基于网络环境的医学影像学自主学习体系的建设与应用

介绍了基于网络环境的医学影像学自主学习体系的构建原则及组成,分析了其实践应用效果,指出该系统可有效弥补医学影像学教学资源不足、完善教学改革内涵、提升医学影像学教学质量。     

海洛因依赖者静息态下低频振幅及相关功能网络的 fMRI 研究

目的：采用静息态下低频振幅(ALFF)与功能连接的方法,观察长期使用海洛因对大脑相关脑区局部神经元的基线活动影响,并分析这些相关脑区神经活动改变与大脑功能组织模式的关系。方法采集17例海洛因依赖者和15例正常被试者的 fMRI 数据,分析海洛因依赖者 ALFF 的变化及其与使用海洛因的关系。以产生差异脑区为感兴趣区,用功能连接方法分析海洛因依赖者功能连接的改变。结果与对照组相比,海洛因依赖者的右侧尾状核、右背侧前扣带回、右额上回的 ALFF 明显降低,而双侧小脑、左颞上回和左枕上回 ALFF 增加。以上脑区中,仅右侧尾状核的 ALFF 值与海洛因使用总时间及每日剂量呈负相关。功能连接分析显示右侧尾状核和背外侧前额叶皮层(dlPFC)的功能连接降低,与小脑的功能连接增强。结论海洛因依赖者基线水平大脑神经元ALFF 减少伴随着大脑功能连接的失调;慢性海洛因依赖者前额-纹状体环路和前额-小脑环路功能失调,后者支持小脑内部模型理论以及促成成瘾者从机械行为向成瘾习惯的转换。     

肺内炎性肌纤维母细胞瘤1例

患者 女,16岁,自感全身乏力及头昏3个月,体重减轻6 kg,外院胸部平片提示右肺下叶包块.查体:右侧胸廓扩张度降低,右下胸部语颤减弱,肝肺浊音界上移,左肺及右上肺叩诊呈清音,右下肺呼吸音减弱.实验室检查(实验室各项检查正常)RBC 3.56×1012/L,WBC 8.8×109/L,N 80%,血沉10 mm/h.肺功能检查:轻度限制性肺通气功能障碍.     

海洛因依赖者前额叶皮质及杏仁核1H-MR波谱研究

目的 探讨海洛因依赖(HD)患者前额叶皮质及杏仁核1H-MRS特征,以及与吸食海洛因累计总量的关系.方法 选择14例HD患者(HD组)和12名健康志愿者(HC组)行前额叶皮质及双侧杏仁核1H-MRS检查,测量两组前额叶皮质区及双侧杏仁核N-乙酰天冬氨酸/肌酸(NAA/Cr)、胆碱/肌酸(Cho/Cr)值,并采用独立样本t检验进行比较.对HD患者吸食海洛因累计总量[(852±341)g]与前额叶皮质及左、右侧杏仁核区NAA/Cr作直线相关分析.结果 与HC组相比,HD组的前额叶皮质、左侧杏仁核及右侧杏仁核NAA/Cr比值降低,分别为1.44±0.46、1.32±0.08、1.34±0.09,HC组分别为1.50±0.75、1.42±0.08、1.44±0.10,2组间差异有统计学意义(t值分别为1.77、3.41、2.63,JP值均<0.05);HD组前额叶皮质、左侧杏仁核及右侧杏仁核Cho/Cr分别为0.92±0.06、1.20±0.12、1.26±0.15,对照组分别为0.86±0.08、1.07±0.04、1.12±0.11,2组差异有统计学意义(t值分别为2.31、3.60、2.60,P值均<0.05).前额叶皮质、左侧杏仁核及右侧杏仁核代谢物NAA/Cr与海洛因累计吸食总量呈负相关性(r值分别为-0.9159、-0.8756、-0.9399,P值均<0.01).结论 1H-MRS能显示前额叶皮质及杏仁核的神经元受损及神经胶质增生,从该区代谢物的改变反映出HD患者执行及情感功能的异常,其代谢物改变程度与海洛因累计吸食总量有关.     

原发性气管及主支气管肿瘤的影像学诊断及评价(附33例报告)

目的 探讨原发性气管及主支气管肿瘤影像学检查价值.方法 回顾性分析33例经病理证实的原发性气管及主支气管肿瘤影像资料,并与手术、病理进行对照.结果 气管及主支气管肿瘤位于气管上段3例,中段9例,下段14例,气管隆突1例及主支气管6例.本组通过影像学检查显示为良性肿瘤9例,恶性肿瘤24例,和手术及病理改变相一致.影像学表现可分为以下几种:(1)宽基底管腔内结节;(2)窄基底管腔内结节;(3)管腔外肿块.本组27例根据胸片表现导致漏、误诊有4例,22例根据CT表现导致漏、误诊有3例.结论 影像学检查对原发性气管、主支气管肿瘤的检测具有重要意义.     

海洛因依赖者前额叶皮质及杏仁核1H-MR波谱研究

Objective To explore the characteristic findings of 1H-MR spectroscopy(1H-MRS) in the prefrontal cortex and amygdala of patients with heroine dependence(HD), and the relationship to total cumulative dose of inhaled heroine.Methods Fourteen male HD patients and 12 healthy controls (HC) underwent 1H-MRS at the prefrontal cortex and amygdala regions.The total cumulative in haled heroin dose was (852±341) g in HD.Ratios of N-acetylaspartate/creatine(NAA/Cr) and choline/creatine (Cho/Cr) were respectively measured in the prefrontal cortex and bilateral amygdale regions.The student's t test and the linear correlation were employed for statistical analysis.Results Compared to HC group, HD patients had a significant lower ratio of NAA/Cr in the prefrontal cortex (1.44±0.46 vs 1.50±0.75, t=1.77 ,P <0.05), left amygdala region (1.32±0.08 vs 1.42±0.08, t=3.41, P < 0.05), and right amygdala region (1.34±0.09 vs 1.44±0.10, t=2.63, P <0.05), the HD patients had a significant increased ratio of Cho/Cr in the prefrontal cortex (0.92±0.06 vs 0.86±0.08, t=2.31, P < 0.05), left amygdala region (1.20+0.12 vs 1.07±0.04, t=3.60,P<0.05) and right amygdala region(1.26±0.15 vs 1.12±0.11,t=2.60,P <0.05).There was a negative linear correlation between the total cumulative inhaled heroine dose and the ratio of NKA/Cr in the prefrontal cortex (r=-0.9159, P < 0.01), left amygdala region (r=-0.8756, P < 0.01), and right amygdala region (r=-0.9399, P < 0.01) respectively.Conclusions The study indicates that neuronal damage and glial proliferation may occur in the prefrontal cortex and amygdala region, which suggests the abnormalities of executive function and emotion in patients with HD.A relationship exists between the heroin-induced metabolic abnormality and the total cumulative dose of inhaled heroine.     

海洛因依赖者前额叶皮质及杏仁核1H-MR波谱研究

Objective To explore the characteristic findings of 1H-MR spectroscopy(1H-MRS) in the prefrontal cortex and amygdala of patients with heroine dependence(HD), and the relationship to total cumulative dose of inhaled heroine.Methods Fourteen male HD patients and 12 healthy controls (HC) underwent 1H-MRS at the prefrontal cortex and amygdala regions.The total cumulative in haled heroin dose was (852±341) g in HD.Ratios of N-acetylaspartate/creatine(NAA/Cr) and choline/creatine (Cho/Cr) were respectively measured in the prefrontal cortex and bilateral amygdale regions.The student's t test and the linear correlation were employed for statistical analysis.Results Compared to HC group, HD patients had a significant lower ratio of NAA/Cr in the prefrontal cortex (1.44±0.46 vs 1.50±0.75, t=1.77 ,P <0.05), left amygdala region (1.32±0.08 vs 1.42±0.08, t=3.41, P < 0.05), and right amygdala region (1.34±0.09 vs 1.44±0.10, t=2.63, P <0.05), the HD patients had a significant increased ratio of Cho/Cr in the prefrontal cortex (0.92±0.06 vs 0.86±0.08, t=2.31, P < 0.05), left amygdala region (1.20+0.12 vs 1.07±0.04, t=3.60,P<0.05) and right amygdala region(1.26±0.15 vs 1.12±0.11,t=2.60,P <0.05).There was a negative linear correlation between the total cumulative inhaled heroine dose and the ratio of NKA/Cr in the prefrontal cortex (r=-0.9159, P < 0.01), left amygdala region (r=-0.8756, P < 0.01), and right amygdala region (r=-0.9399, P < 0.01) respectively.Conclusions The study indicates that neuronal damage and glial proliferation may occur in the prefrontal cortex and amygdala region, which suggests the abnormalities of executive function and emotion in patients with HD.A relationship exists between the heroin-induced metabolic abnormality and the total cumulative dose of inhaled heroine.     

高胆固醇对Oddi括约肌舒缩性与[Ca2+]i的影响

目的探讨高胆固醇对Odd i括约肌张力及细胞内钙离子浓度的影响。方法新西兰兔16只随机分为2组,对照组8只,实验组8只,分别对对照组及实验组兔行Odd i括约肌测压、造影、胆管括约肌(SO)细胞中钙离子浓度测定。结果对照组兔血清胆固醇浓度<3 mmol/L,实验组兔血清胆固醇浓度约30 mmol/L左右;胆管造影显示实验组造影剂排空时间延迟,Odd i括约肌狭窄;Odd i括约肌近侧段基础压力测定,对照组和实验组分别为1.56 kPa和3.41 kPa(P<0.01),Odd i括约肌高压带(HPZ)压力分别为9.24 kPa和19.27 kPa(P<0.0.1);SO细胞中钙离子浓度测定显示实验组较对照组升高。结论高胆固醇血症可引起细胞内钙离子浓度升高及Odd i括约肌张力持续升高。     

fMRI观察强制戒断对海洛因成瘾者渴求任务下大型脑网络的影响

目的 探讨强制戒断对海洛因成瘾者毒品线索任务下心理渴求及脑网络功能的影响。方法 对37例强制戒断的海洛因成瘾者（强制戒断组）和32名正常志愿者（对照组）先行静息态及渴求任务fMRI数据采集,并进行心理渴求量化评分。对静息态fMRI数据进行分析获取任务负相关网络（TNN）和任务正相关网络（TPN）。对任务态fMRI数据进行建模,与对照组比较,获得强制戒断组TNN和TPN中异常激活的脑区,并分析其与心理行为学的相关性。结果 强制戒断组任务线索图片呈现前后渴求评分均显著高于对照组（P均<0.01）。渴求任务下,与对照组比较,强制戒断组在TNN中右侧海马旁回显著激活,TPN中显著性增强的网络包括视觉空间网络（双侧中央前回、额下回）和感觉运动网络（左侧中央后回）。强制戒断组双侧额下回激活强度与吸食海洛因时间呈负相关（右侧：r=－0.37,P=0.02;左侧：r=－0.41,P=0.01）。结论 强制戒断的海洛因成瘾者主观渴求依然增高,多个大型脑网络异常功能尚未完全恢复,可能是导致复吸的神经病理学基础。