(负重构,RI<1.0)和B组(正重构,RI≥1.0),根据管腔面积狭窄率分为管腔面积狭窄率<70%组(轻中度狭窄组)和管腔面积狭窄率≥70%组(重度狭窄组)。结果:①与A组比较,B组近端参考段斑块负荷小,病变处的管腔面积和外弹力膜面积大、斑块负荷小,硬斑块所占比例少,病变处最大钙化弧度和长度小;②与轻中度狭窄组比较,重度狭窄组负重构多,软斑块少,病变处管腔面积小,病变处斑块面积和斑块负荷大,RI偏小,病变最大钙化弧度大。结论:不同程度管腔狭窄的SAP患者中,斑块钙化在负重构和严重管腔狭窄中占优势,负重构更常见于严重狭窄病变。     

双源CT评价代谢综合征患者冠状动脉病变的临床研究

目的:研究双源CT冠脉造影评估伴或不伴代谢综合征(MS)患者冠状动脉病变的效果。方法:74例拟诊为冠心病患者被分为MS组(26例)和非MS组(48例),在传统的冠脉造影前,使用双源CT血管造影评估冠脉钙化积分,同时定量评估冠脉显著狭窄程度和不同性质的冠脉粥样硬化斑块数目。结果:MS组患者冠脉显著狭窄的血管支数明显高于非MS组[(2.27±0.92)支:(1.46±1.20)支,P0.005]。两组患者间的钙化积分无显著性差异(P0.05)。非参数检验显示两组患者的钙化斑块[MS组144个(5.54个/例),非MS组140个(2.91个/例)和软斑块[MS组134个(5.15个/例),非MS组109个(2.27个/例]有显著性差异(钙化斑块,P0.05;软斑块,P0.005)。多元回归分析显示MS与软斑块独立相关(OR=1.44,P=0.028)。结论:在伴代谢综合征的患者中,冠状动脉显著狭窄的血管支数、钙化斑块和软斑块发病率升高,提示代谢异常可以增加冠脉斑块和斑块的易损性。     

基于冠脉CT血管成像的人工智能平台在检测老年冠脉病变及冠状动脉狭窄程度评估中的应用价值

目的 探讨基于冠脉CT血管成像的人工智能(AI)平台在检测老年冠脉病变及冠状动脉狭窄程度评估中的应用价值。方法 选取老年疑似冠心病患者116例，均行冠脉CT血管成像和侵入性冠状动脉造影检查。分别由数坤AI影像辅助诊断平台和3名不同职称的放射科诊断医师对管腔狭窄程度≥50%的阻塞性冠脉狭窄进行诊断，并进行冠心病诊断报告与数据系统(CAD-RADS)分级，以侵入性冠状动脉造影为金标准评价诊断效能，采用Kappa检验对CAD-RADS分级评估结果进行一致性分析。结果 受试者工作特征(ROC)曲线分析显示，在老年冠脉病变患者冠状动脉狭窄总样本、非重度钙化病变样本、重度钙化病变样本中，AI影像辅助诊断平台、3名放射科诊断医师均能够较好诊断管腔狭窄程度≥50%的阻塞性冠脉狭窄，其中高级职称放射科诊断医师的诊断效能最高，其次为AI影像辅助诊断平台。AI影像辅助诊断平台与高级职称放射科诊断医师的一致性良好(Kappa=0.719,P=0.001);与中级职称放射科诊断医师的一致性中等(Kappa=0.568,P=0.017);与初级职称放射科诊断医师的一致性较差(Kappa=0.340,P=0.097...     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.