电子束CT检出冠状动脉钙化及其与心肌灌注显像的对比研究

目的比较电子束ＣＴ（ＥＢＣＴ）检查冠状动脉钙化（ＣＡＣ）及核素心肌灌注显像（ＭＰＩ）评价冠心病（ＣＨＤ）的价值。材料与方法本组５０例均为临床疑诊或确诊为ＣＨＤ患者。所有患者均行ＥＢＣＴ、ＭＰＩ及冠状动脉造影。结果４０例患者共８４支血管冠状动脉造影证实有明显的冠状动脉病变（ＣＡＤ）（狭窄＞５０％），其中１４例为单支病变，８例为双支病变，１８例为三支病变，另有１０例冠状动脉造影正常。ＥＢＣＴ预测ＣＡＤ的敏感性、特异性及准确性为８３％、８０％及８２％，ＭＰＩ预测ＣＡＤ的敏感性、特异性及准确性分别为８５％、８０％及８４％，ＥＢＣＴ与ＭＰＩ的结果间无显著性差异（Ｐ＞０．０５）。ＣＡＣ血管供血区出现心肌缺血者达６５％。结论ＣＡＣ是预测ＣＡＤ的有价值指标。在有症状的人群中ＥＢＣＴ检出ＣＡＣ预测ＣＡＤ的敏感性、特异性及准确性与ＭＰＩ相似。有症状人群中检出ＣＡＣ患者多有心肌缺血或梗死，因此为早期诊断冠心病，应对无症状人群进行筛选。     

Improved diffusion imaging through SNR‐enhancing joint reconstruction

Quantitative diffusion imaging is a powerful technique for the characterization of complex tissue microarchitecture. However, long acquisition times and limited signal‐to‐noise ratio represent significant hurdles for many in vivo applications. This article presents a new approach to reduce noise while largely maintaining resolution in diffusion weighted images, using a statistical reconstruction method that takes advantage of the high level of structural correlation observed in typical datasets. Compared to existing denoising methods, the proposed method performs reconstruction directly from the measured complex k‐space data, allowing for Gaussian noise modeling and theoretical characterizations of the resolution and signal‐to‐noise ratio of the reconstructed images. In addition, the proposed method is compatible with many different models of the diffusion signal (e.g., diffusion tensor modeling and q‐space modeling). The joint reconstruction method can provide significant improvements in signal‐to‐noise ratio relative to conventional reconstruction techniques, with a relatively minor corresponding loss in image resolution. Results are shown in the context of diffusion spectrum imaging tractography and diffusion tensor imaging, illustrating the potential of this signal‐to‐noise ratio‐enhancing joint reconstruction approach for a range of different diffusion imaging experiments. Magn Reson Med, 2013. © 2012 Wiley Periodicals, Inc.     

Etiology and body area of injuries in young female dancers presenting to sports medicine clinic: A comparison by age group

Introduction. Improving knowledge regarding injuries sustained by pediatric dancers is important in order to better understand injury risk. The aim of this study is to analyze dance injury etiology and body area by age in a cohort of young female dancers presenting to a pediatric sports/dance medicine clinic. Methods. The cross-sectional epidemiological study of a 5% probability sample of dancers evaluated between 1/1/2000 and 12/31/2009 with a musculoskeletal injury requiring physician evaluation. A total of 2,133 charts were reviewed from which 171 female dancers 8–17 years old (mean age 14.7 years) were identified. Data were stratified by age, <12 years and ≥12 years, and analyzed based on injury body area, type, and etiology. Fisher’s exact test was used to determine statistical significance. Results. Injuries sustained by dancers in the younger age category (<12 years) were largely to the foot-ankle/lower leg/knee (93.3%) versus thigh-hip/spine/upper extremity (6.7%). In comparison, dancers in the older age group (≥12 years) had a large proportion of injuries to the foot-ankle/lower leg/knee (67.3%) as well, but had a notably larger fraction of injuries to the thigh-hip/spine/upper extremity (32.7%; p = 0.04). Approximately two-thirds of the injuries sustained in the younger age group (<12 years) were classified as bony. In comparison, injuries in the older age group (≥12 years) were roughly half bony and half soft tissue (51.3% and 48.7%, respectively; p = 0.29). Most injuries were overuse in etiology for both younger and older age groups (86.7% and 82.1%, respectively; p = 1.00). Through puberty, there was a decline in the injuries to the foot-ankle/lower leg/knee. Conversely, there was an increase in the thigh/hip-pelvis/spine/upper extremity injuries through growth. Conclusions. Injuries to young female dancers in this study cohort were mostly categorized as overuse in etiology, and differed by the age group and the body area. Increased information regarding dance injuries can help guide future injury prevention efforts.     

Role of CT perfusion imaging in evaluating the effects of multiple burr hole surgery on adult ischemic Moyamoya disease

Introduction

To evaluate the effects of the multiple burr hole (MBH) revascularization on ischemic type adult Moyamoya disease (MMD) by computed tomography perfusion (CTP).

Methods

Eighty-six ischemic MMD patients received CTP 1 week before and 3 weeks after MBH operation. Fifty-seven patients received it again at 6 month and underwent digital subtraction angiography (DSA) and mRS follow-up. Cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and relative values of ischemic symptomatic hemispheres were measured. Differences in pre- and post-surgery perfusion CT values were assessed.

Results

There were significant differences of CBF, TTP, and relative time to peak (rTTP) in ischemic hemisphere between 1 week before and 3 weeks after surgery, and no significant difference in relative cerebral blood flow (rCBF), CBV, relative cerebral blood volume (rCBV), MTT, relative mean transit time (rMTT). According to whether there was symptom improvement or not on 3 weeks after MBH, the rTTP value was not statistically significant in the patients whose symptoms were not improved at all on 3 weeks after operation. Six-month follow-up showed that CBF, rCBF, and rCBV values were significantly higher than those before operation. Postoperative MTT, TTP, rMTT, and rTTP values were significantly lower than those before operation.

Conclusion

CTP is a sensitive method to obtain functional imaging of cerebral microcirculation, which can be a noninvasive assessment of the abnormalities of intracranial arteries and cerebral perfusion changes in MMD before and after surgery. CBF and TTP map, especially the relative values of TTP, seems to have the capability of being quite sensitive to the presence of altered brain perfusion at early time after indirect revascularization.     

血清8种胆固醇脂肪酸与胆囊结石成因分析

为分析胆结石形成与胆固醇脂肪酸的关系,采用气相色谱法(HPLC)测定结石组59例、非结石组43例血清中8种胆固醇脂肪酸含量。经统计学处理,发现20:5、20:4、18:2、14:0、18:1均有显著差异,认为肥胖及高胆固醇血症是胆囊结石的高危因素。     

Heterogeneity of glomerular size in normal donor kidneys: impact of race

Glomerular size has been the subject of many studies and, in a number of settings, has a direct association with the development of glomerular sclerosis. However, the normal distribution of glomerular size has not been thoroughly evaluated in the general population in the United States. To address this issue, we analyzed the baseline biopsy specimens of 103 human donor kidneys to determine the maximal planar area (MPA) of the glomerular tuft in a heterogeneous human population. The MPA of each glomerulus was determined by measurement of sections through the vascular pole and/or origin of the proximal tubule, and was determined on each section by two methods: point counting and computer planimetry. There was very high agreement between these two methods. Multivariate analysis was used to identify significant correlates with MPA. Overall, younger donors had smaller glomeruli (P < 0.0001). Black donors had a larger MPA (23.4+/-8.6 mm2 x 10(-3)) than white donors (17.9+/-6.7 mm2 x 10(-3); P < 0.001), independent of donor age. MPA was not significantly different between genders. This heterogeneity in glomerular size may confound clinical studies if not recognized and may help explain differences in glomerular structure and function in response to injurious processes.     

保留幽门的胰十二指肠切除术的技术改进

作者在30例保留幽门的胰十二指肠切除术中，对手术细节上作了改进，胰腺空肠吻合时可很顺利地将胰腺套入空肠，胰管内放置长的内支撑引流管行肠腔内引流；胆道空肠吻合采用人工合成可吸收线连续单层吻合；胆道内不放置T型引流管，可避免术后胰液、胆法丢失，从而稳定内环境。本组无胰瘘发生。经胃窦放置高位空肠营养造瘘管，可明显降低术后胃排空障碍。     

同种异体皮质骨移植的生物力学研究

目的探讨不同力学环境下同种异体皮质骨的生物力学性能变化。方法以４０只家兔前肢尺骨中段骨移植后造成不同受力状态的动物模型,左前肢承受正常生理载荷,右前肢承受低载荷,对植骨区标本进行三点弯曲破坏载荷、骨密度值、骨孔隙率的测试。结果同种异体皮质骨植入后,移植骨－宿主骨界面间的连接强度持续上升,而移植骨自身的生物力学性能呈较快下降再缓慢上升的趋势;从骨移植后第８周开始,正常载荷侧的移植骨－宿主骨界面间的连接强度明显高于低载荷侧,到第１６周时,正常载荷侧移植骨自身的生物力学强度改善也更为明显。结论同种异体皮质骨植入以后的生物力学性能呈较快下降再缓慢上升的趋势;生理载荷的刺激有利于同种异体皮质骨生物力学性能的恢复与改善     

^18F-FDGPET／CT对不同分级和分期滤泡性淋巴瘤诊断及预后评估的价值

目的探讨^18F—FDGPET／CT对治疗前不同组织学分级及不同临床分期的滤泡性淋巴瘤（FL）的诊断价值,及其对一线治疗后的预后评估作用。方法回顾性分析2007年5月至2013年4月经病理学证实的24例（男11例,女13例,中位年龄55岁）治疗前行^18F—FDGPET／CT显像的FL患者。将患者按不同组织学分级和临床分期进行分组,计算对各组的诊断效能,并采用析因设计的方差分析比较不同组患者的病灶SUVmax。将同期一线治疗后行^18F—FDGPET／CT显像的16例[男9例,女7例,中位年龄50．5岁;其中7例为前述治疗前也行显像的患者]按照PET／CT结果分为阳性组和阴性组,对患者进行随访（6～49个月）并评价预后。结果（1）24例患者中惰性FL（组织学分级1＋2级）13例,侵袭性FL11例（组织学分级3级及2级伴DLBCL转化）。PET／CT显像诊断隋性FL和侵袭性FL患者的灵敏度分别为92．3％（12／13）和100％（11／11）;SUVmax分别为5．26±1．70和9．54±5．09（F=5．196,P〈0．05）;（2）PET／CT将AnnArbor分期为I-Ⅱ3例患者（12．5％,3／24）上调至Ⅲ～Ⅳ期,将2例患者（8．3％,2／24）的分期由Ⅲ～Ⅳ期下调至I-Ⅱ期。I～Ⅱ期和Ⅲ～Ⅳ期患者的SUV～分别为5．22＋2．92和8．04＋4．46（F=2．904,P〉0．05）;（3）16例一线治疗后行PET／CT显像的FL患者中,PET／CT阴性和阳性患者分别为13和3例,2组6个月、1年及3年总生存率分别为100％（13／13）、9／9、4／5和2／3、2／3和1／2;无进展生存率分别为92．3％（12／13）、8／9、3／5和2／3、0／3和0／2。结论^18F—FDGPET／CT对治疗前不同组织学分级及不同临床分期的FL有较高的诊断价值。FL患者一线治疗后行^18F—FDGPET／CT检查可提示预后。     

农村老年人老化期望现状及影响因素研究

目的 了解农村老年人的老化期望现状,分析其影响因素,为针对干预提供参考。方法 采用一般资料调查表、UCLA孤独感量表简化版、老化期望量表、简版自我感知老化量表对199名农村老年人进行问卷调查。结果 老化期望总分为32.72±9.18,孤独感得分为15.11±3.82,自我感知老化得分为52.75±2.76;多元线性回归分析显示,性别、婚姻状况、患慢性病种数、独居、孤独感、自我感知老化及经济来源是农村老年人老化期望的影响因素（调整R2=0.612,均P＜0.05）。结论 农村老年人的老化期望水平较低,女性、孤独、无配偶、患慢性病较多、老化态度消极及低收入人群是关注的重点。