单体素和多体素氢质子MRS在脑胶质瘤分级中的应用

磁共振波谱是一种可以检测人体组织内生化代谢产物浓度的无创检查，它的原理包括化学位移和白旋耦合。氢质子磁共振波谱（proton magnetic resonance spectroscopy，^1H MRS）的检测方法有单体素、多体素及全范围波谱成像。磁共振波谱对于脑胶质瘤的分级有一定帮助。对于指导临床治疗有一定价值。我们就磁共振波谱的原理及检测方法、磁共振波谱在脑胶质瘤分级中的应用加以综述。     

新型1.5T MR对大鼠诱发肝癌进行1 H-MRS扫描可行性的初步分析

目的：探讨应用新型1．5T磁共振扫描仪对二乙基亚硝胺(DEN)诱发大鼠肝癌实施氢质子磁共振波谱(^1H-MRS)检查的可行性，并对该模型不同阶段的波谱曲线变化特征作初步了解。方法：建立诱发Wistar大鼠肝癌模型，分阶段随机抽取动物进行^1H—MRS检查，而后处死动物，对其肝脏进行组织学观察。结果：3只大鼠意外死亡，其余27只(90％)大鼠均按照计划进行了扫描及病理处置。T1WI图像显示解剖结构较好，但在病变细节方面不如T1WI序列。经过逐步改良扫描方法，本组单体素和多体素扫描的成功率分别达到64％及50％.结论：DEN诱导大鼠肝癌模型适合用于影像研究，新型1．5T磁共振扫描机对大鼠肝脏的^1H-MRS检查是可行的。     

肝细胞癌的磁共振诊断进展

磁共振检查安全、无创,是肝细胞显像学检查的重要手段。磁共振成像运用多种序列、多参数可以对肝细胞癌进行多方位、多角度显示,弥散加权成像和磁共振波谱特色扫描可从功能和代谢水平研究肝细胞癌,另外肝脏特异性对比剂的应用进一步提高了肝细胞癌的检出率。     

多体素1H磁共振波谱在脑胶质瘤诊断及分级中的应用研究

 目的　探讨多体素1H磁共振波谱在脑胶质瘤诊断及分级中的价值。方法　选取经手术病理或临床确诊的36例脑胶质瘤患者。采用美国GE公司Signa EXCITE HD 3.0T 超导型磁共振（MR）扫描仪对所有患者行颅脑常规核磁共振（MRI）扫描和二维多体素144 ms序列扫描。采用Functool软件包后处理,分别测定病变实质、病变周围及健侧相应区域的胆碱（Cho）／肌酸（Cr）、Cho／N-乙酰天门冬氨酸（NAA）、NAA／Cr比值及肌醇（MI）值的变化,并对结果进行统计学分析。结果　全组数据采用SAS8.2软件处理,结果显示：低级别胶质瘤和高级别胶质瘤瘤体区Cho／Cr、Cho／NAA、NAA／Cr比值及MI值分别比较差异有统计学意义（P＜0.05）;瘤周水肿区Cho／Cr、NAA／Cr比值分别比较差异有统计学意义（P＜0.05）,MI值比较差异无统计学意义（P＞0.05）。结论　1H-MRS在鉴别诊断脑胶质瘤中有重要价值,结合MR其他成像方法可对其做出较为准确的分级。     

功能磁共振在食管癌应用的研究进展

目的：近些年,功能影像技术发展迅速,寻找一种准确可靠、价格合理且适宜临床推广的影像学技术成为当前研究的热点。本研究总结国内外功能磁共振成像技术在食管癌中的应用,探讨功能磁共振在食管癌诊断、治疗中的价值。方法应用 PubMed 及 CNKI 期刊全文数据库检索系统,以“食管癌、功能磁共振、磁共振动态增强、磁共振弥散加权和磁共振波谱”为关键词,检索2000-01－2015-01的中英文文献,纳入标准：（1）功能磁共振在食管癌诊断中的应用;（2）功能磁共振在食管癌疗效评价中的应用;（3）功能磁共振在食管癌预后评估中的应用。符合分析的文献56篇。结果功能磁共振在食管癌中的应用涉及磁共振动态增强成像、磁共振弥散加权成像和磁共振波谱成像,其中磁共振动态增强和磁共振弥散加权成像通过对组织血流灌注特征及水分子运动特征的分析,可用于早期评估肿瘤组织新生血管生成情况、放化疗疗效及预后,磁共振波谱成像可从分子水平上反映离体肿瘤组织生化代谢信息,在体研究仍需大量的前瞻性实验获取可靠的数据。结论功能磁共振在食管恶性肿瘤的诊断、疗效判断、预后评估中应用价值明显。     

肝细胞癌患者1.5T氢质子磁共振波谱分析

背景与目的：磁共振波谱成像是目前唯一能无创性检测活体器官和组织代谢物成分,并进行半定量或定量分析的磁共振成像技术。本研究旨在通过对活体肝脏进行单体素氢质子磁共振波谱（^1H-MRS）扫描,分析健康人肝脏、肝硬化患者再生结节聚集区和肝硬化后肝癌患者肝癌代谢物的变化特点。方法：对20例健康志愿者（对照组）、25例肝硬化（肝硬化组）和23例肝硬化后肝癌（肝癌组）患者行^1H-MRS扫描,观察波谱曲线的特征;测量胆碱复合物（Cho）、脂肪亚甲基（Lip2）峰高及Cho/Lip2比值,并对结果进行记录和比较。结果：波谱检查成功率约为88.2%（60/68）;3个研究组Lip2峰高差异有统计学意义;两两比较,对照组与肝癌组Lip2峰高差异有统计学意义（P＜0.05）,对照组与肝硬化组、肝硬化组与肝癌组Lip2峰高差异均无统计学意义（P＞0.05）;3组人群Cho峰高、Cho/Lip2比值,两两比较,差异均有统计学意义（P＜0.05）。结论：^1H-MRS可无创性反应肝脏的代谢变化,可以为肝细胞癌的诊断及与肝硬化再生结节的鉴别提供相关信息。     

氢质子磁共振波谱对脑膜瘤的诊断价值

目的 探讨脑膜瘤氢质子磁共振波谱的表现特点。方法 对20例脑膜瘤行常规磁共振检查、肿瘤部位及健侧相应部位二维相位编码氢质子磁共振波谱成像（2D 1HMRS）检查。分析脑膜瘤的常规磁共振表现,对照分析肿瘤和健侧的磁共振波谱特点。检查包括SE序列, 平扫横断T1WI、T2WI, 所有病例均作了Gd DTPA T1WI横、冠、矢状位增强扫描。结果 20例脑膜瘤中,16例在T1WI表现为等低信号影,3例为混杂信号影;14例在T2WI呈等高信号, 6例为混合信号影,Gd DTPA增强扫描肿瘤实性部分均有不同程度的明显强化, 9例可见“脑膜尾征”。波谱分析见脑膜瘤较健侧Cho峰升高(P＜0.05),Cr峰降低(P＜0.05),Cho/Cr值升高(P＜0.01),未见NAA峰。其中2例出现Lac峰。9例可见Ala峰。结论 脑膜瘤的1HMRS表现有一定的特征性,1HMRS可成为脑膜瘤诊断的重要补充手段。     

肝脏磁共振波谱成像的研究进展

磁共振波谱(MRS)作为一种分子影像学技术在基础医学和临床医学中起着越来越重要的作用,氢谱(1H)和磷谱(31P)的研究日趋增多,腹部磁共振波谱成像目前已成为磁共振波谱的又一研究热点。全文就磁共振波谱在肝脏的研究及临床应用方面的近况进行综述。     

磁共振成像与肿瘤诊断

磁共振成像与肿瘤诊断天津医学院第二附属医院（３００２１１）廉宗磁共振成像（ＭＲＩ）对软组织的分辨率高于ＣＴ，可直接多平面成像，成像参数多和流空效应，可不用造影剂使心血管显示，对肿瘤的检查有其独特的优点。本文仅就胸、腹、盆腔及骨关节肿瘤ＭＲＩ检查现状做...     

单体素1-H MRS在脊柱良恶性压缩性骨折鉴别诊断中的应用

目的:探讨磁共振氢质子波谱（proton magnetic resonance spectroscopy,1H -MRS）在脊柱骨质疏松和恶性肿瘤所致的压缩骨折中的不同特征,为鉴别脊柱良恶性压缩性骨折提供科学的依据。方法:收集2017年2月至2018年3月在西安市红会医院就诊的研究对象共109例,其中骨量正常组21例,骨量减少组38例,骨质疏松压缩骨折组28例,肿瘤压缩性骨折组22例。收集患者的年龄、性别和BMI等指标,所有研究对象均进行脂肪分数和脂水比值等指标的测量。本次研究采用3.0 T Siemens超导MR机及体部线圈进行波谱的采集。结果:四个组之间的脂肪分数和脂水比值之间存在显著差异。对于MRS FF而言,肿瘤组的MRS FF最低,为（16.3±6.7）%,骨质疏松组最高为（68.3±5.75）%,通过Bonferroni法进行不同组别之间的两两比较,发现任意两组之间均存在统计学差异,P＜0.001。MRS 脂肪分数（fat fraction,FF）和脂水比(lipid water ratio,LWR)具有高度相关性（r=0.835,P＜0.001）。结论:单体素1-H MRS在骨质疏松和肿瘤导致的压缩骨质中的MRS FF和LWR之间具有显著的统计学差异,可以有效的进行脊柱良恶性压缩性骨折的鉴别诊断。     

Schwannomas of Head and Neck and Review of Literature

Benign nerve cell tumours have been given various names like schwannoma, neurilemmoma, neurinoma, neurofibroma, spindle cell tumours etc. Extra cranial head and neck schwannomas usually present as solitary and well-demarcated lesions. The lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, depending upon the location of the lesion. Fine needle aspiration cytology, CT scans, and MRI may be of limited help in the diagnosis of schwannomas. The treatment is complete surgical excision of the benign tumour and postoperative histopathological examination establishes the final diagnosis.     

A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Aims: To assess and compare knowledge and awareness of colorectal cancer and breast cancer in a sample of the general population. Methods: Eleven hundred visitors to six different outpatient clinics, in a University Hospital, were given a study-specific questionnaire, based on educational material from the British Association of Cancer United Patients (CancerBACUP). The questionnaire consisted of 12 statements on the incidence, presentation, detection, treatment and prognosis of colorectal and breast cancer. Results: One thousand and sixty-eight individuals returned the questionnaire. One thousand and four completed questionnaires were analysed. The mean age (SD) of respondents was 50.1 (17.2) years, and the male to female ratio was 2:3. Respondents had read more about breast than about colorectal cancer (60.3%vs 32.4%,P <0.0001, McNemar's test). The proportion of correct answers for each statement on breast cancer was higher than for answers to corresponding items on colorectal cancer. Mean overall scores (95% CI) for breast and colorectal cancer were 88.1 (86.9, 89.2) and 64.4 (62.5, 66.3) respectively, the mean difference (95% CI) being 23.7 (22.0, 25.5). Scores were higher for breast cancer irrespective of age or gender. Conclusion: There is a low level of understanding of colorectal cancer in the general population when compared to breast cancer. This highlights the importance of public education in this common cancer.     

Quality of life and care in leukemia,myeloma and non-malignant disease. Opinions of patients and relatives,and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P < 0.05). Similarly, relatives of deceased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P < 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P < 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P < 0.001).     

miRNA与肿瘤侵袭转移

目前,microRNA (miRNA)已成为肿瘤研究中最基本的参与者,主要通过与靶标基因3 'UTR(非翻译区)的完全或不完全配对,降解靶标基因mRNA或抑制其翻译,从而参与调控个体发育、细胞凋亡、增殖及分化等生命活动.miRNA作为调控基因表达的重要分子在肿瘤侵袭转移中的作用越来越受到重视,表明miRNA在肿瘤侵袭和转移中的作用机制具有重要的理论意义,同时也可为肿瘤的诊断和治疗提供新方法.本文就miRNA通过调控上皮间质转化及肿瘤干细胞导致肿瘤侵袭转移的最新研究进展作一综述.     

芦荟大黄素及芦荟提取物的诱变性和抗诱变性

目的:用L5178Y小鼠淋巴瘤细胞体外微核试验评价芦荟大黄素和芦荟提取物的诱变和抗诱变作用,为其安全性评价提供依据。方法:设溶剂对照、阳性对照和抗诱变对照,芦荟大黄素和芦荟提取物诱变和抗诱变试验各设4个剂量组,处理L5178Y细胞12 h后按常规方法进行体外微核试验分析。结果:较高浓度(6.67μg/ml)的芦荟大黄素可致微核细胞率增加,与对照组比较,差异有统计学意义(P0.05);而芦荟提取物未见此效应。在一定剂量范围内,芦荟大黄素(0.22～6μg/ml)和芦荟提取物(20～180μg/ml)对甲磺酸甲酯(MMS)所致微核细胞率均有一定程度的拮抗作用,与对照组比较,差异有统计学意义(P0.01)。结论:芦荟大黄素具有一定的诱变作用,而在本实验剂量范围内的芦荟提取物未见遗传毒性。两种受试物在一定范围内均能较好地拮抗MMS所致的染色体损伤。     

Erythrocyte levels of cadmium and lead and risk of B-cell non-Hodgkin lymphoma and multiple myeloma

Cadmium and lead are persistent environmental toxins that are known or probable carcinogens, based on evidence for causality for nonhematologic cancers. Associations of these metals with risk of non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) are unknown but biologically plausible. To examine the associations of circulating levels of lead and cadmium exposure with risk of B-cell NHL (B-NHL) and multiple myeloma, we conducted a nested case-control study among 299 incident B-cell NHLs and 76 MM cases within the Cancer Prevention Study-II Nutrition Cohort (CPS-II NC). Each case was incidence-density matched to two eligible controls on age, race, sex and blood draw date. Conditional logistic regression was used to estimate relative risks (RR) and 95% confidence intervals (CI) for lymphoid malignancies overall and stratified by subtype. We observed a significant positive association between high erythrocyte lead concentration and risk of lymphoid malignancies overall (RR = 1.16, 95% CI: 1.02-1.33 per 17.6 μg/L (1 standard deviation [SD])) and follicular lymphoma in particular (RR = 1.80, 95% CI: 1.15-2.80 per SD). In contrast, there was no association between erythrocyte cadmium and risk of B-NHL (RR = 0.89, 95% CI: 0.75-1.06 per 0.37 μg/L [1 SD]), or any B-NHL subtypes; but a strong inverse association with MM risk (RR = 0.59, 95% CI: 0.38-0.89, per SD). Results from our study suggest a positive association between erythrocyte lead level and risk of lymphoid malignancies and a possible inverse association between cadmium and myeloma. Additional research is needed to confirm and further explore these findings.     

甲胎蛋白与自噬在肝癌发生发展中的作用及其相互关系

甲胎蛋白（AFP）作为临床诊断肝癌最常用的肿瘤标志物,有抑制免疫、促进细胞生长、抑制癌细胞凋亡的作用。自噬是一种维持细胞生存的重要途径之一,其与肝癌的发生发展及治疗有着密切联系,对肝癌既有抑制又有促进作用。PI3K/AKT作为两者共有的信号通路,它们是否有着相互关系来促进肝癌的发展尚需进一步研究。     

甲状腺手术的技巧及副损伤的预防和处置

鉴于甲状腺手术是普外科的常见手术，为求其日渐完美，以有益于病人，现根据作者的体会，并结合阅读相关文献，就其手术操作、喉返神经处理、甲状旁腺处理进行扼要阐述。     

Comparison of the Efficacy and Safety of Ceftibuten and Cefaclor in the Treatment of Pneumonia and Bronchiectasis

Summary

In a multicentre, international study of 187 adult patients with bacterial pneumonia or bronchiectasis, the safety and efficacy of a regimen of 200 mg ceftibuten administered twice-daily was compared with cefaclor given in a dosage of 500 mg three times a day. Of the 94 evaluable patients, 66 received ceftibuten and 28 received cefaclor. The overall bacteriological response was similar in the two treatment groups with elimination of the original pathogen in 91% and 89% of the patients receiving ceftibuten and cefaclor, respectively. The overall clinical response mirrored the bacteriological results with a successful clinical outcome in 92% of ceftibuten-treated patients compared with 93% in patients receiving cefaclor. Adverse experiences were, in general, few and mild, being reported in 8% and 17% of patients receiving ceftibuten and cefaclor, respectively.