中国汉族成人额叶体积的高分辨率MRI测量

Objective To explore the normal range of the volume of frontal lobe in Chinese adults of the Han nationality and provide morphological data for the construction of database for Chinese Standard Brain. Methods This is a clinical multi-center study. Two hundred Chinese healthy volunteers (age range= 18 to 70) recruited from 16 hospitals were divided into 5 groups, i. e. , age range from 18 to 30, age range from 31 to 40, age range from 41 to 50, age range from 51 to 60, and age range from 61 to 70. Each group contained 20 males and 20 females. All of the volunteers were scanned by MR using T1 weighted threedimensional magnetization prepared rapid acquisition gradient echo sequence. We used the manual method to trace the region of interest and measured the left and right frontal lobe volumes separately. All the data were analyzed with SPSS (version 13.0). The sex differences in the frontal lobe volumes were analyzed by independent-samples t test, and the side differences were analyzed by paired-samples t test. Correlation and regression analysis was used between the age and the frontal lobe volumes. Results In 200 healthy Chinese Han volunteers, the total frontal lobe volumes was (563 ± 73) cm3. For male, the volumes of the left and the right frontal lobe were (288±42) cm3 and (292 ±41 ) cm3 ,respectively. The volumes of the left and right frontal lobe in 100 women were (273 ±30) cm3 and (274 ± 30) cm3 respectively. The differences of sex (t = 3. 334, P < 0. 05 ) and side ( t = - 3.09, P < 0. 05 ) in the total frontal lobe volumes reach significant. There was no significant differences in women ( t = - 1. 304, P > 0. 05 ). There were negative correlations between the frontal lobe volumes and age in men and women ( r = - 0. 586, - 0. 498, P <0. 01 ). Conclusions The total frontal lobe volume of men was larger than that of women. The volume of the right frontal lobe was larger than the left frontal lobe in men, and the asymmetries didn't exist in women.The total frontal lobe volumes were both shrinking with age in men and women, which was more rapid in men than in women.     

中国汉族正常成人视束的高分辨率MRI测量

Objective To explore the morphological characteristics of optic tracts in healthy Chinese Han adults on the high-resolution MRI and fill the database of Chinese standard brain with morphological data of optic tracts.Methods Cerebral MRI scans with T1 WI 3D MPRAGE sequence of 1000 healthy Chinese volunteers from 15 hospitals were divided into five stages, ranging in age from 18 to 70.With the technique of multi-baseline, structure and morphology of optic tracts were displayed optimally on the images with multiplanar reconstruction.Data were measured as following: transverse distance of the cisternal optic tract (TD1) and peri-crural optic tract (TD2), length from the cisternal optic tract to the peri-crural optic tract (L) ,angle between optic tract(AOT) and height of optic tract from its first segment to plane of anterior commissure (H) including H1, H2, H3, H4 and HS.The measurements of optic tracts between sexualities and among age groups were compared by anasis of covariance; those among five age groups were compared pairwisedly by least significant difference analysis (LSD); and the differences of measurements between left and right optic tracts were analyzed using paired t test.Results (1) Comparisons of optic tract structures between male and female: the mean optic tract length of male [(11.69±1.45),(11.56±1.44) mm] was significant longer than that of female [(10.58±1.29),(10.40±1.34) mm] (F=22.236, 29.703, P=0.000); the mean H1 of male [(2.56±0.28),(2.60±0.29) mm] and female [(2.57±0.31 ), (2.63±0.32) mm] were significantly different ( F =11.130,7.805, P = 0.000, 0.005).No significant differences of the other measurements were found between male and female ( P > 0.05 ).(2) Comparisons among age groups: among 5 age groups, TD1 of both sides [left TD1 :(4.64±0.51 ), (4.64±0.57), (4.55±0.58), (4.39±0.53), (4.36±0.58)mm;right TD1 :(4.84±0.53) ,(4.80±0.60), (4.77±0.65), (4.60±0.59), (4.57±0.59) mm] and the right TD2[(3.33±0.45),(3.34±0.41),(3.33±0.36),(3.23±0.38),(3.23±0.39) mm] had statistical differences ( F = 3.458, 2.735, 4.711, P = 0.008,0.028, 0.001 ).The LSD analysis found that the 50 years old group was the watershed with significant differences ( P < 0.05 ).The results also showed that the L of both sides had statistical differences among 5 age groups ( F = 14.510,14.532, P = 0.000).The LSD analysis found that the 60 years old group was the watershed with significant differences (P <0.05).Left TD2 and the H1-H5 of both sides had no significant differences among age groups ( P >0.05).(3) Comparisons of the measurements between left and right optic tracts: TD1 of bilateral optic tracts were (4.52±0.57)and(4.72±0.60) mm respectively; H1 of bilateral optic tracts were (2.56±0.30)and (2.61±0.30) mm respectively; H2 of bilateral optic tracts were (2.66±0.30)and (2.70±0.30) mm respectively; and L of bilateral optic tracts were ( 11.14±1.47 ) and ( 10.98±1.50 )mm respectively.There were significant differences in these measurements between left and right optic tracts( t =12.460, - 6.013,5.595,4.784, P = 0.000 ), while there were no significant differences in TD2, H3, H4 and H5( P > 0.05 ).Conclusions With high-resolution MR1 and 3D reconstruction, optic tract can be displayed clearly and measured accurately.There are definite differences in anterior segments of optic tracts between sexualities, sides and among ages in normal Chinese Han adults, while the posterior segments of optic tracts keep stable.Normal reference values of optic tracts in Chinese Han adults are provided to clinical practices and scientific researches, which are valuable for building of Chinese standard brain.     

中国汉族正常成人岛叶体积的高分辨率MRI测量

目的 测量中国正常汉族成人岛叶体积,分析岛叶体积与年龄、性别、体重及颅脑容积的相关性,为建立中国标准脑提供可靠数据.方法 选择健康汉族成人志愿者1000名,按照年龄18～30、31～40、41～50、51～60、61～70岁分为A、B、C、D、E组,每组男、女各100名.所有受试者均行3D磁化强度预备梯度回波序列T1WI,应用3D体积分析软件手工勾绘ROI,测最健康中国成年人岛叶的体积,并进行标准化处理.双侧岛叶体积间比较采用配对t检验分析,不同性别间岛叶体积比较用两独立样本t检验分析,不同年龄段之间进行单因素方差分析.结果 标准化前1000名受试者左、右侧岛叶体积分别为(7764±1165)、(7387±1128)mm3,标准化后为(8413±1201)、(7871±1140)mm3,左侧大于右侧(t值分别为-10.565、-16.014,P值均<0.01).标准化前男性左、右侧岛叶体积分别为(8146±1181)、(7735±1113)mm3,女性左、右侧岛叶体积分别为(7393±1022)、(7050±1038)mm3,男性左、右侧岛叶体积均大于女性(t值分别为10.934、9.945,P值均<0.01).标准化后男性左、右侧岛叶体积分别为(8779±1230)、(8224±1081)mm3,女性左、右侧岛叶体积分别为(8043±1054)、(7515±1091)mm3,男性左、右侧岛叶体积均大于女性(t值分别为4.858、4.632,P值均<0.01).标准化前A、B、C、D、E组左侧岛叶体积分别为(8268±1221)、(8067±1107)、(7869±1109)、(7603±1111)、(6997±934)mm3,右侧岛叶体积分别为(8028±1156)、(7636±1075)、(7294±986)、(7249±1068)、(6717±916)mm3,5组间左、右侧岛叶体积差异均有统计学意义(F值分别为-0.361、-0.337,P值均<0.01).标准化后A、B、C、D、E组左侧岛叶体积分别为(9093±1105)、(8679±965)、(8810±1136)、(8202±980)、(7273±940)mm3,右侧岛叶体积分别为(8694±1005)、(8136±1100)、(8034±910)、(7496±990)、(6989±932)mm3,5组间左、右侧岛叶体积差异均有统计学意义(F值分别为-0.490、-0.512,P值均<0.01).岛叶体积与年龄的相关性分析:标准化前、后,左、右侧岛叶体积与年龄之间均呈负相关(标准化前:r值分别为-0.361、-0.337,标准化后r值分别为-0.490、-0.512,P值均<0.05).标准化前左、右侧岛叶体积与颅脑容积之间均呈正相关(r值分别为0.470、0.459,P值均<0.05).标准化前左、右侧岛叶体积与体重之间均呈正相关,(r值分别为0.141、0.092,p值均<0.05).结论 1.5 T MR扫描仪分辨率高,能清晰显示脑内灰白质,能明确辨别岛叶的边界,为岛叶体积测量提供依据,为正常成人岛叶体积建立提供科学数据.     

中国汉族正常成人垂体的高分辨率MRI研究

Objective To study the morphological characteristics of pituitary glands in healthy adult of the Han nationality on the High-resolution MRI and provide morphological data of pituitary glands for the construction of database for Chinese Standard Brain.Methods This is a clinical multi-center study.Nine hundred and seventy eight Chinese healthy volunteers (age range = 18 to 70) recruited from 16 hospitals were divided into 5 groups, i.e., Group A ( age range = 18 to 30), B ( age range = 31 to 40), C ( age range = 41 to 50), D ( age range = 51 to 60 ), and E ( age range = 61 to 70).All of the volunteers were scanned by MR using T, weighted three-dimensional magnetization prepared rapid acquisition gradient echo sequence.By Multiplan reconstruction with 3D software, the pituitary gland's volume, size, and inclination of pituitary stalk were measured and the differences between sexualities and among age groups were compared by analysis of variance using SPSS13.0; those among five age groups were compared pair-wised by Tukey analysis; and the differences between male and female were analyzed by independent t test, and the differences of measurements of typing of pituitary glands were analyzed by Chi-square analysis.Results( 1 ) Volume of pituitary glands: the mean volume of male and female among 5 age groups were ( 1142±290), (996±223), (979 ±178), (971 ±174), (930 ±189) and (1247 ±210), (1199 ±216),( 1108 ± 196), ( 1059 ± 212 ), (984 ± 177 ) mm3 respectively.There were significant differences among the age groups(F = 13.811,27.091 ,P <0.01), the volume tended to decrease after 30 years old in male and 40 years old in female.Female has bigger volume than man in the same age group (P < 0.05).There were statistically correlation between sexes, age, typing, heights in middle sagittal width in coronal MR and anteroposterior diameter in middle sagittal MR.(2) The size of pituitary giands:the mean heights on middle sagittal MR images of male and female among 5 age groups were(6.6±1.5), (6.0±1.4), (5.6±1.1 ),(5.0±1.2), (4.9±1.4)and (7.9±1.6), (6.4±2.0), (5.6±1.7), (5.1±1.7), (4.4±1.4)mm respectively.There were significant difference among the age groups ( F = 24.582,62.978, P < 0.01 ).Females demonstrated larger pituitary glands than men in the age from 18 to 30 year old groups ( P < 0.01 ).The pituitary height tended to decline after 30 years old, minimum after 50 years old group in male and 40 years old in female.The heights were statistically correlated with sexes and age.The mean width in coronal MR images of male and female among 5 age groups were( 14.8± 1.8), ( 14.7 ± 1.4), ( 14.2±1.9), (14.3 ±2.1), (13.8 ±2.4) and (14.9±1.8), (15.8±1.7), (15.5±2.1), (15.6±2.2),( 14.9±2.1 ) mm respectively.There were significant difference among the age groups( F = 4.566,4.233,P<0.05),The width of pituitary before 30 years old and after 60 years old were smaller than the other groups (P <0.05 ), but man did not show this relationship.The widths were statistically correlation with sexes, age and weight.The mean anteroposterior diameter in middle sagittal images of male and female among 5 age groups were (11.2±1.2), (11.8±1.3), (11.8±1.5), (12.3±1.8), (12.2±2.0) and (11.9±1.3), (12.5±1.5), (12.4±1.5), (12.9±1.6), (12.7±1.6)mm respectively.There were significant difference among the age groups ( F = 7.270, 5.903, P < 0.01 ).Before 60 year old, the anteroposterior diameter was smaller in male than all female groups (P < 0.05 ), and there was a tendency to grow downwards with age.The anteroposterior diameter was statistically correlated with sexes and age.(3)The angle of inclination of pituitary stalks: on reconstructed coronal MRI imaging, the angle of inclination of pituitary stalk were in the middle, no significant differences in the angle measurements were found between male and female among 5 age groups ( P > 0.05).(4) The typing of pituitary glands in middle sagittal MR images : there were significant differences between each typing ( χ2 = 44.212, 107.518, P < 0.01 ), there was a tendency of pituitary upper border to depressed when age increased.Conclusions With highresolution MRI and 3D volumetric analytic software, volume and size of pituitary glands and the angle of inclination of pituitary stalks were accurately measured, and that provide morphological data of pituitary glands for the construction of database for Chinese Standard Brain.     

中国汉族正常成人视束的高分辨率MRI测量

Objective To explore the morphological characteristics of optic tracts in healthy Chinese Han adults on the high-resolution MRI and fill the database of Chinese standard brain with morphological data of optic tracts.Methods Cerebral MRI scans with T1 WI 3D MPRAGE sequence of 1000 healthy Chinese volunteers from 15 hospitals were divided into five stages, ranging in age from 18 to 70.With the technique of multi-baseline, structure and morphology of optic tracts were displayed optimally on the images with multiplanar reconstruction.Data were measured as following: transverse distance of the cisternal optic tract (TD1) and peri-crural optic tract (TD2), length from the cisternal optic tract to the peri-crural optic tract (L) ,angle between optic tract(AOT) and height of optic tract from its first segment to plane of anterior commissure (H) including H1, H2, H3, H4 and HS.The measurements of optic tracts between sexualities and among age groups were compared by anasis of covariance; those among five age groups were compared pairwisedly by least significant difference analysis (LSD); and the differences of measurements between left and right optic tracts were analyzed using paired t test.Results (1) Comparisons of optic tract structures between male and female: the mean optic tract length of male [(11.69±1.45),(11.56±1.44) mm] was significant longer than that of female [(10.58±1.29),(10.40±1.34) mm] (F=22.236, 29.703, P=0.000); the mean H1 of male [(2.56±0.28),(2.60±0.29) mm] and female [(2.57±0.31 ), (2.63±0.32) mm] were significantly different ( F =11.130,7.805, P = 0.000, 0.005).No significant differences of the other measurements were found between male and female ( P > 0.05 ).(2) Comparisons among age groups: among 5 age groups, TD1 of both sides [left TD1 :(4.64±0.51 ), (4.64±0.57), (4.55±0.58), (4.39±0.53), (4.36±0.58)mm;right TD1 :(4.84±0.53) ,(4.80±0.60), (4.77±0.65), (4.60±0.59), (4.57±0.59) mm] and the right TD2[(3.33±0.45),(3.34±0.41),(3.33±0.36),(3.23±0.38),(3.23±0.39) mm] had statistical differences ( F = 3.458, 2.735, 4.711, P = 0.008,0.028, 0.001 ).The LSD analysis found that the 50 years old group was the watershed with significant differences ( P < 0.05 ).The results also showed that the L of both sides had statistical differences among 5 age groups ( F = 14.510,14.532, P = 0.000).The LSD analysis found that the 60 years old group was the watershed with significant differences (P <0.05).Left TD2 and the H1-H5 of both sides had no significant differences among age groups ( P >0.05).(3) Comparisons of the measurements between left and right optic tracts: TD1 of bilateral optic tracts were (4.52±0.57)and(4.72±0.60) mm respectively; H1 of bilateral optic tracts were (2.56±0.30)and (2.61±0.30) mm respectively; H2 of bilateral optic tracts were (2.66±0.30)and (2.70±0.30) mm respectively; and L of bilateral optic tracts were ( 11.14±1.47 ) and ( 10.98±1.50 )mm respectively.There were significant differences in these measurements between left and right optic tracts( t =12.460, - 6.013,5.595,4.784, P = 0.000 ), while there were no significant differences in TD2, H3, H4 and H5( P > 0.05 ).Conclusions With high-resolution MR1 and 3D reconstruction, optic tract can be displayed clearly and measured accurately.There are definite differences in anterior segments of optic tracts between sexualities, sides and among ages in normal Chinese Han adults, while the posterior segments of optic tracts keep stable.Normal reference values of optic tracts in Chinese Han adults are provided to clinical practices and scientific researches, which are valuable for building of Chinese standard brain.     

中西医结合治疗社区获得性肺炎38例

<正>肺炎按感染的场所不同,分为社区获得性肺炎（community-acquired pneumonia,CAP）和医院获得性肺炎[1]。社区获得性肺炎是指在院外罹患的感染性肺实质性炎症,包括具有明确潜伏期的病原体感染而入院后在平均潜伏期内发病的肺炎,临床治疗过程中由于抗菌药物的广泛应用,导致细菌变异和耐药菌株的增加,给治疗CAP带来困难。我院对2010年11     

Ⅱ、Ⅲ期结肠癌患者根治术后肿瘤转移复发的相关因素分析

目的：探讨Ⅱ、Ⅲ期结肠癌患者根治术后肿瘤转移复发的相关影响因素。方法以我院2008年2月至2010年5月收治并经根治术治疗的78例Ⅱ、Ⅲ期结肠癌患者作为研究对象,通过患者的随访资料对其转移复发情况进行统计,并对经单因素分析后有意义的因素进行Cox模型多因素分析。结果患者术后转移复发与吸烟情况、原发部位、是否为双原发癌、淋巴结转移、癌结节、肿瘤分化程度、肿瘤形态、脉管瘤栓、TMN分期、T分期、化疗方案、术前CEAb、术后CEAb、术前CA19-9b、术后CA19-9b有密切的关系（P＜0.05）;经Cox模型多因素分析显示,原发部位、淋巴结转移、肿瘤形态、TMN分期、化疗方案、术前CEAb、术前CA19-9b是转移复发的主要影响因素。结论Ⅱ、Ⅲ期结肠癌患者根治术后肿瘤的复发转移受多种因素的共同影响,其中以淋巴结转移、TMN分期以及组织学类型等密切相关,临床对患者预后的判断需结合各种因素综合考虑。     

AMA-M2阳性的原发性胆汁性肝硬化患者生物化学指标特点分析

目的分析抗线粒体M2亚型抗体阳性（AMA-M2）的原发性胆汁性肝硬化（primary biliary cirrhosis,PBC）患者生物化学指标特点,为临床PBC诊治提供帮助。方法对本院2010年8月-2012年3月280例AMA-M2阳性的PBC患者分别检测血清蛋白、脂类、胆红素及酶类等16项血清生物化学指标。采用毛细电泳技术,分析患者6种血清蛋白变化情况。采用光电比色法和发色（吸光度）法分别检测患者WBC、RBC、HGB、PLT以及PT等临床血液学指标。采用魏氏法检测患者血沉变化。结果生化指标检测结果显示,血清蛋白及脂类以ALB、TC异常率最高,分别为52%、40%。超过50%的患者出现酶类及胆红素代谢结果异常,异常率由高到低分别为GGT（96%）、ALP（93%）、TBA（81%）、AST（73%）、DB（66%）、CHE（66%）、LAP（63%）、ALT（61%）、TB（54%）,其中以DB、GGT、TBA变化幅度最高[≥2倍正常值上限（ULN）],其次为ALP、TB、ALT、AST（1倍ULN）,LAP低于1倍ULN。患者血清蛋白电泳结果异常主要体现在γ球蛋白和白蛋白百分比,异常率分别为71%和57%,且前者出现低于1倍ULN升高。近半数患者出现临床血液学指标变化,异常率由高到低是：ESR、HGB、RBC、PT、PLT、WBC,其中以ESR的异常率最为突出84%,其余依次为HGB（49%）、RBC（46%）、PT（44%）、PLT（41%）、WBC（39%）,变化幅度以ESR最高（1倍ULN）,其次为RBC、HGB、PT（≤1倍ULN）。结论 PBC患者血清蛋白和脂类、酶类和胆红素代谢以及血清蛋白分布等多种生化指标变化特点,结合临床血液学特点,将为PBC的临床诊断提供重要帮助。     

钙网蛋白促进毒胡萝卜素诱导的胰腺癌细胞间质转化

目的探讨钙网蛋白(calreticulin, CRT)在毒胡萝卜素(thapsigargin, TG)诱导胰腺癌细胞上皮细胞间质转化(epithelial mesenchymal transition, EMT)中的作用及其机制。方法免疫组化检测CRT在胰腺癌组织中表达差异, 分析其与胰腺癌患者临床病理学参数的关系。免疫印迹和Transwell检测CRT沉默对TG诱导EMT表型影响。Fluro-4/AM和共聚焦显微镜检测胰腺癌细胞胞浆内钙离子水平。结果 CRT在胰腺癌组织中高表达(P<0.01), 与淋巴结转移(P=0.017)、UICC分期(P=0.021)呈正相关, 与E钙黏蛋白(E-cadherin, E-cad)表达呈负相关(P=0.013)。CRT高表达联合E-cad低表达胰腺癌患者预后不良(P=0.023)。在胰腺癌细胞中, TG诱导EMT表型被CRT沉默所逆转。同时, CRT沉默能够抑制TG诱导胰腺癌胞浆内钙离子增加。结论 CRT通过介导TG对胞浆内钙离子调控, 最终促进胰腺癌细胞EMT的发生。     

头孢唑啉钠与头孢他啶在肝素化腹膜透析液中的稳定性

目的 探讨肝素钠对头孢唑啉钠和头孢他啶共存于腹膜透析液中稳定性的影响,为腹膜炎患者门诊治疗提供数据支持。方法 采用高效液相色谱法测定在不同温度下肝素化或无肝素化的腹膜透析液中,24 h内头孢唑啉钠和头孢他啶的含量。同时测定药液的pH值,并观察其外观变化。结果 头孢唑啉钠在肝素化或无肝素化4℃、25℃、37℃的腹膜透析液中,24 h内其含量均占原溶液的90%以上。头孢他啶在肝素化或无肝素化4℃和25℃的腹膜透析液中,24 h内其含量均占原溶液的90%以上;37℃时,6 h内其含量占原溶液的90%以上,24 h时,其含量占原溶液的90%以下。头孢唑啉钠含量的配对t检验结果 P=0.9296,头孢他啶含量的配对Wilcoxon检验结果 P=0.0798。所有实验条件下没有观察到药液的颜色改变和沉淀物生成,其pH值没有显著改变。结论 肝素化对腹膜透析液中头孢唑啉钠和头孢他啶的含量变化无显著性影响。4℃和25℃条件下,头孢唑啉钠和头孢他啶存放24 h稳定,可方便药品预处理和保存;在37℃条件下,头孢他啶存放24 h,含量低于90%,会影响治疗效果。