颈动脉超声检查在缺血性脑卒中患者中的应用价值

目的：探讨颈动脉超声检查在缺血性脑卒中患者中的应用价值。方法选取2013年6—12月在我院接受颈动脉超声检查的缺血性脑卒中患者83例为观察组,同期在我院体检健康者50例为对照组。两组受试者均接受颈动脉超声检查,观察颈动脉狭窄情况、颈动脉中层内膜厚度及斑块性质等。结果对照组受试者中发现颈动脉狭窄9例（18.0％）,颈动脉内膜增厚2例（4.0％）,未发现易损斑块;观察组患者中发现颈动脉狭窄47例（56.6％）,颈动脉内膜增厚35例（42.2％）,易损斑块31例（37.3％）。观察组颈动脉狭窄、颈动脉内膜增厚及易损斑块检出率均高于对照组（ P＜0.05）。结论颈动脉超声检查对缺血性脑卒中患者颈动脉异常检出率较高,对缺血性脑卒中有一定的早期筛查价值。     

中青年缺血性脑血管病患者颈动脉彩色B超检查结果分析研究

目的研究颈动脉硬化和中青年缺血性脑血管病的关系。方法对412例中青年缺血性脑血管病患者进行颈动脉彩色B超检查，检测颈动脉内膜增厚及斑块形成、斑块分类、分布及血流动力学改变。412例患者中短暂性脑缺血发作（TIA）143例，脑梗死269例；另设102例非缺血性脑血管病患者为对照组。结果中青年缺血性脑血管病颈动脉内膜-中层厚度（IMT）增厚及颈动脉硬化斑块等异常检出率为69．6％，其中内中膜增厚122例，占38．6％；IMT增厚伴斑块形成占61．4％，对照组异常检出率为17．6％。与对照组比较，差异具有显著性。脑梗死组斑块检出率为50．9％，TIA组39．8％。中青年ICD以脂质斑检出率高，钙化斑次之，混合斑最少。中青年ICD颈动脉脉硬化斑最常见是颈动脉分叉处，其次是颈内动脉颅内段。结论颈动脉硬化是中青年ICD的重要危险因素，颈动脉超声有助于预测中青年ICD的发病危险，指导治疗时机和方法的选择。     

应用彩色多普勒超声检测缺血性脑血管病与颈动脉粥样硬化的关系

目的探讨缺血性脑血管病与颈动脉粥样硬化病变之间的关系。方法对130例缺血性脑血管病患者进行颈动脉彩色多普勒超声检查，130例患者中56例短暂性脑缺血发作（TIA），74例脑梗死；42例非缺血件脑血管病患者为对照组。检测颈动脉内膜增厚及斑块形成等血管异常发牛率、斑块类型及斑块的分布情况。结果TIA组患者颈动脉内膜-中层厚度（IMT）增厚及颈动脉硬化斑块等异常检出率为73．2％（41／56），脑梗死组异常率为87．8％（65／74），对照组受检者异常率为28．6％（12／42），TIA组及脑梗死组与对照组比较差异有显著意义（P〈0．01）。脑梗死组患者脂质性斑块及混合性斑块的发生率高于TIA组。颈动脉硬化斑块最常见部位为颈总动脉分又处，其次为颈内动脉近段。左右侧差异无显著意义。结论颈动脉硬化与缺血性脑血管病有密切相关性，颈动脉超声有助于预测缺血性脑血管病的发病危险。     

老年高血压缺血性脑卒中合并2型糖尿病患者颈动脉粥样硬化程度的分析

目的应用CT血管成像联合颈动脉超声检查对颈动脉粥样硬化斑块进行评价,并探讨其与2型糖尿病的关系。方法选择缺血性脑卒中患者152例,根据诊断分为糖尿病组56例,非糖尿病组96例,并进行CT血管成像联合颈动脉超声检查,分析斑块性质、形态,观察发生缺血性脑卒中事件相关因素,logistic回归分析老年缺血性脑卒中颈动脉粥样硬化程度与糖尿病的相关性。结果与非糖尿病组比较,糖尿病组颈动脉内膜中层增厚及斑块发生率高,易损斑块多,颈总动脉分叉部及动脉狭窄比例高,差异有统计学意义(P<0.05)。logistic回归分析表明,空腹血糖(OR=5.924,95%CI:1.176～2.468,P=0.003)与颈动脉粥样硬化程度密切相关;LDL-C(OR=2.283,95%CI:1.108～4.276,P=0.009)、纤维蛋白原(OR=1.856,95%CI:1.287～3.095;P=0.011)与颈动脉粥样硬化程度相关。结论老年缺血性脑卒中合并2型糖尿病患者颈动脉粥样硬化程度重,危险因素多于非糖尿病患者;常规对于颈动脉粥样硬化患者进行定期的血糖检测有重要参考价值。     

三维超声血管斑块定量分析诊断颈动脉斑块性质的临床价值

目的 分析三维超声血管斑块定量分析诊断颈动脉斑块性质的临床价值。方法 选取2019年2月—2020年6月我院超声科行颈动脉斑块性质超声检查的门诊和住院病人114例,根据术前6个月内是否为首发缺血性脑卒中病人分为缺血组(72例)和非缺血组(42例)。所有病人均接受三维超声血管斑块定量分析,并于超声检查后24 h内进行颈动脉内膜剥脱术和病理学诊断,之后对不同性质、不同狭窄程度血管斑块定量分析结果进行探讨,比较缺血组与非缺血组易损斑块与稳定斑块分布情况,并对标化壁指数(NWI)和灰阶中位数(GSM)诊断颈动脉易损斑块的临床价值进行分析。结果 114例病人共发现121个颈动脉斑块,经病理组织学诊断显示,易损斑块64个,稳定斑块57个。易损斑块NWI高于稳定斑块,易损斑块GSM低于稳定斑块,差异有统计学意义(P<0.001)。不同狭窄程度病人NWI比较,差异有统计学意义(P=0.004);中度狭窄NWI高于轻度狭窄,重度狭窄NWI高于轻度狭窄和中度狭窄,差异有统计学意义(P<0.05)。缺血组易损斑块检出率(89.5%)高于非缺血组的(4.4%),差异有统计学意义(P<0.00...     

颈动脉易损斑块与缺血性脑卒中复发的相关性研究

目的对颈动脉斑块进行评价,分析斑块性质、形态及其危险因素与缺血性脑卒中复发的相关性。方法选择经头颅CT和(或)MRI确诊为缺血性脑卒中复发患者209例,应用CT血管造影联合彩色多普勒超声检查证实122例有颈动脉斑块,根据斑块性质分为易损斑块组86例,稳定斑块组36例,分析斑块性质、形态,观察发生缺血性脑血管事件相关因素,比较2组缺血性脑卒中复发的时间、分布及狭窄的关系,Cox风险比例模型分析缺血性脑卒中复发与颈动脉斑块等危险因素间的相关性。结果 209例患者中,颈动脉斑块122例,占58.4%。与稳定斑块组比较,易损斑块组年龄更高,高血压和冠心病的比例更多(P<0.05)。Cox回归分析显示,易损斑块与冠心病是缺血性脑卒中复发的危险因素。结论颈动脉斑块性质、形态和冠心病是缺血性脑卒中复发的危险因素。     

超声检查对脑梗死患者颈动脉粥样硬化的诊断价值分析

目的探讨超声检查对脑梗死患者颈动脉粥样硬化的诊断价值。方法选取2014年9月—2015年11月荆州市第一人民医院收治的脑梗死患者85例为观察组,同期在本院体检的健康人85例为对照组。两组受试者均进行颈动脉超声检查,观察其颈总动脉内膜-中层厚度(IMT)、颈总动脉血流指标、颈动脉斑块类型及颈动脉狭窄程度。结果观察组患者左、右侧颈总动脉IMT高于对照组,颈总动脉最大血流速度(Vmax)、最小血流速度(Vmin)、左颈总动脉收缩期峰值流速(SPV)、舒张末期容积(EDV)低于对照组,阻力指数(RI)、颈总动脉(CCA)厚度及颈动脉分叉处(BIF)厚度、搏动指数(PI)高于对照组(P0.05)。两组受试者颈动脉斑块类型比较,差异有统计学意义(P0.05);观察组患者颈动脉狭窄程度重于对照组(P0.05)。结论脑梗死患者颈动脉粥样硬化程度较重,表现为颈总动脉IMT增厚、颈总动脉血流变化,超声检查具有很好的诊断价值。     

颈动脉斑块和狭窄与缺血性脑卒中的相关性研究

对120例缺血性脑血管病及60例非脑血管病患者进行颈动脉超声检查，结果显示，缺血性脑血管病组颈动脉粥样斑块检出率为64．2％，以不规则、不均质回声斑块多见；颈动脉狭窄发生率为19．2％，以中、重度为主。非脑血管病组动脉粥样斑块检出率为11．7％，以等回声、强回声斑块多见；颈动脉狭窄发生率为3．3％。两组均有显著差异（P〈0.01）。提示颈动脉狭窄可致缺血性卒中的危险性升高，超声显示不均质回声斑块与缺血性脑卒中的发生有关。     

超声颈动脉粥样硬化检查在缺血性脑卒中病人诊疗中的应用价值

目的探讨超声颈动脉粥样硬化检查在缺血性脑卒中病人诊疗中的应用价值。方法选取2014年5月—2016年5月在我院进行治疗的缺血性脑卒中病人100例作为病例组,选取同一时期我院体检者100名作为对照组,两组均进行超声颈动脉检查。比较两组颈动脉粥样硬化斑块发生率,颈动脉内-中膜厚度、颈动脉粥样硬化斑块的稳定性及血流动力学指标。结果病例组颈动脉粥样硬化斑块发生率、颈动脉内-中膜厚度及颈动脉粥样硬化易损斑块比例明显高于对照组,差异均有统计学意义(P <0.05)。对照组颈动脉血流动力学指标显著优于病例组,差异均有统计学意义(P <0.05)。结论超声检查能够敏感反映动脉粥样硬化斑块及颈动脉狭窄情况,早期实施超声颈动脉粥样硬化检查对缺血性脑卒中的诊疗具有重要的意义。     

血管造影与超声对诊断老年人颈动脉粥样硬化的价值

目的对比颈动脉超声与数字减影血管造影术(DSA)对诊断颈动脉粥样硬化(AS)的差异,探讨颈动脉超声在诊断颈AS的临床价值以及颈动脉造影的最佳适应证。方法选择有≥2项AS危险因素的患者126例,依据DSA检查结果分为颈动脉硬化组(硬化组)68例和颈动脉正常组(正常组)58例,行颈动脉超声及DSA检查,观察动脉管腔内径、颈动脉内膜中层厚度(IMT)、有无斑块及其性质、部位、有无狭窄并计算狭窄率。结果硬化组纤维蛋白元和C反应蛋白明显高于正常组(P=0.000)。DSA检测出68例190支血管斑块和(或)狭窄,总检出率为53.97%;超声检测出76例173支血管斑块和(或)狭窄,总检出率为60.32%,两者检出率比较,差异无统计学意义(P>0.05)。超声与DSA诊断颈动脉狭窄率比较,差异无统计学意义[(43.5±0.6)%vs(46.5±0.7)%,P>0.05]。以DSA为诊断标准,超声诊断颈AS的敏感性、特异性、阳性预测值和阴性预测值分别为83.82%、67.24%、78.89%和78.00%。结论超声对颈动脉粥样斑块检出率高于DSA,2种检查方法各有优劣,对需要行颈动脉内膜剥脱术及支架成形术的患者联合应用对其诊断及治疗更有价值。     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

A Call to Action to Enhance Filovirus Disease Outbreak Preparedness and Response

The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention—Atlanta, and others.     

Interplay between interferon-mediated innate immunity and porcine reproductive and respiratory syndrome virus

Innate immunity is the first line of defense against viral infection, and in turn, viruses have evolved to evade host immune surveillance. As a result, viruses may persist in host and develop chronic infections. Type I interferons (IFN-α/β) are among the most potent antiviral cytokines triggered by viral infections. Porcine reproductive and respiratory syndrome (PRRS) is a disease of pigs that is characterized by negligible induction of type I IFNs and viral persistence for an extended period. For IFN production, RIG-I/MDA5 and JAK-STAT pathways are two major signaling pathways, and recent studies indicate that PRRS virus is armed to modulate type I IFN responses during infection. This review describes the viral strategies for modulation of type I IFN responses. At least three non-structural proteins (Nsp1, Nsp2, and Nsp11) and a structural protein (N nucleocapsid protein) have been identified and characterized to play roles in the IFN suppression and NF-κB pathways. Nsp's are early proteins while N is a late protein, suggesting that additional signaling pathways may be involved in addition to the IFN pathway. The understanding of molecular bases for virus-mediated modulation of host innate immune signaling will help us design new generation vaccines and control PRRS.     

Disease Pandemics and Major Epidemics Arising From New Encounters between Indigenous Viruses and Introduced Crops

Virus disease pandemics and epidemics that occur in the world’s staple food crops pose a major threat to global food security, especially in developing countries with tropical or subtropical climates. Moreover, this threat is escalating rapidly due to increasing difficulties in controlling virus diseases as climate change accelerates and the need to feed the burgeoning global population escalates. One of the main causes of these pandemics and epidemics is the introduction to a new continent of food crops domesticated elsewhere, and their subsequent invasion by damaging virus diseases they never encountered before. This review focusses on providing historical and up-to-date information about pandemics and major epidemics initiated by spillover of indigenous viruses from infected alternative hosts into introduced crops. This spillover requires new encounters at the managed and natural vegetation interface. The principal virus disease pandemic examples described are two (cassava mosaic, cassava brown streak) that threaten food security in sub-Saharan Africa (SSA), and one (tomato yellow leaf curl) doing so globally. A further example describes a virus disease pandemic threatening a major plantation crop producing a vital food export for West Africa (cacao swollen shoot). Also described are two examples of major virus disease epidemics that threaten SSA’s food security (rice yellow mottle, groundnut rosette). In addition, brief accounts are provided of two major maize virus disease epidemics (maize streak in SSA, maize rough dwarf in Mediterranean and Middle Eastern regions), a major rice disease epidemic (rice hoja blanca in the Americas), and damaging tomato tospovirus and begomovirus disease epidemics of tomato that impair food security in different world regions. For each pandemic or major epidemic, the factors involved in driving its initial emergence, and its subsequent increase in importance and geographical distribution, are explained. Finally, clarification is provided over what needs to be done globally to achieve effective management of severe virus disease pandemics and epidemics initiated by spillover events.     

Barrett's Esophagus: Where Do We Stand?

Barrett''s esophagus (BE) is a precursor for esophageal adenocarcinoma, which has an increased incidence rate over the last few decades. Its importance stems from the poor five-year survival of esophageal adenocarcinoma and current data that suggest a survival benefit when surveillance programs are implemented. In this review, we will cover the pathophysiology and natural history of BE and the different endoscopic findings. The prevalence of BE in different geographic areas and the incidence of high-grade dysplasia and adenocarcinoma in this patient population is reviewed. Recent recommendation for screening and surveillance of BE has been covered in this review as well as the efficacy of nonconventional imaging modalities and endoscopic ablation therapies.     

The Technology Transfer from Europe to China in the 17th–18th Centuries: Non-Invasive On-Site XRF and Raman Analyses of Chinese Qing Dynasty Enameled Masterpieces Made Using European Ingredients/Recipes

Two masterpieces of the Qing Dynasty (1644–1912 CE), one in gilded brass (incense burner) decorated with cloisonné enamels stylistically attributed to the end of the Kangxi Emperor’s reign, the other in gold (ewer offered by Napoleon III to the Empress as a birthday present), decorated with both cloisonné and painted enamels bearing the mark of the Qianlong Emperor, were non-invasively studied by optical microscopy, Raman microspectroscopy and X-ray microfluorescence spectroscopy (point measurements and mapping) implemented on-site with mobile instruments. The elemental compositions of the metal substrates and enamels are compared. XRF point measurements and mappings support the identification of the coloring phases and elements obtained by Raman microspectroscopy. Attention was paid to the white (opacifier), blue, yellow, green, and red areas. The demonstration of arsenic-based phases (e.g., lead arsenate apatite) in the blue areas of the ewer, free of manganese, proves the use of cobalt imported from Europe. The high level of potassium confirms the use of smalt as the cobalt source. On the other hand, the significant manganese level indicates the use of Asian cobalt ores for the enamels of the incense burner. The very limited use of the lead pyrochlore pigment (European Naples yellow recipes) in the yellow and soft green cloisonné enamels of the Kangxi incense burner, as well as the use of traditional Chinese recipes for other colors (white, turquoise, dark green, red), reinforces the pioneering character of this object in technical terms at the 17th–18th century turn. The low level of lead in the cloisonné enamels of the incense burner may also be related to the use of European recipes. On the contrary, the Qianlong ewer displays all the enameling techniques imported from Europe to obtain a painted decoration of exceptional quality with the use of complex lead pyrochlore pigments, with or without addition of zinc, as well as cassiterite opacifier.