Reduced microvascular volume and hemispherically deficient vasoreactivity to hypercapnia in acute ischemia: MRI study using permanent middle cerebral artery occlusion rat model

Vasoreactivity to hypercapnia has been used for assessing cerebrovascular tone and control altered by ischemic stroke. Despite the high prognostic potential, traits of hypercapnia-induced hemodynamic changes have not been fully characterized in relation with baseline vascular states and brain tissue damage. To monitor cerebrovascular responses, T2- and T2*-weighted magnetic resonance imaging (MRI) images were acquired alternatively using spin- and gradient-echo echo plannar imaging (GESE EPI) sequence with 5% CO₂ gas inhalation in normal (n=5) and acute stroke rats (n=10). Dynamic relative changes in cerebrovascular volume (CBV), microvascular volume (MVV), and vascular size index (VSI) were assessed from regions of interest (ROIs) delineated by the percent decrease of apparent diffusion coefficient (ADC). The baseline CBV was not affected by middle cerebral artery occlusion (MCAO) whereas the baseline MVV in ischemic areas was significantly lower than that in the rest of the brain and correlated with ADC. Vasoreactivity to hypercapnic challenge was considerably attenuated in the entire ipsilesional hemisphere including normal ADC regions, in which unsolicited, spreading depression-associated increases of CBV and MVV were observed. The lesion-dependent inhomogeneity in baseline MVV indicates the effective perfusion reserve for accurately delineating the true ischemic damage while the cascade of neuronal depolarization is probably responsible for the hemispherically lateralized changes in overall neurovascular physiology.     

Effects of divalproex and atypical antipsychotic drugs on dopamine and acetylcholine efflux in rat hippocampus and prefrontal cortex

Mood stabilizers (e.g., valproic acid) and antipsychotic drugs (APDs) are commonly co-administered in the treatment of bipolar disorder and schizophrenia. The basis for any synergism between these classes of drugs in either group of disorders has been little studied. Previous studies have shown that atypical APDs (e.g., clozapine) preferentially increases dopamine (DA) and acetylcholine (ACh) efflux in rat medial prefrontal cortex (mPFC) and hippocampus (HIP), both of which have been suggested to contribute to their ability to improve cognition in patients with schizophrenia. We have recently reported that the anticonvulsant mood stabilizers (AMS), valproic acid, carbamazepine, and zonisamide, but not lithium, also preferentially increase DA efflux in the rat mPFC, and that, at subthreshold doses, the AMS also augment the ability of the atypical APDs clozapine and risperidone to increase DA but not ACh efflux in the mPFC. The present study examined the ability of divalproex (DVX), which is chemically related to valproic acid, to enhance DA and ACh efflux in the HIP and to augment the effect of atypical APDs on ACh efflux in the HIP and mPFC. DVX, 500 mg/kg, significantly increased DA and ACh efflux in the HIP, and DA, but not ACh, efflux in the mPFC, whereas a lower dose of DVX, 50 mg/kg, had no effect on DA or ACh in either region. However, DVX, 50 mg/kg, combined with the atypical APDs olanzapine (1.0 mg/kg) or aripiprazole (0.3 mg/kg) significantly potentiated the effect of both APDs on DA, but not ACh efflux in the HIP and mPFC. Pretreatment of olanzapine or aripiprazole with the selective serotonin 5-HT(1A) antagonist, WAY100635 (1.0 mg/kg) partially but significantly blocked the effect of the combination of DVX, 50 mg/kg, and olanzapine or aripiprazole, on DA efflux in both the HIP and mPFC. WAY100635 did not affect the ability of the combination of olanzapine or aripiprazole and DVX to enhance ACh efflux in the HIP or mPFC. Subchronic administration of the combination of DVX, 50 mg/kg, and risperidone, produced significantly greater increases in DA and ACh efflux in the mPFC, but these increases were not significantly different from those following the acute administration of the combination of risperidone and DVX. These results provide further evidence that the AMS, DVX, augments the ability of atypical APDs to increase DA or ACh efflux in either the HIP or mPFC or both. The clinical significance of this potentiation for the beneficial clinical effects of this combination of agents and the differences between AMS in this regard warrants further study.     

主动脉缩窄及主动脉弓离断的电子束CT诊断

目的：探讨电子束CT诊断先天性主动脉缩窄和主动脉弓离断的价值。材料和方法：共10例病人，年龄6—18岁，均经手术证实。对所有患儿行EBCT增强扫描，并对图像行三维重建。结果：10例病人术前均得到正确诊断，其中8例为主动脉缩窄，2例为主动脉弓离断。EBCT均显示了全部8例主动脉缩窄及其缩窄的程度、形态，并显示缩窄处与左锁骨下动脉的关系。其中6例（75％）为局限性狭窄，2例（25％）形成中-重度长管状狭窄。合并畸形有：3例合并动脉导管未闭，1例合并室间隔缺损，1例合并肺动脉狭窄，1例合并二尖瓣狭窄，2例同时合并动脉导管未闭和室间隔缺损。2例主动脉弓离断病例，均合并有动脉导管未闭、室间隔缺损和肺动脉狭窄。EBCT均显示升主动脉与降主动脉呈分离状。结论：EBCT作为一种无创性检查方法，对先天性主动脉病变的诊断有重要价值，并能同时显示合并的胸部大血管异常。     

乙型肝炎病毒基因组转染HepG2细胞的microRNA表达研究

目的 检测乙型肝炎病毒(HBV)全基因组转染对人肝母细胞瘤细胞系HepG2细胞中microRNA(miRNA)表达的影响,为进一步探讨肝细胞中HBV复制的分子生物学机制提供平台.方法 分别提取HepG2.2.15细胞(转染HBV全基因组的HepG2细胞,实验组)和其亲本HepG2细胞(对照组)的总RNA并分离miRNA,采用含509条探针的哺乳动物miRNA表达谱芯片对两组之间差异表达的miRNA进行分析.用SAM软件针对差异miRNA筛选的标准为在两组之间荧光强度差异4倍以上,差异miRNA的整体假阳性率为0.选择其中2个miRNA,应用实时荧光定量RT-PCR方法对芯片结果进行验证.结果 HepG2.2.15细胞与HepG2细胞间差异表达的miRNA共27个(占5.3%),其中7个表达上调,20个表达下调.miR-181d和miR-15a的实时荧光定量RT-PCR验证结果与芯片表达结果基本一致.结论 肝细胞中存在着与HBV复制相关的miRNA,这些上调和下调表达的miRNAs可能参与了HBV在肝细胞中的复制.     

LCT及HR-HPV诊断宫颈病变的临床价值

目的探讨LCT和HR-HPV对宫颈病变的诊断价值。方法对20479例患者行LCT检查,LCT阳性者行HR-HPV检测及电子阴道镜下宫颈活检组织病理检查,以组织病理学结果作为诊断的金标准,比较LCT阳性结果、HR-HPV检测结果与阴道镜下宫颈活检病理结果的符合率。结果1)LCT结果为ASCUS、LSIL、ASCH、HSIL与阴道镜下宫颈活检病理结果的符合率分别为54.55%、62.65%)、88.24%、92.99%。其HR-HPV阳性率分别为71.64%、80.56%、88.24%、92.86%。差异有显著性(P<0.001)。2)HR-HPV阳性组与阴性组比较,高级别宫颈病变的检出率分别为48.14%、17.39%,经卡方检验,P<0.001,差异有显著性。结论高危型人乳头瘤病毒检测对于细胞学诊断为非典型鳞状细胞的患者有重要的分流价值。     

RESECTION FOR RUPTURED DUODENAL VARICES SECONDARY TO PORTAL HYPERTENSION

Apatient complicated by gastrointestinal bleeding was treated successfully using resection of ruptured duodenal varies. The paper reviewed the literatures and introduced surgical procedures and its indications.     

小鼠胚胎干细胞体外向血管平滑肌细胞的定向分化*★

目的：血管重建手术在多数情况下以自体血管作为替代品，但来源有限。胚胎干细胞具有发育全能性，目前其定向诱导机制尚不明确。通过选择适当的诱导剂，探讨胚胎干细胞体外向血管平滑肌细胞分化的趋势。 方法：实验于2006-08/2007-02在南昌大学第二附属医院血液病研究所完成。①动物及细胞系：清洁级孕12.5 d昆明小白鼠1只，由南昌大学医学院动物中心提供，实验过程中对动物的处置符合动物伦理学标准。小鼠胚胎干细胞系129X/SvJ编号为SCRC-1018，由American Type Culture Collection提供。②实验方法：取孕12.5 d鼠胚胎，去除头部、内脏及四肢，将组织块剪碎，胰酶消化，分离培养胚胎成纤维细胞，传至3~5代时更换为含体积分数为0.15胎牛血清的DMEM高糖培养基，24 h后收集培养液，加入2.0 mmol/L L-谷氨酰胺，1×非必需氨基酸，0.1 mmol/L β-巯基乙醇，1 000 Ｕ/mL白血病抑制因子，此即为条件培养基。常规复苏小鼠胚胎干细胞系129X/SvJ，以1×106密度接种，传代时用差速贴壁法分离去除已分化的胚胎干细胞，加入条件培养基5 mL，经过悬滴-悬浮培养，构建拟胚体分化模型。设立3组，各组均置于明胶包被的T25培养瓶中，每瓶加入50个拟胚体，使其均匀分布于培养瓶底。诱导组7~10 d加入10-9 mol/L全反式维甲酸和3μg/L转化生长因子β1，10~21ｄ加入 20μg/L血小板源性生长因子。血清对照组仅加入去生长因子胎牛血清，全反式维甲酸组仅加入全反式维甲酸。诱导21ｄ的拟胚体，用胰蛋白酶和胶原酶Ⅱ联合消化为单个细胞，再加入20μg/L血小板源性生长因子继续诱导7ｄ。③实验评估：应用RT-PCR法检测诱导细胞血管平滑肌肌动蛋白、血管平滑肌肌球蛋白重链基因的表达。通过免疫细胞化学技术检测血管平滑肌肌动蛋白的表达来鉴定细胞性质。 结果：①胚胎干细胞生长及拟胚体诱导分化：胚胎干细胞在体外能自发形成拟胚体，经过不同生长因子的分阶段联合诱导，拟胚体贴壁后球体略摊开，周围出现大量的梭形细胞。②RT-PCR检测：拟胚体血管平滑肌肌动蛋白和血管平滑肌肌球蛋白重链基因均呈强阳性表达。③免疫细胞化学检测：荧光显微镜下，罗丹明染色细胞浆呈红色荧光，并可见肌丝结构；DAPI染色细胞核呈蓝色荧光。诱导组血管平滑肌肌动蛋白阳性率明显高于血清对照组、全反式维甲酸组（P < 0.05）。 结论：胚胎干细胞经维甲酸、转化生长因子β1以及血小板源性生长因子分阶段联合诱导后，可分化为血管平滑肌细胞且纯度较高。随着细胞纯度和活性等问题的进一步解决，胚胎干细胞将有可能成为血管组织工程的种子细胞。     

基于Matlab距骨快速图像分割与动画生成的算法

背景：骨科手术导航是利用计算机和机器视觉技术,使医师在计算机屏幕的指导下完成接骨手术。为了后续定位工作的开展,首先必须基于CT图像序列在计算机上对下肢骨进行图像分割、三维重建和动画显示,并对其位姿进行测量。 目的：在计算机上快速自动地实现距骨图像的分割、三维可视化及动画显示,为建立新型的足部手术导航系统搭建计算机显示平台。 方法：基于足部CT图像序列,提出下列算法并采用Matlab编程实现：①基于最大熵原则对足部图像进行阈值分割以提取其中所有足部骨骼。②将形态学算法与Live-wire算法相结合快速自动地从该足部骨骼图像中分割出距骨。③利用移动立方体法对距骨表面进行三维重建。④采用图形学函数生成与显示距骨旋转的动画场景。 结果与结论：实验结果表明,上述算法准确度高且以较少的时间在普通 PC机上实现了距骨的三维可视化工作,可应用于足部手术导航的计算机显示平台中。     

Association between oxidized low‐density lipoprotein and cognitive impairment in patients with ischemic stroke

Background and purpose

The association between oxidized low‐density lipoprotein (oxLDL) and cognitive impairment is unclear. This study aimed to investigate the potential association between oxLDL and cognitive impairment among patients with acute ischemic stroke.

Methods

We measured the levels of oxLDL and recorded the Mini‐Mental State Examination (MMSE) score in patients with acute ischemic stroke who were recruited from the Study of Oxidative Stress in Patients with Acute Ischemic Stroke. Cognitive impairment was defined as an MMSE score of <24. The association between oxLDL and cognitive impairment was assessed by multivariate logistic or linear regression analysis. Other clinical variables of interest were also studied.

Results

A total of 3726 patients [1287 (34.54%) female] were included in this study, with a mean age of 63.62 ± 11.96 years. After adjusting for potential confounders in our logistic regression model, each SD increase in oxLDL was associated with a 26% increase in the prevalence of cognitive impairment (odds radio, 1.26; 95% confidence interval, 1.13–1.39; P < 0.0001). Similarly, higher oxLDL was associated with lower MMSE scores, with a 0.56‐point decrease in MMSE score for every SD increase in oxLDL in a linear regression analysis (β = ?0.56; 95% confidence interval, ?0.81 to ?0.32; P < 0.0001). There were no significant interactions between oxLDL and age, sex or education levels for cognitive impairment (all interactions, P > 0.05).

Conclusions

Elevated levels of oxLDL were associated with a higher prevalence of cognitive impairment in patients with ischemic stroke.     

青少年抑郁症患者自杀行为的影响因素研究

目的 探讨家庭及其他因素对青少年抑郁症患者自杀行为的影响。方法 选取于 2020 年6 月至 2021 年 12 月在荆门市第二人民医院儿童青少年心理科住院的 126 例青少年抑郁症患者进行横断面调查,根据近 6 个月内是否有自杀行为分为自杀组（n=76）及非自杀组（n=50）。采用一般情况调查表、患者健康问卷抑郁症状群量表（PHQ-9）、自杀意念自评量表（SIOSS）、家庭亲密度与适应性评定量表（FACES Ⅱ-CV）对两组患者的一般资料、抑郁程度、自杀意念、家庭分型进行比较。采用 Spearman 相关分析患者自杀行为与一般资料、PHQ-9、SIOSS、FACES Ⅱ-CV 评分的相关性。采用二元 Logistic 回归模型对患者自杀行为的影响因素进行分析。结果 自杀组饮酒者占 40.8%（31/76）,有精神疾病家族史者占 27.6%（21/76）,分别高于非自杀组的 20.0%（10/50）、12.0%（6/50）,差异有统计学意义（P＜ 0.05）。自杀组患者 PHQ-9 评分、SIOSS 总分、绝望因子评分及睡眠因子评分高于非自杀组［19.0（15.0,21.8）分比 15.0（10.8,19.0）分、15.0（14.0,16.8）分比 13.0（11.0,15.0）分、12.0（10.3,12.0）分比 10.0（7.8,12.0）分、3.0（2.0,3.0）分比 2.0（1.0,3.0）分］,家庭亲密度评分低于非自杀组［50.5（43.3,57.0）分比 57.5（48.8,65.5）分］,差异均有统计学意义（P＜ 0.05）。自杀组患者中极端型家庭占 67.1%（51/76）,高于非自杀组的 44.0%（22/50）,差异有统计学意义（P＜ 0.05）。患者自杀行为与家庭亲密度呈负相关（r=-0.224,P＜0.05）,与 PHQ-9 评分、SIOSS 总分、绝望因子评分、睡眠因子评分、饮酒、有精神疾病家族史呈正相关（r=0.346、0.373、0.361、0.324、0.206、0.217、0.186;P＜ 0.05）。二元 Logistic 回归分析显示,饮酒（OR=3.066,95%CI=1.184～7.941）、家 庭 适 应 性 高（OR=1.126,95%CI=1.034～1.227）、PHQ-9 评 分 高（OR=1.197,95%CI=1.087～1.317）是青少年抑郁症患者自杀行为的危险因素（P＜ 0.05）,家庭亲密度高是自杀行为的保护因素（OR=0.878,95%CI=0.813～0.948）。结论 青少年抑郁症患者自杀行为发生率较高,家庭分型更多见于“僵硬 - 松散”的极端型家庭,有饮酒行为、严重抑郁、家庭关系不良者更容易自杀