Congenital anomalies of coronary artery origin in adults: 64-MDCT appearance

OBJECTIVE: The purpose of this pictorial essay is to review the 64-MDCT appearance of congenital anomalies of the origins of the coronary arteries in adults. CONCLUSION: Increasing use of MDCT for cardiac imaging of adults requires familiarity with the cross-sectional appearance of congenital coronary artery anomalies visualized with noninvasive imaging techniques. Many of these anomalies are benign, but a small number are associated with myocardial ischemia and sudden death. Increasing use of MDCT in cardiac imaging may yield diagnostic information not obtained with coronary angiography. Axial, multiplanar, and 3D volume-rendered reconstructions should aid in detection and improve interpretation of such anomalies.     

周围血白细胞的复制型丙型肝炎病毒RNA的检测及临床意义

用简并引物作套式反转录。聚合酶链反应检测正、负链丙型肝炎病毒（ＨＣＶ）ＲＮＡ。显示３０例急、慢性丙型肝炎患者的血清及血浆中，７例无症状抗－ＨＣＶ阳性者的血清、血浆及周围血白细胞（ＰＢＬ／Ｃ）中，均未检出负链ＨＣＶＲＮＡ。慢性丙型肝炎者ＰＢＩ（中正、负链ＨＣＶＲＮＡ的检出率高于急性丙型肝炎及无症状抗－ＨＣＶ阳性者（Ｐ＜０．０５～０．００１）。１７例经肝组织学检查的患者中，急性肝炎（ＡＨ）者ＰＢＬ／Ｃ的正、负链ＨＣＶＲＮＡ检出率低于慢性活动性肝炎（ＣＡＨ）者（Ｐ＜０．０５）。１例ＡＨ及６例ＣＡＨ患者肝组织内正、负链ＨＣＶＲＮＡ全部阳性。证实丙型肝炎患者的ＰＢＬ／Ｃ确可被ＨＣＶ感染，病程越长，被ＨＣＶ感染的可能性越大；病情活动者，ＰＢＬ／Ｃ中负链ＨＣＶＲＮＡ的检出率越高。提示ＨＣＶ不仅可以感染ＰＢＬＣ，而且可在其中复制；负链ＨＣＶＲＮＡ的出现与病情活动有关。     

Coronary CT angiography.

Advances in multidetector CT (MDCT) technology with submillimeter slice collimation and high temporal resolution permit contrast-enhanced imaging of coronary arteries and coronary plaque during a single breath hold. Appropriate patient preparation, detailed technical and technological knowledge with regard to recognition of typical imaging artifacts (such as beam hardening or motion artifacts), and the adequate choice of postprocessing techniques to detect stenosis and plaque are prerequisites to achieving diagnostic image quality. A growing number of studies have suggested that 64-slice coronary CT angiography is highly accurate for the exclusion of significant coronary artery stenosis (>50% luminal narrowing), with negative predictive values of 97%-100%, in comparison with invasive selective coronary angiography. In addition, several studies have indicated that MDCT also can detect calcified and noncalcified coronary atherosclerotic plaques, especially in proximal vessel segments, showing a good correlation with intracoronary ultrasound. Studies on clinical utility, cost, and cost-effectiveness are now warranted to demonstrate whether and how this technique can change and improve the current management of patients with suspected or confirmed coronary artery disease.     

Identification and characterization of autoreactive T cell responses to bullous pemphigoid antigen 2 in patients and healthy controls.

Antibodies against the extracellular domain of bullous pemphigoid antigen 2 (BPAG2) are thought to play a key role in the pathogenesis of bullous pemphigoid (BP), the most frequent autoimmune bullous disease of the skin. Autoreactive T cell responses to BPAG2 were investigated in 16 BP patients and 24 healthy controls by coculture of PBMC with two recombinant BPAG2 proteins (extracellular domain of BPAG2). Primary in vitro T cell responses to BPAG2 were observed in 10/12 BP patients expressing the BP-associated HLA-DQB1*0301 allele and 8/10 DQB1*0301 positive healthy individuals. DQB1*0301 also restricted three autoreactive T cell lines from two BP patients and a healthy donor. In contrast, PBMC from 14 normal patients carrying HLA class II alleles other than DQB1*0301 were not stimulated by BPAG2. Autoreactive BPAG2-specific CD4(+) T cell lines and clones from five BP patients produced both Th1 and Th2 cytokines, whereas three autoreactive T cell lines from three DQB1*0301 positive normal patients produced exclusively IFN-gamma. The absence of BPAG2-specific Th2 cells in healthy individuals strongly suggests that autoreactive Th2 responses to BPAG2 are restricted to BP patients and may thus be critical in the pathogenesis of BP.