腹膜后神经内分泌肿瘤CT表现(附4例报告并文献复习)

神经内分泌肿瘤是一组起源于肽能神经元和神经内分泌细胞的异质性肿瘤,属于胺前体摄取及脱羧细胞(amine precursor uptake and decarboxylation, APUD)肿瘤,主要发生于肺、胃肠道及胰腺等部位,原发于腹膜后的神经内分泌肿瘤十分罕见,文献多为个案报道.现将笔者所见4例报道如下,并对本病的相关文献进行复习,旨在提高对本病的认识.     

纵隔神经内分泌癌的CT诊断(附7例报告)

神经内分泌癌是一种少见的肿瘤,首次报道见于1907年,发生率为1.5/10万[1].笔者回顾性分析了7例纵隔神经内分泌癌及其他文献个案报道,分析其CT征象及临床表现,以期提高对纵隔神经内分泌癌的综合认识.     

运用Endnote和Refviz文献分析软件对太极拳相关英文文献的分析

目的:通过检索和分析太极拳相关文献以了解其当前的研究现状。方法:以"tai chi"和"tai ji"为检索词,通过适当的检索策略检索Pubmed和SCI两个数据库,然后利用Endnote和Refviz两款文献分析软件对检索的文献进行分析。结果:共检索到910篇太极拳相关英文文献,发现当前太极拳相关研究最多的是老年人群,研究主题主要包括疾病和护理问题两类,其中疾病主要有肌肉骨骼系统、心血管系统疾病等;护理问题主要涉及心理健康问题、疼痛、睡眠、社会功能等。太极拳相关英文文献作者大部分来自国外以及台湾地区;太极拳相关研究的文献以随机对照试验为主。结论:目前关于太极拳对癌症患者影响的研究以及太极拳内涵和机理的研究较少,建议进一步深入开展此方面的研究。     

原发性肝脏神经内分泌癌一例

肝原发性神经内分泌癌临床较少见,现报告1例经病理证实的肝原发神经内分泌癌,并对该病的发病特点、诊断及治疗等作一文献复习.     

正电子药物在神经内分泌肿瘤显像中的应用

神经内分泌肿瘤(NETs)起源于器官的多能干细胞或者分化型神经内分泌细胞[1].因此,NETs被分成很多类型[2]:(1)胃肠胰神经内分泌肿瘤(GEP).①胰腺内分泌肿瘤(胃泌素瘤,胰岛素瘤,血管活性肠肽肿瘤,胰高血糖素瘤,生长抑素瘤);②胃神经内分泌肿瘤;③十二指肠神经内分泌肿瘤;④空肠、阑尾、盲肠神经内分泌肿瘤;⑤结肠、直肠神经内     

胰腺神经内分泌肿瘤的MDCT诊断

目的探讨MDCT(Multi-detector Computed Tomography)在胰腺神经内分泌肿瘤(pancreatic neuroendocrine neoplasm,p NENs)诊断及鉴别诊断中的应用价值。方法回顾2010年11月~2016年6月21例在我院经病理确诊的胰腺神经内分泌肿瘤病例资料,均行MDCT检查。结果 21例病例中,功能性肿瘤13例,非功能性8例;其中神经内分泌瘤17例,神经内分泌癌3例,混合性腺神经内分泌癌1例。CT平扫12例为实性,9例为囊实性;三期增强扫描示16例呈明显强化,3例中度强化,2例轻度强化;神经内分泌瘤主要表现为明显强化,内分泌癌以轻中度强化为主,差异有统计学意义(P0.05);神经内分泌瘤的强化方式多较均匀,内分泌癌强化欠均匀,两者比较差异无统计学意义(P0.05)。结论MDCT对胰腺神经内分泌肿瘤诊断有很大的应用价值,能够有效的帮助临床进行治疗。     

肝脏原发性小细胞神经内分泌癌TACE治疗3例报道

目的探讨肝脏原发性小细胞神经内分泌癌的临床特点、诊断、治疗与预后。方法对本组3例肝脏原发性小细胞神经内分泌癌患者的临床病史、影像学表现、病理学免疫组化及介入治疗进行总结,并复习相关文献。结果 3例患者均有不同程度的腹痛,CT平扫表现为肝内稍低密度影,增强扫描表现为不均匀环状强化,穿刺组织病理学结果均确诊为肝脏神经内分泌癌。3例患者经介入治疗后,近期均有一定治疗效果,其中1例患者经多次介入治疗,随访1年半,疗效尚满意,另2例半年后失访。结论肝脏原发性小细胞神经内分泌癌属于临床少见恶性肿瘤,可通过CT引导穿刺行病理学免疫组化确诊,选择TACE治疗安全有效。     

胸腺神经内分泌肿瘤的临床、病理及CT表现

胸腺神经内分泌肿瘤(Thymic neuroendocrine tumour)是起源于胸腺组织中具有神经内分泌功能细胞的一种恶性肿瘤,临床上较为罕见,文献统计约占前纵隔肿瘤的2％～4％[1].笔者搜集3例经病理证实的胸腺神经内分泌肿瘤患者的临床、病理及CT资料进行综合分析,以期提高对该病的认识和鉴别诊断能力.1资料与方法1.1一般资料3例中男2例,女1例,年龄分别为26、37及74岁,均经手术或纵隔镜穿刺后病理证实.1例临床表现为异位ACTH综合征,其余2例未见明显的内分泌异常表现.     

少见部位神经内分泌癌的CT及MRI表现

【摘要】目的：总结少见部位神经内分泌癌的CT及MRI特点,以提高对该病的认识。方法：回顾性分析经病理证实的31例少见部位神经内分泌癌的CT及MRI资料并复习相关文献,总结其影像学特征。结果：病灶位于鼻腔鼻窦7例,纵隔14例,肾脏2例,膀胱4例,前列腺2例,肝脏1例,卵巢1例。30例行CT检查,平扫+增强26例,平扫4例;11例行MRI平扫+增强。病变均表现为浸润性生长的软组织肿块,体积较大,密度或信号不均,强化程度及方式不一,8例DWI高b值扩散受限呈混杂高信号,ADC图为低信号,1例时间-信号强度曲线呈流出型;28/31伴坏死,2/31伴钙化,31/31伴周围组织侵犯,17/31伴淋巴结转移。7例鼻部神经内分泌癌周围骨质均表现为膨胀性与浸润性破坏并存。纵隔神经内分泌癌中,12/14见分隔样强化或小血管穿行征。结论：少见部位神经内分泌癌的影像学表现具有一定特征性：病灶表现为大肿块,坏死常见,钙化少见,极易侵犯周围结构。鼻腔鼻窦神经内分泌癌周围骨质膨胀性与浸润性破坏并存且不伴骨质硬化,纵隔神经内分泌癌伴分隔样强化或瘤内血管穿行征较具特征性。     

MSCT在胰腺神经内分泌肿瘤诊断及其鉴别诊断的应用价值

目的探讨胰腺神经内分泌肿瘤的MSCT表现,以提高对其诊断水平。方法回顾性分析15例经手术后病理证实为NETP患者的MSCT表现。将神经内分泌瘤与神经内分泌癌分组对各期CT值进行统计学分析。结果 15例中,男性4例,女性11例,年龄22~68岁,平均46岁。9例胰腺神经内分泌瘤,5例胰腺神经内分泌癌,1例混合性腺泡-神经内分泌癌。胰头5例、胰颈5例、胰体尾部5例。13例表现为实性肿块,2例表现为囊实性肿块。4例肿瘤的强化较均匀,11例为不均匀强化,其中3例表现为边缘环形强化。神经内分泌瘤与神经内分泌癌的各期CT值无统计学差异。结论神经内分泌肿瘤的影像学表现多样,认识其多样性及不典型影像学征象,对提高诊断水平有较大帮助。     

16周太极拳和快走锻炼对老年女性呼吸机能的影响

目的:探讨太极拳和快走锻炼对老年人呼吸机能的影响。方法:40名老年女性随机分成太极拳组和快走组。两组受试者分别接受16周太极拳和快走锻炼,每周5次,每次1小时,停止练习后再跟踪测试8周。受试者每4周测试1次呼吸机能,共7次,分别为实验前和实验第4、8、12、16、20、24周。结果:锻炼阶段,与实验前相比,两组第12周和第16周肺活量(VC)和时间肺活量(FVC)均显著增加,两组第16周每分钟最大通气量(MVV)均显著增加。停练阶段,与实验第16周相比,太极拳组实验第20周和第24周VC和FVC无明显变化,快走组第20周和第24周显著降低,两组第24周MVV均显著降低。结论:太极拳和快走锻炼在锻炼阶段均能提高老年女性呼吸机能,停练后太极拳锻炼者呼吸机能的维持效果好于快走锻炼者。     

24周太极拳锻炼对中老年人静态平衡功能的影响

目的:探讨24周太极拳锻炼对中老年人静态平衡机能的影响。方法:24周简化太极拳和42式太极拳锻炼(每周锻炼4次,每次60分钟)前后,55～65岁中老年人70名分别在双足睁眼、闭眼,单足睁眼、闭眼状态下,采用WIN-POD平衡功能检测系统测试重心动摇总轨迹长(TL)、外周面积(Area)、前后方向和左右方向的动摇指数,其中,双足状态下测试时间为30s,单足状态下测试时间为10 s。结果:24周太极拳锻炼后,(1)双足测试状态下,男性受试者睁眼TL、Area、X轴动摇速度(X speed)、X轴平均摆幅(X dev.)、Y轴平均摆幅(Y dev.)较实验前显著降低(P<0.05);闭眼TL、Area、重心平均动摇速度(Avg.v)显著低于实验前(P<0.05)。女性睁眼Y轴动摇速度(Y speed)显著低于实验前(P<0.05);(2)单足测试条件下,男性受试者睁眼TL、Avg.v、X speed显著低于实验前(P<0.05,P<0.01)。女性受试者睁眼Area、X dev.、Y dev.显著降低(P<0.05,P<0.01);闭眼单位面积轨迹长(L/A)显著高于实验前(P<0.05)、Y dev.显著低于实验前(P<0.05)。结论:24周太极拳锻炼对中老年人静态平衡机能有积极影响。     

上海市区太极拳练习者膝关节疼痛调查分析

目的:调查分析上海市区太极拳练习者膝关节疼痛的情况。方法:采用现场发放问卷方式,对上海市各区参与太极拳练习者1025人进行调查。回收925份问卷,回收率90.2%。剔除信息不全的问卷87份,有效问卷共838份。调查内容分两部分,一为受访者练习太极拳的基本信息;二为对有膝关节疼痛的受访者进行的针对性调查,内容包括疼痛发生时间、类型、程度、持续时间、发生在练太极拳的什么阶段,每次练习时疼痛的时段、是否就医、医生诊断结果、膝关节实际疼痛部位等。采用卡方检验、Logistic回归等统计学方法分析调查数据。结果:练太极拳后有膝关节疼痛(下称练后膝痛群)404人,占48.2%。练太极拳前有膝关节疼痛(下称练前膝痛群)385人,其中,练拳后膝关节无疼痛者(下称练后无膝痛群)151人,占39.2%。卡方关联程度分析显示,练前膝痛群与练后膝痛群存在一定关联(P<0.001)。线性视觉模拟标尺评分法测试受访者平均疼痛程度为3.7±2.1。练后膝痛群中,61.5%的练习者疼痛持续时间在10分钟以内。练后膝痛群中,57%在初学阶段、23.6%在初学至中等水平阶段膝关节出现疼痛,中等水平时痛者占9.7%,中等水平至高水平时痛者占6.3%,水平高时痛者占3.4%。疼痛以酸痛为主,占55.9%。下蹲时膝关节疼痛比例最大,占55.9%。疼痛位置多在膝关节正前方,占53.6%。Logistic回归结果显示,拳龄、练拳前是否膝痛与膝关节疼痛有一定关联。结果表明:太极拳练习者膝关节疼痛的阶段主要在初学至中等水平阶段,练习者拳龄越长膝关节疼痛比例越小,表明拳龄与膝关节疼痛存在关联。     

太极拳运动对中老年女性Th1/Th2平衡影响的机制研究

目的:从细胞因子角度在基因表达水平上探讨太极拳运动前后调节性T细胞(regulatoryT cells,Treg)对辅助性T细胞(helper T cell,Th)亚群Th1/Th2平衡的影响。方法:将自愿参加本实验的34名中老年女性随机分为太极拳组和对照组。太极拳组参加为期32周、每周3次、每次1小时的24式和42式太极拳锻炼;对照组不锻炼,保持原有生活状态。实验前后采集受试者外周血,使用流式细胞术检测Treg细胞数量;使用Real-time PCR定量分析Th1型淋巴细胞相关细胞因子干扰素-γ(Interferon-gamma,IFN-γ)和Th2型淋巴细胞相关细胞因子白介素-4(Interleukin-4,IL-4)、Treg相关细胞因子白介素-10(Interleukin-10,IL-10)和转化生长因子-β(transforming growth factor,TGF-β)以及细胞毒T淋巴细胞相关抗原-4(cytotoxic T lymphocyte-associated antigen-4,CTLA-4)mRNA表达。结果:实验后,太极拳组IFN-γ、TGF-β、CTLA-4和IL-10 mRNA表达量较实验前显著上升(P<0.01),IFN-γ与IL-4 mRNA表达量比值显著上升(P<0.05),Treg细胞占CD4+T细胞比例显著上升(P<0.01)。实验后,对照组除TGF-βmRNA表达下降(P<0.05)外,其他指标变化均无统计学意义。结论:太极拳运动影响外周血Treg细胞数量及相关细胞因子mRNA表达,提高中老年女性Th1/Th2型细胞因子mRNA表达量比值,在基因表达水平上改善老年女性Th1/Th2失衡。     

Effects of Tai Ji Exercise on Bone Structure and Function

To evaluated the effects of the 24 movements Tai Ji exercise on bone structure and function. Broadband Ultrsonic Attenuation (BUA) and velocity of sound (VOS), bone formation marker Osteocalcin (OSTN) and bone resorption markers urinary Pyridum crosslinks (PYR and D-PYR) were studied before and after four months of Tai Ji exercise. Improved bone structure and increased bone density in menopausal women were reflected by BUA results. The increased BUA appears to be associated with increased bone formation rather than decreased bone resorption.     

Effects of exercise on joint sense and balance in elderly men: Tai Chi versus golf

PURPOSE: Our previous studies showed that experienced Tai Chi practitioners had better joint proprioception and balance control during weight shifting. The objective of the present study was to examine whether experienced golfers had attained similar improvement when compared with the Tai Chi practitioners, as well as healthy elderly subjects and young university students. METHODS: We compared 12 experienced elderly Tai Chi practitioners, with 11 experienced elderly golfers, 12 healthy elderly subjects, and 12 young university students, who were all males, using: 1) passive knee joint repositioning test to assess their joint proprioceptive acuity and 2) limits of stability test to assess their ability to voluntarily weight shift within their base of support. RESULTS: Both Tai Chi practitioners and golfers had better knee joint proprioceptive acuity than did the elderly control subjects (P < 0.05). Of special interest is that their performance was similar to that of the young subjects. In the limits of stability test, Tai Chi practitioners and golfers had faster reaction time, leaned further without losing stability, and showed better control of leaning trajectory than did elderly control subjects (all P < 0.05). The latter two outcome measures were also comparable to those of the young subjects. CONCLUSION: These results demonstrate that both experienced Tai Chi practitioners and golfers had improved knee joint proprioception and limits of stability, when compared with those of elderly control subjects similar in age, gender (male), and physical activity level. Such improved outcome measures were comparable to those of young male subjects. These findings suggest that experienced Tai Chi practitioners and golfers had improved joint proprioceptive acuity and dynamic standing balance control, despite the known aging effects in these specific sensorimotor functions.     

Effect of 4- and 8-wk intensive Tai Chi Training on balance control in the elderly

PURPOSE: The objective of this study was to examine whether 4 and/or 8 wk of intensive Tai Chi practice could improve balance control in the healthy elderly subjects. METHODS: Forty-nine community-dwelling elderly subjects (aged 69.1 +/- SD 5.8 yr) voluntarily participated in an intervention program of either supervised Tai Chi or general education for 1.5 h, 6x wk for 8 wk. Two balance tests were administered using computerized dynamic posturography before, at 4 and 8 wk during training, and at 4 wk after training ended: 1) the sensory organization test measured subjects' abilities to use somatosensory, visual, and vestibular information to control their body sway during stance under six sensory conditions; and 2) the limits of stability test measured subjects' abilities to voluntarily weight shift to eight spatial positions within their base of support. These outcome measures were compared between the two intervention groups, and with those of experienced Tai Chi practitioners having means of 7.2 and 10.1 yr of practice from two previous studies. RESULTS: Statistical analysis demonstrated that, after 4 and 8 wk of intensive Tai Chi training, the elderly subjects achieved significantly better 1) vestibular ratio in the sensory organization test (P = 0.006) and 2) directional control of their leaning trajectory in the limits of stability test (P = 0.018), when compared with those of the control group. These improvements were maintained even at follow-up 4 wk afterward. Furthermore, the improved balance performance from week 4 on was comparable to that of experienced Tai Chi practitioners. CONCLUSIONS: The above findings indicated that even 4 wk of intensive Tai Chi training are sufficient to improve balance control in the elderly subjects.     

多层螺旋CT肺动脉成像评价急性肺栓塞严重性的初步研究

目的:探讨多层螺旋CT肺动脉成像(CTPA)在评价肺栓塞(PE)严重性方面的价值。方法:23例急性PE患者行16层螺旋CT肺动脉和下肢静脉血管成像。根据超声心动图的检查结果,将患者分为右室劳损组(A组,7例)和无右室劳损组(B组,16例)。在CTPA心腔短轴位图像上测量右室最大横径(RVMMA)、左室最大横径(LVMMA)、主肺动脉(PA)直径、升主动脉(AO)直径,观察室间隔移位、下腔静脉对比剂反流情况,并计算RVMMA/LVMMA和PA/AO值及肺动脉阻塞指数。结果:A组与B组比较,差异有显著性意义的参数包括肺动脉阻塞指数(分别为46.79%、25.31%,P=0.024),RVMMA(分别为4.9和3.51cm,P<0.001),LVMMA(分别为3.34和4.07cm,P=0.046),RVMMA/LVMMA(分别为1.56、0.88,P=0.002),主肺动脉直径(分别为3.31和2.67cm,P=0.01),PA/AO(分别为1.03、0.75,P=0.011),室间隔移位比(分别为4/7、1/16,P=0.017)。以肺动脉阻塞指数为47%作为阈值时,诊断右心室劳损的敏感度为57%,特异度为75%;以RVMMA/LVMMA为1.4作为阈值,诊断右心室劳损的敏感度为71%,特异度为100%。结论:CTPA不仅可以诊断PE,并且可以提示急性PE的严重性。     

Tai Chi: improving functional balance and predicting subsequent falls in older persons

PURPOSE: To determine whether improved functional balance through a Tai Chi intervention is related to subsequent reductions in falls among elderly persons. METHODS: Two hundred fifty-six healthy, physically inactive older adults aged 70-92 (mean age +/- SD = 77.48 +/- 4.95), recruited from a local health system in Portland, OR, participated in a 6-month randomized controlled trial, with allocation to Tai Chi or exercise stretching control, followed by a 6-month postintervention follow-up. Functional balance measures included Berg balance scale, dynamic gait index, and functional reach, assessed during the 6-month intervention period (baseline, 3-month, and 6-month intervention endpoint) and again at the 6-month postintervention follow-up. Fall counts were recorded during the 6-month postintervention follow-up period. Data were analyzed through intention-to-treat analysis of variance and logistic regression procedures. RESULTS: Tai Chi participants who showed improvements in measures of functional balance at the intervention endpoint significantly reduced their risk of falls during the 6-month postintervention period, compared with those in the control condition (odds ratio (OR), 0.27, 95% confidence interval (CI), 0.07-0.96 for Berg balance scale; OR, 0.27, 95% CI, 0.09-0.87 for dynamic gait index; OR, 0.20, 95% CI, 0.05-0.82 for functional reach). CONCLUSIONS: Improved functional balance through Tai Chi training is associated with subsequent reductions in fall frequency in older persons.     

肾脏基础疾病对马兜铃酸肾病临床表现及病理改变的影响

目的了解有或无肾炎病史马兜铃酸肾病（ANN）患者发病后的临床表现及肾脏病理改变特点,减少漏诊、误诊。方法11例表现为急性肾衰（ARF）的ANN患者,均为男性,年龄17～53岁。按发病前肾功能正常时有或无肾炎病史,分为有肾炎史组（n=5）和无肾炎史组（n=6）,比较两组发病时的临床表现、尿液中红细胞计数、尿蛋白定量、尿蛋白选择性、尿糖定量、尿NAG酶、尿视黄醇蛋白（RBP）及尿氨基酸定量等指标及’肾活检病理改变。结果有肾炎史组：40％表现为少尿型ARF,问时伴有大量蛋白尿（60％）、镜下血尿（40％）及高血压（40％）,尿糖定量、尿NAG酶、尿RBP及尿氦基酸都比正常明显升高,但不如无肾炎病史组升高明显;肾脏痫理改变,同时伴有不同性质和程度的肾小球病变,以及肾问质炎细胞浸润。无肾炎病史组：均为非少尿型ARF,16％有镜下血尿,无或仅少量蛋白尿,无高血压,尿糖定量、尿NAG酶、尿RBP及尿氨基酸升高更为明显;肾脏病理改变,呈现急性肾小管坏死,兀明显肾小球病变,少或无肾间质炎细胞浸润。结论同样表现为ARF的ANN患者,发病前有肾炎病史者,易误诊为单纯。肾小球疾病而漏诊马兜铃酸肾病,应强调病史、用药史及肾}舌检的作用。无肾炎病史者,肾小管功能损伤明显,但如若不进行肾小管功能相关检查,极易漏诊.