MRI对布鲁杆菌性脊椎炎的诊断价值分析

目的分析磁共振成像(MRI)对布鲁杆菌性脊椎炎的诊断价值。方法回顾分析28例布鲁杆菌性脊椎炎患者椎体与椎间盘受累信号、病发部位、椎管内外脓肿形成及扩散范围、破坏程度、诊疗情况等。结果 28例患者胸椎、骶椎各3例,颈椎1例,腰椎21例,分别占10.71%、3.57%、75.00%;T2WI高信号21例,T1WI低信号25例;椎间盘明显异常信号为35.71%,病变椎体形态变化明显为25.00%,椎旁软组织异常信号为35.71%,椎旁或骨内脓肿形成为25.00%,硬膜外有脓肿形成为10.71%,牵涉椎体≥3个为3.57%。结论 MRI对布鲁杆菌性脊椎炎具有较高鉴别诊断价值。     

布鲁杆菌性脊柱炎的临床特点及预后分析

<正>布鲁杆菌病(布病)属于变态性反应疾病,由布鲁杆菌所引起,可在人畜间相互传染,此病主要对脊柱进行侵袭导致脊柱炎。布鲁杆菌性脊柱炎与脊椎结核在一般临床症状以及影像学方面具有很多相似表现,十分容易误诊。1对象与方法回顾性分析2010年1月至2015年2月本院收治的30例布鲁杆菌性脊柱炎患者(观察组),与同期收治的30例脊柱结核患者(对照组)进行比较。观察组年龄为     

布鲁菌性脊柱炎与脊柱结核临床影像学表现的对比

目的：分析与探讨布鲁菌性脊柱炎与脊柱结核不同的临床影像学特征,提高对布鲁菌性脊柱炎的影像学诊断水平。方法回顾性分析2011年1月至2013年12月,新疆医科大学附属中医医院收治的46例布鲁菌性脊柱炎患者的 X 线片、CT、MRI 影像学资料,与确诊的40例脊柱结核患者的影像学资料进行对比分析。结果布鲁菌性脊柱炎病灶分布于腰椎,其中以 L4患病率最高,骨破坏灶小而多发,多局限于椎体边缘,病灶周围明显增生、硬化,新生骨组织中有新破坏灶形成,椎间盘破坏轻,关节面增生硬化,相邻骨密度增高,少或无椎旁脓肿形成。结核病灶分布于胸腰段,以椎体和椎间盘骨破坏为主,并有死骨形成,椎旁脓肿和骨质疏松变化较常见。结论布鲁菌性脊柱炎和脊柱结核临床影像学特征性表现有助两者的鉴别诊断。     

布鲁杆菌性脊柱炎的92例临床诊断及手术治疗效果探究

布鲁杆菌病是一种人兽共患传染病,可以累及全身,出现众多的临床症状,其流行在我国牧放区,主要发生在人体的膝关节、脊柱等部位,引起这些部位骨关节的损害。而脊柱炎就是其中主要的症状之一,在布鲁杆菌病中的发生率为2％～60％,变化幅度较大。且该病容易被误诊为脊柱结核等疾病。     

兔布鲁杆菌病性脊柱炎动物模型的建立

目的 探讨使用构建兔脊柱结核模型的相同方法用以构建新西兰兔布鲁杆菌病性脊柱炎动物模型,并对其可行性进行评价。方法 48只新西兰兔采用数表法随机分为实验组16只、对照组16只、空白组16只。实验组于第6腰椎(L6)上终板下方钻孔,填入明胶海绵,在其中浸注种植M5羊种布鲁杆菌弱毒苗混悬液0.1ml(3×10 ⁸CFU/ml);对照组浸注0.9% NaCl溶液0.1ml;空白组不做任何处理。 结果 术后8周兔存活率实验组为75.0% (12/16)、对照组为87.5% (14/16),空白组为100.0% (16/16)。实验组术后4周CT扫描三维重建结果显示5只出现椎间隙变窄,MRI检查结果显示7只有椎旁软组织脓肿形成;对照组未出现椎旁软组织脓肿形成,椎间隙无变化。实验组术后8周行CT扫描三维重建复查,结果显示8只出现椎间隙变窄,MRI检查结果显示10只出现椎旁软组织脓肿形成及椎间盘信号改变;对照组未见椎旁软组织脓肿形成及椎间盘信号改变。实验组术后8周进行组织病理学检查,显示兔椎旁软组织均有病变组织细胞增生及以淋巴细胞为主的炎性细胞浸润;对照组与空白组未出现病变组织细胞增生及炎性细胞浸润。结论 在新西兰兔腰椎椎体的上终板下钻孔、明胶海绵填塞、浸注种植M5羊种布鲁杆菌弱毒苗、石蜡封闭孔道的方法,可成功构建兔布鲁杆菌病性脊柱炎动物模型。     

强直性脊柱炎活动期CT与MRI影像学特征分析

目的 分析强直性脊柱炎(ankylosing spondylitis,AS)活动期CT与MRI的影像学表现特征以及对临床诊疗的指导意义。方法 回顾性分析2015-06～2018-12经该院风湿科确诊的48例AS脊柱受累患者的资料,均临床确诊AS多年,近期腰部疼痛加重,在出现症状后2周之内进行MRI及CT检查,并对两种方法的诊断特点进行评价。结果 48例AS患者CT检查中28例椎体边缘骨质增生,25例椎体呈“方椎”,8例脊柱呈“竹节椎”,21例椎小关节炎,其中5例椎小关节骨性连接,11例椎间隙变窄,密度增高。MRI检查中胸椎11例,腰椎39例。其中18例显示椎体终板前上、后上角T1WI低信号,T2WI及压脂高信号改变,30例显示整个及部分椎体T1WI低信号,T2WI及压脂高信号,11例椎间盘T2WI显示髓核结构不均一,信号减低,椎间盘高度降低,21例椎小关节局部骨质及周围滑膜T1WI低信号,T2WI及压脂高信号。结论 AS活动期的MRI及CT检查都具有一定的特点,但MRI检查对AS活动期显示更具特征性,应优选MRI检查。     

磁共振成像对老年骨质疏松及骨转移瘤所致脊柱椎体压缩性骨折的鉴别诊断价值

目的探讨磁共振成像(MRI)对老年骨质疏松及骨转移瘤所致脊柱椎体压缩性骨折的鉴别诊断价值。方法分析80例脊柱椎体压缩性骨折患者的临床资料,对照组46例骨质疏松性脊柱椎体压缩性骨折患者,77节椎节,试验组34例骨转移瘤性脊柱椎体压缩性骨折患者,42节椎节。对比两组MRI影像学特征、磁共振表观扩散系数(ADC值)、血清肿瘤坏死因子(TNF)-α、白细胞介素(IL)-23和IL-6水平。结果试验组主要以扁平形(23. 81%)和倒楔形(71. 43%)为主,椎体信号以T1WI低信号(95. 24%)、T2WI高信号(90. 48%)和DWI高信号(92. 86%)为常见信号,椎体后缘形态以膨隆(85. 71%)为主,椎弓根以膨大(80. 95%)和T1WI低信号(95. 24%)为主,椎管软组织以结节肿块(85. 71%)和环形增厚(71. 43%)为主;对照组主要以楔形(48. 05%)和凹陷形(42. 86%)为主,椎体信号以DWI低信号(83. 12%)、T1WI低信号(67. 53%)为常见信号,椎体后缘形态以成角(79. 22%)为主。两组椎体形态、椎体后缘形态、椎弓根形态、椎体信号和椎管软组织形态变化水平,差异均有统计学意义(P<0. 05)。试验组ADC值明显低于对照组,血清TNF-α、IL-23及IL-6水平明显高于对照组(P<0. 05)。结论采用MRI扫描及血清炎症因子对骨质疏松及骨转移瘤所致脊柱椎体压缩性骨折的鉴别诊断具有临床指导意义。     

应用椎弓根联合治疗布鲁杆菌病术后躁动情况观察

布鲁杆菌病（布病）为一种人畜共患的传染病,是由布鲁杆菌引起的系统性和变态反应性疾病。布鲁杆菌性脊柱炎为脊柱炎中较为少见的病变,全世界发病率为2％～53％,目前尚缺乏一致性治疗方案。经影像学检查证实患者椎体破坏较轻,椎旁无软组织肿胀或神经损伤可进行保守治疗。     

磁共振成像在布鲁氏菌性脊柱炎与脊柱结核的鉴别诊断价值

目的 探讨磁共振成像（MRI）在布鲁氏菌性脊柱炎与脊柱结核鉴别诊断中的应用价值,为布鲁氏菌性脊柱炎与脊柱结核的鉴别诊断提供参考依据。方法 选取广州市胸科医院及中山大学第一附属医院惠亚医院2019年1月到2021年12月期间收治的87例确诊脊柱结核患者作为脊柱结核组（广州市胸科医院87例）,23例确诊布鲁氏菌性脊柱炎患者作为脊柱炎组（广州市胸科医院5例,中山大学第一附属医院惠亚医院18例）,所有患者均行MRI检查,根据影像学资料比较两组的发病部位、椎体受累数、受累椎体信号形态特征、椎体破坏、椎间盘狭窄情况和脓肿信号。结果 两组的发病部位、椎体受累数对比无显著差异（P>0.05）。两组受累椎体信号形态特征对比差异有统计学意义（P <0.05）,其中脊柱炎组的弥散型信号比例(50.00%)低于脊柱结核组(88.89%),局灶型比例(30.43%)高于脊柱结核组(11.11%),扇形信号比例(23.08%)高于脊柱结核组(0)。两组椎体破坏和椎间盘狭窄情况比较差异有统计学意义(P <0.05),其中脊柱炎组的椎体塌陷比例(0)低于脊柱结核组(43.52%),脊柱后凸畸形比例(...     

六例布鲁氏菌性脊柱炎误诊为腰椎结核临床分析

目的: 对误诊为腰椎结核的布鲁氏菌性脊柱炎患者进行分析,探讨布鲁氏菌性脊柱炎的治疗结局。 方法: 收集陕西省结核病防治院2018年6月至2021年6月误诊为腰椎结核的6例布鲁氏菌性脊柱炎患者的临床资料,对临床症状、实验室检查结果、影像学表现、治疗方法及随访结果进行分析。 结果: 6例患者中,男性4例,女性2例;年龄54~81岁,平均(63.00±10.15)岁;2例有布鲁氏菌病接触史,3例有牧区及牛羊接触史,1例接触史不详;1例合并陈旧性肺结核,1例硬膜外脓肿患者行手术治疗。病程20d至1年,平均(4.17±1.32)个月;误诊时间7~24d,平均(15.66±5.53)d;病变部位位于腰2~3椎体2例,腰3~4椎体1例,腰4~5椎体2例,腰5~骶1椎体并发硬膜外脓肿1例。6例患者X线检查均表现为椎间隙狭窄,椎体为边缘型骨质破坏且与增生硬化交替出现,邻近椎间骨桥形成;1例高热,体温>39℃,为波状热,其余5例体温正常;2例结核菌素纯蛋白衍生物(PPD)皮肤试验弱阳性,3例一般阳性,3例结核抗体阳性,2例结核蛋白芯片(LAM抗体)及结核感染T细胞斑点试验(T-SPOT.TB)阳性。所有患者通过虎红平板凝集试验初筛及试管凝集试验阳性确诊为布鲁氏菌性脊柱炎,经盐酸多西环素、利福平治疗12周,随访6个月,最终4例治愈,2例好转,未见复发。 结论: 布鲁氏菌性脊柱炎一般有疾病接触史,通过热型及实验室检查可确诊,布鲁氏菌性脊柱炎患者总体预后良好。     

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.     

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.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.