3.0 T磁共振多体素质子波谱脂质在胶质瘤恶性程度分级的应用

目的研究多体素质子波谱对幕上胶质瘤术前分级的临床应用价值。资料与方法35例经手术及病理证实的幕上胶质瘤采用3.0T超导型磁共振成像/波谱一体化扫描系统,常规MR及多体素波谱检查后利用Functool软件进行分析。结果35例胶质瘤,按WHO标准分类Ⅱ级14例,Ⅲ级11例,Ⅳ级10例。Ⅱ级组、Ⅲ级组、Ⅳ级组肿瘤实体区(Lac Lip)/Cr平均值分别为0.15±0.16,1.14±1.50,2.61±2.75,NAA/nCr平均值1.29±0.96,0.74±0.56,0.53±0.36和(Lac Lip)/nCr平均值0.22±0.23,0.70±0.63,1.01±0.80,Ⅱ级组与Ⅳ级组间(Lac Lip)/Cr、(Lac Lip)/nCr、NAA/nCr有统计学差异(P<0.05)。若将Ⅱ级组列为低度恶性肿瘤组,Ⅲ级组、Ⅳ级组合并为高度恶性肿瘤组,Cho/NAA、Cho/Cr、(Lac Lip)/Cr、(Lac Lip)/nCr平均值在组间有显著性差异。结论MR多体素质子波谱脂质的出现对肿瘤组织学分级有较高的临床应用价值。     

联合检测β2微球蛋白、同型半胱氨酸及结合中医脉象对早期糖尿病肾病的诊断价值

[目的]探讨检测血清β2微球蛋白(β2-MG)、同型半胱氨酸(Hcy)水平及联合中医典型脉象对糖尿病肾病(DN)的诊断价值。[方法]连续采集2013年4月—2014年10月在天津中医药大学第二附属医院内科住院的2型糖尿病患者450例,按尿微量白蛋白排泄率(UAER)结果分为3组,20μg/min为无DN组(NA,176例),20~200μg/min为DN微量白蛋白组(MA,182例),≥200μg/min为DN大量白蛋白尿组(LA,92例)。同时检测患者β2-MG、Hcy水平,并留取患者一般资料,安静状态下采集患者的脉象,采用受试者工作曲线分析各指标对DN的早期诊断价值。[结果]3组患者中β2-MG、Hcy随尿蛋白增多逐渐升高,其中以LA升高最为明显;3组中尺脉沉、细表现者随尿蛋白增多亦逐渐增多。两项指标及联合对DN的ROC曲线分别分析,β2-MG的曲线下面积(AUC)为0.768,Hcy的AUC为0.797,两指标联合的AUC为0.827,与脉象联合的AUC为0.866。[结论]β2-MG及Hcy均可作为DN诊断的生物学标志物,且将两项指标进行联合检测能提高对早期DN的诊断效能,并且联合脉象对DN评估的可信度更优。     

应用模拟低剂量法行新生儿头颅CT扫描

Objective To determine the effects of dose reduction on multi-slice spiral CT(MSCT) of neonatal head and assess the lowest possible radiation for acceptable clinical images.Methods Fifty-seven newborns suspected intracranial hemorrhage were entered into the study and underwent MSCT scans.Original images at three anatomic levels (posterior fossa, basal ganglia, centrum semiovale) were collected and synthetic noise was added so as to simulate dose reductions of 25%, 40%, 50% and 70%, respectively by using the noise addition tool.A total of 855 image data sets were obtained for the 57 patients.Original and simulated dose-reduction scan images were analyzed.Image noise and image quality were assessed by two independent experienced pediatric radiologists using diagnostic acceptability score, subjective image noise score on a 5-peint scale and objective noise index.Image noise was measured by respectively placing region of interest (ROI) at cerebellum, thalamus and corona radiata of 3 different slices.And the noise index and mean value was calculated.The degree of inter-observer concordance was determined by Kappa statistical analysis.The Spearman statistical correlations between the noise index and diagnostic acceptability score were performed.Results On the images of original dose and simulated dose reductions of 25%, 40%, 50% and 70%, the diagnostic acceptability was 4.47±0.51, 3.96±0.33, 3.21±0.45, 2.92±0.32, and 1.85±0.57, respectively,the subjective image scores were 1.62±0.48, 1.99±0.48, 2.76±0.81, 3.19±0.67, and 4.27±0.54, respectively, the noise index were 1.90±0.19, 2.17±0.20.2.44± 0.25, 2.68±0.28, and 3.37±0.39, respectively.The two radiologists had good intembserver agreement for diagnostic acceptability (K=0.860, P=0.017) and for image noise scoff ng (K=0.630, P=0.022).There was significant statistical correlation between image noise index and diagnostic acceptability (r= 0.826,P=0.001).At 40% dose reduction to the standard protocol, the noise index was 2.44 and the image quality score was 3.21 which were considered clinically acceptable.Conclusion The study revealed that acceptable imagos could be obtained with mean noise index of 2.44 and 40% dose reduction.     

L-T4对良性甲状腺结节的抑制性治疗

良性甲状腺结节是临床常见的内分泌疾病,临床上对甲状腺良性结节的主要治疗方法是左旋甲状腺素（L-T4）抑制性治疗,但目前对于L-T4抑制性治疗还存在着很多争议,如L-T4抑制性治疗的疗效,L-T4的应用指征和促甲状腺激素的抑制程度与L-T4治疗效果等.近年来的临床研究结果显示,L-T4抑制性治疗能显著抑制良性甲状腺结节的生长,将促甲状腺激素水平维持在0.1～0.3 IU/L疗程维持在12个月左右即能达到理想的治疗效果,且长期应用可能对心血管和骨骼系统产生影响.     

应用模拟低剂量法行新生儿头颅CT扫描

Objective To determine the effects of dose reduction on multi-slice spiral CT(MSCT) of neonatal head and assess the lowest possible radiation for acceptable clinical images.Methods Fifty-seven newborns suspected intracranial hemorrhage were entered into the study and underwent MSCT scans.Original images at three anatomic levels (posterior fossa, basal ganglia, centrum semiovale) were collected and synthetic noise was added so as to simulate dose reductions of 25%, 40%, 50% and 70%, respectively by using the noise addition tool.A total of 855 image data sets were obtained for the 57 patients.Original and simulated dose-reduction scan images were analyzed.Image noise and image quality were assessed by two independent experienced pediatric radiologists using diagnostic acceptability score, subjective image noise score on a 5-peint scale and objective noise index.Image noise was measured by respectively placing region of interest (ROI) at cerebellum, thalamus and corona radiata of 3 different slices.And the noise index and mean value was calculated.The degree of inter-observer concordance was determined by Kappa statistical analysis.The Spearman statistical correlations between the noise index and diagnostic acceptability score were performed.Results On the images of original dose and simulated dose reductions of 25%, 40%, 50% and 70%, the diagnostic acceptability was 4.47±0.51, 3.96±0.33, 3.21±0.45, 2.92±0.32, and 1.85±0.57, respectively,the subjective image scores were 1.62±0.48, 1.99±0.48, 2.76±0.81, 3.19±0.67, and 4.27±0.54, respectively, the noise index were 1.90±0.19, 2.17±0.20.2.44± 0.25, 2.68±0.28, and 3.37±0.39, respectively.The two radiologists had good intembserver agreement for diagnostic acceptability (K=0.860, P=0.017) and for image noise scoff ng (K=0.630, P=0.022).There was significant statistical correlation between image noise index and diagnostic acceptability (r= 0.826,P=0.001).At 40% dose reduction to the standard protocol, the noise index was 2.44 and the image quality score was 3.21 which were considered clinically acceptable.Conclusion The study revealed that acceptable imagos could be obtained with mean noise index of 2.44 and 40% dose reduction.     

分娩期母儿体液免疫机能的初步观察

孕妇机体的免疫反应受到抑制,是妊娠的一个生理过程,随受精卵的发育与胎儿的成长,体内激素及酶产生了相应的变化,特别是胎儿,胎盘单位产生的绒毛膜促性腺激素、胎盘生乳素与大量雌激素、孕激素和肾上腺皮质激素等都具有体液免疫及细胞免疫的抑制作用,因此妊娠期免疫耐受性增加,机体不把胎儿组织抗原当作异物排斥(5)。     

影像学新技术在神经胶质瘤诊断中的应用

神经胶质瘤是神经系统原发肿瘤中最常见的类型,占神经系统原发肿瘤的50%以上。美国癌症协会2001年统计约占全年所有新发肿瘤的1.4%和肿瘤死亡人数的2.4%[1]。治疗上应采用综合疗法,疗效很难令人满意,是一种常见的危害人类健康的疾病,是目前神经外科的难题和医学研究的重要课题之一。磁共振功能成像(functionalmagnetic resonance im-aging,fMR I)将组织的血流、代谢等功能信息结合到以形态结构成像为主的诊断过程之中,将会大大提高肿瘤诊断的能力。1磁共振灌注成像(perfusion weighted imaging,PW I)PW I能在活体上反映组织血管化程度和…     

脐带块穴位注射治疗小儿喘息性支气管炎的疗效及其机理的探讨

喘息性支气管炎为小儿的常见病。尤以学令期儿童多见,严重地威协着小儿的身心健康,至今国内外尚无特异的根治疗法。我科从70年采用脐带块穴位注射治疗,收到较好疗效,但对其作用机理尚缺乏认识。因此,我们于79年末到82年初对60余名反复持续发作的慢性迁延性患儿进行了免疫学功能检测,试作免疫机理上的探讨,现将资料完整的44例总结如下。     

鞘内注射miR-212反义锁核酸对骨癌小鼠痛行为的影响

目的研究骨癌痛发展和维持过程中小鼠脊髓水平miR-212表达的变化规律及连续鞘内注射miR-212反义锁核酸LNA．anti—miR-212对骨癌痛小鼠痛行为的影响。方法本实验分为两个部分：（一）骨癌痛小鼠脊髓水平miR-212表达的变化规律：C3H／HeJ雄性小鼠36只,随机分为假手术组（sham组,n=18）和肿瘤组（T组,n=18）。sham组小鼠在右侧股骨远端骨髓腔注射不含肿瘤细胞的仪一MEM,T组小鼠在右侧股骨远端骨髓腔注射纤维肉瘤细胞NCTC2472,建立骨癌痛模型。在术前1d,术后4d、7d、10d、14d、21d,sham组和T组各随机取三只小鼠处死,取脊髓腰膨大标本,用Real-timePCR的方法检测脊髓水平miR一212的表达情况。（二）连续鞘内注射LNA—anti-miR-212对骨癌痛小鼠痛行为的影响：C3H／HeJ雄性小鼠24只,随机分为四组：L组（鞘内注射LNA-anti—miR一212,n=6）、L’组（鞘内注射LNA＇-negativecontrol,n=6）、C组（鞘内注射溶媒无核酸酶水,n=6）和S组（假手术处理,n=6）。L组、L’组和C组小鼠在右侧股骨远端注射纤维肉瘤细胞NCTC2472,S组小鼠在右侧股骨远端骨髓腔注射不含肿瘤细胞的仪一MEM。所有小鼠于术前1d、术后4d、7d、10d、14d测小鼠痛行为指标,包括自发抬足次数和机械缩足阈值（PWMT）,术后14d,L组、L’组、C组小鼠分别鞘内注射LNA—anti—miR-21212pmol／5山、LNA＇-negativecontrol12pmol／5I＊1和无核酸酶水5I＊1,连续鞘内注射7d,1次／d,每天测小鼠痛行为指标,至术后第21天。结果miR-212的表达变化表现为：与基础值相比,sham组和T组小鼠在术后第4天,脊髓水平miR一212明显升高（P〈0．05）;与基础值和sham组相比,T组小鼠脊髓水平miR-212在术后7d、10d、14d、21d均明显升高（P〈0．05）。连续鞘内注射LNA—anti—miR-212改善骨癌痛小鼠痛行为：术后19d至21d,与L’组和c组相比,L组小鼠PWMT[19d（1．07-4-0．16）g,20d（1．13±0．21）g,21d（1．27±0．21）g）]明显升高（P〈0．05）,自发抬足次数明显降低[19d（6．674-1．04）,20d（6．62±1．39）,21d（6．47±1．17）]（P〈0．05）。与14d给药前相比,L组小鼠术后19d至21d的PWMT明显升高（P〈0．05）,自发抬足次数明显降低（P〈0．05）。结论骨癌痛发展过程中,脊髓水平miR-212表达量升高。连续鞘内注射LNA-anti—miR一212可以缓解骨癌小鼠痛行为。     

银丹心脑通软胶囊对大脑中动脉闭塞模型大鼠神经功能恢复及VEGF、GFAP表达的影响

脑血管意外是造成我国城乡居民死亡的主要原因,其中缺血性卒中约占脑血管病75％以上,随着人群中高血压、血脂异常、糖尿病等疾病患病率的不断上升及人口老龄化,