腰骶部连合神经根的CT诊断

作者报道了19例CT上发现腰骶部连合神经根(CNR),11例经脊髓造影(LM)和/或手术证实。其中L_5、S_1连合的10例、L_4、L_5连合6例、S_1、S_2连合3例。该变异占人群的1—3％,以L_5、S_1连合最常见,多为非对称性。因连合的神经根体积较大且固定,易受椎弓或关节突压迫引起根性痛疼。如合并椎间盘脱出,可因二者分别处不同平面而致临床表现不典型,并造成手术困难。目前仅LM可明确此变异。CT上则应避免将其误为椎间盘脱出。作者经验和报道表明,多数CNR都能在CT平扫中确认。通常,当硬膜外间隙前外方被等密度或稍高于硬膜囊密度的组织占据应疑及CNR。     

西藏病毒感染性腹泻三间分布的流行病学研究

1990年5月-1992年4月对西藏自治区六个地区1557例腹泻患者粪便标本作了WHO规定方法的调查,经ELISA、SDS—PAGE和EM技术,结果检出四种 (487份) 与腹泻有关的肠道病毒,总阳性率31.28％,其中HRV为26.33％ (410/1557);Edes为3.08％ (48/1557);Reor为1.09％ (17/1557);SRvs为0.77％ (12/1557)。HRV感染冬春占65.76％,夏秋占34.24％;月龄儿占44.18％,3岁组占39.22％,5岁组占82.39％,6岁以上占19.31％。HRV—RNA分析呈4232排列特征,在五个 (S_1、s_2和L_2—L_4) 变异型中.长 (L) 型为主,L_3型占优势。EM鉴定HRV颗粒直径为75—80nm,双层结构,空心和实心两种。研究结果证实HRV是西藏地区腹泻的主要病毒病原,肠遭腺病毒次之,对制订防治对策提供了科学依据。     

MRI检查腰椎多裂肌退变与关节突关节骨性关节炎的临床分析

目的探讨腰椎多裂肌退变与关节突关节骨性关节炎的相关性。方法选取腰腿痛患者84例为研究对象,应用MRI横断面终板水平的轴位图像,计算L_(4～5)及L_5～S_1两个节段多裂肌参数[总截面积(TCSA)、多裂肌单纯肌肉截面积(FCSA)及脂肪化程度(FI)],评定两侧FJOA等级(0～1级、2级、3级);分析同一节段左右两侧多裂肌参数与FJOA等级之间的相关性。结果在L_(4～5)、L_5～S_1两个节段多裂肌相关参数上,同一节段左右两侧TCSA、FCSA比较差异不显著(P0.05);L_(4～5)、L_5～S_(11)两个节段左右两侧FI比较差异显著(P0.05);双侧L_(4～5)、L_5～S_1两个节段TCSA、FCSA、FI比较差异显著(P0.05)。在L_(4～5)、L_5～S_1两个节段FJOA分级比较上,同一节段左右两侧比较差异均不显著(P0.05)。L_(4～5)节段右侧多裂肌FCSA与左侧FJOA等级呈显著负相关(P0.05);L_5～S_1节段多裂肌右侧FI与右侧FJOA等级呈显著正相关(P0.05),多裂肌其他参数与左右两侧FJOA等级差异均不显著(P0.05)。结论腰椎多裂肌的单纯肌肉截面积及脂肪化程度与关节突关节骨性关节炎具有相关性。     

腰椎小关节的不对称与椎间盘脱出的关系

过去一直认为后背痛病人中椎小关节的不对称是一很有意义的征象,提示腰椎的扭转性损伤,而且将导致腰间盘脱出。作者分析了136例由CT诊断为L_4～L(?)或L_5～S_1层面椎间盘脱出,并只接受了保守治疗的患者。根据髓核脱出主要在中心部还是偏于一侧而分为中心型和偏一侧型二组,偏一侧型突出的边缘不超过中线。中心型脱出50例,偏一侧型86例。发生在L_4～L_5、L_5～S_1层面者68例。脱出在L_4～L_5层面的,相邻正常的L_5～S_1层面的椎小关节测量结果同L_5～S_1层面脱出者之测量结果做对比,同样,L_5～S_1层面脱出的其相邻正常的L_4～L_5层面小关节角度同L_4～L_5脱出者做对比。其中2例正常的L_5～S_1层面椎小关节严重增生影响测量而排除。所以共计有136个脱出的椎间盘同134个正常的椎间盘进行对照。     

腰椎间孔MRI和CT三维测量的对比分析

目的对比分析腰椎间孔MRI和CT三维数据,提高腰椎间孔三维测量的准确性。方法收集2013年8月—2016年8月间的56例腰椎退变病人[男24例、女32例,年龄39～72岁,平均(56.5±7.6)岁]和41名体检腰椎正常者[男18名、女23名,年龄25～36岁,平均(31.4±5.2)岁]的MRI和CT影像资料。采用Mimics19.0软件构建腰椎间孔MRI和CT三维模型,分别测量腰椎间孔容积、矢状面最小面积及冠状面长径,测量数据间的比较采用配对样本t检验。采用组内相关系数(ICC)评价不同测量者之间的一致性。结果不同测量者之间存在较高的一致性(均ICC0.9)。腰椎正常者MRI上测得的L_1～S_1各节段椎间孔容积及L_1/L_2、L_2/L_3、L_3/L_4、L_4/L_5节段的矢状面最小面积均小于CT测量结果(均P0.05);腰椎退变病人MRI上测得的L_1～S_1各节段的椎间孔容积以及L_1/L_2和L_2/L_3节段的椎间孔矢状面最小面积均小于CT测量结果(均P0.05)。腰椎退变病人及腰椎正常者其余测量值差异均无统计学意义(均P0.05)。结论腰椎间孔MRI和CT三维测量数据之间存在差异,主要是由于CT成像尚不能精确识别未发生显著退行性改变的椎间孔后壁软组织。     

椎弓根钉加钢丝悬吊治疗腰椎峡部不连及滑脱

我们从1989年以来采用椎弓根钉加钢丝悬吊加大块加压植骨融合术治疗腰椎峡部不连及滑脱5例,疗效满意,报告如下.1 手术方法:病人取侧卧位,L_1～S_2后正中切口,显露L_2～S_2两侧椎板及L_3～S_1两侧小关节突、横突.L_5峡部不连时可见峡部断端与结缔组织相连,L_5棘突移动.若L_5向前滑移则L_4棘突前移.探明L_4、L_5峡部及滑移情况,确定椎弓根钉进针点,用斯氏针打     

安吖啶的抗癌效价

体外实验中观察了本院合成的安吖啶对3株肿瘤细胞的抗癌作用.结果表明,安吖啶对L_(1210)细胞及2株人肿瘤细胞HEP及HCE均具有较强的抗癌效果.对L_(1210)细胞的杀伤效果最强,杀死1或2个log(即杀死90%和99%)瘤细胞的浓度依次为0.08及0.25μg/ml,对HCE和HEP细胞杀死1个log细胞的浓度分别为0.98及1.25μg/ml.体内实验证明本药对小鼠实体瘤S_(180)及腹水瘤L_(1210)均具有较好疗效.1～3mg/kg每天腹腔注射1次连续6天,可使荷腹水型L_(1210)瘤小鼠的活存时间较对照组延长193～214%,对S_(180)实体瘤生长的抑制率可达47～85%.与美国国立肿瘤研究所赠送的标准品NSC-249992作了比较,证明二者的抗癌效价相似.     

肾后结肠对经皮穿刺椎间盘切除术的影响

作者研究了346例(女140例,男206例,年龄15—83岁)CT片以确定肾后结肠的机率。其中21例仅做了L_(4-5)平面的扫描,16例做了L_5-S_1平面的扫描,剩下的309例至少做了两个椎间盘平面的扫描。63例还做了L_(3-4)平面外加1到2个其他层面的     

Far-out综合征的MRI

腰脊椎病时往往伴有椎间孔外的腰部神经根的绞窄,Wiltse等对L_5神经根下垂于横突和骶骨上之间形成的绞窄称为Far-out综合征(FO综合征)。脊髓造影检查难以术前作出神经根损害的诊断。作者报道了MR冠状切面扫描的经验。经手术证实的FO综合征7例(8条神经),男5例,女2例,年龄38～76岁,于矢状正中切面上行冠状面(自L_3椎体后下缘与L_5椎体后上缘连线的平行切面)和半冠状面(自L_4椎体后上缘至L_5前下缘连线的平行切面)扫描,T_1加权象各摄影1张。结果见到,L_5神经7条(其中左侧4例,右侧1例,双侧1例),右S_1神经根1条受损害。全部病例均有移行椎及其关节形成部的骨刺形成,按Richard(神中)的分类:6例(7条)为Ⅱ型,横突与骶骨间的移行部关节形成处出现骨刺,神经根位于该骨刺与骶骨间或与同一水平的椎间盘之间被绞窄;另1例为Ⅰ型肥大,其神经根下垂于横突与骶骨间被绞     

X线平片腰骶椎间隙高度测量及对腰椎间盘病变诊断价值的研究

目的:确定L_5～S_1椎间隙狭窄的标准并探讨其诊断价值。方法:随机选取964例有标准X线平片、CT、MRI影像资料的病例进行回顾性分析,按年龄及性别分组,测量X线平片L_5～S_1椎间隙高度,并与CT或MRI结果进行对照。结果:正常组不同年龄和性别的L_5～S_1椎间隙高度差异无统计学意义,病变组与正常组的L_5～S_1椎间隙高度差异有统计学意义。椎间隙后缘高度变窄与椎间盘病变的相关性最大。结论:X线平片上椎间隙的变化有助于诊断椎间盘病变。     

西藏地区病毒混合感染性腹泻的流行病学特征

作者(1990.5—1992.4)采用PAGE和电镜技术,查获得149例腹泻病毒混合感染病例,进行了流行病学分析。共检出病毒5种13组,病毒混合感染率9.57％(149/1557)。其中多重感染为11.6％;双重感染为4.96％;重叠感染为3.73％。<20岁组为6.49％;>21岁组为3.08％;流行季节前期居多,散发流行在人口密集的拉萨、林芝和昌都地区。呕吐、发热、脱水和腹泻加重为主要临床特征。此外,文中对发现的冠状病毒从形态和分子结构上作了描述和流行病学分析,除证实在当地感染(3.73％)的存在外,讨论了HECV与人类腹泻的密切病因关系。     

The effect of hypoxia and exercise on heart rate variability,immune response,and orthostatic stress

Hypoxia with exercise is commonly used to enhance physiological adaptation in athletes, but may prolong recovery between training bouts. To investigate this, heart rate variability (HRV), systemic immune response, and response to an orthostatic challenge were measured following exercise in hypoxia and air. Eleven trained men performed a 10‐km cycling time trial breathing hypoxia (16.5 ± 0.5% O₂) or air. HRV and the heart rate response to an orthostatic challenge were measured for 3 days before and after each trial, while venous blood samples were collected pre‐, 0, 2, and 24 h post‐exercise. Hypoxia had no significant effect compared with air. Subgroup analysis of those who had a drop in oxyhemoglobin saturation (SpO₂) > 10% between hypoxia and air compared with those who did not, demonstrated a significantly altered HRV response (△HFnu: ?2.1 ± 0.9 vs 8.6 ± 9.3, △LFnu: 2.1 ± 1.0 vs ?8.6 ± 9.4) at 24 h post‐exercise and increased circulating monocytes (1.3 ± 0.2 vs 0.8 ± 0.2 × 10⁹/L) immediately post‐hypoxic exercise. Exercise and hypoxia did not change HRV or the systemic immune response to exercise. However, those who had a greater desaturation during hypoxic exercise had an attenuate recovery 24 h post‐exercise and may be more susceptible to accumulating fatigue with subsequent training bouts.     

高血压合并2型糖尿病患者心率变异与颈动脉内中膜厚度的相关性分析

目的探讨高血压（EH）合并2型糖尿病（T2DM）患者心率变异（HRV）的改变及其与颈动脉内中膜厚度（IMT）的关系。方法选择27例高血压患者、22例高血压合并2型糖尿病患者和25例健康人进行24h动态心电图监测和颈动脉内中膜厚度测量。结果高血压组、高血压合并2型糖尿病组的SDNN、SDANN、RMSSD、SDNNidex较正常对照组均有明显减低（P〈0．01）,高血压合并2型糖尿病组较高血压组也有显著差异（P〈0．05）。高血压或高血压合并2型糖尿病伴颈动脉内中膜增厚者HRV参数较无增厚者有进一步的下降,而且HRV参数与IMT呈负相关。结论心率变异性分析可以作为早期发现高血压和（或）合并2型糖尿病患者心脏自主神经损伤的有价值的指标,HRV也是颈动脉粥样硬化的独立相关因素,可对大血管并发症作出早期的预测．有助于及时治疗,改善预后。     

深呼吸对糖尿病患者心率变异性影响及意义

 目的分析糖尿病患者短程静息及深呼吸心率变异性(Heart rate variability,HRV)的动静变化,探讨深呼吸对自主神经损伤HRV的影响及意义.方法2型糖尿病患者64例分为:单纯糖尿病(SDM)组36例及糖尿病并发症(DMA)组28例,与健康者30例对照;全部施行HRV深呼吸试验(5 min静息态、5 min深呼吸态)检测,分析HRV每一指标的3个变量(静息态值、深呼吸态值、静息深呼差值).结果糖尿病各组深呼吸试验HRV各指标的3个变量值均较对照组有不同程度降低,DMA组较SDM组亦明显降低.结论深呼吸HRV随自主神经损伤程度不同而呈不同程度降低.短程HRV深呼吸试验可静动结合灵敏真实地反映自主神经损伤.     

Diagnosis of spondylolysis on MRI: Importance of recognition of hypoplastic L5 on MRI

Objective

To perform a combined (retrospective and prospective) study to further characterize hypoplastic L5, its correlation with spondylolysis and other associated abnormalities on routine Computed tomography and magnetic resonance imaging.

Methods

We studied the Computed tomography and magnetic resonance imaging images of 29 patients with hypoplasia and posterior wedging of L5 with bilateral spondylolysis at L5. These cases were followed up retrospectively and prospectively. The anteroposterior diameter of L4, L5 and S1 was calculated and compared. The percentage of posterior wedging of L5 was calculated. Anterolisthesis, hypoplastic pedicle, facet joints, L4–5 and L5–S1 intervertebral discs, nerve roots and fragmentation of pars interarticularis were also studied.

Results

The mean difference of anteroposterior diameter between L4 and L5 was 2.75 mm and of L5 and S1 was 3.78 mm. The mean percentage of posterior wedging was 31%. Grade I anterolisthesis was present in 13 patients and grade II in 2 patients. Facet joint arthropathy was seen in 20 patients. In 24 patients, there was hypoplastic pedicle. Pars fragmentation was seen in 7 patients. L5–S1 disc disease was seen in 21 patients out of whom 8 had exiting nerve root compression. L4–L5 disc disease was seen in 10 patients of whom 5 had exiting nerve root compression.

Conclusions

Hypoplastic L5 is a strong predictor of bilateral spondylolysis even in the absence of true anterior slippage. True anterior slippage and disproportionate adjacent disc disease result in varying degrees of exiting nerve root compression.

Advances in knowledge

L5 hypoplasia can simulate anterolisthesis and can predict the bilateral spondylolysis. L5 hypoplasia can lead to early disc disease.     

急性心肌梗死患者心率变异性临床分析

对８４例急性心肌梗死患者进行心率变异性分析。应用２４ｈ磁带记录器。进行２４ｈＨｏｌｔｅｒ心电图记录，对记录磁带采用电子计算机分析，对急性心肌梗死的病变范围和程度及预后进行估计。     

滇南水中钩端螺旋体的调查研究

各种水体保存钩端螺旋体(简称钩体)是钩体病研究的主要问题之一。我所于1997-04在云南省红河州蒙自县和河口县进行了不同生活环境水体钩体的调查。采用过滤培养分离法,分离到18株双曲钩体,未检出问号钩体,检出率为5.54％(18/325)。其中14株生长良好的钩体分属坎群3株,巴索互扎群2株,安达曼群、普尔普代弗群及科肖迈恩群各1株,6株可能是新型。4株生长不好未定群型。     

Association between facet joint osteoarthritis and the Oswestry Disability Index

AIM: To investigate the correlation of facet joint osteoarthritis (FJOA) at lumbar levels L4/L5 and L5/S1 and the Oswestry Disability Index (ODI).METHODS: The study involved lumbar MRIs of 591 patients with a mean age of 47.3 years. The MRIs of the lumbar spine were performed on a 1.5 Tesla scanner (Magnetom^® Avanto, Siemens AG, Erlangen, Germany) using a dedicated receive only spine coil. After initial blinding, each dataset was evaluated by 2 board certified radiologist with more than 5 years experience in musculoskeletal imaging. In total 2364 facet joints were graded. Degenerative changes of the facet joints were evaluated according to the 4-point scale as proposed by Weishaupt et al Functional status was assessed using the ODI. The index is scored from 0 to 100 and interpreted as follows: 0%-20%, minimal disability; 20%-40%, moderate disability; 40%-60%, severe disability; 60%-80%, crippled; 80%-100%, patients are bedbound. Spearman’s coefficient of rank correlation was used for statistical analysis, with significance set at P < 0.05.RESULTS: In total 2364 facet joints at lumbar levels L4/5 and L5/S1 were analysed in 591 individuals. FJOA was present in 97% (L4/L5) and 98% (L5/S1). At level L4/5 (left/right) 17/15 (2.9%/2.5%) were described as grade 0, 146/147 (24.7%/24.9%) as grade 1, 290/302 (49.1%/51.1%) as grade 2 and 138/127 (23.4%/21.5%) as grade 3. At level L5/S1 (left/right) 10/11 (1.7%/1.9%) were described as grade 0, 136/136 (23.0%/23.0%) as grade 1, 318/325 (53.8%/55.0%) as grade 2 and 127/119 (21.5%/20.1%) as grade 3. Regarding the ODI scores, patients’ disability had a minimum of 0% and a maximum of 91.11% with an arithmetic mean of 32.77% ± 17.02%. The majority of patients (48.39%) had moderate functional disability (21%-40%). There was no significant correlation between FJOA and ODI on both sides of lumbar level L4/5 and on the left side of lumbar level L5/S1. A weak positive correlation was evaluated between ODI and FJOA on the right side of lumbar level L5/S1.CONCLUSION: The missing correlation of FJOA and ODI confirms our clinical experience that imaging alone is an insufficient approach explaining low back pain. Clinical correlation is imperative for an adequate diagnostic advance in patients with low back pain.     

I-123 MIBG imaging and heart rate variability analysis to predict the need for an implantable cardioverter defibrillator

BACKGROUND: Iodine 123 metaiodobenzylguanidine (MIBG) imaging and heart rate variability (HRV) analysis were compared in patients with an implantable cardioverter defibrillator (ICD) who did and did not receive defibrillator discharges. Although the ICD has been shown to abort potentially fatal ventricular arrhythmias, identification of patients who most benefit from this device remains difficult. As the autonomic nervous system has been implicated in the genesis of these arrhythmias, we undertook a pilot study to evaluate local myocardial sympathetic innervation with the use of I-123 MIBG myocardial imaging, as well as central autonomic tone with the use of HRV, in patients with implantable defibrillators. Test results were correlated with the occurrence of ICD discharges. METHODS AND RESULTS: Seventeen patients with previously implanted defibrillators were studied. Of these, 10 had at least 1 appropriate device discharge for ventricular tachyarrhythmias, whereas 7 had no discharge. Patients with a discharge had a significantly lower I-123 MIBG heart-mediastinal tracer uptake ratio, higher I-123 MIBG defect scores, more extensive sympathetic denervation, and significantly reduced values for several HRV parameters, particularly those in the frequency domain. When combined, the I-123 MIBG heart-mediastinal ratio and HRV 5-minute low-frequency variables were highly predictive of defibrillator discharges. All patients with a heart-mediastinal ratio lower than 1.54 and 5-minute low frequency lower than 443 ms(2) had an ICD discharge (4/4), whereas no patient with an uptake ratio greater than 1.54 and 5-minute low frequency greater than 443 ms(2) did (0/3, P =.03). CONCLUSIONS: Cardiac autonomic assessment using a combination of myocardial scintigraphic and neurophysiologic techniques may help select patients who would most benefit from an implantable defibrillator by identifying those at increased risk for potentially fatal arrhythmias.     

Reliability of resting and postexercise heart rate measures

In this study, we compared the reliability of short-term resting heart rate (HR) variability (HRV) and postexercise parasympathetic reactivation (i.e., HR recovery (HRR) and HRV) indices following either submaximal or supramaximal exercise. On 4 different occasions, beat-to-beat HR was recorded in 15 healthy males (21.5 ± 1.4 yr) during 5 min of seated rest, followed by submaximal (Sub) and supramaximal (Supra) exercise bouts; both exercise bouts were followed by 5 min of seated recovery. Reliability of all HR-derived indices was assessed by the typical error of measurement expressed as a coefficient of variation (CV,%). CV for HRV indices ranged from 4 to 17%, 7 to 27% and 41 to 82% for time domain, spectral and ratio indices, respectively. The CV for HRR ranged from 15 to 32%. Spectral CVs for HRV were lower at rest compared with Supra (e.g., natural logarithm of the high frequency range (LnHF); 12.6 vs. 26.2%; P=0.02). HRR reliability was not different between Sub and Supra (25 vs. 14%; P=0.10). The present study found discrepancy in the CVs of vagal-related heart rate indices; a finding that should be appreciated when assessing changes in these variables. Further, Supra exercise was shown to worsen the reliability of HRV-spectral indices.