不同时期脑梗死磁共振弥散加权成像及液体衰减反转恢复序列的应用价值探讨

目的:探讨弥散加权成像(diffusion weighted imaging,DWI)序列和液体衰减反转恢复技术(fluid attenuated inversion recovery,FLAIR)在不同时期脑梗死诊断中的应用价值。方法:选取120例不同时期的脑梗死患者作为研究对象,分别行1.5T磁共振DWI和FLAIR序列检查,以双盲法对比分析发现病例的敏感度和病灶面积。结果::DWI、FLAIR发现病例的敏感度:在超急性期内,分别为100%和26.67%(P<0.05);在急性期内,均为100%;在亚急性期内,分别为80%和86.67%(P>0.05);在慢性期内,分别为11.11%和94.44%(P<0.05)。梗塞灶面积显示,在72 h内DWI大于FLAIR(P<0.05),亚急性期间基本相当(P>0.05),慢性期FLAIR大于DWI(P<0.05)。结论:联合应用DWI和FLAIR能准确诊断不同时期脑梗死,并有助对脑梗死进行分期和新旧病灶的鉴别。     

Sodium thiosulfate attenuates high phosphorous induced vascular calcification in rats with 5/6 nephrectomy

Objective To observe the expression of Klotho and Na+/Pi cotransporter in high phosphorous-induced rats with 5/6 nephrectomy and its relationship with vascular calcification, as well as to investigate the effect of early intervention by sodium thiosulfate (STS) on the progression of vascular calcification. Methods Either 5/6 nephrectomy (n=21) or sham operation (n=14) was conducted on 35 Sprague Dawley rats, who were then fed with high phosphorus (HP) diet or normal phosphorus (NP) diet for 16 weeks respectively. The rats were divided into 5 groups as follows: (1) remnant kidney rats receiving HP diet (NHP, n=7), (2) remnant kidney rats receiving NP diet (NNP, n=7), (3) sham operation rats receiving NP diet (SNP, n=7), (4) sham operation rats receiving HP diet (SHP, n=7), (5) remnant kidney rats receiving HP diet with STS (THP, n=7). The treatment group was given STS intraperitoneally three times a week for 16 weeks. At the end of the 16th week, rats tail artery blood pressures were tested, serum creatinine (Scr), calcium (Ca2+), phosphorus (P3+), FGF23, iPTH and urine protein were examined. Throacic aorta and kidney were then removed. Vascular calcification was confirmed by Von kossa staining. Klotho and Pit-1 expression in aortas were determined by immunohistochemistry. Renal lesion was determined by PASM-Masson staining. Renal Klotho and NaPi-2a mRNA were determined by real time RT-PCR. Results After 16 weeks, Scr, P3+, FGF23, iPTH, uric protein and blood pressure were significantly higher in NHP than those in SNP rats (all P＜0.05). PASM-Masson staining revealed typical renal pathology of chronic renal failure in NHP group. With the treatment of STS, THP rats showed significant decrease in Scr, P3+, FGF23, iPTH, uric protein and blood pressure by comparison with NHP group (all P＜0.05). Significant vascular calcification was found in NHP group while NNP and SHP group occasionally had vascular calcification; THP group had marked alleviation of vascular calcification. The aorta and renal expression of Klotho decreased remarkably while expression of Pit-1 and NaPi-2a increased significantly in NHP compared with SNP group (all P＜0.05). Accordingly, the aorta and renal expression of Klotho increased and Pit-1 and NaPi-2a decreased significantly in THP compared with NHP group (P＜0.05). Conclusions The early intervention of sodium thiosulfate might regulate Klotho and Na+/Pi cotransporter expression in both aorth and kidney, decreasing serum phosphate, delaying progression of vascular calcification and improving renal function.     

病理确诊的原发性中枢神经系统血管炎8例分析

目的 总结原发性中枢神经系统血管炎(primary angiitis of central nervous system,PACNS)8例的临床、影像和病理组织分型特点.方法 回顾性分析2008年1月至2015年5月海军总医院脑组织病理确诊的8例原发性中枢神经系统血管炎的患者临床资料、影像学和脑组织病理改变特点.结果 男和女各4例,发病年龄24～58岁.首发症状:头痛2例、头晕2例、肢体活动不利1例、眼球突出1例、视物模糊并复视1例、睡眠增多1例.后续主要症状:头痛4例、肢体活动不利4例、认知功能减退2例、癫痫发作2例、意识障碍2例、视物不全1例.头颅MRI检查8例(单侧病灶5例,双侧病灶3例).病灶分布:额叶3例、顶叶3例、颞叶3例、岛叶3例、小脑2例、胼胝体1例、丘脑1例、颈髓1例、脑膜1例、枕叶1例.增强MRI检查7例(不均匀强化6例,均匀强化1例).DWI检查3例(高信号3例);头颅MRA检查3例无异常,头颅DSA检查3例无异常.病理检查8例(立体定向脑活检7例,开颅手术1例),病理分型淋巴细胞型血管炎6例,肉芽肿型血管炎和坏死型血管炎各1例.结论 PACNS临床表现和影像学检查多无特异性,确诊需进行脑组织病理检查,淋巴细胞型血管炎是国内常见的病理类型.     

C-reactive Protein Level,Apolipoprotein B-to-apolipoprotein A-1 Ratio,and Risks of Ischemic Stroke and Coronary Heart Disease among Inner Mongolians in China

Objective We aimed to investigate the cumulative effect of high CRP level and apolipoprotein B-to-apolipoprotein A-1(ApoB/ApoA-1) ratio on the incidence of ischemic stroke(IS) or coronary heart disease(CHD) in a Mongolian population in China.Methods From June 2003 to July 2012,2589 Mongolian participants were followed up for IS and CHD events based on baseline investigation.All the participants were divided into four subgroups according to C-reactive protein(CRP) level and ApoB/ApoA-1 ratio.Cox proportional hazard models were used to estimate the hazard ratios(HRs) and 95% confidence intervals(CIs) for the IS and CHD events in all the subgroups.Results The HRs(95% CI) for IS and CHD were 1.33(0.84-2.12),1.14(0.69-1.88),and 1.91(1.17-3.11) in the ‘low CRP level with high ApoB/ApoA-1',‘high CRP level with low ApoB/ApoA-1',and ‘high CRP level with high ApoB/ApoA-1' subgroups,respectively,in comparison with the ‘low CRP level with low ApoB/ApoA-1' subgroup.The risks of IS and CHD events was highest in the ‘high CRP level with high ApoB/ApoA-1' subgroup,with statistical significance.Conclusion High CRP level with high ApoB/ApoA-1 ratio was associated with the highest risks of IS and CHD in the Mongolian population.This study suggests that the combination of high CRP and ApoB/ApoA-1 ratio may improve the assessment of future risk of developing IS and CHD in the general population.     

改良分次酶消化法分离培养兔肌腱干细胞及诱导分化鉴定

目的  采用改良分次酶消化法体外分离培养家兔肌腱干细胞,观察其生物学特性,并进行诱导分化及鉴定。方法  无菌条件下取出家兔髌腱组织,分别运用改良的分次酶消化法和酶消化后低密度稀释接种法进行分离、培养、传代,用倒置相差显微镜观察细胞形态特征并绘制两种方法的生长曲线,通过流式细胞鉴定仪检测肌腱干细胞表面抗原标志物的表达,取P3-P4代肌腱干细胞向成骨细胞、成软骨细胞诱导分化并鉴定。结果  改良的分次酶消化法较酶消化后低密度稀释接种法细胞增殖速度加快,形态均一,杂质细胞少。分离出的肌腱干细胞表面抗原标志CD90、CD44呈阳性,而CD34、CD14呈阴性,证实之前分离的细胞为肌腱干细胞。鉴定出肌腱干细胞具有向成骨细胞和成软骨细胞分化能力。结论  采用改良的分次酶消化法分离培养兔肌腱干细胞简单易行,肌腱干细胞生长及传代速度可观,活性良好,纯度较高。另外,肌腱干细胞的成功分离培养,也为肌腱相关疾病的研究开辟了一条新途径。

     

冠状动脉粥样硬化性心脏病患者Betatrophin水平及其与三酰甘油和糖化血红蛋白的相关性研究

目的  Betatrophin是一种新发现的影响糖脂代谢的因子。糖尿病和高脂血症是冠状动脉粥样硬化性心脏病（以下简称冠心病）的重要危险因素。比较冠心病患者与对照组的Betatrophin水平,并探讨其与三酰甘油（TG）和糖化血红蛋白（HbA1c）等因素的相关性。方法  测定冠心病组（107例）及与其年龄、性别、体重指数匹配的对照组（35例）的Betatrophin水平。根据HbA1c水平将冠心病组分为冠心病HbA1c正常组和冠心病HbA1c升高组。获取其他临床指标,并测定TG、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL）、高密度脂蛋白胆固醇（HDL）、肌酐（Scr）、尿酸（UA）、超敏C反应蛋白（hsCRP）、脑钠肽（BNP）和同型半胱氨酸（Hcy）水平等,分析Betatrophin与其的相关性。结果  冠心病组Betatrophin水平比对照组降低26.6%（P =0.040）。冠心病HbA1c正常组比对照组降低33.0%（P =0.001）,冠心病HbA1c升高组比冠心病HbA1c正常组Betatrophin水平升高22.6%（P =0.020）。冠心病组患者Betatrophin与HbA1c呈正相关（r =0.223,P =0.021）。冠心病组男性患者比女性Betatrophin水平更低[（0.149±0.068） vs （0.181±0.078）ng/ml,P =0.028]。结论  Betatrophin可能是与冠心病患者糖脂代谢调节相关的一个新因子。