骨盆骨折大出血伴凝血病的救治策略

目的总结骨盆骨折大出血伴凝血病的救治方法和治疗效果。方法对1995年1月~2003年2月及2007年1月~2015年12月笔者科室收治的严重骨盆骨折大出血病例临床资料进行回顾性分析。其中1995~2003年未采用损害控制外科(DCS)及损害控制复苏(DCR)治疗的198例作为对照组;2007~2015年按照DCS及DCR技术治疗的423例作为治疗组。对照组均行Ⅰ期手术治疗;治疗组Ⅰ期急诊先行髂内动脉断血术以控制出血,伴脏器损伤者同时行相应手术控制出血并阻断污染,然后转往ICU按DCR原则行复苏治疗,生命体征平稳后行确定性手术。结果对照组发生创伤性凝血病52例,其中死亡23例,死亡率44.23%(23/52)。治疗组中382例有进行性出血,86例出现凝血障碍。382例进行性出血急诊行髂内动脉断血术,其中206例加用骨盆外固定支架。对合并脏器伤按DCS原则行剖腹手术,同时按DCR原则作止血性复苏,及时输入血液制品及凝血因子。ICU复苏治疗生命体征平稳后行骨盆骨折固定等确定性手术。主要并发症包括盆腹腔感染17例、腹腔间隙综合征22例、脂肪栓塞综合征12例、深静脉血栓形成30例。治疗组中发生凝血病者死亡率为22.09%(19/86),主要死因为失血性休克。结论严重骨盆骨折易并发创伤性凝血病。按照DCR原则行低压复苏和止血性复苏,同时行髂内动脉断血术加骨盆外固定支架控制出血,将明显提高救治生存率。     

Age-dependent variation of follicular size and expression of iodine transporters in human thyroid tissue.

The high sensitivity of the thyroid gland to the carcinogenic effects of radiation during childhood contrasts with the absence of demonstrable carcinogenic effects of radiation in adults. To better understand these age-related variations, we studied follicular morphometry, functional status, and proliferative activity in 31 thyroid glands removed from relatives of medullary thyroid carcinoma patients, with ages ranging from 3 to 39 y. METHODS: The mean follicular diameter (MFD) was estimated, and immunohistochemistry was performed with antibodies directed to molecules involved in iodide transport (Na(+)/I(-) symporter [NIS], pendrin, and apical iodide transporter), in organification (thyroperoxidase [TPO] and Duox), in cell cycle and growth (Ki-67, cyclin A and D1, and galectin-3), and in angiogenesis (vascular endothelial growth factor and nitric oxide synthase III [NOSIII]). RESULTS: Compared with older patients, patients who were < or =12 y old had a smaller MFD (P < 0.001) and more frequently positive NIS, pendrin, and Duox (P < 0.01). Proliferation rate as indicated by cyclin A expression was also higher in patients < 12 y (P < 0.01) but peaked at the time of puberty. Staining for NIS, pendrin, TPO, Duox, and NOSIII was stronger in thyroid glands with a smaller MFD (P < 0.001). On multiple tests adjusted for age and thyroid mass, TPO, Duox, and NOSIII remained significantly correlated to MFD (P < 0.001), whereas staining for NIS and pendrin did not. This finding suggests that NIS and pendrin expression is related mainly to the age of the patient. CONCLUSION: Smaller follicles with a higher expression of proteins involved in iodide metabolism were found in younger children. In cases of radioiodine contamination in children, the result will be a higher radioactive concentration and, hence, higher radiation doses. This event may induce the development of thyroid cancer under conditions of accelerated proliferation, as evidenced at puberty.     

Facial canal anatomy in patients with microtia: evaluation of the temporal bones with thin-section CT

PURPOSE: To ascertain the location of the facial nerve in patients with microtia by using thin-section computed tomography (CT). MATERIALS AND METHODS: Thin-section CT was performed in 66 ears of patients with microtia (unilateral, n = 12; bilateral, n = 34) and mandibulofacial dysostosis (MFD, n = 20). Findings were compared with those in 22 ears with normal auricles (control group) by using the Dunnett two-sided t test. RESULTS: The facial nerve at the mastoid portion in patients with MFD was 2 mm more lateral and 3 mm more anterior than that in control subjects (P <.01). The same portion in patients with microtia was 3 mm more anterior than that in the control subjects (P <.01). The distance between the facial nerve and the most lateral point of the temporal bone in patients with MFD was 10 mm shorter and that in patients with bilateral microtia was 3 mm shorter than that in the control subjects (P <.01). CONCLUSION: The facial nerve in patients with microtia was not more lateral from the Bill bar (vertical crest) than that in control subjects. The facial nerve in patients with MFD was different from that in patients with microtia who had no other head anomalies.     

严重肝脏损伤并发凝血病32例救治分析

目的探讨严重肝脏损伤并发凝血病的救治方法。方法回顾性分析重庆市急救医疗中心2010年2月—2016年4月收治的32例严重肝脏损伤并发凝血病患者的临床资料。其中男性23例,女性9例;年龄15~84岁,平均37.4岁。致伤原因:道路交通伤17例(56.3%),坠落/跌倒10例(28.1%),压砸/掩埋伤3例,其他2例。分析其救治方法及治疗结果。结果 32例均为多发伤。入院后按"CRASH PLAN"原则,快速做出伤情评估,同时建立静脉通道及抽血做凝血功能、配血等检测,按照损害控制复苏(DCR)原则进行复苏。术前有凝血功能障碍19例。大量输血按新鲜冰冻血浆、悬浮红细胞各6~10U和10U冷沉淀配送22例。肝脏损伤Ⅳ级20例、Ⅴ级12例。手术包括清创性肝切除22例,改良肝周填塞13例;手术时间30~90min。本组共存活24例,死亡8例(25%),因肝脏损伤及其并发症死亡6例(18.8%,6/32)。结论Ⅳ、Ⅴ级肝脏损伤容易并发创伤性凝血病;DCR是严重肝脏损伤并发凝血病的救治策略;"改良肝周填塞法"和清创性肝切除是抢救严重肝脏损伤并发凝血病时的主要损害控制性手术措施。     

数字减影-时间飞跃磁共振血管造影的临床应用研究

目的评价数字减影-时间飞跃磁共振血管造影(DS-TOF MRA)在亚急性及慢性脑出血中的临床应用价值。资料与方法58例T1WI呈高信号的亚急性、慢性脑内血肿患者,行常规静脉血流饱和3D-TOF MRA序列(A)及反向动脉血流饱和3D-TOF MRA序列(B),应用数字减影方法,将反向动脉血流饱和B序列源图像作为蒙片,A序列源图像减去B序列源图像即为DS-TOF MRA的源图像,将其进行最大信号强度投影(MIP)重建产生无高信号组织背景干扰的DS-TOF MRA图像。测量血肿区对比度/噪声比(C/Ns)值并比较动脉血管边缘的显示情况,对减影效果进行评价。结果除2例患者因运动而无法产生清晰图像外,其余56例在3D-TOF MRA上有高信号背景组织干扰影像,在DS-3D MRA图像上均被完全消除。DS-TOF MRA源图像血管-血肿区C/Ns值为19.30±1.72,常规TOFMRA源图像血管-血肿区C/Ns值为2.62±0.31(t=17.3828,P<0.01)。DS-TOF MRA源图像血管-血肿区C为(1.40±0.01)%(P<0.01)。减影后DS-TOF MRA图像脑动脉管壁显示情况明显优于常规TOF-MRA(u=-8.8452,P<0.01)。结论DS-TOF MRA能有效消除常规TOF MRA源图像血肿高信号对血管影像的干扰,增加血管与周围组织的对比度,有利于准确地评价脑动脉的病变     

Burden of myocardial damage in cardiac allograft rejection: Scintigraphic evidence of myocardial injury and histologic evidence of myocyte necrosis and apoptosis

BACKGROUND: Because myocardial damage determines morbidity and outcomes in heart transplant rejection, assessment of total burden of myocardial damage is highly desirable. In addition to myocyte necrosis, programmed cell death, or apoptosis, has recently been shown to contribute to cardiac allograft rejection. In the present study, we noninvasively determined myocardial damage by antimyosin scintigraphy and compared it with necrotic and apoptotic myocardial damage in endomyocardial biopsy (EMB) specimens. METHODS AND RESULTS: Forty scintigraphic and histologic studies were simultaneously performed. Of these, 19 patients had no EMB evidence of allograft rejection (group I, International Society of Heart and Lung Transplantation [ISHLT] grade 0/4), 12 had mild rejection (group II, ISHLT grades 1A and 1B), and 9 had evidence of moderate allograft rejection (group III, ISHLT grades 2, 3A, and 3B). None of the biopsies demonstrated severe allograft rejection (ISHLT grade 4/4). The severity of global myocyte damage in 40 patients was assessed by antimyosin scintigraphy. Endomyocardial biopsies were performed in these patients within 48 hours of imaging study; biopsy specimens were characterized for presence of myocyte necrosis and apoptosis. Evidence of myocyte necrosis was observed in 9 (23%) of 40 EMB specimens. Nineteen EMB specimens of group I had no inflammation and no myocyte necrosis, 12 of group II specimens showed interstitial mononuclear cell infiltration (only) but no myocyte necrosis, and all 9 of group III specimens had evidence of cellular infiltration and myocyte damage. Myocyte necrosis was assessed by hematoxylin-eosin and trichrome staining of EMB specimens. On the other hand, apoptosis of myocytes, as assessed by TUNEL staining of DNA fragments, was seen in 22 (55%) of the 40 biopsy specimens: 47%, 58%, and 67% in groups I, II and III, respectively. Abnormal antimyosin scan findings, indicating presence of myocardial damage, were observed in 9 of the 19 patients in group I and in all patients in groups II and III. Although positive antimyosin scan results in group III patients are concordant with the presence of histologic myocardial necrosis, myocardial uptake of antimyosin antibodies in groups I and II (no apparent myocyte damage at light microscopic examination) could reflect either sampling error of the biopsy or ongoing apoptotic myocyte damage. CONCLUSIONS: Apoptosis of myocytes is frequently observed during cardiac allograft rejection. The presence of apoptotic myocytes in the absence of histologic rejection activity in patients with antimyosin uptake suggests that apoptosis could be an additional mechanism of transplant-associated myocardial damage.     

Lobular carcinoma in situ on core biopsy-what is the clinical significance?

AIM: To retrospectively review the surgical histological findings in all cases where lobular carcinoma in situ(LCIS) was identified on percutaneous core biopsy (CB) performed as part of the Cambridge and Huntingdon breast screening programme.MATERIALS AND METHODS: We retrospectively reviewed all the core biopsies performed in our department for screen detected abnormalities over a 5-year period between 1 April 1994 and 31 March 1999. All patients where LCIS was identified on CB were reviewed. As the significance of LCIS on CB was unclear all went on to surgical excision. We reviewed the clinical and imaging findings, biopsy technique and subsequent surgical histology of each patient.RESULTS: During the study period 60 769 women were invited for screening, of whom 47 975 attended (attendance rate = 79%). Of these, 2330 (4.9%) were recalled for assessment and 749 (1.6%) underwent CB. A malignant diagnosis was obtained in 311 (42%), 211 invasive and 100 in situ lesions. LCIS was identified on CB in 13 (2%). LCIS was the only lesion identified in seven cases. All seven cases subsequently underwent surgical excision. Surgical histology revealed a single case of LCIS and invasive lobular carcinoma. There were two cases of LCIS and DCIS one with a probable focus of invasive ductal carcinoma. In one case LCIS was identified in association with a radial scar. In three of the seven cases LCIS was the only abnormality on both CB and surgical biopsy.CONCLUSION: Our series shows that isolated LCIS on CB following mammographic screening is an infrequent finding, and it may be associated with either an invasive cancer or DCIS. It is therefore advisable that when LCIS is identified on CB, surgical excision of the mammographic abnormality should be performed. Decisions on management should be undertaken in a multidisciplinary setting taking into account clinical and imaging findings.     

4种复苏方法对呼吸骤停猪肺通气的影响观察

目的 观察胸外按压心肺复苏(C-CPR)、经膈肌下抬挤心肺复苏(D-CPR)、腹部按压心肺复苏(A-CPR)和腹部提压心肺复苏(L-CPR)4种复苏方法对呼吸骤停猪通气的影响.方法 健康家猪28只随机分为4组,经静脉推注琥珀胆碱建立猪呼吸骤停模型,于呼吸骤停即刻分别进行C-CPR、D-CPR、A-CPR和L-CPR.复苏2min后停止按压,给予呼吸机辅助呼吸直至实验猪恢复自主呼吸.测定并比较基础状态时和复苏时4种复苏方法产生的潮气量(VT),并计算分钟通气量(MV);比较各组心率(HR)和平均动脉压(MAP)水平及自主呼吸恢复时间.结果 基础状态下,4组间VT和MV之间差异无统计学意义(P＞0.05).复苏2min时的VT和MV,D-CPR组高于C-CPR组,A-CPR组高于D- CPR组,L-CPR组高于A-CPR组,差异均有统计学意义(P＜0.01).复苏2min时,L-CPR组HR恢复接近于基础值,A-CPR组HR维持在呼吸骤停即刻水平,C-CPR组和D-CPR组HR明显低于基础值(P＜0.01);复苏2min后给予机械通气,复苏5min时各组HR均接近基础值.结论 在呼吸骤停猪模型中,L-CPR较其他3种CPR法能产生更大的VT和MV.     

Color and power Doppler sonography versus DMSA scintigraphy in acute pyelonephritis and in prediction of renal scarring.

Capabilities of color and power Doppler sonography (DS) were prospectively evaluated for diagnosis of acute pyelonephritis and for prediction of scarring by comparison with 99mTc-dimercaptosuccinic acid scintigraphy (DMSA). METHODS: Fifty-seven children (mean age, 5 +/- 3 y) with acute pyelonephritis were investigated by biologic testing, DS (DS 1), and DMSA (DMSA 1). Patients who were <6 mo old or had high-grade reflux or obstruction were excluded. Forty-five children had a clinical follow-up examination, biologic testing, DS (DS 2), and DMSA (DMSA 2) at a mean of 7 +/- 2 mo after acute infection. Sonography (gray-scale and DS) was performed by 1 experienced radiologist who was unaware of patient data. DMSA studies were interpreted by 2 physicians who were unaware of patient data. RESULTS: Temperature, neutrophil count, and C-reactive protein value were significantly higher in patients with abnormal DMSA 1 findings than in those with abnormal DS 1 findings (P < 0.05). When compared with DMSA 1, DS 1 had a sensitivity and specificity of 80% and 81%, respectively. At follow-up, all clinical and biologic data had normalized. Scarring after infection occurred in 51% of children. When compared with DMSA 2, DS 1 had positive and negative predictive values of 57% and 75%, respectively, and DMSA 1 had respective values of 62% and 100%. Reflux was not considered a good predictor of scarring. CONCLUSION: DS and DMSA results were concordant in 81% of kidneys with acute pyelonephritis. The predictive value of DS for renal scarring was not considered sufficiently high for DS to be used in routine practice.     

住院慢性支气管炎患者合并支气管扩张调查分析

目的分析住院慢性支气管炎患者合并支气管扩张的情况及危险因素。方法回顾性分析自2008年1月至2015年12月在沈阳军区总医院呼吸与重症医学科因慢性支气管炎住院患者的临床资料,统计分析其中合并支气管扩张患者(扩张组)的临床资料,并与未合并支气管扩张的患者(未扩张组)进行比较。结果 8年内共有2 647例因慢性支气管炎收入院,占同期住院患者18.2%,合并支气管扩张141例,占住院慢性支气管炎患者5.3%。分析住院慢性支气管炎患者21种共存病,只有低蛋白血症和贫血等2种共存病,合并支气管扩张组明显多于同期住院的非合并支气管扩张组,组间差异有统计学意义(P<0.05)。对住院慢性支气管炎患者合并支气管扩张危险因素进行分析,发现危险因素比值比最高的是合并贫血,之后依次为低蛋白血症和女性患者(P<0.05)。结论慢性支气管炎患者合并支气管扩张不容忽视,女性患者、贫血和低蛋白血症等是合并支气管扩张的危险因素。     

Diagnostic significance of the histopathology of bone marrow macrophages in forensic autopsies

Forensic pathologists often encounter autopsies that require an assessment of antemortem general conditions (e.g., infection, metabolic disorders). To establish evaluation clues for such cases, we quantitatively examined macrophages and the general pathology of bone marrow in samples from 180 forensic autopsy cases of decedents with various conditions. Hematoxylin-eosin staining, Berlin blue staining, and immunostainings for CD163, CD138, and CD61 were performed. We determined the numbers per field (density) of total macrophages, swollen macrophages, macrophages with hemophagocytosis, and hemosiderin-laden macrophages. Each density was standardized by identifying its ratio to the total number of macrophages. The decedents' background data (cause of death, other pathological findings, postmortem interval, antemortem symptoms, and presence of resuscitation) were extracted. No correlations were found between the postmortem interval and the other decedent data, indicating that these data are not affected by postmortem changes. In the group in which inflammatory disease was the cause of death, there were significant elevations in the ratio of the swollen macrophage density to total macrophages. Significantly higher ratios of the density of swollen and hemophagocytic macrophages were observed in the group in which conditions with a prolonged agonal period were the cause of death. The group with a return of spontaneous circulation to resuscitation showed a significantly higher ratio of macrophage density with hemophagocytosis. This study provides the first statistical analysis focused on bone marrow histopathology in forensic autopsies. The results will be useful for elucidating causes of death and agonal-period conditions.     

CT angiography in the detection of carotid body enlargement in patients with hypertension and heart failure

Introduction

The carotid body (CB) has previously been found to be enlarged and hyperactive in various disease states such as heart failure (HF), hypertension (HTN), and respiratory disease. Evaluation of CB size in these disease states using imaging has not been performed. The purpose of this case–control study was to compare CB sizes in patients with HF and HTN with those of controls using CT angiography.

Methods

A retrospective review was performed on 323 consecutive patients who had neck computed tomography angiography (CTA) exams in 2011. Following extensive review, 17 HF and HTN patients and 14 controls were identified. Two radiologists blinded to the patient disease status made consensus bilateral carotid body (CB) measurements on the CTA exams using a previously described standardized protocol. CB axial cross-sectional areas were compared between HF and HTN cases and controls using a paired t test.

Results

The right CB demonstrated a mean cross-sectional area of 2.79 mm² in HF and HTN patients vs. 1.40 mm² in controls (p?=?0.02). The left CB demonstrated a mean cross-sectional area of 3.13 mm² in HF and HTN patients vs. 1.53 mm in controls (p?=?0.03).

Conclusion

Our results provide imaging evidence that the carotid bodies are enlarged in patients with HF and HTN. Our case–control series suggests that this enlargement can be detected on neck CTA.     

肝硬化并发微小肝癌DSA的诊断价值

目的探讨DSA对肝硬化并发微小肝癌(MHCC)的诊断价值。方法340例肝硬化患者,腹部增强CT及B超检查未见肝脏占位病变,在经肝动脉自体骨髓干细胞移植术前行肝动脉DSA,多角度投照,对造影发现的MHCC用微导管行肝段TACE治疗。结果DSA检查诊断MHCC20例。病灶均为单发,直径0.4～1.0cm,DSA表现为肝动脉造影早期至中期出现边缘较清楚的结节状染色,染色持续时间15s以上。病灶分布在左叶2例,右叶18例。AFP阳性4例,阴性16例。TACE治疗1次11例,2次7例,3次2例。栓塞后均见病灶内碘油聚集。1例TACE治疗1次后手术切除,病理证实为肝细胞癌。结论DSA对肝硬化并发MHCC的检出能力优于常规增强CT及B超检查。     

Postmortem computed tomography for detecting causes of sudden death in infants and children: retrospective review of cases

Purpose The aim of this study was to investigate the usefulness of postmortem computed tomography (PMCT) in detecting causes of sudden death in infants and children. Materials and methods Our subjects were 15 nontraumatically deceased patients (nine boys and six girls, ranging in age from 20 days after birth to 12 years old, mean age 1.6 years), who had been in a state of cardiopulmonary arrest on arrival at our hospital. PMCT was performed within 2 h after certification of death: head (15 cases), chest (11 cases), and abdomen (12 cases). Blood was collected from 11 of the patients at the time of cardiopulmonary resuscitation. An autopsy was conducted on two. Results PMCT did not show any traumatic changes indicating child abuse. It was difficult to presume the cause of death with PMCT alone, but the cause of death in 14 of 15 cases could be presumed by combining information from their medical history, clinical course before death, PMCT findings, laboratory data, and bacterial culture. The remaining subject was classified as cause unknown. Conclusion The causes of sudden death in infants and children were detected at a high rate when we comprehensively investigated the PMCT and other examination findings. This article was presented at the Japan Radiology Congress, Yokohama, April 2005     

Comparison of Duplex sonography and color Doppler imaging in renal allograft evaluation: a prospective study

A prospective study compared the diagnostic capability of quantitative Duplex sonography (DS) and color Doppler imaging (CDI) in 49 consecutive patients with 50 renal allografts. Sixty five DS examinations and 65 CDI examinations were performed by two independent investigators on two different machines on the same day. The resistive index (RI) was calculated and the color flow of renal arteries was observed up to the arcuate arteries. There was good correlation of RI values obtained by DS and CDI at all vascular sites. Thirty one allografts were functioning stably and 19 were in a state of dysfunction, defined by histology (n = 17). Forty allografts presented with a RI < 0.9 and normal color flow. All five allografts with a pathologic RI 0.9 showed abnormal color flow (missing flow in arcuate and/or interlobar arteries). Five allografts had a RI < 0.9 but abnormal color flow, possibly due to atrial fibrillation, hypertension, heart failure or a combination of these. A normal color flow pattern excludes severe vascular compromise to the allograft. In addition, CDI revealed three biopsy-related vascular lesions; two of them had been missed by DS.     

The usefulness of dipyridamole stress myocardial scintigram as a preoperative test for detecting ischemic heart disease before vascular surgery]

We evaluated the usefulness of dipyridamole 201Tl myocardial scintigraphy (DS) for detecting myocardial ischemia in 18 candidate for vascular surgery. DS indicated significant thallium redistribution in 6 patients. Coronary angiography was performed in 5 of these 6 patients and revealed significant coronary artery disease in all patients. As a result, operation was cancelled in 4 patients with severe coronary artery disease. One of these cases died of acute myocardial infarction after being discharged from hospital. One other patient was operated after percutaneous transluminal coronary angioplasty. Another patient was operated knowing that he had significant but mild coronary artery disease. Subsequently, operations were performed in 14 patients. No serious cardiac event occurred in these 14 patients except one case with T wave inversion without myocardial enzyme elevation. Thus, we concluded that DS was a useful method for detecting ischemic heart disease and prevent cardiac event associated with vascular surgery.     

The Abbreviated Injury Scale and its correlation with preventable traumatic accidental deaths: a study from South Delhi

Anatomic trauma scoring systems are fundamental to trauma research. The Abbreviated Injury Scale (AIS) and its derivative, the Injury Severity Score (ISS), are the most frequently used scales. In a prospective study, 400 autopsies of road traffic accident victims performed between January 2002 and December 2003 were coded according to the AIS and ISS methods. All the cases were classified into different injury groups according to the Injury Severity Scale. Fifty-eight cases (14.5%) were assigned an ISS value of <25; 244 (61%) cases were valued between 25-49; 38 cases (9.5%) were valued between 50-74 and 60 (15%) cases had a value of 75. On analysis of medical care, in cases with ISS<50, about 96% of the victims did not receive optimal care quickly enough with a lack of pre-hospital resuscitation measures and lengthy transportation time to hospital being of major importance.     

Ⅱ型大麻素受体选择性抑制剂在钛颗粒诱导炎症性骨溶解中的作用

目的 观察Ⅱ型大麻素受体(cannabinoid receptor2,CB2)选择性抑制剂(AM630)对磨损颗粒诱导炎症性骨溶解的治疗作用。 方法 雌性 BALB/c小鼠45只,其中15只作为颅骨供体,其余采用随机数字表法分为空白组、对照组和药物治疗组,每组10只。采用钛颗粒诱导的小鼠air-pouch骨溶解模型,药物组建模前2d经腹膜下注射CB2抑制剂-AM630(200 μg·kg-1 ·d-1),持续至建模后2周。小鼠处死取材,大体观察植入骨片周围炎症变化;HE染色观察细胞浸润程度;形态计量学检测囊壁厚度;抗酒石酸酸性磷酸酶(tartrate-resistant acid phosphatase staining,TRAP)染色检测成熟破骨细胞;定量RT-PCR检测CB2、IL-1β、TNF-α、核因子NF-κB配体的受体(receptor activator of NF-κB ligand,RANKL)和核因子NF-κB配体(receptor activator of NF-κB,RANK) mRNA含量。 结果标本大体观察,对照组植入骨片周围有红肿、渗出等明显的炎症变化,药物治疗后,炎症改变明显减轻。HE染色结果表明,对照组囊壁内大量巨噬细胞浸润;空白组及药物组囊壁内细胞少,多为成纤维细胞;对照组囊壁较厚(192.2±19.4) μm,空白组和药物组囊壁厚度分别为(88.5±14.7) μm、(122.1±15.2)μm,与对照组比较差异有统计学意义(P＜0.05);对照组植入骨片周围TRAP深染区域较多,AM630治疗后深染区域明显减少;定量RT-PCR结果表明,钛颗粒刺激能够上调CB2、IL-1β、TNF-α、RANKL和RANK mRNA表达水平,药物组上述基因mRNA水平较低,与对照组比较差异有统计学意义(P＜0.05)。结论 CB2选择性抑制剂能降低磨损颗粒引起的炎症反应,抑制破骨细胞活化。CB2有望成为治疗人工关节无菌性松动的新靶点。     

Stereotactic and sonographic large-core biopsy of nonpalpable breast lesions: results of the Radiologic Diagnostic Oncology Group V study

RATIONALE AND OBJECTIVES: To determine the diagnostic accuracy of stereotactically and sonographically guided core biopsy (CB) for the diagnosis of nonpalpable breast lesions. MATERIALS AND METHODS: Twenty-two institutions enrolled 2,403 women who underwent imaging-guided fine needle aspiration followed by imaging-guided large-CB of nonpalpable breast abnormalities. All mammograms were reviewed for study eligibility by one of two breast imaging radiologists. The protocol for image-guided biopsy, using either ultrasound (USCB) or stereotactic (SCB) guidance, was standardized at all institutions and all biopsy specimens were over-read by one of three expert pathologists. Patients with atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, or lobular neoplasia on CB underwent surgical excision. Those with negative CB but suspicious ("discordant") pre-biopsy mammography also underwent surgical excision. Patients having a negative CB that was concordant with the pre-biopsy mammography suspicion were assigned to follow-up mammography at 6, 12, and 24 months following CB. RESULTS: A gold standard diagnosis based on definitive histopathologic diagnosis, mammography follow-up, or an imputed gold standard diagnosis was established for 1,681 patients. Of 310 cases with a gold standard diagnosis of invasive breast carcinoma, 261 (84.2%) were invasive carcinoma, 31 (10%) were ductal carcinoma in situ (DCIS), four (1.3%) were ADH, one (0.3%) was a non-breast cancer, and 13 (4.2%) were benign on CB. For 138 cases with a gold standard diagnosis of DCIS, 113 (81.9%) were DCIS, 20 (14.5%) were ADH, and five (3.6%) were benign on CB. For 57 cases (13 masses, 44 calcifications) with an initial CB diagnosis of ADH, atypical lobular hyperplasia or lobular neoplasia, 20 (35.1%) had a gold standard diagnosis of DCIS (4 masses, 16 calcifications) and four (7.0%) had a gold standard diagnosis of invasive cancer (4 calcifications). Of 144 cases (22 masses, 122 calcifications) with an initial CB diagnosis of DCIS, 31 (21.5%) had a gold standard diagnosis of invasive cancer (10 masses, 21 calcifications). The sensitivity, specificity and accuracy for CB by either imaging guidance method in this trial were .91, 1.00, and .98, respectively. The sensitivity, predictive value negative, and accuracy of CB for diagnosing masses (.96, .99, and .99, respectively) were significantly greater (P < .001) than for calcifications (.84, .94, and .96, respectively). The sensitivity (.89) of SCB for diagnosing all lesions was significantly lower (P = 0.029) than that of USCB (.97) because of the preponderance of calcifications biopsied by SCB versus USCB. There was no difference between USCB and SCB in sensitivity, predictive value negative, or accuracy for the diagnosis of masses (97.3, 98.9, and 99.2, respectively for USCB; 95.6, 98.5, and 98.9 respectively for SCB). CONCLUSION: Percutaneous, imaged-guided core breast biopsy is an accurate diagnostic alternative to surgical biopsy in women with mammographically detected suspicious breast lesions.     

Immunohistochemical detection of early myocardial infarction. An evaluation of antibodies against the terminal complement complex (C5b-9)

Antibodies (abs) against the terminal complement complex (C5b-9) were used on routinely processed post mortem myocardial tissue in parallel with conventional staining methods. Both monoclonal and polyclonal abs were tested using the avidin biotin peroxidase complex (ABC), alkaline phosphatase anti-alkaline phosphatase (APAAP) methods and an ab-bridge with alkaline phosphatase. Enhancement of the diaminobenzene (DAB) end product with cobalt-nickel (ABC method) was also done. The polyclonal ab gave the most satisfactory results and the alkaline phosphate conjugated ab-bridge had a slight advantage over the ABC method. Cobalt-nickel enhancement of DAB improved the visualization, but with higher background staining. APAAP was the least satisfactory method. Comparing the immunohistochemical method with the conventional staining methods, the former showed positive reaction in 97% of areas of coagulation necrosis and in 65% of contraction band necrosis. On the other hand coagulation necrosis was seen in 44% and contraction band necrosis in 68% of C5b-9 positive areas indicating that C5b-9 abs react with ischemically damaged myocytes before visible alterations are seen in hematoxilin-eosin staining. Moreover, using C5b-9 abs, it seems possible to exclude agonal/artefactual contraction bands which show a negative reaction. Immunohistochemical detection of C5b-9, using an adequate technique could increase the possibility to demonstrate early ischemic myocardial damage.