D-二聚体、纤溶酶原激活物抑制物在急性肾衰竭患者血液净化中的临床意义

目的探讨急性肾衰竭(ARF)时D-二聚体(D-D)、纤溶酶原激活物抑制物(PAI)在不同的血液净化方法中的动态变化及临床意义。方法对我院2007年1月—2010年3月急诊住院58例ARF患者血液净化前、净化后4 h及38例健康人进行血浆中D-D含量及PAI水平测定。ARF患者血液净化方法随机采用血液透析(HD)(31例)、血液透析滤过(HDF)(27例)。结果 ARF患者D-D含量及PAI水平较对照组明显升高[D-D(0.83±0.04)与(0.48±0.03)mg/L,P=0.000 2;PAI(14.95±0.73)与(8.03±0.30)103kat/L,P<0.0001;]HD治疗4 h后D-D含量和PAI活性较治疗前升高[D-D(0.89±0.05)与(1.48±0.37)mg/L,P=0.018;PAI(14.89±1.78)与(22.10±3.56)103kat/L,P=0.025],而HDF治疗后D-D含量和PAI无明显变化[D-D(0.91±0.06)与(1.12±0.09)mg/L,P=0.65;PAI(15.81±1.98)与(16.10±2.56)103kat/L,P=0.86]。结论 ARF患者D-D、PAI水平升高,存在凝血-纤溶系统的紊乱,HD可以加重这种改变,而采用HDF治疗可避免对患者凝血机能的影响,在急性肾衰竭治疗中有一定临床价值。     

高压氧辅助治疗对卒中后抑郁患者血清5-HT、NE及神经功能的影响

目的：观察高压氧（HBO）辅助治疗对卒中后抑郁（PSD）患者血清5-羟色胺（5-HT）、去甲肾上腺素（NE）及神经功能的影响。方法70例PSD患者根据数字表法随机分为2组,对照组（n=35例）采用常规措施治疗,观察组（n=35例）待确定活动性出血已稳定或已趋于稳定后,在对照组治疗基础上加用HBO治疗。两组疗程均为30d,比较两组患者治疗前后血清5-HT、NE表达水平及汉密尔顿抑郁量表（HAMD）、中国脑卒中量表（CSS）,改良Barthel指数（MBI）评分变化。结果两组患者治疗后血清5-HT、NE表达水平均明显升高（P<0.05）,且观察组升高较对照组更为显著（P<0.05）;两组患者治疗后HAMD、CSS评分明显降低（P<0.05）,而MBI评分明显升高（P<0.05）,且观察组降低或升高较对照组更为显著（P<0.05）。结论 HBO辅助治疗可明显升高PSD患者血清5-HT、NE表达水平,改善抑郁状态和神经功能。     

Anterior interosseous nerve lession and distal myoclonus revealing a parsonage turner syndrome associated with hashimoto thyroiditys

Parsonage-Turner Syndrome (PTS), also known as brachial neuritis or neuralgic amyotrophy, is a rare disorder affecting 2 to 3 individuals per 100,000 each year. Abrupt onset shoulder pain, followed by motor weakness, paresthesia and hypoesthesia, is usually reported, lasting several months with variable recovery. The etiology of the disease may be idiopathic or triggered by an underlying autoimmune disease in genetically susceptible individuals. Our report addresses a unique case of Parsonage-Turner Syndrome in a patient suffering from concurrent Hashimoto Thyroiditis. A previously healthy A 22 year-old female was referred to the Department of Neurology after complaints of sudden-onset motor weakness in her left upper limb. On physical examination, the patient could not make an “Ok sign” with her thumb and distal phalanx or form a complete fist, revealing weakness within the anterior interosseous branch of the median nerve. Further testing with electromyography demonstrated muscular atrophy within the arm''s anterior compartment, forearm, and triceps brachii of the posterior compartment. Additional imaging and physical examination were unremarkable, confirming our diagnosis of PTS. Furthermore, lab reports revealed elevated levels of anti-thyroglobulin and anti-thyroid peroxidase antibodies and our patient was concurrently diagnosed with Hashimoto''s thyroiditis.This case aims to highlight the rare co-occurrence of Hashimoto''s thyroiditis with Parsonage-Turner Syndrome in an otherwise healthy patient. A 2014 study published by Nugent et al. had also shed light on brachial neuritis in a patient suffering from autoimmune connective tissue disease, and through this case study, we hope to add to the growing literature regarding the correlation between PTS and autoimmune diseases. Symptoms of PTS can easily be misdiagnosed given its similarity to other peripheral neuropathies, and careful assessment and thorough understanding of the disease is required to successfully distinguish it from other neurological pathologies.     

Image quality dependence on in-plane positions and directions for MDCT images

Objective

The present study was performed to examine the dependence of image quality on in-plane position and direction in computed tomography (CT) imaging using the modulation transfer function (MTF), noise power spectrum (NPS) and analysis of signal-to-noise ratio (SNR). For detailed analysis of SNR, the low-contrast detectability was compared using simulated small low-contrast objects.

Materials and methods

Three models of multidetector-row CT (MDCT) were employed. The measurement positions for MTF were set to the isocentre and several peripheral areas, and NPS and SNR were calculated for the isocentre and 128 mm off-centre. To evaluate directional dependence, the one-dimensional physical properties were measured separately in the radial and azimuthal directions. Seven radiological technologists also performed a perceptual detection study at the different in-plane positions using computer-simulated low-contrast images.

Results

The results of MTF and SNR differed between the isocentre and the peripheral area. The MTF values also tended to decrease with distance from the isocentre, and the SNR values in the low frequency range for the peripheral area were superior to those for the isocentre. In the detection study, the low-contrast detectability in the peripheral area was 13-40% higher than the value in the isocentre.

Conclusion

The results of the present study indicated that clinical CT images have remarkable non-uniformity of image quality. Therefore, the detailed analysis performed in this study will provide useful information for the development of advanced image processing applications, such as computer-aided diagnosis (CAD) and de-noising of CT images.     

Validity of apparent diffusion coefficient (ADC) value in diagnosis and follow-up of multiple sclerosis patients in different clinical subtypes

Background

Multiple sclerosis (MS) is a chronic disease with a wide range of pathologic changes that modify the apparent diffusion coefficient (ADC) value.

强直性脊柱炎80例临床研究

1985年,我院内科对800例患腰背痛,其中部分为外院疑有强直性脊柱炎(AS)的病人,进行了临床及HLA-B_(27)检查。根据纽约诊断标准,确诊为AS病者80例,其发病年龄多在12～30岁之间,男女之比例为6.3∶1;72例AS病人之HLA-B_(27)阳性,5例病人有家族史,提示本病与遗传因素有关。部分病人做到了早期诊断。我们认为,对患腰背痛的病人进行HLA-B_(27)检查,可提高医生对AS发病之警觉。     

脑梗死患者血清同型半胱氨酸检测的临床意义

目的：探讨脑梗死患者血清同型半胱氨酸（Hcy）水平的变化及临床意义。方法：应用比色法对44例脑梗死患者（脑梗死组）进行血清Hcy水平测定,并与40例健康正常人（对照组）作比较。结果：脑梗死组血清Hcy水平（21.42±3.19μmol/L）明显高于对照组（12.04±2.46μmol/L）。结论：脑梗死患者血清Hcy水平明显升高,可作为预测脑梗死发生、发展的敏感指标。     

Humane metapneumovirus (HMPV) associated pulmonary infections in immunocompromised adults—Initial CT findings,disease course and comparison to respiratory-syncytial-virus (RSV) induced pulmonary infections

Aim

To describe computed tomography (CT)-imaging findings in human metapneumovirus (HMPV)-related pulmonary infection as well as their temporal course and to analyze resemblances/differences to pulmonary infection induced by the closely related respiratory-syncytial-virus (RSV) in immunocompromised patients.

Materials and methods

Chest-CT-scans of 10 HMPV PCR-positive patients experiencing pulmonary symptoms were evaluated retrospectively with respect to imaging findings and their distribution and results were then compared with data acquired in 13 patients with RSV pulmonary infection. Subsequently, we analyzed the course of chest-findings in HMPV patients.

Results

In HMPV, 8/10 patients showed asymmetric pulmonary findings, whereas 13/13 patients with RSV-pneumonia presented more symmetrical bilateral pulmonary infiltrates. Image analysis yielded in HMPV patients following results: ground-glass-opacity (GGO) (n = 6), parenchymal airspace consolidations (n = 5), ill-defined nodular-like centrilobular opacities (n = 9), bronchial wall thickening (n = 8). In comparison, results in RSV patients were: GGO (n = 10), parenchymal airspace consolidations (n = 9), ill-defined nodular-like centrilobular opacities (n = 10), bronchial wall thickening (n = 4). In the course of the disease, signs of acute HMPV interstitial pneumonia regressed transforming temporarily in part into findings compatible with bronchitis/bronchiolitis.

Conclusions

Early chest-CT findings in patients with HMPV-related pulmonary symptoms are compatible with asymmetric acute interstitial pneumonia accompanied by signs of bronchitis; the former transforming with time into bronchitis and bronchiolitis before they resolve. On the contrary, RSV-induced pulmonary infection exhibits mainly symmetric acute interstitial pneumonia.     

Comparison of double inversion recovery magnetic resonance imaging (DIR-MRI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in detection of prostate cancer: A pilot study

IntroductionDCE-MRI is established for detecting prostate cancer (PCa). However, it requires a gadolinium contrast agent, with potential risks for patients. The application of DIR-MRI is simple and may allow cancer detection without the use of an intravenous contrast agent by differentially nullifying signal from normal and abnormal prostate tissue, creating contrast between the cancer and background normal prostate. In this pilot study we gathered data from DIR-MRI and DCE-MRI of the prostate for an equivalence trial. We also looked at how the DIR-MRI appearance varies with the aggressiveness of PCa.MethodDIR-MRI and DCE-MRI were acquired. The images were assessed by an experienced Consultant Radiologist and a novice reporter (Radiographer). The potential PCa lesions were quantified using a lesion to normal ratio (LNR). Radiological pathological correlation was made to identify the MRI lesions that represented significant PCa. A Wilcoxon sign rank was used to compare DCE-LNR and DIR-LNR for PCa containing lesions. Pearson's correlation was used to look at the relationship between DIR-LNR and PCa grade group (aggressiveness).ResultsDCE-LNR and DIR-LNR were found to be significantly different (Z = −5.910, p < 0.001). However, a significant correlation was found between PCa grade group and DIR-LNR.ConclusionDIR and DCE sequences are not equivalent and significant cancer is more conspicuous on the DCE sequence. However, DIR-LNR does correlate with PCa aggressiveness.Implications for practiceWith the correlation of PCa grade group with DIR-LNR this may be a useful sequence in evaluation of the prostate; stratifying the risk of there being clinically significant PCa before biopsy is performed. Furthermore, given that DIR-LNR appears to predict PCa aggressiveness DIR might be used as part of a multiparametric MRI protocol designed to avoid biopsy.     

CT and MR features of nasopharyngeal carcinoma in children and young adults

AIM: To clarify CT and MR features of nasopharyngeal carcinoma (NPC) in children and young adults. METHOD: CT and MR findings of 13 patients (30 years old or younger) with a histopathologic diagnosis of NPC were reviewed. RESULTS: Skull base invasion (12/13), lymphadenopathy (10/13), and infiltrative growth (8/8) were common findings. The signal intensity of tumours was slightly higher than that of muscles in six cases and isointense to that of muscles in two cases on T1-weighted images; it was higher than that of muscle and lower than that of cerebellar grey matter on T2-weighted images in all cases. Internal signals were homogeneous in both pre- and post-Gd-enhanced MR images in all cases. CONCLUSIONS: Despite its rarity in this age group, NPC should be included in a differential diagnosis when CT and MR imaging reveal these features.     

Electric current density imaging of mice tumors

The use of electric current density imaging (CDI) to map spatial distribution of electric currents through tumors is presented. Specifically, a method previously tested on phantoms was implemented in vivo and in vitro for mapping electric current pulses of the same order of magnitude (j ∽ 2500 A/m²) as in electrochemotherapy through T50/80 mammary carcinomas, B-16 melanomas and SA-1 sarcomas. A technically simplified method of electric current density imaging is discussed as well. Three geometries of electrodes (flat-flat, point-point, point-flat) indicate altered electric current distribution for the same tumor. This indicates that the method can be used for monitoring the effects of electrochemotherapy as a function of electrode geometry.     

递增负荷运动至力竭大鼠肾脏自由基产生及氧化抗氧化能力的研究

以大鼠增负荷力竭性运动为模型,利用低温电子自旋共振（ＳＥＲ）技术,分别于安静时、运动中、运动后即刻、运动后３０ｍｉｎ、２ｈ、４ｈ、８ｈ提取大鼠肾组织,测定氧自由基（ＯＦＲ）信号强度,同时测定ＳＯＤ活力和ＭＤＡ含量,结果表明：①运动后恢复期３０ｍｉｎ,肾脏ＯＦＲ信号强度升高明显,提示运动性肾缺血及恢复期再灌注诱导的黄嘌呤氧化酶机制可能是肾组织ＯＦＲ生成的主要来源;②在运动过程中及恢复期ＯＦＲ改变与ＳＯＤ变化趋势基本吻合,提示肾内源性ＳＯＤ在防止ＯＦＲ损伤中起重要作用;③肾脏ＭＤＡ于运动后２ｈ出现峰值,而ＯＦＲ则于恢复期３０ｍｉｎ升至最高,说明除肾脏自身产生活性氧诱导脂质过氧化以外,其它部位转移的ＭＤＡ也许占很大比重     

What do patients know about ultrasound,CT and MRI?

OBJECTIVES: To establish the level of patient knowledge of ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI); to describe patient information-seeking behaviour before attendance; and to assess patients' understanding of the main aspects of scanning examinations. DESIGN: Survey of people attending for ultrasound, CT and MRI using a questionnaire, including 12 statements on simple aspects of procedures, to be indicated as true or false. SETTING: Radiology department of an acute teaching hospital NHS Trust in the north-east of Scotland. PARTICIPANTS: A convenience sample of 500 out-patient, non-emergency first time attenders for ultrasound (300), computed tomography (150), and magnetic resonance imaging (50). RESULTS: An 82% response rate to the questionnaire was achieved. Less than half the patients (48.9%, 182/372) indicated they knew the type of investigation they had been referred for. When responses were compared with referral letters, 64% (238/372) were incongruent. Few participants hadsought information (32%, 120/372), but of those who had the main source was family and friends (72%, 86/120). Seven participants searched the Internet. Eighty-two percent (308/372) of participants reported having been given an explanation of why an investigation was necessary. The majority of participants (67.8%, 251/372) expected to receive their results within 2 weeks. The mean score on the 12 true/false knowledge statements was 3.8, and 17% (65/372) answered 'Don't know' to all the statements. One person answered all questions correctly. CONCLUSIONS: Patients were not well informed regarding these investigations. This has significant implications for information-giving strategies and informed consent.     

Role of multidetector computed tomography (MDCT) angiography in preoperative assessment of coarctation of the aorta in pediatric patients and young adults

IntroductionAim of this work is to assess the reliability of 64-slice multidetector computed tomographic (MDCT) angiography for the preoperative assessment of coarctation of the aorta in pediatric patients and young adults.Material and methodsTwenty eight patients with clinical suspicion of coarctation of the aorta who underwent both Doppler echocardiography and MDCT angiography were included in the study. MDCT angiography findings were compared with both Doppler echocardiography and surgical results.ResultsThe overall sensitivity of three-dimensional MDCT angiography for diagnosis of the coarctation of the aorta was (100%) which was higher than that of Doppler echocardiography (91%).The overall sensitivity of MDCT angiography for the assessment of cardiac defects was (88%) which was lower than that of Doppler echocardiography (100%).ConclusionWe concluded that MDCT angiography with multiplanar and three dimensional techniques can be considered the modality of choice for preoperative assessment of coarctation of the aorta in pediatric patients and young adults.     

超声在类风湿关节炎的应用及进展

类风湿关节炎(RA)是一种以滑膜关节进展性损害为主要特征的慢性炎症性病变。肌骨超声(MSUS)在类风湿关节炎的诊断和监测治疗等方面起着越来越重要的作用,它能在关节炎症的早期阶段就发现滑膜炎,软骨的破坏和骨质侵蚀等。而能量多普勒超声(CDE)正逐渐成为评估RA活动性和进展性的一个有效的方法。超声新技术如:超声造影(CEUS)、三维超声(3DUS)、三维能量多普勒超声(3D-PDUS)等方法为RA的早期诊断、治疗监测及预后评估提供了更为敏感和准确的途径。本文将就MSUS在RA的应用及一些研究进展做一综述。     

Cerebral blood flow estimation in vivo using local tissue reference functions

Purpose

To evaluate the use of bolus signals obtained from tissue as reference functions (or local reference functions [LRFs]) rather than arterial input functions (AIFs) when deriving cross‐calibrated cerebral blood flow (CBF_CC) estimates via deconvolution.

Materials and Methods

AIF and white matter (WM) LRF CBF_CC maps (cross‐calibrated so that normal WM was 23.7 mL/minute/100 g) derived using singular value decomposition (SVD) were examined in 28 ischemic stroke patients. Median CBF_CC estimates from normal gray matter (GM) and ischemic tissue were obtained.

Results

AIF and LRF median CBF_CC estimates resembled one another for all 28 patients (average paired CBF_CC difference 0.4 ± 1.7 mL/minute/100 g and –0.4 ± 1.4 mL/minute/100 g in GM and ischemic tissue, respectively). Wilcoxon signed‐rank comparisons of patient median CBF_CC measurements revealed no statistically significant differences between using AIFs and LRFs (P > 0.05).

Conclusion

If CBF is quantified using a patient‐specific cross‐calibration factor, then LRF CBF estimates are at least as accurate as those from AIFs. Therefore, until AIF quantification is achievable in vivo, perfusion protocols tailored for LRFs would simplify the methodology and provide more reliable perfusion information. J. Magn. Reson. Imaging 2009;29:183–188. © 2008 Wiley‐Liss, Inc.     

Application of selective saturation to image the dynamics of arterial blood flow during brain activation using magnetic resonance imaging.

A saturation-based approach is proposed to image the arterial blood flow signal with temporal resolution of 1 to 2 s and in-plane spatial resolution of a few millimeters. Using a saturation approach to suppress the undesired background stationary signal allows the blood water that enters the slice to be imaged at some specified later time. Since the blood protons that are being imaged are not restricted to the intravascular space, this technique is also sensitive to tissue perfusion signal contributions. The signal uptake characteristics of the saturation method proposed were used to study the different signal contributions as a function of the acquisition parameters. A typical perfusion acquisition (FAIR) was also used for comparison. The proposed method was demonstrated in a functional motor activation experiment and the observed signal changes were smaller than those obtained using the FAIR acquisition. The dynamics of the saturation method and FAIR temporal signal changes were investigated and time constants between 2 and 44 s were estimated. The tissue signal contribution to the saturation method's signal was small over the range of acquisition parameters that sensitized it to the arterial compartment.     

An update on the assessment of osteoporosis using radiologic techniques

In this article, the currently available radiologic techniques for assessing osteoporosis are reviewed. Density measurements of the skeleton using dual X-ray absorptiometry (DXA) are clinically indicated for the assessment of osteoporosis and for the evaluation of therapies. DXA is the most widely used technique for identifying patients with osteoporosis. Quantitative computed tomography (QCT) is the only method, which provides a volumetric density. Unlike DXA, QCT allows for selective trabecular measurement and is less sensitive to degenerative diseases of the spine. The analysis of bone structure in conjunction with bone density is an exciting new field in the assessment of osteoporosis. High-resolution multi-slice CT and micro-CT are useful tools for the assessment of bone microarchitecture. A growing literature indicates that quantitative ultrasound (QUS) techniques are capable of assessing fracture risk. Although the ease of use and the absence of ionizing radiation make QUS attractive, the specific role of QUS techniques in clinical practice needs further determination. Considerable progress has been made in the development of MR techniques for assessing osteoporosis during the last few years. In addition to relaxometry techniques, high-resolution MR imaging, diffusion MR imaging and in-vivo MR spectroscopy may be used to quantify trabecular bone architecture and mineral composition.     

临产孕妇凝血功能检测在临床中的应用

目的：探讨血小板检测在临产孕妇的意义。方法：对143例临产孕妇（实验组）与71例正常非妊娠妇女（对照组）的凝血功能进行比较分析。结果：临产孕妇组PLT、PT、APTT和FIB值相应与对照组的PLT、PT、APTT和FIB值比较差异有统计学意义（P〈0.01）。结论：在产前及分娩过程中,及时监测各项凝血指标对预测和治疗产妇异常出血有重要意义。     

力竭性运动时大鼠脑组织自由基产生及氧化、抗氧化能力的动态观察

以大鼠递增负荷力竭性运动为模型,利用低温电子自旋共振（ＥＳＲ）技术,分别测定安静时、运动过程中、运动后即刻、运动后恢复期３０ｍｉｎ、２ｈ、４ｈ及８ｈ脑组织的氧自由基（ＯＴＲ）信号强度,同时测定ＳＯＤ活力和ＭＤＡ含量。结果显示：脑组织在运动过程中ＯＦＲ信号强度逐渐增加,并具有运动强度依赖的阶段性,恢复期４小时达到高峰;ＳＯＤ活性运动时无明显改变,恢复期２ｈ升至峰值;脂质过氧化水平（ＭＤＡ）在整个运动过程中及恢复期无显著变化。提示该运动模型所引起的脂质过氧化尚未累及中枢神经系统,并且脑组织可能存在重要而有效的抗氧化体系。