肝细胞癌累及门腔间隙CT、MRI特征探讨

目的探讨肝细胞癌(HCC)累及门腔间隙(PCS)的CT、MRI表现特征和解剖基础.资料与方法回顾性研究41例HCC累及PCS的随机性病例.其中CT检查22例,MRI检查17例,CT MRI检查2例,均经手术、病理或临床诊断标准确诊.观察HCC累及PCS的CT、MRI表现,PCS病变与原发灶及HCC病理类型的关系.结果 HCC累及PCS的CT、MRI表现包括:门腔淋巴结(PCN)肿大(26/41,63.4%),原发于肝尾状叶的HCC(3/41,7.3%),HCC原发灶直接侵犯PCS(16/41,39.0%),HCC累及肝十二指肠韧带(6/41,14.6%)、PCS血管(2/41,4.9%)、PCS内胆囊管(2/41,4.9%),HCC合并网膜孔区域腹水(2/41,4.9%).PCS下段病变多为PCN肿大,上段病变多为原发灶直接侵犯.PCS病变与HCC原发灶可直接相连(18/41,43.9%);经肝十二指肠韧带间接相连(3/41,7.3%);不相连(18/41,43.9%);直接相连并经肝十二指肠韧带间接相连(2/41,4.9%).HCC累及PCS时,原发灶多为巨块型(22/41,53.7%).结论 HCC可使PCS受累,主要表现为PCN增大.HCC累及PCS的CT、MRI表现与原发灶的位置及病理类型有一定的相关性.     

多层螺旋CT对肝硬化门腔间隙及C/RL-r的临床价值分析

目的探讨多层螺旋动态增强CT对门腔间隙(PCS)及改良肝尾-右叶比值(C/RL-r)的影像学表现临床价值。方法对453例采用多层螺旋动态增强CT进行检查的肝硬化患者作为本次的观察研究对象,测量出各个患者的门腔间隙(PCS),并对其进行分析与改良肝尾-右叶比值(C/RL-r)的相关情况,探究门腔间隙增宽诊断肝硬化的意义。结果C/RL-r≥0.9的患者PCS上段宽度、PCS下段宽度、长度与门腔淋巴结PCN短径C/RL-r0.9的患者均具有明显的差异(P0.05),并且C/RL-r≥0.9的患者PCS下段肝组织出现情况与PCN出现情况与C/RL-r0.9的患者也具有明显差异(P0.05),患者门腔间隙内结构的分布中,C/RL-r≥0.9的患者PCN上段出现的患者为128例,C/RL-r0.9的患者PCN上段出现的患者为299例,为两组最多,PCS上段对于肝硬化患者诊断的特异性为87.1%,敏感性为68.3%,准确度为77.2%,而PCS下段对于肝硬化患者诊断的特异性为76.9%,敏感性为73.4%,准确度为75.6%。结论改良肝尾-右叶比值大于0.9的患者门腔间隙宽度与其比值呈正相关性,患者肝萎缩牵引会导致门腔间隙淋巴结增宽,对患者肝硬化的诊断具有一定的意义。     

上腹部病变门腔静脉间隙结构变化的CT观察

目的 探讨上腹部病变对门腔静脉间隙的影响.资料与方法 回顾性分析68例经临床或病理证实的上腹部病变患者的CT影像资料,重点观察门腔静脉间隙的CT变化.结果 59例有门腔静脉间隙改变的患者中,门腔静脉间隙淋巴结改变42例(71.2%),肝尾状叶增大8例(13.6%),血管迂曲增多8例(13.6%),胆管增粗2例(3.4%),腹水4例(6.8%),病变直接累及门腔静脉间隙6例(10%).结论 上腹部良恶性疾病在一定时期会引起门腔静脉间隙发生改变,包括淋巴结改变、尾状叶增大、血管增多迂曲、胆管增粗和腹水.     

腹腔及腹膜后间隙淋巴结结核的多层螺旋CT强化特征

目的研究腹腔及腹膜后间隙淋巴结结核的多层螺旋CT强化特征,以提高该疾病的影像诊断水平。方法收集本院经临床病理证实的腹部淋巴结结核19例,在多层螺旋CT强化图像上,观察受累淋巴结的大小、形态、密度、强化类型、优势解剖分布以及淋巴结外器官病变的强化特征。结果94.7%淋巴结结核呈典型的环状强化,仅5.3%增大的淋巴结呈均匀强化。腹部淋巴结结核常优势地累及肠系膜(73.7%)、门腔间隙(63.2%)、肝十二指肠韧带(57.9%)、肝胃韧带(47.4%)和腹主动脉周围上部淋巴结(47.4%)。9例(47.4%)脾增大,其中5例(26.3%)脾内有多发低密度灶,病灶周边强化;6例(31.5%)腹腔积液;3例(15.8%)大网膜、肠系膜和壁层腹膜广泛结节样增厚。结论结核累及腹腔及腹膜后间隙淋巴结的多层螺旋CT强化具有一定特征。     

MR扩散加权成像在腹部淋巴结的临床应用

目的:探讨MRDWI显示腹部淋巴结的可行性及其在良恶性淋巴结鉴别诊断中的价值。方法:回顾性分析20例肝癌并腹部淋巴结转移(肝门、门腔间隙和腹腔干、腹主动脉旁区域淋巴结)患者和15例乙型肝炎并肝门淋巴结肿大患者的MRI资料。对比分析T2WI和DWI对显示直径>1.0cm淋巴结的能力。在表观扩散系数(ADC)图上测量肝炎组与肝癌组淋巴结的ADC值并比较其差异。结果:肝炎组和肝癌组中T2WI显示的淋巴结DWI均可显示,淋巴结在DWI上信号强度较T2WI高。肝炎组淋巴结平均ADC值(3.92±0.28)×10-3mm2/s;肝癌组淋巴结平均ADC值(3.19±0.39)×10-3mm2/s,低于肝炎组淋巴结,两组间差异有统计学意义(P<0.001)。结论:MRDWI显示腹部淋巴结的敏感性和特异性高,可作为腹部淋巴结检查及良恶性淋巴结鉴别诊断的一种辅助手段。     

肝尾状叶CT矢状面测量与肝硬化之间的关系探讨

目的 探讨正常人肝尾状叶大小变化的规律及其与肝硬化患者之间的关系.资料与方法 经临床资料、CT及B超证实的30例肝硬化患者和30例正常人肝脏分别行正中矢状面、斜矢状面、垂直斜矢状面CT重组,计算重组后各矢状面的有效层数及肝尾状叶长径及短径的值,比较正常人与肝硬化患者肝尾状叶的关系.结果 肝尾状叶正常组与肝硬化组各矢状面有效层数差异均有统计学意义(P值＜0.001);正常组与肝硬化组各有效层面上尾状叶长径与短径比较均有显著统计学差异,且以正中矢状面短径之间(P=0.001)和斜矢状面短径之间最可靠(P＜0.001),灵敏度分别为73.33%(22/30)、76.67%(23/30),特异度分别为73.33%(22/30)、80.00%(24/30).结论 对肝尾状叶正中矢状面、斜矢状面和垂直斜矢状面有效层数、长径与短径的测量能为临床诊断肝硬化提供有利证据.     

增强MRI观测Budd-Chiari综合征患者肝尾状叶静脉及意义

目的 利用增强MRI观察Budd-Chiari综合征(BCS)患者肝尾状叶静脉,探讨其临床意义.方法 回顾性分析于本院行增强MRI的46例BCS患者(BCS组)、30例乙型病毒性肝炎后肝硬化患者(乙肝肝硬化组)及49例肝脏正常者(正常对照组)的影像资料.计算3组尾状叶静脉的显示率及测量BCS组的尾状叶静脉管径.将BCS组中能显示尾状叶静脉的病例根据病程和下腔静脉是否梗阻各分为2组,进行管径的对比研究.结果 ①BCS组、乙肝肝硬化组及正常对照组尾状叶静脉显示率分别为76.1%、30.0%及36.7%, BCS组尾状叶静脉显示率高于乙肝肝硬化组和正常对照组(P<0.01),乙肝肝硬化组与正常对照组尾状叶静脉显示率比较差异无统计学意义(P>0.05).②BCS组中能显示尾状叶静脉的有35例,平均管径为(4.21±1.66)mm.慢性组尾状叶静脉管径大于急性组(P<0.05).下腔静脉梗阻组尾状叶静脉管径大于下腔静脉通畅组(P<0.05).结论 尾状叶静脉的增强MRI在BCS诊断和病情评估中具有重要意义.     

肝门胆管癌的MSCT与MRI诊断

目的：探讨MSCT、MRI及MRCP对肝门胆管癌的诊疗价值。方法：收集18例肝门胆管癌患者,全部病例行MSCT检查,其中8例同时行MRI及MRPC检查。结果：18例中浸润型9例,结节型6例,乳突型3例。直接征象表现为胆管壁不规则增厚及狭窄、肝门区结节或肿块、乳头状或息肉状向腔突出的小结节。18例中,平扫发现可疑直接征象9例,增强扫描18例全部显示清晰,病灶从轻到中度强化,均有延迟期持续强化。8例MSCT、MRI及MRCP对比：MRI平扫发现1例,CT平扫未能发现的肝门结节;MRCP发现2例,CT及MRI平扫未能显示的管壁浸润,4例肝门结节MRCP均未能显示。间接征象主要有：①18例均有肝门病灶区以上肝内胆管扩张,呈弥漫性柱状、“软藤状”、“蟹足状”或囊状;4例累及一侧胆管为局部胆管扩张;扩张胆管由肝门向外周延伸,胆总管无扩张;②3例受累侧肝叶萎缩;③4例肝叶局部受侵及肝门血管被包饶;④5例肝门淋巴结转移。结论：MSCT、MRI及MPCP对诊断肝门胆管癌有重要价值,三种方法结合运用,能明显提高诊断率,对临床确定治疗方案可提供准确有效的依据。     

肝尾叶下腔静脉部的CT解剖

肝尾叶血管可分为尾叶突起枝、Spiegel叶枝及肝内下腔静脉枝(para-cewal portion,PCP)。肝尾叶下腔静脉枝约80%为1枝,70%其左右从门静脉左枝横行部分出,80%分布于中肝静脉根部的背侧,约50%分布于右及中肝静脉之间。作者对16例肝胆恶性肿瘤经动脉性门脉造影CT图像(CTAP)与尾叶PCP的CT解剖作了研究。其中门脉左枝根部闭塞者11例,右前枝根部闭塞者5例。门脉左枝根部闭塞者11例中8例于CTAP图像上可见Spiegel叶右侧至左肝静脉与中肝静脉间有楔状门脉血流缺损区,门脉右前枝根部闭塞者5例中4例在右叶前上区至右肝静脉与中肝静脉间无     

原发性肝细胞性肝癌局部淋巴结转移的螺旋CT表现

目的 :探讨原发性肝细胞性肝癌 (HCC)局部淋巴结转移的CT表现及病灶的大小、边缘形态与出现局部淋巴结肿大的关系。方法 :盲法下分析 162例HCC病灶的CT扫描影像。结果 :162例病灶中 48例 (占 2 9.63 %)出现局部淋巴结转移。其中肝门组、门腔间隙组以及腹主动脉组最为常见 ,其出现概率分别为 12 .96%,14 .81%,11.73 %。局部淋巴结转移出现概率与病灶大小及边缘形态有统计学意义 (P <0 .0 5 )。结论 :HCC发生局部淋巴结转移的概率为 2 9.63 %。HCC最主要的淋巴转移途径为肝内深、浅淋巴管经肝门淋巴结、门腔间隙淋巴结、腹腔干旁淋巴结至腹主动脉旁淋巴结 ,并常表现为多组、跳跃式淋巴结转移。发生局部淋巴结转移的HCC更容易出现在体积较大和无包膜型HCC中。HCC的CT分型能够反映其病理演变。     

Physiologic and pathologic calcifications and ossifications in the face and neck

The aim was to give a systematic presentation of physiologic and pathologic calcifications and ossifications in the face and neck with a special emphasis on clinical relevance. In a sometimes subacute setting one should recognize specific calcifications which often lead to important diagnoses such as fungal sinusitis or sclerosing labyrinthitis. In a more chronic situation intraocular calcifications in small children are pathognomonic for retinoblastoma. Juxtatumoral sclerosis of the laryngeal cartilage in laryngopharyngeal carcinoma is usually caused by tumor infiltration of the cartilage resulting in a higher tumor stage and, this way, has a major impact on the therapeutical strategy. Calcified lymph nodes are mainly unspecific but can be the result of tuberculosis or metastases of thyroid cancer. Cross-sectional imaging methods, most of all computed tomography, are ideally suited to reveal head and neck calcifications and ossifications, especially those which are clinically relevant.     

Head and neck infection and inflammation

This article discusses the imaging manifestations of infectious and inflammatory conditions of the head and neck. Special attention is paid to the sites, routes of spread, and complications of neck infections. Because the clinical signs and symptoms and the complications of these conditions are often determined by the precise anatomic site involved, anatomic considerations are stressed. Familiarity with the fascial layers, spaces of the neck, and the contents of each space is helpful for this discussion. The fascial layers of the neck are important barriers to infection, and once infection is established, the fascial layers play a part in directing its spread.     

幽门螺杆菌分泌与重组表达的VacA蛋白的分离纯化及其致细胞空泡效应与凋亡的对比研究

目的：分离纯化幽门螺杆菌分泌和重组表达的细胞空泡毒素抗原（ VacA）蛋白,并评价其致细胞空泡效应及致细胞凋亡效应。方法分别从幽门螺杆菌ATCC26695菌株培养上清和重组表达VacA蛋白的pQE30-VacA-E．coliM15基因工程菌中分离纯化VacA蛋白,经酸化后,以不同终浓度（5,10 ng／ml）分别与人胃腺癌AGS细胞共孵24 h,观察致空泡效应,并通过流式细胞术检测细胞凋亡。结果成功分离纯化出幽门螺杆菌分泌和重组表达的VacA蛋白;幽门螺杆菌分泌的VacA蛋白能显著引起AGS细胞的空泡样改变及凋亡（P＜0．01）,而重组表达的VacA蛋白致细胞空泡样改变及凋亡不显著（ P＞0．05）。结论幽门螺杆菌分泌的VacA蛋白有良好的空泡毒性及致凋亡效应,而重组表达的VacA蛋白无致空泡及凋亡效应,幽门螺杆菌分泌的VacA蛋白可用于VacA作用机制的研究。     

化学和生物学融合对国际武器公约履约的影响

化学武器公约（ CWC）和生物武器公约（ BWC）是为禁止生产、发展、储存和使用化学武器和生物武器而制定的国际公约。近年来,科学技术快速发展,知识交叉渗透,学科之间出现整合和融合,促进了科技进步和经济发展。其中化学和生物学融合在有力促进制药、健康卫生、绿色化学和环境保护等产业进步的同时,也对化学和生物武器公约的履约产生了重要的影响。该文综述了与化学武器和生物武器公约相关的化学和生物学融合进展,并分析其对公约履约的影响。     

Oxygen uptake and ventilation during rowing and running in females and males

This study evaluated if the ventilatory response to exercise is impaired by the cramp position of rowing. Maximal oxygen uptake (VO2max), maximal expiratory volume (VEmax), and maximal heart rate (HRmax) during rowing and running were compared in 55 males (age, mean +/- SD, 21 +/- 3 years; height 176 +/- 5 cm; body mass 72 +/- 6 kg) and 18 females (age 20 +/- 2 years; height 164 +/- 5 cm; body mass 61 +/- 4 kg). VEmax was larger during rowing than during running (males, 157 +/- 16 vs. 147 +/- 13 L min(-1); 114 +/- 9 vs. 105 +/- 11 L min(-1), P<0.01). Also VO2max was larger during rowing than during running (males, 4.5 +/- 0.5 vs. 4.3 +/- 0.4 L min(-1); females, 3.3 +/- 0.4 vs. 3.2 +/- 0.4 L min(-1), P<0.01). However, HRmax was lower during rowing than during running (males, 194 +/- 8 vs. 198 +/- 11 beats min(-1); females, 192 +/- 6 vs. 196 +/- 8 beats min(-1), P<0.05). VEmax was correlated to body mass and fat-free mass, as was VO2max. Thus, the oxygen pulse (VO2max/HRmax) was larger during rowing than during running, while the ventilatory equivalent for oxygen (VEmax/VO2max) was similar. We showed that bending the body during rowing does not seem to impair ventilation either in males or in females. The results indicate that VEmax and VO2max relate to body size and fat-free mass for both females and males. The findings indicate that the involvement of more muscles, the entrainment, and the body position during rowing facilitates ventilation and venous return and lowers maximal heart rate.     

Coracoclavicular and coracoacromial ligament calcification and ossification

Thirty-six patients with calcification or ossification at or around the coracoclavicular and coracoacromial regions were analyzed with regard to type, location, and configuration of the deposits and related clinical history. Calcification or ossification in the coracoclavicular region resulted largely from trauma (36%) or renal failure (28%). Trauma patients may develop punctate calcification or ossification but do not develop the tumoral type of calcification. About 5% of the renal failure patients had coracoclavicular ligament calcifications, one-half of which were of the tumoral type. Renal failure patients may have punctate or tumoral calcifications but do not develop ossification.     

CLIP相关技术的研究进展

在真核生物基因表达的转录后调节中,RNA结合蛋白（ RBP）起着关键作用,很多RBP的异常与人类疾病的发生密切相关。自2000年的RNA免疫沉淀和芯片分析方法（ RNA immunoprecipitation with differential display or microarray analysis , RIP-ChIP）出现以来,人们开始就RBP与RNA相互作用进行了系统而广泛的研究。经过改良和发展,基于体内实时紫外交联免疫沉淀法（ ultraviolet crosslinking and immunoprecipitation , CLIP ）、交联免疫沉淀cDNA文库高通量测序法（ high-throughput sequencing of CLIP cDNA library , HITS-CLIP）、光催化核糖核苷增强交联和免疫沉淀法（ photoactivatable-ribonucleoside-enhanced crosslinking and immunprecipitation , PAR-CLIP）以及提高个别核苷酸分辨率交联和免疫共沉淀法（ individual nucleotide resolution CLIP , iCLIP）等RIP-ChIP衍生方法相继产生,使用这些方法,可以解析RBP的RNA识别特异性,而且通过与高通量测序技术结合,可以实现转录组尺度的RBP的靶序列的鉴定,分辨率也得到极大提高。该文就RNA与蛋白的相互作用的基本原理及其研究进展、相关技术存在的问题以及发展趋势进行简要综述。     

Cross-sectional and longitudinal comparisons of self-reported and device-assessed physical activity and sedentary behaviour

ObjectivesTo examine the longitudinal associations and differences between self-reported and device-assessed physical activity (PA) and sedentary behaviour (SB), using a multifaceted statistical approach.DesignLongitudinal measurement burst.MethodsIn total, 52 university students (78% female) aged 18–38 years (mean = 21.94 ± 4.57 years) participated. The study consisted of three blocks of six days of measurement, during which participants wore an accelerometer on their wrist for the entire block, and self-reported their PA over the 6 days at the end of each block.ResultsMeaningful latent differences between methods were observed for moderate PA and SB across all three assessment periods, such that participants underreported the time spent in each activity. Bland–Altman plots revealed a positive mean difference for vigorous PA, with over-reporting increasing as mean levels increased. Negative mean differences were observed for all other intensities. Underreporting of moderate PA increased as the mean level increased, whereas for light PA and SB, underreporting decreased at high levels. Repeated measures correlations revealed a meaningful association for vigorous PA only, suggesting that as self-reported minutes increase so too do device-measured minutes.ConclusionsWe found evidence of cross-sectional and longitudinal differences and weak associations between self-reported and device-assessed PA and SB. Future work is needed to enhance the quality of self-reported methods to assess PA and SB (e.g., face and content validity), and consider improvements to the processing of device-based data.     

Old and dangerous: Prison and dementia

Older prisoners are the fastest growing group of prisoners in many countries. The purpose of this study is to explore the phenomenon of detention of persons suffering from dementia. Medline searches were conducted for relevant articles, chapters and books published until August 2016. Search terms included dementia, elderly, prison and criminal. Publications found through this indexed search were reviewed for further relevant references. As results, there is a lack of data about elderly with dementia in prisons. Given the rise in the average age, it is reasonable to hypothesize that the number of older prisoners is growing. Moreover, some elderly are imprisoned with a concomitant cognitive impairment or psychiatric disorder while others will develop such diseases once incarcerated. At the present time, legal and social systems seem unprepared to handle the phenomenon of dementia in prison. As proposal, health assessments for older first time offenders should become a practice inside the correctional facilities and include an evaluation for specific health issues, such as psychiatric comorbidity and cognitive impairment.