急性冠状动脉综合征患者血管内介入术后溶血磷脂酰肌醇变化及意义

【摘要】 目的 探讨急性冠状动脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）术后血清溶血磷脂酰肌醇（LPI）水平变化及意义。方法 选取2015年5月至2018年5月汉中市三二〇一医院收治的203例ACS患者作为研究对象。根据血清LPI值评估ACS患者预后的最佳截断点（1.04 μmol/L）,将患者分为高LPI组（n=46）和低LPI组（n=157）。检测患者血清LPI水平,并分析其与预后的关系。结果 血清LPI评估ACS患者预后的受试者工作特征曲线下面积（AUC）为0.851,灵敏度、特异度分别为69.44%、88.02%。高LPI组、低LPI组患者间血肌酐、肌钙蛋白I（TnI）、病变血管数、美国纽约心脏病协会（NYHA）心功能分级、糖化血红蛋白（HbA1c）、尿素氮（BUN）、左心室射血分数（LVEF）、LPI差异均有统计学意义（P＜0.05）。高LPI组主要心血管不良事件（MACE）发生率显著高于低LPI组,平均生存时间显著低于低LPI组,差异均有统计学意义（P＜0.001）。Cox单因素和多因素回归分析显示,疾病分型、慢性阻塞性肺疾病、TnI、病变血管数、LPI与ACS患者预后密切相关。 结论 血清LPI与ACS患者预后密切相关。LPI水平检测有助于评估患者预后。     

多囊卵巢综合征脂肪组织IRS-1介导的磷脂酰肌醇-3激酶活性分析

目的　研究多囊卵巢综合征 (PCOS)患者脂肪组织胰岛素受体底物 1(IRS 1)介导的磷脂酰肌醇 3激酶 (PI 3K)活性的改变 ,探讨PCOS产生胰岛素抵抗 (IR)分子的机理。方法　采用放射免疫分析法检测PCOSIR组 (19例 )、PCOS非IR组 (10例 )及对照组 (15例 )血清促黄体生成素 (LH)、促卵泡激素 (FSH)、睾酮 (T)的水平 ;采用放射免疫分析法测定各实验组血清空腹胰岛素 (FIN)的浓度 ;采用葡萄糖氧化酶法测定血浆空腹血糖 (FPG) ;采用稳态模型 (HOMA)计算IR指数 (HOMA IR) ;采用免疫沉淀及增强化学发光法检测IRS 1蛋白质酪氨酸磷酸化 ;采用免疫沉淀、薄层层析及γ液闪计数方法检测PI 3K的活性 ,并进行分析比较。结果　①PCOSIR组患者血清LH、LH FSH、T、FIN及HOMA IR均高于PCOS非IR组与对照组 (P均 <0 0 5 ) ;PCOS非IR组患者血清LH、LH FSH、T、FIN及HOMA IR亦高于对照组 (P均 <0 0 5 ) ;②PCOSIR组与PCOS非IR组及对照组相比 ,IRS 1蛋白质酪氨酸磷酸化程度降低 (P <0 0 1) ;③PCOS组PI 3K活性下降 ,而PCOSIR组激酶活性下降尤为明显 (P <0 0 1) ,与HOMA IR呈负相关 (P <0 0 1)。结论　PCOSIR可能为胰岛素受体后信号转导通路中 ,其上游信号分子IRS 1酪氨酸磷酸化的改变造成激活信号减弱 ,使PI 3K活性降低 ,影响胰     

磷脂酰肌醇3-激酶在油酸型急性肺损伤大鼠肺内的表达及其意义

目的研究磷脂酰肌醇3-激酶（PI3-K）在油酸型急性肺损伤大鼠肺内的表达情况及其与肺组织细胞凋亡的关系。方法健康雄性SD大鼠60只,随机分为5组,每组12只：油酸组共4组,分别在尾静脉注入油酸0．25mi／kg后1h,2h,4h,24h颈总动脉放血处死,对照组：尾静脉注入生理盐水0．25ml／kg,2h颈总动脉放血处死。观察各组动脉血气、左肺湿／干比、肺系数、BALF中蛋白含量、肺通透指数,免疫组化法测定肺内Fas-L表达,免疫组化法和免疫印迹法测定肺内PI3-K蛋白表达。结果油酸组大鼠PaO2明显降低,左肺湿／干比、肺系数、BALF中蛋白含量及肺血管通透性明显增高（P〈0．01）,支气管、肺泡上皮细胞,肺血管内皮细胞,肺泡巨噬细胞上表达PI3-K和Fas-L明显增多（P〈0．01）,且PI3-K表达峰值时间早于Fas-L。结论Fas-L依赖的肺泡上皮细胞、肺血管内皮细胞和巨噬细胞凋亡参与早期ALI发病机制,此过程可能通过PI3-K信号转导通路予以实现。     

金属硫蛋白-3与肝细胞肝癌 TACE治疗近、远期疗效的关系

【摘要】 目的 探究肝细胞癌（HCC）患者癌组织中金属硫蛋白-3（metallothionein-3,MT-3）水平与TACE治疗疗效的关系。方法 选择2013年3月至2015年1月104例确诊的HCC患者作为研究对象。采用蛋白质免疫印迹法（Western blotting）检测HCC组织中MT-3水平,并分析其评价TACE治疗近、远期疗效的价值。结果 有效组HCC组织中MT-3水平高于无效组,差异有统计学意义（P＜0.05）。MT-3评价接受TACE治疗的HCC患者近期疗效的受试者工作特征（ROC）曲线下面积（AUC）、灵敏度和特异度分别为0.825、76.5%和78.6%。MT-3评价接受TACE治疗的HCC患者远期疗效的ROC曲线AUC、灵敏度和特异度分别为0.913、88.10%和83.87%。Cox回归分析结果显示肿瘤分期、Child-Pugh分级和肿瘤直径是HCC患者5年生存预后的独立危险因素（P＜0.05）,MT-3是HCC患者5年生存预后的独立保护因素（P＜0.05）。 结论 MT-3评价接受TACE治疗的HCC患者近、远期疗效的价值均较高,可辅助判断生存预后。     

CT定量诊断脂肪肝的实验研究

目的：研究脂肪肝的脂肪含量与ＣＴ值之间的相关关系，以指导临床诊断和治疗。材料与方法：Ｗｉｓｔａｒ大鼠３５只，随机分为正常组５只，实验组３０只，制成脂肪肝模型。对正常组和随机抽取第一、二、三、四周末的实验组鼠各５只，行ＣＴ扫描，测得全肝的ＣＴ值。取左、中、右叶肝组织各一块，制成光镜切片，用显微图像分析仪测得肝中脂滴的体积占整个肝组织的百分比（Ｖｖ值）。结果：在ＣＴ值与Ｖｖ值之间存在有意义的线性负向相关关系（γ＝－０．９５０，ｔ＝１２．９０，Ｐ＜０．００１）。结论：利用ＣＴ值与Ｖｖ值之间的线性相关关系，通过ＣＴ监测，不仅可对脂肪肝的程度、范围和脂肪含量做出估计，而且可替代肝活检定量法。在脂肪肝的治疗过程中，用该技术追踪随访疗效，不失为一种重要的手段。     

Early liver metastases in resectable periampullary cancer: Incidence and risk factors

PurposeThe aim of the present study was to estimate the incidence of very early hepatic metastases (HMs) (<6 months) and their imaging patterns after cephalic duodenopancreatectomy (CDP) for periampullary carcinoma (excluding duodenal carcinoma) and to identify their associated risk factors.MethodsFrom January 2003 to June 2016, all patients who underwent surgical treatment for periampullary carcinoma by CDP at our institution and with adequate pre- and postoperative CT scans were included. Univariate and multivariate logistic regressions were performed to determine factors associated with very early HM and recurrence.ResultsOf the 132 patients included retrospectively, 27 (20.5%) patients developed HMs. The mean time to diagnosis of HM was 103.9 ± 55.2 days. HMs were multiple in 81.4% of cases and bilobar in 59.3% of cases; their mean maximum size was 16.7 ± 12.7 mm.In univariate logistic analysis, lymphovascular emboli were significantly associated with HM (p = 0.02). No independent risk factors for HM were found in multivariate analysis. In multivariate logistic analysis, two independent risk factors were identified for the occurrence of early recurrence: tumor size >23 mm on preoperative CT scan (OR: 3.3; 95% CI: [1.2–9.3]; p = 0.02) and tumor differentiation (poor vs. good: OR 15.5; 95 CI [1.5–158.3]; moderate vs. good: OR: 17.1; 95% CI: [1.9–154.4]; p = 0.04).ConclusionsNearly one in five patients developed HM after CDP within 6 months with a highly consistent pattern. A thorough preoperative assessment, combining CT scan and MRI with a delay of less than three weeks before surgery, appears essential. A routine systematic postoperative CT scan at 8 weeks is also required prior to initiating adjuvant chemotherapy.The type of surgical intervention does not seem to be a risk factor, although the risk of HM occurrence appears to be related to the lymphovascular invasion of the tumor and maybe its degree of differentiation, elements not assessable by imaging.     

超声引导肝癌裸鼠模型瘤体内注入聚桂醇实验研究

目的 对比研究聚桂醇、无水乙醇及生理盐水经超声介入硬化治疗荷瘤肝癌模型的作用效果,探讨聚桂醇能否成为治疗原发性肝癌的新型硬化剂.方法 取BALB/C裸鼠30只及人肝癌HepG2型细胞系构建裸鼠肝癌模型,将18只造模成功荷瘤裸鼠随机分为聚桂醇组(n=6)、无水乙醇组(n=6)及生理盐水组(n=6),分别向模型瘤体中央部位注入相应药物和生理盐水进行治疗实验,观察原发性肝癌状况;超声测量各组瘤体大小,计算肿瘤生长抑制率,苏木精-伊红染色观察瘤体超声影像学改变,镜下观察肿瘤内部及周围病理学改变.结果 实验鼠造模成功18只,皮下瘤体结节均肉眼可见.聚桂醇组和无水乙醇组肿瘤生长明显受抑制(瘤体缩小,1例完全消失),总有效率100％,肿瘤生长抑制率达77.13％,病理学检查见肿瘤组织大片坏死,细胞核固缩;生理盐水组瘤体体积随时间增加无缓解.结论 聚桂醇可抑制BALB/C裸鼠原发性肝癌模型,达到与无水乙醇相似的近期硬化效果,有望成为治疗肝癌的理想硬化剂.     

Early detection of developing osteoarthritis by scintigraphy: an experimental study on rabbits

Bone scintigraphy (99mTc-MDP) was used to study the development of experimental osteoarthritis produced by extension immobilization in rabbit knees. The purpose of the study was to determine a repeatable and noninvasive method for following the joint reaction leading to osteoarthritis. In comparison with the contralateral joints activity uptake in immobilized joints was already detectable in bone scintigraphy at 24 h, at the same time as the earliest changes in the biochemical reactions of joint tissues can be detected.     

Early diagnosis of spinal metastases by CT and MR studies

Fifteen patients with known metastatic or high-risk primary cancer, normal neurologic examinations, and new abnormalities on 99mTc bone scan were evaluated with spinal CT and magnetic resonance (MR) imaging. Four patients underwent CT metrizamide myelography. Spinal CT and MR agreed in 14 of 15 patients demonstrating spinal metastases in 12 patients and benign disease in two. In one patient spinal CT was normal, but MR showed altered marrow signal consistent with metastatic disease. Epidural tumor was demonstrated by CT metrizamide myelography in four cases, all correctly identified by MR. Further evaluation of spinal MR in this setting is warranted.     

影像组学在结直肠癌肝转移诊疗中的应用进展

结直肠癌发病率呈逐年上升趋势,肝脏是其远处转移最常见的靶器官。目前传统影像学在发现结直肠癌隐匿性肝转移灶、预测异时性肝转移及评估治疗反应方面仍有不足。影像组学可从医学图像数据中挖掘并提取肉眼难以分辨的信息,反映肿瘤内部异质性特征,从而为结直肠癌肝转移的预测、诊断、疗效评估及预后判断提供更多的辅助信息。就影像组学在结直肠癌肝转移诊疗中的应用进展进行综述。     

Bronchobiliary fistula as a complication of liver metastases: diagnosis by HIDA scan

Bronchobiliary fistulas are rare, may result from infection with Echinococcus or Amebiasis, trauma, or hepatic malignancy, and present with biliptysis, the expectoration of bile. The authors present a 49-year-old woman who presented with frank biliptysis as a result of previously treated metastatic colon cancer to the liver. A hepatobiliary scan is the noninvasive diagnostic imaging test of choice for demonstration of such fistulas, and was useful in confirming the diagnosis in our patient.     

超声造影对肝脏转移癌的诊断应用价值

目的:探讨超声造影对肝脏转移癌的诊断应用价值.方法:对49例恶性肿瘤患者肝脏行常规超声检查及低机械指数超声造影检查,对肝内转移性病灶超声造影表现进行分析.结果:经超声造影新发现47个病灶,其中小于1.0cm的病灶占55.3%(26/47).肝转移病灶的增强模式可分为4种:A.病灶周边快速环状强化60/131(45.8%),病灶内部呈低或无增强,之后周边增强部分造影剂迅速退出呈低增强;B.病灶于动脉期呈快速整体强化并迅速廓清51/131(38.9%);C.病灶于动脉期和门脉期基本与肝脏实质同步强化,延迟晚期呈低增强12/131(9.2%);D.病灶于造影三期均低于肝实质呈低增强表现8/119(6.1%).结论:肝脏转移病灶来源和大小不同其增强模式表现亦不相同;实时超声造影可提高对肝脏转移病灶尤其可提高直径小于1.0cm的微小转移灶的检出率.     

经门静脉无水酒精选择性肝段硬化术的动物实验研究

目的　通过动物实验研究 ,初步探讨经门静脉无水酒精选择性肝段硬化术的安全性和有效性 ,以及相关的一些技术问题。方法　健康杂种犬 3 0只经球囊导管向肝段门静脉快速注射无水酒精 ,进行选择性肝段硬化术 ,注射剂量为 0 2～ 1 0ml/kg。术后复查血酒精浓度、WBC、肝功能及CT ;定期处死犬 ,进行肝脏病理学检查。结果　所有犬术后均存活。F组的血液中酒精浓度的峰值最高 ,平均值为 ( 1 60 3± 0 0 83 )mg/ml,远远低于致死阈值。血白细胞 (WBC)、丙氨酸转氨酶 (ALT)值呈一过性升高。术后 2 4hF组WBC均值为 ( 46 3 6± 7 2 8)× 10 9,ALT均值为 ( 82 7 3 6± 147 2 5 )U/L。CT和病理学检查证实 ,注射剂量为 0 3～ 1 0ml/kg的肝段呈“楔形”样区域性完全坏死 ,2 8d后硬化肝段明显萎缩 ,逐步为纤维组织取代。结论　经犬的肝段门静脉注射适当剂量的无水酒精进行选择性肝段硬化术是安全的、有效的 ,因此 ,可以考虑将选择性肝段硬化术应用于临床 ,进一步研究其治疗原发性肝癌的有效性和安全性